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    <VOL>72</VOL>
    <NO>227</NO>
    <DATE>Tuesday, November 27, 2007</DATE>
    <UNITNAME>Contents</UNITNAME>
    <CNTNTS>
        <AGCY>
            <EAR>AID</EAR>
            <PRTPAGE P="iii"/>
            <HD>Agency for International Development</HD>
            <CAT>
                <HD>NOTICES</HD>
                <DOCENT>
                    <DOC>Agency information collection activities; proposals, submissions, and approvals, </DOC>
                    <PGS>66129</PGS>
                    <FRDOCBP T="27NON1.sgm" D="0">07-5840</FRDOCBP>
                </DOCENT>
            </CAT>
        </AGCY>
        <AGCY>
            <EAR>Agriculture</EAR>
            <HD>Agriculture Department</HD>
            <SEE>
                <HD SOURCE="HED">See</HD>
                <P> Forest Service</P>
            </SEE>
            <SEE>
                <HD SOURCE="HED">See</HD>
                <P> Rural Business-Cooperative Service</P>
            </SEE>
            <CAT>
                <HD>RULES</HD>
                <SJ>Administrative regulations:</SJ>
                <SJDENT>
                    <SJDOC>Official records, authentication, </SJDOC>
                    <PGS>66041-66042</PGS>
                    <FRDOCBP T="27NOR1.sgm" D="1">07-5826</FRDOCBP>
                </SJDENT>
            </CAT>
            <CAT>
                <HD>NOTICES</HD>
                <DOCENT>
                    <DOC>Agency information collection activities; proposals, submissions, and approvals, </DOC>
                    <PGS>66129</PGS>
                    <FRDOCBP T="27NON1.sgm" D="0">E7-23035</FRDOCBP>
                </DOCENT>
            </CAT>
        </AGCY>
        <AGCY>
            <EAR>Antitrust</EAR>
            <HD>Antitrust Division</HD>
            <CAT>
                <HD>NOTICES</HD>
                <SJ>Competitive impact statements and proposed consent judgments:</SJ>
                <SJDENT>
                    <SJDOC>Multiple Listing Service of Hilton Head Island, Inc., </SJDOC>
                    <PGS>66188-66198</PGS>
                    <FRDOCBP T="27NON1.sgm" D="10">07-5653</FRDOCBP>
                </SJDENT>
            </CAT>
        </AGCY>
        <AGCY>
            <EAR>Centers</EAR>
            <HD>Centers for Disease Control and Prevention</HD>
            <CAT>
                <HD>NOTICES</HD>
                <DOCENT>
                    <DOC>Agency information collection activities; proposals, submissions, and approvals, </DOC>
                    <PGS>66176-66177</PGS>
                    <FRDOCBP T="27NON1.sgm" D="1">E7-23015</FRDOCBP>
                </DOCENT>
            </CAT>
        </AGCY>
        <AGCY>
            <EAR>Centers</EAR>
            <HD>Centers for Medicare &amp; Medicaid Services</HD>
            <CAT>
                <HD>RULES</HD>
                <SJ>Medicare:</SJ>
                <SJDENT>
                    <SJDOC>Hospital Outpatient Prospective Payment System and CY 2008 payment rates, etc., </SJDOC>
                    <PGS>66580-67225</PGS>
                    <FRDOCBP T="27NOR3.sgm" D="645">07-5507</FRDOCBP>
                </SJDENT>
                <SJDENT>
                    <SJDOC>Physician fee schedule and other Part B payment policies for CY 2008; payment policy revisions, </SJDOC>
                    <PGS>66222-66578</PGS>
                    <FRDOCBP T="27NOR2.sgm" D="356">07-5506</FRDOCBP>
                </SJDENT>
            </CAT>
        </AGCY>
        <AGCY>
            <EAR>Children</EAR>
            <HD>Children and Families Administration</HD>
            <CAT>
                <HD>NOTICES</HD>
                <DOCENT>
                    <DOC>Agency information collection activities; proposals, submissions, and approvals, </DOC>
                    <PGS>66177-66180</PGS>
                    <FRDOCBP T="27NON1.sgm" D="1">07-5831</FRDOCBP>
                    <FRDOCBP T="27NON1.sgm" D="0">07-5832</FRDOCBP>
                    <FRDOCBP T="27NON1.sgm" D="1">07-5835</FRDOCBP>
                    <FRDOCBP T="27NON1.sgm" D="0">07-5841</FRDOCBP>
                    <FRDOCBP T="27NON1.sgm" D="1">07-5842</FRDOCBP>
                </DOCENT>
            </CAT>
        </AGCY>
        <AGCY>
            <EAR>Coast Guard</EAR>
            <HD>Coast Guard</HD>
            <CAT>
                <HD>RULES</HD>
                <SJ>Drawbridge operations:</SJ>
                <SJDENT>
                    <SJDOC>Texas, </SJDOC>
                    <PGS>66046-66048</PGS>
                    <FRDOCBP T="27NOR1.sgm" D="1">E7-23042</FRDOCBP>
                    <FRDOCBP T="27NOR1.sgm" D="1">E7-23046</FRDOCBP>
                </SJDENT>
            </CAT>
            <CAT>
                <HD>PROPOSED RULES</HD>
                <SJ>Ports and waterways safety; regulated navigation areas, safety zones, security zones, etc.:</SJ>
                <SUBSJ>Cape Cod, MA; North Atlantic right whales; port access route study of potential vessel routing measures to reduce vessel strikes</SUBSJ>
                <SSJDENT>
                    <SUBSJDOC>Correction, </SUBSJDOC>
                    <PGS>66122</PGS>
                    <FRDOCBP T="27NOP1.sgm" D="0">E7-23050</FRDOCBP>
                </SSJDENT>
            </CAT>
            <CAT>
                <HD>NOTICES</HD>
                <SJ>Committees; establishment, renewal, termination, etc.:</SJ>
                <SJDENT>
                    <SJDOC>Delaware River and Bay Oil Spill Advisory Committee, </SJDOC>
                    <PGS>66182-66184</PGS>
                    <FRDOCBP T="27NON1.sgm" D="2">E7-23044</FRDOCBP>
                </SJDENT>
            </CAT>
        </AGCY>
        <AGCY>
            <EAR>Commerce</EAR>
            <HD>Commerce Department</HD>
            <SEE>
                <HD SOURCE="HED">See</HD>
                <P> Industry and Security Bureau</P>
            </SEE>
            <SEE>
                <HD SOURCE="HED">See</HD>
                <P> National Institute of Standards and Technology</P>
            </SEE>
            <SEE>
                <HD SOURCE="HED">See</HD>
                <P> National Oceanic and Atmospheric Administration</P>
            </SEE>
            <CAT>
                <HD>NOTICES</HD>
                <DOCENT>
                    <DOC>Agency information collection activities; proposals, submissions, and approvals, </DOC>
                    <PGS>66133-66134</PGS>
                    <FRDOCBP T="27NON1.sgm" D="1">E7-22994</FRDOCBP>
                    <FRDOCBP T="27NON1.sgm" D="0">E7-22996</FRDOCBP>
                    <FRDOCBP T="27NON1.sgm" D="0">E7-22997</FRDOCBP>
                </DOCENT>
            </CAT>
        </AGCY>
        <AGCY>
            <EAR>Commodity</EAR>
            <HD>Commodity Futures Trading Commission</HD>
            <CAT>
                <HD>PROPOSED RULES</HD>
                <SJ>Commodity Exchange Act:</SJ>
                <SJDENT>
                    <SJDOC>Federal speculative position limits; risk management exemption, </SJDOC>
                      
                    <PGS>66097-66103</PGS>
                    <FRDOCBP T="27NOP1.sgm" D="6">E7-22992</FRDOCBP>
                </SJDENT>
            </CAT>
        </AGCY>
        <AGCY>
            <EAR>Defense</EAR>
            <HD>Defense Department</HD>
            <SEE>
                <HD SOURCE="HED">See</HD>
                <P> Navy Department</P>
            </SEE>
            <CAT>
                <HD>NOTICES</HD>
                <SJ>Federal Acquisition Regulation (FAR):</SJ>
                <SJDENT>
                    <SJDOC>Agency information collection activities; proposals, submissions, and approvals, </SJDOC>
                    <PGS>66140</PGS>
                    <FRDOCBP T="27NON1.sgm" D="0">07-5836</FRDOCBP>
                </SJDENT>
            </CAT>
        </AGCY>
        <AGCY>
            <EAR>Delaware</EAR>
            <HD>Delaware River Basin Commission</HD>
            <CAT>
                <HD>NOTICES</HD>
                <DOCENT>
                    <DOC>Meetings and hearings, </DOC>
                    <PGS>66140-66142</PGS>
                    <FRDOCBP T="27NON1.sgm" D="2">E7-23013</FRDOCBP>
                </DOCENT>
            </CAT>
        </AGCY>
        <AGCY>
            <EAR>Drug</EAR>
            <HD>Drug Enforcement Administration</HD>
            <CAT>
                <HD>PROPOSED RULES</HD>
                <SJ>Schedules of controlled substances:</SJ>
                <SJDENT>
                    <SJDOC>U.S. Official Order Form (DEA Form-222); new single-sheet format, </SJDOC>
                      
                    <PGS>66118-66122</PGS>
                    <FRDOCBP T="27NOP1.sgm" D="4">E7-22984</FRDOCBP>
                </SJDENT>
            </CAT>
        </AGCY>
        <AGCY>
            <EAR>Education</EAR>
            <HD>Education Department</HD>
            <CAT>
                <HD>NOTICES</HD>
                <DOCENT>
                    <DOC>Agency information collection activities; proposals, submissions, and approvals, </DOC>
                    <PGS>66142-66143</PGS>
                    <FRDOCBP T="27NON1.sgm" D="1">E7-23061</FRDOCBP>
                </DOCENT>
                <SJ>Grants and cooperative agreements; availability, etc.:</SJ>
                <SUBSJ>Special education and rehabilitative services—</SUBSJ>
                <SSJDENT>
                    <SUBSJDOC>Children with disabilities; personnel development to improve services and results, </SUBSJDOC>
                    <PGS>66143-66154</PGS>
                    <FRDOCBP T="27NON1.sgm" D="11">E7-23080</FRDOCBP>
                </SSJDENT>
                <SJ>Meetings:</SJ>
                <SJDENT>
                    <SJDOC>Historically Black Colleges and Universities President's Board of Advisors, </SJDOC>
                    <PGS>66154-66155</PGS>
                    <FRDOCBP T="27NON1.sgm" D="1">E7-22988</FRDOCBP>
                </SJDENT>
                <DOCENT>
                    <DOC>Privacy Act; systems of records, </DOC>
                    <PGS>66155-66162</PGS>
                    <FRDOCBP T="27NON1.sgm" D="3">E7-23058</FRDOCBP>
                    <FRDOCBP T="27NON1.sgm" D="4">E7-23059</FRDOCBP>
                </DOCENT>
            </CAT>
        </AGCY>
        <AGCY>
            <EAR>Energy</EAR>
            <HD>Energy Department</HD>
            <SEE>
                <HD SOURCE="HED">See</HD>
                <P> Federal Energy Regulatory Commission</P>
            </SEE>
        </AGCY>
        <AGCY>
            <EAR>EPA</EAR>
            <HD>Environmental Protection Agency</HD>
            <CAT>
                <HD>NOTICES</HD>
                <DOCENT>
                    <DOC>Agency information collection activities; proposals, submissions, and approvals, </DOC>
                    <PGS>66165-66170</PGS>
                    <FRDOCBP T="27NON1.sgm" D="2">E7-23052</FRDOCBP>
                    <FRDOCBP T="27NON1.sgm" D="1">E7-23057</FRDOCBP>
                    <FRDOCBP T="27NON1.sgm" D="1">E7-23073</FRDOCBP>
                    <FRDOCBP T="27NON1.sgm" D="1">E7-23074</FRDOCBP>
                </DOCENT>
                <SJ>Environmental statements; notice of intent:</SJ>
                <SJDENT>
                    <SJDOC>Apra Harbor, Guam; permanent ocean dredged material disposal site designation, </SJDOC>
                    <PGS>66170-66171</PGS>
                    <FRDOCBP T="27NON1.sgm" D="1">E7-23043</FRDOCBP>
                </SJDENT>
                <SJ>Reports and guidance documents; availability, etc.:</SJ>
                <SUBSJ>Clean Air Act—</SUBSJ>
                <SSJDENT>
                    <SUBSJDOC>Renewable fuel standard, </SUBSJDOC>
                    <PGS>66171-66173</PGS>
                    <FRDOCBP T="27NON1.sgm" D="2">E7-23095</FRDOCBP>
                </SSJDENT>
                <SJ>Superfund; response and remedial actions, proposed settlements, etc.:</SJ>
                <SJDENT>
                    <SJDOC>Vermiculite Intermountain Site, UT, </SJDOC>
                    <PGS>66173</PGS>
                    <FRDOCBP T="27NON1.sgm" D="0">E7-23064</FRDOCBP>
                </SJDENT>
            </CAT>
        </AGCY>
        <AGCY>
            <EAR>Executive</EAR>
            <HD>Executive Office of the President</HD>
            <SEE>
                <HD SOURCE="HED">See</HD>
                <P> Privacy and Civil Liberties Oversight Board</P>
            </SEE>
        </AGCY>
        <AGCY>
            <EAR>Export</EAR>
            <HD>Export-Import Bank</HD>
            <CAT>
                <HD>RULES</HD>
                <DOCENT>
                    <DOC>Technical amendments, </DOC>
                    <PGS>66042-66043</PGS>
                    <FRDOCBP T="27NOR1.sgm" D="1">07-5807</FRDOCBP>
                </DOCENT>
            </CAT>
        </AGCY>
        <AGCY>
            <EAR>FAA</EAR>
            <PRTPAGE P="iv"/>
            <HD>Federal Aviation Administration</HD>
            <CAT>
                <HD>RULES</HD>
                <SJ>Aircraft:</SJ>
                <SJDENT>
                    <SJDOC>Non fixed-wing aircraft; nationality and registration markings, </SJDOC>
                    <PGS>66045</PGS>
                    <FRDOCBP T="27NOR1.sgm" D="0">E7-23028</FRDOCBP>
                </SJDENT>
                <SJ>Airworthiness directives:</SJ>
                <SJDENT>
                    <SJDOC>Eclipse Aviation Corp., </SJDOC>
                    <PGS>66043-66045</PGS>
                    <FRDOCBP T="27NOR1.sgm" D="2">E7-23024</FRDOCBP>
                </SJDENT>
            </CAT>
            <CAT>
                <HD>PROPOSED RULES</HD>
                <SJ>Airworthiness directives:</SJ>
                <SJDENT>
                    <SJDOC>Alpha Aviation Design Ltd., </SJDOC>
                      
                    <PGS>66089-66091</PGS>
                      
                    <FRDOCBP T="27NOP1.sgm" D="2">E7-23017</FRDOCBP>
                </SJDENT>
                <SJDENT>
                    <SJDOC>British Aerospace Aircraft Group, </SJDOC>
                      
                    <PGS>66087-66089</PGS>
                      
                    <FRDOCBP T="27NOP1.sgm" D="2">E7-23025</FRDOCBP>
                </SJDENT>
                <SJ>Airworthiness standards:</SJ>
                <SUBSJ>Special conditions—</SUBSJ>
                <SSJDENT>
                    <SUBSJDOC>Boeing Model 757 series airplanes, </SUBSJDOC>
                      
                    <PGS>66085-66087</PGS>
                      
                    <FRDOCBP T="27NOP1.sgm" D="2">E7-23079</FRDOCBP>
                </SSJDENT>
            </CAT>
        </AGCY>
        <AGCY>
            <EAR>Federal Election</EAR>
            <HD>Federal Election Commission</HD>
            <CAT>
                <HD>NOTICES</HD>
                <SJ>Special elections; filing dates:</SJ>
                <SJDENT>
                    <SJDOC>Louisiana, </SJDOC>
                    <PGS>66173-66175</PGS>
                    <FRDOCBP T="27NON1.sgm" D="2">E7-23075</FRDOCBP>
                </SJDENT>
            </CAT>
        </AGCY>
        <AGCY>
            <EAR>Federal Energy</EAR>
            <HD>Federal Energy Regulatory Commission</HD>
            <CAT>
                <HD>NOTICES</HD>
                <SJ>Environmental statements; availability, etc.:</SJ>
                <SJDENT>
                    <SJDOC>Alabama Power Co., </SJDOC>
                    <PGS>66164</PGS>
                    <FRDOCBP T="27NON1.sgm" D="0">E7-23039</FRDOCBP>
                </SJDENT>
                <SJ>Meetings:</SJ>
                <SJDENT>
                    <SJDOC>Jordan Cove Energy Project, L.P.; technical conference, </SJDOC>
                    <PGS>66164</PGS>
                    <FRDOCBP T="27NON1.sgm" D="0">E7-23041</FRDOCBP>
                </SJDENT>
                <SJDENT>
                    <SJDOC>Midwest Independent Transmission System Operator, Inc.; technical conference, </SJDOC>
                    <PGS>66164-66165</PGS>
                    <FRDOCBP T="27NON1.sgm" D="1">E7-23038</FRDOCBP>
                </SJDENT>
                <SJ>
                    <E T="03">Applications, hearings, determinations, etc.:</E>
                </SJ>
                <SJDENT>
                    <SJDOC>Alabama Intrastate, LLC, </SJDOC>
                    <PGS>66163</PGS>
                    <FRDOCBP T="27NON1.sgm" D="0">E7-23036</FRDOCBP>
                </SJDENT>
                <SJDENT>
                    <SJDOC>Chambersburg, PA, </SJDOC>
                    <PGS>66163</PGS>
                    <FRDOCBP T="27NON1.sgm" D="0">E7-23037</FRDOCBP>
                </SJDENT>
                <SJDENT>
                    <SJDOC>Discovery Gas Transmission LLC, </SJDOC>
                    <PGS>66163-66164</PGS>
                    <FRDOCBP T="27NON1.sgm" D="1">E7-23065</FRDOCBP>
                </SJDENT>
                <SJDENT>
                    <SJDOC>Enterprise Texas Pipeline LLC, </SJDOC>
                    <PGS>66164</PGS>
                    <FRDOCBP T="27NON1.sgm" D="0">E7-23040</FRDOCBP>
                </SJDENT>
            </CAT>
        </AGCY>
        <AGCY>
            <EAR>FMC</EAR>
            <HD>Federal Maritime Commission</HD>
            <CAT>
                <HD>NOTICES</HD>
                <DOCENT>
                    <DOC>Agreements filed, etc., </DOC>
                    <PGS>66175</PGS>
                    <FRDOCBP T="27NON1.sgm" D="0">E7-23060</FRDOCBP>
                </DOCENT>
            </CAT>
        </AGCY>
        <AGCY>
            <EAR>Federal Reserve</EAR>
            <HD>Federal Reserve System</HD>
            <CAT>
                <HD>NOTICES</HD>
                <SJ>Banks and bank holding companies:</SJ>
                <SJDENT>
                    <SJDOC>Change in bank control, </SJDOC>
                    <PGS>66175-66176</PGS>
                    <FRDOCBP T="27NON1.sgm" D="0">E7-22965</FRDOCBP>
                    <FRDOCBP T="27NON1.sgm" D="1">E7-23014</FRDOCBP>
                </SJDENT>
                <SJDENT>
                    <SJDOC>Permissible nonbanking activities, </SJDOC>
                    <PGS>66176</PGS>
                    <FRDOCBP T="27NON1.sgm" D="0">E7-22964</FRDOCBP>
                </SJDENT>
            </CAT>
        </AGCY>
        <AGCY>
            <EAR>FTC</EAR>
            <HD>Federal Trade Commission</HD>
            <CAT>
                <HD>PROPOSED RULES</HD>
                <SJ>Industry guides:</SJ>
                <SUBSJ>Environmental marketing claims use—</SUBSJ>
                <SSJDENT>
                    <SUBSJDOC>Carbon offsets and renewable energy certificates; workshop, </SUBSJDOC>
                    <PGS>66094-66097</PGS>
                      
                    <FRDOCBP T="27NOP1.sgm" D="3">E7-23006</FRDOCBP>
                </SSJDENT>
                <SSJDENT>
                    <SUBSJDOC>Meetings, </SUBSJDOC>
                      
                    <PGS>66091-66093</PGS>
                      
                    <FRDOCBP T="27NOP1.sgm" D="2">E7-23007</FRDOCBP>
                </SSJDENT>
            </CAT>
        </AGCY>
        <AGCY>
            <EAR>Fish</EAR>
            <HD>Fish and Wildlife Service</HD>
            <CAT>
                <HD>PROPOSED RULES</HD>
                <SJ>Endangered and threatened species:</SJ>
                <SUBSJ>Critical habitat designations—</SUBSJ>
                <SSJDENT>
                    <SUBSJDOC>San Diego thornmint, </SUBSJDOC>
                      
                    <PGS>66122-66128</PGS>
                      
                    <FRDOCBP T="27NOP1.sgm" D="6">E7-22971</FRDOCBP>
                </SSJDENT>
            </CAT>
        </AGCY>
        <AGCY>
            <EAR>Food</EAR>
            <HD>Food and Drug Administration</HD>
            <CAT>
                <HD>RULES</HD>
                <SJ>Animal drugs, feeds, and related products:</SJ>
                <SJDENT>
                    <SJDOC>Fenbendazole, </SJDOC>
                    <PGS>66045-66046</PGS>
                    <FRDOCBP T="27NOR1.sgm" D="1">E7-22987</FRDOCBP>
                </SJDENT>
            </CAT>
            <CAT>
                <HD>PROPOSED RULES</HD>
                <SJ>Food for human consumption:</SJ>
                <SUBSJ>Food labeling—</SUBSJ>
                <SSJDENT>
                    <SUBSJDOC>Alpha-linolenic acid, eicosapentaenoic acid, and docosahexaenoic acid omega-3 fatty acids; nutrient content claims, </SUBSJDOC>
                      
                    <PGS>66103-66118</PGS>
                      
                    <FRDOCBP T="27NOP1.sgm" D="15">E7-22991</FRDOCBP>
                </SSJDENT>
            </CAT>
            <CAT>
                <HD>NOTICES</HD>
                <SJ>Meetings:</SJ>
                <SJDENT>
                    <SJDOC>Behind-the-counter availability of drugs, </SJDOC>
                    <PGS>66180-66181</PGS>
                    <FRDOCBP T="27NON1.sgm" D="1">E7-23026</FRDOCBP>
                </SJDENT>
            </CAT>
        </AGCY>
        <AGCY>
            <EAR>Forest</EAR>
            <HD>Forest Service</HD>
            <CAT>
                <HD>NOTICES</HD>
                <DOCENT>
                    <DOC>Agency information collection activities; proposals, submissions, and approvals, </DOC>
                    <PGS>66130</PGS>
                    <FRDOCBP T="27NON1.sgm" D="0">E7-23034</FRDOCBP>
                </DOCENT>
                <SJ>Reports and guidance documents; availability, etc.:</SJ>
                <SJDENT>
                    <SJDOC>Wind energy development on National Forest Service lands; proposed directives, </SJDOC>
                    <PGS>66130-66131</PGS>
                    <FRDOCBP T="27NON1.sgm" D="1">E7-22977</FRDOCBP>
                </SJDENT>
            </CAT>
        </AGCY>
        <AGCY>
            <EAR>GSA</EAR>
            <HD>General Services Administration</HD>
            <CAT>
                <HD>NOTICES</HD>
                <SJ>Federal Acquisition Regulation (FAR):</SJ>
                <SJDENT>
                    <SJDOC>Agency information collection activities; proposals, submissions, and approvals, </SJDOC>
                    <PGS>66140, 66176</PGS>
                    <FRDOCBP T="27NON1.sgm" D="0">07-5836</FRDOCBP>
                    <FRDOCBP T="27NON1.sgm" D="0">07-5837</FRDOCBP>
                </SJDENT>
            </CAT>
        </AGCY>
        <AGCY>
            <EAR>Health</EAR>
            <HD>Health and Human Services Department</HD>
            <SEE>
                <HD SOURCE="HED">See</HD>
                <P> Centers for Disease Control and Prevention</P>
            </SEE>
            <SEE>
                <HD SOURCE="HED">See</HD>
                <P> Centers for Medicare &amp; Medicaid Services</P>
            </SEE>
            <SEE>
                <HD SOURCE="HED">See</HD>
                <P> Children and Families Administration</P>
            </SEE>
            <SEE>
                <HD SOURCE="HED">See</HD>
                <P> Food and Drug Administration</P>
            </SEE>
            <SEE>
                <HD SOURCE="HED">See</HD>
                <P> Health Resources and Services Administration</P>
            </SEE>
        </AGCY>
        <AGCY>
            <EAR>Health</EAR>
            <HD>Health Resources and Services Administration</HD>
            <CAT>
                <HD>NOTICES</HD>
                <SJ>National Vaccine Injury Compensation Program:</SJ>
                <SJDENT>
                    <SJDOC>Health insurance policy; average cost update, </SJDOC>
                    <PGS>66181</PGS>
                    <FRDOCBP T="27NON1.sgm" D="0">E7-23090</FRDOCBP>
                </SJDENT>
                <SJ>Reports and guidance documents; availability, etc.:</SJ>
                <SJDENT>
                    <SJDOC>Ryan White HIV/AIDS Program; core medical services waiver application requirements; uniform standards (2008 FY), </SJDOC>
                    <PGS>66181-66182</PGS>
                    <FRDOCBP T="27NON1.sgm" D="1">E7-22982</FRDOCBP>
                </SJDENT>
            </CAT>
        </AGCY>
        <AGCY>
            <EAR>Homeland</EAR>
            <HD>Homeland Security Department</HD>
            <SEE>
                <HD SOURCE="HED">See</HD>
                <P> Coast Guard</P>
            </SEE>
            <SEE>
                <HD SOURCE="HED">See</HD>
                <P> U.S. Customs and Border Protection</P>
            </SEE>
        </AGCY>
        <AGCY>
            <EAR>Housing</EAR>
            <HD>Housing and Urban Development Department</HD>
            <CAT>
                <HD>NOTICES</HD>
                <DOCENT>
                    <DOC>Agency information collection activities; proposals, submissions, and approvals, </DOC>
                    <PGS>66185-66186</PGS>
                    <FRDOCBP T="27NON1.sgm" D="1">E7-23081</FRDOCBP>
                </DOCENT>
            </CAT>
        </AGCY>
        <AGCY>
            <EAR>Industry</EAR>
            <HD>Industry and Security Bureau</HD>
            <CAT>
                <HD>NOTICES</HD>
                <DOCENT>
                    <DOC>Agency information collection activities; proposals, submissions, and approvals, </DOC>
                    <PGS>66134-66135</PGS>
                    <FRDOCBP T="27NON1.sgm" D="1">E7-22993</FRDOCBP>
                    <FRDOCBP T="27NON1.sgm" D="0">E7-22998</FRDOCBP>
                </DOCENT>
            </CAT>
        </AGCY>
        <AGCY>
            <EAR>Interior</EAR>
            <HD>Interior Department</HD>
            <SEE>
                <HD SOURCE="HED">See</HD>
                <P> Fish and Wildlife Service</P>
            </SEE>
            <SEE>
                <HD SOURCE="HED">See</HD>
                <P> National Park Service</P>
            </SEE>
        </AGCY>
        <AGCY>
            <EAR>International</EAR>
            <HD>International Trade Commission</HD>
            <CAT>
                <HD>NOTICES</HD>
                <SJ>Import investigations:</SJ>
                <SUBSJ>Brake rotors from—</SUBSJ>
                <SSJDENT>
                    <SUBSJDOC>China, </SUBSJDOC>
                    <PGS>66187-66188</PGS>
                    <FRDOCBP T="27NON1.sgm" D="1">E7-22975</FRDOCBP>
                </SSJDENT>
                <DOCENT>
                    <DOC>Meetings; Sunshine Act, </DOC>
                    <PGS>66188</PGS>
                    <FRDOCBP T="27NON1.sgm" D="0">E7-23008</FRDOCBP>
                </DOCENT>
            </CAT>
        </AGCY>
        <AGCY>
            <EAR>Justice</EAR>
            <HD>Justice Department</HD>
            <SEE>
                <HD SOURCE="HED">See</HD>
                <P> Antitrust Division</P>
            </SEE>
            <SEE>
                <HD SOURCE="HED">See</HD>
                <P> Drug Enforcement Administration</P>
            </SEE>
        </AGCY>
        <AGCY>
            <EAR>Labor</EAR>
            <HD>Labor Department</HD>
            <CAT>
                <HD>NOTICES</HD>
                <DOCENT>
                    <DOC>Agency information collection activities; proposals, submissions, and approvals, </DOC>
                    <PGS>66198-66199</PGS>
                    <FRDOCBP T="27NON1.sgm" D="1">E7-23005</FRDOCBP>
                    <FRDOCBP T="27NON1.sgm" D="0">E7-23030</FRDOCBP>
                </DOCENT>
            </CAT>
        </AGCY>
        <AGCY>
            <EAR>NASA</EAR>
            <PRTPAGE P="v"/>
            <HD>National Aeronautics and Space Administration</HD>
            <CAT>
                <HD>NOTICES</HD>
                <SJ>Federal Acquisition Regulation (FAR):</SJ>
                <SJDENT>
                    <SJDOC>Agency information collection activities; proposals, submissions, and approvals, </SJDOC>
                    <PGS>66140</PGS>
                    <FRDOCBP T="27NON1.sgm" D="0">07-5836</FRDOCBP>
                </SJDENT>
            </CAT>
        </AGCY>
        <AGCY>
            <EAR>National Highway</EAR>
            <HD>National Highway Traffic Safety Administration</HD>
            <CAT>
                <HD>NOTICES</HD>
                <DOCENT>
                    <DOC>Agency information collection activities; proposals, submissions, and approvals, </DOC>
                    <PGS>66218</PGS>
                    <FRDOCBP T="27NON1.sgm" D="0">E7-23045</FRDOCBP>
                </DOCENT>
            </CAT>
        </AGCY>
        <AGCY>
            <EAR>National Institute</EAR>
            <HD>National Institute of Standards and Technology</HD>
            <CAT>
                <HD>NOTICES</HD>
                <SJ>Meetings:</SJ>
                <SJDENT>
                    <SJDOC>Advanced Technology Visiting Committee, </SJDOC>
                    <PGS>66135-66136</PGS>
                    <FRDOCBP T="27NON1.sgm" D="1">E7-23032</FRDOCBP>
                </SJDENT>
                <SJDENT>
                    <SJDOC>Information Security and Privacy Advisory Board, </SJDOC>
                    <PGS>66136</PGS>
                    <FRDOCBP T="27NON1.sgm" D="0">E7-23023</FRDOCBP>
                </SJDENT>
            </CAT>
        </AGCY>
        <AGCY>
            <EAR>NOAA</EAR>
            <HD>National Oceanic and Atmospheric Administration</HD>
            <CAT>
                <HD>RULES</HD>
                <SJ>Fishery conservation and management:</SJ>
                <SUBSJ>Alaska; fisheries of Exclusive Economic Zone—</SUBSJ>
                <SSJDENT>
                    <SUBSJDOC>Gulf of Alaska halibut, </SUBSJDOC>
                    <PGS>66083-66084</PGS>
                    <FRDOCBP T="27NOR1.sgm" D="1">07-5844</FRDOCBP>
                </SSJDENT>
                <SUBSJ>Caribbean, Gulf, and South Atlantic fisheries—</SUBSJ>
                <SSJDENT>
                    <SUBSJDOC>Gulf of Mexico reef fish, </SUBSJDOC>
                    <PGS>66080-66081</PGS>
                    <FRDOCBP T="27NOR1.sgm" D="1">E7-23049</FRDOCBP>
                </SSJDENT>
                <SUBSJ>Northeastern United States fisheries—</SUBSJ>
                <SSJDENT>
                    <SUBSJDOC>Atlantic bluefish, </SUBSJDOC>
                    <PGS>66082</PGS>
                    <FRDOCBP T="27NOR1.sgm" D="0">E7-23051</FRDOCBP>
                    <FRDOCBP T="27NOR1.sgm" D="0">07-5848</FRDOCBP>
                </SSJDENT>
                <SSJDENT>
                    <SUBSJDOC>Summer flounder, </SUBSJDOC>
                    <PGS>66083</PGS>
                    <FRDOCBP T="27NOR1.sgm" D="0">E7-23062</FRDOCBP>
                </SSJDENT>
                <SJ>Marine mammals:</SJ>
                <SUBSJ>Commercial fishing authorizations—</SUBSJ>
                <SSJDENT>
                    <SUBSJDOC>Fisheries categorized according to frequency of incidental takes; 2008 list, </SUBSJDOC>
                    <PGS>66048-66080</PGS>
                    <FRDOCBP T="27NOR1.sgm" D="32">E7-23076</FRDOCBP>
                </SSJDENT>
            </CAT>
            <CAT>
                <HD>NOTICES</HD>
                <DOCENT>
                    <DOC>Agency information collection activities; proposals, submissions, and approvals, </DOC>
                    <PGS>66136-66137</PGS>
                    <FRDOCBP T="27NON1.sgm" D="1">E7-22995</FRDOCBP>
                </DOCENT>
                <SJ>Endangered and threatened species:</SJ>
                <SUBSJ>Anadromous fish take—</SUBSJ>
                <SSJDENT>
                    <SUBSJDOC>Southwest Fisheries Science Center, CA; coho and chinook salmon, and steelhead, </SUBSJDOC>
                    <PGS>66137-66138</PGS>
                    <FRDOCBP T="27NON1.sgm" D="1">E7-23093</FRDOCBP>
                </SSJDENT>
                <DOCENT>
                    <DOC>Marine mammal permit applications, determinations, etc., </DOC>
                    <PGS>66138</PGS>
                    <FRDOCBP T="27NON1.sgm" D="0">E7-23063</FRDOCBP>
                </DOCENT>
                <SJ>Meetings:</SJ>
                <SJDENT>
                    <SJDOC>Mid-Atlantic Fishery Management Council, </SJDOC>
                    <PGS>66138-66139</PGS>
                    <FRDOCBP T="27NON1.sgm" D="1">E7-23018</FRDOCBP>
                </SJDENT>
                <SJDENT>
                    <SJDOC>New England Fishery Management Council, </SJDOC>
                    <PGS>66139</PGS>
                    <FRDOCBP T="27NON1.sgm" D="0">E7-23019</FRDOCBP>
                </SJDENT>
            </CAT>
        </AGCY>
        <AGCY>
            <EAR>National Park</EAR>
            <HD>National Park Service</HD>
            <CAT>
                <HD>NOTICES</HD>
                <DOCENT>
                    <DOC>National Register of Historic Places; pending nominations, </DOC>
                    <PGS>66186-66187</PGS>
                    <FRDOCBP T="27NON1.sgm" D="1">E7-22989</FRDOCBP>
                </DOCENT>
            </CAT>
        </AGCY>
        <AGCY>
            <EAR>National Science</EAR>
            <HD>National Science Foundation</HD>
            <CAT>
                <HD>NOTICES</HD>
                <SJ>Meetings:</SJ>
                <SJDENT>
                    <SJDOC>Proposal reviews, </SJDOC>
                    <PGS>66199-66200</PGS>
                    <FRDOCBP T="27NON1.sgm" D="1">E7-23012</FRDOCBP>
                </SJDENT>
            </CAT>
        </AGCY>
        <AGCY>
            <EAR>Navy</EAR>
            <HD>Navy Department</HD>
            <CAT>
                <HD>NOTICES</HD>
                <SJ>Meetings:</SJ>
                <SJDENT>
                    <SJDOC>Naval Research Advisory Committee; correction, </SJDOC>
                    <PGS>66140</PGS>
                    <FRDOCBP T="27NON1.sgm" D="0">E7-22990</FRDOCBP>
                </SJDENT>
            </CAT>
        </AGCY>
        <AGCY>
            <EAR>Nuclear</EAR>
            <HD>Nuclear Regulatory Commission</HD>
            <CAT>
                <HD>NOTICES</HD>
                <DOCENT>
                    <DOC>Meetings; Sunshine Act, </DOC>
                    <PGS>66200</PGS>
                    <FRDOCBP T="27NON1.sgm" D="0">07-5856</FRDOCBP>
                </DOCENT>
                <SJ>
                    <E T="03">Applications, hearings, determinations, etc.:</E>
                </SJ>
                <SJDENT>
                    <SJDOC>Tennessee Valley Authority, </SJDOC>
                    <PGS>66200</PGS>
                    <FRDOCBP T="27NON1.sgm" D="0">E7-23010</FRDOCBP>
                </SJDENT>
            </CAT>
        </AGCY>
        <AGCY>
            <EAR>Privacy</EAR>
            <HD>Privacy and Civil Liberties Oversight Board</HD>
            <CAT>
                <HD>RULES</HD>
                <DOCENT>
                    <DOC>Freedom of Information Act: CFR removal, </DOC>
                    <PGS>66041</PGS>
                    <FRDOCBP T="27NOR1.sgm" D="0">07-5834</FRDOCBP>
                </DOCENT>
            </CAT>
        </AGCY>
        <AGCY>
            <EAR>Rural</EAR>
            <HD>Rural Business-Cooperative Service</HD>
            <CAT>
                <HD>NOTICES</HD>
                <SJ>Grants and cooperative agreements; availability, etc.:</SJ>
                <SJDENT>
                    <SJDOC>Rural Business Enterprise Program, </SJDOC>
                    <PGS>66131-66133</PGS>
                    <FRDOCBP T="27NON1.sgm" D="2">E7-22986</FRDOCBP>
                </SJDENT>
            </CAT>
        </AGCY>
        <AGCY>
            <EAR>SEC</EAR>
            <HD>Securities and Exchange Commission</HD>
            <CAT>
                <HD>NOTICES</HD>
                <DOCENT>
                    <DOC>Agency information collection activities; proposals, submissions, and approvals, </DOC>
                    <PGS>66200-66203</PGS>
                    <FRDOCBP T="27NON1.sgm" D="1">E7-22978</FRDOCBP>
                    <FRDOCBP T="27NON1.sgm" D="0">E7-22980</FRDOCBP>
                    <FRDOCBP T="27NON1.sgm" D="1">E7-22981</FRDOCBP>
                    <FRDOCBP T="27NON1.sgm" D="0">E7-23002</FRDOCBP>
                    <FRDOCBP T="27NON1.sgm" D="0">E7-23004</FRDOCBP>
                </DOCENT>
                <SJ>Self-regulatory organizations; proposed rule changes:</SJ>
                <SJDENT>
                    <SJDOC>American Stock Exchange LLC, </SJDOC>
                    <PGS>66203-66205</PGS>
                    <FRDOCBP T="27NON1.sgm" D="2">E7-22974</FRDOCBP>
                </SJDENT>
                <SJDENT>
                    <SJDOC>Chicago Board Options Exchange, Inc., </SJDOC>
                    <PGS>66205-66213</PGS>
                    <FRDOCBP T="27NON1.sgm" D="1">E7-22985</FRDOCBP>
                    <FRDOCBP T="27NON1.sgm" D="4">E7-23000</FRDOCBP>
                    <FRDOCBP T="27NON1.sgm" D="1">E7-23001</FRDOCBP>
                    <FRDOCBP T="27NON1.sgm" D="2">E7-23003</FRDOCBP>
                </SJDENT>
                <SJDENT>
                    <SJDOC>Fixed Income Clearing Corp., </SJDOC>
                    <PGS>66213-66214</PGS>
                    <FRDOCBP T="27NON1.sgm" D="1">E7-23021</FRDOCBP>
                </SJDENT>
                <SJDENT>
                    <SJDOC>NYSE Arca,  Inc., </SJDOC>
                    <PGS>66214-66216</PGS>
                    <FRDOCBP T="27NON1.sgm" D="2">E7-22979</FRDOCBP>
                </SJDENT>
            </CAT>
        </AGCY>
        <AGCY>
            <EAR>Social</EAR>
            <HD>Social Security Administration</HD>
            <CAT>
                <HD>NOTICES</HD>
                <DOCENT>
                    <DOC>Agency information collection activities; proposals, submissions, and approvals, </DOC>
                    <PGS>66216</PGS>
                    <FRDOCBP T="27NON1.sgm" D="0">E7-23022</FRDOCBP>
                </DOCENT>
            </CAT>
        </AGCY>
        <AGCY>
            <EAR>State</EAR>
            <HD>State Department</HD>
            <CAT>
                <HD>NOTICES</HD>
                <SJ>Presidential permit applications:</SJ>
                <SJDENT>
                    <SJDOC>Greater Yuma Port Authority, San Luis, AZ, at U.S.-Mexico international boundary; livestock border crossing construction, operation, and maintenance, </SJDOC>
                    <PGS>66216-66217</PGS>
                    <FRDOCBP T="27NON1.sgm" D="1">E7-23085</FRDOCBP>
                </SJDENT>
            </CAT>
        </AGCY>
        <AGCY>
            <EAR>TVA</EAR>
            <HD>Tennessee Valley Authority</HD>
            <CAT>
                <HD>NOTICES</HD>
                <DOCENT>
                    <DOC>Meetings; Sunshine Act, </DOC>
                    <PGS>66217-66218</PGS>
                    <FRDOCBP T="27NON1.sgm" D="1">07-5855</FRDOCBP>
                </DOCENT>
            </CAT>
        </AGCY>
        <AGCY>
            <EAR>Transportation</EAR>
            <HD>Transportation Department</HD>
            <SEE>
                <HD SOURCE="HED">See</HD>
                <P> Federal Aviation Administration</P>
            </SEE>
            <SEE>
                <HD SOURCE="HED">See</HD>
                <P> National Highway Traffic Safety Administration</P>
            </SEE>
        </AGCY>
        <AGCY>
            <EAR>Customs</EAR>
            <HD>U.S. Customs and Border Protection</HD>
            <CAT>
                <HD>NOTICES</HD>
                <SJ>Commercial gauger and laboratory accreditations:</SJ>
                <SUBSJ>Approval—</SUBSJ>
                <SSJDENT>
                    <SUBSJDOC>Columbia Inspection, Inc., </SUBSJDOC>
                    <PGS>66185</PGS>
                    <FRDOCBP T="27NON1.sgm" D="0">E7-23091</FRDOCBP>
                </SSJDENT>
                <SSJDENT>
                    <SUBSJDOC>Intertek USA, Inc., </SUBSJDOC>
                    <PGS>66184</PGS>
                    <FRDOCBP T="27NON1.sgm" D="0">E7-23087</FRDOCBP>
                    <FRDOCBP T="27NON1.sgm" D="0">E7-23088</FRDOCBP>
                </SSJDENT>
                <SSJDENT>
                    <SUBSJDOC>Marine Technical Surveyors, Inc., </SUBSJDOC>
                    <PGS>66184</PGS>
                    <FRDOCBP T="27NON1.sgm" D="0">E7-23086</FRDOCBP>
                </SSJDENT>
                <SSJDENT>
                    <SUBSJDOC>SGS North America Inc., </SUBSJDOC>
                    <PGS>66185</PGS>
                    <FRDOCBP T="27NON1.sgm" D="0">E7-23089</FRDOCBP>
                </SSJDENT>
            </CAT>
        </AGCY>
        <AGCY>
            <EAR>Veterans</EAR>
            <HD>Veterans Affairs Department</HD>
            <CAT>
                <HD>NOTICES</HD>
                <SJ>Reports and guidance documents; availability, etc.:</SJ>
                <SJDENT>
                    <SJDOC>Adjudication Procedures Manual (M21-1); provisions related to exposure to herbicides based on receipt of Vietnam Service Medal, </SJDOC>
                    <PGS>66218-66219</PGS>
                    <FRDOCBP T="27NON1.sgm" D="1">E7-22983</FRDOCBP>
                </SJDENT>
            </CAT>
        </AGCY>
        <PTS>
            <HD SOURCE="HED">Separate Parts In This Issue</HD>
            <HD>Part II</HD>
            <DOCENT>
                <DOC>Health and Human Services Department, Centers for Medicare &amp; Medicaid Services, </DOC>
                <PGS>66222-66578</PGS>
                <FRDOCBP T="27NOR2.sgm" D="356">07-5506</FRDOCBP>
            </DOCENT>
            <HD>Part III</HD>
            <DOCENT>
                <DOC>Health and Human Services Department, Centers for Medicare &amp; Medicaid Services, </DOC>
                <PGS>66580-67225</PGS>
                <FRDOCBP T="27NOR3.sgm" D="645">07-5507</FRDOCBP>
            </DOCENT>
        </PTS>
        <AIDS>
            <HD SOURCE="HED">Reader Aids</HD>
            <P>
                Consult the Reader Aids section at the end of this issue for phone numbers, online resources, finding aids, reminders, and notice of recently enacted public laws.
                <PRTPAGE P="vi"/>
            </P>
            <P>To subscribe to the Federal Register Table of Contents LISTSERV electronic mailing list, go to http://listserv.access.gpo.gov and select Online mailing list archives, FEDREGTOC-L, Join or leave the list (or change settings); then follow the instructions.</P>
        </AIDS>
    </CNTNTS>
    <VOL>72</VOL>
    <NO>227</NO>
    <DATE>Tuesday, November 27, 2007</DATE>
    <UNITNAME>Rules and Regulations</UNITNAME>
    <RULES>
        <RULE>
            <PREAMB>
                <PRTPAGE P="66041"/>
                <AGENCY TYPE="F">EXECUTIVE OFFICE OF THE PRESIDENT</AGENCY>
                <SUBAGY>Privacy and Civil Liberties Oversight Board</SUBAGY>
                <CFR>6 CFR Chapter X</CFR>
                <DEPDOC>[Docket No. 0311-AA00]</DEPDOC>
                <SUBJECT>Removal of 6 CFR Chapter X</SUBJECT>
                <AGY>
                    <HD SOURCE="HED">AGENCY:</HD>
                    <P>Privacy and Civil Liberties Oversight Board, the White House.</P>
                </AGY>
                <ACT>
                    <HD SOURCE="HED">ACTION:</HD>
                    <P>Removal of Regulations. </P>
                </ACT>
                <SUM>
                    <HD SOURCE="HED">SUMMARY:</HD>
                    <P>The Privacy and Civil Liberties Oversight Board (PCLOB), the White House, is removing its Freedom of Information Act regulations currently published at 6 CFR Chapter X. This action is being taken because, pursuant to provisions of the Implementing Recommendations of the 9/11 Commission Act of 2007 (Pub. L. 110-53), PCLOB as it is currently constituted will be abolished no later than January 30, 2008 and replaced with a new independent agency within the Executive Branch. This new independent agency will be responsible for promulgating its own regulations.</P>
                </SUM>
                <EFFDATE>
                    <HD SOURCE="HED">EFFECTIVE DATE:</HD>
                    <P>January 30, 2008.</P>
                </EFFDATE>
                <ADD>
                    <HD SOURCE="HED">ADDRESSES:</HD>
                    <P>Privacy and Civil Liberties Oversight Board, The White House, Washington, DC 20502, (202) 456-1240. Mail security procedures may delay the delivery of mail. The fax number is: (202) 456-1066.</P>
                </ADD>
                <FURINF>
                    <HD SOURCE="HED">FOR FURTHER INFORMATION CONTACT:</HD>
                    <P>Mark A. Robbins, (202) 456-1065. </P>
                </FURINF>
            </PREAMB>
            <SUPLINF>
                <HD SOURCE="HED">SUPPLEMENTARY INFORMATION:</HD>
                <P>
                    The Intelligence Reform and Terrorism Prevention Act (IRTPA) of 2004, Pub. L. 108-458 (IRTPA), established the PCLOB, at the recommendation of the 9/11 Commission. PCLOB is presently part of the White House Office and operates within the Executive Office of the President. It has a general responsibility to ensure that privacy and civil liberties are appropriately considered as part of the development and implementation of policies and programs designed to protect the Nation against terrorism. IRTPA subjected the Board to the Freedom of Information Act, 5 U.S.C. 552 (FOIA). IRTPA § 1061(i)(2). PCLOB promulgated regulations to implement FOIA which were published as interim final regulations in the 
                    <E T="04">Federal Register</E>
                     on April 10, 2007.
                </P>
                <P>On August 3, 2007, the President signed into law the Implementing Recommendations of the 9/11 Commission Act of 2007 (Pub. L. 110-53). Among other things, this law abolishes the present Board no later than January 30, 2008 and replaces it with a new independent agency within the Executive Branch. This new entity will promulgate its own regulations consistent with its responsibilities. </P>
                <P>Upon closure, the records of the present PCLOB will be transferred to the National Archives and Records Administration pursuant to the Federal Records Act (44 U.S.C. 3101) and will be available to interested members of the public consistent with the provisions of FOIA. </P>
                <LSTSUB>
                    <HD SOURCE="HED">List of Subjects in 6 CFR Chapter X</HD>
                    <P>Freedom of Information Act Procedures.</P>
                </LSTSUB>
                <REGTEXT TITLE="6" PART="chap X">
                    <AMDPAR>Accordingly, by the authority of the Intelligence Reform and Terrorism Prevention Act (IRTPA) of 2004, Pub. L. 108-458, the Privacy and Civil Liberties Oversight Board is removing 6 CFR Chapter X, in its entirety. </AMDPAR>
                </REGTEXT>
                <SIG>
                    <NAME>Mark A. Robbins,</NAME>
                    <TITLE>Executive Director, Privacy and Civil Liberties Oversight Board.</TITLE>
                </SIG>
            </SUPLINF>
            <FRDOC>[FR Doc. 07-5834 Filed 11-26-07; 8:45 am]</FRDOC>
            <BILCOD>BILLING CODE 3195-W7-M</BILCOD>
        </RULE>
        <RULE>
            <PREAMB>
                <AGENCY TYPE="N">DEPARTMENT OF AGRICULTURE</AGENCY>
                <SUBAGY>Office of the Secretary</SUBAGY>
                <CFR>7 CFR Part 1</CFR>
                <SUBJECT>Official Records, Authentication</SUBJECT>
                <AGY>
                    <HD SOURCE="HED">AGENCY:</HD>
                    <P>Office of the Secretary, USDA.</P>
                </AGY>
                <ACT>
                    <HD SOURCE="HED">ACTION:</HD>
                    <P>Final rule. </P>
                </ACT>
                <SUM>
                    <HD SOURCE="HED">SUMMARY:</HD>
                    <P>This final rule amends Department of Agriculture (USDA) regulations on the procedures that USDA agencies follow upon receipt of a request for an authenticated copy of an agency document. Specifically, this rule authorizes the Inspector General to authenticate copies of documents in the records of the Office of Inspector General (OIG).</P>
                </SUM>
                <EFFDATE>
                    <HD SOURCE="HED">DATES:</HD>
                    <P>Effective November 27, 2007.</P>
                </EFFDATE>
                <FURINF>
                    <HD SOURCE="HED">FOR FURTHER INFORMATION CONTACT:</HD>
                    <P>
                        Mr. David R. Gray, Counsel to the Inspector General, Office of Inspector General, U.S. Department of Agriculture, 1400 Independence Avenue, SW., Room 441-E, Washington, DC 20250-2308, Telephone: (202) 720-9110, Facsimile: (202) 690-1528, e-mail: 
                        <E T="03">dry@oig.usda.gov</E>
                        .
                    </P>
                </FURINF>
            </PREAMB>
            <SUPLINF>
                <HD SOURCE="HED">SUPPLEMENTARY INFORMATION:</HD>
                <P>7 CFR 1.22 provides that when a USDA agency receives a request for an authenticated copy of an agency document, the agency will send a correct copy to the Office of the General Counsel (OGC). If appropriate, OGC will authenticate the document by certifying that the copy is correct and affixing the USDA seal on the document. The regulation makes an exception for two offices within USDA: (1) The Hearing Clerk in the Office of Administrative Law Judges (OALJ) may authenticate copies of documents in the records of the Hearing Clerk; and (2) the Director of the National Appeals Division (NAD) may authenticate copies of documents in the records of the NAD.</P>
                <P>This amendment provides that the Inspector General may authenticate copies of documents in the records of OIG.</P>
                <P>Pursuant to section 2 of the Inspector General Act of 1978 (5 U.S.C. App. 3), Congress established Offices of Inspectors General to serve as independent and objective units within Government departments and agencies that would promote economy, efficiency, and effectiveness in the administration of, and prevent and detect fraud and abuse in, the programs and operations of such departments and agencies. Toward that end, the USDA-OIG conducts investigations, audits, inspections, and reviews related to USDA programs and operations, and prepares reports and other documents setting forth the results of such investigations, audits, inspections, and reviews.</P>
                <P>
                    OIG controls the distribution and release of its documents in response to requests pursuant to the Freedom of Information Act (5 U.S.C. 552) and the 
                    <PRTPAGE P="66042"/>
                    Privacy Act (5 U.S.C. 552a). This rule ensures that the authentication of OIG documents is conducted by the Inspector General, who may certify that a copy of a requested document is authentic, true, and correct.
                </P>
                <P>
                    This rule relates to internal agency management. Therefore, pursuant to 5 U.S.C. 553, notice of proposed rulemaking and opportunity for comment are not required. This rule may be made effective less than 30 days after publication in the 
                    <E T="04">Federal Register</E>
                    . Further, this rule is exempt from the provisions of Executive Order 12866 because it relates to internal agency management. In addition, the provisions of the Regulatory Flexibility Act relating to an initial and final regulatory flexibility analysis (5 U.S.C. 603, 604) are not applicable to this final rule because USDA was not required to publish a notice of proposed rulemaking under 5 U.S.C. 553 or any other law. Finally, this action does not require review by Congress because it is not a rule as defined in 5 U.S.C. 804.
                </P>
                <LSTSUB>
                    <HD SOURCE="HED">List of Subjects in 7 CFR Part 1</HD>
                    <P>Administrative practice and procedure, Freedom of information, Privacy.</P>
                </LSTSUB>
                <REGTEXT TITLE="7" PART="1">
                    <AMDPAR>For the reasons set forth in the preamble, USDA amends 7 CFR part 1 as follows:</AMDPAR>
                    <PART>
                        <HD SOURCE="HED">PART 1—ADMINISTRATIVE REGULATIONS</HD>
                    </PART>
                    <AMDPAR>1. The authority citation for subpart A continues to read as follows:</AMDPAR>
                    <AUTH>
                        <HD SOURCE="HED">Authority:</HD>
                        <P>5 U.S.C. 301, 552; 7 U.S.C. 3125a; 31 U.S.C. 9701; and 7 CFR 2.28(b)(7)(viii).</P>
                    </AUTH>
                    <AMDPAR>2. Revise § 1.22  to read as follows:</AMDPAR>
                    <SECTION>
                        <SECTNO>§ 1.22</SECTNO>
                        <SUBJECT>Authentication.</SUBJECT>
                        <P>When a request is received for an authenticated copy of a document that the agency determines to make available to the requesting party, the agency shall cause a correct copy to be prepared and sent to the Office of the General Counsel, which shall certify the same and cause the seal of the Department to be affixed, except that the Hearing Clerk in the Office of Administrative Law Judges may authenticate copies of documents in the records of the Hearing Clerk, the Director of the National Appeals Division may authenticate copies of documents in the records of the National Appeals Division, and the Inspector General may authenticate copies of documents in the records of the Office of Inspector General.</P>
                    </SECTION>
                </REGTEXT>
                <SIG>
                    <DATED>Dated: October 18, 2007. </DATED>
                    <NAME>Charles F. Conner, </NAME>
                    <TITLE>Acting Secretary of Agriculture.</TITLE>
                </SIG>
            </SUPLINF>
            <FRDOC>[FR Doc. 07-5826 Filed 11-26-07; 8:45 am]</FRDOC>
            <BILCOD>BILLING CODE 3410-23--M</BILCOD>
        </RULE>
        <RULE>
            <PREAMB>
                <AGENCY TYPE="N">EXPORT-IMPORT BANK OF THE UNITED STATES</AGENCY>
                <CFR>12 CFR Parts 403, 407 and 414</CFR>
                <RIN>RIN 3048-ZA03</RIN>
                <SUBJECT>Technical Amendments</SUBJECT>
                <AGY>
                    <HD SOURCE="HED">AGENCY:</HD>
                    <P> Export-Import Bank of the United States.</P>
                </AGY>
                <ACT>
                    <HD SOURCE="HED">ACTION:</HD>
                    <P> Final rule.</P>
                </ACT>
                <SUM>
                    <HD SOURCE="HED">SUMMARY:</HD>
                    <P> The Export-Import Bank of the United States (Ex-Im Bank) is amending a number of its regulations by making minor, non-substantive revisions. This rule makes the following changes: removing references to an internal committee that no longer exists, correcting the time of Board meetings, and updating contact information at the Department of Justice. The rule also establishes a new part that implements Ex-Im Bank's authority, found at 12 U.S.C. 635(a)(1), to collect reasonable fees to cover the cost of conferences, seminars and publications.</P>
                </SUM>
                <EFFDATE>
                    <HD SOURCE="HED">DATES:</HD>
                    <P> The effective date for this final is November 27, 2007.</P>
                </EFFDATE>
                <FURINF>
                    <HD SOURCE="HED">FOR FURTHER INFORMATION CONTACT:</HD>
                    <P>
                         Brian J. Sonfield, Assistant General Counsel for Administration, (202) 565-3439, 
                        <E T="03">brian.sonfield@exim.gov</E>
                        .
                    </P>
                </FURINF>
            </PREAMB>
            <SUPLINF>
                <HD SOURCE="HED">SUPPLEMENTARY INFORMATION:</HD>
                <HD SOURCE="HD1">A. Background</HD>
                <P>Ex-Im Bank recently reviewed its existing regulations to ensure that they accurately reflect the Bank's current operating procedures. The review revealed that minor, nonsubstantive revisions are necessary to part 407 (governing the public observation of Ex-Im Bank meetings) and part 403 (governing the procedures for handling and safeguarding classified information). The review also indicated the need for a regulation implementing the Bank's statutory authority to collect conference and publication fees. </P>
                <HD SOURCE="HD1">B. Regulatory Changes</HD>
                <HD SOURCE="HD2">Part 407</HD>
                <P>This Part contains Ex-Im Bank's regulations governing the public observation of its Board of Director meetings, promulgated in part under the Government in the Sunshine Act, 5 U.S.C. 552b(g). Several provisions within this part make reference to the “Executive Committee of the Board of Directors,” an entity that no longer exists. The amendment deletes these references. A couple of provisions also make reference to regularly scheduled Board meetings as being held on Thursdays at 9 a.m. The meetings are now held at 9:30 a.m., and the amendments reflect this change.</P>
                <HD SOURCE="HD2">Section 403.11</HD>
                <P>This section concerns classification, declassification and safeguarding of national security information and details enforcement and investigation procedures. Subsection 403.11(b)(12) currently requires Ex-Im Bank to consult with the Department of Justice's Criminal Division prior to taking action against an employee in connection with an unauthorized disclosure of classified information. Disclosures of classified information are now handled by the Department of Justice's National Security Division, and the amendment reflects this change.</P>
                <HD SOURCE="HD2">Section 414</HD>
                <P>This new section is created to implement Ex-Im Bank's authority, pursuant to 12 U.S.C. § 635(a)(1), to collect reasonable fees to cover the costs of conferences, seminars and publications.</P>
                <LSTSUB>
                    <HD SOURCE="HED">List of Subjects</HD>
                    <CFR>12 CFR Part 403</CFR>
                    <P>Classified information.</P>
                    <CFR>12 CFR Part 407</CFR>
                    <P>Sunshine Act.</P>
                    <CFR>12 CFR Part 414</CFR>
                    <P>Exports, Government publications.</P>
                </LSTSUB>
                <REGTEXT TITLE="12" PART="403">
                    <AMDPAR>Accordingly, for the reasons stated in the preamble, Ex-Im Bank amends the Code of Federal Regulations, Title 12, Chapter IV, parts 403 and 407 as follows and adds part 414 as described below:</AMDPAR>
                    <PART>
                        <HD SOURCE="HED">PART 403—CLASSIFICATION, DECLASSIFICATION, AND SAFEGUARDING OF NATIONAL SECURITY INFORMATION</HD>
                    </PART>
                    <AMDPAR>1. The authority citation for part 403 continues to read as follows:</AMDPAR>
                    <AUTH>
                        <HD SOURCE="HED">Authority:</HD>
                        <P>E.O. 12356, National Security Information, April 2, 1982 (3 CFR, 1982 Comp. p. 166) (hereafter referred to as the “Order”), Information Security Oversight Directive No. 1, June 25, 1982 (32 CFR Part 2001) (hereafter referred to as the “Directive”), and National Security Decision Directive 84, “Safeguarding National Security Information,” signed by the President on March 11, 1983 (hereafter referred to as “NSDD 84”).</P>
                    </AUTH>
                </REGTEXT>
                <REGTEXT TITLE="12" PART="403">
                    <SECTION>
                        <PRTPAGE P="66043"/>
                        <SECTNO>§ 403.11 </SECTNO>
                        <SUBJECT>[Amended]</SUBJECT>
                    </SECTION>
                    <AMDPAR>2. Section 403.11(b)(12) is amended by replacing the word “Criminal” with the phrase “National Security”.</AMDPAR>
                </REGTEXT>
                <REGTEXT TITLE="12" PART="407">
                    <PART>
                        <HD SOURCE="HED">PART 407—REGULATIONS GOVERNING PUBLIC OBSERVATION OF EX-IM BANK MEETINGS</HD>
                    </PART>
                    <AMDPAR>3. The authority citation for part 407 continues to read as follows:</AMDPAR>
                    <AUTH>
                        <HD SOURCE="HED">Authority:</HD>
                        <P>Sec. (g) Government in the Sunshine Act, 5 U.S.C. 552b(g); secs. (b) through (f), 5 U.S.C. 552b.</P>
                    </AUTH>
                </REGTEXT>
                <REGTEXT TITLE="12" PART="407">
                    <AMDPAR>4. Amend § 407.1 as follows:</AMDPAR>
                    <AMDPAR>a. Revise paragraph (b) to read as set forth below.</AMDPAR>
                    <AMDPAR>b. In paragraph (c), remove “9:00” and add in its place “9:30”.</AMDPAR>
                    <SECTION>
                        <SECTNO>§ 407.1 </SECTNO>
                        <SUBJECT>Purpose, scope and definitions.</SUBJECT>
                        <STARS/>
                        <P>
                            (b) The term 
                            <E T="03">meeting</E>
                             means any meeting of the Board of Directors of Eximbank at which a quorum is present and where deliberations determine or result in the joint conduct or disposition of official Eximbank business.
                        </P>
                        <STARS/>
                    </SECTION>
                    <SECTION>
                        <SECTNO>§ 407.2 </SECTNO>
                        <SUBJECT>[Amended]</SUBJECT>
                    </SECTION>
                    <AMDPAR>5. Amend § 407.2(a) introductory text by removing the phrase “or the Executive Committee”.</AMDPAR>
                </REGTEXT>
                <REGTEXT TITLE="12" PART="407">
                    <SECTION>
                        <SECTNO>§ 407.2 </SECTNO>
                        <SUBJECT>[Amended]</SUBJECT>
                    </SECTION>
                    <AMDPAR>6. Amend § 407.3 as follows:</AMDPAR>
                    <AMDPAR>a. In paragraph (a), remove the phrase “or the Executive Committee”, and remove “9:00” and add in its place “9:30”.</AMDPAR>
                    <AMDPAR>b. In paragraph (b), remove the phrase “or the Executive Committee”.</AMDPAR>
                </REGTEXT>
                <SECTION>
                    <SECTNO>§ 407.4 </SECTNO>
                    <SUBJECT>[Amended]</SUBJECT>
                </SECTION>
                <REGTEXT TITLE="12" PART="407">
                    <AMDPAR>5. Amend § 407.4 by removing the phrase “or the Executive Committee” wherever it appears.</AMDPAR>
                    <SECTION>
                        <SECTNO>§ 407.6 </SECTNO>
                        <SUBJECT>[Amended]</SUBJECT>
                    </SECTION>
                    <AMDPAR>6. Amend § 407.6 by removing the phrase “or the Executive Committee”.</AMDPAR>
                </REGTEXT>
                <REGTEXT TITLE="12" PART="414">
                    <AMDPAR>7. Part 414 is added to read as follows:</AMDPAR>
                    <PART>
                        <HD SOURCE="HED">PART 414—CONFERENCE AND OTHER FEES</HD>
                        <AUTH>
                            <HD SOURCE="HED">Authority:</HD>
                            <P>12 U.S.C. 635(a)(1), 5 U.S.C. 553.</P>
                        </AUTH>
                        <SECTION>
                            <SECTNO>§ 414.1 </SECTNO>
                            <SUBJECT>Collection of conference and other fees.</SUBJECT>
                            <P>Ex-Im Bank may impose and collect reasonable fees to cover the costs of conferences and seminars sponsored by, and publications provided by Ex-Im Bank. Amounts received under the preceding sentence shall be credited to the fund which initially paid for such activities and shall be offset against the expenses of Ex-Im Bank for such activities.</P>
                        </SECTION>
                    </PART>
                </REGTEXT>
                <SIG>
                    <NAME>Howard A. Schweitzer,</NAME>
                    <TITLE>General Counsel.</TITLE>
                </SIG>
            </SUPLINF>
            <FRDOC>[FR Doc. 07-5807 Filed 11-26-07; 8:45 am]</FRDOC>
            <BILCOD>BILLING CODE 6690-01-M</BILCOD>
        </RULE>
        <RULE>
            <PREAMB>
                <AGENCY TYPE="N">DEPARTMENT OF TRANSPORTATION</AGENCY>
                <SUBAGY>Federal Aviation Administration</SUBAGY>
                <CFR>14 CFR Part 39</CFR>
                <DEPDOC>[Docket No. FAA-2007-0247; Directorate Identifier 2007-CE-083-AD; Amendment 39-15278; AD 2007-24-12]</DEPDOC>
                <RIN>RIN 2120-AA64</RIN>
                <SUBJECT>Airworthiness Directives; Eclipse Aviation Corporation Model EA500 Airplanes</SUBJECT>
                <AGY>
                    <HD SOURCE="HED">AGENCY:</HD>
                    <P>Federal Aviation Administration (FAA), DOT.</P>
                </AGY>
                <ACT>
                    <HD SOURCE="HED">ACTION:</HD>
                    <P>Final rule; request for comments.</P>
                </ACT>
                <SUM>
                    <HD SOURCE="HED">SUMMARY:</HD>
                    <P>The FAA is adopting a new airworthiness directive (AD) for certain Eclipse Aviation Corporation Model (Eclipse) EA500 airplanes. This AD requires you to inspect the fuel filler adapters for primer and/or paint in the surround and, if present, remove the primer and/or paint. This AD results from an observation during a factory walk-around that the fuel filler surround was primed instead of being bare metal. We are issuing this AD to inspect and, if necessary, remove any paint and/or primer to restore the fuel filler adapter lightning strike protection. A lightning strike on the filler cap with insulating primer on the surround could result in the strike not dissipating to the surround. This could lead to arcing and ignition of fuel vapor inside the fuel tank.</P>
                </SUM>
                <EFFDATE>
                    <HD SOURCE="HED">DATES:</HD>
                    <P>This AD becomes effective on November 27, 2007.</P>
                    <P>On November 27, 2007, the Director of the Federal Register approved the incorporation by reference of certain publications listed in this AD.</P>
                    <P>We must receive any comments on this AD by January 28, 2008.</P>
                </EFFDATE>
                <ADD>
                    <HD SOURCE="HED">ADDRESSES:</HD>
                    <P>Use one of the following addresses to comment on this AD.</P>
                    <P>
                        • 
                        <E T="03">Federal eRulemaking Portal:</E>
                         Go to 
                        <E T="03">http://www.regulations.gov.</E>
                         Follow the instructions for submitting comments.
                    </P>
                    <P>
                        • 
                        <E T="03">Fax:</E>
                         (202) 493-2251.
                    </P>
                    <P>
                        • 
                        <E T="03">Mail:</E>
                         U.S. Department of Transportation, Docket Operations, M-30, West Building, Ground Floor, Room W12-140, 1200 New Jersey Avenue, SE., Washington, DC 20590.
                    </P>
                    <P>
                        • 
                        <E T="03">Hand Delivery:</E>
                         U.S. Department of Transportation, Docket Operations, M-30, West Building, Ground Floor, Room W12-140, 1200 New Jersey Avenue, SE., Washington, DC 20590, between 9 a.m. and 5 p.m., Monday through Friday, except Federal holidays.
                    </P>
                    <P>
                        To get the service information identified in this AD, contact Eclipse Aviation Corporation, 4100 Aerospace Parkway, Albuquerque, New Mexico 87121; phone (505) 245-7555; fax: (505) 241-8802; email: 
                        <E T="03">customercare@EclipseAviation.com</E>
                        .
                    </P>
                    <P>
                        To view the comments to this AD, go to 
                        <E T="03">http://www.regulations.gov.</E>
                         The docket number is FAA-2007-0247; Directorate Identifier 2007-CE-083-AD.
                    </P>
                </ADD>
                <FURINF>
                    <HD SOURCE="HED">FOR FURTHER INFORMATION CONTACT:</HD>
                    <P>Mitchell Soth, Flight Test Engineer, 2601 Meacham Blvd., Fort Worth, Texas 76137; telephone: (817) 222-5104; fax: (817) 222-5960.</P>
                </FURINF>
            </PREAMB>
            <SUPLINF>
                <HD SOURCE="HED">SUPPLEMENTARY INFORMATION:</HD>
                <HD SOURCE="HD1">Discussion</HD>
                <P>The aircraft type certification requires compliance to 14 CFR 23.954, Fuel system lightning protection. During the lightning protection testing of certain Eclipse Model EA500 airplanes, it was determined that the fuel filler surround required exposed bare metal to dissipate arc products when the fuel filler cap is struck by lightning. We were notified by Eclipse that, during a factory walk-around, they observed that the fuel filler surround was primed instead of being bare metal. The affected airplanes are only those with the extended tip tanks (ETT).</P>
                <P>A lightning strike on the filler cap with insulating primer on the surround could result in the strike not dissipating to the surround. This could lead to arcing and ignition of fuel vapor inside the fuel tank.</P>
                <HD SOURCE="HD1">Relevant Service Information</HD>
                <P>We reviewed Eclipse Aviation Corporation Alert Service Bulletin SB 500-57-007, Rev A, dated October 12, 2007, and Eclipse Aviation Corporation Alert Service Bulletin SB 500-57-007, Rev B, dated October 23, 2007. The service information describes procedures for inspecting the fuel filler fitting surround for primer and/or paint and removing the primer and/or paint if found.</P>
                <HD SOURCE="HD1">FAA's Determination and Requirements of This AD</HD>
                <P>
                    We are issuing this AD because we evaluated all the information and determined the unsafe condition described previously is likely to exist or develop on other products of the same type design. This AD requires you to 
                    <PRTPAGE P="66044"/>
                    inspect and if necessary restore the fuel filler adapter lightning strike protection by removing any primer and/or paint from the fuel filler adapter surround.
                </P>
                <P>In preparing this rule, we contacted type clubs and aircraft operators to get technical information and information on operational and economic impacts. We did not receive any information through these contacts. If received, we would have included a discussion of any information that may have influenced this action in the rulemaking docket.</P>
                <HD SOURCE="HD1">FAA's Determination of the Effective Date</HD>
                <P>An unsafe condition exists that requires the immediate adoption of this AD. The FAA has found that the risk to the flying public justifies waiving notice and comment prior to adoption of this rule, because a lightning strike to the fuel filler cap might not properly dissipate to the surround and could cause arcing and ignition of fuel vapor inside the fuel tank. Therefore, we determined that notice and opportunity for public comment before issuing this AD are impracticable and that good cause exists for making this amendment effective in fewer than 30 days.</P>
                <HD SOURCE="HD1">Comments Invited</HD>
                <P>
                    This AD is a final rule that involves requirements affecting flight safety, and we did not precede it by notice and an opportunity for public comment. We invite you to send any written relevant data, views, or arguments regarding this AD. Send your comments to an address listed under the 
                    <E T="02">ADDRESSES</E>
                     section. Include the docket number “FAA-2007-0247; Directorate Identifier 2007-CE-083-AD” at the beginning of your comments. We specifically invite comments on the overall regulatory, economic, environmental, and energy aspects of the AD. We will consider all comments received by the closing date and may amend the AD in light of those comments.
                </P>
                <P>
                    We will post all comments we receive, without change, to 
                    <E T="03">http://www.regulations.gov,</E>
                     including any personal information you provide. We will also post a report summarizing each substantive verbal contact we receive concerning this AD.
                </P>
                <HD SOURCE="HD1">Authority for This Rulemaking</HD>
                <P>Title 49 of the United States Code specifies the FAA's authority to issue rules on aviation safety. Subtitle I, Section 106, describes the authority of the FAA Administrator. Subtitle VII, Aviation Programs, describes in more detail the scope of the Agency's authority.</P>
                <P>We are issuing this rulemaking under the authority described in Subtitle VII, Part A, Subpart III, Section 44701, “General requirements.” Under that section, Congress charges the FAA with promoting safe flight of civil aircraft in air commerce by prescribing regulations for practices, methods, and procedures the Administrator finds necessary for safety in air commerce. This regulation is within the scope of that authority because it addresses an unsafe condition that is likely to exist or develop on products identified in this rulemaking action.</P>
                <HD SOURCE="HD1">Regulatory Findings</HD>
                <P>We determined that this AD will not have federalism implications under Executive Order 13132. This AD will not have a substantial direct effect on the States, on the relationship between the national government and the States, or on the distribution of power and responsibilities among the various levels of government.</P>
                <P>For the reasons discussed above, I certify that this AD:</P>
                <P>(1) Is not a “significant regulatory action” under Executive Order 12866;</P>
                <P>(2) Is not a “significant rule” under DOT Regulatory Policies and Procedures (44 FR 11034, February 26, 1979); and</P>
                <P>(3) Will not have a significant economic impact, positive or negative, on a substantial number of small entities under the criteria of the Regulatory Flexibility Act.</P>
                <P>We prepared a regulatory evaluation of the estimated costs to comply with this AD and placed it in the AD docket.</P>
                <HD SOURCE="HD1">Examining the AD Docket</HD>
                <P>
                    You may examine the AD docket that contains the AD, the regulatory evaluation, any comments received, and other information on the Internet at 
                    <E T="03">http://www.regulations.gov</E>
                    ; or in person at the Docket Management Facility between 9 a.m. and 5 p.m., Monday through Friday, except Federal holidays. The Docket Office (telephone (800) 647-5527) is located at the street address stated in the 
                    <E T="02">ADDRESSES</E>
                     section. Comments will be available in the AD docket shortly after receipt.
                </P>
                <LSTSUB>
                    <HD SOURCE="HED">List of Subjects in 14 CFR Part 39</HD>
                    <P>Air transportation, Aircraft, Aviation safety, Incorporation by reference, Safety.</P>
                </LSTSUB>
                <REGTEXT TITLE="14" PART="39">
                    <HD SOURCE="HD1">Adoption of the Amendment</HD>
                    <AMDPAR>Accordingly, under the authority delegated to me by the Administrator, the FAA amends 14 CFR part 39 as follows:</AMDPAR>
                    <PART>
                        <HD SOURCE="HED">PART 39—AIRWORTHINESS DIRECTIVES</HD>
                    </PART>
                    <AMDPAR>1. The authority citation for part 39 continues to read as follows:</AMDPAR>
                    <AUTH>
                        <HD SOURCE="HED">Authority:</HD>
                        <P>49 U.S.C. 106(g), 40113, 44701.</P>
                    </AUTH>
                </REGTEXT>
                <REGTEXT TITLE="14" PART="39">
                    <SECTION>
                        <SECTNO>§ 39.13 </SECTNO>
                        <SUBJECT>[Amended]</SUBJECT>
                    </SECTION>
                    <AMDPAR>2. The FAA amends § 39.13 by adding the following new airworthiness directive (AD):</AMDPAR>
                    <EXTRACT>
                        <FP SOURCE="FP-2">
                            <E T="04">2007-24-12 Eclipse Aviation Corporation:</E>
                             Amendment 39-15278; Docket No. FAA-2007-0247; Directorate Identifier 2007-CE-083-AD.
                        </FP>
                        <HD SOURCE="HD1">Effective Date</HD>
                        <P>(a) This AD becomes effective on November 27, 2007.</P>
                        <HD SOURCE="HD1">Affected ADs</HD>
                        <P>(b) None.</P>
                        <HD SOURCE="HD1">Applicability</HD>
                        <P>(c) This AD applies to Model EA500 airplanes, serial numbers 000039 through 000062, that are certificated in any category.</P>
                        <HD SOURCE="HD1">Unsafe Condition</HD>
                        <P>(d) This AD results from an observation during a factory walk-around that the fuel filler surround was primed instead of being bare metal. We are issuing this AD to inspect and, if necessary, remove any paint and/or primer to restore the fuel filler adapter lightning strike protection. A lightning strike on the filler cap with insulating primer on the surround could result in the strike not dissipating to the surround. This could lead to arcing and ignition of fuel vapor inside the fuel tank.</P>
                        <HD SOURCE="HD1">Compliance</HD>
                        <P>(e) To address this problem, you must do the following, unless already done:</P>
                        <GPOTABLE COLS="3" OPTS="L2,tp0,i1" CDEF="s100,r100,r100">
                            <TTITLE> </TTITLE>
                            <BOXHD>
                                <CHED H="1">Actions</CHED>
                                <CHED H="1">Compliance</CHED>
                                <CHED H="1">Procedures</CHED>
                            </BOXHD>
                            <ROW>
                                <ENT I="01">(1) Inspect the right and left fuel filler adapters for application of primer and/or paint</ENT>
                                <ENT>
                                    At whichever of the following occurs first: (i) Within 10 hours time-in-service (TIS) after November 27, 2007 (the effective date of this AD)
                                    <LI>(ii) Within 30 days after November 27, 2007 (the effective date of this AD)</LI>
                                </ENT>
                                <ENT>Follow the procedures in Eclipse Aviation Corporation Alert Service Bulletin SB 500-57-007, Rev A, dated October 12, 2007, or Eclipse Aviation Corporation Alert Service Bulletin SB 500-57-007, Rev B, dated October 23, 2007.</ENT>
                            </ROW>
                            <ROW>
                                <PRTPAGE P="66045"/>
                                <ENT I="01">(2) Remove any primer and/or paint from the fuel filler adapter surround</ENT>
                                <ENT>Before further flight after the inspection required by paragraph (e)(1) of this AD where primer and/or paint was found on the fuel filler adapter surround</ENT>
                                <ENT>Follow the procedures in Eclipse Aviation Corporation Alert Service Bulletin SB 500-57-007, Rev B, dated October 23, 2007.</ENT>
                            </ROW>
                        </GPOTABLE>
                        <HD SOURCE="HD1">Special Flight Permit</HD>
                        <P>(f) Under 14 CFR 39.23, we are limiting the special flight permits for this AD by allowing “Flight in Day Visual Flight Rules (VFR) Only.”</P>
                        <HD SOURCE="HD1">Alternative Methods of Compliance (AMOCs)</HD>
                        <P>(g) The Manager, Fort Worth Airplane Certification Office, FAA, has the authority to approve AMOCs for this AD, if requested using the procedures found in 14 CFR 39.19. Send information to ATTN: Mitchell Soth, Flight Test Engineer, 2601 Meacham Blvd., Fort Worth, Texas 76137; telephone: (817) 222-5104; fax: (817) 222-5960. Before using any approved AMOC on any airplane to which the AMOC applies, notify your appropriate principal inspector (PI) in the FAA Flight Standards District Office (FSDO), or lacking a PI, your local FSDO.</P>
                        <HD SOURCE="HD1">Material Incorporated by Reference</HD>
                        <P>(h) You must use Eclipse Aviation Corporation Alert Service Bulletin SB 500-57-007, Rev A, dated October 12, 2007 or Eclipse Aviation Corporation Alert Service Bulletin SB 500-57-007, Rev B, dated October 23, 2007, to do the actions required by this AD, unless the AD specifies otherwise.</P>
                        <P>(1) The Director of the Federal Register approved the incorporation by reference of this service information under 5 U.S.C. 552(a) and 1 CFR part 51.</P>
                        <P>
                            (2) For service information identified in this AD, contact Eclipse Aviation Corporation, 4100 Aerospace Parkway, Albuquerque, New Mexico 87121; phone (505) 245-7555; fax: (505) 241-8802; e-mail: 
                            <E T="03">customercare@EclipseAviation.com</E>
                            .
                        </P>
                        <P>
                            (3) You may review copies at the FAA, Central Region, Office of the Regional Counsel, 901 Locust, Kansas City, Missouri 64106; or at the National Archives and Records Administration (NARA). For information on the availability of this material at NARA, call 202-741-6030, or go to: 
                            <E T="03">http://www.archives.gov/federal_register/code_of_federal_regulations/ibr_locations.html</E>
                            .
                        </P>
                    </EXTRACT>
                </REGTEXT>
                <SIG>
                    <DATED>Issued in Kansas City, Missouri, on November 20, 2007.</DATED>
                    <NAME>Kim Smith,</NAME>
                    <TITLE>Manager, Small Airplane Directorate, Aircraft Certification Service.</TITLE>
                </SIG>
            </SUPLINF>
            <FRDOC>[FR Doc. E7-23024 Filed 11-26-07; 8:45 am]</FRDOC>
            <BILCOD>BILLING CODE 4910-13-P</BILCOD>
        </RULE>
        <RULE>
            <PREAMB>
                <AGENCY TYPE="S">DEPARTMENT OF TRANSPORTATION </AGENCY>
                <SUBAGY>Federal Aviation Administration </SUBAGY>
                <CFR>14 CFR Part 45 </CFR>
                <DEPDOC>[Docket No. FAA-2007-27173; Amendment No. 45-25] </DEPDOC>
                <RIN>RIN 2120-AJ02 </RIN>
                <SUBJECT>Nationality and Registration Marks; Non Fixed-Wing Aircraft </SUBJECT>
                <AGY>
                    <HD SOURCE="HED">AGENCY:</HD>
                    <P>Federal Aviation Administration (FAA), DOT. </P>
                </AGY>
                <ACT>
                    <HD SOURCE="HED">ACTION:</HD>
                    <P>Direct final rule confirmation of effective date. </P>
                </ACT>
                <SUM>
                    <HD SOURCE="HED">SUMMARY:</HD>
                    <P>This action confirms the direct final rule issued on September 14, 2007, which became effective on November 13, 2007. The rule changes certain display requirements for nationality and registration marks for powered parachutes and weight-shift-control aircraft. No comments were received on this direct final rule. </P>
                </SUM>
                <EFFDATE>
                    <HD SOURCE="HED">DATES:</HD>
                    <P>The direct final rule published at 72 FR 52467 is confirmed effective November 13, 2007. </P>
                </EFFDATE>
                <ADD>
                    <HD SOURCE="HED">ADDRESSES:</HD>
                    <P>
                        The complete docket for the direct final rule on nationality and registration marks; non fixed-wing aircraft, Docket ID FAA-2007-27173 may be examined at 
                        <E T="03">http://www.regulations.gov</E>
                         at any time or go to Docket Operations in Room W12-140 of the West Building, Ground Floor, at 1200 New Jersey Avenue, SE., Washington, DC, between 9 a.m. and 5 p.m., Monday through Friday, except Federal holidays. 
                    </P>
                </ADD>
                <FURINF>
                    <HD SOURCE="HED">FOR FURTHER INFORMATION CONTACT:</HD>
                    <P>Grant Schneemann, AIR-230, Airworthiness Branch, Production and Airworthiness Division, Aircraft Certification Service, Federal Aviation Administration, 800 Independence Avenue, SW., Washington, DC 20591; telephone (202) 267-8473. </P>
                </FURINF>
            </PREAMB>
            <SUPLINF>
                <HD SOURCE="HED">SUPPLEMENTARY INFORMATION: </HD>
                <HD SOURCE="HD1">Background </HD>
                <P>On September 14, 2007, the FAA published a direct final rule (72 FR 52467) that permits operators of U.S. registered powered parachutes and weight-shift-control aircraft to display their nationality and registration marks in other than a horizontal orientation on the fuselage, a structural member, or a component of the aircraft. The direct final rule also clarifies the size requirements for nationality and registration marks on U.S. registered powered parachutes and weight-shift-control aircraft. </P>
                <HD SOURCE="HD1">Discussion of Comments </HD>
                <P>The FAA received no comments on the nationality and registration marks; non fixed-wing aircraft direct final rule. </P>
                <HD SOURCE="HD1">Conclusion </HD>
                <P>In consideration that no comments were submitted in response to the direct final rule, the FAA has determined that no further rulemaking action is necessary. Amendment 45-25 remains in effect as adopted. </P>
                <SIG>
                    <DATED>Issued in Washington, DC, on November 20, 2007.</DATED>
                    <NAME>John Hickey, </NAME>
                    <TITLE>Director, Aircraft Certification Services.</TITLE>
                </SIG>
            </SUPLINF>
            <FRDOC>[FR Doc. E7-23028 Filed 11-26-07; 8:45 am] </FRDOC>
            <BILCOD>BILLING CODE 4910-13-P </BILCOD>
        </RULE>
        <RULE>
            <PREAMB>
                <AGENCY TYPE="N">DEPARTMENT OF HEALTH AND HUMAN SERVICES</AGENCY>
                <SUBAGY>Food and Drug Administration</SUBAGY>
                <CFR>21 CFR Part 558</CFR>
                <SUBJECT>New Animal Drugs For Use in Animal Feeds; Fenbendazole</SUBJECT>
                <AGY>
                    <HD SOURCE="HED">AGENCY:</HD>
                    <P>Food and Drug Administration, HHS.</P>
                </AGY>
                <ACT>
                    <HD SOURCE="HED">ACTION:</HD>
                    <P>Final rule.</P>
                </ACT>
                <SUM>
                    <HD SOURCE="HED">SUMMARY:</HD>
                    <P>The Food and Drug Administration (FDA) is amending the animal drug regulations to reflect approval of a supplemental new animal drug application (NADA) filed by Intervet Inc. The supplemental NADA provides for a revised food safety warning on labeling for fenbendazole Type A medicated article and Type B and Type C medicated horse feeds.</P>
                </SUM>
                <EFFDATE>
                    <HD SOURCE="HED">DATES:</HD>
                    <P>This rule is effective November 27, 2007.</P>
                </EFFDATE>
                <FURINF>
                    <HD SOURCE="HED">FOR FURTHER INFORMATION CONTACT:</HD>
                    <P>
                        Melanie R. Berson, Center for Veterinary Medicine (HFV-110), Food and Drug Administration, 7500 Standish Pl., Rockville, MD 20855, 301-827-7540, e-mail: 
                        <E T="03">melanie.berson@fda.hhs.gov</E>
                        .
                    </P>
                </FURINF>
            </PREAMB>
            <SUPLINF>
                <HD SOURCE="HED">SUPPLEMENTARY INFORMATION:</HD>
                <P>
                    Intervet Inc., P.O. Box 318, 29160 Intervet Lane, 
                    <PRTPAGE P="66046"/>
                    Millsboro, DE 19966, filed a supplement to NADA 131-675 for use of SAFE-GUARD (fenbendazole) 20% Type A medicated article to formulate Type B and Type C medicated horse feeds. The supplemental NADA provides for a revised food safety warning on labeling. The supplemental NADA is approved as of November 5, 2007, and the regulations are amended in 21 CFR 558.258 to reflect the approval.
                </P>
                <P>Approval of this supplemental NADA did not require review of additional safety or effectiveness data or information. Therefore, a freedom of information summary is not required.</P>
                <P>FDA has determined under 21 CFR 25.33(a)(1) that this action is of a type that does not individually or cumulatively have a significant effect on the human environment. Therefore, neither an environmental assessment nor an environmental impact statement is required.</P>
                <P>This rule does not meet the definition of “rule” in 5 U.S.C. 804(3)(A) because it is a rule of “particular applicability.” Therefore, it is not subject to the congressional review requirements in 5 U.S.C. 801-808.</P>
                <LSTSUB>
                    <HD SOURCE="HED">List of Subjects in 21 CFR Part 558</HD>
                    <P>Animal drugs, Animal feeds.</P>
                </LSTSUB>
                <REGTEXT TITLE="21" PART="558">
                    <AMDPAR>Therefore, under the Federal Food, Drug, and Cosmetic Act and under authority delegated to the Commissioner of Food and Drugs and redelegated to the Center for Veterinary Medicine, 21 CFR part 558 is amended as follows:</AMDPAR>
                    <PART>
                        <HD SOURCE="HED">PART 558—NEW ANIMAL DRUGS FOR USE IN ANIMAL FEEDS</HD>
                    </PART>
                </REGTEXT>
                <REGTEXT TITLE="21" PART="558">
                    <AMDPAR>1. The authority citation for 21 CFR part 558 continues to read as follows:</AMDPAR>
                    <AUTH>
                        <HD SOURCE="HED">Authority:</HD>
                        <P>21 U.S.C. 360b, 371.</P>
                    </AUTH>
                </REGTEXT>
                <SECTION>
                    <SECTNO>§ 558.258</SECTNO>
                    <SUBJECT>[Amended]</SUBJECT>
                </SECTION>
                <REGTEXT TITLE="21" PART="558">
                    <AMDPAR>2. In § 558.258, in the table in paragraph (e)(4)(i), in the “Limitations” column, remove “Do not use in horses intended for food.” and add in its place “Do not use in horses intended for human consumption.”.</AMDPAR>
                </REGTEXT>
                <SIG>
                    <DATED>Dated: November 16, 2007.</DATED>
                    <NAME>Bernadette Dunham,</NAME>
                    <TITLE>Deputy Director, Center for Veterinary Medicine.</TITLE>
                </SIG>
            </SUPLINF>
            <FRDOC>[FR Doc. E7-22987 Filed 11-26-07; 8:45 am]</FRDOC>
            <BILCOD>BILLING CODE 4160-01-S</BILCOD>
        </RULE>
        <RULE>
            <PREAMB>
                <AGENCY TYPE="N">DEPARTMENT OF HOMELAND SECURITY </AGENCY>
                <SUBAGY>Coast Guard </SUBAGY>
                <CFR>33 CFR Part 117 </CFR>
                <DEPDOC>[CGD08-07-040] </DEPDOC>
                <RIN>RIN 1625-AA09 </RIN>
                <SUBJECT>Drawbridge Operation Regulations; Sabine River (Old Channel) Behind Orange Harbor Island, Orange, TX </SUBJECT>
                <AGY>
                    <HD SOURCE="HED">AGENCY:</HD>
                    <P>Coast Guard, DHS. </P>
                </AGY>
                <ACT>
                    <HD SOURCE="HED">ACTION:</HD>
                    <P>Final rule. </P>
                </ACT>
                <SUM>
                    <HD SOURCE="HED">SUMMARY:</HD>
                    <P>The Coast Guard is removing the existing drawbridge operation regulation for the drawbridge across the Sabine River (Old Channel) behind Orange Harbor Island, mile 9.5, at Orange, Texas. The regulation can be removed because the bridge no longer exists. </P>
                </SUM>
                <EFFDATE>
                    <HD SOURCE="HED">DATES:</HD>
                    <P>This rule is effective November 27, 2007. </P>
                </EFFDATE>
                <ADD>
                    <HD SOURCE="HED">ADDRESSES:</HD>
                    <P>Documents indicated in this preamble as being available in the docket are part of docket CGD08-07-040 and are available for inspection or copying at Eighth Coast Guard District, Bridge Administration Branch, Hale Boggs Federal Building, Room 1313, 500 Poydras Street, New Orleans, Louisiana 70130-3310 between 7 a.m. and 3 p.m., Monday through Friday, except Federal holidays. The telephone number is (504) 671-2128. </P>
                </ADD>
                <FURINF>
                    <HD SOURCE="HED">FOR FURTHER INFORMATION CONTACT:</HD>
                    <P>Bart Marcules, Bridge Administration Branch, telephone (504) 671-2128. </P>
                </FURINF>
            </PREAMB>
            <SUPLINF>
                <HD SOURCE="HED">SUPPLEMENTARY INFORMATION:</HD>
                <P>We did not publish a notice of proposed rulemaking (NPRM) for this regulation. Under 5 U.S.C. 553(b)(B), the Coast Guard finds that good cause exists for not publishing an NPRM. Public comment is not necessary since the bridge that the regulation governed no longer exists. </P>
                <P>
                    Under 5 U.S.C. 553(d)(3), the Coast Guard finds that good cause exists for making this rule effective in less than 30 days after publication in the 
                    <E T="04">Federal Register</E>
                    . There is no need to delay the implementation of this rule because the bridge it governs has been removed in its entirety. 
                </P>
                <HD SOURCE="HD1">Background and Purpose </HD>
                <P>The entire drawbridge across the Sabine River (Old Channel) behind Orange Harbor Island, mile 9.5, at Orange, Texas has been removed. Since the bridge has been removed, mariners are no longer required to go around the bridge. The regulation governing the operation of the bridge is found in 33 CFR 117.983. The purpose of this rule is to remove 33 CFR 117.983 from the Code of Federal Regulations since it governs a bridge that is no longer across the waterway. </P>
                <HD SOURCE="HD1">Discussion of Rule </HD>
                <P>The Coast Guard is changing the regulation in 33 CFR 117 without publishing an NPRM. The change removes the regulation governing the bridge since the bridge has been removed in its entirety. This change does not affect vessel operators using the waterway. Thus, it is not necessary to publish an NPRM. </P>
                <HD SOURCE="HD1">Regulatory Evaluation </HD>
                <P>This rule is not a “significant regulatory action” under section 3(f) of Executive Order 12866, Regulatory Planning and Review, and does not require an assessment of potential costs and benefits under section 6(a)(3) of that Order. The Office of Management and Budget has not reviewed it under that Order. </P>
                <P>The Coast Guard does not consider this rule to be “significant” under that Order because it does not affect the way vessels operate on the waterway. </P>
                <HD SOURCE="HD1">Small Entities </HD>
                <P>Under the Regulatory Flexibility Act (5 U.S.C. 601-612), we have considered whether this rule would have a significant economic impact on a substantial number of small entities. The term “small entities” comprises small businesses, not-for-profit organizations that are independently owned and operated and are not dominant in their fields, and governmental jurisdictions with populations of less than 50,000. </P>
                <P>The Coast Guard certifies under 5 U.S.C. 605(b) that this rule will not have a significant economic impact on a substantial number of small entities. This rule will have no impact on any small entities because the bridge has been removed in its entirety, and it will not adversely affect the owners and operators of vessels needing to transit the waterway. </P>
                <HD SOURCE="HD1">Assistance for Small Entities </HD>
                <P>Under section 213(a) of the Small Business Regulatory Enforcement Fairness Act of 1996 (Pub. L. 104-121), we want to assist small entities in understanding this rule so that they can better evaluate its effects on them and participate in the rulemaking process. </P>
                <P>
                    Small businesses may send comments on the actions of Federal employees who enforce, or otherwise determine compliance with, Federal regulations to 
                    <PRTPAGE P="66047"/>
                    the Small Business and Agriculture Regulatory Enforcement Ombudsman and the Regional Small Business Regulatory Fairness Boards. The Ombudsman evaluates these actions annually and rates each agency's responsiveness to small business. If you wish to comment on actions by employees of the Coast Guard, call 1-888-REG-FAIR (1-888-734-3247). The Coast Guard will not retaliate against small entities that question or complain about this rule or any policy or action of the Coast Guard. 
                </P>
                <HD SOURCE="HD1">Collection of Information </HD>
                <P>This rule calls for no new collection of information under the Paperwork Reduction Act of 1995 (44 U.S.C. 3501-3520). </P>
                <HD SOURCE="HD1">Federalism </HD>
                <P>A rule has implications for federalism under Executive Order 13132, Federalism, if it has a substantial direct effect on State or local governments and would either preempt State law or impose a substantial direct cost of compliance on them. We have analyzed this rule under that Order and have determined that it does not have implications for federalism. </P>
                <HD SOURCE="HD1">Unfunded Mandates Reform Act </HD>
                <P>The Unfunded Mandates Reform Act of 1995 (2 U.S.C. 1531-1538) requires Federal agencies to assess the effects of their discretionary regulatory actions. In particular, the Act addresses actions that may result in the expenditure by a State, local, or tribal government, in the aggregate, or by the private sector of $100,000,000 or more in any one year. Though this rule will not result in such an expenditure, we do discuss the effects of this rule elsewhere in this preamble. </P>
                <HD SOURCE="HD1">Taking of Private Property </HD>
                <P>This rule will not affect a taking of private property or otherwise have taking implications under Executive Order 12630, Governmental Actions and Interference with Constitutionally Protected Property Rights. </P>
                <HD SOURCE="HD1">Civil Justice Reform </HD>
                <P>This rule meets applicable standards in sections 3(a) and 3(b)(2) of Executive Order 12988, Civil Justice Reform, to minimize litigation, eliminate ambiguity, and reduce burden. </P>
                <HD SOURCE="HD1">Protection of Children </HD>
                <P>We have analyzed this rule under Executive Order 13045, Protection of Children from Environmental Health Risks and Safety Risks. This rule is not an economically significant rule and would not create an environmental risk to health or risk to safety that might disproportionately affect children. </P>
                <HD SOURCE="HD1">Indian Tribal Governments </HD>
                <P>This rule does not have tribal implications under Executive Order 13175, Consultation and Coordination with Indian Tribal Governments, because it does not have a substantial direct effect on one or more Indian tribes, on the relationship between the Federal Government and Indian tribes, or on the distribution of power and responsibilities between the Federal Government and Indian tribes. </P>
                <HD SOURCE="HD1">Energy Effects </HD>
                <P>We have analyzed this rule under Executive Order 13211, Actions Concerning Regulations That Significantly Affect Energy Supply, Distribution, or Use. We have determined that it is not a “significant energy action” under that order because it is not a “significant regulatory action” under Executive Order 12866 and is not likely to have a significant adverse effect on the supply, distribution, or use of energy. The Administrator of the Office of Information and Regulatory Affairs has not designated it as a significant energy action. Therefore, it does not require a Statement of Energy Effects under Executive Order 13211. </P>
                <HD SOURCE="HD1">Technical Standards </HD>
                <P>The National Technology Transfer and Advancement Act (NTTAA) (15 U.S.C. 272 note) directs agencies to use voluntary consensus standards in their regulatory activities unless the agency provides Congress, through the Office of Management and Budget, with an explanation of why using these standards would be inconsistent with applicable law or otherwise impractical. Voluntary consensus standards are technical standards (e.g., specifications of materials, performance, design, or operation; test methods; sampling procedures; and related management systems practices) that are developed or adopted by voluntary consensus standards bodies. </P>
                <P>This rule does not use technical standards. Therefore, we did not consider the use of voluntary consensus standards. </P>
                <HD SOURCE="HD1">Environment </HD>
                <P>We have analyzed this rule under Commandant Instruction M16475.lD which guides the Coast Guard in complying with the National Environmental Policy Act of 1969 (NEPA) (42 U.S.C. 4321-4370f), and have concluded that there are no factors in this case that would limit the use of a categorical exclusion under section 2.B.2 of the Instruction. Therefore, this rule is categorically excluded, under figure 2-1, paragraph (32)(e) of the Instruction, from further environmental documentation. Under figure 2-1, paragraph (32)(e), of the Instruction, an “Environmental Analysis Check List” and a “Categorical Exclusion Determination” are not required for this rule. </P>
                <LSTSUB>
                    <HD SOURCE="HED">List of Subjects in 33 CFR Part 117 </HD>
                    <P>Bridges.</P>
                </LSTSUB>
                <REGTEXT TITLE="33" PART="117">
                    <AMDPAR>For the reasons discussed in the preamble, the Coast Guard amends 33 CFR part 117 as follows: </AMDPAR>
                    <PART>
                        <HD SOURCE="HED">PART 117—DRAWBRIDGE OPERATION REGULATIONS </HD>
                    </PART>
                    <AMDPAR>1. The authority citation for part 117 continues to read as follows: </AMDPAR>
                    <AUTH>
                        <HD SOURCE="HED">Authority:</HD>
                        <P>33 U.S.C. 499; 33 CFR 1.05-1(g); Department of Homeland Security Delegation No. 0170.1. </P>
                    </AUTH>
                </REGTEXT>
                <REGTEXT TITLE="32" PART="117">
                    <SECTION>
                        <SECTNO>§ 117.983 </SECTNO>
                        <SUBJECT>[Removed] </SUBJECT>
                    </SECTION>
                    <AMDPAR>2. Remove § 117.983. </AMDPAR>
                </REGTEXT>
                <SIG>
                    <DATED>Dated: November 7, 2007. </DATED>
                    <NAME>J.H. Korn, </NAME>
                    <TITLE>Captain U.S. Coast Guard, Commander, 8th Coast Guard District, Acting.</TITLE>
                </SIG>
            </SUPLINF>
            <FRDOC>[FR Doc. E7-23042 Filed 11-26-07; 8:45 am] </FRDOC>
            <BILCOD>BILLING CODE 4910-15-P </BILCOD>
        </RULE>
        <RULE>
            <PREAMB>
                <AGENCY TYPE="S">DEPARTMENT OF HOMELAND SECURITY </AGENCY>
                <SUBAGY>Coast Guard </SUBAGY>
                <CFR>33 CFR Part 117 </CFR>
                <DEPDOC>[CGD08-07-043] </DEPDOC>
                <SUBJECT>Drawbridge Operating Regulations; Sabine Lake, near Sabine Pass, Port Arthur, TX </SUBJECT>
                <AGY>
                    <HD SOURCE="HED">AGENCY:</HD>
                    <P>Coast Guard, DHS. </P>
                </AGY>
                <ACT>
                    <HD SOURCE="HED">ACTION:</HD>
                    <P>Notice of temporary deviation from regulations. </P>
                </ACT>
                <SUM>
                    <HD SOURCE="HED">SUMMARY:</HD>
                    <P>The Commander, Eighth Coast Guard District, has issued a temporary deviation from the regulation governing the operation of the State Route 82 (SR 82) swing span bridge across the Sabine Lake at mile 10.0, Port Arthur, Jefferson County, Texas. This deviation provides for the bridge to remain closed to navigation to repair sections of the steel truss members of the drawbridge. </P>
                </SUM>
                <EFFDATE>
                    <HD SOURCE="HED">DATES:</HD>
                    <P>
                        This deviation is effective from 5 a.m. on Monday, December 3, 2007 until 12 p.m. on Friday, December 7, 2007 and from 5 a.m. on Monday, 
                        <PRTPAGE P="66048"/>
                        December 10, 2007 until 9 p.m. on Friday, December 14, 2007. 
                    </P>
                </EFFDATE>
                <ADD>
                    <HD SOURCE="HED">ADDRESSES:</HD>
                    <P>Materials referred to in this document are available for inspection or copying at the office of the Eighth Coast Guard District, Bridge Administration Branch, Hale Boggs Federal Building, Room 1313, 500 Poydras Street, New Orleans, Louisiana 70130-3310 between 7 a.m. and 3 p.m., Monday through Friday, except Federal holidays. The telephone number is (504) 671-2128. The Bridge Administration Branch maintains the public docket for this temporary deviation. </P>
                </ADD>
                <FURINF>
                    <HD SOURCE="HED">FOR FURTHER INFORMATION CONTACT:</HD>
                    <P>Kay Wade, Bridge Administration Branch, telephone (504) 671-2128. </P>
                </FURINF>
            </PREAMB>
            <SUPLINF>
                <HD SOURCE="HED">SUPPLEMENTARY INFORMATION:</HD>
                <P>The Texas Department of Transportation has requested a temporary deviation in order to repair sections of the steel truss members of the SR 82 swing span bridge across the Sabine Lake at Port Arthur, Jefferson County, Texas. Repair of the steel truss members is necessary for continued operation of the swing span of the bridge. This temporary deviation will allow the bridge to remain in the closed-to-navigation position from 5 a.m. on Monday, December 3, 2007 until 12 p.m. on Friday, December 7, 2007 and from 5 a.m. on Monday, December 10, 2007 until 9 p.m. on Friday, December 14, 2007. During the closure period, the draw may be able to open during the scheduled maintenance period if at least 2 hours' advance notice is given. Currently, the draw opens on signal; except that, from 9 p.m. to 5 a.m., the draw shall open on signal, if at least 6 hours' notice is given to the Maintenance Supervisor at the Port Arthur Area Office. The draw opens on signal at any time for an emergency aboard a vessel. </P>
                <P>The bridge is a swing span bridge with an available vertical navigational clearance of 9 feet above high water in the closed-to-navigation position. Navigation on the waterway consists primarily of recreational craft, although the bridge is occasionally transited by small tugs with tows transporting sand, gravel and marine shells. Due to prior experience, as well as coordination with waterway users, it has been determined that this closure will not have a significant effect on these vessels. An alternate route is available via the Sabine Neches Waterway, which is comprised of the Sabine Pass Channel, Port Arthur Channel and Sabine Neches Canal, thence passage into the lake from the north side. </P>
                <P>In accordance with 33 CFR 117.35(e), the drawbridge must return to its regular operating schedule immediately at the end of the designated time period. This deviation from the operating regulations is authorized under 33 CFR 117.35. </P>
                <SIG>
                    <DATED>Dated: November 19, 2007. </DATED>
                    <NAME>David M. Frank, </NAME>
                    <TITLE>Bridge Administrator.</TITLE>
                </SIG>
            </SUPLINF>
            <FRDOC> [FR Doc. E7-23046 Filed 11-26-07; 8:45 am] </FRDOC>
            <BILCOD>BILLING CODE 4910-15-P </BILCOD>
        </RULE>
        <RULE>
            <PREAMB>
                <AGENCY TYPE="N">DEPARTMENT OF COMMERCE</AGENCY>
                <SUBAGY>National Oceanic and Atmospheric Administration</SUBAGY>
                <CFR>50 CFR Part 229</CFR>
                <DEPDOC>[Docket No. 070417093-7582-02]</DEPDOC>
                <RIN>RIN 0648-AV54</RIN>
                <SUBJECT>List of Fisheries for 2008</SUBJECT>
                <AGY>
                    <HD SOURCE="HED">AGENCY:</HD>
                    <P>National Marine Fisheries Service (NMFS), National Oceanic and Atmospheric Administration (NOAA), Department of Commerce.</P>
                </AGY>
                <ACT>
                    <HD SOURCE="HED">ACTION:</HD>
                    <P>Final rule.</P>
                </ACT>
                <SUM>
                    <HD SOURCE="HED">SUMMARY:</HD>
                    <P>The National Marine Fisheries Service (NMFS) is publishing its final List of Fisheries (LOF) for 2008, as required by the Marine Mammal Protection Act (MMPA). The final LOF for 2008 reflects new information on interactions between commercial fisheries and marine mammals. NMFS must categorize each commercial fishery on the LOF into one of three categories under the MMPA based upon the level of serious injury and mortality of marine mammals that occurs incidental to each fishery. The categorization of a fishery in the LOF determines whether participants in that fishery are subject to certain provisions of the MMPA, such as registration, observer coverage, and take reduction plan requirements.</P>
                </SUM>
                <DATES>
                    <HD SOURCE="HED">DATES:</HD>
                    <P>This final rule is effective January 1, 2008.</P>
                </DATES>
                <ADD>
                    <HD SOURCE="HED">ADDRESSES:</HD>
                    <P>
                        See 
                        <E T="02">SUPPLEMENTARY INFORMATION</E>
                         for a listing of all Regional offices.
                    </P>
                    <P>
                        Written comments regarding the burden-hour estimates, or any other aspect of the collection of information requirements contained in this final rule, should be submitted in writing to Chief, Marine Mammal and Sea Turtle Conservation Division, Office of Protected Resources, NMFS, 1315 East-West Highway, Silver Spring, MD 20910, or to David Rostker, Office of Management and Budget (OMB), by fax to 202-395-7285 or by email to 
                        <E T="03">David_Rostker@omb.eop.gov</E>
                        .
                    </P>
                </ADD>
                <FURINF>
                    <HD SOURCE="HED">FOR FURTHER INFORMATION CONTACT:</HD>
                    <P>Melissa Andersen, Office of Protected Resources, 301-713-2322; David Gouveia, Northeast Region, 978-281-9280; Nancy Young, Southeast Region, 727-551-5607; Elizabeth Petras, Southwest Region, 562-980-3238; Brent Norberg, Northwest Region, 206-526-6733; Bridget Mansfield, Alaska Region, 907-586-7642; Lisa Van Atta, Pacific Islands Region, 808-944-2257. Individuals who use a telecommunications device for the hearing impaired may call the Federal Information Relay Service at 1-800-877-8339 between 8 a.m. and 4 p.m. Eastern time, Monday through Friday, excluding Federal holidays.</P>
                </FURINF>
            </PREAMB>
            <SUPLINF>
                <HD SOURCE="HED">SUPPLEMENTARY INFORMATION:</HD>
                <HD SOURCE="HD1">Availability of Published Materials</HD>
                <P>
                    Information regarding the LOF and the Marine Mammal Authorization Program, including registration procedures and forms, current and past LOFs, observer requirements, and marine mammal injury/mortality reporting forms and submittal procedures, may be obtained at: 
                    <E T="03">http://www.nmfs.noaa.gov/pr/interactions/</E>
                    , or from any NMFS Regional Office at the addresses listed below.
                </P>
                <HD SOURCE="HD1">Regional Offices</HD>
                <P>NMFS, Northeast Region, One Blackburn Drive, Gloucester, MA 01930-2298, Attn: Marcia Hobbs;</P>
                <P>NMFS, Southeast Region, 263 13th Avenue South, St. Petersburg, FL 33701, Attn: Teletha Mincey;</P>
                <P>NMFS, Southwest Region, 501 W. Ocean Blvd., Suite 4200, Long Beach, CA 90802-4213, Attn: Lyle Enriquez;</P>
                <P>NMFS, Northwest Region, 7600 Sand Point Way NE, Seattle, WA 98115, Attn: Permits Office;</P>
                <P>NMFS, Alaska Region, Protected Resources, P.O. Box 22668, 709 West 9th Street, Juneau, AK 99802; or</P>
                <P>NMFS, Pacific Islands Region, Protected Resources, 1601 Kapiolani Boulevard, Suite 1100, Honolulu, HI 96814-4700.</P>
                <HD SOURCE="HD1">What is the List of Fisheries?</HD>
                <P>
                    Section 118 of the MMPA requires NMFS to place all U.S. commercial fisheries into one of three categories based on the level of incidental serious injury and mortality of marine mammals occurring in each fishery (16 U.S.C. 1387(c)(1)). The categorization of a fishery in the LOF determines whether participants in that fishery may be required to comply with certain provisions of the MMPA, such as registration, observer coverage, and take reduction plan requirements. NMFS must reexamine the LOF annually, considering new information in the Marine Mammal Stock Assessment Reports (SAR) and other relevant 
                    <PRTPAGE P="66049"/>
                    sources, and publish in the 
                    <E T="04">Federal Register</E>
                     any necessary changes to the LOF after notice and opportunity for public comment (16 U.S.C. 1387 (c)(1)(C)).
                </P>
                <HD SOURCE="HD1">How Does NMFS Determine in which Category a Fishery is Placed?</HD>
                <P>The definitions for the fishery classification criteria can be found in the implementing regulations for section 118 of the MMPA (50 CFR 229.2). The criteria are also summarized here.</P>
                <HD SOURCE="HD2">Fishery Classification Criteria</HD>
                <P>The fishery classification criteria consist of a two-tiered, stock-specific approach that first addresses the total impact of all fisheries on each marine mammal stock, and then addresses the impact of individual fisheries on each stock. This approach is based on consideration of the rate, in numbers of animals per year, of incidental mortalities and serious injuries of marine mammals due to commercial fishing operations relative to the potential biological removal (PBR) level for each marine mammal stock. The MMPA (16 U.S.C. 1362 (20)) defines the PBR level as the maximum number of animals, not including natural mortalities, that may be removed from a marine mammal stock while allowing that stock to reach or maintain its optimum sustainable population. This definition can also be found in the implementing regulations for section 118 of the MMPA (50 CFR 229.2).</P>
                <P>
                    <E T="03">Tier 1:</E>
                     If the total annual mortality and serious injury of a marine mammal stock, across all fisheries, is less than or equal to 10 percent of the PBR level of the stock, all fisheries interacting with the stock would be placed in Category III (unless those fisheries interact with other stock(s) in which total annual mortality and serious injury is greater than 10 percent of PBR). Otherwise, these fisheries are subject to the next tier (Tier 2) of analysis to determine their classification.
                </P>
                <P>
                    <E T="03">Tier 2, Category I:</E>
                     Annual mortality and serious injury of a stock in a given fishery is greater than or equal to 50 percent of the PBR level.
                </P>
                <P>
                    <E T="03">Tier 2, Category II:</E>
                     Annual mortality and serious injury of a stock in a given fishery is greater than 1 percent and less than 50 percent of the PBR level.
                </P>
                <P>
                    <E T="03">Tier 2, Category III:</E>
                     Annual mortality and serious injury of a stock in a given fishery is less than or equal to 1 percent of the PBR level.
                </P>
                <P>While Tier 1 considers the cumulative fishery mortality and serious injury for a particular stock, Tier 2 considers fishery-specific mortality and serious injury for a particular stock. Additional details regarding how the categories were determined are provided in the preamble to the proposed rule implementing section 118 of the MMPA (60 FR 45086, August 30, 1995).</P>
                <P>Since fisheries are categorized on a per-stock basis, a fishery may qualify as one Category for one marine mammal stock and another Category for a different marine mammal stock. A fishery is typically categorized on the LOF at its highest level of classification (e.g., a fishery qualifying for Category III for one marine mammal stock and for Category II for another marine mammal stock will be listed under Category II).</P>
                <HD SOURCE="HD2">Other Criteria That May Be Considered</HD>
                <P>In the absence of reliable information indicating the frequency of incidental mortality and serious injury of marine mammals by a commercial fishery, NMFS will determine whether the fishery qualifies for Category II by evaluating other factors such as fishing techniques, gear used, methods used to deter marine mammals, target species, seasons and areas fished, qualitative data from logbooks or fisher reports, stranding data, and the species and distribution of marine mammals in the area, or at the discretion of the Assistant Administrator for Fisheries (50 CFR 229.2).</P>
                <HD SOURCE="HD1">How Does NMFS Determine which Species or Stocks are Included as Incidentally Killed or Seriously Injured in a Fishery?</HD>
                <P>The LOF includes a list of marine mammal species or stocks incidentally killed or seriously injured in each commercial fishery, based on the level of mortality or serious injury in each fishery relative to the PBR level for each stock. To determine which species or stocks are included as incidentally killed or seriously injured in a fishery, NMFS annually reviews the information presented in the current SARs. The SARs are based upon the best available scientific information and provide the most current and inclusive information on each stock's PBR level and level of mortality or serious injury incidental to commercial fishing operations. NMFS also reviews other sources of new information, including observer data, stranding data, and fisher self-reports.</P>
                <P>In the absence of reliable information on the level of mortality or serious injury of a marine mammal stock, or insufficient observer data, NMFS will determine whether a species or stock should be added to, or deleted from, the list by considering other factors such as: changes in gear used, increases or decreases in fishing effort, increases or decreases in the level of observer coverage, and/or changes in fishery management that are expected to lead to decreases in interactions with a given marine mammal stock (such as a Fishery Management Plan or a Take Reduction Plan). NMFS will provide case-specific justification in the LOF for changes to the list of species or stocks incidentally killed or seriously injured.</P>
                <HD SOURCE="HD1">How Does NMFS Determine the Level of Observer Coverage in a Fishery?</HD>
                <P>
                    Data obtained from observers and the level of observer coverage are important tools in estimating the level of marine mammal mortality and serious injury in commercial fishing operations. The best available information on the level of observer coverage, and the spatial and temporal distribution of observed marine mammal interactions, is presented in the SARs. Starting with the 2005 SARs, each SAR includes an appendix with detailed descriptions of each Category I and II fishery in the LOF. The SARs generally do not provide detailed information on observer coverage in Category III fisheries because under the MMPA Category III fisheries are not required to accommodate observers aboard vessels due to the remote likelihood of mortality and serious injury of marine mammals. Information presented in the SARs' appendices include: level of observer coverage, target species, levels of fishing effort, spatial and temporal distribution of fishing effort, gear characteristics, management and regulations, and interactions with marine mammals. Copies of the SARs are available on the NMFS Office of Protected Resource's Web site at: 
                    <E T="03">http://www.nmfs.noaa.gov/pr/sars/</E>
                    . Additional information on observer coverage in commercial fisheries can be found on the NMFS National Observer Program's website: 
                    <E T="03">http://www.st.nmfs.gov/st4/nop/</E>
                    .
                </P>
                <HD SOURCE="HD1">How Do I Find Out if a Specific Fishery is in Category I, II, or III?</HD>
                <P>This final rule includes two tables that list all U.S. commercial fisheries by LOF Category. Table 1 lists all of the fisheries in the Pacific Ocean (including Alaska). Table 2 lists all of the fisheries in the Atlantic Ocean, Gulf of Mexico, and Caribbean.</P>
                <HD SOURCE="HD1">Are High Seas Fisheries Included in the LOF?</HD>
                <P>
                    High seas fisheries in which U.S. persons or vessels participate are not included in the LOF. However, NMFS is considering the inclusion of U.S.-authorized high seas fisheries (fisheries operating beyond 200 nmi of U.S. coasts) in future LOFs. At this time, 
                    <PRTPAGE P="66050"/>
                    NMFS is gathering available information on the number of vessels permitted and/or actively fishing in U.S.-authorized high seas fisheries, gear types used, and marine mammal-fishery interactions data included in documents published under the Magnuson-Stevens Fishery Conservation and Management Act (MSA), National Environmental Policy Act (NEPA), Endangered Species Act (ESA), and MMPA, and from relevant Regional Fishery Management Organizations (RFMO) and the International Whaling Commission (IWC).
                </P>
                <HD SOURCE="HD1">Am I Required to Register Under the MMPA?</HD>
                <P>Owners of vessels or gear engaging in a Category I or II fishery are required under the MMPA (16 U.S.C. 1387(c)(2)), as described in 50 CFR 229.4, to register with NMFS and obtain a marine mammal authorization from NMFS in order to lawfully incidentally take a marine mammal in a commercial fishery. Owners of vessels or gear engaged in a Category III fishery are not required to register with NMFS or obtain a marine mammal authorization.</P>
                <HD SOURCE="HD1">How Do I Register?</HD>
                <P>
                    Vessel or gear owners must register with the Marine Mammal Authorization Program (MMAP) by contacting the relevant NMFS Regional Office (see 
                    <E T="02">ADDRESSES</E>
                    ), unless they participate in a fishery that has an integrated registration program (described below). Upon receipt of a completed registration, NMFS will issue vessel or gear owners an authorization certificate. The authorization certificate, or a copy, must be on board the vessel while it is operating in a Category I or II fishery, or for non-vessel fisheries, in the possession of the person in charge of the fishing operation (50 CFR 229.4(e)).
                </P>
                <HD SOURCE="HD1">What is the Process for Registering in an Integrated Fishery?</HD>
                <P>
                    For some fisheries, NMFS has integrated the MMAP registration process with existing state and Federal fishery license, registration, or permit systems. Participants in these fisheries are automatically registered under the MMAP and are not required to submit registration or renewal materials or pay the $25 registration fee. The following section indicates which fisheries are integrated fisheries and has a summary of the integration process for each Region. Although efforts are made to limit the issuance of authorization certificates to only those vessel or gear owners that participate in Category I or II fisheries, not all state and Federal permit systems distinguish between fisheries as classified by the LOF. Therefore, some vessel or gear owners in Category III fisheries may receive authorization certificates even though they are not required for Category III fisheries. Individuals fishing in Category I and II fisheries for which no state or Federal permit is required must register with NMFS by contacting their appropriate Regional Office (see 
                    <E T="02">ADDRESSES</E>
                    ).
                </P>
                <HD SOURCE="HD1">Which Fisheries Have Integrated Registration Programs?</HD>
                <P>The following fisheries have integrated registration programs under the MMPA:</P>
                <P>1. All Alaska Category II fisheries;</P>
                <P>2. All Washington and Oregon Category II fisheries;</P>
                <P>3. Northeast Regional fisheries for which a state or Federal permit is required;</P>
                <P>4. All Southeast Regional fisheries for which a Federal permit is required, as well as fisheries permitted by the states of North Carolina, South Carolina, Georgia, Florida, Alabama, Mississippi, Louisiana, and Texas; and</P>
                <P>5. The HI Swordfish, Tuna, Billfish, Mahi Mahi, Wahoo, Oceanic Sharks Longline/Set line Fishery.</P>
                <HD SOURCE="HD1">How Do I Receive My Authorization Certificate and Injury/Mortality Reporting Forms?</HD>
                <P>All vessel or gear owners will receive their authorization certificates and/or injury/mortality reporting forms via U.S. mail upon registration, except those vessel owners participating in the Northeast and Southeast Regional Integrated Registration Program. Vessel or gear owners participating in the Northeast and Southeast Regional Integrated Registration Program will receive their authorization certificates as follows:</P>
                <P>
                    1. Northeast Region vessel or gear owners participating in Category I or II fisheries for which a state or Federal permit is required may receive their authorization certificate and/or injury/mortality reporting form by contacting the Northeast Regional Office at 978-281-9328 or by visiting the Northeast Regional Office Web site (
                    <E T="03">http://www.nero.noaa.gov/prot_res/</E>
                    ) and following instructions for printing the necessary documents.
                </P>
                <P>
                    2. Southeast Region vessel or gear owners participating in Category I or II fisheries for which a Federal permit is required, as well as fisheries permitted by the states of North Carolina, South Carolina, Georgia, Florida, Alabama, Mississippi, Louisiana, and Texas may receive their authorization certificate and/or injury/mortality reporting form by contacting the Southeast Regional Office at 727-824-5312 or by visiting the Southeast Regional Office Web site (
                    <E T="03">http://sero.nmfs.noaa.gov/pr/pr.htm</E>
                    ) and following instructions for printing the necessary documents.
                </P>
                <HD SOURCE="HD1">How Do I Renew My Registration Under the MMPA?</HD>
                <P>
                     Vessel or gear owners that participate in Pacific Islands or Alaska regional fisheries are automatically renewed and should receive an authorization certificate by January 1 of each new year. Vessel or gear owners in Washington and Oregon fisheries receive authorization with each renewed state fishing license, the timing of which varies based on target species. Vessel or gear owners who participate in Pacific Islands, Alaska, Washington, or Oregon fisheries and have not received authorization certificates by January 1 or with renewed fishing licenses must contact the appropriate NMFS Regional Office (see 
                    <E T="02">ADDRESSES</E>
                    ).
                </P>
                <P>Vessel or gear owners in Southeast or Northeast regional fisheries may receive their authorization certificates by calling the relevant NMFS Regional Office or visiting the relevant NMFS Regional Office Web site (see How Do I Receive My Authorization Certificate and Injury/Mortality Reporting Forms).</P>
                <P>
                    Vessel or gear owners that participate in Southwest regional fisheries, which do not have an integrated registration program, and have previously registered in a Category I or II fishery will receive a renewal packet from the NMFS Southwest Regional Office at least 30 days prior to January 1 of each new year. It is the responsibility of the vessel or gear owner in these fisheries to complete their renewal form and return it to the NMFS Southwest Regional Office at least 30 days in advance of fishing. Individuals who have not received a renewal packet by January 1 must request a registration form from the NMFS Southwest Regional Office (see 
                    <E T="02">ADDRESSES</E>
                    ).
                </P>
                <P>Am I Required to Submit Reports When I Injure or Kill a Marine Mammal During the Course of Commercial Fishing Operations?</P>
                <P>
                    In accordance with the MMPA (16 U.S.C. 1387(e)) and 50 CFR 229.6, any vessel owner or operator, or gear owner or operator (in the case of non-vessel fisheries), participating in a Category I, II, or III fishery must report to NMFS all incidental injuries and mortalities of marine mammals that occur during commercial fishing operations. “Injury” is defined in 50 CFR 229.2 as a wound or other physical harm. In addition, any animal that ingests fishing gear or any animal that is released with fishing gear 
                    <PRTPAGE P="66051"/>
                    entangling, trailing, or perforating any part of the body is considered injured, regardless of the presence of any wound or other evidence of injury, and must be reported. Injury/mortality reporting forms and instructions for submitting forms to NMFS can be downloaded from: 
                    <E T="03">http://www.nmfs.noaa.gov/pr/pdfs/interactions/mmap_reporting_form.pdf</E>
                    . Reporting requirements and procedures can be found in 50 CFR 229.6.
                </P>
                <HD SOURCE="HD1">Am I Required to Take an Observer Aboard My Vessel?</HD>
                <P>Fishers participating in a Category I or II fishery are required to accommodate an observer aboard vessel(s) upon request. Observer requirements can be found in 50 CFR 229.7.</P>
                <HD SOURCE="HD1">Am I Required to Comply With Any Take Reduction Plan Regulations?</HD>
                <P>Fishers participating in a Category I or II fishery are required to comply with any applicable take reduction plans. Take reduction plan regulations can be found at 50 CFR 229.30-35.</P>
                <HD SOURCE="HD1">Sources of Information Reviewed for the Final 2008 LOF</HD>
                <P>NMFS reviewed the marine mammal incidental mortality and serious injury information presented in the SARs for all observed fisheries to determine whether changes in fishery classification were warranted. NMFS' SARs are based on the best scientific information available at the time of preparation, including the level of mortality and serious injury of marine mammals that occurs incidental to commercial fisheries and the PBR levels of marine mammal stocks. The information contained in the SARs is reviewed by regional Scientific Review Groups (SRGs) representing Alaska, the Pacific (including Hawaii), and the U.S. Atlantic, Gulf of Mexico, and Caribbean. The SRGs were created by the MMPA to review the science that informs the SARs, and to advise NMFS on population status and trends, stock structure, uncertainties in the science, research needs, and other issues.</P>
                <P>NMFS also reviewed other sources of new information, including marine mammal stranding data, observer program data, fisher self-reports, and other information that may not be included in the SARs.</P>
                <P>
                    The final LOF for 2008 was based, among other things, on information provided in the final SARs for 1996 (63 FR 60, January 2, 1998), the final SARs for 2001 (67 FR 10671, March 8, 2002), the final SARs for 2002 (68 FR 17920, April 14, 2003), the final SARs for 2003 (69 FR 54262, September 8, 2004), the final SARs for 2004 (70 FR 35397, June 20, 2005), the final SARs for 2005 (71 FR 26340, May 4, 2006), the final SARs for 2006 (72 FR 12774, March 19, 2007), and the draft SARs for 2007 (72 FR 35428, June 28, 2007). All the SARs are available at: 
                    <E T="03">http://www.nmfs.noaa.gov/pr/sars/</E>
                    .
                </P>
                <HD SOURCE="HD1">Fishery Descriptions</HD>
                <P>Below, NMFS briefly describes each Category I and II fishery in the final LOF for 2008. While detailed information describing each fishery in the LOF is included in the SARs, within a Fishery Management Plan (FMP) or Take Reduction Plan (TRP), or by state agencies, general descriptive information is important to include in the LOF for improved clarity. Fisheries are defined based on the gear and fishing methods, target species, temporal and spatial distribution, and management and regulatory schemes. NMFS refers readers to the SARs for more additional information on Category I and II fisheries. Abbreviations used in the following descriptions include: AK (Alaska), AL (Alabama), CA (California), DE (Deleware), FL (Florida), GA (Georgia), HI (Hawaii), LA (Louisiana), MA (Massachusetts), ME (Maine), MS (Mississippi), NC (North Carolina), NJ (New Jersey), NY (New York), OR (Oregon), RI (Rhode Island), SC (South Carolina), TX (Texas), VA (Virginia), and WA (Washington).</P>
                <HD SOURCE="HD2">Category I and II Commercial Fisheries in the Pacific Ocean</HD>
                <HD SOURCE="HD3">HI Swordfish, Tuna, Billfish, Mahi Mahi, Wahoo, Oceanic Sharks Longline/Set Line Fishery</HD>
                <P>The Category I HI longline fishery targets swordfish, tuna, billfish, mahi mahi, wahoo, and oceanic sharks. The basic unit of gear is a 30-40 mi (48-64 km) long mainline made of 0.13-0.16 in (3.2-4.0 mm) diameter monofilament line, with 800-1,000 hooks attached to the mainline. Deployment and retrieval of gear must occur at night. Shallow swordfish sets are required to use size 18/0 circle hooks with a 10-degree offset and mackerel bait. Using squid bait is prohibited. For deep sets, all float lines must be at least 20 m (65.6 ft) long with a minimum of 15 branch lines attached to the mainline between any 2 floats, except for basket-style longline gear that may have as few as 10 branch lines. The use of any light emitting device is prohibited and vessels may not land or possess more than 10 swordfish at any time. The fishery operates over a huge geographic range extending north-south from 40° N. lat. to the equator and east-west from Kure Atoll to as far as 135° W. long. Fishing for swordfish generally occurs north of Hawaii (as much as 2,000 mi (3,219 km) from Honolulu), whereas fishing for tunas occurs primarily around the main Hawaiian Islands and south of the Hawaiian Islands. The fishery operates year-round, with effort generally lower in the third quarter of the year.</P>
                <P>The HI longline fishery is managed in part under the FMP for Pelagic Fisheries of the Western Pacific Region. The shallow-set swordfish component has annual fleetwide limits on interactions with leatherback and loggerhead sea turtles, an annual fleetwide limit of 2,120 shallow sets north of the equator per year, and a requirement for operators to annually participate in a protected species workshop and get a valid protected species certification. Also, regulations mandate 100 percent observer coverage in the shallow-set component of the fishery and at least 20 percent observer coverage in the deep-set component.</P>
                <HD SOURCE="HD3">CA/OR Thresher Shark/Swordfish Drift Gillnet Fishery (≥14 in mesh)</HD>
                <P>The Category I CA/OR thresher shark/swordfish drift gillnet fishery primarily targets common thresher sharks and swordfish using a 1000-fathom (6,000 ft; 1,829 m) gillnet with stretched mesh size from 18-22 in (46-56 cm) with a 14-in (35.6 cm) minimum. Other species caught include: pelagic thresher, bigeye thresher, shortfin mako, blue shark, albacore, other tunas, and dorado. One end of the net is typically attached to the vessel and is set at dusk and allowed to drift during the night, typically for 12-14 hours. Fishing effort extends from the U.S.-Mexico border north to waters off of OR, with the majority of effort occurring from October to December. OR restricts landings to swordfish only.</P>
                <P>This fishery is a limited entry fishery managed under the Pacific Highly Migratory Species (HMS) FMP and by regulations under the Pacific Offshore Cetacean Take Reduction Plan (POCTRP), including multiple area-season closures and gear restrictions, a requirement for pingers on drift gillnets, a requirement that extenders (buoy lines) be at least 36 ft (11 m) long, and a requirement for vessel captains to attend skipper education workshops, when notified by NMFS.</P>
                <HD SOURCE="HD3">CA Angel Shark/Halibut and Other Species Set Gillnet Fishery (&gt;3.5 in mesh)</HD>
                <P>
                    The Category I CA angel shark/halibut and other species set gillnet fishery targets angel shark and halibut from the 
                    <PRTPAGE P="66052"/>
                    U.S.-Mexico border north to Monterey Bay using 200 fathom (1,200 ft; 366 m) gillnet with a stretch mesh size of 8.5 in (31.6 cm). Net soak duration is typically 8-10, 19-24, or 44-49 hours at a depth ranging from 15-50 fathoms (90-300 ft; 27-91 m) with most sets from 15-35 fathoms (90-210 ft; 27-64 m). No more than 1500 fathoms (9,000 ft; 2,743 m) of gill or trammel net may be fished in combination for CA halibut and angel shark. Fishing occurs year-round, with effort generally increasing during summer months and declining during last the 3 months of the year. The central CA portion of the fishery from Point Arguello to Point Reyes has been closed since September, 2002, following a ban on gillnets inshore of 60 fathoms (360 ft; 110 m). Set gill nets have been prohibited in state waters south of Point Arguello and within 70 fathoms (420 ft; 128 m) or one mile (1.6 km), whichever is less, around the Channel Islands since 1990. The CA Department of Fish and Game (CDFG) manages the fishery as a limited entry fishery with gear restrictions and area closures.
                </P>
                <HD SOURCE="HD3">CA Yellowtail, Barracuda, and White Seabass Drift Gillnet (mesh size ≥3.5 in and &lt;14 in) Fishery</HD>
                <P>The Category II CA yellowtail, barracuda, and white seabass drift gillnet fishery targets primarily yellowtail and white seabass, and secondarily barracuda, with target species typically determined by market demand on a short-term basis. Drift gillnets are up to 6,000 ft (1,829 m) long and are set at the surface. The mesh size depends on target species and is typically 6.0-6.5 in (15-16.5 cm). When targeting yellowtail and barracuda, the mesh size must be ≥3.5 in (9 cm); when targeting white seabass, the mesh size must be ≥6 in (15.2 cm). From June 16 to March 14 not more than 20 percent, by number, of a load of fish may be white seabass with a total length of 28 in (71 cm). A maximum of ten white seabass per load may be taken, if taken in gillnet or trammel nets with meshes from 3.5-6.0 in (9-15 cm) in length. The fishery operates year-round, primarily south of Point Conception with some effort around San Clemente Island and San Nicolas Island. This fishery is a limited entry fishery with various gear restrictions and area closures managed by the CDFG. Targeting tuna with this type of gear was effectively prohibited in April, 2004, under the Pacific HMS FMP.</P>
                <HD SOURCE="HD3">CA Anchovy, Mackerel, Sardine Purse Seine Fishery</HD>
                <P>The Category II CA anchovy, mackerel, sardine purse seine fishery targets wetfish (anchovy, mackerel, and sardine), with the target species primarily driven by availability and market demand. The fishery uses purse seines, drum seines, and lampara nets using standard seining techniques. A typical purse seine net is 185 fathoms (1,110 ft; 338 m) long, 22 fathoms (132 ft; 40 m) deep, and 1,600 meshes deep with each mesh measuring 1.25 in (3 cm). The fishery operates year-round predominantly in southern CA (including the Channel Islands) from San Diego, Oceanside, Dana Point, and San Pedro then north to San Francisco. This fishery is a limited entry fishery, and the mackerel and sardine fisheries are quota fisheries. The fishery is managed in accordance with the Coastal Pelagic Species (CPS) FMP.</P>
                <HD SOURCE="HD3">CA Tuna Purse Seine Fishery</HD>
                <P>The Category II CA tuna purse seine fishery targets yellowfin, skipjack, and bluefin tuna using purse seine nets similar to those used to target Coastal Pelagic Species (see the description under “CA anchovy, mackerel, sardine purse seine fishery”). The fishery operates from May to October south of Point Conception to the U.S.-Mexico border and in the Southern California Bight. The fishery is managed under the Pacific HMS FMP. This fishery is considered an opportunistic fishery, meaning that fishers only target tuna when certain oceanographic and market conditions exist to make the fishery viable. Effort in the fishery is highly variable, ranging from zero to ten participants annually over the past several years.</P>
                <HD SOURCE="HD3">CA Squid Purse Seine Fishery</HD>
                <P>The Category II CA squid purse seine fishery targets market squid using several gear types. From 1997-2001, 98 percent of fishermen used purse (77 percent) or drum (21 percent) seine nets. Other types used were lampara, dip, and brail nets. The fishery uses lights (shielded and oriented downward, with a maximum of 30,000 watts) to aggregate spawning squid. The fishery operates year-round with the effort focusing north of Point Conception from April to September and south of Point Conception from October to March. El Nino events cause northern landings to increase, while La Nina events cause southern landings to increase.</P>
                <P>The fishery is managed by the CDFG and is monitored under the CPS FMP and the Market Squid FMP. Commercial squid purse seine fishing is prohibited year-round from noon on Friday until noon on Sunday to allow a 2-day consecutive uninterrupted period of spawning. All vessels must be permitted and comply with a mandatory logbook program for fishing and lighting. Since 2001, a seasonal harvest guideline is set to limit further expansion of the fishery.</P>
                <HD SOURCE="HD3">CA Pelagic Longline Fishery</HD>
                <P>The Category II CA pelagic longline fishery includes both shallow-set and deep-set gear targeting swordfish and bigeye, albacore, and yellowfin tuna. The fishery operates in waters outside of the U.S. Exclusive Economic Zone (EEZ) because the Pacific HMS FMP prohibits targeting swordfish with longlines within 200 nmi of shore. In 2004, the CA-based shallow-set longline fishery was closed due to anticipated levels of sea turtle interactions. The following is a general description of the shallow-set fishery as it operated prior to 2004 and the current deep-set longline fishery.</P>
                <P>Prior to 2004, shallow-set longlines operated year-round primarily targeting swordfish with 15-45 mi (24-72 km) of mainline rigged with 72-ft (22-m) gangions at approximately 197 ft (60 m) intervals. A shallow-set typically has 800-1,300 hooks with large squid or mackerel for bait. Most shallow-set fishing takes place at night when swordfish are at the surface, using various colored lightsticks. A shallow-set mainline is deployed for 4-7 hours and left to drift unattached for 7-10 hours. At this time there is no CA-based shallow-set longline fishing due to anticipated levels of sea turtle interactions.</P>
                <P>Deep-set longlines operate year-round primarily targeting tuna with 4-46.6 mi (7-75 km) mainline rigged with 25.6-36 ft (7.8-10.9 m) gangions with 15-16 branchlines set between floats. Deep-set longlines are set at dawn with an average 12 hour soak time. The deep-set sag of the mainline is between 328-1,050 ft (100-320 m) below the water's surface. A deep-set typically contains 270-1,900 hooks with double weighted leaders and sardine for bait. Deep-sets use a variety of hooks including size 38 tuna hooks, size 9 J-hooks, and size 16/0 circle hooks. A small scale deep-set longline fishery began in January 2005 and continues currently. One hundred percent observer coverage is required in the deep-set longline fishery.</P>
                <HD SOURCE="HD3">WA Puget Sound Regional Salmon Drift Gillnet</HD>
                <P>
                    The Category II WA Puget Sound regional salmon drift gillnet fishery targets coho, pink, sockeye, chinook, and chum salmon in inland marine waters (state waters) south of the U.S.-Canada border and east of the Bonilla-Tatoosh line at the entrance to the Strait of Juan de Fuca. Drift gillnet gear consists of single web construction, not 
                    <PRTPAGE P="66053"/>
                    exceeding 300 fathoms (1,800; 549 m) in length, attached at one end of the vessel. The minimum mesh size varies from 5-7 in (13-18 cm) depending on the target species. While the depths fished vary, fishermen strive to keep the net off of the bottom. The drift times vary depending on the fishing area, tidal condition, and catch. This fishery is a limited entry fishery with seasonal openings, area closures, and gear restrictions. Regulations governing incidental take of marine mammals do not apply to tribal members exercising fishing treaty rights within this fishery .
                </P>
                <HD SOURCE="HD3">AK Prince William Sound Salmon Drift Gillnet Fishery</HD>
                <P>The Category II AK Prince William Sound salmon drift gillnet fishery targets salmon using drift gillnet gear with soak times of 15 minutes to 3 hours. The gear is set both during the day and night, with 10-14 sets per day. The fishery operates from mid-May to the end of September in the Prince William Sound Fisheries Management Area, the Copper River, and the Bering Sea. The Prince William Sound Fisheries Management Area consists of 11 districts with six hatcheries contributing to the salmon fisheries. This drift gillnet fishery is managed by the AK Department of Fish and Game (ADFG) as a limited entry fishery with gear restrictions (mesh and net size) and area closures.</P>
                <HD SOURCE="HD3">AK Peninsula/Aleutian Islands Salmon Drift Gillnet Fishery</HD>
                <P>The Category II AK Peninsula/Aleutian Islands salmon drift gillnet fishery targets salmon using drift gillnet gear with soak times of 2-5 hours. The gear is set during the day and night, with 3-8 sets per day. The fishery operates from mid-June to mid-September in two districts north of the AK Peninsula (Northern and Northwestern), and four districts south of the AK Peninsula (Unimake, Southwestern, Southcentral, and Southeastern). This drift gillnet fishery is managed by ADFG as a limited entry fishery with gear restrictions (mesh and net size) and area closures.</P>
                <HD SOURCE="HD3">AK Peninsula/Aleutian Islands Salmon Set Gillnet Fishery</HD>
                <P>The Category II AK Peninsula/Aleutian Islands salmon set gillnet fishery targets salmon using set gillnet with the gear set every 2 hours during the day and night. The gear is set with continuous soak times during the opener. Salmon may only be fished commercially during periods known as openers established by ADFG in-season. During some periods of the season fishing may be continuous with openers lasting days or even many weeks at a time. The ADFG posts weekly notices of fishing openers and announces the openers on regular radio channels a few days or a few hours before each opener. Fishing periods are often extended by Emergency Order during the last 24 hours of the opener.</P>
                <P>This fishery generally operates from June 18 to mid-August in two districts north of the AK Peninsula (Northern and Northwestern), and four districts south of the AK Peninsula (Unimake, Southwestern, Southcentral, and Southeastern). Set gillnet fishing effort also occurs off Atka and Amelia Islands. This set gillnet fishery is managed by ADFG as a limited entry fishery with gear restrictions (mesh and net size) and area closures.</P>
                <HD SOURCE="HD3">AK Southeast Salmon Drift Gillnet Fishery</HD>
                <P>The Category II AK Southeast salmon drift gillnet fishery targets salmon using drift gillnet gear with soak times of 20 minutes to 3 hours. The gear is set during the day and night, with 6-20 sets set per day. This fishery generally operates from June 18 to early October in five main fishing areas off Southeast AK, as well as at Annette Island, in Terminal Harvest Areas (THA) adjacent to hatchery facilities, and for hatchery cost recovery. The majority of salmon are caught by drift gillnets in the five main fishing areas (81 percent in 2003) and the THAs (13 percent in 2003), with small contributions from Annette Island (4 percent in 2003), and for hatchery cost recovery (1.8 percent in 2003). This drift gillnet fishery is managed by ADFG as a limited entry fishery, with gear restrictions (mesh and net size) and area closures.</P>
                <HD SOURCE="HD3">AK Cook Inlet Salmon Drift Gillnet Fishery</HD>
                <P>The Category II AK Cook Inlet salmon drift gillnet fishery targets salmon using drift gillnet gear with soak times of 15 minutes to 3 hours, or continuously. The gear is set during the day, with 6-18 sets per day. This fishery generally operates from June 25 to end of August in the Central District of the Upper Cook Inlet. Drift gillnet fishing effort for sockeye salmon peaks in mid to late July. Currently, drift gillnet fishing for salmon in the Cook Inlet occurs in the Central District area only for the two regular 12-hour openers on Mondays and Thursdays. This drift gillnet fishery is managed by ADFG as a limited entry fishery with gear restrictions (mesh and net size) and area closures.</P>
                <HD SOURCE="HD3">AK Cook Inlet Salmon Set Gillnet Fishery</HD>
                <P>The Category II AK Cook Inlet salmon set gillnet fishery targets salmon using set gillnet gear with continuous soak times during the opener. Fishing effort occurs during the day and night in the Upper Cook Inlet; while fishing effort occurs only during the day in the Lower Cook Inlet, except during fishery extensions. In the Upper Cook Inlet, the catch is picked from the net (i.e., the net is tended) each day during a slack tide; while the catch is picked from the net every 2-6 hours in the Lower Cook Inlet. The net becomes dry with low tide. The fishery generally operates from June 2 to mid-September in Cook Inlet. This set gillnet fishery is managed by ADFG as a limited entry fishery with gear restrictions (mesh and net size) and area closures.</P>
                <HD SOURCE="HD3">AK Yakutat Salmon Set Gillnet Fishery</HD>
                <P>The Category II AK Yakutat salmon set gillnet fishery targets salmon using set gillnet gear with continuous soak times during the opener, during the day and night. The catch is picked from the net every 2-4 hours each day or continuously during peak fishing times. The fishery generally operates from June 4 to the end of August. The Yakutat salmon set gillnet fishery consists of multiple set gillnet fisheries occurring in two fishing districts, the Yakutat District and the Yakataga District. As many as 25 different areas in the Yakutat and Yakataga Districts are open to commercial fishing each year. The Yakutat District fisheries primarily target sockeye and coho salmon, although all species of salmon are harvested. The Yakataga District fisheries target coho salmon. With a few exceptions, set gillnetting is confined to the intertidal area inside the mouths of rivers and streams, and to the ocean waters immediately adjacent to each. Due to the terminal nature of these fisheries, ADFG has been able to develop salmon escapement goals for most of the major, and several of the minor, fisheries. This set gillnet fishery is managed by ADFG as a limited entry fishery with gear restrictions (mesh and net size) and area closures.</P>
                <HD SOURCE="HD3">AK Kodiak Salmon Set Gillnet Fishery</HD>
                <P>
                    The Category II AK Kodiak salmon set gillnet fishery targets salmon using set gillnet gear with continuous soak times during the opener. Fishing effort occurs during the day, with the catch picked from the net 2 or more times each day. The majority of set gillnets are attached to a shore lead up to 80 fathoms (480 ft; 146 m) long in a straight line to a king 
                    <PRTPAGE P="66054"/>
                    buoy offshore, with numerous anchor lines and buoys holding the net in place. The last 25 fathoms (150 ft; 46 m) of the gillnet is usually formed into a fish trap, also called a hook. The fishery generally operates from June 9 to the end of September or early October. Many areas are open until early October, but most fishermen remove the nets by early September. As the runs progress in late July and change from sockeye to pink salmon, the ADFG often reduces the length of openers if escapement goals have not been met. Fishing effort begins to reduce in mid to late August as salmon runs begin to decline.
                </P>
                <P>This fishery consists of 2 Districts, the Northwest District from Spruce Island to the south side of Uyak Bay, and the Alitak Bay District located on the southwestern corner of Kodiak Island. In most years, the Northwest District is fished by approximately 100 permit holders and constitutes approximately 70 percent of the annual fishing effort, while the Alitak Bay District is fished by approximately 70 permit holders and constitutes approximately 30 percent of the annual fishing effort. Traditionally, the Northwest District is open for the majority of June and July, while effort in the Alitak Bay District typically occurs 5 to 7 days out of every 10 days during the fishing season. This set gillnet fishery is managed by ADFG as a limited entry fishery with gear restrictions (mesh and net size) and area closures.</P>
                <HD SOURCE="HD3">AK Bristol Bay Salmon Drift Gillnet Fishery</HD>
                <P>The Category II AK Bristol Bay salmon drift gillnet fishery targets salmon using drift gillnet gear with continuous soak times for part of the net, while other parts of the net are tended. Fishing effort occurs during the day and night, with a continuous number of sets per day. This fishery generally operates from June 17 to the end of August in Bristol Bay. Approximately 80 percent of the salmon catch in Bristol Bay is caught with drift gillnets. The Bristol Bay management area consists of five management districts including all coastal and inland waters from Cape Newenham to Cape Menshikof. There are eight major river systems in the area, and these form the largest commercial sockeye salmon fishery in the world. Although sockeye salmon is the most abundant salmon species that returns to Bristol Bay each year, chinook, chum, coho, and pink salmon returns are also important to the fishery. This drift gillnet fishery is managed by ADFG as a limited entry fishery with gear restrictions (mesh and net size) and area closures.</P>
                <HD SOURCE="HD3">AK Bristol Bay Salmon Set Gillnet Fishery</HD>
                <P>The Category II AK Bristol Bay salmon set gillnet fishery targets salmon using set gillnet gear with continuous soak times during the opener, but the net is dry during low tide. Fishing effort occurs during the day and night, with 2 or more continuous sets per day. This fishery generally operates from June 17 to the end of August or mid-September in the same areas in Bristol Bay as the AK Bristol Bay salmon drift gillnet fishery discussed above. Approximately 20 percent of the salmon catch in Bristol Bay is caught with set gillnets. This set gillnet fishery is managed by ADFG as a limited entry fishery with gear restrictions (mesh and net size) and area closures.</P>
                <HD SOURCE="HD3">AK Metlakatla/Annette Island Salmon Drift Gillnet Fishery</HD>
                <P>The Category II AK Metlakatla/Annette Island salmon drift gillnet fishery targets salmon using drift gillnet gear off Annette Island in Southeast AK. This drift gillnet fishery is an exclusively tribal fishery. The fishery is a limited entry fishery with gear restrictions (mesh and net size) and area closures. This fishery, as a tribal fishery, is separate from the AK Southeast drift gillnet fishery only for regulation purposes. The fisheries are considered the same for LOF categorization purposes.</P>
                <HD SOURCE="HD3">AK Southeast Salmon Purse Seine Fishery</HD>
                <P>The Category II AK Southeast salmon purse seine fishery targets salmon using purse seine gear with soak times of 20-45 minutes. Fishing effort occurs mostly in daylight hours, except at the peak of the season, with 6-20 sets per day. The fishery generally operates from the end of June to September. In 2003, purse seine fishing ran through November 12 in THAs. Regulations allow purse seine fishing to occur in certain fishing districts, and also in certain THAs, hatchery cost recovery areas, and the Annette Island Fishery Reserve. This purse seine fishery accounts for approximately 80 percent of the total salmon harvest in Southeast AK, and approximately 87 percent of the fish caught are pink salmon. This purse seine fishery is managed by ADFG as a limited entry fishery with gear restrictions (mesh and net size) and area closures.</P>
                <HD SOURCE="HD3">AK Cook Inlet Salmon Purse Seine Fishery</HD>
                <P>The Category II AK Cook Inlet salmon purse seine fishery targets salmon using purse seine gear in Cook Inlet from June 1 to October 31. Purse seines must be between 90 fathoms (540 ft; 165 m) and 250 fathoms (1,500 ft; 457 m) long, and 100 meshes and 325 meshes deep. Detachable or loose leads are not permitted. In Cook Inlet, purse seines may be used in the Southern District, Kamishak Bay District, Outer District, Eastern District, and Chinitna Bay Subdistrict east of a line from the crane on the south shore to the largest boulder on the landward end of Glacier Spit. This purse seine fishery is managed by ADFG as a limited entry fishery with gear restrictions (mesh and net size) and area closures.</P>
                <HD SOURCE="HD3">AK Kodiak Salmon Purse Seine Fishery</HD>
                <P>The Category II AK Kodiak salmon purse seine fishery targets salmon using purse seine gear from June 1 to October 31, with fishing periods open by regulation and emergency orders. Purse seine gear must have a mesh size of less than 7 in (18 cm). Purse seine gear must be between 100 fathoms (600 ft; 183 m) and 200 fathoms (1,200 ft; 366 m) long, and between 100 meshes and 325 meshes deep. At least 50 fathoms (300 ft; 91 m) of a purse seine must be 150 meshes in depth. One lead, no more than 100 fathoms (600 ft; 183 m) in length, may be used with each purse seine. The aggregate length of a seine and lead may not exceed 250 fathoms (1,500 ft; 457 m). Leads must be removed from the water within two hours after a season or fishing period closure. Overlapping panels of net web may not be used in seine leads.</P>
                <P>This fishery occurs in the Kodiak Area, including all waters of AK south of Cape Douglas (58° 51.10′ N. lat.), west of 150° W. long., north of 55° 30′ N. lat., and north and east of the southern entrance of Imuya Bay. This purse seine fishery is managed by ADFG as a limited entry fishery with gear restrictions (mesh and net size) and area closures.</P>
                <HD SOURCE="HD3">AK Bering Sea and Aleutian Islands (BSAI) Flatfish Trawl Fishery</HD>
                <P>
                    The Category II AK BSAI flatfish trawl fishery targets flatfish using trawl gear in the U.S. EEZ of the eastern Bering Sea and the portion of the North Pacific Ocean adjacent to the Aleutian Islands, which is west of 170° W. long. up to the U.S.-Russian Convention Line of 1867. Management measures for the BSAI groundfish fisheries constrain fishing both temporally and spatially. This fishery is federally managed under the BSAI FMP. The authorized gear, fishing season, criteria for determining fishing seasons, and area restrictions by gear type are defined in the regulations 
                    <PRTPAGE P="66055"/>
                    implementing the BSAI FMP (50 CFR part 679).
                </P>
                <HD SOURCE="HD3">AK Bering Sea and Aleutian Islands (BSAI) Pollock Trawl Fishery</HD>
                <P>The Category II AK BSAI pollock trawl fishery targets flatfish using trawl gear in the same location as the AK BSAI flatfish trawl fishery described above. The use of non-pelagic trawl gear in the directed fishery for pollock is prohibited. This fishery is federally managed under the BSAI FMP. Management measures for the BSAI groundfish fisheries constrain fishing both temporally and spatially. The gear authorized, fishing year, criteria for determining fishing seasons, and area restrictions by gear type are defined in the regulations implementing the BSAI FMP (50 CFR part 679).</P>
                <HD SOURCE="HD3">AK Bering Sea and Aleutian Islands (BSAI) Pacific Cod Longline Fishery</HD>
                <P>The Category II AK BSAI Pacific cod longline fishery targets Pacific cod using longline gear in the same location as the AK BSAI flatfish trawl fishery described above. This fishery is federally managed under the BSAI FMP. Management measures for the BSAI groundfish fisheries constrain fishing both temporally and spatially. The gear authorized, fishing year, criteria for determining fishing seasons, and area restrictions by gear type are defined in the regulations implementing the BSAI FMP (50 CFR part 679).</P>
                <HD SOURCE="HD3">AK Bering Sea Sablefish Pot Fishery</HD>
                <P>The Category II AK Bering Sea sablefish pot fishery targets sablefish using pot gear in the same location as the AK BSAI flatfish trawl fishery described above. This fishery is Federally managed under the BSAI FMP and is operated under Individual Fishing Quotas. Management measures for the BSAI groundfish fisheries constrain fishing both temporally and spatially. The gear authorized, fishing year, criteria for determining fishing seasons, and area restrictions by gear type are defined in the regulations implementing the BSAI FMP (50 CFR part 679).</P>
                <HD SOURCE="HD2">Category I and II Commercial Fisheries in the Atlantic Ocean, Gulf of Mexico, and Caribbean</HD>
                <HD SOURCE="HD3">Northeast Sink Gillnet Fishery</HD>
                <P>The Category I Northeast sink gillnet fishery targets Atlantic cod, haddock, pollock, yellowtail flounder, winter flounder, witch flounder, American plaice, windowpane flounder, spiny dogfish, monkfish, silver hake, red hake, white hake, ocean pout, skate spp, mackerel, redfish, and shad. This fishery uses sink gillnet gear, which is anchored gillnet (bottom-tending net) fished in the lower one-third of the water column. The dominant material is monofilament twine with stretched mesh sizes from 6-12 in (15-30.5 cm) and string lengths from 600-10,500 ft (183-3,200 m), depending on the target species. The fishery operates from the U.S.-Canada border to Long Island, NY, at 72° 30′ W. long. south to 36° 33.03′ N. lat. (corresponding with the VA/NC border) and east to the eastern edge of the EEZ, including the Gulf of Maine, Georges Bank, and Southern New England, and excluding Long Island Sound or other waters where gillnet fisheries are listed as Category III. At this time, these Category II and II fisheries include: the Northeast anchored float gillnet; Northeast drift gillnet; Long Island Sound inshore gillnet; and RI, southern MA (to Monomoy Island), and NY Bight (Raritan and Lower NY Bays) inshore gillnet. Fishing effort occurs year-round, peaking from May to July primarily on continental shelf regions in depths from 30-750 ft (9-228.6 m), with some nets deeper than 800 ft (244 m).</P>
                <P>This fishery is managed by the Northeast Multispecies (Groundfish) FMP and the Monkfish FMP. This fishery is also managed by the Atlantic Large Whale Take Reduction Plan (ALWTRP) and the Harbor Porpoise Take Reduction Plan (HPTRP) to reduce the risk of entanglement of right, humpback, and fin whales, and harbor porpoises, respectively. The fishery is primarily managed by Total Allowable Catch (TAC) limits; individual trip limits (quotas); effort caps (limited number of days at sea per vessel); time and area closures; and gear restrictions.</P>
                <HD SOURCE="HD3">Mid-Atlantic Gillnet Fishery</HD>
                <P>The Category I Mid-Atlantic gillnet fishery targets monkfish, spiny dogfish, smooth dogfish, bluefish, weakfish, menhaden, spot, croaker, striped bass, large and small coastal sharks, Spanish mackerel, king mackerel, American shad, black drum, skate spp., yellow perch, white perch, herring, scup, kingfish, spotted seatrout, and butterfish. The fishery uses drift and sink gillnets, including nets set in a sink, stab, set, strike, or drift fashion, with some unanchored drift or sink nets used to target specific species. The dominant material is monofilament twine with stretched mesh sizes from 2.5-12 in (6.4-30.5 cm), and string lengths from 150-8,400 ft. (46-2,560 m). This fishery operates year-round west of a line drawn at 72° 30′ W. long. south to 36° 33.03′ N. lat. and east to the eastern edge of the EEZ and north of the NC/SC border, not including waters where Category II and Category III inshore gillnet fisheries operate in bays, estuaries, and rivers. At this time, these Category II and Category III fisheries include: the Chesapeake Bay inshore gillnet; NC inshore gillnet; DE River inshore gillnet; Long Island Sound inshore gillnet; and RI, southern MA (to Monomy Island), and NY Bight (Raritan and Lower NY Bays) inshore gillnet. This fishery includes any residual large pelagic driftnet effort in the mid-Atlantic and any shark and dogfish gillnet effort in the mid-Atlantic zone described. The fishing effort is prosecuted right off the beach (6 ft [1.8 m]) or in nearshore coastal waters to offshore waters (250 ft [76 m]).</P>
                <P>Gear in this fishery is managed by several Federal FMPs and Inter-State FMPs managed by the Atlantic States Marine Fisheries Commission (ASMFC), the ALWTRP, the HPTRP, and the Bottlenose Dolphin Take Reduction Plan (BDTRP). Fisheries are primarily managed by TACs; individual trip limits (quotas); effort caps (limited number of days at sea per vessel); time and area closures; and gear restrictions and modifications.</P>
                <HD SOURCE="HD3">Atlantic Ocean, Caribbean, Gulf of Mexico Large Pelagics Longline Fishery</HD>
                <P>The Category I Atlantic Ocean, Caribbean, Gulf of Mexico large pelagics longline fishery targets swordfish, yellowfin tuna, bigeye tuna, bluefin tuna, albacore tuna, dolphin fish, wahoo, shortfin mako shark, and a variety of other shark species. The fishery uses a mainline of &gt;700 lb (317.5 kg) test monofilament typically ranging from 10-45 mi (16-72 km) long. Bullet-shaped floats are suspended at regular intervals along the mainline and long sections of gear are marked by radio beacons. Long gangion lines of 200-400 lb (91-181 kg) test monofilament of typically 100-200 ft (30.5-61 m) are suspended from the mainline. Only certain sized hooks and baits are allowed based on fishing location. Hooks are typically fished at depths between 40-120 ft (12-36.6 m). Longlines targeting tuna are typically set at dawn are hauled near dusk, while longlines targeting swordfish are typically set at night and hauled in the morning. Gear remains in the water typically for 10-14 hours. Fishermen generally modify only select sections of longline gear to target dolphin or wahoo, with the remaining gear configured to target swordfish, tuna, and/or sharks.</P>
                <P>
                    This fishery operates year-round and occurs within and outside the U.S. EEZ throughout Atlantic, Caribbean and Gulf 
                    <PRTPAGE P="66056"/>
                    of Mexico waters. The fishery has historically been composed of five relatively distinct segments with different fishing practices and strategies, including: Gulf of Mexico yellowfin tuna fishery; South Atlantic-Florida east coast to Cape Hatteras swordfish fishery; Mid-Atlantic and New England swordfish and bigeye tuna fishery; U.S. distant water swordfish fishery; and Caribbean Islands tuna and swordfish fishery. In addition to geographical area, these segments have historically differed by percentage of various target and non-target species, gear characteristics, and deployment techniques.
                </P>
                <P>This fishery is managed under the Consolidated Atlantic HMS FMP. The dolphin and wahoo portions of the fishery are managed under the South Atlantic FMP for Dolphin and Wahoo. Regulations under the MSA address the target fish species, as well as bycatch species protected under the ESA and/or the MMPA. A portion of this fishery is the subject of the Pelagic Longline Take Reduction Team (PLTRT), convened in 2005. NMFS is currently developing regulations to implement the Take Reduction Plan.</P>
                <HD SOURCE="HD3">Northeast/Mid-Atlantic American Lobster Trap/Pot Fishery</HD>
                <P>The Category I Northeast/Mid-Atlantic American lobster trap/pot fishery targets American lobster primarily with traps, while 2-3 percent of the target species is taken by mobile gear (trawls and dredges). The fishery operates in inshore and offshore waters from ME to NJ and may extend as far south as Cape Hatteras. Approximately 80 percent of American lobster are harvested from state waters; therefore, the ASMFC has a primary regulatory role. The EEZ portion of the fishery operates under regulations from the Federal American Lobster FMP. Both the EEZ and state fishery are operating under Federal regulations from the ALWTRP.</P>
                <HD SOURCE="HD3">Northeast Anchored Float Gillnet Fishery</HD>
                <P>The Category II Northeast anchored float gillnet fishery targets mackerel, herring (particularly for bait), shad, and menhaden using gillnet gear of any size anchored and fished in the upper two-thirds of the water column. The fishery operates from the U.S.-Canada border to Long Island, NY, at 72° 30′ W. long south to 36° 33.03′ N. lat. and east to the eastern edge of the EEZ, not including Long Island Sound or other waters where gillnet fisheries are listed as Category III. The fishery is managed under the Interstate FMPs for Atlantic Menhaden and Shad and is subject to ALWTRP implementing regulations. A total closure of the American shad ocean intercept fishery was fully implemented in January, 2005.</P>
                <HD SOURCE="HD3">Northeast Drift Gillnet Fishery</HD>
                <P>The Category II Northeast drift gillnet fishery targets species other than large pelagics, including shad, herring, mackerel, and menhaden. This fishery uses drift gillnet gear, which is gillnet gear not anchored to the bottom and is free-floating on both ends or free-flowing at one end and attached to the vessel at the other end. Mesh sizes are likely less than those used to target large pelagics. The fishery includes any residual large pelagic driftnet effort in New England and occurs at any depth in the water column from the U.S.-Canada border to Long Island, NY, at 72° 30′ W. long. south to 36° 33.03′ N. lat. and east to the eastern edge of the EEZ. The fishery is managed under the Interstate FMPs for Atlantic Menhaden and Shad and is subject to ALWTRP implementing regulations. A total closure of the American shad ocean intercept fishery was fully implemented in January, 2005.</P>
                <HD SOURCE="HD3">Chesapeake Bay Inshore Gillnet Fishery</HD>
                <P>The Category II Chesapeake Bay inshore gillnet fishery targets menhaden and croaker using gillnet gear with mesh sizes ranging from 2.75-5 in (7-12.7 cm), depending on the target species. The fishery operates between the Chesapeake Bay/Bridge Tunnel and the mainland. The fishery is managed under the Interstate FMPs for Atlantic Menhaden and Atlantic Croaker.</P>
                <HD SOURCE="HD3">Northeast Mid-Water Trawl (Including Pair Trawl) Fishery</HD>
                <P>The Category II Northeast mid-water trawl fishery targets Atlantic herring with bycatch of several finfish species, predominantly mackerel, spiny dogfish, and silver hake. This fishery uses primarily mid-water (pelagic) trawls (single and paired), which is trawl gear designed, capable, or used to fish for pelagic species with no portion designed to be operated in contact with the bottom. The fishery occurs primarily in ME State waters, Jeffrey's Ledge, southern New England, and Georges Bank during the winter months when the target species continues its southerly migration from the Gulf of Maine/Georges Bank, into mid-Atlantic waters. The fishery is managed jointly by the Mid-Atlantic Fishery Management Council and the ASMFC as a migratory stock complex.</P>
                <HD SOURCE="HD3">Mid-Atlantic Flynet Fishery</HD>
                <P>
                    The Category II Mid-Atlantic flynet fishery is a multispecies fishery composed of nearshore and offshore components that operate along the eastern coast of the Mid-Atlantic United States. Flynets are high profile trawls similar to bottom otter trawls. These nets typically range from 80-120 ft (24-36.6 m) in headrope length, with wing mesh sizes of 16-64 in (41-163 cm), following a slow 3:1 taper to smaller mesh sizes in the body, extension, and codend sections of the net. The nearshore fishery operates from October to April inside of 30 fathoms (180 ft; 55 m) from NC to NJ. This nearshore fishery targets Atlantic croaker, weakfish, butterfish, harvestfish, bluefish, menhaden, striped bass, kingfishes, and other finfish species. Flynet fishing is no longer permitted south of Cape Hatteras in order to protect weakfish stocks. The offshore component operates from November to April outside of 30 fathoms (180 ft; 55 m) from the Hudson Canyon off NY, south to Hatteras Canyon off NC. These deeper water fisheries target bluefish, Atlantic mackerel, 
                    <E T="03">Loligo</E>
                     squid, black sea bass, and scup (72 FR 7382, February 15, 2007). 
                    <E T="03">Illex</E>
                     Squid are also targeted offshore (70-200 fathoms [420-1,200 ft; 128-366 m]) during summer months from May to September.
                </P>
                <HD SOURCE="HD3">Northeast Bottom Trawl Fishery</HD>
                <P>The Category II Northeast bottom trawl fishery uses bottom trawl gear to target species included in the NE Multispecies FMP, Summer Flounder FMP, and Scup and Seabass FMP, including, but not limited to: Atlantic cod, haddock, pollock, yellowtail flounder, winter flounder, witch flounder, American plaice, Atlantic halibut, redfish, windowpane flounder, summer flounder, spiny dogfish, monkfish, silver hake, red hake, white hake, ocean pout, and skate spp. The fishery operates year-round, with a peak from May to July, from the U.S.-Canada border through waters east of 72° 30′ W. long., primarily on the continental shelf and throughout the Gulf of Maine, Georges Bank, and Southern New England. The fishery is primarily managed by TACs, individual trip limits (quotas), effort caps (limited number of days at sea per vessel), time and area closures, and gear restrictions.</P>
                <HD SOURCE="HD3">VA Pound Net Fishery</HD>
                <P>
                    The Category II VA pound net fishery targets weakfish, spot, and croaker using stationary gear in nearshore coastal and estuarine waters off VA. Pound net gear includes a large mesh lead posted 
                    <PRTPAGE P="66057"/>
                    perpendicular to the shoreline and extending outward to the corral, or “heart,” where the catch accumulates. This fishery includes all pound net effort in VA State waters, including waters inside the Chesapeake Bay. The fishery is managed under Interstate FMPs for Atlantic Croaker and Spot, and is an affected fishery under the BDTRP.
                </P>
                <HD SOURCE="HD3">Atlantic Mixed Species Trap/Pot Fishery</HD>
                <P>The Category II Atlantic mixed species trap/pot fishery's target species include, but are not limited to, hagfish, shrimp, conch/whelk, red crab, Jonah crab, rock crab, black sea bass, scup, tautog, cod, haddock, Pollock, redfish (ocean perch) white hake, spot, skate, catfish, stone crab, American eel, and cunner. The fishery includes all trap/pot operations from the U.S.-Canada border south through the waters east of the fishery management demarcation line between the Atlantic Ocean and the Gulf of Mexico (50 CFR 600.105), but does not include the following Category I, II, and III trap/pot fisheries: Northeast/Mid-Atlantic American lobster trap/pot; Atlantic blue crab trap/pot; Florida spiny lobster trap/ pot; Southeastern U.S. Atlantic, Gulf of Mexico stone crab trap/pot; U.S. Mid-Atlantic eel trap/pot fisheries; and the Southeastern U.S. Atlantic, Gulf of Mexico golden crab fishery (68 FR 1421, January 10, 2003). The fishery is managed under various Interstate FMPs and is subject to ALWTRP implementing regulations.</P>
                <HD SOURCE="HD3">Atlantic Blue Crab Trap/Pot Fishery</HD>
                <P>The Category II Atlantic blue crab trap/pot fishery targets blue crab using pots baited with fish or poultry typically set in rows in shallow water. The pot position is marked by either a floating or sinking buoy line attached to a surface buoy. The fishery occurs year-round from the south shore of Long Island at 72° 30' W. long. in the Atlantic and east of the fishery management demarcation line between the Atlantic Ocean and the Gulf of Mexico (50 CFR 600.105), including state waters. The fishery is managed under state FMPs, and is subject to ALWTRP implementing regulations. It is also an affected fishery under the BDTRP.</P>
                <HD SOURCE="HD3">Mid-Atlantic Bottom Trawl Fishery</HD>
                <P>The Category II Mid-Atlantic bottom trawl fishery uses bottom trawl gear to target species including, but not limited to, bluefish, croaker, monkfish, summer flounder (fluke), winter flounder, silver hake (whiting), spiny dogfish, smooth dogfish, scup, and black sea bass. The fishery occurs year-round from Cape Cod, MA, to Cape Hatteras, NC, in waters west of 72° 30′ W. long. and north of a line extending due east from the NC/SC border. The gear is managed by several state and Federal FMPs that range from MA to NC.</P>
                <HD SOURCE="HD3">Mid-Atlantic Mid-Water Trawl (Including Pair Trawl) Fishery</HD>
                <P>
                    The Category II Mid-Atlantic mid-water trawl fishery targets Atlantic mackerel, 
                    <E T="03">Loligo</E>
                     squid, 
                    <E T="03">Illex</E>
                     squid, and Atlantic butterfish using mainly mid-trawl gear, with some bottom trawls. The fishery is dominated by small-mesh otter trawls, but 
                    <E T="03">Loligo</E>
                     squid are also taken by inshore pound nets and fish traps in spring and summer. The fishery for 
                    <E T="03">Illex</E>
                     occurs offshore, mainly in continental shelf and slope waters during summer months (June to September), from southern New England to Cape Hatteras, NC. The fishery for 
                    <E T="03">Loligo</E>
                     occurs mostly offshore near the edge of the continental shelf during fall and winter months (October to March), and inshore during spring and summer (April to September) in southern New England and mid-Atlantic waters. The fishery for Atlantic mackerel occurs primarily in southern New England and the mid-Atlantic from January to March, and in the Gulf of Maine during summer and fall (May to December). Atlantic butterfish are mainly caught as bycatch in the directed squid and mackerel fisheries due to their northerly inshore migration in summer months and southerly offshore migration in winter months. The fishery is managed by the Federal Squid, Mackerel, Butterfish FMP. The 
                    <E T="03">Illex</E>
                     and 
                    <E T="03">Loligo</E>
                     fisheries are managed by moratorium permits, gear and area restrictions, quotas, and trip limits. The Atlantic mackerel and Atlantic butterfish fisheries are managed by an annual quota system.
                </P>
                <HD SOURCE="HD3">Mid-Atlantic Haul/Beach Seine Fishery</HD>
                <P>Due to pending rulemakings by the NC Division of Marine Fisheries (NCDMF), particularly pertaining to NC beach gear, NMFS is basing its description of the Category II Mid-Atlantic haul/beach seine fishery on the proposed 2001 LOF (66 FR 6545, January 22, 2001) and components of the proposed 2008 LOF (72 FR 35393, June 28, 2007). NMFS is including components of both definitions that more accurately reflect the current fishery. This includes the following description: The Category II Mid-Atlantic haul/beach seine fishery targets striped bass, mullet, spot, weakfish, sea trout, bluefish, kingfish, and harvestfish using seines with one end secured (e.g., swipe nets and long seines) and seines secured at both ends or those anchored to the beach and hauled up on the beach. The beach seine system also uses a bunt and a wash net that are attached to the beach and extend into the surf. The fishery occurs in waters west of 72° 30′ W. long. and north of a line extending due east from the NC/SC border. The fishery is managed under several state and Interstate FMPs and is an affected fishery under the BDTRP.</P>
                <P>Further revision to the description of this fishery will appear in a future LOF pending the NCDMF rulemakings.</P>
                <HD SOURCE="HD3">Mid-Atlantic Menhaden Purse Seine Fishery</HD>
                <P>The Category II Mid-Atlantic menhaden purse seine fishery targets menhaden and thread herring using purse seine gear. Most sets occur within 3 mi (4.8 km) of shore with the majority of the effort occurring off NC from November to January, and moving northward during warmer months to southern New England. The fishery is managed under the Interstate FMP for Atlantic Menhaden.</P>
                <HD SOURCE="HD3">Southeastern U.S. Atlantic Shark Gillnet Fishery</HD>
                <P>The Category II Southeastern U.S. Atlantic shark gillnet fishery targets large and small coastal sharks (blacktip, blacknose, finetooth, bonnethead, and sharpnose) using gillnets set in a sink, stab, set, strike, or drift fashion. Mesh size is typically greater than 5 in (13 cm), but may be as small as 2.87 in (7.3 cm) when targeting small coastal sharks. Drift gillnets most commonly use a mesh size of 5 in (13 cm) and average 10.2 hours from setting the gear through completion of haulback; sink gillnets most frequently use a mesh size of 7 in (18 cm) soaking for approximately 2.7 hours; and strike gillnets use the largest mesh size of 9 in (23 cm) soaking for approximately 0.8 hours. This fishery has traditionally operated in coastal waters off FL and GA.</P>
                <P> This fishery is managed under the Consolidated Atlantic HMS FMP, the ALWTRP, and the BDTRP, and is subject to ESA biological opinion requirements. Regulations implemented under the MSA address managed target species, as well as bycatch species, including some protected under the ESA and MMPA (e.g., sea turtles, smalltooth sawfish, and right whales).</P>
                <HD SOURCE="HD3">Southeast Atlantic Gillnet Fishery</HD>
                <P>
                    The Category II Southeast Atlantic gillnet fishery targets finfish including, but not limited to, king mackerel, Spanish mackerel, whiting, bluefish, pompano, spot, croaker, little tunny, bonita, jack crevalle, cobia, and striped mullet. This fishery does not include 
                    <PRTPAGE P="66058"/>
                    gillnet effort targeting sharks as part of the “Southeastern U.S. Atlantic shark gillnet” fishery. This fishery uses gillnets set in sink, stab, set, or strike fashion. The fishery operates in waters south of a line extending due east from the NC/SC border and south and east of the fishery management council demarcation line between the Atlantic Ocean and the Gulf of Mexico. The majority of fishing effort occurs in Federal waters since SC, GA, and FL prohibit the use of gillnets, with limited exceptions, in state waters.
                </P>
                <P>Fishing for king mackerel, Spanish mackerel, cobia, cero, and little tunny in Federal waters is managed under the Coastal Migratory Pelagic Resources (CMPR) FMP. None of the other target species are Federally managed under the MSA. In state waters, state and ASMFC Interstate FMPs apply. The fishery is also subject to BDTRP and ALWTRP implementing regulations.</P>
                <HD SOURCE="HD3">NC Inshore Gillnet Fishery</HD>
                <P>The Category II NC inshore gillnet fishery targets species including, but not limited to, southern flounder, weakfish, bluefish, Atlantic croaker, striped mullet, spotted seatrout, Spanish mackerel, striped bass, spot, red drum, black drum, and shad. This fishery includes any fishing effort using any type of gillnet gear, including set (float and sink), drift, and runaround gillnet for any target species inshore of the COLREGS lines in NC. This fishery is managed under state and ASMFC interstate FMPs, applying net and mesh size regulations, and seasonal area closures in the Pamlico Sound Gillnet Restricted Area (PSGNRA). It is also an affected fishery under the BDTRP.</P>
                <HD SOURCE="HD3">Gulf of Mexico Gillnet Fishery</HD>
                <P>The Category II Gulf of Mexico gillnet fishery targets a wide variety of target species, including, but not limited to: black drum, sheepshead, weakfish, mullet, spot, croaker, king mackerel, Spanish mackerel, Florida pompano, flounder shark, menhaden, bluefish, blue runner, ladyfish, spotted seatrout, croaker, kingfish, and red drum. This fishery operates year-round using any type of gillnet, including strike and straight gillnets, in waters north of the U.S.-Mexico border and west of the fishery management council demarcation line between the Atlantic Ocean and the Gulf of Mexico. Gillnet gear is prohibited in TX and FL State waters, but fixed and runaround gillnets are currently used in LA, MS, and AL with highly variable fishing effort.</P>
                <P>Fishing for king mackerel, Spanish mackerel, cobia, cero, little tunny, dolphin, and bluefish are managed under the CMPR FMP. In the Gulf of Mexico, CMPR FMP species are the only Federally managed species for which gillnet gear is authorized, and only run-around gillnetting for these species is allowed. In state waters, state and Gulf States Marine Fisheries Commission (GSMFC) Interstate FMPs apply.</P>
                <HD SOURCE="HD3">NC Long Haul Seine Fishery</HD>
                <P>The Category II NC long haul seine fishery targets species including, but not limited to, weakfish, spot, croaker, menhaden, bluefish, spotted seatrout, and hogfish using multi-filament seines consisting of a 3,000-6,000 ft (914-1,829 m) net pulled by two boats for 1-2 nmi (2-4 km). Fish are encircled and concentrated by pulling the net around a fixed stake. The fishery includes fishing with long haul seine gear to target any species in waters off NC, including estuarine waters in Pamlico and Core Sounds and their tributaries. The fishery occurs from February to November, with peak effort occurring from June to October. The fishery is managed under ASMFC interstate FMPs, and is an affected fishery under the BDTRP.</P>
                <HD SOURCE="HD3">NC Roe Mullet Stop Net Fishery</HD>
                <P>The Category II NC roe mullet stop net fishery targets striped mullet from October to November using a stationary, multi-filament anchored net extended perpendicular to the beach. Once the catch accumulates near the end of the stop net, a beach haul seine is used to capture fish and bring them ashore. The stop net is traditionally left in the water for 1-5 days, but can be left as long as 15 days. This fishery is unique to Bogue Banks, NC. This fishery is managed under the NC Striped Mullet FMP, and is an affected fishery under the BDTRP.</P>
                <HD SOURCE="HD3">Gulf of Mexico Menhaden Purse Seine Fishery</HD>
                <P>The Category II Gulf of Mexico menhaden purse seine fishery targets menhaden and thread herring using purse seine gear in bays, sounds, and nearshore coastal waters along the Gulf of Mexico coast. The majority of the fishing effort is concentrated off LS and MS, with lesser effort in AL and TX State waters. FL prohibits the use of purse seines in state waters. The fishery is managed under the GSMFC Interstate Gulf Menhaden FMP.</P>
                <HD SOURCE="HD1">Comments and Responses</HD>
                <P>NMFS received 10 comment letters and 1 comment via phone on the proposed 2008 LOF (72 FR 35393, June 28, 2007) from the Marine Mammal Commission, Hawaii Longline Association, Western Pacific Regional Fishery Management Council, Mid-Atlantic Fishery Management Council, Pacific Fishery Management Council's Groundfish Management Team, Gulf States Marine Fisheries Commission, Center for Biological Diversity, 2 representatives of the commercial fishing industry, and 2 representatives of Federal agencies. Comments on issues outside the scope of the LOF were noted, but are not responded to in this final rule.</P>
                <HD SOURCE="HD2">General Comments</HD>
                <P>
                    <E T="03">Comment 1:</E>
                     Two commenters commended NMFS for describing all Category I and II fisheries within the proposed 2008 LOF. While additional description materials are available elsewhere, one commenter believes these descriptions provide important context for readers attempting to evaluate the LOF. One commenter recommended NMFS describe all Category III fisheries in future LOFs.
                </P>
                <P>
                    <E T="03">Response:</E>
                     NMFS will consider describing Category III fisheries in future LOFs.
                </P>
                <P>
                    <E T="03">Comment 2:</E>
                     Two commenters commended NMFS for publishing the proposed 2008 LOF early enough to allow for ample time to review and comment on the rule, as well as to publish a final 2008 LOF before the beginning of the 2008 calendar year.
                </P>
                <P>
                    <E T="03">Response:</E>
                     NMFS will make every effort to publish future proposed LOFs by July of each year, to allow sufficient time for review and comment by organizations and individuals. This will also allow NMFS to publish the final LOF in time for the rule to become effective by January 1 of the respective calendar year.
                </P>
                <P>
                    <E T="03">Comment 3:</E>
                     One commenter commended NMFS for its support of depredation studies, as outlined in response to comments in the final 2007 LOF (72 FR 14466, March 28, 2007). The commenter encourages NMFS to continue and enhance its efforts to evaluate and address this developing issue.
                </P>
                <P>
                    <E T="03">Response:</E>
                     NMFS will continue to develop, conduct, and support research efforts on depredation-related interactions between marine mammals and fisheries as funding is available. See the response to Comment 1 in the final 2007 LOF (72 FR 14466, March 28, 2007) for details on research conducted in the past and research currently being conducted.
                </P>
                <P>
                    <E T="03">Comment 4:</E>
                     One commenter reiterated previous letters on the 2005, 2006, and 2007 LOFs calling for the inclusion of observer coverage on the LOF. The Service indicated in its response to comments on the final 2007 
                    <PRTPAGE P="66059"/>
                    LOF that it would “present information associated with the level of observer coverage or lack of observer coverage, if available, as part of the justification for proposing changes in future [lists].” However, information on observer coverage is not provided in the justification for reclassifying the “CA yellowtail, barracuda, and white seabass drift gillnet” fishery in the proposed 2008 LOF. Further, the commenter also believes observer information is important for justifying the status quo. Without such information, it is not possible to determine whether a given fishery was adequately observed and no marine mammals were taken or the fishery was not adequately observed and mortality and serious injury may have occurred, but were not documented.
                </P>
                <P>
                    <E T="03">Response:</E>
                     Please see responses to Comment 6 in the final 2005 LOF (71 FR 250, January 4, 2006), Comment 4 in the final 2006 LOF (71 FR 48802, August 22, 2006), and Comment 8 in the final 2007 LOF (72 FR 14466, March 28, 2007). NMFS still feels that it will be of limited use to include observer coverage data or percentages in the LOF without also including the confidence associated with mortality/serious injury estimates generated from observer data. Presenting the level of observer coverage in the LOF without the associated confidence information will likely lead to misinterpretation of the information provided. Information including details of the interaction data and the Coefficient of Variance (CV) for stock-specific information is reported in the SARs. NMFS continues to refer readers to the SARs for the most current, peer-reviewed information on observer coverage. The SARs can be accessed through the NMFS Office of Protected Resource's web site at: 
                    <E T="03">http://www.nmfs.noaa.gov/pr.sars/</E>
                    . Additional information can also be found on the National Observer Program web site at: 
                    <E T="03">http://www.st.nmfs.gov/st4/nop/</E>
                    .
                </P>
                <P>NMFS acknowledges the lack of inclusion of observer information in the explanation for the proposed elevation of the “CA yellowtail, barracuda, and white seabass drift gillnet” fishery in the proposed 2008 LOF. This was an unintentional oversight. NMFS will ensure that information on observer coverage, if available, is included as part of the justification for proposing classification changes in future LOFs. NMFS has corrected this oversight here: In the draft 2007 Pacific Marine Mammal Stock Assessments, the level of observer coverage in the CA small mesh drift gillnet fishery for white seabass, yellowtail, and barracuda observer coverage was listed as 11 percent in 2002 and 2003. During the public comment of the draft 2007 SARs, errors were found in the listed levels of observer coverage in the CA small mesh drift gillnet for white seabass, yellowtail, and barracuda. The correct levels of observer coverage for 2002, 2003, and 2004, are 11.5 percent, 10.4 percent and 17.6 percent, respectively. There has been no observer coverage in this fishery since 2004. NMFS is seeking funding to observe this fishery in 2008.</P>
                <P>
                    <E T="03">Comment 5:</E>
                     One commenter reiterated previous comments made on the 2004 and 2007 LOFs for inclusion of high seas fisheries on the LOF. Multiple high sea fisheries, in which U.S.-flagged vessels operate, are known to interact or are likely to interact with marine mammals. Section 118 of the MMPA applies to ''commercial fishing operations by persons using vessels of the United States.” Therefore, NMFS failure to include these high seas fisheries is unlawful. The commenter notes that NMFS responded in 2004 stating, “NMFS will consider this comment and whether the LOF applies to high seas fisheries during the development of future proposed LOFs (69 FR 48407, August 10, 2004). The commenter recognized that the proposed 2008 LOF provides a longer explanation of the issue of high seas fisheries, but NMFS has continued to fail to analyze these fisheries and include them on the LOF. Specific fisheries suggested as additions to the LOF are the Cobb Seamount fishery, Pacific pelagic squid jig fishery, South Pacific tuna purse seine fishery, and fisheries in the area of the Convention on the Conservation of Antarctic Marine Living Resources (CCAMLR) including the Patagonian toothfish longline fishery and a trawl fishery for krill.
                </P>
                <P>
                    <E T="03">Response:</E>
                     NMFS is continuing to consider the inclusion of U.S.-authorized high seas fisheries in future LOFs. Also, NMFS is gathering available information on the fishing effort, gear used, and marine mammal interaction levels specific to U.S. vessels operating in high seas fisheries. NMFS faces significant challenges in accurately categorizing high seas fisheries in the LOF. As discussed under in the preamble of this rule, fisheries are categorized in the LOF based on the level of mortality and serious injury of marine mammal stocks relevant to the stock's PBR level. PBR levels are calculated based on the stock's abundance using data presented in the SARs, required under section 117 of the MMPA (16 U.S.C. 1386). Section 117 requires NMFS to prepare SARs for marine mammal stocks occurring “in waters under the jurisdiction of the United States.” NMFS does not develop SARs, or therefore calculate PBR levels, for marine mammal stocks on the high seas. NMFS will continue to explore options for categorizing high seas fisheries in a future LOF in the absence of marine mammal stock abundance and PBR level information. Please see response to Comment 9 in the final 2007 LOF (72 FR 14466, March 28, 2007) and the preamble of this rule for information on NMFS current efforts.
                </P>
                <P>
                    NMFS provides high seas fishing permits under the High Seas Fishing Compliance Act (HSFCA). NMFS issues permits only for high seas fisheries analyzed in accordance with the NEPA and the ESA. There are currently 7 U.S.-authorized high seas fisheries: Atlantic Highly Migratory Species Fisheries (50 CFR 635), Pacific Highly Migratory Species Fisheries (50 CFR 660, subpart K), Western Pacific Pelagic Fisheries (50 CFR 665, subpart C), South Pacific Albacore Troll Fishing, Pacific Tuna Fisheries (50 CFR 300, subpart C), South Pacific Tuna Fisheries (50 CFR 300, subpart D), and the Antarctic Marine Living Resources (50 CFR 300, subpart G). For more information please see the NMFS Office of International Affairs HSPCA information website: 
                    <E T="03">http://www.nmfs.noaa.gov/ia/services/highseas.htm</E>
                    .
                </P>
                <P>The commenter suggested the addition of several specific high sea fisheries to the LOF, including the Cobb Seamount fishery, Pacific pelagic squid jig fishery, South Pacific tuna purse seine fishery, and fisheries in the CCAMLR area including the Patagonian toothfish longline fishery and a trawl fishery for krill. Currently, NMFS does not authorize U.S. vessels to participate in the Cobb Seamount fishery or the Pacific pelagic squid jig fishery. Therefore, these fisheries would not be considered for addition to the LOF. Also, the South Pacific tuna purse seine fishery is managed separately under section 301 of the MMPA (16 U.S.C. 1411); therefore, it would not be added to the LOF required under section 118 of the MMPA. Regarding the CCAMLR fisheries, in the past there has been a single U.S. vessel participating in the trawl fishery for krill. However, this vessel has not fished in the last 2 years. Also, in the past there have been 2 U.S. vessels (under 1 owner) participating in the Patagonian toothfish longline fishery. NMFS has not received any permit applications for U.S. vessels to participate in either of the CCAMLR fisheries in the coming year.</P>
                <P>
                    <E T="03">Comment 6:</E>
                     One commenter stated that all Category I and II fisheries not already subject to take reduction teams should promptly have such teams 
                    <PRTPAGE P="66060"/>
                    convened for them. The Category I HI longline fishery should be the highest priority as takes continue to exceed PBR for false killer whales.
                </P>
                <P>
                    <E T="03">Response:</E>
                     At this time, NMFS' resources for TRTs are fully utilized and new TRTs will be initiated when additional resources become available. When additional TRTs are convened, they will follow priorities set out in section 118(f)(3) of the MMPA (16 U.S.C. 1387). When there is insufficient funding available to develop and implement a TRT for all stocks that interact with Category I and II fisheries, the highest priority for developing and implementing new TRTs will be given to species or stocks whose level of incidental mortality and serious injury exceeds PBR, those with a small population size, and those which are declining most rapidly.
                </P>
                <HD SOURCE="HD2">Comments on Fishery Classification Methodology</HD>
                <P>
                    <E T="03">Comment 7:</E>
                     One commenter reiterated previous recommendations that NMFS revise the dividing PBR thresholds for Category I and II fisheries. The current range for a Category II fishery is an interaction rate between 1 percent and 50 percent of a stock's PBR, which is too broad and unnecessarily lumps fisheries with rare interactions alongside fisheries with numerous interactions. NMFS uses catch as a proxy for fishing effort, unreasonably large expansion factors, and double counting of interactions, resulting in one rare event in a fishery being expanded into an unrealistic overestimation of takes. Given the precautionary methodology in the PBR formula, the minimum threshold for Category II should be increased from 1 percent to 10 percent of PBR. Interactions under 10 percent of PBR should be a Category III. In doing so, rare events (i.e., 1 take in 5 years) would result in a Category III instead of a Category II classification.
                </P>
                <P>
                    <E T="03">Response:</E>
                     NMFS implemented the classification criteria in the final regulations to implement the 1994 amendments to the MMPA (60 FR 45086, August 30, 1995) after ample consideration of comments and suggestions from the public. NMFS refers the reader to the response to comments 5 through 9 in that rule for a detailed explanation of the reasoning for setting the dividing thresholds between Category II and III as 1 percent of PBR. NMFS also finalized an Environmental Assessment (EA) in August, 1995, to analyze the impacts of the regulations implementing the 1994 amendments on the environment and the public. NMFS also finalized a revised EA in December 2005 on the process of classifying U.S. commercial fisheries. A full copy of the updated 2005 EA can be found at 
                    <E T="03">http://www.nmfs.noaa.gov/pr/pdfs/interactions/lof_ea.pdf</E>
                    .
                </P>
                <P>The fishery classification criteria consider the rate of incidental serious injury and mortality of marine mammals in commercial fisheries on a stock-specific basis. Therefore, the rate of interaction of a fishery with a marine mammal stock with a low PBR can be significant even if it appears to be a minimal problem based on the size of the fishery or frequency of the interactions. The chosen approach allows NMFS to focus management actions where fishery interactions have a significant negative effect on the population.</P>
                <P>
                    In addition to the 1-percent threshold, the definitions of Category II and III fisheries include qualitative criteria that allow the Assistant Administrator for Fisheries to place a fishery into Category II or III in the absence of reliable information. This qualitative criteria will allow the Assistant Administrator to take into consideration cases where the PBR level for a particular stock is very low and/or where the level of incidental interaction with commercial fisheries is low and not likely to delay the population's attainment of its Optimum Sustainable Population. See the general description of the two-tiered scheme and qualitative criteria that may be used to classify a fishery in the preamble in this rule under 
                    <E T="03">Fishery Classification Criteria</E>
                    .
                </P>
                <P>
                    <E T="03">Comment 8:</E>
                     One commenter questioned NMFS' inconsistent use of time periods in the LOF, instead of always including interaction data from the most recent 5-year period (e.g. 2002-2006 for the 2006 SAR). For some fisheries, including those with high levels of observer coverage, the time period used to calculate annual take rates to categorize fisheries is 2000-2004. For other fisheries the time period is 2001-2005. Given that the most recent final SAR is 2006, why isn't the time period used to calculate annual interaction rates and classify fisheries for all fisheries 2002-2006? Or consistent for those fisheries with observer coverage every year?
                </P>
                <P>
                    <E T="03">Response:</E>
                     Fishery classifications on the LOF are based on interaction data published in the most recent SARs, when available. SARs are revised on a rotating schedule, so not all SARs will include data from the same period of time. Section 117 of the MMPA requires NMFS to review SARs for strategic stocks and for stocks for which significant new information is available at least annually, and at least once every 3 years for all other stocks, and make changes if necessary. Therefore, while the SARs for strategic stocks are reviewed annually and updated if new information is available, SARs for non-strategic stocks may be updated only once every 3 years.
                </P>
                <P>Also, it takes approximately a full year to develop new, final SARs. The annual interaction rates presented in the SARs are based on the most current observer data available. The draft SARs for 2006 were prepared in the fall of 2005; at which time, observer data for 2004 were the most current data available. Observer data for 2005 became available in 2006 and were incorporated into the draft SARs for 2007, which was published in June, 2007.</P>
                <P>
                    <E T="03">Comment 9:</E>
                     One commenter questioned NMFS' continued use of a recovery factor of 0.1 in the PBR formula for most whale stocks instead of updating the recovery factor based on new information. The commenter cited various sections of the GAMMS Workshop Report (Wade and Angliss, 1996) discussing recovery factors, including text stating that recovery factors can be adjusted to accommodate additional information, when mortality estimates are known to be relatively unbiased based on high observer coverage, and to allow for management discretion as consistent with the goals of the ESA and MMPA. The commenter cites 3 examples in the report of recovery factors for ESA listed stocks being altered.
                </P>
                <P>
                    <E T="03">Response:</E>
                     This comment is not specifically relevant to the LOF. While fisheries on the LOF are categorized based on the incidental mortality and serious injury relevant to a marine mammal stock's PBR, the calculation of PBR levels are completed and peer-reviewed during the annual SARs process. NMFS urges the commenter to present these comments during the public comment period for the draft 2008 SARs, as the comment period for the draft 2007 SARs has closed.
                </P>
                <P>
                    <E T="03">Comment 10:</E>
                     One commenter stated that a take in which the marine mammal stock cannot be determined should not be counted as a take for 2 separate stocks, but should be apportioned across the 2 stocks in question using a weighted probability.
                </P>
                <P>
                    <E T="03">Response:</E>
                     See response to Comments 13 and 14 in the final 2005 LOF (71 FR 247, January 4, 2006) and Comment 10 in the final 2003 LOF (68 FR 41725, July 15, 2003) for detailed responses to the same comment. Where there is considerable uncertainty regarding to 
                    <PRTPAGE P="66061"/>
                    which stock a serious injury or mortality should be assigned, NMFS exercises a conservative approach of assigning the serious injury or mortality to both stocks. Clearly, if information were available regarding the location of take, genetics of the taken animal, or other conclusive information linking the serious injury or mortality to a specific stock, NMFS would use it to assign the take to a specific stock. Also, NMFS continues to conduct research and review data to determine to which stock an incidental mortality or serious injury can be assigned. For example, in this final rule NMFS is removing the Gulf of Alaska, Aleutian Islands, and Bering Sea transient stock of killer whales from the list of species incidentally injured or killed in two AK fisheries based on genetic analyses of tissue samples collected by observers over the past few years, which revealed that the interaction occurred with the resident stock of killer whales (see below under Summary of Changes to the LOF for 2008).
                </P>
                <P>
                    <E T="03">Comment 11:</E>
                     One commenter stated that if NMFS persists in using observed catch as a proxy of effort and expands observed takes, then takes that occur outside of the observed sample should not be counted. The apparent point of expansion is to make an estimate for the “unobserved” takes; therefore, counting takes in the unobserved sample is double counting.
                </P>
                <P>
                    <E T="03">Response:</E>
                     See response to Comments 19 and 20 in the final 2005 LOF (71 FR 247, January 4, 2006) for a very detailed response to the same comment. Also see response to and Comment 47 in the Notice of Availability for the 2005 SARs (71 FR 26430, May 4, 2006). The analysis of bycatch is stratified into many different strata, and estimates of bycatch are calculated for each individual stratum using data from monitored hauls. If an observer reported an injury or mortality incidental to a non-monitored haul, and there were no injuries or mortalities from monitored hauls in that strata, the report in the non-monitored haul is used as the estimate of serious injury and mortality for that stratum. Data from non-monitored hauls are not extrapolated using the ratio estimation approach but are simply added to an extrapolation using observer data from monitored hauls.
                </P>
                <HD SOURCE="HD2">Comments on Fisheries in the Pacific Ocean</HD>
                <P>
                    <E T="03">Comment 12:</E>
                     Two commenters questions the SAR for false killer whales in HI. One commenter stated that the proposed 2008 LOF perpetuates serious errors and uncertainties found in NMFS' SAR for false killer whales, errors which persist in the draft 2007 SAR. NMFS' SAR conflates false killer whale stocks, underestimates false killer whale abundance, and overestimates the seriousness of the deep-set longline fishery's (within the Category I HI longline fishery) interactions with false killer whales.
                </P>
                <P>The second commenter stated that there is no scientifically recognized HI stock of false killer whales that the proposed LOF lists as incidentally killed or injured in the Category I HI longline fishery. There are large uncertainties in the available science for a “HI” stock, including the fact that NMFS' population assessment is based on a single sighting. Available information indicates that the HI-based tuna longline fishery interacts with a larger Eastern North Pacific stock of false killer whales. This information needs to be presented and objectively discussed by NMFS and outside peers.</P>
                <P>
                    <E T="03">Response:</E>
                     This comment pertains to the SAR for false killer whales, HI stock, and has been recently addressed in the response to comments 46-67 in the Notice of Availability of the final 2006 SARs (72 FR 12774, March 19, 2007). NMFS stands by the analysis of the false killer whale stocks and recognizes that it is the best information currently available. NMFS will continue to work to reduce any uncertainties that may be associated with this stock assessment. 
                    <E T="03">Comment 13:</E>
                     Two commenters recommended that NMFS distinguish between the shallow-set and the deep-set fisheries in the Category I HI longline fishery. The HI longline fishery should be split into 2 fisheries based on the fact that the shallow-set and deep-set fisheries have different target species, operating patterns, management regimes, and interaction rates. Splitting the HI longline fishery into two fisheries would result in a Category I deep-set fishery and a Category III shallow-set fishery. The shallow-set fishery began commercial fishing in late 2004 and is distinct from the deep-set fishery in that it targets swordfish while the deep-set fishery targets tuna; uses different gear (including the number of hooks, gangions and float intervals); uses different bait; and fishes in different areas of the Pacific Ocean (generally does not operate within the HI EEZ) at different times of day. The shallow-set fishery, which has 100 percent observer coverage, has significantly different interaction and mortality rates involving protected species. An interaction with a false killer whale has never been observed in the shallow-set fishery. Also, the shallow-set and deep-set fisheries are managed differently by the Western Pacific Regional Fishery Management Council and NMFS and have entirely different regulatory requirements.
                </P>
                <P>
                    <E T="03">Response:</E>
                     The commenters requested that the HI longline fisheries be split and subsequently listed in the LOF as two separately managed commercial fisheries: (1) the deep-set (tuna target) fishery; and (2) the shallow-set (swordfish target) fishery. This is the first request to split the fishery in this manner that NMFS has received to date.
                </P>
                <P>NMFS believes the request to split the HI longline fishery into two fisheries (the deep-set fishery and the shallow-set fishery) for purposes of the LOF has merit, and is therefore taking the commenters' request under consideration. Indeed, NMFS has split other fisheries in prior year's LOFs based upon factors such as different target species, operating patterns, regulations, marine mammal interaction rates, etc. However, if NMFS were to split the HI longline fishery into a deep-set and shallow-set fishery in the LOF, and then potentially re-categorize the shallow-set fishery as a Category III fishery, these changes would necessarily be presented in the 2009 Proposed LOF, and not in the 2008 Final LOF, as making such considerable changes between a “Proposed” and “Final” draft of the LOF would negate the important public comment and response period required for agency rulemaking.</P>
                <P>
                     Additionally, if NMFS were to make the changes articulated above, NMFS would need to consider whether the current system under which the HI longline fishery is permitted would also need to be changed. The HI longline fishery is managed, in part, under the Fishery Management Plan (FMP) for Pelagic Fisheries of the Western Pacific Region (Pelagics FMP), as amended. The Pelagics FMP and its amendments are developed by the Western Pacific Fishery Management Council under the authority of the MSA, 16 U.S.C. 1801 
                    <E T="03">et seq.</E>
                     NMFS also promulgates regulations under the MSA to administer enforceable elements of the Pelagics FMP.
                </P>
                <P>
                    Currently, participants in the HI longline fishery are required to obtain a single HI Longline Limited Entry Permit whether they intend to engage in deep-set longline fishing, shallow-set longline fishing, or both. Integrated with the single Limited Entry Permit requirement is the MMAP Certificate. Any vessel engaging in a Category I or II fishery must obtain a MMAP certificate from NMFS in order to lawfully incidentally take a marine mammal in a commercial fishery. Unless the current fishery permitting system under the FMP is 
                    <PRTPAGE P="66062"/>
                    likewise amended, the single Limited Entry Permit would still require a MMAP certificate even if the longline fishery was subsequently split into Category I deep-set and Category III shallow-set fisheries. NMFS will be soliciting comments on these and other issues in the 2009 Proposed LOF.
                </P>
                <P>
                    <E T="03">Comment 14:</E>
                     One commenter reiterated a comment from the 2007 LOF recommending NMFS elevate the Category III “CA lobster, prawn, shrimp, rock crab, fish pot” and the “WA/OR/CA crab pot” fisheries to Category II based on interactions with humpback and gray whales. At least 14 large whales were documented entangled in this gear type from 2000-2005.
                </P>
                <P>
                    <E T="03">Response:</E>
                     As described in responses to comment 18 in the final 2007 LOF (72 FR 38393, March 28, 2007), NMFS is aware of interactions between humpback and gray whales and pot and trap gear and is taking steps to address this issue. The NMFS Northwest Regional Office reviewed interactions between humpback and gray whales and all crab trap/pot gear in the waters off WA and OR and found that there have been no observed takes of humpback whales and that the level of take of gray whale was well below 10 percent of the stock's PBR. Therefore, the available information did not support elevating the WA and OR crab fisheries to Category I or II on the 2007 LOF. The NMFS Southwest Regional Office recently completed a draft characterization of the CA pot and trap fisheries as a first step in helping to determine which fisheries are most likely to be interacting with large whales and whether recategorization of the “CA lobster, prawn, shrimp, rock crab, fish pot” fishery or the CA component of the “WA/OR/CA crab pot” fishery is appropriate. Before NMFS can recategorize these fisheries, a better understanding of the fisheries is necessary, since reports of interactions between large whales and pot and trap gear come primarily from stranding reports (including sighting of free-swimming whales). These reports may not provide reliable identification of the fishing gear types associated with an interaction because it is difficult to distinguish between various pot and trap gears from surface observations of line and floats. Currently, NMFS is working with the State of CA to develop the characterization of the state and Federal fisheries that utilize these gear types in the waters off of CA. Furthermore, NMFS is reviewing observed marine mammal entanglements from stranding reports to assess the extent of injuries (i.e., whether or not the injuries were serious injuries) and whether specific fisheries can be identified from the available data.
                </P>
                <P>NMFS is also considering whether to change descriptions for the CA pot and trap fishery in the LOF. Currently, the CA lobster, prawn, shrimp, rock crab and fish pot fisheries are listed as one fishery on the LOF. NMFS is reviewing of the CA pot and trap fisheries to determine whether these fisheries should be listed separately on future LOFs to more accurately reflect spatial and temporal differences in the various fisheries, the regulatory authority for the fisheries, and the likelihood of interactions with marine mammals.</P>
                <P>
                    <E T="03">Comment 15:</E>
                     One commenter commended NMFS for its support of efforts to address concerns regarding trap and pot fisheries, such as support for research efforts and outreach efforts to encourage voluntary reductions in the amount of potentially entangling gear. The commenter encouraged NMFS to continue its work with Regional Fishery Management Councils to improve monitoring and mitigation of serious injury and mortality.
                </P>
                <P>
                    <E T="03">Response:</E>
                     NMFS acknowledges this comment. See the response to comment 14 above for more information related to these fisheries.
                </P>
                <P>
                    <E T="03">Comment 16:</E>
                     One commenter noted that the number of vessels listed in Table 1 of the proposed 2008 LOF for the Category III “WA/OR/CA groundfish trawl” fishery is incorrect. Table 1 indicates an estimated 585 vessels participating; however, the Pacific Fishery Management Council's Groundfish Management Team estimates that 160-180 vessels will participate in 2007. The estimated range is based on recent participants, which varies depending on the choice of some skippers to participate in trawl fisheries on the West Coast or in AK.
                </P>
                <P>
                    <E T="03">Response:</E>
                     NMFS acknowledges this comment and will make the suggested change to the number of participants in the “WA/OR/CA groundfish trawl” fishery to 160-180.
                </P>
                <P>
                    <E T="03">Comment 17:</E>
                     Two commenters supported the elevation of the “CA yellowtail, barracuda, and white seabass drift gillnet” fishery to Category I because the estimated annual serious injury and mortality of long-beaked common dolphins incidental to the fishery exceeds 50 percent of the stock's PBR. One commenter stated that a take reduction team must now be convened because this fishery interacts with strategic marine mammal stocks.
                </P>
                <P>
                    <E T="03">Response:</E>
                     Since the publication of the proposed 2008 LOF, new information has become available on the level of serious injury and mortality of the CA stock of long-beaked common dolphin in the “CA yellowtail, barracuda, and white seabass drift gillnet” fishery which indicates that elevating this fishery to Category I is not appropriate at this time. The proposed 2008 LOF states that, based on observer documented interactions in 2003 and 2004, reported in the draft 2007 SAR for long-beaked common dolphin, the estimated annual serious injury and mortality of the CA stock of long-beaked common dolphins in the “CA yellowtail, barracuda, and white seabass drift gillnet” fishery is approximately 82 percent of the stock's PBR. However, during the public comment on the draft 2007 SARs, errors were found in the reported levels of observer coverage in this fishery. The correct levels of observer coverage for 2002, 2003, and 2004, are 11.5 percent, 10.4 percent, and 17.6 percent, respectively. Based upon these observer coverage levels, NMFS recalculated the mean annual serious injury or mortality of the CA stock of long-beaked common dolphin. The revised mean annual serious injury or mortality in this fishery is 4.7 (0.98) (CV in parenthesis), which is 43 percent of the stock's PBR of 11. Based upon these revisions to the draft 2007 SAR, the “CA yellowtail, barracuda, and white seabass drift gillnet” fishery will remain a Category II fishery, and will not be elevated to a Category I fishery as proposed in the proposed 2008 LOF. The strategic stock classification of the CA stock of long-beaked common dolphins remains supported by the updated information in the SAR. Please also see the response to Comment 4 in this rule for additional information.
                </P>
                <P>
                    In April 2007, the Pacific Offshore Cetacean Take Reduction Team (POCTRT) considered CA State gillnet fisheries at their team meeting, including the “CA yellowtail, barracuda, and white seabass drift gillnet” fishery, and the possible impacts on marine mammals. The POCTRT made a number of recommendations to NMFS related to these fisheries, including expanding observer coverage, encouraging research and information sharing on methods to reduce marine mammal bycatch, and adding representatives from these fisheries and an additional CDFG advisor to the POCTRT to address marine mammal bycatch in state gillnet fisheries. NMFS and the POCTRT are considering expanding the scope of the POCTRT to include CA gillnet fisheries, including the “CA yellowtail, barracuda, and white seabass drift gillnet” fishery. Please see response to 
                    <PRTPAGE P="66063"/>
                    comment 6 in this rule for more information on Take Reduction Teams.
                </P>
                <P>
                    <E T="03">Comment 18:</E>
                     One commenter recommended NMFS remove short-finned pilot whales from the list of species incidentally killed or injured in the Category II “CA squid purse seine” fishery for two reasons. First, the information presented in the draft 2007 SAR for the CA squid purse seine fishery does not reflect the best available science. The SAR states that the fishery is “not currently monitored, and has expanded markedly since 1992.” However, NMFS Southwest Region observer data from the CA Coastal Pelagic Purse Seine Observer Program indicates that 95 pilot whale interaction-free trips were observed from July 2004 to March 2007. Second, the draft 2007 SAR assigns each of the 14 incidents of “undetermined” strandings of short-finned pilot whales as “probably” the result of interactions with the “CA squid purse seine” fishery. However, the SAR does not provide clear evidence for this determination. Since NMFS does not typically assign fishery-specific mortality from fishery interaction stranding events in the absence of clear evidence (for example, several East Coast species covered under TRPs including harbor porpoise, bottlenose dolphins, and large whales), then it should not be done in this case.
                </P>
                <P>
                    <E T="03">Response:</E>
                     NMFS acknowledges the error in the draft 2007 SAR regarding the monitoring of the “CA squid purse seine” fishery and it will be corrected in the final 2007 SAR. NMFS has reviewed the report with records of the stranded short-finned pilot whales from 1975 through 1990 and has concluded that the strandings were most likely caused by interactions with the purse seine fishery for squid. This is based upon the location and time of the strandings and the operation of the squid fishery in the same area and time and other details from the stranding. NMFS notes that there have been no observed takes of short-finned pilot whales in this fishery since the observer program began in 2004. However, observer coverage in this fishery is quite low at less than 2 percent annually. The recommendation to remove short-finned pilot whales from the list of marine mammals incidentally killed in the squid purse seine fishery will be further reviewed by NMFS when more observer information becomes available. NMFS will continue to monitor this fishery and consider the recommendation to remove short-finned pilot whales, CA/OR/WA stock, from the list of species incidentally killed or injured in the “CA squid purse seine” fishery for the 2009 LOF.
                </P>
                <P>
                    <E T="03">Comment 19:</E>
                     One commenter requested a review of the Category II “CA squid purse seine” fishery interaction with a species listed as “common dolphin, unknown” and removal of this species from the list of species incidentally killed or injured in this fishery if supported by the data. The CA Coastal Pelagic Purse Seine Observer Program data contains an observed “1 dead unidentified common dolphin” off Santa Barbara on January 3, 2005. The observer data also indicated that a group of seven unidentified common dolphins were sighted near the vessel during this particular haul. The commenter requests that NMFS re-examine this interaction and determine whether the animals' location, group size, and time of capture might better match the survey distribution and group observations for short-beaked common dolphins than for long-beaked common dolphins. Given the recent increased abundance reported for short-beaked common dolphins and virtual disappearance of long-beaked common dolphins in CA waters, the commenter believes the animal interaction was likely with a short-beaked common dolphin.
                </P>
                <P>
                    <E T="03">Response:</E>
                     There is insufficient information available to identify the species of common dolphin observed taken in the “CA squid purse seine” fishery. Both species, long-beaked common dolphins and short-beaked common dolphins, utilize much of the same habitat and overlap in areas with this fishery. Therefore, it is possible that either species could have been taken.
                </P>
                <P>
                    <E T="03">Comment 20:</E>
                     One commenter recommended that the “strategic” designation for the long-beaked common dolphin be viewed with extreme caution in the 2008 LOF. The draft 2007 SAR and proposed 2008 LOF do not adequately reflect the stock's high interannual variability. Despite a slight increase in human interactions from 11 to 17 animals, the observed population plummeted causing the PBR to drop from 242 animals to 11 animals reported in the draft 2007 SAR. Clearly the reason for the strategic listing is not fishery interactions but likely environmental in nature, and the LOF should clearly reflect this.
                </P>
                <P>
                    <E T="03">Response:</E>
                     It is the purpose of the LOF to categorize fisheries based on their level of mortality and serious injury of a marine mammal stock relative to the stock's PBR level. It is not the purpose or intent of the LOF to determine a stock's PBR or status as strategic. The factors leading to a stock's designation as “strategic” are irrelevant for the purposes of categorization fisheries on the LOF. NMFS urges the commenter to present these comments during the public comment period for the draft 2008 SARs, as the comment period for the 2007 SARs has closed.
                </P>
                <P>One error was found in the draft 2007 SAR during public review related to long-beaked common dolphins and takes in the CA small mesh drift gillnet fishery for white seabass, yellowtail, and barracuda; the fishery was observed at 11.5 percent, 10.4 percent and 17.6 percent respectively in 2002, 2003, and 2004, and one serious injury or mortality was observed in 2003 and one in 2004, with none observed in 2002. The draft SAR does not list the 2004 observer coverage and assigned the observed takes of long-beaked common dolphins to the years 2002 and 2003. This error will be corrected in the final 2007 SARs and will lower the mean annual takes estimate for this stock to from 17 to 12.5, but this adjustment does not change the strategic designation of this stock.</P>
                <P>
                    <E T="03">Comment 21:</E>
                     One commenter stated that the Category II Bering Sea Aleutian Islands (BSAI) Pacific cod longline fishery has a high level of observer coverage and effort is known, yet catch is used as a proxy for estimating effort. A proxy is not needed in cases where observer coverage is high and effort is known. Also, the Science and Statistical Committee (SSC) of the North Pacific Fishery Management Council stated in minutes from its February 2005 meeting that NMFS should “ explore the use of direct measures of fishing effort (instead of using catch as a proxy for effort) in future analyses at least when and where possible.”
                </P>
                <P>
                    <E T="03">Response:</E>
                     The response to Comment 15 in the final LOF for 2005 states that catch is the only data that can be used to measure effort for all vessels, seasons, and areas, to measure relative levels of effort (71 FR 247, 4 January 2006). NMFS took note of the recommendation made by the North Pacific Fishery Management Council's SSC to consider other measures of fishing effort, and discussed this with the analyst. At this time, catch remains the best method of quantifying observed and total fishing effort. Should another measure of effort become available that can be used for all vessels, seasons, and areas, NMFS will consider modifying the analytical approach.
                </P>
                <P>
                    <E T="03">Comment 22:</E>
                     One commenter noted that, according to a study by Perez in 2004, 68 percent of longline hauls from 1998-2003 were sampled by observers. Also, NMFS stated in 2000 (in a Pacific cod paper) that 94 percent of the BSAI Pacific cod longline harvest came from observed vessels.
                    <PRTPAGE P="66064"/>
                </P>
                <P>
                    <E T="03">Response:</E>
                     The response to Comment 25 in the final LOF for 2005 (71 FR 247, 4 January 2006) describes why there is a difference between the percent of hauls observed (or the percent of hooks observed, or the percent of sets observed) and the percent of boats observed. Also, NMFS notes that the commenter did not provide citations for the literature referenced in the comment.
                </P>
                <P>
                    <E T="03">Comment 23:</E>
                     One commenter asked NMFS to explain certain observer percentages and associated expansions of takes in the 2006 SARs associated with the Category II BSAI Pacific cod longline fishery. The 2006 SAR for ribbon seal lists one take in 2001 (although the most recent 5-year period of 2002-2006 should make this interaction drop out), which is expanded to 3.0 takes with observer coverage of 29.5 percent; for Steller sea lion (Western stock) lists one take in 2002, expanded to 3.7 takes with observer coverage of 29.6 percent; and for killer whale (Eastern North Pacific Alaska resident) lists one take in 2003, expanded to 4.2 takes with observer coverage of 29.9 percent. Why does one take, at the same stated level of observer coverage (29 percent) expand to a range of 3 to 4.2 takes depending on the stock?
                </P>
                <P>
                    <E T="03">Response:</E>
                     To provide as precise an estimate of marine mammal bycatch as possible, fishery effort and observed marine mammal serious injury/mortality levels are stratified by fishery, geographic area and by 2-week period. The percent observer coverage reflected in the SARs is an average percent observer coverage, not the percent for each strata. Thus, users of the SARs cannot use the reported percent observer coverage in the SARs to directly calculate an estimated marine mammal serious injury/mortality from the observed serious injury/mortality level.
                </P>
                <P>
                    <E T="03">Comment 24:</E>
                     One commenter questioned why the observer coverage in these SARs listed as 29 percent when 94 percent of the BSAI pacific cod longline catch comes from observed vessels (NMFS 2000 Pacific cod paper) and 68 percent of the catch comes from observed sets (Perez 2004)?
                </P>
                <P>
                    <E T="03">Response:</E>
                     Please see response to comment 22. Also, NMFS notes that the commenter did not provide citations for the literature referenced in the comment.
                </P>
                <P>
                    <E T="03">Comment 25:</E>
                     One commenter stated that the formula used to estimate PBR for the strategic Central North Pacific stock of humpback whales uses a population estimate from 1993, which causes several fisheries that interact with this stock to be classified as Category II. However, all studies indicate that this stock is steadily increasing. A 2001 study calculates an annual growth rate increase of 7 percent (now used as r max) and a 2004 study calculates an annual growth rate increase of 10 percent. A 2002 study of the Southeast humpback stock reports that estimates are substantially higher and that the abundance has increased in recent years. The commenter cites the GAMMS workshop report (Wade and Angliss, 1996) which states, “ The SARs should be revised whenever new information becomes available on abundance, mortality, r max, or stock structure “ Why then is the 1993 estimate still used if growth population has been 7 percent-10 percent annually?
                </P>
                <P>
                    <E T="03">Response:</E>
                     This is a comment that related to the Stock Assessment Reports, not the proposed List of Fisheries for 2008. In short, a change in the abundance estimate will be made when the results of a recent basin-wide study of North Pacific humpback whales is available in 2009 or 2010.
                </P>
                <P>
                    <E T="03">Comment 26:</E>
                     One commenter questioned the use of 16-year old data to categorize the Prince William Sound salmon drift gillnet fishery as Category II. The categorization is partly due to estimated takes of Stellar sea lions (Western stock) observed in 1990-1991, when 0 and 2 takes of Stellar sea lions were observed in 1990-1991, respectively. With 4-5 percent observer coverage the take expanded to 29, or 14.5 takes per year, comprising 50 percent of all fishing mortality of Stellar sea lions (Western stock).
                </P>
                <P>
                    <E T="03">Response:</E>
                     NMFS agrees that marine mammal interaction data used to classify commercial fisheries should be as current as is practicable to ensure that the estimated levels of serious injury and mortality reflect current fishing practices and conditions. In some cases, information on marine mammal serious injury and mortality is quite dated. Currently there are eleven Category II state-managed fisheries in Alaska on the LOF. Since 1990, seven Category II fisheries have been observed. Of those, two have been reclassified from Category II to Category III because the observer program documented very low levels of marine mammal serious injuries and mortalities that occurred incidental to these fisheries. Six state-managed Category II fisheries have never been observed. With currently available funds, only one fishery can be observed at a time due to the high cost of the observer programs. There have also been interim years with no Alaska state-managed fishery observed. Ideally, NMFS would observe each of these fisheries every five years to ensure data quality and timeliness. However, without the availability of newer information, NMFS must rely on the best available information.
                </P>
                <P>
                    <E T="03">Comment 27:</E>
                     One commenter noted that the fishery description for the Category II AK Metlakatla/Annette Island salmon drift gillnet fishery is incorrect. The proposed 2008 LOF states that this fishery is managed by the ADFG with a tribal portion separate from the Category II “AK Southeast salmon drift gillnet” fishery only for regulation purposes. The commenter states that this fishery is an exclusively tribal fishery managed exclusively by the tribe. There is no relation or connection with any state fishery or management by any other state or Federal agency.
                </P>
                <P>
                    <E T="03">Response:</E>
                     NMFS agrees and the change has been made to the final 2008 LOF.
                </P>
                <HD SOURCE="HD2">Comments on Fisheries in the Atlantic Ocean, Gulf of Mexico, and Caribbean</HD>
                <P>
                    <E T="03">Comment 28:</E>
                     One commenter stated that all of the butterfish and 
                    <E T="03">Illex</E>
                     and 
                    <E T="03">Loligo</E>
                     squid fisheries on the East coast are bottom trawl fisheries, yet the proposed 2008 LOF defines them as Mid-Atlantic mid-water trawl fisheries. The mackerel fishery consists primarily of mid-water trawlers, but also includes bottom trawls. This information can be found in the most recent stock assessments for each fish and squid species at: 
                    <E T="03">http://www.nefsc.noaa.gov/nefsc/publications/series/crdlist.htm</E>
                    . In addition, butterfish were deemed overfished in 2005 and there is no longer a directed fishery. Trip limits and a very low bycatch quota will be in place for 2008.
                </P>
                <P>
                    <E T="03">Response:</E>
                     NMFS agrees that based on how some trawl gear is fished in the 
                    <E T="03">Illex</E>
                     and 
                    <E T="03">Loligo</E>
                     squid fisheries, the current “Mid-Atlantic mid-water trawl” designation for the 
                    <E T="03">Illex</E>
                     and 
                    <E T="03">Loligo</E>
                     squid fisheries may not be an appropriate description of the fishing gear used for these specific Mid-Atlantic fisheries. However, in the past NMFS has also received information that suggests that the 
                    <E T="03">Illex</E>
                     and 
                    <E T="03">Loligo</E>
                     squid fisheries utilize their trawl gear in a more traditional mid-water trawl fishing operation. Therefore, NMFS believes that it would be inappropriate to re-classify this fishery in this 2008 final LOF. NMFS will consult with the Atlantic Trawl Gear Take Reduction Team and the Northeast Fisheries Science Center to determine a more appropriate characterization. NMFS will then propose any necessary changes in the 2009 proposed LOF, allowing adequate time for public comment. The 
                    <PRTPAGE P="66065"/>
                    inclusion of the butterfish fishery within the “Mid-Atlantic mid-water trawl” fishery will also be addressed and examined at that time.
                </P>
                <P>
                    <E T="03">Comment 29:</E>
                     One commenter reiterated their comment from the 2007 LOF raising concern over NMFS' failure to adequately classify certain Gulf of Mexico fisheries as Category I or II based on known or estimated mortality and serious injury of marine mammals in those fisheries. The commenter specifically recommended NMFS elevate the Gulf of Mexico blue crab trap/pot fishery to at least a Category II and perhaps a Category I, and the Gulf of Mexico menhaden purse seine fishery to a Category I, based on known or likely impacts to bottlenose dolphin stocks.
                </P>
                <P>
                    <E T="03">Response:</E>
                     NMFS does not believe elevation of the “Gulf of Mexico blue crab trap/pot” fishery or “Gulf of Mexico menhaden purse seine” fishery is warranted at this time. There is no observer program for either of these fisheries; therefore, NMFS relies on stranding data and fishermen self-reports to document fishery interactions with marine mammals. Available data from both of these sources do not justify a reclassification of either fishery at this time. However, NMFS will continue monitoring fishermen self-reports and stranding data, as well as enhance stranding response in the Gulf of Mexico, which has been low, particularly following Hurricanes Katrina and Rita. Observer coverage for both these fisheries also remains a priority when resources become available.
                </P>
                <P>Available data indicate interactions with marine mammals occurred in both fisheries between 2002-2006. In the Gulf of Mexico blue crab trap/pot fishery, stranding data indicate there were two confirmed bottlenose dolphin interactions with crab pot fishing gear between 2002-2006, one alive and one dead. In the same period, four dead bottlenose dolphins stranded with rope or rope marks that may have been from trap/pot gear, but cause of death could not be determined. NMFS acknowledges these numbers may underestimate the number of interactions that are occurring. However, interpreting the data is difficult due to limitations of the stranding network to accurately document human interactions, and insufficient information on bottlenose dolphin abundance and stock structure in the Gulf of Mexico to calculate PBR or quantify the impacts of fishery interactions on bottlenose dolphin stocks.</P>
                <P>The “Gulf of Mexico menhaden purse seine” fishery was observed by researchers from Louisiana State University in 1992, 1994, and 1995. The observers documented nine bottlenose dolphin captures, three of which were mortalities. Using observed and total fishery effort data, the number of takes was linearly extrapolated to an estimate of 68 animals. On the basis of this information, the fishery was elevated from Category III to Category II on the 1999 LOF (64 FR 9067, February 24, 1999). Since that time, there has been no observer coverage in this fishery. Fishermen self-reports through the MMAP reveal five bottlenose dolphin mortalities from 2002-2006, with two mortalities in 2002, one in 2004, and two in 2005. One of these animals was believed to have been dead prior to capture. However, information gathered under the MMAP cannot be verified and it is not possible to extrapolate these numbers to obtain an estimate of total takes in this fishery.</P>
                <P>The current lack of information on bottlenose dolphin abundance and stock structure in the Gulf of Mexico combined with a low level of stranding response, particularly following Hurricanes Katrina and Rita, make it difficult to assess the population-level impacts of either of these fisheries. For example, the percentage of stranded animals that are necropsied is low (FL, TX, and AL necropsied over 50 percent of all stranded marine mammals from 2002-2006, but MS and LA had much lower necropsy rates, 16 percent and 3 percent, respectively), making documentation of human interactions difficult. NMFS is focused on building capacity in the Gulf and increasing the level and quality of stranding response. NMFS held workshops in LA and MS in September 2007 to raise awareness of marine mammal management challenges in the Gulf of Mexico and to enhance marine mammal stranding response. NMFS staff met with representatives from state fishery and wildlife management agencies, marine mammal stranding networks, research institutions, universities, Sea Grant, and other Federal agencies to identify ways to better manage protected and endangered marine mammals in the Gulf of Mexico. Furthermore, NMFS intends to provide additional training workshops in 2008 to enhance the stranding network's capacity for identifying and documenting human interaction, and instruction on conducting necropsies. NMFS expects these efforts to increase the effectiveness of the stranding networks and better inform management decisions in the future.</P>
                <P>
                    <E T="03">Comment 30:</E>
                     One commenter reiterated concerns raised in their letters on the 2003 through 2007 LOFs recommending that NMFS expedite its investigation of bottlenose dolphin stock structure and reevaluate the classification of Gulf of Mexico fisheries. The commenter further recommended that NMFS expand its efforts to collect reliable information on serious injury and mortality of marine mammals incidental to Gulf of Mexico fisheries, with priority given to instituting an observer program for the menhaden purse seine fishery and expanding efforts to evaluate bottlenose dolphin entanglement in the blue crab trap/pot fishery. NMFS has initiated efforts to address some of these issues and has indicated that it intends to reevaluate these fisheries as new information becomes available, particularly information regarding the stock structure of bottlenose dolphins in the Gulf of Mexico. Nonetheless, the commenter remains concerned about marine mammal interactions with Gulf of Mexico fisheries, believes that more active management is needed in this region, and therefore reiterates its previous recommendations.
                </P>
                <P>
                    <E T="03">Response:</E>
                     NMFS agrees that collection of reliable information on serious injury and mortality of marine mammals in the Gulf of Mexico is essential. NMFS is making efforts to more actively manage marine mammals and build capacity in this area to: (1) address significant data gaps regarding the distribution, abundance, stock structure, and health of marine mammals; (2) enhance stranding response capabilities to better understand threats to marine mammals in the Gulf of Mexico ecosystem, and (3) ensure constituents are informed regarding NMFS efforts, threats to the ecosystem, and mitigation strategies to further reduce impacts to marine mammals. See the response to Comment 29 regarding efforts to enhance stranding network coverage and response in the Gulf of Mexico.
                </P>
                <P>
                    Managing bottlenose dolphin stocks in the Gulf of Mexico is especially challenging due to lack of data, particularly regarding abundance and stock structure. There is currently no PBR calculated for coastal stocks or bay, sound, and estuarine stocks, so NMFS is unable to assess the population-level impacts of fishery-related serious injuries and mortalities. To address this, NMFS is working towards updating estimates of bottlenose dolphin abundance and refining our understanding of bottlenose dolphin stock structure in the Gulf of Mexico. Specifically, in July and August 2007, NMFS completed a ship-based survey of the Gulf of Mexico continental shelf 
                    <PRTPAGE P="66066"/>
                    from 20 m (65.6 ft) depth to 500 m (1640 ft) depth from Cedar Key, FL, to Brownsville, TX, which included line-transect abundance surveys and the collection of over 200 bottlenose dolphin biopsies for stock structure analysis. In 2007, NMFS also completed winter and summer aerial line-transect abundance surveys of coastal bottlenose dolphin stocks (shore to 20 m [65.6 ft] depth) from Key West to the MS River delta. NMFS has also worked on bay, sound, and estuarine stocks, conducting a photo-ID mark-recapture study and biopsy sampling in Choctawhatchee Bay, FL in July and August 2007 and biopsy sampling in Mississippi Sound in 2005 and 2006. Data collected during these surveys are currently being analyzed, and updated information on population abundance and stock structure should be available in the 2008 SARs. Once this information is available and PBR is calculated for each stock, NMFS will be better able to assess the impacts of mortality and serious injury of marine mammals associated with commercial fisheries in the Gulf. Observer coverage remains a priority for Gulf of Mexico fisheries, when resources become available.
                </P>
                <P>
                    <E T="03">Comment 31:</E>
                     One commenter stated that the number of vessels listed in the proposed 2008 LOF for the Category II Gulf of Mexico menhaden purse seine fishery is incorrect. Table 2 lists 50 vessels as operating in this fishery; however, 1999 was the last year that the number of vessels in the fishery exceeded 50. Since 2000 there have been between 40 and 42 vessels annually participating in the fishery, 2 of which are typically run boats from the fishing grounds back to the reduction plants and do not actively fish.
                </P>
                <P>
                    <E T="03">Response:</E>
                     NMFS thanks the commenter for this information. The number of vessels in the Gulf of Mexico menhaden purse seine fishery has been updated from 50 to 40-42.
                </P>
                <HD SOURCE="HD1">Summary of Changes to the LOF for 2008</HD>
                <P>The following summarizes changes to the LOF for 2008 in fishery classification, fisheries listed in the LOF, the number of participants in a particular fishery, and the species and/or stocks that are incidentally killed or seriously injured in a particular fishery. The classifications and definitions of U.S. commercial fisheries for 2008 are identical to those provided in the LOF for 2007 with the following exceptions.</P>
                <HD SOURCE="HD2">Commercial Fisheries in the Pacific Ocean</HD>
                <HD SOURCE="HD3">Fishery Classification</HD>
                <P>The “CA yellowtail, barracuda, and white seabass drift gillnet (mesh size ≥3.5 inches and &lt;14 inches)” fishery is not elevated to a Category I fishery as proposed in the proposed 2008 LOF. The mean annual mortality and serious injury for the CA stock of long-beaked common dolphins was recalculated due to errors in the reporting of observer coverage for this fishery discovered during the public comment period for the draft 2007 SARs. Using the correct information, the data indicate that the annual mortality and serious injury of this stock in this fishery is 43 percent, not 82 percent, of the stock's PBR as had been reported in the proposed 2008 LOF. For this reason, the “CA yellowtail, barracuda, and white seabass drift gillnet (mesh size ≥3.5 inches and &lt;14 inches)” fishery remains a Category II on the final 2008 LOF.</P>
                <P>The superscript “2” is removed from Table 1 following the “CA yellowtail, barracuda, and white seabass drift gillnet (mesh size ≥3.5 inches and &lt;14 inches)” fishery because it is no longer classified by analogy to other gillnet fisheries. The current data shows that the mortality and serious injury of the CA stock of long-beaked common dolphin is 43 percent; therefore, it is driving the classification of this fishery. A superscript “1” is placed next to this stock in Table 1 to indicate its role as a driving stock.</P>
                <HD SOURCE="HD3">Removal of Fisheries from the LOF</HD>
                <P>The Category II “OR blue shark floating longline” fishery is removed from the LOF.</P>
                <P>The Category II “OR swordfish floating longline” fishery is removed from the LOF.</P>
                <HD SOURCE="HD3">Fishery Name and Organizational Changes and Clarifications</HD>
                <P>The Category II “CA yellowtail, barracuda, and white seabass drift gillnet (mesh size &gt;3.5 inches and &lt;14 inches)” fishery is renamed the “CA yellowtail, barracuda, and white seabass drift gillnet (mesh size ≥3.5 inches and &lt;14 inches)” fishery.</P>
                <P>The Category III “CA set and drift gillnet fisheries that use a stretched mesh size of 3.5 in or less” is renamed the “CA set gillnet fishery (mesh size &lt;3.5 inches).”</P>
                <P>NMFS reviewed the various West Coast pot and trap fisheries for information on the takes of humpback and gray whales in Category III trap/pot fisheries on the Pacific Coast. NMFS anticipates that incidental serious injury and mortality of gray and humpback whales in OR and WA crab fisheries is unlikely to increase; therefore, NMFS did not reclassify the crab pot fisheries at this time. NMFS will continue to analyze information from the remaining pot fisheries along the West Coast for potential recategorization of certain West Coast trap/pot fisheries in future LOFs.</P>
                <P>The fishery description for the Category II “AK Metlakatla/Annette Island salmon drift gillnet” fishery is changed to reflect that the fishery is an exclusively tribal fishery managed exclusively by the tribe. There is no management by any state or Federal agency.</P>
                <HD SOURCE="HD3">Number of Vessels/Persons</HD>
                <P>The estimated number of vessels or persons in the Category II “CA anchovy, mackerel, and sardine purse seine” fishery is updated to 63.</P>
                <P>The estimated number of vessels or persons in the Category II “CA squid purse seine” fishery is updated to 71.</P>
                <P>The estimated number of vessels or persons in the Category III “HI inshore gillnet” fishery is updated to 5.</P>
                <P>The estimated number of vessels or persons in the Category III “WA/OR/CA groundfish trawl” fishery is updated to 160-180.</P>
                <P>The estimated number of vessels or persons in the Category III “CA abalone” fishery is updated to zero.</P>
                <P>The estimated number of vessels or persons in the Category III “CA set gillnet (mesh size &lt;3.5 inches)” fishery (renamed from the “CA set and drift gillnet fisheries that use a stretched mesh size of 3.5 in or less” fishery in this final rule) is updated to 304.</P>
                <HD SOURCE="HD3">List of Species That are Incidentally Injured or Killed</HD>
                <P>The Hawaiian stocks of striped dolphin and Bryde's whale are added to the list of marine mammal species and stocks incidentally injured or killed in the Category I “HI swordfish, tuna, billfish, mahi mahi, wahoo, oceanic sharks longline/set line” fishery.</P>
                <P>
                    The Gulf of Alaska, Aleutian Islands, and Bering Sea transient stock of killer whales is removed from the list of marine mammal species and stocks incidentally injured or killed in the Category II “AK Bering Sea and Aleutian Islands Pacific cod longline” fishery and the Category III “AK Bering Sea and Aleutian Islands Greenland turbot longline” fishery.
                    <PRTPAGE P="66067"/>
                </P>
                <HD SOURCE="HD2">Commercial Fisheries in the Atlantic Ocean, Gulf of Mexico, and Caribbean</HD>
                <HD SOURCE="HD3">Addition of Fisheries to the LOF</HD>
                <P>The “GA cannonball jellyfish trawl” fishery is added to the LOF as a Category III fishery.</P>
                <HD SOURCE="HD3">Removal of Fisheries from the LOF</HD>
                <P>The Category III “U.S. Mid-Atlantic hand seine” fishery is removed from the LOF.</P>
                <HD SOURCE="HD3">Fishery Name and Organizational Changes and Clarifications</HD>
                <P>The estimated number of vessels or persons in the Category II “Gulf of Mexico menhaden purse seine” fishery is updated to 40-42.</P>
                <P>The list of target fish species associated with the Category II “Atlantic mixed species trap/pot” fishery is expanded to include cunner.</P>
                <P> The list of target species associated with the Category II “Southeast Atlantic gillnet” fishery is updated by removing shad.</P>
                <P>The description of the Category II “Southeast Atlantic gillnet” fishery is corrected by clarifying that the fishery is also managed under ALWTRP implementing regulations. Management under the ALWTRP was inadvertently left out of the description in the proposed rule.</P>
                <P>The boundaries and excluded fisheries associated with the Category I “Mid-Atlantic gillnet” fishery are updated through the addition of the following language, “ NC/SC border, but not including waters where gillnet fisheries are listed as Category II and Category III. At this time, these Category II and Category III fisheries include: the Chesapeake Bay inshore gillnet; NC inshore gillnet; DE River inshore gillnet; Long Island Sound inshore gillnet; and RI, southern MA (to Monomy Island), and NY Bight (Raritan and Lower NY Bays) inshore gillnet.”</P>
                <P>The boundaries and excluded fisheries associated with the Category II “Atlantic mixed species trap/pot” fishery are updated through the addition of the following language, “The Atlantic mixed species trap/pot fishery (Category II) includes all trap/pot operations for species from the U.S.-Canada border down through the waters east of the fishery management demarcation line between the Atlantic Ocean and the Gulf of Mexico (50 CFR 600.105), but does not include the following Category I, II, and III trap/pot fisheries: Northeast/Mid-Atlantic American lobster trap/pot; Atlantic blue crab trap/pot; FL spiny lobster trap/ pot; Southeastern U.S. Atlantic, Gulf of Mexico stone crab trap/pot; U.S. Mid-Atlantic eel trap/pot fisheries; and the Southeastern U.S. Atlantic, Gulf of Mexico golden crab fishery (68 FR 1421, January 10, 2003).”</P>
                <P>
                    The definition of the Category II “Mid-Atlantic flynet” fishery, provided in the final 2007 LOF (71 FR 70345, December 4, 2006), is replaced with the following language: “The flynet fishery is a multispecies fishery composed of nearshore and offshore components that operate along the eastern coast of the Mid-Atlantic United States. Flynets are high profile trawls similar to bottom otter trawls. These nets typically range from 80-120 ft (24-36.6 m) in headrope length, with wing mesh sizes of 16-64 in (41-163 cm), following a slow 3:1 taper to smaller mesh sizes in the body, extension, and codend sections of the net. The nearshore fishery operates from October to April inside of 30 fathoms (180 ft-55 m) from NC to NJ. This nearshore fishery targets Atlantic croaker, weakfish, butterfish, harvestfish, bluefish, menhaden , striped bass, kingfishes, and other finfish species. Flynet fishing is no longer permitted south of Cape Hatteras in order to protect weakfish stocks. The offshore component operates from November to April outside of 30 fathoms (180 ft; 55 m) from the Hudson Canyon off NY, south to Hatteras Canyon off NC. These deeper water fisheries target bluefish, Atlantic mackerel, 
                    <E T="03">Loligo</E>
                     squid, black sea bass, and scup (72 FR 7382, February 15, 2007). 
                    <E T="03">Illex</E>
                     squid are also targeted offshore (70-200 fathoms [420-1,200 ft; 128-366 m]) during summer months from May to September.” NMFS acknowledges that concerns have been raised over the possible colloquial nature of this fishery and will continue working to resolve these concerns.
                </P>
                <P>The descriptions of the Category II “Northeast anchored float gillnet”, “Northeast drift gillnet”, “Atlantic blue crab trap/pot, and “Atlantic mixed species trap/pot” fisheries are updated to reflect that each is now also managed under ALWTRP implementing regulations under a recent rulemaking (72 FR 57104, October 5, 2007).</P>
                <P>The description of the Category II “Mid-Atlantic haul/beach seine” fishery is undergoing change, particularly pertaining to NC beach gear, due to pending rulemakings by NCDMF. An updated description of this fishery will be provided in a future LOF.</P>
                <HD SOURCE="HD3">List of Species That are Incidentally Seriously Injured or Killed</HD>
                <P>The Northern Gulf of Mexico continental shelf and Eastern Gulf of Mexico coastal stocks of bottlenose dolphins are added to the list of marine mammal species and stocks incidentally injured or killed in the Category III “Southeastern U.S. Atlantic, Gulf of Mexico, shark bottom longline/hook-and-line” fishery.</P>
                <P>The name of the bottlenose dolphin stocks incidentally seriously injured or killed in the Category I “Atlantic Ocean, Caribbean, Gulf of Mexico large pelagics longline” and Category III “Gulf of Mexico butterfish trawl” fisheries are changed from “Bottlenose dolphin, Northern Gulf of Mexico outer continental shelf” to “Bottlenose dolphin, Northern Gulf of Mexico oceanic”, and from “Bottlenose dolphin, Northern Gulf of Mexico continental shelf edge and slope” to “Bottlenose dolphin, Northern Gulf of Mexico continental shelf.”</P>
                <P>The name the humpback whale stock incidentally killed/injured in the Category I “Northeast sink gillnet”, Category I “Northeast/Mid-Atlantic American lobster trap/pot”, Category II “Northeast anchored float gillnet”, and Category III “Gulf of Maine, U.S. Mid-Atlantic tuna, shark, swordfish hook-and-line/harpoon” fisheries is changed from “Western North Atlantic (WNA)” to “Gulf of Maine.”</P>
                <HD SOURCE="HD1">List of Fisheries</HD>
                <P>The following two tables list U.S. commercial fisheries according to their assigned categories under section 118 of the MMPA. The estimated number of vessels/participants is expressed in terms of the number of active participants in the fishery, when possible. If this information is not available, the estimated number of vessels or persons licensed for a particular fishery is provided. If no recent information is available on the number of participants in a fishery, the number from the most recent LOF is used.</P>
                <P>
                    The tables also list the marine mammal species and stocks incidentally killed or injured in each fishery based on observer data, logbook data, stranding reports, and fisher reports. This list includes all species or stocks known to experience mortality or injury in a given fishery, but also includes species or stocks for which there are anecdotal records of interaction. Additionally, species identified by logbook entries may not be verified. Bycatch of species or stocks identified is not necessarily driving a fishery's classification in a given Category. NMFS has designated those stocks driving a fishery's classification (i.e., the fishery is classified based on serious injuries and mortalities of a marine mammal stock greater than 50 percent [Category I], or greater than 1 percent and less 
                    <PRTPAGE P="66068"/>
                    than 50 percent [Category II], of a stock's PBR) by a “1” after the stock's name.
                </P>
                <P>There are several fisheries classified in Category II that have no recently documented interactions with marine mammals, or interactions that did not result in a serious injury or mortality. Justification for classifying these fisheries as a Category II is by analogy to other gear types that are known to cause mortality or serious injury of marine mammals, as discussed in the final LOF for 1996 (60 FR 67063, December 28, 1995), and according to factors listed in the definition of a “Category II fishery” in 50 CFR 229.2. NMFS has designated those fisheries originally listed by analogy in Tables 1 and 2 by a “2” after the fishery's name.</P>
                <P>Table 1 lists commercial fisheries in the Pacific Ocean (including Alaska); Table 2 lists commercial fisheries in the Atlantic Ocean, Gulf of Mexico, and Caribbean.</P>
                <GPOTABLE COLS="3" OPTS="L4,i1" CDEF="s60L,xl36C,xl66L">
                    <TTITLE>Table 1 - List of Fisheries Commercial Fisheries in the Pacific Ocean</TTITLE>
                    <BOXHD>
                        <CHED H="1">Fishery Description</CHED>
                        <CHED H="1">Estimated # of vessels/persons</CHED>
                        <CHED H="1">Marine mammal species and stocks incidentally killed/injured</CHED>
                    </BOXHD>
                    <ROW RUL="s,n,s" EXPSTB="02">
                        <ENT I="22">CATEGORY I</ENT>
                    </ROW>
                    <ROW RUL="s,s,s" EXPSTB="00">
                        <ENT I="22">
                            <E T="02">GILLNET FISHERIES:</E>
                        </ENT>
                        <ENT> </ENT>
                        <ENT> </ENT>
                    </ROW>
                    <ROW RUL="s,s,s">
                        <ENT I="22">CA angel shark/halibut and other species set gillnet (&gt;3.5 in. mesh)</ENT>
                        <ENT>58</ENT>
                        <ENT>
                            California sea lion, U.S.
                            <LI>Harbor seal, CA</LI>
                            <LI>
                                Harbor porpoise, Central CA
                                <SU>1</SU>
                            </LI>
                            <LI>Long-beaked common dolphin, CA</LI>
                            <LI>Northern elephant seal, CA breeding</LI>
                            <LI>Sea otter, CA</LI>
                            <LI>Short-beaked common dolphin, CA/OR/WA</LI>
                        </ENT>
                    </ROW>
                    <ROW RUL="s,s,s">
                        <ENT I="22">CA/OR thresher shark/swordfish drift gillnet (≥14 in. mesh)</ENT>
                        <ENT>85</ENT>
                        <ENT>
                            California sea lion, U.S.
                            <LI>Dall's porpoise, CA/OR/WA</LI>
                            <LI>Fin whale, CA/OR/WA</LI>
                            <LI>Gray whale, Eastern North Pacific</LI>
                            <LI>Humpback whale, Eastern North Pacific</LI>
                            <LI>Long-beaked common dolphin, CA</LI>
                            <LI>Northern elephant seal, CA breeding</LI>
                            <LI>Northern right-whale dolphin, CA/OR/WA</LI>
                            <LI>Pacific white-sided dolphin, CA/OR/WA</LI>
                            <LI>Risso's dolphin, CA/OR/WA</LI>
                            <LI>Short-beaked common dolphin, CA/OR/WA</LI>
                            <LI>
                                Short-finned pilot whale, CA/OR/WA
                                <SU>1</SU>
                            </LI>
                            <LI>Sperm whale, CA/OR/WA</LI>
                        </ENT>
                    </ROW>
                    <ROW RUL="s,s,s">
                        <ENT I="22">
                            <E T="02">LONGLINE/SET LINE FISHERIES:</E>
                        </ENT>
                        <ENT> </ENT>
                        <ENT> </ENT>
                    </ROW>
                    <ROW RUL="s,s,s">
                        <ENT I="22">HI swordfish, tuna, billfish, mahi mahi, wahoo, oceanic sharks longline/set line</ENT>
                        <ENT>140</ENT>
                        <ENT>
                            Blainville's beaked whale, HI
                            <LI>Bottlenose dolphin, HI</LI>
                            <LI>Bryde's whale, HI</LI>
                            <LI>
                                False killer whale, HI
                                <SU>1</SU>
                            </LI>
                            <LI>Humpback whale, Central North Pacific</LI>
                            <LI>Pantropical spotted dolphin, HI</LI>
                            <LI>Risso's dolphin, HI</LI>
                            <LI>Short-finned pilot whale, HI</LI>
                            <LI>Spinner dolphin, HI</LI>
                            <LI>Sperm whale, HI</LI>
                            <LI>Striped dolphin, HI</LI>
                        </ENT>
                    </ROW>
                    <ROW RUL="s,n,s" EXPSTB="02">
                        <ENT I="22">CATEGORY II</ENT>
                    </ROW>
                    <ROW RUL="s,s,s" EXPSTB="00">
                        <ENT I="22">
                            <E T="02">GILLNET FISHERIES:</E>
                        </ENT>
                        <ENT>  </ENT>
                        <ENT> </ENT>
                    </ROW>
                    <ROW RUL="s,s,s">
                        <ENT I="22">
                            AK Bristol Bay salmon drift gillnet
                            <SU>2</SU>
                        </ENT>
                        <ENT>1,903</ENT>
                        <ENT>
                            Beluga whale, Bristol Bay
                            <LI>Gray whale, Eastern North Pacific</LI>
                            <LI>Harbor seal, Bering Sea</LI>
                            <LI>Northern fur seal, Eastern Pacific</LI>
                            <LI>Pacific white-sided dolphin, North Pacific</LI>
                            <LI>Spotted seal, AK</LI>
                            <LI>
                                Steller sea lion, Western U.S.
                                <SU>1</SU>
                            </LI>
                        </ENT>
                    </ROW>
                    <ROW RUL="s,s,s">
                        <ENT I="22">
                            AK Bristol Bay salmon set gillnet
                            <SU>2</SU>
                        </ENT>
                        <ENT>1,014</ENT>
                        <ENT>
                            Beluga whale, Bristol Bay
                            <LI>Gray whale, Eastern North Pacific</LI>
                            <LI>Harbor seal, Bering Sea</LI>
                            <LI>Northern fur seal, Eastern Pacific</LI>
                            <LI>Spotted seal, AK</LI>
                        </ENT>
                    </ROW>
                    <ROW RUL="s,s,s">
                        <PRTPAGE P="66069"/>
                        <ENT I="22">AK Cook Inlet salmon set gillnet</ENT>
                        <ENT>745</ENT>
                        <ENT>
                            Beluga whale, Cook Inlet
                            <LI>Dall's porpoise, AK</LI>
                            <LI>Harbor porpoise, GOA</LI>
                            <LI>Harbor seal, GOA</LI>
                            <LI>
                                Humpback whale, Central North Pacific
                                <SU>1</SU>
                            </LI>
                            <LI>Steller sea lion, Western U.S.</LI>
                        </ENT>
                    </ROW>
                    <ROW RUL="s,s,s">
                        <ENT I="22">AK Cook Inlet salmon drift gillnet</ENT>
                        <ENT>576</ENT>
                        <ENT>
                            Beluga whale, Cook Inlet
                            <LI>Dall's porpoise, AK</LI>
                            <LI>
                                Harbor porpoise, GOA
                                <SU>1</SU>
                            </LI>
                            <LI>Harbor seal, GOA</LI>
                            <LI>Steller sea lion, Western U.S.</LI>
                        </ENT>
                    </ROW>
                    <ROW RUL="s,s,s">
                        <ENT I="22">AK Kodiak salmon set gillnet</ENT>
                        <ENT>188</ENT>
                        <ENT>
                            Harbor porpoise, GOA
                            <SU>1</SU>
                            <LI>Harbor seal, GOA</LI>
                            <LI>Sea otter, Southwest AK</LI>
                            <LI>Steller sea lion, Western U.S.</LI>
                        </ENT>
                    </ROW>
                    <ROW RUL="s,s,s">
                        <ENT I="22">
                            AK Metlakatla/Annette Island salmon drift gillnet
                            <SU>2</SU>
                        </ENT>
                        <ENT>60</ENT>
                        <ENT>None documented</ENT>
                    </ROW>
                    <ROW RUL="s,s,s">
                        <ENT I="22">
                            AK Peninsula/Aleutian Islands salmon drift gillnet
                            <SU>2</SU>
                        </ENT>
                        <ENT>164</ENT>
                        <ENT>
                            Dall's porpoise, AK
                            <LI>Harbor porpoise, GOA</LI>
                            <LI>Harbor seal, GOA</LI>
                            <LI>Northern fur seal, Eastern Pacific</LI>
                        </ENT>
                    </ROW>
                    <ROW RUL="s,s,s">
                        <ENT I="22">
                            AK Peninsula/Aleutian Islands salmon set gillnet
                            <SU>2</SU>
                        </ENT>
                        <ENT>116</ENT>
                        <ENT>
                            Harbor porpoise, Bering Sea
                            <LI>Steller sea lion, Western U.S.</LI>
                        </ENT>
                    </ROW>
                    <ROW RUL="s,s,s">
                        <ENT I="22">AK Prince William Sound salmon drift gillnet</ENT>
                        <ENT>541</ENT>
                        <ENT>
                            Dall's porpoise, AK
                            <LI>
                                Harbor porpoise, GOA
                                <SU>1</SU>
                            </LI>
                            <LI>Harbor seal, GOA</LI>
                            <LI>Northern fur seal, Eastern Pacific</LI>
                            <LI>Pacific white-sided dolphin, North Pacific</LI>
                            <LI>Sea Otter, South Central AK</LI>
                            <LI>
                                Steller sea lion, Western U.S.
                                <SU>1</SU>
                            </LI>
                        </ENT>
                    </ROW>
                    <ROW RUL="s,s,s">
                        <ENT I="22">AK Southeast salmon drift gillnet</ENT>
                        <ENT>481</ENT>
                        <ENT>
                            Dall's porpoise, AK
                            <LI>Harbor porpoise, Southeast AK</LI>
                            <LI>Harbor seal, Southeast AK</LI>
                            <LI>
                                Humpback whale, Central North Pacific
                                <SU>1</SU>
                            </LI>
                            <LI>Pacific white-sided dolphin, North Pacific</LI>
                            <LI>Steller sea lion, Eastern U.S.</LI>
                        </ENT>
                    </ROW>
                    <ROW RUL="s,s,s">
                        <ENT I="22">
                            AK Yakutat salmon set gillnet
                            <SU>2</SU>
                        </ENT>
                        <ENT>170</ENT>
                        <ENT>
                            Gray whale, Eastern North Pacific
                            <LI>Harbor seal, Southeast AK</LI>
                            <LI>Humpback whale, Central North Pacific (Southeast AK)</LI>
                        </ENT>
                    </ROW>
                    <ROW RUL="s,s,s">
                        <ENT I="22">CA yellowtail, barracuda, and white seabass drift gillnet fishery (mesh size ≥3.5 in and &lt;14 in)</ENT>
                        <ENT>24</ENT>
                        <ENT>
                            California sea lion, U.S.
                            <LI>
                                Long-beaked common dolphin, CA
                                <SU>1</SU>
                            </LI>
                            <LI>Short-beaked common dolphin, CA/OR/WA</LI>
                        </ENT>
                    </ROW>
                    <ROW RUL="s,s,s">
                        <ENT I="22">WA Puget Sound Region salmon drift gillnet (includes all inland waters south of US-Canada border and eastward of the Bonilla-Tatoosh line-Treaty Indian fishing is excluded)</ENT>
                        <ENT>210</ENT>
                        <ENT>
                            Dall's porpoise, CA/OR/WA
                            <LI>
                                Harbor porpoise, inland WA
                                <SU>1</SU>
                            </LI>
                            <LI>Harbor seal, WA inland</LI>
                        </ENT>
                    </ROW>
                    <ROW RUL="s,s,s">
                        <ENT I="22">
                            <E T="02">PURSE SEINE FISHERIES:</E>
                        </ENT>
                        <ENT>  </ENT>
                        <ENT> </ENT>
                    </ROW>
                    <ROW RUL="s,s,s">
                        <ENT I="22">AK Southeast salmon purse seine</ENT>
                        <ENT>416</ENT>
                        <ENT>
                            Humpback whale, Central North Pacific
                            <SU>1</SU>
                        </ENT>
                    </ROW>
                    <ROW RUL="s,s,s">
                        <ENT I="22">AK Cook Inlet salmon purse seine</ENT>
                        <ENT>82</ENT>
                        <ENT>
                            Humpback whale, Central North Pacific
                            <SU>1</SU>
                        </ENT>
                    </ROW>
                    <ROW RUL="s,s,s">
                        <ENT I="22">AK Kodiak salmon purse seine</ENT>
                        <ENT>370</ENT>
                        <ENT>
                            Humpback whale, Central North Pacific
                            <SU>1</SU>
                        </ENT>
                    </ROW>
                    <ROW RUL="s,s,s">
                        <ENT I="22">CA anchovy, mackerel, sardine purse seine</ENT>
                        <ENT>63</ENT>
                        <ENT>
                            Bottlenose dolphin, CA/OR/WA offshore
                            <SU>1</SU>
                            <LI>California sea lion, U.S.</LI>
                            <LI>Harbor seal, CA</LI>
                        </ENT>
                    </ROW>
                    <ROW RUL="s,s,s">
                        <ENT I="22">CA squid purse seine</ENT>
                        <ENT>71</ENT>
                        <ENT>
                            Common dolphin, unknown
                            <LI>
                                Short-finned pilot whale, CA/OR/WA
                                <SU>1</SU>
                            </LI>
                        </ENT>
                    </ROW>
                    <ROW RUL="s,s,s">
                        <PRTPAGE P="66070"/>
                        <ENT I="22">
                            CA tuna purse seine
                            <SU>2</SU>
                        </ENT>
                        <ENT>10</ENT>
                        <ENT>None documented</ENT>
                    </ROW>
                    <ROW RUL="s,s,s">
                        <ENT I="22">
                            <E T="02">TRAWL FISHERIES:</E>
                        </ENT>
                        <ENT>  </ENT>
                        <ENT> </ENT>
                    </ROW>
                    <ROW RUL="s,s,s">
                        <ENT I="22">AK Bering Sea, Aleutian Islands flatfish trawl</ENT>
                        <ENT>26</ENT>
                        <ENT>
                            Bearded seal, AK
                            <LI>Harbor porpoise, Bering Sea</LI>
                            <LI>Harbor seal, Bering Sea</LI>
                            <LI>
                                Killer whale, AK resident
                                <SU>1</SU>
                            </LI>
                            <LI>Northern fur seal, Eastern North Pacific</LI>
                            <LI>Spotted seal, AK</LI>
                            <LI>
                                Steller sea lion, Western U.S.
                                <SU>1</SU>
                            </LI>
                            <LI>Walrus, AK</LI>
                        </ENT>
                    </ROW>
                    <ROW RUL="s,s,s">
                        <ENT I="22">AK Bering Sea, Aleutian Islands pollock trawl</ENT>
                        <ENT>120</ENT>
                        <ENT>
                            Dall's porpoise, AK
                            <LI>Harbor seal, AK</LI>
                            <LI>
                                Humpback whale, Central North Pacific
                                <SU>1</SU>
                            </LI>
                            <LI>
                                Humpback whale, Western North Pacific
                                <SU>1</SU>
                            </LI>
                            <LI>
                                Killer whale, Eastern North Pacific, GOA, Aleutian Islands, and Bering Sea transient
                                <SU>1</SU>
                            </LI>
                            <LI>Minke whale, AK</LI>
                            <LI>Ribbon seal, AK</LI>
                            <LI>Spotted seal, AK</LI>
                            <LI>
                                Steller sea lion, Western U.S.
                                <SU>1</SU>
                            </LI>
                        </ENT>
                    </ROW>
                    <ROW RUL="s,s,s">
                        <ENT I="22">
                            <E T="02">LONGLINE/SET LINE FISHERIES:</E>
                        </ENT>
                        <ENT>  </ENT>
                        <ENT> </ENT>
                    </ROW>
                    <ROW RUL="s,s,s">
                        <ENT I="22">AK Bering Sea, Aleutian Islands Pacific cod longline</ENT>
                        <ENT>114</ENT>
                        <ENT>
                            Killer whale, AK resident
                            <SU>1</SU>
                            <LI>Ribbon seal, AK</LI>
                            <LI>Steller sea lion, Western U.S.</LI>
                        </ENT>
                    </ROW>
                    <ROW RUL="s,s,s">
                        <ENT I="22">
                            CA pelagic longline
                            <SU>2</SU>
                        </ENT>
                        <ENT>6</ENT>
                        <ENT>
                            California sea lion, U.S.
                            <LI>Risso's dolphin, CA/OR/WA</LI>
                        </ENT>
                    </ROW>
                    <ROW RUL="s,s,s">
                        <ENT I="22">
                            <E T="02">POT, RING NET, AND TRAP FISHERIES:</E>
                        </ENT>
                        <ENT>  </ENT>
                        <ENT> </ENT>
                    </ROW>
                    <ROW RUL="s,s,s">
                        <ENT I="22">AK Bering Sea sablefish pot</ENT>
                        <ENT>6</ENT>
                        <ENT>
                            Humpback whale, Central North Pacific
                            <SU>1</SU>
                            <LI>
                                Humpback whale, Western North Pacific
                                <SU>1</SU>
                            </LI>
                        </ENT>
                    </ROW>
                    <ROW RUL="s,n,s" EXPSTB="02">
                        <ENT I="22">CATEGORY III</ENT>
                    </ROW>
                    <ROW RUL="s,s,s" EXPSTB="00">
                        <ENT I="22">
                            <E T="02">GILLNET FISHERIES:</E>
                        </ENT>
                        <ENT>  </ENT>
                        <ENT> </ENT>
                    </ROW>
                    <ROW RUL="s,s,s">
                        <ENT I="22">AK Kuskokwim, Yukon, Norton Sound, Kotzebue salmon gillnet</ENT>
                        <ENT>1,922</ENT>
                        <ENT>Harbor porpoise, Bering Sea</ENT>
                    </ROW>
                    <ROW RUL="s,s,s">
                        <ENT I="22">AK miscellaneous finfish set gillnet</ENT>
                        <ENT>3</ENT>
                        <ENT>Steller sea lion, Western U.S.</ENT>
                    </ROW>
                    <ROW RUL="s,s,s">
                        <ENT I="22">AK Prince William Sound salmon set gillnet</ENT>
                        <ENT>30</ENT>
                        <ENT>
                            Harbor seal, GOA
                            <LI>Steller sea lion, Western U.S.</LI>
                        </ENT>
                    </ROW>
                    <ROW RUL="s,s,s">
                        <ENT I="22">AK roe herring and food/bait herring gillnet</ENT>
                        <ENT>2,034</ENT>
                        <ENT>None documented</ENT>
                    </ROW>
                    <ROW RUL="s,s,s">
                        <ENT I="22">CA set gillnet (mesh size &lt;3.5 inches)</ENT>
                        <ENT>304</ENT>
                        <ENT>None documented</ENT>
                    </ROW>
                    <ROW RUL="s,s,s">
                        <ENT I="22">HI inshore gillnet</ENT>
                        <ENT>5</ENT>
                        <ENT>
                            Bottlenose dolphin, HI
                            <LI>Spinner dolphin, HI</LI>
                        </ENT>
                    </ROW>
                    <ROW RUL="s,s,s">
                        <ENT I="22">WA Grays Harbor salmon drift gillnet (excluding treaty Tribal fishing)</ENT>
                        <ENT>24</ENT>
                        <ENT>Harbor seal, OR/WA coast</ENT>
                    </ROW>
                    <ROW RUL="s,s,s">
                        <ENT I="22">WA/OR herring, smelt, shad, sturgeon, bottom fish, mullet, perch, rockfish gillnet</ENT>
                        <ENT>913</ENT>
                        <ENT>None documented</ENT>
                    </ROW>
                    <ROW RUL="s,s,s">
                        <ENT I="22">WA/OR lower Columbia River (includes tributaries) drift gillnet</ENT>
                        <ENT>110</ENT>
                        <ENT>
                            California sea lion, U.S.
                            <LI>Harbor seal, OR/WA coast</LI>
                        </ENT>
                    </ROW>
                    <ROW RUL="s,s,s">
                        <ENT I="22">WA Willapa Bay drift gillnet</ENT>
                        <ENT>82</ENT>
                        <ENT>
                            Harbor seal, OR/WA coast
                            <LI>Northern elephant seal, CA breeding</LI>
                        </ENT>
                    </ROW>
                    <ROW RUL="s,s,s">
                        <ENT I="22">
                            <E T="02">PURSE SEINE, BEACH SEINE, ROUND HAUL AND THROW NET FISHERIES:</E>
                        </ENT>
                        <ENT>  </ENT>
                        <ENT> </ENT>
                    </ROW>
                    <ROW RUL="s,s,s">
                        <PRTPAGE P="66071"/>
                        <ENT I="22">AK Metlakatla salmon purse seine</ENT>
                        <ENT>10</ENT>
                        <ENT>None documented</ENT>
                    </ROW>
                    <ROW RUL="s,s,s">
                        <ENT I="22">AK miscellaneous finfish beach seine</ENT>
                        <ENT>1</ENT>
                        <ENT>None documented</ENT>
                    </ROW>
                    <ROW RUL="s,s,s">
                        <ENT I="22">AK miscellaneous finfish purse seine</ENT>
                        <ENT>3</ENT>
                        <ENT>None documented</ENT>
                    </ROW>
                    <ROW RUL="s,s,s">
                        <ENT I="22">AK octopus/squid purse seine</ENT>
                        <ENT>2</ENT>
                        <ENT>None documented</ENT>
                    </ROW>
                    <ROW RUL="s,s,s">
                        <ENT I="22">AK roe herring and food/bait herring beach seine</ENT>
                        <ENT>8</ENT>
                        <ENT>None documented</ENT>
                    </ROW>
                    <ROW RUL="s,s,s">
                        <ENT I="22">AK roe herring and food/bait herring purse seine</ENT>
                        <ENT>624</ENT>
                        <ENT>None documented</ENT>
                    </ROW>
                    <ROW RUL="s,s,s">
                        <ENT I="22"> AK salmon beach seine</ENT>
                        <ENT>34</ENT>
                        <ENT>None documented</ENT>
                    </ROW>
                    <ROW RUL="s,s,s">
                        <ENT I="22">AK salmon purse seine (except Southeast Alaska, which is in Category II)</ENT>
                        <ENT>953</ENT>
                        <ENT>Harbor seal, GOA</ENT>
                    </ROW>
                    <ROW RUL="s,s,s">
                        <ENT I="22">WA/OR sardine purse seine</ENT>
                        <ENT>42</ENT>
                        <ENT>None documented</ENT>
                    </ROW>
                    <ROW RUL="s,s,s">
                        <ENT I="22">HI Kona crab loop net</ENT>
                        <ENT>42</ENT>
                        <ENT>None documented</ENT>
                    </ROW>
                    <ROW RUL="s,s,s">
                        <ENT I="22">HI opelu/akule net</ENT>
                        <ENT>12</ENT>
                        <ENT>None documented</ENT>
                    </ROW>
                    <ROW RUL="s,s,s">
                        <ENT I="22">HI inshore purse seine</ENT>
                        <ENT>23</ENT>
                        <ENT>None documented</ENT>
                    </ROW>
                    <ROW RUL="s,s,s">
                        <ENT I="22">HI throw net, cast net</ENT>
                        <ENT>14</ENT>
                        <ENT>None documented</ENT>
                    </ROW>
                    <ROW RUL="s,s,s">
                        <ENT I="22">WA (all species) beach seine or drag seine</ENT>
                        <ENT>235</ENT>
                        <ENT>None documented</ENT>
                    </ROW>
                    <ROW RUL="s,s,s">
                        <ENT I="22">WA/OR herring, smelt, squid purse seine or lampara</ENT>
                        <ENT>130</ENT>
                        <ENT>None documented</ENT>
                    </ROW>
                    <ROW RUL="s,s,s">
                        <ENT I="22">WA salmon purse seine</ENT>
                        <ENT>440</ENT>
                        <ENT>None documented</ENT>
                    </ROW>
                    <ROW RUL="s,s,s">
                        <ENT I="22">WA salmon reef net</ENT>
                        <ENT>53</ENT>
                        <ENT>None documented</ENT>
                    </ROW>
                    <ROW RUL="s,s,s">
                        <ENT I="22">
                            <E T="02">DIP NET FISHERIES:</E>
                        </ENT>
                        <ENT> </ENT>
                        <ENT> </ENT>
                    </ROW>
                    <ROW RUL="s,s,s">
                        <ENT I="22">CA squid dip net</ENT>
                        <ENT>115</ENT>
                        <ENT>None documented</ENT>
                    </ROW>
                    <ROW RUL="s,s,s">
                        <ENT I="22">WA/OR smelt, herring dip net</ENT>
                        <ENT>119</ENT>
                        <ENT>None documented</ENT>
                    </ROW>
                    <ROW RUL="s,s,s">
                        <ENT I="22">
                            <E T="02">MARINE AQUACULTURE FISHERIES:</E>
                        </ENT>
                        <ENT> </ENT>
                        <ENT> </ENT>
                    </ROW>
                    <ROW RUL="s,s,s">
                        <ENT I="22">CA marine shellfish aquaculture</ENT>
                        <ENT>unknown</ENT>
                        <ENT>None documented</ENT>
                    </ROW>
                    <ROW RUL="s,s,s">
                        <ENT I="22">CA salmon enhancement rearing pen</ENT>
                        <ENT>&gt;1</ENT>
                        <ENT>None documented</ENT>
                    </ROW>
                    <ROW RUL="s,s,s">
                        <ENT I="22">CA white seabass enhancement net pens</ENT>
                        <ENT>13</ENT>
                        <ENT>California sea lion, U.S.</ENT>
                    </ROW>
                    <ROW RUL="s,s,s">
                        <ENT I="22">HI offshore pen culture</ENT>
                        <ENT>2</ENT>
                        <ENT>None documented</ENT>
                    </ROW>
                    <ROW RUL="s,s,s">
                        <ENT I="22">OR salmon ranch</ENT>
                        <ENT>1</ENT>
                        <ENT>None documented</ENT>
                    </ROW>
                    <ROW RUL="s,s,s">
                        <ENT I="22">WA/OR salmon net pens</ENT>
                        <ENT>14</ENT>
                        <ENT>
                            California sea lion, U.S.
                            <LI>Harbor seal, WA inland waters</LI>
                        </ENT>
                    </ROW>
                    <ROW RUL="s,s,s">
                        <ENT I="22">
                            <E T="02">TROLL FISHERIES:</E>
                        </ENT>
                        <ENT> </ENT>
                        <ENT> </ENT>
                    </ROW>
                    <ROW RUL="s,s,s">
                        <ENT I="22">AK North Pacific halibut, AK bottom fish, WA/OR/CA albacore, groundfish, bottom fish, CA halibut non-salmonid troll fisheries</ENT>
                        <ENT>1,530 (330 AK)</ENT>
                        <ENT>None documented</ENT>
                    </ROW>
                    <ROW RUL="s,s,s">
                        <ENT I="22">AK salmon troll</ENT>
                        <ENT>2,335</ENT>
                        <ENT>
                            Steller sea lion, Eastern U.S.
                            <LI>Steller sea lion, Western U.S.</LI>
                        </ENT>
                    </ROW>
                    <ROW RUL="s,s,s">
                        <ENT I="22">American Samoa tuna troll</ENT>
                        <ENT>&lt; 50</ENT>
                        <ENT>None documented</ENT>
                    </ROW>
                    <ROW RUL="s,s,s">
                        <ENT I="22">CA/OR/WA salmon troll</ENT>
                        <ENT>4,300</ENT>
                        <ENT>None documented</ENT>
                    </ROW>
                    <ROW RUL="s,s,s">
                        <ENT I="22">Commonwealth of the Northern Mariana Islands tuna troll</ENT>
                        <ENT>88</ENT>
                        <ENT>None documented</ENT>
                    </ROW>
                    <ROW RUL="s,s,s">
                        <PRTPAGE P="66072"/>
                        <ENT I="22">Guam tuna troll</ENT>
                        <ENT>401</ENT>
                        <ENT>None documented</ENT>
                    </ROW>
                    <ROW RUL="s,s,s">
                        <ENT I="22">HI trolling, rod and reel</ENT>
                        <ENT>1,321</ENT>
                        <ENT>None documented</ENT>
                    </ROW>
                    <ROW RUL="s,s,s">
                        <ENT I="22">
                            <E T="02">LONGLINE/SET LINE FISHERIES:</E>
                        </ENT>
                        <ENT> </ENT>
                        <ENT> </ENT>
                    </ROW>
                    <ROW RUL="s,s,s">
                        <ENT I="22">AK Bering Sea, Aleutian Islands Greenland turbot longline</ENT>
                        <ENT>12</ENT>
                        <ENT>Killer whale, AK resident</ENT>
                    </ROW>
                    <ROW RUL="s,s,s">
                        <ENT I="22">AK Bering Sea, Aleutian Islands rockfish longline</ENT>
                        <ENT>17</ENT>
                        <ENT>None documented</ENT>
                    </ROW>
                    <ROW RUL="s,s,s">
                        <ENT I="22">AK Bering Sea, Aleutian Islands sablefish longline</ENT>
                        <ENT>63</ENT>
                        <ENT>None documented</ENT>
                    </ROW>
                    <ROW RUL="s,s,s">
                        <ENT I="22">AK Gulf of Alaska halibut longline</ENT>
                        <ENT>1,302</ENT>
                        <ENT>None documented</ENT>
                    </ROW>
                    <ROW RUL="s,s,s">
                        <ENT I="22">AK Gulf of Alaska Pacific cod longline</ENT>
                        <ENT>440</ENT>
                        <ENT>None documented</ENT>
                    </ROW>
                    <ROW RUL="s,s,s">
                        <ENT I="22">AK Gulf of Alaska rockfish longline</ENT>
                        <ENT>421</ENT>
                        <ENT>None documented</ENT>
                    </ROW>
                    <ROW RUL="s,s,s">
                        <ENT I="22">AK Gulf of Alaska sablefish longline</ENT>
                        <ENT>412</ENT>
                        <ENT>
                            Sperm whale, North Pacific
                            <LI>Steller sea lion, Eastern U.S.</LI>
                        </ENT>
                    </ROW>
                    <ROW RUL="s,s,s">
                        <ENT I="22">AK halibut longline/set line (State and Federal waters)</ENT>
                        <ENT>3,079</ENT>
                        <ENT>Steller sea lion, Western U.S.</ENT>
                    </ROW>
                    <ROW RUL="s,s,s">
                        <ENT I="22">AK octopus/squid longline</ENT>
                        <ENT>7</ENT>
                        <ENT>None documented</ENT>
                    </ROW>
                    <ROW RUL="s,s,s">
                        <ENT I="22">AK state-managed waters groundfish longline/setline (including sablefish, rockfish, and miscellaneous finfish)</ENT>
                        <ENT>731</ENT>
                        <ENT>None documented</ENT>
                    </ROW>
                    <ROW RUL="s,s,s">
                        <ENT I="22">American Samoa longline</ENT>
                        <ENT>60</ENT>
                        <ENT>None documented</ENT>
                    </ROW>
                    <ROW RUL="s,s,s">
                        <ENT I="22">WA/OR/CA groundfish, bottomfish longline/set line</ENT>
                        <ENT>367</ENT>
                        <ENT>None documented</ENT>
                    </ROW>
                    <ROW RUL="s,s,s">
                        <ENT I="22">WA/OR North Pacific halibut longline/set line</ENT>
                        <ENT>350</ENT>
                        <ENT>None documented</ENT>
                    </ROW>
                    <ROW RUL="s,s,s">
                        <ENT I="22">
                            <E T="02">TRAWL FISHERIES:</E>
                        </ENT>
                        <ENT> </ENT>
                        <ENT> </ENT>
                    </ROW>
                    <ROW RUL="s,s,s">
                        <ENT I="22">AK Bering Sea, Aleutian Islands Atka mackerel trawl</ENT>
                        <ENT>8</ENT>
                        <ENT>Steller sea lion, Western U.S.</ENT>
                    </ROW>
                    <ROW RUL="s,s,s">
                        <ENT I="22">AK Bering Sea, Aleutian Islands Pacific cod trawl</ENT>
                        <ENT>87</ENT>
                        <ENT>
                            Harbor seal, Bering Sea
                            <LI>Steller sea lion, Western U.S.</LI>
                        </ENT>
                    </ROW>
                    <ROW RUL="s,s,s">
                        <ENT I="22">AK Bering Sea, Aleutian Islands rockfish trawl</ENT>
                        <ENT>9</ENT>
                        <ENT>None documented</ENT>
                    </ROW>
                    <ROW RUL="s,s,s">
                        <ENT I="22">AK Gulf of Alaska flatfish trawl</ENT>
                        <ENT>52</ENT>
                        <ENT>None documented</ENT>
                    </ROW>
                    <ROW RUL="s,s,s">
                        <ENT I="22">AK Gulf of Alaska Pacific cod trawl</ENT>
                        <ENT>101</ENT>
                        <ENT>Steller sea lion, Western U.S.</ENT>
                    </ROW>
                    <ROW RUL="s,s,s">
                        <ENT I="22">AK Gulf of Alaska pollock trawl</ENT>
                        <ENT>83</ENT>
                        <ENT>
                            Fin whale, Northeast Pacific
                            <LI>Northern elephant seal, North Pacific</LI>
                            <LI>Steller sea lion, Western U.S.</LI>
                        </ENT>
                    </ROW>
                    <ROW RUL="s,s,s">
                        <ENT I="22">AK Gulf of Alaska rockfish trawl</ENT>
                        <ENT>45</ENT>
                        <ENT>None documented</ENT>
                    </ROW>
                    <ROW RUL="s,s,s">
                        <ENT I="22">AK food/bait herring trawl</ENT>
                        <ENT>3</ENT>
                        <ENT>None documented</ENT>
                    </ROW>
                    <ROW RUL="s,s,s">
                        <ENT I="22">AK miscellaneous finfish otter or beam trawl</ENT>
                        <ENT>6</ENT>
                        <ENT>None documented</ENT>
                    </ROW>
                    <ROW RUL="s,s,s">
                        <ENT I="22">AK shrimp otter trawl and beam trawl (statewide and Cook Inlet)</ENT>
                        <ENT>58</ENT>
                        <ENT>None documented</ENT>
                    </ROW>
                    <ROW RUL="s,s,s">
                        <ENT I="22">AK state-managed waters of Cook Inlet, Kachemak Bay, Prince William Sound, Southeast AK groundfish trawl</ENT>
                        <ENT>2</ENT>
                        <ENT>None documented</ENT>
                    </ROW>
                    <ROW RUL="s,s,s">
                        <ENT I="22">CA halibut bottom trawl</ENT>
                        <ENT>53</ENT>
                        <ENT>None documented</ENT>
                    </ROW>
                    <ROW RUL="s,s,s">
                        <PRTPAGE P="66073"/>
                        <ENT I="22">WA/OR/CA groundfish trawl</ENT>
                        <ENT>160-180</ENT>
                        <ENT>
                            California sea lion, U.S.
                            <LI>Dall's porpoise, CA/OR/WA</LI>
                            <LI>Harbor seal, OR/WA coast</LI>
                            <LI>Northern fur seal, Eastern Pacific</LI>
                            <LI>Pacific white-sided dolphin, CA/OR/WA</LI>
                            <LI>Steller sea lion, Eastern U.S.</LI>
                        </ENT>
                    </ROW>
                    <ROW RUL="s,s,s">
                        <ENT I="22">WA/OR/CA shrimp trawl</ENT>
                        <ENT>300</ENT>
                        <ENT>None documented</ENT>
                    </ROW>
                    <ROW RUL="s,s,s">
                        <ENT I="22">
                            <E T="02">POT, RING NET, AND TRAP FISHERIES:</E>
                        </ENT>
                        <ENT> </ENT>
                        <ENT> </ENT>
                    </ROW>
                    <ROW RUL="s,s,s">
                        <ENT I="22">AK Aleutian Islands sablefish pot</ENT>
                        <ENT>8</ENT>
                        <ENT>None documented</ENT>
                    </ROW>
                    <ROW RUL="s,s,s">
                        <ENT I="22">AK Bering Sea, Aleutian Islands Pacific cod pot</ENT>
                        <ENT>76</ENT>
                        <ENT>None documented</ENT>
                    </ROW>
                    <ROW RUL="s,s,s">
                        <ENT I="22">AK Bering Sea, Aleutian Islands crab pot</ENT>
                        <ENT>329</ENT>
                        <ENT>None documented</ENT>
                    </ROW>
                    <ROW RUL="s,s,s">
                        <ENT I="22">AK Gulf of Alaska crab pot</ENT>
                        <ENT>unknown</ENT>
                        <ENT>None documented</ENT>
                    </ROW>
                    <ROW RUL="s,s,s">
                        <ENT I="22">AK Gulf of Alaska Pacific cod pot</ENT>
                        <ENT>154</ENT>
                        <ENT>Harbor seal, GOA</ENT>
                    </ROW>
                    <ROW RUL="s,s,s">
                        <ENT I="22">AK Southeast Alaska crab pot</ENT>
                        <ENT>unknown</ENT>
                        <ENT>Humpback whale, Central North Pacific (Southeast AK)</ENT>
                    </ROW>
                    <ROW RUL="s,s,s">
                        <ENT I="22">AK Southeast Alaska shrimp pot</ENT>
                        <ENT>unknown</ENT>
                        <ENT>Humpback whale, Central North Pacific (Southeast AK)</ENT>
                    </ROW>
                    <ROW RUL="s,s,s">
                        <ENT I="22">AK octopus/squid pot</ENT>
                        <ENT>72</ENT>
                        <ENT>None documented</ENT>
                    </ROW>
                    <ROW RUL="s,s,s">
                        <ENT I="22">AK snail pot</ENT>
                        <ENT>2</ENT>
                        <ENT>None documented</ENT>
                    </ROW>
                    <ROW RUL="s,s,s">
                        <ENT I="22">CA lobster, prawn, shrimp, rock crab, fish pot</ENT>
                        <ENT>608</ENT>
                        <ENT>
                            Gray whale, Eastern North Pacific
                            <LI>Harbor seal, CA</LI>
                            <LI>Humpback whale, Eastern North Pacific</LI>
                            <LI>Sea otter, CA</LI>
                        </ENT>
                    </ROW>
                    <ROW RUL="s,s,s">
                        <ENT I="22">OR/CA hagfish pot or trap</ENT>
                        <ENT>25</ENT>
                        <ENT>None documented</ENT>
                    </ROW>
                    <ROW RUL="s,s,s">
                        <ENT I="22">WA/OR/CA crab pot</ENT>
                        <ENT>1,478</ENT>
                        <ENT>
                            Gray whale, Eastern North Pacific
                            <LI>Humpback whale, Eastern North Pacific</LI>
                        </ENT>
                    </ROW>
                    <ROW RUL="s,s,s">
                        <ENT I="22">WA/OR/CA sablefish pot</ENT>
                        <ENT>176</ENT>
                        <ENT>None documented</ENT>
                    </ROW>
                    <ROW RUL="s,s,s">
                        <ENT I="22">WA/OR shrimp pot/trap</ENT>
                        <ENT>254</ENT>
                        <ENT>None documented</ENT>
                    </ROW>
                    <ROW RUL="s,s,s">
                        <ENT I="22">HI crab trap</ENT>
                        <ENT>22</ENT>
                        <ENT>None documented</ENT>
                    </ROW>
                    <ROW RUL="s,s,s">
                        <ENT I="22">HI fish trap</ENT>
                        <ENT>19</ENT>
                        <ENT>None documented</ENT>
                    </ROW>
                    <ROW RUL="s,s,s">
                        <ENT I="22">HI lobster trap</ENT>
                        <ENT>0</ENT>
                        <ENT>Hawaiian monk seal</ENT>
                    </ROW>
                    <ROW RUL="s,s,s">
                        <ENT I="22">HI shrimp trap</ENT>
                        <ENT>5</ENT>
                        <ENT>None documented</ENT>
                    </ROW>
                    <ROW RUL="s,s,s">
                        <ENT I="22">
                            <E T="02">HANDLINE AND JIG FISHERIES:</E>
                        </ENT>
                        <ENT> </ENT>
                        <ENT> </ENT>
                    </ROW>
                    <ROW RUL="s,s,s">
                        <ENT I="22">AK miscellaneous finfish handline and mechanical jig</ENT>
                        <ENT>100</ENT>
                        <ENT>None documented</ENT>
                    </ROW>
                    <ROW RUL="s,s,s">
                        <ENT I="22">AK North Pacific halibut handline and mechanical jig</ENT>
                        <ENT>93</ENT>
                        <ENT>None documented</ENT>
                    </ROW>
                    <ROW RUL="s,s,s">
                        <ENT I="22">AK octopus/squid handline</ENT>
                        <ENT>2</ENT>
                        <ENT>None documented</ENT>
                    </ROW>
                    <ROW RUL="s,s,s">
                        <ENT I="22">American Samoa bottomfish</ENT>
                        <ENT>&lt;50</ENT>
                        <ENT>None documented</ENT>
                    </ROW>
                    <ROW RUL="s,s,s">
                        <ENT I="22">Commonwealth of the Northern Mariana Islands bottomfish</ENT>
                        <ENT>&lt;50</ENT>
                        <ENT>None documented</ENT>
                    </ROW>
                    <ROW RUL="s,s,s">
                        <ENT I="22">Guam bottomfish</ENT>
                        <ENT>200</ENT>
                        <ENT>None documented</ENT>
                    </ROW>
                    <ROW RUL="s,s,s">
                        <ENT I="22">HI aku boat, pole and line</ENT>
                        <ENT>4</ENT>
                        <ENT>None documented</ENT>
                    </ROW>
                    <ROW RUL="s,s,s">
                        <ENT I="22">HI Main Hawaiian Islands, Northwest Hawaiian Islands deep sea bottomfish</ENT>
                        <ENT>300</ENT>
                        <ENT>Hawaiian monk seal</ENT>
                    </ROW>
                    <ROW RUL="s,s,s">
                        <PRTPAGE P="66074"/>
                        <ENT I="22">HI inshore handline</ENT>
                        <ENT>307</ENT>
                        <ENT>None documented</ENT>
                    </ROW>
                    <ROW RUL="s,s,s">
                        <ENT I="22">HI tuna handline</ENT>
                        <ENT>298</ENT>
                        <ENT>Hawaiian monk seal</ENT>
                    </ROW>
                    <ROW RUL="s,s,s">
                        <ENT I="22">WA groundfish, bottomfish jig</ENT>
                        <ENT>679</ENT>
                        <ENT>None documented</ENT>
                    </ROW>
                    <ROW RUL="s,s,s">
                        <ENT I="22">Western Pacific squid jig</ENT>
                        <ENT>6</ENT>
                        <ENT>None documented</ENT>
                    </ROW>
                    <ROW RUL="s,s,s">
                        <ENT I="22">
                            <E T="02">HARPOON FISHERIES:</E>
                        </ENT>
                        <ENT> </ENT>
                        <ENT> </ENT>
                    </ROW>
                    <ROW RUL="s,s,s">
                        <ENT I="22">CA swordfish harpoon</ENT>
                        <ENT>30</ENT>
                        <ENT>None documented</ENT>
                    </ROW>
                    <ROW RUL="s,s,s">
                        <ENT I="22">
                            <E T="02">POUND NET/WEIR FISHERIES:</E>
                        </ENT>
                        <ENT> </ENT>
                        <ENT> </ENT>
                    </ROW>
                    <ROW RUL="s,s,s">
                        <ENT I="22">AK herring spawn on kelp pound net</ENT>
                        <ENT>452</ENT>
                        <ENT>None documented</ENT>
                    </ROW>
                    <ROW RUL="s,s,s">
                        <ENT I="22">AK Southeast herring roe/food/bait pound net</ENT>
                        <ENT>3</ENT>
                        <ENT>None documented</ENT>
                    </ROW>
                    <ROW RUL="s,s,s">
                        <ENT I="22">WA herring brush weir</ENT>
                        <ENT>1</ENT>
                        <ENT>None documented</ENT>
                    </ROW>
                    <ROW RUL="s,s,s">
                        <ENT I="22">
                            <E T="02">BAIT PENS:</E>
                        </ENT>
                        <ENT> </ENT>
                        <ENT> </ENT>
                    </ROW>
                    <ROW RUL="s,s,s">
                        <ENT I="22">WA/OR/CA bait pens</ENT>
                        <ENT>13</ENT>
                        <ENT>California sea lion, U.S.</ENT>
                    </ROW>
                    <ROW RUL="s,s,s">
                        <ENT I="22">
                            <E T="02">DREDGE FISHERIES:</E>
                        </ENT>
                        <ENT> </ENT>
                        <ENT> </ENT>
                    </ROW>
                    <ROW RUL="s,s,s">
                        <ENT I="22">Coastwide scallop dredge</ENT>
                        <ENT>108 (12 AK)</ENT>
                        <ENT>None documented</ENT>
                    </ROW>
                    <ROW RUL="s,s,s">
                        <ENT I="22">
                            <E T="02">DIVE, HAND/MECHANICAL COLLECTION FISHERIES:</E>
                        </ENT>
                        <ENT> </ENT>
                        <ENT> </ENT>
                    </ROW>
                    <ROW RUL="s,s,s">
                        <ENT I="22">AK abalone</ENT>
                        <ENT>0</ENT>
                        <ENT>None documented</ENT>
                    </ROW>
                    <ROW RUL="s,s,s">
                        <ENT I="22">AK clam</ENT>
                        <ENT>156</ENT>
                        <ENT>None documented</ENT>
                    </ROW>
                    <ROW RUL="s,s,s">
                        <ENT I="22">WA herring spawn on kelp</ENT>
                        <ENT>4</ENT>
                        <ENT>None documented</ENT>
                    </ROW>
                    <ROW RUL="s,s,s">
                        <ENT I="22">AK dungeness crab</ENT>
                        <ENT>3</ENT>
                        <ENT>None documented</ENT>
                    </ROW>
                    <ROW RUL="s,s,s">
                        <ENT I="22">AK herring spawn on kelp</ENT>
                        <ENT>363</ENT>
                        <ENT>None documented</ENT>
                    </ROW>
                    <ROW RUL="s,s,s">
                        <ENT I="22">AK urchin and other fish/shellfish</ENT>
                        <ENT>471</ENT>
                        <ENT>None documented</ENT>
                    </ROW>
                    <ROW RUL="s,s,s">
                        <ENT I="22">CA abalone</ENT>
                        <ENT>0</ENT>
                        <ENT>None documented</ENT>
                    </ROW>
                    <ROW RUL="s,s,s">
                        <ENT I="22">CA sea urchin</ENT>
                        <ENT>583</ENT>
                        <ENT>None documented</ENT>
                    </ROW>
                    <ROW RUL="s,s,s">
                        <ENT I="22">HI black coral diving</ENT>
                        <ENT>1</ENT>
                        <ENT>None documented</ENT>
                    </ROW>
                    <ROW RUL="s,s,s">
                        <ENT I="22">HI fish pond</ENT>
                        <ENT>N/A</ENT>
                        <ENT>None documented</ENT>
                    </ROW>
                    <ROW RUL="s,s,s">
                        <ENT I="22">HI handpick</ENT>
                        <ENT>37</ENT>
                        <ENT>None documented</ENT>
                    </ROW>
                    <ROW RUL="s,s,s">
                        <ENT I="22">HI lobster diving</ENT>
                        <ENT>19</ENT>
                        <ENT>None documented</ENT>
                    </ROW>
                    <ROW RUL="s,s,s">
                        <ENT I="22">HI squiding, spear</ENT>
                        <ENT> 91</ENT>
                        <ENT>None documented</ENT>
                    </ROW>
                    <ROW RUL="s,s,s">
                        <ENT I="22">WA/CA kelp</ENT>
                        <ENT>4</ENT>
                        <ENT>None documented</ENT>
                    </ROW>
                    <ROW RUL="s,s,s">
                        <ENT I="22">WA/OR sea urchin, other clam, octopus, oyster, sea cucumber, scallop, ghost shrimp hand, dive, or mechanical collection</ENT>
                        <ENT>637</ENT>
                        <ENT>None documented</ENT>
                    </ROW>
                    <ROW RUL="s,s,s">
                        <ENT I="22">WA shellfish aquaculture</ENT>
                        <ENT>684</ENT>
                        <ENT>None documented</ENT>
                    </ROW>
                    <ROW RUL="s,s,s">
                        <ENT I="22">
                            <E T="02">COMMERCIAL PASSENGER FISHING VESSEL (CHARTER BOAT) FISHERIES:</E>
                        </ENT>
                        <ENT> </ENT>
                        <ENT> </ENT>
                    </ROW>
                    <ROW RUL="s,s,s">
                        <ENT I="22">AK/WA/OR/CA commercial passenger fishing vessel</ENT>
                        <ENT>&gt;7,000 (1,107 AK)</ENT>
                        <ENT>
                            Killer whale, stock unknown
                            <LI>Steller sea lion, Eastern U.S.</LI>
                            <LI>Steller sea lion, Western U.S.</LI>
                        </ENT>
                    </ROW>
                    <ROW RUL="s,s,s">
                        <PRTPAGE P="66075"/>
                        <ENT I="22">HI charter vessel</ENT>
                        <ENT>114</ENT>
                        <ENT>None documented</ENT>
                    </ROW>
                    <ROW RUL="s,s,s">
                        <ENT I="22">
                            <E T="02">LIVE FINFISH/SHELLFISH FISHERIES:</E>
                        </ENT>
                        <ENT> </ENT>
                        <ENT> </ENT>
                    </ROW>
                    <ROW>
                        <ENT I="22">CA finfish and shellfish live trap/hook-and-line</ENT>
                        <ENT>93</ENT>
                        <ENT>None documented</ENT>
                    </ROW>
                    <TNOTE>List of Abbreviations and Symbols Used in Table 1: AK - Alaska; CA - California; GOA - Gulf of Alaska; HI - Hawaii; OR - Oregon; WA - Washington</TNOTE>
                    <TNOTE>
                        <SU>1</SU>
                         Fishery classified based on serious injuries and mortalities of this stock, which are greater than 1 percent of the stock's PBR
                    </TNOTE>
                    <TNOTE>
                        <SU>2</SU>
                         Fishery classified by analogy.
                    </TNOTE>
                </GPOTABLE>
                <GPOTABLE COLS="3" OPTS="L4,i1" CDEF="s60,xl16C,xl70L">
                    <TTITLE>Table 2 - List of Fisheries Commercial Fisheries in the Atlantic Ocean, Gulf of Mexico, and Caribbean</TTITLE>
                    <BOXHD>
                        <CHED H="1">Fishery Description</CHED>
                        <CHED H="1">Estimated # of vessels/persons</CHED>
                        <CHED H="1">Marine mammal species and stocks incidentally killed/injured</CHED>
                    </BOXHD>
                    <ROW RUL="s,n,s" EXPSTB="02">
                        <ENT I="22">CATEGORY I</ENT>
                    </ROW>
                    <ROW RUL="s,s,s" EXPSTB="00">
                        <ENT I="22">
                            <E T="02">GILLNET FISHERIES:</E>
                        </ENT>
                        <ENT> </ENT>
                        <ENT> </ENT>
                    </ROW>
                    <ROW RUL="s,s,s">
                        <ENT I="22">Mid-Atlantic gillnet</ENT>
                        <ENT>&gt;670</ENT>
                        <ENT>
                            Bottlenose dolphin, WNA coastal
                            <SU>1</SU>
                            <LI>Bottlenose dolphin, WNA offshore</LI>
                            <LI>Common dolphin, WNA</LI>
                            <LI>Gray seal, WNA</LI>
                            <LI>
                                Harbor porpoise, GME/BF
                                <SU>1</SU>
                            </LI>
                            <LI>Harbor seal, WNA</LI>
                            <LI>Harp seal, WNA</LI>
                            <LI>
                                Humpback whale, Gulf of Maine
                                <SU>1</SU>
                            </LI>
                            <LI>Long-finned pilot whale, WNA</LI>
                            <LI>Minke whale, Canadian east coast</LI>
                            <LI>Short-finned pilot whale, WNA</LI>
                            <LI>White-sided dolphin, WNA</LI>
                        </ENT>
                    </ROW>
                    <ROW RUL="s,s,s">
                        <ENT I="22">Northeast sink gillnet</ENT>
                        <ENT>341</ENT>
                        <ENT>
                            Bottlenose dolphin, WNA offshore
                            <LI>Common dolphin, WNA</LI>
                            <LI>Fin whale, WNA</LI>
                            <LI>Gray seal, WNA</LI>
                            <LI>
                                Harbor porpoise, GME/BF
                                <SU>1</SU>
                            </LI>
                            <LI>Harbor seal, WNA</LI>
                            <LI>Harp seal, WNA</LI>
                            <LI>Hooded seal, WNA</LI>
                            <LI>
                                Humpback whale, Gulf of Maine
                                <SU>1</SU>
                            </LI>
                            <LI>
                                Minke whale, Canadian east coast
                                <SU>1</SU>
                            </LI>
                            <LI>
                                North Atlantic right whale, WNA
                                <SU>1</SU>
                            </LI>
                            <LI>Risso's dolphin, WNA</LI>
                            <LI>White-sided dolphin, WNA</LI>
                        </ENT>
                    </ROW>
                    <ROW RUL="s,s,s">
                        <ENT I="22">
                            <E T="02">LONGLINE FISHERIES:</E>
                        </ENT>
                        <ENT> </ENT>
                        <ENT> </ENT>
                    </ROW>
                    <ROW RUL="s,s,s">
                        <ENT I="22">Atlantic Ocean, Caribbean, Gulf of Mexico large pelagics longline</ENT>
                        <ENT>94</ENT>
                        <ENT>
                            Atlantic spotted dolphin, Northern GMX
                            <LI>Atlantic spotted dolphin, WNA</LI>
                            <LI>Bottlenose dolphin, Northern GMX oceanic</LI>
                            <LI>Bottlenose dolphin, Northern GMX continental shelf</LI>
                            <LI>Bottlenose dolphin, WNA offshore</LI>
                            <LI>Common dolphin, WNA</LI>
                            <LI>Cuvier's beaked whale, WNA</LI>
                            <LI>
                                Long-finned pilot whale, WNA
                                <SU>1</SU>
                            </LI>
                            <LI>Mesoplodon beaked whale, WNA</LI>
                            <LI>Northern bottlenose whale, WNA</LI>
                            <LI>Pantropical spotted dolphin, Northern GMX</LI>
                            <LI>Pantropical spotted dolphin, WNA</LI>
                            <LI>
                                Pygmy sperm whale, WNA
                                <SU>1</SU>
                            </LI>
                            <LI>Risso's dolphin, Northern GMX</LI>
                            <LI>Risso's dolphin, WNA</LI>
                            <LI>Short-finned pilot whale, Northern GMX</LI>
                            <LI>
                                Short-finned pilot whale, WNA
                                <SU>1</SU>
                            </LI>
                        </ENT>
                    </ROW>
                    <ROW RUL="s,s,s">
                        <ENT I="22">
                            <E T="02">TRAP/POT FISHERIES:</E>
                        </ENT>
                        <ENT> </ENT>
                        <ENT> </ENT>
                    </ROW>
                    <ROW RUL="s,s,s">
                        <PRTPAGE P="66076"/>
                        <ENT I="22">Northeast/Mid-Atlantic American lobster trap/pot</ENT>
                        <ENT>13,000</ENT>
                        <ENT>
                            Fin whale, WNA
                            <LI>Harbor seal, WNA</LI>
                            <LI>
                                Humpback whale, Gulf of Maine
                                <SU>1</SU>
                            </LI>
                            <LI>
                                Minke whale, Canadian east coast
                                <SU>1</SU>
                            </LI>
                            <LI>
                                North Atlantic right whale, WNA
                                <SU>1</SU>
                            </LI>
                        </ENT>
                    </ROW>
                    <ROW RUL="s,n,s" EXPSTB="02">
                        <ENT I="22">CATEGORY II</ENT>
                    </ROW>
                    <ROW RUL="s,s,s" EXPSTB="00">
                        <ENT I="22">
                            <E T="02">GILLNET FISHERIES:</E>
                        </ENT>
                        <ENT> </ENT>
                        <ENT> </ENT>
                    </ROW>
                    <ROW RUL="s,s,s">
                        <ENT I="22">
                            Chesapeake Bay inshore gillnet
                            <SU>2</SU>
                        </ENT>
                        <ENT>45</ENT>
                        <ENT>None documented</ENT>
                    </ROW>
                    <ROW RUL="s,s,s">
                        <ENT I="22">
                            Gulf of Mexico gillnet
                            <SU>2</SU>
                        </ENT>
                        <ENT>724</ENT>
                        <ENT>
                            Bottlenose dolphin, Eastern GMX coastal
                            <LI>Bottlenose dolphin, GMX bay, sound, and estuarine</LI>
                            <LI>Bottlenose dolphin, Northern GMX coastal</LI>
                            <LI>Bottlenose dolphin, Western GMX coastal</LI>
                        </ENT>
                    </ROW>
                    <ROW RUL="s,s,s">
                        <ENT I="22">NC inshore gillnet</ENT>
                        <ENT>94</ENT>
                        <ENT>
                            Bottlenose dolphin, WNA coastal
                            <SU>1</SU>
                        </ENT>
                    </ROW>
                    <ROW RUL="s,s,s">
                        <ENT I="22">
                            Northeast anchored float gillnet
                            <SU>2</SU>
                        </ENT>
                        <ENT>133</ENT>
                        <ENT>
                            Harbor seal, WNA
                            <LI>Humpback whale, Gulf of Maine</LI>
                            <LI>White-sided dolphin, WNA</LI>
                        </ENT>
                    </ROW>
                    <ROW RUL="s,s,s">
                        <ENT I="22">
                            Northeast drift gillnet
                            <SU>2</SU>
                        </ENT>
                        <ENT>unknown</ENT>
                        <ENT>None documented</ENT>
                    </ROW>
                    <ROW RUL="s,s,s">
                        <ENT I="22">
                            Southeast Atlantic gillnet
                            <SU>2</SU>
                        </ENT>
                        <ENT>779</ENT>
                        <ENT>Bottlenose dolphin, WNA coastal</ENT>
                    </ROW>
                    <ROW RUL="s,s,s">
                        <ENT I="22">Southeastern U.S. Atlantic shark gillnet</ENT>
                        <ENT>30</ENT>
                        <ENT>
                            Atlantic spotted dolphin, WNA
                            <LI>
                                Bottlenose dolphin, WNA coastal
                                <SU>1</SU>
                            </LI>
                            <LI>North Atlantic right whale, WNA</LI>
                        </ENT>
                    </ROW>
                    <ROW RUL="s,s,s">
                        <ENT I="22">
                            <E T="02">TRAWL FISHERIES:</E>
                        </ENT>
                        <ENT> </ENT>
                        <ENT> </ENT>
                    </ROW>
                    <ROW RUL="s,s,s">
                        <ENT I="22">Mid-Atlantic mid-water trawl (including pair trawl)</ENT>
                        <ENT>620</ENT>
                        <ENT>
                            Bottlenose dolphin, WNA offshore
                            <LI>Common dolphin, WNA</LI>
                            <LI>Long-finned pilot whale, WNA</LI>
                            <LI>Risso's dolphin, WNA</LI>
                            <LI>Short-finned pilot whale, WNA</LI>
                            <LI>
                                White-sided dolphin, WNA
                                <SU>1</SU>
                            </LI>
                        </ENT>
                    </ROW>
                    <ROW RUL="s,s,s">
                        <ENT I="22">Mid-Atlantic bottom trawl</ENT>
                        <ENT>&gt;1,000</ENT>
                        <ENT>
                            Common dolphin, WNA
                            <SU>1</SU>
                            <LI>
                                Long-finned pilot whale, WNA
                                <SU>1</SU>
                            </LI>
                            <LI>
                                Short-finned pilot whale, WNA
                                <SU>1</SU>
                            </LI>
                        </ENT>
                    </ROW>
                    <ROW RUL="s,s,s">
                        <ENT I="22">
                            Mid-Atlantic flynet
                            <SU>2</SU>
                        </ENT>
                        <ENT>21</ENT>
                        <ENT>None documented</ENT>
                    </ROW>
                    <ROW RUL="s,s,s">
                        <ENT I="22">Northeast mid-water trawl (including pair trawl)</ENT>
                        <ENT>17</ENT>
                        <ENT>
                            Harbor seal, WNA
                            <LI>
                                Long-finned pilot whale, WNA
                                <SU>1</SU>
                            </LI>
                            <LI>
                                Short-finned pilot whale, WNA
                                <SU>1</SU>
                            </LI>
                            <LI>White-sided dolphin, WNA</LI>
                        </ENT>
                    </ROW>
                    <ROW RUL="s,s,s">
                        <ENT I="22">Northeast bottom trawl</ENT>
                        <ENT>1,052</ENT>
                        <ENT>
                            Common dolphin, WNA
                            <LI>Harbor porpoise, GME/BF</LI>
                            <LI>Harp seal, WNA</LI>
                            <LI>Long-finned pilot whale, WNA</LI>
                            <LI>Short-finned pilot whale, WNA</LI>
                            <LI>
                                White-sided dolphin, WNA
                                <SU>1</SU>
                            </LI>
                        </ENT>
                    </ROW>
                    <ROW RUL="s,s,s">
                        <ENT I="22">
                            <E T="02">TRAP/POT FISHERIES:</E>
                        </ENT>
                        <ENT> </ENT>
                        <ENT> </ENT>
                    </ROW>
                    <ROW RUL="s,s,s">
                        <ENT I="22">Atlantic blue crab trap/pot</ENT>
                        <ENT>&gt;16,000</ENT>
                        <ENT>
                            Bottlenose dolphin, WNA coastal
                            <SU>1</SU>
                            <LI>
                                West Indian manatee, FL
                                <SU>1</SU>
                            </LI>
                        </ENT>
                    </ROW>
                    <ROW RUL="s,s,s">
                        <ENT I="22">
                            Atlantic mixed species trap/pot
                            <SU>2</SU>
                        </ENT>
                        <ENT>unknown</ENT>
                        <ENT>
                            Fin whale, WNA
                            <LI>Humpback whale, Gulf of Maine</LI>
                        </ENT>
                    </ROW>
                    <ROW RUL="s,s,s">
                        <ENT I="22">
                            <E T="02">PURSE SEINE FISHERIES:</E>
                        </ENT>
                        <ENT> </ENT>
                        <ENT> </ENT>
                    </ROW>
                    <ROW RUL="s,s,s">
                        <PRTPAGE P="66077"/>
                        <ENT I="22">Gulf of Mexico menhaden purse seine</ENT>
                        <ENT>40-42</ENT>
                        <ENT>
                            Bottlenose dolphin, Eastern GMX coastal
                            <LI>Bottlenose dolphin, GMX bay, sound, estuarine</LI>
                            <LI>
                                Bottlenose dolphin, Northern GMX coastal
                                <SU>1</SU>
                            </LI>
                            <LI>Bottlenose dolphin, Western GMX coastal</LI>
                        </ENT>
                    </ROW>
                    <ROW RUL="s,s,s">
                        <ENT I="22">
                            Mid-Atlantic menhaden purse seine
                            <SU>2</SU>
                        </ENT>
                        <ENT>22</ENT>
                        <ENT>Bottlenose dolphin, WNA coastal</ENT>
                    </ROW>
                    <ROW RUL="s,s,s">
                        <ENT I="22">
                            <E T="02">HAUL/BEACH SEINE FISHERIES:</E>
                        </ENT>
                        <ENT> </ENT>
                        <ENT> </ENT>
                    </ROW>
                    <ROW RUL="s,s,s">
                        <ENT I="22">Mid-Atlantic haul/beach seine</ENT>
                        <ENT>25</ENT>
                        <ENT>
                            Bottlenose dolphin, WNA coastal
                            <SU>1</SU>
                        </ENT>
                    </ROW>
                    <ROW RUL="s,s,s">
                        <ENT I="22">NC long haul seine</ENT>
                        <ENT>33</ENT>
                        <ENT>
                            Bottlenose dolphin, WNA coastal
                            <SU>1</SU>
                        </ENT>
                    </ROW>
                    <ROW RUL="s,s,s">
                        <ENT I="22">
                            <E T="02">STOP NET FISHERIES:</E>
                        </ENT>
                        <ENT> </ENT>
                        <ENT> </ENT>
                    </ROW>
                    <ROW RUL="s,s,s">
                        <ENT I="22">NC roe mullet stop net</ENT>
                        <ENT>13</ENT>
                        <ENT>
                            Bottlenose dolphin, WNA coastal
                            <SU>1</SU>
                        </ENT>
                    </ROW>
                    <ROW RUL="s,s,s">
                        <ENT I="22">
                            <E T="02">POUND NET FISHERIES:</E>
                        </ENT>
                        <ENT> </ENT>
                        <ENT> </ENT>
                    </ROW>
                    <ROW RUL="s,s,s">
                        <ENT I="22">VA pound net</ENT>
                        <ENT>187</ENT>
                        <ENT>
                            Bottlenose dolphin, WNA coastal
                            <SU>1</SU>
                        </ENT>
                    </ROW>
                    <ROW RUL="s,n,s" EXPSTB="02">
                        <ENT I="22">CATEGORY III</ENT>
                    </ROW>
                    <ROW RUL="s,s,s" EXPSTB="00">
                        <ENT I="22">
                            <E T="02">GILLNET FISHERIES:</E>
                        </ENT>
                        <ENT> </ENT>
                        <ENT> </ENT>
                    </ROW>
                    <ROW RUL="s,s,s">
                        <ENT I="22">Caribbean gillnet</ENT>
                        <ENT>&gt;991</ENT>
                        <ENT>
                            Dwarf sperm whale, WNA
                            <LI>West Indian manatee, Antillean</LI>
                        </ENT>
                    </ROW>
                    <ROW RUL="s,s,s">
                        <ENT I="22">DE River inshore gillnet</ENT>
                        <ENT>60</ENT>
                        <ENT>None documented</ENT>
                    </ROW>
                    <ROW RUL="s,s,s">
                        <ENT I="22">Long Island Sound inshore gillnet</ENT>
                        <ENT>20</ENT>
                        <ENT>None documented</ENT>
                    </ROW>
                    <ROW RUL="s,s,s">
                        <ENT I="22">RI, southern MA (to Monomoy Island), and NY Bight (Raritan and Lower NY Bays) inshore gillnet</ENT>
                        <ENT>32</ENT>
                        <ENT>None documented</ENT>
                    </ROW>
                    <ROW RUL="s,s,s">
                        <ENT I="22">Southeast Atlantic inshore gillnet</ENT>
                        <ENT>unknown</ENT>
                        <ENT>None documented</ENT>
                    </ROW>
                    <ROW RUL="s,s,s">
                        <ENT I="22">
                            <E T="02">TRAWL FISHERIES:</E>
                        </ENT>
                        <ENT> </ENT>
                        <ENT> </ENT>
                    </ROW>
                    <ROW RUL="s,s,s">
                        <ENT I="22">Atlantic shellfish bottom trawl</ENT>
                        <ENT>972</ENT>
                        <ENT>None documented</ENT>
                    </ROW>
                    <ROW RUL="s,s,s">
                        <ENT I="22">Gulf of Mexico butterfish trawl</ENT>
                        <ENT>2</ENT>
                        <ENT>
                            Bottlenose dolphin, Northern GMX oceanic
                            <LI>Bottlenose dolphin, Northern GMX continental shelf</LI>
                        </ENT>
                    </ROW>
                    <ROW RUL="s,s,s">
                        <ENT I="22">Gulf of Mexico mixed species trawl</ENT>
                        <ENT>20</ENT>
                        <ENT>None documented</ENT>
                    </ROW>
                    <ROW RUL="s,s,s">
                        <ENT I="22">GA cannonball jellyfish trawl</ENT>
                        <ENT>1</ENT>
                        <ENT>None documented</ENT>
                    </ROW>
                    <ROW RUL="s,s,s">
                        <ENT I="22">Southeastern U.S. Atlantic, Gulf of Mexico shrimp trawl</ENT>
                        <ENT>&gt;18,000</ENT>
                        <ENT>
                            Bottlenose dolphin, WNA coastal
                            <LI>Bottlenose dolphin, Eastern GMX coastal</LI>
                            <LI>Bottlenose dolphin, Western GMX coastal</LI>
                            <LI>Bottlenose dolphin, GMX bay, sound, estuarine</LI>
                            <LI>West Indian Manatee, FL</LI>
                        </ENT>
                    </ROW>
                    <ROW RUL="s,s,s">
                        <ENT I="22">
                            <E T="02">MARINE AQUACULTURE FISHERIES:</E>
                        </ENT>
                        <ENT> </ENT>
                        <ENT> </ENT>
                    </ROW>
                    <ROW RUL="s,s,s">
                        <ENT I="22">Finfish aquaculture</ENT>
                        <ENT>48</ENT>
                        <ENT>Harbor seal, WNA</ENT>
                    </ROW>
                    <ROW RUL="s,s,s">
                        <ENT I="22">Shellfish aquaculture</ENT>
                        <ENT>unknown</ENT>
                        <ENT>None documented</ENT>
                    </ROW>
                    <ROW RUL="s,s,s">
                        <ENT I="22">
                            <E T="02">PURSE SEINE FISHERIES:</E>
                        </ENT>
                        <ENT> </ENT>
                        <ENT> </ENT>
                    </ROW>
                    <ROW RUL="s,s,s">
                        <ENT I="22">Gulf of Maine Atlantic herring purse seine</ENT>
                        <ENT>30</ENT>
                        <ENT>
                            Harbor seal, WNA
                            <LI>Gray seal, WNA</LI>
                        </ENT>
                    </ROW>
                    <ROW RUL="s,s,s">
                        <ENT I="22">Gulf of Maine menhaden purse seine</ENT>
                        <ENT>50</ENT>
                        <ENT>None documented</ENT>
                    </ROW>
                    <ROW RUL="s,s,s">
                        <ENT I="22">FL west coast sardine purse seine</ENT>
                        <ENT>10</ENT>
                        <ENT>Bottlenose dolphin, Eastern GMX coastal</ENT>
                    </ROW>
                    <ROW RUL="s,s,s">
                        <PRTPAGE P="66078"/>
                        <ENT I="22">U.S. Atlantic tuna purse seine</ENT>
                        <ENT>5</ENT>
                        <ENT>
                            Long-finned pilot whale, WNA
                            <LI>Short-finned pilot whale, WNA</LI>
                        </ENT>
                    </ROW>
                    <ROW RUL="s,s,s">
                        <ENT I="22">
                            <E T="02">LONGLINE/HOOK-AND-LINE FISHERIES:</E>
                        </ENT>
                        <ENT> </ENT>
                        <ENT> </ENT>
                    </ROW>
                    <ROW RUL="s,s,s">
                        <ENT I="22">Northeast/Mid-Atlantic bottom longline/hook-and-line</ENT>
                        <ENT>46</ENT>
                        <ENT>None documented</ENT>
                    </ROW>
                    <ROW RUL="s,s,s">
                        <ENT I="22">Gulf of Maine, U.S. Mid-Atlantic tuna, shark swordfish hook-and-line/harpoon</ENT>
                        <ENT>26,223</ENT>
                        <ENT>Humpback whale, Gulf of Maine</ENT>
                    </ROW>
                    <ROW RUL="s,s,s">
                        <ENT I="22">Southeastern U.S. Atlantic, Gulf of Mexico, and Caribbean snapper-grouper and other reef fish bottom longline/hook-and-line</ENT>
                        <ENT>&gt;5,000</ENT>
                        <ENT>None documented</ENT>
                    </ROW>
                    <ROW RUL="s,s,s">
                        <ENT I="22">Southeastern U.S. Atlantic, Gulf of Mexico shark bottom longline/hook-and-line</ENT>
                        <ENT>&lt;125</ENT>
                        <ENT>
                            Bottlenose dolphin, Eastern GMX coastal
                            <LI>Bottlenose dolphin, Northern GMX continental shelf</LI>
                        </ENT>
                    </ROW>
                    <ROW RUL="s,s,s">
                        <ENT I="22">Southeastern U.S. Atlantic, Gulf of Mexico, and Caribbean pelagic hook-and-line/harpoon</ENT>
                        <ENT>1,446</ENT>
                        <ENT>None documented</ENT>
                    </ROW>
                    <ROW RUL="s,s,s">
                        <ENT I="22">
                            <E T="02">TRAP/POT FISHERIES:</E>
                        </ENT>
                        <ENT> </ENT>
                        <ENT> </ENT>
                    </ROW>
                    <ROW RUL="s,s,s">
                        <ENT I="22">Caribbean mixed species trap/pot</ENT>
                        <ENT>&gt;501</ENT>
                        <ENT>None documented</ENT>
                    </ROW>
                    <ROW RUL="s,s,s">
                        <ENT I="22">Caribbean spiny lobster trap/pot</ENT>
                        <ENT>&gt;197</ENT>
                        <ENT>None documented</ENT>
                    </ROW>
                    <ROW RUL="s,s,s">
                        <ENT I="22">FL spiny lobster trap/pot</ENT>
                        <ENT>2,145</ENT>
                        <ENT>Bottlenose dolphin, Eastern GMX coastal</ENT>
                    </ROW>
                    <ROW RUL="s,s,s">
                        <ENT I="22">Gulf of Mexico blue crab trap/pot</ENT>
                        <ENT>4,113</ENT>
                        <ENT>
                            Bottlenose dolphin, Western GMX coastal
                            <LI>Bottlenose dolphin, Northern GMX coastal</LI>
                            <LI>Bottlenose dolphin, Eastern GMX coastal</LI>
                            <LI>Bottlenose dolphin, GMX Bay, Sound, &amp; Estuarine</LI>
                            <LI>West Indian manatee, FL</LI>
                        </ENT>
                    </ROW>
                    <ROW RUL="s,s,s">
                        <ENT I="22">Gulf of Mexico mixed species trap/pot</ENT>
                        <ENT>unknown</ENT>
                        <ENT>None documented</ENT>
                    </ROW>
                    <ROW RUL="s,s,s">
                        <ENT I="22">Southeastern U.S. Atlantic, Gulf of Mexico golden crab trap/pot</ENT>
                        <ENT>10</ENT>
                        <ENT>None documented</ENT>
                    </ROW>
                    <ROW RUL="s,s,s">
                        <ENT I="22">Southeastern U.S. Atlantic, Gulf of Mexico stone crab trap/pot</ENT>
                        <ENT>4,453</ENT>
                        <ENT>None documented</ENT>
                    </ROW>
                    <ROW RUL="s,s,s">
                        <ENT I="22">U.S. Mid-Atlantic eel trap/pot</ENT>
                        <ENT>&gt;700</ENT>
                        <ENT>None documented</ENT>
                    </ROW>
                    <ROW RUL="s,s,s">
                        <ENT I="22">
                            <E T="02">STOP SEINE/WEIR/POUND NET FISHERIES:</E>
                        </ENT>
                        <ENT> </ENT>
                        <ENT> </ENT>
                    </ROW>
                    <ROW RUL="s,s,s">
                        <ENT I="22">Gulf of Maine herring and Atlantic mackerel stop seine/weir</ENT>
                        <ENT>50</ENT>
                        <ENT>
                            Gray seal, Northwest North Atlantic
                            <LI>Harbor porpoise, GME/BF</LI>
                            <LI>Harbor seal, WNA</LI>
                            <LI>Minke whale, Canadian east coast</LI>
                            <LI>White-sided dolphin, WNA</LI>
                        </ENT>
                    </ROW>
                    <ROW RUL="s,s,s">
                        <ENT I="22">U.S. Mid-Atlantic crab stop seine/weir</ENT>
                        <ENT>2,600</ENT>
                        <ENT>None documented</ENT>
                    </ROW>
                    <ROW RUL="s,s,s">
                        <ENT I="22">U.S. Mid-Atlantic mixed species stop seine/weir/pound net (except the North Carolina roe mullet stop net)</ENT>
                        <ENT>751</ENT>
                        <ENT>None documented</ENT>
                    </ROW>
                    <ROW RUL="s,s,s">
                        <ENT I="22">
                            <E T="02">DREDGE FISHERIES:</E>
                        </ENT>
                        <ENT> </ENT>
                        <ENT> </ENT>
                    </ROW>
                    <ROW RUL="s,s,s">
                        <ENT I="22">Gulf of Maine mussel</ENT>
                        <ENT>&gt;50</ENT>
                        <ENT>None documented</ENT>
                    </ROW>
                    <ROW RUL="s,s,s">
                        <ENT I="22">Gulf of Maine, U.S. Mid-Atlantic sea scallop dredge</ENT>
                        <ENT>233</ENT>
                        <ENT>None documented</ENT>
                    </ROW>
                    <ROW RUL="s,s,s">
                        <ENT I="22">U.S. Mid-Atlantic/Gulf of Mexico oyster</ENT>
                        <ENT>7,000</ENT>
                        <ENT>None documented</ENT>
                    </ROW>
                    <ROW RUL="s,s,s">
                        <ENT I="22">U.S. Mid-Atlantic offshore surf clam and quahog dredge</ENT>
                        <ENT>100</ENT>
                        <ENT>None documented</ENT>
                    </ROW>
                    <ROW RUL="s,s,s">
                        <ENT I="22">
                            <E T="02">HAUL/BEACH SEINE FISHERIES:</E>
                        </ENT>
                        <ENT> </ENT>
                        <ENT> </ENT>
                    </ROW>
                    <ROW RUL="s,s,s">
                        <PRTPAGE P="66079"/>
                        <ENT I="22">Caribbean haul/beach seine</ENT>
                        <ENT>15</ENT>
                        <ENT>West Indian manatee, Antillean</ENT>
                    </ROW>
                    <ROW RUL="s,s,s">
                        <ENT I="22">Gulf of Mexico haul/beach seine</ENT>
                        <ENT>unknown</ENT>
                        <ENT>None documented</ENT>
                    </ROW>
                    <ROW RUL="s,s,s">
                        <ENT I="22">Southeastern U.S. Atlantic, haul/beach seine</ENT>
                        <ENT>25</ENT>
                        <ENT>None documented</ENT>
                    </ROW>
                    <ROW RUL="s,s,s">
                        <ENT I="22">
                            <E T="02">DIVE, HAND/MECHANICAL COLLECTION FISHERIES:</E>
                        </ENT>
                        <ENT> </ENT>
                        <ENT> </ENT>
                    </ROW>
                    <ROW RUL="s,s,s">
                        <ENT I="22">Atlantic Ocean, Gulf of Mexico, Caribbean shellfish dive, hand/mechanical collection</ENT>
                        <ENT>20,000</ENT>
                        <ENT>None documented</ENT>
                    </ROW>
                    <ROW RUL="s,s,s">
                        <ENT I="22">Gulf of Maine urchin dive, hand/mechanical collection</ENT>
                        <ENT>&gt;50</ENT>
                        <ENT>None documented</ENT>
                    </ROW>
                    <ROW RUL="s,s,s">
                        <ENT I="22">Gulf of Mexico, Southeast Atlantic, Mid-Atlantic, and Caribbean cast net</ENT>
                        <ENT>unknown</ENT>
                        <ENT>None documented</ENT>
                    </ROW>
                    <ROW RUL="s,s,s">
                        <ENT I="22">
                            <E T="02">COMMERCIAL PASSENGER FISHING VESSEL (CHARTER BOAT) FISHERIES:</E>
                        </ENT>
                        <ENT> </ENT>
                        <ENT> </ENT>
                    </ROW>
                    <ROW>
                        <ENT I="22">Atlantic Ocean, Gulf of Mexico, Caribbean commercial passenger fishing vessel</ENT>
                        <ENT>4,000</ENT>
                        <ENT>
                            Bottlenose dolphin, Eastern GMX coastal
                            <LI>Bottlenose dolphin, Northern GMX coastal</LI>
                            <LI>Bottlenose dolphin, Western GMX coastal</LI>
                            <LI>Bottlenose dolphin, WNA coastal</LI>
                        </ENT>
                    </ROW>
                    <TNOTE>List of Abbreviations and Symbols Used in Table 2: DE - Delaware; FL - Florida; GA - Georgia; GME/BF - Gulf of Maine/Bay of Fundy; GMX - Gulf of Mexico; MA - Massachusetts; NC - North Carolina; VA - Virginia; WNA - Western North Atlantic</TNOTE>
                    <TNOTE>
                        <SU>1</SU>
                         - Fishery classified based on serious injuries and mortalities of this stock, which are greater than 1 percent of the stock's PBR
                    </TNOTE>
                    <TNOTE>
                        <SU>2</SU>
                         - Fishery classified by analogy.
                    </TNOTE>
                </GPOTABLE>
                <HD SOURCE="HD1">Classification</HD>
                <P> During the proposed rulemaking stage for this rule, the Chief Counsel for Regulation of the Department of Commerce certified to the Chief Counsel for Advocacy of the Small Business Administration that this rule would not have a significant economic impact on a substantial number of small entities. The factual basis leading to the certification is repeated below.</P>
                <P>Under existing regulations, all fishers participating in Category I or II fisheries must register under the MMPA, obtain an Authorization Certificate, and pay a fee of $25 (with the exception of those in regions with a registration process integrated with existing state and Federal permitting processes). Additionally, fishers may be subject to a Take Reduction Plan (TRP) and requested to carry an observer. The Authorization Certificate authorizes the taking of marine mammals incidental to commercial fishing operations. NMFS has estimated that approximately 42,000 fishing vessels, most of which are small entities, operate in Category I or II fisheries, and therefore, are required to register. However, registration has been integrated with existing state or Federal registration programs for the majority of these fisheries so these fishers do not need to register separately under the MMPA. Currently, approximately 350 fishers register directly with NMFS under the MMPA authorization program.</P>
                <P>Though this final rule will affect approximately 350 small entities, the $25 registration fee, with respect to anticipated revenues, is not considered a significant economic impact. If a vessel is requested to carry an observer, fishers will not incur any direct economic costs associated with carrying that observer. Potential indirect costs to individual fishers required to take observers may include: lost space on deck for catch, lost bunk space, and lost fishing time due to time needed to process bycatch data. However, effective monitoring will rotate observers among a limited number of vessels in a fishery at any given time and each vessel within an observed fishery has an equal probability of being requested to accommodate an observer. Therefore, the potential indirect costs to individual fishers are expected to be minimal since observer coverage would only be required for a small percentage of an individual's total annual fishing time. In addition, section 118 of the MMPA states that an observer will not be placed on a vessel if the facilities for quartering an observer or performing observer functions are inadequate or unsafe, thereby exempting vessels too small to accommodate an observer from this requirement. As a result of this certification, an initial regulatory flexibility analysis is not required and was not prepared. In the event that reclassification of a fishery to Category I or II results in a TRP, economic analyses of the effects of that plan will be summarized in subsequent rulemaking actions.</P>
                <P>
                    This final rule contains collection-of-information requirements subject to the Paperwork Reduction Act. The collection of information for the registration of fishers under the MMPA has been approved by the Office of Management and Budget (OMB) under OMB control number 0648-0293 (0.15 hours per report for new registrants and 0.09 hours per report for renewals). The requirement for reporting marine mammal injuries or mortalities has been approved by OMB under OMB control number 0648-0292 (0.15 hours per report). These estimates include the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding these reporting burden estimates or any other aspect of the collections of information, including suggestions for reducing burden, to 
                    <PRTPAGE P="66080"/>
                    NMFS and OMB (see 
                    <E T="02">ADDRESSES</E>
                     and 
                    <E T="02">SUPPLEMENTARY INFORMATION</E>
                    ).
                </P>
                <P>Notwithstanding any other provision of law, no person is required to respond to nor shall a person be subject to a penalty for failure to comply with a collection of information subject to the requirements of the Paperwork Reduction Act unless that collection of information displays a currently valid OMB control number.</P>
                <P>This final rule has been determined to be not significant for the purposes of Executive Order 12866.</P>
                <P>An environmental assessment (EA) was prepared under the National Environmental Policy Act (NEPA) for regulations to implement section 118 of the MMPA in June 1995. NMFS revised that EA relative to classifying U.S. commercial fisheries on the LOF in December 2005. Both the 1995 EA and the 2005 EA concluded that implementation of MMPA section 118 regulations would not have a significant impact on the human environment. This final rule does not make any significant change in the management of reclassified fisheries, and therefore, this final rule is not expected to change the analysis or conclusion of the 2005 EA. If NMFS takes a management action, for example, through the development of a TRP, NMFS will first prepare an environmental document, as required under NEPA, specific to that action.</P>
                <P>This final rule will not affect species listed as threatened or endangered under the Endangered Species Act (ESA) or their associated critical habitat. The impacts of numerous fisheries have been analyzed in various biological opinions, and this final rule will not affect the conclusions of those opinions. The classification of fisheries on the LOF is not considered to be a management action that would adversely affect threatened or endangered species. If NMFS takes a management action, for example, through the development of a TRP, NMFS would conduct consultation under ESA section 7 for that action.</P>
                <P>This final rule will have no adverse impacts on marine mammals and may have a positive impact on marine mammals by improving knowledge of marine mammals and the fisheries interacting with marine mammals through information collected from observer programs, stranding and sighting data, or take reduction teams.</P>
                <P>This final rule will not affect the land or water uses or natural resources of the coastal zone, as specified under section 307 of the Coastal Zone Management Act.</P>
                <SIG>
                    <DATED>Dated: November 19, 2007.</DATED>
                    <NAME>Samuel D. Rauch III,</NAME>
                    <TITLE>Deputy Assistant Administrator for Regulatory Programs, National Marine Fisheries Service.</TITLE>
                </SIG>
            </SUPLINF>
            <FRDOC>[FR Doc. E7-23076 Filed 11-26-07; 8:45 am]</FRDOC>
            <BILCOD>BILLING CODE 3510-22-S</BILCOD>
        </RULE>
        <RULE>
            <PREAMB>
                <AGENCY TYPE="S">DEPARTMENT OF COMMERCE</AGENCY>
                <SUBAGY>National Oceanic and Atmospheric Administration</SUBAGY>
                <CFR>50 CFR Part 622</CFR>
                <DEPDOC>[Docket No. 061121304-7053-02; I.D. 112006B]</DEPDOC>
                <RIN>RIN 0648-AT87</RIN>
                <SUBJECT>Fisheries of the Caribbean, Gulf of Mexico, and South Atlantic; Reef Fish Fishery of the Gulf of Mexico; Republication of Gulf Red Snapper Interim Management Measures</SUBJECT>
                <AGY>
                    <HD SOURCE="HED">AGENCY:</HD>
                    <P>National Marine Fisheries Service (NMFS), National Oceanic and Atmospheric Administration (NOAA), Commerce.</P>
                </AGY>
                <ACT>
                    <HD SOURCE="HED">ACTION:</HD>
                    <P>Temporary rule; republication of interim measures.</P>
                </ACT>
                <SUM>
                    <HD SOURCE="HED">SUMMARY:</HD>
                    <P>This temporary rule republishes interim measures to reduce overfishing of Gulf red snapper that were previously implemented via a temporary rule published by NMFS on April 2, 2007, and extended through March 28, 2008, by a temporary rule published by NMFS on September 24, 2007. The interim measures reduce the commercial and recreational quotas for red snapper, reduce the commercial minimum size limit for red snapper, reduce the recreational bag limit for Gulf red snapper, prohibit the retention of red snapper under the bag limit for captain and crew of a vessel operating as a charter vessel or headboat, and establish a target level of reduction of shrimp trawl bycatch mortality of red snapper. The intended effect of this temporary rule is to reinstate the text of the interim measures in the Code of Federal Regulations that was inadvertently removed.</P>
                </SUM>
                <DATES>
                    <HD SOURCE="HED">DATES:</HD>
                    <P>This rule is effective November 27, 2007 through March 28, 2008.</P>
                </DATES>
                <ADD>
                    <HD SOURCE="HED">ADDRESSES:</HD>
                    <P>Copies of the final environmental impact statement (FEIS) and Record of Decision (ROD) prepared for the April 2, 2007, temporary final rule (72 FR 15617) are available from Peter Hood, Southeast Regional Office, NMFS, 263 13th Avenue South, St. Petersburg, FL 33701.</P>
                </ADD>
            </PREAMB>
            <SUPLINF>
                <HD SOURCE="HED">SUPPLEMENTARY INFORMATION:</HD>
                <P>The red snapper fishery of the Gulf of Mexico is managed under the Fishery Management Plan (FMP) for the Reef Fish Fishery of the Gulf of Mexico, and the shrimp fishery is managed under the FMP for the Shrimp Fishery of the Gulf of Mexico. The FMPs were prepared by the Gulf of Mexico Fishery Management Council (Council) and are implemented under the authority of the Magnuson-Stevens Fishery Conservation and Management Act (Magnuson-Stevens Act) by regulations at 50 CFR part 622.</P>
                <P>NMFS issued a temporary rule (72 FR 15617, April 2, 2007) under section 305(c) of the Magnuson-Stevens Act, to implement interim measures to reduce fishing mortality on red snapper by reducing harvest and bycatch levels. Specifically, that rule: (1) reduced red snapper total allowable catch (TAC) from 9.12 million lb (4.14 million kg) to 6.5 million lb (2.9 million kg), whole weight, resulting in a commercial quota of 3.315 million lb (1.504 million kg) and a recreational quota of 3.185 million lb (1.445 million kg); (2) reduced the commercial minimum size limit for red snapper from 15 inches (38 cm) to 13 inches (33 cm) total length (TL); (3) reduced the daily recreational bag limit from four fish to two fish per person and prohibits the captain and crew of for-hire vessels (charter vessels and headboats) from retaining the recreational bag limit; and (4) established a goal to reduce red snapper bycatch mortality in the shrimp fishery to 50 percent of the bycatch mortality that occurred during 2001-2003. These measures remain necessary to address overfishing of the red snapper resource.</P>
                <P>
                    Under section 305(c)(3)(B) of the Magnuson-Stevens Act, NMFS may extend the effectiveness of interim measures for one additional period of not more than 186 days, provided the public has had an opportunity to comment on the interim measures and the Council is actively preparing proposed regulations to address the overfishing on a permanent basis. NMFS solicited public comments on the interim measures in a temporary proposed rule (71 FR 75220, December 14, 2006) and received numerous comments. These comments were summarized and NMFS's responses were provided in the temporary final rule (72 FR 15617, April 2, 2007). The Council prepared joint Amendment 27/14 to the Reef Fish and Shrimp FMPs in the Gulf of Mexico (Amendment 27/14) to address overfishing of red snapper. NMFS partially approved Amendment 27/14 on October 19, 2007. The approved portions of the amendment include additional measures to end overfishing and to rebuild the red snapper stock.
                    <PRTPAGE P="66081"/>
                </P>
                <P>To continue to address overfishing of red snapper pending implementation of more permanent measures recommended by the Council in Amendment 27/14, NMFS published a temporary rule (72 FR 54223, September 24, 2007) to extend the effective date of the interim measures contained in the April 2, 2007, temporary final rule (72 FR 15617). Although the extension of the interim measures was properly promulgated and those interim measures are still applicable, a technical error resulted in the extended interim measures not being incorporated into the Code of Federal Regulations as intended. To correct this inadvertent error, NMFS, via this temporary rule, is republishing the regulatory text of the interim measures contained in the April 2, 2007, temporary final rule (72 FR 15617), with an effective date from November 27, 2007 through March 28, 2008, which is consistent with the Magnuson-Stevens Act and with the intent of the September 24, 2007, temporary rule (72 FR 54223).</P>
                <P>Additional details concerning the basis for these interim measures and discussion of the ongoing efforts of the Council and NMFS to evaluate and implement measures to rebuild the red snapper stock consistent with the requirements of the Magnuson-Stevens Act are contained in the preamble of the December 14, 2006, temporary proposed rule (71 FR 75220) and are not repeated here. Public comment and NMFS' responses are contained in the preamble of the April 2, 2007, temporary final rule (72 FR 15617) and are not repeated here.</P>
                <HD SOURCE="HD1">Classification</HD>
                <P>The Administrator, Southeast Region, NMFS, (RA), has determined that this temporary rule is necessary to resolve an inadvertent error in the Code of Federal Regulations, and is consistent with the Magnuson-Stevens Act and other applicable laws.</P>
                <P>This temporary rule has been determined to be not significant for purposes of Executive Order 12866.</P>
                <P>This temporary rule is exempt from the procedures of the Regulatory Flexibility Act because the rule is issued without opportunity for prior notice and comment.</P>
                <P>
                    An FEIS was prepared for the interim measures contained in the April 2, 2007, temporary rule. The conditions that existed at the time the April 2, 2007, temporary rule was implemented have not changed, and the republication of those same interim measures has no additional impact beyond those already considered in the FEIS. Copies of the FEIS are available from NMFS (see 
                    <E T="02">ADDRESSES</E>
                    ).
                </P>
                <P>The Assistant Administrator for Fisheries, NOAA (AA) finds good cause under 5 U.S.C. 553(b)(B) to waive prior notice and opportunity for public comment on this temporary rule. This rule would republish the same interim measures for which opportunity for public comment was solicited in a proposed interim rule published on December 14, 2006 (71 FR 75220). These same interim measures were implemented by the April 2, 2007, interim final rule (72 FR 15617) and extended by the September 24, 2007, interim rule (72 FR 54223). The conditions prompting the initial temporary rule still remain. Because the republishing of these interim measures is only necessary to resolve an inadvertent technical error that resulted in these extended interim measures not being incorporated into the Code of Federal Regulations as intended, there is no additional regulatory burden associated with this temporary rule. Therefore, the AA finds that it would be unnecessary to provide additional opportunity for public comment.</P>
                <P>The AA also finds good cause under 5 U.S.C. 553(d)(3) to waive the delay of the effective date of this temporary rule. This republication of interim measures does not impose any additional regulatory burden on the public; it resolves a technical error that resulted in the already effective interim measures not being incorporated into the Code of Federal Regulations as intended. Therefore, NMFS finds good cause to waive the 30-day delay in effectiveness for this temporary rule.</P>
                <LSTSUB>
                    <HD SOURCE="HED">List of Subjects in 50 CFR Part 622</HD>
                </LSTSUB>
                <P>Fisheries, Fishing, Puerto Rico, Reporting and recordkeeping requirements, Virgin Islands.</P>
                <SIG>
                    <DATED>Dated: November 20, 2007.</DATED>
                    <NAME>Samuel D. Rauch III,</NAME>
                    <TITLE>Deputy Assistant Administrator For Regulatory Programs, National Marine Fisheries Service.</TITLE>
                </SIG>
                <REGTEXT TITLE="50" PART="622">
                    <AMDPAR>For the reasons set out in the preamble, 50 CFR part 622 is amended as follows:</AMDPAR>
                    <PART>
                        <HD SOURCE="HED">PART 622—FISHERIES OF THE CARIBBEAN, GULF, AND SOUTH ATLANTIC</HD>
                        <P>1. The authority citation for part 622 continues to read as follows:</P>
                        <AUTH>
                            <HD SOURCE="HED">Authority:</HD>
                            <P>
                                16 U.S.C. 1801 
                                <E T="03">et seq.</E>
                            </P>
                        </AUTH>
                    </PART>
                </REGTEXT>
                <REGTEXT TITLE="50" PART="622">
                    <AMDPAR>2. In § 622.37, paragraph (d)(1)(iv) is suspended and paragraph (d)(1)(vi) is added to read as follows:</AMDPAR>
                    <SECTION>
                        <SECTNO>§ 622.37</SECTNO>
                        <SUBJECT>Size limits.</SUBJECT>
                        <STARS/>
                        <P>(d) * * *</P>
                        <P>(1) * * *</P>
                        <P>(vi) Red snapper--16 inches (40.6 cm), TL, for a fish taken by a person subject to the bag limit specified in § 622.39(b)(1)(iii) and 13 inches (38.1 cm), TL, for a fish taken by a person not subject to the bag limit.</P>
                        <STARS/>
                    </SECTION>
                </REGTEXT>
                <REGTEXT TITLE="50" PART="622">
                    <AMDPAR>3. In § 622.39, paragraphs (b)(1)(iii) and (b)(1)(v) are suspended and paragraphs (b)(1)(viii) and (b)(1)(ix) are added to read as follows:</AMDPAR>
                    <SECTION>
                        <SECTNO>§ 622.39</SECTNO>
                        <SUBJECT>Bag and possession limits.</SUBJECT>
                        <STARS/>
                        <P>(b) * * *</P>
                        <P>(1) * * *</P>
                        <P>(viii) Red snapper -2. However, no red snapper may be retained by the captain or crew of a vessel operating as a charter vessel or headboat. The bag limit for such captain and crew is zero.</P>
                        <P>(ix) Gulf reef fish, combined, excluding those specified in paragraphs (b)(1)(i), (ii), (iv), (vi), (vii), and (viii) of this section and excluding dwarf sand perch and sand perch--20, but not to exceed 10 vermilion snapper.</P>
                        <STARS/>
                    </SECTION>
                </REGTEXT>
                <REGTEXT TITLE="50" PART="622">
                    <AMDPAR>4. In § 622.42, paragraphs (a)(1)(i) and (a)(2) are suspended and paragraphs (a)(1)(v) and (a)(3) are added to read as follows:</AMDPAR>
                    <SECTION>
                        <SECTNO>§ 622.42</SECTNO>
                        <SUBJECT>Quotas.</SUBJECT>
                        <STARS/>
                        <P>(a) * * *</P>
                        <P>(1) * * *</P>
                        <P>(v) Red snapper -3.315 million lb (1.504 million kg), round weight.</P>
                        <STARS/>
                        <P>
                            (3) 
                            <E T="03">Recreational quota for red snapper</E>
                            . The following quota applies to persons who harvest red snapper other than under commercial vessel permits for Gulf reef fish and the commercial quota specified in paragraph (a)(1)(v) of this section-- 3.185 million lb (1.445 million kg), round weight.
                        </P>
                        <STARS/>
                    </SECTION>
                </REGTEXT>
            </SUPLINF>
            <FRDOC>[FR Doc. E7-23049 Filed 11-26-07; 8:45 am]</FRDOC>
            <BILCOD>BILLING CODE 3510-22-S</BILCOD>
        </RULE>
        <RULE>
            <PREAMB>
                <PRTPAGE P="66082"/>
                <AGENCY TYPE="S">DEPARTMENT OF COMMERCE</AGENCY>
                <SUBAGY>National Oceanic and Atmospheric Administration</SUBAGY>
                <CFR>50 CFR Part 648</CFR>
                <DEPDOC>[Docket No. 061109296-7009-02]</DEPDOC>
                <RIN>RIN 0648-XE07</RIN>
                <SUBJECT>Fisheries of the Northeastern United States; Atlantic Bluefish Fishery; Quota Transfer</SUBJECT>
                <AGY>
                    <HD SOURCE="HED">AGENCY:</HD>
                    <P>National Marine Fisheries Service (NMFS), National Oceanic and Atmospheric Administration (NOAA), Commerce.</P>
                </AGY>
                <ACT>
                    <HD SOURCE="HED">ACTION:</HD>
                    <P>Temporary rule; inseason quota transfer.</P>
                </ACT>
                <SUM>
                    <HD SOURCE="HED">SUMMARY:</HD>
                    <P>NMFS announces that the State of Delaware is transferring commercial bluefish quota to the State of Rhode Island from its 2007 quota.  By this action, NMFS adjusts the quotas and announces the revised commercial quota for each state involved.</P>
                </SUM>
                <DATES>
                    <HD SOURCE="HED">DATES:</HD>
                    <P>Effective November 21, 2007, through December 31, 2007.</P>
                </DATES>
                <FURINF>
                    <HD SOURCE="HED">FOR FURTHER INFORMATION CONTACT:</HD>
                    <P>Emily Bryant, Fishery Management Specialist, (978) 281-9244, fax (978) 281-9135.</P>
                </FURINF>
            </PREAMB>
            <SUPLINF>
                <HD SOURCE="HED">SUPPLEMENTARY INFORMATION:</HD>
                <P>Regulations governing the Atlantic bluefish fishery are found at 50 CFR part 648.  The regulations require annual specification of a commercial quota that is apportioned among the coastal states from Florida through Maine.  The process to set the annual commercial quota and the percent allocated to each state is described in § 648.160.</P>
                <P>Two or more states, under mutual agreement and with the concurrence of the Administrator, Northeast Region, NMFS (Regional Administrator), can transfer or combine bluefish commercial quota under § 648.160(f).  The Regional Administrator is required to consider the criteria set forth in § 648.160(f)(1) in the evaluation of requests for quota transfers or combinations.</P>
                <P>Delaware has agreed to transfer 80,000 lb (36,287 kg) of its 2007 commercial quota to Rhode Island.  The Regional Administrator has determined that the criteria set forth in § 648.160(f)(1) have been met.  The revised bluefish quotas for calendar year 2007 are:  Rhode Island, 663,790 lb (301,090 kg); and Delaware, 81,055 lb (36,766 kg).</P>
                <HD SOURCE="HD1">Classification</HD>
                <P>This action is taken under 50 CFR part 648 and is exempt from review under Executive Order 12866.</P>
                <AUTH>
                    <HD SOURCE="HED">Authority:</HD>
                    <P>
                        16 U.S.C. 1801 
                        <E T="03">et seq.</E>
                    </P>
                </AUTH>
                <SIG>
                    <DATED>Dated: November 21, 2007.</DATED>
                    <NAME>Emily Menashes,</NAME>
                    <TITLE>Acting Director, Office of Sustainable Fisheries, National Marine Fisheries Service.</TITLE>
                </SIG>
            </SUPLINF>
            <FRDOC>[FR Doc. 07-5848 Filed 11-21-07; 2:53 pm]</FRDOC>
            <BILCOD>BILLING CODE 3510-22-S</BILCOD>
        </RULE>
        <RULE>
            <PREAMB>
                <AGENCY TYPE="S">DEPARTMENT OF COMMERCE</AGENCY>
                <SUBAGY>National Oceanic and Atmospheric Administration</SUBAGY>
                <CFR>50 CFR Part 648</CFR>
                <DEPDOC>[Docket No. 061109296-7009-02]</DEPDOC>
                <RIN>RIN 0648-XD64</RIN>
                <SUBJECT>Fisheries of the Northeastern United States; Atlantic Bluefish Fishery; Commercial Quota Harvested for New York</SUBJECT>
                <AGY>
                    <HD SOURCE="HED">AGENCY:</HD>
                    <P>National Marine Fisheries Service (NMFS), National Oceanic and Atmospheric Administration (NOAA), Commerce.</P>
                </AGY>
                <ACT>
                    <HD SOURCE="HED">ACTION:</HD>
                    <P>Temporary rule; closure.</P>
                </ACT>
                <SUM>
                    <HD SOURCE="HED">SUMMARY:</HD>
                    <P>NMFS announces that the 2007 Atlantic bluefish commercial quota allocated to the State of New York has been harvested. Vessels issued a commercial Federal fisheries permit for the Atlantic bluefish fishery may not land bluefish in New York for the remainder of calendar year 2007, unless additional quota becomes available through a transfer from another state. Regulations governing the Atlantic bluefish fishery require publication of this notification to advise New York that the quota has been harvested and to advise vessel permit holders and dealer permit holders that no commercial quota is available for landing bluefish in New York.</P>
                </SUM>
                <DATES>
                    <HD SOURCE="HED">DATES:</HD>
                    <P>Effective 0001 hours, November 27, 2007, through 2400 hours, December 31, 2007.</P>
                </DATES>
                <FURINF>
                    <HD SOURCE="HED">FOR FURTHER INFORMATION CONTACT:</HD>
                    <P>Emily Bryant, Fishery Management Specialist, (978) 281-9244.</P>
                </FURINF>
            </PREAMB>
            <SUPLINF>
                <HD SOURCE="HED">SUPPLEMENTARY INFORMATION:</HD>
                <P>Regulations governing the Atlantic bluefish fishery are found at 50 CFR part 648. The regulations require annual specification of a commercial quota that is apportioned on a percentage basis among the coastal states from Florida through Maine. The process to set the annual commercial quota and the percent allocated to each state is described in § 648.160.</P>
                <P>The initial total commercial quota for Atlantic bluefish for the 2007 calendar year was set equal to 8,688,760 lb (3,941 mt) (72 FR 4458, January 31, 2007). The percent allocated to vessels landing bluefish in New York is 10.3851 percent, resulting in a commercial quota of 902,336 lb (409,927 kg). The 2007 allocation was reduced to 884,278 lb (401,106 kg) when research set-aside was deducted and after the 2006 overages had been applied. Subsequently, during the 2007 fishing year, New York received two transfers of bluefish quota from Virginia in the amounts of 150,000 lb (68,039 kg) (72 FR 10934) and 200,000 lb (90,718 kg) (72 FR 62416). These transfers increased New York's bluefish quota allocation to 1,234,278 lb (559,859 kg).</P>
                <P>
                    Section 648.161(b) requires the Administrator, Northeast Region, NMFS (Regional Administrator) to monitor state commercial quotas and to determine when a state's commercial quota has been harvested. NMFS then publishes a notification in the 
                    <E T="04">Federal Register</E>
                     to advise the state and to notify Federal vessel and dealer permit holders that, effective upon a specific date, the state's commercial quota has been harvested and no commercial quota is available for landing bluefish in that state. The Regional Administrator has determined, based upon dealer reports and other available information, that New York has harvested its quota for 2007.
                </P>
                <P>
                    The regulations at § 648.4(b) provide that Federal permit holders agree, as a condition of the permit, not to land bluefish in any state that the Regional Administrator has determined no longer has commercial quota available. Therefore, effective 0001 hours, November 27, 2007, further landings of bluefish in New York by vessels holding bluefish commercial Federal fisheries permits are prohibited for the remainder of the 2007 calendar year, unless additional quota becomes available through a transfer and is announced in the 
                    <E T="04">Federal Register</E>
                    . Effective 0001 hours, November 27, 2007, federally permitted dealers are also notified that they may not purchase bluefish from federally permitted vessels that land in New York for the remainder of the calendar year, or until additional quota becomes available through a transfer from another state.
                </P>
                <HD SOURCE="HD1">Classification</HD>
                <P>This action is required by 50 CFR part 648 and is exempt from review under Executive Order 12866.</P>
                <AUTH>
                    <HD SOURCE="HED">Authority:</HD>
                    <P>
                        16 U.S.C. 1801 
                        <E T="03">et seq.</E>
                    </P>
                </AUTH>
                <SIG>
                    <DATED>Dated: November 21, 2007.</DATED>
                    <NAME>Emily H. Menashes,</NAME>
                    <TITLE>Acting Director, Office of Sustainable Fisheries, National Marine Fisheries Service.</TITLE>
                </SIG>
            </SUPLINF>
            <FRDOC>[FR Doc. E7-23051 Filed 11-26-07; 8:45 am]</FRDOC>
            <BILCOD>BILLING CODE 3510-22-S</BILCOD>
        </RULE>
        <RULE>
            <PREAMB>
                <PRTPAGE P="66083"/>
                <AGENCY TYPE="S">DEPARTMENT OF COMMERCE</AGENCY>
                <SUBAGY>National Oceanic and Atmospheric Administration</SUBAGY>
                <CFR>50 CFR Part 648</CFR>
                <DEPDOC>[Docket No. 061020273-7001-03]</DEPDOC>
                <RIN>RIN 0648-XE00</RIN>
                <SUBJECT>Fisheries of the Northeastern United States; Summer Flounder Fishery; Commercial Quota Harvested for New Jersey</SUBJECT>
                <AGY>
                    <HD SOURCE="HED">AGENCY:</HD>
                    <P>National Marine Fisheries Service (NMFS), National Oceanic and Atmospheric Administration (NOAA), Commerce.</P>
                </AGY>
                <ACT>
                    <HD SOURCE="HED">ACTION:</HD>
                    <P>Temporary rule; closure.</P>
                </ACT>
                <SUM>
                    <HD SOURCE="HED">SUMMARY:</HD>
                    <P>NMFS announces that the 2007 summer flounder commercial quota allocated to the State of New Jersey has been harvested. Vessels issued a commercial Federal fisheries permit for the summer flounder fishery may not land summer flounder in New Jersey for the remainder of calendar year 2007, unless additional quota becomes available through a transfer from another state. Regulations governing the summer flounder fishery require publication of this notification to advise New Jersey that the quota has been harvested and to advise vessel permit holders and dealer permit holders that no commercial quota is available for landing summer flounder in New Jersey.</P>
                </SUM>
                <DATES>
                    <HD SOURCE="HED">DATES:</HD>
                    <P>Effective 0001 hours, November 27, 2007, through 2400 hours, December 31, 2007.</P>
                </DATES>
                <FURINF>
                    <HD SOURCE="HED">FOR FURTHER INFORMATION CONTACT:</HD>
                    <P>Emily Bryant, Fishery Management Specialist, (978) 281-9244.</P>
                </FURINF>
            </PREAMB>
            <SUPLINF>
                <HD SOURCE="HED">SUPPLEMENTARY INFORMATION:</HD>
                <P>Regulations governing the summer flounder fishery are found at 50 CFR part 648. The regulations require annual specification of a commercial quota that is apportioned on a percentage basis among the coastal states from North Carolina through Maine. The process to set the annual commercial quota and the percent allocated to each state is described in § 648.100.</P>
                <P>The initial total commercial quota for summer flounder for the 2007 calendar year was set equal to 7,789,800 lb (3,533 mt) (71 FR 75134, December 14, 2006). This quota was increased through an emergency action to 10,267,098 lb (4,658 mt) (72 FR 2458, January 19, 2007). The percent allocated to vessels landing summer flounder in New Jersey is 16.72499 percent, resulting in a commercial quota of 1,302,843 lb (591 mt). The 2007 allocation was reduced to 1,263,758 lb (573 mt) when research set-aside was deducted.</P>
                <P>
                    Section 648.101(b) requires the Administrator, Northeast Region, NMFS (Regional Administrator) to monitor state commercial quotas and to determine when a state's commercial quota has been harvested. NMFS then publishes a notification in the 
                    <E T="04">Federal Register</E>
                     to advise the state and to notify Federal vessel and dealer permit holders that, effective upon a specific date, the state's commercial quota has been harvested and no commercial quota is available for landing summer flounder in that state. The Regional Administrator has determined, based upon dealer reports and other available information, that New Jersey has harvested its quota for 2007.
                </P>
                <P>
                    The regulations at § 648.4(b) provide that Federal permit holders agree, as a condition of the permit, not to land summer flounder in any state that the Regional Administrator has determined no longer has commercial quota available. Therefore, effective 0001 hours, November 27, 2007, further landings of summer flounder in New Jersey by vessels holding summer flounder commercial Federal fisheries permits are prohibited for the remainder of the 2007 calendar year, unless additional quota becomes available through a transfer and is announced in the 
                    <E T="04">Federal Register</E>
                    . Effective 0001 hours, November 27, 2007, federally permitted dealers are also notified that they may not purchase summer flounder from federally permitted vessels that land in New Jersey for the remainder of the calendar year, or until additional quota becomes available through a transfer from another state.
                </P>
                <HD SOURCE="HD1">Classification</HD>
                <P>This action is required by 50 CFR part 648 and is exempt from review under Executive Order 12866.</P>
                <AUTH>
                    <HD SOURCE="HED">Authority:</HD>
                    <P>
                        16 U.S.C. 1801 
                        <E T="03">et seq.</E>
                    </P>
                </AUTH>
                <SIG>
                    <DATED>Dated: November 21, 2007.</DATED>
                    <NAME>Emily H. Menashes,</NAME>
                    <TITLE>Acting Director, Office of Sustainable Fisheries, National Marine Fisheries Service.</TITLE>
                </SIG>
            </SUPLINF>
            <FRDOC>[FR Doc. E7-23062 Filed 11-26-07; 8:45 am]</FRDOC>
            <BILCOD>BILLING CODE 3510-22-S</BILCOD>
        </RULE>
        <RULE>
            <PREAMB>
                <AGENCY TYPE="S">DEPARTMENT OF COMMERCE</AGENCY>
                <SUBAGY>National Oceanic and Atmospheric Administration </SUBAGY>
                <CFR>50 CFR Part 679</CFR>
                <DEPDOC>[Docket No. 070213032-7032-01]</DEPDOC>
                <RIN>RIN 0648-XE05</RIN>
                <SUBJECT>Fisheries of the Exclusive Economic Zone Off Alaska; Reallocation of Halibut in the Gulf of Alaska</SUBJECT>
                <AGY>
                    <HD SOURCE="HED">AGENCY:</HD>
                    <P>National Marine Fisheries Service (NMFS), National Oceanic and Atmospheric Administration (NOAA), Commerce.</P>
                </AGY>
                <ACT>
                    <HD SOURCE="HED">ACTION:</HD>
                    <P>Temporary rule; reallocation.</P>
                </ACT>
                <SUM>
                    <HD SOURCE="HED">SUMMARY:</HD>
                    <P>NMFS is reallocating the projected unused amount of halibut prohibited species catch (PSC) from rockfish cooperatives in the Central Gulf of Alaska (GOA) Rockfish Pilot Program to vessels using trawl gear in the GOA. This action is necessary to provide the opportunity to vessels using trawl gear to harvest available GOA groundfish total allowable catch (TAC) under existing PSC limits.</P>
                </SUM>
                <DATES>
                    <HD SOURCE="HED">DATES:</HD>
                    <P>Effective November 21, 2007, until 2400 hours, A.l.t., December 31, 2007.</P>
                </DATES>
                <FURINF>
                    <HD SOURCE="HED">FOR FURTHER INFORMATION CONTACT:</HD>
                    <P>Jennifer Hogan, 907-586-7228.</P>
                </FURINF>
            </PREAMB>
            <SUPLINF>
                <HD SOURCE="HED">SUPPLEMENTARY INFORMATION:</HD>
                <P>NMFS manages the groundfish fishery in the GOA according to the Fishery Management Plan for Groundfish of the Gulf of Alaska Management Area (FMP) prepared by the North Pacific Fishery Management Council under authority of the Magnuson-Stevens Fishery Conservation and Management Act. Regulations governing fishing by U.S. vessels in accordance with the FMP appear at subpart H of 50 CFR part 600 and 50 CFR part 679.</P>
                <P>
                    The 2007 allocation of halibut PSC to vessels using trawl gear in the GOA is 2,000 metric tons (mt) as established by the 2007 and 2008 final harvest specifications (72 FR 9676, March 5, 2007, as corrected by 72 FR 13217, March 21, 2007) for groundfish in the GOA. Section 679.81(c) allocates 176 mt to catcher processor and catcher vessel rockfish cooperatives in the Central GOA. The website at 
                    <E T="03">http://www.fakr.noaa.gov/sustainablefisheries/goarat/07rppallocations.xls</E>
                     lists this amount. The remaining 1,824 mt is allocated to vessels using trawl gear not in a rockfish cooperative.
                </P>
                <P>
                    As of November 19, 2007, the Administrator, Alaska Region, NMFS (Regional Administrator), has 
                    <PRTPAGE P="66084"/>
                    determined that rockfish cooperatives in the Central GOA have not used 128 mt of the allocation under § 679.21(d)(5)(iii)(B). Therefore, NMFS reallocates 128 mt of halibut PSC from rockfish cooperatives in the Central GOA to the last seasonal apportionment for vessels using trawl gear in the GOA.
                </P>
                <P>The harvest specifications for halibut PSC included in the harvest specifications for groundfish in the GOA (72 FR 9676, March 5, 2007, as corrected by 72 FR 13217, March 21, 2007) are revised as follows: 48 mt to rockfish cooperatives in the Central GOA and 1,952 mt to vessels using trawl gear.</P>
                <HD SOURCE="HD1">Classification</HD>
                <P>This action responds to the best available information recently obtained from the fishery. The Assistant Administrator for Fisheries, NOAA, (AA) finds good cause to waive the requirement to provide prior notice and opportunity for public comment pursuant to the authority set forth at 5 U.S.C. 553(b)(B) as such a requirement is impracticable and contrary to the public interest. This requirement is impracticable and contrary to the public interest as it would prevent NMFS from responding to the most recent fisheries data in a timely fashion and would delay the reallocation of projected unused amounts of halibut PSC in the GOA. NMFS was unable to publish a notice providing time for public comment because the most recent, relevant data only became available as of November 19, 2007.</P>
                <P>The AA also finds good cause to waive the 30-day delay in the effective date of this action under 5 U.S.C. 553(d)(3). This finding is based upon the reasons provided above for waiver of prior notice and opportunity for public comment.</P>
                <P>This action is required by § 679.20 and is exempt from review under Executive Order 12866.</P>
                <AUTH>
                    <HD SOURCE="HED">Authority:</HD>
                    <P>
                        16 U.S.C. 1801 
                        <E T="03">et seq.</E>
                    </P>
                </AUTH>
                <SIG>
                    <DATED>Dated: November 20, 2007.</DATED>
                    <NAME>Emily H. Menashes,</NAME>
                    <TITLE>Acting Director, Office of Sustainable Fisheries, National Marine Fisheries Service.</TITLE>
                </SIG>
            </SUPLINF>
            <FRDOC>[FR Doc. 07-5844 Filed 11-21-07; 1:45 pm]</FRDOC>
            <BILCOD>BILLING CODE 3510-22-S</BILCOD>
        </RULE>
    </RULES>
    <VOL>72</VOL>
    <NO>227</NO>
    <DATE>Tuesday, November 27, 2007</DATE>
    <UNITNAME>Proposed Rules</UNITNAME>
    <PRORULES>
        <PRORULE>
            <PREAMB>
                <PRTPAGE P="66085"/>
                <AGENCY TYPE="F">DEPARTMENT OF TRANSPORTATION</AGENCY>
                <SUBAGY>Federal Aviation Administration</SUBAGY>
                <CFR>14 CFR Part 25</CFR>
                <DEPDOC>[Docket No. NM385; Notice No. 25-07-17-SC]</DEPDOC>
                <SUBJECT>Special Conditions: Boeing Model 757 Series Airplanes; Seats With Non-Traditional, Large, Non-Metallic Panels</SUBJECT>
                <AGY>
                    <HD SOURCE="HED">AGENCY:</HD>
                    <P>Federal Aviation Administration (FAA), DOT.</P>
                </AGY>
                <ACT>
                    <HD SOURCE="HED">ACTION:</HD>
                    <P>Notice of proposed special conditions.</P>
                </ACT>
                <SUM>
                    <HD SOURCE="HED">SUMMARY:</HD>
                    <P>This action proposes special conditions for Boeing Model 757 series airplanes. These airplanes, as modified by Triad International Maintenance Company (TIMCO), will have a novel or unusual design feature(s) associated with seats that include non-traditional, large, non-metallic panels that would affect survivability during a post-crash fire event. The applicable airworthiness regulations do not contain adequate or appropriate safety standards for this design feature. These proposed special conditions contain the additional safety standards that the Administrator considers necessary to establish a level of safety equivalent to that established by the existing airworthiness standards.</P>
                </SUM>
                <EFFDATE>
                    <HD SOURCE="HED">DATES:</HD>
                    <P>We must receive your comments by December 12, 2007.</P>
                </EFFDATE>
                <ADD>
                    <HD SOURCE="HED">ADDRESSES:</HD>
                    <P>You must mail two copies of your comments to: Federal Aviation Administration, Transport Airplane Directorate, Attn: Rules Docket (ANM-113), Docket No. NM385, 1601 Lind Avenue, SW., Renton, Washington 98057-3356. You may deliver two copies to the Transport Airplane Directorate at the above address. You must mark your comments: Docket No. NM385. You can inspect comments in the Rules Docket weekdays, except Federal holidays, between 7:30 a.m. and 4 p.m.</P>
                </ADD>
                <FURINF>
                    <HD SOURCE="HED">FOR FURTHER INFORMATION CONTACT:</HD>
                    <P>
                        Dan Jacquet, FAA, Airframe/Cabin Safety Branch, ANM-115, Transport Airplane Directorate, Aircraft Certification Service, 1601 Lind Avenue, SW., Renton, Washington 98057-3356; telephone (425) 227-2676; facsimile (425) 227-1232; electronic mail 
                        <E T="03">daniel.jacquet@faa.gov</E>
                        .
                    </P>
                </FURINF>
            </PREAMB>
            <SUPLINF>
                <HD SOURCE="HED">SUPPLEMENTARY INFORMATION:</HD>
                <HD SOURCE="HD1">Comments Invited</HD>
                <P>We invite interested people to take part in this rulemaking by sending written comments, data, or views. The most helpful comments reference a specific portion of the special conditions, explain the reason for any recommended change, and include supporting data. We ask that you send us two copies of written comments.</P>
                <P>
                    We will file in the docket all comments we receive, as well as a report summarizing each substantive public contact with FAA personnel concerning these special conditions. You can inspect the docket before and after the comment closing date. If you wish to review the docket in person, go to the address in the 
                    <E T="02">ADDRESSES</E>
                     section of this preamble between 9 a.m. and 5 p.m., Monday through Friday, except Federal holidays.
                </P>
                <P>We will consider all comments we receive on or before the closing date for comments. We will consider comments filed late if it is possible to do so without incurring expense or delay. We may change these special conditions based on the comments we receive.</P>
                <P>If you want the FAA to acknowledge receipt of your comments on this proposal, include with your comments a pre-addressed, stamped postcard on which the docket number appears. We will stamp the date on the postcard and mail it back to you.</P>
                <HD SOURCE="HD1">Background</HD>
                <P>On July 31, 2007, Triad International Maintenance Company (TIMCO), 623 Radar Road, Greensboro, North Carolina 27410, applied for a supplemental type certificate for installing seats that include non-traditional, large, non-metallic panels in a Boeing Model 757 series airplane. The Boeing Model 757 series airplanes, currently approved under Type Certificate No. A2NM, are swept-wing, conventional tail, twin-engine, turbofan-powered, single aisle, medium-sized transport category airplanes.</P>
                <P>The applicable regulations to airplanes currently approved under Type Certificate No. A2NM do not require seats to meet the more stringent flammability standards required of large, non-metallic panels in the cabin interior. At the time the applicable rules were written, seats were designed with a metal frame covered by fabric, not with large, non-metallic panels. Seats also met the then recently adopted standards for flammability of seat cushions. With the seat design being mostly fabric and metal, the contribution to a fire in the cabin had been minimized and was not considered a threat. For these reasons, seats did not need to be tested to heat release and smoke emission requirements.</P>
                <P>Seat designs have now evolved to occasionally include non-traditional, large, non-metallic panels. Taken in total, the surface area of these panels is on the same order as the sidewall and overhead stowage bin interior panels. To provide the level of passenger protection intended by the airworthiness standards, these non-traditional, large, non-metallic panels in the cabin must meet the standards of Title 14 Code of Federal Regulations (CFR), part 25, Appendix F, parts IV and V, heat release and smoke emission requirements.</P>
                <HD SOURCE="HD1">Type Certification Basis</HD>
                <P>Under the provisions of 14 CFR 21.101, TIMCO must show that the Boeing Model 757 series airplanes, as changed, continue to meet the applicable provisions of the regulations incorporated by reference in Type Certificate No. A2NM, or the applicable regulations in effect on the date of application for the change. The regulations incorporated by reference in the type certificate are commonly referred to as the “original type certification basis.” The regulations incorporated by reference in Type Certificate No. A2NM are as follows:</P>
                <P>• For Model 757-200 airplanes—part 25, as amended by Amendment 25-1 through Amendment 25-45. In addition, an equivalent safety finding exists with respect to § 25.853(c), Compartment interiors.</P>
                <P>• For Model 757-300 airplanes—part 25, as amended by Amendment 25-1 through Amendment 25-85 with the exception listed: Section 25.853(d)(3), Compartment interiors, at Amendment 25-72.</P>
                <P>
                    In addition, the certification basis includes certain special conditions, 
                    <PRTPAGE P="66086"/>
                    exemptions, or later amended sections of the applicable part that are not relevant to these proposed special conditions.
                </P>
                <P>If the Administrator finds that the applicable airworthiness regulations (i.e., part 25) do not contain adequate or appropriate safety standards for the Boeing Model 757 series airplanes because of a novel or unusual design feature, special conditions are prescribed under the provisions of § 21.16.</P>
                <P>In addition to the applicable airworthiness regulations and special conditions, the Boeing Model 757 series airplanes must comply with the fuel vent and exhaust emission requirements of 14 CFR part 34 and the noise certification requirements of 14 CFR part 36.</P>
                <P>The FAA issues special conditions, as defined in § 11.19, under § 11.38 and they become part of the type certification basis under § 21.101.</P>
                <P>Special conditions are initially applicable to the model for which they are issued. Should the applicant apply for a supplemental type certificate to modify any other model included on the same type certificate to incorporate the same or similar novel or unusual design feature, the special conditions would also apply to the other model under § 21.101.</P>
                <HD SOURCE="HD1">Novel or Unusual Design Features</HD>
                <P>The Boeing Model 757 series airplanes will incorporate the following novel or unusual design features: These models offer interior arrangements that include passenger seats that incorporate non-traditional, large, non-metallic panels in lieu of the traditional metal frame covered by fabric. The flammability properties of these panels have been shown to significantly affect the survivability of the cabin in the case of fire. These seats are considered a novel design for transport category airplanes that include Amendment 25-61 and Amendment 25-66 in the certification basis, and were not considered when those airworthiness standards were established.</P>
                <P>The existing regulations do not provide adequate or appropriate safety standards for seat designs that incorporate non-traditional, large, non-metallic panels in their designs. In order to provide a level of safety that is equivalent to that afforded to the balance of the cabin, additional airworthiness standards, in the form of special conditions, are necessary. These special conditions supplement § 25.853. The requirements contained in these special conditions consist of applying the identical test conditions required of all other large panels in the cabin, to seats with non-traditional, large, non-metallic panels.</P>
                <HD SOURCE="HD1">Definition of “Non-Traditional, Large, Non-Metallic Panel”</HD>
                <P>A non-traditional, large, non-metallic panel, in this case, is defined as a panel with exposed-surface areas greater than 1.5 square feet installed per seat place. The panel may consist of either a single component or multiple components in a concentrated area. Examples of parts of the seat where these non-traditional panels are installed include, but are not limited to: Seat backs, bottoms and leg/foot rests, kick panels, back shells, credenzas and associated furniture. Examples of traditional exempted parts of the seat include: Arm caps, armrest close-outs such as end bays and armrest-styled center consoles, food trays, video monitors, and shrouds.</P>
                <HD SOURCE="HD1">Clarification of “Exposed”</HD>
                <P>“Exposed” is considered to include panels that are directly exposed to the passenger cabin in the traditional sense, and panels that are enveloped, such as by a dress cover. Traditional fabrics or leathers currently used on seats are excluded from these special conditions. These materials must still comply with § 25.853(a) and § 25.853(c) if used as a covering for a seat cushion, or § 25.853(a) if installed elsewhere on the seat. Non-traditional, large, non-metallic panels covered with traditional fabrics or leathers will be tested without their coverings or covering attachments.</P>
                <HD SOURCE="HD1">Discussion</HD>
                <P>In the early 1980s the FAA conducted extensive research on the effects of post-crash flammability in the passenger cabin. As a result of this research and service experience, we adopted new standards for interior surfaces associated with large surface area parts. Specifically, the rules require measurement of heat release and smoke emission (part 25, Appendix F, parts IV and V) for the affected parts. Heat release has been shown to have a direct correlation with post-crash fire survival time. Materials that comply with the standards (i.e., § 25.853 entitled “Compartment interiors” as amended by Amendment 25-61 and Amendment 25-66) extend survival time by approximately 2 minutes over materials that do not comply.</P>
                <P>At the time these standards were written the potential application of the requirements of heat release and smoke emission to seats was explored. The seat frame itself was not a concern because it was primarily made of aluminum and there were only small amounts of non-metallic materials. It was determined that the overall effect on survivability was negligible, whether or not the food trays met the heat release and smoke requirements. The requirements therefore did not address seats. The preambles to both the Notice of Proposed Rule Making (NPRM), Notice No. 85-10 (50 FR 15038, April 16, 1985) and the Final Rule at Amendment 25-61 (51 FR 26206, July 21, 1986), specifically note that seats were excluded “because the recently-adopted standards for flammability of seat cushions will greatly inhibit involvement of the seats.”</P>
                <P>Subsequently, the Final Rule at Amendment 25-83 (60 FR 6615, March 6, 1995) clarified the definition of minimum panel size: “It is not possible to cite a specific size that will apply in all installations; however, as a general rule, components with exposed-surface areas of one square foot or less may be considered small enough that they do not have to meet the new standards. Components with exposed-surface areas greater than two square feet may be considered large enough that they do have to meet the new standards. Those with exposed-surface areas greater than one square foot, but less than two square feet, must be considered in conjunction with the areas of the cabin in which they are installed before a determination could be made.”</P>
                <P>
                    In the late 1990s, the FAA issued Policy Memorandum 97-112-39, 
                    <E T="03">Guidance for Flammability Testing of Seat/Console Installations</E>
                    , October 17, 1997 (
                    <E T="03">http://rgl.faa.gov</E>
                    ). That memo was issued when it became clear that seat designs were evolving to include large, non-metallic panels with surface areas that would impact survivability during a cabin fire event, comparable to partitions or galleys. The memo noted that large surface area panels must comply with heat release and smoke emission requirements, even if they were attached to a seat. If the FAA had not issued such policy, seat designs could have been viewed as a loophole to the airworthiness standards that would result in an unacceptable decrease in survivability during a cabin fire event.
                </P>
                <P>
                    In October of 2004, an issue was raised regarding the appropriate flammability standards for passenger seats that incorporated non-traditional, large, non-metallic panels in lieu of the traditional metal covered by fabric. The Seattle Aircraft Certification Office and Transport Standards Staff reviewed this design and determined that it represented the kind and quantity of material that should be required to pass the heat release and smoke emissions 
                    <PRTPAGE P="66087"/>
                    requirements. We have determined that special conditions would be promulgated to apply the standards defined in § 25.853(d) to seats with large, non-metallic panels in their design.
                </P>
                <HD SOURCE="HD1">Applicability</HD>
                <P>As discussed above, these special conditions are applicable to Boeing Model 757 series airplanes. It is not our intent, however, to require seats with large, non-metallic panels to meet § 25.853, Appendix F, parts IV and V, if they are installed in cabins of airplanes that otherwise are not required to meet these standards. Because the heat release and smoke testing requirements of § 25.853 per Appendix F, parts IV and V, are not part of the type certification basis of the Model 757, these special conditions are only applicable if the Model 757 series airplanes are in 14 CFR part 121 operations. Section 121.312 requires compliance with the heat release and smoke testing requirements of § 25.853, for certain airplanes, irrespective of the type certification bases of those airplanes. For Model 757 series airplanes, these are the airplanes that would be affected by these special conditions. Should TIMCO apply at a later date for a supplemental type certificate to modify any other model included on Type Certificate No. A2NM to incorporate the same novel or unusual design feature, the special conditions would apply to that model as well.</P>
                <HD SOURCE="HD1">Conclusion</HD>
                <P>This action affects only certain novel or unusual design features on one model series of airplanes. It is not a rule of general applicability and it affects only the applicant who applied to the FAA for approval of these features on the airplane.</P>
                <LSTSUB>
                    <HD SOURCE="HED">List of Subjects in 14 CFR Part 25</HD>
                    <P>Aircraft, Aviation safety, Reporting and recordkeeping requirements. </P>
                </LSTSUB>
                <P>The authority citation for these special conditions is as follows:</P>
                <AUTH>
                    <HD SOURCE="HED">Authority:</HD>
                    <P>49 U.S.C. 106(g), 40113, 44701, 44702, 44704.</P>
                </AUTH>
                <HD SOURCE="HD1">The Proposed Special Conditions</HD>
                <P>Accordingly, the Federal Aviation Administration (FAA) proposes the following special conditions as part of the type certification basis for Boeing Model 757 series airplanes modified by TIMCO.</P>
                <P>1. Except as provided in paragraph 3 of these special conditions, compliance with Title 14 CFR part 25, Appendix F, parts IV and V, heat release and smoke emission, is required for seats that incorporate non-traditional, large, non-metallic panels that may either be a single component or multiple components in a concentrated area in their design.</P>
                <P>2. The applicant may designate up to and including 1.5 square feet of non-traditional, non-metallic panel material per seat place that does not have to comply with special condition Number 1, above. A triple seat assembly may have a total of 4.5 square feet excluded on any portion of the assembly (e.g., outboard seat place 1 square foot, middle 1 square foot, and inboard 2.5 square feet).</P>
                <P>3. Seats do not have to meet the test requirements of Title 14 CFR part 25, Appendix F, parts IV and V, when installed in compartments that are not otherwise required to meet these requirements. Examples include: </P>
                <P>a. Airplanes with passenger capacities of 19 or less, </P>
                <P>b. Airplanes that do not have § 25.853, Amendment 25-61 or later, in their certification basis and do not need to comply with the requirements of 14 CFR § 121.312, and </P>
                <P>c. Airplanes exempted from § 25.853, Amendment 25-61 or later.</P>
                <SIG>
                    <DATED>Issued in Renton, Washington, on November 19, 2007.</DATED>
                    <NAME>Ali Bahrami,</NAME>
                    <TITLE>Manager, Transport Airplane Directorate, Aircraft Certification Service.</TITLE>
                </SIG>
            </SUPLINF>
            <FRDOC>[FR Doc. E7-23079 Filed 11-26-07; 8:45 am]</FRDOC>
            <BILCOD>BILLING CODE 4910-13-P</BILCOD>
        </PRORULE>
        <PRORULE>
            <PREAMB>
                <AGENCY TYPE="S">DEPARTMENT OF TRANSPORTATION </AGENCY>
                <SUBAGY>Federal Aviation Administration </SUBAGY>
                <CFR>14 CFR Part 39 </CFR>
                <DEPDOC>[Docket No. FAA-2007-0248; Directorate Identifier 2007-CE-084-AD] </DEPDOC>
                <RIN>RIN 2120-AA64 </RIN>
                <SUBJECT>Airworthiness Directives; British Aerospace Aircraft Group, Scottish Division, Model Beagle B.121 Series 1, 2, 3 Airplanes </SUBJECT>
                <AGY>
                    <HD SOURCE="HED">AGENCY:</HD>
                    <P>Federal Aviation Administration (FAA), Department of Transportation (DOT). </P>
                </AGY>
                <ACT>
                    <HD SOURCE="HED">ACTION:</HD>
                    <P>Notice of proposed rulemaking (NPRM). </P>
                </ACT>
                <SUM>
                    <HD SOURCE="HED">SUMMARY:</HD>
                    <P>We propose to adopt a new airworthiness directive (AD) for the products listed above. This proposed AD results from mandatory continuing airworthiness information (MCAI) originated by an aviation authority of another country to identify and correct an unsafe condition on an aviation product. The MCAI describes the unsafe condition as:</P>
                    <EXTRACT>
                        <P>The Type Certificate Holder (TCH) has received several reports of failed Rudder torque tube assemblies. The torque tube assemblies are subject to repetitive inspection in accordance Airworthiness Directive 2060 PRE 80. The recent failures occurred in service after the inspections required by AD 2060 PRE 80 had been performed. In the event of such failures, loss of directional control through both the Rudder and Nosewheel Steering may occur. The TCH has also received reports of loose rivets attaching the inboard Anchor Assembly to the Starboard Torque Tube.</P>
                    </EXTRACT>
                </SUM>
                <FP>The proposed AD would require actions that are intended to address the unsafe condition described in the MCAI. </FP>
                <EFFDATE>
                    <HD SOURCE="HED">DATES:</HD>
                    <P>We must receive comments on this proposed AD by December 27, 2007. </P>
                </EFFDATE>
                <ADD>
                    <HD SOURCE="HED">ADDRESSES:</HD>
                    <P>You may send comments by any of the following methods: </P>
                    <P>
                        • 
                        <E T="03">Federal eRulemaking Portal:</E>
                         Go to 
                        <E T="03">http://www.regulations.gov</E>
                        . Follow the instructions for submitting comments. 
                    </P>
                    <P>
                        • 
                        <E T="03">Fax:</E>
                         (202) 493-2251. 
                    </P>
                    <P>
                        • 
                        <E T="03">Mail:</E>
                         U.S. Department of Transportation, Docket Operations, M-30, West Building Ground Floor, Room W12-140, 1200 New Jersey Avenue, SE., Washington, DC 20590. 
                    </P>
                    <P>
                        • 
                        <E T="03">Hand Delivery:</E>
                         U.S. Department of Transportation, Docket Operations, M-30, West Building Ground Floor, Room W12-140, 1200 New Jersey Avenue, SE., Washington, DC 20590, between 9 a.m. and 5 p.m., Monday through Friday, except Federal holidays. 
                    </P>
                </ADD>
                <HD SOURCE="HD1">Examining the AD Docket </HD>
                <P>
                    You may examine the AD docket on the Internet at 
                    <E T="03">http://www.regulations.gov</E>
                    ; or in person at the Docket Management Facility between 9 a.m. and 5 p.m., Monday through Friday, except Federal holidays. The AD docket contains this proposed AD, the regulatory evaluation, any comments received, and other information. The street address for the Docket Office (telephone (800) 647-5527) is in the 
                    <E T="02">ADDRESSES</E>
                     section. Comments will be available in the AD docket shortly after receipt. 
                </P>
                <FURINF>
                    <HD SOURCE="HED">FOR FURTHER INFORMATION CONTACT:</HD>
                    <P>Taylor Martin, Aerospace Engineer, FAA, Small Airplane Directorate, 901 Locust, Room 301, Kansas City, Missouri 64106; telephone: (816) 329-4138; fax: (816) 329-4090. </P>
                </FURINF>
            </PREAMB>
            <SUPLINF>
                <HD SOURCE="HED">SUPPLEMENTARY INFORMATION:</HD>
                <P/>
                <HD SOURCE="HD1">Comments Invited </HD>
                <P>
                    We invite you to send any written relevant data, views, or arguments about this proposed AD. Send your comments 
                    <PRTPAGE P="66088"/>
                    to an address listed under the 
                    <E T="02">ADDRESSES</E>
                     section. Include “Docket No. FAA-2007-****; Directorate Identifier 2007-CE-084-AD” at the beginning of your comments. We specifically invite comments on the overall regulatory, economic, environmental, and energy aspects of this proposed AD. We will consider all comments received by the closing date and may amend this proposed AD because of those comments. 
                </P>
                <P>
                    We will post all comments we receive, without change, to 
                    <E T="03">http://www.regulations.gov</E>
                    , including any personal information you provide. We will also post a report summarizing each substantive verbal contact we receive about this proposed AD. 
                </P>
                <HD SOURCE="HD1">Discussion </HD>
                <P>The United Kingdom Civil Aviation Authority, which is the aviation authority for United Kingdom, has issued AD No: G-2005-0030, dated October 12, 2005 (referred to after this as “the MCAI”), to correct an unsafe condition for the specified products. The MCAI states:</P>
                <EXTRACT>
                    <P>The Type Certificate Holder (TCH) has received several reports of failed Rudder torque tube assemblies. The torque tube assemblies are subject to repetitive inspection in accordance Airworthiness Directive 2060 PRE 80. The recent failures occurred in service after the inspections required by AD 2060 PRE 80 had been performed. In the event of such failures, loss of directional control through both the Rudder and Nosewheel Steering may occur. The TCH has also received reports of loose rivets attaching the inboard Anchor Assembly to the Starboard Torque Tube.</P>
                </EXTRACT>
                <P>The MCAI requires the inspection of the rudder torque tube assemblies and hubs for cracking and loose rivets with conditional correction or replacement following de Havilland Support Limited Service Bulletin B121/65, Issue 2, dated August 10, 2005. </P>
                <P>You may obtain further information by examining the MCAI in the AD docket. </P>
                <HD SOURCE="HD1">Relevant Service Information </HD>
                <P>De Havilland Support Limited has issued Service Bulletin No. B121/65, Issue 2, dated August 10, 2005. The actions described in this service information are intended to correct the unsafe condition identified in the MCAI. </P>
                <HD SOURCE="HD1">FAA's Determination and Requirements of the Proposed AD </HD>
                <P>This product has been approved by the aviation authority of another country, and is approved for operation in the United States. Pursuant to our bilateral agreement with this State of Design Authority, they have notified us of the unsafe condition described in the MCAI and service information referenced above. We are proposing this AD because we evaluated all information and determined the unsafe condition exists and is likely to exist or develop on other products of the same type design. </P>
                <HD SOURCE="HD1">Differences Between This Proposed AD and the MCAI or Service Information </HD>
                <P>We have reviewed the MCAI and related service information and, in general, agree with their substance. But we might have found it necessary to use different words from those in the MCAI to ensure the AD is clear for U.S. operators and is enforceable. In making these changes, we do not intend to differ substantively from the information provided in the MCAI and related service information. </P>
                <P>We might also have proposed different actions in this AD from those in the MCAI in order to follow FAA policies. Any such differences are highlighted in a NOTE within the proposed AD. </P>
                <HD SOURCE="HD1">Costs of Compliance </HD>
                <P>Based on the service information, we estimate that this proposed AD would affect about 1 product of U.S. registry. We also estimate that it would take about 1 work-hour per product to comply with the basic requirements of this proposed AD. The average labor rate is $80 per work-hour. </P>
                <P>Based on these figures, we estimate the cost of the proposed AD on U.S. operators to be $80, or $80 per product. </P>
                <P>In addition, we estimate that any necessary follow-on actions would take about 12 work-hours and require parts costing $10,000 for a cost of $10,960 per product. </P>
                <HD SOURCE="HD1">Authority for This Rulemaking </HD>
                <P>Title 49 of the United States Code specifies the FAA's authority to issue rules on aviation safety. Subtitle I, section 106, describes the authority of the FAA Administrator. “Subtitle VII: Aviation Programs,” describes in more detail the scope of the Agency's authority. </P>
                <P>We are issuing this rulemaking under the authority described in “Subtitle VII, Part A, Subpart III, Section 44701: General requirements.” Under that section, Congress charges the FAA with promoting safe flight of civil aircraft in air commerce by prescribing regulations for practices, methods, and procedures the Administrator finds necessary for safety in air commerce. This regulation is within the scope of that authority because it addresses an unsafe condition that is likely to exist or develop on products identified in this rulemaking action. </P>
                <HD SOURCE="HD1">Regulatory Findings </HD>
                <P>We determined that this proposed AD would not have federalism implications under Executive Order 13132. This proposed AD would not have a substantial direct effect on the States, on the relationship between the national Government and the States, or on the distribution of power and responsibilities among the various levels of government. </P>
                <P>For the reasons discussed above, I certify this proposed regulation:</P>
                <P>1. Is not a “significant regulatory action” under Executive Order 12866; </P>
                <P>2. Is not a “significant rule” under the DOT Regulatory Policies and Procedures (44 FR 11034, February 26, 1979); and </P>
                <P>3. Will not have a significant economic impact, positive or negative, on a substantial number of small entities under the criteria of the Regulatory Flexibility Act. </P>
                <P>We prepared a regulatory evaluation of the estimated costs to comply with this proposed AD and placed it in the AD docket. </P>
                <LSTSUB>
                    <HD SOURCE="HED">List of Subjects in 14 CFR Part 39 </HD>
                    <P>Air transportation, Aircraft, Aviation safety, Safety.</P>
                </LSTSUB>
                <HD SOURCE="HD1">The Proposed Amendment </HD>
                <P>Accordingly, under the authority delegated to me by the Administrator, the FAA proposes to amend 14 CFR part 39 as follows: </P>
                <PART>
                    <HD SOURCE="HED">PART 39—AIRWORTHINESS DIRECTIVES </HD>
                    <P>1. The authority citation for part 39 continues to read as follows: </P>
                    <AUTH>
                        <HD SOURCE="HED">Authority:</HD>
                        <P>49 U.S.C. 106(g), 40113, 44701. </P>
                    </AUTH>
                    <SECTION>
                        <SECTNO>§ 39.13 </SECTNO>
                        <SUBJECT>[Amended] </SUBJECT>
                        <P>2. The FAA amends § 39.13 by adding the following new AD:</P>
                        <EXTRACT>
                            <FP SOURCE="FP-2">
                                <E T="04">British Aerospace (Scotland):</E>
                                 Docket No. FAA-2007-0248; Directorate Identifier 2007-CE-084-AD. 
                            </FP>
                            <HD SOURCE="HD1">Comments Due Date </HD>
                            <P>(a) We must receive comments by December 27, 2007. </P>
                            <HD SOURCE="HD1">Affected ADs </HD>
                            <P>(b) None. </P>
                            <HD SOURCE="HD1">Applicability </HD>
                            <P>(c) This AD applies to Beagle B.121 Series 1, 2, 3 airplanes, all serial numbers, certificated in any category. </P>
                            <HD SOURCE="HD1">Subject </HD>
                            <P>
                                (d) Air Transport Association of America (ATA) Code 27: Flight Controls. 
                                <PRTPAGE P="66089"/>
                            </P>
                            <HD SOURCE="HD1">Reason </HD>
                            <P>(e) The mandatory continuing airworthiness information (MCAI) states: </P>
                            <P>The Type Certificate Holder (TCH) has received several reports of failed Rudder torque tube assemblies. The torque tube assemblies are subject to repetitive inspection in accordance Airworthiness Directive 2060 PRE 80. The recent failures occurred in service after the inspections required by AD 2060 PRE 80 had been performed. In the event of such failures, loss of directional control through both the Rudder and Nosewheel Steering may occur. The TCH has also received reports of loose rivets attaching the inboard Anchor Assembly to the Starboard Torque Tube. </P>
                            <FP>The MCAI requires the inspection of the rudder torque tube assemblies and hubs for cracking and loose rivets with conditional correction or replacement in accordance with de Havilland Support Limited Service Bulletin B121/65, Issue 2, dated August 10, 2005. </FP>
                            <HD SOURCE="HD1">Actions and Compliance </HD>
                            <P>(f) Unless already done, do the following actions: </P>
                            <P>(1) Within 100 hours time-in-service (TIS) after the effective date of this AD and thereafter at intervals not to exceed 100 hours TIS, inspect the Rudder Torque Tube Assemblies following de Havilland Support Limited Service Bulletin B121/65, Issue 2, dated August 10, 2005. </P>
                            <P>(2) Before further flight, replace any cracked Rudder Torque Tube Assemblies and correct any loose rivets in the Rudder Torque Tube Assemblies that are found in the inspections required in paragraph (f)(1) of this AD, following de Havilland Support Limited Service Bulletin B121/65, Issue 2, dated August 10, 2005. </P>
                            <P>(3) After the effective date of this AD, used rudder torque assemblies held as spares for British Aerospace Aircraft Group, Scottish Division, Model Beagle B.121 Series 1, 2, 3 airplanes must be inspected following de Havilland Support Limited Service Bulletin B121/65, Issue 2, dated August 10, 2005, and found free of cracks prior to installation. </P>
                            <HD SOURCE="HD1">FAA AD Differences </HD>
                            <NOTE>
                                <HD SOURCE="HED">Note:</HD>
                                <P>This AD differs from the MCAI and/or service information as follows: No differences.</P>
                            </NOTE>
                            <HD SOURCE="HD1">Other FAA AD Provisions </HD>
                            <P>(g) The following provisions also apply to this AD: </P>
                            <P>
                                (1) 
                                <E T="03">Alternative Methods of Compliance (AMOCs):</E>
                                 The Manager, Standards Office, FAA, has the authority to approve AMOCs for this AD, if requested using the procedures found in 14 CFR 39.19. Send information to ATTN: Taylor Martin, Aerospace Engineer, FAA, Small Airplane Directorate, 901 Locust, Room 301, Kansas City, Missouri 64106; telephone: (816) 329-4138; fax: (816) 329-4090. Before using any approved AMOC on any airplane to which the AMOC applies, notify your appropriate principal inspector (PI) in the FAA Flight Standards District Office (FSDO), or lacking a PI, your local FSDO. 
                            </P>
                            <P>
                                (2) 
                                <E T="03">Airworthy Product:</E>
                                 For any requirement in this AD to obtain corrective actions from a manufacturer or other source, use these actions if they are FAA-approved. Corrective actions are considered FAA-approved if they are approved by the State of Design Authority (or their delegated agent). You are required to assure the product is airworthy before it is returned to service. 
                            </P>
                            <P>
                                (3) 
                                <E T="03">Reporting Requirements:</E>
                                 For any reporting requirement in this AD, under the provisions of the Paperwork Reduction Act (44 U.S.C. 3501 et seq.), the Office of Management and Budget (OMB) has approved the information collection requirements and has assigned OMB Control Number 2120-0056. 
                            </P>
                            <HD SOURCE="HD1">Related Information </HD>
                            <P>(h) Refer to MCAI United Kingdom Civil Aviation Authority AD No:  G-2005-0030, dated October 12, 2005; and de Havilland Support Limited Service Bulletin B121/65, Issue 2, dated August 10, 2005, for related information. </P>
                        </EXTRACT>
                    </SECTION>
                    <SIG>
                        <DATED>Issued in Kansas City, Missouri, on November 20, 2007. </DATED>
                        <NAME>Kim Smith, </NAME>
                        <TITLE>Manager, Small Airplane Directorate, Aircraft Certification Service.</TITLE>
                    </SIG>
                </PART>
            </SUPLINF>
            <FRDOC> [FR Doc. E7-23025 Filed 11-26-07; 8:45 am] </FRDOC>
            <BILCOD>BILLING CODE 4910-13-P </BILCOD>
        </PRORULE>
        <PRORULE>
            <PREAMB>
                <AGENCY TYPE="S">DEPARTMENT OF TRANSPORTATION</AGENCY>
                <SUBAGY>Federal Aviation Administration</SUBAGY>
                <CFR>14 CFR Part 39</CFR>
                <DEPDOC>[Docket No. FAA-2007-0249; Directorate Identifier 2007-CE-088-AD]</DEPDOC>
                <RIN>RIN 2120-AA64</RIN>
                <SUBJECT>Airworthiness Directives; Alpha Aviation Design Limited Model R2160 Airplanes</SUBJECT>
                <AGY>
                    <HD SOURCE="HED">AGENCY:</HD>
                    <P>Federal Aviation Administration (FAA), Department of Transportation (DOT).</P>
                </AGY>
                <ACT>
                    <HD SOURCE="HED">ACTION:</HD>
                    <P>Notice of proposed rulemaking (NPRM).</P>
                </ACT>
                <SUM>
                    <HD SOURCE="HED">SUMMARY:</HD>
                    <P>We propose to adopt a new airworthiness directive (AD) for the products listed above that would supersede an existing AD. This proposed AD results from mandatory continuing airworthiness information (MCAI) originated by an aviation authority of another country to identify and correct an unsafe condition on an aviation product. The MCAI describes the unsafe condition as distortion of the rudder bars due to rudder control forces during aerobatic operation and nose wheel steering reaction forces. Rudder bar distortion could result in reduced control or loss of control. The proposed AD would require actions that are intended to address the unsafe condition described in the MCAI.</P>
                </SUM>
                <DATES>
                    <HD SOURCE="HED">DATES:</HD>
                    <P>We must receive comments on this proposed AD by December 27, 2007.</P>
                </DATES>
                <ADD>
                    <HD SOURCE="HED">ADDRESSES:</HD>
                    <P>You may send comments by any of the following methods:</P>
                    <P>
                        • 
                        <E T="03">Federal eRulemaking Portal:</E>
                         Go to 
                        <E T="03">http://www.regulations.gov.</E>
                         Follow the instructions for submitting comments.
                    </P>
                    <P>
                        • 
                        <E T="03">Fax:</E>
                         (202) 493-2251.
                    </P>
                    <P>
                        • 
                        <E T="03">Mail:</E>
                         U.S. Department of Transportation, Docket Operations, M-30, West Building Ground Floor, Room W12-140, 1200 New Jersey Avenue, SE., Washington, DC 20590.
                    </P>
                    <P>
                        • 
                        <E T="03">Hand Delivery:</E>
                         U.S. Department of Transportation, Docket Operations, M-30, West Building Ground Floor, Room W12-140, 1200 New Jersey Avenue, SE., Washington, DC 20590, between 9 a.m. and 5 p.m., Monday through Friday, except Federal holidays.
                    </P>
                </ADD>
                <HD SOURCE="HD1">Examining the AD Docket</HD>
                <P>
                    You may examine the AD docket on the Internet at 
                    <E T="03">http://www.regulations.gov;</E>
                     or in person at the Docket Management Facility, U.S. Department of Transportation, Docket Operations, M-30, West Building Ground Floor, Room W12-140, 1200 New Jersey Avenue, SE., Washington, DC 20590.
                </P>
                <P>
                    Docket Management Facility between 9 a.m. and 5 p.m., Monday through Friday, except Federal holidays. The AD docket contains this proposed AD, the regulatory evaluation, any comments received, and other information. The street address for the Docket Office (telephone (800) 647-5527) is in the 
                    <E T="02">ADDRESSES</E>
                     section. Comments will be available in the AD docket shortly after receipt.
                </P>
                <FURINF>
                    <HD SOURCE="HED">FOR FURTHER INFORMATION CONTACT:</HD>
                    <P>Karl Schletzbaum, Aerospace Engineer, FAA, Small Airplane Directorate, 901 Locust, Room 301, Kansas City, Missouri 64106; telephone: (816) 329-4146; fax: (816) 329-4090.</P>
                </FURINF>
            </PREAMB>
            <SUPLINF>
                <HD SOURCE="HED">SUPPLEMENTARY INFORMATION:</HD>
                <P/>
                <HD SOURCE="HD1">Comments Invited</HD>
                <P>
                    We invite you to send any written relevant data, views, or arguments about this proposed AD. Send your comments to an address listed under the 
                    <E T="02">ADDRESSES</E>
                     section. Include “Docket No. FAA-2007-0249; Directorate Identifier 2007-CE-088-AD” at the beginning of your comments. We specifically invite comments on the overall regulatory, economic, environmental, and energy aspects of this proposed AD. We will consider all comments received by the closing date and may amend this 
                    <PRTPAGE P="66090"/>
                    proposed AD because of those comments.
                </P>
                <P>
                    We will post all comments we receive, without change, to 
                    <E T="03">http://regulations.gov,</E>
                     including any personal information you provide. We will also post a report summarizing each substantive verbal contact we receive about this proposed AD.
                </P>
                <HD SOURCE="HD1">Discussion</HD>
                <P>In 1987, we issued AD 87-08-01, Amendment 39-5601, and in 1999, we issued AD 99-01-04, Amendment 39-10971. Those two ADs required actions intended to address an unsafe condition on the products listed above.</P>
                <P>We since determined that it is necessary to expand the airplane applicability of AD 99-01-04 to require rudder bar replacement on Alpha Aviation Design Limited Model R2160 airplanes, serial numbers 1 through 378. The requirement to replace the rudder bars makes the inspection requirement of AD 87-08-01 no longer necessary.</P>
                <P>The Civil Aviation Authority, which is the aviation authority for New Zealand, has issued AD DCA/R2000/23B, dated October 25, 2007 (referred to after this as “the MCAI”), to correct an unsafe condition for the specified products. The MCAI states that rudder control forces during aerobatic operation and nose wheel steering reaction forces may cause rudder bar distortion. Rudder bar distortion could result in reduced control or loss of control.</P>
                <P>The MCAI requires you to replace the left and right rudder bars with reinforced rudder bars.</P>
                <P>You may obtain further information by examining the MCAI in the AD docket.</P>
                <HD SOURCE="HD1">Relevant Service Information</HD>
                <P>Alpha Aviation has issued Service Bulletin AA-SB-27-003, dated October 19, 2007. The actions described in this service information are intended to correct the unsafe condition identified in the MCAI.</P>
                <HD SOURCE="HD1">FAA's Determination and Requirements of the Proposed AD</HD>
                <P>This product has been approved by the aviation authority of another country, and is approved for operation in the United States. Pursuant to our bilateral agreement with this State of Design Authority, they have notified us of the unsafe condition described in the MCAI and service information referenced above. We are proposing this AD because we evaluated all information and determined the unsafe condition exists and is likely to exist or develop on other products of the same type design.</P>
                <HD SOURCE="HD1">Differences Between This Proposed AD and the MCAI or Service Information</HD>
                <P>We have reviewed the MCAI and related service information and, in general, agree with their substance. But we might have found it necessary to use different words from those in the MCAI to ensure the AD is clear for U.S. operators and is enforceable. In making these changes, we do not intend to differ substantively from the information provided in the MCAI and related service information.</P>
                <P>We might also have proposed different actions in this AD from those in the MCAI in order to follow FAA policies. Any such differences are highlighted in a NOTE within the proposed AD.</P>
                <HD SOURCE="HD1">Costs of Compliance</HD>
                <P>Based on the service information, we estimate that this proposed AD would affect about 9 products of U.S. registry. We also estimate that it would take about 3 work-hours per product to comply with the basic requirements of this proposed AD. The average labor rate is $80 per work-hour. Required parts would cost about $657 per product.</P>
                <P>Based on these figures, we estimate the cost of the proposed AD on U.S. operators to be $8,073, or $897 per product.</P>
                <HD SOURCE="HD1">Authority for This Rulemaking</HD>
                <P>Title 49 of the United States Code specifies the FAA's authority to issue rules on aviation safety. Subtitle I, section 106, describes the authority of the FAA Administrator. “Subtitle VII: Aviation Programs,” describes in more detail the scope of the Agency's authority.</P>
                <P>We are issuing this rulemaking under the authority described in “Subtitle VII, Part A, Subpart III, Section 44701: General requirements.” Under that section, Congress charges the FAA with promoting safe flight of civil aircraft in air commerce by prescribing regulations for practices, methods, and procedures the Administrator finds necessary for safety in air commerce. This regulation is within the scope of that authority because it addresses an unsafe condition that is likely to exist or develop on products identified in this rulemaking action.</P>
                <HD SOURCE="HD1">Regulatory Findings</HD>
                <P>We determined that this proposed AD would not have federalism implications under Executive Order 13132. This proposed AD would not have a substantial direct effect on the States, on the relationship between the national Government and the States, or on the distribution of power and responsibilities among the various levels of government.</P>
                <P>For the reasons discussed above, I certify this proposed regulation:</P>
                <P>1. Is not a “significant regulatory action” under Executive Order 12866;</P>
                <P>2. Is not a “significant rule” under the DOT Regulatory Policies and Procedures (44 FR 11034, February 26, 1979); and</P>
                <P>3. Will not have a significant economic impact, positive or negative, on a substantial number of small entities under the criteria of the Regulatory Flexibility Act.</P>
                <P>We prepared a regulatory evaluation of the estimated costs to comply with this proposed AD and placed it in the AD docket.</P>
                <LSTSUB>
                    <HD SOURCE="HED">List of Subjects in 14 CFR Part 39</HD>
                    <P>Air transportation, Aircraft, Aviation safety, Safety.</P>
                </LSTSUB>
                <HD SOURCE="HD1">The Proposed Amendment</HD>
                <P>Accordingly, under the authority delegated to me by the Administrator, the FAA proposes to amend 14 CFR part 39 as follows:</P>
                <PART>
                    <HD SOURCE="HED">PART 39—AIRWORTHINESS DIRECTIVES</HD>
                    <P>1. The authority citation for part 39 continues to read as follows:</P>
                    <AUTH>
                        <HD SOURCE="HED">Authority:</HD>
                        <P>49 U.S.C. 106(g), 40113, 44701.</P>
                    </AUTH>
                    <SECTION>
                        <SECTNO>§ 39.13 </SECTNO>
                        <SUBJECT>[Amended]</SUBJECT>
                        <P>2. The FAA amends § 39.13 by removing Amendment 39-5601 and Amendment 39-10971, and adding the following new AD:</P>
                        <EXTRACT>
                            <FP SOURCE="FP-2">
                                <E T="04">Alpha Aviation Design Limited:</E>
                                 Docket No. FAA-2007-0249; Directorate Identifier 2007-CE-088-AD.
                            </FP>
                            <HD SOURCE="HD1">Comments Due Date</HD>
                            <P>(a) We must receive comments by December 27, 2007.</P>
                            <HD SOURCE="HD1">Affected ADs</HD>
                            <P>(b) This AD supersedes AD 87-08-01, Amendment 39-5601; and AD 99-01-04, Amendment 39-10971.</P>
                            <HD SOURCE="HD1">Applicability</HD>
                            <P>(c) This AD applies to Model R2160 airplanes, serial numbers 1 through 378, that:</P>
                            <P>(1) Are certificated in any category; and</P>
                            <P>(2) Have not installed the improved design rudder bars part number (P/N) 27.40.31.010 and P/N 27.40.31.020 following either Avions Pierre Robin Service Bulletin No. 143, dated September 8, 1995, or Alpha Aviation Service Bulletin AA-SB-27-003, dated October 19, 2007.</P>
                            <HD SOURCE="HD1">Subject</HD>
                            <P>
                                (d) Air Transport Association of America (ATA) Code 27: Flight Controls.
                                <PRTPAGE P="66091"/>
                            </P>
                            <HD SOURCE="HD1">Reason</HD>
                            <P>(e) The mandatory continuing airworthiness information (MCAI) states that rudder control forces during aerobatic operation and nose wheel steering reaction forces may cause rudder bar distortion. Rudder bar distortion could result in reduced or loss of control. The MCAI requires you to replace the left and right rudder bars with reinforced rudder bars.</P>
                            <HD SOURCE="HD1">Restatement of Requirements of AD 99-01-04</HD>
                            <P>(f) For airplanes with serial numbers 250 through 378: Unless already done, within the next 50 hours time-in-service (TIS) after March 12, 1999 (the effective date of AD 99-01-04) replace the left and right rudder bars, part number (P/N) 27.23.01.010 (left) and P/N 27.23.01.020 (right), with the reinforced rudder bars, P/N 27.40.31.010 (left) and P/N 27.40.31.020 (right) or FAA-equivalent part numbers, following Alpha Aviation Service Bulletin AA-SB-27-003, dated October 19, 2007.</P>
                            <HD SOURCE="HD1">New Requirements of This AD: Actions and Compliance</HD>
                            <P>(g) For airplanes with serial numbers 1 through 249: Unless already done, within the next 50 hours TIS after the effective date of this AD or within the next 3 months after the effective date of this AD, whichever occurs first, replace the left and right rudder bars, P/N 27.23.05.010 (left) and P/N 27.23.05.020 (right), with the reinforced rudder bars, P/N 27.40.31.010 (left) and P/N 27.40.31.020 (right) or FAA-equivalent part numbers, following Alpha Aviation Service Bulletin AA-SB-27-003, dated October 19, 2007.</P>
                            <HD SOURCE="HD1">FAA AD Differences</HD>
                            <NOTE>
                                <HD SOURCE="HED">Note:</HD>
                                <P>This AD differs from the MCAI and/or service information as follows: No differences.</P>
                            </NOTE>
                            <HD SOURCE="HD1">Other FAA AD Provisions</HD>
                            <P>(h) The following provisions also apply to this AD:</P>
                            <P>
                                (1) 
                                <E T="03">Alternative Methods of Compliance (AMOCs):</E>
                                 The Manager, Standards Office, FAA, has the authority to approve AMOCs for this AD, if requested using the procedures found in 14 CFR 39.19. Send information to ATTN: Karl Schletzbaum, Aerospace Engineer, FAA, Small Airplane Directorate, 901 Locust, Room 301, Kansas City, Missouri 64106; telephone: (816) 329-4146; fax: (816) 329-4090. Before using any approved AMOC on any airplane to which the AMOC applies, notify your appropriate principal inspector (PI) in the FAA Flight Standards District Office (FSDO), or lacking a PI, your local FSDO.
                            </P>
                            <P>
                                (2) 
                                <E T="03">Airworthy Product:</E>
                                 For any requirement in this AD to obtain corrective actions from a manufacturer or other source, use these actions if they are FAA-approved. Corrective actions are considered FAA-approved if they are approved by the State of Design Authority (or their delegated agent). You are required to assure the product is airworthy before it is returned to service.
                            </P>
                            <P>
                                (3) 
                                <E T="03">Reporting Requirements:</E>
                                 For any reporting requirement in this AD, under the provisions of the Paperwork Reduction Act (44 U.S.C. 3501 et seq.), the Office of Management and Budget (OMB) has approved the information collection requirements and has assigned OMB Control Number 2120-0056.
                            </P>
                            <HD SOURCE="HD1">Related Information</HD>
                            <P>(i) Refer to New Zealand Civil Aviation Authority AD DCA/R2000/23B, dated October 25, 2007; and Alpha Aviation Service Bulletin AA-SB-27-003, dated October 19, 2007, for related information.</P>
                        </EXTRACT>
                    </SECTION>
                    <SIG>
                        <DATED>Issued in Kansas City, Missouri, on November 20, 2007.</DATED>
                        <NAME>Kim Smith,</NAME>
                        <TITLE>Manager, Small Airplane Directorate, Aircraft Certification Service.</TITLE>
                    </SIG>
                </PART>
            </SUPLINF>
            <FRDOC>[FR Doc. E7-23017 Filed 11-26-07; 8:45 am]</FRDOC>
            <BILCOD>BILLING CODE 4910-13-P</BILCOD>
        </PRORULE>
        <PRORULE>
            <PREAMB>
                <AGENCY TYPE="N">FEDERAL TRADE COMMISSION </AGENCY>
                <CFR>16 CFR Part 260 </CFR>
                <SUBJECT>Guides for the Use of Environmental Marketing Claims </SUBJECT>
                <AGY>
                    <HD SOURCE="HED">AGENCY:</HD>
                    <P>Federal Trade Commission. </P>
                </AGY>
                <ACT>
                    <HD SOURCE="HED">ACTION:</HD>
                    <P>Request for public comment; announcement of public meetings. </P>
                </ACT>
                <SUM>
                    <HD SOURCE="HED">SUMMARY:</HD>
                    <P>The Federal Trade Commission (“FTC” or “Commission”) requests public comment on its Guides for the Use of Environmental Marketing Claims (“Green Guides” or “Guides”). The Commission is soliciting comment as part of its systematic review of all current FTC rules and guides. The Commission also is announcing plans to host public meetings to explore developments in environmental and “green energy-related” marketing. </P>
                </SUM>
                <EFFDATE>
                    <HD SOURCE="HED">DATES:</HD>
                    <P>
                        Written comments relating to the Green Guides review must be received by February 11, 2008. The first public meeting, “Carbon Offsets and Renewable Energy Certificates,” will be held on January 8, 2008 in Washington, DC. Details, including location and registration information, are set forth in a separate 
                        <E T="04">Federal Register</E>
                         notice published concurrently. The Commission plans to announce additional environmental marketing public meetings at later dates. 
                    </P>
                </EFFDATE>
                <ADD>
                    <HD SOURCE="HED">ADDRESSES:</HD>
                    <P>
                        Interested parties are invited to submit written comments relating to the Green Guides review. Comments should refer to “Green Guides Regulatory Review, 16 CFR part 260, Comment, Project No. P954501” to facilitate organization of comments. A comment filed in paper form should include this reference both in the text and on the envelope, and should be mailed or delivered to the following address: Federal Trade Commission/Office of the Secretary, Room H-135 (Annex B), 600 Pennsylvania Avenue, NW., Washington, DC 20580. Comments containing confidential material must be filed in paper form, must be clearly labeled “Confidential”, and must comply with Commission Rule 4.9(c).
                        <SU>1</SU>
                        <FTREF/>
                         The FTC is requesting that any comment filed in paper form be sent by courier or overnight service, if possible, because postal mail in the Washington area and at the Commission is subject to delay due to heightened security precautions. 
                    </P>
                    <FTNT>
                        <P>
                            <SU>1</SU>
                             The comment must be accompanied by an explicit request for confidential treatment, including the factual and legal basis for the request, and must identify the specific portions of the comment to be withheld from the public record. The request will be granted or denied by the Commission's General Counsel, consistent with applicable law and the public interest. 
                            <E T="03">See</E>
                             Commission Rule 4.9(C), 16 CFR 4.9(c).
                        </P>
                    </FTNT>
                    <P>
                        Comments filed in electronic form should be submitted by following the instructions on the web-based form at 
                        <E T="03">https://secure.commentworks.com/ftc-GreenGuidesReview.</E>
                         To ensure that the Commission considers an electronic comment, you must file it on that web-based form. You may also visit 
                        <E T="03">http://www.regulations.gov</E>
                         to read this notice, and may file an electronic comment through that Web site. The Commission will consider all comments that 
                        <E T="03">www.regulations.gov</E>
                         forwards to it. 
                    </P>
                    <P>
                        The FTC Act and other laws the Commission administers permit the collection of public comments to consider and use in this proceeding as appropriate. The Commission will consider all timely and responsive public comments that it receives, whether filed in paper or electronic form. Comments received will be available to the public on the FTC Web site, to the extent practicable, at 
                        <E T="03">http://www.ftc.gov.</E>
                         As a matter of discretion, the FTC makes every effort to remove home contact information for individuals from the public comments it receives before placing those comments on the FTC Web site. To read our policy on how we handle the information you submit—including routine uses permitted by the Privacy Act—please review the FTC's privacy policy, at 
                        <E T="03">http://www.ftc.gov/ftc/privacy.shtm.</E>
                    </P>
                </ADD>
                <FURINF>
                    <HD SOURCE="HED">FOR FURTHER INFORMATION CONTACT:</HD>
                    <P>Janice Podoll Frankle, Attorney, 202-326-3022, or Laura Koss, Attorney, 202-326-2890, Division of Enforcement, Bureau of Consumer Protection, Federal Trade Commission. </P>
                </FURINF>
            </PREAMB>
            <SUPLINF>
                <HD SOURCE="HED">SUPPLEMENTARY INFORMATION:</HD>
                <HD SOURCE="HD1">I. Background </HD>
                <P>
                    The Commission issued the Green Guides, 16 CFR part 260, to help marketers avoid making environmental 
                    <PRTPAGE P="66092"/>
                    claims that are unfair or deceptive under Section 5 of the FTC Act, 15 U.S.C. 45.
                    <SU>2</SU>
                    <FTREF/>
                     Industry guides, such as these, are administrative interpretations of the law. Therefore, they do not have the force and effect of law and are not independently enforceable. The Commission can take action under the FTC Act, however, if a business makes environmental marketing claims inconsistent with the Guides. In any such enforcement action, the Commission must prove that the act or practice at issue is unfair or deceptive. 
                </P>
                <FTNT>
                    <P>
                        <SU>2</SU>
                         The Commission issued the Green Guides in 1992, 57 FR 36363, and subsequently revised them in 1996 (61 FR 53311) and 1998 (63 FR 24240). The FTC also administers other rules and guides in the environmental and energy areas, pursuant to several federal statutes including the FTC Act. 
                        <E T="03">See</E>
                         Guide Concerning Fuel Economy Advertising for New Automobiles (16 CFR part 259), Appliance Labeling Rule (16 CFR part 305), Fuel Rating Rule (16 CFR part 306), Alternative Fuel Vehicles Rule (16 CFR part 309), Recycled Oil Rule (16 CFR part 311), and Labeling and Advertising of Home Insulation Rule (the “R-Value” Rule) (16 CFR part 460).
                    </P>
                </FTNT>
                <P>The Green Guides outline general principles that apply to all environmental marketing claims and then provide guidance regarding specific environmental claims. For all claims, the Guides advise: That qualifications and disclosures be sufficiently clear and prominent to prevent deception; that marketers make clear whether their claims apply to the product, the package, or a component of either; that claims not overstate an environmental attribute or benefit, expressly or by implication; and that marketers present comparative claims in a manner that makes the basis for the comparison sufficiently clear to avoid consumer deception. </P>
                <P>
                    The Guides then specifically address: general environmental benefit claims, such as “environmentally friendly”; degradable claims; compostable claims; recyclable claims; recycled content claims; source reduction claims; refillable claims; and ozone safe/ozone friendly claims. For each of these claims, the Green Guides explain how reasonable consumers are likely to interpret them. The Guides also describe the basic elements necessary to substantiate claims within each category and present options for qualifying specific claims to avoid deception.
                    <SU>3</SU>
                    <FTREF/>
                     The illustrative qualifications provide “safe harbors” for marketers who want certainty about how to make environmental claims, but do not represent the only permissible approaches to qualifying a claim. 
                </P>
                <FTNT>
                    <P>
                        <SU>3</SU>
                         The Guides do not, however, establish standards for environmental performance or prescribe testing protocols.
                    </P>
                </FTNT>
                <HD SOURCE="HD1">II. Regulatory Review of the Green Guides </HD>
                <P>The Commission reviews all of its rules and guides periodically to examine their efficacy, costs, and benefits; and to determine whether to retain, modify, or rescind them. This notice commences the Commission's review of the Green Guides. </P>
                <HD SOURCE="HD2">A. General Areas of Interest for FTC Review </HD>
                <P>As part of its review, the Commission is seeking comment on a number of general issues, including the continuing need for the Guides and their economic impact, the effect of the Guides on the accuracy of various environmental claims, and the interaction of the Guides with other environmental marketing regulations. The Commission believes that this review is important to ensure that the Guides are appropriately responsive to any changes in the marketplace. Since the Commission's last revisions in 1998, sellers and marketers increasingly have publicized the environmental attributes of certain products, packaging, services, and manufacturing processes. Moreover, sellers and marketers are making new green claims, including those regarding renewable energy, carbon offsets, and sustainability, among others, that are not currently covered by the Green Guides. </P>
                <P>The Commission also seeks to ensure that the Guides are appropriately responsive to any changes in consumer perception of environmental claims. As the Commission recognized in originally issuing the Guides, science and technology in the environmental area are constantly changing and new developments might affect consumer perception. Thus, the Commission solicits specific consumer survey evidence and consumer perception data addressing environmental claims, including claims not currently covered by the Guides. </P>
                <HD SOURCE="HD2">B. Specific Areas of Interest for FTC Review </HD>
                <P>Since the last revisions to the Guides in 1998, the Commission occasionally has received informal input regarding the efficacy of its guidance on specific claims as well as requests for clarification through additional examples. Some of the questions included in this notice, therefore, address claim-specific issues. By including these issues, the Commission intends to facilitate comment, and the inclusion or exclusion of any issue is no indication of the Commission's intent to make any specific modifications to the Guides. </P>
                <HD SOURCE="HD1">III. Issues for Comment </HD>
                <P>The Commission requests written comment on any or all of the following questions. The Commission requests that responses to its questions be as specific as possible, including a reference to the question being answered, and reference to empirical data or other evidence wherever available and appropriate. </P>
                <HD SOURCE="HD2">A. General Issues </HD>
                <P>(1) Is there a continuing need for the Guides? Why or why not? </P>
                <P>(2) What benefits have the Guides provided to consumers? What evidence supports the asserted benefits? </P>
                <P>(3) What modifications, if any, should be made to the Guides to increase their benefits to consumers? </P>
                <P>(a) What evidence supports your proposed modifications? </P>
                <P>(b) How would these modifications affect the costs the Guides impose on businesses, and in particular on small businesses? </P>
                <P>(c) How would these modifications affect the benefits to consumers? </P>
                <P>(4) What impact have the Guides had on the flow of truthful information to consumers and on the flow of deceptive information to consumers? </P>
                <P>(5) What significant costs have the Guides imposed on consumers? What evidence supports the asserted costs? </P>
                <P>(6) What modifications, if any, should be made to the Guides to reduce the costs imposed on consumers? </P>
                <P>(a) What evidence supports your proposed modifications? </P>
                <P>(b) How would these modifications affect the benefits provided by the Guides? </P>
                <P>(7) Please provide any evidence that has become available since 1998 concerning consumer perception of environmental claims, including claims not currently covered by the Guides. Does this new information indicate that the Guides should be modified? If so, why, and how? If not, why not? </P>
                <P>(8) Please provide any evidence that has become available since 1998 concerning consumer interest in particular environmental issues. Does this new information indicate that the Guides should be modified? If so, why, and how? If not, why not? </P>
                <P>(9) What benefits, if any, have the Guides provided to businesses, and in particular to small businesses? What evidence supports the asserted benefits? </P>
                <P>
                    (10) What modifications, if any, should be made to the Guides to increase their benefits to businesses, and in particular to small businesses? 
                    <PRTPAGE P="66093"/>
                </P>
                <P>(a) What evidence supports your proposed modifications? </P>
                <P>(b) How would these modifications affect the costs the Guides impose on businesses, and in particular on small businesses? </P>
                <P>(c) How would these modifications affect the benefits to consumers? </P>
                <P>(11) What significant costs, including costs of compliance, have the Guides imposed on businesses, and in particular on small businesses? What evidence supports the asserted costs? </P>
                <P>(12) What modifications, if any, should be made to the Guides to reduce the costs imposed on businesses, and in particular on small businesses? </P>
                <P>(a) What evidence supports your proposed modifications? </P>
                <P>(b) How would these modifications affect the benefits provided by the Guides? </P>
                <P>(13) What evidence is available concerning the degree of industry compliance with the Guides? </P>
                <P>(a) To what extent has there been a reduction in deceptive environmental claims since the Guides were issued? Please provide any supporting evidence. Does this evidence indicate that the Guides should be modified? If so, why, and how? If not, why not? </P>
                <P>(b) To what extent have the Guides reduced marketers' uncertainty about which claims might lead to FTC law enforcement actions? Please provide any supporting evidence. Does this evidence indicate that the Guides should be modified? If so, why, and how? If not, why not? </P>
                <P>(14) Are there claims addressed in the Guides on which guidance is no longer needed? If so, explain. Please provide supporting evidence. </P>
                <P>(15) What potentially unfair or deceptive environmental marketing claims, if any, are not covered by the Guides? </P>
                <P>(a) What evidence demonstrates the existence of such claims? </P>
                <P>(b) With reference to such claims, should the Guides be modified? If so, why, and how? If not, why not? </P>
                <P>(16) What modifications, if any, should be made to the Guides to account for changes in relevant technology or economic conditions? What evidence supports the proposed modifications? </P>
                <P>(17) Do the Guides overlap or conflict with other federal, state, or local laws or regulations? If so, how? </P>
                <P>(a) What evidence supports the asserted conflicts? </P>
                <P>(b) With reference to the asserted conflicts, should the Guides be modified? If so, why, and how? If not, why not? </P>
                <P>(c) Is there evidence concerning whether the Guides have assisted in promoting national consistency with respect to the regulation of environmental claims? If so, please provide that evidence. </P>
                <P>(18) Are there international laws, regulations, or standards with respect to environmental marketing claims that the Commission should consider as it reviews the Guides, such as the International Organization for Standardization (“ISO”) 14021, Environmental Labels and Declarations—Self-Declared Environmental Claims? If so, what are they? Should the Guides be modified in order to harmonize with these international laws, regulations, or standards? If so, why, and how? If not, why not? </P>
                <HD SOURCE="HD2">B. Specific Issues </HD>
                <P>(1) Should the Guides be revised to include guidance regarding renewable energy or carbon offset claims? If so, why, and what guidance should be provided? If not, why not? </P>
                <P>(a) What evidence supports making your proposed revision(s)? </P>
                <P>(b) What evidence is available concerning consumer understanding of the terms “renewable energy” and “carbon offset”? </P>
                <P>(c) What evidence constitutes a reasonable basis to support each such claim? </P>
                <P>(2) Should the Guides be revised to include guidance regarding “sustainable” claims? If so, why, and what guidance should be provided? If not, why not? </P>
                <P>(a) What evidence supports making your proposed revision(s)? </P>
                <P>(b) What evidence is available concerning consumer understanding of the term “sustainable”? </P>
                <P>(c) What evidence constitutes a reasonable basis to support a “sustainable” claim? </P>
                <P>(3) Should the Guides be revised to include guidance regarding “renewable” claims? If so, why, and what guidance should be provided? If not, why not? </P>
                <P>(a) What evidence supports making your proposed revision(s)? </P>
                <P>(b) What evidence is available concerning consumer understanding of the term “renewable”? </P>
                <P>(c) What evidence constitutes a reasonable basis to support a “renewable” claim? </P>
                <P>(4) The Guides provide that a recycled content claim may be made only for materials that have been recovered or otherwise diverted from the solid waste stream, either during the manufacturing process or after consumer use. Do the current Guides provide sufficient guidance for recycled content claims for textile products? If so, why? If not, why not, and what guidance should be provided? What evidence supports making your proposed revision(s)? </P>
                <P>
                    (5) The Guides suggest that recycled content be calculated on the annual weighted average of a product. Should the Guides be revised to include alternative method(s) of calculating recycled content, 
                    <E T="03">e.g.</E>
                    , based on the average recycled content within a product line, or an average amount of recycled content used by a manufacturer across many or all of its product lines? If so, why, and what is the appropriate method(s) of calculation? If not, why not? What evidence supports making your proposed revision(s)? 
                </P>
                <P>(6) The Guides provide that an unqualified claim that a product or package is degradable, biodegradable or photodegradable should be substantiated by competent and reliable scientific evidence that the entire product or package will completely break down and return to nature within a “reasonably short period of time after customary disposal.” Should the Guides be revised to provide more specificity with respect to the time frame for product decomposition? If so, why, and what should the time frame be? If not, why not? What evidence supports making your proposed revision(s)? </P>
                <HD SOURCE="HD1">IV. Public Meetings </HD>
                <P>Because of the wide-reaching issues involved in environmental marketing, the Commission also believes it would be beneficial to facilitate public dialogue on select issues by hosting public meetings. Commission staff will review and consider information gathered at these meetings in addition to the public comments in formulating its final recommendation to the Commission concerning the Green Guides review. As noted above, the first public meeting, to be held on January 8, 2008, will address carbon offsets and renewable energy certificates. The Commission plans to announce additional public meetings addressing other green topics, such as green labeling and advertising developments and consumer perception of green marketing claims. </P>
                <LSTSUB>
                    <HD SOURCE="HED">List of Subjects in 16 CFR Part 260 </HD>
                    <P>Advertising, Environmental claims, Labeling, Trade practices.</P>
                </LSTSUB>
                <AUTH>
                    <HD SOURCE="HED">Authority:</HD>
                    <P>15 U.S.C. 41-58. </P>
                </AUTH>
                <SIG>
                    <P>By direction of the Commission. </P>
                    <NAME>Donald S. Clark, </NAME>
                    <TITLE>Secretary. </TITLE>
                </SIG>
            </SUPLINF>
            <FRDOC> [FR Doc. E7-23007 Filed 11-26-07; 8:45 am] </FRDOC>
            <BILCOD>BILLING CODE 6750-01-P </BILCOD>
        </PRORULE>
        <PRORULE>
            <PREAMB>
                <PRTPAGE P="66094"/>
                <AGENCY TYPE="S">FEDERAL TRADE COMMISSION </AGENCY>
                <CFR>16 CFR Part 260 </CFR>
                <SUBJECT>Guides for the Use of Environmental Marketing Claims; Carbon Offsets and Renewable Energy Certificates; Public Workshop </SUBJECT>
                <AGY>
                    <HD SOURCE="HED">AGENCY:</HD>
                    <P>Federal Trade Commission. </P>
                </AGY>
                <ACT>
                    <HD SOURCE="HED">ACTION:</HD>
                    <P>Announcement of public workshop; request for public comment. </P>
                </ACT>
                <SUM>
                    <HD SOURCE="HED">SUMMARY:</HD>
                    <P>
                        The Federal Trade Commission (“FTC” or “Commission”) is planning to host a public workshop on January 8, 2008 to examine the emerging market for carbon offsets (
                        <E T="03">i.e.</E>
                        , greenhouse gas emission reduction products) and renewable energy certificates, and related advertising claims. The workshop is a component of the Commission's regulatory review of the Guides for the Use of Environmental Marketing Claims, which is being announced in a separate 
                        <E T="04">Federal Register</E>
                         notice published concurrently. 
                    </P>
                </SUM>
                <EFFDATE>
                    <HD SOURCE="HED">DATES:</HD>
                    <P>The workshop will be held on Tuesday, January 8, 2008, from 9 a.m. to 5 p.m. at the FTC's Satellite Building Conference Center, located at 601 New Jersey Avenue, NW., Washington, DC. Any written comments related to the workshop must be received by January 25, 2008. </P>
                </EFFDATE>
                <ADD>
                    <HD SOURCE="HED">ADDRESSES:</HD>
                    <P>
                        <E T="03">Registration Information:</E>
                         The workshop is open to the public, and there is no fee for attendance. The FTC also plans to make this workshop available via a webcast (see 
                        <E T="03">http://www.ftc.gov/bcp/workshops/carbonoffsets/index.shtml</E>
                        ). For admittance to the Conference Center, all attendees will be required to show a valid photo identification, such as a driver's license. The FTC will accept pre-registration for this workshop. Pre-registration is not necessary to attend, but is encouraged so that we may better plan this event. To pre-register, please e-mail your name and affiliation to 
                        <E T="03">carbonworkshop@ftc.gov</E>
                        . When you pre-register, we will collect your name, affiliation, and your e-mail address. This information will be used to estimate how many people will attend. We may use your e-mail address to contact you with information about the workshop. 
                    </P>
                    <P>
                        Under the Freedom of Information Act (“FOIA”) or other laws, we may be required to disclose to outside organizations the information you provide. For additional information, including routine uses permitted by the Privacy Act, see the Commission's Privacy Policy at 
                        <E T="03">http://www.ftc.gov/ftc/privacy.htm</E>
                        . The FTC Act and other laws the Commission administers permit the collection of this contact information to consider and use for the above purposes. 
                    </P>
                    <P>
                        <E T="03">Written and Electronic Comments:</E>
                         The submission of comments is not required for attendance at the workshop. If you wish to submit written or electronic comments about the topics to be discussed at the workshop, such comments must be received by January 25, 2008. Such comments may be submitted before or after the workshop at the discretion of the commenter. Comments should refer to “Carbon Offset Workshop—Comment, Project No. P074207,” to facilitate organization of comments. A comment filed in paper form should include this reference both in the text and on the envelope, and should be mailed or delivered to the following address: Federal Trade Commission/Office of the Secretary, Room H-135 (Annex O), 600 Pennsylvania Avenue, NW., Washington, DC 20580. Comments containing confidential material must be filed in paper form; must be clearly labeled “Confidential;” and must comply with Commission Rule 4.9(c).
                        <SU>1</SU>
                        <FTREF/>
                         The FTC is requesting that any comment filed in paper form be sent by courier or overnight service, if possible, because postal mail in the Washington area and at the Commission is subject to delay due to heightened security precautions. 
                    </P>
                    <P>
                        Comments filed in electronic form should be submitted by following the instructions on the web-based form at 
                        <E T="03">http://secure.commentworks.com/ftc-carbonworkshop</E>
                        . To ensure that the Commission considers an electronic comment, you must file it on that web-based form. You may also visit 
                        <E T="03">http://www.regulations.gov</E>
                         to read this notice, and may file an electronic comment through that Web site. The Commission will consider all comments that 
                        <E T="03">http://www.regulations.gov</E>
                         forwards to it. 
                    </P>
                    <P>
                        The FTC Act and other laws the Commission administers permit the collection of public comments to consider and use in this proceeding as appropriate. The Commission will consider all timely and responsive public comments that it receives, whether filed in paper or electronic form. Comments received will be available to the public on the FTC Web site, to the extent practicable, at 
                        <E T="03">http://www.ftc.gov</E>
                        . As a matter of discretion, the FTC makes every effort to remove home contact information for individuals from the public comments it receives before placing those comments on the FTC Web site. To read our policy on how we handle the information you submit—including routine uses permitted by the Privacy Act—please review the FTC's privacy policy, at 
                        <E T="03">http://www.ftc.gov/ftc/privacy.shtm</E>
                        . 
                    </P>
                    <FTNT>
                        <P>
                            <SU>1</SU>
                             The comment must be accompanied by an explicit request for confidential treatment, including the factual and legal basis for the request, and must identify the specific portions of the comment to be withheld from the public record. The request will be granted or denied by the Commission's General Counsel, consistent with applicable law and the public interest. 
                            <E T="03">See</E>
                             Commission Rule 4.9(c), 16 CFR 4.9(c). 
                        </P>
                    </FTNT>
                </ADD>
                <FURINF>
                    <HD SOURCE="HED">FOR FURTHER INFORMATION CONTACT:</HD>
                    <P>Hampton Newsome, Attorney, 202-326-2889, Division of Enforcement, Bureau of Consumer Protection, Federal Trade Commission. </P>
                </FURINF>
            </PREAMB>
            <SUPLINF>
                <HD SOURCE="HED">SUPPLEMENTARY INFORMATION:</HD>
                <P/>
                <HD SOURCE="HD1">I. Introduction </HD>
                <P>
                    The FTC staff is planning to conduct a one-day workshop on January 8, 2008 related to the marketing of greenhouse gas reduction credits (commonly referred to as “carbon offsets”) and renewable energy certificates (“RECs”). The workshop will focus on consumer protection issues in these markets, such as consumer perception of carbon offset and REC advertising claims and substantiation for such claims. This workshop is one component of the Commission's regulatory review of the Guides for the Use of Environmental Marketing Claims (16 CFR Part 260), which the FTC is announcing in a separate, concurrent 
                    <E T="04">Federal Register</E>
                     notice.
                    <SU>2</SU>
                    <FTREF/>
                     The FTC is seeking comment on the issues that will be addressed at this workshop. Comments may be submitted before or after the workshop provided they are received by January 25, 2008 as explained in the “WRITTEN AND ELECTRONIC COMMENTS” section of this notice. 
                </P>
                <FTNT>
                    <P>
                        <SU>2</SU>
                         The Commission reviews all of its rules and guides periodically. These reviews seek information about the costs and benefits of the Commission's existing rules and guides and their regulatory and economic impact. The information obtained during these reviews assists the Commission in identifying rules and guides that warrant modification or rescission.
                    </P>
                </FTNT>
                <P>
                    This notice addresses several issues related to the upcoming workshop. It provides background on carbon offsets and RECs. It briefly discusses the existing regulatory framework in this area, including the FTC's consumer protection authority. In addition, the notice discusses consumer protection issues raised by the marketing of offsets and RECs, as well as marketing and advertising claims based on the purchase of these products. The notice concludes with a short description of possible issues for discussion at the workshop and questions for comment. 
                    <PRTPAGE P="66095"/>
                </P>
                <HD SOURCE="HD1">II. Background </HD>
                <HD SOURCE="HD2">A. Carbon Offsets and RECs </HD>
                <P>
                    The market for the sale of carbon offsets in the United States has experienced significant growth in the last two years.
                    <SU>3</SU>
                    <FTREF/>
                     The FTC's workshop, therefore, will focus primarily on consumer protection issues involving the newly-emerging carbon offset market. Because the REC market is closely associated with the sale of carbon offsets, the workshop also will address REC marketing.
                    <SU>4</SU>
                    <FTREF/>
                     This notice briefly describes these products, as well as the current regulatory framework in which these activities take place. 
                </P>
                <FTNT>
                    <P>
                        <SU>3</SU>
                         
                        <E T="03">See, e.g.</E>
                        , Hamilton, Katherine, 
                        <E T="03">et al.</E>
                        , “State of the Voluntary Carbon Market 2007: Picking Up Steam,” New Carbon Finance and The Ecosystem Marketplace (July 17, 2007) (
                        <E T="03">http://ecosystemmarketplace.com/documents/acrobat/StateoftheVoluntaryCarbonMarket-18July_Final.pdf</E>
                        ).
                    </P>
                </FTNT>
                <FTNT>
                    <P>
                        <SU>4</SU>
                         RECs are known also as green certificates, green tags, or tradable renewable certificates.
                    </P>
                </FTNT>
                <P>
                    <E T="03">Carbon Offsets:</E>
                     In general, carbon offsets are credits or certificates that represent the right to claim responsibility for greenhouse gas emission reductions. For example, a carbon offset provider might use offset proceeds to pay for landfill methane collection activities or tree planting in an effort to reduce greenhouse gasses. In some cases, carbon offset sellers use the proceeds to purchase RECs (discussed below). By acquiring these greenhouse gas reduction credits, purchasers, including individuals and businesses, seek to reduce their “carbon footprints” or to make themselves “carbon neutral.” For example, a consumer who flies across the country is “responsible” for a percentage of the carbon emitted from the fossil fuel burned by the plane. That consumer can purchase a certificate that funds activities that purport to reduce carbon emissions elsewhere, in quantities equal to all, or a portion, of the carbon for which that consumer is “responsible.” Additionally, some businesses purchase offsets to provide a basis for their advertising claims (
                    <E T="03">e.g.</E>
                    , “our coffee is carbon neutral”). 
                </P>
                <P>
                    <E T="03">Renewable Energy Certificates (“RECs”):</E>
                     Generally, retail electricity customers can support renewable energy 
                    <SU>5</SU>
                    <FTREF/>
                     through one of two methods: by purchasing renewable electricity or by purchasing renewable energy certificates.
                    <SU>6</SU>
                    <FTREF/>
                     Under the first approach, consumers purchase renewable energy through traditional electricity contracts with their local utility or power provider, in areas in which such energy is sold.
                    <SU>7</SU>
                    <FTREF/>
                     This energy is often more expensive to produce than conventional energy; consequently, consumers usually pay a premium.
                    <SU>8</SU>
                    <FTREF/>
                     Some generators who cannot sell all of their renewable energy at a sufficient premium in their “home” market, therefore, may find it advantageous to split their output into two products: The electricity itself and certificates (RECs) representing the renewable attributes of that electricity. Under this second approach, generators sell their electricity at market prices applicable to conventionally-produced power. Generators then charge for the electricity's renewable attribute separately by selling certificates to individuals and business purchasers across the country who use them to characterize the conventional electricity they buy as renewable.
                    <SU>9</SU>
                    <FTREF/>
                     The REC market, therefore, helps renewable energy generators by significantly expanding the number of potential renewable energy purchasers, possibly avoiding transmission costs associated with traditional contracts, and helping to ameliorate supply and demand problems associated with the intermittent operation of some renewable energy facilities (
                    <E T="03">e.g.</E>
                    , solar power facilities).
                    <SU>10</SU>
                    <FTREF/>
                </P>
                <FTNT>
                    <P>
                        <SU>5</SU>
                         Renewable energy, such as wind and solar power, is energy derived from sources that are constantly replenished. 
                        <E T="03">See, e.g.</E>
                        , 
                        <E T="03">http://www.nrel.gov/learning/re_basics.html</E>
                         and 
                        <E T="03">http://www.epa.gov/greenpower/whatis/renewableenergy.htm</E>
                        .
                    </P>
                </FTNT>
                <FTNT>
                    <P>
                        <SU>6</SU>
                         Some consumers may also have the option of producing their own electricity.
                    </P>
                </FTNT>
                <FTNT>
                    <P>
                        <SU>7</SU>
                         Electricity generated from renewable sources is physically indistinguishable from conventional electricity once it is introduced into the power grid. Therefore, it is impossible for consumers to determine that the electricity that flows into their homes is generated by renewable energy. By purchasing a certain amount of renewable electricity through their utility, consumers simply buy the right to call the electricity they use “renewable” and ensure that an equivalent amount of renewable electricity is supplied to the power grid.
                    </P>
                </FTNT>
                <FTNT>
                    <P>
                        <SU>8</SU>
                         While some generators may be able to sell renewable energy at the same price as, or even lower prices than, conventional electricity, they nonetheless may be able to charge premium prices—either through direct sales or the marketing of certificates.
                    </P>
                </FTNT>
                <FTNT>
                    <P>
                        <SU>9</SU>
                         The certificate represents a property right in the technological and environmental attributes of renewable energy. The precise nature of the attributes represented by a REC, however, continues to be a matter of discussion. Generally, one REC represents the right to describe one megawatt of electricity as “renewable.” Currently, there is no uniform or mandatory definition of a REC.
                    </P>
                </FTNT>
                <FTNT>
                    <P>
                        <SU>10</SU>
                         
                        <E T="03">See</E>
                         Holt, Ed and Bird, Lori, “Emerging Markets for Renewable Energy Certificates: Opportunities and Challenges,” National Renewable Energy Laboratory (Jan. 2005) at 8-9.
                    </P>
                </FTNT>
                <HD SOURCE="HD2">B. Regulatory Framework  </HD>
                <P>Offset and REC sales can generally occur in two types of markets: (1) Markets that facilitate compliance with regulatory targets (so called “mandatory” or “compliance” markets), and (2) markets unrelated to existing regulatory programs (so called “voluntary” markets).</P>
                <P>
                    RECs currently play a role in mandatory markets. For example, some states require certain electricity providers to purchase a minimum percentage of their electricity from renewable sources. Purchasing renewable energy directly, however, is not always practical. Thus, some states allow providers to meet their quotas, usually called “renewable portfolio standards,” through the purchase of RECs. Although there are no current mandatory markets for carbon offsets in the United States, there are ongoing efforts at the state level to develop greenhouse gas reduction programs that may impact carbon offset sales in the future.
                    <SU>11</SU>
                    <FTREF/>
                     Because the sale of RECs to meet regulatory targets already involves ongoing state oversight, and there are no current, mandatory markets for carbon offsets, the workshop will concentrate on marketing in the voluntary market.
                </P>
                <FTNT>
                    <P>
                        <SU>11</SU>
                        <E T="03"> See, e.g.</E>
                        , Regional Greenhouse Gas Initiative, 
                        <E T="03">http://www.rggi.org/</E>
                        .
                    </P>
                </FTNT>
                <P>
                    Where offsets and RECs are not generated to meet regulatory targets, they are bought and sold in a voluntary market to meet demand. In this voluntary market, no federal agency currently has a comprehensive environmental regulatory program.
                    <SU>12</SU>
                    <FTREF/>
                     In the absence of national regulation, voluntary third-party certification programs have arisen, and more are under development, to help reduce inappropriate practices and to provide guidance to marketers through the development of industry standards.
                </P>
                <FTNT>
                    <P>
                        <SU>12</SU>
                         The Environmental Protection Agency has established the Green Power Partnership, a voluntary program to encourage organizations in the United States to purchase renewable power through RECs and other renewable energy products (
                        <E T="03">http://www.epa.gov/grnpower/</E>
                        ).
                    </P>
                </FTNT>
                <P>
                    The FTC, however, has an important role to play in combating unfair and deceptive practices in this market. In carrying out this mission, the Commission enforces the FTC Act, which states that unfair or deceptive trade practices are unlawful.
                    <SU>13</SU>
                    <FTREF/>
                     In interpreting the FTC Act, the Commission has determined that a representation, omission, or practice is deceptive if it is likely to mislead 
                    <PRTPAGE P="66096"/>
                    consumers acting reasonably in the circumstances and is material.
                    <SU>14</SU>
                    <FTREF/>
                </P>
                <FTNT>
                    <P>
                        <SU>13</SU>
                         15 U.S.C. 45. An act or practice is unfair if the injury it causes, or is likely to cause, is substantial, not outweighed by other benefits, and not reasonably avoidable. 
                        <E T="03">See</E>
                         Section 5(n) of the FTC Act, 15 U.S.C. 5(n); 
                        <E T="03">see also</E>
                         FTC Policy Statement on Unfairness, appended to 
                        <E T="03">International Harvester Co.</E>
                        , 104 F.T.C. 949, 1070 (1984) (
                        <E T="03">http://www.ftc.gov/bcp/policystmt/ad-unfair.htm</E>
                        ).
                    </P>
                </FTNT>
                <FTNT>
                    <P>
                        <SU>14</SU>
                         
                        <E T="03">See</E>
                         FTC Policy Statement on Deception, appended to 
                        <E T="03">Cliffdale Associates, Inc.</E>
                        , 103 F.T.C. 110, 174 (1984) (
                        <E T="03">http://www.ftc.gov/bcp/policystmt/ ad-decept.htm</E>
                        ).
                    </P>
                </FTNT>
                <P>Under the FTC Act, all marketers making express or implied claims about the attributes of their product or service must have a reasonable basis for their claims at the time they make them. In the realm of environmental advertising, a reasonable basis often requires competent and reliable scientific evidence. Such evidence includes tests, research, studies, or other evidence, based on the expertise of professionals in the relevant area, that have been conducted and evaluated in an objective manner by persons qualified to do so, using procedures generally accepted in the profession to yield accurate and reliable results. </P>
                <P>
                    In exercising its authority under the FTC Act or other statutes, the FTC has developed a variety of rules and guides related to energy and environmental marketing practices.
                    <SU>15</SU>
                    <FTREF/>
                     One of these, the Guides for the Use of Environmental Marketing Claims (“Green Guides”), addresses the application of Section 5 of the FTC Act to environmental advertising and marketing practices.
                    <SU>16</SU>
                    <FTREF/>
                     The Green Guides provide information on consumer interpretation of certain environmental marketing claims so that marketers can avoid making false or misleading claims. The Guides focus on the way in which consumers understand environmental claims and not necessarily the technical or scientific definition of various terms. 
                </P>
                <FTNT>
                    <P>
                        <SU>15</SU>
                         
                        <E T="03">See</E>
                         Guide Concerning Fuel Economy Advertising for New Automobiles (16 CFR part 259), Guides for the Use of Environmental Marketing Claims (16 CFR part 260), Appliance Labeling Rule (16 CFR part 305), Fuel Rating Rule (16 CFR part 306), Alternative Fuel Vehicles Rule (16 CFR part 309), Recycled Oil Rule (16 CFR part 311), and Labeling and Advertising of Home Insulation Rule (the “R-Value” Rule) (16 CFR part 460).
                    </P>
                </FTNT>
                <FTNT>
                    <P>
                        <SU>16</SU>
                         FTC guides “are administrative interpretations of laws administered by the Commission for the guidance of the public in conducting its affairs in conformity with legal requirements.” 16 CFR part 17. Conduct that is inconsistent with the guides may result in corrective action by the Commission, if after investigation, the Commission has reason to believe that the conduct is unfair or deceptive to consumers.
                    </P>
                </FTNT>
                <P>While the FTC has often addressed consumer protection issues related to energy and environmental issues, the FTC does not have the authority or expertise to establish environmental performance standards. Accordingly, we do not plan to develop environmental standards for carbon offsets and RECs. Instead, the FTC's efforts in this area will focus on our traditional consumer protection role, addressing deceptive and unfair practices under the FTC Act. </P>
                <HD SOURCE="HD2">C. Consumer Protection Issues </HD>
                <P>
                    Carbon offset and REC marketing activities raise several consumer protection issues. These issues stem both from claims for offset and REC products themselves and from claims for other products based on offset and REC purchases (
                    <E T="03">e.g.</E>
                    , “our snacks are made with green electricity”). As discussed in more detail below, the nature of these products, consumer understanding of claims, and substantiation of claims all raise consumer protection challenges for offset and REC marketers. 
                </P>
                <P>
                    The nature of offset and REC claims raises particular challenges because consumers cannot easily verify that they are receiving that for which they paid. For example, most consumers would have great difficulty confirming that their payments actually fund projects that may take place in a distant location. Moreover, even if a consumer could verify a project's existence, it likely would be impossible for the average consumer to determine whether the scientifically complex project actually reduces atmospheric carbon in the amount claimed, or how much the consumer's offset purchase actually contributes to the project.
                    <SU>17</SU>
                    <FTREF/>
                     As a result, the potential for deception is greater than with more tangible products for which consumers more easily can confirm most advertising claims. 
                </P>
                <FTNT>
                    <P>
                        <SU>17</SU>
                         Similarly, it is difficult for consumers to determine for themselves whether the RECs they purchase actually represent the environmental attributes of renewable energy generation. 
                    </P>
                </FTNT>
                <P>In addition, consumer interpretation of offset and REC-related claims is an essential factor in addressing consumer protection questions in these markets. We are not aware of any research that addresses consumer understanding of advertising claims related to carbon offsets and RECs. As a result, there appear to be many open questions. For example, when consumers buy these products, do they know what they are buying? How do consumers interpret express or implied claims about environmental benefits from offsets and RECs? Do consumers assume that their offset purchases are creating reductions in greenhouse gas emissions beyond what would have otherwise occurred without offset sales? How quickly do they believe reductions occur? Should marketers consider consumer understanding about the incidental benefits of renewable energy, such as air pollutant reductions or regional environmental improvements? Do consumers interpret REC and offset claims to include implied claims of broader (or narrower) environmental benefit? Questions of consumer interpretation are important because marketers must ensure that all reasonable interpretations of their claims are truthful, not misleading, and substantiated. </P>
                <P>
                    Substantiation in particular can pose challenges in the REC and offset markets. For example, bringing RECs and offsets to market may involve multiple transactions and a large number of entities; consequently, the methods used to track RECs and offsets through the market are often complicated. In addition, efforts to verify the validity of these products can be difficult because the underlying activities may take place in remote locations or over an extended time period. Inadequate tracking and verification systems could lead to substantiation problems, even for marketers acting in good faith, and create opportunities for bad actors to deceive consumers. For example, marketers could inadvertently, or intentionally, sell multiple certificates based on the same carbon reduction or renewable energy activities (
                    <E T="03">i.e.</E>
                    , “double counting”). 
                </P>
                <P>
                    One carbon offset issue, commonly referred to as “additionality,” has generated significant discussion.
                    <SU>18</SU>
                    <FTREF/>
                     “Additionality” addresses whether carbon offset consumers are paying for a project that would have occurred without the offset market. In the view of many involved with this market,
                    <SU>19</SU>
                    <FTREF/>
                     offset sellers have a duty to demonstrate that their underlying greenhouse gas reduction projects would not have occurred but for the sale of the offset; otherwise, they argue, sellers are not really reducing greenhouse gas 
                    <PRTPAGE P="66097"/>
                    emissions. Under this view, for example, it would not be appropriate to sell offsets based on a project (
                    <E T="03">e.g.</E>
                    , capturing methane from a landfill) implemented to comply with existing environmental regulations because any greenhouse gas reductions would have occurred without the sale of the offsets. The practical application of the “additionality” concept to specific fact scenarios has raised a large number of questions and produced a variety of opinions among industry members and other stakeholders. 
                </P>
                <FTNT>
                    <P>
                        <SU>18</SU>
                         “Additionality” is a term generally associated with mandatory carbon reduction programs implemented pursuant to the Kyoto Protocol, an international agreement under the United Nations Framework Convention on Climate Change (
                        <E T="03">http://unfccc.int/resource/docs/convkp/kpeng.pdf</E>
                        ). While no such mandatory program exists in the United States, many offset marketers and other interested parties here have looked to the Kyoto framework in developing practices in the voluntary offset market in the United States.
                    </P>
                </FTNT>
                <FTNT>
                    <P>
                        <SU>19</SU>
                         
                        <E T="03">See, e.g.</E>
                        , “A Consumers' ” Guide to Retail Carbon Offset Providers,” Clean Air-Cool Planet (2006) (
                        <E T="03">http://www.cleanair-coolplanet.org/ConsumersGuidetoCarbonOffsets.pdf</E>
                        ); Kollmus, A., “Voluntary Offsets For Air-Travel Carbon Emissions: Evaluations and Recommendations of Thirteen Offset Companies,” Tufts Climate Initiative (Dec. 2006) (
                        <E T="03">http://www.tufts.edu/tie/tci/pdf/TCI_Carbon_Offsets_Paper_April-2-07.pdf</E>
                        ); and “The Green-e Greenhouse Gas Emission Reduction Product Certification Program Standard,” Center for Resource Solutions (June 2007) (
                        <E T="03">http://resource-solutions.org/mv/docs/Ge_GHG_Product_Standard_V1.pdf</E>
                        ).
                    </P>
                </FTNT>
                <HD SOURCE="HD1">III. Issues and Questions for Discussion at the Workshop </HD>
                <P>
                    As discussed above, the Commission's public workshop will explore advertising claims for carbon offsets and RECs, as well as advertising claims based on the purchase of those products. We have identified several possible issues for discussion at the workshop: (1) Trends in marketing carbon offsets and RECs, (2) the nature of the commodities in question (
                    <E T="03">i.e.</E>
                    , the property rights transferred from seller to buyer through the sale of offsets and RECs), (3) product marketing based on offset or REC purchases, (4) consumer perception of carbon offset and REC claims, (5) potential market problems such as double-counting and other forms of fraud, (6) third-party certification and other standard-setting programs, (7) the issue of “additionality” for carbon offsets and its relationship to potential consumer deception, (8) the use of RECs as a basis for carbon offset claims, (9) the state of substantiation for offsets and REC claims, and (10) the need for additional FTC guidance in these areas. 
                </P>
                <P>In addition to considering these possible topics, the Commission invites written comments on any or all of the following questions regarding the consumer protection aspects of the carbon offset and REC market. The Commission requests that responses to these questions be as specific as possible, including a reference to the question being answered, and reference to empirical data or other evidence wherever available and appropriate. </P>
                <EXTRACT>
                    <P>(1) What express claims are sellers making for carbon offsets and RECs? What claims, if any, are implied by that advertising? How do consumers interpret these claims? Please provide any supporting evidence. What evidence constitutes a reasonable basis to support these claims? What challenges do offset and REC sellers face in substantiating their claims? Is there evidence that any claims in the current marketplace are unsubstantiated or otherwise deceptive? </P>
                    <P>
                        (2) What express claims are companies making for their products and services based on their purchase of carbon offsets or RECs (
                        <E T="03">e.g.</E>
                        , “our product is made with renewable energy”)? What claims, if any, are implied by that advertising? How do consumers interpret these claims? Please provide any supporting evidence. What evidence constitutes a reasonable basis to support these claims? Is there evidence that any claims in the current marketplace are unsubstantiated or otherwise deceptive? 
                    </P>
                    <P>(3) When consumers purchase carbon offsets or RECs, what property rights do they acquire? </P>
                    <P>(4) When consumers purchase carbon offsets or RECs, what do they think they are buying? Please provide any supporting evidence. </P>
                    <P>(5) What impact do consumers believe their carbon offset purchases will have on the future quantities of greenhouse gasses in the atmosphere? Please provide any supporting evidence. </P>
                    <P>(6) Do consumers understand that some activities supported by carbon offset programs do not result in immediate carbon emission reductions? If so, when do consumers expect such offset programs will have an impact? Please provide any supporting evidence. </P>
                    <P>(7) What is the relationship between the concept of “additionality” in carbon offset markets and the FTC's standard for deception under the FTC Act? </P>
                    <P>(8) Please identify state laws that specifically address consumer protection issues in the carbon offset and REC markets. Please explain how the laws address these issues and whether they are effective. </P>
                    <P>(9) Please identify third-party and self-regulatory programs that address consumer protection issues in the carbon offset and REC markets. Please explain how the programs address these issues and whether they are effective.</P>
                </EXTRACT>
                <SIG>
                    <P>By direction of the Commission. </P>
                    <NAME>Donald S. Clark, </NAME>
                    <TITLE>Secretary.</TITLE>
                </SIG>
            </SUPLINF>
            <FRDOC>[FR Doc. E7-23006 Filed 11-26-07; 8:45 am] </FRDOC>
            <BILCOD>BILLING CODE 6750-01-P </BILCOD>
        </PRORULE>
        <PRORULE>
            <PREAMB>
                <AGENCY TYPE="N">COMMODITY FUTURES TRADING COMMISSION</AGENCY>
                <CFR>17 CFR Part 150</CFR>
                <RIN>RIN 3038-AC40</RIN>
                <SUBJECT>Risk Management Exemption From Federal Speculative Position Limits</SUBJECT>
                <AGY>
                    <HD SOURCE="HED">AGENCY:</HD>
                    <P>Commodity Futures Trading Commission.</P>
                </AGY>
                <ACT>
                    <HD SOURCE="HED">ACTION:</HD>
                    <P>Notice of proposed rulemaking.</P>
                </ACT>
                <SUM>
                    <HD SOURCE="HED">SUMMARY:</HD>
                    <P>Section 150.2 of the Commodity Futures Trading Commission's (“Commission”) regulations imposes limits on the size of speculative positions that traders may hold or control in futures and futures equivalent option contracts on certain designated agricultural commodities named therein. Section 150.3 lists certain types of positions that may be exempted from these Federal speculative position limits. The Commission is proposing to provide an additional exemption for “risk management positions.” A risk management position would be defined as a futures or futures equivalent position, held as part of a broadly diversified portfolio of long-only or short-only futures or futures equivalent positions, that is based upon either: A fiduciary obligation to match or track the results of a broadly diversified index that includes the same commodity markets in fundamentally the same proportions as the futures or futures equivalent position; or a portfolio diversification plan that has, among other substantial asset classes, an exposure to a broadly diversified index that includes the same commodity markets in fundamentally the same proportions as the futures or futures equivalent position. The exemption would be subject to conditions, including that the positions must be passively managed, must be unleveraged, and may not be carried into the spot month.</P>
                </SUM>
                <DATES>
                    <HD SOURCE="HED">DATES:</HD>
                    <P>Comments must be received on or before January 28, 2008.</P>
                </DATES>
                <ADD>
                    <HD SOURCE="HED">ADDRESSES:</HD>
                    <P>
                        Comments should be submitted to David Stawick, Secretary, Commodity Futures Trading Commission, Three Lafayette Centre, 1155 21st Street, NW., Washington, DC 20581. Comments also may be sent by facsimile to (202) 418-5521, or by electronic mail to 
                        <E T="03">secretary@cftc.gov</E>
                        . Reference should be made to “Proposed Risk Management Exemption from Federal Speculative Position Limits.” Comments may also be submitted by connecting to the Federal eRulemaking Portal at 
                        <E T="03">http://www.regulations.gov</E>
                         and following comment submission instructions.
                    </P>
                </ADD>
                <FURINF>
                    <HD SOURCE="HED">FOR FURTHER INFORMATION CONTACT:</HD>
                    <P>
                        Donald Heitman, Senior Special Counsel, Division of Market Oversight, Commodity Futures Trading Commission, Three Lafayette Centre, 1155 21st Street, NW., Washington, DC 20581, telephone (202) 418-5041, facsimile number (202) 418-5507, electronic mail 
                        <E T="03">dheitman@cftc.gov</E>
                        ; or John Fenton, Director of Surveillance, Division of Market Oversight, telephone (202) 418-5298, facsimile number (202) 418-5507, electronic mail 
                        <E T="03">jfenton@cftc.gov</E>
                        .
                    </P>
                </FURINF>
            </PREAMB>
            <SUPLINF>
                <HD SOURCE="HED">
                    SUPPLEMENTARY INFORMATION:
                    <PRTPAGE P="66098"/>
                </HD>
                <HD SOURCE="HD1">I. Background</HD>
                <HD SOURCE="HD2">A. Statutory Framework</HD>
                <P>Speculative position limits have been a tool for the regulation of the U.S. futures markets since the adoption of the Commodity Exchange Act of 1936. Section 4a(a) of the Commodity Exchange Act (“Act”), 7 U.S.C. 6a(a), states that:</P>
                <EXTRACT>
                    <P>Excessive speculation in any commodity under contracts of sale of such commodity for future delivery made on or subject to the rules of contract markets or derivatives transaction execution facilities causing sudden or unreasonable fluctuations or unwarranted changes in the price of such commodity, is an undue and unnecessary burden on interstate commerce in such commodity.</P>
                </EXTRACT>
                <P>Accordingly, section 4a(a) of the Act provides the Commission with the authority to:</P>
                <EXTRACT>
                    <P>Fix such limits on the amounts of trading which may be done or positions which may be held by any person under contracts of sale of such commodity for future delivery on or subject to the rules of any contract market or derivatives transaction execution facility as the Commission finds are necessary to diminish, eliminate, or prevent such burden.</P>
                </EXTRACT>
                <P>This longstanding statutory framework providing for Federal speculative position limits was supplemented with the passage of the Futures Trading Act of 1982, which acknowledged the role of exchanges in setting their own speculative position limits. The 1982 legislation also provided, under section 4a(e) of the Act, that limits set by exchanges and approved by the Commission were subject to Commission enforcement.</P>
                <P>Finally, the Commodity Futures Modernization Act of 2000 (“CFMA”) established designation criteria and core principles with which a designated contract market (“DCM”) must comply to receive and maintain designation. Among these, Core Principle 5 in section 5(d) of the Act states:</P>
                <EXTRACT>
                    <P>Position Limitations or Accountability—To reduce the potential threat of market manipulation or congestion, especially during trading in the delivery month, the board of trade shall adopt position limitations or position accountability for speculators, where necessary and appropriate.</P>
                </EXTRACT>
                <HD SOURCE="HD2">B. Regulatory Framework</HD>
                <P>
                    The regulatory structure based upon these statutory provisions consists of three elements, the levels of the speculative position limits, certain exemptions from the limits (for hedging, spreading/arbitrage, and other positions), and the policy on aggregating commonly owned or controlled accounts for purposes of applying the limits. This regulatory structure is administered under a two-pronged framework. Under the first prong, the Commission establishes and enforces speculative position limits for futures contracts on a limited group of agricultural commodities. These Federal limits are enumerated in Commission regulation 150.2, and apply to the following futures and option markets: Chicago Board of Trade (“CBOT”) corn, oats, soybeans, wheat, soybean oil, and soybean meal; Minneapolis Grain Exchange (“MGE”) hard red spring wheat and white wheat; ICE Futures U.S. (formerly the New York Board of Trade) cotton No. 2; and Kansas City Board of Trade (“KCBOT”) hard winter wheat. Under the second prong, individual DCMs establish and enforce their own speculative position limits or position accountability provisions (including exemption and aggregation rules), subject to Commission oversight and separate authority to enforce exchange-set speculative position limits approved by the Commission. Thus, responsibility for enforcement of speculative position limits is shared by the Commission and the DCMs.
                    <SU>1</SU>
                    <FTREF/>
                </P>
                <FTNT>
                    <P>
                        <SU>1</SU>
                         Provisions regarding the establishment of exchange-set speculative position limits were originally set forth in CFTC regulation 1.61. In 1999, the Commission simplified and reorganized its rules by relocating the substance of regulation 1.61's requirements to part 150 of the Commission's rules, thereby incorporating within part 150 provisions for both Federal speculative position limits and exchange-set speculative position limits (see 64 FR 24038, May 5, 1999). With the passage of the Commodity Futures Modernization Act in 2000 and the Commission's subsequent adoption of the Part 38 regulations covering DCMs in 2001 (66 FR 42256, August 10, 2001), Part 150's approach to exchange-set speculative position limits was incorporated as an acceptable practice under DCM Core Principle 5—Position Limitations and Accountability. Section 4a(e) provides that a violation of a speculative position limit set by a Commission-approved exchange rule is also a violation of the Act. Thus, the Commission can enforce directly violations of exchange-set speculative position limits as well as those provided under Commission rules.
                    </P>
                </FTNT>
                <P>
                    Commission regulation 150.3, “Exemptions,” lists certain types of positions that may be exempted from (and thus may exceed) the Federal speculative position limits. For example, under § 150.3(a)(1), 
                    <E T="03">bona fide</E>
                     hedging transactions, as defined in § 1.3(z) of the Commission's regulations, may exceed the limits. The Commission has periodically amended the exemptive rules applicable to Federal speculative position limits in response to changing conditions and practices in futures markets. These amendments have included an exemption from speculative position limits for the positions of multi-advisor commodity pools and other similar entities that use independent account controllers,
                    <SU>2</SU>
                    <FTREF/>
                     and an amendment to extend the exemption for positions that have a common owner but are independently controlled to include certain commodity trading advisors.
                    <SU>3</SU>
                    <FTREF/>
                     In 1987, the Commission also issued an agency interpretation clarifying certain aspects of the hedging definition.
                    <SU>4</SU>
                    <FTREF/>
                     The Commission has also issued guidance with respect to exchange speculative limits, including guidelines regarding the exemption of risk-management positions from exchange-set speculative position limits in financial futures contracts.
                    <SU>5</SU>
                    <FTREF/>
                     However, the last significant amendment to the Commission's exemptive rules was implemented in 1991.
                </P>
                <FTNT>
                    <P>
                        <SU>2</SU>
                         53 FR 41563 (October 24, 1988).
                    </P>
                </FTNT>
                <FTNT>
                    <P>
                        <SU>3</SU>
                         56 FR 14308 (April 9, 1991).
                    </P>
                </FTNT>
                <FTNT>
                    <P>
                        <SU>4</SU>
                         52 FR 27195 (July 20, 1987).
                    </P>
                </FTNT>
                <FTNT>
                    <P>
                        <SU>5</SU>
                         52 FR 34633 (September 14, 1987).
                    </P>
                </FTNT>
                <HD SOURCE="HD2">C. Changes in Trading Practices</HD>
                <P>
                    The intervening 16 years have seen significant changes in trading patterns and practices in derivatives markets, thus prompting the Commission to reassess its policies regarding exemptions from the Federal speculative position limits. These changes primarily involve trading strategies and programs based on commodity indexes. In particular, pension funds and other investors (including individual investors participating in commodity index-based funds or trading programs) have become interested in taking on commodity price exposure as a way of diversifying portfolios that might otherwise be limited to stocks and interest rate instruments. Financial research has shown that the risk/return performance of a portfolio is improved by acquiring uncorrelated or negatively correlated assets, and commodities (including agricultural commodities) generally perform that role in a portfolio of other financial assets.
                    <SU>6</SU>
                    <FTREF/>
                </P>
                <FTNT>
                    <P>
                        <SU>6</SU>
                         The argument has also been made that commodities act as a general hedge of liability obligations that are linked to inflation.
                    </P>
                </FTNT>
                <P>
                    The components of a commodity index-based investment might include energy commodities, metals (both precious metals and industrial metals), agricultural commodities that are subject to exchange limits (including coffee, sugar, cocoa, and orange juice, as well as livestock and meat), and those agricultural commodities named above that are subject to Federal speculative position limits (grains, the soybean complex and cotton). With respect to agricultural commodities subject to Federal limits, the Commission has responded to various instances where 
                    <PRTPAGE P="66099"/>
                    index-based positions in such commodities exceed (or might grow to exceed) the Federal speculative position limits. In certain cases, the Commission has granted exemptive or no-action relief from Federal speculative position limits. In granting such relief, the Commission has included conditions to protect the market from the potential for the sudden or unreasonable fluctuations or unwarranted changes in prices that speculative limits are designed to prevent.
                </P>
                <P>
                    For example, in 1991, the Commission received a request from a large commodity merchandising firm that engaged in commodity related swaps 
                    <SU>7</SU>
                    <FTREF/>
                     as a part of a commercial line of business. The firm, through an affiliate, wished to enter into an OTC swap transaction with a qualified counterparty (a large pension fund) involving an index based on the returns afforded by investments in exchange-traded futures contracts on certain non-financial commodities meeting specified criteria. The commodities making up the index included wheat, corn and soybeans, all of which were (and still are) subject to Federal speculative position limits. As a result of the swap, the swap dealing firm would, in effect, be going short the index. In other words, it would be required to make payments to the pension fund counterparty if the value of the index was higher at the end of the swap payment period than at the beginning. In order to hedge itself against this risk, the swap dealer planned to establish a portfolio of long futures positions in the commodities making up the index, in such amounts as would replicate its exposure under the swap transaction. By design, the index did not include contract months that had entered the delivery period and the swap dealer, in replicating the index, stated that it would not maintain futures positions based on index-related swap activity into the spot month (when physical commodity markets are most vulnerable to manipulation and attendant unreasonable price fluctuations). The result of the hedge was that the composite return on the futures portfolio would offset the net payments the swap dealer would be required to make to the pension fund counterparty.
                </P>
                <FTNT>
                    <P>
                        <SU>7</SU>
                         A swap is a privately negotiated exchange of one asset or cash flow for another asset or cash flow. In a commodity swap, at least one of the assets or cash flows is related to the price of one or more commodities.
                    </P>
                </FTNT>
                <P>
                    Because the futures positions the swap dealer would have to establish to hedge its exposure on the swap transaction would be in excess of the speculative position limits on wheat, corn and soybeans, it requested, and was granted, a hedge exemption for those positions. The swap transaction allowed the pension fund to add commodities exposure to its portfolio indirectly, through the OTC trade with the swap dealer—something it could have done directly, but only in a limited fashion.
                    <SU>8</SU>
                    <FTREF/>
                </P>
                <FTNT>
                    <P>
                        <SU>8</SU>
                         The pension fund would have been limited in its ability to take on this commodities exposure directly, by putting on the long futures position itself, because the pension fund—having no offsetting price risk incidental to commercial cash or spot operations—would not have qualified for a hedge exemption with respect to the position. (
                        <E T="03">See</E>
                         § 1.3(z) of the Commission's regulations.)
                    </P>
                </FTNT>
                <P>Similar hedge exemptions were subsequently granted in other cases where the futures positions clearly offset risks related to swaps or similar OTC positions involving both individual commodities and commodity indexes. These non-traditional hedges were all subject to specific limitations to protect the marketplace from potential ill effects. The limitations included: (1) The futures positions must offset specific price risk; (2) the dollar value of the futures positions would be no greater than the dollar value of the underlying risk; and (3) the futures positions would not be carried into the spot month.</P>
                <P>
                    The Commission's Division of Market Oversight (“Division” or “DMO”) has also recently issued two no-action letters involving another type of index-based trading.
                    <SU>9</SU>
                    <FTREF/>
                     Both cases involved trading that offered investors the opportunity to participate in a broadly diversified commodity index-based fund or program (“index fund”). The futures positions of these index funds differed from the futures positions taken by the swap dealers described above. The swap dealer positions were taken to offset OTC swaps exposure that was directly linked to the price of an index. For that reason, the Division granted hedge exemptions to these swap dealer positions. On the other hand, in the index fund positions described in the no-action letters, the price exposure results from a promise or obligation to track an index, rather than from holding an OTC swap position whose value is directly linked to the price of the index. The Division believed that this difference was significant enough that the index fund positions would not qualify for a hedge exemption. Nevertheless, because the index fund positions represented a legitimate and potentially useful investment strategy, the Division granted the index funds no-action relief, subject to certain conditions, described below, that were intended to protect the futures markets from potential ill effects.
                </P>
                <FTNT>
                    <P>
                        <SU>9</SU>
                         CFTC Letter 06-09 (April 19, 2006); CFTC Letter 06-19 (September 6, 2006).
                    </P>
                </FTNT>
                <HD SOURCE="HD1">II. Proposed Amendment</HD>
                <HD SOURCE="HD2">A. Introduction</HD>
                <P>In light of the changing trading practices and conditions described above, the Commission is now considering whether to amend its Part 150 regulations to create a new exemption from Federal speculative position limits. In addition to the above-described policy of granting index-based hedge exemptions to swap dealers, which policy would remain in effect, the proposal would create an additional risk management exemption. That exemption would apply to positions held by: (1) Intermediaries, such as index funds, who pass price risks on to their customers; and (2) pension funds and other institutional investors seeking to diversify risks in portfolios by including an allocation to commodity exposure. As noted above, pension funds can already benefit from a hedge exemption indirectly, by entering into an OTC position with a swap dealer who, in turn, puts on an offsetting futures position in reliance on the existing hedge exemption policy. The proposed rules would allow a pension fund to receive an exemption directly, by putting on a futures position itself pursuant to the new risk management exemption provision.</P>
                <P>
                    In determining whether the new risk management exemption proposed herein is appropriate, it is important to recall that the purpose of position limits, as specified in Section 4a(a) of the Act, is to diminish, eliminate, or prevent sudden or unreasonable fluctuations or unwarranted changes in the prices of commodities. Within this constraint, it is appropriate that the Commission (and the exchanges) not unduly restrict trading activity. A position limit is a means to an end, not an end in itself. Accordingly, to the extent that a type of trading activity can be identified that is unlikely to cause sudden or unreasonable fluctuations or unwarranted changes in prices, it is a good candidate to qualify for an exemption from position limits. Commodity index-based trading has characteristics that recommend it on that score: (1) It is generally passively managed, so that positions tend not to be changed based on market news or short-term price volatility; (2) it is generally unleveraged, so that financial considerations should not cause rapid liquidation of positions; and (3) it is inherently diversified, in that futures positions are normally held in many 
                    <PRTPAGE P="66100"/>
                    different markets, and its purpose typically is to diversify a portfolio containing assets with different risk profiles.
                </P>
                <HD SOURCE="HD2">B. Conditions for the Exemption</HD>
                <P>
                    To be eligible for an exemption as a “risk management position” under the proposed amendments to Part 150, a futures position would need to comply with several conditions designed to protect the futures markets from sudden or unreasonable fluctuations or unwarranted changes in prices. First, § 150.3(a) would be amended to add a requirement that all positions subject to the exemptive provisions must be “established and liquidated in an orderly manner.” This requirement already applies to the positions referred to in § 150.3(a)(1), which exempts 
                    <E T="03">bona fide</E>
                     hedging transactions, by virtue of similar language appearing in the 
                    <E T="03">bona fide</E>
                     hedging definition (
                    <E T="03">see</E>
                     § 1.3(z)(1)). However, the proposed amendment would clarify that the same requirement would apply not only to the risk management positions to be exempted under proposed new § 150.3(a)(2), but also to the spread or arbitrage positions already exempted under current § 150.3(a)(3) and the positions carried in the separate account of an independent account controller already exempted under current § 150.3(a)(4).
                </P>
                <P>
                    Second, the proposed rules would define a “risk management position” as a futures or futures equivalent position, held as part of a broadly diversified portfolio of long-only or short-only 
                    <SU>10</SU>
                    <FTREF/>
                     futures or futures equivalent 
                    <SU>11</SU>
                    <FTREF/>
                     positions, that is based upon either: (1) A fiduciary obligation to match or track the results of a broadly diversified index that includes the same commodity markets in fundamentally the same proportions as the futures or futures equivalent position; or (2) a portfolio diversification plan that has, among other substantial asset classes, an exposure to a broadly diversified index that includes the same commodity markets in fundamentally the same proportions as the futures or futures equivalent position. The first of these alternatives covers positions held by index funds, such as those that were the subject of the Commission No-action letters discussed above. The second alternative covers positions held directly by pension funds and other institutional investors.
                </P>
                <FTNT>
                    <P>
                        <SU>10</SU>
                         The long-only or short-only qualification would limit risk management positions to positions offsetting either a long index or portfolio or a short index or portfolio, and thus would not allow for spread or straddle positions. With respect to short-only positions, it should be noted that all the applications for index-based trading relief received by the Commission to date, whether for hedge exemptions or no-action relief, have involved long-only futures positions. However, the proposed rules would also provide for an entity that might offer investors a “bear market index.” Such an index would require the offeror to be long opposite its customers. It would, therefore, need to offset that exposure with short futures positions.
                    </P>
                </FTNT>
                <FTNT>
                    <P>
                        <SU>11</SU>
                         For example, a long call option combined with a short put option is equivalent to a long futures contract.
                    </P>
                </FTNT>
                <P>
                    A “broadly diversified index” would be defined to limit the weighting of certain agricultural commodities in the index so that commodities subject to Federal speculative position limits would not comprise a disproportionate share of the index. Thus, a “broadly diversified index” would mean an index based on physical commodities in which: (1) not more than 15% of the index is composed of any single agricultural commodity named in § 150.2 (for which purposes, wheat shall be regarded as a single commodity, so that positions in all varieties of wheat, on all exchanges, combined, may not exceed 15% of the index, and the soybean complex shall likewise be regarded as a single commodity, so that positions in soybeans, soybean oil and soybean meal, on all exchanges combined, may not exceed 15% of the index); and (2) not more than 50% of the index as a whole is composed of agricultural commodities named in § 150.2. The Commission believes that a narrowly based index could be used to evade speculative position limits. For example, the grains all tend to have similar risk profiles—
                    <E T="03">i.e,</E>
                     they tend to respond similarly to common market factors, such as weather. Therefore, the Commission is concerned that an index composed, for example, of 25% each of corn, wheat, oats and soybeans—rather than constituting a means of portfolio diversification—could operate as a mechanism for evading speculative position limits in one or more of those commodities.
                </P>
                <P>Third, the positions subject to the exemption must be passively managed. The proposed rules would define a “passively managed position” as a futures or futures equivalent position that is part of a portfolio that tracks a broadly diversified index, which index is calculated, adjusted, and re-weighted pursuant to an objective, predetermined mathematical formula the application of which allows only limited discretion with respect to trading decisions. This definition contemplates a certain limited amount of discretion in the manner in which the futures position tracks the underlying index. For example, index funds generally provide rules or standards for periodically re-weighting the index to account for price changes in the commodities that make up the index, or readjusting the composition of the index to account for changing economic or market factors. Such discretion would be permissible. However, the definition contemplates that the position holder's discretion would not extend to frequently or arbitrarily changing the composition of the index or the weighting of the commodities in the index. Such actions would indicate that the position was being actively managed with a view to taking advantage of short-term market trends. The definition also contemplates that the position holder could exercise some discretion as to when to roll futures positions forward into the next delivery month without violating the “passively managed” requirement (provided no positions were carried into the spot month). The Commission believes that limited discretion as to when a position must be rolled forward can mitigate the market impact that might otherwise result from large positions being rolled forward on a pre-determined date and, consequently, help to avoid liquidity problems.</P>
                <P>Fourth, the futures trading undertaken pursuant to the exemption must be unleveraged. An unleveraged position would be defined as a futures or futures equivalent position that is part of a portfolio of futures or futures equivalent positions directly relating to an underlying broadly diversified index, the notional value of which positions does not exceed the sum of the value of: (1) Cash set aside in an identifiable manner, or unencumbered short-term U.S. Treasury obligations so set aside, plus any funds deposited as margin on such position; and (2) accrued profits on such position held at the futures commission merchant. Because the futures positions would be fully offset by cash or profits on such positions, financial considerations (e.g., significant price changes) should not cause rapid liquidation of positions, which can cause sudden or unreasonable fluctuations or unwarranted changes in prices.</P>
                <P>Finally, positions may not be carried into the spot month, a period during which physical commodity markets are particularly vulnerable to manipulations, squeezes and sudden or unreasonable fluctuations or unwarranted changes in prices.</P>
                <P>
                    Entities intending to hold risk management positions pursuant to the exemption in § 150.3(a)(2) would be required to apply to the Commission and receive Commission approval in order to receive an exemption. The applicant would be required to provide the following information:
                    <PRTPAGE P="66101"/>
                </P>
                <HD SOURCE="HD3">Application for a Risk Management Exemption as Defined in § 150.1(j)</HD>
                <P>1. Initial application materials:</P>
                <P>A. For an exemption related to a “fiduciary obligation”.</P>
                <P>• A description of the underlying index or group of commodities, including the commodities, the weightings, the method and timing of re-weightings, the selection of futures months, and the timing and criteria for rolling from one futures month to another;</P>
                <P>• A description of the “fiduciary obligation;”</P>
                <P>• The actual or anticipated value of the underlying funds to be invested in commodities within the next fiscal or calendar year and the method for calculating that value, as well as the equivalent numbers of futures contracts in each of the § 150.2 markets for which the exemption is sought;</P>
                <P>• A description of the manner in which the funds to be invested in commodities will be set aside;</P>
                <P>• A statement certifying that the requirements of this exemption are met and will be observed at all times going forward and that the Commission will be notified promptly of any material changes in this information; and</P>
                <P>• Such other information as the Commission may request.</P>
                <P>B. For an exemption based upon a “portfolio diversification plan”.</P>
                <P>• A description of the investment index or group of commodities, including the commodities, the weightings, the method and timing of re-weightings, the selection of futures months, and the timing and criteria for rolling from one futures month to another;</P>
                <P>• A description of the entire portfolio, including the total size of the assets, the asset classes making up the portfolio, and a description of the allocation among the asset classes;</P>
                <P>• The actual or anticipated value of the underlying funds to be invested in commodities and the method for calculating that value, as well as the equivalent numbers of futures contracts in each of the § 150.2 markets for which the exemption is sought;</P>
                <P>• A description of the manner in which the funds to be invested in commodities will be set aside;</P>
                <P>• A statement certifying that the requirements of this exemption are met and will be observed at all times going forward and that the Commission will be notified promptly of any material changes in this information; and</P>
                <P>• Such other information as the Commission may request.</P>
                <P>2. Supplemental Material: Whenever the purchases or sales that a person wishes to qualify under this risk management exemption shall exceed the amount provided in the person's most recent filing pursuant to this section, or the amount previously specified by the Commission pursuant to this section, such person shall file with the Commission a statement that updates the information provided in the person's most recent filing and provides the reasons for this change. Such statement shall be filed at least ten business days in advance of the date that such person wishes to exceed those amounts and if the notice filer is not notified otherwise by the Commission within the 10-day period, the exemption will continue to be effective. The Commission may, upon call, obtain such additional materials from the applicant or person availing themselves of this exemption as the Commission deems necessary to exercise due diligence with respect to granting and monitoring this exemption.</P>
                <P>
                    Entities holding risk management positions pursuant to the exemption in § 150.3(a)(2) would also be required to immediately report to the Commission in the event they know, or have reason to know,
                    <SU>12</SU>
                    <FTREF/>
                     that any person holds a greater than 25% interest in such position. The reason for this requirement is to alert the Commission to the possibility that an individual might be attempting to use the exemption as a means of avoiding otherwise applicable speculative position limits.
                </P>
                <FTNT>
                    <P>
                        <SU>12</SU>
                         The Commission understands that not every entity that might qualify for this exemption would necessarily know the identities of all of the participants in the position. For example, a fund based on a commodity index may qualify for the exemption but the entity operating the fund may not know the identities of the owners of outstanding shares and, therefore, may not know when any given person had acquired a 25% or more interest in the position held by the fund.
                    </P>
                </FTNT>
                <HD SOURCE="HD2">C. Questions</HD>
                <P>The Commission would welcome public comments on any aspect of the proposed risk management exemption from Federal speculative position limits. However, the Commission is particularly interested in the views of commenters on the following specific questions:</P>
                <P>(1) Are any of the proposed conditions for receiving a risk management exemption unnecessary and, if so, why? Alternatively, should any of the proposed conditions be modified and, if so, why?</P>
                <P>
                    (2) Should any other conditions, in addition to those set out in these proposed rules, be imposed as a prerequisite for receiving a risk management exemption? If so, what is the rationale for such additional conditions (
                    <E T="03">i.e.</E>
                    , what potential harm would they address)?
                </P>
                <P>(3) Is there any type of index-based trading that should be covered by the proposed rules, but is not? If so, how should the proposed rules be revised to apply to such trading?</P>
                <P>(4) The proposed rules would allow for a risk management exemption in the case of short-only futures or futures equivalent positions used to manage risks in connection with a “bear market index.” Would any of the exemptive rules, as proposed, create potential problems as applied to such an index? For example, in applying the definition of “unleveraged position,” would problems be encountered in comparing the notional value of an unleveraged short futures position to the value of the cash, margins and accrued profits on such position?</P>
                <P>(5) Should the proposed rules impose any restrictions or conditions regarding how broad- or narrow-based an index should be if a position based on the index is to qualify for an exemption? For example, with respect to narrow-based indices reflecting specific industry or commodity sectors, should the Commission be concerned that a narrow-based index composed entirely of agricultural commodities—for example, 25% each of corn, wheat, oats and soybeans—could operate as a mechanism for evading speculative position limits in one or more of those commodities?</P>
                <P>(6) The proposed rules list the information that must be provided in an application for a risk management exemption. Are the requirements set out in the proposed rules appropriate? Should the requirements be revised and, if so, how?</P>
                <HD SOURCE="HD1">III. Related Matters</HD>
                <HD SOURCE="HD2">A. Cost Benefit Analysis</HD>
                <P>Section 15(a) of the Act requires the Commission to consider the costs and benefits of its action before issuing a new regulation under the Act. By its terms, section 15(a) does not require the Commission to quantify the costs and benefits of a new regulation or to determine whether the benefits of the proposed regulation outweigh its costs. Rather, section 15(a) requires the Commission to “consider the costs and benefits” of the subject rule.</P>
                <P>
                    Section 15(a) further specifies that the costs and benefits of the proposed rule shall be evaluated in light of five broad areas of market and public concern: (1) Protection of market participants and the public; (2) efficiency, competitiveness, and financial integrity of futures markets; (3) price discovery; 
                    <PRTPAGE P="66102"/>
                    (4) sound risk management practices; and (5) other public interest considerations. The Commission may, in its discretion, give greater weight to any one of the five enumerated areas of concern and may, in its discretion, determine that, notwithstanding its costs, a particular rule is necessary or appropriate to protect the public interest or to effectuate any of the provisions or to accomplish any of the purposes of the Act.
                </P>
                <P>The proposed rules would provide for a risk management exemption from the Federal speculative position limits applicable to certain agricultural commodities, thus giving entities such as index funds and pension funds an opportunity to more effectively manage risks for their investors through greater diversification of their portfolios. The rules would seek to protect the futures markets from potential ill effects of such risk management positions by imposing conditions on the exemption and creating an application process (including a requirement to file updates as necessary) to assure those conditions are met. The Commission, in proposing these rules, has endeavored to impose the minimum requirements necessary consistent with its mandate to protect the markets and the public from ill effects.</P>
                <P>The Commission specifically invites public comment on its application of the cost benefits criteria of the Act. Commenters are also invited to submit any quantifiable data that they may have concerning the costs and benefits of the proposed rules with their comment letter.</P>
                <HD SOURCE="HD2">B. Regulatory Flexibility Act</HD>
                <P>
                    The Regulatory Flexibility Act (“RFA”), 5 U.S.C. 601 
                    <E T="03">et seq.</E>
                    , requires Federal agencies, in proposing rules, to consider the impact of those rules on small businesses. The Commission believes that the proposed rule amendments to implement a new exemption from Federal speculative position limits would only affect large traders. The Commission has previously determined that large traders are not small entities for the purposes of the RFA.
                    <SU>13</SU>
                    <FTREF/>
                     Therefore, the Chairman, on behalf of the Commission, hereby certifies, pursuant to 5 U.S.C. 605(b), that the action taken herein will not have a significant economic impact on a substantial number of small entities.
                </P>
                <FTNT>
                    <P>
                        <SU>13</SU>
                         47 FR 18618 (April 30, 1982).
                    </P>
                </FTNT>
                <HD SOURCE="HD2">C. Paperwork Reduction Act</HD>
                <P>When publishing proposed rules, the Paperwork Reduction Act of 1995 (44 U.S.C. 3507(d)) imposes certain requirements on Federal agencies (including the Commission) in connection with their conducting or sponsoring any collection of information as defined by the Paperwork Reduction Act. In compliance with the Act, the Commission, through this rule proposal, solicits comment to: (1) Evaluate whether the proposed collection of information is necessary for the proper performance of the functions of the agency, including the validity of the methodology and assumptions used; (2) evaluate the accuracy of the agency's estimate of the burden of the proposed collection of information including the validity of the methodology and assumptions used; (3) enhance the quality, utility and clarity of the information to be collected; and (4) minimize the burden of the collection of the information on those who are to respond through the use of appropriate automated, electronic, mechanical, or other technological collection techniques or other forms of information technology, e.g., permitting electronic submission of responses.</P>
                <P>The Commission has submitted the proposed rule and its associated information collection requirements to the Office of Management and Budget (“OMB”) for its review.</P>
                <P>
                    <E T="03">Collection of Information:</E>
                     Rules Establishing Risk Management Exemption From Federal Speculative Position Limits, OMB Control Number.
                </P>
                <P>The estimated burden was calculated as follows:</P>
                <P>
                    <E T="03">Estimated number of respondents:</E>
                     6.
                </P>
                <P>
                    <E T="03">Annual responses by each respondent:</E>
                     1.
                </P>
                <P>
                    <E T="03">Total annual responses:</E>
                     6.
                </P>
                <P>
                    <E T="03">Estimated average hours per response:</E>
                     10.
                </P>
                <P>
                    <E T="03">Annual reporting burden:</E>
                     60 hours.
                </P>
                <LSTSUB>
                    <HD SOURCE="HED">List of Subjects in 17 CFR Part 150</HD>
                    <P>Agricultural commodities, Bona fide hedge positions, Position limits, Spread exemptions.</P>
                </LSTSUB>
                <P>In consideration of the foregoing, pursuant to the authority contained in the Commodity Exchange Act, the Commission hereby proposes to amend part 150 of chapter I of title 17 of the Code of Federal Regulations as follows:</P>
                <PART>
                    <HD SOURCE="HED">PART 150—LIMITS ON POSITIONS</HD>
                    <P>1. The authority citation for part 150 is revised to read as follows:</P>
                    <AUTH>
                        <HD SOURCE="HED">Authority:</HD>
                        <P>7 U.S.C. 6a, 6c, and 12a(5), as amended by the Commodity Futures Modernization Act of 2000, Appendix E of Pub. L. 106-554, 114 Stat. 2763 (2000).</P>
                    </AUTH>
                    <P>2. Section 150.1 is amended by adding new paragraphs (j) through (m) to read as follows:</P>
                    <SECTION>
                        <SECTNO>§ 150.1 </SECTNO>
                        <SUBJECT>Definitions.</SUBJECT>
                        <STARS/>
                        <P>
                            (j) 
                            <E T="03">Risk management position</E>
                            , for the purposes of an exemption under § 150.3(a)(2), means a futures or futures equivalent position, held as part of a broadly diversified portfolio of long-only or short-only futures or futures equivalent positions, that is based upon either:
                        </P>
                        <P>(1) A fiduciary obligation to match or track the results of a broadly diversified index that includes the same commodity markets in fundamentally the same proportions as the futures or futures equivalent position; or</P>
                        <P>(2) A portfolio diversification plan that has, among other substantial asset classes, an exposure to a broadly diversified index that includes the same commodity markets in fundamentally the same proportions as the futures or futures equivalent position.</P>
                        <P>
                            (k) 
                            <E T="03">Broadly diversified index</E>
                             means an index based on physical commodities in which:
                        </P>
                        <P>(1) Not more than 15% of the index is composed of any single agricultural commodity named in § 150.2 (for which purposes, wheat shall be regarded as a single commodity, so that positions in all varieties of wheat, on all exchanges combined, may not exceed 15% of the index, and the soybean complex shall be regarded as a single commodity, so that positions in soybeans, soybean oil and soybean meal, on all exchanges combined, may not exceed 15% of the index); and</P>
                        <P>(2) Not more than 50% of the index as a whole is composed of agricultural commodities named in § 150.2.</P>
                        <P>
                            (l) 
                            <E T="03">Passively managed position</E>
                             means a futures or futures equivalent position that is part of a portfolio that tracks a broadly diversified index, which index is calculated, adjusted, and re-weighted pursuant to an objective, predetermined mathematical formula the application of which allows only limited discretion with respect to trading decisions.
                        </P>
                        <P>
                            (m) 
                            <E T="03">Unleveraged position</E>
                             means:
                        </P>
                        <P>(1) A futures or futures equivalent position that is part of a portfolio of futures or futures equivalent positions directly relating to an underlying broadly diversified index, the notional value of which positions does not exceed the sum of the value of:</P>
                        <P>
                            (i) Cash set aside in an identifiable manner, or unencumbered short-term U.S. Treasury obligations so set aside, plus any funds deposited as margin on such position; and
                            <PRTPAGE P="66103"/>
                        </P>
                        <P>(ii) Accrued profits on such position held at the futures commission merchant.</P>
                        <P>(2) [Reserved]</P>
                        <P>3. Section 150.3 is amended by revising paragraph (a) introductory text, adding a new paragraph (a)(2), and adding a new paragraph (c) to read as follows:</P>
                    </SECTION>
                    <SECTION>
                        <SECTNO>§ 150.3 </SECTNO>
                        <SUBJECT>Exemptions.</SUBJECT>
                        <P>
                            (a) 
                            <E T="03">Positions which may exceed limits</E>
                            . The position limits set forth in § 150.2 of this part may be exceeded to the extent such positions are established and liquidated in an orderly manner and are:
                        </P>
                        <STARS/>
                        <P>(2) Risk management positions, as defined in § 150.1(j), that fulfill the following requirements:</P>
                        <P>(i) Such risk management positions must comply with the following conditions:</P>
                        <P>(A) The positions must be passively managed;</P>
                        <P>(B) The positions must be unleveraged; and</P>
                        <P>(C) The positions must not be carried into the spot month.</P>
                        <P>(ii) Entities intending to hold risk management positions pursuant to the exemption in § 150.3(a)(2) must apply to the Commission and receive Commission approval. Such applications must include the following information:</P>
                        <P>(A) In the case of an exemption based on a fiduciary obligation, as described in § 150.1(j)(1), an application must include:</P>
                        <P>
                            (
                            <E T="03">1</E>
                            ) A description of the underlying index or group of commodities, including the commodities, the weightings, the method and timing of re-weightings, the selection of futures months, and the timing and criteria for rolling from one futures month to another;
                        </P>
                        <P>
                            (
                            <E T="03">2</E>
                            ) A description of the “fiduciary obligation;”
                        </P>
                        <P>
                            (
                            <E T="03">3</E>
                            ) The actual or anticipated value of the underlying funds to be invested in commodities within the next fiscal or calendar year and the method for calculating that value, as well as the equivalent numbers of futures contracts in each of the § 150.2 markets for which the exemption is sought;
                        </P>
                        <P>
                            (
                            <E T="03">4</E>
                            ) A description of the manner in which the funds to be invested in commodities will be set aside;
                        </P>
                        <P>
                            (
                            <E T="03">5</E>
                            ) A statement certifying that the requirements of this exemption are met and will be observed at all times going forward and that the Commission will be notified promptly of any material changes in this information; and
                        </P>
                        <P>
                            (
                            <E T="03">6</E>
                            ) Such other information as the Commission may request.
                        </P>
                        <P>(B) In the case of an exemption based on a portfolio diversification plan, as described in § 150.1(j)(2), an application must include:</P>
                        <P>
                            (
                            <E T="03">1</E>
                            ) A description of the investment index or group of commodities, including the commodities, the weightings, the method and timing of re-weightings, the selection of futures months, and the timing and criteria for rolling from one futures month to another;
                        </P>
                        <P>
                            (
                            <E T="03">2</E>
                            ) A description of the entire portfolio, including the total size of the assets, the asset classes making up the portfolio, and a description of the allocation among the asset classes;
                        </P>
                        <P>
                            (
                            <E T="03">3</E>
                            ) The actual or anticipated value of the underlying funds to be invested in commodities and the method for calculating that value, as well as the equivalent numbers of futures contracts in each of the § 150.2 markets for which the exemption is sought;
                        </P>
                        <P>
                            (
                            <E T="03">4</E>
                            ) A description of the manner in which the funds to be invested in commodities will be set aside;
                        </P>
                        <P>
                            (
                            <E T="03">5</E>
                            ) A statement certifying that the requirements of this exemption are met and will be observed at all times going forward and that the Commission will be notified promptly of any material changes in this information; and
                        </P>
                        <P>
                            (
                            <E T="03">6</E>
                            ) Such other information as the Commission may request.
                        </P>
                        <P>(iii) Whenever the purchases or sales that a person wishes to qualify under this risk management exemption shall exceed the amount provided in the person's most recent filing pursuant to this section, or the amount previously specified by the Commission pursuant to this section, such person shall file with the Commission a statement that updates the information provided in the person's most recent filing and provides the reasons for this change. Such statement shall be filed at least ten business days in advance of the date that such person wishes to exceed those amounts and if the notice filer is not notified otherwise by the Commission within the 10-day period, the exemption will continue to be effective. The Commission may, upon call, obtain such additional materials from the applicant or person availing themselves of this exemption as the Commission deems necessary to exercise due diligence with respect to granting and monitoring this exemption.</P>
                        <P>(iv) Entities holding risk management positions pursuant to the exemption in § 150.3(a)(2) shall immediately report to the Commission in the event that they know, or have reason to know, that any person holds a greater than 25% interest in such position.</P>
                        <STARS/>
                        <P>(c) The Commission hereby delegates, until such time as the Commission orders otherwise, to the Director of the Division of Market Oversight, or the Director's designee, the functions reserved to the Commission in § 150.3(a)(2) of this chapter.</P>
                    </SECTION>
                    <SIG>
                        <DATED>Issued by the Commission this 20th day of November, 2007, in Washington, DC.</DATED>
                        <NAME>David Stawick,</NAME>
                        <TITLE>Secretary of the Commission.</TITLE>
                    </SIG>
                </PART>
            </SUPLINF>
            <FRDOC>[FR Doc. E7-22992 Filed 11-26-07; 8:45 am]</FRDOC>
            <BILCOD>BILLING CODE 6351-01-P</BILCOD>
        </PRORULE>
        <PRORULE>
            <PREAMB>
                <AGENCY TYPE="N">DEPARTMENT OF HEALTH AND HUMAN SERVICES</AGENCY>
                <SUBAGY>Food and Drug Administration</SUBAGY>
                <CFR>21 CFR Part 101</CFR>
                <DEPDOC>[Docket Nos. 2004N-0217, 2005P-0189, and 2006P-0137]</DEPDOC>
                <RIN>RIN No. 0910-ZA28</RIN>
                <SUBJECT>Food Labeling: Nutrient Content Claims; Alpha-Linolenic Acid, Eicosapentaenoic Acid, and Docosahexaenoic Acid Omega-3 Fatty Acids</SUBJECT>
                <AGY>
                    <HD SOURCE="HED">AGENCY:</HD>
                    <P>Food and Drug Administration, HHS.</P>
                </AGY>
                <ACT>
                    <HD SOURCE="HED">ACTION:</HD>
                    <P>Notice of proposed rulemaking.</P>
                </ACT>
                <SUM>
                    <HD SOURCE="HED">SUMMARY:</HD>
                    <P>The Food and Drug Administration (FDA) proposes to issue this rule finding that certain nutrient content claims for foods, including conventional foods and dietary supplements, that contain omega-3 fatty acids, do not meet the requirements of the Federal Food, Drug, and Cosmetic Act (the act) and may not appear in food labeling. This rule is being proposed in response to three notifications submitted to FDA under the act. One notification concerning nutrient content claims for alpha-linolenic acid (ALA), docosahexaenoic acid (DHA), and eicosapentaenoic acid (EPA) was submitted collectively by Alaska General Seafoods, Ocean Beauty Seafoods, Inc., and Trans-Ocean Products, Inc. (the seafood processors notification); a second notification concerning nutrient content claims for ALA, DHA, and EPA was submitted by Martek Biosciences Corp. (the Martek notification); and a third notification concerning nutrient content claims for DHA and EPA was submitted by Ocean Nutrition Canada, Ltd. (the Ocean Nutrition notification).</P>
                    <P>
                        FDA has reviewed the information included in the three notifications and is proposing to prohibit the nutrient content claims for DHA and EPA set 
                        <PRTPAGE P="66104"/>
                        forth in the three notifications because they are not based on an authoritative statement that identifies a nutrient level to which the claims refer, as required by the controlling statutory authority. FDA is also proposing to prohibit the nutrient content claims for ALA set forth in the seafood processors notification because they are based on a daily value that was determined by a different method than daily values already established for other nutrients. Because of the different methodology used to set the daily value, the ALA claims set forth in the seafood processors notification do not enable the public to comprehend the information provided in the claims and to understand the relative significance of such information in the context of the daily diet, as required by the controlling statutory authority. FDA is proposing to take no regulatory action with respect to the nutrient content claims for ALA set forth in the Martek notification. Therefore, if this proposed rule is finalized without change, these claims will be allowed to remain on the market.
                    </P>
                </SUM>
                <DATES>
                    <HD SOURCE="HED">DATES:</HD>
                    <P>Submit written or electronic comments by February 11, 2008.</P>
                </DATES>
                <ADD>
                    <HD SOURCE="HED">ADDRESSES:</HD>
                    <P>You may submit comments, identified by Docket Nos. 2004N-0217, 2005P-0189, and 2006P-0137 by any of the following methods:</P>
                    <FP>
                        <E T="03">Electronic Submissions</E>
                    </FP>
                    <P>Submit electronic comments in the following ways:</P>
                    <P>
                        • Federal eRulemaking Portal: 
                        <E T="03">http://www.regulations.gov</E>
                        . Follow the instructions for submitting comments.
                    </P>
                    <P>
                        • Agency Web site: 
                        <E T="03">http://www.fda.gov/dockets/ecomments</E>
                        . Follow the instructions for submitting comments on the agency Web site.
                    </P>
                    <FP>
                        <E T="03">Written Submissions</E>
                    </FP>
                    <P>Submit written submissions in the following ways:</P>
                    <P>• FAX: 301-827-6870.</P>
                    <P>• Mail/Hand delivery/Courier [For paper, disk, or CD-ROM submissions]: Division of Dockets Management (HFA-305), Food and Drug Administration, 5630 Fishers Lane, rm. 1061, Rockville, MD 20852.</P>
                    <P>
                        To ensure more timely processing of comments, FDA is no longer accepting comments submitted to the agency by e-mail. FDA encourages you to continue to submit electronic comments by using the Federal eRulemaking Portal or the agency Web site, as described in the 
                        <E T="03">Electronic Submissions</E>
                         portion of this paragraph.
                    </P>
                    <P>
                        <E T="03">Instructions</E>
                        : All submissions received must include the agency name and Docket No(s). and Regulatory Information Number (RIN) (if a RIN number has been assigned) for this rulemaking. All comments received may be posted without change to 
                        <E T="03">http://www.fda.gov/ohrms/dockets/default.htm</E>
                        , including any personal information provided. For additional information on submitting comments, see the “Comments” heading of the 
                        <E T="02">SUPPLEMENTARY INFORMATION</E>
                         section of this document.
                    </P>
                    <P>
                        <E T="03">Docket</E>
                        : For access to the docket to read background documents or comments received, go to 
                        <E T="03">http://www.fda.gov/ohrms/dockets/default.htm</E>
                         and insert the docket number(s), found in brackets in the heading of this document, into the “Search” box and follow the prompts and/or go to the Division of Dockets Management, 5630 Fishers Lane, rm. 1061, Rockville, MD 20852.
                    </P>
                </ADD>
                <FURINF>
                    <HD SOURCE="HED">FOR FURTHER INFORMATION CONTACT:</HD>
                    <P>Vincent de Jesus, Center for Food Safety and Applied Nutrition (HFS-830), Food and Drug Administration, 5100 Paint Branch Pkwy., College Park, MD 20740-3835, 301-436-1450.</P>
                </FURINF>
            </PREAMB>
            <SUPLINF>
                <HD SOURCE="HED">SUPPLEMENTARY INFORMATION:</HD>
                <HD SOURCE="HD1">I. Background</HD>
                <HD SOURCE="HD2">A. Section 403(r) of the Act</HD>
                <P>
                    On November 8, 1990, President George H.W. Bush signed into law the Nutrition Labeling and Education Act of 1990 (the 1990 amendments) (Public Law 101-535), which amended the act. Section 403(r)(1)(A) of the act (21 U.S.C. 343(r)(1)(A)), which was added by the 1990 amendments, states that a food for human consumption is misbranded if a claim is made in its label or labeling that expressly or implicitly characterizes the level of any nutrient of the type required to be declared in nutrition labeling, unless such claim uses terms defined in regulations by FDA under section 403(r)(2)(A) of the act.
                    <SU>1</SU>
                    <FTREF/>
                </P>
                <FTNT>
                    <P>
                        <SU>1</SU>
                        The requirements in section 403(r)(2) of the act for nutrient content claims, apply to foods and food labeling unless an exemption applies for the food or the claim under section 403(r)(2) of the act, another section of the act, or FDA regulations.
                    </P>
                </FTNT>
                <P>In 1993, FDA established regulations that implemented the 1990 amendments (58 FR 2066 to 2941, January 6, 1993). Among these regulations, § 101.13 (21 CFR 101.13) sets forth general principles for nutrient content claims (see 58 FR 2302, January 6, 1993). Other sections in part 101, subpart D (21 CFR part 101, subpart D), define specific nutrient content claims, such as “high,” “good source,” and “more,” and provide that claims such as these must be made in relation to reference values set out in regulations by FDA. For example, to bear the claim “high in fiber” in its label or labeling, a food must contain 20 percent or more of the reference value for fiber set out in 21 CFR 101.9(c)(9). Other provisions set forth the procedures whereby a person who wishes to make a nutrient content claim not already defined by regulation may petition the agency to authorize that claim under section 403(r)(4) of the act (see 21 CFR 101.69). A petitioner bears the burden of establishing the scientific basis for a proposed nutrient content claim.</P>
                <P>On November 21, 1997, President William J. Clinton signed the Food and Drug Administration Modernization Act (FDAMA) into law (Public Law 105-115), which, among other things, added new sections (r)(2)(G) and (r)(2)(H) to the act. These sections provide for the filing of notifications as an alternative to the petition process in section 403(r)(4) of the act. Under the notification process, the scientific basis for a nutrient content claim or health claim is established through reliance on an authoritative statement.</P>
                <P>Section 403(r)(2)(G) of the act requires that a notification of the prospective nutrient content claim be submitted to FDA at least 120 days before a food bearing the claim may be introduced into interstate commerce. The notification must contain specific information including the following: (1) The exact wording of the prospective nutrient content claim; (2) a concise description of the basis upon which the notifier relied for determining that the requirements for an authoritative statement in section 403(r)(2)(G)(i) have been satisfied; (3) a copy of the authoritative statement that serves as the basis for the claim; and (4) a balanced representation of the scientific literature relating to the nutrient level for a prospective nutrient content claim. An authoritative statement must have been published by a scientific body of the U.S. Government that has official responsibility for public health protection or research directly relating to human nutrition or the National Academy of Sciences (NAS) or any of its subdivisions. In addition, an authoritative statement must identify the nutrient level to which the claim refers and must be currently in effect. Thus, the requirements of 403(r)(2)(G) of the act are not met by a statement that does not identify the nutrient level to which the claim refers.</P>
                <P>
                    FDA considers the term “nutrient level” as used in section 403(r)(2)(G) of the act to mean a reference value that is similar to a label reference value for use in nutrition labeling. To date, FDA has established by regulation two sets of label reference values: Reference Daily Intakes (RDIs) and Daily Reference Values (DRVs) (see 21 CFR 
                    <PRTPAGE P="66105"/>
                    101.9(c)(8)(iv) and 101.9(c)(9), respectively). FDA based its RDIs on Recommended Daily Allowances (RDAs) and Estimated Safe and Adequate Daily Dietary Intakes (ESADDIs) established by NAS. FDA based its DRVs on recommendations in the NAS Diet and Health Report, the Surgeon General's Report on Nutrition and Health, and the 1990 Dietary Guidelines for Americans. FDA uses RDIs and DRVs as Daily Values (DVs) for purposes of nutrition labeling. Thus, FDA considers DVs to be a specific set of reference values established by regulation (58 FR 2079 at 2125, January 6, 1993).
                </P>
                <P>A DV for a particular nutrient is used to calculate the percent DV that a serving of food provides for that nutrient, based on the assumption of a 2,000 calorie per day diet. The percent DV is listed in the Nutrition Facts and Supplement Facts boxes in nutrition labeling and provides consumers with an overall reference value for the nutrient. DVs are intended to help consumers understand the relative significance of information about the amount of certain nutrients in a food in the context of a total daily diet, and to help consumers compare the nutritional values of food products.</P>
                <P>
                    In the preamble to one of its regulations implementing the 1990 amendments (1990 preamble), FDA drew a distinction between the term “Daily Value,” or “DV,” used as a proper noun, and the term “daily value,” used in a more generic sense. As noted above, DVs are established by regulation. By contrast, “daily values” are alternate values that are not established by regulation, such as those based on alternate daily caloric requirements (i.e., 2,500 calories per day) (58 FR 2079 at 2125, January 6, 1993). Notwithstanding this distinction between “Daily Values” or “DVs” and “daily values,” FDA and industry have occasionally used the term “Daily Value” or “DV” to refer to alternate values that are not established by regulation, such as the quantity of a nutrient that has been proposed for use in nutrition labeling, or that is the basis for the use of a claim with respect to which FDA has taken no regulatory action under section 403(r)(2)(H) of the act (21 U.S.C. 343(r)(2)(H)).
                    <SU>2</SU>
                    <FTREF/>
                </P>
                <FTNT>
                    <P>
                        <SU>2</SU>
                        See, e.g., FDA's statement titled “Nutrient Content Claims Notification for Choline Containing Foods,” August 30, 2001, and also the notifications addressed by this rulemaking.
                    </P>
                </FTNT>
                <P>FDA intends to maintain the distinction between “Daily Values” or “DVs” and “daily values” that it articulated in its 1990 preamble. FDA has not established by regulation any DV for ALA, DHA, or EPA. Therefore, this proposal uses the term “daily value” when referring to the quantity of ALA, DHA, and EPA on which the nutrient content claims at issue are based, unless the proposal is quoting a claim submitted by one of the notifiers.</P>
                <P>Under section 403(r)(2)(H) of the act, a nutrient content claim authorized under section 403(r)(2)(G) may be made beginning 120 days after submission of the notification until the following occurs: (1) FDA issues an effective regulation that prohibits or modifies the claim; (2) the agency issues a regulation finding that the requirements under section 403(r)(2)(G) have not been met; or (3) a district court of the United States in an enforcement proceeding under chapter III of the act has determined that the requirements under section 403(r)(2)(G) have not been met.</P>
                <HD SOURCE="HD2">B. The IOM Final Report</HD>
                <P>In 2005, the Food and Nutrition Board of the Institute of Medicine (IOM) of the National Academy of Sciences published a report titled “Dietary Reference Intakes for Energy, Carbohydrate, Fiber, Fat, Fatty Acids, Cholesterol, Protein, and Amino Acids” (IOM Final Report, Ref. 1). The report is one in a series that presents a comprehensive set of reference values for nutrient intakes for healthy U.S. and Canadian individuals and populations. Publication of the IOM Final Report was preceded by release in 2002 of a prepublication copy under the same title (IOM Prepublication Report, Ref. 2).</P>
                <P>
                    In relevant part, the IOM Final Report establishes Dietary Reference Intakes (DRIs) for a number of nutrients that are essential
                    <SU>3</SU>
                    <FTREF/>
                     in the human diet (e.g., linoleic acid) or provide a beneficial role in human health (e.g., total fiber). According to the IOM Final Report, DRIs “comprise a set of reference values for specific nutrients, each category of which has special uses.” These reference values “include the Estimated Average Requirement (EAR), Recommended Daily Allowance (RDA), AI, and Tolerable Upper Intake Level (UL).”
                    <SU>4</SU>
                    <FTREF/>
                </P>
                <FTNT>
                    <P>
                        <SU>3</SU>
                        The criteria for essentiality of a nutrient are that absence of the nutrient from the diet results in characteristic signs of a deficiency disease and these signs are prevented only by the nutrient itself or a specific precursor of it. (Ref. 3 Carpenter and Harper, Modern Nutrition in Health and Disease).
                    </P>
                </FTNT>
                <FTNT>
                    <P>
                        <SU>4</SU>
                        The IOM Final Report also establishes Acceptable Macronutrient Distribution Ranges (AMDRs) for some nutrients. AMDRs are ranges of macronutrient intakes that are associated with reduced risk of chronic disease, while providing recommended intakes of other essential nutrients. AMDRs are not considered to be a type of DRI.
                    </P>
                </FTNT>
                <P>An RDA is an estimate of the minimum daily average dietary intake level that meets the nutrient requirements of nearly all (97 to 98 percent) healthy individuals in a particular life stage and gender group. The setting of an RDA is contingent on there being sufficient scientific evidence to establish an EAR, which is the average daily nutrient intake level estimated to meet the requirement of half the healthy individuals in a particular life stage and gender group.</P>
                <P>If there is insufficient scientific evidence to establish an EAR, then an AI is established instead of an RDA (assuming there is sufficient data to support establishment of an AI). An AI is the recommended average daily intake level that is assumed to be adequate based on observed or experimentally determined approximations or estimates of nutrient intake by a group (or groups) of apparently healthy people.</P>
                <P>
                    Among other nutrients, the IOM Final Report addresses omega-3 fatty acids, including ALA, EPA, and DHA. These fatty acids are also called 
                    <E T="03">n</E>
                    -3 fatty acids because the first double bond is located at the third carbon from the methyl end of the molecule (Ref. 4). For ALA, the IOM Final Report does not establish a DRI in the form of an RDA because there is insufficient scientific evidence to establish an EAR. As noted, if there is insufficient scientific evidence to establish an EAR, then no RDA is established. Instead, the IOM Final Report establishes AIs for different life stage groups (e.g., girls ages 9 through 13, boys ages 14 through 18). Those AIs are based on median intakes in the United States, where an omega-3 fatty acid deficiency is nonexistent in healthy individuals. The IOM Final Report does not establish a DRI in any form for either EPA or DHA.
                </P>
                <HD SOURCE="HD1">II. The Three Notifications Submitted to FDA</HD>
                <HD SOURCE="HD2">A. The Seafood Processors Notification</HD>
                <P>
                    On January 16, 2004, FDA received a nutrient content claim notification for foods, including conventional foods and dietary supplements, containing ALA, EPA, and DHA omega-3 fatty acids submitted jointly in the seafood processors notification under section 403(r)(2)(G) of the act (Ref. 5). The notification stated that the nutrient content claims it proposed were based upon authoritative statements made in the IOM Prepublication Report (Ref. 2). As of May 16, 2004, it has been permissible to make the nutrient content claims set forth in the notification.
                    <PRTPAGE P="66106"/>
                </P>
                <P>
                    The notification proposed “high,” “good source,” and “more” claims for ALA, and “high” claims for DHA and EPA. With respect to specific authoritative statements that identify a nutrient level for ALA, the seafood processors notification referenced the following age-gender group specific AIs identified in the IOM Prepublication Report: 0.9 grams/day (g/day) for males and females age 4 to 8 years; 1.2 g/day for males age 9 to 13 years; 1.0 g/day for females age 9 to 13 years; 1.6 g/day for males 14 and more years of age; and 1.1 g/day for females 14 and more years of age. Also, the notification quoted the following as authoritative statements that identify a nutrient level for ALA, EPA, and DHA: “Because of a lack of evidence for determining the requirement for 
                    <E T="03">n</E>
                    -3 fatty acids, an AI [for ALA] is set based on the highest median intake of [ALA] by adults in the United States where a deficiency is basically nonexistent in free-living populations * * * and rounding. Small amounts of EPA and DHA can contribute towards reversing an 
                    <E T="03">n</E>
                    -3 fatty acid deficiency * * * EPA and DHA can contribute up to 10 percent of the total 
                    <E T="03">n</E>
                    -3 fatty acid intake and therefore up to this percent can contribute toward the AI for [ALA] * * *” (Ref. 2, p. 8 to 38).
                </P>
                <P>
                    In calculating a qualifying level for the basis of the “high,” “good source,” and “more” claims for ALA, the seafood processors notification set 1.3 g as a daily value for ALA and applied the specific percentages of this value as qualifying levels for the three ALA nutrient content claims as outlined in 21 CFR 101.54.
                    <SU>5</SU>
                    <FTREF/>
                     The value of 1.3 g was a result of computing a population-weighted average of age and gender-specific AIs for ALA, using 2005 projected U.S. census data. The notification acknowledged that there is currently in effect a nutrient content claim for choline that is based on the highest age and gender-specific AI for that nutrient (Refs. 6 and 7). Nonetheless, the notification set a daily value for ALA using a population-weighted average because a recent report from the IOM, titled “Dietary Reference Intakes: Guiding Principles for Nutrition Labeling and Fortification” (IOM Guiding Principles Report, Ref. 8), recommended setting new DVs based on this method, rather than on the highest age and gender-specific AI.
                </P>
                <FTNT>
                    <P>
                        <SU>5</SU>
                        For a “high” claim, the food must contain 20 percent or more of the reference value per reference amount customarily consumed. For a “good source” claim, the food must contain 10 to 19 percent of the reference value per reference amount customarily consumed. For a “more” claim, the food must contain at least 10 percent more of the reference value per reference amount customarily consumed than an appropriate reference food.
                    </P>
                </FTNT>
                <P>In setting a qualifying level for the “high” claim for EPA or DHA, the seafood processors notification set 130 milligrams (mg) as the daily value for EPA or DHA (i.e., 10 percent of the daily value for ALA) and set 130 mg (i.e., equal to the daily value) as the qualifying level for the “high” claim. The notification did not request “good source” or “more” claims for EPA or DHA.</P>
                <P>Also, the seafood processors notification specified accompanying statements for the above claims. The “high” and “good source” claims would include one of the following statements:</P>
                <P>(1) “Contains ___ mg of [DHA/EPA/ALA] per serving, which is ___ % of the Daily Value for [DHA/EPA (130 mg) or {ALA (1.3 g)}].”</P>
                <P>(2) “Contains ___ % of the Daily Value for [DHA/EPA/ALA] per serving. The Daily Value for [{DHA/EPA is 130 mg} or [ALA is 1.3 g]].”</P>
                <P>For “more” claims, the notification specified that the claims would be accompanied by statements such as: “___ % [10 % or greater] more of the Daily Value for ALA per serving than [reference food]. This product contains ___ mg ALA omega-3 per serving, which is ___ % of the Daily Value for ALA omega-3 (1.3 g). [Reference food] contains ___ mg ALA omega-3 per serving.”</P>
                <P>To qualify for “high” claims for ALA, the product would need to contain at least 260 mg of ALA per reference amount customarily consumed (RACC). To qualify for “good source” claims for ALA, the product would need to contain at least 130 mg of ALA per RACC. To qualify for “more” claims for ALA, the product would need to contain at least 130 mg or more of ALA per RACC than the reference food. To qualify for “high” claims for EPA or DHA, the product would need to contain at least 130 mg of EPA or DHA per RACC.</P>
                <HD SOURCE="HD2">B. The Martek Notification</HD>
                <P>On January 21, 2005, FDA received a notification of nutrient content claims for foods, including conventional foods and dietary supplements, containing ALA and DHA omega-3 fatty acids in the Martek Notification, under section 403(r)(2)(G) of the act (Ref. 9). The notification stated that the nutrient content claims were based upon authoritative statements made in the IOM Prepublication Report (Ref. 2). As of May 22, 2005, it has been permissible to make the nutrient content claims set forth in the notification.</P>
                <P>
                    The notification proposed “high,” “good source,” and “more” claims for ALA, and “high” claims for DHA. With respect to specific authoritative statements that identify a nutrient level for ALA, the Martek notification cited AIs for ALA identified in the IOM Prepublication Report (i.e., 1.6 grams per (g)/ day for adult men and 1.1 g/day for adult women, specifically) and cited the following sentence: “While intake levels much lower than the AI occur in the United States without the presence of a deficiency, the AI can provide the beneficial health effects associated with the consumption of 
                    <E T="03">n</E>
                    -3 fatty acids” (Ref. 2, p. 8-2). As authoritative statements that identify a nutrient level for DHA, the notification cited the following statements from the IOM Prepublication Report the following: (1) “EPA and DHA can contribute up to 10 percent of the total 
                    <E T="03">n</E>
                    -3 fatty acid intake and therefore up to this percent can contribute towards the AI for alpha-linolenic acid;” (2) “The AMDR for [ALA] is set at 0.6 to 1.2 percent of energy. Up to 10 percent of this range can be consumed as [EPA] and/or [DHA];” and (3) “A growing body of literature suggests that higher intakes of [ALA], [EPA] and [DHA] may afford some degree of protection against CHD. Because the physiological potency of EPA and DHA is much greater than that for [ALA] acid, it is not possible to estimate one AMDR for all 
                    <E T="03">n</E>
                    -3 fatty acids. Up to 10 percent of the AMDR can be consumed as EPA and/or DHA.”
                </P>
                <P>In determining nutrient qualifying levels for the proposed “excellent,” “good source,” and “more” claims for ALA, the Martek notification set 1.6 g as the daily value for ALA and applied specific percentages of this value as qualifying levels for these claims as outlined in § 101.54. The Martek notification based the daily value for ALA on the AI of 1.6 g identified for adult males in the IOM Prepublication Report, making no adjustments for intakes based on population-weighted averages. The Martek notification took issue with the seafood processors notification because that notification set a daily value for ALA based on a population-weighted method rather than the historically used highest age and gender-specific reference value.</P>
                <P>In determining a qualifying level of nutrient for the proposed “excellent” claim for DHA, the Martek notification set 160 mg as the daily value for DHA (i.e., 10 percent of the daily value for ALA) and applied 32 mg or more (i.e., 20 percent of the daily value for DHA) as a qualifying level for the claim. The Martek notification proposed the following exact words for the claims:</P>
                <P>
                    (1) “ ‘Excellent source of ALA.’ (‘High in ALA,’ ‘Rich in ALA’) Contains ___ mg 
                    <PRTPAGE P="66107"/>
                    of ALA per serving, which is ___ % of the 1.6 g Daily Value for ALA.” [Products would need to contain at least 320 mg of ALA per RACC to qualify for the claim.]
                </P>
                <P>(2) “ ‘Good source of ALA.’ (‘Contains ALA,’ ‘Provides ALA’) Contains ___ mg of ALA per serving, which is ___ % of the 1.6 g Daily Value for ALA” [Products would need to contain at least 160 mg of ALA per RACC to qualify for the claim.]</P>
                <P>(3) “ ‘More ALA.’ (‘Fortified with ALA,’ ‘Enriched with ALA,’ ‘Added ALA,’ ‘Extra ALA,’ ‘Plus ALA’) Contains ___ % more of the Daily Value for ALA per serving than [reference food]. This product contains ___ mg of ALA which is ___ % of the Daily Value for ALA (1.6 g).” [Products would need to contain at least 160 mg or more ALA per RACC than an appropriate reference food and would comply with the requirements for relative claims found at 21 CFR 101.13(j).]</P>
                <P>(4) “ ‘Excellent source of DHA.’ (‘High in DHA,’ ‘Rich in DHA’) Contains ___ mg of DHA per serving, which is ___ % of the 160 mg Daily Value for DHA.” [Products would need to contain at least 32 mg of DHA per RACC to qualify for the claim.]</P>
                <HD SOURCE="HD2">C. The Ocean Nutrition Notification</HD>
                <P>On December 9, 2005, FDA received a notification of nutrient content claims for foods, including conventional foods and dietary supplements, containing both EPA and DHA omega-3 fatty acids in the Ocean Nutrition notification, under section 403(r)(2)(G) of the act (Ref. 10). The notification stated that the nutrient content claims were based upon authoritative statements made in the IOM prepublication report (Ref. 2). As of April 9, 2006, it has been permissible to make the nutrient content claims set forth in the notification.</P>
                <P>
                    The Ocean Nutrition notification proposed “high” claims for EPA and DHA combined. With respect to specific authoritative statements that identify the nutrient level for EPA and DHA combined, the Ocean Nutrition notification referenced the AI for adult males of 1.6 g per day of ALA identified in the IOM Prepublication Report (Ref. 2). In addition, the notification referenced the following statements from the IOM Prepublication Report (Ref. 2): (1) “EPA and DHA can contribute up to 10 percent of the total 
                    <E T="03">n</E>
                    -3 fatty acid intake and therefore up to this percent can contribute towards the AI for [ALA],” and (2) “The AMDR for [ALA] is set at 0.6 to 1.2 percent of energy. Up to 10 percent of this range can be consumed as [EPA] and/or [DHA].” The notification contended that a combination of EPA and DHA is the most appropriate basis for establishing nutrient content claims derived from the IOM Prepublication Report.
                </P>
                <P>In calculating a nutrient qualifying level for the proposed “excellent source” claim for the combination of EPA and DHA, the Ocean Nutrition notification set 1.6 g as a daily value for ALA and 160 mg as a daily value for the combination of EPA and DHA (i.e., 10 percent of the daily value for ALA), and used 32 mg or more (i.e., 20 percent of the daily value for the combination of EPA and DHA) as a qualifying level for the “excellent source” claim.</P>
                <P>The Ocean Nutrition notification proposed the following exact words for the claims:</P>
                <P>“ ‘Excellent source of Omega-3 EPA and DHA.’ (‘High in Omega-3 EPA and DHA;’ ‘Rich in Omega-3 EPA and DHA’). Contains ___mg of EPA and DHA combined per serving, which is ___% of the 160 mg EPA and DHA combined per serving, which is ___% of the 160 mg Daily Value for a combination of EPA and DHA.”</P>
                <HD SOURCE="HD1">III. Basis for the Proposed Action</HD>
                <P>
                    FDA has reviewed the three notifications submitted in support of the claims for ALA, EPA, and DHA. With respect to the claims for ALA in the Martek notification, FDA proposes to take no regulatory action at this time. FDA expresses no opinion as to whether those claims are supported by a statement that satisfies the requirements of section 403(r)(2)(G) of the act for authoritative statements. In the November 2, 2007, 
                    <E T="04">Federal Register</E>
                     (72 FR 62149), we have published an Advance Notice of Proposed Rulemaking (ANPRM) soliciting comment on how daily values for nutrients should be calculated, including the appropriateness of using an AI to set a DV.
                    <SU>6</SU>
                    <FTREF/>
                </P>
                <FTNT>
                    <P>
                        <SU>6</SU>
                        In one other instance, FDA has taken no regulatory action with respect to a notification that proposed a nutrient content claim based on an AI. The nutrient content claim for choline (Ref. 7) was based upon a reference value that the notifier set using the AIs established by the IOM in 1998 for that nutrient (Ref. 8). Choline is essential in the human diet and the AIs for that nutrient were established based upon experimental data demonstrating prevention of alanine aminotransferase abnormalities in healthy men.
                    </P>
                </FTNT>
                <P>
                    With respect to the claims for ALA in the seafood processors notification, FDA proposes to prohibit those claims because they are based on a population-weighted average of the AIs for ALA. The population-weighted average approach to determining DVs for nutrients is different from the “population coverage” approach that FDA has used to date and continues to use, pending any possible rulemaking based on the issuance of the agency's ANPRM on DV issues.
                    <SU>7</SU>
                    <FTREF/>
                     The concurrent use of two different methods to set daily values on which nutrient content claims in food labeling are based creates an inconsistency that could lead to consumer confusion about such claims, as discussed more fully below. Therefore, FDA proposes to conclude that the ALA claims set forth in the seafood processors notification do not enable the public to comprehend the information provided and to understand the relative significance of such information in the context of the daily diet, as required by section 403(r)(2)(G)(iv) of the act. A claim that does not meet the requirements of section 403(r)(2)(G) of the act may not be made on the label or labeling of food.
                </P>
                <FTNT>
                    <P>
                        <SU>7</SU>
                        FDA seeks comment in the ANPRM on whether the agency should continue to use the population-coverage approach or switch to the population-weighted average approach to setting DVs. The agency's reasons for adopting the population-coverage approach to set DVs in 1993 are discussed in the final rule entitled “Reference Daily Intakes and Daily Reference Values” (see 58 FR 2206 at 2211, January 6, 1993).
                    </P>
                </FTNT>
                <P>With respect to claims for EPA and DHA, whether singly or in combination, FDA proposes to conclude that the IOM statements submitted as the basis of the claims do not meet the requirements of section 403(r)(2)(G) of the act in two respects. First, none of the statements identify the nutrient level to which the claims refer (i.e., daily values for EPA and DHA that can serve as the basis for the requested nutrient content claims) (see section 403(r)(2)(G)(i) of the act). Second, in the absence of a nutrient level for EPA and DHA derived from the authoritative statement of a scientific body defined in 403(r)(2)(G)(i) of the act, the requested claims do not convey meaningful information about EPA and DHA content because they lack an adequate scientific basis. Thus, the claims do not enable the public to comprehend the information provided and to understand the relative significance of such information in the context of the daily diet, as required by section 403(r)(2)(G)(iv) of the act.</P>
                <P>
                    In this regard, FDA notes that the setting of daily values and qualifying levels for claims in food labeling on the basis of statements that do not identify the nutrient level to which the claims refer can result in inconsistent and conflicting claims that confuse consumers. The requirement in section 403(r)(2)(G) of the act that an authoritative statement identify the nutrient level to which the claim refers helps to ensure consistency in the use of a particular nutrient content claim 
                    <PRTPAGE P="66108"/>
                    among different products from different manufacturers.
                </P>
                <P>The notification process in section 403(r)(2)(G) of the act provides a mechanism for authorizing a new nutrient content claim based on an authoritative statement by a scientific body of the United States government with official responsibility for public health protection or research directly relating to human nutrition, or by the National Academy of Sciences or any of its subdivisions. Under this expedited process, the scientific basis for a nutrient content claim is established through reliance on an authoritative statement of one of the scientific bodies designated in section 403(r)(2)(G), which has already reviewed the relevant scientific evidence. Therefore, when FDA is reviewing a notification under section 403(r)(2)(G) , the agency does not conduct an independent review of the body of scientific evidence associated with the proposed nutrient content claim. Rather, FDA's review is limited to considering whether the authoritative statement and the proposed nutrient content claim meet the requirements of section 403(r)(2)(G) of the act. (In contrast, the agency will conduct its own review of the scientific evidence for the proposed claim when a nutrient content claim petition is submitted under section 403(r)(4) of the act (see 21 CFR 101.69).)</P>
                <P>FDA notes that all of the notifications at issue in this rulemaking relied on statements made in the IOM Prepublication Report. For purposes of this proposed rule, FDA has evaluated the claims in the notifications in light of relevant statements made in the IOM Final Report. Unless stated otherwise, those statements may be presumed to be identical to statements made in the IOM Prepublication Report.</P>
                <HD SOURCE="HD2">A. ALA</HD>
                <P>The following statement in the IOM Final Report is pertinent to this proposed rule and is identical to a statement made in the IOM Prepublication Report that was cited by all three of the notifications: “The AI for [ALA] is 1.6 and 1.1 g/day for men and women, respectively.” (Ref. 1, Summary, p. 9). ALA is essential in the human diet. The IOM established AIs for ALA based upon the median intake of ALA by different gender and life stage groups in the United States, where a deficiency is basically nonexistent in free-living populations (see pages 427, 469 to 472, 1051 to 1051) (Ref. 1).</P>
                <P>At this time, FDA proposes to take no regulatory action with respect to the nutrient content claims for ALA in the Martek notification. FDA notes that those claims are based on a daily value that the notifier set using the highest gender and life-stage AI (i.e., 1.6 g/day of ALA for men ages 19 years and older). Assuming, without deciding the issue, that it is appropriate to use an AI to set a DV, the population-coverage approach used by Martek in this notification ensures that the nutritional needs of almost all segments of the population are covered. This approach is consistent with the method that FDA has used in determining DVs to date (see 58 FR 2206 at 2211, January 6, 1993).</P>
                <P>
                    In contrast, FDA proposes to prohibit the claims for ALA in the seafood processors notification because those claims are based on a daily value that the notifier set using a population-weighted average of AI reference values (1.3 g/day).
                    <SU>8</SU>
                    <FTREF/>
                     A daily intake level based on a population-weighted average of AI values may not be adequate for some segments of the population (e.g., men ages 19 and over). Use of the population-weighted average approach in the seafood processors notification also results in a daily value for ALA that is inconsistent with the daily value for ALA claims based on the population-coverage approach used in the Martek ALA notification. As discussed in the preceding paragraph, FDA is proposing no regulatory action concerning nutrient content claims for ALA based on the Martek ALA notification, which means that such claims will continue to be permitted on food labels if this rule is finalized as proposed.
                </P>
                <FTNT>
                    <P>
                        <SU>8</SU>
                        FDA's proposal to prohibit the claims for ALA in the seafood processors notification should not be read as an endorsement of the use of an AI to set a DV. As previously noted, FDA has published an ANPRM to seek comment on the appropriateness of using an AI to set a DV, among other issues.
                    </P>
                </FTNT>
                <P>The inconsistency between the population-weighted average method used to set the daily value for ALA in the seafood processors notification and the population coverage method used for that purpose in the Martek notification is likely to result in inconsistent and conflicting nutrient content claims on food labels.. For example, a food labeled as a “good source” of ALA must contain at least 160 mg of ALA per RACC under the criteria in the Martek notification, while another food containing only 130 mg ALA per RACC would also be able to bear the same “good source” claim under the criteria in the seafood processors notification. Such inconsistencies make meaningful product-to-product comparisons of ALA content based on label claims impossible. To enable the public to comprehend the information provided in nutrient content claims and understand the relative significance of that information in the context of the daily diet, as required by section 403(r)(2)(G)(iv) of the act, qualifying ALA levels for nutrient content claims in food labeling must be based on a single daily value determined using the same method as the DVs for other nutrients.</P>
                <P>
                    FDA recognizes that the IOM Guiding Principles Report recommends setting new DVs based on a population-weighted average of reference values. However, that report disclaims any intent to make regulatory recommendations; rather, the guiding principles it provides are recommendations that FDA may accept or reject as appropriate to its activities. As previously noted, in the November 2, 2007, 
                    <E T="04">Federal Register</E>
                     (72 FR 62149), we have published an ANPRM that seeks comment on the appropriateness of using a population-weighted average, as opposed to a population-coverage approach, to set a DV. In the interim, FDA's position continues to be that the population-coverage approach should be used, for the reasons discussed in the 1993 final rule on DVs (58 FR 2206 at 2211) and for consistency with the manner in which FDA has determined DVs for nutrients to date.
                </P>
                <P>Therefore, FDA is proposing to find that the nutrient content claims for ALA set forth in the seafood processors notification do not meet the requirements of the act.</P>
                <HD SOURCE="HD2">B. EPA and DHA</HD>
                <P>The following statements about EPA and DHA in the IOM Final Report are pertinent to this proposed rule and are essentially similar to statements made in the IOM Prepublication Report that were cited by one or more of the notifications:</P>
                <P>
                    “[EPA] and [DHA] contribute approximately 10 percent of the total 
                    <E T="03">n</E>
                    -3 fatty acid intake and therefore this percent contributes toward the AI for [ALA].”
                </P>
                <P>
                    “Small amounts of EPA and DHA can contribute towards reversing an 
                    <E T="03">n</E>
                    -3 fatty acid deficiency * * * and can therefore contribute toward the AI for [ALA]. EPA and DHA contribute approximately 10 percent of the total 
                    <E T="03">n</E>
                    -3 fatty acid intake and therefore this percent contributes toward the AI for [ALA].”
                </P>
                <P>“The AMDR for [ALA] is set at 0.6 to 1.2 percent of energy. Ten percent of this range can be consumed as [EPA] and/or [DHA].”</P>
                <P>
                    “Approximately 10 percent of the AMDR for 
                    <E T="03">n</E>
                    -3 fatty acids ([ALA]) can be 
                    <PRTPAGE P="66109"/>
                    consumed as EPA and/or DHA (0.06 to 0.12 percent of energy).”
                    <SU>9</SU>
                    <FTREF/>
                </P>
                <FTNT>
                    <P>
                        <SU>9</SU>
                        Generally, in place of “approximately 10 percent” and “this percent,” the IOM Prepublication Report stated “up to 10 percent” and “up to this percent.”
                    </P>
                </FTNT>
                <P>FDA proposes to conclude that these statements do not identify a nutrient level, or reference value, for EPA and/or DHA that FDA could use to establish by regulation a label reference value for use in nutrition labeling. As noted, the IOM Final Report establishes reference values in the form of DRIs for a number of nutrients. DRIs include the EAR, RDA, AI, and UL. The IOM Final Report does not establish an EAR, RDA, AI, or UL for EPA or DHA. The “approximately 10 percent” statements in the IOM Final Report are not reference values. They do not reflect a recommended or defined intake level of EPA and/or DHA that could serve as a basis for setting a DV that could be used to characterize a given level of EPA and/or DHA for purposes of nutrition labeling.</P>
                <P>In summary, FDA proposes to conclude that the statements cited by the three notifications and the essentially similar statements in the IOM Final Report do not identify a nutrient level to which the EPA and DHA claims refer, and therefore do not meet the requirements of section 403(r)(2)(G) of the act for authoritative statements. In the absence of an authoritative statement that identifies the nutrient level to which a claim refers, the requirements of section 403(r)(2)(G) of the act are not met. Therefore, FDA proposes to find that any nutrient content claim pertaining to EPA or DHA that is made on the label or labeling of a food renders that food misbranded under section 403(r) of the act.</P>
                <P>FDA recognizes that consumption of EPA and/or DHA may provide health benefits and that industry may wish to alert consumers to those benefits. There are numerous lawful means of doing so. Under 21 CFR 101.13(i)(3), the label or labeling of a food may contain a statement about the amount or percentage of a nutrient if the statement does not in any way implicitly characterize the level of the nutrient in the food and is not false or misleading in any respect. For example, a conventional food or a dietary supplement may bear a statement such as “Contains x mg of EPA and DHA omega-3 fatty acids per serving.” Also, under 21 CFR 101.13(q)(3)(ii)(A), dietary supplements are permitted to bear simple percentage claims (e.g., 40 percent EPA and DHA omega-3 fatty acids), and under 21 CFR 101.14(q)(3)(ii)(B), they are permitted to bear comparative percentage claims (e.g., “four times the EPA and DHA omega-3 fatty acids per capsule (80 mg) as in 100 mg of menhaden oil (20 mg)”). In addition, the potential health benefits of consuming EPA and DHA can be communicated to consumers by using the qualified health claim about the relationship between EPA and DHA and reduced risk of CHD (Refs. 11 and 12).</P>
                <HD SOURCE="HD1">IV. Environmental Impact</HD>
                <P>We have carefully considered the potential environmental effects of this action. FDA has determined under 21 CFR 25.30(k) that this action is of a type that does not have a significant effect on the human environment. Therefore, neither an environmental assessment nor an environmental impact statement is required.</P>
                <HD SOURCE="HD1">V. Analysis of Impacts</HD>
                <P>FDA has examined the impacts of the proposed rule under Executive Order 12866 and the Regulatory Flexibility Act (5 U.S.C. 601-612), and the Unfunded Mandates Reform Act of 1995 (Public Law 104-4). Executive Order 12866 directs agencies to assess all costs and benefits of available regulatory alternatives and, when regulation is necessary, to select regulatory approaches that maximize net benefits (including potential economic, environmental, public health and safety, and other advantages; distributive impacts; and equity). FDA has determined that this proposed rule is not a significant regulatory action as defined by the Executive order.</P>
                <P>The Regulatory Flexibility Act requires agencies to analyze regulatory options that would minimize any significant impact of a rule on small entities. Based on FDA's review of the labels in the marketplace, FDA does not believe that a substantial number of small entities will be significantly affected. The agency requests comment on whether this rule will have a significant economic impact on a substantial number of small entities.</P>
                <P>Section 202(a) of the Unfunded Mandates Reform Act of 1995 requires that agencies prepare a written statement, which includes an assessment of anticipated costs and benefits, before proposing “any rule that includes any Federal mandate that may result in the expenditure by State, local, and tribal governments, in the aggregate, or by the private sector, of $100,000,000 or more (adjusted annually for inflation) in any one year.” The current threshold after adjustment for inflation is $127 million, using the most current (2006) Implicit Price Deflator for the Gross Domestic Product. FDA does not expect this proposed rule to result in any 1-year expenditure that would meet or exceed this amount.</P>
                <FP>
                    <E T="03">Benefit-Cost Analysis</E>
                </FP>
                <HD SOURCE="HD3">1. The Need for This Regulation</HD>
                <P>We discussed the legal and regulatory need for this proposed rule in section III of this document.</P>
                <HD SOURCE="HD3">2. Options</HD>
                <P>We analyzed two regulatory options: (1) Take no new regulatory action; and (2) prohibit the EPA and DHA claims and the ALA claims based on a daily value of 1.3 grams, but allow the ALA claims based on a daily value of 1.6 grams.</P>
                <P>
                    <E T="03">Option 1: Take No New Regulatory Action</E>
                </P>
                <P>This option would result in no change to the current situation, and so would result in no costs or benefits. This is not a viable option under FDA's current statutory and regulatory framework, as we discussed earlier in this preamble. However, we use this option as the basis for comparing the costs and benefits of other regulatory options.</P>
                <P>
                    <E T="03">Option 2: Take the Regulatory Actions as Described in the Proposed Rule</E>
                </P>
                <P>FDA received the first notification from the seafood processors on January 16, 2004. Because FDA did not issue a regulation prohibiting the use of these nutrient content claims within 120 days, “high” claims for ALA, EPA, and DHA, as well as “good source” and “more” claims for ALA have been permissible since May 16, 2004. A second notification, from Martek, received on January 21, 2005, notified FDA of “high” claims for ALA and DHA, as well “good source”, and “more” claims for ALA. A third notification, from Ocean Nutrition, received on December 9, 2005, notified FDA of a “high” claim and an “excellent source” claim for EPA and DHA combined. All of these claims became permissible 120 days after the FDA received the respective notifications because the agency did not issue a regulation prohibiting them. A cost of this rule will be label changes for products bearing claims that are prohibited. These costs may be lower if producers can schedule regulatory label changes to coincide with their scheduled label changes.</P>
                <P>
                    <E T="03">Number of Labels Affected</E>
                </P>
                <P>
                    FDA does not have data on the number of products bearing an ALA, EPA, DHA, or EPA plus DHA nutrient content claim on the label. Therefore, we attempt to estimate a range for the number of products that may bear an affected nutrient content claim. 
                    <PRTPAGE P="66110"/>
                    Products whose eligibility will be affected by this rule:
                </P>
                <P>• Have levels of DHA greater than 32 mg.;</P>
                <P>• Have levels of EPA greater than 130 mg.;</P>
                <P>• Have levels of EPA and DHA combined of greater than 32 mg.;</P>
                <P>• Have levels of ALA greater than 130 mg and less than 160 mg for “good source” or “more” claim; and</P>
                <P>• Have levels of ALA greater than 260 mg and less than 320 mg for “high” claim.</P>
                <P>In this analysis, we distinguish between levels of DHA greater than 32 mg and less than 130 mg and levels greater than 130 mg, because FDA received the notification for “high” claims for foods with more than 32 mg of DHA in January of 2005 and the notification for “high” claims for foods with more than 130 mg of DHA in January of 2004. The longer a claim has been in effect, the more likely that it is in use by manufacturers. More time allows manufacturers to integrate the label change with other packaging changes. Also, if a food is reformulated to meet claim requirements, it may take more time to test the new formulation and put it into the marketplace. In addition to label changes due to loss of claims, products that refer to the ALA daily value of 1.3 g have to alter their packaging to refer to the revised daily value of 1.6 g. FDA was not able to undertake a comprehensive review of labels in the marketplace to determine how many products currently have labels with an affected nutrient content claim. Instead, FDA went through a multi-step process to estimate the likely number of claims in the marketplace.</P>
                <P>1. We determined which products are eligible to make a nutrient content claim.</P>
                <P>2. We conducted an informal review of these products in local groceries and online groceries to determine if any were making an affected nutrient content claim.</P>
                <P>3. We determined how many labels there were in the marketplace for each of the products eligible to make an affected nutrient content claim.</P>
                <P>4. We estimated the number of products likely to make an affected claim based on the number of products in the marketplace, the results of the informal review, and the length of time the claim had been in effect.</P>
                <P>EPA and DHA occur naturally in some fish, with higher levels in fattier fish. Many dietary supplements, particularly fish oils, contain EPA and DHA. ALA is present in some nuts and nut oils, flaxseeds and flaxseed oil, vegetable oils, and in many prepared foods that include flaxseeds, nuts, or oils as an ingredient. We searched an online grocer for all packaged fish and seafood products and expanded this list by a review of all canned, frozen, and refrigerated fish and seafood products in the 1999 Infoscan supermarket scanner data collected by Information Resources, Inc. (IRI) (Ref. 13). The IRI Infoscan supermarket scanner data provide very specific information on individual food items. Infoscan store tracking is based primarily on all-store, census scanner data, which are collected weekly from more than 32,000 supermarket, drug, and mass merchandiser outlets across the United States. For these products, we determined the average serving size for each product type, for example, 2 ounces (oz) for canned tuna. We then used the United States Department of Agriculture (USDA) National Nutrient Database for Standard Reference (Ref. 14) to determine the levels of EPA and/or DHA in a serving size of that food. USDA updates this database frequently. We used the most current version available when we calculated these numbers. However, we have not recalculated the numbers with each subsequent update because we do not expect that doing so would affect our estimates to any significant degree. Therefore, the benefit of recalculating the numbers would probably not justify the time and cost of doing so. We classified all products whose levels of EPA and/or DHA exceeded the threshold for a nutrient content claim as potential claim losers. Tables 1 and 2 of this document show the products and their levels of EPA and/or DHA. Table 2 reflects a 3-oz serving size for cooked fish.</P>
                <GPOTABLE COLS="7" OPTS="L4,nj,i2" CDEF="xl30,13,10,10,xl19L,xl15L,xl18L">
                    <TTITLE>
                        <E T="04">Table 1.—DHA and/or EPA Levels of Canned Seafood and Fish</E>
                    </TTITLE>
                    <BOXHD>
                        <CHED H="1">Canned Foods</CHED>
                        <CHED H="1">Serving Size</CHED>
                        <CHED H="1">DHA (mg)</CHED>
                        <CHED H="1">EPA (mg)</CHED>
                        <CHED H="1">
                            EPA or DHA
                            <LI>Eligible ≥ 130 mg</LI>
                        </CHED>
                        <CHED H="1">
                            DHA Eligible
                            <LI>≥ 32 mg</LI>
                        </CHED>
                        <CHED H="1">
                            EPA plus DHA
                            <LI>Eligible ≥ 32 mg</LI>
                        </CHED>
                    </BOXHD>
                    <ROW RUL="s,s,s,s,s,s,s,">
                        <ENT I="01">Herring</ENT>
                        <ENT>2 oz</ENT>
                        <ENT>668</ENT>
                        <ENT>550</ENT>
                        <ENT>Yes</ENT>
                        <ENT>Yes</ENT>
                        <ENT>Yes</ENT>
                    </ROW>
                    <ROW RUL="s,s,s,s,s,s,s,">
                        <ENT I="01">Mackerel</ENT>
                        <ENT>2 oz</ENT>
                        <ENT>452</ENT>
                        <ENT>246</ENT>
                        <ENT>Yes</ENT>
                        <ENT>Yes</ENT>
                        <ENT>Yes</ENT>
                    </ROW>
                    <ROW RUL="s,s,s,s,s,s,s,">
                        <ENT I="01">Caviar</ENT>
                        <ENT>.5 oz</ENT>
                        <ENT>539</ENT>
                        <ENT>389</ENT>
                        <ENT>Yes</ENT>
                        <ENT>Yes</ENT>
                        <ENT>Yes</ENT>
                    </ROW>
                    <ROW RUL="s,s,s,s,s,s,s,">
                        <ENT I="01">Salmon</ENT>
                        <ENT>2 oz</ENT>
                        <ENT>459</ENT>
                        <ENT>481</ENT>
                        <ENT>Yes</ENT>
                        <ENT>Yes</ENT>
                        <ENT>Yes</ENT>
                    </ROW>
                    <ROW RUL="s,s,s,s,s,s,s,">
                        <ENT I="01">White Tuna in water</ENT>
                        <ENT>2 oz</ENT>
                        <ENT>358</ENT>
                        <ENT>133</ENT>
                        <ENT>Yes</ENT>
                        <ENT>Yes</ENT>
                        <ENT>Yes</ENT>
                    </ROW>
                    <ROW RUL="s,s,s,s,s,s,s,">
                        <ENT I="01">Sardines</ENT>
                        <ENT>2 oz</ENT>
                        <ENT>288</ENT>
                        <ENT>268</ENT>
                        <ENT>Yes</ENT>
                        <ENT>Yes</ENT>
                        <ENT>Yes</ENT>
                    </ROW>
                    <ROW RUL="s,s,s,s,s,s,s,">
                        <ENT I="01">Anchovies</ENT>
                        <ENT>.5 oz</ENT>
                        <ENT>123</ENT>
                        <ENT>73</ENT>
                        <ENT>No</ENT>
                        <ENT>Yes</ENT>
                        <ENT>Yes</ENT>
                    </ROW>
                    <ROW RUL="s,s,s,s,s,s,s,">
                        <ENT I="01">Shrimp, mixed species</ENT>
                        <ENT>2 oz</ENT>
                        <ENT>126</ENT>
                        <ENT>146</ENT>
                        <ENT>Yes</ENT>
                        <ENT>Yes</ENT>
                        <ENT>Yes</ENT>
                    </ROW>
                    <ROW RUL="s,s,s,s,s,s,s,">
                        <ENT I="01">Oyster</ENT>
                        <ENT>2 oz</ENT>
                        <ENT>130</ENT>
                        <ENT>120</ENT>
                        <ENT>Yes</ENT>
                        <ENT>Yes</ENT>
                        <ENT>Yes</ENT>
                    </ROW>
                    <ROW RUL="s,s,s,s,s,s,s,">
                        <ENT I="01">Canned shrimp</ENT>
                        <ENT>3 oz</ENT>
                        <ENT>249</ENT>
                        <ENT>214</ENT>
                        <ENT>Yes</ENT>
                        <ENT>Yes</ENT>
                        <ENT>Yes</ENT>
                    </ROW>
                    <ROW RUL="s,s,s,s,s,s,s,">
                        <ENT I="01">Light Tuna in water</ENT>
                        <ENT>2 oz</ENT>
                        <ENT>127</ENT>
                        <ENT>27</ENT>
                        <ENT>No</ENT>
                        <ENT>Yes</ENT>
                        <ENT>Yes</ENT>
                    </ROW>
                    <ROW RUL="s,s,s,s,s,s,s,">
                        <ENT I="01">Crabmeat</ENT>
                        <ENT>2 oz</ENT>
                        <ENT>71</ENT>
                        <ENT>81</ENT>
                        <ENT>No</ENT>
                        <ENT>Yes</ENT>
                        <ENT>Yes</ENT>
                    </ROW>
                    <ROW RUL="s,s,s,s,s,s,s,">
                        <ENT I="01">White Tuna in oil</ENT>
                        <ENT>2 oz</ENT>
                        <ENT>101</ENT>
                        <ENT>38</ENT>
                        <ENT>No</ENT>
                        <ENT>Yes</ENT>
                        <ENT>Yes</ENT>
                    </ROW>
                    <ROW RUL="s,s,s,s,s,s,s,">
                        <ENT I="01">Light Tuna in oil</ENT>
                        <ENT>2 oz</ENT>
                        <ENT>58</ENT>
                        <ENT>15</ENT>
                        <ENT>No</ENT>
                        <ENT>Yes</ENT>
                        <ENT>Yes</ENT>
                    </ROW>
                    <ROW>
                        <PRTPAGE P="66111"/>
                        <ENT I="01">Gefiltefish</ENT>
                        <ENT>1.5 oz</ENT>
                        <ENT>19</ENT>
                        <ENT>32</ENT>
                        <ENT>No</ENT>
                        <ENT>No</ENT>
                        <ENT>Yes</ENT>
                    </ROW>
                </GPOTABLE>
                <GPOTABLE COLS="7" OPTS="L4,nj,i2" CDEF="xl30,13,10,10,xl19L,xl15L,xl18L">
                    <TTITLE>
                        <E T="04">Table 2.—DHA and/or EPA Levels of Frozen and Refrigerated Seafood and Fish</E>
                    </TTITLE>
                    <BOXHD>
                        <CHED H="1">Frozen and Refrigerated</CHED>
                        <CHED H="1">Serving Size</CHED>
                        <CHED H="1">DHA (mg)</CHED>
                        <CHED H="1">EPA (mg)</CHED>
                        <CHED H="1">
                            EPA or DHA
                            <LI>Eligible ≥ 130 mg</LI>
                        </CHED>
                        <CHED H="1">
                            DHA Eligible
                            <LI>≥ 32 mg</LI>
                        </CHED>
                        <CHED H="1">
                            EPA plus DHA
                            <LI>Eligible ≥ 32 mg</LI>
                        </CHED>
                    </BOXHD>
                    <ROW RUL="s,s,s,s,s,s,s,">
                        <ENT I="01">Salmon</ENT>
                        <ENT>3 oz</ENT>
                        <ENT>1099</ENT>
                        <ENT>525</ENT>
                        <ENT>Yes</ENT>
                        <ENT>Yes</ENT>
                        <ENT>Yes</ENT>
                    </ROW>
                    <ROW RUL="s,s,s,s,s,s,s,">
                        <ENT I="01">Mackerel</ENT>
                        <ENT>3 oz</ENT>
                        <ENT>1016</ENT>
                        <ENT>555</ENT>
                        <ENT>Yes</ENT>
                        <ENT>Yes</ENT>
                        <ENT>Yes</ENT>
                    </ROW>
                    <ROW RUL="s,s,s,s,s,s,s,">
                        <ENT I="01">Tuna</ENT>
                        <ENT>3 oz</ENT>
                        <ENT>757</ENT>
                        <ENT>241</ENT>
                        <ENT>Yes</ENT>
                        <ENT>Yes</ENT>
                        <ENT>Yes</ENT>
                    </ROW>
                    <ROW RUL="s,s,s,s,s,s,s,">
                        <ENT I="01">Herring</ENT>
                        <ENT>3 oz</ENT>
                        <ENT>733</ENT>
                        <ENT>603</ENT>
                        <ENT>Yes</ENT>
                        <ENT>Yes</ENT>
                        <ENT>Yes</ENT>
                    </ROW>
                    <ROW RUL="s,s,s,s,s,s,s,">
                        <ENT I="01">Albacore Tuna</ENT>
                        <ENT>3 oz</ENT>
                        <ENT>535</ENT>
                        <ENT>198</ENT>
                        <ENT>Yes</ENT>
                        <ENT>Yes</ENT>
                        <ENT>Yes</ENT>
                    </ROW>
                    <ROW RUL="s,s,s,s,s,s,s,">
                        <ENT I="01">Trout</ENT>
                        <ENT>3 oz</ENT>
                        <ENT>449</ENT>
                        <ENT>172</ENT>
                        <ENT>Yes</ENT>
                        <ENT>Yes</ENT>
                        <ENT>Yes</ENT>
                    </ROW>
                    <ROW RUL="s,s,s,s,s,s,s,">
                        <ENT I="01">Sardines</ENT>
                        <ENT>3 oz</ENT>
                        <ENT>433</ENT>
                        <ENT>402</ENT>
                        <ENT>Yes</ENT>
                        <ENT>Yes</ENT>
                        <ENT>Yes</ENT>
                    </ROW>
                    <ROW RUL="s,s,s,s,s,s,s,">
                        <ENT I="01">Mussels</ENT>
                        <ENT>3 oz</ENT>
                        <ENT>430</ENT>
                        <ENT>235</ENT>
                        <ENT>Yes</ENT>
                        <ENT>Yes</ENT>
                        <ENT>Yes</ENT>
                    </ROW>
                    <ROW RUL="s,s,s,s,s,s,s,">
                        <ENT I="01">Pollock</ENT>
                        <ENT>3 oz</ENT>
                        <ENT>383</ENT>
                        <ENT>77</ENT>
                        <ENT>Yes</ENT>
                        <ENT>Yes</ENT>
                        <ENT>Yes</ENT>
                    </ROW>
                    <ROW RUL="s,s,s,s,s,s,s,">
                        <ENT I="01">Squid</ENT>
                        <ENT>3 oz</ENT>
                        <ENT>323</ENT>
                        <ENT>138</ENT>
                        <ENT>Yes</ENT>
                        <ENT>Yes</ENT>
                        <ENT>Yes</ENT>
                    </ROW>
                    <ROW RUL="s,s,s,s,s,s,s,">
                        <ENT I="01">Other (fish sticks)</ENT>
                        <ENT>6 sticks</ENT>
                        <ENT>216</ENT>
                        <ENT>144</ENT>
                        <ENT>Yes</ENT>
                        <ENT>Yes</ENT>
                        <ENT>Yes</ENT>
                    </ROW>
                    <ROW RUL="s,s,s,s,s,s,s,">
                        <ENT I="01">Halibut</ENT>
                        <ENT>3 oz</ENT>
                        <ENT>248</ENT>
                        <ENT>60</ENT>
                        <ENT>Yes</ENT>
                        <ENT>Yes</ENT>
                        <ENT>Yes</ENT>
                    </ROW>
                    <ROW RUL="s,s,s,s,s,s,s,">
                        <ENT I="01">Oyster</ENT>
                        <ENT>3 oz</ENT>
                        <ENT>245</ENT>
                        <ENT>225</ENT>
                        <ENT>Yes</ENT>
                        <ENT>Yes</ENT>
                        <ENT>Yes</ENT>
                    </ROW>
                    <ROW RUL="s,s,s,s,s,s,s,">
                        <ENT I="01">Sole/Flounder</ENT>
                        <ENT>3 oz</ENT>
                        <ENT>219</ENT>
                        <ENT>207</ENT>
                        <ENT>Yes</ENT>
                        <ENT>Yes</ENT>
                        <ENT>Yes</ENT>
                    </ROW>
                    <ROW RUL="s,s,s,s,s,s,s,">
                        <ENT I="01">Whiting</ENT>
                        <ENT>3 oz</ENT>
                        <ENT>200</ENT>
                        <ENT>241</ENT>
                        <ENT>Yes</ENT>
                        <ENT>Yes</ENT>
                        <ENT>Yes</ENT>
                    </ROW>
                    <ROW RUL="s,s,s,s,s,s,s,">
                        <ENT I="01">Shrimp</ENT>
                        <ENT>3 oz</ENT>
                        <ENT>189</ENT>
                        <ENT>219</ENT>
                        <ENT>Yes</ENT>
                        <ENT>Yes</ENT>
                        <ENT>Yes</ENT>
                    </ROW>
                    <ROW RUL="s,s,s,s,s,s,s,">
                        <ENT I="01">Grouper</ENT>
                        <ENT>3 oz</ENT>
                        <ENT>187</ENT>
                        <ENT>23</ENT>
                        <ENT>Yes</ENT>
                        <ENT>Yes</ENT>
                        <ENT>Yes</ENT>
                    </ROW>
                    <ROW RUL="s,s,s,s,s,s,s,">
                        <ENT I="01">Perch</ENT>
                        <ENT>3 oz</ENT>
                        <ENT>179</ENT>
                        <ENT>68</ENT>
                        <ENT>Yes</ENT>
                        <ENT>Yes</ENT>
                        <ENT>Yes</ENT>
                    </ROW>
                    <ROW RUL="s,s,s,s,s,s,s,">
                        <ENT I="01">Yellowfin Tuna</ENT>
                        <ENT>3 oz</ENT>
                        <ENT>154</ENT>
                        <ENT>31</ENT>
                        <ENT>Yes</ENT>
                        <ENT>Yes</ENT>
                        <ENT>Yes</ENT>
                    </ROW>
                    <ROW RUL="s,s,s,s,s,s,s,">
                        <ENT I="01">Haddock</ENT>
                        <ENT>3 oz</ENT>
                        <ENT>138</ENT>
                        <ENT>65</ENT>
                        <ENT>Yes</ENT>
                        <ENT>Yes</ENT>
                        <ENT>Yes</ENT>
                    </ROW>
                    <ROW RUL="s,s,s,s,s,s,s,">
                        <ENT I="01">Cod</ENT>
                        <ENT>3 oz</ENT>
                        <ENT>131</ENT>
                        <ENT>3</ENT>
                        <ENT>Yes</ENT>
                        <ENT>Yes</ENT>
                        <ENT>Yes</ENT>
                    </ROW>
                    <ROW RUL="s,s,s,s,s,s,s,">
                        <ENT I="01">Clams</ENT>
                        <ENT>3 oz</ENT>
                        <ENT>124</ENT>
                        <ENT>117</ENT>
                        <ENT>No</ENT>
                        <ENT>Yes</ENT>
                        <ENT>Yes</ENT>
                    </ROW>
                    <ROW RUL="s,s,s,s,s,s,s,">
                        <ENT I="01">Lobster</ENT>
                        <ENT>3 oz</ENT>
                        <ENT>118</ENT>
                        <ENT>290</ENT>
                        <ENT>Yes</ENT>
                        <ENT>Yes</ENT>
                        <ENT>Yes</ENT>
                    </ROW>
                    <ROW RUL="s,s,s,s,s,s,s,">
                        <ENT I="01">Catfish</ENT>
                        <ENT>3 oz</ENT>
                        <ENT>109</ENT>
                        <ENT>42</ENT>
                        <ENT>No</ENT>
                        <ENT>Yes</ENT>
                        <ENT>Yes</ENT>
                    </ROW>
                    <ROW RUL="s,s,s,s,s,s,s,">
                        <ENT I="01">Crab</ENT>
                        <ENT>3 oz</ENT>
                        <ENT>96</ENT>
                        <ENT>239</ENT>
                        <ENT>Yes</ENT>
                        <ENT>Yes</ENT>
                        <ENT>Yes</ENT>
                    </ROW>
                    <ROW RUL="s,s,s,s,s,s,s,">
                        <ENT I="01">Scallop</ENT>
                        <ENT>3 oz</ENT>
                        <ENT>92</ENT>
                        <ENT>76</ENT>
                        <ENT>No</ENT>
                        <ENT>Yes</ENT>
                        <ENT>Yes</ENT>
                    </ROW>
                    <ROW RUL="s,s,s,s,s,s,s,">
                        <ENT I="01">Octopus</ENT>
                        <ENT>3 oz</ENT>
                        <ENT>69</ENT>
                        <ENT>65</ENT>
                        <ENT>No</ENT>
                        <ENT>Yes</ENT>
                        <ENT>Yes</ENT>
                    </ROW>
                    <ROW RUL="s,s,s,s,s,s,s,">
                        <ENT I="01">Snapper</ENT>
                        <ENT>3 oz</ENT>
                        <ENT>43</ENT>
                        <ENT>3</ENT>
                        <ENT>No</ENT>
                        <ENT>Yes</ENT>
                        <ENT>Yes</ENT>
                    </ROW>
                    <ROW RUL="s,s,s,s,s,s,s,">
                        <ENT I="01">Gefiltefish/Whitefish/Pike</ENT>
                        <ENT>3 oz</ENT>
                        <ENT>38</ENT>
                        <ENT>63</ENT>
                        <ENT>No</ENT>
                        <ENT>Yes</ENT>
                        <ENT>Yes</ENT>
                    </ROW>
                    <ROW RUL="s,s,s,s,s,s,s,">
                        <ENT I="01">Crawfish</ENT>
                        <ENT>3 oz</ENT>
                        <ENT>23</ENT>
                        <ENT>99</ENT>
                        <ENT>No</ENT>
                        <ENT>No</ENT>
                        <ENT>Yes</ENT>
                    </ROW>
                    <ROW>
                        <ENT I="01">Orange Roughy</ENT>
                        <ENT>3 oz</ENT>
                        <ENT>2</ENT>
                        <ENT>2</ENT>
                        <ENT>No</ENT>
                        <ENT>No</ENT>
                        <ENT>No</ENT>
                    </ROW>
                </GPOTABLE>
                <PRTPAGE P="66112"/>
                <P>FDA was not able to carry out a similar systematic review of foods for ALA claims, because a much wider range of foods may meet the ALA claim. However, only a small proportion of foods have ALA levels between 130 and 160 mg (for “good source” and “more” claims) and ALA levels between 260 and 320 mg (for “high” claim), and therefore will lose their eligibility. In addition to foods that naturally contain these fatty acids, some manufacturers have been increasing the levels of ALA, EPA, or DHA in their products. Foods, such as eggs and milk, can be enriched with ALA, EPA, or DHA by manipulating the diet of chickens and cows, respectively. Also, manufacturers can add ALA to their products by including ingredients like flaxseed oil or ground flaxseed. To find ALA-, EPA-, or DHA-enriched foods, we searched the Internet using keyword searches and in local grocery stores.</P>
                <P>FDA searched three local grocery stores for products bearing claims involving ALA, EPA, or DHA. FDA found one new line of products making an ALA claim: pasta with ground flaxseeds to increase the ALA content. This product meets the level of ALA needed to make a “good source” ALA claim under both the 130 and 160 mg levels. FDA did not find any products making a “high” claim. However, the labels refer to an ALA daily value of 1.3 g, so they will have to be changed to reflect the 1.6 g daily value. FDA also searched the Internet to find food products that are likely to include a nutrient content claim. FDA found several brands of eggs, one with added DHA and many with added ALA. FDA reviewed 12 Web sites for ALA- or DHA-enriched eggs. In many cases the Web sites provided a picture of the egg carton, but did not give the full label information. For the ALA eggs, nutrition information on the Web site always emphasized the omega-3 content (which is appropriate on the label or in the labeling of the product as long as the statement does not in any way implicitly characterize the level of the nutrient in the food and it is not false or misleading in any respect (e.g., “100 mg omega-3 fatty acids per serving”) (21 CFR 101.13(i)(3)), not the specific ALA content. However, the Web site for the DHA-enriched eggs emphasized the DHA content and the DHA daily value established under the seafood processors notification. Based on the Internet review, FDA thinks it unlikely that any of the ALA-enriched eggs would be making an affected claim and likely that the DHA-enriched egg would make an affected claim. The DHA-enriched eggs included processed and shell eggs and were sold in six different packages. FDA also searched a major online drugstore that compiles dietary supplements sold by many other online retailers. This Web site also provided all the labeling information in the dietary supplement package. FDA searched for dietary supplements using the keywords EPA, DHA, fish oil, and ALA. The searches resulted in 53 hits for EPA, 49 hits for DHA, 55 hits for fish oil, and 48 hits for ALA. Many of the products in the searches overlapped. In reviewing these products, FDA found two dietary supplements making affected claims. Overall, these searches were limited and ad hoc and do not constitute a representative sample of the marketplace. Table 3 of this document presents the affected stock keeping units (SKUs). Every product and package size combination represents an SKU. Therefore, the number of SKUs corresponds to the number of product labels.</P>
                <GPOTABLE COLS="3" OPTS="L4,nj,i2" CDEF="xls50,xl32,xl20">
                    <TTITLE>
                        <E T="04">Table 3.—Claims Found in the Marketplace</E>
                    </TTITLE>
                    <BOXHD>
                        <CHED H="1">Product</CHED>
                        <CHED H="1">
                            Number of
                            <LI>Manufacturers</LI>
                        </CHED>
                        <CHED H="1">
                            Number
                            <LI>of SKUs</LI>
                        </CHED>
                    </BOXHD>
                    <ROW RUL="s,s,s">
                        <ENT I="01">Dietary supplements</ENT>
                        <ENT>2</ENT>
                        <ENT>2</ENT>
                    </ROW>
                    <ROW RUL="s,s,s">
                        <ENT I="01">Eggs</ENT>
                        <ENT>1</ENT>
                        <ENT>6</ENT>
                    </ROW>
                    <ROW>
                        <ENT I="01">Pasta</ENT>
                        <ENT>1</ENT>
                        <ENT>6</ENT>
                    </ROW>
                </GPOTABLE>
                <P>
                    Because FDA is unsure about whether the egg product that we identified actually makes a claim, the actual number of SKUs may be slightly lower than FDA indicates in Table 3 of this document. However, because our searches were not representative and we did not perform a comprehensive review of food labels, there are likely to be more claims in the marketplace than we were able to identify using the ad-hoc search procedure we discussed above. For the categories of food FDA was able to identify as containing more than the qualifying levels of EPA and/or DHA, FDA counted the number of SKUs in the 1999 IRI database by downloading all canned, frozen, and refrigerated seafood and fish from the database, then further breaking down these categories into types of seafood and fish using the information provided in each record. FDA only counted branded products, because private label brands make claims infrequently. In the IRI data, the type of fish is usually represented by an abbreviation in the product name, like “abtn” for albacore tuna. So, we counted the number of each type of fish using the abbreviations in the name provided by IRI. For some products, we were not able to identify the fish or we could not find data on the EPA and/or DHA contents. Most of the foods in the IRI data that did not specify the type of fish were breaded fish fillets or fish sticks. Therefore, for the “other” category of fish we assigned the usual serving size and EPA and DHA levels for fish sticks. Some fish and seafood had multiple levels of EPA and DHA in the USDA Nutrient Laboratory database, depending on the specific variety. If we were not able to determine the relevant type of fish or seafood, we used the median value in the database for the type of fish or seafood. Because 1999 is the most recent IRI data available to us, we needed to correct for changes in the marketplace since 1999. To do so, we used the USDA food disappearance data to estimate changes in the availability of seafood on the market between 1999 and 2003 (the most recent year for which data is available) (Ref. 15). FDA then adjusted the 1999 IRI data by the growth in the relevant seafood category. FDA made an additional adjustment to the count of potentially affected products based on the usual frequency of scheduled label changes. Table 4 of this document presents the proportion of branded SKUs that are typically redesigned within a given period of time. Therefore, FDA estimates that 67 percent of labels would have been redesigned in the timeframe since the seafood processors notification went into effect, 33 percent of the labels would have been redesigned since the Martek notification went into effect, and 5 percent of the labels would have been redesigned since the Ocean Nutrition notification went into effect. In tables 5 and 6 of this document, FDA presents an estimate of the number of labels (SKUs) in the market currently eligible to make an EPA and/or DHA claim. Because foods eligible to make ALA claims include nuts and nut oils and flaxseed and flaxseed oils, as well as foods that include one of these sources as an ingredient, FDA was not able to estimate the number of foods eligible to make an ALA claim. However, only foods with between 130 mg and 160 mg of ALA or foods with between 260 mg and 320 mg of ALA will have a change in their eligibility status, which should be a relatively small number of the total number of eligible foods. Also, we do not count the number of packages of enriched foods because we did not have a comprehensive, up-to-date database of foods enriched with ALA, EPA, or DHA.
                    <PRTPAGE P="66113"/>
                </P>
                <GPOTABLE COLS="2" OPTS="L4,nj,i2" CDEF="xls50,xl50">
                    <TTITLE>
                        <E T="04">Table 4.—Frequency of Label Redesigns</E>
                    </TTITLE>
                    <BOXHD>
                        <CHED H="1">Time period</CHED>
                        <CHED H="1">Proportion of SKUs</CHED>
                    </BOXHD>
                    <ROW RUL="s,s">
                        <ENT I="01">6-month</ENT>
                        <ENT>5 percent</ENT>
                    </ROW>
                    <ROW RUL="s,s">
                        <ENT I="01">12-month</ENT>
                        <ENT>33 percent</ENT>
                    </ROW>
                    <ROW RUL="s,s">
                        <ENT I="01">24-month</ENT>
                        <ENT>67 percent</ENT>
                    </ROW>
                    <ROW>
                        <ENT I="01">36-month</ENT>
                        <ENT>100 percent</ENT>
                    </ROW>
                </GPOTABLE>
                <GPOTABLE COLS="5" OPTS="L4,nj,i2" CDEF="xl50,26,19,29,13">
                    <TTITLE>
                        <E T="04">Table 5.—Number of Canned Foods Eligible to Make an EPA and/or DHA Claim</E>
                    </TTITLE>
                    <BOXHD>
                        <CHED H="1">Canned Foods</CHED>
                        <CHED H="1">EPA or DHA Eligible at 130 mg</CHED>
                        <CHED H="1">DHA Eligible at 32 mg</CHED>
                        <CHED H="1">EPA plus DHA Eligible at 32 mg</CHED>
                        <CHED H="1">Adjusted SKUs</CHED>
                    </BOXHD>
                    <ROW RUL="s,s,s,s,s,">
                        <ENT I="01">Salmon</ENT>
                        <ENT>Yes</ENT>
                        <ENT>Yes</ENT>
                        <ENT>Yes</ENT>
                        <ENT>335</ENT>
                    </ROW>
                    <ROW RUL="s,s,s,s,s,">
                        <ENT I="01">Sardines</ENT>
                        <ENT>Yes</ENT>
                        <ENT>Yes</ENT>
                        <ENT>Yes</ENT>
                        <ENT>282</ENT>
                    </ROW>
                    <ROW RUL="s,s,s,s,s,">
                        <ENT I="01">Gefiltefish</ENT>
                        <ENT>No</ENT>
                        <ENT>No</ENT>
                        <ENT>Yes</ENT>
                        <ENT>161</ENT>
                    </ROW>
                    <ROW RUL="s,s,s,s,s,">
                        <ENT I="01">Light Tuna in water</ENT>
                        <ENT>No</ENT>
                        <ENT>Yes</ENT>
                        <ENT>Yes</ENT>
                        <ENT>130</ENT>
                    </ROW>
                    <ROW RUL="s,s,s,s,s,">
                        <ENT I="01">Shrimp, mixed species</ENT>
                        <ENT>Yes</ENT>
                        <ENT>Yes</ENT>
                        <ENT>Yes</ENT>
                        <ENT>146</ENT>
                    </ROW>
                    <ROW RUL="s,s,s,s,s,">
                        <ENT I="01">Anchovies</ENT>
                        <ENT>No</ENT>
                        <ENT>Yes</ENT>
                        <ENT>Yes</ENT>
                        <ENT>116</ENT>
                    </ROW>
                    <ROW RUL="s,s,s,s,s,">
                        <ENT I="01">Oyster</ENT>
                        <ENT>Yes</ENT>
                        <ENT>Yes</ENT>
                        <ENT>Yes</ENT>
                        <ENT>111</ENT>
                    </ROW>
                    <ROW RUL="s,s,s,s,s,">
                        <ENT I="01">Shrimp</ENT>
                        <ENT>Yes</ENT>
                        <ENT>Yes</ENT>
                        <ENT>Yes</ENT>
                        <ENT>104</ENT>
                    </ROW>
                    <ROW RUL="s,s,s,s,s,">
                        <ENT I="01">Crabmeat</ENT>
                        <ENT>No</ENT>
                        <ENT>Yes</ENT>
                        <ENT>Yes</ENT>
                        <ENT>93</ENT>
                    </ROW>
                    <ROW RUL="s,s,s,s,s,">
                        <ENT I="01">Herring</ENT>
                        <ENT>Yes</ENT>
                        <ENT>Yes</ENT>
                        <ENT>Yes</ENT>
                        <ENT>93</ENT>
                    </ROW>
                    <ROW RUL="s,s,s,s,s,">
                        <ENT I="01">Light Tuna in oil</ENT>
                        <ENT>No</ENT>
                        <ENT>Yes</ENT>
                        <ENT>Yes</ENT>
                        <ENT>76</ENT>
                    </ROW>
                    <ROW RUL="s,s,s,s,s,">
                        <ENT I="01">Mackerel</ENT>
                        <ENT>Yes</ENT>
                        <ENT>Yes</ENT>
                        <ENT>Yes</ENT>
                        <ENT>84</ENT>
                    </ROW>
                    <ROW RUL="s,s,s,s,s,">
                        <ENT I="01">White Tuna in water</ENT>
                        <ENT>Yes</ENT>
                        <ENT>Yes</ENT>
                        <ENT>Yes</ENT>
                        <ENT>58</ENT>
                    </ROW>
                    <ROW RUL="s,s,s,s,s,">
                        <ENT I="01">Caviar</ENT>
                        <ENT>Yes</ENT>
                        <ENT>Yes</ENT>
                        <ENT>Yes</ENT>
                        <ENT>33</ENT>
                    </ROW>
                    <ROW RUL="s,s,s,s,s,">
                        <ENT I="01">White Tuna in oil</ENT>
                        <ENT>No</ENT>
                        <ENT>Yes</ENT>
                        <ENT>Yes</ENT>
                        <ENT>9</ENT>
                    </ROW>
                    <ROW RUL="s,s,s,s,s,">
                        <ENT I="01">Number of SKUs eligible</ENT>
                        <ENT>1,246</ENT>
                        <ENT>1,540</ENT>
                        <ENT>1,701</ENT>
                        <ENT> </ENT>
                    </ROW>
                    <ROW>
                        <ENT I="01">Adjusted for time since eligibility</ENT>
                        <ENT>835</ENT>
                        <ENT>508</ENT>
                        <ENT>85</ENT>
                        <ENT> </ENT>
                    </ROW>
                </GPOTABLE>
                <GPOTABLE COLS="5" OPTS="L4,nj,i2" CDEF="xl50,26,19,29,13">
                    <TTITLE>
                        <E T="04">Table 6.—Number of Frozen and Refrigerated Seafood and Fish Eligible to Make an EPA and/or DHA Claim</E>
                    </TTITLE>
                    <BOXHD>
                        <CHED H="1">Frozen and Refrigerated</CHED>
                        <CHED H="1">EPA or DHA Eligible at 130 mg</CHED>
                        <CHED H="1">DHA Eligible at 32 mg</CHED>
                        <CHED H="1">EPA plus DHA Eligible at 32 mg</CHED>
                        <CHED H="1">Adjusted SKUs</CHED>
                    </BOXHD>
                    <ROW RUL="s,s,s,s,s,">
                        <ENT I="01">Shrimp</ENT>
                        <ENT>Yes</ENT>
                        <ENT>Yes</ENT>
                        <ENT>Yes</ENT>
                        <ENT>1,272</ENT>
                    </ROW>
                    <ROW RUL="s,s,s,s,s,">
                        <ENT I="01">Salmon</ENT>
                        <ENT>Yes</ENT>
                        <ENT>Yes</ENT>
                        <ENT>Yes</ENT>
                        <ENT>329</ENT>
                    </ROW>
                    <ROW RUL="s,s,s,s,s,">
                        <ENT I="01">Other</ENT>
                        <ENT>Yes</ENT>
                        <ENT>Yes</ENT>
                        <ENT>Yes</ENT>
                        <ENT>116</ENT>
                    </ROW>
                    <ROW RUL="s,s,s,s,s,">
                        <ENT I="01">Tuna</ENT>
                        <ENT>Yes</ENT>
                        <ENT>Yes</ENT>
                        <ENT>Yes</ENT>
                        <ENT>249</ENT>
                    </ROW>
                    <ROW RUL="s,s,s,s,s,">
                        <ENT I="01">Herring</ENT>
                        <ENT>Yes</ENT>
                        <ENT>Yes</ENT>
                        <ENT>Yes</ENT>
                        <ENT>242</ENT>
                    </ROW>
                    <ROW RUL="s,s,s,s,s,">
                        <ENT I="01">Oyster</ENT>
                        <ENT>Yes</ENT>
                        <ENT>Yes</ENT>
                        <ENT>Yes</ENT>
                        <ENT>228</ENT>
                    </ROW>
                    <ROW RUL="s,s,s,s,s,">
                        <ENT I="01">Crab</ENT>
                        <ENT>Yes</ENT>
                        <ENT>Yes</ENT>
                        <ENT>Yes</ENT>
                        <ENT>155</ENT>
                    </ROW>
                    <ROW RUL="s,s,s,s,s,">
                        <ENT I="01">Octopus</ENT>
                        <ENT>No</ENT>
                        <ENT>Yes</ENT>
                        <ENT>Yes</ENT>
                        <ENT>160</ENT>
                    </ROW>
                    <ROW RUL="s,s,s,s,s,">
                        <ENT I="01">Cod</ENT>
                        <ENT>Yes</ENT>
                        <ENT>Yes</ENT>
                        <ENT>Yes</ENT>
                        <ENT>95</ENT>
                    </ROW>
                    <ROW RUL="s,s,s,s,s,">
                        <ENT I="01">Lobster</ENT>
                        <ENT>Yes</ENT>
                        <ENT>Yes</ENT>
                        <ENT>Yes</ENT>
                        <ENT>126</ENT>
                    </ROW>
                    <ROW RUL="s,s,s,s,s,">
                        <ENT I="01">Scallop</ENT>
                        <ENT>No</ENT>
                        <ENT>Yes</ENT>
                        <ENT>Yes</ENT>
                        <ENT>101</ENT>
                    </ROW>
                    <ROW RUL="s,s,s,s,s,">
                        <ENT I="01">Whiting</ENT>
                        <ENT>Yes</ENT>
                        <ENT>Yes</ENT>
                        <ENT>Yes</ENT>
                        <ENT>82</ENT>
                    </ROW>
                    <ROW RUL="s,s,s,s,s,">
                        <PRTPAGE P="66114"/>
                        <ENT I="01">Clams</ENT>
                        <ENT>No</ENT>
                        <ENT>Yes</ENT>
                        <ENT>Yes</ENT>
                        <ENT>75</ENT>
                    </ROW>
                    <ROW RUL="s,s,s,s,s,">
                        <ENT I="01">Crawfish</ENT>
                        <ENT>No</ENT>
                        <ENT>No</ENT>
                        <ENT>Yes</ENT>
                        <ENT>80</ENT>
                    </ROW>
                    <ROW RUL="s,s,s,s,s,">
                        <ENT I="01">Albacore Tuna</ENT>
                        <ENT>Yes</ENT>
                        <ENT>Yes</ENT>
                        <ENT>Yes</ENT>
                        <ENT>78</ENT>
                    </ROW>
                    <ROW RUL="s,s,s,s,s,">
                        <ENT I="01">Sole/Flounder</ENT>
                        <ENT>Yes</ENT>
                        <ENT>Yes</ENT>
                        <ENT>Yes</ENT>
                        <ENT>61</ENT>
                    </ROW>
                    <ROW RUL="s,s,s,s,s,">
                        <ENT I="01">Catfish</ENT>
                        <ENT>No</ENT>
                        <ENT>Yes</ENT>
                        <ENT>Yes</ENT>
                        <ENT>55</ENT>
                    </ROW>
                    <ROW RUL="s,s,s,s,s,">
                        <ENT I="01">Haddock</ENT>
                        <ENT>Yes</ENT>
                        <ENT>Yes</ENT>
                        <ENT>Yes</ENT>
                        <ENT>37</ENT>
                    </ROW>
                    <ROW RUL="s,s,s,s,s,">
                        <ENT I="01">Squid</ENT>
                        <ENT>Yes</ENT>
                        <ENT>Yes</ENT>
                        <ENT>Yes</ENT>
                        <ENT>43</ENT>
                    </ROW>
                    <ROW RUL="s,s,s,s,s,">
                        <ENT I="01">Pollock</ENT>
                        <ENT>Yes</ENT>
                        <ENT>Yes</ENT>
                        <ENT>Yes</ENT>
                        <ENT>31</ENT>
                    </ROW>
                    <ROW RUL="s,s,s,s,s,">
                        <ENT I="01">Mussels</ENT>
                        <ENT>Yes</ENT>
                        <ENT>Yes</ENT>
                        <ENT>Yes</ENT>
                        <ENT>39</ENT>
                    </ROW>
                    <ROW RUL="s,s,s,s,s,">
                        <ENT I="01">Orange Roughy</ENT>
                        <ENT>No</ENT>
                        <ENT>No</ENT>
                        <ENT>No</ENT>
                        <ENT>30</ENT>
                    </ROW>
                    <ROW RUL="s,s,s,s,s,">
                        <ENT I="01">Gefiltefish/Whitefish/Pike</ENT>
                        <ENT>No</ENT>
                        <ENT>Yes</ENT>
                        <ENT>Yes</ENT>
                        <ENT>19</ENT>
                    </ROW>
                    <ROW RUL="s,s,s,s,s,">
                        <ENT I="01">Halibut</ENT>
                        <ENT>Yes</ENT>
                        <ENT>Yes</ENT>
                        <ENT>Yes</ENT>
                        <ENT>17</ENT>
                    </ROW>
                    <ROW RUL="s,s,s,s,s,">
                        <ENT I="01">Trout</ENT>
                        <ENT>Yes</ENT>
                        <ENT>Yes</ENT>
                        <ENT>Yes</ENT>
                        <ENT>19</ENT>
                    </ROW>
                    <ROW RUL="s,s,s,s,s,">
                        <ENT I="01">Perch</ENT>
                        <ENT>Yes</ENT>
                        <ENT>Yes</ENT>
                        <ENT>Yes</ENT>
                        <ENT>18</ENT>
                    </ROW>
                    <ROW RUL="s,s,s,s,s,">
                        <ENT I="01">Yellowfin Tuna</ENT>
                        <ENT>Yes</ENT>
                        <ENT>Yes</ENT>
                        <ENT>Yes</ENT>
                        <ENT>7</ENT>
                    </ROW>
                    <ROW RUL="s,s,s,s,s,">
                        <ENT I="01">Mackerel</ENT>
                        <ENT>Yes</ENT>
                        <ENT>Yes</ENT>
                        <ENT>Yes</ENT>
                        <ENT>9</ENT>
                    </ROW>
                    <ROW RUL="s,s,s,s,s,">
                        <ENT I="01">Snapper</ENT>
                        <ENT>No</ENT>
                        <ENT>Yes</ENT>
                        <ENT>Yes</ENT>
                        <ENT>7</ENT>
                    </ROW>
                    <ROW RUL="s,s,s,s,s,">
                        <ENT I="01">Grouper</ENT>
                        <ENT>Yes</ENT>
                        <ENT>Yes</ENT>
                        <ENT>Yes</ENT>
                        <ENT>3</ENT>
                    </ROW>
                    <ROW RUL="s,s,s,s,s,">
                        <ENT I="01">Sardines</ENT>
                        <ENT>Yes</ENT>
                        <ENT>Yes</ENT>
                        <ENT>Yes</ENT>
                        <ENT>4</ENT>
                    </ROW>
                    <ROW RUL="s,s,s,s,s,">
                        <ENT I="01">Number of SKUs eligible</ENT>
                        <ENT>3,335</ENT>
                        <ENT>3,677</ENT>
                        <ENT>3,757</ENT>
                        <ENT> </ENT>
                    </ROW>
                    <ROW>
                        <ENT I="01">Adjusted for time since eligibility</ENT>
                        <ENT>2,234</ENT>
                        <ENT>1,213</ENT>
                        <ENT>188</ENT>
                        <ENT> </ENT>
                    </ROW>
                </GPOTABLE>
                <P>
                    <E T="03">Cost of Label Changes</E>
                </P>
                <P>Producers who will be affected by this rule are likely to go through several steps to modify their labels to come into compliance with the proposed requirements. The producers will do the following: (1) Conduct administrative activities, (2) alter the graphic design, (3) conduct prepress activities, engrave plates or cylinders, and (4) print and manufacture labels. Producers incur costs associated with each step of the process. The first step requires that producers read and develop a strategy to comply with the proposed requirements. Second, they will develop a new graphic design for the label that complies with the proposed requirements. Third, a prepress operator will convert the new design into printing plates or cylinders. Fourth, the new labels will be printed. The costs associated with label changes will also vary depending on whether the label change can be coordinated with a scheduled label change. There may be an additional inventory cost to producers if they have to dispose of already printed labels.</P>
                <P>FDA contracted with RTI International to estimate the costs of label changes to producers (Ref. 16). RTI estimated the costs associated with each of these steps, as well as the cost of discarded inventory of unused labels. Manufacturers regularly redesign their labels, so RTI only estimated a cost associated with the label change if the regulatory label change could not be done with a regularly scheduled label change. The estimated schedule for label changes is presented in table 4 of this table. Tables 7 and 8 present estimates of per SKU cost of a label change.</P>
                <GPOTABLE COLS="5" OPTS="L4,nj,i2" CDEF="xl50,24,20,20,20">
                    <TTITLE>
                        <E T="04">Table 7.—Cost of Label Change (per SKU) for Seafood and Pasta (in 2005 Dollars)</E>
                    </TTITLE>
                    <BOXHD>
                        <CHED H="1"> </CHED>
                        <CHED H="1">Canned Seafood</CHED>
                        <CHED H="1">Frozen Seafood</CHED>
                        <CHED H="1">Refrigerated Seafood</CHED>
                        <CHED H="1">Pasta</CHED>
                    </BOXHD>
                    <ROW RUL="s,s,s,s,s,">
                        <ENT I="01">Administrative</ENT>
                        <ENT>$200</ENT>
                        <ENT>$200</ENT>
                        <ENT>$400</ENT>
                        <ENT>$500</ENT>
                    </ROW>
                    <ROW RUL="s,s,s,s,s,">
                        <ENT I="01">Graphic</ENT>
                        <ENT>$800</ENT>
                        <ENT>$900</ENT>
                        <ENT>$1,400</ENT>
                        <ENT>$1,600</ENT>
                    </ROW>
                    <ROW RUL="s,s,s,s,s,">
                        <PRTPAGE P="66115"/>
                        <ENT I="01">Prepress</ENT>
                        <ENT>$1,200</ENT>
                        <ENT>$500</ENT>
                        <ENT>$800</ENT>
                        <ENT>$900</ENT>
                    </ROW>
                    <ROW RUL="s,s,s,s,s,">
                        <ENT I="01">Engraving</ENT>
                        <ENT>$2,900</ENT>
                        <ENT>$700</ENT>
                        <ENT>$1,100</ENT>
                        <ENT>$1,300</ENT>
                    </ROW>
                    <ROW RUL="s,s,s,s,s,">
                        <ENT I="01">Inventory</ENT>
                        <ENT>$0</ENT>
                        <ENT>$0</ENT>
                        <ENT>$0</ENT>
                        <ENT>$0</ENT>
                    </ROW>
                    <ROW>
                        <ENT I="01">Total</ENT>
                        <ENT>$5,100</ENT>
                        <ENT>$2,300</ENT>
                        <ENT>$3,700</ENT>
                        <ENT>$4,300</ENT>
                    </ROW>
                </GPOTABLE>
                <GPOTABLE COLS="5" OPTS="L4,nj,i2" CDEF="xl50,24,20,20,20">
                    <TTITLE>
                        <E T="04">Table 8.—Cost of Label Change (per SKU) for Dietary Supplements and Eggs (in 2005 Dollars)</E>
                    </TTITLE>
                    <BOXHD>
                        <CHED H="1"> </CHED>
                        <CHED H="1">Dietary Supplement Liquid</CHED>
                        <CHED H="1">Dietary Supplement Pills</CHED>
                        <CHED H="1">Processed Eggs</CHED>
                        <CHED H="1">Shell Eggs</CHED>
                    </BOXHD>
                    <ROW RUL="s,s,s,s,s,">
                        <ENT I="01">Administrative</ENT>
                        <ENT>$900</ENT>
                        <ENT>$900</ENT>
                        <ENT>$500</ENT>
                        <ENT>$500</ENT>
                    </ROW>
                    <ROW RUL="s,s,s,s,s,">
                        <ENT I="01">Graphic</ENT>
                        <ENT>$3,300</ENT>
                        <ENT>$2,200</ENT>
                        <ENT>$1,600</ENT>
                        <ENT>$1,600</ENT>
                    </ROW>
                    <ROW RUL="s,s,s,s,s,">
                        <ENT I="01">Prepress</ENT>
                        <ENT>$2,100</ENT>
                        <ENT>$2,100</ENT>
                        <ENT>$1,100</ENT>
                        <ENT>$1,100</ENT>
                    </ROW>
                    <ROW RUL="s,s,s,s,s,">
                        <ENT I="01">Engraving</ENT>
                        <ENT>$2,100</ENT>
                        <ENT>$2,100</ENT>
                        <ENT>$900</ENT>
                        <ENT>$900</ENT>
                    </ROW>
                    <ROW RUL="s,s,s,s,s,">
                        <ENT I="01">Inventory</ENT>
                        <ENT>$0</ENT>
                        <ENT>$100</ENT>
                        <ENT>$0</ENT>
                        <ENT>$500</ENT>
                    </ROW>
                    <ROW>
                        <ENT I="01">Total</ENT>
                        <ENT>$8,400</ENT>
                        <ENT>$7,400</ENT>
                        <ENT>$4,100</ENT>
                        <ENT>$4,600</ENT>
                    </ROW>
                </GPOTABLE>
                <P>Based on our ad hoc searching, it is clear that not all products eligible to make an affected claim are making a claim. Overall, we estimate that at least 14 product labels will have to be changed as a result of this rule. Table 9 of this document presents an estimate of the cost associated with known label changes. This is probably an underestimate of the labeling cost because FDA has not conducted a comprehensive review of food labels to identify the number of products bearing these claims and we have probably underestimated the number of such claims. However, we are uncertain about the true number of existing claims.</P>
                <GPOTABLE COLS="3" OPTS="L4,nj,i2" CDEF="xl40,20,35">
                    <TTITLE>
                        <E T="04">Table 9.—Lower Bound Estimate of Total Costs from Labeling Changes</E>
                    </TTITLE>
                    <BOXHD>
                        <CHED H="1">Product</CHED>
                        <CHED H="1">Number of SKUs</CHED>
                        <CHED H="1">
                            Cost of Label Change
                            <SU>*</SU>
                        </CHED>
                    </BOXHD>
                    <ROW RUL="s,s,s">
                        <ENT I="01">Dietary supplements</ENT>
                        <ENT>2</ENT>
                        <ENT>$5,200</ENT>
                    </ROW>
                    <ROW RUL="s,s,s">
                        <ENT I="01">Eggs</ENT>
                        <ENT>6</ENT>
                        <ENT>$8,600</ENT>
                    </ROW>
                    <ROW RUL="s,s,s">
                        <ENT I="01">Pasta</ENT>
                        <ENT>6</ENT>
                        <ENT>$8,500</ENT>
                    </ROW>
                    <ROW>
                        <ENT I="01">Total</ENT>
                        <ENT>14</ENT>
                        <ENT>$22,300</ENT>
                    </ROW>
                    <TNOTE>
                        <SU>*</SU>
                        Assumes 67 percent of label changes can be made with regularly scheduled label changes.
                    </TNOTE>
                </GPOTABLE>
                <P>To determine the number of dietary supplements that qualify for a nutrient content claim, FDA counted the number of dietary supplements that have fish oil, ALA, EPA, or DHA as an ingredient in the Dietary Supplement Sales Information database (Ref. 17). The Dietary Supplement Sales Information database is a survey of the ingredients in 3,000 dietary supplements. Based on a total count of 113 qualifying dietary supplements in the database, FDA estimates that the Internet review of dietary supplements covered approximately half of the qualifying dietary supplements, and so a likely estimate is that four dietary supplements would have to change their labels. In the search of local grocery stores, we reviewed approximately 200 fish and seafood packages. None of the labels we reviewed included an affected claim. However, it seems likely that each of the five companies that participated in notifications to FDA may make some nutrient content claim. Therefore, FDA estimates that it is likely that a label change would be required for six SKUs for each of the five manufacturers. FDA estimated 6 SKUs per manufacturer because the product lines identified for eggs and pasta that were making an affected nutrient content claim both included 6 SKUS. Finally, for the other two types of products we found that made a label claim, we estimate that, similar to dietary supplements, there are twice as many affected claims in the market. Table 10 of this document presents an estimate of the likely total cost of label changes.</P>
                <GPOTABLE COLS="3" OPTS="L4,nj,i2" CDEF="xl30,30,40">
                    <TTITLE>
                        <E T="04">Table 10.—Likely Estimate of Total Costs From Labeling Changes</E>
                    </TTITLE>
                    <BOXHD>
                        <CHED H="1">Product</CHED>
                        <CHED H="1">Number of SKUs</CHED>
                        <CHED H="1">
                            Cost of Label Change
                            <SU>*</SU>
                        </CHED>
                    </BOXHD>
                    <ROW RUL="s,s,s">
                        <ENT I="01">Dietary supplements</ENT>
                        <ENT>4</ENT>
                        <ENT>$10,400</ENT>
                    </ROW>
                    <ROW RUL="s,s,s">
                        <PRTPAGE P="66116"/>
                        <ENT I="01">Notifiers</ENT>
                        <ENT>30</ENT>
                        <ENT>$39,200</ENT>
                    </ROW>
                    <ROW RUL="s,s,s">
                        <ENT I="01">Eggs</ENT>
                        <ENT>12</ENT>
                        <ENT>$17,200</ENT>
                    </ROW>
                    <ROW RUL="s,s,s">
                        <ENT I="01">Pasta</ENT>
                        <ENT>12</ENT>
                        <ENT>$17,000</ENT>
                    </ROW>
                    <ROW>
                        <ENT I="01">Total</ENT>
                        <ENT>58</ENT>
                        <ENT>$83,800</ENT>
                    </ROW>
                    <TNOTE>
                        <SU>*</SU>
                        Assumes 67 percent of label changes can be made with regularly scheduled label changes
                    </TNOTE>
                </GPOTABLE>
                <P>
                    <E T="03">Health Effects</E>
                </P>
                <P>Benefits from a labeling rule typically arise from changes in consumption of nutrients, either increases in consumption of beneficial nutrients or decreases in consumption of detrimental nutrients. Consumption changes because the behavior of producers or consumers changes. Product reformulation, in which producers alter the composition of their product to qualify for a positive label claim or avoid a negative label statement, may lead to substantial changes in the consumption of certain beneficial nutrients. There may also be direct changes in consumer choices, if consumers purchase healthier food based on information they see on the label. Several studies have linked label use to improved diet (Refs. 18 and 19).</P>
                <P>The removal of nutrient content claims for EPA and/or DHA may result in reduced consumption of EPA and DHA under two scenarios. First, consumption of these nutrients may be reduced if consumers choose not to purchase and consume products because they do not have the prohibited nutrient content claims on the label. Second, producers might face reduced incentives to increase levels of EPA and DHA in products, which might lead some producers to a decision not to reformulate. A review of the literature on product reformulation in a report on modeling manufacturers' decision to reformulate finds evidence that increased provision of nutrition information on labels leads manufacturers to reformulate to make healthier products or to attempt to market new healthier products (Ref. 20). If the continued availability of nutrient content claims for EPA and/or DHA would have encouraged producers to increase levels of EPA and/or DHA, there may be additional reductions in consumption of EPA and/or DHA due to lower levels in the food supply. However, because the agency has yet to conduct a review of the scientific evidence concerning the health effects of consuming EPA and DHA at different levels, we cannot determine whether the loss of these claims would have any impact on consumer health, either beneficial or detrimental.</P>
                <P>Furthermore, FDA wishes to emphasize that this ruling does not affect the continuing availability of a qualified health claim that states, “Supportive but not conclusive research shows that consumption of EPA and DHA omega-3 fatty acids may reduce the risk of CHD. One serving of [Name of the food] provides [ ] gram of EPA and DHA omega-3 fatty acids. [See nutrition information for total fat, saturated fat, and cholesterol content.].” To make the qualified health claim, the product must contain EPA and DHA, and meet limits for cholesterol, saturated fat, total fat, and sodium and meet the 10 percent nutrient content requirement for vitamin C, vitamin A, iron, calcium, protein, or fiber (Ref. 21). Producers may opt to reformulate their products to use the qualified health claim.</P>
                <P>Therefore, FDA estimates the quantitative costs of this rule to be $83,800 due entirely to projected labeling changes, and potential non-quantified costs associated with a potential forgone decrease in risk of CHD resulting from a possible decrease in the consumption of EPA and/or DHA.</P>
                <P>
                    <E T="03">Benefits</E>
                </P>
                <P>This option would prevent consumers from mistakenly interpreting “high,” “good source,” and “more” claims relating to the level of EPA and/or DHA in food to imply that an authoritative scientific body has determined that consumers should consume a particular level of EPA and/or DHA per day. This, in turn, might prevent some consumers from forming an incorrect assessment of the relationship of the levels of EPA and/or DHA in particular foods to such recommended levels. This could generate a health benefit because if consumers base their consumption patterns on an incorrect assessment of the significance of the amount of EPA and/or DHA in particular foods, then they might change their consumption patterns in ways that could be detrimental to their health. For example, some consumers might believe they would not receive any additional benefit from consuming additional food containing EPA and/or DHA after eating a food that is labeled as being “high” in those nutrients even though they might actually benefit significantly from additional amounts of those nutrients. Alternatively, some consumers might believe that it is worthwhile to forgo a certain level of other nutrients in order to consume a food that is “high” level of EPA and/or DHA when, in fact, they could obtain nearly the same benefit from a food with less EPA and/or DHA. FDA does not have sufficient information to quantify this potential benefit.</P>
                <HD SOURCE="HD1">VI. The Paperwork Reduction Act of 1995</HD>
                <P>FDA tentatively concludes that this proposed rule contains no collection of information. Therefore clearance by OMB under the Paperwork Reduction Act of 1995 is not required.</P>
                <HD SOURCE="HD1">VII. Federalism Analysis</HD>
                <P>
                    FDA has analyzed this proposed rule in accordance with the principles set forth in Executive Order 13132. FDA has determined that the proposed rule, if finalized as proposed, would have a preemptive effect on State law. Section 4(a) of the Executive order requires agencies to “construe * * * a Federal Statute to preempt State law only where the statute contains an express preemption provision, there is some other clear evidence that the Congress intended preemption of State law, or where the exercise of State authority conflicts with the exercise of Federal authority under the Federal statute.” Section 403A of the act (21 U.S.C. 343-1) is an express preemption provision. In relevant part, section 403A(a)(5) of the act (21 U.S.C. 343-1(a)(5)) provides that: “* * * no State or political subdivision of a State may directly or indirectly establish under any authority or continue in effect as to any food in interstate commerce— * * * (5) any requirement respecting any claim of the type described in section 403(r)(1) made 
                    <PRTPAGE P="66117"/>
                    in the label or labeling of food that is not identical to the requirement of section 403(r) * * *”.
                </P>
                <P>Currently, this provision operates to preempt States from imposing nutrient content claim labeling requirements concerning ALA, EPA, DHA, and EPA and DHA combined because no such requirements have been imposed by FDA under section 403(r) of the act. Under FDA's authority under section 403(r)(2)(H) of the act, the agency proposes to find that the requirements of section 403(r)(2)(G) have not been met with respect to the nutrient content claims for EPA and DHA in the seafood processors notification, the nutrient content claim for DHA in the Martek notification, and the nutrient content claim for EPA and DHA in the Ocean Nutrition notification. FDA also proposes to prohibit the nutrient content claims for ALA in the seafood processors notification.</P>
                <P>
                    Although this proposed rule, if finalized as proposed, would have preemptive effect in that it would preclude States from promulgating any nutrient content claim labeling requirements for ALA, EPA, DHA, and EPA and DHA combined that are not identical to those required by this proposed rule, this preemptive effect would be consistent with what Congress set forth in section 403A of the act. Section 403A(a)(5) of the act displaces both state legislative requirements and state common law duties. 
                    <E T="03">Medtronic</E>
                     v. 
                    <E T="03">Lohr, 518 U.S. 470, 503 (1996)</E>
                     (Breyer, J., concurring in part and concurring in judgment); 
                    <E T="03">id. at 510</E>
                     (O'Connor, J., joined by Rehnquist, C.J., Scalia, J., and Thomas, J., concurring in part and dissenting in part); 
                    <E T="03">Cipollone</E>
                     v. 
                    <E T="03">Liggett Group, Inc., 505 U.S. 504, 521 (1992)</E>
                     (plurality opinion); 
                    <E T="03">id. at 548-49</E>
                     (Scalia, J., joined by Thomas, J., concurring in judgment in part and dissenting in part).
                </P>
                <P>FDA believes that the preemptive effect of the proposed rule, if finalized as a proposed, would be consistent with Executive Order 13132. Section 4(e) of the Executive order provides that “when an agency proposes to act through adjudication or rulemaking to preempt State law, the agency shall provide all affected State and local officials notice and an opportunity for appropriate participation in the proceedings.” FDA's Division of Federal and State Relations is inviting the States' participation in this rulemaking by providing notice via fax and e-mail transmission to State health commissioners, State agriculture commissioners, food program directors, and drug program directors as well as FDA field personnel of FDA's publication of the proposed rule prohibiting the nutrient content claims for ALA, EPA, DHA, and EPA and DHA combined set forth in the three FDAMA notifications received by FDA. The notice provides the States with further opportunity for input on the rule. It advises the States of FDA's publication of the proposed rule and encourages the States and local governments to review the notice of proposed rulemaking and to provide any comments to the docket (Docket No. 2004N-0217, 2005P-0189, or 2006P-0137).</P>
                <P>In conclusion, FDA has determined that the preemptive effects of this proposed rule, if finalized as proposed, are consistent with Executive Order 13132.</P>
                <HD SOURCE="HD1">VIII. Effective Date</HD>
                <P>FDA is proposing to make this regulation effective on the uniform compliance date for food labeling regulations established by the agency that is applicable to the publication date of the final rule.</P>
                <HD SOURCE="HD1">IX. Comments</HD>
                <P>
                    Interested persons may submit to the Division of Dockets Management (see 
                    <E T="02">ADDRESSES</E>
                    ) written or electronic comments regarding this document. Submit a single copy of electronic comments or two paper copies of any mailed comments, except that individuals may submit one paper copy. Comments are to be identified with the docket number found in brackets in the heading of this document. Received comments may be seen in the Division of Dockets Management between 9 a.m. and 4 p.m., Monday through Friday.
                </P>
                <P>
                    Please note that in January 2008, the FDA Web site is expected to transition to the Federal Dockets Management System (FDMS). FDMS is a Government-wide, electronic docket management system. After the transition date, electronic submissions will be accepted by FDA through the FDMS only. When the exact date of the transition to FDMS is known, FDA will publish a 
                    <E T="04">Federal Register</E>
                     notice announcing that date.
                </P>
                <HD SOURCE="HD1">X. References</HD>
                <P>
                    The following references have been placed on display in the Division of Dockets Management (see 
                    <E T="02">ADDRESSES</E>
                    ) and may be seen between 9 a.m. and 4 p.m., Monday through Friday, except on Federal Government holidays. (FDA has verified the Web site addresses, but is not responsible for any subsequent changes to the Web sites after this document publishes in the 
                    <E T="04">Federal Register</E>
                    .)
                </P>
                <EXTRACT>
                    <P>1. Institute of Medicine of the National Academies, “Dietary Reference Intakes for Energy, Carbohydrate, Fiber, Fat, Fatty Acids, Cholesterol, Protein, and Amino Acids,” Summary, Chapter 8, and Chapter 11, the National Academies Press, Washington, DC, 2005.</P>
                    <P>2. Institute of Medicine of the National Academies, Prepublication Copy, “Dietary Reference Intakes for Energy, Carbohydrate, Fiber, Fat, Fatty Acids, Cholesterol, Protein, and Amino Acids,” Summary, Chapter 8, and Chapter 11, the National Academies Press, Washington, DC, 2002.</P>
                    <P>
                        3. Carpenter, K.J. and A.E. Harper, “Evolution of Knowledge of Essential Nutrients,” in 
                        <E T="03">Modern Nutrition in Health and Disease</E>
                        , Eds. M.E. Shils, M. Shike, A.C. Ross, B. Caballero, and R.J. Cousins, Philadelphia, P.A.: Lippincott Williams &amp; Wilkins, p. 7, 2006.
                    </P>
                    <P>
                        4. Stryer, L., 
                        <E T="03">Biochemistry</E>
                        , Fourth Edition, New York: W.H. Freeman and Co., p. 604, 1995.
                    </P>
                    <P>5. Alaska General Seafoods, Ocean Beauty Seafoods, Inc., and Trans-Ocean Products, Inc. “Notification for a Nutrient Content Claim Based on an Authoritative Statement,” Item CP1, Docket No. 2004N-0217, Division of Dockets Management, May 15, 2004.</P>
                    <P>
                        6. U.S. Food and Drug Administration, “Nutrient Content Claims Notification for Choline Containing Foods,” (
                        <E T="03">http://www.cfsan.fda.gov/~dms/flcholin.html</E>
                        ) August 30, 2001.
                    </P>
                    <P>7. Institute of Medicine of the National Academies, “Dietary Reference Intakes for Thiamin, Riboflavin, Niacin, Vitamin B6, Folate, Vitamin B12, Pantothenic Acid, Biotin, and Choline,” the National Academies Press, Washington, DC, pp. 390 to 422, 1998.</P>
                    <P>8. Institute of Medicine of the National Academies, “Dietary Reference Intakes: Guiding Principles for Nutrition Labeling and Fortification,” the National Academies Press, Washington, DC, pp. 82 to 95, 2003.</P>
                    <P>9. Martek Biosciences Corporation, “Notification for a Nutrient Content Claim Based on an Authoritative Statement,” Item CP1, Docket 2005P-0189, Division of Dockets Management, May 23, 2005.</P>
                    <P>10. Ocean Nutrition Canada, “Notification for a Nutrient Content Claim Based on an Authoritative Statement,” Item CP1, Docket No. 2006P-0137, Division of Dockets Management, December 9, 2005.</P>
                    <P>
                        11. A letter from William K. Hubbard, FDA to Jonathan W. Emord, Esq., Emord &amp; Associates, P.C., (
                        <E T="03">http://www.cfsan.fda.gov/~dms/ds-ltr38.html</E>
                        ), September 8, 2004.
                    </P>
                    <P>
                        12. A letter from William K. Hubbard, FDA to Martin J. Hahn, Esq., Hogan &amp; Hartson, L.L.P., (
                        <E T="03">http://www.cfsan.fda.gov/~dms/ds-ltr37.html</E>
                        ), September 8, 2004.
                    </P>
                    <P>
                        13. Information Resources, Inc., (IRI), download, (
                        <E T="03">http://www.infores.com/public/us/content/infoscan/fooddrugmass.htm</E>
                        ), 1999.
                    </P>
                    <P>14. U.S. Department of Agriculture, Agricultural Research Service, USDA National Nutrient Database for Standard Reference, Release 17, Nutrient Data Laboratory Home Page (http://www.nal.usda.gov/fnic/foodcomp), 2004.</P>
                    <P>
                        15. U.S. Department of Agriculture Economic Research Service, Food Consumption Data System (http://www.ers.usda.gov/data/foodconsumption/Index.htm), 2005.
                        <PRTPAGE P="66118"/>
                    </P>
                    <P>16. RTI International, “FDA Labeling Cost Model,” Prepared for FDA, January, 2003.</P>
                    <P>17. RTI International, “Dietary Supplement Sales Information,” Prepared for FDA, October 1999.</P>
                    <P>
                        18. Neuhouser, M.L., A.R. Kristal, and R.E. Patterson, “Use of Food Nutrition Labels Associated with Lower Fat Intake,” 
                        <E T="03">Journal of the American Dietetic Association</E>
                        , vol. 53, pp. 45 to 50, 53, 1999.
                    </P>
                    <P>
                        19. Kim, S., R.M. Nayga, Jr., and O. Capps, Jr., “The Effect of Food Label Use on Nutrient Intakes: An Endogenous Switching Regression Analysis,” 
                        <E T="03">Journal of Agricultural and Resource Economics</E>
                        , vol. 25, pp. 215 to 231, 2000.
                    </P>
                    <P>20. RTI International, “Modeling the Decision to Reformulate Food and Cosmetics,” Prepared for FDA, October 2003.</P>
                    <P>
                        21. U.S. Food and Drug Administration, “Summary of Qualified Health Claims Permitted,” Accessed at 
                        <E T="03">http://www.cfsan.fda.gov/~dms/qhc-sum.html#omega3</E>
                         on September 26, 2005.
                    </P>
                </EXTRACT>
                <SIG>
                    <DATED>Dated: November 19, 2007.</DATED>
                    <NAME>Jeffrey Shuren,</NAME>
                    <TITLE>Assistant Commissioner for Policy.</TITLE>
                </SIG>
            </SUPLINF>
            <FRDOC>[FR Doc. E7-22991 Filed 11-26-07; 8:45 am]</FRDOC>
            <BILCOD>BILLING CODE 4160-01-S</BILCOD>
        </PRORULE>
        <PRORULE>
            <PREAMB>
                <AGENCY TYPE="S">DEPARTMENT OF JUSTICE </AGENCY>
                <SUBAGY>Drug Enforcement Administration </SUBAGY>
                <CFR>21 CFR PART 1305 </CFR>
                <DEPDOC>[Docket No. DEA—303P] </DEPDOC>
                <RIN>RIN 1117-AB15 </RIN>
                <SUBJECT>New Single-Sheet Format for U.S. Official Order Form for Schedule I and II Controlled Substances (DEA Form 222) </SUBJECT>
                <AGY>
                    <HD SOURCE="HED">AGENCY:</HD>
                    <P>Drug Enforcement Administration (DEA), Department of Justice. </P>
                </AGY>
                <ACT>
                    <HD SOURCE="HED">ACTION:</HD>
                    <P>Notice of proposed rulemaking. </P>
                </ACT>
                <SUM>
                    <HD SOURCE="HED">SUMMARY:</HD>
                    <P>The Drug Enforcement Administration (DEA) is proposing to amend its regulations to implement a new format for order forms (DEA Form 222) which are issued by DEA to DEA registrants to allow them to order schedule I and/or II controlled substances. The present format utilizes a three-part, carbon-copy form with Copies 2 and 3 replicating Copy 1. The proposed format will employ a single-sheet form. The new form will have enhanced security features and will be easier for DEA registrants to use. </P>
                </SUM>
                <EFFDATE>
                    <HD SOURCE="HED">DATES:</HD>
                    <P>Written comments must be postmarked, and electronic comments must be sent, on or before January 28, 2008. </P>
                </EFFDATE>
                <ADD>
                    <HD SOURCE="HED">ADDRESSES:</HD>
                    <P>
                        To ensure proper handling of comments, please reference “Docket No. DEA-303P” on all written and electronic correspondence. Written comments being sent via regular mail should be sent to the Deputy Assistant Administrator, Office of Diversion Control, Drug Enforcement Administration, Washington, DC 20537, 
                        <E T="03">Attention:</E>
                         DEA Federal Register Representative/ODL. Written comments sent via express mail should be sent to DEA Headquarters, 
                        <E T="03">Attention:</E>
                         DEA Federal Register Representative/ODL, 8701 Morrissette Drive, Springfield, VA 22152. Comments may be sent directly to DEA electronically by sending an electronic message to 
                        <E T="03">dea.diversion.policy@usdoj.gov</E>
                        . Comments may also be sent electronically through 
                        <E T="03">http://www.regulations.gov</E>
                         using the electronic comment form provided on that site. An electronic copy of this document is also available at the 
                        <E T="03">http://www.regulations.gov</E>
                         Web site. DEA will accept electronic comments containing MS Word, WordPerfect, Adobe PDF, or Excel files only. DEA will not accept any file format other than those specifically listed here. 
                    </P>
                    <P>
                        <E T="03">Posting of Public Comments:</E>
                         Please note that all comments received are considered part of the public record and made available for public inspection online at 
                        <E T="03">http://www.regulations.gov</E>
                         and in the Drug Enforcement Administration's public docket. Such information includes personal identifying information (such as your name, address, etc.) voluntarily submitted by the commenter. 
                    </P>
                    <P>If you want to submit personal identifying information (such as your name, address, etc.) as part of your comment, but do not want it to be posted online or made available in the public docket, you must include the phrase “PERSONAL IDENTIFYING INFORMATION” in the first paragraph of your comment. You must also place all the personal identifying information you do not want posted online or made available in the public docket in the first paragraph of your comment and identify what information you want redacted. </P>
                    <P>If you want to submit confidential business information as part of your comment, but do not want it to be posted online or made available in the public docket, you must include the phrase “CONFIDENTIAL BUSINESS INFORMATION” in the first paragraph of your comment. You must also prominently identify confidential business information to be redacted within the comment. If a comment has so much confidential business information that it cannot be effectively redacted, all or part of that comment may not be posted online or made available in the public docket. </P>
                    <P>
                        Personal identifying information and confidential business information identified and located as set forth above will be redacted and the comment, in redacted form, will be posted online and placed in the Drug Enforcement Administration's public docket file. If you wish to inspect the agency's public docket file in person by appointment, please see the 
                        <E T="02">FOR FURTHER INFORMATION CONTACT</E>
                         paragraph. 
                    </P>
                </ADD>
                <FURINF>
                    <HD SOURCE="HED">FOR FURTHER INFORMATION CONTACT:</HD>
                    <P>Mark W. Caverly, Chief, Liaison and Policy Section, Office of Diversion Control, Drug Enforcement Administration, Washington, DC 20537, Telephone (202) 307-7297. </P>
                </FURINF>
            </PREAMB>
            <SUPLINF>
                <HD SOURCE="HED">SUPPLEMENTARY INFORMATION:</HD>
                <HD SOURCE="HD1">Background </HD>
                <HD SOURCE="HD2">Legal Authority </HD>
                <P>
                    The Drug Enforcement Administration (DEA) administers the Controlled Substances Act (CSA) (21 U.S.C. 801 
                    <E T="03">et seq.</E>
                    ) as amended. DEA regulations implementing this statute are published in Title 21 of the Code of Federal Regulations (CFR), Parts 1300 to 1316. These regulations are designed to establish a framework for the legal distribution of controlled substances to ensure that there is a sufficient supply of these drugs for legitimate medical purposes while deterring their diversion to illegal purposes. Controlled substances are those substances listed in the schedules of the CSA and 21 CFR 1308.11-1308.15, and generally include narcotics, stimulants, depressants, hallucinogens, and anabolic steroids that have potential for abuse and physical and psychological dependence. 
                </P>
                <P>Controlled substances are divided into five schedules. Schedule I substances are drugs which have a high potential for abuse and no currently accepted medical use in treatment in the United States. They may be used only for research, chemical analysis, or manufacture of other drugs. Schedule II substances have legitimate medical uses, but a high potential for abuse and physical and psychological dependence, and are subject to more stringent controls than other legitimate controlled substances. Schedule III through V substances have legitimate medical uses; however, they have a lower potential for abuse and physical and psychological dependence than do schedule II controlled substances. </P>
                <P>
                    The CSA and DEA regulations require that persons involved in the manufacture, distribution, research, dispensing, import, and export of controlled substances register with DEA, keep track of all stocks of controlled substances, and maintain records to 
                    <PRTPAGE P="66119"/>
                    account for all controlled substances received, distributed, or otherwise disposed of. The overall goal of the CSA and its implementing regulations is to provide a closed distribution system so that a controlled substance is at all times under the legal control of a person registered, or specifically exempted from registration, by the Drug Enforcement Administration until it reaches the ultimate user or is destroyed. DEA achieves this goal by registering manufacturers, distributors, reverse distributors, dispensers, researchers, importers and exporters of controlled substances. Thus, any movement of controlled substances between these registered persons is covered by DEA regulations. 
                </P>
                <HD SOURCE="HD1">Order Forms </HD>
                <P>The CSA requires that schedule I and II controlled substances be distributed only pursuant to a written order made by the purchaser on a form issued by the Attorney General, (21 U.S.C. 828). This responsibility has been delegated to the Administrator of DEA (28 CFR 0.100) and redelegated to the Deputy Assistant Administrator of the DEA Office of Diversion Control (28 CFR 0.104; Appendix to Subpart R, § 7). DEA uses these order forms to allow better tracking of all distributions of schedule I and II controlled substances. As stated previously, order forms are required for schedule I and II controlled substances because they have a higher potential for abuse and physical and psychological dependence than schedule III through V controlled substances. The order forms are issued to DEA registrants to allow them to purchase controlled substances. The order forms are designated as DEA Form 222. The law and regulations require that DEA preprint certain information on these order forms including the name, address, and DEA number of the registrant, the authorized activity, and the schedules of the registrant (21 U.S.C. 828, 21 CFR 1305.11). Order forms are triplicate forms, printed on interleaved carbon sheets. </P>
                <P>Whenever a DEA registrant wishes to acquire a schedule I and/or II controlled substance, that registrant must annotate on the order form the name and address of the supplying DEA registrant, the date requested, the number of packages of controlled substance ordered, the size of the package of the controlled substance ordered, and the name of the controlled substance ordered. The purchaser retains one copy (Copy 3) of the form and sends two copies to the supplier so that the order for a controlled substance can be filled. The supplier annotates the form by entering the actual number of packages of the controlled substance(s) shipped and the actual date shipped. The supplier retains one copy (Copy 1) of the order form sent to him/her by the purchaser, and sends the other copy (Copy 2) of the form to the DEA Special Agent in Charge in the area where the supplier is located. Upon receiving the controlled substances, the purchaser annotates on its copy of the order form the number of packages of the controlled substance(s) ordered which are actually received and the actual date received. Both the purchaser and the supplier are required to preserve their respective copy of the order form for two years and make it available to officials of the DEA for inspection, if requested. </P>
                <HD SOURCE="HD1">Need for New Form </HD>
                <P>The proposed new format for DEA Form 222 will employ a single-sheet form. In executing a transaction of a schedule I and/or II controlled substance, a DEA registrant will process the new single-sheet form in a similar manner to the processing of the current three-part form. The change in processing will be that the single-sheet form will have to be copied rather than having the copies pre-printed. DEA will continue to preprint and issue the original form. </P>
                <P>The new form is being initiated to improve security and to allow better ease in handling. The new form will have enhanced security features over the current three-part form. DEA will preprint the new form on sturdier paper with a special embedded watermark of the DEA emblem making it more difficult to copy for counterfeit purposes. If photocopied, the photocopy of the new form will display the DEA emblem and the statement “Copy” to hinder counterfeiting. </P>
                <P>It is anticipated that the new form will be more convenient for DEA registrants to utilize. The old three-part form format was created more than thirty years ago and the processing of a transaction with carbon copies is an outdated concept. Today, new office technology exists such as laser printers and photocopiers which will allow DEA registrants greater ease in utilizing the single-sheet form. </P>
                <P>The single-sheet form will be beneficial for DEA as well. The equipment used to print the interleaved carbon forms is old, and finding replacement parts and otherwise maintaining the equipment is costly, difficult, and time-consuming. </P>
                <HD SOURCE="HD1">Transition From Old to New Format </HD>
                <P>If this regulation is finalized as proposed, once the new single-sheet form is in use, the current three-part form will be phased out, and eventually will no longer be issued by DEA. DEA registrants will be allowed to exhaust their supply of the old three-part forms as part of the transition. To effect a smooth transition, DEA registrants will be allowed to continue to order the current three-part form for at least one year once the new single-sheet form is introduced. Approximately two years after the establishment of the new single-sheet format, the old three-part form will be totally discontinued. Thus, business firms will have time to shift their processes to accommodate the new form. </P>
                <HD SOURCE="HD1">Revision of DEA Regulations to Accommodate Single Sheet DEA Form 222 </HD>
                <P>DEA proposes to amend its regulations pertaining to orders for schedule I and II controlled substances to allow for the transition from the three-part form to the single-sheet form of DEA Form 222. Initially, the new procedures for the single-sheet format will exist alongside the existing procedures for the three-part form. Eventually, in a later rulemaking, the procedures detailing the use of the three-part form will be deleted from the regulations. </P>
                <P>DEA is amending its regulations to reflect the fact that only one original DEA Form 222 will be provided to purchasing registrants by DEA. Registrants purchasing schedule I and II controlled substances will now be required to make a copy of the form and send the original to their supplier for filling. It is important to note that the process for handling the DEA Form 222 remains unchanged. The only difference made by these proposed amendments is to require registrants to make photocopies of the form, rather than having DEA provide an original and two carbon copies. </P>
                <HD SOURCE="HD1">Other Minor Regulatory Changes </HD>
                <P>In addition to the changes discussed above, DEA is proposing several minor regulatory changes as part of this rulemaking, as discussed below. </P>
                <P>
                    Currently, interleaved triplicate order forms are produced in books, with each book containing 7 order forms. The new single-sheet form will not be produced in books, giving DEA and registrants greater flexibility regarding the number of order forms to be requisitioned. Therefore, in § 1305.11, DEA is proposing to modify the language regarding the new single-sheet DEA Form 222 to indicate that a predetermined number of order forms, based on the business activity of the 
                    <PRTPAGE P="66120"/>
                    registrant, will be issued, rather than books of 7 order forms. 
                </P>
                <P>In § 1305.12, DEA is proposing to add to the list of acceptable methods for filling out a DEA Form 222 use of a computer printer, in addition to the existing typewriter, pen, or indelible pencil. </P>
                <HD SOURCE="HD1">Regulatory Certifications </HD>
                <HD SOURCE="HD1">Regulatory Flexibility Act </HD>
                <P>The Deputy Assistant Administrator hereby certifies that this rulemaking has been drafted in accordance with the Regulatory Flexibility Act (5 U.S.C. 605(b)), and by approving it certifies that this regulation will not have a significant economic impact upon a substantial number of small entities. This rule proposes that DEA regulations be amended to implement a new format for order forms (DEA Form 222) which are issued by DEA to DEA registrants to allow them to order schedule I and/or II controlled substances. The present format utilizes a three-part, carbon-copy form with Copies 2 and 3 replicating Copy 1. The proposed format will employ a single-sheet form, which will incorporate additional security features and will be easier for DEA registrants to use. </P>
                <HD SOURCE="HD1">Executive Order 12866 </HD>
                <P>The Deputy Assistant Administrator further certifies that this rulemaking has been drafted in accordance with the principles of Executive Order 12866 Section 1(b). It has been determined that this is a significant regulatory action. Therefore, this action has been reviewed by the Office of Management and Budget. </P>
                <HD SOURCE="HD1">Executive Order 12988 </HD>
                <P>The Deputy Assistant Administrator further certifies that this regulation meets the applicable standards set forth in Sections 3(a) and 3(b)(2) of Executive Order 12988. </P>
                <HD SOURCE="HD1">Executive Order 13132 </HD>
                <P>This rulemaking does not preempt or modify any provision of State law; nor does it impose enforcement responsibilities on any State; nor does it diminish the power of any State to enforce its own laws. Accordingly, this rulemaking does not have federalism implications warranting the application of Executive Order 13132. </P>
                <HD SOURCE="HD1">Unfunded Mandates Reform Act of 1995 </HD>
                <P>This rule will not result in the expenditure by State, local and tribal governments, in the aggregate, or by the private sector, of $120,000,000 or more (adjusted for inflation) in any one year, and will not significantly or uniquely affect small governments. Therefore, no actions were deemed necessary under the provisions of the Unfunded Mandates Reform Act of 1995. </P>
                <HD SOURCE="HD1">Paperwork Reduction Act </HD>
                <P>Although this rule establishes a new DEA Form 222, it does not affect the time necessary to complete the collection of information nor the persons required to use DEA Form 222 in the ordering of schedule I and II controlled substances. Nor does the revision of the design of the form—use of triplicate interleaved sheets versus single sheet—revise the fields contained on the form. The new form does not collect any new information or modify any existing information being collected. Accordingly, revisions to the DEA information collection entitled “U.S. Official Order Forms for Schedule I and II Controlled Substances (Accountable Forms), Order Form Requisition” (OMB approval number 1117-0010) are not necessary. </P>
                <HD SOURCE="HD1">Congressional Review Act </HD>
                <P>This rule is not a major rule as defined by Section 804 of the Small Business Regulatory Enforcement Fairness Act of 1996 (Congressional Review Act). This rule will not result in an annual effect on the economy of $100,000,000 or more; a major increase in costs or prices; or significant adverse effects on competition, employment, investment, productivity, innovation, or on the ability of United States-based companies to compete with foreign-based companies in domestic and export markets. </P>
                <LSTSUB>
                    <HD SOURCE="HED">List of Subjects in 21 CFR Part 1305 </HD>
                    <P>Drug traffic control, Reporting requirements.</P>
                </LSTSUB>
                <P>For the reasons set forth above, 21 CFR part 1305 is proposed to be amended as follows: </P>
                <PART>
                    <HD SOURCE="HED">PART 1305—ORDERS FOR SCHEDULE I AND II CONTROLLED SUBSTANCES [AMENDED] </HD>
                    <P>1. The authority citation for part 1305 continues to read as follows: </P>
                    <AUTH>
                        <HD SOURCE="HED">Authority:</HD>
                        <P>21 U.S.C. 821, 828, and 871, unless otherwise noted. </P>
                    </AUTH>
                    <P>2. Section 1305.11 is amended by revising paragraphs (a) and (b) to read as follows: </P>
                    <SECTION>
                        <SECTNO>§ 1305.11 </SECTNO>
                        <SUBJECT>Procedure for obtaining DEA Forms 222. </SUBJECT>
                        <P>(a)(1) Except as provided in paragraph (a)(2) of this section, DEA Forms 222 are issued in mailing envelopes containing seven forms, each form containing an original, duplicate, and triplicate copy (respectively, Copy 1, Copy 2, and Copy 3) (hereafter referred to as the “triplicate” form). A limit, which is based on the business activity of the registrant, will be imposed on the number of DEA Forms 222 which will be furnished on any requisition, unless additional forms are specifically requested and a reasonable need for such additional forms is shown. </P>
                        <P>(2) DEA Forms 222 are issued in mailing envelopes containing a predetermined number of forms based on the business activity of the registrant, each form consisting of one single-sheet (hereafter referred to as the “single sheet” form). A limit, which is based on the business activity of the registrant, will be imposed on the number of DEA Forms 222 which will be furnished on any requisition unless additional forms are specifically requested and a reasonable need for such additional forms is shown. </P>
                        <P>(b) Any person applying for a registration that would entitle him or her to obtain a DEA Form 222 may requisition the forms by so indicating on the application or renewal form; a DEA Form 222 will be supplied upon the registration of the applicant. Any person holding a registration entitling him or her to obtain a DEA Form 222 may requisition the forms for the first time by contacting any Division Office or the Registration Section of the Administration. Any person already holding a DEA Form 222 may requisition additional forms by contacting any Division Office or the Registration Section of the Administration. </P>
                        <STARS/>
                        <P>3. Section 1305.12 is amended by revising paragraph (a) to read as follows: </P>
                    </SECTION>
                    <SECTION>
                        <SECTNO>§ 1305.12 </SECTNO>
                        <SUBJECT>Procedure for executing DEA Forms 222. </SUBJECT>
                        <P>(a)(1) A purchaser must prepare and execute a triplicate DEA Form 222 simultaneously in triplicate by means of interleaved carbon sheets that are part of the DEA Form 222. DEA Form 222 must be prepared by use of a typewriter, computer printer, pen, or indelible pencil. </P>
                        <P>(2) A purchaser must prepare a single sheet DEA Form 222 by use of a typewriter, computer printer, pen, or indelible pencil. </P>
                        <STARS/>
                        <P>4. Section 1305.13 is amended by revising paragraphs (a), (b), (d), and (e) to read as follows: </P>
                    </SECTION>
                    <SECTION>
                        <PRTPAGE P="66121"/>
                        <SECTNO>§ 1305.13 </SECTNO>
                        <SUBJECT>Procedure for filling DEA Forms 222. </SUBJECT>
                        <P>(a)(1) A purchaser must submit Copy 1 and Copy 2 of the triplicate DEA Form 222 to the supplier and retain Copy 3 in the purchaser's files. </P>
                        <P>(2) A purchaser must submit the original of the single sheet DEA Form 222 to the supplier and retain a copy in the purchaser's files. </P>
                        <P>(b)(1) For the triplicate DEA Form 222, a supplier may fill the order, if possible and if the supplier desires to do so, and must record on Copies 1 and 2 the number of commercial or bulk containers furnished on each item and the date on which the containers are shipped to the purchaser. If an order cannot be filled in its entirety, it may be filled in part and the balance supplied by additional shipments within 60 days following the date of the DEA Form 222. No DEA Form 222 is valid more than 60 days after its execution by the purchaser, except as specified in paragraph (f) of this section. </P>
                        <P>(2) For the single sheet DEA Form 222, a supplier may fill the order, if possible and if the supplier desires to do so, and must record on the original and a copy the number of commercial or bulk containers furnished on each item and the date on which the containers are shipped to the purchaser. If an order cannot be filled in its entirety, it may be filled in part and the balance supplied by additional shipments within 60 days following the date of the DEA Form 222. No DEA Form 222 is valid more than 60 days after its execution by the purchaser, except as specified in paragraph (f) of this section. </P>
                        <STARS/>
                        <P>(d)(1) The supplier must retain Copy 1 of the triplicate DEA Form 222 for his or her files and forward Copy 2 to the Special Agent in Charge of the Drug Enforcement Administration in the area in which the supplier is located. Copy 2 must be forwarded at the close of the month during which the order is filled. If an order is filled by partial shipments, Copy 2 must be forwarded at the close of the month during which the final shipment is made or the 60-day validity period expires. </P>
                        <P>(2) The supplier must retain the original of the single sheet DEA Form 222 for his or her files and forward a copy to the Special Agent in Charge of the Drug Enforcement Administration in the area in which the supplier is located. The copy must be forwarded at the close of the month during which the order is filled. If an order is filled by partial shipments, the copy must be forwarded at the close of the month during which the final shipment is made or the 60-day validity period expires. </P>
                        <P>(e)(1) The purchaser must record on Copy 3 of the triplicate DEA Form 222 the number of commercial or bulk containers furnished on each item and the dates on which the containers are received by the purchaser. </P>
                        <P>(2) The purchaser must record on its copy of the single sheet DEA Form 222 the number of commercial or bulk containers furnished on each item and the dates on which the containers are received by the purchaser. </P>
                        <STARS/>
                        <P>5. Section 1305.14 is amended by revising paragraph (a) to read as follows: </P>
                    </SECTION>
                    <SECTION>
                        <SECTNO>§ 1305.14 </SECTNO>
                        <SUBJECT>Procedure for endorsing DEA Forms 222. </SUBJECT>
                        <P>(a)(1) A triplicate DEA Form 222, made out to any supplier who cannot fill all or a part of the order within the time limitation set forth in § 1305.13, may be endorsed to another supplier for filling. The endorsement must be made only by the supplier to whom the DEA Form 222 was first made, must state (in the spaces provided on the reverse sides of Copies 1 and 2 of the triplicate DEA Form 222) the name and address of the second supplier, and must be signed by a person authorized to obtain and execute DEA Forms 222 on behalf of the first supplier. The first supplier may not fill any part of an order on an endorsed form. The second supplier may fill the order, if possible and if the supplier desires to do so, in accordance with § 1305.13(b), (c), and (d), including shipping all substances directly to the purchaser. </P>
                        <P>(2) A single-sheet DEA Form 222, made out to any supplier who cannot fill all or a part of the order within the time limitation set forth in § 1305.13, may be endorsed to another supplier for filling. The endorsement must be made only by the supplier to whom the DEA Form 222 was first made, must state (in the spaces provided in Part 2 on the original DEA Form 222 and on the copy to be sent to DEA) the name and address of the second supplier, and must be signed by a person authorized to obtain and execute DEA Forms 222 on behalf of the first supplier. The first supplier may not fill any part of an order on an endorsed form. The second supplier may fill the order, if possible and if the supplier desires to do so, in accordance with § 1305.13(b), (c), (d), including shipping all substances directly to the purchaser. </P>
                        <STARS/>
                        <P>6. Section 1305.15 is amended by revising paragraphs (b) and (d) to read as follows: </P>
                    </SECTION>
                    <SECTION>
                        <SECTNO>§ 1305.15 </SECTNO>
                        <SUBJECT>Unaccepted and defective DEA Forms 222. </SUBJECT>
                        <STARS/>
                        <P>(b)(1) If a triplicate DEA Form 222 cannot be filled for any reason under this section, the supplier must return Copies 1 and 2 to the purchaser with a statement as to the reason (e.g. illegible or altered). </P>
                        <P>(2) If a single-sheet DEA Form 222 cannot be filled for any reason under this section, the supplier must return the original copy to the purchaser with a statement as to the reason (e.g. illegible or altered). </P>
                        <STARS/>
                        <P>(d)(1) When a purchaser receives an unaccepted order, Copies 1 and 2 of the triplicate DEA Form 222 and the statement must be attached to Copy 3 and retained in the files of the purchaser in accordance with § 1305.17. A defective DEA Form 222 may not be corrected; it must be replaced by a new DEA Form 222 for the order to be filled. </P>
                        <P>(2) When a purchaser receives an unaccepted order, the original of the single-sheet DEA Form 222 and the statement must be retained in the files of the purchaser in accordance with § 1305.17. A defective DEA Form 222 may not be corrected; it must be replaced by a new DEA Form 222 for the order to be filled. </P>
                        <P>7. Section 1305.16 is amended by revising paragraph (a) to read as follows: </P>
                    </SECTION>
                    <SECTION>
                        <SECTNO>§ 1305.16 </SECTNO>
                        <SUBJECT>Lost and stolen DEA Forms 222. </SUBJECT>
                        <P>(a)(1) If a purchaser ascertains that an unfilled triplicate DEA Form 222 has been lost, he or she must execute another in triplicate and attach a statement containing the serial number and date of the lost form, and stating that the goods covered by the first DEA Form 222 were not received through loss of that DEA Form 222. Copy 3 of the second form and a copy of the statement must be retained with Copy 3 of the DEA Form 222 first executed. A copy of the statement must be attached to Copies 1 and 2 of the second DEA Form 222 sent to the supplier. If the first DEA Form 222 is subsequently received by the supplier to whom it was directed, the supplier must mark upon the face “Not accepted” and return Copies 1 and 2 to the purchaser, who must attach it to Copy 3 and the statement. </P>
                        <P>
                            (2) If a purchaser ascertains that an unfilled single-sheet DEA Form 222 has been lost, he or she must execute another and attach a statement containing the serial number and date of the lost form, and stating that the goods covered by the first DEA Form 222 were not received through loss of that DEA Form 222. A copy of the second form and a copy of the statement must be 
                            <PRTPAGE P="66122"/>
                            retained with a copy of the DEA Form 222 first executed. A copy of the statement must be attached to a copy of the second DEA Form 222 sent to the supplier. If the first DEA Form 222 is subsequently received by the supplier to whom it was directed, the supplier must mark upon the face “Not accepted” and return it (“the original”) to the purchaser, who must attach it to the statement. 
                        </P>
                        <STARS/>
                        <P>8. Section 1305.17 is amended by revising paragraphs (a), (b), and (c) to read as follows: </P>
                    </SECTION>
                    <SECTION>
                        <SECTNO>§ 1305.17 </SECTNO>
                        <SUBJECT>Preservation of DEA Forms  222. </SUBJECT>
                        <P>(a)(1) The purchaser must retain Copy 3 of each executed triplicate DEA Form 222 and all copies of unaccepted or defective forms with each statement attached. </P>
                        <P>(2) The purchaser must retain a copy of each executed single-sheet DEA Form 222 and all copies of unaccepted or defective forms with each statement attached. </P>
                        <P>(b)(1) The supplier must retain Copy 1 of each triplicate DEA Form 222 that it has filled. </P>
                        <P>(2) The supplier must retain the original of each single-sheet DEA Form 222 that it has filled. </P>
                        <P>(c)(1) Triplicate DEA Forms 222 must be maintained separately from all other records of the registrant. DEA Forms 222 are required to be kept available for inspection for a period of two years. If a purchaser has several registered locations, the purchaser must retain Copy 3 of the executed triplicate DEA Form 222 and any attached statements or other related documents (not including unexecuted DEA Forms 222, which may be kept elsewhere under § 1305.12 (e)), at the registered location printed on the DEA Form 222. </P>
                        <P>(2) Single-sheet DEA Forms 222 must be maintained separately from all other records of the registrant. DEA Forms 222 are required to be kept available for inspection for a period of two years. If a purchaser has several registered locations, the purchaser must retain a copy of the executed single-sheet DEA Form 222 and any attached statements or other related documents (not including unexecuted DEA Forms 222, which may be kept elsewhere under § 1305.12 (e)), at the registered location printed on the DEA Form 222. </P>
                        <STARS/>
                        <P>9. Section 1305.19 is revised to read as follows: </P>
                    </SECTION>
                    <SECTION>
                        <SECTNO>§ 1305.19 </SECTNO>
                        <SUBJECT>Cancellation and voiding of DEA Forms 222. </SUBJECT>
                        <P>(a)(1) A purchaser may cancel part or all of an order on a triplicate DEA Form 222 by notifying the supplier in writing of the cancellation. The supplier must indicate the cancellation on Copies 1 and 2 of the triplicate DEA Form 222 by drawing a line through the canceled items and printing “canceled” in the space provided for the number of items shipped. </P>
                        <P>(2) A purchaser may cancel part or all of an order on a single-sheet DEA Form 222 by notifying the supplier in writing of the cancellation. The supplier must indicate the cancellation on the original copy of the DEA Form 222 sent by the purchaser to the supplier by drawing a line through the canceled items and printing “canceled” in the space provided for the number of items shipped. </P>
                        <P>(b)(1) A supplier may void part or all of an order on a triplicate DEA Form 222 by notifying the purchaser in writing of the voiding. The supplier must indicate the voiding in the manner prescribed for cancellation in paragraph (a)(1) of this section. </P>
                        <P>(2) A supplier may void part or all of an order on a single-sheet DEA Form 222 by notifying the purchaser in writing of the voiding. The supplier must indicate the voiding in the manner prescribed for cancellation in paragraph (a)(2) of this section. </P>
                    </SECTION>
                    <SIG>
                        <DATED> Dated: November 17, 2007. </DATED>
                        <NAME>Joseph T. Rannazzisi, </NAME>
                        <TITLE>Deputy Assistant Administrator, Office of Diversion Control.</TITLE>
                    </SIG>
                </PART>
            </SUPLINF>
            <FRDOC> [FR Doc. E7-22984 Filed 11-26-07; 8:45 am] </FRDOC>
            <BILCOD>BILLING CODE 4410-09-P </BILCOD>
        </PRORULE>
        <PRORULE>
            <PREAMB>
                <AGENCY TYPE="N">DEPARTMENT OF HOMELAND SECURITY</AGENCY>
                <SUBAGY>Coast Guard</SUBAGY>
                <CFR>33 CFR Part 167</CFR>
                <DEPDOC>[USCG-2007-0057]</DEPDOC>
                <SUBJECT>Port Access Route Study of Potential Vessel Routing Measures To Reduce Vessel Strikes of North Atlantic Right Whales; Correction</SUBJECT>
                <AGY>
                    <HD SOURCE="HED">AGENCY:</HD>
                    <P>Coast Guard, DHS.</P>
                </AGY>
                <ACT>
                    <HD SOURCE="HED">ACTION:</HD>
                    <P>Notice of study; request for comments; correction.</P>
                </ACT>
                <SUM>
                    <HD SOURCE="HED">SUMMARY:</HD>
                    <P>
                        The Coast Guard is correcting a notice of study and request for comments that appeared in the 
                        <E T="04">Federal Register</E>
                         on November 19, 2007 (72 FR 64968). That notice informed the public the Coast Guard is conducting a Port Access Route Study (PARS) on the area east and south of Cape Cod, Massachusetts, to include the northern right whale critical habitat, mandatory ship reporting system area, and the Great South Channel including Georges Bank out to the exclusive economic zone (EEZ) boundary. The purpose of the PARS is to analyze potential vessel routing measures that might help reduce ship strikes with the highly endangered North Atlantic right whale while minimizing any adverse effects on vessel operations. The recommendations of the study will inform the Coast Guard and may lead to appropriate international actions.
                    </P>
                </SUM>
                <DATES>
                    <HD SOURCE="HED">DATES:</HD>
                    <P>Comments and related material must reach the Docket Management Facility on or before January 18, 2008.</P>
                </DATES>
                <FURINF>
                    <HD SOURCE="HED">FOR FURTHER INFORMATION CONTACT:</HD>
                    <P>
                        If you have questions on the notice of study, call Mr. George Detweiler, Coast Guard Division of Navigation Systems, 202-372-1566, or send e-mail to 
                        <E T="03">George.H.Detweiler@uscg.mil.</E>
                         If you have questions on viewing or submitting material to the docket, call Ms. Renee K. Wright, Program Manager, Docket Operations, telephone 202-366-9826.
                    </P>
                </FURINF>
            </PREAMB>
            <SUPLINF>
                <HD SOURCE="HED">SUPPLEMENTARY INFORMATION:</HD>
                <P>
                    In 
                    <E T="04">Federal Register</E>
                     Volume 72, Number 222, appearing on page 64969 on Monday, November 19, 2007, the following correction is made:
                </P>
                <P>
                    1. On page 64969, in the third column, under 
                    <E T="03">“What are the timeline, study area, and processes of this PARS?”,</E>
                     remove the words “and must be completed by December 2007.”
                </P>
                <SIG>
                    <DATED>Dated: November 20, 2007.</DATED>
                    <NAME>Stefan G. Venckus,</NAME>
                    <TITLE>Chief, Office of Regulations and Administrative Law, United States Coast Guard.</TITLE>
                </SIG>
            </SUPLINF>
            <FRDOC>[FR Doc. E7-23050 Filed 11-26-07; 8:45 am]</FRDOC>
            <BILCOD>BILLING CODE 4910-15-P</BILCOD>
        </PRORULE>
        <PRORULE>
            <PREAMB>
                <AGENCY TYPE="N">DEPARTMENT OF THE INTERIOR </AGENCY>
                <SUBAGY>Fish and Wildlife Service </SUBAGY>
                <CFR>50 CFR Part 17 </CFR>
                <RIN>RIN 1018-AU86 </RIN>
                <SUBJECT>Endangered and Threatened Wildlife and Plants; Designation of Critical Habitat for Acanthomintha ilicifolia (San Diego Thornmint) </SUBJECT>
                <AGY>
                    <HD SOURCE="HED">AGENCY:</HD>
                    <P>Fish and Wildlife Service, Interior. </P>
                </AGY>
                <ACT>
                    <HD SOURCE="HED">ACTION:</HD>
                    <P>Proposed rule; reopening of comment period, corrections to proposed critical habitat, notice of availability of draft economic analysis, and amended Required Determinations. </P>
                </ACT>
                <SUM>
                    <HD SOURCE="HED">SUMMARY:</HD>
                    <P>
                        We, the U.S. Fish and Wildlife Service (Service), announce the reopening of the comment period on the 
                        <PRTPAGE P="66123"/>
                        proposed designation of critical habitat for 
                        <E T="03">Acanthomintha ilicifolia</E>
                         (San Diego thornmint) under the Endangered Species Act of 1973, as amended (Act). We also announce corrections to proposed critical habitat subunits 3C, 3D, 3F, 4A, 4B, and 4C as described in the preamble to the proposed rule published in the 
                        <E T="04">Federal Register</E>
                         on March 14, 2007 (72 FR 11946); announce the availability of the draft economic analysis for the proposed critical habitat designation; and announce amended Required Determinations for the proposal. The draft economic analysis provides information about the pre-designation costs and forecasts post-designation costs associated with conservation efforts for 
                        <E T="03">Acanthomintha ilicifolia.</E>
                         The draft economic analysis estimates potential future costs to be approximately $0.6 to $2.8 million in undiscounted dollars over a 20-year period in areas proposed as final critical habitat and approximately $1.6 to $5.1 million in undiscounted dollars over a 20-year period in areas proposed for exclusion from critical habitat under section 4(b)(2) of the Act. The amended Required Determinations section provides our determination concerning compliance with applicable statutes and Executive orders that we have deferred until the information from the draft economic analysis of the proposal was available. 
                    </P>
                    <P>We are reopening the comment period to allow all interested parties an opportunity to comment simultaneously on the proposed rule, corrections to the preamble of the proposed rule, the associated draft economic analysis, and the amended Required Determinations section. Comments previously submitted need not be resubmitted as they will be incorporated into the public record as part of this comment period and will be fully considered in preparation of the final rule. </P>
                </SUM>
                <DATES>
                    <HD SOURCE="HED">DATES:</HD>
                    <P>We will accept public comments until December 27, 2007. </P>
                </DATES>
                <ADD>
                    <HD SOURCE="HED">ADDRESSES:</HD>
                    <P>If you wish to comment, you may submit your comments and materials by any one of several methods: </P>
                    <P>
                        (1) 
                        <E T="03">By mail or hand-delivery to:</E>
                         Jim Bartel, Field Supervisor, U.S. Fish and Wildlife Service, Carlsbad Fish and Wildlife Office, 6010 Hidden Valley Road, Carlsbad, CA 92011. 
                    </P>
                    <P>
                        (2) 
                        <E T="03">By electronic mail (e-mail) to:</E>
                          
                        <E T="03">fw8cfwocomments@fws.gov.</E>
                         Please see the Public Comments Solicited section below for other information about electronic filing. 
                    </P>
                    <P>
                        (3) 
                        <E T="03">By fax to:</E>
                         the attention of Jim Bartel at 760-431-5901. 
                    </P>
                    <P>
                        (4) 
                        <E T="03">Via the Federal eRulemaking Portal:</E>
                         at 
                        <E T="03">http://www.regulations.gov.</E>
                         Follow the instructions for submitting comments. 
                    </P>
                </ADD>
                <FURINF>
                    <HD SOURCE="HED">FOR FURTHER INFORMATION CONTACT:</HD>
                    <P>
                        Jim Bartel, Field Supervisor, Carlsbad Fish and Wildlife Office, at the address listed in the 
                        <E T="02">ADDRESSES</E>
                         section (telephone 760-431-9440; facsimile 760-431-5901). If you use a telecommunications device for the deaf (TDD), call the Federal Information Relay Service (FIRS) at 800-877-8339. 
                    </P>
                </FURINF>
            </PREAMB>
            <SUPLINF>
                <HD SOURCE="HED">SUPPLEMENTARY INFORMATION:</HD>
                <P/>
                <HD SOURCE="HD1">Public Comments Solicited </HD>
                <P>
                    We will accept written comments and information during this reopened comment period on the proposed critical habitat designation for 
                    <E T="03">Acanthomintha ilicifolia</E>
                     published in the 
                    <E T="04">Federal Register</E>
                     on March 14, 2007 (72 FR 11946), the corrections to the proposed critical habitat described herein (see Corrections to Proposed Critical Habitat section), and our draft economic analysis of the proposed designation. We will consider information and recommendations from all interested parties. We are particularly interested in comments concerning: 
                </P>
                <P>
                    (1) The reasons why we should or should not designate habitat as “critical habitat” under section 4 of the Act (16 U.S.C. 1531 
                    <E T="03">et seq.</E>
                    ), including whether the benefit of designation would outweigh threats to the species caused by the designation, such that the designation of critical habitat is prudent. 
                </P>
                <P>(2) Specific information on: </P>
                <P>
                    • The amount and distribution of 
                    <E T="03">Acanthomintha ilicifolia</E>
                     habitat, 
                </P>
                <P>• What areas occupied at the time of listing and that contain features essential to the conservation of the species we should include in the designation and why, and </P>
                <P>• What areas not occupied at the time of listing are essential to the conservation of the species and why. </P>
                <P>(3) Land use designations and current or planned activities in the subject areas and their possible impacts on proposed critical habitat. </P>
                <P>
                    (4) Our proposed exclusion of 1,134 acres (ac) (459 hectares (ha)) of lands already conserved or targeted for conservation within subarea plans under the San Diego Multiple Species Conservation Program (MSCP) and the San Diego Multiple Habitat Conservation Program (MHCP) from the final designation of critical habitat for 
                    <E T="03">Acanthomintha ilicifolia</E>
                     under section 4(b)(2) of the Act (see Exclusions Under Section 4(b)(2) of the Act in the proposed critical habitat rule for details of these habitat conservation plans (HCPs)). Please note that in the March 14, 2007, proposed rule (72 FR 11946), we sought comments on our proposed exclusion of 1,302 ac (527 ha) of non-Federal lands from the final designation. In this notice, we have made several corrections that have resulted in reductions in the areas being proposed as critical habitat and the area being proposed for exclusion (see Corrections to the Proposed Rule below for a detailed discussion of these corrections). 
                </P>
                <P>
                    We are specifically seeking public comment on our proposed exclusion of lands covered under the City of Encinitas subarea plan of the MHCP (see Exclusions Under Section 4(b)(2) of the Act in the proposed critical habitat rule for details of this HCP). It is our understanding that little progress has been made by the City of Encinitas to finalize their subarea plan since the 2001 release of the draft plan. Based on information received during the public comment period, the Secretary may determine that sufficient progress has not been made and that lands within the City of Encinitas' subarea plan should not be excluded from the final designation. Specifically, useful information would include: whether essential lands within Encinitas are being managed, or are reasonably assured of being managed, to conserve 
                    <E T="03">Acanthomintha ilicifolia,</E>
                     and the outlook for completion of the draft subarea plan. 
                </P>
                <P>Please provide information concerning whether the benefit of excluding any of these specific areas from the critical habitat designation outweighs the benefit of including these areas in the designation under section 4(b)(2). If the Secretary determines that the benefits of including these lands outweigh the benefits of excluding them, they will not be excluded from final critical habitat. </P>
                <P>(5) Our corrections to proposed critical habitat subunits 3C, 3D, 3F, 4A, 4B, and 4C as described in this notice (see Corrections to Proposed Critical Habitat section below). </P>
                <P>
                    (6) Information on whether, and, if so, the extent to which any State and local environmental protection measures referenced in the draft economic analysis were adopted largely as a result of the listing of 
                    <E T="03">Acanthomintha ilicifolia,</E>
                     and which were either already in place at the time of listing or enacted for other reasons. 
                </P>
                <P>
                    (7) Information on whether the draft economic analysis identifies all State and local costs and benefits attributable to the proposed critical habitat 
                    <PRTPAGE P="66124"/>
                    designation, and information on any costs or benefits that have been inadvertently overlooked. 
                </P>
                <P>(8) Information on whether the draft economic analysis makes appropriate assumptions regarding current practices and likely regulatory changes imposed as a result of the designation of critical habitat. </P>
                <P>(9) Information on whether the draft economic analysis correctly assesses the effect on regional costs associated with any land use controls that may derive from the designation of critical habitat. </P>
                <P>
                    (10) Information on areas that could potentially be disproportionately impacted by designation of critical habitat for 
                    <E T="03">Acanthomintha ilicifolia</E>
                    . 
                </P>
                <P>(11) Any foreseeable economic, national security, or other potential impacts resulting from the proposed designation, and in particular, any impacts on small entities, and the benefits of including or excluding areas that exhibit these impacts; the reasons why our conclusion that the proposed designation of critical habitat will not result in a disproportionate impact on small businesses should or should not warrant further consideration; and other information that would indicate that the designation of critical habitat would or would not have any impacts on small entities. </P>
                <P>(12) Information on whether the draft economic analysis appropriately identifies all costs that could result from the designation. </P>
                <P>(13) Information on whether there are any quantifiable economic benefits that could result from the designation of critical habitat. </P>
                <P>(14) Whether the benefit of excluding any particular area from the critical habitat designation under section 4(b)(2) of the Act outweighs the benefit of including the area in the designation. </P>
                <P>(15) Economic data on the incremental impacts that would result from designating any particular area as critical habitat, since it is our intent to include the incremental costs attributed to the critical habitat designation in the final economic analysis. </P>
                <P>(16) Whether we could improve or modify our approach to designating critical habitat in any way to provide for greater public participation and understanding, or to better accommodate public concerns and comments. </P>
                <P>The Secretary shall designate critical habitat on the basis of the best scientific data available and after taking into consideration the economic impact, the impact on national security, and any other relevant impact of specifying any particular area as critical habitat. Pursuant to section 4(b)(2) of the Act, an area may be excluded from critical habitat if it is determined that the benefits of such exclusion outweigh the benefits of including the area as critical habitat, unless the failure to designate such area as critical habitat will result in the extinction of the species. We may exclude an area from designated critical habitat based on economic impacts, national security, or any other relevant impact. </P>
                <P>
                    Comments and information submitted during the initial comment period from March 14, 2007, to May 14, 2007, on the proposed rule (72 FR 11946) need not be resubmitted as they will be incorporated into the public record as part of this comment period and will be fully considered in preparation of the final rule. If you wish to comment, you may submit your comments and materials concerning the draft economic analysis and the proposed rule by any one of several methods (see 
                    <E T="02">ADDRESSES</E>
                    ). Our final designation of critical habitat will take into consideration all comments and any additional information we have received during both comment periods. On the basis of public comment on the draft economic analysis, the critical habitat proposal, and the final economic analysis, we may, during the development of our final determination, find that areas proposed are not essential, are appropriate for exclusion under section 4(b)(2) of the Act, or are not appropriate for exclusion. 
                </P>
                <P>
                    If you use e-mail to submit your comments, please include “
                    <E T="03">Attn:</E>
                     San Diego thornmint” in your e-mail subject header, preferably with your name and return address in the body of your message. If you do not receive a confirmation from the system that we have received your e-mail, please contact the person listed under 
                    <E T="02">FOR FURTHER INFORMATION CONTACT</E>
                    . 
                </P>
                <P>Before including your address, phone number, e-mail address, or other personal identifying information in your comment, you should be aware that your entire comment—including your personal identifying information—may be made publicly available at any time. While you can ask us in your comment to withhold your personal identifying information from public review, we cannot guarantee that we will be able to do so.</P>
                <P>
                    Comments and materials received, as well as supporting documentation used in preparation of the proposal to designate critical habitat, will be available for public inspection, by appointment during normal business hours, at the Carlsbad Fish and Wildlife Office (see 
                    <E T="02">ADDRESSES</E>
                    ). You may obtain copies of the proposed critical habitat rule and the draft economic analysis by mail from the Carlsbad Fish and Wildlife Office (see 
                    <E T="02">ADDRESSES</E>
                    ) or by visiting our Web site at 
                    <E T="03">http://www.fws.gov/carlsbad</E>
                    .
                </P>
                <HD SOURCE="HD1">Background </HD>
                <P>
                    On August 10, 2004, the Center for Biological Diversity and California Native Plant Society challenged our failure to designate critical habitat for this species as well as four other plant species (
                    <E T="03">Center for Biological Diversity, et al.</E>
                     v. 
                    <E T="03">Norton</E>
                    , C-04-3240 JL (N. D. Cal.)). In settlement of the lawsuit, the Service agreed to submit to the 
                    <E T="04">Federal Register</E>
                     a proposed rule to designate critical habitat, if prudent, on or before February 28, 2007, and a final designation by February 28, 2008. On March 14, 2007, we published a proposed rule to designate critical habitat for 
                    <E T="03">Acanthomintha ilicifolia</E>
                     (72 FR 11946), identifying a total of approximately 1,936 ac (783 ha) of land in San Diego County, California. Of the total area proposed, we proposed to exclude from the final critical habitat designation 1,302 ac (527 ha) of land under section 4(b)(2) of the Act. 
                </P>
                <P>Critical habitat is defined in section 3 of the Act as the specific areas within the geographical area occupied by a species, at the time it is listed in accordance with the Act, on which are found those physical or biological features essential to the conservation of the species and that may require special management considerations or protection, and specific areas outside the geographical area occupied by a species at the time it is listed, upon a determination that such areas are essential for the conservation of the species. If the proposed rule is made final, section 7 of the Act will prohibit destruction or adverse modification of critical habitat by any activity funded, authorized, or carried out by any Federal agency. Federal agencies proposing actions affecting areas designated as critical habitat must consult with us on the effects of their proposed actions, in accordance with section 7(a)(2) of the Act. </P>
                <HD SOURCE="HD1">Corrections to Proposed Critical Habitat </HD>
                <P>
                    By this notice, we are advising the public of corrections in area, land ownership, and San Diego MSCP boundary associations within six of the subunits described in the March 14, 2007, proposed rule (72 FR 11946): Subunit 3C (Viejas Mountain), Subunit 3D (Viejas Mountain), Subunit 3F (Poser Mountain), Subunit 4A (McGinty Mountain), Subunit 4B (McGinty Mountain), and Subunit 4C (McGinty Mountain). 
                    <PRTPAGE P="66125"/>
                </P>
                <P>In our March 14, 2007, proposed rule (72 FR 11946) we proposed to exclude a total of 95 ac (38 ha) of private lands in subunits 3C, 3D, and 3F from the final critical habitat designation under section 4(b)(2) of the Act. We believed that these lands were within the planning boundary for the San Diego MSCP (see “Relationship of Critical Habitat to Habitat Conservation Plan Lands—Exclusions Under Section 4(b)(2) of the Act” section of the proposed rule (72 FR 11946, March 14, 2007) for a detailed discussion of this proposed exclusion). However, the private lands in subunits 3C, 3D, and 3F are not within the planning boundary for the San Diego MSCP, and we are no longer proposing to exclude these lands from the final designation under section 4(b)(2) of the Act. The draft economic analysis reflects that we are no longer proposing to exclude these 95 ac (38 ha) of lands. </P>
                <P>In this notice, we are also correcting errors within subunits 4A and 4B. The maps and boundary descriptions of subunits 4A and 4B were delineated correctly in the March 14, 2007, proposed rule (72 FR 11946); however, the area estimates in the preamble were incorrect. The correct area for subunit 4A is 20 ac (8 ha) rather than 18 ac (7 ha), and the correct area for subunit 4B is 148 ac (60 ha) rather than 220 ac (89 ha). The draft economic analysis reflects these corrections to area estimates. </P>
                <P>
                    Furthermore, the March 14, 2007, proposed rule (72 FR 11946), did not identify that subunit 4A contains 2 ac (1 ha) of federally owned land and subunit 4C contains 1 ac (less then 
                    <FR>1/2</FR>
                     ha) of federally owned land. Both of these subunits overlap slightly with the Service's San Diego National Wildlife Refuge. We proposed to exclude all private and State/local lands in subunits 4A and 4C from the final designation based on the benefits provided to 
                    <E T="03">Acanthomintha ilicifolia</E>
                     by the MSCP (see “Relationship of Critical Habitat to Habitat Conservation Plan Lands—Exclusions Under Section 4(b)(2) of the Act” section of the proposed rule (72 FR 11946, March 14, 2007) for a detailed discussion of this proposed exclusion). While we are continuing to propose to exclude all private and State/local lands covered by the MSCP, we are clarifying that this proposed exclusion does not include Federal lands, and, therefore, we overestimated the proposed exclusion by 3 acres (1 ha). The draft economic analysis does not reflect this change; however, the final economic analysis will be revised to address the incorporation of 3 ac (1 ha) of the San Diego National Wildlife Refuge into the proposed designation. 
                </P>
                <P>As a result of these corrections, the total identified critical habitat area has been reduced from 1,936 ac (783 ha) to 1,867 ac (756 ha). The total area being proposed for exclusion from the final designation has been reduced from 1,302 ac (527 ha) to 1,134 ac (459 ha). The draft economic analysis states that we are proposing to exclude 1,137 ac (460 ha) of critical habitat; however, that figure erroneously includes 3 ac (1 ha) of federally owned lands in subunits 4A and 4C. Other than these corrections, the proposed rule of March 14, 2007, remains intact. </P>
                <HD SOURCE="HD1">Draft Economic Analysis </HD>
                <P>
                    Section 4(b)(2) of the Act requires that we designate or revise critical habitat based upon the best scientific and commercial data available, after taking into consideration the economic impact, impact on national security, or any other relevant impact of specifying any particular area as critical habitat. Based on the March 14, 2007, proposed rule to designate critical habitat for 
                    <E T="03">Acanthomintha ilicifolia</E>
                    , (72 FR 11946), we have prepared a draft economic analysis of the proposed critical habitat designation. 
                </P>
                <P>
                    The draft economic analysis is intended to quantify the economic impacts of all potential conservation efforts for 
                    <E T="03">Acanthomintha ilicifolia</E>
                    ; some of these costs will likely be incurred regardless of whether critical habitat is designated. The draft economic analysis provides estimated costs of the foreseeable potential economic impacts of the proposed critical habitat designation and other conservation-related actions for this species over the next 20 years. It also considers past costs associated with conservation of the species from the time it was listed (63 FR 54938, October 13, 1998), until the year the proposed critical habitat rule was published (72 FR 11946, March 14, 2007). 
                </P>
                <P>
                    Activities associated with the conservation of 
                    <E T="03">Acanthomintha ilicifolia</E>
                     are likely to primarily impact future land development, recreation management, and exotic plant species management. Pre-designation (1998-2007) impacts associated with species conservation activities in areas proposed for final designation are estimated at $53,000 in 2007 dollars. The draft economic analysis forecasts post-designation impacts in the areas proposed for final designation at $0.6 to $2.8 million (undiscounted dollars) over the next 20 years. The present value of these impacts, applying a 3 percent discount rate, is $0.4 to $2.1 million ($25,000 to $137,000 annualized); or $0.3 to $1.5 million ($25,000 to $136,000 annualized) using a 7 percent discount rate. Total undiscounted future impacts in areas proposed for exclusion according to section 4(b)(2) of the Act are forecast at approximately $1.6 to $5.1 million over the next 20 years. The present value of these impacts applying a 3 percent discount rate is approximately $1.2 to $3.7 million or approximately $0.8 to $2.6 million applying a 7 percent discount rate. In annualized terms, potential impacts are expected to range from $77,000 to $253,000 (annualized at 3 percent) and $72,000 to $248,000 (annualized at 7 percent) in areas proposed for exclusion. The cost estimates are based on the proposed designation of critical habitat published in the 
                    <E T="04">Federal Register</E>
                     on March 14, 2007 (72 FR 11946) as well as the corrections we have identified above in subunits 3C, 3D, 3F, 4A, and 4B. The cost estimates assume that we are proposing to exclude 3 ac (1 ha) of federally owned lands in subunits 4A and 4C; we are not proposing to exclude any federally owned lands from this designation. We will address the costs associated with this last correction in more detail in the final economic analysis. 
                </P>
                <P>
                    The draft economic analysis considers the potential economic effects of actions relating to the conservation of 
                    <E T="03">Acanthomintha ilicifolia</E>
                    , including costs associated with sections 4, 7, and 10 of the Act, and including those attributable to the designation of critical habitat. It further considers the economic effects of protective measures taken as a result of other Federal, State, and local laws that aid habitat conservation for 
                    <E T="03">Acanthomintha ilicifolia</E>
                     in areas containing features essential to the conservation of the species. The draft economic analysis considers both economic efficiency and distributional effects. In the case of habitat conservation, efficiency effects generally reflect the “opportunity costs” associated with the commitment of resources to comply with habitat protection measures (such as lost economic opportunities associated with restrictions on land use). 
                </P>
                <P>
                    This analysis also addresses how potential economic impacts are likely to be distributed, including an assessment of any local or regional impacts of habitat conservation and the potential effects of conservation activities on small entities and the energy industry. This information can be used by decision-makers to assess whether the effects of the designation might unduly burden a particular group or economic sector. Finally, the draft analysis looks retrospectively at costs that have been incurred since the date 
                    <E T="03">
                        Acanthomintha 
                        <PRTPAGE P="66126"/>
                        ilicifolia
                    </E>
                     was listed as threatened (63 FR 54938; October 13, 1998) and considers those costs that may occur in the 20 years following the designation of critical habitat. Forecasts of economic conditions and other factors beyond this point would be speculative. 
                </P>
                <P>As stated earlier, we solicit data and comments from the public on the draft economic analysis, as well as on all aspects of the proposal. We may revise the proposal or its supporting documents to incorporate or address new information received during the comment period. In particular, we may exclude an area from critical habitat if we determine that the benefits of excluding the area outweigh the benefits of including the area as critical habitat, provided such exclusion will not result in the extinction of the species. </P>
                <HD SOURCE="HD1">Required Determinations—Amended </HD>
                <P>In our March 14, 2007 proposed rule (72 FR 11946), we indicated that we would be deferring our determination of compliance with several statutes and Executive Orders until the information concerning potential economic impacts of the designation and potential effects on landowners and stakeholders was available in the draft economic analysis. Those data are now available for our use in making these determinations. In this notice we are affirming the information contained in the proposed rule concerning Executive Order (E.O.) 13132; E.O. 12988; the Paperwork Reduction Act; and the President's memorandum of April 29, 1994, “Government-to-Government Relations with Native American Tribal Governments'' (59 FR 22951). Based on the information made available to us in the draft economic analysis, we are amending our Required Determinations, as provided below, concerning E.O. 12866 and the Regulatory Flexibility Act, E.O. 13211, E.O. 12630, and the Unfunded Mandates Reform Act. </P>
                <HD SOURCE="HD2">Regulatory Planning and Review </HD>
                <P>
                    In accordance with E.O. 12866, this document is a significant rule because it may raise novel legal and policy issues. Based on our draft economic analysis of the proposed designation of critical habitat for 
                    <E T="03">Acanthomintha ilicifolia</E>
                    , post-designation impacts are estimated to be approximately $0.6 to $2.8 million (undiscounted dollars) over the next 20 years in the areas proposed as final critical habitat and approximately $1.6 to $5.1 million (undiscounted dollars) over the next 20 years in areas proposed for exclusion from the final critical habitat designation. These impacts would occur only if the area proposed for exclusion is instead designated as critical habitat. The cost estimates are based on the proposed designation of critical habitat published in the 
                    <E T="04">Federal Register</E>
                     on March 14, 2007 (72 FR 11946), as well as the corrections we have identified above in subunits 3C, 3D, 3F, 4A, and 4B. The cost estimates assume that we are proposing to exclude 3 ac (1 ha) of federally owned lands in subunits 4A and 4C; we are not proposing to exclude any federally owned lands from this designation. We will address the costs associated with this last correction in more detail in the final economic analysis. 
                </P>
                <P>Discounted future costs in areas proposed as final critical habitat are estimated to be approximately $0.4 to $2.1 million ($25,000 to $137,000 annualized) at a 3 percent discount rate or approximately $0.3 to $1.5 million ($25,000 to $136,000 annualized) at a 7 percent discount rate. In areas proposed for exclusion from the final critical habitat designation, the discounted future costs are estimated to be approximately $1.2 to $3.7 million ($77,000 to $253,000 annualized) at a 3 percent discount rate or approximately $0.8 to $2.6 million ($72,000 to $248,000 annualized) over the next 20 years. </P>
                <P>
                    Therefore, based on our draft economic analysis, we have determined that the proposed designation of critical habitat for 
                    <E T="03">Acanthomintha ilicifolia</E>
                     would not result in an annual effect on the economy of $100 million or more or affect the economy in a material way. Due to the timeline for publication in the 
                    <E T="04">Federal Register</E>
                    , the Office of Management and Budget (OMB) has not formally reviewed the proposed rule or accompanying draft economic analysis. 
                </P>
                <P>Further, E.O. 12866 directs Federal agencies promulgating regulations to evaluate regulatory alternatives (Office of Management and Budget, Circular A-4, September 17, 2003). Pursuant to Circular A-4, once it has determined that the Federal regulatory action is appropriate, the agency will then need to consider alternative regulatory approaches. Since the designation of critical habitat is a statutory requirement pursuant to the Act, we must then evaluate alternative regulatory approaches, where feasible, when promulgating a designation of critical habitat. </P>
                <P>In developing our designations of critical habitat, we consider economic impacts, impacts to national security, and other relevant impacts pursuant to section 4(b)(2) of the Act. Based on the discretion allowable under this provision, we may exclude any particular area from the designation of critical habitat providing that the benefits of such exclusion outweigh the benefits of specifying the area as critical habitat and that such exclusion would not result in the extinction of the species. As such, we believe that the evaluation of the inclusion or exclusion of particular areas, or combination thereof, in a designation constitutes our regulatory alternative analysis. </P>
                <HD SOURCE="HD2">
                    Regulatory Flexibility Act (5 U.S.C. 601 
                    <E T="03">et seq.</E>
                    ) 
                </HD>
                <P>
                    Under the Regulatory Flexibility Act (RFA) (5 U.S.C. 601 
                    <E T="03">et seq.</E>
                    ), as amended by the Small Business Regulatory Enforcement Fairness Act (5 U.S.C. 802(2)) (SBREFA), whenever an agency is required to publish a notice of rulemaking for any proposed or final rule, it must prepare and make available for public comment a regulatory flexibility analysis that describes the effect of the rule on small entities (i.e., small businesses, small organizations, and small government jurisdictions). However, no regulatory flexibility analysis is required if the head of an agency certifies the rule will not have a significant economic impact on a substantial number of small entities. Based upon our draft economic analysis of the proposed designation, we provide our analysis for determining whether the proposed rule would result in a significant economic impact on a substantial number of small entities. Based on comments received, this determination is subject to revision as part of the final rulemaking. 
                </P>
                <P>
                    According to the Small Business Administration (SBA), small entities include small organizations, such as independent nonprofit organizations; small governmental jurisdictions, including school boards and city and town governments that serve fewer than 50,000 residents; and small businesses (13 CFR 121.201). Small businesses include manufacturing and mining concerns with fewer than 500 employees, wholesale trade entities with fewer than 100 employees, retail and service businesses with less than $5 million in annual sales, general and heavy construction businesses with less than $27.5 million in annual business, special trade contractors doing less than $11.5 million in annual business, and agricultural businesses with annual sales less than $750,000. To determine if potential economic impacts to these small entities are significant, we considered the types of activities that might trigger regulatory impacts under this designation as well as types of project modifications that may result. In general, the term “significant economic impact” is meant to apply to a typical 
                    <PRTPAGE P="66127"/>
                    small business firm's business operations. 
                </P>
                <P>
                    To determine if the proposed designation of critical habitat for 
                    <E T="03">Acanthomintha ilicifolia</E>
                     would affect a substantial number of small entities, we considered the number of small entities affected within particular types of economic activities (such as residential development and dispersed recreational activities). We considered each industry or category individually to determine if certification is appropriate. In estimating the numbers of small entities potentially affected, we also considered whether their activities have any Federal involvement; some kinds of activities are unlikely to have any Federal involvement and thus will not be affected by the designation of critical habitat. Designation of critical habitat affects only activities conducted, funded, permitted, or authorized by Federal agencies; non-Federal activities are not affected by the designation. 
                </P>
                <P>If this proposed critical habitat designation is made final, Federal agencies must consult with us under section 7 of the Act if their activities may affect designated critical habitat. Consultations to avoid the destruction or adverse modification of critical habitat would be incorporated into the existing consultation process. </P>
                <P>
                    In our draft economic analysis of the proposed critical habitat designation (including those areas proposed for exclusion), we evaluated the potential economic effects on small business entities resulting from conservation actions related to the listing of 
                    <E T="03">Acanthomintha ilicifolia</E>
                     and the proposed designation of critical habitat. The analysis is based on the estimated impacts associated with the proposed rulemaking as described in Chapters 2 through 4 and Appendices A, B, C, and F of the analysis and evaluates the potential for economic impacts related to three categories: development and HCP implementation; recreation management; and invasive, nonnative plant management. 
                </P>
                <P>
                    The U.S. Forest Service (USFS), the California Department of Fish and Game (CDFG), and the U.S. Fish and Wildlife Service are not considered small entities by the Small Business Administration. Two nonprofit organizations, The Nature Conservancy (TNC) and the Center for Natural Lands Management (CNLM), are involved with conservation activities for 
                    <E T="03">Acanthomintha ilicifolia</E>
                    ; however, the primary mission of both of these organizations is to preserve, restore, and protect natural resources. Therefore, impacts from species conservation on these organizations is not considered in the small business impacts analysis. 
                </P>
                <P>Additionally, the boundaries of four city governments encompass portions of the proposed critical habitat—Carlsbad, Encinitas, San Diego, and Poway—with the remainder of the proposed critical habitat located within unincorporated San Diego County. All four cities and the County exceed the criteria to be considered a “small entity” under the RFA. </P>
                <P>The draft analysis identified 18 privately owned, undeveloped parcels within areas proposed as critical habitat. The 18 parcels are owned by 9 individual landowners. For the nine individual landowners that may be affected by the proposed designation of critical habitat, the DEA could not determine if any of these landowners qualify as small businesses. However, for the purposes of estimating potential costs associated with the proposed designation of critical habitat, the DEA determine that two landowners own four parcels that are in proposed subunits 3D, 3E, and 3F, and the remaining seven landowners own parcels in subunits we are proposing to exclude from the final designation. </P>
                <P>
                    For the two landowners of proposed subunits 3D, 3E, and 3F, the DEA estimates annualized impacts associated with conservation activities for 
                    <E T="03">Acanthomintha ilicifolia</E>
                     could range from a low of $700 to $35,700, with an average range of annualized impact of $5,300 to $42,300 per landowner over the next 20 years. The remaining seven landowners of the 14 parcels in subunits we are proposing to exclude from the final designation, annualized impacts are estimated to range from a low of $300 in subunit 4D up to $18,700 in subunit 2C, with an average annualized impact ranging from $17,000 to $84,000. 
                </P>
                <P>
                    With only nine private landowners, it is not considered a substantial number. However, even if the landowners were to represent small development businesses, any developer directly impacted by the proposed designation of critical habitat would not be expected to bear the additional cost of conservation measures for 
                    <E T="03">Acanthomintha ilicifolia.</E>
                     We anticipate that additional costs that could arise from the designation would be passed on to individual homebuyers if the parcels were to be developed. Please refer to our DEA of the proposed critical habitat designation for a more detailed discussion of potential economic impacts. 
                </P>
                <P>In summary, we have considered whether this proposed designation of critical habitat would result in a significant economic impact on a substantial number of small entities. We have determined, and therefore, certify that, for the above reasons and based on currently available information, the proposed designation will not have a significant economic impact on a substantial number of small business entities. </P>
                <HD SOURCE="HD2">Executive Order 13211—Energy Supply, Distribution, and Use </HD>
                <P>
                    On May 18, 2001, the President issued E.O. 13211 on regulations that significantly affect energy supply, distribution, and use. E.O. 13211 requires agencies to prepare Statements of Energy Effects when undertaking certain actions. This proposed designation of critical habitat for 
                    <E T="03">Acanthomintha ilicifolia</E>
                     is considered a significant regulatory action under E.O. 12866 due to its potentially raising novel legal and policy issues. OMB has provided guidance for implementing E.O. 13211 that outlines nine outcomes that may constitute “a significant adverse effect” when compared without the regulatory action under consideration. The draft economic analysis finds that none of these criteria are relevant to this analysis. Thus, based on the information in the draft economic analysis, energy-related impacts associated with 
                    <E T="03">Acanthomintha ilicifolia</E>
                     conservation activities within proposed critical habitat are not expected. As such, the proposed designation of critical habitat is not expected to significantly affect energy supplies, distribution, or use and a Statement of Energy Effects is not required. 
                </P>
                <HD SOURCE="HD2">
                    Unfunded Mandates Reform Act (2 U.S.C. 1501 
                    <E T="03">et seq.</E>
                    ) 
                </HD>
                <P>In accordance with the Unfunded Mandates Reform Act (2 U.S.C. 1501), the Service makes the following findings: </P>
                <P>
                    (a) This rule will not produce a Federal mandate. In general, a Federal mandate is a provision in legislation, statute, or regulation that would impose an enforceable duty upon State, local, or Tribal governments, or the private sector, and includes both “Federal intergovernmental mandates” and “Federal private sector mandates.” These terms are defined in 2 U.S.C. 658(5)-(7). “Federal intergovernmental mandate” includes a regulation that “would impose an enforceable duty upon State, local, or tribal governments,” with two exceptions. It excludes “a condition of federal assistance.” It also excludes “a duty arising from participation in a voluntary Federal program,” unless the regulation “relates to a then-existing Federal 
                    <PRTPAGE P="66128"/>
                    program under which $500,000,000 or more is provided annually to State, local, and Tribal governments under entitlement authority,” if the provision would “increase the stringency of conditions of assistance” or “place caps upon, or otherwise decrease, the Federal Government's responsibility to provide funding” and the State, local, or tribal governments “lack authority” to adjust accordingly. (At the time of enactment, these entitlement programs were: Medicaid; Aid to Families with Dependent Children work programs; Child Nutrition; Food Stamps; Social Services Block Grants; Vocational Rehabilitation State Grants; Foster Care, Adoption Assistance, and Independent Living; Family Support Welfare Services; and Child Support Enforcement.) “Federal private sector mandate” includes a regulation that “would impose an enforceable duty upon the private sector, except (i) a condition of Federal assistance; or (ii) a duty arising from participation in a voluntary Federal program.” 
                </P>
                <P>The designation of critical habitat does not impose a legally binding duty on non-Federal government entities or private parties. Under the Act, the only regulatory effect is that Federal agencies must ensure that their actions do not destroy or adversely modify critical habitat under section 7. Non-Federal entities that receive Federal funding, assistance, permits, or otherwise require approval or authorization from a Federal agency for an action may be indirectly impacted by the designation of critical habitat. However, the legally binding duty to avoid destruction or adverse modification of critical habitat rests squarely on the Federal agency. Furthermore, to the extent that non-Federal entities are indirectly impacted because they receive Federal assistance or participate in a voluntary Federal aid program, the Unfunded Mandates Reform Act would not apply, nor would critical habitat shift the costs of the large entitlement programs listed above on to State governments. </P>
                <P>(b) We do not believe that this rule will significantly or uniquely affect small governments. As discussed in the DEA, approximately 59 percent of the lands proposed as critical habitat are owned or managed by Federal, State, or local governments, none of which qualify as a small government. Consequently, we do not believe that critical habitat designation would significantly or uniquely affect small government entities. As such, a Small Government Agency Plan is not required. </P>
                <HD SOURCE="HD2">Executive Order 12630—Takings </HD>
                <P>
                    In accordance with E.O. 12630 (“Government Actions and Interference with Constitutionally Protected Private Property Rights”), we have analyzed the potential takings implications of proposing critical habitat for 
                    <E T="03">Acanthomintha ilicifolia</E>
                     in a takings implications assessment. The takings implications assessment concludes that this proposed designation of critical habitat for 
                    <E T="03">Acanthomintha ilicifolia</E>
                     does not pose significant takings implications. 
                </P>
                <HD SOURCE="HD1">Author </HD>
                <P>The primary author of this notice is staff of the Carlsbad Fish and Wildlife Office. </P>
                <HD SOURCE="HD1">Authority </HD>
                <P>
                    The authority for this action is the Endangered Species Act of 1973 (16 U.S.C. 1531 
                    <E T="03">et seq.</E>
                    ). 
                </P>
                <SIG>
                    <DATED>Dated: November 15, 2007. </DATED>
                    <NAME>Todd Willens, </NAME>
                    <TITLE>Acting Assistant Secretary for Fish and Wildlife and Parks.</TITLE>
                </SIG>
            </SUPLINF>
            <FRDOC> [FR Doc. E7-22971 Filed 11-26-07; 8:45 am] </FRDOC>
            <BILCOD>BILLING CODE 4310-55-P </BILCOD>
        </PRORULE>
    </PRORULES>
    <VOL>72</VOL>
    <NO>227</NO>
    <DATE>Tuesday, November 27, 2007</DATE>
    <UNITNAME>Notices</UNITNAME>
    <NOTICES>
        <NOTICE>
            <PREAMB>
                <PRTPAGE P="66129"/>
                <AGENCY TYPE="F">AGENCY FOR INTERNATIONAL DEVELOPMENT</AGENCY>
                <SUBJECT>Notice of Public Information Collections Being Reviewed by the U.S. Agency for International Development: Comments Requested</SUBJECT>
                <SUM>
                    <HD SOURCE="HED">SUMMARY:</HD>
                    <P>U.S. Agency for International Development (USAID) is making efforts to reduce the paperwork burden. USAID invites the general public and other Federal agencies to take this opportunity to comment on the following proposed and/or continuing information collections, as required by the Paperwork Reduction Act for 1995. Comments are requested concerning: (a) Whether the proposed or continuing collections of information are necessary for the proper performance of the functions of the agency, including whether the information shall have practical utility: (b) the accuracy of the burden estimates: (c) ways to enhance the quality, utility, an clarity of the information collected: and (d) ways to minimize the burden of the collection of information on the respondents, including the use of automated collection techniques or other forms of information technology.</P>
                </SUM>
                <DATES>
                    <HD SOURCE="HED">DATES:</HD>
                    <P>Submit comments on or before January 28, 2008.</P>
                </DATES>
                <FURINF>
                    <HD SOURCE="HED">FOR FURTHER INFORMATION CONTACT:</HD>
                    <P>
                        Beverly Johnson, Bureau for Management, Office of Administrative Services, Information and Records Division, U.S. Agency for International Development, Room 2.07-106, RRB, Washington, DC, 20523, (202) 712-1365 or via e-mail 
                        <E T="03">bjohnson@usaid.gov.</E>
                    </P>
                </FURINF>
            </PREAMB>
            <SUPLINF>
                <HD SOURCE="HED">SUPPLEMENTARY INFORMATION:</HD>
                <P SOURCE="NPAR">
                    <E T="03">OMB No:</E>
                     OMB 0412-0035.
                </P>
                <P>
                    <E T="03">Form No.:</E>
                     AID 1550-2.
                </P>
                <P>
                    <E T="03">Title:</E>
                     PVO Initial and Annual Registration Form.
                </P>
                <P>
                    <E T="03">Type of Review:</E>
                     Renewal of Information Collection.
                </P>
                <P>
                    <E T="03">Purpose:</E>
                     USAID is required to collect information regarding the financial support of private and voluntary organizations registered with the Agency. The information is used to determine the eligibility of PVOs to receive USAID funding.
                </P>
                <P>
                    <E T="03">Annual Reporting Burden:</E>
                </P>
                <P>
                    <E T="03">Respondents:</E>
                     533.
                </P>
                <P>
                    <E T="03">Total annual responses:</E>
                     533.
                </P>
                <P>
                    <E T="03">Total annual hours requested:</E>
                     1,599 hours.
                </P>
                <SIG>
                    <DATED>Dated: November 19, 2007.</DATED>
                    <NAME>Joanne Paskar,</NAME>
                    <TITLE>Chief, Information and Records Division, Office of Administrative Services, Bureau for Management.</TITLE>
                </SIG>
            </SUPLINF>
            <FRDOC>[FR Doc. 07-5840  Filed 11-26-07; 8:45 am]</FRDOC>
            <BILCOD>BILLING CODE 6116-01-M</BILCOD>
        </NOTICE>
        <NOTICE>
            <PREAMB>
                <AGENCY TYPE="N">DEPARTMENT OF AGRICULTURE </AGENCY>
                <SUBJECT> Submission for OMB Review; Comment Request </SUBJECT>
                <DATE>November 21, 2007. </DATE>
                <P>
                    The Department of Agriculture has submitted the following information collection requirement(s) to OMB for review and clearance under the Paperwork Reduction Act of 1995, Public Law 104-13. Comments regarding (a) whether the collection of information is necessary for the proper performance of the functions of the agency, including whether the information will have practical utility; (b) the accuracy of the agency's estimate of burden including the validity of the methodology and assumptions used; (c) ways to enhance the quality, utility and clarity of the information to be collected; (d) ways to minimize the burden of the collection of information on those who are to respond, including through the use of appropriate automated, electronic, mechanical, or other technological collection techniques or other forms of information technology should be addressed to: jDesk Officer for Agriculture, Office of Information and Regulatory Affairs, Office of Management and Budget (OMB), 
                    <E T="03">OIRA_Submission@OMB.EOP.GOV</E>
                     or fax (202) 395-5806 and to Departmental Clearance Office, USDA, OCIO, Mail Stop 7602, Washington, DC 20250-7602. Comments regarding these information collections are best assured of having their full effect if received within 30 days of this notification. Copies of the submission(s) may be obtained by calling (202) 720-8681. 
                </P>
                <P>An agency may not conduct or sponsor a collection of information unless the collection of information displays a currently valid OMB control number and the agency informs potential persons who are to respond to the collection of information that such persons are not required to respond to the collection of information unless it displays a currently valid OMB control number. </P>
                <HD SOURCE="HD1">Rural Housing Service </HD>
                <P>
                    <E T="03">Title:</E>
                     Rural Rental Housing Program, 7 CFR Part 3560. 
                </P>
                <P>
                    <E T="03">OMB Control Number:</E>
                     0575-0189. 
                </P>
                <P>
                    <E T="03">Summary of Collection:</E>
                     The programs covered by 7 CFR Part 3560 provide financing to support the development of adequate, affordable housing and rental units for very low-, low-, and moderate-income households, and farm workers. Rural Housing Service (RHS) is authorized to collect the information needed to administer these various programs under Title V of the Housing Act of 1949, Section 515 Rural Rental Housing, Sections 514 and 516 Farm Labor Housing loans and grants, and Section 521 Rental Assistance. 
                </P>
                <P>
                    <E T="03">Need and Use of the Information:</E>
                     The information collected by RHS is used to plan, manage, evaluate and account for Government resources. The reports are required to ensure the proper and judicious use of public funds. The purpose of the Multi-Family Housing programs is to provide adequate, affordable, decent, safe, and sanitary rental units for very low-, low-, and moderate-income households and farm workers in rural areas. 
                </P>
                <P>
                    <E T="03">Description of Respondents:</E>
                     Business or other for profit: Individual or households; Farms; Not-for-profit institutions; State, Local, or Tribal Government. 
                </P>
                <P>
                    <E T="03">Number of Respondents:</E>
                     500,000. 
                </P>
                <P>
                    <E T="03">Frequency of Responses:</E>
                     Recordkeeping; Reporting: Quarterly; Monthly, Annually. 
                </P>
                <P>
                    <E T="03">Total Burden Hours:</E>
                     1,138,607. 
                </P>
                <SIG>
                    <NAME>Charlene Parker, </NAME>
                    <TITLE>Departmental Information Collection Clearance Officer.</TITLE>
                </SIG>
            </PREAMB>
            <FRDOC>[FR Doc. E7-23035 Filed 11-26-07; 8:45 am] </FRDOC>
            <BILCOD>BILLING CODE 3410-XT-P </BILCOD>
        </NOTICE>
        <NOTICE>
            <PREAMB>
                <PRTPAGE P="66130"/>
                <AGENCY TYPE="S">DEPARTMENT OF AGRICULTURE </AGENCY>
                <SUBAGY>Forest Service </SUBAGY>
                <SUBJECT>Information Collection; Federal Excess Personal Property (FEPP) Inventory </SUBJECT>
                <AGY>
                    <HD SOURCE="HED">AGENCY:</HD>
                    <P>Forest Service, USDA. </P>
                </AGY>
                <ACT>
                    <HD SOURCE="HED">ACTION:</HD>
                    <P>Request for comment; notice. </P>
                </ACT>
                <SUM>
                    <HD SOURCE="HED">SUMMARY:</HD>
                    <P>In accordance with the Paperwork Reduction Act of 1995, the Forest Service is seeking comments from all interested individuals and organizations on the new information collection, Federal Excess Personal Property (FEPP) Inventory. </P>
                </SUM>
                <DATES>
                    <HD SOURCE="HED">DATES:</HD>
                    <P>Comments must be received in writing on or before January 28, 2008 to be assured of consideration. Comments received after that date will be considered to the extent practicable. </P>
                </DATES>
                <ADD>
                    <HD SOURCE="HED">ADDRESSES:</HD>
                    <P>Comments concerning this notice should be addressed to Melissa Frey, USDA Forest Service, F&amp;AM, 1400 Independence Ave., SW., Mailstop Code: 1107, Washington, DC 20250-1107. </P>
                    <P>
                        Comments also may be submitted via facsimile to (202) 205-1401; or by e-mail to 
                        <E T="03">mfrey@fs.fed.us</E>
                        . 
                    </P>
                    <P>The public may inspect comments received at USDA Forest Service, Fire and Aviation Management—Room 2SO, 201 14th St., SW., Washington, DC 20024 during normal business hours. Visitors are encouraged to call ahead to (202) 205-1483 to facilitate entry to the building. </P>
                </ADD>
                <FURINF>
                    <HD SOURCE="HED">FOR FURTHER INFORMATION CONTACT:</HD>
                    <P>
                        Melissa Frey, Fire and Aviation Management, phone: (202) 205-0955, 
                        <E T="03">mfrey@fs.fed.us.</E>
                         Individuals who use TDD may call the Federal Relay Service (FRS) at 1-800-877-8339, 24 hours a day, every day of the year, including holidays. 
                    </P>
                </FURINF>
            </PREAMB>
            <SUPLINF>
                <HD SOURCE="HED">SUPPLEMENTARY INFORMATION:</HD>
                <P SOURCE="NPAR">
                    <E T="03">Title:</E>
                     Federal Excess Personal Property (FEPP) Inventory. 
                </P>
                <P>
                    <E T="03">OMB Number:</E>
                     0596-New. 
                </P>
                <P>
                    <E T="03">Type of Request:</E>
                     New. 
                </P>
                <P>
                    <E T="03">Abstract:</E>
                     The Forest Service acquires excess federally-owned property to loan to state cooperators for wildland fire fighting. Since the property belongs to the Forest Service, the proposed inventory system will facilitate reporting by state agencies to the Forest Service on the status and location of the property. 
                </P>
                <P>Program authorities include, the Federal Property and Administrative Services Act of 1949, as amended (40 U.S.C. 483), and the Cooperative Forestry Assistance Act of 1978 (16 U.S.C. 2101 (note)). Additional pertinent regulations include the USDA Organic Act of 1944 (16 U.S.C. 508a) and Federal Property Management Regulations 101-43.309-1, 101-43-313, and 101-43-314 (40 U.S.C. 483). </P>
                <P>State agencies will use the electronic database (Federal Excess Property Management Information System or FEPMIS) to submit information regarding property make, model, serial number, acquisition value, location, and acquisition date when an item is acquired or no longer needed. Forest Service property management technicians will collect the information from FEPMIS and enter it into a National Finance Center database (PROP), as required by Federal Property Management Regulations. Forest Service property management officers will analyze the data collected to ensure that the property accountability is accurate and no misuse of property is occurring. </P>
                <P>
                    <E T="03">Estimate of Annual Burden:</E>
                     2 minutes. 
                </P>
                <P>
                    <E T="03">Type of Respondents:</E>
                     State agency FEPP property managers. 
                </P>
                <P>
                    <E T="03">Estimated Annual Number of Respondents:</E>
                     55. 
                </P>
                <P>
                    <E T="03">Estimated Annual Number of Responses per Respondent:</E>
                     300. 
                </P>
                <P>
                    <E T="03">Estimated Total Annual Burden on Respondents:</E>
                     5,800 hours. 
                </P>
                <P>Comment is invited on: (1) Whether this collection of information is necessary for the stated purposes and the proper performance of the functions of the agency, including whether the information will have practical or scientific utility; (2) the accuracy of the agency's estimate of the burden of the collection of information, including the validity of the methodology and assumptions used; (3) ways to enhance the quality, utility, and clarity of the information to be collected; and (4) ways to minimize the burden of the collection of information on respondents, including the use of automated, electronic, mechanical, or other technological collection techniques or other forms of information technology. </P>
                <P>All comments received in response to this notice, including names and addresses when provided, will be a matter of public record. Comments will be summarized and included in the request for Office of Management and Budget approval. </P>
                <SIG>
                    <DATED>Dated: November 20, 2007. </DATED>
                    <NAME>Kent P. Connaughton, </NAME>
                    <TITLE>Associate Deputy Chief, State and Private Forestry.</TITLE>
                </SIG>
            </SUPLINF>
            <FRDOC>[FR Doc. E7-23034 Filed 11-26-07; 8:45 am] </FRDOC>
            <BILCOD>BILLING CODE 3410-11-P</BILCOD>
        </NOTICE>
        <NOTICE>
            <PREAMB>
                <AGENCY TYPE="S">DEPARTMENT OF AGRICULTURE </AGENCY>
                <SUBAGY>Forest Service </SUBAGY>
                <RIN>RIN 0596-AC61 </RIN>
                <SUBJECT>Notice of Extension of Public Comment Period for the Forest Service Proposed Wind Energy Directives (FSM 2720, FSH 2609.13 and FSH 2709.11) </SUBJECT>
                <AGY>
                    <HD SOURCE="HED">AGENCY:</HD>
                    <P>Forest Service, USDA. </P>
                </AGY>
                <ACT>
                    <HD SOURCE="HED">ACTION:</HD>
                    <P>Notice of extension of public comment period. </P>
                </ACT>
                <SUM>
                    <HD SOURCE="HED">SUMMARY:</HD>
                    <P>
                        The Forest Service is extending the public comment period an additional 60 days, from November 23, 2007, to January 23, 2008, for the proposed directives for wind energy development on National Forest System (NFS) lands. As stated in the original Public Notice which was published on Monday, September 24, 2007, 
                        <E T="04">Federal Register</E>
                         Vol. 72, No. 184, the Forest Service is proposing to amend its internal directives for special use authorizations and wildlife monitoring. Reviewers may obtain a copy of the proposed amendments from the address cited in the addresses section below or from the Forest Service home page on the World Wide Web at: 
                        <E T="03">http://www.fs.fed.us/recreation/permits/energy.htm.</E>
                         Public comment is invited and will be considered in the development of final directives. 
                    </P>
                </SUM>
                <DATES>
                    <HD SOURCE="HED">DATES:</HD>
                    <P>Comments must be received by January 23, 2008. </P>
                </DATES>
                <ADD>
                    <HD SOURCE="HED">ADDRESSES:</HD>
                    <P>
                        Send written comments to Wind Energy Proposed Directives, 
                        <E T="03">Attention:</E>
                         Director, Lands Staff, 4th Floor-South, USDA Forest Service, 1400 Independence Avenue, SW., Mailstop 1124, Washington, DC 20250, or by facsimile to (202) 205-1604. You may also submit comments by following the instructions at the Federal e-rulemaking portal at 
                        <E T="03">http://www.regulations.gov.</E>
                    </P>
                    <P>All comments, including names and addresses when provided, will be placed in the record and will be available for public inspection and copying. The public may inspect comments received on the proposed directives in the USDA Forest Service Headquarters located at 201 14th Street, SW., Washington, DC, during regular business hours between 8:30 a.m. and 4:30 p.m., Monday through Friday, except holidays. Those wishing to inspect comments are encouraged to call ahead to (202) 205-1248 or (202) 205-0895 to facilitate entry into the building. </P>
                </ADD>
                <FURINF>
                    <HD SOURCE="HED">FOR FURTHER INFORMATION CONTACT:</HD>
                    <P>
                        Paul Johnson, Minerals and Geology Management, (703) 605-4793, or Julett Denton, Lands Staff, (202) 205-1256. 
                        <PRTPAGE P="66131"/>
                    </P>
                    <P>Individuals who use telecommunication devices for the deaf (TDD) may call the Federal Information Relay Service (FIRS) at 1-800-877-8339 between 8 a.m. and 8 p.m., Eastern Standard Time, Monday through Friday. </P>
                    <SIG>
                        <DATED>Dated: November 20, 2007. </DATED>
                        <NAME>Corbin L. Newman, Jr., </NAME>
                        <TITLE>Acting Deputy Chief, National Forest System.</TITLE>
                    </SIG>
                </FURINF>
            </PREAMB>
            <FRDOC>[FR Doc. E7-22977 Filed 11-26-07; 8:45 am] </FRDOC>
            <BILCOD>BILLING CODE 3410-11-P</BILCOD>
        </NOTICE>
        <NOTICE>
            <PREAMB>
                <AGENCY TYPE="S">DEPARTMENT OF AGRICULTURE </AGENCY>
                <SUBAGY>Rural Business-Cooperative Service </SUBAGY>
                <SUBJECT>Inviting Rural Business Enterprise Grant Program Preapplications for Technical Assistance for Rural Transportation Systems </SUBJECT>
                <AGY>
                    <HD SOURCE="HED">AGENCY:</HD>
                    <P>Rural Business-Cooperative Service, USDA. </P>
                </AGY>
                <ACT>
                    <HD SOURCE="HED">ACTION:</HD>
                    <P>Notice. </P>
                </ACT>
                <SUM>
                    <HD SOURCE="HED">SUMMARY:</HD>
                    <P>The Rural Business-Cooperative Service (RBS), an Agency within the USDA Rural Development mission area, announces the availability of two individual grants: one grant from the passenger transportation funds appropriated for the Rural Business Enterprise Grant (RBEG) program and another grant for Federally Recognized Native American Tribes' (FRNAT) from funds appropriated for the RBEG program. USDA Rural Development will administer these awards under the RBEG program and 7 U.S.C. 1932(c)(2) for fiscal year (FY) 2008. Historically, Congress has appropriated funding for these specific programs. This notice is being issued prior to passage of a FY 2008 Appropriations Act, which may or may not provide an appropriation for these programs, to allow applicants sufficient time to leverage financing, submit applications, and give the Agency time to process applications within the current fiscal year. A subsequent notice identifying the amount received in the appropriations will be published, if any. Each grant is to be competitively awarded to a qualified national organization. One grant is for the provision of technical assistance to rural transportation projects. The other grant is for the provision of technical assistance to rural transportation projects operated by FRNAT's only. This notice will be amended to publish final funding levels, if any. </P>
                </SUM>
                <DATES>
                    <HD SOURCE="HED">DATES:</HD>
                    <P>The deadline for receipt of preapplications in the USDA Rural Development State Office is January 31, 2008. Applications received at a USDA Rural Development State Office after that date will not be considered for FY 2008 funding. </P>
                </DATES>
                <FURINF>
                    <HD SOURCE="HED">FOR FURTHER INFORMATION CONTACT:</HD>
                    <P>
                        Cindy Mason, Loan Specialist, USDA Rural Development, USDA, STOP 3225, Room 6866, 1400 Independence Avenue, SW., Washington, DC 20250-3225. 
                        <E T="03">Telephone:</E>
                         (202) 690-1433, Fax: (202) 720-2213. 
                    </P>
                </FURINF>
                <ADD>
                    <HD SOURCE="HED">ADDRESSES:</HD>
                    <P>For additional information, entities wishing to apply for assistance should contact a USDA Rural Development State Office to obtain copies of the application package. A list of USDA Rural Development State Offices follows: </P>
                    <P>District of Columbia, Rural Development Business Programs, USDA, Specialty Lenders Division, 1400 Independence Avenue, SW., STOP 3225, Room 6867, Washington, DC 20250-3225, (202) 720-1400. </P>
                    <P>Alabama, USDA Rural Development State Office, Sterling Centre, Suite 601, 4121 Carmichael Road, Montgomery, AL 36106-3683, (334) 279-3400/TDD (334) 279-3495. </P>
                    <P>Alaska, USDA Rural Development State Office, 800 West Evergreen, Suite 201, Palmer, AK 99645-6539, (907) 761-7705/TDD (907) 761-8905. </P>
                    <P>Arizona, USDA Rural Development State Office, 230 N. 1st Ave., Suite 206, Phoenix, AZ 85003, (602) 280-8701/TDD (602) 280-8705. </P>
                    <P>Arkansas, USDA Rural Development State Office, 700 West Capitol Avenue, Room 3416, Little Rock, AR 72201-3225, (501) 301-3200/TDD (501) 301-3279. </P>
                    <P>California, USDA Rural Development State Office, 430 G Street, # 4169, Davis, CA 95616-4169, (530) 792-5800/TDD (530) 792-5848. </P>
                    <P>Colorado, USDA Rural Development State Office, 655 Parfet Street, Room E-100, Lakewood, CO 80215, (720) 544-2903/TDD (720) 544-2976. </P>
                    <P>Delaware-Maryland, USDA Rural Development State Office, 1221 College Park Drive, Suite 200, Dover, DE 19904, (302) 857-3580/TDD (302) 857-3585. </P>
                    <P>Florida/Virgin Islands, USDA Rural Development State Office, 4440 NW 25th Place, P.O. Box 147010, Gainesville, FL 32614-7010, (352) 338-3400/TDD (352) 338-3499.</P>
                    <P>Georgia, USDA Rural Development State Office, Stephens Federal Building, 355 E. Hancock Avenue, Athens, GA 30601-2768, (706) 546-2162/TDD (706) 546-2034. </P>
                    <P>Hawaii, USDA Rural Development State Office, Federal Building, Room 311, 154 Waianuenue Avenue, Hilo, HI 96720, (808) 933-8380/TDD (808) 933-8321. </P>
                    <P>Idaho, USDA Rural Development State Office, 9173 West Barnes Dr., Suite A1, Boise, ID 83709, (208) 378-5600/TDD (208) 378-5644. </P>
                    <P>Illinois, USDA Rural Development State Office, 2118 West Park Court, Suite A, Champaign, IL 61821, (217) 403-6200/TDD (217) 403-6240. </P>
                    <P>Indiana, USDA Rural Development State Office, 5975 Lakeside Boulevard, Indianapolis, IN 46278, (317) 290-3100/TDD (317) 290-3343. </P>
                    <P>Iowa, USDA Rural Development State Office, Federal Building, Room 873, 210 Walnut Street, Des Moines, IA 50309, (515) 284-4663/TDD (515) 284-4858. </P>
                    <P>Kansas, USDA Rural Development State Office, 1303 SW. First American Place, Suite 100, Topeka, KS 66604-4040, (785) 271-2700/TDD (785) 271-2767. </P>
                    <P>Kentucky, USDA Rural Development State Office, 771 Corporate Drive, Suite 200, Lexington, KY 40503, (859) 224-7300/TDD (859) 224-7422. </P>
                    <P>Louisiana, USDA Rural Development State Office, 3727 Government Street, Alexandria, LA 71302, (318) 473-7921/TDD (318) 473-7655. </P>
                    <P>Maine, USDA Rural Development State Office, 967 Illinois Avenue, Suite 4, P.O. Box 405, Bangor, ME 04402-0405, (207) 990-9160/TDD (207) 942-7331. </P>
                    <P>Massachusetts/Rhode Island/Connecticut, USDA Rural Development State Office, 451 West Street, Suite 2, Amherst, MA 01002-2999, (413) 253-4300/TDD (413) 253-4590. </P>
                    <P>Michigan, USDA Rural Development State Office, 3001 Coolidge Road, Suite 200, East Lansing, MI 48823, (517) 324-5190/TDD (517) 324-5169. </P>
                    <P>Minnesota, USDA Rural Development State Office, 375 Jackson Street, Suite 410, St. Paul, MN 55101-1853, (651) 602-7800/TDD (651) 602-3799. </P>
                    <P>Mississippi, USDA Rural Development State Office, Federal Building, Suite 831, 100 W. Capitol Street, Jackson, MS 39269, (601) 965-4316/TDD (601) 965-5850.</P>
                    <P>Missouri, USDA Rural Development State Office, 601 Business Loop 70 West, Parkade Center, Suite 235, Columbia, MO 65203, (573) 876-0976/TDD (573) 876-9480. </P>
                    <P>Montana, USDA Rural Development State Office, 900 Technology Boulevard, Suite B, P.O. Box 850, Bozeman, MT 59771, (406) 585-2580/TDD (406) 585-2562. </P>
                    <P>Nebraska, USDA Rural Development State Office Federal Building, Room 152, 100 Centennial Mall North Lincoln, NE 68508 (402) 437-5551/TDD (402) 437-5093. </P>
                    <P>
                        Nevada, USDA Rural Development State Office, 1390 South Curry Street, Carson City, NV 89703-5146, (775) 887-1222/TDD (775) 885-0633. 
                        <PRTPAGE P="66132"/>
                    </P>
                    <P>New Jersey, USDA Rural Development State Office, 8000 Midlantic Drive, 5th Floor North, Suite 500, Mt. Laurel, NJ 08054, (856) 787-7700/TDD (856) 787-7784. </P>
                    <P>New Mexico, USDA Rural Development State Office, 6200 Jefferson Street, NE, Room 255, Albuquerque, NM 87109, (505) 761-4950/TDD (505) 761-4938. </P>
                    <P>New York, USDA Rural Development State Office, The Galleries of Syracuse, 441 South Salina Street, Suite 357, Syracuse, NY 13202-2541, (315) 477-6400/TDD (315) 477-6447. </P>
                    <P>North Carolina, USDA Rural Development State Office, 4405 Bland Road, Suite 260, Raleigh, NC 27609, (919) 873-2000/TDD (919) 873-2003. </P>
                    <P>North Dakota, USDA Rural Development State Office, Federal Building, Room 208, 220 East Rosser, P.O. Box 1737, Bismarck, ND 58502-1737, (701) 530-2037/TDD (701) 530-2113. </P>
                    <P>Ohio, USDA Rural Development State Office, Federal Building, Room 507, 200 North High Street, Columbus, OH 43215-2418, (614) 255-2400/TDD (614) 255-2554. </P>
                    <P>Oklahoma, USDA Rural Development State Office, 100 USDA, Suite 108, Stillwater, OK 74074-2654, (405) 742-1000/TDD (405) 742-1007. </P>
                    <P>Oregon, USDA Rural Development State Office, 1201 NE Lloyd Blvd., Suite 801, Portland, OR 97232, (503) 414-3300/TDD (503) 414-3387. </P>
                    <P>Pennsylvania, USDA Rural Development State Office, One Credit Union Place, Suite 330, Harrisburg, PA 17110-2996, (717) 237-2299/TDD (717) 237-2261. </P>
                    <P>Puerto Rico, USDA Rural Development State Office, IBM Building, Suite 601, 654 Munos Rivera Avenue, San Juan, PR 00918-6106, (787) 766-5095/TDD (787) 766-5332.</P>
                    <P>South Carolina, USDA Rural Development State Office, Strom Thurmond Federal Building, 1835 Assembly Street, Room 1007, Columbia, SC 29201, (803) 765-5163/TDD (803) 765-5697. </P>
                    <P>South Dakota, USDA Rural Development State Office, Federal Building, Room 210, 200 Fourth Street, SW., Huron, SD 57350, (605) 352-1100/TDD (605) 352-1147. </P>
                    <P>Tennessee, USDA Rural Development State Office, 3322 West End Avenue, Suite 300, Nashville, TN 37203-1084, (615) 783-1300. </P>
                    <P>Texas, USDA Rural Development State Office, Federal Building, Suite 102, 101 South Main, Temple, TX 76501, (254) 742-9700/TDD (254) 742-9712. </P>
                    <P>Utah, USDA Rural Development State Office, Wallace F. Bennett Federal Building, 125 South State Street, Room 4311, Salt Lake City, UT 84138, (801) 524-4320/TDD (801) 524-3309. </P>
                    <P>Vermont/New Hampshire, USDA Rural Development State Office, City Center, 3rd Floor, 89 Main Street, Montpelier, VT 05602, (802) 828-6000/TDD (802) 223-6365. </P>
                    <P>Virginia, USDA Rural Development State Office, 1606 Santa Rosa Road, Suite 238, Richmond, VA 23229-5014, (804) 287-1550/TDD (804) 287-1753. </P>
                    <P>Washington, USDA Rural Development State Office, 1835 Black Lake Boulevard SW., Suite B, Olympia, WA 98512-5715, (360) 704-7740/TDD (360) 704-7760. </P>
                    <P>West Virginia, USDA Rural Development State Office, 75 High Street, Room 320, Morgantown, WV 26505-7500, (304) 284-4860/TDD (304) 284-4836. </P>
                    <P>Wisconsin, USDA Rural Development State Office, 4949 Kirschling Court, Stevens Point, WI 54481, (715) 345-7600/TDD (715) 345-7614. </P>
                    <P>Wyoming, USDA Rural Development State Office, 100 East B, Federal Building, Room 1005, P.O. Box 11005, Casper, WY 82602-5006, (307) 233-6700/TDD (307) 233-6733. </P>
                </ADD>
            </PREAMB>
            <SUPLINF>
                <HD SOURCE="HED">SUPPLEMENTARY INFORMATION:</HD>
                <HD SOURCE="HD1">Overview </HD>
                <P>
                    <E T="03">Federal Agency:</E>
                     Rural Business-Cooperative Service (Rural Development). 
                </P>
                <P>
                    <E T="03">Funding Opportunity Title:</E>
                     Rural Business Enterprise Grants. 
                </P>
                <P>
                    <E T="03">Announcement Type:</E>
                     Initial Announcement. 
                </P>
                <P>
                    <E T="03">Catalog of Federal Domestic Assistance Number:</E>
                     10.769. 
                </P>
                <P>
                    <E T="03">Dates:</E>
                     Application Deadline: Completed applications must be received in the USDA Rural Development State Office no later than January 31, 2008, to be eligible for FY 2008 grant funding. Applications received after this date will not be eligible for FY 2008 grant funding. 
                </P>
                <P>I. Funding Opportunity Description </P>
                <P>The RBEG program is authorized by section 310B(c)(2) of the Consolidated Farm and Rural Development Act (CONACT) (7 U.S.C. 1932(c)(2)). Regulations are contained in 7 CFR part 1942, subpart G. The primary objective of the program is to improve the economic conditions of rural areas. The program is administered on behalf of RBS at the State level by the USDA Rural Development State Offices. Assistance provided to rural areas under this program may include on-site technical assistance to local and regional governments, public transit agencies, and related nonprofit and for-profit organizations in rural areas; the development of training materials; and the provision of necessary training assistance to local officials and agencies in rural areas. </P>
                <P>Awards under the RBEG passenger transportation program will be made on a competitive basis using specific selection criteria contained in 7 CFR part 1942, subpart G, and in accordance with section 310B(c)(2) of the CONACT. Information required to be in the application package include Forms SF 424; “Application for Federal Assistance;” RD 1940-20, “Request for Environmental Information;” Scope of Work Narrative; Income Statement; Balance Sheet or Audit for previous 3 years; AD-1047, “Debarment/Suspension Certification;” AD-1048, “Certification Regarding Debarment, Suspension, Ineligibility and Voluntary Exclusion;” AD-1049, “Certification Regarding Drug-Free Workplace Requirements;” Restrictions on Lobbying, RD 400-1; “Equal Opportunity Agreement;” RD 400-4, “Assurance Agreement;” Letter stating Board authorization to obtain assistance; and Letter certifying citizenship, as referenced in 7 CFR 1942.307(b). For the FRNAT grant, which must benefit Federally Recognized Native American Tribes, at least 75 percent of the benefits of the project must be received by members of Federally Recognized Native American Tribes. The project that scores the greatest number of points based on the RBEG selection criteria and the discretionary points will be selected for each grant. Applications will be tentatively scored by the State Offices and submitted to the National Office for review, final scoring, and selection. </P>
                <P>Applicants must be qualified national nonprofit organizations with experience in providing technical assistance and training to rural communities for the purpose of improving passenger transportation service or facilities. To be considered “national” RBS requires a qualified organization to provide evidence that it operates rural transportation assistance programming in multiple States. There is not a requirement to use the grant funds in a multi-State area. Under this notice, grants will be made to qualified, private, nonprofit organizations for the provision of technical assistance and training to rural communities for the purpose of improving passenger transportation services or facilities. </P>
                <HD SOURCE="HD2">Definitions </HD>
                <P>
                    The definitions are published at 7 CFR 1942.304. 
                    <PRTPAGE P="66133"/>
                </P>
                <HD SOURCE="HD1">II. Award Information </HD>
                <P>
                    <E T="03">Type of Award:</E>
                     Grant.
                </P>
                <P>
                    <E T="03">Fiscal Year Funds:</E>
                     FY 2008. 
                </P>
                <P>
                    <E T="03">Total Funding:</E>
                     To be determined by appropriations bill. 
                </P>
                <P>
                    <E T="03">Approximate Number of Awards:</E>
                     Two. 
                </P>
                <P>
                    <E T="03">Average Award:</E>
                     Will be determined by amount received in appropriations. This Notice will be amended to provide this information once an appropriation has been enacted. 
                </P>
                <P>
                    <E T="03">Anticipated Award Date:</E>
                     April 30, 2008. 
                </P>
                <HD SOURCE="HD1">III. Eligibility Information </HD>
                <HD SOURCE="HD2">A. Eligible Applicants </HD>
                <P>To be considered eligible, an entity must be a public body or private non-profit corporation serving rural areas. Grants will be competitively awarded to one or more qualified national organizations. </P>
                <HD SOURCE="HD2">B. Cost Sharing or Matching </HD>
                <P>Matching funds are not required. </P>
                <HD SOURCE="HD2">C. Other Eligibility Requirements </HD>
                <P>Applications will only be accepted from qualified national organizations to provide technical assistance for rural transportation. </P>
                <HD SOURCE="HD2">D. Completeness Eligibility </HD>
                <P>Applications will not be considered for funding if they do not provide sufficient information to determine eligibility or are missing required elements. </P>
                <HD SOURCE="HD1">IV. Fiscal Year 2008 Application and Submission Information: </HD>
                <HD SOURCE="HD2">A. Address To Request Application Package </HD>
                <P>For further information, entities wishing to apply for assistance should contact the USDA Rural Development State Office identified in this NOFA to obtain copies of the application package. </P>
                <HD SOURCE="HD2">B. Content and Form of Submission </HD>
                <P>An application must contain all of the required elements. Each application received in a USDA Rural Development State Office will be reviewed to determine if it is consistent with the eligible purposes contacted in section 310B(c) of the CONACT. Each selection priority criterion outlined in 7 CFR 1942.305 (b)(3), must be addressed in the application. Failure to address any of the criteria will result in a zero-point score for that criterion and will impact the overall evaluation of the application. Copies of 7 CFR part 1942, subpart G, will be provided by any interested applicant making a request to a USDA Rural Development State Office listed in this notice. </P>
                <P>All projects to receive technical assistance through these passenger transportation grant funds are to be identified when the applications are submitted to the USDA Rural Development State Office. Multiple project applications must identify each individual project, indicate the amount of funding requested for each individual project, and address the criteria as stated above for each individual project. </P>
                <P>For multiple-project applications, the average of the individual project scores will be the score for that application. </P>
                <HD SOURCE="HD2">C. Submission Dates and Times </HD>
                <P>
                    <E T="03">Application Deadline Date:</E>
                     January 31, 2008. 
                </P>
                <P>
                    <E T="03">Explanation of Deadlines:</E>
                     Applications must be in the USDA Rural Development State Office by the deadline date. 
                </P>
                <HD SOURCE="HD1">V. Application Review Information </HD>
                <P>The National Office will score applications based on the grant selection criteria and weights contained in 7 CFR part 1942, subpart G and will select a grantee subject to the grantee's satisfactory submission of the additional items required by 7 CFR part 1942, subpart G and the USDA Rural Development Letter of Conditions. </P>
                <HD SOURCE="HD1">VI. Award Administration Information </HD>
                <HD SOURCE="HD2">A. Award Notices </HD>
                <P>Successful applicants will receive notification for funding from the USDA Rural Development State Office. Applicants must comply with all applicable statutes and regulations before the grant award will be approved. Unsuccessful applications will receive notification by mail. </P>
                <HD SOURCE="HD2">B. Administrative and National Policy Requirements </HD>
                <P>Additional requirements that apply to grantees selected for this program can be found in the 7 CFR 1942, subpart G and 7 CFR chapter XXX. </P>
                <HD SOURCE="HD1">VII. Agency Contacts </HD>
                <P>For general questions about this announcement, please contact your USDA Rural Development State Office identified in this NOFA. </P>
                <P>
                    <E T="03">Nondiscrimination Statement:</E>
                     “The U.S. Department of Agriculture (USDA) prohibits discrimination in all its programs and activities on the basis of race, color, national origin, age, disability, and where applicable, sex, marital status, familial status, parental status, religion, sexual orientation, genetic information, political beliefs, reprisal, or because all or part of an individual's income is derived from any public assistance program. (Not all prohibited bases apply to all programs.) Persons with disabilities who require alternative means for communication of program information (Braille, large print, audiotape, etc.) should contact USDA's TARGET Center at (202) 720-2600 (voice and TDD). To file a complaint of discrimination write to USDA, Director, Office of Civil Rights, 1400 Independence Avenue, SW., Washington, DC 20250-9410 or call (800) 795-3272 (voice) or (202) 720-6382 (TDD). USDA is an equal opportunity provider, employer, and lender.” 
                </P>
                <SIG>
                    <DATED>Dated: November 19, 2007. </DATED>
                    <NAME>Ben Anderson, </NAME>
                    <TITLE>Administrator, Rural Business-Cooperative Service. </TITLE>
                </SIG>
            </SUPLINF>
            <FRDOC>[FR Doc. E7-22986 Filed 11-26-07; 8:45 am] </FRDOC>
            <BILCOD>BILLING CODE 3410-XY-P </BILCOD>
        </NOTICE>
        <NOTICE>
            <PREAMB>
                <AGENCY TYPE="N">DEPARTMENT OF COMMERCE </AGENCY>
                <SUBJECT>Submission for OMB Review; Comment Request </SUBJECT>
                <P>The Department of Commerce will submit to the Office of Management and Budget (OMB) for clearance the following proposal for collection of information under the provisions of the Paperwork Reduction Act (44 U.S.C. Chapter 35). </P>
                <P>
                    <E T="03">Agency:</E>
                     Bureau of Industry and Security (BIS). 
                </P>
                <P>
                    <E T="03">Title:</E>
                     Technology Letter of Explanation. 
                </P>
                <P>
                    <E T="03">OMB Control Number:</E>
                     0694-0047. 
                </P>
                <P>
                    <E T="03">Form Number(s):</E>
                     None. 
                </P>
                <P>
                    <E T="03">Type of Request:</E>
                     Regular submission. 
                </P>
                <P>
                    <E T="03">Burden Hours:</E>
                     10,964. 
                </P>
                <P>
                    <E T="03">Number of Respondents:</E>
                     6,313. 
                </P>
                <P>
                    <E T="03">Average Hours Per Response:</E>
                     Letter of Assurance, 30 minutes; and Technology. Letter of Explanation, 2 hours. 
                </P>
                <P>
                    <E T="03">Needs and Uses:</E>
                     The information contained in the Technology Letter of Explanation, and the Letter of Assurance will assure BIS that no unauthorized technical data will be exported for unauthorized end-uses or to unauthorized destinations. This will also provide assurance of compliance to U.S. national security and foreign policy programs. 
                </P>
                <P>
                    <E T="03">Affected Public:</E>
                     Businesses and other for-profit institutions. 
                </P>
                <P>
                    <E T="03">Frequency:</E>
                     On occasion. 
                </P>
                <P>
                    <E T="03">Respondent's Obligation:</E>
                     Required to obtain or retain benefits. 
                </P>
                <P>
                    <E T="03">OMB Desk Officer:</E>
                     David Rostker, (202) 395-3897. 
                </P>
                <P>
                    Copies of the above information collection proposal can be obtained by 
                    <PRTPAGE P="66134"/>
                    calling or writing Diana Hynek, Departmental Paperwork Clearance Officer, (202) 482-0266, Department of Commerce, Room 6625, 14th and Constitution Avenue, NW., Washington, DC 20230 (or via the Internet at 
                    <E T="03">dHynek@doc.gov</E>
                    ). 
                </P>
                <P>
                    Written comments and recommendations for the proposed information collection should be sent within 30 days of publication of this notice to David Rostker, OMB Desk Officer, Fax number (202) 395-7285 or via the Internet at 
                    <E T="03">David_Rostker@omb.eop.gov</E>
                    . 
                </P>
                <SIG>
                    <DATED>Dated: November 20, 2007. </DATED>
                    <NAME>Gwellnar Banks, </NAME>
                    <TITLE>Management Analyst, Office of the Chief Information Officer. </TITLE>
                </SIG>
            </PREAMB>
            <FRDOC>[FR Doc. E7-22994 Filed 11-26-07; 8:45 am] </FRDOC>
            <BILCOD>BILLING CODE 3510-33-P</BILCOD>
        </NOTICE>
        <NOTICE>
            <PREAMB>
                <AGENCY TYPE="S">DEPARTMENT OF COMMERCE </AGENCY>
                <SUBJECT>Submission for OMB Review; Comment Request </SUBJECT>
                <P>The Department of Commerce will submit to the Office of Management and Budget (OMB) for clearance the following proposal for collection of information under the provisions of the Paperwork Reduction Act (44 U.S.C. Chapter 35). </P>
                <P>
                    <E T="03">Agency:</E>
                     International Trade Administration (ITA). 
                </P>
                <P>
                    <E T="03">Title:</E>
                     ITA Environmental Technologies Non-Tariff Barriers Survey. 
                </P>
                <P>
                    <E T="03">OMB Control Number:</E>
                     0625-0241. 
                </P>
                <P>
                    <E T="03">Form Number(s):</E>
                     ITA-4150P. 
                </P>
                <P>
                    <E T="03">Type of Request:</E>
                     Regular submission. 
                </P>
                <P>
                    <E T="03">Burden Hours:</E>
                     33. 
                </P>
                <P>
                    <E T="03">Number of Respondents:</E>
                     200. 
                </P>
                <P>
                    <E T="03">Average Hours Per Response:</E>
                     10 minutes. 
                </P>
                <P>
                    <E T="03">Needs and Uses</E>
                    : The environmental technologies industry has cited the proliferation of non-tariff barriers as a factor that is making U.S. exporting more difficult. This factor has been cited across all sub-sectors of environmental technologies products and all global geographic regions. The collection of information related to the experience of U.S. exporters with regard to these non-tariff measures is essential to the mission of the U.S. Department of Commerce's ITA, Office of Energy and Environmental Industries. 
                </P>
                <P>
                    <E T="03">Affected Public:</E>
                     Business or other for-profit organizations. 
                </P>
                <P>
                    <E T="03">Frequency:</E>
                     On occasion. 
                </P>
                <P>
                    <E T="03">Respondent's Obligation:</E>
                     Voluntary. 
                </P>
                <P>
                    <E T="03">OMB Desk Officer:</E>
                     David Rostker, (202) 395-3897. 
                </P>
                <P>
                    Copies of the above information collection proposal can be obtained by calling or writing Diana Hynek, Departmental Paperwork Clearance Officer, (202) 482-0266, Department of Commerce, Room 6625, 14th and Constitution Avenue, NW., Washington, DC 20230 (or via the Internet at 
                    <E T="03">dHynek@doc.gov</E>
                    ). 
                </P>
                <P>
                    Written comments and recommendations for the proposed information collection should be sent within 30 days of publication of this notice to David Rostker, OMB Desk Officer, Fax number (202) 395-7285 or via the Internet at 
                    <E T="03">David_Rostker@omb.eop.gov</E>
                    . 
                </P>
                <SIG>
                    <DATED>Dated: November 20, 2007. </DATED>
                    <NAME>Gwellnar Banks, </NAME>
                    <TITLE>Management Analyst, Office of the Chief Information Officer. </TITLE>
                </SIG>
            </PREAMB>
            <FRDOC>[FR Doc. E7-22996 Filed 11-26-07; 8:45 am] </FRDOC>
            <BILCOD>BILLING CODE 3510-DR-P </BILCOD>
        </NOTICE>
        <NOTICE>
            <PREAMB>
                <AGENCY TYPE="S">DEPARTMENT OF COMMERCE </AGENCY>
                <SUBJECT>Submission for OMB Review; Comment Request </SUBJECT>
                <P>The Department of Commerce will submit to the Office of Management and Budget (OMB) for clearance the following proposal for collection of information under the provisions of the Paperwork Reduction Act (44 U.S.C. Chapter 35). </P>
                <P>
                    <E T="03">Agency:</E>
                     International Trade Administration (ITA). 
                </P>
                <P>
                    <E T="03">Title:</E>
                     Information on Articles for Physically or Mentally Handicapped Persons Imported  Free of Duty. 
                </P>
                <P>
                    <E T="03">OMB Control Number:</E>
                     0625-0118. 
                </P>
                <P>
                    <E T="03">Form Number(s):</E>
                     ITA-362P. 
                </P>
                <P>
                    <E T="03">Type of Request:</E>
                     Regular submission. 
                </P>
                <P>
                    <E T="03">Burden Hours:</E>
                     188. 
                </P>
                <P>
                    <E T="03">Number of Respondents:</E>
                     180. 
                </P>
                <P>
                    <E T="03">Average Hours Per Response:</E>
                     4 minutes. 
                </P>
                <P>
                    <E T="03">Needs and Uses:</E>
                     When Congress enacted legislation to implement the Nairobi Protocol to the Florence Agreement, it included a provision for the Departments of Commerce and Homeland Security to collect information on the import of articles for the handicapped. 
                </P>
                <P>The form ITA-362P, Information on Articles for Physically or Mentally Handicapped Persons Imported Free of Duty, is the instrument by which statistical information is obtained to assess whether the duty-free treatment of articles for the handicapped has had a significant adverse impact on a domestic industry (or portion thereof) manufacturing or producing a like or directly competitive article. Without the collection of this information, it would be impossible for ITA to make a sound determination of the adverse impact and the President to appropriately redress the situation. </P>
                <P>
                    <E T="03">Affected Public:</E>
                     Businesses or other for-profit; not-for-profit institutions; state, local or tribal government; federal government; individuals or households. 
                </P>
                <P>
                    <E T="03">Frequency:</E>
                     On occasion. 
                </P>
                <P>
                    <E T="03">Respondent's Obligation:</E>
                     Required to obtain or retain a benefit. 
                </P>
                <P>
                    <E T="03">OMB Desk Officer:</E>
                     David Rostker, (202) 395-3897. 
                </P>
                <P>
                    Copies of the above information collection proposal can be obtained by calling or writing Diana Hynek, Departmental Paperwork Clearance Officer, (202) 482-0266, Department of Commerce, Room 6625, 14th and Constitution Avenue, NW., Washington, DC 20230 (or via the Internet at 
                    <E T="03">dHynek@doc.gov.</E>
                </P>
                <P>
                    Written comments and recommendations for the proposed information collection should be sent within 30 days of publication of this notice to David Rostker, OMB Desk Officer, Fax number (202) 395-7285 or via the Internet at 
                    <E T="03">David_Rostker@omb.eop.gov.</E>
                </P>
                <SIG>
                    <DATED>Dated: November 20, 2007. </DATED>
                    <NAME>Gwellnar Banks, </NAME>
                    <TITLE>Management Analyst, Office of the Chief Information Officer. </TITLE>
                </SIG>
            </PREAMB>
            <FRDOC>[FR Doc. E7-22997 Filed 11-26-07; 8:45 am] </FRDOC>
            <BILCOD>BILLING CODE 3510-DS-P </BILCOD>
        </NOTICE>
        <NOTICE>
            <PREAMB>
                <AGENCY TYPE="S">DEPARTMENT OF COMMERCE </AGENCY>
                <SUBAGY>Bureau of Industry and Security </SUBAGY>
                <SUBJECT>Proposed Information Collection; Comment Request; Procedures for Acceptance or Rejection of a Rated Order </SUBJECT>
                <AGY>
                    <HD SOURCE="HED">AGENCY:</HD>
                    <P>Bureau of Industry and Security, DOC. </P>
                </AGY>
                <ACT>
                    <HD SOURCE="HED">ACTION:</HD>
                    <P>Notice. </P>
                </ACT>
                <SUM>
                    <HD SOURCE="HED">SUMMARY:</HD>
                    <P>The Department of Commerce, as part of its continuing effort to reduce paperwork and respondent burden, invites the general public and other Federal agencies to take this opportunity to comment on proposed and/or continuing information collections, as required by the Paperwork Reduction Act of 1995. </P>
                </SUM>
                <DATES>
                    <HD SOURCE="HED">DATES:</HD>
                    <P>Written comments must be submitted on or before January 28, 2008. </P>
                </DATES>
                <ADD>
                    <HD SOURCE="HED">ADDRESSES:</HD>
                    <P>
                        Direct all written comments to Diana Hynek, Departmental Paperwork Clearance Officer, Department of Commerce, Room 6625, 14th and Constitution Avenue, NW., Washington, DC 20230 (or via the Internet at 
                        <E T="03">dHynek@doc.gov</E>
                        ). 
                    </P>
                </ADD>
                <FURINF>
                    <HD SOURCE="HED">FOR FURTHER INFORMATION CONTACT:</HD>
                    <P>
                        Requests for additional information or 
                        <PRTPAGE P="66135"/>
                        copies of the information collection instrument and instructions should be directed to Larry Hall, BIS ICB Liaison, (202)482-4896, 
                        <E T="03">lhall@bis.doc.gov.</E>
                    </P>
                </FURINF>
            </PREAMB>
            <SUPLINF>
                <HD SOURCE="HED">SUPPLEMENTARY INFORMATION:</HD>
                <HD SOURCE="HD1">I. Abstract </HD>
                <P>This collection is necessary for administration and enforcement of delegated authority under the Defense Production Act of 1950, as amended (50 U.S.C. App. 2061, et seq.) and the selective Service Act of 1948 (50 U.S.C. App. 468). Any person (supplier) who receives a priority rated order under Defense Priorities and Allocations System (DPAS) regulation (15 CFR 700) must notify the customer of acceptance or rejection of that order within a specified period of time. Also, if shipment against a priority rated order will be delayed, the supplier must immediately notify the customer. The purpose of this authority is to ensure the timely delivery of goods and services to meet current national defense and civil emergency preparedness program requirements. </P>
                <HD SOURCE="HD1">II. Method of Collection </HD>
                <P>Paper form or electronically. </P>
                <HD SOURCE="HD1">III. Data </HD>
                <P>
                    <E T="03">OMB Control Number:</E>
                     0694-0092. 
                </P>
                <P>
                    <E T="03">Form Number(s):</E>
                     None. 
                </P>
                <P>
                    <E T="03">Type of Review:</E>
                     Business or other for-profit organizations. 
                </P>
                <P>
                    <E T="03">Estimated Number of Respondents:</E>
                     18,000. 
                </P>
                <P>
                    <E T="03">Estimated Time Per Response:</E>
                     1 to 15 minutes. 
                </P>
                <P>
                    <E T="03">Estimated Total Annual Burden Hours:</E>
                     21,963. 
                </P>
                <P>
                    <E T="03">Estimated Total Annual Cost to Public:</E>
                     $0. 
                </P>
                <HD SOURCE="HD1">IV. Request for Comments </HD>
                <P>Comments are invited on: (a) Whether the proposed collection of information is necessary for the proper performance of the functions of the agency, including whether the information shall have practical utility; (b) the accuracy of the agency's estimate of the burden (including hours and cost) of the proposed collection of information; (c) ways to enhance the quality, utility, and clarity of the information to be collected; and (d) ways to minimize the burden of the collection of information on respondents, including through the use of automated collection techniques or other forms of information technology. </P>
                <P>Comments submitted in response to this notice will be summarized and/or included in the request for OMB approval of this information collection; they also will become a matter of public record. </P>
                <SIG>
                    <DATED>Dated: November 20, 2007.</DATED>
                    <NAME>Gwellnar Banks,</NAME>
                    <TITLE>Management Analyst, Office of the Chief Information Officer.</TITLE>
                </SIG>
            </SUPLINF>
            <FRDOC>[FR Doc. E7-22993 Filed 11-26-07; 8:45 am]</FRDOC>
            <BILCOD>BILLING CODE 3510-33-P</BILCOD>
        </NOTICE>
        <NOTICE>
            <PREAMB>
                <AGENCY TYPE="S">DEPARTMENT OF COMMERCE </AGENCY>
                <SUBAGY>Bureau of Industry and Security </SUBAGY>
                <SUBJECT>Proposed Information Collection; Comment Request; Export and Reexport Controls for Iraq </SUBJECT>
                <AGY>
                    <HD SOURCE="HED">AGENCY:</HD>
                    <P>Bureau of Industry and Security, DOC. </P>
                </AGY>
                <ACT>
                    <HD SOURCE="HED">ACTION:</HD>
                    <P>Notice. </P>
                </ACT>
                <SUM>
                    <HD SOURCE="HED">SUMMARY:</HD>
                    <P>The Department of Commerce, as part of its continuing effort to reduce paperwork and respondent burden, invites the general public and other Federal agencies to take this opportunity to comment on proposed and/or continuing information collections, as required by the Paperwork Reduction Act of 1995. </P>
                </SUM>
                <DATES>
                    <HD SOURCE="HED">DATES:</HD>
                    <P>Written comments must be submitted on or before January 28, 2008. </P>
                </DATES>
                <ADD>
                    <HD SOURCE="HED">ADDRESSES:</HD>
                    <P>
                        Direct all written comments to Diana Hynek, Departmental Paperwork Clearance Officer, Department of Commerce, Room 6625, 14th and Constitution Avenue, NW., Washington, DC 20230 (or via the Internet at 
                        <E T="03">dHynek@doc.gov</E>
                        ). 
                    </P>
                </ADD>
                <FURINF>
                    <HD SOURCE="HED">FOR FURTHER INFORMATION CONTACT:</HD>
                    <P>
                        Requests for additional information or copies of the information collection instrument and instructions should be directed to Larry Hall, BIS ICB Liaison, (202)482-4896, 
                        <E T="03">lhall@bis.doc.gov</E>
                        . 
                    </P>
                </FURINF>
            </PREAMB>
            <SUPLINF>
                <HD SOURCE="HED">SUPPLEMENTARY INFORMATION:</HD>
                <HD SOURCE="HD1">I. Abstract </HD>
                <P>The primary purpose of this collection of information is to maintain an expedited export license type developed specifically for exports and reexports of controlled items destined to civil infrastructure rebuilding projects in Iraq. The name given this license type is the Special Iraq Reconstruction License or SIRL. The information covered under this collection is furnished by U.S. exporters when applying for an export license. The export license is authorized under OMB 0694-0088 “Multipurpose Application.” This collection involves additional information and documentation about the project in Iraq which are necessary to properly evaluate the request. </P>
                <HD SOURCE="HD1">II. Method of Collection </HD>
                <P>Information will be supplied electronically via the BIS SNAP-R system or in paper form. </P>
                <HD SOURCE="HD1">III. Data </HD>
                <P>
                    <E T="03">OMB Control Number:</E>
                     0694-0129. 
                </P>
                <P>
                    <E T="03">Form Number(s):</E>
                     None. 
                </P>
                <P>
                    <E T="03">Type of Review:</E>
                     Business or other for-profit organizations. 
                </P>
                <P>
                    <E T="03">Estimated Number of Respondents:</E>
                     25. 
                </P>
                <P>
                    <E T="03">Estimated Time Per Response:</E>
                     3 to 3.5 hours. 
                </P>
                <P>
                    <E T="03">Estimated Total Annual Burden Hours:</E>
                     93. 
                </P>
                <P>
                    <E T="03">Estimated Total Annual Cost to Public:</E>
                     $0. 
                </P>
                <HD SOURCE="HD1">IV. Request for Comments </HD>
                <P>Comments are invited on: (a) Whether the proposed collection of information is necessary for the proper performance of the functions of the agency, including whether the information shall have practical utility; (b) the accuracy of the agency's estimate of the burden (including hours and cost) of the proposed collection of information; (c) ways to enhance the quality, utility, and clarity of the information to be collected; and (d) ways to minimize the burden of the collection of information on respondents, including through the use of automated collection techniques or other forms of information technology. </P>
                <P>Comments submitted in response to this notice will be summarized and/or included in the request for OMB approval of this information collection; they also will become a matter of public record. </P>
                <SIG>
                    <DATED>Dated: November 20, 2007. </DATED>
                    <NAME>Gwellnar Banks, </NAME>
                    <TITLE>Management Analyst, Office of the Chief Information Officer.</TITLE>
                </SIG>
            </SUPLINF>
            <FRDOC>[FR Doc. E7-22998 Filed 11-26-07; 8:45 am] </FRDOC>
            <BILCOD>BILLING CODE 3510-33-P </BILCOD>
        </NOTICE>
        <NOTICE>
            <PREAMB>
                <AGENCY TYPE="S">DEPARTMENT OF COMMERCE </AGENCY>
                <SUBAGY>National Institute of Standards and Technology </SUBAGY>
                <SUBJECT>Visiting Committee on Advanced Technology </SUBJECT>
                <AGY>
                    <HD SOURCE="HED">AGENCY:</HD>
                    <P>National Institute of Standards and Technology, Department of Commerce. </P>
                </AGY>
                <ACT>
                    <HD SOURCE="HED">ACTION:</HD>
                    <P>Notice of partially closed meeting. </P>
                </ACT>
                <SUM>
                    <HD SOURCE="HED">SUMMARY:</HD>
                    <P>
                        Pursuant to the Federal Advisory Committee Act, 5 U.S.C. app. 2, notice is hereby given that the Visiting Committee on Advanced 
                        <PRTPAGE P="66136"/>
                        Technology (VCAT), National Institute of Standards and Technology (NIST), will meet Tuesday, December 11, 2007, from 8:30 a.m. to 2:30 p.m. and Wednesday, December 12, 2007, from 8:30 a.m. to 12 p.m. The Visiting Committee on Advanced Technology is composed of fifteen members appointed by the Director of NIST who are eminent in such fields as business, research, new product development, engineering, labor, education, management consulting, environment, and international relations. The purpose of this meeting is to review and make recommendations regarding general policy for the Institute, its organization, its budget, and its programs within the framework of applicable national policies as set forth by the President and the Congress. The agenda will include an update on NIST and its R&amp;D priorities, NIST's vision for 2017, and strategic plan; an overview presentation on the U.S. standards and conformity assessment system; break-out sessions of the Information Technology and Nanotechnology subcommittees to discuss NIST's programs and plans and how they fit into the national agenda with input back to the full committee. Discussions on NIST budget and planning information scheduled to begin at 8 a.m. and to end at 8:30 a.m. on December 11 will be closed. The agenda may change to accommodate Committee business. The final agenda will be posted on the NIST Web site at 
                        <E T="03">http://www.nist.gov/director/vcat/agenda.htm</E>
                        . 
                    </P>
                    <P>
                        Anyone wishing to attend this meeting should submit name, e-mail address and phone number to Denise Herbert (
                        <E T="03">denise.herbert@nist.gov</E>
                         or 301-975-5607) no later than December 7, 2007. 
                    </P>
                </SUM>
                <DATES>
                    <HD SOURCE="HED">DATES:</HD>
                    <P>The meeting will convene on December 11, 2007 at 8:30 a.m. and will adjourn on December 12, 2007 at 12 p.m. </P>
                </DATES>
                <ADD>
                    <HD SOURCE="HED">ADDRESSES:</HD>
                    <P>The meeting will be held at the Doubletree Guest Suites, Historic Charleston, 181 Church Street, Charleston, South Carolina, 29401. </P>
                </ADD>
                <FURINF>
                    <HD SOURCE="HED">FOR FURTHER INFORMATION CONTACT:</HD>
                    <P>Denise Herbert, Visiting Committee on Advanced Technology, National Institute of Standards and Technology, Gaithersburg, Maryland 20899-1000, telephone number (301) 975-5607. </P>
                </FURINF>
            </PREAMB>
            <SUPLINF>
                <HD SOURCE="HED">SUPPLEMENTARY INFORMATION:</HD>
                <P>The Assistant Secretary for Administration, with the concurrence of the General Counsel, formally determined on November 19, 2007, that portions of the meeting of the Visiting Committee on Advanced Technology which deal with discussion of sensitive budget and planning information that would cause harm to third parties if publicly shared be closed in accordance with section 10 (d) of the Federal Advisory Committee Act, 5 U.S. C. app. 2. </P>
                <SIG>
                    <DATED>Dated: November 20, 2007. </DATED>
                    <NAME>Richard F. Kayser, </NAME>
                    <TITLE>Acting Deputy Director.</TITLE>
                </SIG>
            </SUPLINF>
            <FRDOC> [FR Doc. E7-23032 Filed 11-26-07; 8:45 am] </FRDOC>
            <BILCOD>BILLING CODE 3510-13-P </BILCOD>
        </NOTICE>
        <NOTICE>
            <PREAMB>
                <AGENCY TYPE="S">DEPARTMENT OF COMMERCE </AGENCY>
                <SUBAGY>National Institute of Standards and Technology </SUBAGY>
                <SUBJECT>Announcing a Meeting of the Information Security and Privacy Advisory Board </SUBJECT>
                <AGY>
                    <HD SOURCE="HED">AGENCY:</HD>
                    <P>National Institute of Standards and Technology, DOC. </P>
                </AGY>
                <ACT>
                    <HD SOURCE="HED">ACTION:</HD>
                    <P>Notice of meeting. </P>
                </ACT>
                <SUM>
                    <HD SOURCE="HED">SUMMARY:</HD>
                    <P>
                        Pursuant to the Federal Advisory Committee Act, 5 U.S.C. App., notice is hereby given that the Information Security and Privacy Advisory Board (ISPAB) will meet Thursday, December 6, 2007, from 8:30 a.m. until 5 p.m., and Friday, December 7, 2007, from 8 a.m. until 4:30 p.m. All sessions will be open to the public. The Advisory Board was established by the Computer Security Act of 1987 (Pub. L. 100-235) and amended by the Federal Information Security Management Act of 2002 (Pub. L. 107-347) to advise the Secretary of Commerce and the Director of NIST on security and privacy issues pertaining to federal computer systems. Details regarding the Board's activities are available at 
                        <E T="03">http://csrc.nist.gov/ispab/</E>
                        . 
                    </P>
                </SUM>
                <DATES>
                    <HD SOURCE="HED">DATES:</HD>
                    <P>The meeting will be held on December 6, 2007 from 8:30 a.m. until 5 p.m. and December 7, 2007, from 8 a.m. until 4:30 p.m. </P>
                </DATES>
                <ADD>
                    <HD SOURCE="HED">ADDRESSES:</HD>
                    <P>The meeting will take place at the George Washington University Cafritz Conference Center, 800 21st Street, NW., Room 405, Washington, DC. </P>
                </ADD>
                <HD SOURCE="HD1">Agenda </HD>
                <FP SOURCE="FP-2">—Welcome and Overview. </FP>
                <FP SOURCE="FP-2">—NIST Computer Security Division (CSD) Update. </FP>
                <FP SOURCE="FP-2">—DHS National Communication Systems Update. </FP>
                <FP SOURCE="FP-2">—Identify Management Briefing. </FP>
                <FP SOURCE="FP-2">—System Assurance Activities Update. </FP>
                <FP SOURCE="FP-2">—Privacy Technology White Paper Update. </FP>
                <FP SOURCE="FP-2">—ISPAB Work Plan Discussion and Panel on Einstein Program. </FP>
                <FP SOURCE="FP-2">—Federal IT Security Products. </FP>
                <FP SOURCE="FP-2">—ISPAB Work Plan Discussion on SISA Alliance. </FP>
                <FP SOURCE="FP-2">—Social Networking and Security Briefing. </FP>
                <FP>Note that agenda items may change without notice because of possible unexpected schedule conflicts of presenters. </FP>
                <P>
                    <E T="03">Public Participation:</E>
                     The Board agenda will include a period of time, not to exceed thirty minutes, for oral comments and questions from the public. Each speaker will be limited to five minutes. Members of the public who are interested in speaking are asked to contact the Board Secretariat at the telephone number indicated below. In addition, written statements are invited and may be submitted to the Board at any time. Written statements should be directed to the ISPAB Secretariat, Information Technology Laboratory, 100 Bureau Drive, Stop 8930, National Institute of Standards and Technology, Gaithersburg, MD 20899-8930. It would be appreciated if 25 copies of written material were submitted for distribution to the Board and attendees no later than November 20, 2007. Approximately 15 seats will be available for the public and media. 
                </P>
                <FURINF>
                    <HD SOURCE="HED">FOR FURTHER INFORMATION CONTACT:</HD>
                    <P>Ms. Pauline Bowen, Board Secretariat, Information Technology Laboratory, National Institute of Standards and Technology, 100 Bureau Drive, Stop 8930, Gaithersburg, MD 20899-8930, telephone: (301) 975-2938. </P>
                    <SIG>
                        <DATED>Dated: November 20, 2007. </DATED>
                        <NAME>Richard F. Kayser, </NAME>
                        <TITLE>Acting Deputy Director.</TITLE>
                    </SIG>
                </FURINF>
            </PREAMB>
            <FRDOC> [FR Doc. E7-23023 Filed 11-26-07; 8:45 am] </FRDOC>
            <BILCOD>BILLING CODE 3510-CN-P </BILCOD>
        </NOTICE>
        <NOTICE>
            <PREAMB>
                <AGENCY TYPE="S">DEPARTMENT OF COMMERCE </AGENCY>
                <SUBAGY>National Oceanic and Atmospheric Administration </SUBAGY>
                <SUBJECT>Proposed Information Collection; Comment Request; Cooperative Charting Programs </SUBJECT>
                <AGY>
                    <HD SOURCE="HED">AGENCY:</HD>
                    <P>National Oceanic and Atmospheric Administration (NOAA), DOC. </P>
                </AGY>
                <ACT>
                    <HD SOURCE="HED">ACTION:</HD>
                    <P>Notice. </P>
                </ACT>
                <SUM>
                    <HD SOURCE="HED">SUMMARY:</HD>
                    <P>The Department of Commerce, as part of its continuing effort to reduce paperwork and respondent burden, invites the general public and other Federal agencies to take this opportunity to comment on proposed and/or continuing information collections, as required by the Paperwork Reduction Act of 1995. </P>
                </SUM>
                <DATES>
                    <PRTPAGE P="66137"/>
                    <HD SOURCE="HED">DATES:</HD>
                    <P>Written comments must be submitted on or before January 28, 2008. </P>
                </DATES>
                <ADD>
                    <HD SOURCE="HED">ADDRESSES:</HD>
                    <P>
                        Direct all written comments to Diana Hynek, Departmental Paperwork Clearance Officer, Department of Commerce, Room 6625, 14th and Constitution Avenue, NW., Washington, DC 20230 (or via the Internet at 
                        <E T="03">dHynek@doc.gov</E>
                        ). 
                    </P>
                </ADD>
                <FURINF>
                    <HD SOURCE="HED">FOR FURTHER INFORMATION CONTACT:</HD>
                    <P>
                        Requests for additional information or copies of the information collection instrument and instructions should be directed to Ken Forster, 301-713-2737 or 
                        <E T="03">ken.forster@noaa.gov</E>
                        . 
                    </P>
                </FURINF>
            </PREAMB>
            <SUPLINF>
                <HD SOURCE="HED">SUPPLEMENTARY INFORMATION:</HD>
                <HD SOURCE="HD1">I. Abstract </HD>
                <P>The U.S. Coast Guard Auxiliary members report observations of changes that require additions, corrections or revisions to Nautical Charts, on the NOAA Form 77-05. The U.S. Power Squadrons use a Web site to report the same information. The information provided is used by NOAA National Ocean Service to maintain and prepare new additions that are used nationwise by commercial and recreational navigators. </P>
                <HD SOURCE="HD1">II. Method of Collection </HD>
                <P>Methods of submittal include Internet and facsimile transmission of paper forms. </P>
                <HD SOURCE="HD1">III. Data </HD>
                <P>
                    <E T="03">OMB Number:</E>
                     0648-0022. 
                </P>
                <P>
                    <E T="03">Form Number:</E>
                     NOAA 77-5. 
                </P>
                <P>
                    <E T="03">Type of Review:</E>
                     Regular submission. 
                </P>
                <P>
                    <E T="03">Affected Public:</E>
                     Individuals or households; not-for-profit institutions. 
                </P>
                <P>
                    <E T="03">Estimated Number of Respondents:</E>
                     1,025. 
                </P>
                <P>
                    <E T="03">Estimated Time Per Response:</E>
                     2
                    <FR>1/2</FR>
                     hours. 
                </P>
                <P>
                    <E T="03">Estimated Total Annual Burden Hours:</E>
                     4,400. 
                </P>
                <P>
                    <E T="03">Estimated Total Annual Cost to Public:</E>
                     $0. 
                </P>
                <HD SOURCE="HD1">IV. Request for Comments </HD>
                <P>Comments are invited on: (a) Whether the proposed collection of information is necessary for the proper performance of the functions of the agency, including whether the information shall have practical utility; (b) the accuracy of the agency's estimate of the burden (including hours and cost) of the proposed collection of information; (c) ways to enhance the quality, utility, and clarity of the information to be collected; and (d) ways to minimize the burden of the collection of information on respondents, including through the use of automated collection techniques or other forms of information technology. </P>
                <P>Comments submitted in response to this notice will be summarized and/or included in the request for OMB approval of this information collection; they also will become a matter of public record. </P>
                <SIG>
                    <DATED>Dated: November 20, 2007. </DATED>
                    <NAME>Gwellnar Banks, </NAME>
                    <TITLE>Management Analyst, Office of the Chief Information Officer. </TITLE>
                </SIG>
            </SUPLINF>
            <FRDOC>[FR Doc. E7-22995 Filed 11-26-07; 8:45 am] </FRDOC>
            <BILCOD>BILLING CODE 3510-JS-P </BILCOD>
        </NOTICE>
        <NOTICE>
            <PREAMB>
                <AGENCY TYPE="S">DEPARTMENT OF COMMERCE</AGENCY>
                <SUBAGY>National Oceanic and Atmospheric Administration</SUBAGY>
                <RIN>RIN 0648-XE08</RIN>
                <SUBJECT>Endangered and Threatened Species; Take of Anadromous Fish</SUBJECT>
                <AGY>
                    <HD SOURCE="HED">AGENCY:</HD>
                    <P>National Marine Fisheries Service (NMFS), National Oceanic and Atmospheric Administration (NOAA), Commerce.</P>
                </AGY>
                <ACT>
                    <HD SOURCE="HED">ACTION:</HD>
                    <P>Notice.</P>
                </ACT>
                <SUM>
                    <HD SOURCE="HED">SUMMARY:</HD>
                    <P>Notice is hereby given that NMFS has issued Permit 1044 Modification 4 to the NMFS Southwest Fisheries Science Center (SWFSC) Fisheries Ecology Division (FED) in Santa Cruz, California.</P>
                </SUM>
                <ADD>
                    <HD SOURCE="HED">ADDRESSES:</HD>
                    <P>
                        The application, permit, and related documents are available for review by appointment at: Protected Resources Division, NMFS, 777 Sonoma Avenue, Room 315, Santa Rosa, CA 95404 (ph: 707-575-6097, fax: 707-578-3435, e-mail at: 
                        <E T="03">Jeffrey.Jahn@noaa.gov</E>
                        ).
                    </P>
                </ADD>
                <FURINF>
                    <HD SOURCE="HED">FOR FURTHER INFORMATION CONTACT:</HD>
                    <P>
                        Jeffrey Jahn at 707-575-6097, or e-mail: 
                        <E T="03">Jeffrey.Jahn@noaa.gov</E>
                        .
                    </P>
                </FURINF>
            </PREAMB>
            <SUPLINF>
                <HD SOURCE="HED">SUPPLEMENTARY INFORMATION:</HD>
                <HD SOURCE="HD1">Authority</HD>
                <P>The issuance of permits and permit modifications, as required by the Endangered Species Act of 1973 (16 U.S.C. 1531-1543) (ESA), is based on a finding that such permits/modifications: (1) are applied for in good faith; (2) would not operate to the disadvantage of the listed species which are the subject of the permits; and (3) are consistent with the purposes and policies set forth in section 2 of the ESA. Authority to take listed species is subject to conditions set forth in the permits. Permits and modifications are issued in accordance with and are subject to the ESA and NMFS regulations (50 CFR parts 222-226) governing listed fish and wildlife permits.</P>
                <HD SOURCE="HD1">Species Covered in This Notice</HD>
                <P>
                    This notice is relevant to federally threatened Southern Oregon/Northern California Coast coho salmon (
                    <E T="03">Oncorhynchus kisutch</E>
                    ), endangered Central California Coast coho salmon (
                    <E T="03">O. kisutch</E>
                    ), threatened California Coastal Chinook salmon (
                    <E T="03">O. tshawytscha</E>
                    ), endangered Sacramento River winter-run Chinook salmon (
                    <E T="03">O. tshawytscha</E>
                    ), threatened Central Valley spring-run Chinook salmon (
                    <E T="03">O. tshawytscha</E>
                    ), threatened Northern California steelhead (
                    <E T="03">O. mykiss</E>
                    ), threatened Central California Coast steelhead (
                    <E T="03">O. mykiss</E>
                    ), threatened California Central Valley steelhead (
                    <E T="03">O. mykiss</E>
                    ), threatened South-Central California Coast steelhead (
                    <E T="03">O. mykiss</E>
                    ), and endangered Southern California steelhead (
                    <E T="03">O. mykiss</E>
                    ).
                </P>
                <HD SOURCE="HD1">Permit Issued</HD>
                <P>
                    A notice of the receipt of an application for a scientific research permit (1044 Modification 4) was published in the 
                    <E T="04">Federal Register</E>
                     on August 16, 2006 (71 FR 47179). Permit 1044 Modification 4 was issued to SWFSC FED on July 26, 2007.
                </P>
                <P>
                    Permit 1044 Modification 4 authorizes SWFSC FED to capture (by backpack electrofishing, seine, rotary screw trap, fyke-net trap, pipe-trap, weir-trap, or hook-and-line), sample (by collection of scales, fin-clips, or stomach contents), mark (using fin-clips, passive integrated transponder (PIT) tags, visible implant elastomer (VIE) tags, or visible implant alpha (VI alpha) tags), and release juvenile Southern Oregon/Northern California Coast coho salmon, Central California Coast coho salmon, California Coastal Chinook salmon, Sacramento River winter-run Chinook salmon, Central Valley spring-run Chinook salmon, Northern California steelhead, Central California Coast steelhead, California Central Valley steelhead, South-Central California Coast steelhead, and Southern California steelhead. Permit 1044 Modification 4 also authorizes SWFSC FED to capture (by seine, weir-trap, or hook-and-line), sample (by collection of scales or fin-clips), mark (using fin-clips, PIT tags, or external anchor tags), and release adult Southern Oregon/Northern California Coast coho salmon and Northern California steelhead. In addition, Permit 1044 Modification 4 authorizes SWFSC FED to capture, handle, sample (by collection of scales, fin-clips, or other tissue), mark, and release adult carcasses of Southern Oregon/Northern California Coast coho salmon, Central California Coast coho salmon, California Coastal Chinook salmon, Sacramento 
                    <PRTPAGE P="66138"/>
                    River winter-run Chinook salmon, Central Valley spring-run Chinook salmon, and Northern California steelhead.
                </P>
                <P>Permit 1044 Modification 4 authorizes unintentional lethal take of juvenile Southern Oregon/Northern California Coast coho salmon, Central California Coast coho salmon, California Coastal Chinook salmon, Sacramento River winter-run Chinook salmon, Central Valley spring-run Chinook salmon, Northern California steelhead, Central California Coast steelhead, California Central Valley steelhead, South-Central California Coast steelhead, and Southern California steelhead not to exceed 2.5 percent of fish captured. Permit 1044 Modification 4 authorizes unintentional lethal take of adult Southern Oregon/Northern California Coast coho salmon and Northern California steelhead not to exceed 1 percent of fish captured. Permit 1044 Modification 4 authorizes intentional lethal take of 500 juvenile Northern California steelhead, 300 juvenile Central California Coast steelhead, 300 juvenile California Central Valley steelhead, and 200 juvenile South-Central California Coast steelhead.</P>
                <P>Permit 1044 Modification 4 is for research to be conducted in streams and estuaries throughout the State of California. The purpose of the research is to support conservation and recovery planning of ESA-listed salmonids, address information needs identified by NMFS, and contribute to the general body of scientific knowledge pertaining to ESA-listed salmonids. Permit 1044 Modification 4 expires on December 31, 2012.</P>
                <SIG>
                    <DATED>Dated: November 21, 2007.</DATED>
                    <NAME>Angela Somma,</NAME>
                    <TITLE>Chief, Endangered Species Division, Office of Protected Resources, National Marine Fisheries Service.</TITLE>
                </SIG>
            </SUPLINF>
            <FRDOC>[FR Doc. E7-23093 Filed 11-26-07; 8:45 am]</FRDOC>
            <BILCOD>BILLING CODE 3510-22-S</BILCOD>
        </NOTICE>
        <NOTICE>
            <PREAMB>
                <AGENCY TYPE="S">DEPARTMENT OF COMMERCE</AGENCY>
                <SUBAGY>National Oceanic and Atmospheric Administration</SUBAGY>
                <RIN>RIN 0648-XC38</RIN>
                <SUBJECT>Marine Mammals; File No. 1034-1854</SUBJECT>
                <AGY>
                    <HD SOURCE="HED">AGENCY:</HD>
                    <P>National Marine Fisheries Service (NMFS), National Oceanic and Atmospheric Administration (NOAA), Commerce.</P>
                </AGY>
                <ACT>
                    <HD SOURCE="HED">ACTION:</HD>
                    <P>Notice; issuance of permit amendment.</P>
                </ACT>
                <SUM>
                    <HD SOURCE="HED">SUMMARY:</HD>
                    <P>Notice is hereby given that Dr. Markus Horning, Department of Fisheries &amp; Wildlife, Oregon State University, Hatfield Marine Science Center, 2030 SE Marine Science Drive, Newport, OR 97365 has been issued an amendment to scientific research Permit No. 1034-1854.</P>
                </SUM>
                <ADD>
                    <HD SOURCE="HED">ADDRESSES:</HD>
                    <P>The amendment and related documents are available for review upon written request or by appointment in the following office(s):</P>
                    <P>Permits, Conservation and Education Division, Office of Protected Resources, NMFS, 1315 East-West Highway, Room 13705, Silver Spring, MD 20910; phone (301)713-2289; fax (301)427-2521; and</P>
                    <P>Southwest Region, NMFS, 501 West Ocean Blvd., Suite 4200, Long Beach, CA 90802-4213; phone (562)980-4001; fax (562)980-4018.</P>
                </ADD>
                <FURINF>
                    <HD SOURCE="HED">FOR FURTHER INFORMATION CONTACT:</HD>
                    <P>Amy Sloan or Tammy Adams, (301)713-2289.</P>
                </FURINF>
            </PREAMB>
            <SUPLINF>
                <HD SOURCE="HED">SUPPLEMENTARY INFORMATION:</HD>
                <P>
                    On September 10, 2007, notice was published in the 
                    <E T="04">Federal Register</E>
                     (72 FR 51621) that an amendment of Permit No. 1034-1854, had been requested by the above-named individual. The requested amendment has been granted under the authority of the Marine Mammal Protection Act of 1972, as amended (16 U.S.C. 1361 
                    <E T="03">et seq.</E>
                    ), and the regulations governing the taking and importing of marine mammals (50 CFR part 216).
                </P>
                <P>The permit amendment authorizes the permit holder to (1) increase the number of blood samples taken from animals with Evans blue dye administered; (2) leave satellite data transmitters on adult females until they fall off during the annual molt, rather than removing them at the end of the field season; and (3) opportunistically attach satellite transmitters to selected adult females older than 21 years when first encountered, for subsequent recapture, sampling, and outfitting with remaining telemetry devices. The permit holder is also authorized to collect opportunistic fecal samples and import them into the U.S..</P>
                <P>
                    In compliance with the National Environmental Policy Act of 1969 (42 U.S.C. 4321 
                    <E T="03">et seq.</E>
                    ), a final determination has been made that the activity proposed is categorically excluded from the requirement to prepare an environmental assessment or environmental impact statement.
                </P>
                <SIG>
                    <DATED>Dated: November 21, 2007.</DATED>
                    <NAME>P. Michael Payne,</NAME>
                    <TITLE>Chief, Permits, Conservation and Education Division, Office of Protected Resources, National Marine Fisheries Service.</TITLE>
                </SIG>
            </SUPLINF>
            <FRDOC>[FR Doc. E7-23063 Filed 11-26-07; 8:45 am]</FRDOC>
            <BILCOD>BILLING CODE 3510-22-S</BILCOD>
        </NOTICE>
        <NOTICE>
            <PREAMB>
                <AGENCY TYPE="S">DEPARTMENT OF COMMERCE</AGENCY>
                <SUBAGY>National Oceanic and Atmospheric Administration</SUBAGY>
                <RIN>RIN: 0648-XE10</RIN>
                <SUBJECT>Mid-Atlantic Fishery Management Council; Public Meetings</SUBJECT>
                <AGY>
                    <HD SOURCE="HED">AGENCY:</HD>
                    <P>National Marine Fisheries Service (NMFS), National Oceanic and Atmospheric Administration (NOAA), Commerce.</P>
                </AGY>
                <ACT>
                    <HD SOURCE="HED">ACTION:</HD>
                    <P>Notice of public meetings.</P>
                </ACT>
                <SUM>
                    <HD SOURCE="HED">SUMMARY:</HD>
                    <P>The Mid-Atlantic Fishery Management Council (Council), its Mid-Atlantic section of the Monkfish Committee, its Squid, Mackerel, and Butterfish Committee, its Bycatch/Limited Access Committee, and its Executive Committee will hold public meetings.</P>
                </SUM>
                <DATES>
                    <HD SOURCE="HED">DATES:</HD>
                    <P>
                        The meetings will be held on Monday, December 10, 2007 through Thursday, December 14, 2007. See 
                        <E T="02">SUPPLEMENTARY INFORMATION</E>
                         for specific dates and times
                    </P>
                </DATES>
                <ADD>
                    <HD SOURCE="HED">ADDRESSES:</HD>
                    <P>This meeting will be held at the Holiday Inn Harmon Meadow, 300 Plaza Drive, Secaucus, NJ 07094; telephone: (201) 348-2000.</P>
                    <P>
                        <E T="03">Council address</E>
                        : Mid-Atlantic Fishery Management Council, 300 S. New Street, Dover, DE 19904; telephone: (302) 674-2331.
                    </P>
                </ADD>
                <FURINF>
                    <HD SOURCE="HED">FOR FURTHER INFORMATION CONTACT:</HD>
                    <P>Daniel T. Furlong, Executive Director, Mid-Atlantic Fishery Management Council; telephone: (302) 674-2331, ext. 19.</P>
                </FURINF>
            </PREAMB>
            <SUPLINF>
                <HD SOURCE="HED">SUPPLEMENTARY INFORMATION:</HD>
                <P>
                    On Monday, December 10, the Council will convene to conduct a workshop on the impact of the Reauthorized Magnuson-Stevens Act on its specification setting process. On Tuesday, December 11, the Council will convene jointly with the Atlantic States Marine Fisheries Commission's (ASMFC) Summer Flounder, Scup, and Black Sea Bass Board beginning at 8:30 a.m. through 4:30 p.m. From 4:30 p.m. until 5:30 p.m. the Mid-Atlantic section of the Monkfish Committee will meet. On Wednesday, December 12, the Council will convene at 8 a.m. until 1:15 p.m. From 1:15 p.m. until 3:30 p.m. the Squid, Mackerel, and Butterfish Committee will meet. From 3:30 p.m. until 5:30 p.m. the Bycatch / Limited Access Committee will meet. On Thursday, December 13, the Executive Committee will meet from 8 a.m. until 9 a.m. The Council will convene at 9 a.m. and remain in session until approximately 12 p.m.
                    <PRTPAGE P="66139"/>
                </P>
                <P>Agenda items by day for the Council's committees and the Council itself are: Monday, December 10 - The Council will convene to conduct a workshop on the impact of the Reauthorized Magnuson-Stevens Act on its specification setting process. Tuesday, December 11 - The Council will convene jointly with the Atlantic States Marine Fisheries Commission's (ASFMC) Summer Flounder, Scup, and Black Sea Bass Board. They will review and discuss the Monitoring Committee's and the Advisory Panel's recommendations on summer flounder, scup, and black sea bass recreational management measures, and develop and approve management measures for the 2008 summer flounder recreational fisheries. The Mid-Atlantic section of the Monkfish Committee will review and discuss action taken by the New England Council regarding Framework 5 and 6, and develop a Council position regarding Framework 5 and Framework 6. Wednesday, December 12 - The Council will conduct its regular business session to approve October Council minutes, approve actions from the October meeting, and receive various organizational reports. The Council will review and approve the final action on Framework 5 to the Monkfish FMP. There will be an awards presentation to recognize the 2007 Fisheries Achievement Award winner. The Squid, Mackerel, and Butterfish Committee will review management alternatives to address the mackerel limited entry program. The Bycatch/Limited Access Committee will receive an update on the National Bycatch Report. Thursday, December 13 - The Executive Committee will review the Scientific and Statistical Committee (SSC) membership process and SSC member stipends. The Council will then convene to receive a Marine Debris presentation and Committee reports, review and approve changes to the Statement of Organization, Practices, and Procedures (SOPP) related to the SSC role, address reappointment of existing members, fill two vacancies on the SSC, and discuss the concept of adjunct SSC members.</P>
                <P>Although non-emergency issues not contained in this agenda may come before the Council for discussion, these issues may not be the subject of formal Council action during this meeting. Council action will be restricted to those issues specifically listed in this notice and any issues arising after publication of this notice that require emergency action under section 305(c) of the Magnuson-Stevens Act, provided the public has been notified of the Council's intent to take final actions to address such emergencies.</P>
                <HD SOURCE="HD1">Special Accommodations</HD>
                <P>This meeting is physically accessible to people with disabilities. Requests for sign language interpretation or other auxiliary aids should be directed to M. Jan Bryan, (302) 674-2331 ext: 18, at least 5 days prior to the meeting date.</P>
                <SIG>
                    <DATED>Dated: November 21, 2007.</DATED>
                    <NAME>Tracey L. Thompson,</NAME>
                    <TITLE>Acting Director, Office of Sustainable Fisheries, National Marine Fisheries Service.</TITLE>
                </SIG>
            </SUPLINF>
            <FRDOC>[FR Doc. E7-23018 Filed 11-26-07; 8:45 am]</FRDOC>
            <BILCOD>BILLING CODE 3510-22-S</BILCOD>
        </NOTICE>
        <NOTICE>
            <PREAMB>
                <AGENCY TYPE="S">DEPARTMENT OF COMMERCE</AGENCY>
                <SUBAGY>National Oceanic and Atmospheric Administration</SUBAGY>
                <RIN>RIN 0648-XE12</RIN>
                <SUBJECT>New England Fishery Management Council; Public Meeting</SUBJECT>
                <AGY>
                    <HD SOURCE="HED">AGENCY:</HD>
                    <P>National Marine Fisheries Service (NMFS), National Oceanic and Atmospheric Administration (NOAA), Commerce.</P>
                </AGY>
                <ACT>
                    <HD SOURCE="HED">ACTION:</HD>
                    <P>Notice of a public meeting.</P>
                </ACT>
                <SUM>
                    <HD SOURCE="HED">SUMMARY:</HD>
                    <P>The New England Fishery Management Council's (Council) Multispecies (Groundfish) Committee will meet to consider actions affecting New England fisheries in the exclusive economic zone (EEZ).</P>
                </SUM>
                <DATES>
                    <HD SOURCE="HED">DATES:</HD>
                    <P>The two-day meeting will be held on Wednesday, December 12, 2007, at 9 a.m. and Thursday, December 13, 2007, at 8:30 a.m.</P>
                </DATES>
                <ADD>
                    <HD SOURCE="HED">ADDRESSES:</HD>
                    <P>The meeting will be held at the Holiday Inn, One Newbury Street, Peabody, MA 01960; telephone: (978) 535-4600.</P>
                    <P>
                        <E T="03">Council address</E>
                        : New England Fishery Management Council, 50 Water Street, Mill 2, Newburyport, MA 01950.
                    </P>
                </ADD>
                <FURINF>
                    <HD SOURCE="HED">FOR FURTHER INFORMATION CONTACT:</HD>
                    <P>Paul J. Howard, Executive Director, New England Fishery Management Council; telephone: (978) 465-0492.</P>
                </FURINF>
            </PREAMB>
            <SUPLINF>
                <HD SOURCE="HED">SUPPLEMENTARY INFORMATION:</HD>
                <P>The Multispecies (Groundfish) Committee will meet for two days to consider additional issues for Amendment 16 to the Northeast Multispecies Fishery Management Plan. The items of discussion in the committee's agenda are as follows:</P>
                <HD SOURCE="HD1">Wednesday, December 12, 2007</HD>
                <P>The Committee will continue to develop a process for allocation of groundfish species and a process to set the Annual Catch Limits (ACL's) and Accountability Measures (AM's)for the recreational users. It also will continue to develop days-at-sea (DAS) measures to meet the mortality requirements set under Amendment 13, establishing a process to set ACL's and AM's for the common pool commercial users, and developing DAS transfer and leasing taxes. The Committee may also consider other DAS measures necessary to complete its work for Amendment 16.</P>
                <HD SOURCE="HD1">Thursday, December 13, 2007</HD>
                <P>The Committee will finish any uncompleted issues from day one and work on the following items:</P>
                <P>Measures for sector management to include baseline time-frame; allocation mechanisms, replacing the 20% species cap; monitoring mechanisms for sectors.</P>
                <P>The Committee may also consider other sector issues and any measures necessary to complete its work for Amendment 16.</P>
                <P>Although non-emergency issues not contained in this agenda may come before this group for discussion, those issues may not be the subject of formal action during this meeting. Action will be restricted to those issues specifically identified in this notice and any issues arising after publication of this notice that require emergency action under section 305(c) of the Magnuson-Stevens Fishery Conservation and Management Act, provided the public has been notified of the Council's intent to take final action to address the emergency.</P>
                <HD SOURCE="HD1">Special Accommodations</HD>
                <P>
                    This meeting is physically accessible to people with disabilities. Requests for sign language interpretation or other auxiliary aids should be directed to Paul J. Howard (see 
                    <E T="02">ADDRESSES</E>
                    ) at least 5 days prior to the meeting date.
                </P>
                <AUTH>
                    <HD SOURCE="HED">Authority:</HD>
                    <P>
                         16 U.S.C. 1801 
                        <E T="03">et seq.</E>
                    </P>
                </AUTH>
                <SIG>
                    <DATED>Dated: November 21, 2007.</DATED>
                    <NAME>Tracey L. Thompson,</NAME>
                    <TITLE>Acting Director, Office of Sustainable Fisheries, National Marine Fisheries Service.</TITLE>
                </SIG>
            </SUPLINF>
            <FRDOC>[FR Doc. E7-23019 Filed 11-26-07; 8:45 am]</FRDOC>
            <BILCOD>BILLING CODE 3510-22-S</BILCOD>
        </NOTICE>
        <NOTICE>
            <PREAMB>
                <PRTPAGE P="66140"/>
                <AGENCY TYPE="N">DEPARTMENT OF DEFENSE</AGENCY>
                <AGENCY TYPE="O">GENERAL SERVICES ADMINISTRATION</AGENCY>
                <AGENCY TYPE="O">NATIONAL AERONAUTICS AND SPACE ADMINISTRATION</AGENCY>
                <DEPDOC>[OMB Control No. 9000-0013]</DEPDOC>
                <SUBJECT>Federal Acquisition Regulation; Information Collection; Cost or Pricing Data Requirements and Information Other Than Cost or Pricing Data</SUBJECT>
                <AGY>
                    <HD SOURCE="HED">AGENCIES:</HD>
                    <P>Department of Defense (DOD), General Services Administration (GSA), and National Aeronautics and Space Administration (NASA).</P>
                </AGY>
                <ACT>
                    <HD SOURCE="HED">ACTION:</HD>
                    <P>Notice of request for public comments regarding an extension to an existing OMB clearance.</P>
                </ACT>
                <SUM>
                    <HD SOURCE="HED">SUMMARY:</HD>
                    <P>Under the provisions of the Paperwork Reduction Act of 1995 (44 U.S.C. Chapter 35), the Federal Acquisition Regulation (FAR) Secretariat will be submitting to the Office of Management and Budget (OMB) a request to review and approve an extension of a currently approved information collection requirement concerning cost or pricing data requirements and information other than cost or pricing data.  The clearance currently expires on May 31, 2008.</P>
                    <P>Public comments are particularly invited on:  Whether this collection of information is necessary for the proper performance of functions of the FAR, and whether it will have practical utility; whether our estimate of the public burden of this collection of information is accurate, and based on valid assumptions and methodology; ways to enhance the quality, utility, and clarity of the information to be collected; and ways in which we can minimize the burden of the collection of information on those who are to respond, through the use of appropriate technological collection techniques or other forms of information technology.</P>
                </SUM>
                <EFFDATE>
                    <HD SOURCE="HED">DATES:</HD>
                    <P>Submit comments on or before January 28, 2008.</P>
                </EFFDATE>
                <ADD>
                    <HD SOURCE="HED">ADDRESSES:</HD>
                    <P>Submit comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden to the General Services Administration, FAR Secretariat (VIR), 1800 F Street, NW., Room 4035, Washington, DC 20405.</P>
                </ADD>
                <FURINF>
                    <HD SOURCE="HED">FOR FURTHER INFORMATION CONTACT:</HD>
                    <P>Edward Chambers, Contract Policy Division, GSA (202) 501-3221.</P>
                </FURINF>
            </PREAMB>
            <SUPLINF>
                <HD SOURCE="HED">SUPPLEMENTARY INFORMATION:</HD>
                <HD SOURCE="HD1">A.  Purpose</HD>
                <P>The Truth in Negotiations Act requires the Government to obtain certified cost or pricing data under certain circumstances.  Contractors may request an exemption from this requirement under certain conditions and provide other information instead.</P>
                <HD SOURCE="HD1">B.  Annual Reporting Burden</HD>
                <P>
                    <E T="03">Respondents:</E>
                     33,332.
                </P>
                <P>
                    <E T="03">Responses Per Respondent:</E>
                     6.
                </P>
                <P>
                    <E T="03">Total Responses:</E>
                     199,992.
                </P>
                <P>
                    <E T="03">Hours Per Response:</E>
                     50.51.
                </P>
                <P>
                    <E T="03">Total Burden Hours:</E>
                     10,101,684.
                </P>
                <P>
                    <E T="03">OBTAINING COPIES OF PROPOSALS:</E>
                     Requesters may obtain a copy of the information collection documents from the General Services Administration, FAR Secretariat (VIR), Room 4035, 1800 F Street, NW., Washington, DC 20405, telephone (202) 501-4755.  Please cite OMB Control No. 9000-0013, Cost or Pricing Data Requirements and Information Other Than Cost or Pricing Data, in all correspondence.
                </P>
                <SIG>
                    <DATED>Dated:  November 8, 2007.</DATED>
                    <NAME>Al Matera,</NAME>
                    <TITLE>Director, Office of Acquisition Policy.</TITLE>
                </SIG>
            </SUPLINF>
            <FRDOC>[FR Doc. 07-5836 Filed 11-26-07; 8:45 am]</FRDOC>
            <BILCOD>BILLING CODE 6820-EP-S</BILCOD>
        </NOTICE>
        <NOTICE>
            <PREAMB>
                <AGENCY TYPE="S">DEPARTMENT OF DEFENSE </AGENCY>
                <SUBAGY>Department of the Navy </SUBAGY>
                <SUBJECT>Notice of Partially Closed Meeting of the Naval Research Advisory Committee; Correction </SUBJECT>
                <AGY>
                    <HD SOURCE="HED">AGENCY:</HD>
                    <P>Department of the Navy, DoD. </P>
                </AGY>
                <ACT>
                    <HD SOURCE="HED">ACTION:</HD>
                    <P>Notice; correction. </P>
                </ACT>
                <SUM>
                    <HD SOURCE="HED">SUMMARY:</HD>
                    <P>
                        The Department of the Navy published a document in the 
                        <E T="04">Federal Register</E>
                         of November 14, 2007, announcing a partially closed meeting of the Naval Research Advisory Committee (NRAC). The dates of the meeting contained in the document have changed. 
                    </P>
                </SUM>
                <FURINF>
                    <HD SOURCE="HED">FOR FURTHER INFORMATION CONTACT:</HD>
                    <P>
                        Mr. William H. Ellis, Jr., Program Director, Naval Research Advisory Committee, 875 North Randolph Street, Arlington, VA 22203-1995; 
                        <E T="03">telephone:</E>
                         703-696-5775. 
                    </P>
                    <HD SOURCE="HD1">Correction </HD>
                    <P>
                        In the 
                        <E T="04">Federal Register</E>
                         of November 14, 2007, in FR Doc. E7-22200, make the following changes: 
                    </P>
                    <P>
                        1. In the second column, on page 64060, correct the second sentence of the 
                        <E T="02">SUMMARY</E>
                         to read: 
                    </P>
                    <P>“With the exception of two unclassified sessions on December 19, 2007 from 2 p.m. to 3 p.m. and from 3 p.m. to 4 p.m., all other sessions on December 18, 2007 and December 19, 2007 will include discussions involving proprietary information regarding technology applications and systems under development in the private sector between competing companies and/or information classified at the SECRET level that is devoted to intelligence briefings; emerging threats posed by potential adversaries; the exploitation of physical vulnerabilities; the tactical applications of known and emerging technologies; an assessment of the emerging concepts in such areas as: Training, S&amp;T funding allocation, technology monitoring, progress assessments, and probable timeframes for transformation and implementation; the challenges raised with the utilization and fielding of various technology applications; and a security briefing that will discuss security policies and procedures, and counterintelligence information classified at the SECRET level.” </P>
                    <P>
                        2. In the third column, on page 64060, correct the 
                        <E T="02">DATES</E>
                         caption to read: 
                    </P>
                    <P>
                        “
                        <E T="02">DATES</E>
                        : The Winter Meetings will be held on Tuesday, December 18, 2007 and Wednesday, December 19, 2007. The open sessions of the meeting will be held on Wednesday, December 19, 2007, from 2 p.m. to 3 p.m. and from 3 p.m. to 4 p.m. The closed sessions will be held all day on Tuesday, December 18, 2007, and on Wednesday, December 19, 2007, from 8 a.m. to 2 p.m. and 4 p.m. to 4:15 p.m.” 
                    </P>
                    <SIG>
                        <DATED>Dated: November 20, 2007. </DATED>
                        <NAME>T. M. Cruz, </NAME>
                        <TITLE>Lieutenant, Judge Advocate Generals Corps, U.S. Navy, Federal Register Liaison Officer. </TITLE>
                    </SIG>
                </FURINF>
            </PREAMB>
            <FRDOC>[FR Doc. E7-22990 Filed 11-26-07; 8:45 am] </FRDOC>
            <BILCOD>BILLING CODE 3810-FF-P </BILCOD>
        </NOTICE>
        <NOTICE>
            <PREAMB>
                <AGENCY TYPE="N">DELAWARE RIVER BASIN COMMISSION </AGENCY>
                <SUBJECT>Notice of Commission Meeting and Public Hearing </SUBJECT>
                <P>
                    Notice is hereby given that the Delaware River Basin Commission will hold an informal conference followed by a public hearing on Wednesday, December 12, 2007. The hearing will be part of the Commission's regular business meeting. Both the conference session and business meeting are open to the public and will be held at the Commission's office building, located at 25 State Police Drive in West Trenton, New Jersey. The conference among the commissioners and staff will begin at 10 a.m. Topics of discussion will include: 
                    <PRTPAGE P="66141"/>
                    a status report by staff of the U.S. Geological Survey on the flood analysis model under development in accordance with DRBC Resolution No. 2006-20 to evaluate the potential for reservoirs throughout the basin to be used to mitigate flooding along the Delaware River and its tributaries; status of a proposal to update the water quality standard for PCBs in the Delaware Estuary and provide for implementation of the new standard; a report on the status of three pending rulemakings—(a) amendments to the Water Code and Water Quality Regulations relating to water accountability and source metering, recording and reporting; (b) Water Code amendments to implement a Flexible Flow Management Program proposed by the parties to the Supreme Court Decree of 1954 for operation of the New York City Delaware Basin reservoirs; and (c) amendments to the Water Code and Water Quality Regulations regarding Special Protection Waters. In addition, there will be a discussion of the proposed DRBC FY 2008-2009 Water Resources Program and a presentation by Dr. Rebecca L. Schneider of Cornell University on how networks of roadside ditches across watersheds contribute significantly to flooding, droughts, and degraded water quality downstream. 
                </P>
                <P>The subjects of the public hearing to be held during the 1:30 p.m. business meeting include the dockets listed below: </P>
                <P>
                    1. 
                    <E T="03">Deptford Township Municipal Utilities Authority D-94-68 CP-2.</E>
                     An application for the renewal of a ground water withdrawal project to continue withdrawal of 123 mg/30 days to supply the applicant's public water supply distribution system from existing Wells Nos. 1, 2, 4, 6, 7, 8 and 9R in the Potomac-Raritan-Magothy Formation. The project is located in the Lower Delaware Watershed in Deptford Township, Gloucester County, New Jersey, in New Jersey Critical Water Supply Area 2. 
                </P>
                <P>
                    2. 
                    <E T="03">City of Vineland D-95-47 CP-2.</E>
                     An application for the renewal of a ground water withdrawal project to continue the withdrawal of 494.5 mg/30 days to supply the applicant's public water supply distribution system from existing Wells Nos. 2 through 14 in the Cohansey Formation. The project is located in the Maurice River Watershed in the City of Vineland, Cumberland County, New Jersey. 
                </P>
                <P>
                    3. 
                    <E T="03">Merchantville-Pennsauken Water Commission D-97-5 CP-2.</E>
                     An application for the renewal of a ground water withdrawal project to continue withdrawal of 335 mg/30 days to supply the applicant's public water supply distribution system from fifteen (15) existing wells in the Potomac-Raritan-Magothy Formation. The project is located in the Pennsauken Creek Watershed in Merchantville Borough and Pennsauken Township, Camden County, New Jersey. 
                </P>
                <P>
                    4. 
                    <E T="03">Nestlé Waters North America, Inc. D-98-27-3.</E>
                     An application for the renewal of a spring water withdrawal project to continue withdrawal of 9 mg/30 days to supply the applicant's bottled water operations from existing Hoffman Springs Nos. 1, 2 and 3 and new Mattos Catchment No. 1. The project is located in the Ontelaunee Creek Watershed in Lynn Township, Lehigh County, Pennsylvania. 
                </P>
                <P>
                    5. 
                    <E T="03">Sapa Extrusions, Inc. (formerly Alcoa Extrusions, Inc.) D-2005-1-3.</E>
                     An application to continue to discharge up to 0.10 mgd from an existing outfall to the West Branch Schuylkill River. No expansion of the treatment facility is proposed and no alterations to the existing effluent limits are requested. The treatment facility is located in Cressona Borough, Schuylkill County, Pennsylvania. 
                </P>
                <P>
                    6. 
                    <E T="03">E. I. du Pont de Nemours and Company D-71-86-2.</E>
                     An application for the renewal and update of the Edge Moor facility's IWTP and non-contact cooling water discharges and for approval of the installation of an effluent diffuser. The permitted discharges from the applicant's titanium dioxide production facility include a 5.2 mgd discharge of treated IWTP effluent from Outfall 001, a 2.89 mgd discharge of non-contact cooling water and storm water from Outfall 002, and a 5.9 mgd discharge of non-contact cooling water and stormwater from Outfall 003. The facility will continue to discharge to the Delaware River. The facility is located in Edgemoor, Delaware. 
                </P>
                <P>
                    7. 
                    <E T="03">Warren County (Pequest River) Municipal Authority D-71-96 CP-2.</E>
                     An application to modify an existing docket by providing a Total Dissolved Solids (TDS) determination for the Warren County (Pequest River) Municipal Utilities Authority's Oxford Area Wastewater Treatment Plant (WWTP). The Oxford Area WWTP has a design flow of 0.5 million gallons per day (mgd) and treats primarily domestic sewage prior to discharge to the Pequest River at River Mile 197.8-7.2-0.9. The facility also accepts leachate from a landfill operated by the Pollution Control Financing Authority of Warren County and from Covanta Industry. Because these waste streams can result in a WWTP discharge that exceeds DRBC's basinwide effluent TDS limitation of 1000 mg/L, the applicant has requested a variance in the form of an adjusted effluent TDS limitation of 9,864 pounds per day. DRBC criteria allow for a variance from a TDS effluent limit where the variance would not result in an instream TDS concentration in excess of 500 mg/L or an increase in the instream TDS concentrations of more than 33%. The Pequest is a tributary of the Lower Delaware River, which DRBC has designated on an interim basis as Special Protection Waters with a classification of Significant Resource Waters. The facility is located in Oxford Township, Warren County, New Jersey. 
                </P>
                <P>
                    8. 
                    <E T="03">County of Chester Department of Facilities Management D-83-15 CP-3.</E>
                     An application for approval to expand a 0.105 mgd WWTP to treat an average flow of 0.13676 mgd. The WWTP will continue to serve only the Pocopson Home and Prison, located in Pocopson Township, Chester County, Pennsylvania. Following advanced treatment, the WWTP effluent will be applied to expanded adjacent spray fields, which are located in the Pocopson Creek Watershed. A new aerated lagoon will be constructed to provide sufficient supplemental effluent storage, so that a WWTP discharge to a stream will not be needed. 
                </P>
                <P>
                    9. 
                    <E T="03">The Premcor Refining Group, Inc. D-93-4-6.</E>
                     An application to replace the withdrawal of water from Wells Nos. P-3A and P-4A in the applicant's water supply system that have become unreliable sources of supply and to increase the applicant's surface water withdrawal from the Delaware River and Red Lion Creek. Premcor requests that its combined withdrawal from replacement Wells Nos. P-3B and P-4B and seven existing wells remain limited to 180 million gallons per thirty days (mg/30 days); that its withdrawal from the Delaware River intake remain 13,560 mg/30 days; that the docket authorize withdrawals of 38.9 mg/30 days from the Red Lion Creek intake and up to 56.2 mg/30 days from the Dragon Run intake, and that Premcor's combined withdrawal from all sources be limited to 13,835.1 mg/30 days. The proposed allocation represents no increase in groundwater withdrawals and no increase from the Delaware River intake. The docket is proposed to include previously un-docketed pre-Compact DNREC allocations from Dragon Run and Red Lion Creek. The project is located in the Potomac Formation in the C&amp;D Canal East, Dragon Run Creek, Red Lion Creek and Delaware River watersheds in Delaware City, New Castle County, Delaware. 
                </P>
                <P>
                    10. 
                    <E T="03">Valero Paulsboro Refinery D-2006-28-1.</E>
                     An application for approval of a surface water withdrawal project to 
                    <PRTPAGE P="66142"/>
                    supply up to 10.8 mgd (324 mg/30 days) of water to the applicant's petroleum refinery from an existing surface water intake. The project is located in the Delaware Watershed in Greenwich Township, Gloucester County, New Jersey, in New Jersey Critical Water Supply Area 2. 
                </P>
                <P>
                    11. 
                    <E T="03">Exelon Power D-2006-44-1.</E>
                     An application for approval of an existing surface water withdrawal project to supply up to 9,975 mg/30 days of water to the applicant's Cromby Generating Station from the Schuylkill River and to limit the existing withdrawal from all intakes to 9,975 mg/30 days. No increase in withdrawals is requested. The project is located in the Schuylkill River Watershed in East Pikeland Township, Chester County, Pennsylvania and is located in the Southeastern Pennsylvania Ground Water Protected Area. 
                </P>
                <P>
                    12. 
                    <E T="03">To-Jo Mushrooms Inc. D-2007-3-1.</E>
                     An application for approval of the rerate of the existing To-Jo Mushroom IWTP from 0.03 mgd to 0.049 mgd and for approval of the existing 0.035 mgd discharge of contact cooling water. The applicant's IWTP serves a mushroom canning facility. The IWTP and contact cooling water will continue to be discharged to Trout Run, a tributary of the White Clay Creek. The facility is located in New Garden Township, Chester County, Pennsylvania. 
                </P>
                <P>
                    13. 
                    <E T="03">The Asbury Graphite Mills, Inc. D-2007-26-1.</E>
                     An application for approval of a ground water withdrawal project to supply up to 5.65 mg/30 days of water to the applicant's manufacturing facility from Intakes Nos. 1, 2A, 2B and 2C in the Musconetcong River and to supply up to 1.43 mg/30 days from Wells Nos. 1 and 2 completed in the Allentown Dolomite Formation in the Musconetcong River Watershed, for a total allocation of 7.08 mg/30 days. The project is located in Bethlehem Township, Hunterdon County, New Jersey, within the drainage area to the section of the non-tidal Delaware River known as the Lower Delaware, which is designated as Special Protection Waters. 
                </P>
                <P>
                    14. 
                    <E T="03">Woodbourne Correctional Facility D-2007-28 CP-1.</E>
                     An application for approval of a ground water withdrawal project to supply up to 7.20 mg/30 days of water to the applicant's domestic water supply from Wells Nos. 1, 2, 3, 4, 5, 6 and 7 and to limit the existing withdrawal from all wells to 7.20 mg/30 days. The project is located in the Valley Fill Aquifer in the Middle Delaware Watershed in Woodbourne Township, Sullivan County, New York, within the drainage area to the section of the non-tidal Delaware River known as the Upper Delaware, which is designated as Special Protection Waters. 
                </P>
                <P>In addition, the Commission's 1:30 p.m. business meeting will include a public hearing on the proposed Fiscal Year 2008-2009 Current Expense and Capital Budgets. </P>
                <P>The business meeting also will include adoption of the Minutes of the Commission's September 26, 2007 business meeting; announcements of upcoming advisory committee meetings and other events; a report by the Executive Director; a report by the Commission's General Counsel; and an opportunity for public dialogue. </P>
                <P>
                    Draft dockets scheduled for public hearing on December 12, 2007 will be posted on the Commission's Web site, 
                    <E T="03">http://www.drbc.net</E>
                    , where they can be accessed through the Notice of Commission Meeting and Public Hearing. Additional documents relating to the dockets and other items may be examined at the Commission's offices. Please contact William Muszynski at 609-883-9500, extension 221, with any docket-related questions. 
                </P>
                <P>Individuals in need of an accommodation as provided for in the Americans with Disabilities Act who wish to attend the informational meeting, conference session or hearings should contact the Commission secretary directly at 609-883-9500 ext. 203 or through the Telecommunications Relay Services (TRS) at 711, to discuss how the Commission can accommodate your needs. </P>
                <SIG>
                    <DATED>November 19, 2007. </DATED>
                    <NAME>Pamela M. Bush, </NAME>
                    <TITLE>Commission Secretary.</TITLE>
                </SIG>
            </PREAMB>
            <FRDOC> [FR Doc. E7-23013 Filed 11-26-07; 8:45 am] </FRDOC>
            <BILCOD>BILLING CODE 6360-01-P </BILCOD>
        </NOTICE>
        <NOTICE>
            <PREAMB>
                <AGENCY TYPE="N">DEPARTMENT OF EDUCATION </AGENCY>
                <SUBJECT>Submission for OMB Review; Comment Request </SUBJECT>
                <AGY>
                    <HD SOURCE="HED">AGENCY:</HD>
                    <P>Department of Education. </P>
                </AGY>
                <SUM>
                    <HD SOURCE="HED">SUMMARY:</HD>
                    <P>The IC Clearance Official, Regulatory Information Management Services, Office of Management invites comments on the submission for OMB review as required by the Paperwork Reduction Act of 1995. </P>
                </SUM>
                <DATES>
                    <HD SOURCE="HED">DATES:</HD>
                    <P>Interested persons are invited to submit comments on or before December 27, 2007. </P>
                </DATES>
                <ADD>
                    <HD SOURCE="HED">ADDRESSES:</HD>
                    <P>
                        Written comments should be addressed to the Office of Information and Regulatory Affairs, 
                        <E T="03">Attention:</E>
                         Education Desk Officer, Office of Management and Budget, 725 17th Street, NW., Room 10222, Washington, DC 20503. Commenters are encouraged to submit responses electronically by email to 
                        <E T="03">oira_submission@omb.eop.gov</E>
                         or via fax to (202) 395-6974. Commenters should include the following subject line in their response “Comment: [insert OMB number], [insert abbreviated collection name, e.g., “Upward Bound Evaluation”]. Persons submitting comments electronically should not submit paper copies. 
                    </P>
                </ADD>
            </PREAMB>
            <SUPLINF>
                <HD SOURCE="HED">SUPPLEMENTARY INFORMATION:</HD>
                <P>Section 3506 of the Paperwork Reduction Act of 1995 (44 U.S.C. Chapter 35) requires that the Office of Management and Budget (OMB) provide interested Federal agencies and the public an early opportunity to comment on information collection requests. OMB may amend or waive the requirement for public consultation to the extent that public participation in the approval process would defeat the purpose of the information collection, violate State or Federal law, or substantially interfere with any agency's ability to perform its statutory obligations. The IC Clearance Official, Regulatory Information Management Services, Office of Management, publishes that notice containing proposed information collection requests prior to submission of these requests to OMB. Each proposed information collection, grouped by office, contains the following: (1) Type of review requested, e.g. new, revision, extension, existing or reinstatement; (2) Title; (3) Summary of the collection; (4) Description of the need for, and proposed use of, the information; (5) Respondents and frequency of collection; and (6) Reporting and/or Recordkeeping burden. OMB invites public comment. </P>
                <SIG>
                    <DATED>Dated: November 20, 2007. </DATED>
                    <NAME>Angela C. Arrington, </NAME>
                    <TITLE>IC Clearance Official, Regulatory Information Management Services, Office of Management.</TITLE>
                </SIG>
                <HD SOURCE="HD1">Office of Postsecondary Education </HD>
                <P>
                    <E T="03">Type of Review:</E>
                     Revision. 
                </P>
                <P>
                    <E T="03">Title:</E>
                     Targeted Teacher Shortage Areas. 
                </P>
                <P>
                    <E T="03">Frequency:</E>
                     Annually. 
                </P>
                <P>
                    <E T="03">Affected Public:</E>
                     State, Local, or Tribal Gov't, SEAs or LEAs. 
                </P>
                <P>
                    <E T="03">Reporting and Recordkeeping Hour Burden:</E>
                </P>
                <P>
                     
                    <E T="03">Responses:</E>
                     57. 
                </P>
                <P>
                     
                    <E T="03">Burden Hours:</E>
                     4,560. 
                </P>
                <P>
                    <E T="03">Abstract:</E>
                     This request is for approval of record-keeping and reporting requirements that are contained in the FFELP regulations which address the targeted teacher deferment provision of the Higher Education Act of 1965, as amended. The information collected is necessary for a state to support its 
                    <PRTPAGE P="66143"/>
                    annual request for designation of teacher shortage areas within the state. The collection of certification documentation by the borrower/scholar is necessary to support his/her request for a deferment/reduction in teaching obligation or cancellation of their loan debt. 
                </P>
                <P>
                    Requests for copies of the information collection submission for OMB review may be accessed from 
                    <E T="03">http://edicsweb.ed.gov,</E>
                     by selecting the “Browse Pending Collections” link and by clicking on link number 3460. When you access the information collection, click on “Download Attachments “ to view. Written requests for information should be addressed to U.S. Department of Education, 400 Maryland Avenue, SW., Potomac Center, 9th Floor, Washington, DC 20202-4700. Requests may also be electronically mailed to 
                    <E T="03">ICDocketMgr@ed.gov</E>
                     or faxed to 202-245-6623. Please specify the complete title of the information collection when making your request. 
                </P>
                <P>
                    Comments regarding burden and/or the collection activity requirements should be electronically mailed to 
                    <E T="03">ICDocketMgr@ed.gov.</E>
                     Individuals who use a telecommunications device for the deaf (TDD) may call the Federal Information Relay Service (FIRS) at 1-800-877-8339. 
                </P>
            </SUPLINF>
            <FRDOC>[FR Doc. E7-23061 Filed 11-26-07; 8:45 am] </FRDOC>
            <BILCOD>BILLING CODE 4000-01-P </BILCOD>
        </NOTICE>
        <NOTICE>
            <PREAMB>
                <AGENCY TYPE="S">DEPARTMENT OF EDUCATION</AGENCY>
                <SUBJECT>Office of Special Education and Rehabilitative Services; Overview Information; Personnel Development to Improve Services and Results for Children With Disabilities; Notice Inviting Applications for New Awards for Fiscal Year (FY) 2008</SUBJECT>
                <P>
                    <E T="03">Catalog of Federal Domestic Assistance (CFDA) Numbers:</E>
                     84.325D, 84.325K, 84.325R, and 84.325T.
                </P>
                <NOTE>
                    <HD SOURCE="HED">Note:</HD>
                    <P>
                        This notice invites applications for four separate competitions. For key dates, contact person information, and funding information regarding each of the four competitions, see the chart in the 
                        <E T="03">Award Information</E>
                         section of this notice.
                    </P>
                </NOTE>
                <P>
                    <E T="03">Dates: Applications Available:</E>
                     See chart.
                </P>
                <P>
                    <E T="03">Deadline for Transmittal of Applications:</E>
                     See chart.
                </P>
                <P>
                    <E T="03">Deadline for Intergovernmental Review:</E>
                     See chart.
                </P>
                <HD SOURCE="HD1">Full Text of Announcement</HD>
                <HD SOURCE="HD1">I. Funding Opportunity Description</HD>
                <P>
                    <E T="03">Purpose of Program:</E>
                     The purposes of this program are to (1) help address State-identified needs for highly qualified personnel—in special education, related services, early intervention, and regular education—to work with infants, toddlers and children with disabilities; and (2) ensure that those personnel have the necessary skills and knowledge, derived from practices that have been determined through scientifically based research and experience, to be successful in serving those children.
                </P>
                <P>
                    <E T="03">Priorities:</E>
                     In accordance with 34 CFR 75.105(b)(2)(iv), these priorities are from allowable activities specified in the statute (see sections 662 and 681 of the Individuals with Disabilities Education Act (IDEA)). Each of the absolute priorities announced in this notice corresponds to a separate competition as follows:
                </P>
                <GPOTABLE COLS="2" OPTS="L2,tp0,i1" CDEF="s50,12">
                    <TTITLE> </TTITLE>
                    <BOXHD>
                        <CHED H="1">Absolute priority </CHED>
                        <CHED H="1">Competition CFDA No. </CHED>
                    </BOXHD>
                    <ROW>
                        <ENT I="01">Preparation of Leadership Personnel </ENT>
                        <ENT>84.325D </ENT>
                    </ROW>
                    <ROW>
                        <ENT I="01">Combined Personnel Preparation </ENT>
                        <ENT>84.325K </ENT>
                    </ROW>
                    <ROW>
                        <ENT I="01">National Outreach and Technical Assistance Center on Discretionary Awards for Minority Institutions </ENT>
                        <ENT>84.325R </ENT>
                    </ROW>
                    <ROW>
                        <ENT I="01">Special Education Preservice Training Improvement Grants </ENT>
                        <ENT>84.325T </ENT>
                    </ROW>
                </GPOTABLE>
                <P>
                    <E T="03">Absolute Priorities:</E>
                     For FY 2008 and any subsequent year in which we make awards based on the list of unfunded applications from these competitions, these priorities are absolute priorities. Under 34 CFR 75.105(c)(3), for each competition, we consider only applications that meet the absolute priority for that competition.
                </P>
                <P>The priorities are:</P>
                <HD SOURCE="HD2">Absolute Priority 1—Preparation of Leadership Personnel (84.325D)</HD>
                <HD SOURCE="HD3">Background</HD>
                <P>Training of special educators and related services personnel at the highest levels, including both the doctoral and post-doctoral levels, is critical to ensure the continued development and availability of quality services for children with disabilities. Over the last several decades, research has consistently suggested that there is a persistent need for additional special education and related services personnel who have been trained at the doctoral and post-doctoral levels. Such personnel play a critical role in ensuring the availability of, and improving the quality of, services for children with disabilities and their families. Accordingly, the Department seeks to support programs that provide doctoral, post-doctoral, and advanced graduate level training that is designed to prepare professionals to work in special education as researchers, teacher educators, administrators, and direct service providers.</P>
                <HD SOURCE="HD3">Priority</HD>
                <P>The Preparation of Leadership Personnel priority supports and is limited to projects that train personnel at the preservice doctoral or post-doctoral level in early intervention, special education or related services, and at the advanced graduate level (masters and specialists) in special education administration/supervision. In order to be eligible under this priority, programs must provide training and support for scholars to complete their training within the project period of the grant. Therefore, only the following types of programs of study will meet the requirements of this priority:</P>
                <P>1. A major in special education, related services or early intervention at the doctoral or post-doctoral level; and</P>
                <P>2. Training at the advanced graduate level (masters and specialists programs) in special education administration/supervision.</P>
                <NOTE>
                    <HD SOURCE="HED">Note:</HD>
                    <P>Training that leads to a Doctor of Audiology (DAud) degree is not included as part of this priority because training programs that lead to a DAud degree are eligible to apply for funding under the Combined Personnel Preparation priority (CFDA 84.325K) announced elsewhere in this notice.</P>
                </NOTE>
                <P>To be considered for funding under the Preparation of Leadership Personnel absolute priority, applicants must meet the application requirements contained in the priority. All projects funded under the absolute priority also must meet the programmatic and administrative requirements specified in the priority. The application, programmatic, and administrative requirements are as follows:</P>
                <P>(a) Demonstrate, in the narrative section of the application under “Quality of Project Services,” how—</P>
                <P>(1) The program prepares personnel to address the specialized needs of children with disabilities from diverse cultural and language backgrounds, including limited English proficient children with disabilities, by—</P>
                <P>(i) Identifying the competencies needed by leadership personnel to understand and work with culturally and linguistically diverse populations (the competencies identified should reflect the current knowledge base); and</P>
                <P>
                    (ii) Preparing personnel to use those competencies through early 
                    <PRTPAGE P="66144"/>
                    intervention, special education, and related services training programs;
                </P>
                <P>(2) All relevant coursework for the proposed program reflects current research and pedagogy on—</P>
                <P>(i) Participation and achievement in the general education curriculum and improved outcomes for all children with disabilities; and</P>
                <P>(ii) The provision of coordinated services in natural environments to improve outcomes for infants and toddlers with disabilities and their families;</P>
                <P>(3) The program is designed to offer integrated training and practice opportunities that will enhance the competencies of all personnel who share responsibility for providing effective services for children with disabilities;</P>
                <P>(4) For programs that train personnel in early intervention, special education or related services, the program ensures that scholars are knowledgeable about: (i) The provisions of the No Child Left Behind Act of 2001 (NCLB); (ii) the IDEA and NCLB requirement that teachers be highly qualified; and (iii) the need to foster collaboration between regular and special education teachers; and</P>
                <P>(5) The proposed training program includes training on State academic achievement standards for children, if applicable.</P>
                <P>
                    (b) Submit electronically annual data on each scholar who receives grant support within 60 days after the end of each grant budget year. Applicants are encouraged to visit the Personnel Prep Data (PPD) Web site at 
                    <E T="03">www.osepppd.org</E>
                     for further information about this data collection requirement. This data collection is in addition to and does not supplant the annual grant performance report required of each grantee for continuation funding (see 34 CFR 75.590).
                </P>
                <P>(c) Budget for attendance at a three-day Project Director's meeting in Washington, DC, during each year of the project.</P>
                <P>(d) If the project maintains a Web site, include relevant information and documents in a format that meets a government or industry-recognized standard for accessibility.</P>
                <P>(e) Include, in the application appendix, all course syllabi for the proposed training program. Course syllabi must clearly reflect the incorporation of research-based curriculum and pedagogy as required under paragraph (a) of this priority.</P>
                <P>(f) Provide, in the application narrative, a detailed description of the program, including the sequence of the courses offered in the program, that describes the comprehensive curriculum designed to meet program goals and obtain mastery of the following required professional domains:</P>
                <P>(1) Research methodology.</P>
                <P>(2) Personnel preparation.</P>
                <P>(3) Policy/advocacy or professional practice.</P>
                <P>(g) Include, in the application narrative under “Quality of Project Evaluation,” a clear and effective plan for evaluating the extent to which graduates of the training program have the knowledge and competencies necessary to provide research-based instruction and services that result in improved outcomes for children with disabilities.</P>
                <P>(h) Communicate the results of the evaluation conducted in accordance with paragraph (g) of this priority to the Office of Special Education Programs (OSEP) in required annual performance reports for continuation funding and the project final performance report.</P>
                <P>(i) Certify that all scholars will be recruited into the program with the intention of graduating from the program during the performance period of the grant.</P>
                <P>(j) Certify that the institution will not require scholars recruited into the program to work as a condition of receiving a scholarship, e.g., as graduate assistants, unless the work is required to complete their training program.</P>
                <P>(k) If the program is addressing national or regional needs, demonstrate in the application narrative the existence of the needs through appropriate research data.</P>
                <P>(l) Ensure that at least 65 percent of the total requested budget per year be used for student support or provide justification in the application narrative for any designation less than 65 percent. Examples of sufficient justification for proposing less than 65 percent of the budget for student support might include:</P>
                <P>(1) A project servicing rural areas that provides long distance training, and that may require Web Masters, adjunct professors, or mentors to operate effectively.</P>
                <P>(2) A project that is expanding or adding a new area of emphasis to the program, and as a result of this expansion, may need additional faculty or other resources such as expert consultants, additional training supplies, or equipment that would enhance the program.</P>
                <NOTE>
                    <HD SOURCE="HED">Note:</HD>
                    <P>Applicants proposing projects to develop, expand, or add a new area of emphasis to special education or related services programs must provide, in their applications, information on how these new areas will be sustained once Federal funding ends.</P>
                </NOTE>
                <P>(m) Meet the statutory requirements contained in section 662(e) through 662(h) of IDEA.</P>
                <HD SOURCE="HD2">Absolute Priority 2—Combined Personnel Preparation (84.325K)</HD>
                <HD SOURCE="HD3">Background</HD>
                <P>State agencies, university training programs, local schools, and community-based entities have indicated the importance and difficulty of improving training programs for personnel to serve infants, toddlers, and children with disabilities.</P>
                <P>The national demand for fully credentialed early intervention, special education, and related services personnel to serve infants, toddlers, and children with disabilities exceeds available supply. Thus, Federal support is required to improve both the quality and supply of these personnel.</P>
                <HD SOURCE="HD3">Priority</HD>
                <P>The purpose of the Combined Personnel Preparation priority is to improve the quality, and increase the number, of personnel who are fully credentialed to serve infants, toddlers, and children with disabilities—especially in areas of chronic personnel shortage—by supporting projects that prepare early intervention, special education, and related services personnel at the associate, baccalaureate, master's, and specialist levels. In order to be eligible under this priority, programs must provide training and support for students to complete, within the project period of the grant, a degree, State certification, professional license, or State endorsement in early intervention, special education or related services. Programs preparing students to be special education paraprofessionals, related services assistants or educational interpreters are also eligible under this priority.</P>
                <P>To be considered for funding under the Combined Personnel Preparation absolute priority, applicants must meet the application requirements contained in the priority. All projects funded under the absolute priority also must meet the programmatic and administrative requirements specified in the priority. The application, programmatic, and administrative requirements are as follows:</P>
                <P>(a) Demonstrate, in the narrative section of the application under “Quality of Project Services”, how—</P>
                <P>
                    (1) Training requirements and required coursework for the proposed training program incorporate research-
                    <PRTPAGE P="66145"/>
                    based practices that improve outcomes for children with disabilities (including relevant research citations);
                </P>
                <P>(2) The program is designed to offer integrated training and practice opportunities that will enhance the competencies of all personnel who share responsibility for providing effective services for children with disabilities;</P>
                <P>(3) The program prepares personnel to address the specialized needs of children with disabilities from diverse cultural and language backgrounds, including limited English proficient children with disabilities, by—</P>
                <P>(i) Identifying the competencies needed by personnel to understand and work with culturally and linguistically diverse populations (the competencies identified should reflect the current knowledge base); and</P>
                <P>(ii) Preparing personnel to use those competencies through early intervention, special education, and related services training programs;</P>
                <P>(4) If preparing beginning special educators, the program is designed to provide extended clinical learning opportunities, field experiences, or supervised practica (such as an additional year) and ongoing high quality mentoring and induction opportunities;</P>
                <P>(5) The program includes field-based training opportunities for scholars (as defined in 34 CFR 304.3(g)) in diverse settings including schools and settings in high-poverty communities, rural areas, and urban areas;</P>
                <P>(6) The proposed training program will enable scholars to be highly qualified, in accordance with section 602(10) of IDEA, in the State(s) to be served by the applicant;</P>
                <P>(7) The training program equips scholars with the knowledge and skills necessary to assist children effectively in achieving State academic achievement standards; and</P>
                <P>(8) The training program provides student support systems (including tutors, mentors, and other innovative practices) to enhance student retention and success in the program.</P>
                <P>(b) Include, in the narrative section of the application under “Quality of Project Evaluation,” a clear, effective plan for evaluating the extent to which graduates of the training program have the knowledge and skills necessary to provide scientifically based or evidence-based instruction and services that result in improved outcomes for children with disabilities. Applicants also must clearly describe, under “Quality of Project Evaluation,” how the project will report these evaluation results to the Office of Special Education Programs (OSEP) in the grantee's annual performance reports and final performance report.</P>
                <P>(c) Meet the statutory requirements contained in section 662(e) through 662(h) of IDEA.</P>
                <P>(d) Ensure that at least 65 percent of the total requested budget per year be used for student support.</P>
                <P>(e) Budget for attendance at a three-day Project Director's meeting in Washington, DC, during each year of the project.</P>
                <P>(f) If the project maintains a Web site, include relevant information and documents in a form that meets a government or industry-recognized standard for accessibility.</P>
                <P>(g) Include, in the application appendix, all course syllabi for the proposed training program. Course syllabi must clearly reflect the incorporation of research-based curriculum and pedagogy as required under paragraph (a) of this priority.</P>
                <P>
                    (h) Submit electronically annual data on each scholar who receives grant support within 60 days after the end of each grant budget year. Applicants are encouraged to visit the Personnel Prep Data (PPD) Web site at 
                    <E T="03">www.osepppd.org</E>
                     for further information about this data collection requirement. This data collection is in addition to and does not supplant the annual grant performance report required of each grantee for continuation funding (see 34 CFR 75.590).
                </P>
                <HD SOURCE="HD3">Focus Areas</HD>
                <P>Within this absolute priority, the Secretary intends to support projects under the following four focus areas: (a) Training Personnel to Serve Infants, Toddlers, and Pre-school Age Children with Disabilities, (b) Training Personnel to Serve School Age Children with Low Incidence Disabilities, (c) Training Personnel to Provide Related Services, Speech/Language Services, and Adapted Physical Education to Infants, Toddlers, and Children with Disabilities, and (d) Training Personnel in Minority Institutions to Serve Infants, Toddlers, and Children with Disabilities.</P>
                <NOTE>
                    <HD SOURCE="HED">Note:</HD>
                    <P>Applicants must identify the specific focus area (i.e., (a), (b), (c), or (d)), under which they are applying as part of the competition title on the application cover sheet (SF form 424, line 4). Applicants may not submit the same proposal under more than one focus area. </P>
                </NOTE>
                <P>
                    <E T="03">Focus Area a: Training Personnel To Serve Infants, Toddlers, and Pre-School Age Children With Disabilities</E>
                    . For the purpose of this focus area, early intervention personnel are those who are trained to provide services to infants and toddlers with disabilities ages birth through two, and early childhood personnel are those who are trained to provide services to children with disabilities ages three through five (in States where the age range is other than ages three through five, we will defer to the State's certification for early childhood). In States where certification in early intervention (EI) is combined with certification in early childhood (EC), applicants may propose a combined EI/EC training project under this focus area. Projects training related services, speech/language, or adapted physical education personnel are 
                    <E T="03">not</E>
                     eligible under this focus area (see Focus Area c).
                </P>
                <P>
                    <E T="03">Focus Area b: Training Personnel To Serve School Age Children with Low Incidence Disabilities</E>
                    . For the purpose of this focus area, low incidence personnel are special education personnel, including paraprofessionals, trained to serve school-age children with low incidence disabilities including visual impairments, hearing impairments, simultaneous vision and hearing impairments, significant cognitive impairments (severe mental retardation), orthopedic impairments, autism, and traumatic brain injury. Programs preparing special education personnel to provide services to visually impaired or blind children that can be appropriately provided in Braille must prepare those individuals to provide those services in Braille. Projects training educational interpreters are eligible under this focus area. Projects training other related services, speech/language or adapted physical education personnel are 
                    <E T="03">not</E>
                     eligible under this focus area (see Focus Area c). Projects training special education pre-school personnel are eligible under Focus Area a.
                </P>
                <P>
                    <E T="03">Focus Area c: Training Personnel to Provide Related Services, Speech/Language Services, and Adapted Physical Education to Infants, Toddlers, and Children with Disabilities</E>
                    . Programs training related services, speech/language or adapted physical education personnel to serve infants, toddlers, or children with disabilities are eligible within this focus area. For the purpose of this focus area, related services include, but are not limited to, psychological services, physical therapy (including therapy provided by personnel trained at the Doctor of Physical Therapy (DPT) level), occupational therapy, therapeutic recreation, social work services, counseling services, audiology services (including services provided by personnel trained at the Doctor of Audiology (DAud) level), and speech/
                    <PRTPAGE P="66146"/>
                    language services. Training programs in States where personnel trained to serve children with speech/language impairments are considered to be special educators are eligible under this focus area. Projects training educational interpreters are not eligible under this focus area, but may apply under Focus Area b.
                </P>
                <P>
                    <E T="03">Focus Area d: Training Personnel in Minority Institutions to Serve Infants, Toddlers, and Children with Disabilities</E>
                    . Programs in minority institutions are eligible under this focus area if they train: (a) Personnel to serve one or more of the following: Infants, toddlers, and pre-school age children with disabilities; (b) personnel to serve school age children with low incidence disabilities; or (c) personnel to provide related services, speech/language or adapted physical education to infants, toddlers, and children with disabilities. Minority institutions include institutions with a minority student enrollment of 25 percent or more, which may include Historically Black Colleges and Universities, Tribal Colleges, and Predominantly Hispanic Serving Colleges and Universities.
                </P>
                <P>
                    Within this focus area, institutions that are recommended for funding in FY 2008 and that have not received support under the IDEA Personnel Development Program in FY 2007 will receive 10 competitive preference points. (Programs in minority institutions training personnel in Focus Areas a, b and c are eligible within Focus Area d. Programs that are training high incidence special education personnel are 
                    <E T="03">not</E>
                     eligible within Focus Area d. However, programs that are training high incidence special education personnel are eligible under Absolute Priority 4 located elsewhere in this notice.)
                </P>
                <P>Under Focus Area d, a project may budget for less than the required percentage (65 percent) for student support if the applicant can provide sufficient justification for any designation less than 65 percent. Sufficient justification for proposing less than 65 percent of the budget for student support would include support for activities such as program development, program expansion, or the addition of a new area of emphasis. Some examples include the following:</P>
                <P>(1) A project that is starting a new program may request up to a year for program development and capacity building. In the initial project year, no student support would be required. Instead, a project could hire a new faculty member or a consultant to assist in program development.</P>
                <P>(2) A project that is proposing to build capacity may hire a field supervisor so that additional students can be trained.</P>
                <P>(3) A project that is expanding or adding a new area of emphasis to the program may hire additional faculty or obtain other resources such as expert consultants, additional training supplies, or equipment that would enhance the program.</P>
                <NOTE>
                    <HD SOURCE="HED">Note:</HD>
                    <P>Applicants proposing projects to develop, expand, or to add a new area of emphasis to special education or related services programs must provide information, in their applications, on how these new areas will be sustained once Federal funding ends.</P>
                </NOTE>
                <P>Within this absolute priority, we are particularly interested in applications that address the following invitational priorities.</P>
                <P>
                    <E T="03">Invitational Priorities</E>
                    : Under 34 CFR 75.105(c)(1) we do not give an application that meets these invitational priorities a competitive or absolute preference over other applications.
                </P>
                <P>These priorities are:</P>
                <P>(1) In Focus Areas b and d, the Secretary is particularly interested in programs that prepare special educators who provide instruction in core academic areas to children with disabilities.</P>
                <P>(2) The Secretary is also particularly interested in programs that provide enhanced support for beginning special educators (see section 662(b)(3) of IDEA).</P>
                <HD SOURCE="HD2">Absolute Priority 3—National Outreach and Technical Assistance Center on Discretionary Awards for Minority Institutions (84.325R)</HD>
                <HD SOURCE="HD3">Background</HD>
                <P>Section 681(c)(2) of IDEA requires the Secretary to set aside funds to support one or both of the following activities: (1) The provision of outreach and technical assistance to Historically Black Colleges and Universities (HBCUs) and to institutions of higher education (IHEs) with minority enrollments of not less than 25 percent to promote their participation in certain activities under IDEA; or (2) the provision of support to enable the institutions to assist other institutions and agencies in improving educational and transitional results for children with disabilities. Consistent with this requirement, this priority is aimed at promoting the participation of HBCUs and IHEs with minority enrollments of not less than 25 percent in discretionary grant competitions conducted by the Department, pursuant to section 662 of IDEA (the Personnel Development to Improve Services and Results for Children with Disabilities program); and building the capacity of such institutions to prepare personnel to work effectively with children with disabilities from diverse backgrounds.</P>
                <P>The current technical assistance center funded by the Office of Special Education Programs (OSEP) under section 681(c)(2) of IDEA provides technical assistance to IHEs in grant writing and disseminates specific information to aid HBCUs and other minority IHEs in developing applications for grants, cooperative agreements, and contracts. This priority shifts the focus of the center that will be funded by OSEP under section 681(c)(2) of IDEA from that of grant-writing technical assistance to assistance that will help HBCUs and minority IHEs build their capacity to prepare personnel to work effectively with children with disabilities from linguistically and culturally diverse backgrounds.</P>
                <HD SOURCE="HD3">Priority</HD>
                <P>The purpose of the National Outreach and Technical Assistance Center on Discretionary Awards for Minority Institutions (Center) is to increase: (a) The participation of HBCUs and other institutions with a minority student enrollment of at least 25 percent in the Personnel Development to Improve Services and Results for Children with Disabilities program competitions authorized under section 662 of IDEA; and (b) the capacity of these institutions to prepare personnel to work with children with disabilities from diverse backgrounds.</P>
                <P>To be considered for funding under the National Outreach and Technical Assistance Center on Discretionary Awards for Minority Institutions absolute priority, each applicant must demonstrate, in its application, that it will—</P>
                <P>(a) Maintain contacts with HBCUs and other minority institutions;</P>
                <P>(b) Prepare and disseminate grant-writing technical assistance materials that will enable HBCUs and other minority IHEs to become competitive applicants in competitions authorized under section 662 of IDEA;</P>
                <P>
                    (c) Prepare and disseminate Web-based program development materials, such as: Modules on a variety of research-based pedagogy and practices that are effective in preparing personnel to provide quality service to children with disabilities; a State-by-State directory of resources organized by such topics as State, disability type, personnel supply and demand, etc.; other materials that include information on identifying competencies that personnel need to work effectively with 
                    <PRTPAGE P="66147"/>
                    linguistically and culturally diverse populations and how to increase those competencies through personnel preparation programs;
                </P>
                <P>(d) Analyze the results of each applicable discretionary grant competition conducted by the Department under IDEA to determine which HBCUs and minority IHEs applied and whether they were successful, and submit this analysis to the Department;</P>
                <P>(e) Provide support and guidance to faculty at HBCUs and other minority IHEs to enhance the capacity of these institutions to design and implement professional education programs that graduate highly qualified special educators;</P>
                <P>(f) Ensure that all program development and professional education program enhancements that the Center recommends to HBCUs and minority IHEs include research-based practices, and appropriate competencies that personnel need to work effectively with linguistically and culturally diverse populations to improve outcomes for infants, toddlers, and children with disabilities;</P>
                <P>(g) Develop a plan in the first three months of the project period that outlines a comprehensive technical assistance approach based on effective strategies;</P>
                <P>(h) Establish, maintain, and meet (at least once a year) with an Advisory Board that includes individuals with disabilities, members from underrepresented groups, technical assistance providers, and university personnel;</P>
                <P>(i) Use a third party evaluator, approved by OSEP, that will conduct a rigorous evaluation of core Center activities, and determine the overall impact of its work;</P>
                <P>(j) Budget for attendance at a three-day Project Directors' meeting in Washington, DC, the Technical Assistance and Dissemination Project Directors' meeting, and at least 2 one-day planning meetings with the OSEP Project Officer and other appropriate staff in Washington, DC;</P>
                <P>(k) If the project maintains a Web site, include relevant information and documents in a form that meets a government or industry-recognized standard for accessibility; and</P>
                <P>(l) Include a line item in the proposed budget for an annual set-aside of five percent of the grant amount to support emerging needs that are consistent with the proposed project's activities, as those needs are identified in consultation with OSEP.</P>
                <NOTE>
                    <HD SOURCE="HED">Note:</HD>
                    <P>With approval from the OSEP Project Officer, the Center will reallocate any remaining funds from this annual set-aside no later than the end of the third quarter of each budget period.</P>
                </NOTE>
                <P>
                    <E T="03">Fourth and Fifth Years of Project:</E>
                     Finally, in deciding whether to continue funding the Center for the fourth and fifth years, the Secretary will consider the requirements of 34 CFR 75.253(a), in addition to the following items:
                </P>
                <P>(a) The recommendation of a review team consisting of experts selected by the Secretary. This review will be conducted in Washington, DC during the last half of the project's second year. Projects must budget for travel expenses associated with this one-day intensive review.</P>
                <P>(b) The timeliness and effectiveness with which all requirements of the negotiated cooperative agreement have been or are being met by the Center.</P>
                <P>(c) Evidence of changes in capacity at HBCUs and other participating institutions.</P>
                <P>(d) Evidence of increased participation of HBCUs and IHEs with minority enrollments of not less than 25 percent in competitions conducted under section 662 of IDEA.</P>
                <HD SOURCE="HD2">Absolute Priority 4—Special Education Preservice Training Improvement Grants (84.325T)</HD>
                <HD SOURCE="HD3">Background</HD>
                <P>State educational agencies, IHEs, and local educational agencies consistently report that it is necessary to restructure or redesign most preparation programs for kindergarten through grade 12 (K-12) special education teachers to ensure that graduates of these programs are able to meet the highly qualified teacher (HQT) requirements in the No Child Left Behind Act of 2001 (NCLB) and the Individuals with Disabilities Education Act, as amended by the Individuals with Disabilities Education Improvement Act of 2004 (IDEA). To accomplish this goal, preparation programs must ensure that their graduates who expect to be providing instruction in core academic subjects are not only able to meet State certification or licensure requirements, but that they also have the necessary content knowledge, consistent with the HQT requirements in NCLB and IDEA.</P>
                <P>Children with disabilities are now expected to meet high standards for learning in core academic subjects, regardless of classroom setting. Because this is the case, K-12 special education teacher preparation programs must address content knowledge, standards, assessments, and evidence-based practices. Federal support can assist in improving the quality of IHE programs that prepare special education teachers, and help to ensure that these teachers have the knowledge and skills needed to teach students with disabilities using evidence-based interventions.</P>
                <HD SOURCE="HD3">Priority</HD>
                <P>The purpose of this priority is to improve the quality of K-12 special education teacher preparation programs to ensure that program graduates are able to meet the HQT requirements under sections 602(10) and 612(a)(14) of IDEA, and are well prepared to serve children with high incidence disabilities. For purposes of this priority, the term “high incidence disabilities” refers to learning disabilities, emotional disturbance, or mental retardation. In order to be eligible under this priority, applicants must currently prepare personnel (at the baccalaureate or master's level) to serve school-age children with high incidence disabilities.</P>
                <NOTE>
                    <HD SOURCE="HED">Note:</HD>
                    <P>This priority only supports the improvement or expansion of existing programs for high incidence personnel, such as the expansion of an elementary program to include a secondary program in high incidence. This priority does not support the development of new programs for high incidence personnel.</P>
                </NOTE>
                <P>To be considered for funding under the Special Education Preservice Training Improvement Grants priority, applicants must meet the application requirements contained in the priority. All projects funded under the absolute priority also must meet the programmatic and administrative requirements specified in the priority. The application, programmatic, and administrative requirements are as follows:</P>
                <P>(a) Demonstrate, in the narrative section of the application under “Quality of Project Services,” how—</P>
                <P>
                    (1) The first year of the project period will be used for planning an improved or restructured K-12 teacher preparation program that includes induction and mentoring components; revising curriculum for, and integrating evidence-based interventions that improve outcomes for children with high incidence disabilities into, the improved or restructured program (including providing research citations for those evidence-based interventions); and coordinating with the National Center to Enhance the Professional Development of School Personnel on the use of its web-based training modules (see 
                    <E T="03">http://www.iris.peabody.vanderbilt.edu</E>
                    ). Applicants must describe first year activities and include a five-year timeline and implementation plan in their applications. This plan must describe the proposed project activities 
                    <PRTPAGE P="66148"/>
                    associated with implementation of the improved or restructured program that includes the induction and mentoring components, and may not be implemented without the approval of OSEP, if the proposed project is funded under this competition;
                </P>
                <P>(2) The improved or restructured program is designed to offer integrated training and practice opportunities that will enhance the competencies of beginning special education teachers who share responsibility with general education teachers and other personnel for providing effective services and instruction in academic subjects to children with high incidence disabilities in K-12 classrooms;</P>
                <P>(3) The improved or restructured program is designed to prepare special education teachers to address the specialized needs of children with high incidence disabilities from diverse cultural and language backgrounds, including limited English proficient children with disabilities, by identifying the competencies that special education teachers need to work effectively with culturally and linguistically diverse populations;</P>
                <P>(4) The improved or restructured program is designed to provide extended clinical learning opportunities, field experiences, or supervised practica and ongoing high quality mentoring and induction opportunities in local schools. Applicants also must demonstrate how they will coordinate with the National Center on Policy and Practice in Special Education in designing the program to provide extended clinical learning opportunities, field experiences, or supervised practica;</P>
                <P>(5) The improved or restructured program is designed to include field-based training opportunities in diverse settings including schools and settings in high-poverty communities and in schools not making adequate yearly progress (AYP) under NCLB;</P>
                <P>(6) Upon completion of the improved or restructured program, graduates will be able to meet the HQT requirements in accordance with section 602(10) of IDEA and 34 CFR 300.18; and will be equipped with the knowledge and skills necessary to assist children in achieving State academic achievement standards;</P>
                <P>(7) The improved or restructured program is designed to provide support systems (including tutors, mentors, and other innovative practices) to enhance retention and success in the program; and</P>
                <P>(8) The improved or restructured program will be maintained once Federal funding ends.</P>
                <P>(b) For programs that will be restructured or re-designed to produce graduates who will meet the standards of HQT upon program completion, particularly as those standards relate to certification in core academic subjects, applicants will establish partnerships with appropriate academic departments in schools of arts and sciences. To address this requirement, applications must also—</P>
                <P>(i) Demonstrate how such partnerships will include representation by academic departments that have expertise in the core academic subjects being addressed in the application;</P>
                <P>(ii) Demonstrate how such partnerships will include a permanent faculty member, from one or more of the corresponding academic departments, who will be involved in developing the overall project and designing the curriculum used to train scholars in core academic subjects;</P>
                <P>(iii) Provide evidence of the extent of participation by permanent faculty members from the corresponding academic departments; and</P>
                <P>(iv) Provide funding to the core academic subject departments appropriate to the significant involvement outlined in paragraph (4) of this priority;</P>
                <P>(c) Include, in the narrative section of the application under “Quality of Project Evaluation,” a clear, effective plan for evaluating the extent to which graduates of the training program have the knowledge and skills necessary to provide scientifically based or evidence-based instruction and services that result in improved outcomes for children with disabilities. Applicants also must clearly describe, under “Quality of Project Evaluation,” how the project will report these evaluation results to the OSEP in the grantee's annual performance reports and final performance report.</P>
                <P>(d) Meet the statutory requirements in section 662(e) through 662(f) of IDEA.</P>
                <P>(e) Budget for planning and improvement activities, including activities to be performed by consultants. This priority does not provide for financial support of scholars during any year of the project.</P>
                <P>(f) Budget for attendance at a three-day Project Director's meeting in Washington, DC, during each year of the project.</P>
                <P>(g) If the project maintains a Web site, include relevant information and documents in a form that meets a government or industry-recognized standard for accessibility.</P>
                <P>(h) Include, in the application appendix, all course syllabi for the existing teacher preparation program. Revised syllabi for the improved or restructured program must be submitted at the end of the first year of the project period.</P>
                <P>Within this absolute priority, we give competitive preference to applications that address the following priority.</P>
                <P>
                    <E T="03">Competitive Preference Priority:</E>
                     Under 34 CFR 75.105(c)(2)(i) we award up to an additional 10 points to an application, depending on how well the application meets this priority.
                </P>
                <P>This priority is:</P>
                <HD SOURCE="HD2">Competitive Preference Points Based on Number of High Incidence Special Education Teacher Graduates From Program in a Recent Year</HD>
                <P>In order to earn competitive preference points under this priority, applicants must document the number of K-12 special education teachers who have graduated from a preparation program that prepares personnel (at the baccalaureate or master's level) to serve school-age children with high incidence disabilities in any recent year, regardless of whether the graduates received support from a Federal grant. For purposes of this competitive preference priority, the term “recent year” is defined as any of the past three fiscal years (i.e., FY 2004, FY 2005, or FY 2006). For example, an applicant that documents 10 graduates (new K-12 high incidence special education teachers) during a recent year earns 2 competitive preference points. An applicant that documents 30 graduates (new K-12 high incidence special education teachers) during a recent year earns 6 competitive preference points. An applicant that documents 50 or more graduates (new K-12 high incidence special education teachers) during a recent year earns 10 competitive preference points.</P>
                <GPOTABLE COLS="2" OPTS="L2,tp0,i1" CDEF="s50,12">
                    <BOXHD>
                        <CHED H="1">Number of students graduating (new K-12 high incidence special education teachers) from program in a recent year (including non-OSEP funded graduates) </CHED>
                        <CHED H="1">Number of competitive preference points awarded </CHED>
                    </BOXHD>
                    <ROW>
                        <ENT I="01">8-19 </ENT>
                        <ENT>2 </ENT>
                    </ROW>
                    <ROW>
                        <ENT I="01">20-29 </ENT>
                        <ENT>4 </ENT>
                    </ROW>
                    <ROW>
                        <ENT I="01">30-39 </ENT>
                        <ENT>6 </ENT>
                    </ROW>
                    <ROW>
                        <ENT I="01">40-49 </ENT>
                        <ENT>8 </ENT>
                    </ROW>
                    <ROW>
                        <ENT I="01">50+ </ENT>
                        <ENT>10 </ENT>
                    </ROW>
                </GPOTABLE>
                <P>
                    The number of students (i.e., new K-12 high incidence special education teachers) graduating from the program must be documented in the application. A letter from the Dean or Department Chair reporting the number of high incidence graduates in a recent fiscal year is adequate documentation for purposes of this competitive preference.
                    <PRTPAGE P="66149"/>
                </P>
                <P>
                    <E T="03">Waiver of Proposed Rulemaking:</E>
                     Under the Administrative Procedure Act (APA) (5 U.S.C. 553) the Department generally offers interested parties the opportunity to comment on proposed priorities and requirements. Section 681(d) of IDEA, however, makes the public comment requirements of the APA inapplicable to the priorities in this notice.
                </P>
                <AUTH>
                    <HD SOURCE="HED">Program Authority:</HD>
                    <P>20 U.S.C. 1462 and 1481.</P>
                </AUTH>
                <P>
                    <E T="03">Applicable Regulations:</E>
                     (a) The Education Department General Administrative Regulations (EDGAR) in 34 CFR parts 74, 75, 77, 79, 80, 81, 82, 84, 85, 86, 97, 98, and 99. (b) The regulations for this program in 34 CFR part 304.
                </P>
                <HD SOURCE="HD1">II. Award Information</HD>
                <P>
                    <E T="03">Type of Awards:</E>
                     Discretionary grants for competitions CFDA 84.325D, 84.325K, and 84.325R, and one cooperative agreement for competition CFDA 84.325T.
                </P>
                <P>
                    <E T="03">Estimated Available Funds:</E>
                     The Administration has requested $89,719,000 for the Personnel Development to Improve Services and Results for Children with Disabilities program for FY 2008, of which we intend to use an estimated $2,950,000 for the competitions announced in this notice. Please refer to the “Estimated Range of Awards” column of the chart in this section for the estimated dollar amounts for individual competitions. The actual level of funding, if any, depends on final congressional action. However, we are inviting applications to allow enough time to complete the grant process if Congress appropriates funds for this program.
                </P>
                <P>Contingent upon the availability of funds and the quality of applications for the competitions announced in this notice, we may make additional awards in FY 2009 from the lists of unfunded applicants from individual competitions.</P>
                <P>
                    <E T="03">Estimated Range of Awards:</E>
                     See chart.
                </P>
                <P>
                    <E T="03">Estimated Average Size of Awards:</E>
                     See chart.
                </P>
                <P>
                    <E T="03">Maximum Award:</E>
                     See chart.
                </P>
                <P>
                    <E T="03">Estimated Number of Awards:</E>
                     See chart.
                </P>
                <P>
                    <E T="03">Project Period:</E>
                     See chart.
                    <PRTPAGE P="66150"/>
                </P>
                <GPOTABLE COLS="10" OPTS="L2,i1" CDEF="s75,11,11,11,r50,r50,r50,7,xs52,r75">
                    <TTITLE>Personnel Development to Improve Services and Results for Children With Disabilities Application Notice for Fiscal Year 2008 </TTITLE>
                    <BOXHD>
                        <CHED H="1">CFDA number and name </CHED>
                        <CHED H="1">Applications available </CHED>
                        <CHED H="1">Deadline for transmittal of applications </CHED>
                        <CHED H="1">Deadline for intergovernmental review </CHED>
                        <CHED H="1">Estimated range of awards </CHED>
                        <CHED H="1">Estimated average size of awards </CHED>
                        <CHED H="1">Maximum award </CHED>
                        <CHED H="1">Estimated number of awards </CHED>
                        <CHED H="1">Project period </CHED>
                        <CHED H="1">Contact person </CHED>
                    </BOXHD>
                    <ROW>
                        <ENT I="01">84.325D Preparation of Leadership Personnel</ENT>
                        <ENT>11/27/07</ENT>
                        <ENT>01/04/08</ENT>
                        <ENT>03/04/08</ENT>
                        <ENT>$171,969-$200,000</ENT>
                        <ENT>$196,200</ENT>
                        <ENT>$200,000 *</ENT>
                        <ENT>25</ENT>
                        <ENT>Up to 60 mos.</ENT>
                        <ENT>Bob Gilmore (202) 245-7354 Rm 4083. </ENT>
                    </ROW>
                    <ROW>
                        <ENT I="01">84.325K Combined Personnel Preparation</ENT>
                        <ENT>11/27/07</ENT>
                        <ENT/>
                        <ENT/>
                        <ENT/>
                        <ENT/>
                        <ENT/>
                        <ENT/>
                        <ENT/>
                        <ENT/>
                    </ROW>
                    <ROW>
                        <ENT I="01">Focus Area a: Training Personnel to Serve Infants, Toddlers, and Pre-school Age Children with Disabilities</ENT>
                        <ENT>11/27/07</ENT>
                        <ENT>01/11/08</ENT>
                        <ENT>03/11/08</ENT>
                        <ENT>$150,000-$200,000</ENT>
                        <ENT>$175,000</ENT>
                        <ENT>$200,000 *</ENT>
                        <ENT>14</ENT>
                        <ENT>Up to 48 mos.</ENT>
                        <ENT>Maryann McDermott (202) 245-7439 Rm 4062. </ENT>
                    </ROW>
                    <ROW>
                        <ENT I="01">Focus Area b: Training Personnel to Serve School Age Children with Low Incidence Disabilities</ENT>
                        <ENT>11/27/07</ENT>
                        <ENT>01/11/08</ENT>
                        <ENT>03/11/08</ENT>
                        <ENT>$150,000-$200,000</ENT>
                        <ENT>$175,000</ENT>
                        <ENT>$200,000 *</ENT>
                        <ENT>23</ENT>
                        <ENT>Up to 48 mos.</ENT>
                        <ENT/>
                    </ROW>
                    <ROW>
                        <ENT I="01">Focus Area c: Training Personnel to Provide Related Services, Speech/Language Services, and Adapted Physical Education to Infants, Toddlers, and Children with Disabilities</ENT>
                        <ENT>11/27/07</ENT>
                        <ENT>01/11/08</ENT>
                        <ENT>03/11/08</ENT>
                        <ENT>$150,000-$200,000</ENT>
                        <ENT>$175,000</ENT>
                        <ENT>$200,000 *</ENT>
                        <ENT>14</ENT>
                        <ENT>Up to 48 mos.</ENT>
                        <ENT/>
                    </ROW>
                    <ROW>
                        <ENT I="01">Focus Area d: Training Personnel in Minority Institutions to Serve Infants, Toddlers, and Children with Disabilities</ENT>
                        <ENT>11/27/07</ENT>
                        <ENT>01/11/08</ENT>
                        <ENT>03/11/08</ENT>
                        <ENT>$150,000-$200,000</ENT>
                        <ENT>$175,000</ENT>
                        <ENT>$200,000 *</ENT>
                        <ENT>14</ENT>
                        <ENT>Up to 48 mos.</ENT>
                        <ENT/>
                    </ROW>
                    <ROW>
                        <ENT I="01">84.325R National Outreach and Technical Assistance Center on Discretionary Awards for Minority Institutions</ENT>
                        <ENT>11/27/07</ENT>
                        <ENT>01/11/08</ENT>
                        <ENT>03/11/08</ENT>
                        <ENT O="xl"/>
                        <ENT O="xl"/>
                        <ENT>$1,500,000 *</ENT>
                        <ENT>1</ENT>
                        <ENT>Up to 60 mos.</ENT>
                        <ENT>Ernest Hairston (202) 245-7366 Rm 4070. </ENT>
                    </ROW>
                    <ROW>
                        <ENT I="01">84.325T Special Education Preservice Training Improvement Grants</ENT>
                        <ENT>11/27/07</ENT>
                        <ENT>01/18/08</ENT>
                        <ENT>03/18/08</ENT>
                        <ENT>$100,000-$150,000 (first year of project)</ENT>
                        <ENT>$125,000 (first year of project)</ENT>
                        <ENT>$150,000 ** (first year of project)</ENT>
                        <ENT>21</ENT>
                        <ENT>Up to 60 mos.</ENT>
                        <ENT>Bonnie Jones (202) 245-7395 Rm 4153. </ENT>
                    </ROW>
                    <TNOTE>
                        * We will reject any application that proposes a budget exceeding the maximum award for a single budget period of 12 months. The Assistant Secretary for Special Education and Rehabilitative Services may change the maximum amount through a notice published in the 
                        <E T="03">Federal Register</E>
                        . 
                    </TNOTE>
                    <TNOTE>
                        ** For the 
                        <E T="03">Special Education Preservice Training Improvement Grants</E>
                        , 84.325T competition: 
                    </TNOTE>
                    <TNOTE>
                        <E T="04">Note:</E>
                         We will reject any application that proposes a budget exceeding $150,000 for a single budget period of 12 months for the first year of the project; we will reject any application that proposes a budget exceeding $100,000 for a single budget period of 12 months over the last four years of the project; and we will reject any application that exceeds $500,000 for the five-years of the budget period. 
                    </TNOTE>
                    <TNOTE>
                        <E T="04">Note:</E>
                         No more than one cooperative agreement will be awarded per IHE. Programs in minority institutions that are preparing special education teachers of children with high incidence disabilities are eligible to apply under this competition. For purposes of this competition, the term “minority institutions” include IHEs with a minority student enrollment of 25 percent or more, which may include Historically Black Colleges and Universities, Tribal Colleges, and Predominantly Hispanic Serving Colleges and Universities. 
                    </TNOTE>
                    <TNOTE>
                        <E T="04">Note:</E>
                         The Department is not bound by any estimates in this notice. 
                    </TNOTE>
                </GPOTABLE>
                <PRTPAGE P="66151"/>
                <HD SOURCE="HD1">III. Eligibility Information</HD>
                <P>
                    1. 
                    <E T="03">Eligible Applicants:</E>
                     Institutions of higher education (IHEs).
                </P>
                <NOTE>
                    <HD SOURCE="HED">Note:</HD>
                    <P>
                        For Absolute Priority 4 (
                        <E T="03">Special Education Preservice Training Improvement Grants</E>
                        , 84.325T), programs in IHEs that are preparing preschool teachers are not eligible to apply under that competition.
                    </P>
                </NOTE>
                <P>
                    2. 
                    <E T="03">Cost Sharing or Matching</E>
                    : This program does not require cost sharing or matching.
                </P>
                <P>
                    3. 
                    <E T="03">Other</E>
                    : 
                    <E T="03">General Requirements</E>
                    —(a) The projects funded under this program must make positive efforts to employ and advance in employment qualified individuals with disabilities (see section 606 of IDEA).
                </P>
                <P>(b) Each applicant and grant recipient funded under this program must involve individuals with disabilities or parents of individuals with disabilities ages birth through 26 in planning, implementing, and evaluating the project (see section 682(a)(1)(A) of IDEA).</P>
                <HD SOURCE="HD1">IV. Application and Submission Information</HD>
                <P>
                    1. 
                    <E T="03">Address to Request Application Package</E>
                    : Education Publications Center (ED Pubs), P.O. Box 1398, Jessup, MD 20794-1398. Telephone, toll free: 1-877-433-7827. FAX: (301) 470-1244. If you use a telecommunications device for the deaf (TDD), call, toll free: 1-877-576-7734.
                </P>
                <P>
                    You can contact ED Pubs at its Web site, also: 
                    <E T="03">http://www.ed.gov/pubs/edpubs.html</E>
                     or at its e-mail address: 
                    <E T="03">edpubs@inet.ed.gov</E>
                    .
                </P>
                <P>If you request an application from ED Pubs, be sure to identify the competition to which you want to apply, as follows: CFDA number 84.325D, 84.325K, 84.325R, or 84.325T.</P>
                <P>
                    Individuals with disabilities may obtain a copy of the application package in an alternative format (
                    <E T="03">e.g.</E>
                    , Braille, large print, audiotape, or computer diskette) by contacting the person or team listed under 
                    <E T="03">Alternative Format</E>
                     in section VIII of this notice.
                </P>
                <P>
                    2. 
                    <E T="03">Content and Form of Application Submission</E>
                    : Requirements concerning the content of an application, together with the forms you must submit, are in the application package for each competition announced in this notice.
                </P>
                <P>
                    <E T="03">Page Limit</E>
                    : The application narrative (Part III of the application) is where you, the applicant, address the selection criteria that reviewers use to evaluate your application. You must limit Part III to the equivalent of no more than 50 pages for each absolute priority, using the following standards:
                </P>
                <P>• A “page” is 8.5″ x 11″, on one side only, with 1” margins at the top, bottom, and both sides.</P>
                <P>• Double space (no more than three lines per vertical inch) all text in the application narrative, including titles, headings, footnotes, quotations, references, and captions, as well as all text in charts, tables, figures, and graphs.</P>
                <P>• Use a font that is either 12 point or larger or no smaller than 10 pitch (characters per inch).</P>
                <P>The page limit does not apply to Part I, the cover sheet; Part II, the budget section, including the narrative budget justification; Part IV, the assurances and certifications; or the two-page abstract, the resumes, the bibliography, the references, or the letters of support. However, you must include all of the application narrative in Part III.</P>
                <P>We will reject your application if—</P>
                <P>• You apply these standards and exceed the page limit; or</P>
                <P>• You apply other standards and exceed the equivalent of the page limit.</P>
                <P>
                    3. 
                    <E T="03">Submission Dates and Times</E>
                    :
                </P>
                <P>
                    <E T="03">Applications Available</E>
                    : See chart.
                </P>
                <P>
                    <E T="03">Deadline for Transmittal of Applications:</E>
                     See chart.
                </P>
                <P>
                    Applications for grants under this program may be submitted electronically using the Grants.gov Apply site (Grants.gov), or in paper format by mail or hand delivery. For information (including dates and times) about how to submit your application electronically, or in paper format by mail or hand delivery, please refer to section IV. 6. 
                    <E T="03">Other Submission Requirements</E>
                     in this notice.
                </P>
                <P>We do not consider an application that does not comply with the deadline requirements.</P>
                <P>
                    Individuals with disabilities who need an accommodation or auxiliary aid in connection with the application process should contact the person listed under 
                    <E T="02">FOR FURTHER INFORMATION CONTACT</E>
                     in section VII in this notice. If the Department provides an accommodation or auxiliary aid to an individual with a disability in connection with the application process, the individual's application remains subject to all other requirements and limitations in this notice.
                </P>
                <P>
                    <E T="03">Deadline for Intergovernmental Review:</E>
                     See chart.
                </P>
                <P>
                    4. 
                    <E T="03">Intergovernmental Review</E>
                    : This program is subject to Executive Order 12372 and the regulations in 34 CFR part 79. Information about Intergovernmental Review of Federal Programs under Executive Order 12372 is in the application package for each of the competitions announced in this notice.
                </P>
                <P>
                    5. 
                    <E T="03">Funding Restrictions</E>
                    : We reference regulations outlining funding restrictions in the 
                    <E T="03">Applicable Regulations</E>
                     section in this notice.
                </P>
                <P>
                    6. 
                    <E T="03">Other Submission Requirements</E>
                    : Applications for grants under this program may be submitted electronically or in paper format by mail or hand delivery. 
                </P>
                <P>
                    a. 
                    <E T="03">Electronic Submission of Applications</E>
                    .
                </P>
                <P>To comply with the President's Management Agenda, we are participating as a partner in the Governmentwide Grants.gov Apply site. The Personnel Development to Improve Services and Results for Children with Disabilities competitions, CFDA numbers 84.325D, 84.325K, 84.325R, and 84.325T, announced in this notice are included in this project. We request your participation in Grants.gov.</P>
                <P>
                    If you choose to submit your application electronically, you must use the Governmentwide Grants.gov Apply site at 
                    <E T="03">http://www.Grants.gov.</E>
                     Through this site, you will be able to download a copy of the application package, complete it offline, and then upload and submit your application. You may not e-mail an electronic copy of a grant application to us.
                </P>
                <P>
                    You may access the electronic grant application for the Personnel Development to Improve Services and Results for Children with Disabilities program competitions—CFDA numbers 84.325D, 84.325K, 84.325R, and 84.325T at 
                    <E T="03">http://www.Grants.gov.</E>
                     You must search for the downloadable application package for this program by the CFDA number. Do not include the CFDA number's alpha suffix in your search (e.g., search for 84.325, not 84.325D).
                </P>
                <P>Please note the following:</P>
                <P>• Your participation in Grants.gov is voluntary.</P>
                <P>• When you enter the Grants.gov site, you will find information about submitting an application electronically through the site, as well as the hours of operation.</P>
                <P>
                    • Applications received by Grants.gov are date and time stamped. Your application must be fully uploaded and submitted and must be date and time stamped by the Grants.gov system no later than 4:30 p.m., Washington, DC time, on the application deadline date. Except as otherwise noted in this section, we will not consider your application if it is date and time stamped by the Grants.gov system later than 4:30 p.m., Washington, DC time, on the application deadline date. When we retrieve your application from Grants.gov, we will notify you if we are rejecting your application because it was date and time stamped by the Grants.gov system after 4:30 p.m., 
                    <PRTPAGE P="66152"/>
                    Washington, DC time, on the application deadline date.
                </P>
                <P>• The amount of time it can take to upload an application will vary depending on a variety of factors, including the size of the application and the speed of your Internet connection. Therefore, we strongly recommend that you do not wait until the application deadline date to begin the submission process through Grants.gov.</P>
                <P>
                    • You should review and follow the Education Submission Procedures for submitting an application through Grants.gov that are included in the application package for the competition to which you are applying to ensure that you submit your application in a timely manner to the Grants.gov system. You can also find the Education Submission Procedures pertaining to Grants.gov at 
                    <E T="03">http://e-Grants.ed.gov/help/GrantsgovSubmissionProcedures.pdf.</E>
                </P>
                <P>
                    • To submit your application via Grants.gov, you must complete all steps in the Grants.gov registration process (see 
                    <E T="03">http://www.grants.gov/applicants/get_registered.jsp</E>
                    ). These steps include (1) registering your organization, a multi-part process that includes registration with the Central Contractor Registry (CCR); (2) registering yourself as an Authorized Organization Representative (AOR); and (3) getting authorized as an AOR by your organization. Details on these steps are outlined in the Grants.gov 3-Step Registration Guide (see 
                    <E T="03">http://www.grants.gov/section910/Grants.govRegistrationBrochure.pdf</E>
                    ). You also must provide on your application the same D-U-N-S Number used with this registration. Please note that the registration process may take five or more business days to complete, and you must have completed all registration steps to allow you to submit successfully an application via Grants.gov. In addition you will need to update your CCR registration on an annual basis. This may take three or more business days to complete.
                </P>
                <P>• You will not receive additional point value because you submit your application in electronic format, nor will we penalize you if you submit your application in paper format.</P>
                <P>• If you submit your application electronically, you must submit all documents electronically, including all information you typically provide on the following forms: Application for Federal Assistance (SF 424), the Department of Education Supplemental Information for SF 424, Budget Information—Non-Construction Programs (ED 524), and all necessary assurances and certifications. Please note that two of these forms—the SF 424 and the Department of Education Supplemental Information for SF 424—have replaced the ED 424 (Application for Federal Education Assistance).</P>
                <P>• If you submit your application electronically, you must attach any narrative sections of your application as files in a .DOC (document), .RTF (rich text), or .PDF (Portable Document) format. If you upload a file type other than the three file types specified in this paragraph or submit a password-protected file, we will not review that material.</P>
                <P>• Your electronic application must comply with any page-limit requirements described in this notice.</P>
                <P>• After you electronically submit your application, you will receive from Grants.gov an automatic notification of receipt that contains a Grants.gov tracking number. (This notification indicates receipt by Grants.gov only, not receipt by the Department.) The Department then will retrieve your application from Grants.gov and send a second notification to you by e-mail. This second notification indicates that the Department has received your application and has assigned your application a PR/Award number (an ED-specified identifying number unique to your application).</P>
                <P>• We may request that you provide us original signatures on forms at a later date.</P>
                <P>
                    <E T="03">Application Deadline Date Extension in Case of Technical Issues With the Grants.gov System:</E>
                     If you are experiencing problems submitting your application through Grants.gov, please contact the Grants.gov Support Desk, toll free, at 1-800-518-4726. You must obtain a Grants.gov Support Desk Case Number and must keep a record of it.
                </P>
                <P>If you are prevented from electronically submitting your application on the application deadline date because of technical problems with the Grants.gov system, we will grant you an extension until 4:30 p.m., Washington, DC time, the following business day to enable you to transmit your application electronically or by hand delivery. You also may mail your application by following the mailing instructions described elsewhere in this notice.</P>
                <P>
                    If you submit an application after 4:30 p.m., Washington, DC time, on the application deadline date, please contact the person listed under 
                    <E T="02">FOR FURTHER INFORMATION CONTACT</E>
                     in section VII in this notice and provide an explanation of the technical problem you experienced with Grants.gov, along with the Grants.gov Support Desk Case Number. We will accept your application if we can confirm that a technical problem occurred with the Grants.gov system and that that problem affected your ability to submit your application by 4:30 p.m., Washington, DC time, on the application deadline date. The Department will contact you after a determination is made on whether your application will be accepted.
                </P>
                <NOTE>
                    <HD SOURCE="HED">Note:</HD>
                    <P>The extensions to which we refer in this section apply only to the unavailability of, or technical problems with, the Grants.gov system. We will not grant you an extension if you failed to fully register to submit your application to Grants.gov before the application deadline date and time or if the technical problem you experienced is unrelated to the Grants.gov system.</P>
                </NOTE>
                <P>
                    b. 
                    <E T="03">Submission of Paper Applications by Mail</E>
                    .
                </P>
                <P>If you submit your application in paper format by mail (through the U.S. Postal Service or a commercial carrier), you must mail the original and two copies of your application, on or before the application deadline date, to the Department at the applicable following address:</P>
                <P>
                    <E T="03">By mail through the U.S. Postal Service:</E>
                     U.S. Department of Education, Application Control Center, Attention: (CFDA Number 84.325D, 84.325K, 84.325R, or 84.325T), 400 Maryland Avenue, SW., Washington, DC 20202-4260; or
                </P>
                <P>
                    <E T="03">By mail through a commercial carrier:</E>
                     U.S. Department of Education, Application Control Center—Stop 4260, Attention: (CFDA Number 84.325D, 84.325K, 84.325R, or 84.325T), 7100 Old Landover Road, Landover, MD 20785-1506.
                </P>
                <P>Regardless of which address you use, you must show proof of mailing consisting of one of the following:</P>
                <P>(1) A legibly dated U.S. Postal Service postmark.</P>
                <P>(2) A legible mail receipt with the date of mailing stamped by the U.S. Postal Service.</P>
                <P>(3) A dated shipping label, invoice, or receipt from a commercial carrier.</P>
                <P>(4) Any other proof of mailing acceptable to the Secretary of the U.S. Department of Education.</P>
                <P>If you mail your application through the U.S. Postal Service, we do not accept either of the following as proof of mailing:</P>
                <P>(1) A private metered postmark.</P>
                <P>(2) A mail receipt that is not dated by the U.S. Postal Service.</P>
                <P>If your application is postmarked after the application deadline date, we will not consider your application.</P>
                <NOTE>
                    <HD SOURCE="HED">Note:</HD>
                    <P>The U.S. Postal Service does not uniformly provide a dated postmark. Before relying on this method, you should check with your local post office.</P>
                </NOTE>
                <PRTPAGE P="66153"/>
                <P>
                    c. 
                    <E T="03">Submission of Paper Applications by Hand Delivery.</E>
                </P>
                <P>If you submit your application in paper format by hand delivery, you (or a courier service) must deliver the original and two copies of your application by hand, on or before the application deadline date, to the Department at the following address: U.S. Department of Education, Application Control Center, Attention: (CFDA Number 84.325D, 84.325K, 84.325R, or 84.325T), 550 12th Street, SW., Room 7041, Potomac Center Plaza, Washington, DC 20202-4260.</P>
                <P>
                    The Application Control Center accepts hand deliveries daily between 8 a.m. and 4:30 p.m., Washington, DC time, except Saturdays, Sundays and Federal holidays. 
                    <E T="03">Note for Mail or Hand Delivery of Paper Applications:</E>
                     If you mail or hand deliver your application to the Department— 
                </P>
                <P>(1) You must indicate on the envelope and—if not provided by the Department—in Item 11 of the SF 424 the CFDA number, including suffix letter, if any, of the competition under which you are submitting your application; and</P>
                <P>(2) The Application Control Center will mail to you a notification of receipt of your grant application. If you do not receive this notification within 15 business days from the application deadline date, you should call the U.S. Department of Education Application Control Center at (202) 245-6288.</P>
                <HD SOURCE="HD1">V. Application Review Information</HD>
                <P>
                    1. 
                    <E T="03">Selection Criteria:</E>
                     The selection criteria for this program are from 34 CFR 75.210 and are listed in the application packages for each competition announced in this notice.
                </P>
                <P>
                    2. 
                    <E T="03">Peer Review:</E>
                     In the past, the Department has had difficulty finding peer reviewers for certain competitions, because so many individuals who are eligible to serve as peer reviewers have conflicts of interest. The Standing Panel requirements under IDEA also have placed additional constraints on the availability of reviewers. Therefore, the Department has determined that, for some discretionary grant competitions, applications may be separated into two or more groups and ranked and selected for funding within specific groups. This procedure will make it easier for the Department to find peer reviewers, by ensuring that greater numbers of individuals who are eligible to serve as reviewers for any particular group of applicants will not have conflicts of interest. It also will increase the quality, independence, and fairness of the review process, while permitting panel members to review applications under discretionary grant competitions for which they also have submitted applications. However, if the Department decides to select an equal number of applications in each group for funding, this may result in different cut-off points for fundable applications in each group.
                </P>
                <HD SOURCE="HD1">VI. Award Administration Information</HD>
                <P>
                    1. 
                    <E T="03">Award Notices:</E>
                     If your application is successful, we notify your U.S. Representative and U.S. Senators and send you a Grant Award Notice (GAN). We may notify you informally, also.
                </P>
                <P>If your application is not evaluated or not selected for funding, we notify you.</P>
                <P>
                    2. 
                    <E T="03">Administrative and National Policy Requirements:</E>
                     We identify administrative and national policy requirements in the application package and reference these and other requirements in the 
                    <E T="03">Applicable Regulations</E>
                     section in this notice.
                </P>
                <P>
                    We reference the regulations outlining the terms and conditions of an award in the 
                    <E T="03">Applicable Regulations</E>
                     section in this notice and include these and other specific conditions in the GAN. The GAN also incorporates your approved application as part of your binding commitments under the grant.
                </P>
                <P>
                    3. 
                    <E T="03">Reporting:</E>
                     At the end of your project period, you must submit a final performance report, including financial information, as directed by the Secretary. If you receive a multi-year award, you must submit an annual performance report that provides the most current performance and financial expenditure information as directed by the Secretary under 34 CFR 75.118. The Secretary may also require more frequent performance reports under 34 CFR 75.720(c). For specific requirements on reporting, please go to 
                    <E T="03">http://www.ed.gov/fund/grant/apply/appforms/appforms.html.</E>
                </P>
                <P>
                    4. 
                    <E T="03">Performance Measures:</E>
                     Under the Government Performance and Results Act of 1993 (GPRA), the Department has established a set of performance measures, including long-term measures, that are designed to yield information on various aspects of the effectiveness and quality of the Personnel Development to Improve Services and Results for Children with Disabilities program. These measures include:
                </P>
                <GPOTABLE COLS="2" OPTS="L2,tp0,p1,8/9,i1" CDEF="s100,r100">
                    <TTITLE>  </TTITLE>
                    <BOXHD>
                        <CHED H="1">  </CHED>
                        <CHED H="1">  </CHED>
                    </BOXHD>
                    <ROW>
                        <ENT I="01">For 84.325D, 84.325K and 84.325T</ENT>
                        <ENT>(1) The percentage of projects that incorporate scientifically based or evidence-based practices; </ENT>
                    </ROW>
                    <ROW>
                        <ENT I="22"> </ENT>
                        <ENT>(2) The percentage of scholars who exit training programs prior to completion due to poor academic performance; </ENT>
                    </ROW>
                    <ROW>
                        <ENT I="22"> </ENT>
                        <ENT>(3) The percentage of degree or certification recipients who are working in the area(s) for which they were trained upon program completion; </ENT>
                    </ROW>
                    <ROW>
                        <ENT I="22"> </ENT>
                        <ENT>(4) The percentage of degree or certification recipients who are working in the area(s) for which they were trained upon program completion and are fully qualified under IDEA; </ENT>
                    </ROW>
                    <ROW>
                        <ENT I="22"> </ENT>
                        <ENT>(5) The percentage of scholars completing IDEA-funded training programs who are knowledgeable and skilled in scientifically based or evidence-based practices for infants, toddlers, and children with disabilities; </ENT>
                    </ROW>
                    <ROW>
                        <ENT I="22"> </ENT>
                        <ENT>(6) The percentage of low incidence positions that are filled by personnel who are fully qualified under IDEA; and </ENT>
                    </ROW>
                    <ROW>
                        <ENT I="22"> </ENT>
                        <ENT>(7) The percentage of program graduates who maintain employment for three or more years in the area(s) for which they were trained. </ENT>
                    </ROW>
                    <ROW>
                        <ENT I="01">84.325R</ENT>
                        <ENT>(1) The extent to which projects provide high quality products and services; </ENT>
                    </ROW>
                    <ROW>
                        <ENT I="22"> </ENT>
                        <ENT>(2) The relevance of project products and services to educational and early intervention policy and practice; and </ENT>
                    </ROW>
                    <ROW>
                        <ENT I="22"> </ENT>
                        <ENT>(3) The use of products and services to improve educational and early intervention policy and practice. </ENT>
                    </ROW>
                </GPOTABLE>
                <PRTPAGE P="66154"/>
                <P>Grantees may be asked to participate in assessing and providing information on these aspects of program quality.</P>
                <HD SOURCE="HD1">VII. Agency Contact</HD>
                <P>
                    <E T="03">For Further Information Contact:</E>
                     See chart in the 
                    <E T="03">Award Information</E>
                     section in this notice for the name, room number and telephone number of the contact person for each competition. You can write to the contact person at the following address: U.S. Department of Education, 400 Maryland Avenue, SW., Potomac Center Plaza (PCP), Washington, DC 20202-2600.
                </P>
                <P>If you use a TDD, call the FRS at 1-800-877-8339.</P>
                <HD SOURCE="HD1">VIII. Other Information</HD>
                <P>
                    <E T="03">Alternative Format:</E>
                     Individuals with disabilities can obtain this document and a copy of the application package in an alternative format (e.g., Braille, large print, audiotape, or computer diskette) by contacting the Grants and Contracts Services Team, U.S. Department of Education, 400 Maryland Avenue, SW., room 5075, PCP, Washington, DC 20202-2550. Telephone: (202) 245-7363. If you use a TDD, call the FRS, toll-free, at 1-800-877-8339.
                </P>
                <P>
                    <E T="03">Electronic Access to This Document:</E>
                     You can view this document, as well as all other documents of this Department published in the 
                    <E T="04">Federal Register</E>
                    , in text or Adobe Portable Document Format (PDF) on the Internet at the following site: 
                    <E T="03">www.ed.gov/news/fedregister.</E>
                </P>
                <P>To use PDF you must have Adobe Acrobat Reader, which is available free at this site. If you have questions about using PDF, call the U.S. Government Printing Office (GPO), toll free, at 1-888-293-6498; or in the Washington, DC, area at (202) 512-1530.</P>
                <NOTE>
                    <HD SOURCE="HED">Note:</HD>
                    <P>
                        The official version of this document is the document published in the 
                        <E T="04">Federal Register</E>
                        . Free Internet access to the official edition of the 
                        <E T="04">Federal Register</E>
                         and the Code of Federal Regulations is available on GPO Access at: 
                        <E T="03">www.gpoaccess.gov/nara/index.html.</E>
                    </P>
                </NOTE>
                <SIG>
                    <DATED>Dated: November 21, 2007.</DATED>
                    <NAME>William W. Knudsen,</NAME>
                    <TITLE>Deputy Assistant Secretary for Special Education and Rehabilitative Services.</TITLE>
                </SIG>
            </PREAMB>
            <FRDOC>[FR Doc. E7-23080 Filed 11-26-07; 8:45 am]</FRDOC>
            <BILCOD>BILLING CODE 4000-01-P</BILCOD>
        </NOTICE>
        <NOTICE>
            <PREAMB>
                <AGENCY TYPE="S">DEPARTMENT OF EDUCATION</AGENCY>
                <SUBJECT>President's Board of Advisors on Historically Black Colleges and Universities</SUBJECT>
                <AGY>
                    <HD SOURCE="HED">AGENCY:</HD>
                    <P>U.S. Department of Education, White House Initiative on Historically Black Colleges and Universities.</P>
                </AGY>
                <ACT>
                    <HD SOURCE="HED">ACTION:</HD>
                    <P>Notice of an open meeting.</P>
                </ACT>
                <SUM>
                    <HD SOURCE="HED">SUMMARY:</HD>
                    <P>This notice sets forth the schedule and agenda of the meeting of the President's Board of Advisors on Historically Black Colleges and Universities. This notice also describes the functions of the Board. Notice of this meeting is required by section 10(a)(2) of the Federal Advisory Committee Act and is intended to notify the public of its opportunity to attend.</P>
                </SUM>
                <DATES>
                    <HD SOURCE="HED">DATES:</HD>
                    <P>Saturday, December 8, 2007.</P>
                </DATES>
                <PREAMHD>
                    <HD SOURCE="HED">TIME:</HD>
                    <P>9 a.m.-3 p.m.</P>
                </PREAMHD>
                <ADD>
                    <HD SOURCE="HED">ADDRESSES:</HD>
                    <P>The Board will meet at the Xavier University of Louisiana, University Center Building, Suite 308, 1 Drexel Drive, New Orleans, LA 70125, Phone: 504-520-7904, Fax: 504-520-7904.</P>
                </ADD>
                <FURINF>
                    <HD SOURCE="HED">FOR FURTHER INFORMATION, CONTACT:</HD>
                    <P>Leonard L. Haynes III, Executive Director, White House Initiative on Historically Black Colleges and Universities, 1990 K Street, NW., Washington, DC 20006; telephone: (202) 502-7549, fax: 202-502-7852.</P>
                </FURINF>
            </PREAMB>
            <SUPLINF>
                <HD SOURCE="HED">SUPPLEMENTARY INFORMATION:</HD>
                <P>The President's Board of Advisors on Historically Black Colleges and Universities is established under Executive Order 13256, dated February 12, 2002 and Executive Order 13316 dated September 17, 2003. The Board is established (a) to report to the President annually on the results of the participation of historically black colleges and universities (HBCUs) in federal programs, including recommendations on how to increase the private sector role in strengthening these institutions, with particular emphasis given to enhancing institutional planning and development; strengthening fiscal stability and financial management; and improving institutional infrastructure, including the use of technology, to ensure the long-term viability and enhancement of these institutions; (b) to advise the President and the Secretary of Education (Secretary) on the needs of HBCUs in the areas of infrastructure, academic programs, and faculty and institutional development; (c) to advise the Secretary in the preparation of an annual Federal plan for assistance to HBCUs in increasing their capacity to participate in Federal programs; (d) to provide the President with an annual progress report on enhancing the capacity of HBCUs to serve their students; and (e) to develop, in consultation with the Department of Education and other Federal agencies, a private sector strategy to assist HBCUs.</P>
                <P>
                    <E T="03">Agenda:</E>
                     The purpose of the meeting is to receive and deliberate on policy issues pertinent to the Board and the nation's HBCUs and to discuss relevant issues to be addressed in the Board's annual report. This meeting will also provide the Board with a forum to vote and approve action items regarding implementation of Presidential Executive Order 13256.
                </P>
                <P>
                    <E T="03">Additional Information:</E>
                     Individuals who will need accommodations for a disability in order to attend the meeting (e.g., interpreting services, assistive listening devices, or material in alternative format) should notify ReShone Moore at (202) 502-7893, no later than Thursday, December 6, 2007. We will attempt to meet requests for accommodations after this date, but, cannot guarantee availability. The meeting site is accessible to individuals with disabilities.
                </P>
                <P>An opportunity for public comment is available on Saturday, December 8, 2007, between 2:30 p.m.-3 p.m. Individuals who wish to provide comments will be allowed three to five minutes to speak. Those members of the public interested in submitting written comments may do so by submitting it to the attention of Leonard L. Haynes, 1990 K Street NW., Washington, DC., by Thursday, December 6, 2007.</P>
                <P>Records are kept of all Board proceedings and are available for public inspection at the office of the White House Initiative on Historically Black Colleges and Universities, U.S. Department of Education, 1990 K Street, NW., Washington, DC 20006, Monday-Friday during the hours of 8 a.m. to 5 p.m.</P>
                <P>
                    <E T="03">Electronic Access to this Document:</E>
                     You may view this document, as well as all other documents of this Department published in the 
                    <E T="04">Federal Register</E>
                    , in text or Adobe Portable Document Format (PDF) on the internet at the following site: 
                    <E T="03">http://www.ed.gov/news/fedregister/index.html.</E>
                     To use PDF you must have Adobe Acrobat Reader, which is available free at this site. If you have questions about using PDF, call the U.S. Government Printing Office (GPO), toll free at 1-888-293-6498; or in the Washington, DC area at 202-512-1530.
                </P>
                <SIG>
                    <PRTPAGE P="66155"/>
                    <DATED>Dated: November 16, 2007.</DATED>
                    <NAME>Diane Auer Jones,</NAME>
                    <TITLE>Assistant Secretary, U.S. Department of Education, Office of Postsecondary Education.</TITLE>
                </SIG>
            </SUPLINF>
            <FRDOC>[FR Doc. E7-22988 Filed 11-26-07; 8:45 am]</FRDOC>
            <BILCOD>BILLING CODE 4000-01-P</BILCOD>
        </NOTICE>
        <NOTICE>
            <PREAMB>
                <AGENCY TYPE="S">DEPARTMENT OF EDUCATION</AGENCY>
                <SUBJECT>Privacy Act of 1974; System of Records—Department of Education Federal Docket Management System (EDFDMS) </SUBJECT>
                <AGY>
                    <HD SOURCE="HED">AGENCY:</HD>
                    <P>Office of the General Counsel, Department of Education. </P>
                </AGY>
                <ACT>
                    <HD SOURCE="HED">ACTION:</HD>
                    <P>Notice of a new system of records. </P>
                </ACT>
                <SUM>
                    <HD SOURCE="HED">SUMMARY:</HD>
                    <P>In accordance with the Privacy Act of 1974, as amended (Privacy Act), the Department of Education (Department) publishes this notice of a new system of records entitled “Department of Education Federal Docket Management System” (EDFDMS) (18-09-05). </P>
                    <P>
                        EDFDMS contains individually identifying information voluntarily provided by individuals who submit public comments on the Department's rulemaking documents that are in the Federal Docket Management System (FDMS). FDMS is an interagency system that allows the public to search, view, download, and comment on Federal agency rulemaking documents through a single online system. The public accesses the FDMS Web portal at 
                        <E T="03">http://www.regulations.gov.</E>
                    </P>
                </SUM>
                <DATES>
                    <HD SOURCE="HED">DATES:</HD>
                    <P>The Department seeks comment on the new system of records described in this notice, in accordance with the requirements of the Privacy Act. We must receive your comments on the proposed routine uses for the system of records referenced in this notice on or before December 27, 2007. </P>
                    <P>The Department filed a report describing the new system of records covered by this notice with the Chair of the Senate Committee on Homeland Security and Governmental Affairs, the Chair of the House Committee on Oversight and Government Reform, and the Administrator of the Office of Information and Regulatory Affairs, Office of Management and Budget (OMB) on November 21, 2007. This system of records will become effective at the later date of—(1) The expiration of the 40-day period for OMB review on December 31, 2007, unless OMB waives 10 days of the 40-day review period for compelling reasons shown by the Department, or (2) December 27, 2007, unless the system of records needs to be changed as a result of public comment or OMB review. </P>
                </DATES>
                <ADD>
                    <HD SOURCE="HED">ADDRESSES:</HD>
                    <P>
                        Address all comments about the proposed routine uses to Elizabeth McFadden, Assistant General Counsel, Regulatory Services Division, Office of the General Counsel, U.S. Department of Education, 400 Maryland Avenue, SW., room 6E227, Washington, DC 20202-6110. 
                        <E T="03">Telephone:</E>
                         (202) 401-6307. If you prefer to send comments through the Internet, use the following address: 
                        <E T="03">comments@ed.gov.</E>
                    </P>
                    <P>You must include the term “EDFDMS” in the subject line of the electronic message. </P>
                    <P>During and after the comment period, you may inspect all comments about this notice in room 6E227, 400 Maryland Avenue, SW., Washington, DC, between the hours of 8 a.m. and 4:30 p.m., Eastern time, Monday through Friday of each week except Federal holidays. </P>
                </ADD>
                <HD SOURCE="HD1">Assistance to Individuals With Disabilities in Reviewing the Rulemaking Record </HD>
                <P>
                    On request, we will supply an appropriate aid to an individual with a disability who needs assistance to review the comments or other documents in the public rulemaking record for this notice. If you want to schedule an appointment for this type of aid, please contact the person listed under 
                    <E T="02">FOR FURTHER INFORMATION CONTACT</E>
                    . 
                </P>
                <FURINF>
                    <HD SOURCE="HED">FOR FURTHER INFORMATION CONTACT:</HD>
                    <P>
                        Elizabeth McFadden. 
                        <E T="03">Telephone:</E>
                         (202) 401-6307. If you use a telecommunications device for the deaf (TDD), call the Federal Relay Service (FRS) at 1-800-877-8339. 
                    </P>
                    <P>Individuals with disabilities can obtain this document in an alternative format (e.g., Braille, large print, audiotape, or computer diskette) on request to the contact person listed in this section. </P>
                </FURINF>
            </PREAMB>
            <SUPLINF>
                <HD SOURCE="HED">SUPPLEMENTARY INFORMATION:</HD>
                <HD SOURCE="HD1">Introduction </HD>
                <P>
                    FDMS serves as a central, electronic repository for Federal rulemaking dockets and includes 
                    <E T="04">Federal Register</E>
                     notices, supporting materials such as scientific or economic analyses, and public comments, as well as non-rulemaking dockets. Each agency that uses FDMS, including the Department, is responsible for managing its own dockets and rulemaking documents. 
                </P>
                <P>Through the Department's portion of FDMS, members of the public may comment on the Department's rulemaking documents contained in the system. In order to submit a comment through the Department's portion of FDMS, members of the public only need to complete two fields—the “Category” field and the “General Comments” field. To complete the “Category” field, commenters are prompted to select the most appropriate category from the following list: Parent/relative, teacher, student, individual, public elementary/secondary school, private elementary/secondary school, school administrator, institution of higher education, lender, guarantor, local educational agency, State educational agency, State agency, association/organization, Federal agency, child advocate, lobbyist, law firm, tribal organization, and other. The “General Comments” field in FDMS is a free text field in which individuals provide their actual comments. In addition to these two required fields, commenters may, but are not required to, provide the following information: First name, last name, city, country, State or province, e-mail address, organization name, submitter's representative, government agency type, and government agency. </P>
                <P>
                    Generally, the Department makes all of the information provided by commenters, including commenters' names and other individually identifying information provided within the comments, publicly viewable on the Federal government's interagency FDMS Web portal at 
                    <E T="03">http://www.regulations.gov</E>
                    . FDMS has full text search capability, enabling any member of the public to search all public submissions on any Department rulemaking in FDMS by any term, including any name and contact information submitted in or as part of a comment. 
                </P>
                <P>
                    On the 
                    <E T="03">http://www.regulations.gov</E>
                     Web site and in the Department's notices of proposed rulemaking, the Department clearly notifies the public that, with few exceptions, comments received from members of the public (including those comments submitted by mail, commercial delivery, or hand delivery) are made publicly available on the Federal eRulemaking Portal (
                    <E T="03">http://www.regulations.gov</E>
                    ) without change. The Department makes efforts to ensure that comments containing material the disclosure of which is restricted by Federal law, such as the Children's Online Privacy Protection Act of 1998 (COPPA), are not made publicly available. While not publicly posted, the Department will retain, evaluate, and consider these comments. EDFDMS is comprised of both these comments that are not publicly available, as well as the comments on the Department's rulemakings that are available to the 
                    <PRTPAGE P="66156"/>
                    public through 
                    <E T="03">http://www.regulations.gov.</E>
                </P>
                <HD SOURCE="HD1">The Privacy Act </HD>
                <P>The Department is publishing this new system of records notice, in accordance with the applicable requirements of the Privacy Act, to inform the public about how it will collect, maintain, use, and disclose the information that members of the public provide when commenting on a Department rulemaking that is part of FDMS. </P>
                <P>
                    The Privacy Act applies to information about individuals that contains individually identifying information and that is retrieved by a unique identifier associated with each individual, such as a name or social security number. The information about each individual is called a “record,” and the system, whether manual or computer-based, is called a “system of records.” The Privacy Act requires each agency to publish notices of systems of records in the 
                    <E T="04">Federal Register</E>
                     and to prepare reports to OMB and Congress whenever the agency publishes a new system of records. 
                </P>
                <P>
                    The portion of the EDFDMS system that comes under the Privacy Act includes only the individually identifying information that commenters voluntarily submit to the Department when they comment on the Department's rulemaking documents in FDMS. The Privacy Act, 5 U.S.C. 552a(e)(4), requires the Department to publish in the 
                    <E T="04">Federal Register</E>
                     this notice of a new system of records maintained by the Department. The Department's regulations implementing the Privacy Act are contained in the Code of Federal Regulations (CFR) in 34 CFR part 5b. 
                </P>
                <HD SOURCE="HD1">Electronic Access to This Document </HD>
                <P>
                    You may view this document, as well as all other documents of this Department published in the 
                    <E T="04">Federal Register</E>
                    , in text or Adobe Portable Document Format (PDF) on the Internet at the following site: 
                    <E T="03">http://www.ed.gov/news/fedregister.</E>
                </P>
                <P>To use PDF you must have Adobe Acrobat Reader, which is available free at this site. If you have questions about using PDF, call the U.S. Government Printing Office (GPO), toll free, at 1-888-293-6498; or in the Washington, DC area, at (202) 512-1530. </P>
                <NOTE>
                    <HD SOURCE="HED">Note:</HD>
                    <P>
                        The official version of this document is the document published in the 
                        <E T="04">Federal Register</E>
                        . Free Internet access to the official edition of the 
                        <E T="04">Federal Register</E>
                         and the Code of Federal Regulations is available on GPO Access at: 
                        <E T="03">http://www.gpoaccess.gov/nara/index.html.</E>
                    </P>
                </NOTE>
                <SIG>
                    <DATED>Dated: November 21, 2007. </DATED>
                    <NAME>Kent D. Talbert, </NAME>
                    <TITLE>General Counsel.</TITLE>
                </SIG>
                <P>For the reasons discussed in the preamble, the General Counsel of the Department of Education publishes a notice of a new system of records to read as follows: </P>
                <PRIACT>
                    <HD SOURCE="HD1">18-09-05 </HD>
                    <HD SOURCE="HD2">SYSTEM NAME: </HD>
                    <P>Department of Education Federal Docket Management System (EDFDMS). </P>
                    <HD SOURCE="HD2">SECURITY CLASSIFICATION: </HD>
                    <P>None. </P>
                    <HD SOURCE="HD2">SYSTEM LOCATION: </HD>
                    <P>The central location is at the U.S. Environmental Protection Agency, Research Triangle Park, NC 27711-0001. Access is available through the Internet from other locations. </P>
                    <HD SOURCE="HD2">CATEGORIES OF INDIVIDUALS COVERED BY THE SYSTEM: </HD>
                    <P>Information on individuals who voluntarily provide individually identifying information when submitting a public comment or supporting materials in response to a Department rulemaking document or notice in the Federal Docket Management System (FDMS) are covered by this system. Although this system may also contain information on and public comments submitted by representatives of governmental or organizational entities, the purpose for which the Department is establishing this system of records is only to cover individuals protected under the Privacy Act of 1974 (5 U.S.C. 552a(a)(2)). </P>
                    <HD SOURCE="HD2">CATEGORIES OF RECORDS IN THE SYSTEM: </HD>
                    <P>The categories of records in the system include: First name, last name, category (such as parent/relative, student, teacher, local educational agency, or lender), city, country, State or province, email address, organization name, submitter's representative, government agency type, government agency, additional information provided in the “General Comments” section, and other supporting documentation furnished by the submitter. </P>
                    <HD SOURCE="HD2">AUTHORITY FOR MAINTENANCE OF THE SYSTEM: </HD>
                    <P>Section 206(d) of the E-Government Act of 2002 (Pub. L. 107-347, 44 U.S.C. 3501 note); 5 U.S.C. 301; and 5 U.S.C. 553. </P>
                    <HD SOURCE="HD2">PURPOSE: </HD>
                    <P>The EDFDMS system of records permits the Department to identify individuals who have submitted comments, in response to the Department's rulemaking documents or notices that are in FDMS, so that communications or other actions, as appropriate and necessary, can be effected. Examples of such communications are seeking clarification of a comment and responding directly to a comment. </P>
                    <HD SOURCE="HD2">ROUTINE USES OF RECORDS MAINTAINED IN THE SYSTEM, INCLUDING CATEGORIES OF USERS AND THE PURPOSES OF SUCH USES: </HD>
                    <P>The Department may disclose information contained in a record in this system of records without the consent of the individual if the disclosure is compatible with the purposes for which the record was collected. The Department may make these disclosures on a case-by-case basis, or, if the Department has complied with the computer matching requirements of the Computer Matching and Privacy Protection Act of 1988, as amended, under a computer matching agreement. </P>
                    <P>
                        (1) 
                        <E T="03">Disclosure to the Public.</E>
                         With few exceptions, the Department may disclose information in EDFDMS to any member of the public. EDFDMS permits members of the public to search the public comments that are received by the Department and included in FDMS by the name of the individual submitting the comment. Unless the individual submits a comment anonymously, a full-text search, using the individual's name, will generally result in the comment and the commenter's information being displayed for view. With few exceptions, comments that are submitted using the FDMS system will include any information that the commenter provided when submitting the comment. In addition, with few exceptions, comments that are submitted in writing and then scanned and uploaded into the FDMS system will include any identifying information about the submitter that is provided in the written comment. If a commenter provides individually identifying information about a third party, a full-text search using the third party's name, with some exceptions, will result in the third party's information being displayed for view. 
                    </P>
                    <NOTE>
                        <HD SOURCE="HED">Note:</HD>
                        <P>Identification of an individual commenter or third party is possible only if the commenter voluntarily provides his or her name or contact information, or that of a third party. If this information is not furnished, the submitted comments or supporting documentation cannot be linked to the commenter or a third party.</P>
                    </NOTE>
                    <P>
                        (2) 
                        <E T="03">Disclosure for Use by Other Law Enforcement Agencies.</E>
                         The Department may disclose information to any 
                        <PRTPAGE P="66157"/>
                        Federal, State, local, or foreign agency, or other public authority responsible for enforcing, investigating, or prosecuting violations of administrative, civil, or criminal law or regulation if that information is relevant to any enforcement, regulatory, investigative, or prosecutorial responsibility within the receiving entity's jurisdiction. 
                    </P>
                    <P>
                        (3) 
                        <E T="03">Enforcement Disclosure.</E>
                         In the event that information in this system of records indicates, either on its face or in connection with other information, a violation or potential violation of any applicable statute, regulation, or order of a competent authority, the Department may disclose the relevant records to the appropriate agency, whether foreign, Federal, State, Tribal, or local, charged with the responsibility of investigating or prosecuting that violation or charged with enforcing or implementing the statute, Executive order, rule, regulation, or order issued pursuant thereto. 
                    </P>
                    <P>
                        (4) 
                        <E T="03">Litigation and Alternative Dispute Resolution (ADR) Disclosure.</E>
                    </P>
                    <P>
                        (a) 
                        <E T="03">Introduction.</E>
                         In the event that one of the parties listed below is involved in litigation or ADR, or has an interest in litigation or ADR, the Department may disclose certain records to the parties described in paragraphs (b), (c), and (d) of this routine use under the conditions specified in those paragraphs: 
                    </P>
                    <P>(i) The Department or any of its components. </P>
                    <P>(ii) Any Department employee in his or her official capacity. </P>
                    <P>(iii) Any Department employee in his or her individual capacity if the U.S. Department of Justice (DOJ) has been requested to or has agreed to provide or arrange for representation for the employee. </P>
                    <P>(iv) Any Department employee in his or her individual capacity where the Department has agreed to represent the employee. </P>
                    <P>(v) The United States where the Department determines that the litigation is likely to affect the Department or any of its components. </P>
                    <P>
                        (b) 
                        <E T="03">Disclosure to DOJ</E>
                        . If the Department determines that disclosure of certain records to DOJ is relevant and necessary to litigation or ADR, the Department may disclose those records as a routine use to DOJ. 
                    </P>
                    <P>
                        (c) 
                        <E T="03">Adjudicative Disclosure</E>
                        . If the Department determines that it is relevant and necessary to the litigation or ADR to disclose certain records to an adjudicative body before which the Department is authorized to appear, to an individual, or to an entity designated by the Department or otherwise empowered to resolve or mediate disputes, the Department may disclose those records as a routine use to the adjudicative body, individual, or entity. 
                    </P>
                    <P>
                        (d) 
                        <E T="03">Disclosure to parties, counsels, representatives, or witnesses</E>
                        . If the Department determines that disclosure of certain records to a party, counsel, representative, or witness is relevant and necessary to the litigation or ADR, the Department may disclose those records as a routine use to the party, counsel, representative, or witness. 
                    </P>
                    <P>
                        (5) 
                        <E T="03">Freedom of Information Act (FOIA) and Privacy Act Advice Disclosure</E>
                        . The Department may disclose records to DOJ or OMB if the Department concludes that disclosure is desirable or necessary in determining whether particular records are required to be disclosed under the FOIA or the Privacy Act. 
                    </P>
                    <P>
                        (6) 
                        <E T="03">Disclosure to DOJ</E>
                        . The Department may disclose records to DOJ to the extent necessary for obtaining DOJ advice on any matter relevant to an audit, inspection, or other inquiry related to the programs covered by this system. 
                    </P>
                    <P>
                        (7) 
                        <E T="03">Contract Disclosure</E>
                        . If the Department contracts with an entity for the purposes of performing any function that requires disclosure of records in this system to employees of the contractor, the Department may disclose the records to those employees. Before entering into such a contract, the Department shall require the contractor to maintain Privacy Act safeguards as required under 5 U.S.C. 552a(m) with respect to the records in the system. 
                    </P>
                    <P>
                        (8) 
                        <E T="03">Congressional Member Disclosure</E>
                        . The Department may disclose the records of an individual to a member of Congress or the member's staff in response to an inquiry from the member made at the written request of that individual. The member's right to the information is no greater than the right of the individual who requested the inquiry. 
                    </P>
                    <P>
                        (9) 
                        <E T="03">Disclosure in the Course of Responding to Breach of Data</E>
                        . The Department may disclose records to appropriate agencies, entities, and persons when (1) it is suspected or confirmed that the security or confidentiality of information in this system has been compromised; (2) the Department has determined that as a result of the suspected or confirmed compromise, there is a risk of harm to economic or property interests, identity theft or fraud, or harm to the security or integrity of this system or other systems or programs (whether maintained by the Department or by another agency or entity) that rely upon the compromised information; and (3) the disclosure is made to such agencies, entities, and persons who are reasonably necessary to assist the Department in responding to the suspected or confirmed compromise and in helping the Department prevent, minimize, or remedy such harm. 
                    </P>
                    <HD SOURCE="HD2">POLICIES AND PRACTICES FOR STORING, RETRIEVING, ACCESSING, RETAINING, AND DISPOSING OF RECORDS IN THE SYSTEM: </HD>
                    <HD SOURCE="HD2">STORAGE:</HD>
                    <P>Records are maintained on electronic storage media and in paper. </P>
                    <HD SOURCE="HD2">RETRIEVABILITY:</HD>
                    <P>EDFDMS enables record retrieval by various data elements and key word searches. These data elements are: document identification number, comment tracking number, document title, Code of Federal Regulation (CFR) (search for a specific title within the CFR), CFR citation (search for the part or parts within the CFR title being searched), document type, document sub type, date posted, and comment period end date. </P>
                    <HD SOURCE="HD2">SAFEGUARDS:</HD>
                    <P>
                        As discussed above in routine use (1), 
                        <E T="03">Disclosure to the Public</E>
                        , any member of the public who accesses FDMS through 
                        <E T="03">http://www.regulations.gov</E>
                         and searches the comments associated with the Department's rulemakings can view EDFDMS records that are included in FDMS. 
                    </P>
                    <P>To the extent paper records from this system of records are maintained, they will be maintained in a controlled facility where physical entry is restricted by locks, guards, and administrative procedures. </P>
                    <P>Access to electronic and paper EDFDMS records that are not otherwise available to the public through FDMS is limited to those Department and contract staff who require the records to perform their official duties consistent with the purposes for which the information was collected. Personnel whose official duties require access to either electronic or written EDFDMS records that are not otherwise available to the public through FDMS are trained in the proper safeguarding and use of the information. </P>
                    <HD SOURCE="HD2">RETENTION AND DISPOSAL:</HD>
                    <P>Until the National Archives and Records Administration (NARA) approves a retention and disposition schedule for EDFDMS, the Department will treat all EDFDMS records as permanent. </P>
                    <HD SOURCE="HD2">SYSTEM MANAGER AND ADDRESS:</HD>
                    <P>
                        Elizabeth McFadden, Assistant General Counsel, Regulatory Services Division, Office of the General Counsel, U.S. Department of Education, 400 
                        <PRTPAGE P="66158"/>
                        Maryland Avenue, SW., room 6E227, Washington, DC 20202-6110. 
                    </P>
                    <HD SOURCE="HD2">NOTIFICATION PROCEDURE: </HD>
                    <P>If you wish to determine whether a record exists regarding you in the system of records, contact the system manager. Your request must meet the requirements of regulations in 34 CFR 5b.5, including proof of identity. </P>
                    <HD SOURCE="HD2">RECORD ACCESS PROCEDURES: </HD>
                    <P>
                        If you wish to gain access to your record in the system of records, contact the system manager at the address listed under 
                        <E T="02">SYSTEM MANAGER AND ADDRESS</E>
                        . Requests should contain your full name, address, and telephone number. Your request must meet the requirements of regulations in 34 CFR 5b.5, including proof of identity. 
                    </P>
                    <HD SOURCE="HD2">CONTESTING RECORD PROCEDURES: </HD>
                    <P>If you wish to contest the content of a record regarding you in the system of records, contact the system manager. Your request must meet the requirements of the regulations in 34 CFR 5b.7, including proof of identity. </P>
                    <HD SOURCE="HD2">RECORD SOURCE CATEGORIES: </HD>
                    <P>Information maintained in this system of records is obtained from anyone who chooses to voluntarily submit a public comment or supporting materials in response to a Department rulemaking document or notice, including individuals and representatives of Federal, State or local governments, businesses, and other organizations. </P>
                    <HD SOURCE="HD2">EXEMPTIONS CLAIMED FOR THE SYSTEM: </HD>
                    <P>None. </P>
                </PRIACT>
            </SUPLINF>
            <FRDOC>[FR Doc. E7-23058 Filed 11-26-07; 8:45 am] </FRDOC>
            <BILCOD>BILLING CODE 4000-01-P </BILCOD>
        </NOTICE>
        <NOTICE>
            <PREAMB>
                <AGENCY TYPE="S">DEPARTMENT OF EDUCATION </AGENCY>
                <SUBJECT>Privacy Act of 1974; System of Records—Investigatory Material Compiled for Personnel Security, Suitability, Positive Identification Verification and Access Control for the Department of Education Security Tracking and Reporting System (EDSTAR) </SUBJECT>
                <AGY>
                    <HD SOURCE="HED">AGENCY:</HD>
                    <P>Office of Management, Department of Education. </P>
                </AGY>
                <ACT>
                    <HD SOURCE="HED">ACTION:</HD>
                    <P>Notice of altered and deleted systems of records. </P>
                </ACT>
                <SUM>
                    <HD SOURCE="HED">SUMMARY:</HD>
                    <P>In accordance with the Privacy Act of 1974, as amended (Privacy Act), the Department of Education (Department), publishes this notice to amend and rename the system of records entitled “Investigatory Material Compiled for Personnel Security and Suitability Purposes” (18-05-17) as “Investigatory Material Compiled for Personnel Security, Suitability, Positive Identification Verification and Access Control for the Department of Education Security Tracking and Reporting System (EDSTAR)” (18-05-17) and to delete the system of records entitled “Identification Media Records” (18-05-16). The Department is taking these actions because these systems of records have been merged into and consolidated with the EDSTAR system of records. </P>
                    <P>EDSTAR is designed to implement the requirements of Homeland Security Presidential Directive (HSPD)-12. HSPD-12 is a Presidential directive that requires the promulgation of a Federal standard to ensure a common, governmentwide standard for secure and reliable forms of Personal Identity Verification (PIV). On February 25, 2005, the National Institute of Standards and Technology's (NIST's) Computer Security Division issued Federal Information Processing Standard (FIPS) 201, entitled “Personal Identity Verification of Federal Employees and Contractors”, in order to satisfy the requirements of HSPD-12 to improve the identification and authentication of Federal employees and contractors for access to Federal facilities and information systems. </P>
                    <P>The Department maintains records in EDSTAR for the purpose of making individual positive identification verification, adjudication determinations concerning suitability for Federal employment and contract positions, decisions concerning access to the Department's facilities and information systems, and information related to the issuance of PIV and FIPS compliant identification media and access to restricted areas. Because many of these records are currently covered by the systems of records entitled “Identification Media Records” (18-05-16) and “Investigatory Material Compiled for Personnel Security and Suitability Purposes” (18-05-17), the Department is merging and consolidating these systems of records by amending and renaming the “Investigatory Material Compiled for Personnel Security and Suitability Purposes” (18-05-17) system as EDSTAR and deleting the system of records for “Identification Media Records” (18-05-16). </P>
                </SUM>
                <DATES>
                    <HD SOURCE="HED">DATES:</HD>
                    <P>We must receive your comments about the altered and deleted systems of records notice on or before December 27, 2007. </P>
                    <P>The Department filed a report describing the altered system of records covered by this notice with the Chair of the Senate Committee on Homeland Security and Governmental Affairs, the Chair of the House Committee on Oversight and Government Reform, and the Administrator of the Office of Information and Regulatory Affairs, Office of Management and Budget (OMB) on November 21, 2007. The altered system of records will become effective at the later date of—(1) The expiration of the 40-day period for OMB review on December 31, 2007 or (2) December 27, 2007, unless the system of records needs to be changed as a result of public comment or OMB review. </P>
                </DATES>
                <ADD>
                    <HD SOURCE="HED">ADDRESSES:</HD>
                    <P>
                        Address all comments about the altered and deleted systems of records to Cecelia E. Briscoe, Senior Program Analyst, Security Services, Office of Management, Room 2W312, U.S. Department of Education, 400 Maryland Avenue, SW., Washington, DC 20202-5345. If you prefer to send comments through the Internet, use the following address: 
                        <E T="03">Security.Services@Ed.gov.</E>
                    </P>
                    <P>You must include the term “EDSTAR Comments” in the subject line of your electronic message. </P>
                    <P>During and after the comment period, you may inspect all public comments about this notice at the U.S. Department of Education in room 2W330, 400 Maryland Avenue, SW., Washington, DC, between the hours of 8 a.m. and 4:30 p.m., Eastern time, Monday through Friday of each week except Federal holidays. </P>
                </ADD>
                <HD SOURCE="HD1">Assistance to Individuals With Disabilities in Reviewing the Rulemaking Record </HD>
                <P>
                    On request, we will supply an appropriate aid, such as a reader or print magnifier, to an individual with a disability who needs assistance to review the comments or other documents in the public rulemaking record for this notice. If you want to schedule an appointment for this type of aid, please contact the person listed under 
                    <E T="02">FOR FURTHER INFORMATION CONTACT</E>
                    . 
                </P>
                <FURINF>
                    <HD SOURCE="HED">FOR FURTHER INFORMATION CONTACT:</HD>
                    <P>Colette Hawley, Security Services, Office of Management, room 2W312, U.S. Department of Education, 400 Maryland Avenue, SW., Washington, DC 20202-5345. Telephone number: (202) 401-2993. If you use a telecommunications device for the deaf (TDD), you may call the Federal Relay Service (FRS) at 1-800-877-8339. </P>
                    <P>
                        Individuals with disabilities may obtain this document in an alternative format (e.g., Braille, large print, audiotape, or computer diskette) on 
                        <PRTPAGE P="66159"/>
                        request to the contact person listed in the preceding paragraph. 
                    </P>
                </FURINF>
            </PREAMB>
            <SUPLINF>
                <HD SOURCE="HED">SUPPLEMENTARY INFORMATION:</HD>
                <HD SOURCE="HD1">Introduction </HD>
                <P>
                    The Privacy Act (5 U.S.C. 552a(e)(4)) requires the Department to publish in the 
                    <E T="04">Federal Register</E>
                     this notice of an altered system of records maintained by the Department. The Department's regulations implementing the Privacy Act are contained in part 5b of title 34 of the Code of Federal Regulations (CFR). 
                </P>
                <P>
                    The Privacy Act applies to information about individuals that is maintained in a system of records from which individually identifying information is retrieved by a unique identifier associated with each individual, such as a name or social security number. The information about each individual is called a “record,” and the system, whether manual or computer-based, is called a “system of records.” The Privacy Act requires each agency to publish notices of new or altered systems of records in the 
                    <E T="04">Federal Register</E>
                     and to submit reports to the Administrator of the Office of Information and Regulatory Affairs, OMB, the Chair of the House Committee on Oversight and Government Reform, and the Chair of the Senate Committee on Homeland Security and Governmental Affairs, whenever the agency publishes a new or altered system of records. 
                </P>
                <HD SOURCE="HD1">Electronic Access to This Document </HD>
                <P>
                    You can view this document, as well as all other documents of this Department published in the 
                    <E T="04">Federal Register</E>
                    , in text or Adobe Portable Document Format (PDF) on the Internet at the following site: 
                    <E T="03">www.ed.gov/news/fedregister.</E>
                </P>
                <P>To use PDF you must have Adobe Acrobat Reader, which is available free at this site. If you have questions about using PDF, call the U.S. Government Printing Office (GPO), toll free, at 1-888-293-6498; or in the Washington, DC, area at (202) 512-1530. </P>
                <NOTE>
                    <HD SOURCE="HED">Note:</HD>
                    <P>
                        The official version of this document is the document published in the 
                        <E T="04">Federal Register</E>
                        . Free Internet access to the official edition of the 
                        <E T="04">Federal Register</E>
                         and the Code of Federal Regulations is available on GPO Access at: 
                        <E T="03">www.gpoaccess.gov/nara/index.html.</E>
                    </P>
                </NOTE>
                <SIG>
                    <DATED>Dated: November 21, 2007. </DATED>
                    <NAME>Michell C. Clark, </NAME>
                    <TITLE>Assistant Secretary for Management.</TITLE>
                </SIG>
                <P>For the reasons discussed in the preamble, the Assistant Secretary for Management of the Department publishes a notice of altered and deleted systems of records to read as follows: </P>
                <PRIACT>
                    <HD SOURCE="HD1">DELETED SYSTEM OF RECORDS </HD>
                    <P>
                        The Department identifies the system of records entitled Identification Media Records (18-05-16), as published in the 
                        <E T="04">Federal Register</E>
                         on December 26, 2002 (67 FR 78794-96), to be deleted because it has been merged into and consolidated with the following system of records: 
                    </P>
                    <HD SOURCE="HD1">ALTERED SYSTEM OF RECORDS </HD>
                    <HD SOURCE="HD2">18-05-17 </HD>
                    <HD SOURCE="HD2">SYSTEM NAME: </HD>
                    <P>Investigatory Material Compiled for Personnel Security, Suitability, Positive Identification Verification and Access Control for the Department of Education Security Tracking and Reporting System (EDSTAR). </P>
                    <HD SOURCE="HD2">SECURITY CLASSIFICATION: </HD>
                    <P>None. </P>
                    <HD SOURCE="HD2">SYSTEM LOCATIONS: </HD>
                    <P>(1) Security Services, Office of Management, U.S. Department of Education, 400 Maryland Avenue, SW., Washington, DC 20202-5345. </P>
                    <P>(2) U.S. Department of Education, Data Center, 6710 Oxon Hill Road, Oxon Hill, MD 20745-1117. </P>
                    <P>(3) U.S. Office of Personnel Management (OPM), Federal Investigations Processing Center, P.O. Box 618, 1137 Branchton Road, Boyers, PA 16018-0618. </P>
                    <P>(4) Verisign, 487 E. Middlefield Road, Mountain View, CA 94043-4047. </P>
                    <P>(5) U.S. Department of Justice (DOJ), DOJ Rockville Data Center, 1151-D Seven Locks Road, Rockville, MD 20854-0001. </P>
                    <HD SOURCE="HD2">CATEGORIES OF INDIVIDUALS COVERED BY THE SYSTEM: </HD>
                    <P>This system contains information on applicants seeking Federal or contract employment with the Department, current Federal employees and contractors, and other persons or entities doing business with the Department, or persons either seeking unescorted access to the facilities, or access to the information systems of the Department, or both. The system does not cover term employees of less than 30 calendar days with monitored access to either the Department's facilities or information system, or both. Nor does it cover occasional visitors or short-term guests to the Department to the extent that they are issued non-Personal Identity Verification (PIV) temporary identification. </P>
                    <HD SOURCE="HD2">CATEGORIES OF RECORDS IN THE SYSTEM: </HD>
                    <P>This system consists of records containing investigative information pertaining to current and former Department employees, current and former contractor personnel, and current employees of entities making offers to the Department for purposes of doing business. This information may include information pertaining to the individuals' character, conduct, and loyalty to the United States as relevant to determination of their suitability for employment in the Department. This system of records may include an individual's name, former names, birth date, birth place, Social Security number, home address, phone numbers, employment history, residential history, education and degrees earned, names of associates and references and their contact information, citizenship, names of relatives, birth dates and birth places of relatives, citizenship of relatives, names of relatives who work for the Federal government, mental health history, drug use, financial information, summary report of investigation, results of suitability decisions, level of security clearance, date of issuance of security clearance, requests for appeal, witness statements, investigator's notes, tax return information, credit reports, security violations, circumstances of violation, and agency action taken. </P>
                    <P>These records also may, as appropriate to the individual being investigated, include the following types of information: </P>
                    <P>(1) Documentation as to his or her arrests and convictions for violations of the law. </P>
                    <P>(2) Reporting as to interviews held with the individual, his or her present and former supervisors, co-workers, associates, neighbors, educators, etc. </P>
                    <P>(3) Correspondence relating to adjudication matters involving the individual. </P>
                    <P>(4) Reports of inquiries made of law enforcement agencies for information about the individual contained in the agencies' records. </P>
                    <P>(5) Information provided by organizations having association with the individual, such as employers, educational institutions attended, professional or fraternal or social organizations to which the individual is or was a member, etc. </P>
                    <P>(6) Reports of action following an OPM investigation or a Federal Bureau of Investigation Section 8(d) full field investigation. </P>
                    <P>(7) Personal access logs of individuals entering access controlled space. </P>
                    <P>
                        (8) Public Key Infrastructure (PKI) Certificates issued under direct guidance from Homeland Security 
                        <PRTPAGE P="66160"/>
                        Presidential Directive (HSPD)-12 and Federal Information Processing Standard (FIPS)-201. 
                    </P>
                    <P>(9) Personal fingerprint records for identification and criminal records checks. </P>
                    <P>(10) Other information developed from the previous sources. </P>
                    <P>In addition, this system contains records maintained on individuals issued PIV credentials by the Department. These records may include the following data fields: Full name; Social Security number; date of birth; signature; image (photograph); fingerprints; hair color; eye color; height; weight; organization or office of assignment; company name; copy of background investigation form; PIV card issuance and expiration dates; personal identification number (PIN); results of background investigation; PIV request form; PIV registrar approval signature; PIV card serial number; emergency responder designation (if applicable); copies of documents used to verify identification or information derived from those documents such as document title, document issuing authority, document number, document expiration date, document other information); level of national security clearance and expiration date; computer system user name; user access and permission rights, authentication certificates; and digital signature information. For those issued non-PIV identification these fields do not apply. </P>
                    <NOTE>
                        <HD SOURCE="HED">Note 1:</HD>
                        <P>OPM and DOJ issue the standard forms used to collect information in this system, i.e. Standard Form (SF) 85, SF-85P, SF-85PS, SF-86, SF-87, and Fingerprint card FD-258.</P>
                    </NOTE>
                    <NOTE>
                        <HD SOURCE="HED">Note 2:</HD>
                        <P>To the extent that the Department has records of a personnel investigative nature that come from OPM or its contractors, these records are covered by OPM/CENTRAL-9, Personnel Investigations Records, and are not covered by this system notice.</P>
                    </NOTE>
                    <HD SOURCE="HD2">AUTHORITY FOR MAINTENANCE OF THE SYSTEM: </HD>
                    <P>HSPD-12, Policy for a Common Identification Standard for Federal Employees and Contractors (August 27, 2004); Executive Orders 10450, 18 FR 2489, 3 CFR 1949-1953 Comp., p. 936); 10577 (3 CFR 1954-1958 Comp., p. 218); and 12968 (Access to Classified Information); 5 U.S.C. 3301 and 7301; Federal Property and Administrative Act of 1949, as amended through Public Law 106-580; and 5 CFR parts 5, 731, 732, and 736. </P>
                    <HD SOURCE="HD2">PURPOSE(S): </HD>
                    <P>Records in this system are maintained to assist in making determinations concerning suitability for Federal employment, security clearances, access to classified information, unescorted access to Federal government owned and Federal government leased facilities or restricted areas, and evaluations as to acceptability for performance under Federal contracts or other agreements with the Federal government. Purposes of this system also include: Ensuring the safety and security of Federal facilities, systems, and information resources, as well as the safety and security of the occupants and users of these facilities, systems, and information resources; verifying that persons entering Federal facilities and using Federal systems and information resources, are authorized to do so; and tracking and controlling PIV cards issued to persons entering the Federal government's facilities and using its systems and information resources. </P>
                    <HD SOURCE="HD2">ROUTINE USES OF RECORDS MAINTAINED IN THE SYSTEM, INCLUDING CATEGORIES OF USERS AND THE PURPOSES OF SUCH USES: </HD>
                    <P>The Department may disclose information contained in a record in this system of records under the routine uses listed in this system of records without the consent of the individual if the disclosure is compatible with the purposes for which the record was collected. The Department may make these disclosures on a case-by-case basis or, if the Department has complied with the computer matching requirements of the Computer Matching and Privacy Protection Act of 1998, as amended, under a computer matching agreement. </P>
                    <P>
                        (1) 
                        <E T="03">Program Purpose.</E>
                         The Department may disclose records from this system of records to any source or potential source from which information is requested in the course of an investigation concerning the suitability or retention of an employee or a contractor, or the retention of a security clearance, contract, grant, license, or other benefit, to the extent necessary to identify the individual being investigated, inform the source of the nature and purpose of the investigation, and to identify the type of information requested. 
                    </P>
                    <P>
                        (2) 
                        <E T="03">Enforcement Disclosure.</E>
                         The Department may disclose relevant records to a Federal, State, local, foreign, or tribal entity or other public authority responsible for the investigation, prosecution, enforcement, or implementation of a statute, rule, regulation, or order, when a record on its face or in combination with any other information indicates a violation or potential violation of law (whether civil, criminal, or regulatory in nature) if that information is relevant to any enforcement, regulatory, investigative, or prosecutorial responsibility of the receiving entity. It is Office of Management policy not to disclose records under this routine use that pertain to those questions for which the Office of Management has promised confidentiality under SF-85P, Questionnaire for Public Trust Positions. 
                    </P>
                    <P>
                        (3) 
                        <E T="03">Contract Disclosure.</E>
                         If the Department contracts with an entity for the purpose of performing any function that requires disclosure of records in this system to employees of the contractor, the Department may disclose the records as a routine use to those employees. Before entering into such a contract, the Department shall require the contractor to maintain Privacy Act safeguards as required under 5 U.S.C. 552a(m) with respect to the records in the system. 
                    </P>
                    <P>
                        (4) 
                        <E T="03">Litigation or Alternative Dispute Resolution (ADR) Disclosure.</E>
                         (a) 
                        <E T="03">Introduction.</E>
                         In the event that one of the following parties is involved in litigation or ADR, or has an interest in litigation or ADR, the Department may disclose certain records to the parties described in paragraphs (b), (c), and (d) of this routine use under the conditions specified in those paragraphs: 
                    </P>
                    <P>(i) The Department or any of its components. </P>
                    <P>(ii) Any Department employee in his or her official capacity. </P>
                    <P>(iii) Any employee of the Department in his or her individual capacity where the DOJ has agreed to or has been requested to provide or arrange for representation of the employee. </P>
                    <P>(iv) Any employee of the Department in his or her individual capacity where the Department has agreed to represent the employee. </P>
                    <P>(v) The United States where the Department determines that the litigation is likely to affect the Department or any of its components. </P>
                    <P>
                        (b) 
                        <E T="03">Disclosure to the DOJ</E>
                        . If the Department determines that disclosure of certain records to the DOJ or attorneys engaged by DOJ is relevant and necessary to litigation or ADR and is compatible with the purpose for which the records were collected, the Department may disclose those records as a routine use to DOJ. 
                    </P>
                    <P>
                        (c) 
                        <E T="03">Adjudicative Disclosure</E>
                        . If the Department determines that disclosure of certain records to an adjudicative body before which the Department is authorized to appear or to an individual or entity designated by the Department or otherwise empowered to resolve or mediate disputes is relevant and necessary to litigation or ADR and is compatible with the purpose for which the records were collected, the Department may disclose those records 
                        <PRTPAGE P="66161"/>
                        as a routine use to the adjudicative body, individual, or entity. 
                    </P>
                    <P>
                        (d) 
                        <E T="03">Disclosure to Parties, Counsel, Representative, or Witnesses</E>
                        . If the Department determines that disclosure of certain records to a party, an opposing counsel, representative, or witness is relevant and necessary to litigation or ADR and is compatible with the purpose for which the records were collected, the Department may disclose those records as a routine use to a party, counsel, representative, or witness. 
                    </P>
                    <P>
                        (5) 
                        <E T="03">Freedom of Information Act (FOIA) Advice Disclosure</E>
                        . The Department may disclose information from this system of records to DOJ for the purpose of obtaining advice regarding the releasability of records maintained in this system of records under the FOIA and the Privacy Act of 1974. 
                    </P>
                    <P>
                        (6) 
                        <E T="03">Congressional Member Disclosure</E>
                        . The Department may disclose information from this system of records to a Member of Congress or to a Congressional staff member in response to an inquiry of the Congressional office made at the written request of the constituent about whom the record is maintained. 
                    </P>
                    <P>
                        (7) 
                        <E T="03">Disclosure for Use by Other Law Enforcement Agencies</E>
                        . The Department may disclose information from this system of records to any Federal, State, local or foreign agency or other public authority responsible for enforcing, investigating, or prosecuting violations of administrative, civil, or criminal law or regulation if that information is relevant to any enforcement, investigative, or prosecutorial responsibility within the receiving entity's jurisdiction. 
                    </P>
                    <P>
                        (8) 
                        <E T="03">Disclosure for Use for Intelligence Activities</E>
                        . The Department may disclose information from this system of records to Federal, State, or local agencies, other appropriate entities or individuals, or, through established liaison channels, to selected foreign governments, in order to enable an intelligence agency to carry out its responsibilities as authorized by law, including the National Security Act of 1947 as amended, the CIA Act of 1949 as amended, Executive Order 12333 or any successor order, applicable national security directives, or classified implementing procedures approved by the Attorney General and promulgated pursuant to such statutes, orders or directives. 
                    </P>
                    <P>
                        (9) 
                        <E T="03">Employment, Benefits, and Contracting Disclosure</E>
                        . (a) 
                        <E T="03">For Decisions by the Department</E>
                        . The Department may disclose information from this system of records to a Federal, State, or local agency or to another public authority or professional organization, to obtain information relevant to the Department's conduct of a security or suitability investigation of an individual seeking employment, licensure, other benefits, or to perform contractual services for, or to otherwise associate with, the Department. 
                    </P>
                    <P>
                        (b) 
                        <E T="03">For Decisions by Other Public Agencies and Professional Organizations</E>
                        . The Department may disclose information from this system of records to a Federal, State, local, or foreign agency, or other public authority or professional organization, so that the receiving entity may obtain information relevant to its conduct of a security or suitability investigation of an individual seeking employment, licensure, other benefits, or to perform contractual services for, or to otherwise associate with, the receiving entity. 
                    </P>
                    <P>
                        (10) 
                        <E T="03">Employee Grievance, Complaint, or Conduct Disclosure</E>
                        . If a record is relevant and necessary to a grievance, complaint, or disciplinary proceeding regarding a present or former employee of the Department, the Department may disclose the record in the course of an investigation, fact-finding, or adjudication to another agency of the Federal government, or to any witness, designated fact-finder, mediator, or other person designated to resolve issues or decide the matter. The disclosure may only be made during the course of the investigation or the proceeding. 
                    </P>
                    <P>
                        (11) 
                        <E T="03">Disclosure in the Course of Responding to Breach of Data</E>
                        . The Department may disclose records to appropriate agencies, entities, and persons when (a) it is suspected or confirmed that the security or confidentiality of information in this system has been compromised; (b) the Department has determined that as a result of the suspected or confirmed compromise there is a risk of harm to economic or property interests, identity theft or fraud, or harm to the security or integrity of this system or other systems or programs (whether maintained by the Department or by another agency or entity) that rely upon the compromised information; and (c) the disclosure is made to such agencies, entities, and persons who are reasonably necessary to assist the Department in responding to the suspected or confirmed compromise and in helping the Department prevent, minimize, or remedy such harm. 
                    </P>
                    <P>
                        (12) 
                        <E T="03">Disclosure to Protect Safety and Security of Department Employees, Customers, and Facilities</E>
                        . The Department may disclose to Federal, State, and local law enforcement agencies and private security contractors, as appropriate, information that the Department deems necessary in order to: (a) Assist with the protection of the safety of Department employees and customers, the security of the Department's workplace, or the operation of the Department's facilities or information systems; or (b) assist with investigations or prosecutions with respect to activities that affect such safety and security or activities that disrupt the operation of the Department. 
                    </P>
                    <NOTE>
                        <HD SOURCE="HED">Note 3:</HD>
                        <P>
                            Disclosures within the Department of data pertaining to date and time of entry and exit of a Department employee working in the District of Columbia may not be made to supervisors, managers, or any other persons (other than the individual to whom the information applies) to verify employee time and attendance records for personnel actions because 5 U.S.C. 6106 prohibits Federal Executive agencies (other than the Bureau of Engraving and Printing) from using a recording clock within the District of Columbia, unless used as a part of a flexible schedule or compressed work schedule under 5 U.S.C. 6120, 
                            <E T="03">et seq.</E>
                        </P>
                    </NOTE>
                    <HD SOURCE="HD2">POLICIES AND PRACTICES OF STORING, RETRIEVING, ACCESSING, RETAINING, AND DISPOSING OF RECORDS IN THE SYSTEM: </HD>
                    <HD SOURCE="HD2">STORAGE:</HD>
                    <P>Records are maintained on paper and in electronic form. Paper records are stored in fire resistant locked file cabinets in locked access-controlled rooms. Within the locked access-controlled room, electronic files are encrypted and stored in alarmed electronic retrieval file systems. The data servers, the laptops, and the desk computers where the data resides are in locked access-controlled rooms. </P>
                    <P>PIV identification card data on cardholders entering the Department's facilities is stored in an encrypted database. </P>
                    <HD SOURCE="HD2">RETRIEVABILITY:</HD>
                    <P>Electronic and paper records are retrieved by an unique identifying number by the Department pursuant to the National Institute of Standards and Technology (NIST), Federal Information Processing Standard (FIPS) 201, Personal Identity Verification for Federal Employees and Contractors; this number is cross-referenced to the name of the individual. </P>
                    <HD SOURCE="HD2">SAFEGUARDS:</HD>
                    <P>All physical access to the Department's sites, and the sites of the Department's contractors where this system of records is maintained, is controlled and monitored by security personnel who check each individual entering the building for his or her employee or visitor badge. </P>
                    <P>
                        In accordance with the Department's Administrative Communications System (ACS) Directive OM: 5-101 entitled 
                        <PRTPAGE P="66162"/>
                        “Contractor Employee Personnel Security Screenings,” all contract and Department personnel who have facility access and system access are required to undergo a security clearance investigation. Individuals requiring access to Privacy Act data are required to hold, at a minimum, a moderate-risk security clearance level. These individuals are required to undergo periodic screening at five-year intervals. 
                    </P>
                    <P>In addition to undergoing a security clearance investigation, contract and Department personnel are required to complete security awareness training on an annual basis. This training is required to ensure that contract and Department users are trained appropriately in safeguarding Privacy Act data in accordance with OMB Circular No. A-130, Appendix III. </P>
                    <P>Computer databases are kept on encrypted servers on an isolated virtual local area network (V-LAN) that is not connected to any outside network including the Internet. Database accessibility is restricted to hard wire network connection from within the Office Management, Security Services, and direct Integrated Services Digital Network (ISDN) line to the Department of Justice (DOJ), or via secure portal to the Office of Personnel Management (OPM). Authorized log-on codes and passwords prevent unauthorized users from gaining access to data and system resources. All users have unique log-on codes and passwords. The password scheme requires that users must change passwords every 60 days and may not repeat the old password. </P>
                    <P>Any individual attempting to log on who fails is locked out of the system after three attempts. Access after that time requires intervention by the system manager. </P>
                    <HD SOURCE="HD2">RETENTION AND DISPOSAL:</HD>
                    <P>Most background investigative records are maintained in accordance with General Records Schedule (GRS) 18, Item 22—destroy not later than five years after separation or transfer of employee or no later than five years after contract relationship expires, whichever is later. Records are destroyed by deletion or shredding. </P>
                    <P>Reports of background investigations conducted by the Office of Inspector General under delegated authority of the OPM are retained in accordance with OPM retention standards for similar records, pending National Archives and Records Administration (NARA) approval. Records will be maintained for 15 years after the last investigative activity, except investigations involving potentially actionable issue(s) will be maintained for 25 years after the last investigative activity and then destroyed by deletion or shredding. </P>
                    <P>Personal access logs of individuals entering controlled space are retained in accordance with GRS 18, Item 17. In the Department's secured facilities, records are destroyed five years after final entry or five years after date of document, as appropriate. For all other facilities, records are destroyed two years after final entry or two years after date of document, as appropriate. Records are destroyed by deletion or shredding. </P>
                    <P>PKI certificates and PIV cards issued under guidance of HSPD-12 and FIPS-201 will be retained in accordance with the pending GRS disposition authority as issued by NARA, or in a NARA-approved, Departmental records retention schedule, as appropriate. </P>
                    <HD SOURCE="HD2">SYSTEM MANAGER(S) AND  ADDRESS:</HD>
                    <P>Security Services, Office of Management, U.S. Department of Education, 400 Maryland Avenue, SW., Room 2W314, Washington, DC 20202-5345. </P>
                    <HD SOURCE="HD2">NOTIFICATION PROCEDURE:</HD>
                    <P>If an individual wishes to determine whether a record exists regarding him or her in this system of records, the individual must contact the system manager and provide his or her name, date of birth, social security number, signature, and the address to which the record information should be sent. This information is required to ensure the positive identification of the person's record in the system. Requests for notification about an individual must meet the requirements of the regulations in 34 CFR 5b.5. </P>
                    <HD SOURCE="HD2">RECORD ACCESS PROCEDURE:</HD>
                    <P>If an individual wishes to gain access to a record in this system, he or she must contact the system manager and provide information as described in the notification procedure. </P>
                    <HD SOURCE="HD2">CONTESTING RECORD PROCEDURE:</HD>
                    <P>If an individual wishes to change the content of a record in the system of records, he or she must contact the system manager with the information described in the notification procedure, identify the specific item or items to be changed, and provide a written justification for the change, including any supporting documentation. Requests to amend a record must meet the requirements of the regulations in 34 CFR 5b.7. </P>
                    <HD SOURCE="HD2">RECORD SOURCE CATEGORIES:</HD>
                    <P>Information contained in this system of records is obtained from— </P>
                    <P>(a) Investigative and other record material furnished by other Federal entities, other departmental components, State, local, and foreign governments; </P>
                    <P>(b) Applications and other personnel and security forms; </P>
                    <P>(c) Personal investigation, written inquiry, interview, and the electronic accessing of computer databases of sources, such as the OPM system of records known as Personnel Investigations Records (OPM/Central-9), employers, educational institutions, references, neighbors, associates, police departments, courts, credit bureaus, medical records, probation officials, prison officials, DOJ, newspapers, magazines, periodicals, and other publications; and </P>
                    <P>(d) Confidential sources. </P>
                    <HD SOURCE="HD2">EXEMPTIONS CLAIMED FOR THE SYSTEM:</HD>
                    <P>The Secretary has exempted by regulation—in 34 CFR 5b.11(d)—this system of records only to the extent that the information is investigatory material compiled solely for the purpose of determining suitability, eligibility, or qualifications for Federal civilian employment, Federal contracts, or access to classified information from the following provisions of the Privacy Act pursuant to 5 U.S.C. 552a(k)(5): </P>
                    <P>(1) 5 U.S.C. 552a(c)(3), regarding access to an accounting of disclosures of records. </P>
                    <P>(2) 5 U.S.C. 552a(d)(1) through (4) and (f), regarding notification of and access to records and correction or amendment of records. </P>
                    <P>(3) 5 U.S.C. 552a(e)(4)(G) and (H) regarding inclusion of information in the system notice about procedures for notification, access, and correction of records. </P>
                    <P>As indicated in 34 CFR 5b.11(f), individuals will be provided access to information in this system, except when, in accordance with the provisions of 5 U.S.C. 552a(k)(5): </P>
                    <P>(1) The disclosure of such information would reveal the identity of a source who furnished information to the Government under an express promise that the identity of the source would be held in confidence; or </P>
                    <P>(2) The information was obtained prior to September 28, 1975 and the disclosure of such information would reveal the identity of the source under an implied promise that the identity of the source would be held in confidence. </P>
                </PRIACT>
            </SUPLINF>
            <FRDOC>[FR Doc. E7-23059 Filed 11-26-07; 8:45 am] </FRDOC>
            <BILCOD>BILLING CODE 4000-01-P </BILCOD>
        </NOTICE>
        <NOTICE>
            <PREAMB>
                <PRTPAGE P="66163"/>
                <AGENCY TYPE="N">DEPARTMENT OF ENERGY</AGENCY>
                <SUBAGY>Federal Energy Regulatory Commission</SUBAGY>
                <DEPDOC>[Docket No. PR07-13-002]</DEPDOC>
                <SUBJECT>Alabama Intrastate, LLC; Notice of Compliance Filing</SUBJECT>
                <DATE>November 19, 2007.</DATE>
                <P>Take notice that on November 13, 2007, Enterprise Alabama Intrastate, LLC filed a Report of Refunds in compliance with the Commission's letter order issued on September 4, 2007, in Docket Nos. PR07-13-000 and PR07-13-001.</P>
                <P>Any person desiring to protest this filing must file in accordance with Rule 211 of the Commission's Rules of Practice and Procedure (18 CFR 385.211). Protests to this filing will be considered by the Commission in determining the appropriate action to be taken, but will not serve to make protestants parties to the proceeding. Such protests must be filed on or before the date as indicated below. Anyone filing a protest must serve a copy of that document on all the parties to the proceeding.</P>
                <P>
                    The Commission encourages electronic submission of protests in lieu of paper using the “eFiling” link at 
                    <E T="03">http://www.ferc.gov.</E>
                     Persons unable to file electronically should submit an original and 14 copies of the protest to the Federal Energy Regulatory Commission, 888 First Street, NE., Washington, DC 20426.
                </P>
                <P>
                    This filing is accessible on-line at 
                    <E T="03">http://www.ferc.gov,</E>
                     using the “eLibrary” link and is available for review in the Commission's Public Reference Room in Washington, DC. There is an “eSubscription” link on the Web site that enables subscribers to receive e-mail notification when a document is added to a subscribed docket(s). For assistance with any FERC Online service, please e-mail 
                    <E T="03">FERCOnlineSupport@ferc.gov,</E>
                     or call (866) 208-3676 (toll free). For TTY, call (202) 502-8659.
                </P>
                <P>
                    <E T="03">Comment Date:</E>
                     5 p.m. Eastern Time Monday, November 26, 2007.
                </P>
                <SIG>
                    <NAME>Kimberly D. Bose,</NAME>
                    <TITLE>Secretary.</TITLE>
                </SIG>
            </PREAMB>
            <FRDOC>[FR Doc. E7-23036 Filed 11-26-07; 8:45 am]</FRDOC>
            <BILCOD>BILLING CODE 6717-01-P</BILCOD>
        </NOTICE>
        <NOTICE>
            <PREAMB>
                <AGENCY TYPE="S">DEPARTMENT OF ENERGY </AGENCY>
                <SUBAGY>Federal Energy Regulatory Commission </SUBAGY>
                <DEPDOC> [Docket No. EL08-7-000] </DEPDOC>
                <SUBJECT>The Borough of Chambersburg, PA; Notice of Filing </SUBJECT>
                <DATE>November 19, 2007. </DATE>
                <P>Take notice that on November 11, 2007, The Borough of Chambersburg, Pennsylvania (Chambersburg), tendered for filing pursuant to Rule 207(a)(5) of the Commission's Rules of Practice and Procedure a petition for approval of Chambersburg's annual revenue requirement for its contribution to the supply of Reactive Power and Voltage Control from Generation Sources Service under Schedule 2 of the PJM Interconnection, L.L.C. open access transmission tariff. </P>
                <P>Any person desiring to intervene or to protest this filing must file in accordance with Rules 211 and 214 of the Commission's Rules of Practice and Procedure (18 CFR 385.211, 385.214). Protests will be considered by the Commission in determining the appropriate action to be taken, but will not serve to make protestants parties to the proceeding. Any person wishing to become a party must file a notice of intervention or motion to intervene, as appropriate. Such notices, motions, or protests must be filed on or before the comment date. On or before the comment date, it is not necessary to serve motions to intervene or protests on persons other than the Applicant. </P>
                <P>
                    The Commission encourages electronic submission of protests and interventions in lieu of paper using the “eFiling” link at 
                    <E T="03">http://www.ferc.gov.</E>
                     Persons unable to file electronically should submit an original and 14 copies of the protest or intervention to the Federal Energy Regulatory Commission, 888 First Street, NE., Washington, DC 20426. 
                </P>
                <P>
                    This filing is accessible on-line at 
                    <E T="03">http://www.ferc.gov,</E>
                     using the “eLibrary” link and is available for review in the Commission's Public Reference Room in Washington, DC. There is an “eSubscription” link on the Web site that enables subscribers to receive e-mail notification when a document is added to a subscribed docket(s). For assistance with any FERC Online service, please e-mail 
                    <E T="03">FERCOnlineSupport@ferc.gov,</E>
                     or call (866) 208-3676 (toll free). For TTY, call (202) 502-8659. 
                </P>
                <P>
                    <E T="03">Comment Date:</E>
                     5 p.m. Eastern Time on November 27, 2007. 
                </P>
                <SIG>
                    <NAME>Kimberly D. Bose, </NAME>
                    <TITLE>Secretary.</TITLE>
                </SIG>
            </PREAMB>
            <FRDOC>[FR Doc. E7-23037 Filed 11-26-07; 8:45 am] </FRDOC>
            <BILCOD>BILLING CODE 6717-01-P </BILCOD>
        </NOTICE>
        <NOTICE>
            <PREAMB>
                <AGENCY TYPE="S">DEPARTMENT OF ENERGY </AGENCY>
                <SUBAGY>Federal Energy Regulatory Commission </SUBAGY>
                <DEPDOC>[Docket No. RP08-70-000] </DEPDOC>
                <SUBJECT>Discovery Gas Transmission LLC; Notice of Petition for Approval of Settlement </SUBJECT>
                <DATE>November 20, 2007. </DATE>
                <P>Take notice on November 16, 2007, Discovery Gas Transmission, LLC (Discovery) tendered for filing a “Petition for Approval of Settlement,” including a proposed stipulation and settlement agreement (Settlement Agreement) and associated pro forma tariff sheets. </P>
                <P>Discovery states that copies of its filing have been served upon all affected customers of Discovery and interested state commissions. </P>
                <P>Any person desiring to intervene or to protest this filing must file in accordance with Rules 211 and 214 of the Commission's Rules of Practice and Procedure (18 CFR 385.211 and 385.214). Protests will be considered by the Commission in determining the appropriate action to be taken, but will not serve to make protestants parties to the proceeding. Any person wishing to become a party must file a notice of intervention or motion to intervene, as appropriate. Such notices, motions, or protests must be filed on or before the date as indicated below. Anyone filing an intervention or protest must serve a copy of that document on the Applicant. Anyone filing an intervention or protest on or before the intervention or protest date need not serve motions to intervene or protests on persons other than the Applicant. </P>
                <P>
                    The Commission encourages electronic submission of protests and interventions in lieu of paper using the “eFiling” link at 
                    <E T="03">http://www.ferc.gov</E>
                    . Persons unable to file electronically should submit an original and 14 copies of the protest or intervention to the Federal Energy Regulatory Commission, 888 First Street, NE., Washington, DC 20426. 
                </P>
                <P>
                    This filing is accessible on-line at 
                    <E T="03">http://www.ferc.gov</E>
                    , using the “eLibrary” link and is available for review in the Commission's Public Reference Room in Washington, DC. 
                    <PRTPAGE P="66164"/>
                    There is an “eSubscription” link on the Web site that enables subscribers to receive e-mail notification when a document is added to a subscribed docket(s). For assistance with any FERC Online service, please e-mail 
                    <E T="03">FERCOnlineSupport@ferc.gov</E>
                    , or call (866) 208-3676 (toll free). For TTY, call (202) 502-8659. 
                </P>
                <P>
                    <E T="03">Comment Date:</E>
                     5 p.m. Eastern Time, Tuesday, November 27, 2007.
                </P>
                <SIG>
                    <NAME>Kimberly D. Bose, </NAME>
                    <TITLE>Secretary.</TITLE>
                </SIG>
            </PREAMB>
            <FRDOC> [FR Doc. E7-23065 Filed 11-26-07; 8:45 am] </FRDOC>
            <BILCOD>BILLING CODE 6717-01-P</BILCOD>
        </NOTICE>
        <NOTICE>
            <PREAMB>
                <AGENCY TYPE="S">DEPARTMENT OF ENERGY </AGENCY>
                <SUBAGY>Federal Energy Regulatory Commission </SUBAGY>
                <DEPDOC>[Docket No. PR07-12-002] </DEPDOC>
                <SUBJECT>Enterprise Texas Pipeline LLC; Notice of Compliance Filing </SUBJECT>
                <DATE>November 19, 2007. </DATE>
                <P>Take notice that on November 13, 2007, Enterprise Texas Pipeline LLC filed a Report of Refunds in compliance with the Commission's letter order issued on September 4, 2007 in Docket Nos. PR07-12-000 and PR07-12-001. </P>
                <P>Any person desiring to protest this filing must file in accordance with Rule 211 of the Commission's Rules of Practice and Procedure (18 CFR 385.211). Protests to this filing will be considered by the Commission in determining the appropriate action to be taken, but will not serve to make protestants parties to the proceeding. Such protests must be filed on or before the date as indicated below. Anyone filing a protest must serve a copy of that document on all the parties to the proceeding. </P>
                <P>
                    The Commission encourages electronic submission of protests in lieu of paper using the “eFiling” link at 
                    <E T="03">http://www.ferc.gov</E>
                    . Persons unable to file electronically should submit an original and 14 copies of the protest to the Federal Energy Regulatory Commission, 888 First Street, NE., Washington, DC 20426. 
                </P>
                <P>
                    This filing is accessible on-line at 
                    <E T="03">http://www.ferc.gov</E>
                    , using the “eLibrary” link and is available for review in the Commission's Public Reference Room in Washington, DC. There is an “eSubscription” link on the Web site that enables subscribers to receive e-mail notification when a document is added to a subscribed docket(s). For assistance with any FERC Online service, please e-mail 
                    <E T="03">FERCOnlineSupport@ferc.gov</E>
                    , or call (866) 208-3676 (toll free). For TTY, call (202) 502-8659. 
                </P>
                <P>
                    <E T="03">Comment Date:</E>
                     5 p.m. Eastern Time, Monday, November 26, 2007. 
                </P>
                <SIG>
                    <NAME>Kimberly D. Bose, </NAME>
                    <TITLE>Secretary.</TITLE>
                </SIG>
            </PREAMB>
            <FRDOC>[FR Doc. E7-23040 Filed 11-26-07; 8:45 am] </FRDOC>
            <BILCOD>BILLING CODE 6717-01-P</BILCOD>
        </NOTICE>
        <NOTICE>
            <PREAMB>
                <AGENCY TYPE="S">DEPARTMENT OF ENERGY </AGENCY>
                <SUBAGY>Federal Energy Regulatory Commission </SUBAGY>
                <DEPDOC>[Project Nos. 349-134 and 2407-121] </DEPDOC>
                <SUBJECT>Alabama Power Company; Notice of Availability Of Environmental Assessment </SUBJECT>
                <DATE>November 19, 2007. </DATE>
                <P>An environmental assessment (EA) is available for public review. The EA was prepared for an application filed by Alabama Power Company (licensee) on October 23, 2007, and supplemented on November 14, 2007, requesting Commission approval for a drought-based temporary variance to the Martin Project (FERC No. 349) rule curve and associated temporarily modified minimum flows from the Thurlow development of the Yates and Thurlow Project (FERC No. 2407). The projects are located on the Tallapoosa River in the counties of Coosa, Elmore and Tallapoosa, Alabama. </P>
                <P>The EA evaluates the environmental impacts that would result from approving the licensee's temporary variance to the Martin Project rule curve and associated minimum flow modification from the Thurlow Development. The EA finds that approval of the application would not constitute a major federal action significantly affecting the quality of the human environment. </P>
                <P>
                    A copy of the EA is available for review in the Commission's Public Reference Room. A copy of the EA may also be viewed on the Commission's Web site at 
                    <E T="03">http://www.ferc.gov</E>
                     using the “eLibrary” link. Enter the docket number (P-349) in the docket number field to access the document. For assistance, contact FERC Online Support at 
                    <E T="03">FERCOnlineSupport@ferc.gov</E>
                     or toll-free at 1-866-208-3676, or for TTY, (202) 502-8659. 
                </P>
                <SIG>
                    <NAME>Kimberly D. Bose, </NAME>
                    <TITLE>Secretary.</TITLE>
                </SIG>
            </PREAMB>
            <FRDOC>[FR Doc. E7-23039 Filed 11-26-07; 8:45 am] </FRDOC>
            <BILCOD>BILLING CODE 6717-01-P </BILCOD>
        </NOTICE>
        <NOTICE>
            <PREAMB>
                <AGENCY TYPE="S">DEPARTMENT OF ENERGY </AGENCY>
                <SUBAGY>Federal Energy Regulatory Commission </SUBAGY>
                <DEPDOC> [Docket No. CP07-444-000] </DEPDOC>
                <SUBJECT>Jordan Cove Energy Project, L.P.; Notice of Technical Conference </SUBJECT>
                <DATE>November 19, 2007. </DATE>
                <P>On Wednesday, December 12, 2007, at 9 a.m. (PST), staff of the Office of Energy Projects will convene an engineering design and technical conference regarding the proposed Jordan Cove LNG import terminal. The conference will be held at the Red Lion Hotel in Coos Bay, Oregon. The hotel is located at 1313 N Bayshore Dr. #1, Coos Bay, OR 97420. For hotel details call (541) 267-4141. </P>
                <P>
                    In view of the nature of critical energy infrastructure information and security issues to be explored, the cryogenic conference will not be open to the public. Attendance at this conference will be limited to existing parties to the proceeding (anyone who has specifically requested to intervene as a party) and to representatives of interested federal, state, and local agencies. Any person planning to attend the December 12th cryogenic conference 
                    <E T="03">must register</E>
                     by close of business on Monday, December 10, 2007. Registrations may be submitted either online at 
                    <E T="03">http://www.ferc.gov/whats-new/registration/cryo-conf-form.asp</E>
                     or by faxing a copy of the form (found at the referenced online link) to 202-208-0353. All attendees must sign a non-disclosure statement prior to entering the conference. Upon arrival at the hotel, check the reader board in the hotel lobby for venue. For additional information regarding the cryogenic conference, please contact Steven Busch at 202-502-6353. 
                </P>
                <SIG>
                    <NAME>Kimberly D. Bose,</NAME>
                    <TITLE> Secretary.</TITLE>
                </SIG>
            </PREAMB>
            <FRDOC>[FR Doc. E7-23041 Filed 11-26-07; 8:45 am] </FRDOC>
            <BILCOD>BILLING CODE 6717-01-P </BILCOD>
        </NOTICE>
        <NOTICE>
            <PREAMB>
                <AGENCY TYPE="S">DEPARTMENT OF ENERGY </AGENCY>
                <SUBAGY>Federal Energy Regulatory Commission </SUBAGY>
                <DEPDOC>[Docket Nos. ER07-1372-000, ER07-1372-001] </DEPDOC>
                <SUBJECT>Midwest Independent Transmission System Operator, Inc.; Notice of Staff Technical Conference </SUBJECT>
                <DATE>November 19, 2007. </DATE>
                <P>
                    Take notice that on December 6, 2007, a staff technical conference will be held 
                    <PRTPAGE P="66165"/>
                    at the Federal Energy Regulatory Commission to discuss the market power analysis and mitigation measures set forth in the Midwest Independent Transmission System Operator, Inc.'s (Midwest ISO) ancillary services market proposal. This technical conference was established in an Order Establishing Technical Conference in the above-captioned dockets, issued November 19, 2007. It will be held in the Commission Meeting Room at the headquarters of the Federal Energy Regulatory Commission, 888 First Street, NE, Washington, DC from 9 a.m.-4 p.m. (EST). 
                </P>
                <P>The technical conference will be divided into two sessions. The first session will address market power issues and the second session will address mitigation issues. The format of the conference and sessions will be as follows: </P>
                <P>Staff and Midwest ISO Introduction To Conference: 9-9:15. </P>
                <P>First Session: Market Power Issues: </P>
                <P>Independent Market Monitor (IMM) Presentation Addressing Appendix Questions: 9:15-9:45. </P>
                <P>(See attached Appendix to this Notice) </P>
                <P>Questions and Issues From Parties: 9:45-11:30. </P>
                <P>Staff Follow-up Questions: 11:30-12. </P>
                <P>Lunch: 12-1. </P>
                <P>Second Session: Mitigation Issues: </P>
                <P>IMM Presentation Addressing Appendix Questions: 1-1:30. </P>
                <P>Questions and Issues From Parties: 1:30-3:15. </P>
                <P>Staff Follow-up Questions: 3:15-3:45. </P>
                <P>Next Steps; 3:45-4. </P>
                <P>The conference is open for the public to attend. The conference will not be transcribed and telephone participation will not be available. </P>
                <P>The Commission will accept written comments on the discussion at this technical conference no later than 5 p.m. Eastern Time on December 20, 2007, and reply comments no later than 5 p.m. Eastern Time on January 7, 2008. </P>
                <P>
                    Commission conferences are accessible under section 508 of the Rehabilitation Act of 1973. For accessibility accommodations please send an e-mail to 
                    <E T="03">accessibility@ferc.gov</E>
                     or call toll free 1-866-208-3372 (voice) or 202-208-1659 (TTY), or send a FAX to 202-208-2106 with the required accommodations. 
                </P>
                <P>
                    For more information about this conference, please contact: John Nail, Office of Energy Market Regulation, Federal Energy Regulatory Commission, (202) 502-8209, 
                    <E T="03">john.nail @ferc.gov.</E>
                </P>
                <SIG>
                    <NAME>Kimberly D. Bose, </NAME>
                    <TITLE>Secretary.</TITLE>
                </SIG>
                <APPENDIX>
                    <HD SOURCE="HED">Appendix </HD>
                    <P>The following questions pertain to aspects of the Midwest ISO proposal that require further clarification. The Midwest ISO is requested to provide materials at the conference addressing these questions and to be prepared to discuss them. The Midwest ISO should provide its full and complete answers to all questions for the record of this proceeding in its filing of comments. </P>
                    <HD SOURCE="HD1">Questions To Be Discussed in the First Session </HD>
                    <P>• Provide a market power analysis for the spring and fall shoulder seasons. Present the results of the new analysis at the technical conference. </P>
                    <P>• The definition of ancillary services sub-markets: </P>
                    <P>• Provide the basis for how the sub-markets and reserve zones are defined and explain the differences between the two. </P>
                    <P>• Is the IMM market power analysis for only illustrative purposes or is it intended to be relied on in this proceeding? </P>
                    <P>• How will the potential for market power be evaluated as a result of any zonal reconfiguration? </P>
                    <P>• Either submit separate analyses for spinning and supplemental reserves or provide an analysis demonstrating that the two products are substitutes for each other. Present the results of the analysis at the technical conference. </P>
                    <P>• Provide historical data, separately for each ancillary services product (regulating reserves, spinning reserves and supplemental reserves), since the start of the Midwest ISO energy markets that indicates: (1) The capacity (in MWs) and number of generator resources that could provide ancillary services; and (2) the actual ancillary services provided, in MW and number of generator resources. Present the results of the analysis at the technical conference. </P>
                    <HD SOURCE="HD1">Questions To Be Discussed in the Second Session </HD>
                    <P>• What is the basis for the IMM's conclusion that there will be sufficient competition to ensure just and reasonable prices in those hours and locations when mitigation thresholds are not triggered? </P>
                    <P>• Explain how reference levels are determined for suppliers in constrained areas, such as those identified in the IMM analysis. In his testimony, the IMM indicates reference levels are based on competitive offers. Please provide the basis for this assertion and explain whether all offers by suppliers in constrained areas are considered to be offers made under competitive conditions. If not, how does the IMM determine which offers are made under competitive conditions? </P>
                    <P>• Is a backstop reference price, such as is used in the New York Independent System Operator (NYISO), appropriate for sub-markets with only one or two suppliers? Explain the reasons underlying your response. </P>
                    <P>• Considering the market power characteristics of the Midwest ISO ancillary services market and its sub-markets, what are the pros and cons of conduct/impact mitigation compared to mitigating offers at a cost-based rate? </P>
                    <P>• What method and criteria will the IMM use to audit and identify any supplier that withholds power in either the energy or ancillary services markets, including during periods of scarcity pricing? </P>
                    <P>• The Midwest ISO states that variations of how it intends to mitigate its ancillary services market are being used by existing RTOs/ISOs. Explain the similarities and differences between the Midwest ISO mitigation proposal and the PJM Interconnection (PJM) and California Independent System Operator (CAISO) ancillary services markets mitigation programs. </P>
                    <P>• The Midwest ISO states that there are no unreasonable barriers to entry that would compromise the competitiveness of the Regulating Reserve market. Prospectively, what will the Midwest ISO do to ensure a lack of barriers to entry and encourage suppliers to bid into the congested submarket areas? </P>
                </APPENDIX>
            </PREAMB>
            <FRDOC>[FR Doc. E7-23038 Filed 11-26-07; 8:45 am] </FRDOC>
            <BILCOD>BILLING CODE 6717-01-P </BILCOD>
        </NOTICE>
        <NOTICE>
            <PREAMB>
                <AGENCY TYPE="N">ENVIRONMENTAL PROTECTION AGENCY </AGENCY>
                <DEPDOC>[EPA-HQ-OA-2007-0933; FRL-8499-6] </DEPDOC>
                <SUBJECT>Agency Information Collection Activities; Proposed Collection; Comment Request; Confidential Financial Disclosure Form for Special Government Employees Serving on Federal Advisory Committees at the U.S. Environmental Protection Agency; EPA ICR No. 2260.02, OMB Control No. 2090-0029 </SUBJECT>
                <AGY>
                    <HD SOURCE="HED">AGENCY:</HD>
                    <P>Environmental Protection Agency. </P>
                </AGY>
                <ACT>
                    <HD SOURCE="HED">ACTION:</HD>
                    <P>Notice. </P>
                </ACT>
                <SUM>
                    <HD SOURCE="HED">SUMMARY:</HD>
                    <P>
                        In compliance with the Paperwork Reduction Act (PRA) (44 U.S.C. 3501, 
                        <E T="03">et seq.</E>
                        ), this document announces that EPA is planning to submit a request to renew an existing approved Information Collection Request (ICR) to the Office of Management and Budget (OMB). This ICR is scheduled to expire on 2/29/2008. Before submitting the ICR to OMB for review and approval, EPA is soliciting comments on specific aspects of the proposed information collection as described below. 
                    </P>
                </SUM>
                <DATES>
                    <HD SOURCE="HED">DATES:</HD>
                    <P>Comments must be submitted on or before January 28, 2008. </P>
                </DATES>
                <ADD>
                    <HD SOURCE="HED">ADDRESSES:</HD>
                    <P>
                        Submit your comments, identified by Docket ID No. EPA-HQ-OA-2007-0933 by one of the following methods: 
                        <PRTPAGE P="66166"/>
                    </P>
                    <P>
                        • 
                        <E T="03">www.regulations.gov:</E>
                         Follow the on-line instructions for submitting comments. 
                    </P>
                    <P>
                        • 
                        <E T="03">E-mail: oei.docket.@epa.gov.</E>
                    </P>
                    <P>
                        • 
                        <E T="03">Fax:</E>
                         202-566-9744 
                    </P>
                    <P>
                        • 
                        <E T="03">Mail:</E>
                         OEI Docket, USEPA, Mail Code: 2822T, 1200 Pennsylvania Ave., NW., Washington, DC 20460. 
                        <E T="03">Hand Delivery:</E>
                         EPA Docket Center, EPA West Room 3334, 1301 Constitution Ave., NW., Washington, DC 20460. Such deliveries are only accepted during the Docket's normal hours of operation, and special arrangements should be made for deliveries of boxed information. 
                    </P>
                    <P>
                        <E T="03">Instructions:</E>
                         Direct your comments to Docket ID No. EPA-HQ-OA-2007-0933. EPA's policy is that all comments received will be included in the public docket without change and may be made available online at 
                        <E T="03">www.regulations.gov,</E>
                         including any personal information provided, unless the comment includes information claimed to be Confidential Business Information (CBI) or other information whose disclosure is restricted by statute. Do not submit information that you consider to be CBI or otherwise protected through 
                        <E T="03">www.regulations.gov</E>
                         or e-mail. The 
                        <E T="03">www.regulations.gov</E>
                         Web site is an “anonymous access” system, which means EPA will not know your identity or contact information unless you provide it in the body of your comment. If you send an e-mail comment directly to EPA without going through 
                        <E T="03">www.regulations.gov</E>
                         your e-mail address will be automatically captured and included as part of the comment that is placed in the public docket and made available on the Internet. If you submit an electronic comment, EPA recommends that you include your name and other contact information in the body of your comment and with any disk or CD-ROM you submit. If EPA cannot read your comment due to technical difficulties and cannot contact you for clarification, EPA may not be able to consider your comment. Electronic files should avoid the use of special characters, any form of encryption, and be free of any defects or viruses. For additional information about EPA's public docket visit the EPA Docket Center homepage at 
                        <E T="03">http://www.epa.gov/epahome/dockets.htm.</E>
                    </P>
                </ADD>
                <FURINF>
                    <HD SOURCE="HED">FOR FURTHER INFORMATION CONTACT:</HD>
                    <P>
                        Vicki Ellis, Office of Cooperative Environmental Management, Mail Code 1601M, Environmental Protection Agency, 1200 Pennsylvania Ave., NW., Washington, DC 20460; telephone number: 202-564-1203; fax number: 202-564-8129; e-mail address: 
                        <E T="03">ellis.vicki@epa.gov.</E>
                    </P>
                </FURINF>
            </PREAMB>
            <SUPLINF>
                <HD SOURCE="HED">SUPPLEMENTARY INFORMATION:</HD>
                <HD SOURCE="HD1">How Can I Access the Docket and/or Submit Comments? </HD>
                <P>
                    EPA has established a public docket for this ICR under Docket ID No. EPA-HQ-OA-2007-0933, which is available for online viewing at 
                    <E T="03">www.regulations.gov,</E>
                     or in person viewing at the Environmental Information Docket in the EPA Docket Center (EPA/DC), EPA West Room 3334, 1301 Constitution Ave., NW., Washington, DC 20460. The EPA/DC Public Reading Room is open from 8:30 a.m. to 4:30 p.m., Monday through Friday, excluding legal holidays. The telephone number for the Reading Room is 202-566-1744, and the telephone number for the Environmental Information Docket is 202-566-9744. 
                </P>
                <P>
                    Use 
                    <E T="03">www.regulations.gov</E>
                     to obtain a copy of the draft collection of information, submit or view public comments, access the index listing of the contents of the docket, and to access those documents in the public docket that are available electronically. Once in the system, select “search,” then key in the docket ID number identified in this document. 
                </P>
                <HD SOURCE="HD1">What Information Is EPA Particularly Interested In? </HD>
                <P>Pursuant to section 3506(c)(2)(A) of the PRA, EPA specifically solicits comments and information to enable it to: </P>
                <P>(i) Evaluate whether the proposed collection of information is necessary for the proper performance of the functions of the Agency, including whether the information will have practical utility; </P>
                <P>(ii) evaluate the accuracy of the Agency's estimate of the burden of the proposed collection of information, including the validity of the methodology and assumptions used; </P>
                <P>(iii) enhance the quality, utility, and clarity of the information to be collected; and </P>
                <P>(iv) minimize the burden of the collection of information on those who are to respond, including through the use of appropriate automated electronic, mechanical, or other technological collection techniques or other forms of information technology, e.g., permitting electronic submission of responses. In particular, EPA is requesting comments from very small businesses (those that employ less than 25) on examples of specific additional efforts that EPA could make to reduce the paperwork burden for very small businesses affected by this collection. </P>
                <HD SOURCE="HD1">What Should I Consider When I Prepare My Comments for EPA? </HD>
                <P>You may find the following suggestions helpful for preparing your comments: </P>
                <P>1. Explain your views as clearly as possible and provide specific examples. </P>
                <P>2. Describe any assumptions that you used. </P>
                <P>3. Provide copies of any technical information and/or data you used that support your views. </P>
                <P>4. If you estimate potential burden or costs, explain how you arrived at the estimate that you provide. </P>
                <P>5. Offer alternative ways to improve the collection activity. </P>
                <P>
                    6. Make sure to submit your comments by the deadline identified under 
                    <E T="02">DATES</E>
                    . 
                </P>
                <P>
                    7. To ensure proper receipt by EPA, be sure to identify the docket ID number assigned to this action in the subject line on the first page of your response. You may also provide the name, date, and 
                    <E T="04">Federal Register</E>
                     citation. 
                </P>
                <HD SOURCE="HD1">What Information Collection Activity or ICR Does This Apply to? </HD>
                <P>
                    <E T="03">Affected entities:</E>
                     Entities potentially affected by this action are approximately 300 candidates for membership as Special Government Employees (SGEs) on EPA Federal advisory committees. The Form 3110-48 is completed as part of the member selection process and before they are invited to serve as a member of a Federal advisory committee (FAC) at EPA. 
                </P>
                <P>
                    <E T="03">Title:</E>
                     Confidential Financial Disclosure Form for Special Government Employees Serving on Federal Advisory Committees at the U.S. Environmental Protection Agency. 
                </P>
                <P>
                    <E T="03">ICR numbers:</E>
                     EPA ICR No. 2260.02, OMB Control No. 2090-0029. 
                </P>
                <P>
                    <E T="03">ICR status:</E>
                     This ICR is currently scheduled to expire on 02/29/2008. An Agency may not conduct or sponsor, and a person is not required to respond to, a collection of information, unless it displays a currently valid OMB control number. The OMB control numbers for EPA's regulations in title 40 of the CFR, after appearing in the 
                    <E T="04">Federal Register</E>
                     when approved, are listed in 40 CFR part 9, and are displayed either by publication in the 
                    <E T="04">Federal Register</E>
                     or by other appropriate means, such as on the related collection instrument or form, if applicable. The display of OMB control numbers in certain EPA regulations is consolidated in 40 CFR part 9. 
                </P>
                <P>
                    <E T="03">Abstract:</E>
                     The purpose of this information collection request is to assist the United States Environmental 
                    <PRTPAGE P="66167"/>
                    Protection Agency (EPA or the Agency) in selecting Federal advisory committee members who will be appointed as Special Government Employees (SGEs), mostly to EPA's scientific and technical committees. To select SGE members as efficiently and cost effectively as possible, the Agency needs to evaluate potential conflicts of interest before a candidate is hired as an SGE and appointed as a member to a committee by EPA's Administrator or Deputy Administrator. 
                </P>
                <P>Agency officials developed the “Confidential Financial Disclosure Form for Special Government Employees Serving on Federal Advisory Committees at the U.S. Environmental Protection Agency,” also referred to as Form 3110-48, for a greater inclusion of information to discover any potential conflicts of interest as recommended by the Government Accountability Office. </P>
                <P>
                    <E T="03">Burden Statement:</E>
                     The annual public reporting and recordkeeping burden for this collection of information is estimated to average one hour per response. Burden means the total time, effort, or financial resources expended by persons to generate, maintain, retain, or disclose or provide information to or for a Federal agency. This includes the time needed to review instructions; develop, acquire, install, and utilize technology and systems for the purposes of collecting, validating, and verifying information, processing and maintaining information, and disclosing and providing information; adjust the existing ways to comply with any previously applicable instructions and requirements which have subsequently changed; train personnel to be able to respond to a collection of information; search data sources; complete and review the collection of information; and transmit or otherwise disclose the information. 
                </P>
                <P>The ICR provides a detailed explanation of the Agency's estimate, which is only briefly summarized here: </P>
                <P>
                    • 
                    <E T="03">Estimated total number of potential respondents:</E>
                     300. 
                </P>
                <P>
                    • 
                    <E T="03">Frequency of response:</E>
                     Annual. 
                </P>
                <P>
                    • 
                    <E T="03">Estimated total average number of responses for each respondent:</E>
                     1. 
                </P>
                <P>
                    • 
                    <E T="03">Estimated total annual burden hours:</E>
                     300 hours/1 hour per respondent. 
                </P>
                <P>
                    • 
                    <E T="03">Estimated total annual costs:</E>
                     $33,000. There are no capital investment or maintenance and operational costs. 
                </P>
                <HD SOURCE="HD1">Are There Changes in the Estimates From the Last Approval? </HD>
                <P>The burden estimates have been changed to reflect an expected increase of the number of respondents (from 276 to 300), as well as an increase of respondents' costs to complete the form, to cover the next 3 years. </P>
                <HD SOURCE="HD1">What is the Next Step in the Process for This ICR? </HD>
                <P>
                    EPA will consider the comments received and amend the ICR as appropriate. The final ICR package will then be submitted to OMB for review and approval pursuant to 5 CFR 1320.12. At that time, EPA will issue another 
                    <E T="04">Federal Register</E>
                     notice pursuant to 5 CFR 1320.5(a)(1)(iv) to announce the submission of the ICR to OMB and the opportunity to submit additional comments to OMB. If you have any questions about this ICR or the approval process, please contact Vicki Ellis, Office of Cooperative Environmental Management, Mail Code 1601M, Environmental Protection Agency, 1200 Pennsylvania Ave., NW., Washington, DC 20460; telephone number: 202-564-1203; fax number: 202-564-8129; e-mail address: 
                    <E T="03">ellis.vicki@epa.gov.</E>
                </P>
                <SIG>
                    <DATED>Dated: November 20, 2007. </DATED>
                    <NAME>Rafael DeLeon, </NAME>
                    <TITLE>Director, Office of Cooperative Environmental Management, Office of the Administrator. </TITLE>
                </SIG>
            </SUPLINF>
            <FRDOC>[FR Doc. E7-23052 Filed 11-26-07; 8:45 am] </FRDOC>
            <BILCOD>BILLING CODE 6560-50-P</BILCOD>
        </NOTICE>
        <NOTICE>
            <PREAMB>
                <AGENCY TYPE="S">ENVIRONMENTAL PROTECTION AGENCY </AGENCY>
                <DEPDOC>[EPA-HQ-RCRA-2007-0387; FRL-8499-1] </DEPDOC>
                <SUBJECT>Agency Information Collection Activities; Submission to OMB for Review and Approval; Comment Request; Hazardous Waste Specific Unit Requirements, and Special Waste Processes and Types (Renewal), EPA ICR Number 1572.07, OMB Control Number 2050-0050 </SUBJECT>
                <AGY>
                    <HD SOURCE="HED">AGENCY:</HD>
                    <P>Environmental Protection Agency (EPA). </P>
                </AGY>
                <ACT>
                    <HD SOURCE="HED">ACTION:</HD>
                    <P>Notice. </P>
                </ACT>
                <SUM>
                    <HD SOURCE="HED">SUMMARY:</HD>
                    <P>
                        In compliance with the Paperwork Reduction Act (PRA)(44 U.S.C. 3501, 
                        <E T="03">et seq.</E>
                        ), this document announces that an Information Collection Request (ICR) has been forwarded to the Office of Management and Budget (OMB) for review and approval. This is a request to renew an existing approved collection. The ICR, which is abstracted below, describes the nature of the information collection and its estimated burden and cost. 
                    </P>
                </SUM>
                <DATES>
                    <HD SOURCE="HED">DATES:</HD>
                    <P>Additional comments may be submitted on or before December 27, 2007. </P>
                </DATES>
                <ADD>
                    <HD SOURCE="HED">ADDRESSES:</HD>
                    <P>
                        Submit your comments, referencing Docket ID No. EPA-HQ-RCRA-2007-0387, to (1) EPA, either online using 
                        <E T="03">www.regulations.gov</E>
                         (our preferred method), or by e-mail to 
                        <E T="03">rcra-docket@epa.gov</E>
                        , or by mail to: RCRA Docket (2822T), U.S. Environmental Protection Agency, 1200 Pennsylvania Avenue, NW., Washington, DC 20460; and (2) OMB, by mail to: Office of Information and Regulatory Affairs, Office of Management and Budget (OMB), Attention: Desk Officer for EPA, 725 17th Street, NW., Washington, DC 20503. 
                    </P>
                </ADD>
                <FURINF>
                    <HD SOURCE="HED">FOR FURTHER INFORMATION CONTACT:</HD>
                    <P>
                        Norma Abdul-Malik, Office of Solid Waste (5303P), Environmental Protection Agency, 1200 Pennsylvania Ave., NW., Washington, DC 20460; telephone number: 703-308-8753; fax number: 703-308-8617; e-mail address: 
                        <E T="03">abdul-malik.norma@epa.gov</E>
                        . 
                    </P>
                </FURINF>
            </PREAMB>
            <SUPLINF>
                <HD SOURCE="HED">SUPPLEMENTARY INFORMATION:</HD>
                <P>
                    EPA has submitted the following ICR to OMB for review and approval according to the procedures prescribed in 5 CFR 1320.12. On June 11, 2007 (72 
                    <E T="03">FR</E>
                     32093), EPA sought comments on this ICR pursuant to 5 CFR 1320.8(d). EPA received no comments. Any additional comments on this ICR should be submitted to EPA and OMB within 30 days of this notice. 
                </P>
                <P>
                    EPA has established a public docket for this ICR under Docket ID No. EPA-HQ-RCRA-2007-0387, which is available for online viewing at 
                    <E T="03">www.regulations.gov</E>
                    , or in person viewing at the Resource Conservation and Recovery Act (RCRA) Docket in the EPA Docket Center (EPA/DC), EPA West, Room 3334, 1301 Constitution Ave., NW., Washington, DC. The EPA/DC Public Reading Room is open from 8:30 a.m. to 4:30 p.m., Monday through Friday, excluding legal holidays. The telephone number for the Reading Room is (202) 566-1744, and the telephone number for the RCRA Docket is (202) 566-0270. 
                </P>
                <P>
                    Use EPA's electronic docket and comment system at 
                    <E T="03">www.regulations.gov</E>
                    , to submit or view public comments, access the index listing of the contents of the docket, and to access those documents in the docket that are available electronically. Once in the system, select “docket search,” then key in the docket ID number identified above. Please note that EPA's policy is that public comments, whether submitted electronically or in paper, will be made available for public viewing at 
                    <E T="03">www.regulations.gov</E>
                     as EPA receives them and without change, unless the comment contains copyrighted material, Confidential Business Information (CBI), or other information whose public disclosure is restricted by statute. For further 
                    <PRTPAGE P="66168"/>
                    information about the electronic docket, go to 
                    <E T="03">www.regulations.gov.</E>
                </P>
                <P>
                    <E T="03">Title:</E>
                     Hazardous Waste Specific Unit Requirements, and Special Waste Processes and Types (Renewal). 
                </P>
                <P>
                    <E T="03">ICR numbers:</E>
                     EPA ICR No. 1572.07, OMB Control No. 2050-0050. 
                </P>
                <P>
                    <E T="03">ICR Status:</E>
                     This ICR is scheduled to expire on November 30, 2007. Under OMB regulations, the Agency may continue to conduct or sponsor the collection of information while this submission is pending at OMB. An Agency may not conduct or sponsor, and a person is not required to respond to, a collection of information, unless it displays a currently valid OMB control number. The OMB control numbers for EPA's regulations in title 40 of the CFR, after appearing in the 
                    <E T="04">Federal Register</E>
                     when approved, are listed in 40 CFR part 9, are displayed either by publication in the 
                    <E T="04">Federal Register</E>
                     or by other appropriate means, such as on the related collection instrument or form, if applicable. The display of OMB control numbers in certain EPA regulations is consolidated in 40 CFR part 9. 
                </P>
                <P>
                    <E T="03">Abstract:</E>
                     This ICR provides a discussion of all of the information collection requirements associated with specific unit standards applicable to owners and operators of facilities that treat, store, or dispose of hazardous wastes as defined by 40 CFR part 261. It includes a detailed description of the data items and respondent activities associated with each requirement and with each hazardous waste management unit at a facility. The specific units and processes included in this ICR are: Tank systems, Surface impoundments, Waste piles, Land treatment, Landfills, Incinerators, Thermal treatment , Chemical, physical, and biological treatment, Miscellaneous (subpart X), Drip pads, Process vents, Equipment leaks , Containment buildings, Recovery/recycling. 
                </P>
                <P>With each information collection covered in this ICR, EPA is aiding the goal of complying with its statutory mandate under RCRA to develop standards for hazardous waste treatment, storage, and disposal facilities, to protect human health and the environment. Without the information collection, the agency cannot assure that the facilities are designed and operated properly. </P>
                <P>
                    <E T="03">Burden Statement</E>
                    : The annual public reporting and recordkeeping burden for this collection of information is estimated to average as follows: 
                </P>
                <GPOTABLE COLS="2" OPTS="L2,tp0,i1" CDEF="s100,10">
                    <TTITLE> </TTITLE>
                    <BOXHD>
                        <CHED H="1">Unit type </CHED>
                        <CHED H="1">Hours per response </CHED>
                    </BOXHD>
                    <ROW>
                        <ENT I="01">Subpart I: Containers</ENT>
                        <ENT>73 </ENT>
                    </ROW>
                    <ROW>
                        <ENT I="01">Subpart J: Tank Systems</ENT>
                        <ENT>74 </ENT>
                    </ROW>
                    <ROW>
                        <ENT I="01">Subpart K: Surface Impoundments</ENT>
                        <ENT>78 </ENT>
                    </ROW>
                    <ROW>
                        <ENT I="01">Subpart L: Waste Piles</ENT>
                        <ENT>17 </ENT>
                    </ROW>
                    <ROW>
                        <ENT I="01">Subpart M: Land Treatment</ENT>
                        <ENT>0 </ENT>
                    </ROW>
                    <ROW>
                        <ENT I="01">Subpart N: Landfills</ENT>
                        <ENT>37 </ENT>
                    </ROW>
                    <ROW>
                        <ENT I="01">Subpart O: Incinerators</ENT>
                        <ENT>3 </ENT>
                    </ROW>
                    <ROW>
                        <ENT I="01">Subpart W: Drip Pads</ENT>
                        <ENT>0 </ENT>
                    </ROW>
                    <ROW>
                        <ENT I="01">Subpart X: Miscellaneous Units</ENT>
                        <ENT>0 </ENT>
                    </ROW>
                    <ROW>
                        <ENT I="01">Subpart AA: Process Vents</ENT>
                        <ENT>400 </ENT>
                    </ROW>
                    <ROW>
                        <ENT I="01">Subpart BB: Equipment Leaks</ENT>
                        <ENT>4 </ENT>
                    </ROW>
                    <ROW>
                        <ENT I="01">Subpart DD: Containment Buildings</ENT>
                        <ENT>27 </ENT>
                    </ROW>
                </GPOTABLE>
                <P>Burden means the total time, effort, or financial resources expended by persons to generate, maintain, retain, or disclose or provide information to or for a Federal agency. This includes the time needed to review instructions; develop, acquire, install, and utilize technology and systems for the purposes of collecting, validating, and verifying information, processing and maintaining information, and disclosing and providing information; adjust the existing ways to comply with any previously applicable instructions and requirements which have subsequently changed; train personnel to be able to respond to a collection of information; search data sources; complete and review the collection of information; and transmit or otherwise disclose the information. </P>
                <P>
                    <E T="03">Respondents/Affected Entities:</E>
                     Private sector and State, Local, or Tribal governments. 
                </P>
                <P>
                    <E T="03">Estimated Number of Respondents:</E>
                     3,326. 
                </P>
                <P>
                    <E T="03">Frequency of Response:</E>
                     On occasion. 
                </P>
                <P>
                    <E T="03">Estimated Total Annual Hour Burden:</E>
                     626,476. 
                </P>
                <P>
                    <E T="03">Estimated Total Annual Cost:</E>
                     $27,289,816, which includes $23,349,024 annualized labor and $3,940,793 annualized capital and O&amp;M costs. 
                </P>
                <P>
                    <E T="03">Changes in the Estimates:</E>
                     There is a decrease of 42,098 hours in the total estimated burden currently identified in the OMB Inventory of Approved ICR Burdens. This decrease is due to the decrease in the number of respondents, which is based on more accurate, current data. 
                </P>
                <SIG>
                    <DATED>Dated: November 19, 2007. </DATED>
                    <NAME>Joseph A. Sierra, </NAME>
                    <TITLE>Acting Director, Collection Strategies Division. </TITLE>
                </SIG>
            </SUPLINF>
            <FRDOC> [FR Doc. E7-23057 Filed 11-26-07; 8:45 am] </FRDOC>
            <BILCOD>BILLING CODE 6560-50-P </BILCOD>
        </NOTICE>
        <NOTICE>
            <PREAMB>
                <AGENCY TYPE="S">ENVIRONMENTAL PROTECTION AGENCY </AGENCY>
                <DEPDOC>[EPA-HQ-OAR-2007-0093; FRL-8499-4] </DEPDOC>
                <SUBJECT>Agency Information Collection Activities; Submission to OMB for Review and Approval; Comment Request; Clean Air Act Tribal Authority (Renewal); EPA ICR No. 1676.05, OMB Control No. 2060-0306 </SUBJECT>
                <AGY>
                    <HD SOURCE="HED">AGENCY:</HD>
                    <P>Environmental Protection Agency (EPA). </P>
                </AGY>
                <ACT>
                    <HD SOURCE="HED">ACTION:</HD>
                    <P>Notice. </P>
                </ACT>
                <SUM>
                    <HD SOURCE="HED">SUMMARY:</HD>
                    <P>
                        In compliance with the Paperwork Reduction Act (PRA) (44 U.S.C. 3501, 
                        <E T="03">et seq.</E>
                        ), this document announces that an Information Collection Request (ICR) has been forwarded to the Office of Management and Budget (OMB) for review and approval. This is a request to renew an existing approved collection. The ICR, which is abstracted below, describes the nature of the information collection and its estimated burden and cost. 
                    </P>
                </SUM>
                <DATES>
                    <HD SOURCE="HED">DATES:</HD>
                    <P>Additional comments may be submitted on or before December 27, 2007. </P>
                </DATES>
                <ADD>
                    <HD SOURCE="HED">ADDRESSES:</HD>
                    <P>
                        Submit your comments, referencing Docket ID No. EPA-HQ-OAR-2007-0093, to (1) EPA online using 
                        <E T="03">www.regulations.gov</E>
                         (our preferred method), by e-mail to 
                        <E T="03">a-and-r-Docket@epa.gov</E>
                         or by mail to: EPA Docket Center, Environmental Protection Agency, Clean Air and Radiation Docket and Information Center (Mailcode 2822T), 1200 Pennsylvania Ave., NW., Washington, DC 20460, and (2) OMB by mail to: Office of Information and Regulatory Affairs, Office of Management and Budget (OMB), Attention: Desk Officer for EPA, 725 17th Street, NW., Washington, DC 20503. 
                    </P>
                </ADD>
                <FURINF>
                    <HD SOURCE="HED">FOR FURTHER INFORMATION CONTACT:</HD>
                    <P>
                        Darrel Harmon, Office of Air and Radiation, Immediate Office, (6101A), Environmental Protection Agency, 1200 Pennsylvania Ave., NW., Washington, DC 20460; telephone number: 202-564-7416; fax number: 202-501-0394; e-mail address: 
                        <E T="03">harmon.darrel@epa.gov</E>
                        . 
                    </P>
                </FURINF>
            </PREAMB>
            <SUPLINF>
                <HD SOURCE="HED">SUPPLEMENTARY INFORMATION:</HD>
                <P>EPA has submitted the following ICR to OMB for review and approval according to the procedures prescribed in 5 CFR 1320.12. On July 6, 2007 (72 FR 37002), EPA sought comments on this ICR pursuant to 5 CFR 1320.8(d). EPA received no comments. Any additional comments on this ICR should be submitted to EPA and OMB within 30 days of this notice. </P>
                <P>
                    EPA has established a public docket for this ICR under Docket ID No. EPA-HQ-OAR-2007-0093, which is 
                    <PRTPAGE P="66169"/>
                    available for online viewing at 
                    <E T="03">www.regulations.gov</E>
                    , or in person viewing at the Air Docket in the EPA Docket Center (EPA/DC), EPA West, Room 3334, 1301 Constitution Ave., NW., Washington, DC. The EPA/DC Public Reading Room is open from 8:30 a.m. to 4:30 p.m., Monday through Friday, excluding legal holidays. The telephone number for the Reading Room is 202-566-1744, and the telephone number for the Air Docket is 202-566-1742. 
                </P>
                <P>
                    Use EPA's electronic docket and comment system at 
                    <E T="03">www.regulations.gov</E>
                    , to submit or view public comments, access the index listing of the contents of the docket, and to access those documents in the docket that are available electronically. Once in the system, select “docket search,” then key in the docket ID number identified above. Please note that EPA's policy is that public comments, whether submitted electronically or in paper, will be made available for public viewing at 
                    <E T="03">www.regulations.gov</E>
                     as EPA receives them and without change, unless the comment contains copyrighted material, Confidential Business Information (CBI), or other information whose public disclosure is restricted by statute. For further information about the electronic docket, go to 
                    <E T="03">www.regulations.gov</E>
                    . 
                </P>
                <P>
                    <E T="03">Title:</E>
                     Clean Air Act Tribal Authority (Renewal). 
                </P>
                <P>
                    <E T="03">ICR Numbers:</E>
                     EPA ICR No. 1676.05, OMB Control No. 2060-0306. 
                </P>
                <P>
                    <E T="03">ICR Status:</E>
                     This ICR is scheduled to expire on 12/31/2007. Under OMB regulations, the Agency may continue to conduct or sponsor the collection of information while this submission is pending at OMB. An Agency may not conduct or sponsor, and a person is not required to respond to, a collection of information, unless it displays a currently valid OMB control number. The OMB control numbers for EPA's regulations in title 40 of the CFR, after appearing in the 
                    <E T="04">Federal Register</E>
                     when approved, are listed in 40 CFR part 9, are displayed either by publication in the 
                    <E T="04">Federal Register</E>
                     or by other appropriate means, such as on the related collection instrument or form, if applicable. The display of OMB control numbers in certain EPA regulations is consolidated in 40 CFR part 9. 
                </P>
                <P>
                    <E T="03">Abstract:</E>
                     This Information Collection Request (ICR) seeks authorization for tribes to demonstrate their eligibility to be treated in the same manner as states under the Clean Air Act (CAA) and to submit applications to implement a CAA program. This ICR extends the collection period of information for determining eligibility, which expires December 31, 2007. 
                </P>
                <P>The program regulation provides for Indian tribes, if they so choose, to assume responsibility for the development and implementation of CAA programs. The regulation, Indian Tribes: Air Quality Planning and Management (Tribal Authority Rule [TAR] 40 CFR parts 9, 35, 49, 50 and 81), sets forth how tribes may seek authority to implement their own air quality planning and management programs. The rule establishes: (1) Which CAA provisions Indian tribes may seek authority to implement, (2) what requirements the tribes must meet when seeking such authorization, and (3) what Federal financial assistance may be available to help tribes establish and manage their air quality programs. The TAR provides tribes the authority to administer air quality programs over all air resources, including non-Indian owned fee lands, within the exterior boundaries of a reservation and other areas over which the tribe can demonstrate jurisdiction. An Indian tribe that takes responsibility for a CAA program would essentially be treated in the same way as a state would be treated for that program. </P>
                <P>
                    <E T="03">Burden Statement:</E>
                     The annual public reporting and recordkeeping burden for this collection of information is estimated to average 40 hours per response. Burden means the total time, effort, or financial resources expended by persons to generate, maintain, retain, or disclose or provide information to or for a Federal agency. This includes the time needed to review instructions; develop, acquire, install, and utilize technology and systems for the purposes of collecting, validating, and verifying information, processing and maintaining information, and disclosing and providing information; adjust the existing ways to comply with any previously applicable instructions and requirements which have subsequently changed; train personnel to be able to respond to a collection of information; search data sources; complete and review the collection of information; and transmit or otherwise disclose the information. 
                </P>
                <P>
                    <E T="03">Respondents/Affected Entities:</E>
                     Indian tribes. 
                </P>
                <P>
                    <E T="03">Estimated Number of Respondents:</E>
                     27. 
                </P>
                <P>
                    <E T="03">Frequency of Response:</E>
                     One-time application. 
                </P>
                <P>
                    <E T="03">Estimated Total Annual Hour Burden:</E>
                     360. 
                </P>
                <P>
                    <E T="03">Estimated Total Annual Cost:</E>
                     $18,838.20, includes $0 annualized capital or O&amp;M costs. 
                </P>
                <P>
                    <E T="03">Changes in the Estimates:</E>
                     There is no change in hours in the total estimated burden currently identified in the OMB Inventory of Approved ICR Burdens. 
                </P>
                <SIG>
                    <DATED>Dated: November 20, 2007. </DATED>
                    <NAME>Sara Hisel-McCoy, </NAME>
                    <TITLE> Director, Collections Strategies Division.</TITLE>
                </SIG>
            </SUPLINF>
            <FRDOC> [FR Doc. E7-23073 Filed 11-26-07; 8:45 am] </FRDOC>
            <BILCOD>BILLING CODE 6560-50-P </BILCOD>
        </NOTICE>
        <NOTICE>
            <PREAMB>
                <AGENCY TYPE="S">ENVIRONMENTAL PROTECTION AGENCY </AGENCY>
                <DEPDOC>[EPA-HQ-OAR-2007-0176; FRL-8499-3] </DEPDOC>
                <SUBJECT>Agency Information Collection Activities; Submission to OMB for Review and Approval; Comment Request; Reformulated Gasoline and Conventional Gasoline: Requirements for Refiners, Oxygenated Blenders, and Importers of Gasoline, Requirements for Parties in the Gasoline Distribution Network (Renewal), EPA ICR No. 1591.24, OMB Control No. 2060-0277 </SUBJECT>
                <AGY>
                    <HD SOURCE="HED">AGENCY:</HD>
                    <P>Environmental Protection Agency (EPA). </P>
                </AGY>
                <ACT>
                    <HD SOURCE="HED">ACTION:</HD>
                    <P>Notice. </P>
                </ACT>
                <SUM>
                    <HD SOURCE="HED">SUMMARY:</HD>
                    <P>
                        In compliance with the Paperwork Reduction Act (PRA) (44 U.S.C. 3501, 
                        <E T="03">et seq.</E>
                        ), this document announces that an Information Collection Request (ICR) has been forwarded to the Office of Management and Budget (OMB) for review and approval. This is a request to renew an existing approved collection. The ICR, which is abstracted below, describes the nature of the information collection and its estimated burden and cost. 
                    </P>
                </SUM>
                <DATES>
                    <HD SOURCE="HED">DATES:</HD>
                    <P>Additional comments may be submitted on or before December 27, 2007. </P>
                </DATES>
                <ADD>
                    <HD SOURCE="HED">ADDRESSES:</HD>
                    <P>
                        Submit your comments, referencing Docket ID No. EPA-HQ-OAR-2007-0176, to (1) EPA online using 
                        <E T="03">www.regulations.gov</E>
                         (our preferred method), by e-mail to 
                        <E T="03">a-and-r-Docket@epa.gov</E>
                         or by mail to: EPA Docket Center, Environmental Protection Agency, EPA Docket Center (EPA/DC), Air and Radiation Docket, 1200 Pennsylvania Ave., NW., Washington, DC 20460, and (2) OMB by mail to: Office of Information and Regulatory Affairs, Office of Management and Budget (OMB), Attention: Desk Officer for EPA, 725 17th Street, NW., Washington, DC 20503. 
                    </P>
                </ADD>
                <FURINF>
                    <HD SOURCE="HED">FOR FURTHER INFORMATION CONTACT:</HD>
                    <P>
                        Jose M. Solar, Office of Transportation and Air Quality, mail code 6406J, Environmental Protection Agency, 1200 
                        <PRTPAGE P="66170"/>
                        Pennsylvania Ave., NW., Washington, DC 20460; telephone number: 202-343-9027; fax number: 202-343-2801; e-mail address: 
                        <E T="03">Solar.Jose@epa.gov.</E>
                    </P>
                </FURINF>
            </PREAMB>
            <SUPLINF>
                <HD SOURCE="HED">SUPPLEMENTARY INFORMATION:</HD>
                <P>EPA has submitted the following ICR to OMB for review and approval according to the procedures prescribed in 5 CFR 1320.12. On Tuesday, July 31, 2007 (72 FR 41747), EPA sought comments on this ICR pursuant to 5 CFR 1320.8(d). EPA received no comments. Any additional comments on this ICR should be submitted to EPA and OMB within 30 days of this notice. </P>
                <P>
                    EPA has established a public docket for this ICR under Docket ID No. EPA-HQ-OAR-2007-0176, which is available for online viewing at 
                    <E T="03">www.regulations.gov,</E>
                     or in person viewing at the Office of Air and Radiation Docket in the EPA Docket Center (EPA/DC), EPA West, Room 3334, 1301 Constitution Ave., NW., Washington, DC. The EPA/DC Public Reading Room is open from 8 a.m. to 4:30 p.m., Monday through Friday, excluding legal holidays. The telephone number for the Reading Room is 202-566-1744, and the telephone number for the Office of Air and Radiation Docket is 202-566-1742. 
                </P>
                <P>
                    Use EPA's electronic docket and comment system at 
                    <E T="03">www.regulations.gov,</E>
                     to submit or view public comments, access the index listing of the contents of the docket, and to access those documents in the docket that are available electronically. Once in the system, select “docket search,” then key in the docket ID number identified above. Please note that EPA's policy is that public comments, whether submitted electronically or in paper, will be made available for public viewing at 
                    <E T="03">www.regulations.gov</E>
                     as EPA receives them and without change, unless the comment contains copyrighted material, confidential business information (CBI), or other information whose public disclosure is restricted by statute. For further information about the electronic docket, go to 
                    <E T="03">www.regulations.gov.</E>
                </P>
                <P>
                    <E T="03">Title:</E>
                     Reformulated Gasoline and Conventional Gasoline: Requirements for Refiners, Oxygenated Blenders, and Importers of Gasoline and Requirements for Parties in the Gasoline Distribution Network (Renewal). 
                </P>
                <P>
                    <E T="03">ICR numbers:</E>
                     EPA ICR No. 1591.24, OMB Control No. 2060-0277. 
                </P>
                <P>
                    <E T="03">ICR Status:</E>
                     This ICR is scheduled to expire on November 30, 2007. Under OMB regulations, the Agency may continue to conduct or sponsor the collection of information while this submission is pending at OMB. An Agency may not conduct or sponsor, and a person is not required to respond to, a collection of information, unless it displays a currently valid OMB control number. The OMB control numbers for EPA's regulations in title 40 of the CFR, after appearing in the 
                    <E T="04">Federal Register</E>
                     when approved, are listed in 40 CFR part 9, are displayed either by publication in the 
                    <E T="04">Federal Register</E>
                     or by other appropriate means, such as on the related collection instrument or form, if applicable. The display of OMB control numbers in certain EPA regulations is consolidated in 40 CFR part 9. 
                </P>
                <P>
                    <E T="03">Abstract:</E>
                     Gasoline combustion is the major source of air pollution in most urban areas. In the 1990 Amendments to the Clean Air Act (Act), section 211(k), Congress required that gasoline dispensed in nine areas with severe air quality problems, and areas that opt-in, be reformulated to reduce toxic and ozone-forming emissions. (Ozone is also known as smog.) Congress also required that, in the process of producing reformulated gasoline (RFG), dirty components removed in the reformulation process not be “dumped” into the remainder of the country's gasoline, known as conventional gasoline (CG). The Environmental Protection Agency (EPA) promulgated regulations at 40 CFR part 80, Subpart D—Reformulated Gasoline, Subpart E—Anti-Dumping, and Subpart F—Attest Engagements, implementing the statutory requirements, which include standards for RFG (§ 80.41) and CG (§ 80.101). The regulations also contain reporting and recordkeeping requirements for the production, importation, transport and storage of gasoline, in order to demonstrate compliance and facilitate compliance and enforcement. 
                </P>
                <P>The program is run by the Transportation and Regional Programs Division, Office of Transportation and Air Quality, Office of Air and Radiation. Enforcement is done by the Air Enforcement Division, Office of Regulatory Enforcement, Office of Enforcement and Compliance Assurance. This program excludes California, which has separate requirements for gasoline. </P>
                <P>
                    <E T="03">Burden Statement:</E>
                     The annual public reporting and recordkeeping burden for this collection of information is estimated to average 2.4 hours per response. Burden means the total time, effort, or financial resources expended by persons to generate, maintain, retain, or disclose or provide information to or for a Federal agency. This includes the time needed to review instructions; develop, acquire, install, and utilize technology and systems for the purposes of collecting, validating, and verifying information, processing and maintaining information, and disclosing and providing information; adjust the existing ways to comply with any previously applicable instructions and requirements which have subsequently changed; train personnel to be able to respond to a collection of information; search data sources; complete and review the collection of information; and transmit or otherwise disclose the information. 
                </P>
                <P>
                    <E T="03">Respondents/Affected Entities:</E>
                     Refiners, Oxygenate Blenders, and Importers of Gasoline; Requirements for Parties in the Gasoline Distribution Network. 
                </P>
                <P>
                    <E T="03">Estimated Number of Respondents:</E>
                     4,068. 
                </P>
                <P>
                    <E T="03">Frequency of Response:</E>
                     Once, Quarterly, Annually, On Occasion. 
                </P>
                <P>
                    <E T="03">Estimated Total Annual Hour Burden:</E>
                     127,041. 
                </P>
                <P>
                    <E T="03">Estimated Total Annual Cost:</E>
                     $35,255,669, which includes $25,092,389 in annualized capital or O&amp;M costs. 
                </P>
                <P>
                    <E T="03">Changes in the Estimates:</E>
                     There is an increase of 5,351 hours in the total estimated burden currently identified in the OMB Inventory of Approved ICR Burdens. This increase is due to new requirements. 
                </P>
                <SIG>
                    <DATED>Dated: November 20, 2007. </DATED>
                    <NAME>Sara Hisel-McCoy, </NAME>
                    <TITLE>Director, Collection Strategies Division. </TITLE>
                </SIG>
            </SUPLINF>
            <FRDOC>[FR Doc. E7-23074 Filed 11-26-07; 8:45 am] </FRDOC>
            <BILCOD>BILLING CODE 6560-50-P </BILCOD>
        </NOTICE>
        <NOTICE>
            <PREAMB>
                <AGENCY TYPE="S">ENVIRONMENTAL PROTECTION AGENCY </AGENCY>
                <DEPDOC>[ER-FRL-6693-4] </DEPDOC>
                <SUBJECT>Intent To Prepare an Environmental Impact Statement; Apra Harbor, GU</SUBJECT>
                <AGY>
                    <HD SOURCE="HED">AGENCY:</HD>
                    <P>U.S. Environmental Protection Agency (EPA). </P>
                </AGY>
                <ACT>
                    <HD SOURCE="HED">ACTION:</HD>
                    <P>Notice of Intent to prepare an Environmental Impact Statement (EIS) to designate a permanent ocean dredged material disposal site (ODMDS) off Apra Harbor, Guam. </P>
                </ACT>
                <P>
                    <E T="03">Purpose:</E>
                     EPA has the authority to designate ODMDSs under section 102 of the Marine Protection, Research and Sanctuaries Act (MPRSA) of 1972 (33 USC 1401 
                    <E T="03">et. seq.</E>
                    ). It is EPA's policy to publish an EIS for all ODMDS designations (39 FR 37119, October 1974). Comments on the scope of the EIS evaluation will be accepted for 45 days from the date of this notice. 
                </P>
                <FURINF>
                    <HD SOURCE="HED">
                        FOR FURTHER INFORMATION, TO SUBMIT COMMENTS, AND TO BE PLACED ON A 
                        <PRTPAGE P="66171"/>
                        PROJECT MAILING LIST, CONTACT:
                    </HD>
                    <P>
                        Mr. Allan Ota, U.S. Environmental Protection Agency, Region 9, Dredging and Sediment Management Team (WTR-8), 75 Hawthorne Street, San Francisco, California 94105-3901, Telephone: (415) 972-3476 or Fax: (415) 947-3537 or E-mail: 
                        <E T="03">R9Guam_ODMDS_Scoping@epa.gov.</E>
                    </P>
                </FURINF>
                <SUM>
                    <HD SOURCE="HED">SUMMARY:</HD>
                    <P>EPA intends to conduct public meetings and collect public comments in advance of preparing an EIS to designate a permanent ODMDS off Apra Harbor, Guam. This EIS will be prepared in cooperation with the U.S. Department of the Navy (Navy). An EIS is needed to provide the environmental information necessary to evaluate the potential environmental impacts associated with ODMDS alternatives and select a preferred alternative that meets EPA's site selection criteria at 40 CFR 228.5 and 228.6. </P>
                    <P>
                        <E T="03">Need for Action:</E>
                         Both the Navy and the Port Authority of Guam (PAG) have plans to expand their operations in Apra Harbor, Guam. Expansion of the Apra Harbor Naval Complex and Commercial Port is proposed to accommodate projected increases in vessel and cargo traffic, newer classes of vessels and dockside maintenance and support operations. Expansion plans would require dredging to increase water depths for the safe navigation of military and commercial vessels. In addition, ongoing navigation activities also require periodic maintenance dredging. It should be noted that designation of an ODMDS does not constitute approval of ocean disposal. The Corps, with EPA concurrence, must first determine on a case by case basis that the proposed dredged material is suitable and that all beneficial reuse or other alternatives to ocean disposal have been considered. However, not all of the anticipated dredged materials can be accommodated in existing landfills and these sediments may not all be suitable for beneficial re-use (e.g., construction fills, wetlands restoration). Therefore, it is necessary to establish a permanent ODMDS to accommodate dredged material generated from anticipated new work and maintenance dredging in Apra Harbor. 
                    </P>
                    <P>
                        <E T="03">Alternatives:</E>
                         The following proposed alternatives have been tentatively defined. 
                    </P>
                    <FP SOURCE="FP-1">—“No Action”—Do not designate a permanent ODMDS, and continue to manage dredged material generated from new work and maintenance dredging with existing landfill and construction fill options subject to disposal volume limits. Future expansion of the naval and commercial port facilities will be limited significantly. </FP>
                    <FP SOURCE="FP-1">—“North Alternative ODMDS”—Designate a permanent ODMDS north of Apra Harbor, Guam, in a study area approximately 12-15 nautical miles offshore and in depths ranging from 6,000 to 6,600 feet. </FP>
                    <FP SOURCE="FP-1">—“Northwest Alternative ODMDS”—Designate a permanent ODMDS northwest of Apra Harbor, Guam, in a study area approximately 9-15 nautical miles offshore and in depths ranging from 6,600 to 8,400 feet. </FP>
                    <P>The North and Northwest study areas were identified in the Zone of Siting Feasibility (ZSF) Study, Ocean Dredged Material Disposal Site, Apra Harbor, Guam, Final Report (September 2006). This ZSF study excluded areas from further consideration, such as: shipping lanes, navigational hazards, military operating areas (i.e., for submarines), marine protected areas (i.e., marine preserves), and important fishing areas (commercial and recreational). </P>
                    <P>
                        <E T="03">Scoping:</E>
                         EPA is requesting written comments from federal, state, and local governments, industry, non-governmental organizations, and the general public on the range of alternatives considered, specific environmental issues to be evaluated in the EIS, and the potential impacts of the alternatives for an ODMDS designated offshore of Apra Harbor, Guam. Scoping comments will be accepted for 45 days, beginning with the date of this Notice. A public scoping meeting is scheduled on the following date: December 6, 2007, from 6-8 p.m., at The Weston Resort Guam, 105 Gun Beach Road, Tumon, Guam. The EPA presentation will be followed by public comments and questions. 
                    </P>
                    <P>
                        <E T="03">Estimated Date of Draft EIS Release:</E>
                         March 2009. 
                    </P>
                </SUM>
                <SIG>
                    <DATED>Dated: November 9, 2007. </DATED>
                    <NAME>Laura Yoshii, </NAME>
                    <TITLE>Deputy Regional Administrator, Environmental Protection Agency, Region 9.</TITLE>
                    <DATED>Dated: November 20, 2007. </DATED>
                    <NAME>Anne Norton-Miller, </NAME>
                    <TITLE>Director, OFA.</TITLE>
                </SIG>
            </PREAMB>
            <FRDOC>[FR Doc. E7-23043 Filed 11-26-07; 8:45 am] </FRDOC>
            <BILCOD>BILLING CODE 6560-50-P </BILCOD>
        </NOTICE>
        <NOTICE>
            <PREAMB>
                <AGENCY TYPE="S">ENVIRONMENTAL PROTECTION AGENCY </AGENCY>
                <DEPDOC>[EPA-HQ-OAR-2006-0340; FRL-8499-5] </DEPDOC>
                <SUBJECT>Renewable Fuel Standard Under Section 211(o) of the Clean Air Act as Amended by the Energy Policy Act of 2005 </SUBJECT>
                <AGY>
                    <HD SOURCE="HED">AGENCY:</HD>
                    <P>Environmental Protection Agency (EPA). </P>
                </AGY>
                <ACT>
                    <HD SOURCE="HED">ACTION:</HD>
                    <P>Notice. </P>
                </ACT>
                <SUM>
                    <HD SOURCE="HED">SUMMARY:</HD>
                    <P>
                        Section 211(o) of the Clean Air Act (the Act), as amended by the Energy Policy Act of 2005, requires the Administrator of the Environmental Protection Agency (EPA) to annually determine a renewable fuel standard (RFS) which is applicable to refiners, importers and certain blenders of gasoline, and publish the standard in the 
                        <E T="04">Federal Register</E>
                         by November 30 of each year. On the basis of this standard, each obligated party determines the volume of renewable fuel that it must ensure is consumed as motor vehicle fuel. This standard is calculated as a percentage, by dividing the amount of renewable fuel that the Act requires to be blended into gasoline for a given year by the amount of gasoline expected to be used during that year, including certain adjustments specified by the Act. In this notice we are publishing an RFS of 4.66% for 2008. 
                    </P>
                </SUM>
                <FURINF>
                    <HD SOURCE="HED">FOR FURTHER INFORMATION CONTACT:</HD>
                    <P>
                        Chris McKenna, Environmental Protection Agency, MC 6406J, 1200 Pennsylvania Ave., NW., Washington, DC 20460; 
                        <E T="03">telephone number:</E>
                         202-343-9037; 
                        <E T="03">fax number:</E>
                         202-343-2801; 
                        <E T="03">e-mail address: mckenna.chris@epa.gov</E>
                        . 
                    </P>
                </FURINF>
            </PREAMB>
            <SUPLINF>
                <HD SOURCE="HED">SUPPLEMENTARY INFORMATION:</HD>
                <HD SOURCE="HD1">I. Calculation of the 2008 RFS </HD>
                <HD SOURCE="HD2">A. Background </HD>
                <P>
                    The preamble to the final rulemaking for the Renewable Fuel Standard Program included a projected RFS for 2008 of 4.63%. 72 FR 23912 (May 1, 2007). In today's notice we are again using the calculational procedure from the final rulemaking to calculate the 2008 RFS. However, since some projections and assumptions used in the final rulemaking to calculate the projected 2008 RFS have changed, today's notice includes a recalculated and final 2008 RFS using the most recently available information. Since the RFS rule established clear legal criteria for deriving the standard (including specification of the formula used in today's notice, and all data sources), EPA is simply applying facts to pre-established law in issuing the final 2008 RFS standard. EPA is advising the 
                    <PRTPAGE P="66172"/>
                    regulated community of the revised standard through a 
                    <E T="04">Federal Register</E>
                     Notice, without prior notice and comment, in accordance with the Clean Air Act and EPA regulations. 
                </P>
                <P>The 2008 RFS is calculated by dividing the volume of renewable fuels required by the Act to be blended into gasoline in 2008, by the volume of gasoline projected by the Energy Information Administration (EIA) to be consumed in 2008 (including certain adjustments specified by the Act). The following equation from the final RFS Program regulations summarizes all of the variables that must be considered in the calculation. </P>
                <MATH SPAN="3" DEEP="31">
                    <MID>EN27NO07.004</MID>
                </MATH>
                <EXTRACT>
                    <FP SOURCE="FP-2">Where: </FP>
                    <FP SOURCE="FP-2">
                        RFStd
                        <E T="52">i</E>
                         = Renewable Fuel Standard in year i, in percent 
                    </FP>
                    <FP SOURCE="FP-2">
                        RFV
                        <E T="52">i</E>
                         = Annual volume of renewable fuels required by section 211(o)(2)(B) of the Act for year i, in gallons 
                    </FP>
                    <FP SOURCE="FP-2">
                        G
                        <E T="52">i</E>
                         = Amount of gasoline projected to be used in the 48 contiguous states, in year i, in gallons 
                    </FP>
                    <FP SOURCE="FP-2">
                        R
                        <E T="52">i</E>
                         = Amount of renewable fuel blended into gasoline that is projected to be consumed in the 48 contiguous states, in year i, in gallons 
                    </FP>
                    <FP SOURCE="FP-2">
                        GS
                        <E T="52">i</E>
                         = Amount of gasoline projected to be used in Alaska, Hawaii, or a U.S. territory in year i if the state or territory opts-in, in gallons 
                    </FP>
                    <FP SOURCE="FP-2">
                        RS
                        <E T="52">i</E>
                         = Amount of renewable fuel blended into gasoline that is projected to be consumed in Alaska, Hawaii, or a U.S. territory in year i if the state or territory opts-in, in gallons 
                    </FP>
                    <FP SOURCE="FP-2">
                        GE
                        <E T="52">i</E>
                         = Amount of gasoline projected to be produced by exempt small refineries and small refiners in year i, in gallons (through 2010 only unless exemption extended under §§ 211(o)(9)(A)(ii) or (B)). 
                    </FP>
                    <FP SOURCE="FP-2">
                        Cell
                        <E T="52">i</E>
                         = Beginning in 2013, the amount of renewable fuel that is required to come from cellulosic sources, in year i, in gallons (250,000,000 gallons minimum) 
                    </FP>
                </EXTRACT>
                <HD SOURCE="HD2">B. Data Sources for 2008 RFS Calculation </HD>
                <P>
                    The following discussion describes the sources of data for the variables in the above equation. For ease of calculation, this discussion regroups the terms (G
                    <E T="52">i</E>
                     − R
                    <E T="52">i</E>
                    ) + (GS
                    <E T="52">i</E>
                     − RS
                    <E T="52">i</E>
                    ) in the denominator of the above equation into the terms (G
                    <E T="52">i</E>
                     + GS
                    <E T="52">i</E>
                    ) − (R
                    <E T="52">i</E>
                     + RS
                    <E T="52">i</E>
                    ). 
                </P>
                <HD SOURCE="HD3">
                    Calculation of (RFV
                    <E T="52">i</E>
                     − Cell
                    <E T="52">i</E>
                    ), Total Amount of Renewable Fuels From Non-cellulosic Sources That Must Be Blended Into Gasoline in 2008 
                </HD>
                <P>
                    The Act requires 5.4 billion gallons of renewable fuels to be blended into gasoline in 2008. Because there is no cellulosic volume requirement in the Act until 2013, the amount of renewable fuel that the Act requires to be produced from cellulosic sources in 2008 (Cell
                    <E T="52">i</E>
                    ) is zero. Thus the total amount of renewable fuels from non-cellulosic sources that must be blended into gasoline in 2008 is 5.4 billion gallons. 
                </P>
                <HD SOURCE="HD3">
                    Calculation of (G
                    <E T="52">i</E>
                     + GS
                    <E T="52">i</E>
                    ), Total Amount of Gasoline Projected To Be Used in the 48 Contiguous States Plus Opt-in States/Territories, in Year i, in Gallons 
                </HD>
                <P>
                    The Act requires the Administrator of the EIA by October 31 of each year to provide EPA with an estimate of the volumes of gasoline projected to be sold or introduced into commerce in the United States for the following year. During the development of the RFS Program, EIA informed EPA that the projected gasoline consumption in “Table 4a: U.S. Petroleum Supply, Consumption, and Inventories” (formerly “Table 5a. U.S. Petroleum Supply and Demand: Base Case”) of the October issue of the monthly 
                    <E T="03">Short-Term Energy Outlook</E>
                     (STEO) should be used to calculate the RFS for the coming year. The October 2007 STEO projects that an average of 9.42 million barrels/day of gasoline will be consumed in all of the United States in 2008. Multiplying this average consumption rate by 366 days (2008 is a leap year) produces a total consumption of 144.80 billion gallons of gasoline in 2008. 
                </P>
                <P>
                    Only one non-contiguous state or territory has petitioned EPA to opt into the RFS Program beginning in 2008. Hawaii petitioned EPA on June 22, 2007 to opt into the RFS program, and EPA approved their request.
                    <SU>1</SU>
                    <FTREF/>
                     Thus, Alaska is the only one of the 50 states that is not included in the RFS Program. 
                </P>
                <FTNT>
                    <P>
                        <SU>1</SU>
                         Letter to the Honorable Laura Lingle, Governor of Hawaii, from Stephen Johnson of EPA dated July 30, 2007. 
                    </P>
                </FTNT>
                <P>
                    In order to calculate gasoline consumption in the 48 contiguous states plus Hawaii, we subtracted Alaska's projected gasoline consumption from the projected nationwide gasoline consumption of 144.80 billion gallons. Alaska's projected gasoline consumption was calculated by multiplying the projected nationwide gasoline consumption in 2008 by the ratio of Alaska's gasoline consumption in 2006 to the total U.S. consumption in 2006, based on Table 48, “Prime Supplier Sales Volumes of Motor Gasoline by Grade Formulation, PAD District, and State” gasoline data from EIA's 
                    <E T="03">Petroleum Marketing Annual</E>
                     2006 (the final rulemaking used data from 
                    <E T="03">Petroleum Marketing Annual 2005</E>
                    ). According to EIA, Prime Supplier data reflects where gasoline is used, rather than where it is produced.
                    <SU>2</SU>
                    <FTREF/>
                     Alaska's projected gasoline consumption in 2008 is 0.30 billion gallons. Subtracting this consumption from the projected nationwide consumption of 144.80 billion gallons in 2008 produces a total consumption of 144.50 billion gallons of gasoline in 2008 in the 48 contiguous states plus Hawaii. 
                </P>
                <FTNT>
                    <P>
                        <SU>2</SU>
                         Energy Information Administration, Petroleum Marketing Annual 2006, Explanatory Notes, Relationship of Refiner and Prime Supplier Sales Volumes (p. 382). 
                    </P>
                </FTNT>
                <HD SOURCE="HD3">
                    Calculation of (R
                    <E T="52">i</E>
                     + RS
                    <E T="52">i</E>
                    ), Total Amount of Renewable Fuel Blended Into Gasoline That Is Projected To Be Consumed in the 48 Contiguous States Plus Opt-in States/Territories, in Year i, in Gallons 
                </HD>
                <P>The projected gasoline consumption in the October 2007 STEO includes renewable fuel that is blended into gasoline. This volume of renewable fuel must be subtracted from the total volume of gasoline in order to calculate the total consumption of non-renewable gasoline. In Table 8 of the October 2007 STEO, EIA estimates that 0.755 quadrillion Btu of ethanol will be used as transportation fuel in all of the United States in 2008. Dividing this energy usage by the high heating value of ethanol (3.539 million Btu/barrel), and multiplying by 42 gallons/barrel produces a total ethanol usage of 8.96 billion gallons nationwide in 2008. </P>
                <P>
                    Since Hawaii has opted in, but Alaska has not opted in, to the RFS program for 2008, Alaska's renewable fuels consumption must be subtracted from the nationwide renewable fuels consumption to calculate renewable consumption in the 48 contiguous states plus Hawaii. In Chapter 2 of the Regulatory Impact Analysis for the RFS program rulemaking, EPA estimated that ethanol consumption in Alaska would be negligible prior to 2012. Thus, we project renewable fuels consumption in 
                    <PRTPAGE P="66173"/>
                    the 48 contiguous states plus Hawaii to be 8.96 billion gallons in 2008.
                    <SU>3</SU>
                    <FTREF/>
                </P>
                <FTNT>
                    <P>
                        <SU>3</SU>
                         Table 2.2-21 “2012 Forecasted Ethanol Consumption by State,” Regulatory Impact Analysis: Renewable Fuel Standard Program, April 2007. 
                    </P>
                </FTNT>
                <HD SOURCE="HD3">
                    Calculation of GE
                    <E T="52">i</E>
                    , Amount of Gasoline Projected To Be Produced by Exempt Small Refineries and Small Refiners in Year i, in Gallons 
                    <SU>4</SU>
                    <FTREF/>
                </HD>
                <FTNT>
                    <P>
                        <SU>4</SU>
                         Through 2010 only, unless the exemption is extended under 211(o)(9(A)(ii) or (B) of the Act. 
                    </P>
                </FTNT>
                <P>
                    In the final rulemaking, we stated that we would estimate the combined small refinery and small refiner gasoline volume using a constant percentage of national consumption. Using information from gasoline batch reports submitted to EPA, EIA data and input from the California Air Resources Board regarding California small refiners, we estimated this percentage to be 13.5%.
                    <SU>5</SU>
                    <FTREF/>
                     Multiplying the projected nationwide consumption of gasoline in 2008 (144.80 billion gallons) by 13.5% results in a total projected production of 19.55 billion gallons of gasoline from small refiners and small refineries in 2008. 
                </P>
                <FTNT>
                    <P>
                        <SU>5</SU>
                         “Calculation of the Small Refiner/Small Refinery Fraction for the Renewable Fuel Program,” memo to the docket from Christine Brunner, ASD, OTAQ, EPA, September 2006.
                    </P>
                </FTNT>
                <HD SOURCE="HD3">
                    Calculation of RFStd
                    <E T="52">i</E>
                    , Renewable Fuel Standard in Year i, in Percent 
                </HD>
                <P>
                    Substituting all of the terms calculated above into the equation for RFStd
                    <E T="52">i</E>
                     results in the following RFS for 2008, 
                </P>
                <MATH SPAN="3" DEEP="28">
                    <MID>EN27NO07.005</MID>
                </MATH>
                <P>Therefore, the RFS for 2008 is 4.66%. This is the standard referenced in 40 CFR 80.1105(b) through (d) and which obligated parties apply to determine their renewable volume obligation under 40 CFR 80.1107. </P>
                <SIG>
                    <DATED>Dated: November 20, 2007. </DATED>
                    <NAME>Stephen L. Johnson, </NAME>
                    <TITLE>Administrator.</TITLE>
                </SIG>
            </SUPLINF>
            <FRDOC> [FR Doc. E7-23095 Filed 11-26-07; 8:45 am] </FRDOC>
            <BILCOD>BILLING CODE 6560-50-P </BILCOD>
        </NOTICE>
        <NOTICE>
            <PREAMB>
                <AGENCY TYPE="S">ENVIRONMENTAL PROTECTION AGENCY </AGENCY>
                <DEPDOC>[FRL-8499-2] </DEPDOC>
                <SUBJECT>Proposed Cercla Administrative Agreement for the Recovery of Past and Future Response Costs Incurred at the Vermiculite Intermountain Site in Salt Lake City, UT </SUBJECT>
                <AGY>
                    <HD SOURCE="HED">AGENCY:</HD>
                    <P>Environmental Protection Agency (EPA). </P>
                </AGY>
                <ACT>
                    <HD SOURCE="HED">ACTION:</HD>
                    <P>Notice and request for public comment. </P>
                </ACT>
                <SUM>
                    <HD SOURCE="HED">SUMMARY:</HD>
                    <P>In accordance with the requirements of Section 122(i) of the Comprehensive Environmental Response, Compensation, and Liability Act, as amended (“CERCLA”), 42 U.S.C. 9622(i), notice is hereby given of a proposed administrative settlement under section 122(h)(1)of CERCLA, 42 U.S.C. 9622(h)(1), concerning the Vermiculite Intermountain Site located at and around 333 West 100 South in Salt Lake City, Utah. This settlement, embodied in a CERCLA Section 104, 106(a), 107 and 122(h) Administrative Settlement Agreement and Order On Consent for Removal Action (“Agreement”), is designed to resolve the liability of Settling Respondents for past and future costs at the Site through covenants under sections 106 and 107 of CERCLA, 42 U.S.C. 9606 and 9607, while requiring long-term institutional controls to protect remedies already in place at the Site. The proposed Agreement requires the Van Cott, Bagley, Cornwall &amp; McCarthy 401(k) Profit Sharing Plan Supplemental Trust to pay a total of $100,000, La Quinta Properties, Inc., to pay a total of $441,000 and recognizes PacifiCorp's performance of approximately $3.5 million in cleanup work at the Site. In addition, PacifiCorp and La Quinta Properties, Inc., will record EPA-approved Environmental Covenants to ensure the continued protection of remedial features at the Site. </P>
                    <P>
                        <E T="03">Opportunity for Comment:</E>
                         For thirty (30) days following the date of publication of this notice, the Agency will consider all comments received, and may modify or withdraw its consent to the Agreement if comments received disclose facts or considerations which indicate that the Agreement is inappropriate, improper, or inadequate. The Agency's response to any comments received will be available for public inspection at EPA Region 8's Central Records Center, 1595 Wynkoop Street, 3rd Floor, in Denver, Colorado. 
                    </P>
                </SUM>
                <DATES>
                    <HD SOURCE="HED">DATES:</HD>
                    <P>Comments must be submitted on or before December 27, 2007. </P>
                </DATES>
                <ADD>
                    <HD SOURCE="HED">ADDRESSES:</HD>
                    <P>The proposed Agreement and additional background information relating to the settlement are available for public inspection at EPA Region 8's Central Records Center, 1595 Wynkoop Street, 3rd Floor, in Denver, Colorado. Comments and requests for a copy of the proposed Agreement should be addressed to Kelcey Land (8ENF-RC), Technical Enforcement Program, U.S. Environmental Protection Agency, 1595 Wynkoop Street, Denver, Colorado 80202-1129, and should reference the Settlement for the Vermiculite Intermountain Site, in Salt Lake City, Utah. </P>
                </ADD>
                <FURINF>
                    <HD SOURCE="HED">FOR FURTHER INFORMATION CONTACT:</HD>
                    <P>Kelcey Land, Enforcement Specialist (8ENF-RC), Technical Enforcement Program, U.S. Environmental Protection Agency, 1595 Wynkoop Street, Denver, Colorado 80202-1129, (303) 312-6393. </P>
                </FURINF>
            </PREAMB>
            <SUPLINF>
                <HD SOURCE="HED">SUPPLEMENTARY INFORMATION:</HD>
                <P>Regarding the proposed administrative settlement under Sections 104, 106(a), 107 and 122(h)(1) of CERCLA, 42 U.S.C. 9604, 9606(a), 9607 and 9622(h)(1): In accordance with section 122(i) of CERCLA, 42 U.S.C. 9622(i), notice is hereby given that the terms of the Agreement have been agreed to by the Settling Respondents and EPA. By the terms of the proposed Agreement, the Van Cott, Bagley, Cornwall &amp; McCarthy 401(k) Profit Sharing Plan Supplemental Trust will pay a total of $100,000 and La Quinta Properties will pay $441,000 to the Hazardous Substance Superfund. These payments, in addition to the cleanup already performed by PacifiCorp, amounts to more than half of the funds expended at the Site. </P>
                <P>
                    <E T="03">It is so agreed:</E>
                </P>
                <SIG>
                    <DATED>Dated: November 14, 2007. </DATED>
                    <NAME>Eddie A. Sierra, </NAME>
                    <TITLE>Acting Assistant Regional Administrator, Office of Enforcement, Compliance, and Environmental Justice, Region 8.</TITLE>
                </SIG>
            </SUPLINF>
            <FRDOC> [FR Doc. E7-23064 Filed 11-26-07; 8:45 am] </FRDOC>
            <BILCOD>BILLING CODE 6560-50-P </BILCOD>
        </NOTICE>
        <NOTICE>
            <PREAMB>
                <AGENCY TYPE="N">FEDERAL ELECTION COMMISSION </AGENCY>
                <DEPDOC>[Notice 2007-24] </DEPDOC>
                <SUBJECT>Filing Dates for the Louisiana Special Election in the 1st Congressional District </SUBJECT>
                <AGY>
                    <HD SOURCE="HED">AGENCY:</HD>
                    <P>Federal Election Commission. </P>
                </AGY>
                <ACT>
                    <PRTPAGE P="66174"/>
                    <HD SOURCE="HED">ACTION:</HD>
                    <P>Notice of filing dates for special election. </P>
                </ACT>
                <SUM>
                    <HD SOURCE="HED">SUMMARY:</HD>
                    <P>Louisiana has scheduled special elections to fill the U.S. House of Representatives seat in the First Congressional District being vacated by Representative Bobby Jindal. There are three possible special elections, but only two may be necessary. </P>
                    <P>
                        • 
                        <E T="03">Primary Election:</E>
                         March 8, 2008. 
                    </P>
                    <P>
                        • 
                        <E T="03">Possible Runoff Election:</E>
                         April 5, 2008. In the event that one candidate does not achieve a majority vote in his/her party's Special Primary Election, the top two vote-getters will participate in a Special Runoff Election. 
                    </P>
                    <P>
                        • 
                        <E T="03">General Election:</E>
                         May 3, 2008. However, if a Special Runoff Election is not necessary, the Special General will instead be held on April 5, 2008. 
                    </P>
                </SUM>
                <FURINF>
                    <HD SOURCE="HED">FOR FURTHER INFORMATION CONTACT:</HD>
                    <P>Mr. Kevin R. Salley, Information Division, 999 E Street, NW., Washington, DC 20463; Telephone: (202) 694-1100; Toll Free (800) 424-9530. </P>
                </FURINF>
            </PREAMB>
            <SUPLINF>
                <HD SOURCE="HED">SUPPLEMENTARY INFORMATION:</HD>
                <HD SOURCE="HD1">Principal Campaign Committees </HD>
                <HD SOURCE="HD2">Special Primary Only </HD>
                <P>
                    All principal campaign committees of candidates 
                    <E T="03">only</E>
                     participating in the Louisiana Special Primary shall file a 12-day Pre-Primary Report on February 25, 2008. (See chart below for the closing date for the report.) 
                </P>
                <HD SOURCE="HD2">Special Primary and General Without Runoff </HD>
                <P>If only two elections are held, all principal campaign committees of candidates participating in the Louisiana Special Primary and Special General Elections shall file a 12-day Pre-Primary Report on February 25, 2008; a Pre-General Report on March 24, 2008; and a Post-General Report on May 5, 2008. (See chart below for the closing date for each report.) </P>
                <HD SOURCE="HD2">Special Primary and Runoff Elections </HD>
                <P>
                    If three elections are held, all principal campaign committees of candidates 
                    <E T="03">only</E>
                     participating in the Louisiana Special Primary and Special Runoff Elections shall file a 12-day Pre-Primary Report on February 25, 2008; and a Pre-Runoff Report on March 24, 2008. (See chart below for the closing date for each report.) 
                </P>
                <HD SOURCE="HD2">Special Primary, Runoff and General Elections </HD>
                <P>All principal campaign committees of candidates participating in the Louisiana Special Primary, Special Runoff and Special General Elections shall file a 12-day Pre-Primary Report on February 25, 2008; a Pre-Runoff Report on March 24, 2008; a Pre-General Report on April 21, 2008; and a Post-General Report on June 2, 2008. (See chart below for the closing date for each report.) </P>
                <HD SOURCE="HD1">Unauthorized Committees (PACs and Party Committees) </HD>
                <P>Political committees that file on a quarterly basis during 2008 are subject to special election reporting if they make previously undisclosed contributions or expenditures in connection with the Louisiana Special Primary, Runoff or General Elections by the close of books for the applicable report(s). Consult the chart below that corresponds to the committee's situation for close of books and filing date information. </P>
                <P>Committees filing monthly that support candidates in the Louisiana Special Primary, Special Runoff or Special General Elections should continue to file according to the monthly reporting schedule. </P>
                <P>
                    Additional disclosure information in connection with the Louisiana Special Election may be found on the FEC Web site at 
                    <E T="03">http://www.fec.gov/info/report_dates.shtml</E>
                    . 
                </P>
                <GPOTABLE COLS="4" OPTS="L2,i1" CDEF="s100,14,14,14">
                    <TTITLE>Calendar of Reporting Dates for Louisiana Special Elections </TTITLE>
                    <BOXHD>
                        <CHED H="1">Report </CHED>
                        <CHED H="1">
                            Close of books 
                            <SU>1</SU>
                        </CHED>
                        <CHED H="1">Reg./cert. &amp; overnight mailing deadline </CHED>
                        <CHED H="1">Filing deadline </CHED>
                    </BOXHD>
                    <ROW EXPSTB="03" RUL="s ">
                        <ENT I="21">Committees Involved in Only the Special Primary (03/08/08) Must File: </ENT>
                    </ROW>
                    <ROW EXPSTB="00">
                        <ENT I="01">Pre-Primary </ENT>
                        <ENT>02/17/08 </ENT>
                        <ENT>02/22/08 </ENT>
                        <ENT>02/25/08 </ENT>
                    </ROW>
                    <ROW RUL="s ">
                        <ENT I="01">April Quarterly </ENT>
                        <ENT>03/31/08 </ENT>
                        <ENT>04/15/08 </ENT>
                        <ENT>04/15/08 </ENT>
                    </ROW>
                    <ROW EXPSTB="03" RUL="s">
                        <ENT I="21">
                            If Only Two Elections Are Held, Committees Involved in Both the Special Primary (03/08/08) and the Special General (04/05/08) 
                            <SU>2</SU>
                             Must File: 
                        </ENT>
                    </ROW>
                    <ROW EXPSTB="00">
                        <ENT I="01">Pre-Primary </ENT>
                        <ENT>02/17/08 </ENT>
                        <ENT>02/22/08 </ENT>
                        <ENT>02/25/08 </ENT>
                    </ROW>
                    <ROW>
                        <ENT I="01">Pre-General </ENT>
                        <ENT>03/16/08 </ENT>
                        <ENT>03/21/08 </ENT>
                        <ENT>03/24/08 </ENT>
                    </ROW>
                    <ROW>
                        <ENT I="01">April Quarterly </ENT>
                        <ENT>03/31/08 </ENT>
                        <ENT>04/15/08 </ENT>
                        <ENT>04/15/08 </ENT>
                    </ROW>
                    <ROW>
                        <ENT I="01">Post-General </ENT>
                        <ENT>04/25/08 </ENT>
                        <ENT>05/05/08 </ENT>
                        <ENT>05/05/08 </ENT>
                    </ROW>
                    <ROW RUL="s">
                        <ENT I="01">July Quarterly </ENT>
                        <ENT>06/30/08 </ENT>
                        <ENT>07/15/08 </ENT>
                        <ENT>07/15/08 </ENT>
                    </ROW>
                    <ROW EXPSTB="03" RUL="s">
                        <ENT I="21">
                            If Two Elections Are Held, Committees Involved in 
                            <E T="03">Only</E>
                             the Special General (04/05/08) 
                            <SU>2</SU>
                             Must File: 
                        </ENT>
                    </ROW>
                    <ROW EXPSTB="00">
                        <ENT I="01">Pre-General </ENT>
                        <ENT>03/16/08 </ENT>
                        <ENT>03/21/08 </ENT>
                        <ENT>03/24/08 </ENT>
                    </ROW>
                    <ROW>
                        <ENT I="01">April Quarterly </ENT>
                        <ENT>03/31/08 </ENT>
                        <ENT>04/15/08 </ENT>
                        <ENT>04/15/08 </ENT>
                    </ROW>
                    <ROW>
                        <ENT I="01">Post-General </ENT>
                        <ENT>04/25/08 </ENT>
                        <ENT>05/05/08 </ENT>
                        <ENT>05/05/08 </ENT>
                    </ROW>
                    <ROW RUL="s">
                        <ENT I="01">July Quarterly </ENT>
                        <ENT>06/30/08 </ENT>
                        <ENT>07/15/08 </ENT>
                        <ENT>07/15/08 </ENT>
                    </ROW>
                    <ROW EXPSTB="03" RUL="s">
                        <ENT I="21">If Three Elections Are Held, Committees Involved in Only the Special Primary (03/08/08) and Special Runoff (04/05/08) Must File: </ENT>
                    </ROW>
                    <ROW EXPSTB="00">
                        <ENT I="01">Pre-Primary </ENT>
                        <ENT>02/17/08 </ENT>
                        <ENT>02/22/08 </ENT>
                        <ENT>02/25/08 </ENT>
                    </ROW>
                    <ROW>
                        <ENT I="01">Pre-Runoff </ENT>
                        <ENT>03/16/08 </ENT>
                        <ENT>03/21/08 </ENT>
                        <ENT>03/24/08 </ENT>
                    </ROW>
                    <ROW RUL="s">
                        <ENT I="01">April Quarterly </ENT>
                        <ENT>03/31/08 </ENT>
                        <ENT>04/15/08 </ENT>
                        <ENT>04/15/08 </ENT>
                    </ROW>
                    <ROW EXPSTB="03" RUL="s">
                        <ENT I="21">Committees Involved in Only the Special Runoff (04/05/08) Must File: </ENT>
                    </ROW>
                    <ROW EXPSTB="00">
                        <ENT I="01">Pre-Runoff </ENT>
                        <ENT>03/16/08 </ENT>
                        <ENT>03/21/08</ENT>
                        <ENT>03/24/08</ENT>
                    </ROW>
                    <ROW RUL="s">
                        <ENT I="01">April Quarterly </ENT>
                        <ENT>03/31/08 </ENT>
                        <ENT>04/15/08 </ENT>
                        <ENT>04/15/08 </ENT>
                    </ROW>
                    <ROW EXPSTB="03" RUL="s">
                        <PRTPAGE P="66175"/>
                        <ENT I="21">Committees Involved in the Special Primary (03/08/08), Special Runoff (04/05/08) and the Special General (05/03/08) Must File: </ENT>
                    </ROW>
                    <ROW EXPSTB="00">
                        <ENT I="01">Pre-Primary </ENT>
                        <ENT>02/17/08 </ENT>
                        <ENT>02/22/08 </ENT>
                        <ENT>02/25/08 </ENT>
                    </ROW>
                    <ROW RUL="s">
                        <ENT I="01">Pre-Runoff </ENT>
                        <ENT>03/16/08 </ENT>
                        <ENT>03/21/08 </ENT>
                        <ENT>03/24/08 </ENT>
                    </ROW>
                    <ROW RUL="s">
                        <ENT I="01">April Quarterly</ENT>
                        <ENT A="02">—Waived— </ENT>
                    </ROW>
                    <ROW>
                        <ENT I="01">Pre-General </ENT>
                        <ENT>04/13/08 </ENT>
                        <ENT>04/18/08 </ENT>
                        <ENT>04/21/08 </ENT>
                    </ROW>
                    <ROW>
                        <ENT I="01">Post-General </ENT>
                        <ENT>05/23/08 </ENT>
                        <ENT>06/02/08 </ENT>
                        <ENT>06/02/08 </ENT>
                    </ROW>
                    <ROW RUL="s">
                        <ENT I="01">July Quarterly </ENT>
                        <ENT>06/30/08 </ENT>
                        <ENT>07/15/08 </ENT>
                        <ENT>07/15/08 </ENT>
                    </ROW>
                    <ROW EXPSTB="03" RUL="s">
                        <ENT I="21">
                            If Three Elections Are Held, Committees Involved in 
                            <E T="03">Only</E>
                             the Special General (05/03/08) Must File: 
                        </ENT>
                    </ROW>
                    <ROW EXPSTB="00" RUL="s">
                        <ENT I="01">April Quarterly</ENT>
                        <ENT A="02">—Waived— </ENT>
                    </ROW>
                    <ROW>
                        <ENT I="01">Pre-General </ENT>
                        <ENT>04/13/08 </ENT>
                        <ENT>04/18/08 </ENT>
                        <ENT>04/21/08 </ENT>
                    </ROW>
                    <ROW>
                        <ENT I="01">Post-General </ENT>
                        <ENT>05/23/08 </ENT>
                        <ENT>06/02/08 </ENT>
                        <ENT>06/02/08 </ENT>
                    </ROW>
                    <ROW>
                        <ENT I="01">July Quarterly </ENT>
                        <ENT>06/30/08 </ENT>
                        <ENT>07/15/08 </ENT>
                        <ENT>07/15/08 </ENT>
                    </ROW>
                    <TNOTE>
                        <SU>1</SU>
                         The period begins with the close of books of the last report filed by the committee. If the committee has filed no previous reports, the period begins with the date of the committee's first activity. 
                    </TNOTE>
                    <TNOTE>
                        <SU>2</SU>
                         If a Special Runoff Election is necessary, it will be held April 5, 2008, and the Special General Election will be held on May 3, 2008. 
                    </TNOTE>
                </GPOTABLE>
                <SIG>
                    <DATED>Dated: November 21, 2007. </DATED>
                    <NAME>Robert D. Lenhard, </NAME>
                    <TITLE>Chairman, Federal Election Commission.</TITLE>
                </SIG>
            </SUPLINF>
            <FRDOC> [FR Doc. E7-23075 Filed 11-26-07; 8:45 am] </FRDOC>
            <BILCOD>BILLING CODE 6715-01-P </BILCOD>
        </NOTICE>
        <NOTICE>
            <PREAMB>
                <AGENCY TYPE="N">FEDERAL MARITIME COMMISSION </AGENCY>
                <SUBJECT>Notice of Agreements Filed </SUBJECT>
                <P>
                    The Commission hereby gives notice of the filing of the following agreements under the Shipping Act of 1984. Interested parties may submit comments on agreements to the Secretary, Federal Maritime Commission, Washington, DC 20573, within ten days of the date this notice appears in the 
                    <E T="04">Federal Register</E>
                    . Copies of agreements are available through the Commission's Office of Agreements (202-523-5793 or 
                    <E T="03">tradeanalysis@fmc.gov).</E>
                </P>
                <P>
                    <E T="03">Agreement No.:</E>
                     011602-011. 
                </P>
                <P>
                    <E T="03">Title:</E>
                     Grand Alliance Agreement II. 
                </P>
                <P>
                    <E T="03">Parties:</E>
                     Hapag-Lloyd AG; Hapag-Lloyd USA LLC; Nippon Yusen Kaisha; Orient Overseas Container Line, Inc.; Orient Overseas Container Line Limited; and Orient Overseas Container Line (Europe) Limited. 
                </P>
                <P>
                    <E T="03">Filing Party:</E>
                     Wayne R. Rohde, Esq.; Sher &amp; Blackwell; 1850 M Street, NW.; Suite 900; Washington, DC 20036. 
                </P>
                <P>
                    <E T="03">Synopsis:</E>
                     The amendment extends the agreement for ten years. It would also increase the number and size of vessels the parties are authorized to deploy, clarify the parties' use of space, delete the minimum service duration, and reduce the notice required for membership withdrawals. The parties request expedited review. 
                </P>
                <P>
                    <E T="03">Agreement No.:</E>
                     201048-002. 
                </P>
                <P>
                    <E T="03">Title:</E>
                     Restated Lease and Operating Agreement between PRPA and DRS. 
                </P>
                <P>
                    <E T="03">Parties:</E>
                     Philadelphia Regional Port Authority and Delaware River Stevedores, Inc. 
                </P>
                <P>
                    <E T="03">Filing Party:</E>
                     Paul D. Coleman, Esq.; Hoppel, Mayer &amp; Coleman; 1000 Connecticut Avenue, NW.; Washington, DC 20036. 
                </P>
                <P>
                    <E T="03">Synopsis:</E>
                     The amendment changes the insurance language of the lease. 
                </P>
                <SIG>
                    <P>By Order of the Federal Maritime Commission. </P>
                    <DATED>Dated: November 21, 2007. </DATED>
                    <NAME>Karen V. Gregory, </NAME>
                    <TITLE>Assistant Secretary. </TITLE>
                </SIG>
            </PREAMB>
            <FRDOC>[FR Doc. E7-23060 Filed 11-26-07; 8:45 am] </FRDOC>
            <BILCOD>BILLING CODE 6730-01-P</BILCOD>
        </NOTICE>
        <NOTICE>
            <PREAMB>
                <AGENCY TYPE="N">FEDERAL RESERVE SYSTEM</AGENCY>
                <SUBJECT>Change in Bank Control Notices; Acquisition of Shares of Bank or Bank Holding Companies</SUBJECT>
                <P>The notificants listed below have applied under the Change in Bank Control Act (12 U.S.C. 1817(j)) and § 225.41 of the Board’s Regulation Y (12 CFR 225.41) to acquire a bank or bank holding company. The factors that are considered in acting on the notices are set forth in paragraph 7 of the Act (12 U.S.C. 1817(j)(7)).</P>
                <P>The notices are available for immediate inspection at the Federal Reserve Bank indicated. The notices also will be available for inspection at the office of the Board of Governors. Interested persons may express their views in writing to the Reserve Bank indicated for that notice or to the offices of the Board of Governors. Comments must be received not later than December 10, 2007.</P>
                <P>
                    <E T="04">A. Federal Reserve Bank of Dallas</E>
                     (W. Arthur Tribble, Vice President) 2200 North Pearl Street, Dallas, Texas 75201-2272:
                </P>
                <P>
                    <E T="03">1. Christopher T. Moser, and FFP Investments, Ltd. (its general partner, WAFCO, Inc., and William A. Freed, principal)</E>
                    , all of San Antonio, Texas; to acquire voting shares of Medina Community Bancshares, Inc., and thereby indirectly acquire voting shares of Community National Bank, both of Hondo, Texas.
                </P>
                <SIG>
                    <DATED>Dated: November 20, 2007.</DATED>
                    <P>Board of Governors of the Federal Reserve System.</P>
                    <NAME>Robert deV. Frierson,</NAME>
                    <TITLE>Deputy Secretary of the Board.</TITLE>
                </SIG>
            </PREAMB>
            <FRDOC>[FR Doc. E7-22965 Filed 11-26-07; 8:45 am]</FRDOC>
            <BILCOD>BILLING CODE 6210-01-S</BILCOD>
        </NOTICE>
        <NOTICE>
            <PREAMB>
                <AGENCY TYPE="S">FEDERAL RESERVE SYSTEM</AGENCY>
                <SUBJECT>Change in Bank Control Notices; Acquisition of Shares of Bank or Bank Holding Companies</SUBJECT>
                <P>
                    The notificants listed below have applied under the Change in Bank Control Act (12 U.S.C. 1817(j)) and § 225.41 of the Board’s Regulation Y (12 CFR 225.41) to acquire a bank or bank holding company. The factors that are 
                    <PRTPAGE P="66176"/>
                    considered in acting on the notices are set forth in paragraph 7 of the Act (12 U.S.C. 1817(j)(7)).
                </P>
                <P>The notices are available for immediate inspection at the Federal Reserve Bank indicated. The notices also will be available for inspection at the office of the Board of Governors. Interested persons may express their views in writing to the Reserve Bank indicated for that notice or to the offices of the Board of Governors. Comments must be received not later than December 14, 2007.</P>
                <P/>
                <P>
                    <E T="04">A. Federal Reserve Bank of Kansas City</E>
                     (Todd Offenbacker, Assistant Vice President) 925 Grand Avenue, Kansas City, Missouri 64198-0001:
                </P>
                <P>
                    <E T="03">1. Max T. Wake</E>
                    , Lincoln, Nebraska and Elizabeth B. Wake, San Francisco, California; to acquire voting shares of Jones National Corporation, and thereby acquire shares of The Jones National Bank &amp; Trust Company of Seward, both in Seward, Nebraska.
                </P>
                <SIG>
                    <P>Board of Governors of the Federal Reserve System, November 21, 2007.</P>
                    <NAME>Robert deV. Frierson,</NAME>
                    <TITLE>Deputy Secretary of the Board.</TITLE>
                </SIG>
            </PREAMB>
            <FRDOC>[FR Doc. E7-23014 Filed 11-26-07; 8:45 am]</FRDOC>
            <BILCOD>BILLING CODE 6210-01-S</BILCOD>
        </NOTICE>
        <NOTICE>
            <PREAMB>
                <AGENCY TYPE="S">FEDERAL RESERVE SYSTEM</AGENCY>
                <SUBJECT>Notice of Proposals to Engage in Permissible Nonbanking Activities or to Acquire Companies that are Engaged in Permissible Nonbanking Activities</SUBJECT>
                <P>
                    The companies listed in this notice have given notice under section 4 of the Bank Holding Company Act (12 U.S.C. 1843) (BHC Act) and Regulation Y (12 CFR Part 225) to engage 
                    <E T="03">de novo</E>
                    , or to acquire or control voting securities or assets of a company, including the companies listed below, that engages either directly or through a subsidiary or other company, in a nonbanking activity that is listed in § 225.28 of Regulation Y (12 CFR 225.28) or that the Board has determined by Order to be closely related to banking and permissible for bank holding companies. Unless otherwise noted, these activities will be conducted throughout the United States.
                </P>
                <P>
                    Each notice is available for inspection at the Federal Reserve Bank indicated. The notice also will be available for inspection at the offices of the Board of Governors. Interested persons may express their views in writing on the question whether the proposal complies with the standards of section 4 of the BHC Act. Additional information on all bank holding companies may be obtained from the National Information Center Web site at 
                    <E T="03">www.ffiec.gov/nic/</E>
                    .
                </P>
                <P>Unless otherwise noted, comments regarding the applications must be received at the Reserve Bank indicated or the offices of the Board of Governors not later than December 20, 2007.</P>
                <P>
                    <E T="04">A. Federal Reserve Bank of New York</E>
                     (Anne MacEwen, Bank Applications Officer) 33 Liberty Street, New York, New York 10045-0001:
                </P>
                <P>
                    <E T="03">1. Investors Bancorp, MHC, and Investors Bancorp, Inc.</E>
                    , both of Short Hills, New Jersey; to acquire Summit Federal Bankshares, MHC, and thereby indirectly acquire Summit Federal Bankshares, Inc., and Summit Federal Savings Bank, all of Summit, New Jersey, and engage in operating a savings and loan association, pursuant to section 225.28(b)(4)(ii) of Regulation Y.
                </P>
                <SIG>
                    <DATED>November 20, 2007.</DATED>
                    <P>Board of Governors of the Federal Reserve System.</P>
                    <NAME>Robert deV. Frierson,</NAME>
                    <TITLE>Deputy Secretary of the Board.</TITLE>
                </SIG>
            </PREAMB>
            <FRDOC>[FR Doc.E7-22964 Filed 11-26-07; 8:45 am]</FRDOC>
            <BILCOD>BILLING CODE 6210-01-S</BILCOD>
        </NOTICE>
        <NOTICE>
            <PREAMB>
                <AGENCY TYPE="N">GENERAL SERVICES ADMINISTRATION</AGENCY>
                <DEPDOC>[OMB Control No. 3090-0200]</DEPDOC>
                <SUBJECT>General Services Administration Acquisition Regulation; Information Collection; Sealed Bidding</SUBJECT>
                <AGY>
                    <HD SOURCE="HED">AGENCY:</HD>
                    <P>Office of the Chief Acquisition Officer, GSA.</P>
                </AGY>
                <ACT>
                    <HD SOURCE="HED">ACTION:</HD>
                    <P>Notice of request for comments regarding a renewal to an existing OMB clearance.</P>
                </ACT>
                <SUM>
                    <HD SOURCE="HED">SUMMARY:</HD>
                    <P>Under the provisions of the Paperwork Reduction Act of 1995 (44 U.S.C. Chapter 35), the General Services Administration will be submitting to the Office of Management and Budget (OMB) a request to review and approve an extension of a currently approved information collection requirement regarding sealed bidding.  The clearance currently expires on April 30, 2008.</P>
                    <P>Public comments are particularly invited on:  Whether this collection of information is necessary and whether it will have practical utility; whether our estimate of the public burden of this collection of information is accurate and based on valid assumptions and methodology; and ways to enhance the quality, utility, and clarity of the information to be collected.</P>
                </SUM>
                <EFFDATE>
                    <HD SOURCE="HED">DATES:</HD>
                    <P>Submit comments on or before January 28, 2008.</P>
                </EFFDATE>
                <FURINF>
                    <HD SOURCE="HED">FOR FURTHER INFORMATION CONTACT:</HD>
                    <P>
                        Michael Jackson, Procurement Analyst, Contract Policy Division, at telephone (202) 208-4949 or via e-mail to 
                        <E T="03">michaelo.jackson@gsa.gov</E>
                        .
                    </P>
                </FURINF>
                <ADD>
                    <HD SOURCE="HED">ADDRESSES:</HD>
                    <P>Submit comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden to the Regulatory Secretariat (VIR), General Services Administration, Room 4035, 1800 F Street, NW., Washington, DC 20405.  Please cite OMB Control No. 3090-0200, Sealed Bidding, in all correspondence.</P>
                </ADD>
            </PREAMB>
            <SUPLINF>
                <HD SOURCE="HED">SUPPLEMENTARY INFORMATION:</HD>
                <HD SOURCE="HD1">A.  Purpose</HD>
                <P>The General Services Administration is requesting that the Office of Management and Budget (OMB) review and approve information collection, 3090-0200, Sealed Bidding.  The information requested regarding an offeror's monthly production capability is needed to make progressive awards to ensure coverage of stock items.</P>
                <HD SOURCE="HD1">B.  Annual Reporting Burden</HD>
                <P>
                    <E T="03">Respondents:</E>
                     10.
                </P>
                <P>
                    <E T="03">Responses Per Respondent:</E>
                     1.
                </P>
                <P>
                    <E T="03">Hours Per Response:</E>
                     .5.
                </P>
                <P>
                    <E T="03">Total Burden Hours:</E>
                     5.
                </P>
                <P>
                    <E T="03">OBTAINING COPIES OF PROPOSALS:</E>
                     Requesters may obtain a copy of the information collection documents from the General Services Administration, Regulatory Secretariat (VIR), 1800 F Street, NW., Room 4035, Washington, DC 20405, telephone (202) 208-7312.  Please cite OMB Control No. 3090-0200, Sealed Bidding, in all correspondence.
                </P>
                <SIG>
                    <DATED>Dated: November 8, 2007.</DATED>
                    <NAME>Al Matera,</NAME>
                    <TITLE>Director, Acquisition Policy.</TITLE>
                </SIG>
            </SUPLINF>
            <FRDOC>[FR Doc. 07-5837 Filed 11-26-07; 8:45 am]</FRDOC>
            <BILCOD>BILLING CODE 6820-61-S</BILCOD>
        </NOTICE>
        <NOTICE>
            <PREAMB>
                <AGENCY TYPE="N">DEPARTMENT OF HEALTH AND HUMAN SERVICES </AGENCY>
                <SUBAGY>Centers for Disease Control and Prevention </SUBAGY>
                <DEPDOC>[30Day-08-0591] </DEPDOC>
                <SUBJECT>Agency Forms Undergoing Paperwork Reduction Act Review </SUBJECT>
                <P>
                    The Centers for Disease Control and Prevention (CDC) publishes a list of information collection requests under review by the Office of Management and Budget (OMB) in compliance with the Paperwork Reduction Act (44 U.S.C. Chapter 35). To request a copy of these requests, call the CDC/ATSDR Reports Clearance Officer at (404) 639-5960 or send an e-mail to 
                    <E T="03">omb@cdc.gov.</E>
                     Send 
                    <PRTPAGE P="66177"/>
                    written comments to CDC Desk Officer, Office of Management and Budget, Washington, DC or by fax to (303) 395-6974. Written comments should be received within 30 days of this notice. 
                </P>
                <HD SOURCE="HD1">Proposed Project </HD>
                <P>
                    <E T="03">Select Agent Distribution Activity:</E>
                     Request for Select Agent (OMB Control No. 0920-0591)—Reinstatement without change—National Center for Preparedness, Detection, and Control of Infectious Diseases (NCPDCID), Centers for Disease Control and Prevention (CDC). 
                </P>
                <HD SOURCE="HD2">Background and Brief Description </HD>
                <P>The Centers for Disease Control and Prevention is requesting a three year extension to continue data collection under the Select Agent Distribution Activity. The form used for this activity is currently approved under OMB Control No. 0920-0591. The purpose of this data collection is to provide a systematic and consistent mechanism to review requests that come to CDC for Select Agents. The term select agents is used to described a limited group of viruses, bacteria, rickettsia, and toxins that have the potential for use as agents of bioterrorism, inflicting significant morbidity and mortality on susceptible populations. In light of current terrorism concerns and the significant NIH grant monies directed toward Select Agent research, CDC receives hundreds of requests for Select Agents from researchers. Applicants are required to complete an application form in which they identify themselves and their institution, provide a Curriculum Vitae or biographical sketch, a summary of their research proposal, and sign indemnification and material transfer agreement statements. A user fee will be collected to recover costs for materials, handling and shipping (except for public health laboratories). The cost to the respondent will vary based on which agent is requested. CDC is updating the name of the National Center on the application form. The National Center for Preparedness, Detection, and Control of Infectious Diseases officially became a National Center in April, 2007. The total estimated annualized burden hours are 450. </P>
                <GPOTABLE COLS="4" OPTS="L1,i1" CDEF="s100,12C,12C,12C">
                    <TTITLE>Estimated Annualized Burden </TTITLE>
                    <BOXHD>
                        <CHED H="1">Respondent </CHED>
                        <CHED H="1">
                            Number of 
                            <LI>respondents </LI>
                        </CHED>
                        <CHED H="1">
                            Number of 
                            <LI>responses </LI>
                            <LI>per</LI>
                            <LI>respondent </LI>
                        </CHED>
                        <CHED H="1">
                            Average 
                            <LI>burden per </LI>
                            <LI>response </LI>
                            <LI>(in hours) </LI>
                        </CHED>
                    </BOXHD>
                    <ROW>
                        <ENT I="01">Researcher </ENT>
                        <ENT>900 </ENT>
                        <ENT>1 </ENT>
                        <ENT>30/60 </ENT>
                    </ROW>
                </GPOTABLE>
                <SIG>
                    <DATED>Dated: November 20, 2007. </DATED>
                    <NAME>Maryam I. Daneshvar, </NAME>
                    <TITLE>Acting Reports Clearance Officer, Centers for Disease Control and Prevention.</TITLE>
                </SIG>
            </PREAMB>
            <FRDOC>[FR Doc. E7-23015 Filed 11-26-07; 8:45 am] </FRDOC>
            <BILCOD>BILLING CODE 4163-18-P </BILCOD>
        </NOTICE>
        <NOTICE>
            <PREAMB>
                <AGENCY TYPE="S">DEPARTMENT OF HEALTH AND HUMAN SERVICES</AGENCY>
                <SUBAGY>Administration for Children and Families</SUBAGY>
                <SUBJECT>Submission for OMB Review; Comment Request</SUBJECT>
                <P>
                    <E T="03">Title:</E>
                     Assets for Independence Program Performance Management and Report to Congress Data Collection Form. 
                </P>
                <P>
                    <E T="03">OMB No.:</E>
                     New Collection. 
                </P>
                <P>
                    <E T="03">Description:</E>
                     The Assets for Independence (AFI) program is a program authorized by Section 403 of the Community Opportunities, Accountability, and Training and Educational Services Act of 1998 (the Act). The Office of Community Services (OCS) within the U.S. Department of Health and Human Services (HHS) administers the AFI program to support innovative asset-building projects that feature Individual Development Accounts (IDAs), financial education, and related services. The Act requires AFI program grantees to submit annual reports to OCS with detailed information about project operations and participant activities. The information collected is issued by OCS for performance management and to prepare mandated Reports to Congress. 
                </P>
                <P>The AFI Program Performance Management and Report to Congress Data Collection Form is used to collect eight categories of information, as required by the Act. Examples of the types of information collected include: Project features; the number and characteristics of project participants; amounts of participant savings and matching funds deposited in the IDAs; amounts withdrawn from the IDAs; the withdrawal purposes; and current balances in participant IDAs. The data collection form is an online from available on the OCS asset-building Web site. Grantees provided training and technical assistance in completing the form. </P>
                <P>
                    <E T="03">Respondents:</E>
                     Organizations receiving funding to implement an AFI program. 
                </P>
                <GPOTABLE COLS="5" OPTS="L1,i1" CDEF="s100,12C,12C,12C,12C">
                    <BOXHD>
                        <CHED H="1">Instrument </CHED>
                        <CHED H="1">Number of respondents </CHED>
                        <CHED H="1">Number of responses per respondent </CHED>
                        <CHED H="1">Average burden hours per response </CHED>
                        <CHED H="1">Total burden hours </CHED>
                    </BOXHD>
                    <ROW>
                        <ENT I="01">Assets for Independence Program Performance Management and Report to Congress Data Collection Form </ENT>
                        <ENT>400 </ENT>
                        <ENT>1 </ENT>
                        <ENT>10 </ENT>
                        <ENT>4,000 </ENT>
                    </ROW>
                </GPOTABLE>
                <P>
                    <E T="03">Estimated Total Annual Burden Hours:</E>
                </P>
                <P>
                    Copies of the proposed collection may be obtained by writing to the Administration for Children and Families, Office of Administration, Office of Information Services, 370 L'Enfant Promenade, SW., Washington, DC 20447, Attn: ACF Reports Clearance Officer. All requests should be identified by the title of the information collection. E-mail address: 
                    <E T="03">infocollection@acf.hhs.gov.</E>
                </P>
                <HD SOURCE="HD1">OMB Comment</HD>
                <P>
                    OMB is required to make a decision concerning the collection of information between 30 and 60 days after publication of this document in the 
                    <E T="04">Federal Register</E>
                    . Therefore, a comment is best assured of having its full effect if OMB receives it within 30 days of publication. Written comments and recommendations for the proposed 
                    <PRTPAGE P="66178"/>
                    information collection should be sent directly to the following:
                </P>
                <P>Office of Management and Budget, Paperwork Reduction Project, Fax: 202-395-6974, Attn: Desk Officer for the Administration for Children and Families.</P>
                <SIG>
                    <DATED>Dated: November 19, 2007.</DATED>
                    <NAME>Robert Sargis,</NAME>
                    <TITLE>Reports Clearance Officer.</TITLE>
                </SIG>
            </PREAMB>
            <FRDOC>[FR Doc. 07-5831  Filed 11-26-07; 8:45 am]</FRDOC>
            <BILCOD>BILLING CODE 4184-01-M</BILCOD>
        </NOTICE>
        <NOTICE>
            <PREAMB>
                <AGENCY TYPE="S">DEPARTMENT OF HEALTH AND HUMAN SERVICES</AGENCY>
                <SUBAGY>Administration for Children and Families</SUBAGY>
                <SUBJECT>Submission for OMB Review; Comment Request</SUBJECT>
                <P>
                    <E T="03">Title:</E>
                     Administrative Subpoena.
                </P>
                <P>
                    <E T="03">OMB No.:</E>
                     0970-0152.
                </P>
                <P>
                    <E T="03">Description:</E>
                     Section 452(a)(11) of the Social Security Act requires the Secretary of the Department of Health and Human Services to promulgate a form for administrative subpoenas to be used in State child support enforcement programs to collect information for use in the establishment, modification and enforcement of child support orders in interstate cases. Section 454(9)(E) of the Social Security Act requires each State to cooperate with any other State in using the Federal form for issuance of administrative subpoenas in interstate child support cases. Tribal IV-D agencies are not required to use this form but may choose to do so. OMB approval of this form is expiring in January 2008 and the administration for Children and Families is requesting an extension of this form.
                </P>
                <P>
                    <E T="03">Respondents:</E>
                     State, local or Tribal agencies administering a child support enforcement program under title IV-D of the Social Security Act.
                </P>
                <GPOTABLE COLS="5" OPTS="L1,i1" CDEF="s100,12C,12C,12C,12C">
                    <TTITLE>Annual Burden Estimates</TTITLE>
                    <BOXHD>
                        <CHED H="1">Instrument</CHED>
                        <CHED H="1">Number of respondents</CHED>
                        <CHED H="1">Number of responses per respondent</CHED>
                        <CHED H="1">Average burden hours per response</CHED>
                        <CHED H="1">Total burden hours</CHED>
                    </BOXHD>
                    <ROW>
                        <ENT I="01">Administrative Subpoena</ENT>
                        <ENT>19,508</ENT>
                        <ENT>1</ENT>
                        <ENT>.5</ENT>
                        <ENT>9,754</ENT>
                    </ROW>
                </GPOTABLE>
                <P>
                    <E T="03">Estimated Total Annual Burden Hours:</E>
                     9,754.
                </P>
                <HD SOURCE="HD1">Additional Information</HD>
                <P>
                    Copies of the proposed collection may be obtained by writing to the Administration for Children and Families, Office of Administration, Office of Information Services, 370 L'Enfant Promenade, SW., Washington, DC 20447, Attn: ACF Reports Clearance Officer. All requests should be identified by the title of the information collection. E-mail address: 
                    <E T="03">infocollection@acf.hhs.gov</E>
                    .
                </P>
                <HD SOURCE="HD1">OMB Comment</HD>
                <P>
                    OMB is required to make a decision concerning the collection of information between 30 and 60 days after publication of this document in the 
                    <E T="04">Federal Register</E>
                    . Therefore, a comment is best assured of having its full effect if OMB receives it within 30 days of publication. Written comments and recommendations for the proposed information collection should be sent directly to the following:
                </P>
                <P>Office of Management and Budget, Paperwork Reduction Project, Fax: 202-395-6974, Attn: Desk Officer for the Administration for Children and Families.</P>
                <SIG>
                    <DATED>Dated: November 19, 2007.</DATED>
                    <NAME>Robert Sargis,</NAME>
                    <TITLE>Reports Clearance Officer.</TITLE>
                </SIG>
            </PREAMB>
            <FRDOC>[FR Doc. 07-5832 Filed 11-26-07; 8:45 am]</FRDOC>
            <BILCOD>BILLING CODE 4184-01-M</BILCOD>
        </NOTICE>
        <NOTICE>
            <PREAMB>
                <AGENCY TYPE="S">DEPARTMENT OF HEALTH AND HUMAN SERVICES</AGENCY>
                <SUBAGY>Administration for Children and Families</SUBAGY>
                <SUBJECT>Submission for OMB Review; Comment Request</SUBJECT>
                <P>
                    <E T="03">Title:</E>
                     Voluntary Surveys of Program Partners to Implement Executive Order 12862.
                </P>
                <P>
                    <E T="03">OMB No.:</E>
                     0980-0266.
                </P>
                <P>
                    <E T="03">Description:</E>
                     Under the provisions of the Federal Paperwork Reduction Act of 1995 (Pub. L. 104-13), the Administration for Children and Families (ACFR) is requesting clearance for instruments to implement Executive Order 12862 within ACF. The purpose of the data collection is to obtain customer satisfaction information from those entities who are funded to be ACF's partners in the delivery of services to the American public. ACF partners are those entities that receive funding to deliver services or assistance from ACF programs. Examples of partners are State and local governments, Territories, service providers, Indian Tribes and Tribal organizations, grantees, researchers or other intermediaries serving target populations identified by and funded directly or indirectly by ACF. The surveys will obtain information about how well ACF is meeting the needs of its partners in operating the programs.
                </P>
                <P>
                    <E T="03">Respondents:</E>
                     State, local, Tribal governments or Not-for-profit organizations.
                </P>
                <GPOTABLE COLS="5" OPTS="L2,i1" CDEF="s50,12,12,12,12">
                    <TTITLE>Annual Burden Estimates </TTITLE>
                    <BOXHD>
                        <CHED H="1">Instrument </CHED>
                        <CHED H="1">Number of respondents </CHED>
                        <CHED H="1">Number of responses per respondent </CHED>
                        <CHED H="1">Average burden hours per response </CHED>
                        <CHED H="1">Total burden hours </CHED>
                    </BOXHD>
                    <ROW>
                        <ENT I="01">State Governments, Territories and District of Columbia</ENT>
                        <ENT>54</ENT>
                        <ENT>10</ENT>
                        <ENT>1</ENT>
                        <ENT>540 </ENT>
                    </ROW>
                    <ROW>
                        <ENT I="01">Head Start grantees &amp; Delegates</ENT>
                        <ENT>200</ENT>
                        <ENT>1</ENT>
                        <ENT>0.5</ENT>
                        <ENT>100 </ENT>
                    </ROW>
                    <ROW>
                        <ENT I="01">Other Discretionary grant Programs</ENT>
                        <ENT>200</ENT>
                        <ENT>10</ENT>
                        <ENT>0.5</ENT>
                        <ENT>1,000 </ENT>
                    </ROW>
                    <ROW>
                        <ENT I="01">Indian Tribes and Tribal Organizations</ENT>
                        <ENT>25</ENT>
                        <ENT>10</ENT>
                        <ENT>0.5</ENT>
                        <ENT>125 </ENT>
                    </ROW>
                </GPOTABLE>
                <PRTPAGE P="66179"/>
                <P>
                    <E T="03">Estimated Total Annual Burden Hours:</E>
                     1,765.
                </P>
                <HD SOURCE="HD1">Additional Information</HD>
                <P>
                    Copies of the proposed collection may be obtained by writing to the Administration for Children and Families, Office of Administration, Office of Information Services, 370 L'Enfant Promenade, SW., Washington, DC 20447, Attn: ACF Reports Clearance Officer. All requests should be identified by the title of the information collection. E-mail address: 
                    <E T="03">infocollection@acf.hhs.gov.</E>
                </P>
                <HD SOURCE="HD1">OMB Comment</HD>
                <P>
                    OMB is required to make a decision concerning the collection of information between 30 and 60 days after publication of this document in the 
                    <E T="04">Federal Register</E>
                    . Therefore, a comment is best assured of having its full effect of OMB receives it within 30 days of publication. Written comments and recommendations for the proposed information collection should be sent directly to the following:
                </P>
                <P>Office of Management and Budget, Paperwork Reduction Project, Fax: 202-395-6974, Attn: Desk Officer for the Administration for Children and Families.</P>
                <SIG>
                    <DATED>Dated: November 20, 2007.</DATED>
                    <NAME>Robert Sargis,</NAME>
                    <TITLE>Reports Clearance Officer.</TITLE>
                </SIG>
            </PREAMB>
            <FRDOC>[FR Doc. 07-5835 Filed 11-26-07; 8:45 am]</FRDOC>
            <BILCOD>BILLING CODE 4184-01-M</BILCOD>
        </NOTICE>
        <NOTICE>
            <PREAMB>
                <AGENCY TYPE="S">DEPARTMENT OF HEALTH AND HUMAN SERVICES</AGENCY>
                <SUBAGY>Administration for Children and Families</SUBAGY>
                <SUBJECT>Proposed Information Collection Activity; Comment Request</SUBJECT>
                <HD SOURCE="HD1">Proposed Projects</HD>
                <P>
                    <E T="03">Title:</E>
                     Required Data Elements for Voluntary Establishment of Paternity Affidavits.
                </P>
                <P>
                    <E T="03">OMB No.:</E>
                     0970-0171.
                </P>
                <P>
                    <E T="03">Description:</E>
                     Section 466(a)(5)(C)(iv) of the Social Security Act (the Act) requires States to develop and use an affidavit for the voluntary acknowledgement of paternity. The affidavit for the voluntary acknowledgement of paternity must include the minimum requirements specified by the Secretary under section 452(a)(7) of the Act. The affidavits will be used by hospitals, birth record agencies, and other entities participating in the voluntary paternity establishment program.
                </P>
                <P>
                    <E T="03">Respondents:</E>
                     State and Tribal IV-D agencies, hospitals, birth record agencies and other entities participating in the voluntary paternity establishment program.
                </P>
                <GPOTABLE COLS="5" OPTS="L2,i1" CDEF="s100,12C,12C,12C,12C">
                    <TTITLE>Annual Burden Estimates</TTITLE>
                    <BOXHD>
                        <CHED H="1">Instrument</CHED>
                        <CHED H="1">Number of respondents</CHED>
                        <CHED H="1">Number of responses per respondent</CHED>
                        <CHED H="1">Average burden hours per response</CHED>
                        <CHED H="1">Total burden hours</CHED>
                    </BOXHD>
                    <ROW>
                        <ENT I="01">None</ENT>
                        <ENT>1,025,521</ENT>
                        <ENT>Variable</ENT>
                        <ENT>.166</ENT>
                        <ENT>170,236</ENT>
                    </ROW>
                </GPOTABLE>
                <P>
                    <E T="03">Estimated Total Annual Burden Hours:</E>
                     170,236.
                </P>
                <P>
                    In compliance with the requirements of section 3506(c)(2)(A) of the Paperwork Reduction Act of 1995, the Administration for Children and Families is soliciting public comment on the specific aspects of the information collection described above. Copies of the proposed collection of information can be obtained and comments may be forwarded by writing to the Administration for Children and Families, Office of Administration, Office of Information Services, 370 L'Enfant Promenade, SW., Washington, DC 20447, Attn: ACF Reports Clearance Officer. E-mail address: 
                    <E T="03">infocollection@acf.hhs.gov</E>
                    . All requests should be identified by the title of the information collection.
                </P>
                <P>
                    <E T="03">The Department specifically requests comments on:</E>
                     (a) Whether the proposed collection of information is necessary for the proper performance of the functions of the agency, including whether the information shall have practical utility; (b) the accuracy of the agency's estimate of the burden of the proposed collection of information; (c) the quality, utility, and clarity of the information to be collected; and (d) ways to minimize the burden of the collection of information on respondents, including through the use of automated collection techniques or other forms of information technology. Consideration will be given to comments and suggestions submitted within 60 days of this publication.
                </P>
                <SIG>
                    <DATED>Dated: November 20, 2007.</DATED>
                    <NAME>Robert Sargis,</NAME>
                    <TITLE>Reports Clearance Officer.</TITLE>
                </SIG>
            </PREAMB>
            <FRDOC>[FR Doc. 07-5841 Filed 11-26-07; 8:45 am]</FRDOC>
            <BILCOD>BILLING CODE 4184-01-M</BILCOD>
        </NOTICE>
        <NOTICE>
            <PREAMB>
                <AGENCY TYPE="S">DEPARTMENT OF HEALTH AND HUMAN SERVICES</AGENCY>
                <SUBAGY>Administration for Children and Families</SUBAGY>
                <SUBJECT>Proposed Information Collection Activity; Comment Request</SUBJECT>
                <HD SOURCE="HD1">Proposed Project</HD>
                <P>
                    <E T="03">Title:</E>
                     Descriptive Study of Early Head Start (DSEHS).
                </P>
                <P>
                    <E T="03">OMB No.:</E>
                     New Collection.
                </P>
                <P>
                    <E T="03">Description:</E>
                     The Administration for Children and Families (ACF), U.S. Department of Health and Human Services (HHS), requests clearance to recruit Early Head Start (EHS) programs for participation in the Descriptive Study of Early Head Start (DSEHS) and to conduct a pilot test of potential measures.
                </P>
                <P>DSEHS is a longitudinal study of a representative sample of programs and children in three age cohorts, which will collect information about programs, families, and services. When completed, data will be collected on a sample of approximately 2,100 children and families from 60 EHS programs. Data will be collected in four waves: Fall 2008, Fall 2009, Fall 2010, and Fall 2011. Children and families will be followed until children are three years old and exit EHS programs.</P>
                <P>
                    Data collected under DSEHS will complement information gathered under the Survey of Early Head Start Programs (SEHSP), OMB Control No. 0992-0008. SEHSP gathered information on the management systems, services, and characteristics of children and families served by EHS programs. To complement this information, DSEHS will gather information on the needs and characteristics of children and families enrolled in EHS programs, including an assessment of children's and families' needs, how programs meet 
                    <PRTPAGE P="66180"/>
                    the needs of children and families in EHS programs, and how children and families in EHS programs progress over time.
                </P>
                <P>The activity proposed under this notice includes only the data collected during the selection and recruitment of programs to participate in DSEHS and a pilot study on the feasibility of proposed measures.</P>
                <P>To select and recruit programs, ACF intends to send letters to program directors of selected EHS programs. Directors will receive a summary of the study goals that will include an overview of the design and data collection, a brochure describing the study, and examples of the consent materials for enrolling study participants. Programs will not be asked to enroll participants during the initial selection and recruitment phase.</P>
                <P>Selected programs may also receive a follow-up phone call to answer questions from EHS directors or staff. Program directors will be asked to provide information on the numbers of families enrolled with children who will be within two months of the target ages at the time of each of the four fall data collections.</P>
                <P>ACF intends to conduct a feasibility pilot study at two EHS programs in June 2008. In the pilot study, ACF will test the feasibility of administering various direct child assessment measures and parent interviews.</P>
                <P>
                    <E T="03">Respondents:</E>
                     EHS Program Directors, Parents, and Children.
                </P>
                <GPOTABLE COLS="5" OPTS="L2,i1" CDEF="s100,12,12,12,12">
                    <TTITLE>Annual Burden Estimates </TTITLE>
                    <BOXHD>
                        <CHED H="1">Instrument </CHED>
                        <CHED H="1">Annual number of respondents </CHED>
                        <CHED H="1">Number of responses per respondent </CHED>
                        <CHED H="1">Average burden hours per response </CHED>
                        <CHED H="1">Estimated annual burden hours </CHED>
                    </BOXHD>
                    <ROW>
                        <ENT I="01">Recruitment materials sent to program sites</ENT>
                        <ENT>60</ENT>
                        <ENT>1</ENT>
                        <ENT>.25</ENT>
                        <ENT>15 </ENT>
                    </ROW>
                    <ROW>
                        <ENT I="01">Program roster of children in target ages</ENT>
                        <ENT>60</ENT>
                        <ENT>1</ENT>
                        <ENT>.50</ENT>
                        <ENT>30 </ENT>
                    </ROW>
                    <ROW>
                        <ENT I="01">Pilot Test—Child Assessment</ENT>
                        <ENT>40</ENT>
                        <ENT>1</ENT>
                        <ENT>1.0</ENT>
                        <ENT>40 </ENT>
                    </ROW>
                    <ROW>
                        <ENT I="01">Pilot Test—Parent Interview</ENT>
                        <ENT>40</ENT>
                        <ENT>1</ENT>
                        <ENT>1.0</ENT>
                        <ENT>40 </ENT>
                    </ROW>
                </GPOTABLE>
                <P>
                    <E T="03">Estimated Total Annual Burden Hours:</E>
                     125.
                </P>
                <P>
                    In compliance with the requirements of Section 3506(c)(2)(A) of the Paperwork Reduction Act of 1995, the Administration for Children and Families is soliciting public comment on the specific aspects of the information collection described above. Copies of the proposed collection of information can be obtained and comments may be forwarded by writing to the Administration for Children and Families, Office of Administration, Office of Information Services, 370 L'Enfant Promenade, SW., Washington, DC 20447, Attn: ACF Reports Clearance Officer. E-mail address: 
                    <E T="03">infocollection@acf.hhs.gov.</E>
                     All requests should be identified by the title of the information collection.
                </P>
                <P>The Department specifically requests comments on (a) whether the proposed collection of information is necessary for the proper performance of the functions of the agency, including whether the information shall have practical utility; (b) the accuracy of the agency's estimate of the burden of the proposed collection of information; (c) the quality, utility, and clarity of the information to be collected; and (d) ways to minimize the burden of the collection of information on respondents, including through the use of automated collection techniques or other forms of information technology. Consideration will be given to comments and suggestions submitted within 60 days of this publication.</P>
                <SIG>
                    <DATED>Dated: November 20, 2007.</DATED>
                    <NAME>Brendan C. Kelly,</NAME>
                    <TITLE>OPRE Reports Clearance Officer.</TITLE>
                </SIG>
            </PREAMB>
            <FRDOC>[FR Doc. 07-5842  Filed 11-26-07; 8:45 am]</FRDOC>
            <BILCOD>BILLING CODE 4184-01-M</BILCOD>
        </NOTICE>
        <NOTICE>
            <PREAMB>
                <AGENCY TYPE="S">DEPARTMENT OF HEALTH AND HUMAN SERVICES</AGENCY>
                <SUBAGY>Food and Drug Administration</SUBAGY>
                <DEPDOC>[Docket No. 2007N-0356]</DEPDOC>
                <SUBJECT>Behind the Counter Availability of Certain Drugs; Public Meeting; Comment Period Clarification</SUBJECT>
                <AGY>
                    <HD SOURCE="HED">AGENCY:</HD>
                    <P>Food and Drug Administration, HHS.</P>
                </AGY>
                <ACT>
                    <HD SOURCE="HED">ACTION:</HD>
                    <P> Notice; comment period clarification.</P>
                </ACT>
                <SUM>
                    <HD SOURCE="HED">SUMMARY:</HD>
                    <P>
                         In the 
                        <E T="04">Federal Register</E>
                         of October 4, 2007 (72 FR 56769), the Food and Drug Administration (FDA) published a notice that announced a public meeting to obtain comments regarding behind-the-counter (BTC) availability of human drugs. An incorrect date was published in that notice. This document clarifies that Docket No. 2007N-0356 will close on December 17, 2007.
                    </P>
                </SUM>
                <ADD>
                    <HD SOURCE="HED">ADDRESSES:</HD>
                    <P>You may submit comments, identified by Docket No. 2007N-0356, by any of the following methods:</P>
                    <FP>
                        <E T="03">Electronic Submissions</E>
                    </FP>
                    <P>Submit electronic comments in the following ways:</P>
                    <P>
                        • Federal eRulemaking Portal: 
                        <E T="03">http://www.regulations.gov</E>
                        . Follow the instructions for submitting comments.
                    </P>
                    <P>
                        • Agency Web site: 
                        <E T="03">http://www.fda.gov/dockets/ecomments</E>
                        . Follow the instructions for submitting comments on the agency Web site.
                    </P>
                    <FP>
                        <E T="03">Written Submissions</E>
                    </FP>
                    <P>Submit written registration and comments in the following ways:</P>
                    <P>• FAX: 301-827-6870.</P>
                    <P>• Mail/Hand delivery/Courier (for paper, disk, or CD-ROM submissions): Division of Dockets Management (HFA-305), Food and Drug Administration, 5630 Fishers Lane, rm. 1061, Rockville, MD 20852.</P>
                    <P>
                        To ensure more timely processing of comments, FDA is no longer accepting comments submitted to the agency by e-mail. FDA encourages you to continue to submit electronic comments by using the Federal eRulemaking Portal or the agency Web site, as described previously, in the 
                        <E T="02">ADDRESSES</E>
                         portion of this document under 
                        <E T="03">Electronic Submissions</E>
                        .
                    </P>
                    <P>
                        <E T="03">Instructions</E>
                        : All submissions received must include the agency name and docket number for this notice. All comments received may be posted without change to 
                        <E T="03">http://www.fda.gov/ohrms/dockets/default.htm</E>
                        , including any personal information provided. For additional information on submitting comments, see the “Comments” heading of the 
                        <E T="02">SUPPLEMENTARY INFORMATION</E>
                         section of this document.
                    </P>
                    <P>
                        <E T="03">Docket</E>
                        : For access to the docket to read background documents or comments received, go to 
                        <E T="03">http://www.fda.gov/ohrms/dockets/default.htm</E>
                         and insert the docket number, found in brackets in the heading of this document, into the “Search” box and follow the prompts and/or go to the Division of Dockets Management, 5630 Fishers Lane, rm. 1061, Rockville, MD 20852.
                        <PRTPAGE P="66181"/>
                    </P>
                    <P>
                        Transcripts of the meeting will be available for review at the Division of Dockets Management and on the Internet at 
                        <E T="03">http://www.fda.gov/ohrms/dockets</E>
                         approximately 30 days after the meeting.
                    </P>
                </ADD>
                <FURINF>
                    <HD SOURCE="HED">FOR FURTHER INFORMATION CONTACT:</HD>
                    <P>
                         Erik Mettler, Office of Policy (HF-11), Food and Drug Administration, 5600 Fishers Lane, Rockville, MD 20857, 301-827-3360, FAX: 301-594-6777 
                        <E T="03">Erik.Mettler@fda.hhs.gov</E>
                        .
                    </P>
                </FURINF>
            </PREAMB>
            <SUPLINF>
                <HD SOURCE="HED">SUPPLEMENTARY INFORMATION:</HD>
                <HD SOURCE="HD1">I. Background</HD>
                <P>
                    In the 
                    <E T="04">Federal Register</E>
                     of October 4, 2007 (72 FR 56769), FDA announced that it would hold a public meeting regarding BTC availability of certain human drugs. BTC availability could make certain drugs available behind the counter at the pharmacy without a prescription and require the intervention of a pharmacist before dispensing.
                </P>
                <P>Some groups have asserted that pharmacist interaction with the consumer could ensure safe and effective use of a drug product that otherwise might require a prescription. Because pharmacists have the training and knowledge to provide certain interventions, they may be able to ensure that patients meet the conditions for use and educate patients on appropriate use of the drug product. These groups have suggested that the availability of certain drugs BTC could increase patient access to medications that may be underutilized, particularly by patients without health insurance, because these medications otherwise would be available only with a prescription.</P>
                <P>
                    The 
                    <E T="04">Federal Register</E>
                     notice stated that interested persons would be able to submit comments to the Division of Dockets Management and that the public docket would remain open for 30 days following the meeting. Our intent was to state that the docket would remain open until December 17, 2007 (30 days after the meeting, which occurred on November 14, 2007). However, the notice also instructed persons to register if they wished to attend or participate in the meeting; the instructions stated that registration would occur on a first-come, first-serve basis, but then mistakenly declared that written or electronic comments would be accepted “until November 28, 2007” (72 FR 56769).
                </P>
                <HD SOURCE="HD1">II. Comments</HD>
                <P>This notice clarifies that we will accept comments to the public docket until December 17, 2007.</P>
                <P>
                    Interested persons may submit to the Division of Dockets Management (see 
                    <E T="02">ADDRESSES</E>
                    ) written or electronic comments regarding this document. Submit a single copy of electronic comments or two paper copies of any mailed comments, except that individuals may submit one paper copy. Comments are to be identified with the docket number found in brackets in the heading of this document. Received comments may be seen in the Division of Dockets Management between 9 a.m. and 4 p.m., Monday through Friday.
                </P>
                <P>
                    Please note that in January 2008, the FDA Web site is expected to transition to the Federal Dockets Management System (FDMS). FDMS is a Government-wide, electronic docket management system. After the transition date, electronic submissions will be accepted by FDA through the FDMS only. When the exact date of the transition to FDMS is known, FDA will publish a 
                    <E T="04">Federal Register</E>
                     notice announcing that date.
                </P>
                <SIG>
                    <DATED>Dated: November 20, 2007.</DATED>
                    <NAME>Randall W. Lutter,</NAME>
                    <TITLE>Deputy Commissioner for Policy.</TITLE>
                </SIG>
            </SUPLINF>
            <FRDOC>[FR Doc. E7-23026 Filed 11-26-07; 8:45 am]</FRDOC>
            <BILCOD>BILLING CODE 4160-01-S</BILCOD>
        </NOTICE>
        <NOTICE>
            <PREAMB>
                <AGENCY TYPE="S">DEPARTMENT OF HEALTH AND HUMAN SERVICES </AGENCY>
                <SUBAGY>Health Resources and Services Administration </SUBAGY>
                <SUBJECT>National Vaccine Injury Compensation Program: Revised Amount of the Average Cost of a Health Insurance Policy </SUBJECT>
                <P>The Health Resources and Services Administration is publishing an updated monetary amount of the average cost of a health insurance policy as it relates to the National Vaccine Injury Compensation Program (VICP). </P>
                <P>Pursuant to section 100.2 of the VICP's implementing regulations (42 CFR Part 100), the Secretary announces that the revised average cost of a health insurance policy under the VICP is $380.04 per month. In accordance with § 100.2, the revised amount was effective upon its delivery by the Secretary to the United States Court of Federal Claims. Such notice was delivered to the Court on October 17, 2007. </P>
                <SIG>
                    <DATED>Dated: November 19, 2007. </DATED>
                    <NAME>Elizabeth M. Duke, </NAME>
                    <TITLE>Administrator.</TITLE>
                </SIG>
            </PREAMB>
            <FRDOC> [FR Doc. E7-23090 Filed 11-26-07; 8:45 am] </FRDOC>
            <BILCOD>BILLING CODE 4165-15-P </BILCOD>
        </NOTICE>
        <NOTICE>
            <PREAMB>
                <AGENCY TYPE="S">DEPARTMENT OF HEALTH AND HUMAN SERVICES </AGENCY>
                <SUBAGY>Health Resources and Services Administration </SUBAGY>
                <SUBJECT>HIV/AIDS Bureau; Ryan White HIV/AIDS Program Core Medical Services Waiver Application Requirements </SUBJECT>
                <AGY>
                    <HD SOURCE="HED">AGENCY:</HD>
                    <P>Health Resources and Services Administration (HRSA), HHS. </P>
                </AGY>
                <ACT>
                    <HD SOURCE="HED">ACTION:</HD>
                    <P>Notice of opportunity to provide written comments. </P>
                </ACT>
                <SUM>
                    <HD SOURCE="HED">SUMMARY:</HD>
                    <P>This notice solicits comments on the HRSA proposed uniform waiver standards for Ryan White HIV/AIDS Program grantees requesting a core medical services waiver for Fiscal Year 2008 and beyond. Title XXVI of the Public Health Service Act (PHS) Act, as amended by the Ryan White HIV/AIDS Treatment Modernization Act of 2006 (Ryan White HIV/AIDS Program) requires that grantees expend 75 percent of Parts A, B, and C funds on core medical services, including antiretroviral drugs, for individuals with HIV/AIDS identified and eligible under the legislation, effective Fiscal Year (FY) 2007. HRSA has issued guidance for obtaining a waiver for FY 2007 and seeks to issue waiver requirements for grantees under Parts A, B, and C of Title XXVI of the PHS Act for FY 2008 and future years. </P>
                </SUM>
                <DATES>
                    <HD SOURCE="HED">DATES:</HD>
                    <P>
                        Written comments must be received no later than 30 days after date of publication in the 
                        <E T="04">Federal Register</E>
                        . 
                    </P>
                </DATES>
                <ADD>
                    <HD SOURCE="HED">ADDRESSES:</HD>
                    <P>
                        Written comments should be sent to HRSA, HAB, Division of Science and Policy, 
                        <E T="03">Attention:</E>
                         LCDR Gettie A. Butts, 5600 Fishers Lane, Room 7-18, Rockville, Maryland 20857. 
                    </P>
                </ADD>
                <FURINF>
                    <HD SOURCE="HED">FOR FURTHER INFORMATION CONTACT:</HD>
                    <P>
                        <E T="03">LCDR Gettie A. Butts, at: GButts@hrsa.gov</E>
                         or by writing to the address above. 
                    </P>
                </FURINF>
            </PREAMB>
            <SUPLINF>
                <HD SOURCE="HED">SUPPLEMENTARY INFORMATION:</HD>
                <P>
                    The statute, Title XXVI of the Public Health Service Act (PHS) Act, as amended by the Ryan White HIV/AIDS Treatment Modernization Act of 2006, imposes two criteria for waiver eligibility: (1) No waiting lists for AIDS Drug Assistance Program (ADAP) services; and (2) core medical services availability within the relevant service area to all individuals with HIV/AIDS identified and eligible under Title XXVI of the PHS Act. See sections 2604(c)(2), 2612(b)(2), and 2651(c)(2) of the PHS Act. The Health Resources and Services Administration (HRSA) HIV/AIDS Bureau has issued interim waiver eligibility guidance for FY 2007 to provide immediate implementation of these waiver provisions. The FY 2007 guidance 
                    <PRTPAGE P="66182"/>
                    required that grantees provide written certification stating that all Ryan White-funded core medical services are available in the service area and that no ADAP waiting list exists. Given the need for immediate implementation, the guidance offered an expeditious process by which grantees could apply for a waiver for FY 2007. HRSA now provides notice of its proposal for a more permanent process by which such waivers will be granted beginning in FY 2008 and seeks public comment on its proposal. 
                </P>
                <P>Beginning in FY 2008, HRSA will utilize new standards for granting waivers of the core medical services requirement for Ryan White HIV/AIDS Programs. These standards meet the intent of the Ryan White HIV/AIDS Treatment Modernization Act of 2006 to increase access to core medical services, including antiretroviral drugs, for persons with HIV/AIDS and to ensure that grantees receiving waivers demonstrate the availability of such services for individuals with HIV/AIDS identified and eligible under Title XXVI of the PHS Act. The purposes of this notice are: (1) To establish requirements for core medical services waiver eligibility for grantees under Parts A, B, and C of Title XXVI of the PHS Act; and (2) to establish a process for waiver request submission, review and notification. The core medical services waiver uniform standard and waiver request process proposed in this notice will apply to Ryan White HIV/AIDS Program grant awards under Parts A, B, and C of Title XXVI of the PHS Act. </P>
                <HD SOURCE="HD1">Proposed Uniform Standard for Waiver of Core Medical Services Requirements for Grantees Under Parts A, B, and C </HD>
                <P>Grantees must submit a waiver request with the annual grant application containing the following certifications and documentation which will be utilized by HRSA in determining whether to grant a waiver. The waiver must be signed by the chief elected official or the fiscally responsible agent, and include: </P>
                <P>1. Certification from the Part B state grantee that there are no current or anticipated ADAP services waiting lists in the state for the year in which such waiver request is made. This certification must also specify that there are no waiting lists for a particular core class of antiretroviral therapeutics established by the Secretary, e.g., fusion inhibitors; </P>
                <P>2. Certification that all core medical services listed in the statute (Part A section 2604(c)(3), Part B section 2612(b)(3), and Part C section 2651(c)(3)), regardless of whether such services are funded by the Ryan White HIV/AIDS Program, are available within 30 days for all identified and eligible individuals with HIV/AIDS in the service area; </P>
                <P>3. Evidence that a public process was conducted to seek public input on availability of core medical services; </P>
                <P>4. Evidence that receipt of the core medical services waiver is consistent with the grantee's Ryan White HIV/AIDS Program application (e.g., “Description of Priority Setting and Resource Allocation Processes” and “Unmet Need Estimate and Assessment” sections of the application for Parts A, “Needs Assessment and Unmet Need” section of the application under Part B, and “Description of the Local HIV Service Delivery System,” and “Current and Projected Sources of Funding” sections of the application under Part C). </P>
                <HD SOURCE="HD1">Types of Documentation and Evidence </HD>
                <P>Grantees must provide evidence that all of the core medical services listed in the statute, regardless of whether such services are funded by the Ryan White HIV/AIDS Program, are available to all individuals with HIV/AIDS identified and eligible under Title XXVI of the PHS Act in the service area within 30 days. Such documentation may include one or more of the following types of information for the service area for the prior fiscal year: HIV/AIDS care and treatment services inventories including funding sources, HIV/AIDS met and unmet need assessments, HIV/AIDS client/patient service utilization data, planning council core medical services priority setting and funding allocations documents, and letters from Medicaid and other state and local HIV/AIDS entitlement and benefits programs including private insurers. Information provided by grantees must show specific verifiable evidence that all listed core medical services are available and are being utilized to meet the needs of persons with HIV/AIDS who are identified and eligible for Ryan White HIV/AIDS Program services without further infusion of Ryan White HIV/AIDS Program dollars. Such documentation must also describe which specific core medical services are available, from whom, and through what funding source. </P>
                <P>Grantees must have evidence of a public process for the dissemination of information and must seek input from affected communities related to the availability of core medical services and the decision to request a waiver. This public process may be the same one utilized for obtaining input on community needs as part of the comprehensive planning process. In addition, grantees must describe in narrative form the following: </P>
                <P>1. Local/state underlying issues that influenced the grantee's decision to request a waiver and how the submitted documentation supports the assertion that such services are available and accessible to all individuals with HIV/AIDS identified and eligible under Title XXVI in the service area. </P>
                <P>2. How the approval of a waiver will impact the grantee's ability to address unmet need for HIV/AIDS services and perform outreach to HIV-positive individuals not currently in care. </P>
                <P>3. The consistency of the waiver request with the grantee's grant application, including proposed service priorities and funding allocations. </P>
                <HD SOURCE="HD1">Waiver Review and Notification Process </HD>
                <P>As indicated, grantees must submit a waiver request with their annual grant application. No waiver requests will be accepted at any other time (other than with the annual grant application). Application guidance documents will be amended to include this requirement. HRSA/HAB will review requests for waiver of the core medical services requirement and will notify grantees of waiver approval no later than the date of issuance of Notice of Grant Award. Core medical services waivers will be effective for a one-year period consistent with the grant award period. </P>
                <HD SOURCE="HD1">The Paperwork Reduction Act of 1995 </HD>
                <P>This activity is subject to Office of Management and Budget review and approval under the Paperwork Reduction Act of 1995. </P>
                <SIG>
                    <DATED>Dated: November 16, 2007. </DATED>
                    <NAME>Elizabeth M. Duke, </NAME>
                    <TITLE>Administrator.</TITLE>
                </SIG>
            </SUPLINF>
            <FRDOC>[FR Doc. E7-22982 Filed 11-26-07; 8:45 am] </FRDOC>
            <BILCOD>BILLING CODE 4165-15-P</BILCOD>
        </NOTICE>
        <NOTICE>
            <PREAMB>
                <AGENCY TYPE="N">DEPARTMENT OF HOMELAND SECURITY </AGENCY>
                <SUBAGY>Coast Guard </SUBAGY>
                <DEPDOC>[Docket No. USCG-2007-29114] </DEPDOC>
                <SUBJECT>Delaware River and Bay Oil Spill Advisory Committee; Vacancies </SUBJECT>
                <AGY>
                    <HD SOURCE="HED">AGENCY:</HD>
                    <P>Coast Guard, DHS. </P>
                </AGY>
                <ACT>
                    <HD SOURCE="HED">ACTION:</HD>
                    <P>Notice of committee establishment and request for applications. </P>
                </ACT>
                <SUM>
                    <HD SOURCE="HED">SUMMARY:</HD>
                    <P>
                        The Secretary of Homeland Security is establishing the Delaware River and Bay Oil Spill Advisory 
                        <PRTPAGE P="66183"/>
                        Committee (DRBOSAC) under authority of the Coast Guard and Maritime Transportation Act of 2006, Public Law 109-241. Individuals interested in serving on this committee are invited to apply for membership. 
                    </P>
                </SUM>
                <DATES>
                    <HD SOURCE="HED">DATES:</HD>
                    <P>Application forms for membership should reach the Coast Guard on or before January 28, 2008. </P>
                </DATES>
                <ADD>
                    <HD SOURCE="HED">ADDRESSES:</HD>
                    <P>
                        You may request a copy of the charter for the Delaware River and Bay Oil Spill Advisory Committee or a form to apply for membership by writing to Captain David L. Scott, Designated Federal Officer (DFO) of the Delaware River and Bay Oil Spill Advisory Committee, USCG Sector Delaware Bay, 1 Washington Avenue, Philadelphia, PA 19147. Send your application in written form to the above street address. A copy of this notice, the Committee Charter, and the application form are available in our online docket, USCG-2007-29114, at 
                        <E T="03">http://www.regulations.gov</E>
                        . 
                    </P>
                </ADD>
                <FURINF>
                    <HD SOURCE="HED">FOR FURTHER INFORMATION CONTACT:</HD>
                    <P>Mr. Gerald Conrad, Assistant to the DFO of the Delaware River and Bay Oil Spill Advisory Committee, at 215-271-4824. </P>
                </FURINF>
            </PREAMB>
            <SUPLINF>
                <HD SOURCE="HED">SUPPLEMENTARY INFORMATION:</HD>
                <P>
                    <E T="03">Establishment of the Delaware River and Bay Oil Spill Advisory Committee.</E>
                     The Federal Advisory Committee Act (FACA), 5 U.S.C. App. (Pub. L. 92-463), governs the establishment of committees by Federal agencies. Section 607 of the Coast Guard and Maritime Transportation Act of 2006 (Pub. L. 109-241) requires the Secretary of the Department in which the Coast Guard is operating to establish a Delaware River and Bay Oil Spill Advisory Committee. The Commandant of the Coast Guard will select the people to be on the advisory committee. 
                </P>
                <P>The DRBOSAC shall provide advice and recommendations and a ranking of priorities for measures to improve the prevention of, and response to, future oil spills in the Delaware River and Delaware Bay to the Commandant of the Coast Guard, the Governors of the States of New Jersey, Pennsylvania, and Delaware, the Committee on Commerce, Science and Transportation of the Senate, and the Committee on Transportation and Infrastructure of the House of Representatives. </P>
                <P>FACA requires advisory committees to meet at least yearly. However, we anticipate that this Committee will meet more frequently. Subcommittees, if established, may also meet between meetings of the parent committee. Most meetings will be held at Coast Guard Sector Delaware Bay in Philadelphia, Pennsylvania, but some meetings may be held at nearby facilities. </P>
                <HD SOURCE="HD1">Request for Applications </HD>
                <P>The Committee will be composed of 27 members who are appointed by the Commandant of the Coast Guard and who have a particular expertise, knowledge, and experience regarding the transportation, equipment, and techniques that are used to ship cargo and to navigate vessels in the Delaware River and Delaware Bay, as follows: </P>
                <P>(A) Three members who are employed by port authorities that oversee operations on the Delaware River or have been selected to represent these port authorities, of whom—</P>
                <P>(i) One member shall be an employee or representative of the Port of Wilmington; </P>
                <P>(ii) One member shall be an employee or representative of the South Jersey Port Corporation; </P>
                <P>(iii) One member shall be an employee or representative of the Philadelphia Regional Port Authority. </P>
                <P>(B) Two members who represent organizations that operate tugs or barges that utilize the port facilities on the Delaware River and Delaware Bay. </P>
                <P>(C) Two members who represent shipping companies that transport cargo by vessel from ports on the Delaware River and Delaware Bay, of whom at least one may not be a representative of a shipping company that transports oil or petroleum products. </P>
                <P>(D) Two members who represent operators of oil refineries adjacent to the Delaware River and Delaware Bay. </P>
                <P>(E) Two members who represent State-licensed pilots who work on the Delaware River and Delaware Bay. </P>
                <P>(F) One member who represents labor organizations whose members load and unload cargo at ports on the Delaware River and Delaware Bay. </P>
                <P>(G) One member who represents local commercial fishing interests or an aquaculture organization that depends on fisheries and resources of the Delaware River or Delaware Bay. </P>
                <P>(H) Three members who represent environmental organizations active with respect to the Delaware River and Delaware Bay, including a watershed advocacy group and a wildlife conservation advocacy group. </P>
                <P>(I) One member who represents an organization affiliated with recreational fishing interests in the vicinity of the Delaware River and Delaware Bay. </P>
                <P>(J) Two members who are scientists or researchers associated with an academic institution, and who have professional credentials in fields of research relevant to oil spill safety, oil spill response, or wildlife and ecological recovery. </P>
                <P>(K) Two members who are municipal or county officials from Delaware. </P>
                <P>(L) Two members who are municipal or county officials from New Jersey. </P>
                <P>(M) Two members who are municipal or county officials from Pennsylvania. </P>
                <P>(N) One member who represents an oil spill response organization located on the lower Delaware River and Delaware Bay. </P>
                <P>(O) One member who represents the general public. </P>
                <P>The DRBOSAC may also consist of an appropriate number (as determined by the Commandant of the Coast Guard) of non-voting members who represent Federal agencies and the agencies of the states of New Jersey, Pennsylvania, and Delaware with an interest in oil spill prevention in the Delaware River and Delaware Bay. </P>
                <P>The members outlined in (A) can be either Special Government Employees (SGEs) or representatives. Members who are merely employed by port authorities shall be designated as SGEs and members that represent these port authorities shall be designated as representative members. </P>
                <P>The members in paragraphs (B), (C), (D), (E), (F), (G), (H), (I), (K), (L), (M) and (N) are representative members and not Special Government Employees as defined in section 202(a) of Title 18, United States Code. </P>
                <P>The members in paragraphs, (J), and (O) serve as Special Government Employees as defined in section 202(a) of Title 18, United States Code. </P>
                <P>The terms of office for members initially appointed to the committee shall expire 18 months from the date of their appointment. Applicants may be required to pass an appropriate security background check prior to appointment to the committee. </P>
                <P>
                    Applicants should submit their application on Form DOT F 1120.1 to Captain David L. Scott at the address given in the 
                    <E T="02">ADDRESSES</E>
                     section at the beginning of this Notice. The application form is available from Mr. Gerald Conrad by calling him at 215-271-4824, or by going to the docket for this notice [USCG-2007-29114] at 
                    <E T="03">http://www.regulations.gov</E>
                    . 
                </P>
                <P>While attending meetings or otherwise engaged in Committee business, members will be reimbursed for travel expenses as permitted under applicable Federal travel regulations. However, members will not receive any salary or other compensation for their service on the Committee. </P>
                <P>In support of the policy of the U.S.C.G. on gender and ethnic diversity, we encourage qualified women and members of minority groups to apply. </P>
                <P>
                    If you are selected as a Special Government Employee (SGE), including a member of the general public, we will 
                    <PRTPAGE P="66184"/>
                    require you to complete a Confidential Financial Disclosure Report (OGE Form 450). We may not release the report or the information in it to the public, except under an order issued by a Federal court or as otherwise provided under the Privacy Act (5 U.S.C. 552a). 
                </P>
                <SIG>
                    <DATED>Dated: October 13, 2007. </DATED>
                    <NAME>David. L. Scott, </NAME>
                    <TITLE>Captain, U.S. Coast Guard, Commanding Officer, Sector Delaware Bay.</TITLE>
                </SIG>
            </SUPLINF>
            <FRDOC> [FR Doc. E7-23044 Filed 11-26-07; 8:45 am] </FRDOC>
            <BILCOD>BILLING CODE 4910-15-P </BILCOD>
        </NOTICE>
        <NOTICE>
            <PREAMB>
                <AGENCY TYPE="S">DEPARTMENT OF HOMELAND SECURITY </AGENCY>
                <SUBAGY>U.S. Customs and Border Protection </SUBAGY>
                <DEPDOC>[CBP Dec. 07-87] </DEPDOC>
                <SUBJECT>Re-Approval of Marine Technical Surveyors, Inc., as a Commercial Gauger </SUBJECT>
                <AGY>
                    <HD SOURCE="HED">AGENCY:</HD>
                    <P>U.S. Customs and Border Protection, Department of Homeland Security. </P>
                </AGY>
                <ACT>
                    <HD SOURCE="HED">ACTION:</HD>
                    <P>Notice of re-approval of Marine Technical Surveyors, Inc., of Donaldsonville, LA, as a commercial gauger. </P>
                </ACT>
                <SUM>
                    <HD SOURCE="HED">SUMMARY:</HD>
                    <P>
                        Notice is hereby given that, pursuant to 19 CFR 151.13, Marine Technical Surveyors, Inc., 2382 Highway 1 South, Donaldsonville, Louisiana 70346, has been re-approved to gauge petroleum and petroleum products, organic chemicals and vegetable oils for customs purposes, in accordance with the provisions of 19 CFR 151.13. Anyone wishing to employ this entity for gauger services should request and receive written assurances from the entity that it is approved by the U.S. Customs and Border Protection to conduct the specific gauger service requested. Alternatively, inquiries regarding the specific gauger services this entity is approved to perform may be directed to the U.S. Customs and Border Protection by calling (202) 344-1060. The inquiry may also be sent to 
                        <E T="03">http://www.cbp.gov/xp/cgov/import/operations_support/labs_scientific_ svcs/org_and_operations.xml</E>
                        . 
                    </P>
                </SUM>
                <DATES>
                    <HD SOURCE="HED">DATES:</HD>
                    <P>The re-approval of Marine Technical Surveyors, Inc., as a commercial gauger became effective on January 10, 2006. The next triennial inspection date will be scheduled for January 2009. </P>
                </DATES>
                <FURINF>
                    <HD SOURCE="HED">FOR FURTHER INFORMATION CONTACT:</HD>
                    <P>Eugene J. Bondoc, Ph.D, or Randall Breaux, Laboratories and Scientific Services, U.S. Customs and Border Protection, 1300 Pennsylvania Avenue, NW., Suite 1500N, Washington, DC 20229, 202-344-1060. </P>
                    <SIG>
                        <DATED>Dated: November 19, 2007. </DATED>
                        <NAME>Ira S. Reese, </NAME>
                        <TITLE>Executive Director, Laboratories and Scientific Services.</TITLE>
                    </SIG>
                </FURINF>
            </PREAMB>
            <FRDOC> [FR Doc. E7-23086 Filed 11-26-07; 8:45 am] </FRDOC>
            <BILCOD>BILLING CODE 9111-14-P </BILCOD>
        </NOTICE>
        <NOTICE>
            <PREAMB>
                <AGENCY TYPE="S">DEPARTMENT OF HOMELAND SECURITY </AGENCY>
                <SUBAGY>U.S. Customs and Border Protection </SUBAGY>
                <DEPDOC>[CBP Dec. 07-88] </DEPDOC>
                <SUBJECT>Re-Approval of Intertek USA, Inc., as a Commercial Gauger </SUBJECT>
                <AGY>
                    <HD SOURCE="HED">AGENCY:</HD>
                    <P>U.S. Customs and Border Protection, Department of Homeland Security. </P>
                </AGY>
                <ACT>
                    <HD SOURCE="HED">ACTION:</HD>
                    <P>Notice of re-approval of Intertek USA, Inc., of Valdez, AK, as a commercial gauger. </P>
                </ACT>
                <SUM>
                    <HD SOURCE="HED">SUMMARY:</HD>
                    <P>
                        Notice is hereby given that, pursuant to 19 CFR 151.13, Intertek USA, Inc., 354 Fairbanks Street, Valdez, Alaska 99686, has been re-approved to gauge petroleum and petroleum products, organic chemicals and vegetable oils for customs purposes, in accordance with the provisions of 19 CFR 151.13. Anyone wishing to employ this entity for gauger services should request and receive written assurances from the entity that it is approved by the U.S. Customs and Border Protection to conduct the specific gauger service requested. Alternatively, inquiries regarding the specific gauger services this entity is approved to perform may be directed to the U.S. Customs and Border Protection by calling (202) 344-1060. The inquiry may also be sent to 
                        <E T="03">http://www.cbp.gov/xp/cgov/import/operations_support/labs_scientific_svcs/ org_and_operations.xml</E>
                        . 
                    </P>
                </SUM>
                <DATES>
                    <HD SOURCE="HED">DATES:</HD>
                    <P>The re-approval of Intertek USA, Inc., as a commercial gauger became effective on September 6, 2006. The next triennial inspection date will be scheduled for September 2009. </P>
                </DATES>
                <FURINF>
                    <HD SOURCE="HED">FOR FURTHER INFORMATION CONTACT:</HD>
                    <P>Eugene J. Bondoc, Ph.D, or Randall Breaux, Laboratories and Scientific Services, U.S. Customs and Border Protection, 1300 Pennsylvania Avenue, NW., Suite 1500N, Washington, DC 20229, 202-344-1060. </P>
                    <SIG>
                        <DATED>Dated: November 19, 2007. </DATED>
                        <NAME>Ira S. Reese, </NAME>
                        <TITLE>Executive Director, Laboratories and Scientific Services.</TITLE>
                    </SIG>
                </FURINF>
            </PREAMB>
            <FRDOC> [FR Doc. E7-23087 Filed 11-26-07; 8:45 am] </FRDOC>
            <BILCOD>BILLING CODE 9111-14-P </BILCOD>
        </NOTICE>
        <NOTICE>
            <PREAMB>
                <AGENCY TYPE="S">DEPARTMENT OF HOMELAND SECURITY </AGENCY>
                <SUBAGY>U.S. Customs and Border Protection </SUBAGY>
                <DEPDOC>[CBP Dec. 07-89] </DEPDOC>
                <SUBJECT>Re-Approval of Intertek USA, Inc., as a Commercial Gauger </SUBJECT>
                <AGY>
                    <HD SOURCE="HED">AGENCY:</HD>
                    <P>U.S. Customs and Border Protection, Department of Homeland Security. </P>
                </AGY>
                <ACT>
                    <HD SOURCE="HED">ACTION:</HD>
                    <P>Notice of re-approval of Intertek USA, Inc., of Kapolei, Hawaii, as a commercial gauger. </P>
                </ACT>
                <SUM>
                    <HD SOURCE="HED">SUMMARY:</HD>
                    <P>
                        Notice is hereby given that, pursuant to 19 CFR 151.13, Intertek USA, Inc., 91-110 Hanua Street, #204, Kapolei, Hawaii 96707, has been re-approved to gauge petroleum and petroleum products, organic chemicals and vegetable oils for customs purposes, in accordance with the provisions of 19 CFR 151.13. Anyone wishing to employ this entity for gauger services should request and receive written assurances from the entity that it is approved by the U. S. Customs and Border Protection to conduct the specific gauger service requested. Alternatively, inquiries regarding the specific gauger services this entity is approved to perform may be directed to the U. S. Customs and Border Protection by calling (202) 344-1060. The inquiry may also be sent to 
                        <E T="03">http://www.cbp.gov/xp/cgov/import/operations_support/labs_scientific_svcs/ org_and_operations.xml</E>
                        . 
                    </P>
                </SUM>
                <DATES>
                    <HD SOURCE="HED">DATES:</HD>
                    <P>The re-approval of Intertek USA, Inc., as a commercial gauger became effective on August 22, 2006. The next triennial inspection date will be scheduled for August 2009. </P>
                </DATES>
                <FURINF>
                    <HD SOURCE="HED">FOR FURTHER INFORMATION CONTACT:</HD>
                    <P>Eugene J. Bondoc, Ph.D, or Randall Breaux, Laboratories and Scientific Services, U. S. Customs and Border Protection, 1300 Pennsylvania Avenue, NW., Suite 1500N, Washington, DC 20229, 202-344-1060. </P>
                    <SIG>
                        <DATED>Dated: November 19, 2007. </DATED>
                        <NAME>Ira S. Reese. </NAME>
                        <TITLE>Executive Director, Laboratories and Scientific Services.</TITLE>
                    </SIG>
                </FURINF>
            </PREAMB>
            <FRDOC>[FR Doc. E7-23088 Filed 11-26-07; 8:45 am] </FRDOC>
            <BILCOD>BILLING CODE 9111-14-P </BILCOD>
        </NOTICE>
        <NOTICE>
            <PREAMB>
                <PRTPAGE P="66185"/>
                <AGENCY TYPE="S">DEPARTMENT OF HOMELAND SECURITY </AGENCY>
                <SUBAGY>U.S. Customs and Border Protection </SUBAGY>
                <DEPDOC>[CBP Dec. 07-90] </DEPDOC>
                <SUBJECT>Re-Accreditation and Re-Approval of SGS North America Inc., as a Commercial Gauger and Laboratory </SUBJECT>
                <AGY>
                    <HD SOURCE="HED">AGENCY:</HD>
                    <P>U. S. Customs and Border Protection, Department of Homeland Security. </P>
                </AGY>
                <ACT>
                    <HD SOURCE="HED">ACTION:</HD>
                    <P>Notice of re-approval of SGS North America Inc., of Wilmington, North Carolina, as a commercial gauger and laboratory. </P>
                </ACT>
                <SUM>
                    <HD SOURCE="HED">SUMMARY:</HD>
                    <P>
                        Notice is hereby given that, pursuant to 19 CFR 151.12 and 151.13, SGS North America Inc., 111 Cowan Road, Wilmington, North Carolina 28401, has been re-approved to gauge petroleum and petroleum products, organic chemicals and vegetable oils, and to test petroleum and petroleum products for customs purposes, in accordance with the provisions of 19 CFR 151.12 and 151.13. Anyone wishing to employ this entity to conduct laboratory analysis or gauger services should request and receive written assurances from the entity that it is accredited or approved by the U. S. Customs and Border Protection to conduct the specific test or gauger service requested. Alternatively, inquiries regarding the specific tests or gauger services this entity is accredited or approved to perform may be directed to the U. S. Customs and Border Protection by calling (202) 344-1060. The inquiry may also be sent to 
                        <E T="03">http://www.cbp.gov/xp/ cgov/import/operations_support/labs_scientific_svcs/org_and_operations.xml</E>
                        . 
                    </P>
                </SUM>
                <DATES>
                    <HD SOURCE="HED">DATES:</HD>
                    <P>The re-approval of SGS North America Inc., as a commercial gauger and laboratory became effective on August 31, 2006. The next triennial inspection date will be scheduled for August 2009. </P>
                </DATES>
                <FURINF>
                    <HD SOURCE="HED">FOR FURTHER INFORMATION CONTACT:</HD>
                    <P>Eugene J. Bondoc, Ph.D, or Randall Breaux, Laboratories and Scientific Services, U. S. Customs and Border Protection, 1300 Pennsylvania Avenue, NW., Suite 1500N, Washington, DC 20229, 202-344-1060. </P>
                    <SIG>
                        <DATED>Dated: November 19, 2007. </DATED>
                        <NAME>Ira S. Reese,</NAME>
                        <TITLE>Executive Director, Laboratories and Scientific Services.</TITLE>
                    </SIG>
                </FURINF>
            </PREAMB>
            <FRDOC>[FR Doc. E7-23089 Filed 11-26-07; 8:45 am]</FRDOC>
            <BILCOD>BILLING CODE 9111-14-P</BILCOD>
        </NOTICE>
        <NOTICE>
            <PREAMB>
                <AGENCY TYPE="S">DEPARTMENT OF HOMELAND SECURITY </AGENCY>
                <SUBAGY>U.S. Customs and Border Protection </SUBAGY>
                <DEPDOC>[CBP Dec. 07-91] </DEPDOC>
                <SUBJECT>Re-Accreditation and Re-Approval of Columbia  Inspection, Inc., as a Commercial Gauger and Laboratory </SUBJECT>
                <AGY>
                    <HD SOURCE="HED">AGENCY:</HD>
                    <P>U.S. Customs and Border Protection, Department of Homeland Security. </P>
                </AGY>
                <ACT>
                    <HD SOURCE="HED">ACTION:</HD>
                    <P>Notice of re-approval of Columbia Inspection, Inc., of Fife, Washington, as a commercial gauger and laboratory. </P>
                </ACT>
                <SUM>
                    <HD SOURCE="HED">SUMMARY:</HD>
                    <P>
                        Notice is hereby given that, pursuant to 19 CFR 151.12 and 151.13, Columbia Inspection, Inc., 5013 Pacific Highway East, Suite #2, Fife, Washington 98424, has been re-approved to gauge petroleum and petroleum products, organic chemicals and vegetable oils, and to test petroleum and petroleum products for customs purposes, in accordance with the provisions of 19 CFR 151.12 and 151.13. Anyone wishing to employ this entity to conduct laboratory analysis or gauger services should request and receive written assurances from the entity that it is accredited or approved by the U.S. Customs and Border Protection to conduct the specific test or gauger service requested. Alternatively, inquiries regarding the specific tests or gauger services this entity is accredited or approved to perform may be directed to the U.S. Customs and Border Protection by calling (202) 344-1060. The inquiry may also be sent to 
                        <E T="03">http://www.cbp.gov/xp/cgov/import/operations_support/labs_scientific_svcs/ org_and_operations.xml</E>
                        . 
                    </P>
                </SUM>
                <DATES>
                    <HD SOURCE="HED">DATES:</HD>
                    <P>The re-approval of Columbia Inspection, Inc., as a commercial gauger and laboratory became effective on March 13, 2007. The next triennial inspection date will be scheduled for March 2010. </P>
                </DATES>
                <FURINF>
                    <HD SOURCE="HED">FOR FURTHER INFORMATION CONTACT:</HD>
                    <P>Eugene J. Bondoc, Ph.D, or Randall Breaux, Laboratories and Scientific Services, U.S. Customs and Border Protection, 1300 Pennsylvania Avenue, NW., Suite 1500N, Washington, DC 20229, 202-344-1060. </P>
                    <SIG>
                        <DATED>Dated: November 19, 2007. </DATED>
                        <NAME>Ira S. Reese, </NAME>
                        <TITLE>Executive Director, Laboratories and Scientific Services.</TITLE>
                    </SIG>
                </FURINF>
            </PREAMB>
            <FRDOC> [FR Doc. E7-23091 Filed 11-26-07; 8:45 am] </FRDOC>
            <BILCOD>BILLING CODE 9111-14-P </BILCOD>
        </NOTICE>
        <NOTICE>
            <PREAMB>
                <AGENCY TYPE="N">DEPARTMENT OF HOUSING AND URBAN DEVELOPMENT </AGENCY>
                <DEPDOC>[Docket No. FR-5117-N-100] </DEPDOC>
                <SUBJECT>Notice of Submission of Proposed Information Collection to OMB; Brownfields Economic Development Initiative (BEDI) Grant Application </SUBJECT>
                <AGY>
                    <HD SOURCE="HED">AGENCY:</HD>
                    <P>Office of the Chief Information Officer, HUD. </P>
                </AGY>
                <ACT>
                    <HD SOURCE="HED">ACTION:</HD>
                    <P>Notice. </P>
                </ACT>
                <SUM>
                    <HD SOURCE="HED">SUMMARY:</HD>
                    <P>The proposed information collection requirement described below has been submitted to the Office of Management and Budget (OMB) for review, as required by the Paperwork Reduction Act. The Department is soliciting public comments on the subject proposal. </P>
                    <P>This information collection is required to rate and rank applications submitted as part of a funding competition and to ensure funding eligibility of applicant activities. Respondents are units of general local government eligible for Section 108 Loan Guarantees. </P>
                </SUM>
                <DATES>
                    <HD SOURCE="HED">DATES:</HD>
                    <P>
                        <E T="03">Comments Due Date:</E>
                         December 27, 2007. 
                    </P>
                </DATES>
                <ADD>
                    <HD SOURCE="HED">ADDRESSES:</HD>
                    <P>Interested persons are invited to submit comments regarding this proposal. Comments should refer to the proposal by name and/or OMB approval Number (2506-0153) and should be sent to: HUD Desk Officer, Office of Management and Budget, New Executive Office Building, Washington, DC 20503; fax: 202-395-6974. </P>
                </ADD>
                <FURINF>
                    <HD SOURCE="HED">FOR FURTHER INFORMATION CONTACT:</HD>
                    <P>
                        Lillian Deitzer, Departmental Reports Management Officer, QDAM, Department of Housing and Urban Development, 451 Seventh Street, SW., Washington, DC 20410; e-mail 
                        <E T="03">Lillian_L._Deitzer@HUD.gov</E>
                         or telephone (202) 402-8048. This is not a toll-free number. Copies of available documents submitted to OMB may be obtained from Ms. Deitzer or from HUD's Web site at 
                        <E T="03">http://www5.hud.gov:63001/po/i/icbts/collectionsearch.cfm.</E>
                    </P>
                </FURINF>
            </PREAMB>
            <SUPLINF>
                <HD SOURCE="HED">SUPPLEMENTARY INFORMATION:</HD>
                <P>
                    This notice informs the public that the Department of Housing and Urban Development has submitted to OMB a request for approval of the information collection described below. This notice is soliciting comments from members of the public and affecting agencies concerning the proposed collection of information to: (1) Evaluate whether the proposed collection of information is necessary for the proper performance of the functions of the agency, including whether the information will have 
                    <PRTPAGE P="66186"/>
                    practical utility; (2) Evaluate the accuracy of the agency's estimate of the burden of the proposed collection of information; (3) Enhance the quality, utility, and clarity of the information to be collected; and (4) Minimize the burden of the collection of information on those who are to respond; including through the use of appropriate automated collection techniques or other forms of information technology, e.g., permitting electronic submission of responses. 
                </P>
                <P>This notice also lists the following information: </P>
                <P>
                    <E T="03">Title of Proposal:</E>
                     Brownfields Economic Development Initiative (BEDI) Grant Application. 
                </P>
                <P>
                    <E T="03">OMB Approval Number:</E>
                     2506-0153. 
                </P>
                <P>
                    <E T="03">Form Numbers:</E>
                     HUD 40122, HUD 40123, SF 424, SF 424S, SF LLL, HUD 424B, HUD 2880, HUD 96010 and HUD 2993. 
                </P>
                <P>
                    <E T="03">Description of the Need for the Information and Its Proposed Use:</E>
                     This information collection is required to rate and rank applications submitted as part of a funding competition and to ensure funding eligibility of applicant activities. Respondents are units of general local government eligible for Section 108 Loan Guarantees. 
                </P>
                <P>
                    <E T="03">Frequency of Submission:</E>
                     Quarterly, Annually. 
                </P>
                <GPOTABLE COLS="8" OPTS="L1,tp0,i1" CDEF="s100,12C,2,12C,2,12C,2,12C">
                    <TTITLE>  </TTITLE>
                    <BOXHD>
                        <CHED H="1">  </CHED>
                        <CHED H="1">
                            Number of 
                            <LI>respondents </LI>
                        </CHED>
                        <CHED H="1">x </CHED>
                        <CHED H="1">
                            Annual 
                            <LI>responses </LI>
                        </CHED>
                        <CHED H="1">x </CHED>
                        <CHED H="1">
                            Hours per 
                            <LI>response </LI>
                        </CHED>
                        <CHED H="1">= </CHED>
                        <CHED H="1">Burden hours </CHED>
                    </BOXHD>
                    <ROW>
                        <ENT I="01">Reporting Burden</ENT>
                        <ENT>50 </ENT>
                        <ENT> </ENT>
                        <ENT>1 </ENT>
                        <ENT> </ENT>
                        <ENT>40 </ENT>
                        <ENT> </ENT>
                        <ENT>2,000 </ENT>
                    </ROW>
                </GPOTABLE>
                <P>
                    <E T="03">Total Estimated Burden Hours:</E>
                     2,000 
                </P>
                <P>
                    <E T="03">Status:</E>
                     Extension of a currently approved collection. 
                </P>
                <AUTH>
                    <HD SOURCE="HED">Authority:</HD>
                    <P>Section 3507 of the Paperwork Reduction Act of 1995, 44 U.S.C. 35, as amended. </P>
                </AUTH>
                <SIG>
                    <DATED>Dated: November 19, 2007. </DATED>
                    <NAME>Lillian L. Deitzer, </NAME>
                    <TITLE>Departmental Paperwork Reduction Act Officer, Office of the Chief Information Officer.</TITLE>
                </SIG>
            </SUPLINF>
            <FRDOC>[FR Doc. E7-23081 Filed 11-26-07; 8:45 am] </FRDOC>
            <BILCOD>BILLING CODE 4210-67-P </BILCOD>
        </NOTICE>
        <NOTICE>
            <PREAMB>
                <AGENCY TYPE="N">DEPARTMENT OF THE INTERIOR </AGENCY>
                <SUBAGY>National Park Service </SUBAGY>
                <SUBJECT>National Register of Historic Places; Notification of Pending Nominations and Related Actions </SUBJECT>
                <P>Nominations for the following properties being considered for listing or related actions in the National Register were received by the National Park Service before November 10, 2007. Pursuant to section 60.13 of 36 CFR part 60 written comments concerning the significance of these properties under the National Register criteria for evaluation may be forwarded by United States Postal Service, to the National Register of Historic Places, National Park Service, 1849 C St., NW., 2280, Washington, DC 20240; by all other carriers, National Register of Historic Places, National Park Service, 1201 Eye St., NW., 8th floor, Washington, DC 20005; or by fax, 202-371-6447. Written or faxed comments should be submitted by December 12, 2007. </P>
                <SIG>
                    <NAME>J. Paul Loether, </NAME>
                    <TITLE>Chief, National Register of Historic Places/National Historic Landmarks Program.</TITLE>
                </SIG>
                <EXTRACT>
                    <HD SOURCE="HD1">Colorado </HD>
                    <HD SOURCE="HD2">Las Animas County </HD>
                    <FP SOURCE="FP-1">East Street School, 206 East St., Trinidad, 07001277 </FP>
                    <HD SOURCE="HD1">Indiana </HD>
                    <HD SOURCE="HD2"> Elkhart County </HD>
                    <FP SOURCE="FP-1">Conn, Charles Gerard, Mansion, 723 Strong Ave., Elkhart, 07001278 </FP>
                    <HD SOURCE="HD2">Hendricks County </HD>
                    <FP SOURCE="FP-1">Smith Farm, 2698 S Cty. Rd. 900 E., Plainfield, 07001279 </FP>
                    <HD SOURCE="HD2">Jackson County </HD>
                    <FP SOURCE="FP-1">Cavanaugh Bridge, .6 mi S of Cty. Rd. 700 S on Cty. Rd. 550 W over Muscatatuck R., Brownstown, 07001280 </FP>
                    <HD SOURCE="HD2">Porter County </HD>
                    <FP SOURCE="FP-1">Wolf, Josephus, House, 453 W 700 N., Valparaiso, 07001281 </FP>
                    <HD SOURCE="HD2">Pulaski County </HD>
                    <FP SOURCE="FP-1">Pulaski County Courthouse, 112 E Main St., Winamac, 07001282 </FP>
                    <HD SOURCE="HD2">Vermillion County </HD>
                    <FP SOURCE="FP-1">Vermillion County Courthouse, 255 S Main St., Newport, 07001283 </FP>
                    <HD SOURCE="HD1">Maryland </HD>
                    <HD SOURCE="HD2">Baltimore County </HD>
                    <FP SOURCE="FP-1">Winters Lane Historic District, Winters Ln. between Frederick Rd. &amp; Baltimore National Pike, Catonsville, 07001285 </FP>
                    <HD SOURCE="HD2"> Baltimore Independent City </HD>
                    <FP SOURCE="FP-1">Grief, L. and Bro., Inc. Manufactory, 901 N Milton Ave., Baltimore (Independent City), 07001284 </FP>
                    <HD SOURCE="HD2">Carroll County </HD>
                    <FP SOURCE="FP-1">Keefer—Brubaker Farm, 2719 Roop Rd., Taneytown, 07001286 </FP>
                    <HD SOURCE="HD2">Kent County </HD>
                    <FP SOURCE="FP-1">Woodland Hall, 13111 Shallcross Wharf Rd., Kennedyville, 07001287 </FP>
                    <HD SOURCE="HD2">Prince George's County </HD>
                    <FP SOURCE="FP-1">Hilltop Manor, 4100-4112, 4200-4214 53rd Ave., 4100-4210 53rd Pl., &amp; 5300-5304 Annapolis Rd., Bladensburg, 07001288 </FP>
                    <HD SOURCE="HD1">Missouri </HD>
                    <HD SOURCE="HD2">Greene County </HD>
                    <FP SOURCE="FP-1">Gottfried Furniture Company Building, (Springfield MPS) 326 Boonville Ave., Springfield, 07001289 </FP>
                    <HD SOURCE="HD2"> Jackson County </HD>
                    <FP SOURCE="FP-1">Smith and Sons Manufacturing Company Building, (Railroad Related Historic Commercial and Industrial Resources in Kansas City, Missouri MPS) 1400-26 Guinotte Ave., Kansas City, 07001290 </FP>
                    <HD SOURCE="HD2">St. Louis Independent City </HD>
                    <FP SOURCE="FP-1">Central Carondelet Historic District (Boundary Increase), Roughly bounded by Loughborough, Holly Hills, Idaho and S. Broadway, St. Louis (Independent City), 07001291 </FP>
                    <FP SOURCE="FP-1">Wagoner Place Historic District, Bounded by Dick Gregory, Marcus, Dr. M.L. King &amp; N. Market Sts., St. Louis (Independent City), 07001292 </FP>
                    <HD SOURCE="HD1">Montana </HD>
                    <HD SOURCE="HD2">Golden Valley County </HD>
                    <FP SOURCE="FP-1">Lavina State Bank, 101 Main St., Lavina, 07001293 </FP>
                    <HD SOURCE="HD1">Ohio </HD>
                    <HD SOURCE="HD2">Ashtabula County </HD>
                    <FP SOURCE="FP-1">Cleveland Hotel, The, 230-238 State St., Conneaut, 07001294 </FP>
                    <HD SOURCE="HD2">Hamilton County </HD>
                    <FP SOURCE="FP-1">Bullerdick, Frederick E. and Catherine, House, 4321 Hamilton Ave., Cincinnati, 07001295 </FP>
                    <HD SOURCE="HD2">Summit County </HD>
                    <FP SOURCE="FP-1">
                        Rhodes and Watters Apartment Buildings, The, 614, 608, 610, 612 W. Market St. &amp; 16 Rhodes Ave., Akron, 07001296 
                        <PRTPAGE P="66187"/>
                    </FP>
                    <HD SOURCE="HD1">Rhode Island </HD>
                    <HD SOURCE="HD2">Washington County </HD>
                    <FP SOURCE="FP-1">Westerly Downtown Historic District (Boundary Increase), 12 Canal St., Westerly, 07001297 </FP>
                    <HD SOURCE="HD1">Vermont </HD>
                    <HD SOURCE="HD2"> Franklin County </HD>
                    <FP SOURCE="FP-1">Bridge 12, (Metal Truss, Masonry, and Concrete Bridges in Vermont MPS) Boston Post Rd., Enosburg, 07001299 </FP>
                    <HD SOURCE="HD2"> Bridge 9, </HD>
                    <FP SOURCE="FP-1">(Metal Truss, Masonry, and Concrete Bridges in Vermont MPS) Shawville Rd., Sheldon, 07001298 </FP>
                    <HD SOURCE="HD2"> Lamoille County </HD>
                    <FP SOURCE="FP-1">Bridge 6, (Metal Truss, Masonry, and Concrete Bridges in Vermont MPS) Railroad St., Johnson, 07001300</FP>
                    <P>A request for REMOVAL has been made for the following resource: </P>
                    <HD SOURCE="HD1">Tennessee </HD>
                    <HD SOURCE="HD2"> Shelby County </HD>
                    <FP SOURCE="FP-1">Douglass High School, 3200 Mount Olive Rd., Memphis, 98000241</FP>
                </EXTRACT>
            </PREAMB>
            <FRDOC>[FR Doc. E7-22989 Filed 11-26-07; 8:45 am] </FRDOC>
            <BILCOD>BILLING CODE 4312-51-P </BILCOD>
        </NOTICE>
        <NOTICE>
            <PREAMB>
                <AGENCY TYPE="N">INTERNATIONAL TRADE COMMISSION</AGENCY>
                <DEPDOC>[Investigation No. 731-TA-744 (Second Review)]</DEPDOC>
                <SUBJECT>Brake Rotors From China</SUBJECT>
                <AGY>
                    <HD SOURCE="HED">AGENCY:</HD>
                    <P>United States International Trade Commission.</P>
                </AGY>
                <ACT>
                    <HD SOURCE="HED">ACTION:</HD>
                    <P>Scheduling of a full five-year review concerning the antidumping duty order on brake rotors from China.</P>
                </ACT>
                <SUM>
                    <HD SOURCE="HED">SUMMARY:</HD>
                    <P>The Commission hereby gives notice of the scheduling of a full review pursuant to section 751(c)(5) of the Tariff Act of 1930 (19 U.S.C. 1675(c)(5)) (the Act) to determine whether revocation of the antidumping duty order on brake rotors from China would be likely to lead to continuation or recurrence of material injury within a reasonably foreseeable time. For further information concerning the conduct of this review and rules of general application, consult the Commission's Rules of Practice and Procedure, part 201, subparts A through E (19 CFR part 201), and part 207, subparts A, D, E, and F (19 CFR part 207).</P>
                </SUM>
                <EFFDATE>
                    <HD SOURCE="HED">EFFECTIVE DATE:</HD>
                    <P>November 19, 2007.</P>
                </EFFDATE>
                <FURINF>
                    <HD SOURCE="HED">FOR FURTHER INFORMATION CONTACT:</HD>
                    <P>
                        Mary Messer (202-205-3193), Office of Investigations, U.S. International Trade Commission, 500 E Street, SW., Washington, DC 20436. Hearing-impaired persons can obtain information on this matter by contacting the Commission's TDD terminal on 202-205-1810. Persons with mobility impairments who will need special assistance in gaining access to the Commission should contact the Office of the Secretary at 202-205-2000. General information concerning the Commission may also be obtained by accessing its internet server (
                        <E T="03">http://www.usitc.gov</E>
                        ). The public record for this review may be viewed on the Commission's electronic docket (EDIS) at 
                        <E T="03">http://edis.usitc.gov.</E>
                    </P>
                </FURINF>
            </PREAMB>
            <SUPLINF>
                <HD SOURCE="HED">SUPPLEMENTARY INFORMATION:</HD>
                <P SOURCE="NPAR">
                    <E T="03">Background.</E>
                     On October 5, 2007, the Commission determined that responses to its notice of institution of the subject five-year review were such that a full review pursuant to section 751(c)(5) of the Act should proceed (72 F.R. 59111, October 18, 2007). A record of the Commissioners' votes, the Commission's statement on adequacy, and any individual Commissioner's statements are available from the Office of the Secretary and at the Commission's Web site.
                </P>
                <P>
                    <E T="03">Participation in the review and public service list.</E>
                     Persons, including industrial users of the subject merchandise and, if the merchandise is sold at the retail level, representative consumer organizations, wishing to participate in this review as parties must file an entry of appearance with the Secretary to the Commission, as provided in section 201.11 of the Commission's rules, by 45 days after publication of this notice. A party that filed a notice of appearance following publication of the Commission's notice of institution of the review need not file an additional notice of appearance. The Secretary will maintain a public service list containing the names and addresses of all persons, or their representatives, who are parties to the review.
                </P>
                <P>
                    <E T="03">Limited disclosure of business proprietary information (BPI) under an administrative protective order (APO) and BPI service list.</E>
                     Pursuant to section 207.7(a) of the Commission's rules, the Secretary will make BPI gathered in this review available to authorized applicants under the APO issued in the review, provided that the application is made by 45 days after publication of this notice. Authorized applicants must represent interested parties, as defined by 19 U.S.C. 1677(9), who are parties to the review. A party granted access to BPI following publication of the Commission's notice of institution of the review need not reapply for such access. A separate service list will be maintained by the Secretary for those parties authorized to receive BPI under the APO.
                </P>
                <P>
                    <E T="03">Staff report.</E>
                     The prehearing staff report in the review will be placed in the nonpublic record on March 25, 2008, and a public version will be issued thereafter, pursuant to section 207.64 of the Commission's rules.
                </P>
                <P>
                    <E T="03">Hearing.</E>
                     The Commission will hold a hearing in connection with the review beginning at 9:30 a.m. on April 15, 2008, at the U.S. International Trade Commission Building. Requests to appear at the hearing should be filed in writing with the Secretary to the Commission on or before April 8, 2008. A nonparty who has testimony that may aid the Commission's deliberations may request permission to present a short statement at the hearing. All parties and nonparties desiring to appear at the hearing and make oral presentations should attend a prehearing conference to be held at 9:30 a.m. on April 10, 2008, at the U.S. International Trade Commission Building. Oral testimony and written materials to be submitted at the public hearing are governed by sections 201.6(b)(2), 201.13(f), 207.24, and 207.66 of the Commission's rules. Parties must submit any request to present a portion of their hearing testimony 
                    <E T="03">in camera</E>
                     no later than 7 business days prior to the date of the hearing.
                </P>
                <P>
                    <E T="03">Written submissions.</E>
                     Each party to the review may submit a prehearing brief to the Commission. Prehearing briefs must conform with the provisions of section 207.65 of the Commission's rules; the deadline for filing is April 3, 2008. Parties may also file written testimony in connection with their presentation at the hearing, as provided in section 207.24 of the Commission's rules, and posthearing briefs, which must conform with the provisions of section 207.67 of the Commission's rules. The deadline for filing posthearing briefs is April 24, 2008; witness testimony must be filed no later than three days before the hearing. In addition, any person who has not entered an appearance as a party to the review may submit a written statement of information pertinent to the subject of the review on or before April 24, 2008. On May 19, 2008, the Commission will make available to parties all information on which they have not had an opportunity to comment. Parties may submit final comments on this information on or before May 21, 2008, but such final comments must not contain new factual information and must otherwise comply with section 207.68 of the Commission's rules. All written submissions must conform with the provisions of section 201.8 of the Commission's rules; any 
                    <PRTPAGE P="66188"/>
                    submissions that contain BPI must also conform with the requirements of sections 201.6, 207.3, and 207.7 of the Commission's rules. The Commission's rules do not authorize filing of submissions with the Secretary by facsimile or electronic means, except to the extent permitted by section 201.8 of the Commission's rules, as amended, 67 FR 68036 (November 8, 2002). Even where electronic filing of a document is permitted, certain documents must also be filed in paper form, as specified in II (C) of the Commission's Handbook on Electronic Filing Procedures, 67 FR 68168, 68173 (November 8, 2002).
                </P>
                <P>Additional written submissions to the Commission, including requests pursuant to section 201.12 of the Commission's rules, shall not be accepted unless good cause is shown for accepting such submissions, or unless the submission is pursuant to a specific request by a Commissioner or Commission staff.</P>
                <P>In accordance with sections 201.16(c) and 207.3 of the Commission's rules, each document filed by a party to the review must be served on all other parties to the review (as identified by either the public or BPI service list), and a certificate of service must be timely filed. The Secretary will not accept a document for filing without a certificate of service.</P>
                <AUTH>
                    <HD SOURCE="HED">Authority:</HD>
                    <P>This review is being conducted under authority of title VII of the Tariff Act of 1930; this notice is published pursuant to section 207.62 of the Commission's rules.</P>
                </AUTH>
                <SIG>
                    <DATED>Issued: November 20, 2007.</DATED>
                    <P>By order of the Commission.</P>
                    <NAME>Marilyn R. Abbott,</NAME>
                    <TITLE>Secretary to the Commission.</TITLE>
                </SIG>
            </SUPLINF>
            <FRDOC>[FR Doc. E7-22975 Filed 11-26-07; 8:45 am]</FRDOC>
            <BILCOD>BILLING CODE 7020-02-P</BILCOD>
        </NOTICE>
        <NOTICE>
            <PREAMB>
                <AGENCY TYPE="S">INTERNATIONAL TRADE COMMISSION </AGENCY>
                <DEPDOC>[USITC SE-07-026] </DEPDOC>
                <SUBJECT>Government in the Sunshine Act Meeting Notice </SUBJECT>
                <P>
                    <E T="03">Agency Holding the Meeting:</E>
                     United States International Trade Commission. 
                </P>
                <P>
                    <E T="03">Time and Date:</E>
                     November 29, 2007 at 11 a.m. 
                </P>
                <P>
                    <E T="03">Place:</E>
                     Room 101, 500 E Street SW., Washington, DC 20436, Telephone: (202) 205-2000. 
                </P>
                <P>
                    <E T="03">Status:</E>
                     Open to the public. 
                </P>
                <HD SOURCE="HD1">Matters To Be Considered </HD>
                <P>
                    1. 
                    <E T="03">Agenda for future meetings</E>
                    : None. 
                </P>
                <P>2. Minutes. </P>
                <P>3. Ratification List. </P>
                <P>
                    4. 
                    <E T="03">Inv. No. 731-TA-909 (Review)(Low Enriched Uranium from France)</E>
                    —briefing and vote. (The Commission is currently scheduled to transmit its determination and Commissioners' opinions to the Secretary of Commerce on or before December 13, 2007.) 
                </P>
                <P>
                    5. 
                    <E T="03">Outstanding action jackets</E>
                    : None. 
                </P>
                <P>In accordance with Commission policy, subject matter listed above, not disposed of at the scheduled meeting, may be carried over to the agenda of the following meeting. </P>
                <SIG>
                    <P>By order of the Commission.</P>
                    <DATED>Issued: November 21, 2007. </DATED>
                    <NAME>William R. Bishop, </NAME>
                    <TITLE>Hearings and Meetings Coordinator.</TITLE>
                </SIG>
            </PREAMB>
            <FRDOC>[FR Doc. E7-23008 Filed 11-26-07; 8:45 am] </FRDOC>
            <BILCOD>BILLING CODE 7020-02-P </BILCOD>
        </NOTICE>
        <NOTICE>
            <PREAMB>
                <AGENCY TYPE="N">DEPARTMENT OF JUSTICE </AGENCY>
                <SUBAGY>Antitrust Division </SUBAGY>
                <SUBJECT>United States v. Multiple Listing Service Of Hilton Head Island, Inc.; Proposed Final Judgment and Competitive Impact Statement </SUBJECT>
                <P>
                    Notice is hereby given pursuant to the Antitrust Procedures and Penalties Act, 15 U.S.C. 16(b)-(h), that a proposed Final Judgment, Stipulation and Competitive Impact Statement have been filed with the United States District Court for the District of South Carolina in 
                    <E T="03">United States of America</E>
                     v. 
                    <E T="03">Multiple Listing Service of Hilton Head Island, Inc.</E>
                    , Civil Action No, 07-3435. On October 17, 2007, the United States filed a Complaint alleging that the Multiple Listing Service of Hilton Head Island, Inc. violated section 1 of the Sherman Act, 15 U.S.C. 1, by adopting and enforcing rules that restrict access to the Multiple Listing Service database and limit members' business behavior. The proposed Final Judgment, filed at the same time as the Complaint, requires the group to change its membership rules so that low-priced and innovative real estate brokers can compete in the Hilton Head area. 
                </P>
                <P>
                    Copies of the Complaint, proposed Final Judgment and Competitive Impact Statement are available for inspection at the Department of Justice, Antitrust Division, Antitrust Documents Group, 325 7th Street, NW., Room 215, Washington, DC 20530 (telephone: 202-514-2481), on the Department of Justice's Web site at 
                    <E T="03">http://www.usdoj.gov/atr</E>
                    . and at the Office of the Clerk of the United States District Court for the District of South Carolina. Copies of these materials may be obtained from the Antitrust Division upon request and payment of the copying fee set by Department of Justice regulations. 
                </P>
                <P>
                    Public comment is invited within 60 days of the date of this notice. Such comments, and responses thereto, will be published in the 
                    <E T="04">Federal Register</E>
                     and filed with the Court. Comments should be addressed to John R. Read, Chief, Litigation III Section, Antitrust Division, U.S. Department of Justice, 325 7th Street, NW., Suite 300, Washington, DC 20530, (202) 307-0468. 
                </P>
                <SIG>
                    <NAME>J. Robert Kramer II,</NAME>
                    <TITLE>Director of Operations Antitrust Division.</TITLE>
                </SIG>
                <HD SOURCE="HD1">United States District Court for the District of South Carolina Beaufort Division </HD>
                <HD SOURCE="HD2">United States of America, Department of Justice, Antitrust Division, 325 7th Street, NW., Suite 300, Washington, DC 20530, Plaintiff, v. Multiple Listing Service of Hilton Head Island, Inc., 18 Bow Circle, Hilton Head Island, SC 29928, Defendant</HD>
                <P>Civil Action No.9 :07-CV-3435-SB </P>
                <P>Filed: 10/16/07 </P>
                <P>Complaint for Equitable Relief for Violation of 15 U.S.C. 1 Sherman Antitrust Act </P>
                <HD SOURCE="HD1">Complaint </HD>
                <P>The United States of America, by its attorneys acting under the direction of the acting Attorney General, brings this civil antitrust action against Defendant Multiple Listing Service of Hilton Head Island, Inc. (“Hilton Head MLS”) to obtain equitable and other relief for violation of Section 1 of the Sherman Act, 15 U.S.C. 1, as amended. </P>
                <HD SOURCE="HD1">Introduction </HD>
                <P>1. The United States brings this action to enjoin the Defendant from enforcing certain of its rules that unreasonably restrain competition among real estate brokers in the Hilton Head, South Carolina area Defendant is a multiple listing service, which is controlled by its members who are real estate brokers competing to sell brokerage services to consumers in the Hilton Head area. </P>
                <P>2. Defendant provides a variety of services to its members, including the maintenance of a database of past and current listings of properties for sale in the Hilton Head area. Access to the database is critical to being a successful broker. Therefore, brokers seeking to provide brokerage services in the Hilton Head area need to be members of the Hilton Head MLS. </P>
                <P>
                    3. By its rules, Defendant denies membership to brokers who would likely compete aggressively on price or would introduce Internet-based brokerage into the market, and imposes unreasonable membership costs on publicly-owned brokerage companies. 
                    <PRTPAGE P="66189"/>
                    Defendant's rules also stabilize prices by forcing member brokers to provide a certain set of brokerage services, whether or not the consumer desires to purchase those services. 
                </P>
                <P>4. Additionally, Defendant has authorized its Board of Trustees to adopt rules that would regulate commissions and impose discriminatory requirements on Internet-based brokers. The mere prospect that the Board might adopt such rules likely inhibits price and service competition. Their actual adoption would stabilize prices and competitively disadvantage Internet-based brokers. </P>
                <P>5. By adopting and enforcing rules that restrict access to its database and limit members' business behavior, Defendant has restrained competition, reduced consumers' choices, and stabilized prices on Hilton Head Island. </P>
                <HD SOURCE="HD1">Defendant And Its Members</HD>
                <P>6. Defendant Hilton Head MLS is organized as a not-for-profit corporation under the laws of South Carolina with its principal place of business on Hilton Head Island, Beaufort County, South Carolina. </P>
                <P>7. Hilton Head MLS is a joint venture of over one hundred competing licensed brokers and other licensed real estate professionals doing business in the Hilton Head area. Hilton Head MLS serves Hilton Head Island, South Carolina. Although Hilton Head MLS also serves several surrounding counties as well as Hilton Head Island, close to 85 percent of the properties listed—as measured by dollar volume of closed transactions—in the Hilton Head MLS are located on Hilton Head Island, which no other MLS serves. </P>
                <P>8. Whenever this complaint refers to any act, deed, or transaction of the Hilton Head MLS, it means the Hilton Head MLS is engaged in the act, deed, or transaction by or through its members, officers, directors, trustees, employees, or other representatives while they were actively engaged in the management, direction, control, or transaction of its business or affairs. </P>
                <P>9. Various others, not named as Defendants, have participated as conspirators with Hilton Head MLS in the violations alleged in this complaint, and have performed acts and made statements to further the conspiracy. </P>
                <HD SOURCE="HD1">Jurisdiction and Venue</HD>
                <P>10. This Court has subject matter jurisdiction over this action under Section 4 of the Sherman Act, as amended, 15 U.S.C. 4, and 28 U.S.C. 1331, 1337(a), and 1345. </P>
                <P>11. Because Hilton Head MLS maintains its principal place of business on Hilton Head Island, South Carolina and transacts business and is found within this District, venue is proper in this District under 15 U.S.C. 22 and 28 U.S.C. 1391(b) . </P>
                <HD SOURCE="HD1">Trade and Commerce</HD>
                <P>12. Broker-members of the Hilton Head MLS provided residential real estate brokerage services to in-state and out-of-state clients seeking to buy or sell property in the Hilton Head area. In 2005, those brokers facilitated the exchange of property worth over $2.5 billion, and they collected fees of approximately $170 million for their services. Interstate mortgage financing is affected by this exchange of property. </P>
                <P>13. The Hilton Head MLS's activities and the violations alleged in this Complaint affect brokers, home buyers, and home sellers located throughout the United States. The Hilton Head MLS' s real estate activities are in the flow of, and have a substantial effect on, interstate commerce. </P>
                <HD SOURCE="HD1">Concerted Action </HD>
                <P>14. The rules of the Hilton Head MLS are the product of agreements or concerted action among brokers who compete in the Hilton Head area. The broker-members of the Hilton Head MLS, as a group and through the Board they elect and the staff they indirectly employ, maintain and enforce MLS rules affecting a broker's participation in the MLS. </P>
                <HD SOURCE="HD1">Relevant Markets </HD>
                <P>15. The provision of real estate brokerage services to sellers of residential real property and the provision of real estate brokerage services to buyers of residential real property are relevant service markets within the meaning of the antitrust laws. In the event of a small but significant increase in the price of brokerage services, the number of buyers and sellers that would switch to another way of selling or buying a home would not be sufficient to make such a price increase unprofitable. </P>
                <P>16. The real estate brokerage business is local in nature. Most sellers prefer to work  with a broker who is familiar with local market conditions. Likewise, most buyers seek to purchase property in a particular city, community, or neighborhood, and typically prefer to work with a broker who has knowledge of the area in which they have an interest. Both home buyers and home sellers desire a residential real estate broker who is a member of the MLS that serves the area in which they are purchasing or selling a home. Even though the Hilton Head MLS's service area encompasses neighboring counties as well as Hilton Head Island, nearly 85 percent of the properties listed—as measured by dollar volume of closed transactions—in the database are located on Hilton Head Island. In the event of a small but significant increase in the price of brokerage services relating to properties located on Hilton Head Island, the number of buyers and sellers who would switch to brokerage services relating to properties located elsewhere would not be sufficient to make such a price increase unprofitable. Therefore, for purposes of this complaint, Hilton Head Island constitutes the relevant geographic market, within the meaning of the antitrust laws. </P>
                <HD SOURCE="HD1">Background Of The Offense </HD>
                <HD SOURCE="HD2">Industry Background and MLS Market Power </HD>
                <P>17. Most prospective home sellers and buyers engage the services of a broker to purchase and sell homes. Real estate brokers formed the Hilton Head MLS to facilitate the provision of real estate brokerage services to such buyers and sellers. </P>
                <P>18. The Hilton Head MLS pools and disseminates information on almost every property available for sale on Hilton Head Island. It combines its members' property listings information into an electronic database and makes this data available to all brokers who are members of the MLS. By listing information on a home in the MLS, a broker can market it to a large number of potential buyers. A broker representing a buyer likewise can search the MLS to provide a home buyer with information about nearly all the listed properties in the area that match the buyer's housing needs. </P>
                <P>19. Members of the Hilton Head MLS utilize the database as a clearinghouse to, among other things: communicate the listings information of the properties that they have for sale to other members; offer to compensate other members as cooperating brokers if they locate purchasers for those listings; locate properties for prospective purchasers; distribute listings to other members for advertisement purposes; and compile and distribute market statistics. </P>
                <P>20. The Hilton Head MLS also maintains records of sold homes. These “sold data” records are very important for brokers working with sellers to set an optimum sales price. Brokers representing a buyer likewise use the sold data to help buyers determine what price to offer for a home. </P>
                <P>
                    21. Access to the database provided by the Hilton Head MLS is critical for 
                    <PRTPAGE P="66190"/>
                    brokers who wish to serve buyers or sellers successfully on Hilton Head Island. By virtue of marketwide participation and control over a critically important input, the Hilton Head MLS has market power. 
                </P>
                <HD SOURCE="HD2">Growth of Alternative Business Models</HD>
                <P>22. The prices consumers paid to brokers for the brokerage services associated with a typical home sales transaction have increased substantially since 2003 on Hilton Head Island and in many other parts of the country. This is because brokers who adhere to traditional methods of doing business typically charge a fee calculated as a percentage of the sales price of the home, and that percentage has tended to be relatively inflexible as housing prices on Hilton Head Island and in many other parts of the country have increased dramatically. As a result of these higher prices, brokers offering competitively significant alternatives to traditional methods have emerged in other areas of the country. </P>
                <P>
                    23. 
                    <E T="03">Technology-Savvy Brokers.</E>
                     Some brokers in other parts of the United States use technology to automate certain tasks and to communicate more efficiently with consumers. For example, technology enables brokers to contact, communicate with, and service consumers remotely or in-person without the need for a retail office location that consumers can visit. Such technology-savvy brokers can reduce brokerage costs by operating fewer or no physical offices, and may pass cost savings on to consumers through reduced brokerage fees. 
                </P>
                <P>
                    24. 
                    <E T="03">Fee-for-Service Brokers.</E>
                     Other brokers around the country now contract with buyers and sellers to provide a subset of services for a flat fee rather than for a percentage of the home sale price. Fee-for-service brokers provide certain enumerated services such as marketing the house or attending closings, while the buyer or seller takes responsibility for other services associated with brokerages such as making offers and counteroffers or conducting open houses on their own. Through fee-for-service packages, buyers and sellers can save money by purchasing only the services that they wish for their broker to provide. 
                </P>
                <P>
                    25. 
                    <E T="03">Price Discounters and Publicly-owned Brokerages.</E>
                     Brokers in other areas of the country have attracted customers by offering full-service, reduced commission brokerage services. Additionally, brokers in other areas of the country have sought competitive advantage by creating nationwide firms. These firms raise capital through public ownership, invest in nationwide brands and provide brokerage services to consumers in multiple markets. 
                </P>
                <P>26. These types of brokerage models have not emerged on Hilton Head Island due to Defendant's rules. As a result, the prices that consumers pay for brokerage services are higher on Hilton Head Island than in other areas of the country. </P>
                <HD SOURCE="HD1">Restraints on Competition </HD>
                <P>27. Defendant's rules and practices have harmed competition in a variety of ways. As a result of Defendant's rules, consumers of residential real estate brokerage services on Hilton Head Island have fewer choices among types of brokers and pay higher fees for those services than consumers in other areas of the country. Defendant's rules and practices are not reasonably necessary to achieve the procompetitive benefits of the MLS. Instead, the rules at issue here unreasonably: (1) Raise entry barriers for potential competitors by imposing burdensome prerequisites for membership; (2) provide a means of identifying potentially aggressive competitors so they can be excluded from membership; (3) stabilize the price of brokerage services through the prospect of price controls; (4) deter the emergence of Internet-based brokerages; (5) stabilize the price of, and reduce consumer options for, brokerage services by dictating the services that all brokers must provide; and (6) discourage entry of potential competitors who raise funds through public ownership. </P>
                <P>28. Defendant's rules achieve these adverse effects by requiring that broker-members: (1) Maintain a physical office within the Hilton Head MLS service area; (2) reside within the area served by the Hilton Head MLS; (3) operate their offices during hours deemed reasonable by the Hilton Head MLS; and (4) hold a South Carolina real estate license as their primary license. (Bylaw Article II, Section II; Bylaw Article VII; &amp; Rule II.) These rules allow Defendant to deny membership to brokers who operate business models that would increase competition. For example, these rules enable Defendant to exclude technology-savvy brokers who serve their clients without a physical office and who can pass along the cost savings to consumers through reduced commission rates. These rules also deprive consumers of the benefits of competition from brokers who work part-time or who are licensed under reciprocity provisions of South Carolina law. </P>
                <P>
                    29. Defendant's rules have enabled it to identify applicants who could be aggressive competitors and deny their application for membership. Broker-applicants are required to disclose their business history and prior employment, undergo a credit check, and obtain letters of recommendation from three current broker-members, 
                    <E T="03">i.e.</E>
                    , those with whom the applicant would compete. (Bylaw Article VII, Section IV; Bylaw Article VII, Section IV(a); Rule II.A.2.) These rules have allowed unreasonable denials of membership and thus deprived consumers of the benefits of competition. 
                </P>
                <P>30. Defendant has authorized its Board of Trustees to adopt mandatory guidelines that would regulate the commission that listing brokers offer to selling brokers in exchange for their cooperation on the home sale. (Bylaw Article XI, Section I.) The mere prospect that the Board might adopt such controls likely inhibits price competition. Their actual adoption would directly fix and stabilize prices. </P>
                <P>31. Defendant has a rule that requires its members to provide certain services to all brokerage customers, whether or not desired by the customer. (Bylaw Article X; MLS Listing Agreement.) Embodied in the terms of Defendant's mandatory form listing agreement, this rule prevents current and prospective members from operating a fee-for-service business model. This rule decreases competition and harms consumers because it insulates Defendant's members from the competitive pressures posed by brokers who would offer additional pricing and service choices to their customers. </P>
                <P>32. Defendant has authorized its Board of Trustees to impose discriminatory requirements on Internet-based real estate brokers. (Bylaw Article II, Section II.) The mere prospect that the Board might adopt such controls likely deters Hilton Head brokers from developing that business mode! and thereby inhibits such service competition. Such requirements, if implemented, would competitively disadvantage Internet-based brokers and discourage them from joining the MLS and competing on Hilton Head Island, thereby limiting consumer choice. </P>
                <P>33. Defendant has a “change in ownership” rule that requires publicly-held brokerages to make a significant payment to the Defendant every time a share of their stock changes hands. (Bylaw Article VII, Section X; Rules II.A.3; II.B &amp; II.E.) This rule competitively disadvantages publicly-owned companies and discourages them from joining the MLS and competing on Hilton Head Island, thereby limiting consumer choice. </P>
                <P>
                    34. Taken together, Defendant's rules discourage competition on price and service, and inhibit competitive actions 
                    <PRTPAGE P="66191"/>
                    that would alter the status quo. As a result of Defendant's anticompetitive rules, consumers of brokerage services on Hilton Head Island have fewer choices of service options and pay higher prices for real estate brokerage services than do consumers in other parts of the country. 
                </P>
                <HD SOURCE="HD1">Violations Alleged </HD>
                <P>35. Defendant's above-referenced rules and practices constitute a contract, combination, or conspiracy by competitors with market power that unreasonably restrains competition on Hilton Head Island in violation of section I of the Sherman Act, 15 U.S.C. 1. Defendant's rules and practices are not reasonably necessary to carry out the procompetitive purposes of a multiple listing service. </P>
                <P>36. The aforesaid contract, combination, or conspiracy has had and will continue to have unreasonable anticompetitive effects in the relevant market, including: </P>
                <P>a. stabilizing and raising prices for real estate brokerage services; </P>
                <P>b. reducing competition on price and quality for real estate brokerage services; </P>
                <P>c. impeding innovation in the provision of real estate brokerage services; </P>
                <P>d. preventing consumers from choosing fee-for-service brokerage models; and </P>
                <P>e. creating barriers to entry into the provision of real estate brokerage services. </P>
                <HD SOURCE="HD1">Request for Relief </HD>
                <P>
                    <E T="03">Wherefore,</E>
                     the United States prays that final judgment be entered against Defendant declaring, ordering, and adjudging: 
                </P>
                <P>a. That the aforesaid contract, combination, or conspiracy unreasonably restrains trade and is illegal under Section 1 of the Sherman Act, 15 U.S.C. 1; </P>
                <P>b. That the Defendant, its officers, directors, agents, employees, successors, and assigns and all other persons acting or claiming to act on their behalf, be permanently enjoined from engaging in, carrying out, renewing or attempting to engage in, carry out or renew the combination and conspiracy alleged herein, or any other combination or conspiracy having a similar purpose or effect in violation of section 1 of the Sherman Act, 15 U.S.C. 1; and </P>
                <P>c. That the Court grant such other relief as the United States may request and the Court deems just and proper.</P>
                <EXTRACT>
                    <P>Dated: October 16, 2007.</P>
                    <FP SOURCE="FP-1">For Plaintiff United States of America.</FP>
                    <FP>Thomas O. Barnett, </FP>
                    <FP SOURCE="FP-1">
                        <E T="03">Assistant Attorney General.</E>
                    </FP>
                    <FP>David L. Meyer,</FP>
                    <FP SOURCE="FP-1">
                        <E T="03">Deputy Assistant Attorney General.</E>
                    </FP>
                    <FP>J. Robert Kramer II, </FP>
                    <FP SOURCE="FP-1">
                        <E T="03">Director of Operations.</E>
                    </FP>
                    <FP>John Read, </FP>
                    <FP SOURCE="FP-1">
                        <E T="03">Chief, Litigation III Section.</E>
                    </FP>
                    <FP>Nina Hale, </FP>
                    <FP SOURCE="FP-1">
                        <E T="03">Assistant Chief, Litigation III Section.</E>
                    </FP>
                    <FP>Lisa A. Scanlon, Owen M. Kendler, Christopher M. Ries, </FP>
                    <FP SOURCE="FP-1">
                        <E T="03">Attorneys for the United States of America, U.S. Department of Justice, Antitrust Division, 325 7th Street, N.W., Suite 300, Washington, DC 20530, Telephone: (202) 616-5954, Facsimile: (202) 514-7308.</E>
                    </FP>
                    <P>Respectfully submitted,</P>
                    <FP>Reginald I. Lloyd, </FP>
                    <FP SOURCE="FP-1">
                        <E T="03">United States Attorney.</E>
                    </FP>
                    <P>By:</P>
                    <FP>Barbara M. Bowens (I.D. 4004), </FP>
                    <FP SOURCE="FP-1">
                        <E T="03">Assistant United States Attorney, 1441 Main Street, Suit 500, Columbia, South Carolina 29201.</E>
                    </FP>
                </EXTRACT>
                <HD SOURCE="HD1">United States District Court for the District of South Carolina; </HD>
                <HD SOURCE="HD2">United States of America, Plaintiff, v. Multiple Listing Service of Hilton Head Island, Inc., Defendant </HD>
                <HD SOURCE="HD1">Proposed Final Judgment </HD>
                <P>
                    <E T="03">Whereas,</E>
                     Plaintiff, United States of America, filed its Complaint on October 16, 2007, and Plaintiff and Defendant, Multiple Listing Service of Hilton Head Island, Inc., by their respective attorneys, have consented to the entry of this Final Judgment (the “Final Judgment”) without trial or adjudication of any issue of fact or law, and this Final Judgment shall not be evidence against or an admission by any party regarding any issue of fact or law; 
                </P>
                <P>
                    <E T="03">And Whereas,</E>
                     Defendant is a multiple listing service among competing real estate brokerages, organized as a not-for-profit corporation under the laws of South Carolina, and maintains its principal place of business in Hilton Head Island, South Carolina; 
                </P>
                <P>
                    <E T="03">And Whereas,</E>
                     Defendant agrees to be bound by the provisions of this Final Judgment pending its approval by the Court; 
                </P>
                <P>
                    <E T="03">And Whereas,</E>
                     Defendant agrees to take certain actions for the purpose of remedying the loss of competition alleged in the Complaint; 
                </P>
                <P>
                    <E T="03">And Whereas,</E>
                     Defendant has represented to the United States that the actions required below can and will be made and that Defendant will later raise no claim of hardship or difficulty as grounds for asking the Court to modify any of the provisions contained below; 
                </P>
                <P>
                    <E T="03">Now Therefore,</E>
                     before any testimony is taken, without trial or adjudication of any issue of fact or law, and upon consent of the parties, it is 
                    <E T="03">Ordered, adjudged, and decreed:</E>
                </P>
                <HD SOURCE="HD1">I. Jurisdiction </HD>
                <P>This Court has jurisdiction over the subject matter of and each of the parties to this action. The Complaint states a claim upon which relief may be granted against Defendant under section 1 of the Sherman Act, as amended, 15 U.S.C. 1. </P>
                <HD SOURCE="HD1">II. Definitions </HD>
                <P>As used in this Final Judgment: </P>
                <P>A “Defendant” means the Multiple Listing Service of Hilton Head Island, Inc., its successors and assigns, and its members, officers, managers, committees, and employees. </P>
                <P>B. “Affiliate Member” means any member of the Defendant that is engaged in banking, mortgage lending, mortgage brokering, and similarly related fields. </P>
                <P>C. “Associate Member” means: (1) A member of the Defendant who is an ‘associated licensee' as the term is defined in S.C. Code Ann. § 40-57-30 (2005) or any recodification thereof; and (2) a Licensee who associates with a Full Member or a Broker-in-Charge of a Full Member. </P>
                <P>D. “Applicant” means a person who applies for full, associate, or affiliate membership in the Multiple Listing Service of Hilton Head Island. </P>
                <P>E. “Appraiser” means any person who is licensed under Title 40 Chapter 60 of the South Carolina Revised Statutes or any future recode fication thereof and legally can perform real estate appraisal. </P>
                <P>F. “Appraisal Firm” means a firm owned by or employing an Appraiser. </P>
                <P>G. “Broker-in-Charge” means: (1) A “broker-in-charge” as the term is defined in S.C. Code Ann. § 40-57-30 (2005) or any recodification thereof; or (2) any licensed broker who is designated as having responsibility over the actions of all its associated licensees and is affiliated with a Full Member. </P>
                <P>H. “Buyer's Representation Agreement” means the contract between a Licensee and Client or any other person who is a prospective home buyer. </P>
                <P>I. “Client” means a person with whom a Licensee has established an agency relationship. </P>
                <P>
                    J. “Compensation” means: (1) Any commission or fee charged by, or rebate offered by, a Licensee to a Client or any person who is a prospective home buyer or seller; (2) any commission or payment offered to other Licensees in exchange for cooperation on a property transaction; or (3) any commission, salary, or fee exchanged between a Full Member and its affiliated or employed Licensees. 
                    <PRTPAGE P="66192"/>
                </P>
                <P>K. “Full Member” means any member of the MLS that is a real estate brokerage firm having a Broker-in-Charge or an Appraisal firm. </P>
                <P>L. “Licensee” means: (1) Any person who is licensed under Title 40 Chapter 57 of the South Carolina Code Annotated or any future recodification thereof; (2) any person who legally can perform acts of real estate brokerage; or (3) any person who legally can perform acts of real estate brokerage while acting under the supervision of a licensed broker. </P>
                <P>M. “Listing Agreement” means the contract between a Licensee and Client or any other person who is a prospective home seller. </P>
                <P>N.  “Member MLS Database Access” means the security measures, such as a login-id and password or key token, needed to access the complete MLS database provided by Defendant to Full, Associate or Affiliate Members. Member MLS Database Access does not mean or encompass any login-id or password that a Full or Associate Member establishes for, or grants to, its customers or clients either to access the broker's website or to access listings content provided on the broker's website. </P>
                <P>
                    O. “Method of Service” means the time, place, or manner in which a Licensee provides brokerage services to Clients or any other person who is a prospective home buyer or seller, subject to state and federal law (
                    <E T="03">e.g.</E>
                    , office hours, the method by which the Licensee markets properties for sale, and the method by which the Licensee provides listings information to Clients or any other person who is a prospective home buyer or seller). 
                </P>
                <P>P.  “MLS” means any multiple listing service owned or operated by Multiple Listing  Service of Hilton Head Island, Inc. </P>
                <P>Q.  “MLS Listing” means any listing in which:</P>
                <EXTRACT>
                    <P>1. The Client or any other person who is a prospective home seller grants the Licensee the sole right to make an offer of compensation to cooperating brokers; and </P>
                    <P>2. The Licensee makes an offer of compensation to other cooperating Full or Associate Members.</P>
                </EXTRACT>
                <P>R. “MLS Service Area” means the geographic area from which listings are placed in the MLS by Full or Associate Members. </P>
                <P>S.  “Office Exclusive” means a listing in which the owner refuses to grant permission for distribution of the listing to the MLS. </P>
                <P>T.  “Real Estate Brokerage Firm” means a firm owned by or employing a Broker-in-Charge. </P>
                <P>U. “Scope of Service” means the set of specific brokerage services a Licensee has agreed it will provide to a Client or such other person who is a prospective home buyer or seller as well as the set of specific services that a Licensee will allow a Client or any other person who is prospective home buyer or seller to perform herself or himself (whether or not the licensee offers to provide such services). The Scope of Service may be set forth in a Listing Agreement, Buyers Representation Agreement, or other agreement between a Licensee and a Client or any other person who is a prospective home buyer or seller. </P>
                <P>V. “Trustees” means the Trustees elected by the Full Members of Defendant. </P>
                <HD SOURCE="HD1">III. Applicability </HD>
                <P>This Final Judgment applies to the Defendant and all other persons in active concert or participation with it who receive actual notice of this Final Judgment by personal service or otherwise. </P>
                <HD SOURCE="HD1">IV. Prohibited Conduct </HD>
                <P>A. Subject to the provisions of paragraph VI, Defendant is enjoined and restrained from adopting or enforcing any bylaw, rule, regulation, policy, or practice that has the purpose or effect of excluding:</P>
                <EXTRACT>
                    <P>1. from full membership any Real Estate Brokerage Firm that has a broker-in-charge holding an active real estate broker license issued by the appropriate State of South Carolina governmental licensing authority or any Appraisal Firm owned by or employing at least one person with an active appraiser license issued by the appropriate State of South Carolina governmental licensing authority; or </P>
                    <P>2. from associate membership any Licensee who holds an active real estate broker, agent, or salesman license issued by the appropriate State of South Carolina governmental licensing authority.</P>
                </EXTRACT>
                <P>B. Subject to the provisions of paragraph VI, Defendant is enjoined and restrained from adopting or enforcing any bylaw, rule, regulation, policy, or practice that has the purpose or effect of: </P>
                <EXTRACT>
                    <P>1. failing to make available or furnish on like terms to any Full Member any and all services that Defendant now or hereafter makes available or furnishes to any of its Full Members; </P>
                    <P>2. failing to make available or furnish on like terms to any Associate Member any and all services that Defendant now or hereafter makes available or furnishes to any of its Associate Members; </P>
                    <P>3. failing to make available or furnish on like terms to any member who is an Appraiser any and all services that Defendant now or hereafter makes available or furnishes to any of its members who are Appraisers; </P>
                    <P>4. discriminating against, disfavoring, disciplining, or expelling any Full or Associate Member based on its office location, corporate structure, level or type of Compensation, Scope of Service, or Method of Service; </P>
                    <P>5. requiring any Full or Associate Member to perform brokerage services in excess of those required by South Carolina law; </P>
                    <P>6. prescribing the terms of Listing Agreements, Buyer's Representation Agreements, or any other agreement between a Full or Associate Member and any Client or any other person who is a prospective home buyer or seller; </P>
                    <P>7. refusing to accept or place in the MLS any MLS Listing submitted by a Full or Associate Member; </P>
                    <P>8. prescribing, recommending, setting standards, or guidelines concerning Compensation; </P>
                    <P>9. requiring an Applicant or a Full Member to inform Defendant of the ownership interests that others have in such Applicant or Full Member or charging a fee for a change in ownership; </P>
                    <P>10. requiring any Full or Associate Member, Appraiser or Trustee to reside or have an office in the MLS Service Area or any particular area or location; or </P>
                    <P>11. changing its three classes of membership (Full, Associate, and Affiliate) without the prior approval of the Department of Justice. </P>
                </EXTRACT>
                <HD SOURCE="HD1">V. Required Conduct </HD>
                <P>A. Defendant is required to accept all Applicants into the Applicant's corresponding membership class (Full, Associate, or Affiliate) as follows:</P>
                <EXTRACT>
                    <P>1. any Real Estate Brokerage Firm that has a Broker-in-Charge who holds an active real estate broker license issued by the appropriate State of South Carolina governmental licensing authority shall be granted Full Membership; </P>
                    <P>2. any Licensee who holds an active real estate broker, agent, or salesman license issued by the appropriate State of South Carolina governmental licensing authority shall be granted Associate Membership; and </P>
                    <P>3. any Appraisal Firm with an owner or employee holding an active appraiser license issued by the appropriate State of South Carolina governmental licensing authority shall be granted Full Membership. </P>
                </EXTRACT>
                <P>B.  Defendant is ordered to delete from its Bylaws and Rules and suspend enforcement of: </P>
                <EXTRACT>
                    <P>1. The language in Bylaw Article II, Section II stating: </P>
                    <P>
                        “Any realty or appraisal firm whose Broker in Charge or Head Appraiser applies for membership and which is owned as a subsidiary or affiliate of a realty firm which has its headquarters a state other than South Carolina must comply with the following additional regulations: * * * (2) it must have an office located within the Multiple Listing Service area (Beaufort, Jasper, Allendale, Bamberg, Barnwell, Colleton, Hampton and Orangeburg counties); (3) the broker in charge or head appraiser of such realty or appraisal  must be a resident of the Multiple 
                        <PRTPAGE P="66193"/>
                        Listing Service area (Beaufort, Jasper, Allendale, Bamberg, Barnwell, Colleton, Hampton and Orangeburg counties); and (4) all licensees of the realty firm or appraisal firm must hold their South Carolina license as their primary license.” 
                    </P>
                    <P>2. The language in Bylaw Article V, Section I stating:</P>
                    <P>“The Board of Trustees of MLS shall consist of persons who are residents of the counties served by MLS, including Beaufort, Jasper, Allendale, Bamberg, Barnwell, Colleton, Hampton and Orangeburg, South Carolina,” </P>
                    <P>3. The language in Bylaw Article VII, Section II stating: </P>
                    <P>i. “and shall consist of the brokers-in charge or Head appraiser of realty and appraisal firms who qualify for membership based upon the following criteria: (a) the firm has established and maintained a specific place of business in any of the following counties served by MLS: Beaufort, Jasper, Allendale, Bamberg, Barnwell, Colleton, Hampton and Orangeburg, which office is available to the public during reasonable business hours;” and </P>
                    <P>ii. “Membership of internet only members are subject to restrictions set by the Board of Trustees.” </P>
                    <P>4. The language in Bylaw Article VII, Section ill stating:</P>
                    <P>“which: (a) Have established and maintained a specific place of business within the Multiple Listing Service Area (which includes Beaufort, Jasper, Allendale, Bamberg, Barnwell, Colleton, Hampton and Orangeburg counties) that is available to the public during reasonable business hours;” </P>
                    <P>5. The language in Bylaw Article VII, Section IV stating: </P>
                    <P>i. “to obtain or make credit checks or”; and </P>
                    <P>ii. “and applications may require that the applicant supply various information and recommendations, including but not limited to: </P>
                    <P>(a) Three (3) separate character references from three (3) presently qualified Full Members; and </P>
                    <P>(b) In the case of Full Members, a history of business experience and employment information concerning all persons, including all partners and shareholders, who have any ownership interest in the applicant. Any such party acquiring an ownership interest of any kind after acceptance of the realty firm as a Full Member must submit all information required by this Section within ten (10) days after acquisition of the ownership interest and must be approved by the Board of Trustees.” </P>
                    <P>6. The Bylaw Article VII, Section X stating: </P>
                    <P>“In the event of any change of ownership of a member firm as determined by the Board of Trustees in accordance with the provisions of the Rules and Regulations, the Board of Trustees, at its option, may terminate the membership of such firm and require the firm to reapply for membership and pay the then current initiations fees in MLS as if said firm had never been a member of MLS.” </P>
                    <P>7. The language in Bylaw Article XI, Section I stating: </P>
                    <P>“The listing Full Member shall specify a commission split or other compensation which would be reasonably expected to encourage cooperation by other Full Members. It is to the advantage of the listing Full Member, and, consequently the owner, to establish compensation which will encourage other MLS Full Members to devote time and energy to the sale of the owner's listing with the expectation of reasonable compensation for the member's efforts. The Board of Trustees may adopt compensation guidelines that it deems sufficient to encourage such devotion of time and energy. Any Full Member which the Board of Trustees, in its sole discretion, believes is consistently establishing compensation which would discourage the intended cooperation by other Full Members may have its membership terminated by a majority vote of the Board of Trustees.” </P>
                    <P>8. The language in Rules and Regulations Section II, stating: </P>
                    <P>i. “A.1.c. Establish and maintain a specific place of business in Beaufort, Jasper, Allendale, Bamberg, Barnwell, Colleton, Hampton, Orangeburg Counties, which is available to the public.”; </P>
                    <P>ii. “A.2.c. Submit letters of recommendation from the Broker-In-Charge/Head Appraiser of three (3) firms who are members in good standing with the MLS of Hilton Head Island, Inc.”; </P>
                    <P>iii. “A.2.g. Submit statement of Residence of Owners and Broker-In-Charge/Head Appraiser”; </P>
                    <P>iv. “A.2.h. (2) address of the New Firm's office located within the Multiple Listing Service area (Beaufort, Jasper, Allendale, Bamberg, Barnwell, Colleton, Hampton, [and] Orangeburg Counties); (3) the address of the Broker-In-Charge/Head Appraiser to confirm that he/she is a resident of the Multiple Listing Service area; and (4) confirmation that all licensees of the New Firm hold their South Carolina licenses as their primary license and are residences of the aforementioned area”; and </P>
                    <P>
                        v. “B. Board of Trustees must be notified of any ownership changes within 10 days of said change and all changes of ownership fees paid. Notification must be in writing and signed by the BIC/Head Appraiser. A new Membership Agreement and Principals Audit must be fully executed and signed by the BIC/Head Appraiser and submitted to the MLS office along with notification. (Forms may be obtained on the MLS website 
                        <E T="03">www.hiltonheadmls.com</E>
                         and selecting Members Only.)” 
                    </P>
                    <P>9. The language in Rules and Regulations Section IT, Subsection E referring to principals. </P>
                    <P>10. The language in Rules and Regulations Section VI, Subsection 2 stating:</P>
                    <P>“Only MLS Exclusive Right to Sell Listing Agreements are accepted.”</P>
                </EXTRACT>
                <P>C. Defendant is ordered to delete the term “Exclusive Agency” in Rules and Regulations Section VI, Subsection 7 and replace it with “Office Exclusive.” </P>
                <HD SOURCE="HD1">VI. PERMITTED CONDUCT </HD>
                <P>Notwithstanding the above, nothing shall prohibit Defendant from: </P>
                <P>A. Requiring Applicants or Full, Associate, or Affiliate Members to pay:</P>
                <EXTRACT>
                    <P>1. A fee equal to the reasonable set-up costs of preparing to make Defendant's services available to the Applicant, Full, Associate, or Affiliate Member; </P>
                    <P>2. A reasonable security deposit, to secure against any unpaid claims or charges that may be asserted by Defendant against the Applicant, Full, Associate, or Affiliate Member; and </P>
                    <P>3. Fees for use of Defendant's services that are non-discriminatory and reflect the reasonable expenses of Defendant's operations.</P>
                </EXTRACT>
                <P>B. Adopting or enforcing any bylaw, rule, regulation, policy practice, or agreement that is required for the MLS not to violate South Carolina law. </P>
                <P>C. Publishing or making available illustrative Listing Agreements, Buyer's Representation Agreements, and any other written agreements, or contracts that Full or Associate Members may choose to use or modify, provided any such agreements leave blank the Compensation terms. </P>
                <P>D. Adopting or enforcing any bylaw, rule, regulation, policy, practice, or agreement that prohibits Full, Associate, or Affiliate Members from enabling a third party to make use of its Member MLS Database Access. </P>
                <P>E. Requiring a Full Member to notify the MLS of a change in or departure of its Broker-in-Charge, or the departure of any Associate Member. </P>
                <P>F. Requiring a Full Member to provide the MLS with the name of a designated contact person to whom the MLS may direct correspondence and inquiries. </P>
                <HD SOURCE="HD1">VII. COMPLIANCE AND INSPECTION </HD>
                <P>
                    A. Within sixty (60) days after the date of entry of this Final Judgment, Defendant shall: (J) provide each of its members, trustees, and employees with notice of the amendments to its bylaws, rules, regulations and policies to conform to the provisions of this Order; (2) provide each of its members, trustees, and employees with a copy of this Order via its member-only Internet page; (3) inform all persons who are known to have inquired about membership in the last two years but who are not members of the amendments to its bylaws, rules, regulations and policies to conform to the provisions of this Order; (4) inform all persons under subsection (3) that they may apply or reapply for membership and that Defendant will grant membership if the applicant meets the requirements of the bylaws, rules, regulations and policies as revised by this Order; and (5) place on its home page of its publicly accessible web site (currently 
                    <E T="03">http://www.hiltonheadmls.com</E>
                    ) a notice of the Final Judgment with a link to the Final Judgment. 
                    <PRTPAGE P="66194"/>
                </P>
                <P>B. For the purposes of determining or securing compliance with this Final Judgment, or of determining whether the Final Judgment should be modified or vacated, and subject to any legally recognized privilege, from time to time duly authorized representatives of the United States Department of Justice, including consultants and other persons retained by the United States, shall, upon written request of a duly authorized representative of the Assistant Attorney General in charge of the Antitrust Division, and on reasonable notice to Defendant, be permitted:</P>
                <EXTRACT>
                    <P>1. access during Defendant's office hours to inspect and copy, or at Plaintiffs option, to require Defendant to provide copies of, all books, ledgers, accounts, records and documents in the Defendant's possession, custody, or control, relating to any matters contained in this Final Judgment; and </P>
                    <P>2. to interview, either informally or on the record, Defendant's trustees, officers, employees, or agents, who may have their individual counsel present, regarding such matters. The interviews shall be subject to the reasonable convenience of the interviewee and without restraint or interference by Defendant.</P>
                </EXTRACT>
                <P>C. Upon the written request of a duly authorized representative of the Assistant Attorney General in charge of the Antitrust Division, for the purposes of determining or securing compliance with this Final Judgment, or of determining whether the Final Judgment should be modified or vacated, and subject to any legally recognized privilege, Defendant shall submit written reports or interrogatory responses, under oath if requested, relating to any of the matters contained in this Final Judgment as may be requested. </P>
                <P>D. No information or documents obtained by the means provided in this section shall be divulged by the United States to any person other than an authorized representative of the executive branch of the United States, except in the course of legal proceedings to which the United States is a party (including grand jury proceedings), or for the purpose of securing compliance with this Final Judgment, or as required by law.</P>
                <HD SOURCE="HD1">VIII. Retention Of Jurisdiction </HD>
                <P>This Court retains jurisdiction to enable any party to this Final Judgment to apply to this Court at any time for further orders and directions as may be necessary or appropriate to carry out or construe this Final Judgment, to modify any of its provisions, to extend the duration of the Final Judgment, to enforce compliance, and to punish violations of its provisions. </P>
                <HD SOURCE="HD1">IX. Expiration Of Final Judgment </HD>
                <P>This Final Judgment will expire ten (10) years from the date of its entry. </P>
                <HD SOURCE="HD1">X. Notice </HD>
                <P>For purposes of this Final Judgment, any notice or other communication shall be given to the person at the address set forth below (or such other addresses as the recipient may specify in writing): John R. Read, Chief, Litigation III Section, U.S. Department of Justice, Antitrust Division, 325 Seventh Street, NW., Suite 300, Washington, DC 20530. </P>
                <HD SOURCE="HD1">XI. Public Interest Determination </HD>
                <P>Entry of this Final Judgment is in the public interest. </P>
                <EXTRACT>
                    <P>Date: </P>
                    <FP SOURCE="FP-DASH"/>
                    <FP>Court approval subject to procedures of Antitrust Procedures and Penalties Act, 15 U.S.C. 16</FP>
                    <FP SOURCE="FP-DASH"/>
                    <FP>United States District Judge. </FP>
                </EXTRACT>
                <HD SOURCE="HD1">United States District Court for the District of South Carolina Beaufort Division; </HD>
                <HD SOURCE="HD2">United States of America, Plaintiff, v. Multiple Listing Service of Hilton Head Island, Inc, Defendant </HD>
                <P>Civil Action No. 9:07-CY-3435-SB </P>
                <P>Filed: 10/16/2007 </P>
                <HD SOURCE="HD1">Competitive Impact Statement </HD>
                <P>Plaintiff United States of America (“United States”), pursuant to section 2(b) of the Antitrust Procedures and Penalties Act (“APPA” or “Tunney Act”), 15 U.S.C 16(b)-(h), files this Competitive Impact Statement relating to the proposed Final Judgment submitted for entry in this civil antitrust proceeding. </P>
                <HD SOURCE="HD1">I. Nature and Purpose of the Proceedings </HD>
                <P>On October _, 2007, the United States filed a civil antitrust complaint alleging that Defendant Multiple Listing Service of Hilton Head Island, Inc. (“Hilton Head MLS”) violated Section 1 of the Sherman Act, 15 U.S.C. 1, by enforcing certain rules that unreasonably restrain competition among real estate brokers in the Hilton Head, South Carolina area. Defendant is a multiple listing service, which is controlled by its members who are real estate brokers competing to sell brokerage services to consumers in the Hilton Head area. As explained more fully below, brokers seeking to provide brokerage services in the Hilton Head area need to be members of the Hilton Head MLS. </P>
                <P>In its Complaint, the United States alleges that the Defendant, by its rules, denies membership to brokers who would likely compete aggressively on price or would introduce Internet-based brokerage, and imposes unreasonable membership costs on publicly-owned brokerage companies. Defendant's rules also stabilize prices by forcing member brokers to provide a certain set of brokerage services, whether or not the consumer desires to purchase those services. The United States also alleges that the Defendant has authorized its Board of Trustees to adopt rules that would regulate commissions and impose discriminatory requirements on Internet-based brokers. </P>
                <P>At the same time the Complaint was filed, the United States filed a Stipulation and proposed Final Judgment, which are designed to eliminate the anticompetitive effects of the acquisition. The proposed Final Judgment, which is explained more fully below, requires the Defendant to rescind certain of its rules. The proposed Final Judgment also prohibits Defendant from adopting new rules that have the effect of excluding real estate brokers from membership based on such criteria as their business model, price structure, or office location. The proposed Final Judgment further prohibits Defendant from adopting new rules that would dictate the services and prices that its members must offer to their clients. </P>
                <P>The Stipulation and proposed Order require Hilton Head MLS to take the actions required under the proposed Final Judgment. The United States and Hilton Head MLS have also stipulated that the proposed Final Judgment may be entered after compliance with the APPA, unless the United States withdraws its consent. Entry of the proposed Final Judgment would terminate this action, except that this Court would retain jurisdiction to construe, modify, and enforce the proposed Final Judgment and to punish violations thereof. </P>
                <HD SOURCE="HD1">II. Description of the Events Giving Rise to the Alleged Violation of the Antitrust Laws </HD>
                <HD SOURCE="HD2">A. Description of the Defendant and Its Activities </HD>
                <P>
                    Hilton Head MLS is organized as a not-for-profit corporation under the laws of South Carolina with its principal place of business on Hilton Head Island, Beaufort County, South Carolina. Hilton Head MLS is a joint venture of over one hundred competing licensed brokers and other licensed real 
                    <PRTPAGE P="66195"/>
                    estate professionals doing business in the Hilton Head area.
                    <SU>1</SU>
                    <FTREF/>
                </P>
                <FTNT>
                    <P>
                        <SU>1</SU>
                         The Hilton Head MLS requires that brokerage firms, rather than individual brokers, be members of the MLS. For the purposes of this document, any reference to brokers includes also the brokerage firms with which the broker is associated.
                    </P>
                </FTNT>
                <P>Most prospective home sellers and buyers engage the services of a broker to purchase and sell homes. Real estate brokers formed the Hilton Head MLS to facilitate the provision of real estate brokerage services to such buyers and sellers. The Hilton Head MLS pools and disseminates information on almost every property available for sale on Hilton Head Island. It combines its members' property listings information into an electronic database and makes this data available to all brokers who are members of the MLS. By listing information on a home in the MLS, a broker can market it to a large number of potential buyers. A broker representing a buyer likewise can search the MLS to provide a home buyer with information about nearly all the listed properties in the area that match the buyer's housing needs. </P>
                <P>Members of the Hilton Head MLS utilize the database as a clearinghouse to, among other things: communicate the listings information of the properties that they have for sale to other members; offer to compensate other members as cooperating brokers if they locate purchasers for those listings; locate properties for prospective purchasers; distribute listings to other members for advertisement purposes; and compile and distribute market statistics. The Hilton Head MLS also maintains records of sold homes. These “sold data” records are very important for brokers working with sellers to set an optimum sales price. Brokers representing a buyer likewise use the sold data to help buyers determine what price to offer for a home. </P>
                <P>Access to the database provided by the Hilton Head MLS is critical for brokers who wish to serve buyers or sellers successfully on Hilton Head Island. By virtue of market-wide participation and control over a critically important input, the Hilton Head MLS has market power. </P>
                <HD SOURCE="HD2">Industry Background </HD>
                <P>The prices consumers paid to brokers for the brokerage services associated with a typical home sales transaction have increased substantially since 2003 on Hilton Head Island and in many other parts of the country. This is because brokers who adhere to traditional methods of doing business typically charge a fee calculated as a percentage of the sales price of the home, and that percentage has tended to be relatively inflexible as housing prices on Hilton Head Island and in many other parts of the country have increased dramatically. As a result of these higher prices, brokers offering competitively significant alternatives to traditional methods have emerged in other areas of the country. </P>
                <P>Some brokers in other parts of the United States use technology to automate certain tasks and to communicate more efficiently with consumers. For example, technology enables brokers to contact, communicate with, and service consumers remotely or in-person without the need for a retail office location that consumers can visit. Such technology-savvy brokers can reduce brokerage costs by operating fewer or no physical offices, and may pass cost savings on to consumers through reduced brokerage fees. </P>
                <P>Other brokers around the country now contract with buyers and sellers to provide a subset of services for a flat fee rather than for a percentage of the home sale price. Fee-for-service brokers provide certain enumerated services such as marketing the house or attending closings, while the buyer or seller takes responsibility for other services associated with brokerages such as making offers and counteroffers or conducting open houses on their own. Through fee-for-service packages, buyers and sellers can save money by purchasing only the services that they wish their broker to provide. Brokers in other areas of the country have attracted customers by offering full-service, reduced commission brokerage. Additionally, still other brokers in other areas of the country have sought a competitive advantage by creating nationwide firms. These firms raise capital through public ownership, invest in nationwide brands, and provide brokerage services to consumers in multiple markets. </P>
                <HD SOURCE="HD2">C. Description of the Alleged Violation </HD>
                <P>Defendant Hilton Head MLS, through the collective voting of its broker membership, has adopted and enforced rules and practices that exclude new entry and restrict member output. These rules are not reasonably necessary to carry out the procompetitive purposes of the multiple listing service. As such, these rules are agreements amongst competitors that restrain competition. Accordingly, in its Complaint, the United States alleges that Defendant's rules constitute a contract, combination, or conspiracy by competitors with market power that unreasonably restrains competition on Hilton Head Island in violation of Section I of the Sherman Act, 15 U.S.C. 1. </P>
                <P>Specifically, the Complaint alleges that Defendant has rules and practices that require broker-members to: (1) Maintain a physical office within the Hilton Head MLS service area; (2) reside within the area served by the Hilton Head MLS; (3) operate their offices during hours deemed reasonable by the Hilton Head MLS; and (4) hold a South Carolina real estate license as their primary license. (Bylaw Article II, Section II; Bylaw Article VII; &amp; Rule II.) These rules allow Defendant to deny membership to brokers who operate business models that would increase competition. These rules enable Defendant to exclude technology-savvy brokers who serve their clients without a physical office and who can pass along the cost savings to consumers through reduced commission rates. These rules also deprive consumers of the benefits of competition from brokers who work part-time or who are licensed under reciprocity provisions of South Carolina Law. </P>
                <P>
                    Defendant's rules have also enabled it to identity applicants for MLS membership who could be aggressive competitors and deny their application for membership. Broker-applicants are required to disclose their business history and prior employment, undergo a credit check, and obtain letters of recommendation from three current broker-members, 
                    <E T="03">i.e.,</E>
                     those with whom the applicant would compete. (Bylaw Article VII, Section IV; Bylaw Article VII, Section IV(a); Rule II.A.2.) These rules have allowed unreasonable denials of membership and thus deprived consumers of the benefits of competition. 
                </P>
                <P>
                    Defendant has authorized its Board of Trustees to adopt mandatory guidelines that would regulate the commission that listing brokers offer to selling brokers in exchange for their cooperation on the home sale. (Bylaw Article XI, Section I.) The mere prospect that the Board might adopt such controls likely inhibits price competition. Their actual adoption would directly fix and stabilize prices. Defendant also has a rule that requires its members to provide certain services to all brokerage customers, whether or not desired by the customer. (Bylaw Article X; MLS Listing Agreement.) Embodied in the terms of Defendant's mandatory form listing agreement, this rule prevents current and prospective members from operating a fee-for-service business model. This rule decreases competition and harms consumers because it insulates Defendant's members from the competitive pressures posed by brokers 
                    <PRTPAGE P="66196"/>
                    who would offer additional pricing and service choices to their customers. 
                </P>
                <P>Defendant has also authorized its Board of Trustees to impose discriminatory requirements on Internet-based real estate brokers. (Bylaw Article II, Section II.) Such requirements, if implemented, would competitively disadvantage Internet-based brokers and discourage them from joining the MLS and competing on Hilton Head Island, thereby limiting consumer choice. The mere prospect that the Board might adopt such controls likely deters Hilton Head brokers from developing an Internet-based model and thereby inhibits such service competition. </P>
                <P>In addition, Defendant has a “change in ownership” rule that requires publicly-held brokerages to make a significant payment to the Defendant every time a share of their stock changes hands. (Bylaw Article VII, Section X; Rules II.A.3; IIB &amp; IIE.). This rule competitively disadvantages publicly-owned companies and discourages them from joining the MLS and competing on Hilton Head Island, thereby limiting consumer choice. </P>
                <HD SOURCE="HD2">D. Harm From the Alleged Violation </HD>
                <P>Taken together, Defendant's rules discourage competition on price and service, and inhibit competitive actions that would alter the status quo. Furthermore, there are no plausible justifications that these rules are reasonably necessary to carry out the procompetitive purposes of the multiple listing service. As a result of Defendant's anticompetitive rules, consumers of brokerage services on Hilton Head Island have fewer choices of service options and pay higher prices for real estate brokerage services than do consumers in other parts of the country. </P>
                <P>Data analyzed from a MLS in another area of the country support these allegations. Data have shown an inverse correlation between the share of homes listed by fee-for-service brokers in the area and the level of cooperating commission offered to buyer's brokers for homes in that area. Thus, controlling for other influences, where fee-for-service brokers account for a greater portion of listings in an area, traditional brokers in that area offer lower cooperating commissions, on average, to brokers representing buyers. </P>
                <HD SOURCE="HD1">III. Explanation of the Proposed Amended Final Judgment </HD>
                <P>The proposed Final Judgment will restore the competition that the agreement among the Hilton Head MLS members has eliminated and will prevent Hilton Head MLS from engaging in similar conduct in the future. The proposed Final Judgment will first require Hilton Head MLS to rescind all of the current MLS rules discussed above. Second, the proposed Final Judgment will enjoin Hilton Head MLS from adopting or enforcing any rules that will have a similar purpose or effect. More specifically, the proposed Final Judgment will prevent the Defendant from adopting rules or engaging in practices that (i) exclude active, licensed real estate professionals from their respective membership class in the MLS; (ii) fail to furnish under like terms to any member any services it furnishes to other members in its membership class; (iii) discriminate against any member based on its office location, corporate structure, level or type of compensation, scope of service, or method of service; (iv) require members to perform brokerage services in excess of those required by state law; (v) prescribe the terms of agreements between a member and its clients or any other person who is a prospective home buyer or seller; (vi) refuse to accept and place in the Multiple Listing Service any member's MLS listing; (vii) set standards or guidelines concerning compensation; (viii) charge members a fee for any change in ownership; (ix) require a member to maintain an office or reside in the MLS Service Area or any other particular location; or (x) alter any of its three classes of membership without the prior approval of the Department of Justice. The proposed Final Judgment will also require Hilton Head MLS to provide each of its members, trustees, employees, and agents with a copy of the proposed Final Judgment; inform all persons who inquired about membership in the last two years but who are not members of the MLS of the changes in the MLS rules caused by the proposed Final Judgment; and place on the home page of its publicly accessible website a notice of the proposed Final Judgment with a link to the proposed Final Judgment and the amended rules. </P>
                <HD SOURCE="HD1">IV. Remedies Available to Potential Private Litigants </HD>
                <P>
                    Section 4 of the Clayton Act (15 U.S.C. 15) provides that any person who has been injured as a result of conduct prohibited by the antitrust laws may bring suit in federal court to recover three times the damages the person has suffered, as well as costs and reasonable attorneys' fees. Entry of the proposed Final Judgment will neither impair nor assist the bringing of any private antitrust damage action. Under the provisions of section 5(a) of the Clayton Act (15 U.S.C. 16(a)), the proposed Final Judgment has no 
                    <E T="03">prima facie</E>
                     effect in any subsequent private lawsuit that may be brought against the Defendant. 
                </P>
                <HD SOURCE="HD1">V. Procedures Available for Modification of the Proposed Final Judgment </HD>
                <P>The United States and the Defendant have stipulated that the proposed Final Judgment may be entered by the Court after compliance with the provisions of the APPA, provided that the United States has not withdrawn its consent. The APPA conditions entry upon the Court's determination that the proposed Final Judgment is in the public interest. </P>
                <P>
                    The APPA provides a period of at least sixty (60) days preceding the effective date of the proposed Final Judgment within which any person may submit to the United States written comments regarding the proposed Final Judgment. Any person who wishes to comment should do so within sixty (60) days of the date of publication of this Competitive Impact Statement in the 
                    <E T="04">Federal Register</E>
                    , or the last date of publication in a newspaper of the summary of this Competitive Impact Statement, whichever is later. All comments received during this period will be considered by the United States Department of Justice, which remains free to withdraw its consent to the proposed Final Judgment at any time prior to the Court's entry of judgment. The comments and the response of the United States will be filed with the Court and published in the 
                    <E T="04">Federal Register</E>
                    . 
                </P>
                <P>Written comments should be submitted to: John Read, Chief, Litigation III Section, Antitrust Division, United States Department of Justice, 325 Seventh Street, NW., Suite 300, Washington, DC 20530. </P>
                <P>The proposed Final Judgment provides that the Court retains jurisdiction over this action, and the parties may apply to the Court for any order necessary or appropriate for the modification, interpretation, or enforcement of the Final Judgment. </P>
                <HD SOURCE="HD1">VI. Alternatives to the Proposed Amended Final Judgment </HD>
                <P>
                    The United States considered, as an alternative to the proposed Final Judgment, a full trial on the merits against the Defendant. Given the inherent delays of a full trial and the appeals process, the United States is satisfied that the relief contained in the proposed Final Judgment will quickly establish, preserve, and ensure competition for real estate brokerage services in the Hilton Head MLS Service Area. 
                    <PRTPAGE P="66197"/>
                </P>
                <HD SOURCE="HD1">VII. Standard of Review Under the APPA for Proposed Amended Final Judgment </HD>
                <P>The APPA requires that proposed consent judgments in antitrust cases brought by the United States be subject to a sixty-day comment period, after which the Court shall determine whether entry of the proposed Final Judgment “is in the public interest.” 15 U.S.C. 16(e)(l). In making that determination, the Court, in accordance with amendments to the APPA in 2004, is required to consider: </P>
                <EXTRACT>
                    <P>(A) the competitive impact of such judgment, including termination of alleged violations, provisions for enforcement and modification, duration of relief sought, anticipated effects of alternative remedies actually considered, whether its terms are ambiguous, and any other competitive considerations bearing upon the adequacy of such judgment that the court deems necessary to a determination of whether the consent judgment is in the public interest; and</P>
                    <P>(B) the impact of entry of such judgment upon competition in the relevant market or markets, upon the public generally and individuals alleging specific injury from the violations set forth in the complaint including consideration of the public benefit, if any, to be derived from a determination of the issues at trial.</P>
                </EXTRACT>
                <FP>
                    15 U.S.C. 16(e)(l)(A) &amp; (B); 
                    <E T="03">see generally United States</E>
                     v. 
                    <E T="03">SBC Commc'ns, Inc.</E>
                    , Nos. 05-2102 and 05-2103, 2007 WL 1020746, at *9-16 (D.D.C. Mar. 29, 2007) (assessing public interest standard under APPA and effect of 2004 amendments).
                    <SU>2</SU>
                    <FTREF/>
                     As courts have held—both before and after the 2004 amendments—the United States is entitled to deference in crafting its antitrust settlements, especially with respect to the scope of its complaint and the adequacy of its remedy, which are the “two most significant legal questions” relating to a public interest determination. 
                    <E T="03">United States</E>
                     v. 
                    <E T="03">Microsoft Corp.</E>
                    , 56 F.3d 1448, 1458-62 (D.C. Cir. 1995); 
                    <E T="03">SBC Commc'ns</E>
                    , 2007 WL 1020746, at *12-*16.3.
                    <SU>3</SU>
                    <FTREF/>
                </FP>
                <FTNT>
                    <P>
                        <SU>2</SU>
                         
                        <E T="03">Compare</E>
                         15 U.S.C. 16(e) (2004), 
                        <E T="03">with</E>
                         15 U.S.C. 16(e)(1) (2006) (substituting “shall” for “may” in directing relevant factors for court to consider and amending list of factors to focus on competitive considerations and to address potentially ambiguous judgment terms). The 2004 amendments do not affect the substantial precedent in this and other circuits analyzing the scope and standard of review for APPA proceedings. 
                        <E T="03">See SBC Commc'ns</E>
                        , 2007 WL 1020746, at *9 (“[ A] close reading of the law demonstrates that the 2004 amendments effected minimal changes. * * *”).
                    </P>
                </FTNT>
                <FTNT>
                    <P>
                        <SU>3</SU>
                         The 
                        <E T="03">Microsoft</E>
                         court explained that a court making a public interest determination under the APPA should consider, among other things, the relationship between the remedy secured and the specific allegations set forth in the government's complaint, whether the decree is sufficiently clear, whether enforcement mechanisms are sufficient, and whether the decree may positively harm third parties. 
                        <E T="03">Microsoft</E>
                        , 56 F.3d at 1458-62.
                    </P>
                </FTNT>
                <P>
                    With respect to the adequacy of the relief secured by the decree, a court may not “engage in an unrestricted evaluation of what relief would best serve the public.” 
                    <E T="03">United States</E>
                     v. 
                    <E T="03">BNS, Inc.</E>
                    , 858 F.2d 456, 462 (9th Cir. 1988) (citing 
                    <E T="03">United States</E>
                     v. 
                    <E T="03">Bechtel Corp.</E>
                    , 648 F.2d 660, 666 (9th Cir. 1981)); 
                    <E T="03">see also Microsoft</E>
                    , 56 F.3d at 1460-62. Courts have held that: 
                </P>
                <EXTRACT>
                    <FP>
                        [t]he balancing of competing social and political interests affected by a proposed antitrust consent decree must be left, in the first instance, to the discretion of the Attorney General. The court's role in protecting the public interest is one of insuring that the government has not breached its duty to the public in consenting to the decree. The court is required to determine not whether a particular decree is the one that will best serve society, but whether the settlement is “
                        <E T="03">within the reaches of the public interest.</E>
                        ” More elaborate requirements might undermine the effectiveness of antitrust enforcement by consent decree. 
                    </FP>
                </EXTRACT>
                <FP>
                    <E T="03">Bechtel</E>
                    , 648 F.2d at 666 (emphasis added) (citations omitted).
                    <SU>4</SU>
                    <FTREF/>
                     In making its public interest determination, a district court must accord due respect to the United States' prediction as to the effect of proposed remedies, its perception of the market structure, and its views of the nature of the case. 
                    <E T="03">SBC Commc'ns</E>
                    , 2007 WL 1020746, at *16 (United States entitled to “deference” as to “predictions about the efficacy of its remedies”); 
                    <E T="03">United States</E>
                     v. 
                    <E T="03">Archer-Daniels-Midland Co.</E>
                    , 272 F. Supp. 2d 1, 6 (D.D.C. 2003). 
                </FP>
                <FTNT>
                    <P>
                        <SU>4</SU>
                         
                        <E T="03">Cf BNS</E>
                        , 858 F.2d at 464 (holding that the court's “ultimate authority under the [APPA] is limited to approving or disapproving the consent decree”); 
                        <E T="03">United States</E>
                         v. 
                        <E T="03">Gillette Co</E>
                        ., 406 F. Supp. 713, 716 (D. Mass. 1975) (noting that, in this way, the court is constrained to “look at the overall picture not hypercritically, nor with a microscope, but with an artist's reducing glass”), 
                        <E T="03">aff'd sub nom. Maryland</E>
                         v. 
                        <E T="03">United States</E>
                        , 460 U.S. 1001 (1983). 
                        <E T="03">See generally Microsoft</E>
                        , 56 F.3d at 1461 (discussing whether “the remedies [obtained in the decree are] so inconsonant with the allegations charged as to fall outside of the `reaches of the public interest' ”).
                    </P>
                </FTNT>
                <P>
                    Court approval of a final judgment requires a standard more flexible and less strict than the standard required for a finding of liability. “[A] proposed decree must be approved even if it falls short of the remedy the court would impose on its own, as long as it falls within the range of acceptability or is `within the reaches of public interest.’ ” 
                    <E T="03">United States</E>
                     v. 
                    <E T="03">AT&amp;T Co.</E>
                    , 552 F. Supp. 131, 151 (D.D.C. 1982) (citations omitted) (quoting 
                    <E T="03">Gillette</E>
                    , 406 F. Supp. at 716); see also 
                    <E T="03">United States</E>
                     v. 
                    <E T="03">Alcan Aluminum Ltd.</E>
                    , 605 F. Supp. 619, 622 (W.O. Ky. 1985) (approving the consent decree even though the court would have imposed a greater remedy). To meet this standard, the United States “need only provide a factual basis for concluding that the settlements are reasonably adequate remedies for the alleged harms;” 
                    <E T="03">SBC Commc'ns</E>
                    , 2007 WL 1020746, at *16. 
                </P>
                <P>
                    Moreover, the Court's role under the APPA is limited to reviewing the remedy in relationship to the violations that the United States has alleged in its Complaint, and does not authorize the Court to “construct [its] own hypothetical case and then evaluate the decree against that case.” 
                    <E T="03">Microsoft</E>
                    , 56 F.3d at 1459. Because the “court's authority to review the decree depends entirely on the government's exercising its prosecutorial discretion by bringing a case in the first place,” it follows that “the court is only authorized to review the decree itself,” and not to “effectively redraft the complaint” to inquire into other matters that the United States did not pursue. 
                    <E T="03">Id</E>
                    . at 1459-60. As the United States District Court for the District of Columbia recently confirmed in 
                    <E T="03">SBC Communications</E>
                    , courts “cannot look beyond the complaint in making the public interest determination unless the complaint is drafted so narrowly as to make a mockery of judicial power.” 
                    <E T="03">SBC Commc'ns</E>
                    , 2007 WL 1020746, at *14. 
                </P>
                <P>
                    In its 2004 amendments to the Tunney Act, Congress made clear its intent to preserve the practical benefits of utilizing consent decrees in antitrust enforcement, adding the unambiguous instruction “[n]othing in this section shall be construed to require the court to conduct an evidentiary hearing or to require the court to permit anyone to intervene.” 15 U.S.C. 16(e)(2). This language codified the intent of the original 1974 statute, expressed by Senator Tunney in the legislative history: “[t]he court is nowhere compelled to go to trial or to engage in extended proceedings which might have the effect of vitiating the benefits of prompt and less costly settlement through the consent decree process.” 119 Cong. Rec. 24,598 (1973) (statement of Senator Tunney). Rather, the procedure for the public interest determination is left to the discretion of the court, with the recognition that the court's “scope of review remains sharply proscribed by precedent and the nature of Tunney Act proceedings.” 
                    <E T="03">SSC Commc'ns</E>
                    , 2007 WL 1020746, at *9.
                    <SU>5</SU>
                    <FTREF/>
                </P>
                <FTNT>
                    <P>
                        <SU>5</SU>
                         
                        <E T="03">United States</E>
                         v. 
                        <E T="03">Mid-Am. Dairymen. Inc.</E>
                        , 1977-1 Trade Cas. (CCH) ¶ 61,508, at 71,980 (W.D. Mo. 1977) (“[T]he Court, in making its public interest finding, should * * * carefully consider the explanations of the government in the competitive 
                        <PRTPAGE/>
                        impact statement and its responses to comments in order to determine whether those explanations are reasonable under the circumstances.”). 
                    </P>
                </FTNT>
                <PRTPAGE P="66198"/>
                <HD SOURCE="HD1">VIII. Determinative Documents </HD>
                <P>There are no determinative materials or documents within the meaning of the APPA that were considered by the United States in formulating the proposed Amended Final Judgment. </P>
                <EXTRACT>
                    <P>Dated: October 16, 2007.</P>
                    <P>Respectfully submitted, </P>
                    <FP>Lisa A. Scanlon,</FP>
                    <FP>Owen M. Kendler,</FP>
                    <FP>Christopher M. Ries,</FP>
                    <FP SOURCE="FP-1">
                        <E T="03">Attorneys for the United States of America, U.S. Department of Justice, Antitrust Division, 325 7th Street, NW., Suite 300, Washington, DC 20530, Telephone: (202) 616-5954, Facsimile: (202) 514-7308.</E>
                    </FP>
                    <HD SOURCE="HD1">Certificate of Service </HD>
                    <P>I hereby certify that on October 16, 2007, I caused a copy of the foregoing Competitive Impact Statement to be served on counsel for Defendant in this matter in the manner set forth below:</P>
                    <FP>Jane W. Trinkley, </FP>
                    <FP SOURCE="FP-1">
                        <E T="03">McNair Law Firm, P.A. P.O. Box 11390, Columbia, SC 29211, (via e-mail and first-class mail).</E>
                    </FP>
                    <P>Respectfully submitted,</P>
                    <FP>Reginald I. Lloyd, </FP>
                    <FP SOURCE="FP-1">
                        <E T="03">United States Attorney.</E>
                          
                    </FP>
                    <P>By:</P>
                    <FP>Barbara M. Bowens (I.D. 4004), </FP>
                    <FP SOURCE="FP-1">
                        <E T="03">Counsel for Defendant, Assistant United States Attorney, 1441 Main Street, Suite 500, Columbia, South Carolina 29201.</E>
                    </FP>
                    <FP>Christopher M. Ries, </FP>
                    <FP SOURCE="FP-1">
                        <E T="03">Attorney for the United States of America, U.S. Department of Justice, Antitrust Division, 325 7th Street, NW., Suite 300, Washington, DC 20530,</E>
                         Telephone: (202) 616-5954, Facsimile: (202) 514-7308.
                    </FP>
                </EXTRACT>
            </PREAMB>
            <FRDOC>[FR Doc. 07-5653 Filed 11-26-07; 8:45 am] </FRDOC>
            <BILCOD>BILLING CODE 4410-11-M</BILCOD>
        </NOTICE>
        <NOTICE>
            <PREAMB>
                <AGENCY TYPE="N">DEPARTMENT OF LABOR </AGENCY>
                <SUBAGY>Office of the Secretary </SUBAGY>
                <SUBJECT>Submission for OMB Review: Comment Request </SUBJECT>
                <DATE>November 20, 2007. </DATE>
                <P>
                    The Department of Labor (DOL) hereby announces the submission of the following public information collection requests (ICR) to the Office of Management and Budget (OMB) for review and approval in accordance with the Paperwork Reduction Act of 1995 (Pub. L. 104-13, 44 U.S.C. chapter 35). A copy of each ICR, with applicable supporting documentation; including among other things a description of the likely respondents, proposed frequency of response, and estimated total burden may be obtained from the RegInfo.gov Web site at 
                    <E T="03">http://www.reginfo.gov/public/do/PRAMain</E>
                     or by contacting Darrin King on 202-693-4129 (this is not a toll-free number)/e-mail: 
                    <E T="03">king.darrin@dol.gov</E>
                    . 
                </P>
                <P>
                    Interested parties are encouraged to send comments to the Office of Information and Regulatory Affairs, Attn: Katherine Astrich, OMB Desk Officer for the Employment and Training Administration (ETA), Office of Management and Budget, Room 10235, Washington, DC 20503, Telephone: 202-395-7316/Fax: 202-395-6974 (these are not a toll-free numbers), e-mail: 
                    <E T="03">OIRA_submission@omb.eop.gov</E>
                     within 30 days from the date of this publication in the 
                    <E T="04">Federal Register</E>
                    . In order to ensure the appropriate consideration, comments should reference the OMB Control Number (see below). 
                </P>
                <P>The OMB is particularly interested in comments which:</P>
                <P>• Evaluate whether the proposed collection of information is necessary for the proper performance of the functions of the agency, including whether the information will have practical utility; </P>
                <P>• Evaluate the accuracy of the agency's estimate of the burden of the proposed collection of information, including the validity of the methodology and assumptions used; </P>
                <P>• Enhance the quality, utility, and clarity of the information to be collected; and </P>
                <P>• Minimize the burden of the collection of information on those who are to respond, including through the use of appropriate automated, electronic, mechanical, or other technological collection techniques or other forms of information technology, e.g., permitting electronic submission of responses.</P>
                <P>
                    <E T="03">Agency:</E>
                     Employment and Training Administration. 
                </P>
                <P>
                    <E T="03">Type of Review:</E>
                     Extension without change of a currently approved collection. 
                </P>
                <P>
                    <E T="03">Title:</E>
                     Application for Alien Employment Certification. 
                </P>
                <P>
                    <E T="03">OMB Control Number:</E>
                     1205-0015. 
                </P>
                <P>
                    <E T="03">Form Number:</E>
                     ETA-750, Parts A and B. 
                </P>
                <P>
                    <E T="03">Affected Public:</E>
                     Private Sector: Business or other for-profits; Farms; and Not-for-profit institutions.
                </P>
                <P>
                    <E T="03">Estimated Number of Respondents:</E>
                     38,635. 
                </P>
                <P>
                    <E T="03">Estimated Total Annual Burden Hours:</E>
                     56,426. 
                </P>
                <P>
                    <E T="03">Estimated Total Annual Costs Burden:</E>
                     $1,318,838. 
                </P>
                <P>
                    <E T="03">Description:</E>
                     The information collection is required by section 212(a)(5)(A), section 214(c) and section 218 of the Immigration and Nationality Act (INA) (8 U.S.C. 1182(a)(5)(A), 1184(c) and 1188). The INA mandates the Secretary of Labor to certify that any alien seeking to enter the United States for the purpose of performing skilled or unskilled labor is not adversely affecting wages and working conditions of U.S. workers similarly employed and that there are not sufficient U.S. workers able, willing, and qualified to perform such skilled or unskilled labor. Before any employer may request any skilled or unskilled alien labor, it must submit a request for certification to the Secretary of Labor containing the elements prescribed by the INA or meet one of the exceptions in the INA. Both the Department of Labor and the Department of Homeland Security have promulgated regulations to implement these sections of the INA. The relevant regulations are 20 CFR 655.1-4, 20 CFR 655.90-113, 20 CFR 655.200-215, 8 CFR 204.5(k)(4)(ii), and 8 CFR 214.2(h)(5) and (6). 
                </P>
                <P>In order to meet its statutory responsibilities under the INA, the Department needs to extend an existing collection of information pertaining to employers seeking to import foreign labor. The Form ETA-750 is the mechanism used to collect the necessary information which is utilized not only by the Department, but also by other Federal agencies to meet the requirements of the INA. The Department uses the information collected to implement several of its nonimmigrant worker programs, including the H-2A and H-2B temporary work programs, and for both permanent and temporary programs for the employment of alien professional athletes. The Department of Homeland Security, U.S. Citizenship and Immigration Services, utilizes the form for its National Interest Waiver program for employment-sponsored immigration. </P>
                <P>
                    <E T="03">Agency:</E>
                     Employment and Training Administration. 
                </P>
                <P>
                    <E T="03">Type of Review:</E>
                     Revision and extension of a currently approved collection. 
                </P>
                <P>
                    <E T="03">Title:</E>
                     Employment and Training Data Validation Requirement. 
                </P>
                <P>
                    <E T="03">OMB Number:</E>
                     1205-0448. 
                </P>
                <P>
                    <E T="03">Form Numbers:</E>
                     ETA-DRVS Labor Exchange User's Guide Version 6.3; DRVS Workforce Investment Act Users Guide Version 6.3; NFJP Validation Form Version 2.0; and TAA Handbook Version 2.0. 
                </P>
                <P>
                    <E T="03">Affected Public:</E>
                     State governments and not-for-profit institutions. 
                </P>
                <P>
                    <E T="03">Estimated Number of Respondents:</E>
                     318. 
                    <PRTPAGE P="66199"/>
                </P>
                <P>
                    <E T="03">Estimated Total Annual Burden Hours:</E>
                     69,332. 
                </P>
                <P>
                    <E T="03">Estimated Total Annual Costs Burden:</E>
                     $0. 
                </P>
                <P>
                    <E T="03">Description:</E>
                     The accuracy and reliability of program reports submitted by states and grantees using Federal funds are fundamental elements of good public administration, and are necessary tools for maintaining and demonstrating system integrity. The President's Management Agenda to improve the management and performance of the Federal government has emphasized the importance of complete information for program monitoring and improving program results. States and grantees receiving funding under WIA Title IB, Wagner-Peyser Act, TAA, and the Older Americans Act (i.e., SCSEP) are required to maintain and report accurate program and financial information (WIA section 185 (29 U.S.C. 2935) and WIA Regulations 20 CFR 667.300(e)(2), Wagner-Peyser Act section 10 (29 U.S.C. 49i), Older Americans Act section 503(f)(3) and (4) (42 U.S.C. 3056a(f)(3) and (4)), and TAA regulations 20 CFR 617.57). Further, all states and grantees receiving funding from ETA and the Veterans' Employment and Training Service are required to submit reports or participant records and attest to the accuracy of these reports and records. For additional information, please refer to a related notice published on June 1, 2007 at 72 FR 30639. 
                </P>
                <SIG>
                    <NAME>Darrin A. King, </NAME>
                    <TITLE>Acting Departmental Clearance Officer.</TITLE>
                </SIG>
            </PREAMB>
            <FRDOC> [FR Doc. E7-23005 Filed 11-26-07; 8:45 am] </FRDOC>
            <BILCOD>BILLING CODE 4510-FW-P </BILCOD>
        </NOTICE>
        <NOTICE>
            <PREAMB>
                <AGENCY TYPE="S">DEPARTMENT OF LABOR </AGENCY>
                <SUBAGY>Office of the Secretary </SUBAGY>
                <SUBJECT>Submission for OMB Review: Comment Request </SUBJECT>
                <DATE>November 21, 2007. </DATE>
                <P>
                    The Department of Labor (DOL) hereby announces the submission the following public information collection request (ICR) to the Office of Management and Budget (OMB) for review and approval in accordance with the Paperwork Reduction Act of 1995 (Pub. L. 104-13, 44 U.S.C. chapter 35). A copy of this ICR, with applicable supporting documentation; including among other things a description of the likely respondents, proposed frequency of response, and estimated total burden may be obtained from the RegInfo.gov Web site at 
                    <E T="03">http://www.reginfo.gov/public/do/PRAMain</E>
                     or by contacting Darrin King on 202-693-4129 (this is not a toll-free number) / e-mail: 
                    <E T="03">king.darrin@dol.gov.</E>
                </P>
                <P>
                    Interested parties are encouraged to send comments to the Office of Information and Regulatory Affairs, Attn: John Kraemer, OMB Desk Officer for the Occupational Safety and Health Administration (OSHA), Office of Management and Budget, Room 10235, Washington, DC 20503, Telephone: 202-395-7316 / Fax: 202-395-6974 (these are not a toll-free numbers), E-mail: 
                    <E T="03">OIRA_submission@omb.eop.gov</E>
                     within 30 days from the date of this publication in the 
                    <E T="04">Federal Register</E>
                    . In order to ensure the appropriate consideration, comments should reference the OMB Control Number (see below). 
                </P>
                <P>The OMB is particularly interested in comments which:</P>
                <P>• Evaluate whether the proposed collection of information is necessary for the proper performance of the functions of the agency, including whether the information will have practical utility; </P>
                <P>• Evaluate the accuracy of the agency's estimate of the burden of the proposed collection of information, including the validity of the methodology and assumptions used; </P>
                <P>• Enhance the quality, utility, and clarity of the information to be collected; and </P>
                <P>• Minimize the burden of the collection of information on those who are to respond, including through the use of appropriate automated, electronic, mechanical, or other technological collection techniques or other forms of information technology, e.g., permitting electronic submission of responses. </P>
                <P>
                    <E T="03">Agency:</E>
                     Occupational Safety and Health Administration. 
                </P>
                <P>
                    <E T="03">Type of Review:</E>
                     Extension without change of a previously approved collection. 
                </P>
                <P>
                    <E T="03">Title:</E>
                     Bloodborne Pathogens Standard (29 CFR § 1910.1030). 
                </P>
                <P>
                    <E T="03">OMB Control Number:</E>
                     1218-0180. 
                </P>
                <P>
                    <E T="03">Affected Public:</E>
                     Private Sector: Business or other for-profits and Not-for-profit institutions. 
                </P>
                <P>
                    <E T="03">Estimated Number of Respondents:</E>
                     632,236. 
                </P>
                <P>
                    <E T="03">Estimated Total Annual Burden Hours:</E>
                     14,059,435. 
                </P>
                <P>
                    <E T="03">Estimated Total Annual Costs Burden:</E>
                     $23,774,874. 
                </P>
                <P>
                    <E T="03">Description:</E>
                     The Bloodborne Pathogen Standard (29 CFR 1910.1030) is an occupational safety and health standard that prevents occupational exposure to bloodborne pathogens. The standard's information-collection requirements are essential components that protect employees from occupational exposure. The information is used by employers and employees to implement the protection required by the Standard. OSHA compliance officers will use some of the information in their enforcement of the Standard. For additional information, please refer to a related notice published on July 27, 2007 at 72 FR 41357. 
                </P>
                <SIG>
                    <NAME>Darrin A. King, </NAME>
                    <TITLE>Acting Departmental Clearance Officer.</TITLE>
                </SIG>
            </PREAMB>
            <FRDOC>[FR Doc. E7-23030 Filed 11-26-07; 8:45 am] </FRDOC>
            <BILCOD>BILLING CODE 4510-26-P</BILCOD>
        </NOTICE>
        <NOTICE>
            <PREAMB>
                <AGENCY TYPE="N">NATIONAL SCIENCE FOUNDATION </AGENCY>
                <SUBJECT>Proposal Review; Notice of Meetings </SUBJECT>
                <P>In accordance with the Federal Advisory Committee Act (Pub. L. 92-463, as amended), the National Science Foundation (NSF) announces its intent to hold proposal review meetings throughout the year. The purpose of these meetings is to provide advice and recommendations concerning proposals submitted to the NSF for financial support. The agenda for each of these meetings is to review and evaluate proposals as part of the selection process for awards. The review and evaluation may also include assessment of the progress of awarded proposals. The majority of these meetings will take place at NSF, 4201 Wilson Blvd., Arlington, Virginia 22230. </P>
                <P>These meetings will be closed to the public. The proposals being reviewed include information of a proprietary or confidential nature, including technical information; financial data, such as salaries; and personal information concerning individuals associated with the proposals. These matters are exempt under 5 U.S.C. 552b(c), (4) and (6) of the Government in the Sunshine Act. NSF will continue to review the agenda and merits of each meeting for overall compliance of the Federal Advisory Committee Act. </P>
                <P>
                    These closed proposal review meetings will no longer be announced on an individual basis in the 
                    <E T="04">Federal Register</E>
                    . NSF intends to publish a notice similar to this on a quarterly basis. For an advance listing of the closed proposal review meetings that include the names of the proposal review panel and the time, date, place, and any information on changes, corrections, or cancellations, please visit the NSF Web site: 
                    <E T="03">http://www.nsf.gov/events/advisory.jsp</E>
                    . This information may also be requested by telephoning 703/292-8182. 
                </P>
                <SIG>
                    <PRTPAGE P="66200"/>
                    <DATED>Dated: November 21, 2007. </DATED>
                    <NAME>Susanne Bolton, </NAME>
                    <TITLE>Committee Management Officer.</TITLE>
                </SIG>
            </PREAMB>
            <FRDOC>[FR Doc. E7-23012 Filed 11-26-07; 8:45 am] </FRDOC>
            <BILCOD>BILLING CODE 7555-01-P </BILCOD>
        </NOTICE>
        <NOTICE>
            <PREAMB>
                <AGENCY TYPE="N">NUCLEAR REGULATORY COMMISSION</AGENCY>
                <SUBJECT>Tennessee Valley Authority; Notice of Receipt and Availability of Application for a Combined License</SUBJECT>
                <P>On October 30, 2007, the Tennessee Valley Authority (TVA, or the applicant) filed with the Nuclear Regulatory Commission (NRC, the Commission) pursuant to section 103 of the Atomic Energy Act and 10 CFR Part 52, an application for a combined license (COL) for two AP1000 advanced passive pressurized water reactor nuclear power plants at the Bellefonte facility near the town of Scottsboro in Jackson County, Alabama. The reactors are to be identified as Bellefonte Units 3 and 4.</P>
                <P>An applicant may seek a COL in accordance with Subpart C of 10 CFR part 52. The information submitted by the applicant includes certain administrative information such as financial qualifications submitted pursuant to 10 CFR 52.77, as well as technical information submitted pursuant to 10 CFR 52.79.</P>
                <P>
                    Subsequent 
                    <E T="04">Federal Register</E>
                     notices will address the acceptability of the tendered COL application for docketing and provisions for participation of the public in the COL review process.
                </P>
                <P>
                    A copy of the application is available for public inspection at the Commission's Public Document Room (PDR), located at One White Flint North, 11555 Rockville Pike (first floor), Rockville, Maryland, and via the Agencywide Documents Access and Management System (ADAMS) Public Electronic Reading Room on the Internet at the NRC Web site, 
                    <E T="03">http://www.nrc.gov/reading-rm/adams.html.</E>
                     The accession number for the application is ML073110527. Future publicly available documents related to the application will also be posted in ADAMS. Persons who do not have access to ADAMS, or who encounter problems in accessing the documents located in ADAMS, should contact the NRC Public Document Room staff by telephone at 1-800-397-4209 or 301-415-4737, or by e-mail to 
                    <E T="03">pdr@nrc.gov.</E>
                     The application is also available at 
                    <E T="03">http://www.nrc.gov/reactors/new-licensing/col.html.</E>
                </P>
                <SIG>
                    <DATED>Dated at Rockville, Maryland, this 20th day of November, 2007.</DATED>
                    <P>For the Nuclear Regulatory Commission.</P>
                    <NAME>Thomas A. Bergman,</NAME>
                    <TITLE>Deputy Director for Licensing Operations, Division of New Reactor Licensing, Office of New Reactors.</TITLE>
                </SIG>
            </PREAMB>
            <FRDOC>[FR Doc. E7-23010 Filed 11-26-07; 8:45 am]</FRDOC>
            <BILCOD>BILLING CODE 7590-01-P</BILCOD>
        </NOTICE>
        <NOTICE>
            <PREAMB>
                <AGENCY TYPE="S">NUCLEAR REGULATORY COMMISSION </AGENCY>
                <SUBJECT>Notice of Sunshine Act Meetings </SUBJECT>
                <PREAMHD>
                    <HD SOURCE="HED">Agency Holding the Meetings:</HD>
                    <P>Nuclear Regulatory Commission. </P>
                </PREAMHD>
                <PREAMHD>
                    <HD SOURCE="HED">Dates:</HD>
                    <P>Weeks of November 26, December 3, 10, 17, 24, 31, 2007. </P>
                </PREAMHD>
                <PREAMHD>
                    <HD SOURCE="HED">Place:</HD>
                    <P>Commissioners' Conference Room, 11555 Rockville Pike, Rockville, Maryland. </P>
                </PREAMHD>
                <PREAMHD>
                    <HD SOURCE="HED">Status:</HD>
                    <P>Public and Closed. </P>
                </PREAMHD>
                <HD SOURCE="HD1">Matters To Be Considered </HD>
                <HD SOURCE="HD2">Week of November 26, 2007 </HD>
                <HD SOURCE="HD3">Tuesday, November 27, 2007. </HD>
                <FP SOURCE="FP-2">9:30 a.m. </FP>
                <FP SOURCE="FP1-2">Discussion of Security Issues (Closed—Ex. 1 &amp; 3). </FP>
                <FP SOURCE="FP-2">1:30 p.m. </FP>
                <FP SOURCE="FP1-2">Briefing on Equal Employment Opportunity (EEO) Programs (Public Meeting) (Contact: Sandra Talley, 301-415-8059).</FP>
                <P>
                    This meeting will be webcast live at the Web address—
                    <E T="03">www.nrc.gov</E>
                    . 
                </P>
                <HD SOURCE="HD2">Week of December 3, 2007—Tentative </HD>
                <HD SOURCE="HD3">Friday, December 7, 2007. </HD>
                <FP SOURCE="FP-2">10 a.m.</FP>
                <FP SOURCE="FP1-2">Discussion of Intragovernmental Issues (Closed—Ex. 1 &amp; 9). </FP>
                <FP SOURCE="FP-2">2 p.m. </FP>
                <FP SOURCE="FP1-2">Briefing on Threat Environment Assessment (Closed—Ex. 1). </FP>
                <HD SOURCE="HD2">Week of December 10, 2007—Tentative </HD>
                <HD SOURCE="HD3">Wednesday, December 12, 2007. </HD>
                <FP SOURCE="FP-2">9:30 a.m. </FP>
                <FP SOURCE="FP1-2">Discussion of Management Issues (Closed—Ex. 2). </FP>
                <HD SOURCE="HD2">Week of December 17, 2007—Tentative </HD>
                <P>There are no meetings scheduled for the Week of December 17, 2007. </P>
                <HD SOURCE="HD2">Week of December 24, 2007—Tentative </HD>
                <P>There are no meetings scheduled for the Week of December 24, 2007. </P>
                <HD SOURCE="HD2">Week of December 31, 2007—Tentative </HD>
                <P>There are no meetings scheduled for the Week of December 31, 2007. </P>
                <P>* The schedule for Commission meetings is subject to change on short notice. To verify the status of meetings, call (recording)—(301) 415-1292. Contact person for more information: Michelle Schroll, (301) 415-1662. </P>
                <ADD>
                    <HD SOURCE="HED">Additional Information:</HD>
                    <P>Affirmation of “Pacific Gas and Electric Co. (Diablo Canyon ISFSI), Docket No. 72-26-ISFSI, San Luis Obispo Mothers for Peace's Contentions and Request for a Hearing Regarding Diablo Canyon Environmental Assessment Supplement (Tentative)” previously scheduled on Tuesday, November 20, 2007, at 9:05 a.m. was postponed. </P>
                    <P>
                        The NRC Commission Meeting Schedule can be found on the Internet at: 
                        <E T="03">www.nrc.gov/about-nrc/policy-making/schedule.html.</E>
                    </P>
                    <P>
                        The NRC provides reasonable accommodation to individuals with disabilities where appropriate. If you need a reasonable accommodation to participate in these public meetings, or need this meeting notice or the transcript or other information from the public meetings in another format (e.g. braille, large print), please notify the NRC's Disability Program Coordinator, Rohn Brown, at 301-492-2279, TDD: 301-415-2100, or by e-mail at 
                        <E T="03">REB3@nrc.gov</E>
                        . Determinations on requests for reasonable accommodation will be made on a case-by-case basis. 
                    </P>
                    <P>
                        This notice is distributed by mail to several hundred subscribers; if you no longer wish to receive it, or would like to be added to the distribution, please contact the Office of the Secretary, Washington, DC 20555 (301-415-1969). In addition, distribution of this meeting notice over the Internet system is available. If you are interested in receiving this Commission meeting schedule electronically, please send an electronic message to 
                        <E T="03">dkw@nrc.gov</E>
                        . 
                    </P>
                </ADD>
                <SIG>
                    <DATED>Dated: November 21, 2007. </DATED>
                    <NAME>R. Michelle Schroll, </NAME>
                    <TITLE>Office of the Secretary. </TITLE>
                </SIG>
            </PREAMB>
            <FRDOC>[FR Doc. 07-5856 Filed 11-23-07; 10:27 am] </FRDOC>
            <BILCOD>BILLING CODE 7590-01-P</BILCOD>
        </NOTICE>
        <NOTICE>
            <PREAMB>
                <AGENCY TYPE="N">SECURITIES AND EXCHANGE COMMISSION</AGENCY>
                <SUBJECT>Submission for OMB Review; Comment Request</SUBJECT>
                <FP SOURCE="FP-1">Upon Written Request, Copies Available From: Securities and Exchange Commission, Office of Investor Education and Advocacy, Washington, DC 20549</FP>
                <EXTRACT>
                    <FP SOURCE="FP-2">
                        <E T="03">Extension:</E>
                    </FP>
                    <FP SOURCE="FP1-2">Rule 17a-4(b)(11); SEC File No. 270-449; OMB Control No. 3235-0506</FP>
                </EXTRACT>
                <P>
                    Notice is hereby given that pursuant to the Paperwork Reduction Act of 1995 (44 U.S.C. Sec. 3501 et seq.), the Securities and Exchange Commission 
                    <PRTPAGE P="66201"/>
                    (“Commission”) has submitted to the Office of Management and Budget (“OMB”) a request for extension of the previously approved collection of information discussed below.
                </P>
                <P>Rule 17a-4(b)(11) (17 CFR 240.17a-4(b)(11)) under the Securities Exchange Act of 1934 (15 U.S.C. 78a et seq.) describes the record preservation requirements for those records required to be kept pursuant to Rule 17a-3(a)(16), including how such records should be kept and for how long, to be used in monitoring compliance with the Commission's financial responsibility program and antifraud and antimanipulative rules as well as other rules and regulations of the Commission and the self-regulatory organizations. It is estimated that approximately 105 active broker-dealer respondents registered with the Commission incur an average burden of 315 hours per year (105 respondents multiplied by 3 burden hours per respondent equals 315 total burden hours) to comply with this rule.</P>
                <P>Under Rule 17a-4(a)(11) broker-dealers are required to retain records for a period of not less than three years. Compliance with the rule is mandatory. The required records are available only to the examination staff of the Commission and the self-regulatory organization of which the broker-dealer is a member. An agency may not conduct or sponsor and a person is not required to respond to a collection of information unless it displays a currently valid control number.</P>
                <P>
                    Comments should be directed to (i) Desk Officer for the Securities and Exchange Commission, Office of Information and Regulatory Affairs, Office of Management and Budget, Room 10102, New Executive Office Building, Washington, DC 20503 or by sending an e-mail to: 
                    <E T="03">Alexander_T._Hunt@omb.eop.gov;</E>
                     and (ii) R. Corey Booth, Director/Chief Information Officer, Securities and Exchange Commission, c/o Shirley Martinson, 6432 General Green Way, Alexandria, VA 22312 or send an e-mail to: 
                    <E T="03">PRA_Mailbox@sec.gov.</E>
                     Comments must be submitted within 30 days of this notice.
                </P>
                <SIG>
                    <DATED>Dated: November 19, 2007.</DATED>
                    <NAME>Florence E. Harmon,</NAME>
                    <TITLE>Deputy Secretary.</TITLE>
                </SIG>
            </PREAMB>
            <FRDOC>[FR Doc. E7-22978 Filed 11-26-07; 8:45 am]</FRDOC>
            <BILCOD>BILLING CODE 8011-01-P</BILCOD>
        </NOTICE>
        <NOTICE>
            <PREAMB>
                <AGENCY TYPE="S">SECURITIES AND EXCHANGE COMMISSION</AGENCY>
                <SUBJECT>Submission for OMB Review; Comment Request</SUBJECT>
                <FP SOURCE="FP-1">Upon Written Request, Copy Available From: Securities and Exchange Commission, Office of Investor Education and Advocacy, Washington, DC 20549-0213.</FP>
                <EXTRACT>
                    <FP SOURCE="FP-2">
                        <E T="03">Extension:</E>
                    </FP>
                    <FP SOURCE="FP1-2">Form N-14; SEC File No. 270-297; OMB Control No. 3235-0336</FP>
                </EXTRACT>
                <P>
                    Notice is hereby given that pursuant to the Paperwork Reduction Act of 1995 (44 U.S.C. 3501 
                    <E T="03">et seq.</E>
                    ), the Securities and Exchange Commission (“Commission”) has submitted to the Office of Management and Budget requests for extension of the previously approved collection of information discussed below.
                </P>
                <P>
                    Form N-14 (17 CFR 239.23) is used by investment companies registered under the Investment Company Act of 1940 (15 U.S.C. 80a-1 
                    <E T="03">et seq.</E>
                    ) (“Investment Company Act”) and business development companies as defined by Section 2(a)(48) of the Investment Company Act to register securities under the Securities Act of 1933 (15 U.S.C. 77a 
                    <E T="03">et seq.</E>
                    ) to be issued in business combination transactions specified in rule 145(a) (17 CFR 230.145(a)) and exchange offers. The securities are registered under the Securities Act to ensure that investors receive the material information necessary to evaluate securities issued in business combination transactions. The Commission staff reviews registration statements on Form N-14 for the adequacy and accuracy of the disclosure contained therein. Without Form N-14, the Commission would be unable to verify compliance with securities law requirements. The respondents to the collection of information are investment companies or business development companies issuing securities in business combination transactions. The estimated number of responses is 375 and the collection occurs only when a merger or other business combination is planned. The estimated total annual reporting burden of the collection of information is approximately 620 hours per response for a new registration statement, and approximately 350 hours per response for an amended Form N-14, for a total of 196,050 annual burden hours. Providing the information on Form N-14 is mandatory. Responses will not be kept confidential. Estimates of the burden hours are made solely for the purposes of the Paperwork Reduction Act, and are not derived from a comprehensive or even a representative survey or study of the costs of SEC rules and forms.
                </P>
                <P>An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a currently valid OMB control number.</P>
                <P>
                    Please direct general comments regarding the above information to the following persons: (i) Desk Officer for the Securities and Exchange Commission, Office of Management and Budget, Room 10102, New Executive Office Building, Washington, DC 20503 or e-mail to: 
                    <E T="03">Alexander_T._Hunt@omb.eop.gov;</E>
                     and (ii) R. Corey Booth, Director/Chief Information Officer, Securities and Exchange Commission, C/O Shirley Martinson, 6432 General Green Way, Alexandria, VA 22312; or send an e-mail to: 
                    <E T="03">PRA_Mailbox@sec.gov.</E>
                     Comments must be submitted to OMB within 30 days of this notice.
                </P>
                <SIG>
                    <DATED>Dated: November 19, 2007.</DATED>
                    <NAME>Florence E. Harmon,</NAME>
                    <TITLE>Deputy Secretary.</TITLE>
                </SIG>
            </PREAMB>
            <FRDOC>[FR Doc. E7-22980 Filed 11-26-07; 8:45 am]</FRDOC>
            <BILCOD>BILLING CODE 8011-01-P</BILCOD>
        </NOTICE>
        <NOTICE>
            <PREAMB>
                <AGENCY TYPE="S">SECURITIES AND EXCHANGE COMMISSION</AGENCY>
                <SUBJECT>Submission for OMB Review; Comment Request</SUBJECT>
                <FP SOURCE="FP-1">Upon Written Request, Copies Available From: Securities and Exchange Commission, Office of Investor Education and Advocacy, Washington, DC 20549</FP>
                <EXTRACT>
                    <FP SOURCE="FP-2">
                        <E T="03">Extension:</E>
                    </FP>
                    <FP SOURCE="FP1-2">Rule 17a-3; SEC File No. 270-026; OMB Control No. 3235-0033</FP>
                </EXTRACT>
                <P>
                    Notice is hereby given that pursuant to the Paperwork Reduction Act of 1995 (44 U.S.C. 3501 
                    <E T="03">et seq.</E>
                    ), the Securities and Exchange Commission (“Commission”) has submitted to the Office of Management and Budget (“OMB”) a request for extension of the previously approved collection of information discussed below. The Code of Federal Regulations citation to this collection of information is: 17 CFR 240.17a-3.
                </P>
                <P>
                    Rule 17a-3 under the Securities Exchange Act of 1934 (15 U.S.C. 78a 
                    <E T="03">et seq.</E>
                    ) establishes minimum standards with respect to business records that broker-dealers registered with the Commission must make and keep current. These records are maintained by the broker-dealer (in accordance with a separate rule), so they can be used by the broker-dealer and reviewed by 
                    <PRTPAGE P="66202"/>
                    Commission examiners, as well as other regulatory authority examiners, during inspections of the broker-dealer.
                </P>
                <P>The collection of information included in Rule 17a-3 is necessary to provide Commission, self-regulatory organization, and State examiners to conduct effective and efficient examinations to determine whether broker-dealers are complying with relevant laws, rules, and regulations. If broker-dealers were not required to create these baseline, standardized records, Commission, self-regulatory organization, and State examiners could be unable to determine whether broker-dealers are in compliance with the Commission's antifraud and anti-manipulation rules, financial responsibility program, and other Commission, self-regulatory organization, and State laws, rules, and regulations.</P>
                <P>As of July 30, 2007 there were 5,850 broker-dealers registered with the Commission. The Commission estimates that these broker-dealer respondents incur a total burden of 2,984,760 hours per year to comply with Rule 17a-3. Approximately 1,524,210 of those hours are attributable to Rule 17a-3(a)(17), and about 1,460,550 hours are attributable to the rest of Rule 17a-3. Rule 17a-3(a)(17) contains requirements to provide customers with account information (approximately 975,809 hours) and requirements to update customer account information (approximately 548,401 hours).</P>
                <P>
                    In addition, Rule 17a-3 contains ongoing operation and maintenance costs for broker-dealers including the cost of postage to provide customers with account information, and costs for equipment and systems development. The Commission estimates that under Rule 17a-3(a)(17), approximately 36,365,553 customers will need to be provided with information regarding their account on a yearly basis. The Commission estimates that the postage costs associated with providing those customers with copies of their account record information would be approximately $8,176,435 per year (28,390,400 × $0.288).
                    <SU>1</SU>
                    <FTREF/>
                     Based on comments provided in response to the 2001 Amendments (as adjusted to account for inflation), the staff believes that the ongoing equipment and systems development costs relating to Rule 17a-3 for the industry would be about $23,362,847 per year. Consequently, the total cost burden associated with Rule 17a-3 would be approximately $31,539,282 per year.
                </P>
                <FTNT>
                    <P>
                        <SU>1</SU>
                         Estimates of postage costs are derived from past conversations with industry representatives and have been adjusted to account for inflation.
                    </P>
                </FTNT>
                <P>Rule 17a-3 does not contain record retention requirements. Compliance with the rule is mandatory. The required records are available only to the staffs of the Commission, self-regulatory organizations of which the broker-dealer is a member, and the States during examinations, inspections and investigations. An agency may not conduct or sponsor and a person is not required to respond to a collection of information unless it displays a currently valid control number.</P>
                <P>
                    Comments should be directed to (i) Desk Officer for the Securities and Exchange Commission, Office of Information and Regulatory Affairs, Office of Management and Budget, Room 10102, New Executive Office Building, Washington, DC 20503 or by sending an e-mail to: 
                    <E T="03">Alexander_T._Hunt@omb.eop.gov;</E>
                     and (ii) R. Corey Booth, Director/Chief Information Officer, Securities and Exchange Commission, c/o Shirley Martinson, 6432 General Green Way, Alexandria, VA 22312 or send an e-mail to: 
                    <E T="03">PRA_Mailbox@sec.gov.</E>
                     Comments must be submitted within 30 days of this notice.
                </P>
                <SIG>
                    <DATED>Dated: November 19, 2007.</DATED>
                    <NAME>Florence E. Harmon,</NAME>
                    <TITLE>Deputy Secretary.</TITLE>
                </SIG>
            </PREAMB>
            <FRDOC> [FR Doc. E7-22981 Filed 11-26-07; 8:45 am]</FRDOC>
            <BILCOD>BILLING CODE 8011-01-P</BILCOD>
        </NOTICE>
        <NOTICE>
            <PREAMB>
                <AGENCY TYPE="S">SECURITIES AND EXCHANGE COMMISSION</AGENCY>
                <SUBJECT>Proposed Collection; Comment Request</SUBJECT>
                <FP SOURCE="FP-1">Upon Written Request, Copies Available From: Securities and Exchange Commission, Office of Investor Education and Advocacy, Washington, DC 20549-0213</FP>
                <EXTRACT>
                    <FP SOURCE="FP-2">
                        <E T="03">Extension:</E>
                         Rule 203-3, Form ADV-H; SEC File No. 270-481; OMB Control No. 3235-0538
                    </FP>
                </EXTRACT>
                <P>
                    Notice is hereby given that pursuant to the Paperwork Reduction Act of 1995 (44 U.S.C. 3501 
                    <E T="03">et seq.</E>
                    ) the Securities and Exchange Commission (“Commission”) is soliciting comments on the collection of information summarized below. The Commission plans to submit this existing collection of information to the Office of Management and Budget for extension and approval.
                </P>
                <P>The title for the collection of information is “Rule 203-3 and Form ADV-H under the Investment Advisers Act of 1940.” Rule 203-3 (17 CFR 275.203-3) under the Investment Advisers Act of 1940 (15 U.S.C. 80b) establishes procedures for an investment adviser to obtain a hardship exemption from the electronic filing requirements of the Investment Advisers Act. Rule 203-3 requires every person requesting a hardship exemption to file Form ADV-H (17 CFR 279.3) with the Commission. The purpose of this collection of information is to permit advisers to obtain a hardship exemption, on a continuing or temporary basis, to not complete an electronic filing. The temporary hardship exemption permits advisers to make late filings due to unforeseen computer or software problems, while the continuing hardship exemption permits advisers to submit all required electronic filings on hard copy for data entry by the operator of the IARD.</P>
                <P>The respondents to the collection of information are all investment advisers that are registered with the Commission. The Commission has estimated that compliance with the requirement to complete Form ADV-H imposes a total burden of approximately 1 hour for an adviser. Based on our experience with hardship filings, we estimate that we will receive 11 Form ADV-H filings annually. Based on the 60 minute per respondent estimate, the Commission estimates a total annual burden of 11 hours for this collection of information.</P>
                <P>Written comments are invited on: (a) Whether the proposed collection of information is necessary for the proper performance of the functions of the agency, including whether the information will have practical utility; (b) the accuracy of the agency's estimate of the burden of the collection of information; (c) ways to enhance the quality, utility, and clarity of the information collected; and (d) ways to minimize the burden of the collection of information on respondents, including through the use of automated collection techniques or other forms of information technology. Consideration will be given to comments and suggestions submitted in writing within 60 days of this publication.</P>
                <P>
                    Please direct your written comments to R. Corey Booth, Director/Chief Information Officer, Securities and Exchange Commission, C/O Shirley Martinson, 6432 General Green Way, Alexandria, VA 22312; or send an e-mail to: 
                    <E T="03">PRA_Mailbox@sec.gov</E>
                    .
                </P>
                <SIG>
                    <DATED>Dated: November 19, 2007.</DATED>
                    <NAME>Florence E. Harmon,</NAME>
                    <TITLE>Deputy Secretary.</TITLE>
                </SIG>
            </PREAMB>
            <FRDOC>[FR Doc. E7-23002 Filed 11-26-07; 8:45 am]</FRDOC>
            <BILCOD>BILLING CODE 8011-01-P</BILCOD>
        </NOTICE>
        <NOTICE>
            <PREAMB>
                <PRTPAGE P="66203"/>
                <AGENCY TYPE="S">SECURITIES AND EXCHANGE COMMISSION</AGENCY>
                <SUBJECT>Proposed Collection; Comment Request</SUBJECT>
                <FP SOURCE="FP-1">Upon Written Request, Copies Available From: Securities and Exchange Commission, Office of Investor Education and Advocacy, Washington, DC 20549-0213.</FP>
                <EXTRACT>
                    <FP SOURCE="FP-2">
                        <E T="03">Extension:</E>
                    </FP>
                    <FP SOURCE="FP1-2">Rule 206(4)-4; SEC File No. 270-304; OMB Control No. 3235-0345</FP>
                </EXTRACT>
                <P>
                    Notice is hereby given that, pursuant to the Paperwork Reduction Act of 1995 (44 U.S.C. 3501 
                    <E T="03">et seq.</E>
                    ), the Securities and Exchange Commission (“Commission”) is soliciting comments on the collections of information summarized below. The Commission plans to submit these existing collections of information to the Office of Management and Budget for extension and approval.
                </P>
                <P>
                    The title for the collection of information is “Rule 206(4)-4” (17 CFR 275.206(4)-4) under the Investment Advisers Act of 1940 (15 U.S.C. 80b-1 
                    <E T="03">et seq.</E>
                    ). Rule 206(4)-4 requires advisers to disclose certain financial and disciplinary information to clients. The disclosure requirements in rule 206(4)-4 are designed so that a client will have information about an adviser's financial condition and disciplinary events that may be material to an evaluation of the adviser's integrity or ability to meet contractual commitments to clients. Respondents are registered investment advisers with certain disciplinary history or a financial condition that is reasonably likely to affect contractual commitments. We estimate that approximately 1,839 advisers are subject to this rule. The rule requires approximately 7.5 burden hours per year per adviser and amounts to approximately 13,793 total burden hours (7.5 × 1,839) for all advisers.
                </P>
                <P>Written comments are invited on: (a) Whether the proposed collection of information is necessary for the proper performance of the functions of the agency, including whether the information will have practical utility; (b) the accuracy of the agency's estimate of the burden of the collection of information; (c) ways to enhance the quality, utility, and clarity of the information collected; and (d) ways to minimize the burden of the collection of information on respondents, including through the use of automated collection techniques or other forms of information technology. Consideration will be given to comments and suggestions submitted in writing within 60 days of this publication.</P>
                <P>
                    Please direct your written comments to R. Corey Booth, Director/Chief Information Officer, Securities and Exchange Commission, c/o Shirley Martinson, 6432 General Green Way, Alexandria, VA 22312; or send an e-mail to: 
                    <E T="03">PRA_Mailbox@sec.gov.</E>
                </P>
                <SIG>
                    <DATED>Dated: November 19, 2007.</DATED>
                    <NAME>Florence E. Harmon,</NAME>
                    <TITLE>Deputy Secretary.</TITLE>
                </SIG>
            </PREAMB>
            <FRDOC>[FR Doc. E7-23004 Filed 11-26-07; 8:45 am]</FRDOC>
            <BILCOD>BILLING CODE 8011-01-P</BILCOD>
        </NOTICE>
        <NOTICE>
            <PREAMB>
                <AGENCY TYPE="S">SECURITIES AND EXCHANGE COMMISSION </AGENCY>
                <DEPDOC>[Release No. 34-56809; File No. SR-Amex-2007-116] </DEPDOC>
                <SUBJECT>Self-Regulatory Organizations; American Stock Exchange LLC; Notice of Filing of Proposed Rule Change, as Modified by Amendment Nos. 1 and 2 Thereto, To Harmonize the Annual Listing Fees for All Exchange Traded Funds </SUBJECT>
                <DATE>November 16, 2007. </DATE>
                <P>
                    Pursuant to section 19(b)(1) of the Securities Exchange Act of 1934 (“Act”) 
                    <SU>1</SU>
                    <FTREF/>
                     and Rule 19b-4 thereunder,
                    <SU>2</SU>
                    <FTREF/>
                     notice is hereby given that on October 29, 2007, the American Stock Exchange LLC (“Amex” or “Exchange”) filed with the Securities and Exchange Commission (“Commission”) the proposed rule change as described in Items I, II, and III below, which Items have been substantially prepared by Amex. On November 9, 2007, the Exchange filed Amendment No. 1 to the proposed rule change.
                    <SU>3</SU>
                    <FTREF/>
                     On November 16, 2007, the Exchange filed Amendment No. 2 to the proposal.
                    <SU>4</SU>
                    <FTREF/>
                     The Commission is publishing this notice to solicit comments on the proposed rule change, as modified by Amendment Nos. 1 and 2, from interested persons. 
                </P>
                <FTNT>
                    <P>
                        <SU>1</SU>
                         15 U.S.C. 78s(b)(1). 
                    </P>
                </FTNT>
                <FTNT>
                    <P>
                        <SU>2</SU>
                         17 CFR 240.19b-4. 
                    </P>
                </FTNT>
                <FTNT>
                    <P>
                        <SU>3</SU>
                         Amendment No. 1 made clarifying changes to the purpose section of the original filing and revised the proposed annual listing fee schedule. 
                    </P>
                </FTNT>
                <FTNT>
                    <P>
                        <SU>4</SU>
                         Amendment No. 2 made an additional clarifying change to the proposed annual listing fee schedule. Specifically, all references to a “maximum” or “minimum” identified as a parenthetical in the “Stock Issues” and “Issues Listed Under Section 106 and Section 107; Rule 1000A (Index Fund Shares); Rule 1200 (Trust Issued Receipts); Rule 1200A (Commodity Based Trust Shares); Rule 1200B (Currency Trust Shares); Rule 1400 (Paired Trust Shares); Rule 1500 (Partnership Units); and Closed-End Funds” Annual Fee Tables in the Company Guide are to be removed. 
                    </P>
                </FTNT>
                <HD SOURCE="HD1">I. Self-Regulatory Organization's Statement of the Terms of Substance of the Proposed Rule Change </HD>
                <P>
                    The Exchange proposes to revise the annual listing fees for index fund shares, trust-issued receipts, commodity-based trust shares, currency trust shares, paired trust shares, partnership units, and closed-end funds (collectively, “Exchange Traded Funds” or “ETFs”) set forth in section 141 of the Amex 
                    <E T="03">Company Guide.</E>
                     The text of the proposed rule change is available at 
                    <E T="03">http://www.amex.com,</E>
                     the Exchange's principal, and the Commission's Public Reference Room. 
                </P>
                <HD SOURCE="HD1">II. Self-Regulatory Organization's Statement of the Purpose of, and Statutory Basis for, the Proposed Rule Change </HD>
                <P>In its filing with the Commission, the Exchange included statements concerning the purpose of, and basis for, the proposed rule change and discussed any comments it received on the proposed rule change. The text of these statements may be examined at the places specified in Item IV below. The Exchange has prepared summaries, set forth in sections A, B, and C below, of the most significant aspects of such statements. </P>
                <HD SOURCE="HD2">A. Self-Regulatory Organization's Statement of the Purpose of, and Statutory Basis for, the Proposed Rule Change </HD>
                <HD SOURCE="HD3">1. Purpose </HD>
                <P>
                    Amex proposes to amend section 141 of the 
                    <E T="03">Company Guide</E>
                     to adopt a single annual fee schedule for all ETFs. The proposed annual listing fee schedule is largely based on the existing annual listing fee schedule for index and currency warrants, equity- and index-linked securities, trust-issued receipts, commodity-based trust shares, currency trust shares, paired trust shares, partnership units, and closed-end funds. The current annual listing fees are shown in the table below. 
                    <PRTPAGE P="66204"/>
                </P>
                <GPOTABLE COLS="2" OPTS="L2,i1" CDEF="s100,xs80">
                    <TTITLE>Issues Listed Under Section 106 and Section 107; Rules 1200 (Trust Issued Receipts) and 1200A (Commodity-Based Trust Shares); Rule 1200B (Currency Trust Shares); Rule 1400 (Paired Trust Shares); Rule 1500 (Partnership Units); and Closed-End Funds</TTITLE>
                    <BOXHD>
                        <CHED H="1">Shares or units outstanding </CHED>
                        <CHED H="1">Fee</CHED>
                    </BOXHD>
                    <ROW>
                        <ENT I="01">5,000,000 shares (units) or less </ENT>
                        <ENT>$15,000 (minimum). </ENT>
                    </ROW>
                    <ROW>
                        <ENT I="01">5,000,001 to 10,000,000 shares (units) </ENT>
                        <ENT>17,500. </ENT>
                    </ROW>
                    <ROW>
                        <ENT I="01">10,000,001 to 25,000,000 shares (units) </ENT>
                        <ENT>20,000. </ENT>
                    </ROW>
                    <ROW>
                        <ENT I="01">25,000,001 to 50,000,000 shares (units) </ENT>
                        <ENT>22,500. </ENT>
                    </ROW>
                    <ROW>
                        <ENT I="01">In excess of 50,000,000 shares (units) </ENT>
                        <ENT>30,000 (maximum). </ENT>
                    </ROW>
                </GPOTABLE>
                <GPOTABLE COLS="2" OPTS="L2,i1" CDEF="s100,xs80">
                    <TTITLE>Issues Listed Under Rule 1000A (Index Fund Shares)</TTITLE>
                    <BOXHD>
                        <CHED H="1">Shares outstanding </CHED>
                        <CHED H="1">Fee </CHED>
                    </BOXHD>
                    <ROW>
                        <ENT I="01">1,000,000 shares or less </ENT>
                        <ENT>$6,500 (minimum). </ENT>
                    </ROW>
                    <ROW>
                        <ENT I="01">1,000,001 to 2,000,000 shares </ENT>
                        <ENT>7,000. </ENT>
                    </ROW>
                    <ROW>
                        <ENT I="01">2,000,001 to 3,000,000 shares </ENT>
                        <ENT>7,500. </ENT>
                    </ROW>
                    <ROW>
                        <ENT I="01">3,000,001 to 4,000,000 shares </ENT>
                        <ENT>8,000. </ENT>
                    </ROW>
                    <ROW>
                        <ENT I="01">4,000,001 to 5,000,000 shares </ENT>
                        <ENT>8,500. </ENT>
                    </ROW>
                    <ROW>
                        <ENT I="01">5,000,001 to 6,000,000 shares </ENT>
                        <ENT>9,000. </ENT>
                    </ROW>
                    <ROW>
                        <ENT I="01">6,000,001 to 7,000,000 shares </ENT>
                        <ENT>9,500. </ENT>
                    </ROW>
                    <ROW>
                        <ENT I="01">7,000,001 to 8,000,000 shares </ENT>
                        <ENT>10,000. </ENT>
                    </ROW>
                    <ROW>
                        <ENT I="01">8,000,001 to 9,000,000 shares </ENT>
                        <ENT>10,500. </ENT>
                    </ROW>
                    <ROW>
                        <ENT I="01">9,000,001 to 10,000,000 shares </ENT>
                        <ENT>11,000. </ENT>
                    </ROW>
                    <ROW>
                        <ENT I="01">10,000,001 to 11,000,000 shares </ENT>
                        <ENT>11,500. </ENT>
                    </ROW>
                    <ROW>
                        <ENT I="01">11,000,001 to 12,000,000 shares</ENT>
                        <ENT>12,000. </ENT>
                    </ROW>
                    <ROW>
                        <ENT I="01">12,000,001 to 13,000,000 shares </ENT>
                        <ENT>12,500. </ENT>
                    </ROW>
                    <ROW>
                        <ENT I="01">13,000,001 to 14,000,000 shares </ENT>
                        <ENT>13,000. </ENT>
                    </ROW>
                    <ROW>
                        <ENT I="01">14,000,001 to 15,000,000 shares </ENT>
                        <ENT>13,500. </ENT>
                    </ROW>
                    <ROW>
                        <ENT I="01">15,000,001 to 16,000,000 shares </ENT>
                        <ENT>14,000. </ENT>
                    </ROW>
                    <ROW>
                        <ENT I="01">In excess of 16,000,000 shares </ENT>
                        <ENT>14,500 (maximum). </ENT>
                    </ROW>
                </GPOTABLE>
                <P>The annual listing fees for index fund shares are based on a sliding schedule based on the number of outstanding shares, with a minimum fee of $6,500 and a maximum of $14,500. In comparison, the other ETFs have an annual listing fee schedule based on the number of outstanding shares or units with a minimum fee of $15,000 and a maximum fee of $30,000. This proposal would conform the annual listing fees for index fund shares with those of other ETFs and add an additional demarcation for outstanding shares or units of over 100 million, so that the maximum annual listing fee would increase to $50,000. </P>
                <P>Set forth below is the proposed annual listing fee schedule for all ETFs. </P>
                <GPOTABLE COLS="2" OPTS="L2,i1" CDEF="s150,10">
                    <TTITLE>Securities Listed Under Section 106 and Section 107 of the Company Guide; Rule 1000A-AEMI (Index Fund Shares); 1200-AEMI (Trust Issued Receipts); Rule 1200A-AEMI (Commodity-Based Trust Shares); Rule 1200B-AEMI (Currency Trust Shares); Rule 1400 (Paired Trust Shares); Rule 1500-AEMI (Partnership Units); and Closed-End Funds</TTITLE>
                    <BOXHD>
                        <CHED H="1">Shares or units outstanding </CHED>
                        <CHED H="1">Fee </CHED>
                    </BOXHD>
                    <ROW>
                        <ENT I="01">5,000,000 shares (units) or less </ENT>
                        <ENT>$15,000 </ENT>
                    </ROW>
                    <ROW>
                        <ENT I="01">5,000,001 to 10,000,000 shares (units) </ENT>
                        <ENT>17,500 </ENT>
                    </ROW>
                    <ROW>
                        <ENT I="01">10,000,001 to 25,000,000 shares (units) </ENT>
                        <ENT>20,000 </ENT>
                    </ROW>
                    <ROW>
                        <ENT I="01">25,000,001 to 50,000,000 shares (units) </ENT>
                        <ENT>22,500 </ENT>
                    </ROW>
                    <ROW>
                        <ENT I="01">50,000,001 to 100,000,000 shares (units) </ENT>
                        <ENT>30,000 </ENT>
                    </ROW>
                    <ROW>
                        <ENT I="01">100,000,001 shares (units) or greater </ENT>
                        <ENT>50,000 </ENT>
                    </ROW>
                </GPOTABLE>
                <P>Each series of the securities listed as index fund shares, trust-issued receipts, commodity-based trust shares, currency trust shares, paired trust shares, partnership units, or closed-end funds would be separately aggregated. The annual listing fee would then be applied to all of the outstanding securities of a particular issuer for each appropriate product class. Securities listed under Sections 106 and 107 of the Company Guide would be charged listing fees based on the shares outstanding of each individual issue. </P>
                <P>The Exchange believes that the proposed revision to the annual listing fee schedule for ETFs would benefit the marketplace by providing uniformity to its annual fee structure for similarly situated products. In addition, the Exchange believes that slightly increasing the annual listing fees for index fund shares should provide additional incremental revenue to fund Exchange operations. </P>
                <P>
                    The Exchange submits that the proposal to revise the annual listing fees for ETFs in section 141 of the Company Guide is consistent with section 6(b)(4) of the Act.
                    <SU>5</SU>
                    <FTREF/>
                     The Exchange believes that the proposal provides an equitable allocation of annual listing fees among issuers of ETFs. The Exchange further 
                    <PRTPAGE P="66205"/>
                    submits that the proposal to simplify and slightly increase annual listing fees for similarly situated derivative products is appropriate for the purpose of uniformity and to generate revenue to fund Exchange operations. 
                </P>
                <FTNT>
                    <P>
                        <SU>5</SU>
                         15 U.S.C. 78f(b)(4). 
                    </P>
                </FTNT>
                <HD SOURCE="HD3">2. Statutory Basis </HD>
                <P>
                    The proposed rule change is consistent with section 6(b) of the Act 
                    <SU>6</SU>
                    <FTREF/>
                     in general, and furthers the objectives of sections 6(b)(4) of the Act 
                    <SU>7</SU>
                    <FTREF/>
                     in particular, in that the proposed rule change provides for the equitable allocation of reasonable dues, fees, and other charges among members and issuers and other persons using the Exchange's facilities. 
                </P>
                <FTNT>
                    <P>
                        <SU>6</SU>
                         15 U.S.C. 78f(b). 
                    </P>
                </FTNT>
                <FTNT>
                    <P>
                        <SU>7</SU>
                         15 U.S.C. 78f(b)(4). 
                    </P>
                </FTNT>
                <HD SOURCE="HD2">B. Self-Regulatory Organization's Statement on Burden on Competition </HD>
                <P>The proposed rule change does not impose any burden on competition that is not necessary or appropriate in furtherance of the purposes of the Act. </P>
                <HD SOURCE="HD2">C. Self-Regulatory Organization's Statement on Comments on the Proposed Rule Change Received From Members, Participants, or Others </HD>
                <P>No written comments were solicited nor received with respect to the proposed rule change. </P>
                <HD SOURCE="HD1">III. Date of Effectiveness of the Proposed Rule Change and Timing for Commission Action </HD>
                <P>
                    Within 35 days of the date of publication of this notice in the 
                    <E T="04">Federal Register</E>
                     or within such longer period (i) as the Commission may designate up to 90 days of such date if it finds such longer period to be appropriate and publishes its reasons for so finding or (ii) as to which the Exchange consents, the Commission will: 
                </P>
                <P>(A) By order approve such proposed rule change, or </P>
                <P>(B) Institute proceedings to determine whether the proposed rule change should be disapproved. </P>
                <HD SOURCE="HD1">IV. Solicitation of Comments </HD>
                <P>Interested persons are invited to submit written data, views, and arguments concerning the foregoing, including whether the proposed rule change is consistent with the Act. Comments may be submitted by any of the following methods: </P>
                <HD SOURCE="HD2">Electronic Comments </HD>
                <P>
                    • Use the Commission's Internet comment form (
                    <E T="03">http://www.sec.gov/rules/sro.shtml</E>
                    ); or 
                </P>
                <P>
                    • Send an e-mail to 
                    <E T="03">rule-comments@sec.gov</E>
                    . Please include File Number SR-Amex-2007-116 on the subject line. 
                </P>
                <HD SOURCE="HD2">Paper Comments</HD>
                <P>• Send paper comments in triplicate to Nancy M. Morris, Secretary, Securities and Exchange Commission, 100 F Street, NE., Washington, DC 20549-1090. </P>
                <P>
                    All submissions should refer to File Number SR-Amex-2007-116. This file number should be included on the subject line if e-mail is used. To help the Commission process and review your comments more efficiently, please use only one method. The Commission will post all comments on the Commission's Internet Web site (
                    <E T="03">http://www.sec.gov/rules/sro.shtml</E>
                    ). Copies of the submission, all subsequent amendments, all written statements with respect to the proposed rule change that are filed with the Commission, and all written communications relating to the proposed rule change between the Commission and any person, other than those that may be withheld from the public in accordance with the provisions of 5 U.S.C. 552, will be available for inspection and copying in the Commission's Public Reference Room, 100 F Street, NE., Washington, DC 20549, on official business days between the hours of 10 a.m. and 3 p.m. Copies of such filings also will be available for inspection and copying at the principal office of the Exchange. All comments received will be posted without change; the Commission does not edit personal identifying information from submissions. You should submit only information that you wish to make available publicly. All submissions should refer to File Number SR-Amex-2007-116 and should be submitted on or before December 17, 2007. 
                </P>
                <SIG>
                    <P>
                        For the Commission, by the Division of Trading and Markets, pursuant to delegated authority.
                        <SU>8</SU>
                        <FTREF/>
                    </P>
                    <FTNT>
                        <P>
                            <SU>8</SU>
                             17 CFR 200.30-3(a)(12).
                        </P>
                    </FTNT>
                    <NAME>Florence E. Harmon, </NAME>
                    <TITLE>Deputy Secretary.</TITLE>
                </SIG>
            </PREAMB>
            <FRDOC>[FR Doc. E7-22974 Filed 11-26-07; 8:45 am] </FRDOC>
            <BILCOD>BILLING CODE 8011-01-P </BILCOD>
        </NOTICE>
        <NOTICE>
            <PREAMB>
                <AGENCY TYPE="S">SECURITIES AND EXCHANGE COMMISSION</AGENCY>
                <DEPDOC>[Release No. 34-56818; File No. SR-CBOE-2007-65]</DEPDOC>
                <SUBJECT>Self-Regulatory Organizations; Chicago Board Options Exchange, Incorporated; Notice of Filing of a Proposed Rule Change as Modified by Amendment No. 1 Thereto Regarding Nullification and Modification of Transactions Executed on CBOE Stock Exchange</SUBJECT>
                <DATE>November 19, 2007.</DATE>
                <P>
                    Pursuant to section 19(b)(1) of the Securities Exchange Act of 1934 (“Act”),
                    <SU>1</SU>
                    <FTREF/>
                     and Rule 19b-4 thereunder,
                    <SU>2</SU>
                    <FTREF/>
                     notice is hereby given that on June 12, 2007, the Chicago Board Options Exchange, Incorporated (“CBOE” or “Exchange”) filed with the Securities and Exchange Commission (“Commission”) the proposed rule change as described in Items I, II, and III below, which Items have been substantially prepared by the Exchange. On November 8, 2007, the CBOE submitted Amendment No. 1 to the proposed rule change.
                    <SU>3</SU>
                    <FTREF/>
                     The Commission is publishing this notice to solicit comments on the proposed rule change, as amended, from interested persons.
                </P>
                <FTNT>
                    <P>
                        <SU>1</SU>
                         15 U.S.C. 78s(b)(1).
                    </P>
                </FTNT>
                <FTNT>
                    <P>
                        <SU>2</SU>
                         17 CFR 240.19b-4.
                    </P>
                </FTNT>
                <FTNT>
                    <P>
                        <SU>3</SU>
                         Amendment No. 1 supersedes and replaces the original filing in its entirety. The substance of Amendment No. 1 is incorporated into this notice.
                    </P>
                </FTNT>
                <HD SOURCE="HD1">I. Self-Regulatory Organization's Statement of the Terms of Substance of the Proposed Rule Change</HD>
                <P>
                    The Exchange proposes various revisions to CBOE Stock Exchange (“CBSX”) Rule 52.4, which governs the nullification and modification of transactions executed on CBSX. The text of the proposed rule change is available at the Exchange, the Commission's Public Reference Room, and 
                    <E T="03">http://www.cboe.com</E>
                    .
                </P>
                <HD SOURCE="HD1">II. Self-Regulatory Organization's Statement of the Purpose of, and Statutory Basis for, the Proposed Rule Change</HD>
                <P>
                    In its filing with the Commission, the Exchange included statements concerning the purpose of and basis for the proposed rule change and discussed any comments it received on the proposed rule change. The text of these statements may be examined at the places specified in Item IV below. The Exchange has prepared summaries, set forth in Sections A, B, and C below, of the most significant aspects of such statements.
                    <PRTPAGE P="66206"/>
                </P>
                <HD SOURCE="HD2">A. Self-Regulatory Organization's Statement of the Purpose of, and Statutory Basis for, the Proposed Rule Change</HD>
                <HD SOURCE="HD3">1. Purpose</HD>
                <P>The Exchange states that the purpose of this proposed rule change is to revise CBSX Rule 52.4, which governs the nullification and modification of transactions executed on CBSX. Specifically, the Exchange proposes to: (1) Require a request for review of a transaction to be made by only one of the following methods: Telephone; facsimile; or e-mail (in order to simplify the process for those making requests); (2) require such a request to be made within thirty minutes of the trade in question, or within forty-five minutes of the trade if that trade occurred within the first thirty minutes of trading in the product involved in the trade (in order to give more time for requests which, based on the Exchange's experience so far, is necessary); (3) give the individual(s) who reviews transactions under the Rule the label of “designated official,” so that they need not be officers of the Exchange; and (4) eliminate the requirement that the notification to the parties to the trade of the official's determination be given in writing and by the official. The aforementioned changes labeled (1) and (4) are based on, and conform CBSX Rule 52.4 to NYSE Arca Equities Rules 7.10(b) and 7.10(c)(1), respectively.</P>
                <HD SOURCE="HD3">2. Statutory Basis</HD>
                <P>
                    The Exchange believes the proposed rule change is consistent with section 6(b) of the Act,
                    <SU>4</SU>
                    <FTREF/>
                     in general, and furthers the objectives of section 6(b)(5) of the Act,
                    <SU>5</SU>
                    <FTREF/>
                     in particular, in that it is designed to promote just and equitable principles of trade, serve to remove impediments to and perfect the mechanism of a free and open market and a national market system, and to protect investors and the public interest.
                </P>
                <FTNT>
                    <P>
                        <SU>4</SU>
                         15 U.S.C. 78f(b).
                    </P>
                </FTNT>
                <FTNT>
                    <P>
                        <SU>5</SU>
                         15 U.S.C. 78f(b)(5).
                    </P>
                </FTNT>
                <HD SOURCE="HD2">B. Self-Regulatory Organization's Statement on Burden on Competition</HD>
                <P>The Exchange does not believe that the proposed rule change will impose any burden on competition that is not necessary or appropriate in furtherance of the purposes of the Act.</P>
                <HD SOURCE="HD2">C. Self-Regulatory Organization's Statement on Comments on the Proposed Rule Change Received from Members, Participants or Others</HD>
                <P>No written comments were solicited or received by the Exchange with respect to the proposed rule change.</P>
                <HD SOURCE="HD1">III. Date of Effectiveness of the Proposed Rule Change and Timing for Commission Action</HD>
                <P>
                    Within 35 days of the date of publication of this notice in the 
                    <E T="04">Federal Register</E>
                     or within such longer period (i) as the Commission may designate up to 90 days of such date if it finds such longer period to be appropriate and publishes its reasons for so finding, or (ii) as to which the Exchange consents, the Commission will:
                </P>
                <P>A. By order approve the proposed rule change or</P>
                <P>B. Institute proceedings to determine whether the proposed rule change should be disapproved.</P>
                <HD SOURCE="HD1">IV. Solicitation of Comments</HD>
                <P>Interested persons are invited to submit written data, views, and arguments concerning the foregoing, including whether the proposed rule change is consistent with the Act. Comments may be submitted by any of the following methods:</P>
                <HD SOURCE="HD2">Electronic Comments</HD>
                <P>
                    • Use the Commission's Internet comment form (
                    <E T="03">http://www.sec.gov/rules/sro.shtml</E>
                    ); or
                </P>
                <P>
                    • Send an e-mail to 
                    <E T="03">rule-comments@sec.gov</E>
                    . Please include File Number SR-CBOE-2007-65 on the subject line.
                </P>
                <HD SOURCE="HD2">Paper Comments</HD>
                <P>• Send paper comments in triplicate to Nancy M. Morris, Secretary, Securities and Exchange Commission, 100 F Street, NE., Washington, DC 20549-1090.</P>
                <FP>
                    All submissions should refer to File Number SR-CBOE-2007-65. This file number should be included on the subject line if e-mail is used. To help the Commission process and review your comments more efficiently, please use only one method. The Commission will post all comments on the Commission's Internet Web site (
                    <E T="03">http://www.sec.gov/rules/sro.shtml</E>
                    ). Copies of the submission, all subsequent amendments, all written statements with respect to the proposed rule change that are filed with the Commission, and all written communications relating to the proposed rule change between the Commission and any person, other than those that may be withheld from the public in accordance with the provisions of 5 U.S.C. 552, will be available for inspection and copying in the Commission's Public Reference Room, 100 F Street, NE., Washington, DC 20549, on official business days between the hours of 10 a.m. and 3 p.m. Copies of such filing also will be available for inspection and copying at the principal office of the Exchange. All comments received will be posted without change; the Commission does not edit personal identifying information from submissions. You should submit only information that you wish to make available publicly. All submissions should refer to File Number SR-CBOE-2007-65 and should be submitted on or before December 18, 2007.
                </FP>
                <SIG>
                    <P>
                        For the Commission, by the Division of Trading and Markets, pursuant to delegated authority.
                        <SU>6</SU>
                        <FTREF/>
                    </P>
                    <NAME>Florence E. Harmon,</NAME>
                    <TITLE>Deputy Secretary.</TITLE>
                </SIG>
                <FTNT>
                    <P>
                        <SU>6</SU>
                         17 CFR 200.30-3(a)(12).
                    </P>
                </FTNT>
            </PREAMB>
            <FRDOC> [FR Doc. E7-22985 Filed 11-26-07; 8:45 am]</FRDOC>
            <BILCOD>BILLING CODE 8011-01-P</BILCOD>
        </NOTICE>
        <NOTICE>
            <PREAMB>
                <AGENCY TYPE="S">SECURITIES AND EXCHANGE COMMISSION</AGENCY>
                <DEPDOC>[Release No. 34-56817; File No. SR-CBOE-2007-124]</DEPDOC>
                <SUBJECT>Self-Regulatory Organizations; Chicago Board Options Exchange, Incorporated; Notice of Filing and Order Granting Accelerated Approval of Proposed Rule Change, as Modified by Amendment No. 1 Thereto, To Trade Shares of 93 Funds of the ProShares Trust Pursuant to Unlisted Trading Privileges</SUBJECT>
                <DATE>November 19, 2007.</DATE>
                <P>
                    Pursuant to section 19(b)(1) of the Securities Exchange Act of 1934 (“Act”) 
                    <SU>1</SU>
                    <FTREF/>
                     and Rule 19b-4 thereunder,
                    <SU>2</SU>
                    <FTREF/>
                     notice is hereby given that on October 30, 2007, the Chicago Board Options Exchange, Incorporated (“CBOE” or “Exchange”) filed with the Securities and Exchange Commission (“Commission”) the proposed rule change as described in Items I and II below, which Items have been substantially prepared by the Exchange. On November 15, 2008, the Exchange filed Amendment No. 1 to the proposed rule change. This order provides notice of, and approves, the proposed rule change, as modified by Amendment No. 1 thereto, on an accelerated basis.
                </P>
                <FTNT>
                    <P>
                        <SU>1</SU>
                         15 U.S.C. 78s(b)(1).
                    </P>
                </FTNT>
                <FTNT>
                    <P>
                        <SU>2</SU>
                         17 CFR 240.19b-4.
                    </P>
                </FTNT>
                <PRTPAGE P="66207"/>
                <HD SOURCE="HD1">I. Self-Regulatory Organization's Statement of the Terms of Substance of the Proposed Rule Change</HD>
                <P>CBOE is proposing to trade on its stock trading facility, the CBOE Stock Exchange (“CBSX”), shares (“Shares”) of the 93 funds identified below (collectively, the “Funds”) of the ProShares Trust (“Trust”) pursuant to unlisted trading privileges (“UTP”).</P>
                <P>
                    The text of the proposed rule change is available from the Exchange's Web site (
                    <E T="03">http://www.cboe.org/Legal</E>
                    ), at the principal office of the Exchange, and at the Commission's Public Reference Room.
                </P>
                <HD SOURCE="HD1">II. Self-Regulatory Organization's Statement of the Purpose of, and Statutory Basis for, the Proposed Rule Change</HD>
                <P>In its filing with the Commission, the Exchange included statements concerning the purpose of, and basis for, the proposed rule change and discussed any comments it received on the proposed rule change. The text of these statements may be examined at the places specified in Item III below. The Exchange has prepared summaries, set forth in sections A, B, and C below, of the most significant aspects of such statements.</P>
                <HD SOURCE="HD2">A. Self-Regulatory Organization's Statement of the Purpose of, and Statutory Basis for, the Proposed Rule Change</HD>
                <HD SOURCE="HD3">1. Purpose</HD>
                <P>The Exchange proposes to trade, pursuant to UTP, the Shares of 93 Funds, which are exchange-traded funds (“ETFs”). The Commission has approved exchange rules for the original listing and trading of the Shares on the American Stock Exchange (“Amex”). CBOE is submitting this filing because its current generic listing standards for ETFs do not extend to ETFs with the investment objective of corresponding to a specified multiple of the performance, or the inverse performance, of an index that underlies each Fund (each such index is referred to below as an “Underlying Index”), rather than merely mirroring the performance of the index. Some of the Shares were approved for listing and trading only recently, and actual trading has not yet commenced.</P>
                <HD SOURCE="HD2">Ultra Funds</HD>
                <P>
                    Certain Funds seek daily investment results, before fees and expenses, that correspond to twice (200%) the daily performance of the Underlying Indexes (“Ultra Funds”). If such Funds meet their objective, the net asset value (the “NAV”) 
                    <SU>3</SU>
                    <FTREF/>
                     of the Shares of each Fund should increase (on a percentage basis) approximately twice as much as the Fund's Underlying Index when the prices of the securities in such Index increase on a given day, and should lose approximately twice as much when such prices decline on a given day. This filing applies to the following Ultra Funds: Four Ultra Funds listed and traded on Amex pursuant to Commission order on May 10, 2006: 
                    <SU>4</SU>
                    <FTREF/>
                     (1) Ultra S&amp;P 500, (2) Ultra Nasdaq-100, (3) Ultra Dow 30, and (4) Ultra S&amp;P Mid-Cap 400; and 27 Ultra Funds listed and traded on Amex pursuant to Commission order on January 17, 2007: 
                    <SU>5</SU>
                    <FTREF/>
                     (1) Ultra Russell 2000, (2) Ultra S&amp;P SmallCap 600, (3) Ultra S&amp;P500/Citigroup Value, (4) Ultra S&amp;P500/Citigroup Growth, (5) Ultra S&amp;P MidCap 400/Citigroup Value, (6) Ultra S&amp;P MidCap 400/Citigroup Growth, (7) Ultra S&amp;P SmallCap 600/Citigroup Value, (8) Ultra S&amp;P SmallCap 600/Citigroup Growth, (9) Ultra Basic Materials, (10) Ultra Consumer Goods, (11) Ultra Consumer Services, (12) Ultra Financials, (13) Ultra Health Care, (14) Ultra Industrials, (15) Ultra Oil &amp; Gas, (16) Ultra Real Estate, (17) Ultra Semiconductors, (18) Ultra Technology, (19) Ultra Utilities, (20) Ultra Russell Midcap Index, (21) Ultra Russell Midcap Growth Index, (22) Ultra Russell Midcap Value Index, (23) Ultra Russell 1000 Index, (24) Ultra Russell 1000 Growth Index, (25) Ultra Russell 1000 Value Index, (26) Ultra Russell 2000 Growth Index, and (27) Ultra Russell 2000 Value Index.
                </P>
                <FTNT>
                    <P>
                        <SU>3</SU>
                         NAV per Share of each Fund is computed by dividing the value of the net assets of such Fund (
                        <E T="03">i.e.</E>
                        , the value of its total assets less total liabilities) by its total number of Shares outstanding. Expenses and fees are accrued daily and taken into account for purposes of determining NAV.
                    </P>
                </FTNT>
                <FTNT>
                    <P>
                        <SU>4</SU>
                         Securities Exchange Act Release No. 53784 (May 10, 2006), 71 FR 28721 (May 17, 2006). These Funds were subsequently approved for UTP trading on NYSE Arca, Inc. and The NASDAQ Stock Market LLC. 
                        <E T="03">See</E>
                         Securities Exchange Act Release Nos. 54026 (June 21, 2006), 71 FR 36850 (June 28, 2006) and 55353 (February 26, 2007), 72 FR 9802 (March 5, 2007).
                    </P>
                </FTNT>
                <FTNT>
                    <P>
                        <SU>5</SU>
                         Securities Exchange Act Release No. 55117 (January 17, 2007), 72 FR 3442 (January 25, 2007). These Funds were subsequently approved for UTP trading on NYSE Arca, Inc. and The NASDAQ Stock Market LLC. 
                        <E T="03">See</E>
                         Securities Exchange Act Release Nos. 55125 (January 18, 2007), 72 FR 3462 (January 25, 2007) and 55353 (February 26, 2007), 72 FR 9802 (March 5, 2007).
                    </P>
                </FTNT>
                <HD SOURCE="HD2">Short Funds</HD>
                <P>CBOE also proposes to trade Shares of certain Funds that seek daily investment results, before fees and expenses, that correspond to the inverse or opposite of the daily performance (-100%) of the Underlying Indexes (“Short Funds”). If such a Fund is successful in meeting its objective, the NAV of the corresponding Shares should increase approximately as much (on a percentage basis) as the respective Underlying Index loses when the prices of the securities in the Index decline on a given day, or should decrease approximately as much as the respective Index gains when prices in the Index rise on a given day.</P>
                <P>
                    This filing applies to the following Short Funds: Four Short Funds listed and traded on Amex pursuant to Commission order on May 10, 2006: 
                    <SU>6</SU>
                    <FTREF/>
                     (1) Short S&amp;P 500, (2) Short Nasdaq-100, (3) Short Dow 30, and (4) Short S&amp;P Mid-Cap 400; and 27 Short Funds listed and traded on Amex pursuant to Commission order on January 17, 2007: 
                    <SU>7</SU>
                    <FTREF/>
                     (1) Short Russell 2000, (2) Short S&amp;P SmallCap 600, (3) Short S&amp;P500/Citigroup Value, (4) Short S&amp;P500/Citigroup Growth, (5) Short S&amp;P MidCap 400/Citigroup Value, (6) Short S&amp;P MidCap 400/Citigroup Growth, (7) Short S&amp;P SmallCap 600/Citigroup Value, (8) Short S&amp;P SmallCap 600/Citigroup Growth, (9) Short Basic Materials, (10) Short Consumer Goods, (11) Short Consumer Services, (12) Short Financials, (13) Short Health Care, (14) Short Industrials, (15) Short Oil &amp; Gas, (16) Short Real Estate, (17) Short Semiconductors, (18) Short Technology, (19) Short Utilities, (20) Short Russell Midcap Index, (21) Short Russell Midcap Growth Index, (22) Short Russell Midcap Value Index, (23) Short Russell 1000 Index, (24) Short Russell 1000 Growth Index, (25) Short Russell 1000 Value Index, (26) Short Russell 2000 Growth Index, and (27) Short Russell 2000 Value Index.
                </P>
                <FTNT>
                    <P>
                        <SU>6</SU>
                         
                        <E T="03">See</E>
                         supra note 2.
                    </P>
                </FTNT>
                <FTNT>
                    <P>
                        <SU>7</SU>
                         
                        <E T="03">See</E>
                         supra note 3.
                    </P>
                </FTNT>
                <HD SOURCE="HD2">UltraShort Funds</HD>
                <P>CBOE also proposes to trade Shares of certain Funds that seek daily investment results, before fees and expenses, that correspond to twice the inverse (-200%) of the daily performance of the Underlying Indexes (“UltraShort Funds”). If such a Fund is successful in meeting its objective, the NAV of the corresponding Shares should increase approximately twice as much (on a percentage basis) as the respective Underlying Index loses when the prices of the securities in the Index decline on a given day, or should decrease approximately twice as much as the respective Underlying Index gains when such prices rise on a given day.</P>
                <P>
                    This filing applies to the following UltraShort Funds: Four UltraShort Funds listed and traded on Amex pursuant to Commission order on June 
                    <PRTPAGE P="66208"/>
                    23, 2006: 
                    <SU>8</SU>
                    <FTREF/>
                     (1) UltraShort S&amp;P 500, (2) UltraShort Nasdaq-100, (3) UltraShort Dow 30, and (4) UltraShort S&amp;P Mid-Cap 400; and 27 UltraShort funds listed and traded on Amex pursuant to Commission order on January 17, 2007: 
                    <SU>9</SU>
                    <FTREF/>
                     (1) UltraShort Russell 2000, (2) UltraShort S&amp;P SmallCap 600, (3) UltraShort S&amp;P500/Citigroup Value, (4) UltraShort S&amp;P500/Citigroup Growth, (5) UltraShort S&amp;P MidCap 400/Citigroup Value, (6) UltraShort S&amp;P MidCap 400/Citigroup Growth, (7) UltraShort S&amp;P SmallCap 600/Citigroup Value, (8) UltraShort S&amp;P SmallCap 600/Citigroup Growth, (9) UltraShort Basic Materials, (10) UltraShort Consumer Goods, (11) UltraShort Consumer Services, (12) UltraShort Financials, (13) UltraShort Health Care, (14) UltraShort Industrials, (15) UltraShort Oil &amp; Gas, (16) UltraShort Real Estate, (17) UltraShort Semiconductors, (18) UltraShort Technology, (19) UltraShort Utilities, (20) UltraShort Russell Midcap Index, (21) UltraShort Russell Midcap Growth Index, (22) UltraShort Russell Midcap Value Index, (23) UltraShort Russell 1000 Index, (24) UltraShort Russell 1000 Growth Index, (25) UltraShort Russell 1000 Value Index, (26) UltraShort Russell 2000 Growth Index, and (27) UltraShort Russell 2000 Value Index.
                </P>
                <FTNT>
                    <P>
                        <SU>8</SU>
                         Securities Exchange Act Release No. 54040 (June 23, 2006), 71 FR 37629 (June 30, 2006). These Funds were subsequently approved for UTP trading on NYSE Arca. 
                        <E T="03">See</E>
                         Securities Exchange Act Release No. 54045 (June 26, 2006), 71 FR 37971 (July 3, 2006).
                    </P>
                </FTNT>
                <FTNT>
                    <P>
                        <SU>9</SU>
                         
                        <E T="03">See supra</E>
                         note 5.
                    </P>
                </FTNT>
                <P>
                    Access to the current portfolio composition of each Fund is currently available through the Trust's Web site (
                    <E T="03">http://www.proshares.com</E>
                    ).
                    <SU>10</SU>
                    <FTREF/>
                     The Underlying Indexes are identified in Amex's proposed rule changes to list the Funds (the “Original Filings”).
                    <SU>11</SU>
                    <FTREF/>
                     The Original Filings state that Amex would disseminate for each Fund on a daily basis by means of Consolidated Tape Association (“CTA”) and CQ High Speed Lines information with respect to an Indicative Intra-Day Value (“IIV”), the daily trading volume, closing price, NAV, and final dividend amounts, if any, to be paid for each Fund.
                    <SU>12</SU>
                    <FTREF/>
                </P>
                <FTNT>
                    <P>
                        <SU>10</SU>
                         The Trust's Web site is publicly accessible at no charge and contains the following information for each Fund's Shares: (1) The prior business day's closing NAV, the reported closing price, and a calculation of the premium or discount of such price in relation to the closing NAV; (2) data for a period covering at least the current and three immediately preceding calendar quarters (or the life of a Fund, if shorter) indicating how frequently each Fund's Shares traded at a premium or discount to NAV based on the daily closing price and the closing NAV, and the magnitude of such premiums and discounts; (3) its prospectus and product description; and (4) other quantitative information such as daily trading volume. The prospectus and/or product description for each Fund would inform investors that the Trust's Web site has information about the premiums and discounts at which the Fund's Shares have traded.
                    </P>
                </FTNT>
                <FTNT>
                    <P>
                        <SU>11</SU>
                         
                        <E T="03">See supra</E>
                         notes 4, 5, and 8.
                    </P>
                </FTNT>
                <FTNT>
                    <P>
                        <SU>12</SU>
                         The Original Filings explain that, if the IIV is not disseminated as required, Amex would halt trading in the shares of the Funds. If Amex halts trading for this reason, then CBOE would do so as well.
                    </P>
                </FTNT>
                <P>
                    The Original Filings state that the daily closing index value and the percentage change in the daily closing index value for each Underlying Index would be publicly available on various Web sites such as 
                    <E T="03">http://www.bloomberg.com.</E>
                     The Original Filings further state that data regarding each Underlying Index are also available from the respective index provider to subscribers. According to the Original Filings, several independent data vendors package and disseminate index data in various value-added formats (including vendors displaying both securities and index levels and vendors displaying index levels only).
                </P>
                <P>The Original Filings state that the value of each Underlying Index is updated intra-day on a real-time basis as its individual component securities change in price, and the intra-day values of each Underlying Index are disseminated at least every 15 seconds throughout Amex's trading day by Amex or another organization authorized by the relevant Underlying Index provider.</P>
                <P>To provide updated information relating to each Fund for use by investors, professionals, and persons wishing to create or redeem Shares, Amex disseminates through the facilities of the CTA: (1) Continuously throughout Amex's trading day, the market value of a Share; and (2) at least every 15 seconds throughout Amex's trading day, the IIV as calculated by Amex.</P>
                <P>Shares would trade on CBOE from 8:15 a.m. until 3:15 p.m. Central Time. CBOE has appropriate rules to facilitate transactions in the Shares during that trading session.</P>
                <P>
                    With respect to trading halts, the Exchange may consider all relevant factors in exercising its discretion to halt or suspend trading in the Funds. Trading in the Funds may be halted because of market conditions or for reasons that, in the view of the Exchange, make trading in the Funds inadvisable. These may include: (1) The extent to which trading is not occurring in the securities comprising an underlying Index and/or the financial instruments of the Funds, or (2) whether other unusual conditions or circumstances detrimental to the maintenance of a fair and orderly market are present. In addition, trading in the Funds would be subject to trading halts caused by extraordinary market volatility pursuant to the Exchange's “circuit breaker” rule.
                    <SU>13</SU>
                    <FTREF/>
                </P>
                <FTNT>
                    <P>
                        <SU>13</SU>
                         
                        <E T="03">See</E>
                         CBOE Rule 6.3B.
                    </P>
                </FTNT>
                <P>Moreover, the Exchange represents that it would cease trading a Fund if the listing market stopped trading that Fund because of a regulatory halt similar to a halt based on CBOE Rule 6.3. UTP trading in the Funds is also governed by the trading halts provisions of CBOE Rule 52.3 relating to temporary interruptions in the calculation or wide dissemination of IIVs or the values of underlying indexes. Finally, CBOE would stop trading the Shares of a Fund if the listing market delists them.</P>
                <P>In connection with the trading of the Shares, CBOE will inform its members in an Information Circular of the special characteristics and risks associated with trading the Shares, as well as the requirements of CBOE Rule 53.6, which requires members of the Exchange to determine that a particular security is suitable for a customer before recommending a transaction in it. The Exchange also will require its members to deliver a prospectus or product description to investors purchasing the Shares prior to or concurrently with a transaction in the Shares.</P>
                <P>CBOE deems the Shares to be equity securities, thus rendering trading in the Shares subject to the Exchange's existing rules applicable to UTP trading of equity securities. The Exchange intends to utilize its existing surveillance procedures applicable to equity securities to monitor trading in the Shares. The Exchange represents that these procedures are adequate to monitor Exchange trading of the Shares.</P>
                <P>
                    Finally, the Exchange is proposing to amend CBOE Rule 53.6, the CBSX suitability rule, so that each member organization's obligation under that rule is heightened. Specifically, the Exchange proposes to amend CBOE Rule 53.6 to provide that, in making a recommendation to a customer, a member organization must have reasonable grounds for the recommendation upon the basis of the information furnished by the customer after reasonable inquiry concerning the customer's investment objectives, tax status, financial situation and needs, and any other information known by such member organization. Other exchanges have adopted similar rule text.
                    <SU>14</SU>
                    <FTREF/>
                     That enhanced obligation would apply to a member organization's recommendation of any security that is 
                    <PRTPAGE P="66209"/>
                    subject to Chapters 50 through 54 of the Exchange's rules, including the Shares.
                </P>
                <FTNT>
                    <P>
                        <SU>14</SU>
                         
                        <E T="03">See, e.g.</E>
                        , Amex Rule 411, Commentary .05; NYSE Arca Rule 9.2(a)(2).
                    </P>
                </FTNT>
                <HD SOURCE="HD3">2. Statutory Basis</HD>
                <P>
                    CBOE believes that the proposed rule change is consistent with the Act and the rules and regulations thereunder applicable to a national securities exchange and, in particular, section 6(b) of the Act.
                    <SU>15</SU>
                    <FTREF/>
                     Specifically, CBOE believes that the proposed rule change is consistent with the section 6(b)(5) 
                    <SU>16</SU>
                    <FTREF/>
                     requirements that an exchange have rules designed to promote just and equitable principles of trade, to remove impediments to and perfect the mechanism of a free and open market and a national market system, and, in general, to protect investors and the public interest. In addition, CBOE believes that the proposal is consistent with Rule 12f-5 under the Act 
                    <SU>17</SU>
                    <FTREF/>
                     because it deems the Shares to be equity securities, thus rendering trading in the Shares subject to the Exchange's existing rules governing the trading of equity securities.
                </P>
                <FTNT>
                    <P>
                        <SU>15</SU>
                         15 U.S.C. 78f(b).
                    </P>
                </FTNT>
                <FTNT>
                    <P>
                        <SU>16</SU>
                         15 U.S.C. 78f(b)(5).
                    </P>
                </FTNT>
                <FTNT>
                    <P>
                        <SU>17</SU>
                         17 CFR 240.12f-5.
                    </P>
                </FTNT>
                <HD SOURCE="HD2">B. Self-Regulatory Organization's Statement on Burden on Competition</HD>
                <P>The Exchange does not believe that the proposed rule change will impose any burden on competition that is not necessary or appropriate in furtherance of the purposes of the Act.</P>
                <HD SOURCE="HD2">C. Self-Regulatory Organization's Statement on Comments on the Proposed Rule Change Received From Members, Participants or Others</HD>
                <P>The Exchange neither solicited nor received comments on the proposal.</P>
                <HD SOURCE="HD1">III. Solicitation of Comments</HD>
                <P>Interested persons are invited to submit written data, views, and arguments concerning the foregoing, including whether the proposed rule change is consistent with the Act. Comments may be submitted by any of the following methods:</P>
                <HD SOURCE="HD2">Electronic Comments</HD>
                <P>
                    • Use the Commission's Internet comment form (
                    <E T="03">http://www.sec.gov/rules/sro.shtml</E>
                    ); or
                </P>
                <P>
                    • Send an e-mail to 
                    <E T="03">rule-comments@sec.gov.</E>
                     Please include File Number SR-CBOE-2007-124 on the subject line.
                </P>
                <HD SOURCE="HD2">Paper Comments</HD>
                <P>• Send paper comments in triplicate to Nancy M. Morris, Secretary, Securities and Exchange Commission, 100 F Street, NE., Washington, DC 20549-1090.</P>
                <FP>
                    All submissions should refer to File Number SR-CBOE-2007-124. This file number should be included on the subject line if e-mail is used. To help the Commission process and review your comments more efficiently, please use only one method. The Commission will post all comments on the Commission's Internet Web site (
                    <E T="03">http://www.sec.gov/rules/sro.shtml</E>
                    ). Copies of the submission, all subsequent amendments, all written statements with respect to the proposed rule change that are filed with the Commission, and all written communications relating to the proposed rule change between the Commission and any person, other than those that may be withheld from the public in accordance with the provisions of 5 U.S.C. 552, will be available for inspection and copying in the Commission's Public Reference Room, 100 F Street NE., Washington, DC 20549, on official business days between the hours of 10 a.m. and 3 p.m. Copies of such filing also will be available for inspection and copying at the principal office of the Exchange. All comments received will be posted without change; the Commission does not edit personal identifying information from submissions. You should submit only information that you wish to make available publicly. All submissions should refer to File Number SR-CBOE-2007-124 and should be submitted on or before December 18, 2007.
                </FP>
                <HD SOURCE="HD1">IV. Commission's Findings and Order Granting Accelerated Approval of the Proposed Rule Change</HD>
                <P>
                    After careful review, the Commission finds that the proposed rule change is consistent with the requirements of the Act and the rules and regulations thereunder applicable to a national securities exchange.
                    <SU>18</SU>
                    <FTREF/>
                     In particular, the Commission finds that the proposed rule change is consistent with section 6(b)(5) of the Act,
                    <SU>19</SU>
                    <FTREF/>
                     which requires that an exchange have rules designed, among other things, to promote just and equitable principles of trade, to remove impediments to and perfect the mechanism of a free and open market and a national market system, and in general to protect investors and the public interest. The Commission believes that this proposal should benefit investors by increasing competition among markets that trade the Shares.
                </P>
                <FTNT>
                    <P>
                        <SU>18</SU>
                         In approving this rule change, the Commission notes that it has considered the proposal's impact on efficiency, competition, and capital formation. See 15 U.S.C. 78c(f).
                    </P>
                </FTNT>
                <FTNT>
                    <P>
                        <SU>19</SU>
                         15 U.S.C. 78f(b)(5).
                    </P>
                </FTNT>
                <P>
                    In addition, the Commission finds that the proposal is consistent with section 12(f) of the Act,
                    <SU>20</SU>
                    <FTREF/>
                     which permits an exchange to trade, pursuant to UTP, a security that is listed and registered on another exchange.
                    <SU>21</SU>
                    <FTREF/>
                     The Commission notes that it previously approved the listing and trading of the Shares on Amex and the trading of the Shares on NYSE Arca and The NASDAQ Stock Market pursuant to UTP.
                    <SU>22</SU>
                    <FTREF/>
                     The Commission also finds that the proposal is consistent with Rule 12f-5 under the Act,
                    <SU>23</SU>
                    <FTREF/>
                     which provides that an exchange shall not extend UTP to a security unless the exchange has in effect a rule or rules providing for transactions in the class or type of security to which the exchange extends UTP. The Exchange has represented that it meets this requirement because it deems the Shares to be equity securities, thus rendering trading in the Shares subject to the Exchange's existing rules governing the trading of equity securities.
                </P>
                <FTNT>
                    <P>
                        <SU>20</SU>
                         15 U.S.C. 78
                        <E T="03">l</E>
                        (f).
                    </P>
                </FTNT>
                <FTNT>
                    <P>
                        <SU>21</SU>
                         Section 12(a) of the Act, 15 U.S.C. 78
                        <E T="03">l</E>
                        (a), generally prohibits a broker-dealer from trading a security on a national securities exchange unless the security is registered on that exchange pursuant to Section 12 of the Act. Section 12(f) of the Act excludes from this restriction trading in any security to which an exchange ``extends UTP.'' When an exchange extends UTP to a security, it allows its members to trade the security as if it were listed and registered on the exchange even though it is not so listed and registered.
                    </P>
                </FTNT>
                <FTNT>
                    <P>
                        <SU>22</SU>
                         
                        <E T="03">See supra</E>
                         notes 4-9.
                    </P>
                </FTNT>
                <FTNT>
                    <P>
                        <SU>23</SU>
                         17 CFR 240.12f-5.
                    </P>
                </FTNT>
                <P>
                    The Commission further believes that the proposal is consistent with section 11A(a)(1)(C)(iii) of the Act,
                    <SU>24</SU>
                    <FTREF/>
                     which sets forth Congress' finding that it is in the public interest and appropriate for the protection of investors and the maintenance of fair and orderly markets to assure the availability to brokers, dealers, and investors of information with respect to quotations for and transactions in securities. Quotations for and last-sale information regarding the Shares are disseminated through the facilities of the CTA and the Consolidated Quotation System. Furthermore, the IIV, updated to reflect changes in currency exchange rates, is calculated by Amex and published via the facilities of the Consolidated Tape Association on a 15-second delayed basis throughout the trading hours for the Shares.
                </P>
                <FTNT>
                    <P>
                        <SU>24</SU>
                         15 U.S.C. 78k-1(a)(1)(C)(iii).
                    </P>
                </FTNT>
                <P>
                    The Commission also believes that the proposal appears reasonably designed to preclude trading of the Shares when transparency is impaired. Trading in the 
                    <PRTPAGE P="66210"/>
                    Shares will be subject to CBOE Rule 52.3, which provides that, if the listing market halts trading when the IIV or value of the underlying index is not being calculated or disseminated, the Exchange also would halt trading.
                </P>
                <P>In support of this proposal, the Exchange has made the following additional representations:</P>
                <P>1. The Exchange's surveillance procedures are adequate to properly monitor Exchange trading of the Shares in all trading sessions and to deter and detect violations of Exchange rules.</P>
                <P>2. Prior to the commencement of trading, the Exchange would inform its members in an Information Bulletin of the special characteristics and risks associated with trading the Shares.</P>
                <P>3. The Information Bulletin also would discuss the requirement that members deliver a prospectus to investors purchasing newly issued Shares prior to or concurrently with the confirmation of a transaction.</P>
                <FP>This approval order is based on the Exchange's representations.</FP>
                <P>The Commission notes that, if the Shares should be delisted by the listing exchange, the Exchange would no longer have authority to trade the Shares pursuant to this order.</P>
                <P>
                    The Commission finds good cause for approving this proposal before the thirtieth day after the publication of notice thereof in the 
                    <E T="04">Federal Register</E>
                    . As noted above, the Commission previously found that the listing and trading of the Shares on Amex and the trading of the Shares on NYSE Arca and The NASDAQ Stock Market pursuant to UTP are consistent with the Act. The Commission presently is not aware of any regulatory issue that should cause it to revisit those findings or would preclude the trading of the Shares on the Exchange pursuant to UTP. Therefore, accelerating approval of this proposal should benefit investors by creating, without undue delay, additional competition in the market for the Shares.
                </P>
                <HD SOURCE="HD1">V. Conclusion</HD>
                <P>
                    <E T="03">It is therefore ordered,</E>
                     pursuant to section 19(b)(2) of the Act,
                    <SU>25</SU>
                    <FTREF/>
                     that the proposed rule change (SR-CBOE-2007-124), as modified by Amendment No. 1 thereto, be, and it hereby is, approved on an accelerated basis.
                </P>
                <FTNT>
                    <P>
                        <SU>25</SU>
                         15 U.S.C. 78s(b)(2).
                    </P>
                </FTNT>
                <SIG>
                    <P>
                        For the Commission, by the Division of Trading and Markets, pursuant to delegated authority.
                        <SU>26</SU>
                        <FTREF/>
                    </P>
                    <FTNT>
                        <P>
                            <SU>26</SU>
                             17 CFR 200.30-3(a)(12).
                        </P>
                    </FTNT>
                    <NAME>Florence E. Harmon,</NAME>
                    <TITLE>Deputy Secretary.</TITLE>
                </SIG>
            </PREAMB>
            <FRDOC>[FR Doc. E7-23000 Filed 11-26-07; 8:45 am]</FRDOC>
            <BILCOD>BILLING CODE 8011-01-P</BILCOD>
        </NOTICE>
        <NOTICE>
            <PREAMB>
                <AGENCY TYPE="S">SECURITIES AND EXCHANGE COMMISSION</AGENCY>
                <DEPDOC>[Release No. 34-56821; File No. SR-CBOE-2007-82]</DEPDOC>
                <SUBJECT>Self-Regulatory Organizations; Chicago Board Options Exchange, Incorporated; Order Granting Approval of Proposed Rule Change as Modified by Amendment No. 1 Thereto To Allow the Exchange To List Up to Seven Expiration Months for Broad-Based Security Index Options Upon Which the Exchange Calculates a Constant Three-Month Volatility Index</SUBJECT>
                <DATE>November 20, 2007.</DATE>
                <HD SOURCE="HD1">I. Introduction</HD>
                <P>
                    On July 17, 2007, the Chicago Board Options Exchange, Incorporated (“CBOE” or “Exchange”) filed with the Securities and Exchange Commission (“Commission”) a proposed rule change, pursuant to section 19(b)(1) of the Securities Exchange Act of 1934 (“Act”) 
                    <SU>1</SU>
                    <FTREF/>
                     and Rule 19b-4 thereunder,
                    <SU>2</SU>
                    <FTREF/>
                     to permit the Exchange to: (i) Amend Rule 24.9(a)(2), 
                    <E T="03">Terms of Index Option Contracts</E>
                    , to allow the Exchange to list up to seven expiration months for broad-based security index options upon which the Exchange calculates a constant three-month volatility index; and (ii) remove outdated rule text from Rule 24.9(a)(2). On September 19, 2007, CBOE filed Amendment No. 1 to the proposed rule change. The proposed rule change, as modified by Amendment No. 1, was published for comment in the 
                    <E T="04">Federal Register</E>
                     on October 16, 2007.
                    <SU>3</SU>
                    <FTREF/>
                     The Commission received no comments on the proposal. This order approves the proposed rule change, as amended.
                </P>
                <FTNT>
                    <P>
                        <SU>1</SU>
                         15 U.S.C. 78s(b)(1).
                    </P>
                </FTNT>
                <FTNT>
                    <P>
                        <SU>2</SU>
                         17 CFR 240.19b-4.
                    </P>
                </FTNT>
                <FTNT>
                    <P>
                        <SU>3</SU>
                         
                        <E T="03">See</E>
                         Securities Exchange Act Release No. 56632 (October 9, 2007), 72 FR 58694 (“Notice”).
                    </P>
                </FTNT>
                <HD SOURCE="HD1">II. Description of the Proposal</HD>
                <P>
                    In its proposal, CBOE proposed to amend Rule 24.9(a)(2), 
                    <E T="03">Terms of Index Options</E>
                    , to allow the Exchange to list up to seven expiration months for broad-based security index options upon which the Exchange calculates a constant three-month volatility index. Currently, Rule 24.9(a)(2) permits the Exchange to list only six expiration months in any index options at any one time.
                </P>
                <P>
                    In the filing, CBOE explained that it had plans to introduce new volatility products and new volatility indexes in the near future, including the CBOE S&amp;P 500 Three-Month Volatility Index (“VXV”).
                    <SU>4</SU>
                    <FTREF/>
                     According to CBOE, VXV is a measure of S&amp;P 500 implied volatility—the volatility implied by S&amp;P option prices—but instead of reflecting a constant 1-month implied volatility period (like other volatility indexes such as the CBOE Volatility Index or “VIX”), VXV is designed to reflect the implied volatility of an option with a constant 3 months to expiration. Since there is only one day on which an option has exactly 3 months to expiration, VXV is calculated as a weighted average of options expiring immediately before and immediately after the three-month standard. Accordingly, the Exchange would need to use four consecutive expiration months in order to calculate a constant three-month volatility index.
                </P>
                <FTNT>
                    <P>
                        <SU>4</SU>
                         The Exchange calculates volatility indexes on other broad-based security indexes, such as the Dow Jones Industrial Average index (“DJX”), the Nasdaq-100 index (“NDX”), and the Russell 2000 index (“RUT”). The Exchange may calculate a constant three-month volatility index on DJX, NDX or RUT in the future.
                    </P>
                </FTNT>
                <P>CBOE stated in its filing that under the current application of CBOE Rule 24.9(a)(2), the Exchange generally lists three consecutive near term months and three months on a quarterly expiration cycle. One of the three consecutive near term months is always a quarterly month; however, that near term contract month (which is also a quarterly month) is not included as part of the three months listed on a quarterly expiration cycle. Therefore, in order to permit the addition of four consecutive near term months under current Rule 24.9(a)(2), the Exchange would only be able to list two months on a quarterly expiration cycle. Because of customer demand and other investment strategy reasons for having three months on a quarterly expiration cycle, the Exchange proposed to increase, from six to seven, the number of expiration months for broad-based security index options upon which the Exchange calculates a constant three-month volatility index.</P>
                <P>
                    CBOE explained that without this proposed rule change, if the Exchange calculated a three-month volatility using only three consecutive near term months, this would result in the VXV being calculated with options expiring three months apart about one-third of 
                    <PRTPAGE P="66211"/>
                    the time.
                    <SU>5</SU>
                    <FTREF/>
                     Another one-third of the time, VXV would be calculated with options expiring two months apart. And the final one-third of the time, VXV would be calculated with options expiring one month apart. As a result, the calculation of the three-month VXV under current Rule 24.9(a)(2) would render the VXV subject to inconsistencies that, according to CBOE, may make the index unattractive as an underlying for volatility products.
                </P>
                <FTNT>
                    <P>
                        <SU>5</SU>
                         
                        <E T="03">See</E>
                         Notice, 
                        <E T="03">supra</E>
                         note 3, at 58695 (providing examples to illustrate the effect of the proposed rule change).
                    </P>
                </FTNT>
                <P>Under the proposed rule change, however, the Exchange will be permitted, eight times a year, to add an additional seventh month in order to maintain four consecutive near term contract months.</P>
                <P>
                    The Exchange also proposed to remove outdated rule text from Rule 24.9(a)(2). Specifically, the Exchange proposed to delete the provision that permitted the Exchange to list up to seven expiration months at any one time for the SPX, MNX and DJX index option contracts, provided that one of those expiration months is November 2004.
                    <SU>6</SU>
                    <FTREF/>
                </P>
                <FTNT>
                    <P>
                        <SU>6</SU>
                         This provision was added in July 2004 in response to customer demand for index options expiring in November 2004 to hedge positions in stocks overlying particular index options or to hedge market exposure to the equity markets generally against the uncertainty presented by the elections. 
                        <E T="03">See</E>
                         Securities Exchange Act Release No. 50063 (July 22, 2004), 69 FR 45357 (July 29, 2004)(SR-CBOE-2004-49).
                    </P>
                </FTNT>
                <HD SOURCE="HD2">Capacity</HD>
                <P>CBOE represented that it has analyzed its capacity and represents that it believes the Exchange and the Options Price Reporting Authority have the necessary systems capacity to handle the additional traffic associated with the additional listing of a seventh contract month in order to maintain four consecutive near term contract months for those broad-based security index options upon which the Exchange calculates a constant three-month volatility index.</P>
                <HD SOURCE="HD1">III. Discussion</HD>
                <P>
                    After careful review, the Commission finds that CBOE's proposal to amend Rule 24.9(a)(2), 
                    <E T="03">Terms of Index Option Contracts</E>
                    , to allow the Exchange to list up to seven expiration months for broad-based security index options upon which the Exchange calculates a constant three-month volatility index, and to remove certain outdated rule text from Rule 24.9(a)(2) is consistent with the requirements of the Act and the rules and regulations thereunder applicable to a national securities exchange 
                    <SU>7</SU>
                    <FTREF/>
                     and, in particular, the requirements of section 6 of the Act 
                    <SU>8</SU>
                    <FTREF/>
                     and the rules and regulations thereunder. The Commission believes that increasing, from six to seven, the number of expiration months for broad-based security indexes on which the Exchange calculates a constant three-month volatility index (to accommodate a fourth consecutive near-term month while maintaining the listing of three months on a quarterly expiration cycle) will result in a more consistent and predictable calculation in which the option series that bracket three months to expiration will always expire one month apart, thereby promoting just and equitable principles of trade while protecting investors and the public interest.
                </P>
                <FTNT>
                    <P>
                        <SU>7</SU>
                         In approving this proposed rule change, the Commission has considered the proposed rule's impact on efficiency, competition, and capital formation. 15 U.S.C. 78c(f).
                    </P>
                </FTNT>
                <FTNT>
                    <P>
                        <SU>8</SU>
                         15 U.S.C. 78f.
                    </P>
                </FTNT>
                <P>The Commission also notes CBOE's representations that it possesses the necessary systems capacity to handle the additional traffic associated with the additional listing of a seventh contract month in order to maintain four consecutive near term contract months for those broad-based security index options upon which the Exchange calculates a constant three-month volatility index.</P>
                <HD SOURCE="HD1">IV. Conclusion</HD>
                <P>
                    <E T="03">It is therefore ordered</E>
                    , pursuant to section 19(b)(2) of the Act,
                    <SU>9</SU>
                    <FTREF/>
                     that the proposed rule change (SR-CBOE-2007-82), as amended, be, and hereby is, approved.
                </P>
                <FTNT>
                    <P>
                        <SU>9</SU>
                         15 U.S.C. 78s(b)(2).
                    </P>
                </FTNT>
                <SIG>
                    <P>
                        For the Commission, by the Division of Trading and Markets, pursuant to delegated authority.
                        <SU>10</SU>
                        <FTREF/>
                    </P>
                    <FTNT>
                        <P>
                            <SU>10</SU>
                             17 CFR 200.30-3(a)(12).
                        </P>
                    </FTNT>
                    <NAME>Florence E. Harmon,</NAME>
                    <TITLE>Deputy Secretary.</TITLE>
                </SIG>
            </PREAMB>
            <FRDOC>[FR Doc. E7-23001 Filed 11-26-07; 8:45 am]</FRDOC>
            <BILCOD>BILLING CODE 8011-01-P</BILCOD>
        </NOTICE>
        <NOTICE>
            <PREAMB>
                <AGENCY TYPE="S">SECURITIES AND EXCHANGE COMMISSION</AGENCY>
                <DEPDOC>[Release No. 34-56813; File No. SR-CBOE-2007-52]</DEPDOC>
                <SUBJECT>Self-Regulatory Organizations; Chicago Board Options Exchange, Incorporated; Order Granting Approval of Proposed Rule Change as Modified by Amendment No. 1 Thereto Relating to $1 Strikes for VXD and VXN Options and $1 Strikes for RVX, VIX, VXD and VXN LEAPs</SUBJECT>
                <DATE>November 19, 2007.</DATE>
                <HD SOURCE="HD1">I. Introduction</HD>
                <P>
                    On July 11, 2007, the Chicago Board Options Exchange, Incorporated (“CBOE” or “Exchange”) filed with the Securities and Exchange Commission (“Commission”) a proposed rule change, pursuant to Section 19(b)(1) of the Securities Exchange Act of 1934 (“Act”) 
                    <SU>1</SU>
                    <FTREF/>
                     and Rule 19b-4 thereunder, 
                    <SU>2</SU>
                    <FTREF/>
                     to permit the Exchange to: (i) List and trade CBOE Dow Jones Industrial Average Volatility Index (“VXD”) options and Nasdaq-100 Volatility Index (“VXN”) options in $1 strike price intervals; and (ii) list and trade CBOE Russell 2000 Volatility Index (“RVX”), VXD, VXN and CBOE Volatility Index (“VIX”) LEAPs in $1 strike price intervals. On August 20, 2007, CBOE filed Amendment No. 1 to the proposed rule change. The proposed rule change, as modified by Amendment No. 1, was published for comment in the 
                    <E T="04">Federal Register</E>
                     on September 24, 2007. 
                    <SU>3</SU>
                    <FTREF/>
                     The Commission received one comment letter regarding the proposal. 
                    <SU>4</SU>
                    <FTREF/>
                     This order approves the proposed rule change, as amended.
                </P>
                <FTNT>
                    <P>
                        <SU>1</SU>
                         15 U.S.C. 78s(b)(1).
                    </P>
                </FTNT>
                <FTNT>
                    <P>
                        <SU>2</SU>
                         17 CFR 240.19b-4.
                    </P>
                </FTNT>
                <FTNT>
                    <P>
                        <SU>3</SU>
                         
                        <E T="03">See</E>
                         Securities Exchange Act Release No. 56449 (September 17, 2007), 72 FR 54306 (“Notice”).
                    </P>
                </FTNT>
                <FTNT>
                    <P>
                        <SU>4</SU>
                         
                        <E T="03">See</E>
                         Letter from John C. Nagel, Director &amp; Associate General Counsel, Citadel Investment Group, L.L.C. (“Citadel”) to Nancy Morris, Secretary, Commission, dated November 2, 2007 (“Citadel Comment”).
                    </P>
                </FTNT>
                <HD SOURCE="HD1">II. Description of the Proposal</HD>
                <P>
                    In its proposal, CBOE proposed rules to permit the Exchange to list and trade options on the CBOE Dow Jones Industrial Average Volatility Index (“VXD”) and the Nasdaq-100 Volatility Index (“VXN”) in $1 strike price intervals within certain parameters described below. 
                    <SU>5</SU>
                    <FTREF/>
                     Additionally, the rule change proposed to permit the Exchange 
                    <PRTPAGE P="66212"/>
                    to list and trade CBOE Russell Volatility Index (“RVX”), CBOE Volatility Index (“VIX”), VXD, and VXN LEAPs in $1 strike price intervals within certain parameters also described below.
                </P>
                <FTNT>
                    <P>
                        <SU>5</SU>
                         The Commission previously approved the listing and trading of VXD and VXN options, which the Exchange anticipates trading shortly. 
                        <E T="03">See</E>
                         Securities Exchange Act Release No. 49563 (April 14, 2004), 69 FR 21589 (April 21, 2004) (approving SR-CBOE-2003-40).
                    </P>
                </FTNT>
                <HD SOURCE="HD2"> $1 Strikes for VXD and VXN Options</HD>
                <P>
                    Similar to other volatility indexes, VXD and VXN are calculated using real-time quotes of out-of-the-money and at-the-money and second nearly index puts and calls on the Dow Jones Industrial Index (“DJIA”) and the Nasdaq-100 Index (“NDX”) respectively. VXD and VXN are quoted in absolute numbers that represent the volatility of the DJIA and the NDX respectively in percentage points per annum. For example, a VXD level of 11.63 (the closing value of the VXD on April 26, 2007) represents an annualized volatility of 11.63% in the DJIA Index and a VXN level of 15.97 (the closing value of the VXN on April 26, 2007) represents an annualized volatility of 15.97% in the NDX. 
                    <SU>6</SU>
                    <FTREF/>
                </P>
                <FTNT>
                    <P>
                        <SU>6</SU>
                         In its original filing, CBOE inadvertently reported annualized volatility percentages of 11.637% (rather than 11.63%) and 15.77% (rather than 15.97%). Telephone conversation between Jennifer Yeadon, Senior Attorney, CBOE and Geoffrey Pemble, Special Counsel, Division of Market Regulation, Commission, on November 15, 2007.
                    </P>
                </FTNT>
                <P>According to CBOE, as with other proprietary CBOE volatility indexes, VXD and VXN levels fluctuate quite differently than individual equity securities or indexes of individual equity securities. Specifically, indexes such as VXD and VXN that track volatility are “mean-reverting,” a statistical term used to describe a strong tendency for the volatility index to move toward its long-term historical average level. In other words, at historically low volatility index levels, there is a higher probability that the next big move will be up rather than down. Conversely, at historically high volatility index levels, the next big move is more likely to be down rather than up.</P>
                <P>Thus, as represented by CBOE, volatility indexes such as VXD and VXN tend to move within set ranges, and even when a level moves outside that range, the tendency towards mean-reversion often results in the volatility index returning to a level within the range. In the case of VXD, the historical average index value since January 2, 2002 is 16.92. Since January 2002, VXD has fluctuated in a range between 9.28 and 41.85. Furthermore, VXD closed under 25 for 85% of the days on which the level was calculated since 2002 (1,171 days out of a total of 1,372 days) and has closed under 30 for 91% of the days on which the level was calculated since 2002 (1,245 days out of a total of 1,372 days). VXD has closed between 10 and 25 for 82% of the days on which the level was calculated since 2002 (1,130 days out of a total of 1,372 days).</P>
                <P>In the case of VXN, the historical average index value since January 2, 2002 is 26.14. Since January 2002, VXN has fluctuated in a range between 12.61 and 60.66. Furthermore, VXN closed under 25 for 61% of the days on which the level was calculated since 2002 (822 days out of a total of 1,355 days) and has closed under 30 for 73% of the days on which the level was calculated since 2002 (987 days out of a total of 1,355 days). VXN has closed between 15 and 30 for 66% of the days on which the level was calculated since 2002 (895 days out of a total of 1,355 days).</P>
                <P>
                    Because of the generally limited range in which VXD and VXN have fluctuated, CBOE proposed to list series at $1 or greater strike price intervals for each expiration on up to 5 VXD and VXN option series above and 5 VXD and VXN option series below the current index level. 
                    <SU>7</SU>
                    <FTREF/>
                     As the current index level of VXD and VXN moves from the exercise price of those VXD and VXN option series that already have been opened for trading on the Exchange, the Exchange may open for trading additional series at $1.00 or greater strike price intervals for each expiration on up to 5 VXD and VXN option series above and 5 VXD and VXN option series below the current index level.
                </P>
                <FTNT>
                    <P>
                        <SU>7</SU>
                         The Commission previously approved the listing of VIX and RVX options at $1 strike intervals. 
                        <E T="03">See</E>
                         Securities Exchange Act Release No. 54192 (July 21, 2006), 71 FR 43251 (July 31, 2006) (approving SR-CBOE-2006-27); 
                        <E T="03">see also</E>
                         Securities Exchange Act Release No. 55425 (March 8, 2007), 72 FR 12238 (March 15, 2007) (approving SR-CBOE-2006-73).
                    </P>
                </FTNT>
                <P>
                    Additionally, the Exchange proposed that it would not list series with $1 intervals within $0.50 of an existing $2.50 strike price with the same expiration month (
                    <E T="03">e.g.</E>
                    , if there is an existing 12.50 strike, the Exchange would not list a 12 or 13 strike).
                </P>
                <HD SOURCE="HD2">$1 Strike LEAPs for RVX, VIX, VXN and VXD</HD>
                <P>Similarly, the Exchange proposed rules to permit $1 strike intervals for RVX, VIX, VXD and VXN LEAPs. According to CBOE, typically LEAPs strike prices moves in increments of $2.50 and $5.00 and such incremental pricing is suited for long-term contracts on traditional equity and stock index products. However, as discussed above, the levels of volatility indexes fluctuate quite differently than equities and stock indexes. As a “mean-reverting” product, volatility indexes gravitate towards their historical average levels; thus, limiting the range of movement.</P>
                <P>Consequently, the Exchange proposed to list series at $1 or greater strike price intervals for each expiration on up to 5 RVX, VIX, VXD and VXN LEAPs series above and 5 RVX, VIX, VXD and VXN LEAPs series below the current index level. As the current index level of RVX, VIX, VXD and VXN moves from the exercise price of those RVX, VIX, VXD and VXN LEAPs series that already have been opened for trading on the Exchange, the Exchange may open for trading additional series at $1.00 or greater strike price intervals for each expiration on up to 5 RVX, VIX, VXD and VXN LEAPs series above and 5 RVX, VIX, VXD and VXN LEAPs series below the current index level.</P>
                <P>
                    For purposes of adding strike prices at $1.00 or greater strike price intervals, as well as at $2.50 or greater strike price intervals, the “current index level” would be defined as the “implied forward level” of RVX, VIX, VXN and VXD for each expiration. 
                    <SU>8</SU>
                    <FTREF/>
                </P>
                <FTNT>
                    <P>
                        <SU>8</SU>
                         
                        <E T="03">See</E>
                         Notice, 
                        <E T="03">supra</E>
                         n. 3, for further discussion of this methodology.
                    </P>
                </FTNT>
                <HD SOURCE="HD2">Capacity</HD>
                <P>CBOE represented that it has analyzed its capacity and represents that it believes the Exchange and the Options Price Reporting Authority have the necessary systems capacity to handle the additional traffic associated with the listing and trading of the $1 strikes for VXD and VXN option and of the $1 strikes for RVX, VIX, VXD and VXN LEAPs.</P>
                <HD SOURCE="HD1">III. Summary of Comment Received</HD>
                <P>
                    The Commission received one comment letter regarding the proposed rule change, from Citadel. Citadel supported the adoption of the proposal and, in general, the expansion of $1 strike price intervals, stating that expansion of products available to exchanges and investors was “fundamentally pro-competitive” and that, moreover, “$1 strike price intervals allow traders and investors to customize the risk profiles of their trading positions more precisely, and thus reduce the cost of trading.” 
                    <SU>9</SU>
                    <FTREF/>
                     Citadel commented favorably about the Commission's prior pilot program to allow $1 strike intervals,
                    <SU>10</SU>
                    <FTREF/>
                     and advocated that the Commission “promote the expansion of $1 strike programs even if doing so requires curtailing or slowing further expansion of penny quoting.” 
                    <SU>11</SU>
                    <FTREF/>
                     With regard to the 
                    <PRTPAGE P="66213"/>
                    proposal, Citadel noted that “permitting CBOE to list and trade options that are the subject of the Proposal in $1 strike intervals would benefit the public, including retail investors,” for many of the same reasons $1 strike options do, as well as for reasons specific to volatility options, such a the “mean-reverting” characteristics of volatility indexes.
                    <SU>12</SU>
                    <FTREF/>
                     Similarly, Citadel supported the listing and trading of LEAPs on certain volatility indexes, as proposed by CBOE, arguing that the “case for strike-intervals for LEAPs on volatility indexes is even stronger than the case for narrow-interval LEAPs on single stocks.”
                </P>
                <FTNT>
                    <P>
                        <SU>9</SU>
                         
                        <E T="03">See</E>
                         Citadel Comment at 1.
                    </P>
                </FTNT>
                <FTNT>
                    <P>
                        <SU>10</SU>
                         
                        <E T="03">Id.</E>
                         at 2.
                    </P>
                </FTNT>
                <FTNT>
                    <P>
                        <SU>11</SU>
                         
                        <E T="03">Id.</E>
                         at 3.
                    </P>
                </FTNT>
                <FTNT>
                    <P>
                        <SU>12</SU>
                         
                        <E T="03">Id.</E>
                    </P>
                </FTNT>
                <HD SOURCE="HD1">IV. Discussion</HD>
                <P>
                    After careful review, the Commission finds that CBOE's proposal to (i) list and trade CBOE Dow Jones Industrial Average Volatility Index (“VXD”) options and Nasdaq-100 Volatility Index (“VXN”) options in $1 strike price intervals; and (ii) list and trade CBOE Russell 2000 Volatility Index (“RVX”), VXD, VXN and CBOE Volatility Index (“VIX”) LEAPs in $1 strike price intervals is consistent with the requirements of the Act and the rules and regulations thereunder applicable to a national securities exchange 
                    <SU>13</SU>
                    <FTREF/>
                     and, in particular, the requirements of section 6 of the Act 
                    <SU>14</SU>
                    <FTREF/>
                     and the rules and regulations thereunder. The Commission believes that CBOE's proposal gives options investors the ability to make additional investment choices in a manner consistent with the requirements of section 6(b)(5) of the Act. 
                    <SU>15</SU>
                    <FTREF/>
                     The Commission further believes that trading options and LEAPs in $1 strike price intervals on these volatility indexes provides investors with an important trading and hedging mechanism.
                </P>
                <FTNT>
                    <P>
                        <SU>13</SU>
                         In approving this proposed rule change, the Commission has considered the proposed rule's impact on efficiency, competition, and capital formation. 15 U.S.C. 78c(f).
                    </P>
                </FTNT>
                <FTNT>
                    <P>
                        <SU>14</SU>
                         15 U.S.C. 78f.
                    </P>
                </FTNT>
                <FTNT>
                    <P>
                        <SU>15</SU>
                         15 U.S.C. 78f(b)(5).
                    </P>
                </FTNT>
                <P>As explained by CBOE, volatility indexes such as the RVX, VIX, VXD and VXN fluctuate in a narrow range, and thus, the Commission believes that the implementation of $1 strike price intervals on options and LEAPs based on these indexes, within the parameters detailed in CBOE's proposal, is appropriate.</P>
                <P>The Commission also notes CBOE's representations that it possesses the necessary systems capacity to support new series that would result from the introduction of $1 strikes for VXD and VXN options and of the $1 strikes for RVX, VIX, VXD and VXN LEAPs and that CBOE also has been informed that OPRA has the capacity to support such offerings.</P>
                <HD SOURCE="HD1">V. Conclusion</HD>
                <P>
                    <E T="03">It is therefore ordered</E>
                    , pursuant to section 19(b)(2) of the Act,
                    <SU>16</SU>
                    <FTREF/>
                     that the proposed rule change (SR-CBOE-2007-52), as amended, be, and hereby is,
                    <FTREF/>
                     approved.
                </P>
                <FTNT>
                    <P>
                        <SU>16</SU>
                         15 U.S.C. 78s(b)(2).
                    </P>
                </FTNT>
                <FTNT>
                    <P>
                        <SU>17</SU>
                         17 CFR 200.30-3(a)(12).
                    </P>
                </FTNT>
                <SIG>
                    <P>
                        For the Commission, by the Division of Trading and Markets, pursuant to delegated authority.
                        <SU>17</SU>
                    </P>
                    <NAME>Florence E. Harmon, </NAME>
                    <TITLE>Deputy Secretary.</TITLE>
                </SIG>
            </PREAMB>
            <FRDOC>[FR Doc. E7-23003 Filed 11-26-07; 8:45 am]</FRDOC>
            <BILCOD>BILLING CODE 8011-01-P</BILCOD>
        </NOTICE>
        <NOTICE>
            <PREAMB>
                <AGENCY TYPE="S">SECURITIES AND EXCHANGE COMMISSION </AGENCY>
                <DEPDOC>[Release No. 34-56820; File No. SR-FICC-2007-09] </DEPDOC>
                <SUBJECT>Self-Regulatory Organizations; Fixed Income Clearing Corporation; Notice of Filing and Immediate Effectiveness of a Proposed Rule Change Relating to the Correspondent Clearing Service </SUBJECT>
                <DATE>November 20, 2007. </DATE>
                <P>
                    Pursuant to section 19(b)(1) of the Securities Exchange Act of 1934 (“Act”),
                    <SU>1</SU>
                    <FTREF/>
                     notice is hereby given that on August 17, 2007, the Fixed Income Clearing Corporation (“FICC”) filed with the Securities and Exchange Commission (“Commission”) the proposed rule change as described in Items I, II, and III below, which Items have been prepared primarily by FICC. FICC filed the proposed rule change pursuant to section 19(b)(3)(A)(i) of the Act 
                    <SU>2</SU>
                    <FTREF/>
                     and Rule 19b-4(f)(1) 
                    <SU>3</SU>
                    <FTREF/>
                     thereunder so that the proposal was effective upon filing with the Commission. The Commission is publishing this notice to solicit comments on the proposed rule change from interested persons. 
                </P>
                <FTNT>
                    <P>
                        <SU>1</SU>
                         15 U.S.C. 78s(b)(1). 
                    </P>
                </FTNT>
                <FTNT>
                    <P>
                        <SU>2</SU>
                         15 U.S.C. 78s(b)(3)(A)(i). 
                    </P>
                </FTNT>
                <FTNT>
                    <P>
                        <SU>3</SU>
                         17 CFR 240.19b-4(f)(1). 
                    </P>
                </FTNT>
                <HD SOURCE="HD1">I. Self-Regulatory Organization's Statement of the Terms of Substance of the Proposed Rule Change </HD>
                <P>The proposed rule change enhances FICC's Government Securities Division's (“GSD”) correspondent clearing service for netting members submitting transaction data (“Submitting Members”) on behalf of non-member firms (“Executing Firms”). </P>
                <HD SOURCE="HD1">II. Self-Regulatory Organization's Statement of the Purpose of, and Statutory Basis for, the Proposed Rule Change </HD>
                <P>In its filing with the Commission, FICC included statements concerning the purpose of and basis for the proposed rule change and discussed any comments it received on the proposed rule change. The text of these statements may be examined at the places specified in Item IV below. FICC has prepared summaries, set forth in sections A, B, and C below, of the most significant aspects of such statements. </P>
                <HD SOURCE="HD2">A. Self-Regulatory Organization's Statement of the Purpose of, and Statutory Basis for, the Proposed Rule Change </HD>
                <P>Currently, GSD's rules provide that a Submitting Member must submit transaction data to GSD when it acts on behalf of an Executing Firm for comparison-only processing or for both comparison and netting processing. The election made by the Submitting Member to submit Executing Firm transactions for comparison or comparison and netting is done on a firm level for each Executing Firm on whose behalf the Submitting Member acts. For example, when Submitting Member A elects to submit transactions for netting processing on behalf of Executing Firm B, all trades submitted on behalf of Executing Firm B will proceed to netting, and the Submitting Member will incur all resulting settlement and other obligations that arise under GSD's rules with respect to trade data submitted on behalf of Executing Firm B. Conversely, when Submitting Member A elects to submit transactions for Executing Firm C for comparison-only processing, all transactions submitted on behalf of Executing Firm C will only enter the GSD's comparison system with no settlement obligations arising for Submitting Member A with respect to these transactions. </P>
                <P>
                    Under the rule change, FICC will allow a Submitting Member to select for each Executing Firm for which it submits trades those trade types (
                    <E T="03">i.e.</E>
                    , buy-sell or repurchase agreements) that will be comparison-only transactions and those trade types that will be netting transactions. For example, Submitting Member A may select to submit Executing Firm B's repurchase agreement transactions for comparison-only processing and Executing Firm B's buy-sell transactions for netting. Members will not be permitted to submit trades for either comparison-only or netting processing on a trade-by-
                    <PRTPAGE P="66214"/>
                    trade basis. Elections made with respect to how transaction types are processed through FICC must be effected through the applicable FICC Executing Firm Agreement. As noted above, settlement obligations will arise for Submitting Member A for each transaction that proceeds to netting. 
                </P>
                <P>Under the proposed changes, Submitting Members will be required to notify GSD with respect to each Executing Firm for which they submit data which transactions types that will be processed as comparison-only transactions and which will proceed to netting. Submitting members must notify GSD three business days prior to the commencement of the initial data submission on behalf of an Executing Firm. Any modifications made to an election will require three business days notice to GSD. </P>
                <P>FICC will announce to its members by means of an Important Notice the effective date of this enhancement. GSD anticipates implementation to be during the fourth quarter of this year. </P>
                <P>
                    FICC believes that the proposed rule change is consistent with the requirements of section 17A of the Act 
                    <SU>4</SU>
                    <FTREF/>
                     and the rules thereunder. FICC states that this rule change enhances existing capabilities extended to netting members acting as Submitting Members under GSD's rules. FICC further states that the proposed changes will not affect FICC's ability to safeguard the funds and securities in FICC's control or for which it is responsible. 
                </P>
                <FTNT>
                    <P>
                        <SU>4</SU>
                         15 U.S.C. 78q-1. 
                    </P>
                </FTNT>
                <HD SOURCE="HD2">B. Self-Regulatory Organization's Statement on Burden on Competition </HD>
                <P>FICC does not believe that the proposed rule change will have any impact or impose any burden on competition. </P>
                <HD SOURCE="HD2">C. Self-Regulatory Organization's Statement on Comments on the Proposed Rule Change Received From Members, Participants, or Others </HD>
                <P>Written comments relating to the proposed rule change have not yet been solicited or received. FICC will notify the Commission of any written comments received by FICC. </P>
                <HD SOURCE="HD1">III. Date of Effectiveness of the Proposed Rule Change and Timing for Commission Action </HD>
                <P>
                    The foregoing rule change has become effective pursuant to section 19(b)(3)(A)(iii) 
                    <SU>5</SU>
                    <FTREF/>
                     of the Act and Rule 19b-4(f)(4) 
                    <SU>6</SU>
                    <FTREF/>
                     thereunder because it effects a change in an existing service of FICC that does not adversely affect the safeguarding of securities or funds in FICC's control or for which FICC is responsible and does not significantly affect FICC's or its participants' respective rights or obligations. At any time within 60 days of the filing of the proposed rule change, the Commission could have summarily abrogated such rule change if it appeared to the Commission that such action was necessary or appropriate in the public interest, for the protection of investors, or otherwise in furtherance of the purposes of the Act. 
                </P>
                <FTNT>
                    <P>
                        <SU>5</SU>
                         15 U.S.C. 78s(b)(3)(A)(iii). 
                    </P>
                </FTNT>
                <FTNT>
                    <P>
                        <SU>6</SU>
                         17 CFR 240.19b-4(f)(4). 
                    </P>
                </FTNT>
                <HD SOURCE="HD1">IV. Solicitation of Comments </HD>
                <P>Interested persons are invited to submit written data, views and arguments concerning the foregoing, including whether the proposed rule change is consistent with the Act. Comments may be submitted by any of the following methods: </P>
                <HD SOURCE="HD2">Electronic Comments </HD>
                <P>
                    • Use the Commission's Internet comment form (
                    <E T="03">http://www.sec.gov/rules/sro.shtml</E>
                    ); or 
                </P>
                <P>
                    • Send an e-mail to 
                    <E T="03">rule-comments@sec.gov.</E>
                     Please include File No. SR-FICC-2007-09 on the subject line. 
                </P>
                <HD SOURCE="HD2">Paper Comments </HD>
                <P>• Send paper comments in triplicate to Nancy M. Morris, Secretary, Securities and Exchange Commission, Station Place, 100 F Street, NE., Washington, DC 20549-1090. </P>
                <P>
                    All submissions should refer to File No. FICC-2007-09. This file number should be included on the subject line if e-mail is used. To help the Commission process and review your comments more efficiently, please use only one method. The Commission will post all comments on the Commission's Internet Web site (
                    <E T="03">http://www.sec.gov/rules/sro.shtml</E>
                    ). Copies of the submission, all subsequent amendments, all written statements with respect to the proposed rule change that are filed with the Commission, and all written communications relating to the proposed rule change between the Commission and any person, other than those that may be withheld from the public in accordance with the provisions of 5 U.S.C. 552, will be available for inspection and copying in the Commission's Public Reference Room, 450 Fifth Street, NW., Washington, DC 20549, on official business days between the hours of 10a.m. and 3 p.m. Copies of such filing also will be available for inspection and copying at FICC's principal office and on FICC's Web site at 
                    <E T="03">http://ficc.com/gov/gov.docs.jsp?NS-query=#rf.</E>
                     All comments received will be posted without change; the Commission does not edit personal identifying information from submissions. You should submit only information that you wish to make available publicly. All submission should refer to File No. SR-FICC-2007-09 and should be submitted on or before December 18,
                    <FTREF/>
                     2007. 
                </P>
                <FTNT>
                    <P>
                        <SU>7</SU>
                         17 CFR 200.30-3(a)(12). 
                    </P>
                </FTNT>
                <SIG>
                    <P>
                        For the Commission by the Division of Trading and Markets pursuant to delegated authority.
                        <SU>7</SU>
                    </P>
                    <NAME>Florence E. Harmon, </NAME>
                    <TITLE>Deputy Secretary.</TITLE>
                </SIG>
            </PREAMB>
            <FRDOC>[FR Doc. E7-23021 Filed 11-26-07; 8:45 am] </FRDOC>
            <BILCOD>BILLING CODE 8011-01-P </BILCOD>
        </NOTICE>
        <NOTICE>
            <PREAMB>
                <AGENCY TYPE="S">SECURITIES AND EXCHANGE COMMISSION</AGENCY>
                <DEPDOC>[Release No. 34-56819; File No. SR-NYSEArca-2007-115]</DEPDOC>
                <SUBJECT>Self-Regulatory Organizations; NYSE Arca, Inc.; Notice of Filing of a Proposed Rule Change Relating to Rule 6.87—Obvious Error</SUBJECT>
                <DATE>November 19, 2007.</DATE>
                <P>
                    Pursuant to section 19(b)(1) of the Securities Exchange Act of 1934 (“Act”),
                    <SU>1</SU>
                    <FTREF/>
                     and Rule 19b-4 thereunder,
                    <SU>2</SU>
                    <FTREF/>
                     notice is hereby given that on November 8, 2007, NYSE Arca, Inc. (“NYSE Arca” or “Exchange”) filed with the Securities and Exchange Commission (“Commission”) the proposed rule change as described in Items I, II, and III below, which Items have been substantially prepared by the Exchange. The Commission is publishing this notice to solicit comments on the proposed rule change from interested persons.
                </P>
                <FTNT>
                    <P>
                        <SU>1</SU>
                         15 U.S.C. 78s(b)(1).
                    </P>
                </FTNT>
                <FTNT>
                    <P>
                        <SU>2</SU>
                         17 CFR 240.19b-4.
                    </P>
                </FTNT>
                <HD SOURCE="HD1">I. Self-Regulatory Organization's Statement of the Terms of Substance of the Proposed Rule Change</HD>
                <P>
                    The Exchange proposes to amend NYSE Arca Rule 6.87 governing obvious errors. Specifically, the Exchange proposes a revised review procedure for contesting decisions made pursuant to the options obvious error rule. The text of the proposed rule change is available at the Exchange, the Commission's Public Reference Room, and 
                    <E T="03">http://www.nyse.com</E>
                    .
                    <PRTPAGE P="66215"/>
                </P>
                <HD SOURCE="HD1">II. Self-Regulatory Organization's Statement of the Purpose of, and Statutory Basis for, the Proposed Rule Change</HD>
                <P>In its filing with the Commission, the Exchange included statements concerning the purpose of, and basis for, the proposed rule change and discussed any comments it received on the proposed rule change. The text of these statements may be examined at the places specified in Item IV below. The Exchange has prepared summaries, set forth in Sections A, B, and C below, of the most significant aspects of such statements.</P>
                <HD SOURCE="HD2">A. Self-Regulatory Organization's Statement of the Purpose of, and Statutory Basis for, the Proposed Rule Change</HD>
                <HD SOURCE="HD3">1. Purpose</HD>
                <P>
                    The Exchange proposes to amend NYSE Arca Rule 6.87 governing options obvious errors. Specifically, the Exchange proposes a revised review procedure for contesting decisions made pursuant to the obvious error rule. Currently, NYSE Arca Rule 6.87 provides that the Exchange will determine whether an “Obvious Error” 
                    <SU>3</SU>
                    <FTREF/>
                     has occurred after a market maker believes and notifies the Exchange that it participated in a transaction that was the result of an Obvious Error. If the Exchange believes that an Obvious Error has occurred, the Exchange will take one of the following actions depending on the parties to the trade: (1) Adjust the price with an adjustment; (2) bust the trade; or (3) adjust the trade without an adjustment penalty. Currently, if a party does not agree with the action taken by the Exchange, the party may appeal the decision to the Exchange's Board of Directors (“Board”) pursuant to NYSE Arca Rule 10.14.
                </P>
                <FTNT>
                    <P>
                        <SU>3</SU>
                         “Obvious Error” is defined in NYSE Arca Rule 6.87(a)(1).
                    </P>
                </FTNT>
                <P>
                    The Exchange proposes to amend Rule 6.87 by removing the Board appeal process pursuant to Rule 10.14 and replacing it with a revised appeal process. Proposed NYSE Arca Rule 6.87 would permit a party affected by the determination of an Obvious Error to request an appeal to the Obvious Error Panel (“OE Panel”) to review the determination made by the Exchange's representative pursuant to Rule 6.87(a)(3). The OE Panel would be comprised of the NYSE Arca Chief Regulatory Officer (“CRO”), or a designee of the CRO,
                    <SU>4</SU>
                    <FTREF/>
                     and representatives from two options and trading permit firms (“OTP Firms”).
                    <SU>5</SU>
                    <FTREF/>
                     One representative on the OE Panel will be from an OTP Firm directly engaged in market making activities and one representative on the OE Panel will be from an OTP Firm directly engaged in the handling of options orders for public customers.
                </P>
                <FTNT>
                    <P>
                        <SU>4</SU>
                         The Exchange represents that a designee of the CRO would be an employee of the Exchange, working closely with and reporting directly to, the CRO, such as one of the Directors of Options Regulation. The Exchange notes that the International Securities Exchange, LLC (“ISE”) designates an obvious error panel to independently make appeals decisions and also to overturn or modify actions taken by the ISE. 
                        <E T="03">See</E>
                         ISE Rule 720.
                    </P>
                </FTNT>
                <FTNT>
                    <P>
                        <SU>5</SU>
                         The Exchange proposes to designate at least ten (10) OTP Firm representatives to be called upon to serve on the OE Panel. In no case would the OE Panel include a person related to a party to the trade in question. To the extent reasonably possible, the Exchange proposes to call upon the designated representatives to participate on an OE Panel on an equally frequent basis.
                    </P>
                </FTNT>
                <P>In addition, requests for an appeal would have to be made via facsimile or e-mail within thirty minutes after the party requesting the appeal is given notification of the initial determination. Thereafter, the OE Panel would review the information and may overturn or modify the action taken by the Officer. Such determination by the OE Panel would be considered a final action by the Exchange on the matter at issue. All final determinations made by the OE Panel would be rendered, without prejudice, as to the rights of the parties to the transaction to submit their dispute to arbitration. The Exchange states that the revised process is intended to provide a timely appeal for OTP Firms and options and trading permit holders (“OTP Holders”) in place of the lengthy Board appeals process currently provided in Rule 10.14.</P>
                <P>Finally, if the OE Panel upholds the Exchange's decision made pursuant to Rule 6.87(a)(4) to bust or adjust a trade, the Exchange would assess a $500.00 fee against the OTP Holder or OTP Firm that initiated the request for appeal. The Exchange believes that assessing a $500.00 fee would discourage frivolous and abusive practices of the appeal process.</P>
                <P>The Exchange is also proposing amendments to Rule 10.14 to remove the Board appeals process for Rule 6.87, and remove the appeals process from Commentary .02 of Rule 6.87.</P>
                <HD SOURCE="HD3">2. Statutory Basis</HD>
                <P>
                    The Exchange believes the proposed rule change is consistent with section 6(b) of the Act,
                    <SU>6</SU>
                    <FTREF/>
                     in general, and furthers the objectives of section 6(b)(5) of the Act,
                    <SU>7</SU>
                    <FTREF/>
                     in particular, because it is designed to promote just and equitable principles of trade, to foster cooperation and coordination with persons engaged in facilitating transactions in securities, and to remove impediments and perfect the mechanisms of a free and open market and to protect investors and the public interest.
                </P>
                <FTNT>
                    <P>
                        <SU>6</SU>
                         15 U.S.C. 78f(b).
                    </P>
                </FTNT>
                <FTNT>
                    <P>
                        <SU>7</SU>
                         15 U.S.C. 78f(b)(5).
                    </P>
                </FTNT>
                <HD SOURCE="HD2">B. Self-Regulatory Organization's Statement on Burden on Competition</HD>
                <P>The Exchange does not believe that the proposed rule change will impose any burden on competition that is not necessary or appropriate in furtherance of the purposes of the Act.</P>
                <HD SOURCE="HD2">C. Self-Regulatory Organization's Statement on Comments on the Proposed Rule Change Received From Members, Participants or Others</HD>
                <P>No written comments were solicited or received by the Exchange with respect to the proposed rule change.</P>
                <HD SOURCE="HD1">III. Date of Effectiveness of the Proposed Rule Change and Timing for Commission Action</HD>
                <P>
                    Within 35 days of the date of publication of this notice in the 
                    <E T="04">Federal Register</E>
                     or within such longer period (i) as the Commission may designate up to 90 days of such date if it finds such longer period to be appropriate and publishes its reasons for so finding, or (ii) as to which the Exchange consents, the Commission will:
                </P>
                <P>A. By order approve the proposed rule change; or</P>
                <P>B. Institute proceedings to determine whether the proposed rule change should be disapproved.</P>
                <HD SOURCE="HD1">IV. Solicitation of Comments</HD>
                <P>Interested persons are invited to submit written data, views, and arguments concerning the foregoing, including whether the proposed rule change is consistent with the Act. Comments may be submitted by any of the following methods:</P>
                <HD SOURCE="HD2">Electronic Comments</HD>
                <P>
                    • Use the Commission's Internet comment form (
                    <E T="03">http://www.sec.gov/rules/sro.shtml</E>
                    ); or
                </P>
                <P>
                    • Send an e-mail to 
                    <E T="03">rule-comments@sec.gov</E>
                    . Please include File Number SR-NYSEArca-2007-115 on the subject line.
                </P>
                <HD SOURCE="HD2">Paper Comments</HD>
                <P>• Send paper comments in triplicate to Nancy M. Morris, Secretary, Securities and Exchange Commission, 100 F Street, NE., Washington, DC 20549-1090.</P>
                <FP>
                    All submissions should refer to File Number SR-NYSEArca-2007-115. This file number should be included on the 
                    <PRTPAGE P="66216"/>
                    subject line if e-mail is used. To help the Commission process and review your comments more efficiently, please use only one method. The Commission will post all comments on the Commission's Internet Web site (
                    <E T="03">http://www.sec.gov/rules/sro.shtml</E>
                    ). Copies of the submission, all subsequent amendments, all written statements with respect to the proposed rule change that are filed with the Commission, and all written communications relating to the proposed rule change between the Commission and any person, other than those that may be withheld from the public in accordance with the provisions of 5 U.S.C. 552, will be available for inspection and copying in the Commission's Public Reference Room, 100 F Street, NE., Washington, DC 20549, on official business days between the hours of 10 a.m. and 3 p.m. Copies of such filing also will be available for inspection and copying at the principal office of the Exchange. All comments received will be posted without change; the Commission does not edit personal identifying information from submissions. You should submit only information that you wish to make available publicly. All submissions should refer to File Number SR-NYSEArca-2007-115 and should be submitted on or before December 18, 2007.
                </FP>
                <SIG>
                    <P>
                        For the Commission, by the Division of Trading and Markets, pursuant to delegated authority.
                        <SU>8</SU>
                        <FTREF/>
                    </P>
                    <FTNT>
                        <P>
                            <SU>8</SU>
                             17 CFR 200.30-3(a)(12).
                        </P>
                    </FTNT>
                    <NAME>Florence E. Harmon,</NAME>
                    <TITLE>Deputy Secretary.</TITLE>
                </SIG>
            </PREAMB>
            <FRDOC>[FR Doc. E7-22979 Filed 11-26-07; 8:45 am]</FRDOC>
            <BILCOD>BILLING CODE 8011-01-P</BILCOD>
        </NOTICE>
        <NOTICE>
            <PREAMB>
                <AGENCY TYPE="N">SOCIAL SECURITY ADMINISTRATION </AGENCY>
                <SUBJECT>Agency Information Collection Activities: Comment Request </SUBJECT>
                <P>The Social Security Administration (SSA) publishes a list of information collection packages that will require clearance by the Office of Management and Budget (OMB) in compliance with Pub. L. 104-13, the Paperwork Reduction Act of 1995, effective October 1, 1995. The information collection packages that may be included in this notice are for new information collections, approval of existing information collections, revisions to OMB-approved information collections, and extensions (no change) of OMB-approved information collections. </P>
                <P>SSA is soliciting comments on the accuracy of the agency's burden estimate; the need for the information; its practical utility; ways to enhance its quality, utility, and clarity; and on ways to minimize burden on respondents, including the use of automated collection techniques or other forms of information technology. Written comments and recommendations regarding the information collection(s) should be submitted to the OMB Desk Officer and the SSA Reports Clearance Officer. The information can be mailed, faxed or e-mailed to the individuals at the addresses and fax numbers listed below:</P>
                <FP SOURCE="FP-1">(OMB) </FP>
                <FP SOURCE="FP-1">
                    Office of Management and Budget, Attn: Desk Officer for SSA, Fax: 202-395-6974, E-mail address: 
                    <E T="03">OIRA_Submission@omb.eop.gov</E>
                    .
                </FP>
                <FP SOURCE="FP-1">(SSA) </FP>
                <FP SOURCE="FP-1">
                    Social Security Administration, DCBFM, Attn: Reports Clearance Officer, 1333 Annex Building, 6401 Security Blvd., Baltimore, MD 21235, Fax: 410-965-6400, E-mail address: 
                    <E T="03">OPLM.RCO@ssa.gov.</E>
                </FP>
                <P>The information collections listed below have been submitted to OMB for clearance. Your comments on the information collections would be most useful if received by OMB and SSA within 30 days from the date of this publication. You can obtain a copy of the OMB clearance packages by calling the SSA Reports Clearance Officer at 410-965-0454, or by writing to the address listed above. </P>
                <P>
                    <E T="03">Letter to Custodian of Birth Records/Letter to Custodian of School Records—20 CFR 404.704, 404.716, 416.802, and 422.107—0960-0693.</E>
                     SSA prepares the SSA-L106 and SSA-L706 for individuals who need help in obtaining evidence of their age in connection with Social Security number card applications and claims for benefits. SSA uses the SSA-L706 to determine the existence of primary evidence of age for Social Security Number (SSN) applicants. SSA also uses both letters to verify with the issuing entity, when necessary, the authenticity of the record submitted by the SSN applicant or claimant. The respondents are schools, state and local bureaus of vital statistics, and religious entities. 
                </P>
                <P>
                    <E T="03">Type of Request:</E>
                     Revision of an OMB-approved information collection. 
                </P>
                <P>
                    <E T="03">Number of Respondents:</E>
                     7,200. 
                </P>
                <P>
                    <E T="03">Frequency of Response:</E>
                     1. 
                </P>
                <P>
                    <E T="03">Average Burden Per Response:</E>
                     10 minutes. 
                </P>
                <P>
                    <E T="03">Estimated Annual Burden:</E>
                     1,200 hours. 
                </P>
                <SIG>
                    <DATED>Dated: November 20, 2007. </DATED>
                    <NAME>Elizabeth A. Davidson, </NAME>
                    <TITLE>Reports Clearance Officer, Social Security Administration.</TITLE>
                </SIG>
            </PREAMB>
            <FRDOC>[FR Doc. E7-23022 Filed 11-26-07; 8:45 am] </FRDOC>
            <BILCOD>BILLING CODE 4191-02-P</BILCOD>
        </NOTICE>
        <NOTICE>
            <PREAMB>
                <AGENCY TYPE="N">DEPARTMENT OF STATE </AGENCY>
                <DEPDOC>[Public Notice 5996] </DEPDOC>
                <SUBJECT>Issuance of a Presidential Permit Authorizing the Greater Yuma Port Authority To Construct, Operate, and Maintain a Livestock Border Crossing Near San Luis, Arizona, at the International Boundary Between the United States and Mexico </SUBJECT>
                <SUM>
                    <HD SOURCE="HED">SUMMARY:</HD>
                    <P>The Department of State has issued a Presidential permit, effective November 16, 2007, authorizing the Greater Yuma Port Authority to construct, operate, and maintain a livestock border crossing near San Luis, Arizona, at the international boundary between the United States and Mexico. In making this determination, the Department consulted with other federal agencies, as required by Executive Order 11423, as amended. </P>
                </SUM>
                <FURINF>
                    <HD SOURCE="HED">FOR FURTHER INFORMATION CONTACT:</HD>
                    <P>
                        Mr. Daniel Darrach, U.S.-Mexico Border Affairs Coordinator, via e-mail at 
                        <E T="03">WHA-BorderAffairs@state.gov</E>
                        ; by phone at 202-647-9894 or by mail at WHA/MEX, Room 4258, Department of State, 2201 C St., NW., Washington, DC 20520. 
                    </P>
                </FURINF>
            </PREAMB>
            <SUPLINF>
                <HD SOURCE="HED">SUPPLEMENTARY INFORMATION:</HD>
                <P>Following is the text of the issued permit: </P>
                <P>
                    By virtue of the authority vested in me as Under Secretary of State for Economic, Energy and Agricultural Affairs, pursuant to Department of State Delegation number 118-2 from the Secretary of State dated January 26, 2006, to exercise, to the extent authorized by law, all authorities vested in the Secretary of State, including those authorities under Executive Order 11423, 33 FR 11741 (1968), as amended by Executive Order 12847 of May 17, 1993, 58 FR. 29511 (1993), Executive Order 13284 of January 23, 2003, 68 FR 4075 (2003), and Executive Order 13337 of April 30, 2004, 69 FR 25299 (2004); having considered the environmental effects of the proposed action in accordance with the National Environmental Policy Act of 1969 (83 Stat. 852; 42 U.S.C. § 4321, 
                    <E T="03">et seq.</E>
                    ) and other statutes relating to environmental concerns; having considered the proposed action in accordance with the National Historic Preservation Act (80 Stat. 917, 16 U.S.C. § 470f, 
                    <E T="03">et seq.</E>
                    ); and having requested and received the views of various of the federal departments 
                    <PRTPAGE P="66217"/>
                    and other interested persons; I hereby grant permission, subject to the conditions herein set forth, to the Greater Yuma Port Authority (GYPA, hereinafter referred to as the “permittee”), to construct, operate, and maintain a new livestock border crossing (hereinafter referred to as “San Luis Livestock Crossing”), 2,500 feet (approximately half a mile) east of the existing San Luis cattle crossing on the westerly border of the State of Arizona and the Mexican State of Sonora near the cities of San Luis, Arizona and San Luis Rio Colorado, Sonora, Mexico. 
                </P>
                <P>The term “facilities” as used in this permit means the lane or lanes leading to the livestock crossing, their approaches and any land, structure or installations appurtenant thereto. These facilities are the subject of a Finding of No Significant Impact, FONSI, approved by the Acting Director of the Office of Mexican Affairs in the Department of State on July 27, 2007, 72 FR 43314-43316 (August 3, 2007) . </P>
                <P>The term “United States facilities” as used in this permit means that part of the facilities in the United States. </P>
                <P>This permit is subject to the following conditions:</P>
                <P>
                    <E T="03">Article 1.</E>
                     The United States facilities herein described, and all aspects of their operation, shall be subject to all the conditions, provisions, and requirements of this permit and any amendment thereof. This permit may be terminated at will by the Secretary of State or the Secretary's delegate or may be amended by the Secretary of State or the Secretary's delegate at will or upon proper application therefor. The permittee shall make no substantial change in the location of the livestock crossing facilities or in the operation authorized by this permit until such changes have been approved by the Secretary of State or the Secretary's delegate. 
                </P>
                <P>
                    <E T="03">Article 2.</E>
                     The standards for, and the manner of, the construction, operation, and maintenance of the United States facilities shall be subject to inspection and approval by the representatives of appropriate federal, state and local agencies. The permittee shall allow duly authorized officers and employees of such agencies free and unrestricted access to said facilities in the performance of their official duties. 
                </P>
                <P>
                    <E T="03">Article 3.</E>
                     The permittee shall comply with all applicable federal, state, and local laws and regulations regarding the construction, operation, and maintenance of the United States facilities, and with all applicable industrial codes. The permittee shall obtain the requisite permits from state and local government entities and relevant federal agencies. 
                </P>
                <P>
                    <E T="03">Article 4.</E>
                     Upon the termination, revocation, or surrender of this permit, and unless otherwise agreed by the Secretary of State or the Secretary's delegate, the United States facilities in the immediate vicinity of the international boundary shall be removed by and at the expense of the permittee within such time as the Secretary of State or the Secretary's delegate may specify, and upon failure of the permittee to remove this portion of the United States facilities as ordered, the Secretary of State or the Secretary's delegate may direct that possession of such facilities be taken and that they be removed at the expense of the permittee; and the permittee shall have no claim for damages by reason of such possession or removal. 
                </P>
                <P>
                    <E T="03">Article 5.</E>
                     This permit and the operation of the United States facilities hereunder shall be subject to the limitations, terms, and conditions issued by any competent agency of the United States Government, including but not limited to the Department of Homeland Security (DHS), the Federal Highway Administration (FHWA), and the United States Section of the International Boundary and Water Commission (IBWC). This permit shall continue in force and effect only so long as the permittee shall continue the operations hereby authorized in accordance with such limitations, terms and conditions. 
                </P>
                <P>
                    <E T="03">Article 6.</E>
                     Any transfer of ownership or control of the United States facilities or any part thereof shall be immediately notified in writing to the United States Department of State (the “Department”) for approval, including identification of the transferee. In the event of such transfer of ownership or control, the permit shall remain in force and the United States facilities shall be subject to all the conditions, permissions, and requirements of this permit and any amendments thereof. 
                </P>
                <P>
                    <E T="03">Article 7.</E>
                     (1) The permittee shall acquire such right-of-way grants or easements, permits, and other authorizations as may become necessary and appropriate. 
                </P>
                <P>(2) The permittee shall maintain the United States facilities and every part thereof in a condition of good repair for their safe operation. </P>
                <P>
                    <E T="03">Article 8.</E>
                     (1) The permittee shall take all appropriate measures to prevent or mitigate adverse environmental impacts or disruption of significant archeological resources in connection with the construction, operation and maintenance of the United States facilities, including those mitigation measures set forth in the Finding of No Significant Impact (FONSI) approved by the Department on July 27, 2007, 72 Fed. Reg. 43314-43316 (August 3, 2007). 
                </P>
                <P>(2) Before beginning construction the permittee shall obtain the concurrence of the IBWC. </P>
                <P>
                    <E T="03">Article 9.</E>
                     The permittee shall file with the appropriate agencies of the United States Government such statements or reports under oath with respect to the United States facilities, and/or permittee's actions in connection therewith, as are now or may hereafter be required under any laws or regulations of the United States Government or its agencies. 
                </P>
                <P>
                    <E T="03">Article 10.</E>
                     The permittee shall not begin construction until the Department has provided notification to the permittee that it has completed its exchange of diplomatic notes with the Government of Mexico regarding authorization of construction. The permittee shall provide written notice to the Department at such time as the construction authorized by this permit is begun, and again at such time as construction is completed, interrupted or discontinued. 
                </P>
                <P>
                    <E T="03">In witness whereof,</E>
                     I, Reuben Jeffery III, Under Secretary of State for Economic, Energy and Agricultural Affairs of the United States, have hereunto set my hand this 31st day of October, 2007, in the City of Washington, District of Columbia. 
                </P>
                <P>End Permit text. </P>
                <SIG>
                    <DATED>Dated: November 20, 2007. </DATED>
                    <NAME>Ian G. Brownlee, </NAME>
                    <TITLE>Acting Director, Office of Mexican Affairs, Department of State. </TITLE>
                </SIG>
            </SUPLINF>
            <FRDOC>[FR Doc. E7-23085 Filed 11-26-07; 8:45 am] </FRDOC>
            <BILCOD>BILLING CODE 4710-29-P</BILCOD>
        </NOTICE>
        <NOTICE>
            <PREAMB>
                <AGENCY TYPE="N">TENNESSEE VALLEY AUTHORITY </AGENCY>
                <SUBJECT>Sunshine Act Meeting </SUBJECT>
                <PREAMHD>
                    <HD SOURCE="HED">Agency Holding the Meeting:</HD>
                    <P>Tennessee Valley Authority (Meeting No. 07-06). </P>
                </PREAMHD>
                <PREAMHD>
                    <HD SOURCE="HED">Time and Date:</HD>
                    <P>9 a.m. EST, November 29, 2007, TVA West Tower Auditorium, 400 West Summit Hill Drive, Knoxville, Tennessee 37902. </P>
                </PREAMHD>
                <HD SOURCE="HD1">Agenda </HD>
                <HD SOURCE="HD2">Old Business </HD>
                <P>Approval of minutes of September 27, 2007, Board Meeting. </P>
                <HD SOURCE="HD2">New Business </HD>
                <FP SOURCE="FP-2">1. President's Report </FP>
                <FP SOURCE="FP-2">2. Report of the Finance, Strategy, and Rates Committee </FP>
                <FP SOURCE="FP1-2">
                    A. Tax-equivalent payments for FY 07 
                    <PRTPAGE P="66218"/>
                    and estimated payments for FY 08 
                </FP>
                <FP SOURCE="FP1-2">B. Retention of Net Power Proceeds and Nonpower Proceeds and Payments to the U.S. Treasury </FP>
                <FP SOURCE="FP1-2">C. Customer issues </FP>
                <FP SOURCE="FP1-2">i. Rate adjustment to the Fuel Cost Adjustment baseline </FP>
                <FP SOURCE="FP1-2">ii. Market days option for 5-minute response interruptible product </FP>
                <FP SOURCE="FP-2">3. Report of the Operations, Environment, and Safety Committee </FP>
                <FP SOURCE="FP1-2">A. Gas capacity expansion </FP>
                <FP SOURCE="FP1-2">B. Contracts with BHP Billiton and Areva for uranium fuel </FP>
                <FP SOURCE="FP-2">4. Report of the Human Resources Committee </FP>
                <FP SOURCE="FP1-2">A. Executive compensation approvals for FY 08 </FP>
                <FP SOURCE="FP1-2">B. Amendments to the TVA Retirement System plans </FP>
                <FP SOURCE="FP-2">5. Report of the Audit and Ethics Committee </FP>
                <FP SOURCE="FP-2">6. Report of the Community Relations Committee </FP>
                <FP SOURCE="FP-2">7. Report of the Corporate Governance Committee </FP>
                <FURINF>
                    <HD SOURCE="HED">FOR FURTHER INFORMATION:</HD>
                    <P>Please call Media Relations at (865) 632-6000, Knoxville, Tennessee. People who plan to attend the meeting and have special needs should call (865) 632-6000. Anyone who wishes to comment on any of the agenda in writing may send their comments to: TVA Board of Directors, Board Agenda Comments, 400 West Summit Hill Drive, Knoxville, Tennessee 37902. </P>
                    <SIG>
                        <DATED>Dated: November 21, 2007. </DATED>
                        <NAME>Maureen H. Dunn, </NAME>
                        <TITLE>General Counsel and Secretary. </TITLE>
                    </SIG>
                </FURINF>
            </PREAMB>
            <FRDOC>[FR Doc. 07-5855 Filed 11-23-07; 9:41 am] </FRDOC>
            <BILCOD>BILLING CODE 8120-08-P </BILCOD>
        </NOTICE>
        <NOTICE>
            <PREAMB>
                <AGENCY TYPE="N">DEPARTMENT OF TRANSPORTATION </AGENCY>
                <SUBAGY>National Highway Traffic Safety Administration </SUBAGY>
                <SUBJECT>Reports, Forms and Record Keeping Requirements Agency Information Collection Activity Under OMB Review </SUBJECT>
                <AGY>
                    <HD SOURCE="HED">AGENCY:</HD>
                    <P>National Highway Traffic Safety Administration, DOT. </P>
                </AGY>
                <ACT>
                    <HD SOURCE="HED">ACTION:</HD>
                    <P>Notice. </P>
                </ACT>
                <SUM>
                    <HD SOURCE="HED">SUMMARY:</HD>
                    <P>
                        In compliance with the Paperwork Reduction Act of 1995 (44 U.S.C. 3501, 
                        <E T="03">et seq.</E>
                        ), this notice announces that the Information Collection Request (ICR) abstracted regarding the Uniform Tire Quality Grading Standard (UTQGS) below has been forwarded to the Office of Management and Budget (OMB) for review and comment. The ICR describes the nature of the information collections and their expected burden. The 
                        <E T="04">Federal Register</E>
                         Notice with a 60-day comment period was published on July 20, 2007 [72 FR 39889-39890]. 
                    </P>
                </SUM>
                <DATES>
                    <HD SOURCE="HED">DATES:</HD>
                    <P>Comments must be submitted on or before December 27, 2007. </P>
                </DATES>
                <FURINF>
                    <HD SOURCE="HED">FOR FURTHER INFORMATION CONTACT:</HD>
                    <P>Hisham Mohamed at the National Highway Traffic Safety Administration, Office of International Policy, Fuel Economy and Consumer Programs (NVS-131), 1200 New Jersey Ave, SE., W43-437, Washington, DC 20590. Mr. Mohamed's telephone number is (202) 366-0307. </P>
                </FURINF>
            </PREAMB>
            <SUPLINF>
                <HD SOURCE="HED">SUPPLEMENTARY INFORMATION:</HD>
                <HD SOURCE="HD1">National Highway Traffic Safety Administration </HD>
                <P>
                    <E T="03">Title:</E>
                     49 CFR Part 575.104; Uniform Tire Quality Grading Standard. 
                </P>
                <P>
                    <E T="03">OMB Number:</E>
                     2127-0519. 
                </P>
                <P>
                    <E T="03">Type of Request:</E>
                     Extension of a currently approved information collection. 
                </P>
                <P>
                    <E T="03">Abstract:</E>
                     Part 575 requires tire manufacturers and tire brand owners to submit reports to NHTSA regarding the UTQGS grades of all passenger car tire lines they offer for sale in the United States. This information is used by consumers of passenger car tires to compare tire quality in making their purchase decisions. The information is provided in several different ways to insure that the consumer can readily see and understand the tire grades: (1) The grades are molded into the sidewall of the tire so that they can be reviewed on both the new and old tires; (2) a paper label is affixed to the tread face of the new tires that provides the grades of that particular tireline along with an explanation of the grading system; (3) the tire manufacturer or brand name owner provides prospective purchasers of tires the information for each tire offered for sale at the particular location; (4) vehicle manufacturers include in the owner's manual of each vehicle the grade information for the tires with which the vehicle is equipped; (5) NHTSA compiles the grading information of all manufacturers' tirelines into a booklet that is available to the public both in printed form and on NHTSA's Web site. 
                </P>
                <P>
                    <E T="03">Affected Public:</E>
                     All passenger car tire manufacturers and brand name owners offering passenger car tires for sale in the United States. 
                </P>
                <P>
                    <E T="03">Estimated Total Annual Burden:</E>
                     NHTSA estimates that a cost of approximately $26 million to tire manufacturers is required to comply with this regulation. 
                </P>
                <SUPLHD>
                    <HD SOURCE="HED">ADDRESSES:</HD>
                    <P>Send comments, within 30 days, to the Office of Information and Regulatory Affairs, Office of Management and Budget, 725-17th Street, NW., Washington, DC 20503, Attention NHTSA Desk Officer. </P>
                    <P>
                        <E T="03">Comments are invited on:</E>
                         Whether the proposed collection of information is necessary for the proper performance of the functions of the Department, including whether the information will have practical utility; the accuracy of the Departments' estimate of the burden of the proposed information collection; ways to enhance the quality, utility and clarity of the information to be collected; and ways to minimize the burden of the collection of information on respondents, including the use of automated collection techniques or other forms of information technology. A comment to OMB is most effective if OMB receives it within 30 days of publication. 
                    </P>
                </SUPLHD>
                <SIG>
                    <DATED>Issued on: November 21, 2007. </DATED>
                    <NAME>Stephen R. Kratzke, </NAME>
                    <TITLE>Associate Administrator for Rulemaking.</TITLE>
                </SIG>
            </SUPLINF>
            <FRDOC> [FR Doc. E7-23045 Filed 11-26-07; 8:45 am] </FRDOC>
            <BILCOD>BILLING CODE 4910-59-P </BILCOD>
        </NOTICE>
        <NOTICE>
            <PREAMB>
                <AGENCY TYPE="N">DEPARTMENT OF VETERANS AFFAIRS </AGENCY>
                <SUBJECT>VA Adjudications Manual, M21-1; Rescission of Manual M21-1 Provisions Related To Exposure to Herbicides Based on Receipt of the Vietnam Service Medal </SUBJECT>
                <AGY>
                    <HD SOURCE="HED">AGENCY:</HD>
                    <P>Department of Veterans Affairs. </P>
                </AGY>
                <ACT>
                    <HD SOURCE="HED">ACTION:</HD>
                    <P>Notice, with request for comments. </P>
                </ACT>
                <SUM>
                    <HD SOURCE="HED">SUMMARY:</HD>
                    <P>The Department of Veterans Affairs (VA) proposes to rescind provisions of its Adjudication Procedures Manual, M21-1 (M21-1) that were found by the U.S. Court of Appeals for Veterans Claims (CAVC) not to have been properly rescinded. </P>
                </SUM>
                <DATES>
                    <HD SOURCE="HED">DATES:</HD>
                    <P>Comments must be received by VA on or before January 28, 2008. </P>
                </DATES>
                <ADD>
                    <HD SOURCE="HED">ADDRESSES:</HD>
                    <P>
                        Written comments may be submitted through 
                        <E T="03">www.Regulations.gov</E>
                        ; by mail or hand-delivery to the Director, Regulations Management (00REG), Department of Veterans Affairs, 810 Vermont Ave., NW., Room 1068, Washington, DC 20420; or by fax to (202) 273-9026. Comments should indicate that they are submitted in response to “Rescission of Manual M21-1 Provisions Related to Exposure to Herbicides Based On Receipt of the Vietnam Service Medal.” Copies of comments received will be available for public inspection in the Office of Regulation Policy and Management, Room 1063B, between the 
                        <PRTPAGE P="66219"/>
                        hours of 8 a.m. and 4:30 p.m. Monday through Friday (except holidays). Please call (202) 273-9515 for an appointment. In addition, during the comment period, comments may be viewed online through the Federal Docket Management System (FDMS) at 
                        <E T="03">www.Regulations.gov</E>
                        . 
                    </P>
                </ADD>
                <FURINF>
                    <HD SOURCE="HED">FOR FURTHER INFORMATION CONTACT:</HD>
                    <P>Rhonda F. Ford, Chief, Regulations Staff (211D), Compensation and Pension Service, Veterans Benefits Administration, Department of Veterans Affairs, 810 Vermont Avenue, NW., Washington, DC 20420, (202) 273-7210. </P>
                </FURINF>
            </PREAMB>
            <SUPLINF>
                <HD SOURCE="HED">SUPPLEMENTARY INFORMATION:</HD>
                <P>
                    This rulemaking is necessitated by the opinion rendered by the CAVC in 
                    <E T="03">Haas</E>
                     v. 
                    <E T="03">Nicholson</E>
                    , 20 Vet. App. 257 (2006), 
                    <E T="03">notice of appeal filed</E>
                    , No. 07-7037 (Oct. 26, 2006). In that opinion, the CAVC concluded that certain provisions of VA's Adjudication Procedures Manual M21-1 (M21-1) were substantive provisions that had not been properly rescinded. 
                    <E T="03">Id.</E>
                     at 276-78. We have appealed 
                    <E T="03">Haas</E>
                    , and if we are successful on appeal, this rulemaking will be withdrawn. However, in the event that we do not prevail on appeal, we now take action to properly rescind the provisions. 
                </P>
                <P>
                    In 
                    <E T="03">Haas</E>
                    , the CAVC held that a 1991 M21-1 provision required VA to concede that Mr. Haas had served in Vietnam, and was presumed to have been exposed to herbicides during service, because he had received the Vietnam Service Medal (VSM). 
                    <E T="03">Haas</E>
                    , 20 Vet. App. at 270-72 (quoting in full and discussing M21-1, part III, para. 4.08(k)(1)-(2) (1991)). In 2002, VA had issued a new M21-1 provision that more clearly restated the 1991 provision, advising that receipt of the VSM could indicate service on land in Vietnam but, by itself, was not proof of such service. M21-1, pt. III, para. 4.24(e)(1)-(2), change 88 (Feb. 27, 2002). However, the CAVC held that VA's 2002 revision of the M21-1 was ineffective because VA had not followed the notice and comment procedures of the Administrative Procedure Act, 5 U.S.C. § 553(a). 
                    <E T="03">Haas</E>
                    , 270 Vet. App. at 275-78. 
                </P>
                <P>
                    As interpreted by the CAVC, the 1991 M21-1 provision requires VA, in at least some circumstances, to concede service in Vietnam, and thus herbicide exposure, based merely on the receipt of the VSM, even if all other evidence indicates that the veteran did not serve on land or on inland waterways in Vietnam and therefore was exceedingly unlikely to have been exposed to herbicides as a result of Vietnam service. VA revised the M21-1 in 2002 because, although receipt of the VSM is an indication of possible service in Vietnam, it is not definitive or conclusive evidence of such service. It is inappropriate to include receipt of the VSM as a sole criterion for the presumption of exposure to herbicide agents due to service in Vietnam because a veteran may have received this medal for service in locations other than Vietnam. (The VSM was awarded to all members of the Armed Forces who served between July 3, 1965, and March 28, 1973, either: (1) In Vietnam and contiguous waters and airspace thereover; or (2) in Thailand, Laos, or Cambodia, or airspace thereover, in direct support of operations in Vietnam. 
                    <E T="03">See</E>
                     Army Reg. 600-8-22, para. 2-13.) The 2002 revision was intended to clarify VA's view that receipt of the VSM does not require or permit VA to ignore other evidence indicating that a veteran did not serve in the Republic of Vietnam. Because the CAVC's interpretation of the 1991 M21-1 provision does not accord with VA's intent in issuing that provision, we propose to rescind it. 
                </P>
                <P>The M21-1 is an internal manual used to convey guidance to VA adjudicators. It is not intended to establish substantive rules beyond those contained in statute and regulation. Neither the 1991 nor the 2002 M21-1 provision, nor any intervening revision to such provisions, was intended to establish a substantive rule. Further, the 1991 provision was not intended to convey the rule the CAVC imputed to that provision, treating the VSM as conclusive evidence of service in Vietnam even if other evidence would support a finding that the veteran did not serve in Vietnam. However, because the CAVC held that the 1991 M21-1 provision established a substantive rule, and because that rule, as interpreted by the CAVC, is inconsistent with VA's intent, we are proposing to rescind the M21-1 provision. </P>
                <P>
                    We note as well that we will soon be revising § 3.307(a)(6)(iii) to clarify VA's interpretation of the statutory authority governing service in Vietnam for purposes of the presumption of herbicide exposure. In view of the confusion created by the M21-1 provisions in the 
                    <E T="03">Haas</E>
                     case, we believe it is preferable to rescind the M21-1 provisions relating to proof of service in Vietnam, including the 1991 provision at issue in 
                    <E T="03">Haas</E>
                    , the 2002 clarifying revision to that provision, and intervening revisions. This will enable VA to clarify and ensure that its interpretation of the governing statutory provisions set forth in its regulation and to minimize the possibility of a perceived or unintended inconsistency based on VA's internal manual. 
                </P>
                <P>Hence, VA proposes to rescind the following manual provisions describing service in Vietnam for the purposes of the presumption of exposure to herbicides: M21-1, pt. III, para. 4.08(k)(1)-(2) (November 8, 1991); M21-1, pt. III, para. 4.24(g)(1)-(2), change 23 (October 6, 1993); M21-1, pt. III, para. 4.24(g)(1)-(2), change 41 (July 12, 1995); M21-1, pt. III, para. 4.24(g)(1)-(2), change 76 (June 1, 1999); M21-1, pt. III, para. 4.24(e)(1)-(2), change 88 (February 27, 2002). </P>
                <SIG>
                    <DATED>Approved: November 19, 2007. </DATED>
                    <NAME>Gordon H. Mansfield, </NAME>
                    <TITLE>Acting Secretary of Veterans Affairs.</TITLE>
                </SIG>
            </SUPLINF>
            <FRDOC>[FR Doc. E7-22983 Filed 11-26-07; 8:45 am] </FRDOC>
            <BILCOD>BILLING CODE 8320-01-P</BILCOD>
        </NOTICE>
    </NOTICES>
    <VOL>72</VOL>
    <NO>227</NO>
    <DATE>Tuesday, November 27, 2007</DATE>
    <UNITNAME>Rules and Regulations</UNITNAME>
    <NEWPART>
        <PTITLE>
            <PRTPAGE P="66221"/>
            <PARTNO>Part II</PARTNO>
            <AGENCY TYPE="P">Department of Health and Human Services</AGENCY>
            <SUBAGY>Centers for Medicare &amp; Medicaid Services</SUBAGY>
            <HRULE/>
            <CFR>42 CFR Parts 409, 410, et al.</CFR>
            <TITLE>Medicare Program; Revisions to Payment Policies Under the Physician Fee Schedule, and Other Part B Payment Policies for CY 2008; Revisions to the Payment Policies of Ambulance Services Under the Ambulance Fee Schedule for CY 2008; and the Amendment of the E-Prescribing Exemption for Computer Generated Facsimile Transmissions; Final Rule</TITLE>
        </PTITLE>
        <RULES>
            <RULE>
                <PREAMB>
                    <PRTPAGE P="66222"/>
                    <AGENCY TYPE="S">DEPARTMENT OF HEALTH AND HUMAN SERVICES</AGENCY>
                    <SUBAGY>Centers for Medicare &amp; Medicaid Services</SUBAGY>
                    <CFR>42 CFR Parts 409, 410, 411, 413, 414, 415, 418, 423, 424, 482, 484, and 485</CFR>
                    <DEPDOC>[CMS-1385-FC]</DEPDOC>
                    <RIN>RIN 0938-AO65</RIN>
                    <SUBJECT>Medicare Program; Revisions to Payment Policies Under the Physician Fee Schedule, and Other Part B Payment Policies for CY 2008; Revisions to the Payment Policies of Ambulance Services Under the Ambulance Fee Schedule for CY 2008; and the Amendment of the E-Prescribing Exemption for Computer Generated Facsimile Transmissions</SUBJECT>
                    <AGY>
                        <HD SOURCE="HED">AGENCY:</HD>
                        <P>Centers for Medicare &amp; Medicaid Services (CMS), HHS.</P>
                    </AGY>
                    <ACT>
                        <HD SOURCE="HED">ACTION:</HD>
                        <P>Final rule with comment period.</P>
                    </ACT>
                    <SUM>
                        <HD SOURCE="HED">SUMMARY:</HD>
                        <P>This final rule with comment period addresses certain provisions of the Tax Relief and Health Care Act of 2006, as well as making other proposed changes to Medicare Part B payment policy. We are making these changes to ensure that our payment systems are updated to reflect changes in medical practice and the relative value of services. This final rule with comment period also discusses refinements to resource-based practice expense (PE) relative value units (RVUs); geographic practice cost indices (GPCI) changes; malpractice RVUs; requests for additions to the list of telehealth services; several coding issues including additional codes from the 5-Year Review; payment for covered outpatient drugs and biologicals; the competitive acquisition program (CAP); clinical lab fee schedule issues; payment for renal dialysis services; performance standards for independent diagnostic testing facilities; expiration of the physician scarcity area (PSA) bonus payment; conforming and clarifying changes for comprehensive outpatient rehabilitation facilities (CORFs); a process for updating the drug compendia; physician self referral issues; beneficiary signature for ambulance transport services; durable medical equipment (DME) update; the chiropractic services demonstration; a Medicare economic index (MEI) data change; technical corrections; standards and requirements related to therapy services under Medicare Parts A and B; revisions to the ambulance fee schedule; the ambulance inflation factor for CY 2008; and amending the e-prescribing exemption for computer-generated facsimile transmissions. We are also finalizing the calendar year (CY) 2007 interim RVUs and are issuing interim RVUs for new and revised procedure codes for CY 2008.</P>
                        <P>As required by the statute, we are announcing that the physician fee schedule update for CY 2008 is −10.1 percent, the initial estimate for the sustainable growth rate for CY 2008 is −0.1 percent, and the conversion factor (CF) for CY 2008 is $34.0682.</P>
                    </SUM>
                    <EFFDATE>
                        <HD SOURCE="HED">DATES:</HD>
                        <P>
                            <E T="03">Effective Date:</E>
                             The provisions of this final rule with comment period are effective January 1, 2008, except for the amendments to § 409.17 and § 409.23 which are effective July 1, 2008, and the amendments to § 423.160 which is effective January 1, 2009.
                        </P>
                        <P>
                            <E T="03">Comment Date:</E>
                             Comments will be considered if we receive them at one of the addresses provided below, no later than 5 p.m. e.s.t. on December 31, 2007.
                        </P>
                    </EFFDATE>
                    <ADD>
                        <HD SOURCE="HED">ADDRESSES:</HD>
                        <P>In commenting, please refer to file code CMS-1385-FC. Because of staff and resource limitations, we cannot accept comments by facsimile (FAX) transmission.</P>
                        <P>You may submit comments in one of three ways (no duplicates, please):</P>
                        <P>
                            1. 
                            <E T="03">Electronically.</E>
                             You may submit electronic comments on specific issues in this regulation to 
                            <E T="03">http://www.cms.hhs.gov/eRulemaking.</E>
                             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.)
                        </P>
                        <P>
                            2. 
                            <E T="03">By mail.</E>
                             You may mail written comments (one original and two copies) to the following address ONLY: Centers for Medicare &amp; Medicaid Services, Department of Health and Human Services, Attention: CMS-1385-FC, P.O. Box 8020, Baltimore, MD 21244-8020.
                        </P>
                        <P>Please allow sufficient time for mailed comments to be received before the close of the comment period.</P>
                        <P>
                            3. 
                            <E T="03">By express or overnight mail.</E>
                             You may send written comments (one original and two copies) to the following address ONLY: Centers for Medicare &amp; Medicaid Services, Department of Health and Human Services, Attention: CMS-1385-FC, Mail Stop C4-26-05, 7500 Security Boulevard, Baltimore, MD 21244-1850.
                        </P>
                        <P>
                            4. 
                            <E T="03">By hand or courier.</E>
                             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) 786-7197 in advance to schedule your arrival with one of our staff members.
                        </P>
                        <P>Room 445-G, Hubert H. Humphrey (HHH) Building, 200 Independence Avenue, SW., Washington, DC 20201; or 7500 Security Boulevard, Baltimore, MD 21244-1850.</P>
                        <P>(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.)</P>
                        <P>Comments mailed to the addresses indicated as appropriate for hand or courier delivery may be delayed and received after the comment period.</P>
                        <P>
                            <E T="03">Submission of comments on paperwork requirements.</E>
                             You may submit comments on this document's paperwork requirements by mailing your comments to the addresses provided at the end of the “Collection of Information Requirements” section in this document.
                        </P>
                        <P>
                            For information on viewing public comments, see the beginning of the 
                            <E T="02">SUPPLEMENTARY INFORMATION</E>
                             section.
                        </P>
                    </ADD>
                    <FURINF>
                        <HD SOURCE="HED">FOR FURTHER INFORMATION CONTACT:</HD>
                        <P> Pam West, (410) 786-2302 for issues related to practice expense and comprehensive outpatient rehabilitation facilities.</P>
                        <P>Rick Ensor, (410) 786-5617 for issues related to practice expense methodology.</P>
                        <P>Stephanie Monroe, (410) 786-6864 for issues related to the geographic practice cost index and malpractice RVUs.</P>
                        <P>Craig Dobyski, (410) 786-4584 for issues related to list of telehealth services.</P>
                        <P>Ken Marsalek, (410) 786-4502 for issues related to the DRA imaging cap.</P>
                        <P>Catherine Jansto, (410) 786-7762 for issues related to payment for covered outpatient drugs and biologicals.</P>
                        <P>Edmund Kasaitis (410) 786-0477 for issues related to the Competitive Acquisition Program (CAP) for part B drugs.</P>
                        <P>Anita Greenberg (410) 786-4601 for issues related to the clinical laboratory fee schedule.</P>
                        <P>Henry Richter, (410) 786-4562 for issues related to payments for end-stage renal disease facilities.</P>
                        <P>August Nemec (410) 786-0612 for issues related to independent diagnostic testing facilities.</P>
                        <P>
                            Kate Tillman (410) 786-9252 or Brijit Burton (410) 786-7364 for issues related to the drug compendia.
                            <PRTPAGE P="66223"/>
                        </P>
                        <P>David Walczak (410) 786-4475 for issues related to reassignment and physician self-referral rules for diagnostic tests and beneficiary signature for ambulance transport.</P>
                        <P>Lisa Ohrin (410) 786-4565 or Joanne Sinsheimer (410) 786-4620 for issues related to physician self-referral rules.</P>
                        <P>Bob Kuhl (410) 786-4597 for issues related to the DME update.</P>
                        <P>Rachel Nelson (410) 786-1175 for issues related to the physician quality reporting system for CY 2008.</P>
                        <P>Maria Ciccanti (410) 786-3107 for issues related to the reporting of anemia quality indicators.</P>
                        <P>James Menas (410) 786-4507 for issues related to payment for physician pathology services.</P>
                        <P>Dorothy Shannon, (410) 786-3396 for issues related to the outpatient therapy caps.</P>
                        <P>Drew Morgan, (410) 786-2543 for issues related to the E-Prescribing Exemption for Computer Generated Facsimile Transmissions.</P>
                        <P>Roechel Kujawa (410) 786-9111 or Anne Tayloe (410) 786-4546 for issues related to the ambulance fee schedule.</P>
                        <P>Diane Milstead, (410) 786-3355 or Gaysha Brooks (410) 786-9649 for all other issues.</P>
                    </FURINF>
                </PREAMB>
                <SUPLINF>
                    <HD SOURCE="HED">SUPPLEMENTARY INFORMATION:</HD>
                    <P SOURCE="NPAR">
                        <E T="03">Submitting Comments:</E>
                         We welcome comments from the public on the following issues: Interim Relative Value Units (RVUs) for selected codes identified in Addendum C and the physician self-referral designated health services (DHS) procedures listed in Addendum I. You can assist us by referencing the file code [CMS-1385-FC] and the specific “issue identifier” that precedes the section on which you choose to comment.
                    </P>
                    <P>
                        <E T="03">Inspection of Public Comments:</E>
                         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 have been received: 
                        <E T="03">http://www.cms.hhs.gov/eRulemaking.</E>
                         Click on the link “Electronic Comments on CMS Regulations” on that Web site to view public comments.
                    </P>
                    <P>Comments received timely will also 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 &amp; 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.</P>
                    <P>
                        This 
                        <E T="04">Federal Register</E>
                         document is also available from the 
                        <E T="04">Federal Register</E>
                         online database through Government Printing Office Access a service of the U.S. Government Printing Office. The Web site address is: 
                        <E T="03">http://www.access.gpo.gov/nara/index.html.</E>
                    </P>
                    <P>Information on the physician fee schedule can also be found on the CMS homepage. You can access this data by using the following directions:</P>
                    <P>
                        1. Go to the following Web site: 
                        <E T="03">http://www.cms.hhs.gov/PhysicianFeeSched/.</E>
                    </P>
                    <P>2. Select “PFS Federal Regulation Notices.”</P>
                    <P>
                        To assist readers in referencing sections contained in this preamble, we are providing the following table of contents. Some of the issues discussed in this preamble affect the payment policies, but do not require changes to the regulations in the 
                        <E T="03">Code of Federal Regulations.</E>
                         Information on the regulation's impact appears throughout the preamble and is not exclusively in section VI.
                    </P>
                    <EXTRACT>
                        <HD SOURCE="HD1">Table of Contents</HD>
                        <FP SOURCE="FP-2">I. Background</FP>
                        <FP SOURCE="FP1-2">A. Development of the Relative Value System</FP>
                        <FP SOURCE="FP1-2">B. Components of the Fee Schedule Payment Amounts</FP>
                        <FP SOURCE="FP1-2">C. Most Recent Changes to Fee Schedule</FP>
                        <FP SOURCE="FP-2">II. Provisions of the Final Rule Related to the Physician Fee Schedule</FP>
                        <FP SOURCE="FP1-2">A. Resource Based Practice Expense (PE) Relative Value Units (RVUs)</FP>
                        <FP SOURCE="FP1-2">1. Current Methodology</FP>
                        <FP SOURCE="FP1-2">2. PE Proposals for CY 2008</FP>
                        <FP SOURCE="FP1-2">B. Geographic Practice Cost Indices (GPCIs)</FP>
                        <FP SOURCE="FP1-2">1. GPCI Update</FP>
                        <FP SOURCE="FP1-2">2. Payment Localities</FP>
                        <FP SOURCE="FP1-2">C. Malpractice (MP) RVUs (TC/PC issue)</FP>
                        <FP SOURCE="FP1-2">D. Medicare Telehealth Services</FP>
                        <FP SOURCE="FP1-2">E. Specific Coding Issues Related to PFS</FP>
                        <FP SOURCE="FP1-2">1. Reduction in the Technical Component (TC) Payment for Imaging Services Under the PFS to the Outpatient Department (OPD) Payment Amount</FP>
                        <FP SOURCE="FP1-2">2. Application of Multiple Procedure Payment Reduction for Mohs Micrographic Surgery (CPT Codes 17311 Through 17315)</FP>
                        <FP SOURCE="FP1-2">3. Payment for Intravenous Immune Globulin (IVIG) Add On Code for Preadmission Related Services</FP>
                        <FP SOURCE="FP1-2">4. Reporting of Cardiac Rehabilitation Services</FP>
                        <FP SOURCE="FP1-2">F. Part B Drug Payment</FP>
                        <FP SOURCE="FP1-2">1. Average Sales Price (ASP) Issues</FP>
                        <FP SOURCE="FP1-2">2. Competitive Acquisition Program (CAP) Issues</FP>
                        <FP SOURCE="FP1-2">G. Issues Related to the Clinical Lab Fee Schedule</FP>
                        <FP SOURCE="FP1-2">1. Date of Service for the Technical Component (TC) of Physician Pathology Services (§ 414.510)</FP>
                        <FP SOURCE="FP1-2">2. New Clinical Diagnostic Laboratory Test (§ 414.508)</FP>
                        <FP SOURCE="FP1-2">H. Revisions Related to Payment for Renal Dialysis Services Furnished by End-Stage Renal Disease (ESRD) Facilities</FP>
                        <FP SOURCE="FP1-2">1. Growth Update to the Drug Add-On Adjustment to the Composite Rates</FP>
                        <FP SOURCE="FP1-2">2. Update to the Geographic Adjustment to the Composite Rates</FP>
                        <FP SOURCE="FP1-2">I. Independent Diagnostic Testing Facility (IDTF) Issues</FP>
                        <FP SOURCE="FP1-2">1. Revisions of Existing IDTF Performance Standards</FP>
                        <FP SOURCE="FP1-2">2. New IDTF Standards</FP>
                        <FP SOURCE="FP1-2">J. Expiration of MMA Section 413 Provisions for Physician Scarcity Area (PSA)</FP>
                        <FP SOURCE="FP1-2">K. Comprehensive Outpatient Rehabilitation Facility (CORF) Issues</FP>
                        <FP SOURCE="FP1-2">1. Requirements for Coverage of CORF Services Plan of Treatment (§ 410.105(c))</FP>
                        <FP SOURCE="FP1-2">2. Included Services (§ 410.100)</FP>
                        <FP SOURCE="FP1-2">3. Physician Services (§ 410.100(a))</FP>
                        <FP SOURCE="FP1-2">4. Clarifications of CORF Respiratory Therapy Services</FP>
                        <FP SOURCE="FP1-2">5. Social and Psychological Services</FP>
                        <FP SOURCE="FP1-2">6. Nursing Care Services</FP>
                        <FP SOURCE="FP1-2">7. Drugs and Biologicals</FP>
                        <FP SOURCE="FP1-2">8. Supplies and DME</FP>
                        <FP SOURCE="FP1-2">9. Clarifications and Payment Updates for Other CORF Services</FP>
                        <FP SOURCE="FP1-2">10. Cost Based Payment (§ 413.1)</FP>
                        <FP SOURCE="FP1-2">11. Payment for Comprehensive Outpatient Rehabilitation Facility (CORF) Services</FP>
                        <FP SOURCE="FP1-2">12. Vaccines</FP>
                        <FP SOURCE="FP1-2">L. Compendia for Determination of Medically Accepted Indications for Off Label Uses of Drugs and Biologicals in an Anti-Cancer Chemotherapeutic Regimen (§ 414.930)</FP>
                        <FP SOURCE="FP1-2">1. Background</FP>
                        <FP SOURCE="FP1-2">2. Process for Determining Changes to the Compendia List</FP>
                        <FP SOURCE="FP1-2">M. Physician Self Referral Issues</FP>
                        <FP SOURCE="FP1-2">1. General</FP>
                        <FP SOURCE="FP1-2">2. Changes to Reassignment and Physician Self Referral Rules Relating to Diagnostic Tests (Anti Markup Provision)</FP>
                        <FP SOURCE="FP1-2">N. Beneficiary Signature for Ambulance Transport Services</FP>
                        <FP SOURCE="FP1-2">O. Update to Fee Schedules for Class III DME for CYs 2007 and 2008</FP>
                        <FP SOURCE="FP1-2">1. Background</FP>
                        <FP SOURCE="FP1-2">2. Update to Fee Schedule</FP>
                        <FP SOURCE="FP1-2">P. Discussion of Chiropractic Services Demonstration</FP>
                        <FP SOURCE="FP1-2">Q. Technical Corrections</FP>
                        <FP SOURCE="FP1-2">1. Particular Services Excluded From Coverage (§ 411.15(a))</FP>
                        <FP SOURCE="FP1-2">2. Medical Nutrition Therapy (§ 410.132(a))</FP>
                        <FP SOURCE="FP1-2">3. Payment Exception: Pediatric Patient Mix (§ 413.184)</FP>
                        <FP SOURCE="FP1-2">4. Diagnostic X ray Tests, Diagnostic Laboratory Tests, and Other Diagnostic Tests: Conditions (§ 410.32(a)(1))</FP>
                        <FP SOURCE="FP1-2">R. Other Issues</FP>
                        <FP SOURCE="FP1-2">1. Recalls and Replacement Devices</FP>
                        <FP SOURCE="FP1-2">2. Therapy Standards and Requirements</FP>
                        <FP SOURCE="FP1-2">
                            3. Amendment to the Exemption for Computer Generated Facsimile Transmission from the National Council for Prescription Drug Programs (NCPDP) SCRIPT Standard for Transmitting Prescription and Certain Prescription Related Information for Part D Eligible Individuals
                            <PRTPAGE P="66224"/>
                        </FP>
                        <FP SOURCE="FP1-2">S. Division B of the Tax Relief and Health Care Act of 2006—Medicare Improvements and Extension Act of 2006 (Pub. L. 109-432) (MIEA-TRHCA)</FP>
                        <FP SOURCE="FP1-2">1. Section 101(b)—Physician Quality Reporting Initiative (PQRI)</FP>
                        <FP SOURCE="FP1-2">2. Section 110—Reporting of Hemoglobin or Hematocrit for Part B Cancer Anti-Anemia Drugs (§ 414.707(b))</FP>
                        <FP SOURCE="FP1-2">3. Section 104—Extension of Treatment of Certain Physician Pathology Services Under Medicare</FP>
                        <FP SOURCE="FP1-2">4. Section 201—Extension of Therapy Cap Exception Process</FP>
                        <FP SOURCE="FP1-2">5. Section 101(d)—Physician Assistance and Quality Initiative (PAQI) Fund</FP>
                        <FP SOURCE="FP-2">III. Revisions to the Payment Policies of Ambulance Services Under the Fee Schedule for Ambulance Services; Ambulatory Inflation Factor Update for CY 2007</FP>
                        <FP SOURCE="FP1-2">A. History of Medicare Ambulance Services</FP>
                        <FP SOURCE="FP1-2">1. Statutory Coverage of Ambulance Services</FP>
                        <FP SOURCE="FP1-2">2. Medicare Regulations for Ambulance Services</FP>
                        <FP SOURCE="FP1-2">3. Transition to National Fee Schedule</FP>
                        <FP SOURCE="FP1-2">B. Ambulance Inflation Factor (AIF) During the Transition Period</FP>
                        <FP SOURCE="FP1-2">C. Ambulance Inflation Factor (AIF) for CY 2008</FP>
                        <FP SOURCE="FP1-2">D. Revisions to the Publication of the Ambulance Fee Schedule (§ 414.620)</FP>
                        <FP SOURCE="FP-2">IV. Refinement of Relative Value Units for Calendar Year 2008 and Response to Public Comments on Interim Relative Value Units for 2007</FP>
                        <FP SOURCE="FP1-2">A. Summary of Issues Discussed Related to the Adjustment of Relative Value Units</FP>
                        <FP SOURCE="FP1-2">B. Process for Establishing Work Relative Value Units for the Physician Fee Schedule</FP>
                        <FP SOURCE="FP1-2">C. 5 Year Review of Work RVUs</FP>
                        <FP SOURCE="FP1-2">1. Additional Codes from the 5-Year Review of Work RVUs</FP>
                        <FP SOURCE="FP1-2">2. Anesthesia Coding (Part of 5-Year Review)</FP>
                        <FP SOURCE="FP1-2">3. Budget Neutrality Adjustment</FP>
                        <FP SOURCE="FP1-2">D. Work Relative Value Unit Refinements of Interim Relative Value Units (Interim 2007 Codes)</FP>
                        <FP SOURCE="FP1-2">E. Establishment of Interim Work Relative Value Units for New and Revised Physician's Current Procedural Terminology (CPT) Codes and New Healthcare Common Procedure Coding System Codes (HCPCS) for 2008 (Includes Table Titled “American Medical Association Specialty Relative Value Update Committee and Health Care Professionals Advisory Committee Recommendations and CMS's Decisions for New and Revised 2008 CPT Codes”)</FP>
                        <FP SOURCE="FP1-2">F. Discussion of Codes and RUC/HCPAC Recommendations</FP>
                        <FP SOURCE="FP1-2">G. Additional Coding Issues</FP>
                        <FP SOURCE="FP1-2">H. Establishment of Interim PE RVUs for New and Revised Physician's Current Procedural Terminology (CPT) Codes and New Healthcare Common Procedure Coding System (HCPCS) Codes for 2008</FP>
                        <FP SOURCE="FP-2">V. Physician Self-Referral Prohibition: Annual Update to the List of CPT/HCPCS Codes</FP>
                        <FP SOURCE="FP-2">VI. Physician Fee Schedule Update for CY 2008</FP>
                        <FP SOURCE="FP1-2">A. Physician Fee Schedule Update</FP>
                        <FP SOURCE="FP1-2">B. The Percentage Change in the Medicare Economic Index (MEI)</FP>
                        <FP SOURCE="FP1-2">C. The Update Adjustment Factor (UAF)</FP>
                        <FP SOURCE="FP-2">VII. Allowed Expenditures for Physicians' Services and the Sustainable Growth Rate</FP>
                        <FP SOURCE="FP1-2">A. Medicare Sustainable Growth Rate</FP>
                        <FP SOURCE="FP1-2">B. Physicians' Services</FP>
                        <FP SOURCE="FP1-2">C. Preliminary Estimate of the SGR for 2008</FP>
                        <FP SOURCE="FP1-2">D. Revised Sustainable Growth Rate for 2007</FP>
                        <FP SOURCE="FP1-2">E. Final Sustainable Growth Rate for 2006</FP>
                        <FP SOURCE="FP1-2">F. Calculation of 2008, 2007, and 2006 Sustainable Growth Rates</FP>
                        <FP SOURCE="FP-2">VIII. Anesthesia and Physician Fee Schedule Conversion Factors for CY 2008</FP>
                        <FP SOURCE="FP1-2">A. Physician Fee Schedule Conversion Factor</FP>
                        <FP SOURCE="FP1-2">B. Anesthesia Fee Schedule Conversion Factor</FP>
                        <FP SOURCE="FP-2">IX. Telehealth Originating Site Facility Fee Payment Amount Update</FP>
                        <FP SOURCE="FP-2">X. Provisions of the Final Rule</FP>
                        <FP SOURCE="FP-2">XI. Waiver of Proposed Rulemaking and Delay in Effective Date</FP>
                        <FP SOURCE="FP-2">XII. Collection of Information Requirements</FP>
                        <FP SOURCE="FP-2">XIII. Response to Comments</FP>
                        <FP SOURCE="FP-2">XIV. Regulatory Impact Analysis</FP>
                        <FP SOURCE="FP-2">Regulation Text</FP>
                        <FP SOURCE="FP-2">Addendum A—Explanation and Use of Addendum B</FP>
                        <FP SOURCE="FP-2">Addendum B—2008 Relative Value Units and Related Information Used in Determining Medicare Payments for 2007</FP>
                        <FP SOURCE="FP-2">Addendum C—Codes With Interim RVUS</FP>
                        <FP SOURCE="FP-2">Addendum D—2008 Geographic Adjustment Factors (GAFs)</FP>
                        <FP SOURCE="FP-2">Addendum E—2008 Geographic Practice Cost Indices (GPCIs) by State and Medicare Locality</FP>
                        <FP SOURCE="FP-2">Addendum F—CPT/HCPCS Imaging Codes Defined by Section 5102(b) of the DRA</FP>
                        <FP SOURCE="FP-2">Addendum G—FY 2008 Wage Index for Urban Areas Based on CBSA Labor Market Areas</FP>
                        <FP SOURCE="FP-2">Addendum H—FY 2008 Wage Index Based on CBSA Labor Market Areas for Rural Areas</FP>
                        <FP SOURCE="FP-2">Addendum I—Updated List of CPT/HCPCS Codes Used To Describe Certain Designated Health Services Under the Physician Self-Referral Provision </FP>
                    </EXTRACT>
                    <HD SOURCE="HD1">Acronyms</HD>
                    <P>In addition, because of the many organizations and terms to which we refer by acronym in this final rule with comment period, we are listing these acronyms and their corresponding terms in alphabetical order below: </P>
                      
                    <EXTRACT>
                        <FP SOURCE="FP-1">AAA Abdominal aortic aneurysm</FP>
                        <FP SOURCE="FP-1">AAP Average acquisition price</FP>
                        <FP SOURCE="FP-1">ACOTE Accreditation Council for Occupational Therapy Education</FP>
                        <FP SOURCE="FP-1">ACR American College of Radiology</FP>
                        <FP SOURCE="FP-1">AFROC Association of Freestanding Radiation Oncology Centers</FP>
                        <FP SOURCE="FP-1">AHFS-DI American Hospital Formulary Service—Drug Information</FP>
                        <FP SOURCE="FP-1">AHRQ Agency for Healthcare Research and Quality (HHS)</FP>
                        <FP SOURCE="FP-1">AIF Ambulance inflation factor</FP>
                        <FP SOURCE="FP-1">AMA American Medical Association</FP>
                        <FP SOURCE="FP-1">AMA-DE American Medical Association Drug Evaluations</FP>
                        <FP SOURCE="FP-1">AMP Average manufacturer price</FP>
                        <FP SOURCE="FP-1">AOTA American Occupational Therapy Association</FP>
                        <FP SOURCE="FP-1">APC Ambulatory payment classification</FP>
                        <FP SOURCE="FP-1">APTA American Physical Therapy Association</FP>
                        <FP SOURCE="FP-1">ASA American Society of Anesthesiologists</FP>
                        <FP SOURCE="FP-1">ASC Ambulatory surgical center</FP>
                        <FP SOURCE="FP-1">ASP Average sales price</FP>
                        <FP SOURCE="FP-1">ASTRO American Society for Therapeutic Radiology and Oncology</FP>
                        <FP SOURCE="FP-1">ATA American Telemedicine Association</FP>
                        <FP SOURCE="FP-1">AWP Average wholesale price</FP>
                        <FP SOURCE="FP-1">BBA Balanced Budget Act of 1997 (Pub. L. 105-33)</FP>
                        <FP SOURCE="FP-1">BBRA [Medicare, Medicaid and State Child Health Insurance Program] Balanced Budget Refinement Act of 1999 (Pub. L. 106-113)</FP>
                        <FP SOURCE="FP-1">BIPA Medicare, Medicaid, and SCHIP Benefits Improvement Protection Act of 2000</FP>
                        <FP SOURCE="FP-1">BLS Bureau of Labor Statistics</FP>
                        <FP SOURCE="FP-1">BMD Bone mineral density</FP>
                        <FP SOURCE="FP-1">BMI Body mass index</FP>
                        <FP SOURCE="FP-1">BMM Bone mass measurement</FP>
                        <FP SOURCE="FP-1">BN Budget neutrality</FP>
                        <FP SOURCE="FP-1">BSA Body surface area</FP>
                        <FP SOURCE="FP-1">CAD Computer aided detection</FP>
                        <FP SOURCE="FP-1">CAH Critical access hospital</FP>
                        <FP SOURCE="FP-1">CAP Competitive acquisition program</FP>
                        <FP SOURCE="FP-1">CBSA Core-Based Statistical Area</FP>
                        <FP SOURCE="FP-1">CEM Cardiac event monitoring</FP>
                        <FP SOURCE="FP-1">CF Conversion factor</FP>
                        <FP SOURCE="FP-1">CFR Code of Federal Regulations</FP>
                        <FP SOURCE="FP-1">CMA California Medical Association</FP>
                        <FP SOURCE="FP-1">CMS Centers for Medicare &amp; Medicaid Services</FP>
                        <FP SOURCE="FP-1">CNS Clinical nurse specialist</FP>
                        <FP SOURCE="FP-1">CORF Comprehensive Outpatient Rehabilitation Facility</FP>
                        <FP SOURCE="FP-1">COTA Certified Occupational Therapy Assistant</FP>
                        <FP SOURCE="FP-1">CPEP Clinical Practice Expert Panel</FP>
                        <FP SOURCE="FP-1">CPI Consumer Price Index</FP>
                        <FP SOURCE="FP-1">CPI-U Consumer price index for urban customers</FP>
                        <FP SOURCE="FP-1">CPT (Physicians') Current Procedural Terminology (4th Edition, 2002, copyrighted by the American Medical Association)</FP>
                        <FP SOURCE="FP-1">CRT-D Cardiac resynchronization therapy defibrillator</FP>
                        <FP SOURCE="FP-1">CT Computed tomography</FP>
                        <FP SOURCE="FP-1">CTA Computed tomographic angiography</FP>
                        <FP SOURCE="FP-1">CY Calendar year</FP>
                        <FP SOURCE="FP-1">DEXA Dual energy x-ray absorptiometry</FP>
                        <FP SOURCE="FP-1">DHS Designated health services</FP>
                        <FP SOURCE="FP-1">DME Durable medical equipment</FP>
                        <FP SOURCE="FP-1">DMEPOS Durable medical equipment, prosthetics, orthotics, and supplies</FP>
                        <FP SOURCE="FP-1">DO Doctor of Osteopathy</FP>
                        <FP SOURCE="FP-1">DRA Deficit Reduction Act of 2005 (Pub. L. 109-432)</FP>
                        <FP SOURCE="FP-1">E/M Evaluation and management</FP>
                        <FP SOURCE="FP-1">ECI Employment cost index</FP>
                        <FP SOURCE="FP-1">EHR Electronic health record</FP>
                        <FP SOURCE="FP-1">EPC [Duke] Evidence-based Practice Centers</FP>
                        <FP SOURCE="FP-1">EPO Erythopoeitin</FP>
                        <FP SOURCE="FP-1">ESRD End stage renal disease</FP>
                        <FP SOURCE="FP-1">F&amp;C Facts and Comparisons</FP>
                        <FP SOURCE="FP-1">
                            FAW Furnish as written
                            <PRTPAGE P="66225"/>
                        </FP>
                        <FP SOURCE="FP-1">FAX Facsimile</FP>
                        <FP SOURCE="FP-1">FDA Food and Drug Administration (HHS)</FP>
                        <FP SOURCE="FP-1">FMR Fair market rents</FP>
                        <FP SOURCE="FP-1">FQHC Federally qualified health center</FP>
                        <FP SOURCE="FP-1">
                            FR 
                            <E T="04">Federal Register</E>
                        </FP>
                        <FP SOURCE="FP-1">GAF Geographic adjustment factor</FP>
                        <FP SOURCE="FP-1">GAO General Accounting Office</FP>
                        <FP SOURCE="FP-1">GII Global Insight, Inc.</FP>
                        <FP SOURCE="FP-1">GPO Group purchasing organization</FP>
                        <FP SOURCE="FP-1">GPCI Geographic practice cost index</FP>
                        <FP SOURCE="FP-1">HCPAC Health Care Professional Advisory Committee</FP>
                        <FP SOURCE="FP-1">HCPCS Healthcare Common Procedure Coding System</FP>
                        <FP SOURCE="FP-1">HCRIS Healthcare Cost Report Information System</FP>
                        <FP SOURCE="FP-1">HIPAA Health Insurance Portability and Accountability Act of 1996 (Pub. L. 104-191)</FP>
                        <FP SOURCE="FP-1">HHA Home health agency</FP>
                        <FP SOURCE="FP-1">HHS [Department of] Health and Human Services</FP>
                        <FP SOURCE="FP-1">HIT Health information technology</FP>
                        <FP SOURCE="FP-1">HMO Health maintenance organization</FP>
                        <FP SOURCE="FP-1">HPSA Health Professional Shortage Area</FP>
                        <FP SOURCE="FP-1">HRSA Health Resources Services Administration (HHS)</FP>
                        <FP SOURCE="FP-1">HUD [Department of] Housing and Urban Development</FP>
                        <FP SOURCE="FP-1">ICD Implantable cardioverter-defibrillator</FP>
                        <FP SOURCE="FP-1">ICF Intermediate care facilities</FP>
                        <FP SOURCE="FP-1">IDTF Independent diagnostic testing facility</FP>
                        <FP SOURCE="FP-1">IFC Interim final rule with comment period</FP>
                        <FP SOURCE="FP-1">IOTED International Occupational Therapy Eligibility Determination</FP>
                        <FP SOURCE="FP-1">IPPE Initial preventive physical examination</FP>
                        <FP SOURCE="FP-1">IPPS Inpatient prospective payment system</FP>
                        <FP SOURCE="FP-1">IV Intravenous</FP>
                        <FP SOURCE="FP-1">IVIG Intravenous immune globulin</FP>
                        <FP SOURCE="FP-1">IWPUT Intra-service work per unit of time</FP>
                        <FP SOURCE="FP-1">JCAAI Joint Council of Allergy, Asthma, and Immunology</FP>
                        <FP SOURCE="FP-1">LPN Licensed practical nurse</FP>
                        <FP SOURCE="FP-1">MA Medicare Advantage</FP>
                        <FP SOURCE="FP-1">MA-PD Medicare Advantage Prescription Drug Plans</FP>
                        <FP SOURCE="FP-1">MD Medical doctor</FP>
                        <FP SOURCE="FP-1">MedCAC Medicare Evidence Development and Coverage Advisory Committee (formerly the Medicare Coverage Advisory Committee (MCAC))</FP>
                        <FP SOURCE="FP-1">MedPAC Medicare Payment Advisory Commission</FP>
                        <FP SOURCE="FP-1">MEI Medicare Economic Index</FP>
                        <FP SOURCE="FP-1">MIEA-TRHCA Medicare Improvements and Extension Act of 2006 (That is, Division B of the Tax Relief and Health Care Act of 2006 (TRHCA)</FP>
                        <FP SOURCE="FP-1">MMA Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (Pub. L. 108-173)</FP>
                        <FP SOURCE="FP-1">MNT Medical nutrition therapy</FP>
                        <FP SOURCE="FP-1">MP Malpractice</FP>
                        <FP SOURCE="FP-1">MRA Magnetic resonance angiography</FP>
                        <FP SOURCE="FP-1">MRI Magnetic resonance imaging</FP>
                        <FP SOURCE="FP-1">MSA Metropolitan statistical area</FP>
                        <FP SOURCE="FP-1">MSP Medicare Secondary Payer</FP>
                        <FP SOURCE="FP-1">MSVP Multi-specialty visit package</FP>
                        <FP SOURCE="FP-1">NBCOT National Board for Certification in Occupational Therapy, Inc.</FP>
                        <FP SOURCE="FP-1">NCCN National Comprehensive Cancer Network</FP>
                        <FP SOURCE="FP-1">NCPDP National Council for Prescription Drug Programs</FP>
                        <FP SOURCE="FP-1">NCQDIS National Coalition of Quality Diagnostic Imaging Services</FP>
                        <FP SOURCE="FP-1">NDC National drug code</FP>
                        <FP SOURCE="FP-1">NEMC New England Medical Center</FP>
                        <FP SOURCE="FP-1">NISTA National Institute of Standards and Technology Act</FP>
                        <FP SOURCE="FP-1">NLA National limitation amount</FP>
                        <FP SOURCE="FP-1">NP Nurse practitioner</FP>
                        <FP SOURCE="FP-1">NPP Nonphysician practitioners</FP>
                        <FP SOURCE="FP-1">NQF National Quality Forum</FP>
                        <FP SOURCE="FP-1">NTTAA National Technology Transfer and Advancement Act of 1995 (Pub. L. 104-113)</FP>
                        <FP SOURCE="FP-1">OACT [CMS'] Office of the Actuary</FP>
                        <FP SOURCE="FP-1">OBRA Omnibus Budget Reconciliation Act</FP>
                        <FP SOURCE="FP-1">OIG Office of Inspector General</FP>
                        <FP SOURCE="FP-1">OMB Office of Management and Budget</FP>
                        <FP SOURCE="FP-1">OPD Outpatient Department</FP>
                        <FP SOURCE="FP-1">OPPS Outpatient prospective payment system</FP>
                        <FP SOURCE="FP-1">OPT Outpatient physical therapy</FP>
                        <FP SOURCE="FP-1">OSCAR Online Survey and Certification and Reporting</FP>
                        <FP SOURCE="FP-1">PA Physician assistant</FP>
                        <FP SOURCE="FP-1">PC Professional component</FP>
                        <FP SOURCE="FP-1">PCF Patient compensation fund</FP>
                        <FP SOURCE="FP-1">PDP Prescription Drug Plan</FP>
                        <FP SOURCE="FP-1">PE Practice Expense</FP>
                        <FP SOURCE="FP-1">PE/HR Practice expense per hour</FP>
                        <FP SOURCE="FP-1">PEAC Practice Expense Advisory Committee</FP>
                        <FP SOURCE="FP-1">PECOS Provider Enrollment, Chain, and Ownership System</FP>
                        <FP SOURCE="FP-1">PERC Practice Expense Review Committee</FP>
                        <FP SOURCE="FP-1">PET Positron emission tomography</FP>
                        <FP SOURCE="FP-1">PFS Physician Fee Schedule</FP>
                        <FP SOURCE="FP-1">PLI Professional liability insurance</FP>
                        <FP SOURCE="FP-1">PPI Producer price index</FP>
                        <FP SOURCE="FP-1">PPS Prospective payment system</FP>
                        <FP SOURCE="FP-1">PQRI Physician Quality Reporting Initiative</FP>
                        <FP SOURCE="FP-1">PRA Paperwork Reduction Act</FP>
                        <FP SOURCE="FP-1">PSA Physician scarcity areas</FP>
                        <FP SOURCE="FP-1">PT Physical therapy</FP>
                        <FP SOURCE="FP-1">PT/INR Prothrombin time, international normalized ratio</FP>
                        <FP SOURCE="FP-1">RFA Regulatory Flexibility Act</FP>
                        <FP SOURCE="FP-1">RHC Rural health clinic</FP>
                        <FP SOURCE="FP-1">RIA Regulatory impact analysis</FP>
                        <FP SOURCE="FP-1">RN Registered nurse</FP>
                        <FP SOURCE="FP-1">RT Respiratory therapist</FP>
                        <FP SOURCE="FP-1">RUC [AMA's Specialty Society] Relative (Value) Update Committee</FP>
                        <FP SOURCE="FP-1">RVU Relative value unit</FP>
                        <FP SOURCE="FP-1">SBA Small Business Administration</FP>
                        <FP SOURCE="FP-1">SGR Sustainable growth rate</FP>
                        <FP SOURCE="FP-1">SLP Speech—language pathology</FP>
                        <FP SOURCE="FP-1">SLPs Speech—language pathologists</FP>
                        <FP SOURCE="FP-1">SMS [AMA's] Socioeconomic Monitoring System</FP>
                        <FP SOURCE="FP-1">SNF Skilled nursing facility</FP>
                        <FP SOURCE="FP-1">STS Society of Thoracic Surgeons</FP>
                        <FP SOURCE="FP-1">TA Technology Assessment</FP>
                        <FP SOURCE="FP-1">TC Technical Component</FP>
                        <FP SOURCE="FP-1">TENS Transcutaneous electric nerve stimulator</FP>
                        <FP SOURCE="FP-1">TRHCA Tax Relief and Health Care Act of 2006 (Pub. L. 109-432)</FP>
                        <FP SOURCE="FP-1">USP-DI United States Pharmacopoeia-Drug Information</FP>
                        <FP SOURCE="FP-1">WAC Wholesale acquisition cost</FP>
                        <FP SOURCE="FP-1">WAMP Widely available market price</FP>
                        <FP SOURCE="FP-1">Wet AMD Exudative age-related macular degeneration</FP>
                        <FP SOURCE="FP-1">WFOT World Federation of Occupational Therapists</FP>
                    </EXTRACT>
                    <HD SOURCE="HD1">I. Background</HD>
                    <P>Since January 1, 1992, Medicare has paid for physicians' services under section 1848 of the Social Security Act (the Act), “Payment for Physicians’ Services.” The Act requires that payments under the physician fee schedule (PFS) 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. Before the establishment of the resource-based relative value system, Medicare payment for physicians’ services was based on reasonable charges.</P>
                    <HD SOURCE="HD2">A. Development of the Relative Value System</HD>
                    <HD SOURCE="HD3">1. Work RVUs</HD>
                    <P>The concepts and methodology underlying the PFS were enacted as part of the Omnibus Budget Reconciliation Act (OBRA) of 1989, Pub. L. 101-239, and OBRA 1990, (Pub. L. 101-508). The final rule, published November 25, 1991 (56 FR 59502), set forth the fee schedule for payment for physicians’ services beginning January 1, 1992. Initially, only the physician work RVUs were resource-based, and the PE and malpractice RVUs were based on average allowable charges.</P>
                    <P>The physician work RVUs established for the implementation of the fee schedule in January 1992 were developed with extensive input from the physician community. A research team at the Harvard School of Public Health developed the original physician work RVUs for most codes in a cooperative agreement with the Department of Health and Human Services (HHS). In constructing the code-specific vignettes for the original physician work RVUs, Harvard worked with panels of experts, both inside and outside the Federal government, and obtained input from numerous physician specialty groups.</P>
                    <P>Section 1848(b)(2)(B) of the Act specifies that the RVUs for anesthesia services are based on RVUs from a uniform relative value guide. We established a separate conversion factor (CF) for anesthesia services, and we continue to utilize time units as a factor in determining payment for these services. As a result, there is a separate formula used to calculate payment for anesthesia services.</P>
                    <P>
                        We establish physician work RVUs for new and revised codes based on recommendations received from the American Medical Association's (AMA) Specialty Society Relative Value Update Committee (RUC).
                        <PRTPAGE P="66226"/>
                    </P>
                    <HD SOURCE="HD3">2. Practice Expense Relative Value Units (PE RVUs)</HD>
                    <P>Section 121 of the Social Security Act Amendments of 1994 (Pub. L. 103-32), enacted on October 31, 1994, amended section 1848(c)(2)(C)(ii) of the Act and required us to develop resource-based PE RVUs for each physician's service beginning in 1998. We were to consider general categories of expenses (such as office rent and wages of personnel, but excluding malpractice expenses) comprising PEs.</P>
                    <P>Section 4505(a) of the Balanced Budget Act of 1997 (BBA) (Pub. L. 105 33), amended section 1848(c)(2)(C)(ii) of the Act to delay implementation of the resource based PE RVU system until January 1, 1999. In addition, section 4505(b) of the BBA provided for a 4-year transition period from charge based PE RVUs to resource-based RVUs.</P>
                    <P>We established the resource based PE RVUs for each physician's service in a final rule, published November 2, 1998 (63 FR 58814), effective for services furnished in 1999. Based on the requirement to transition to a resource based system for PE over a 4-year period, resource-based PE RVUs did not become fully effective until 2002.</P>
                    <P>This resource-based system was based on two significant sources of actual PE data: The Clinical Practice Expert Panel (CPEP) data and the AMA's Socioeconomic Monitoring System (SMS) data. The CPEP data were collected from panels of physicians, practice administrators, and nonphysicians (for example, registered nurses (RNs)) nominated by physician specialty societies and other groups. The CPEP panels identified the direct inputs required for each physician's service in both the office setting and out-of-office setting. We have since refined and revised these inputs based on recommendations from the RUC. The AMA's SMS data provided aggregate specialty-specific information on hours worked and PEs.</P>
                    <P>Separate PE RVUs are established for procedures that can be performed in both a nonfacility setting, such as a physician's office, and a facility setting, such as a hospital outpatient department. The difference between the facility and nonfacility RVUs reflects the fact that a facility typically receives separate payment from Medicare for its costs of providing the service, apart from payment under the PFS. The nonfacility RVUs reflect all of the direct and indirect PEs of providing a particular service.</P>
                    <P>
                        Section 212 of the Balanced Budget Refinement Act of 1999 (BBRA) (Pub. L. 106-113) directed the Secretary of Health and Human Services (the Secretary) to establish a process under which we accept and use, to the maximum extent practicable and consistent with sound data practices, data collected or developed by entities and organizations to supplement the data we normally collect in determining the PE component. On May 3, 2000, we published the interim final rule (65 FR 25664) that set forth the criteria for the submission of these supplemental PE survey data. The criteria were modified in response to comments received, and published in the 
                        <E T="04">Federal Register</E>
                         (65 FR 65376) as part of a November 1, 2000 final rule. The PFS final rules published in 2001 and 2003, respectively, (66 FR 55246 and 68 FR 63196) extended the period during which we would accept these supplemental data through March 1, 2005.
                    </P>
                    <P>In the CY 2007 PFS final rule with comment period (71 FR 69624), we revised the methodology for calculating PE RVUs beginning in CY 2007 and provided for a 4-year transition for the new PE RVUs under this new methodology. We will continue to reexamine this policy and proposed necessary revisions through future rulemaking.</P>
                    <HD SOURCE="HD3">3. Resource-Based Malpractice (MP) RVUs</HD>
                    <P>Section 4505(f) of the BBA amended section 1848(c) of the Act to require us to implement resource-based malpractice (MP) RVUs for services furnished on or after 2000. The resource-based MP RVUs were implemented in the PFS final rule published November 2, 1999 (64 FR 59380). The MP RVUs were based on malpractice insurance premium data collected from commercial and physician-owned insurers from all the States, the District of Columbia, and Puerto Rico.</P>
                    <HD SOURCE="HD3">4. Refinements to the RVUs</HD>
                    <P>Section 1848(c)(2)(B)(i) of the Act requires that we review RVUs no less often than every 5 years. The first 5-Year Review of the physician work RVUs was effective in 1997, published on November 22, 1996 (61 FR 59489). The second 5-Year Review went into effect in 2002, published in the CY 2002 PFS final rule (66 FR 55246). The third 5-Year Review of physician work RVUs went into effect on January 1, 2007 and was published in the CY 2007 PFS final rule with comment period (71 FR 69624) (although we note that certain additional proposals relating to the third 5-Year Review are addressed in the CY 2008 PFS proposed rule and in this final rule with comment period).</P>
                    <P>In 1999, the AMA's RUC established the Practice Expense Advisory Committee (PEAC) for the purpose of refining the direct PE inputs. Through March 2004, the PEAC provided recommendations to CMS for over 7,600 codes (all but a few hundred of the codes currently listed in the AMA's Current Procedural Terminology (CPT) codes). As part of the CY 2007 PFS final rule with comment period (71 FR 69624), we implemented a new methodology for determining resource-based PE RVUs and are transitioning this over a 4-year period.</P>
                    <P>In the CY 2005 PFS final rule with comment period (69 FR 66236), we implemented the first 5-Year Review of the malpractice RVUs (69 FR 66263).</P>
                    <HD SOURCE="HD3">5. Adjustments to RVUs are Budget Neutral</HD>
                    <P>Section 1848(c)(2)(B)(ii)(II) of the Act provides that adjustments in RVUs for a year 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. In accordance with section 1848(c)(2)(B)(ii)(II) of the Act, if adjustments to RVUs cause expenditures to change by more than $20 million, we make adjustments to ensure that expenditures do not increase or decrease by more than $20 million.</P>
                    <P>As explained in the CY 2007 PFS final rule with comment period (71 FR 69624), due to the increase in work RVUs resulting from the third 5-Year Review of physician work RVUs, we are applying a separate budget neutrality (BN) adjustor to the work RVUs for services furnished during 2007. This approach is consistent with the method we use to make BN adjustments to the PE RVUs to reflect the changes in these PE RVUs.</P>
                    <HD SOURCE="HD2">B. Components of the Fee Schedule Payment Amounts</HD>
                    <P>To calculate the payment for every physician service, the components of the fee schedule (physician work, PE, and MP RVUs) are adjusted by a geographic practice cost index (GPCI). The GPCIs reflect the relative costs of physician work, PE, and malpractice insurance in an area compared to the national average costs for each component.</P>
                    <P>Payments are converted to dollar amounts through the application of a CF, which is calculated by the Office of the Actuary (OACT) and is updated annually for inflation.</P>
                    <P>
                        The formula for calculating the Medicare fee schedule amount for a given service and fee schedule area can be expressed as:
                        <PRTPAGE P="66227"/>
                    </P>
                    <P>
                        <E T="03">Payment = [(RVU work × budget neutrality adjuster × work GPCI) + (RVU PE × PE GPCI) + (MP RVU × MP GPCI)] × CF.</E>
                    </P>
                    <HD SOURCE="HD2">C. Most Recent Changes to the Fee Schedule</HD>
                    <P>The CY 2007 PFS final rule with comment period (71 FR 69624) addressed certain provisions of the Deficit Reduction Act of 2005 (Pub. L. 109-432) (DRA) and made other changes to Medicare Part B payment policy to ensure that our payment systems are updated to reflect changes in medical practice and the relative value of services. This final rule with comment period also discussed GPCI changes; requests for additions to the list of telehealth services; payment for covered outpatient drugs and biologicals; payment for renal dialysis services; policies related to private contracts and opt-out; policies related to bone mass measurement (BMM) services, independent diagnostic testing facilities (IDTFs), the physician self-referral prohibition; laboratory billing for the technical component (TC) of physician pathology services; the clinical laboratory fee schedule; certification of advanced practice nurses; health information technology, the health care information transparency initiative; updated the list of certain services subject to the physician self-referral prohibitions, finalized ASP reporting requirements, and codified Medicare's longstanding policy that payment of bad debts associated with services paid under a fee schedule/charge-based system is not allowable.</P>
                    <P>We also finalized the CY 2006 interim RVUs and issued interim RVUs for new and revised procedure codes for CY 2007.</P>
                    <P>In addition, the CY 2007 PFS final rule with comment period included revisions to payment policies under the fee schedule for ambulance services and announced the ambulance inflation factor (AIF) update for CY 2007.</P>
                    <P>In accordance with section 1848(d)(1)(E)(i) of the Act, we also announced that the PFS update for CY 2007 is −5.0 percent, the initial estimate for the sustainable growth rate (SGR) for CY 2007 is 1.8 percent and the CF for CY 2007 is $35.9848. However, subsequent to publication of the CY 2007 PFS final rule with comment period, section 101(a) of Division B, Title I of the Tax Relief and Health Care Act of 2006 (Pub. L. 109-432) (MIEA-TRHCA), which was enacted on December 20, 2006, amended section 1848(d) of the Act. [Division B of the Tax Relief and Health Care Act of 2006 is entitled Medicare and Other Health Provisions and its short title is the Medicare Improvements and Extension Act of 2006. Therefore, the law is hereinafter referred to as “MIEA-TRHCA”.] As a result of this statutory change, the CF of $37.8975 was maintained for CY 2007.</P>
                    <HD SOURCE="HD1">II. Provisions of the Final Rule Related to the Physician Fee Schedule</HD>
                    <P>In response to the CY 2008 PFS proposed rule (72 FR 38122), we received approximately 27,000 comments. We received comments from individual physicians, health care workers, professional associations and societies, and beneficiaries. The majority of the comments addressed the proposals related to anesthesia coding and the 5-Year Review, the physician self-referral provisions and the technical correction to § 410.32(a)(1) concerning an exception to the requirement that diagnostic services (including x-rays) must be ordered by the treating physician. To the extent that comments were outside the scope of the proposed rule, they are not addressed in this final rule with comment period.</P>
                    <P>RVU changes implemented through this final rule with comment are subject to the $20 million limitation on annual adjustments contained in section 1848(c)(2)(B)(ii)(II) of the Act. After reviewing the comments and determining the policies we would implement, we have estimated the costs and savings of these policies and discuss in detail the effects of these changes in the Regulatory Impact Analysis in section XIV. For the convenience of the reader, the headings for the policy issues correspond to the headings used in the CY 2008 PFS proposed rule (72 FR 38122). More detailed background information for each issue can be found in the CY 2008 PFS proposed rule.</P>
                    <HD SOURCE="HD2">A. Resource Based Practice Expense (PE) Relative Value Units (RVUs)</HD>
                    <P>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 personnel wages but excluding malpractice expenses, as specified in section 1848(c)(1)(B) of the Act.</P>
                    <P>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, PE RVUs were based on historical allowed charges. This legislation required 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 furnishing the service.</P>
                    <P>The initial implementation of resource-based PE RVUs was delayed from January 1, 1998, until January 1, 1999, by section 4505(a) of the BBA. In addition, section 4505(b) of the BBA 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 the BBA required that, in developing the resource-based PE RVUs, the Secretary must:</P>
                    <P>• 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 and actual data on equipment utilization.</P>
                    <P>• Develop a refinement method to be used during the transition.</P>
                    <P>• Consider, in the course of notice and comment rulemaking, impact projections that compare new proposed payment amounts to data on actual physician PE.</P>
                    <P>In CY 1999, we began the 4-year transition to resource-based PE RVUs utilizing a “top-down” methodology whereby we allocated aggregate specialty-specific practice costs to individual procedures. The specialty-specific PEs were derived from the American Medical Association's (AMA's) Socioeconomic Monitoring Survey (SMS). In addition, under section 212 of the BBRA, we established a process extending through March 2005 to supplement the SMS data with data submitted by a specialty. The aggregate PEs for a given specialty were then allocated to the services furnished by that specialty on the basis of the direct input data (that is, the staff time, equipment, and supplies) and work RVUs assigned to each CPT code.</P>
                    <P>
                        For CY 2007, we implemented a new methodology for calculating PE RVUs. Under this new methodology, we use the same data sources for calculating PE, but instead of using the “top-down” approach to calculate the direct PE RVUs, under which the aggregate direct and indirect costs for each specialty are allocated to each individual service, we now utilize a “bottom-up” approach to 
                        <PRTPAGE P="66228"/>
                        calculate the direct costs. Under the “bottom-up” approach, we determine the direct PE by adding the costs of the resources (that is, the clinical staff, equipment, and supplies) typically required to furnish each service. The costs of the resources are calculated using the refined direct PE inputs assigned to each CPT code in our PE database, which are based on our review of recommendations received from the AMA's Relative Value Update Committee (RUC). For a more detailed explanation of the PE methodology see the Five-Year Review of Work RVUs Under the PFS and Proposed Changes to the PE Methodology proposed notice (71 FR 37242) and the CY 2007 PFS final rule with comment period (71 FR 69629).
                    </P>
                    <HD SOURCE="HD3">1. Current Methodology </HD>
                    <HD SOURCE="HD3">a. Data Sources for Calculating Practice Expense</HD>
                    <P>The AMA's SMS survey data and supplemental survey data from the specialties of cardio-thoracic surgery, vascular surgery, physical and occupational therapy, independent laboratories, allergy/immunology, cardiology, dermatology, gastroenterology, radiology, independent diagnostic testing facilities (IDTFs), radiation oncology, and urology are used to develop the PE per hour (PE/HR) for each specialty. For those specialties for which we do not have PE/HR, the appropriate PE/HR is obtained from a crosswalk to a similar specialty.</P>
                    <P>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 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 (66 FR 55246, November 1, 2002) (hereinafter referred to as CY 2002 PFS final rule).) The SMS PE survey data are adjusted to a common year, 2005. The SMS data provide the following six categories of PE costs:</P>
                    <P>• Clinical payroll expenses, which are payroll expenses (including fringe benefits) for nonphysician clinical personnel.</P>
                    <P>• Administrative payroll expenses, which are payroll expenses (including fringe benefits) for nonphysician personnel involved in administrative, secretarial or clerical activities.</P>
                    <P>• Office expenses, which include expenses for rent, mortgage interest, depreciation on medical buildings, utilities and telephones.</P>
                    <P>• Medical material and supply expenses, which include expenses for drugs, x-ray films, and disposable medical products.</P>
                    <P>• Medical equipment expenses, which include expenses depreciation, leases, and rent of medical equipment used in the diagnosis or treatment of patients.</P>
                    <P>• All other expenses, which include expenses for legal services, accounting, office management, professional association memberships, and any professional expenses not previously mentioned in this section.</P>
                    <P>In accordance with section 212 of the BBRA, 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, (65 FR 25664, May 3, 2000).) Originally, the deadline to submit supplementary survey data was through August 1, 2001. In the CY 2002 PFS final rule (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).</P>
                    <P>The direct cost data for individual services were originally developed by the Clinical Practice Expert Panels (CPEP). The CPEP data include the supplies, equipment, and staff times specific to each procedure. The CPEPs consisted of panels of physicians, practice administrators, and nonphysicians (for example, RNs) 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.</P>
                    <P>The CPEPs identified specific inputs involved in each physician's service provided in an office or facility setting. The inputs identified were the quantity and type of nonphysician labor, medical supplies, and medical equipment.</P>
                    <P>In 1999, the AMA's RUC established the Practice Expense Advisory Committee (PEAC). From 1999 to 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 for over 7,600 codes which we have reviewed and accepted. As a result, the current PE 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. </P>
                    <HD SOURCE="HD3">b. Allocation of PE to Services</HD>
                    <P>The aggregate level specialty-specific PEs are derived from the AMA's SMS survey and supplementary survey data. To establish PE RVUs for specific services, it is necessary to establish the direct and indirect PE associated with each service.</P>
                    <P>
                        (i) 
                        <E T="03">Direct costs.</E>
                         The direct costs are 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 these resources are calculated from the refined direct PE inputs in our PE database. These direct inputs are then scaled to the current aggregate pool of direct PE RVUs. The aggregate pool of direct PE RVUs can be derived using the following formula: (PE RVUs * physician CF) * (average direct percentage from SMS/(Supplemental PE/HR data)).
                    </P>
                    <P>
                        (ii) 
                        <E T="03">Indirect costs.</E>
                         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 the code level on the basis of the direct costs specifically associated with a code and the maximum of either the clinical labor costs or the physician work RVUs. For calculation of the 2008 PE RVUs, we are using the 2006 procedure-specific utilization data crosswalked to 2007 services. To arrive at the indirect PE costs:
                    </P>
                    <P>
                        • We apply a specialty-specific indirect percentage factor to the direct expenses to recognize the varying proportion that indirect costs represent of total costs by specialty. For a given service, the specific indirect percentage factor to apply to the direct costs for the purpose of the indirect allocation is calculated as the weighted average of the ratio of the indirect to direct costs (based on the survey data) for the specialties that furnish the service. For example, if a service is furnished 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 
                        <PRTPAGE P="66229"/>
                        allocation would be (0.75/0.25) = 3.0. The indirect percentage factor is then applied to the service level adjusted indirect PE allocators.
                    </P>
                    <P>
                        • We use the specialty-specific PE/HR from the SMS survey data, as well as the supplemental surveys for cardio-thoracic surgery, vascular surgery, physical and occupational therapy, independent laboratories, allergy/immunology, cardiology, dermatology, radiology, gastroenterology, IDTFs, radiation oncology and urology. (
                        <E T="04">Note:</E>
                         For radiation oncology, the data represent the combined survey data from the American Society for Therapeutic Radiology and Oncology (ASTRO) and the Association of Freestanding Radiation Oncology Centers (AFROC).) We incorporate this PE/HR into the calculation of indirect costs using an index which reflects 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.
                    </P>
                    <P>• When the clinical labor portion of the direct PE RVU is greater than the physician work RVU for a particular service, the indirect costs are allocated based upon the direct costs and the clinical labor costs. For example, if a service has no physician work and 1.10 direct PE RVUs, and the clinical labor portion of the direct PE RVUs is 0.65 RVUs, we would use the 1.10 direct PE RVUs and the 0.65 clinical labor portions of the direct PE RVUs to allocate the indirect PE for that service.</P>
                    <HD SOURCE="HD3">c. Facility/Nonfacility Costs</HD>
                    <P>Procedures that can be furnished in a physician's office, as well as in a hospital or facility setting, have two PE RVUs: facility and nonfacility. The nonfacility 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 PE RVUs is the same for both, facility and nonfacility 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 PFS), the PE RVUs are generally lower for services provided in the facility setting. </P>
                    <HD SOURCE="HD3">d. Services With Technical Components (TCs) and Professional Components (PCs)</HD>
                    <P>Diagnostic services are generally comprised of two components; a professional component (PC) and a technical component (TC), which may be furnished independently or by different providers. When services have TC, PC, and global components that can be billed separately, the payment for the global component equals the sum of the payment for the TC and PCs. This is a result of using a weighted average of the ratio of indirect to direct costs across all the specialties that furnish the global components, TCs, and PCs; that is, we apply the same weighted average indirect percentage factor to allocate indirect expenses to the global components, PC, and TCs for a service. (The direct PE RVUs for the TC and PCs sum to the global under the bottom-up methodology.) </P>
                    <HD SOURCE="HD3">e. Transition Period</HD>
                    <P>As discussed in the CY 2007 PFS final rule with comment period (71 FR 69674), we are implementing the change in the methodology for calculating PE RVUs over a 4-year period. During this transition period, the PE RVUs will be calculated on the basis of a blend of RVUs calculated using our methodology described previously in this section (weighted by 25 percent during CY 2007, 50 percent during CY 2008, 75 percent during CY 2009, and 100 percent thereinafter), and the CY 2006 PE RVUs for each existing code. PE RVUs for codes that are new during this period will be calculated using only the current PE methodology, and will be paid at the fully transitioned rate. </P>
                    <HD SOURCE="HD3">f. PE RVU Methodology</HD>
                    <P>The following is a description of the PE RVU methodology.</P>
                    <HD SOURCE="HD3">(i) Setup File</HD>
                    <P>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.</P>
                    <HD SOURCE="HD3">(ii) Calculate the Direct Cost PE RVUs</HD>
                    <HD SOURCE="HD2">Sum the Costs of Each Direct Input</HD>
                    <P>
                        <E T="03">Step 1:</E>
                         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.
                    </P>
                    <HD SOURCE="HD2">Apply a BN Adjustment to the Direct Inputs</HD>
                    <P>
                        <E T="03">Step 2:</E>
                         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.
                    </P>
                    <P>
                        <E T="03">Step 3:</E>
                         Calculate the aggregate pool of 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.
                    </P>
                    <P>
                        <E T="03">Step 4:</E>
                         Using the results of Step 2 and Step 3 calculate a direct PE BN 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.
                    </P>
                    <P>
                        <E T="03">Step 5:</E>
                         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.
                    </P>
                    <HD SOURCE="HD3">(iii) Create the Indirect PE RVUs</HD>
                    <HD SOURCE="HD2">Create Indirect Allocators</HD>
                    <P>
                        <E T="03">Step 6:</E>
                         Based on the SMS and supplementary specialty survey data, calculate direct and indirect PE percentages for each physician specialty.
                    </P>
                    <P>
                        <E T="03">Step 7:</E>
                         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 furnish the service. Note that for services with a TC and PCs we are calculating the direct and indirect percentages across the global components, PCs and TCs. That is, the direct and indirect percentages for a given service (for example, echocardiogram) do not vary by the PC, TC and global component.
                    </P>
                    <P>
                        <E T="03">Step 8:</E>
                         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 
                        <PRTPAGE P="66230"/>
                        RVU, the clinical PE RVU and the work RVU.
                    </P>
                    <P>
                        For most services the indirect allocator is: 
                        <E T="03">indirect percentage * (direct PE RVU/direct percentage) + work RVU.</E>
                    </P>
                    <P>There are two situations where this formula is modified:</P>
                    <P>
                        • If the service is a global service (that is, a service with global, professional and technical components), then the indirect allocator is: 
                        <E T="03">indirect percentage * (direct PERVU/direct percentage) + clinical PE RVU + work RVU.</E>
                    </P>
                    <P>
                        • If the clinical labor PE RVU exceeds the work RVU (and the service is not a global service), then the indirect allocator is: 
                        <E T="03">indirect percentage * (direct PERVU/direct percentage) + clinical PE RVU.</E>
                    </P>
                    <P>(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 TC 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 PC and TC RVUs.)</P>
                    <P>
                        For presentation purposes in the examples in Table 1, the formulas were divided into two parts for each service. The first part does not vary by service and is 
                        <E T="03">the indirect percentage * (direct PE RVU/direct percentage).</E>
                         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 exceeds the work RVU (as described earlier in this step.)
                    </P>
                    <HD SOURCE="HD2">Apply a BN Adjustment to the Indirect Allocators</HD>
                    <P>
                        <E T="03">Step 9:</E>
                         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.
                    </P>
                    <P>
                        <E T="03">Step 10:</E>
                         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.
                    </P>
                    <P>
                        <E T="03">Step 11:</E>
                         Using the results of Step 9 and Step 10, calculate an indirect PE adjustment so that the 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.
                    </P>
                    <HD SOURCE="HD2">Calculate the Indirect Practice Cost Index</HD>
                    <P>
                        <E T="03">Step 12:</E>
                         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.
                    </P>
                    <P>
                        <E T="03">Step 13:</E>
                         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.
                    </P>
                    <P>
                        <E T="03">Step 14:</E>
                         Using the results of Step 12 and Step 13, calculate the specialty-specific indirect PE scaling factors as under the current methodology.
                    </P>
                    <P>
                        <E T="03">Step 15:</E>
                         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.
                    </P>
                    <P>
                        <E T="03">Step 16:</E>
                         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 furnish the service. Note: For services with TC and PCs, we calculate the indirect practice cost index across the global components, PCs and TCs. Under this method, the indirect practice cost index for a given service (for example, echocardiogram) does not vary by the PC, TC and global components.
                    </P>
                    <P>
                        <E T="03">Step 17:</E>
                         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.
                    </P>
                    <HD SOURCE="HD3">(iv) Calculate the Final PE RVUs</HD>
                    <P>
                        <E T="03">Step 18:</E>
                         Add the direct PE RVUs from Step 6 to the indirect PE RVUs from Step 17.
                    </P>
                    <P>
                        <E T="03">Step 19:</E>
                         Calculate and apply the final PE BN adjustment by comparing the results of Step 18 to the current pool of PE RVUs. This final BN adjustment is required primarily because certain specialties are excluded from the PE RVU calculation for rate-setting purposes, but all specialties are included for purposes of calculating the final BN adjustment. (See “Specialties excluded from rate-setting calculation” below in this section.)
                    </P>
                    <HD SOURCE="HD3">(v) Setup File Information</HD>
                    <P>
                        • 
                        <E T="03">Specialties excluded from rate-setting calculation:</E>
                         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. These specialties 
                        <E T="03">are</E>
                         included for the purposes of calculating the BN adjustment.
                    </P>
                    <P>
                        • 
                        <E T="03">Crosswalk certain low volume physician specialties:</E>
                         Crosswalk the utilization of certain specialties with relatively low PFS utilization to the associated specialties.
                    </P>
                    <P>
                        • 
                        <E T="03">Physical therapy utilization:</E>
                         Crosswalk the utilization associated with all physical therapy services to the specialty of physical therapy.
                    </P>
                    <P>
                        • 
                        <E T="03">Identify professional and technical services not identified under the usual TC and 26 modifier:</E>
                         Flag the services that are PC and TC services, but do not use TC and 26 modifiers (for example, electrocardiograms). This flag associates the PC and TC 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.
                    </P>
                    <P>
                        • 
                        <E T="03">Payment modifiers:</E>
                         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.
                    </P>
                    <P>
                        • 
                        <E T="03">Work RVUs:</E>
                         The setup file contains the work RVUs from this final rule with comment period.
                    </P>
                    <HD SOURCE="HD3">(vi) Equipment Cost Per Minute =</HD>
                    <P>The equipment cost per minute is calculated as:</P>
                    <P>
                        <E T="03">(1/(minutes per year * usage)) * price * ((interest rate/(1−(1/((1 + interest rate) * life of equipment)))) + maintenance)</E>
                          
                    </P>
                    <FP SOURCE="FP-2">Where: </FP>
                    <FP SOURCE="FP-2">
                        <E T="03">minutes per year</E>
                         = maximum minutes per year if usage were continuous (that is, usage = 1); 150,000 minutes. 
                    </FP>
                    <FP SOURCE="FP-2">
                        <E T="03">usage</E>
                         = equipment utilization assumption; 0.5. 
                    </FP>
                    <FP SOURCE="FP-2">
                        <E T="03">price</E>
                         = price of the particular piece of equipment. 
                    </FP>
                    <FP SOURCE="FP-2">
                        <E T="03">interest rate</E>
                         = 0.11. 
                    </FP>
                    <FP SOURCE="FP-2">
                        <E T="03">life of equipment</E>
                         = useful life of the particular piece of equipment. 
                    </FP>
                    <FP SOURCE="FP-2">
                        <E T="03">maintenance</E>
                         = factor for maintenance; 0.05.
                        <PRTPAGE P="66231"/>
                    </FP>
                    <GPOTABLE COLS="12" OPTS="L2,p7,7/8,i1" CDEF="s50,r50,r50,r50,9,9,9,9,9,9,9,9">
                        <TTITLE>Table 1.—Calculation of PE RVUs Under Methodology for Selected Codes </TTITLE>
                        <BOXHD>
                            <CHED H="1">  </CHED>
                            <CHED H="1">Step </CHED>
                            <CHED H="1">Source </CHED>
                            <CHED H="1">Formula </CHED>
                            <CHED H="1">99213 </CHED>
                            <CHED H="2">Office visit, est nonfacility </CHED>
                            <CHED H="1">33533 </CHED>
                            <CHED H="2">CABG, arterial, single facility </CHED>
                            <CHED H="1">71020 </CHED>
                            <CHED H="2">Chest x-ray nonfacility </CHED>
                            <CHED H="1">71020TC </CHED>
                            <CHED H="2">Chest x-ray nonfacility </CHED>
                            <CHED H="1">7102026 </CHED>
                            <CHED H="2">Chest x-ray nonfacility </CHED>
                            <CHED H="1">93000 </CHED>
                            <CHED H="2">ECG, complete nonfacility </CHED>
                            <CHED H="1">93005 </CHED>
                            <CHED H="2">ECG, tracing nonfacility </CHED>
                            <CHED H="1">93010 </CHED>
                            <CHED H="2">ECG, report nonfacility </CHED>
                        </BOXHD>
                        <ROW>
                            <ENT I="01">(1) Labor cost (Lab) </ENT>
                            <ENT>Step 1 </ENT>
                            <ENT>AMA </ENT>
                            <ENT/>
                            <ENT>$13.32 </ENT>
                            <ENT>$77.52 </ENT>
                            <ENT>$5.74 </ENT>
                            <ENT>$5.74 </ENT>
                            <ENT>$     </ENT>
                            <ENT>$6.12 </ENT>
                            <ENT>$6.12 </ENT>
                            <ENT>$     </ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">(2) Supply cost (Sup) </ENT>
                            <ENT>Step 1 </ENT>
                            <ENT>AMA </ENT>
                            <ENT/>
                            <ENT>$2.98 </ENT>
                            <ENT>$7.34 </ENT>
                            <ENT>$3.39 </ENT>
                            <ENT>$3.39 </ENT>
                            <ENT>$     </ENT>
                            <ENT>$1.19 </ENT>
                            <ENT>$1.19 </ENT>
                            <ENT>$     </ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">(3) Equipment cost (Eqp) </ENT>
                            <ENT>Step 1 </ENT>
                            <ENT>AMA </ENT>
                            <ENT/>
                            <ENT>$0.19 </ENT>
                            <ENT>$0.65 </ENT>
                            <ENT>$8.17 </ENT>
                            <ENT>$8.17 </ENT>
                            <ENT>$     </ENT>
                            <ENT>$0.12 </ENT>
                            <ENT>$0.12 </ENT>
                            <ENT>$     </ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">(4) Direct cost (Dir) </ENT>
                            <ENT>Step 1 </ENT>
                            <ENT/>
                            <ENT>=(1)+(2)+(3) </ENT>
                            <ENT>$16.50 </ENT>
                            <ENT>$85.51 </ENT>
                            <ENT>$17.31 </ENT>
                            <ENT>$17.31 </ENT>
                            <ENT>$     </ENT>
                            <ENT>$7.43 </ENT>
                            <ENT>$7.60 </ENT>
                            <ENT>$     </ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">(5) Direct adjustment (Dir Adj) </ENT>
                            <ENT>Steps 2-4 </ENT>
                            <ENT>
                                See footnote 
                                <SU>1</SU>
                            </ENT>
                            <ENT/>
                            <ENT>0.592 </ENT>
                            <ENT>0.592 </ENT>
                            <ENT>0.592 </ENT>
                            <ENT>0.592 </ENT>
                            <ENT>0.592 </ENT>
                            <ENT>0.592 </ENT>
                            <ENT>0.592 </ENT>
                            <ENT>0.592 </ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">(6) Adjusted labor </ENT>
                            <ENT>Steps 2-4 </ENT>
                            <ENT>=Lab * Dir Adj </ENT>
                            <ENT>=(1) * (5) </ENT>
                            <ENT>$7.89 </ENT>
                            <ENT>$45.89 </ENT>
                            <ENT>$3.40 </ENT>
                            <ENT>$3.40 </ENT>
                            <ENT>$     </ENT>
                            <ENT>$3.62 </ENT>
                            <ENT>$3.62 </ENT>
                            <ENT>$     </ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">(7) Adjusted supplies </ENT>
                            <ENT>Steps 2-4 </ENT>
                            <ENT>=Sup * Dir Adj </ENT>
                            <ENT>=(2) * (5) </ENT>
                            <ENT>$1.77 </ENT>
                            <ENT>$4.35 </ENT>
                            <ENT>$2.01 </ENT>
                            <ENT>$2.01 </ENT>
                            <ENT>$     </ENT>
                            <ENT>$0.71 </ENT>
                            <ENT>$0.71 </ENT>
                            <ENT>$     </ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">(8) Adjusted equipment </ENT>
                            <ENT>Steps 2-4 </ENT>
                            <ENT>=Eqp *Dir Adj </ENT>
                            <ENT>=(3) * (5) </ENT>
                            <ENT>$0.12 </ENT>
                            <ENT>$0.39 </ENT>
                            <ENT>$4.84 </ENT>
                            <ENT>$4.84 </ENT>
                            <ENT>$     </ENT>
                            <ENT>$0.07 </ENT>
                            <ENT>$0.07 </ENT>
                            <ENT>$     </ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">(9) Adjusted direct </ENT>
                            <ENT>Steps 2-4 </ENT>
                            <ENT/>
                            <ENT>=(6)+(7)+(8) </ENT>
                            <ENT>$9.77 </ENT>
                            <ENT>$50.62 </ENT>
                            <ENT>$10.25 </ENT>
                            <ENT>$10.25 </ENT>
                            <ENT>$     </ENT>
                            <ENT>$4.40 </ENT>
                            <ENT>$4.40 </ENT>
                            <ENT>$     </ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">(10) Conversion Factor (CF) </ENT>
                            <ENT>Step 5 </ENT>
                            <ENT>MFS </ENT>
                            <ENT/>
                            <ENT>$34.0682 </ENT>
                            <ENT>$34.0682 </ENT>
                            <ENT>$34.0682 </ENT>
                            <ENT>$34.0682 </ENT>
                            <ENT>$34.0682 </ENT>
                            <ENT>$34.0682 </ENT>
                            <ENT>$34.0682 </ENT>
                            <ENT>$34.0682 </ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">(11) Adj. labor cost converted </ENT>
                            <ENT>Step 5 </ENT>
                            <ENT>=(Lab * Dir Adj)/CF </ENT>
                            <ENT>=(6)/(10) </ENT>
                            <ENT>0.23 </ENT>
                            <ENT>1.35 </ENT>
                            <ENT>0.10 </ENT>
                            <ENT>0.10 </ENT>
                            <ENT/>
                            <ENT>0.11 </ENT>
                            <ENT>0.11 </ENT>
                            <ENT/>
                        </ROW>
                        <ROW>
                            <ENT I="01">(12) Adj. supply cost converted </ENT>
                            <ENT>Step 5 </ENT>
                            <ENT>=(Sup * Dir Adj)/CF </ENT>
                            <ENT>=(7)/(10) </ENT>
                            <ENT>0.05 </ENT>
                            <ENT>0.13 </ENT>
                            <ENT>0.06 </ENT>
                            <ENT>0.06 </ENT>
                            <ENT/>
                            <ENT>0.02 </ENT>
                            <ENT>0.02 </ENT>
                            <ENT/>
                        </ROW>
                        <ROW>
                            <ENT I="01">(13) Adj. equip cost converted </ENT>
                            <ENT>Step 5 </ENT>
                            <ENT>=(Eqp * Dir Adj)/CF </ENT>
                            <ENT>=(8)/(10) </ENT>
                            <ENT>0.00 </ENT>
                            <ENT>0.01 </ENT>
                            <ENT>0.14 </ENT>
                            <ENT>0.14 </ENT>
                            <ENT/>
                            <ENT>0.00 </ENT>
                            <ENT>0.00 </ENT>
                            <ENT/>
                        </ROW>
                        <ROW>
                            <ENT I="01">(14) Adj. direct cost converted </ENT>
                            <ENT>Step 5 </ENT>
                            <ENT/>
                            <ENT>=(11)+(12)+(13) </ENT>
                            <ENT>0.29 </ENT>
                            <ENT>1.49 </ENT>
                            <ENT>0.30 </ENT>
                            <ENT>0.30 </ENT>
                            <ENT/>
                            <ENT>0.13 </ENT>
                            <ENT>0.13 </ENT>
                            <ENT/>
                        </ROW>
                        <ROW>
                            <ENT I="01">(15) Wrk RVU * Wrk Scaler </ENT>
                            <ENT>Setup File </ENT>
                            <ENT>MFS </ENT>
                            <ENT>0.8806 </ENT>
                            <ENT>0.81 </ENT>
                            <ENT>29.62 </ENT>
                            <ENT>0.19 </ENT>
                            <ENT>0.00− </ENT>
                            <ENT>0.19 </ENT>
                            <ENT>0.15 </ENT>
                            <ENT>0.00 </ENT>
                            <ENT>0.15 </ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">(16) Dir_pct </ENT>
                            <ENT>Steps 6, 7 </ENT>
                            <ENT>Surveys </ENT>
                            <ENT/>
                            <ENT>33.8% </ENT>
                            <ENT>32.6% </ENT>
                            <ENT>40.7% </ENT>
                            <ENT>40.7% </ENT>
                            <ENT>40.7% </ENT>
                            <ENT>37.7% </ENT>
                            <ENT>37.7% </ENT>
                            <ENT>37.7% </ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">(17) Ind_pct </ENT>
                            <ENT>Steps 6, 7 </ENT>
                            <ENT>Surveys </ENT>
                            <ENT/>
                            <ENT>66.2% </ENT>
                            <ENT>67.4% </ENT>
                            <ENT>59.3% </ENT>
                            <ENT>59.3% </ENT>
                            <ENT>59.3% </ENT>
                            <ENT>62.3% </ENT>
                            <ENT>62.3% </ENT>
                            <ENT>62.3% </ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01"> (18) Ind. Alloc. formula (1st part) </ENT>
                            <ENT>Step 8 </ENT>
                            <ENT>See Step 8 </ENT>
                            <ENT/>
                            <ENT>((14)/(16)) * (17) </ENT>
                            <ENT>((14)/(16)) * (17) </ENT>
                            <ENT>((14)/(16)) * (17) </ENT>
                            <ENT>((14)/(16)) * (17) </ENT>
                            <ENT>((14)/(16)) * (17) </ENT>
                            <ENT>((14)/(16)) * (17) </ENT>
                            <ENT>((14)/(16)) * (17) </ENT>
                            <ENT>((14)/(16)) * (17) </ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">(19) Ind. Alloc. (1st part) </ENT>
                            <ENT>Step 8 </ENT>
                            <ENT/>
                            <ENT>See (18) </ENT>
                            <ENT>0.56 </ENT>
                            <ENT>3.07 </ENT>
                            <ENT>0.44 </ENT>
                            <ENT>0.44 </ENT>
                            <ENT/>
                            <ENT>0.21 </ENT>
                            <ENT>0.21 </ENT>
                            <ENT/>
                        </ROW>
                        <ROW>
                            <ENT I="01">(20) Ind. Alloc. formulas (2nd part) </ENT>
                            <ENT>Step 8 </ENT>
                            <ENT>See Step 8 </ENT>
                            <ENT/>
                            <ENT>(15) </ENT>
                            <ENT>(15) </ENT>
                            <ENT>(15)+(11) </ENT>
                            <ENT>(11) </ENT>
                            <ENT>(15) </ENT>
                            <ENT>(15)+(11) </ENT>
                            <ENT>(11) </ENT>
                            <ENT>(15) </ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">(21) Ind. Alloc. (2nd part) </ENT>
                            <ENT>Step 8 </ENT>
                            <ENT/>
                            <ENT>See (20) </ENT>
                            <ENT>0.81 </ENT>
                            <ENT>29.62 </ENT>
                            <ENT>0.29 </ENT>
                            <ENT>0.10 </ENT>
                            <ENT>0.19 </ENT>
                            <ENT>0.26 </ENT>
                            <ENT>0.11 </ENT>
                            <ENT>0.15 </ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">(22) Indirect Allocator (1st+2nd) </ENT>
                            <ENT>Step 8 </ENT>
                            <ENT/>
                            <ENT>=(19)+(21) </ENT>
                            <ENT>1.37 </ENT>
                            <ENT>32.70 </ENT>
                            <ENT>0.73 </ENT>
                            <ENT>0.54 </ENT>
                            <ENT>0.19 </ENT>
                            <ENT>0.47 </ENT>
                            <ENT>0.32 </ENT>
                            <ENT>0.15 </ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">(23) Indirect Adjustment (Ind Adj) </ENT>
                            <ENT>Steps 9-11 </ENT>
                            <ENT>
                                See footnote 
                                <SU>2</SU>
                            </ENT>
                            <ENT/>
                            <ENT>0.362 </ENT>
                            <ENT>0.362 </ENT>
                            <ENT>0.362 </ENT>
                            <ENT>0.362 </ENT>
                            <ENT>0.362 </ENT>
                            <ENT>0.362 </ENT>
                            <ENT>0.362 </ENT>
                            <ENT>0.362 </ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">(24) Adjusted Indirect Allocator </ENT>
                            <ENT>Steps 9-11 </ENT>
                            <ENT>=Ind Alloc * Ind Adj </ENT>
                            <ENT/>
                            <ENT>0.50 </ENT>
                            <ENT>11.84 </ENT>
                            <ENT>0.26 </ENT>
                            <ENT>0.19 </ENT>
                            <ENT>0.07 </ENT>
                            <ENT>0.17 </ENT>
                            <ENT>0.12 </ENT>
                            <ENT>0.05 </ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">(25) Ind. Practice Cost Index (PCI) </ENT>
                            <ENT>Steps 12-16 </ENT>
                            <ENT>See Steps 12-16 </ENT>
                            <ENT/>
                            <ENT>0.968 </ENT>
                            <ENT>0.942 </ENT>
                            <ENT>1.054 </ENT>
                            <ENT>1.054 </ENT>
                            <ENT>1.054 </ENT>
                            <ENT>1.280 </ENT>
                            <ENT>1.280 </ENT>
                            <ENT>1.280 </ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">(26) Adjusted Indirect </ENT>
                            <ENT>Step 17 </ENT>
                            <ENT>= Adj. Ind Alloc * PCI </ENT>
                            <ENT>=(24) * (25) </ENT>
                            <ENT>0.48 </ENT>
                            <ENT>11.15 </ENT>
                            <ENT>0.28 </ENT>
                            <ENT>0.21 </ENT>
                            <ENT>0.07 </ENT>
                            <ENT>0.22 </ENT>
                            <ENT>0.15 </ENT>
                            <ENT>0.07 </ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">(27) PE RVU </ENT>
                            <ENT>Steps 18-19 </ENT>
                            <ENT>=(Adj Dir+Adj Ind) * budn </ENT>
                            <ENT>=((14)+(26)) * budn </ENT>
                            <ENT>0.77 </ENT>
                            <ENT>12.64 </ENT>
                            <ENT>0.58 </ENT>
                            <ENT>0.51 </ENT>
                            <ENT>0.07 </ENT>
                            <ENT>0.35 </ENT>
                            <ENT>0.28 </ENT>
                            <ENT>0.07 </ENT>
                        </ROW>
                        <TNOTE>
                            <SU>1</SU>
                             The direct adj = [current pe rvus * CF * avg dir pct] / [sum direct inputs] = [Step 2] / [Step 3]. 
                        </TNOTE>
                        <TNOTE>
                            <SU>2</SU>
                             The indirect adj = [current pe rvus * avg ind pct] / [sum of ind allocators] = [Step 9] / [Step 10. 
                        </TNOTE>
                    </GPOTABLE>
                    <PRTPAGE P="66232"/>
                    <HD SOURCE="HD2">Comments Related to PE Methodology</HD>
                    <P>
                        <E T="03">Comment:</E>
                         Several commenters recommend that the unadjusted work RVUs be used in the allocation of the indirect PE RVUs.
                    </P>
                    <P>
                        <E T="03">Response:</E>
                         The decision to use the budget neutralized work RVUs in the calculation of indirect PEs appropriately maintains the current relationships between the work, PE, and professional liability payments. We also believe it is important to apply the revised, budget neutralized work RVUs consistently within the PFS framework. It would not be consistent to apply one set of work RVUs for work payments, but a different set for purposes of calculating indirect PEs. Therefore, we will base the calculation of both the work payments and the indirect PE payments on the adjusted work RVUs, and maintain the current overall relationships between work, PE, and professional liability. The PE RVUs in Addendum B and throughout the rest of this rule reflect this policy.
                    </P>
                    <P>
                        <E T="03">Comment:</E>
                         Several commenters commended CMS on the bottom up approach to calculating resource based PE RVUs. Commenters expressed gratitude for the transparency and straight forward nature of the revised methodology.
                    </P>
                    <P>
                        <E T="03">Response:</E>
                         We appreciate the support for the revised bottom up practice methodology and agree that the bottom up methodology is a more straight forward methodology then its predecessor.
                    </P>
                    <P>
                        <E T="03">Comment:</E>
                         Some commenters contend that the approach of basing PE calculations on the weighted average of all specialties furnishing a service is flawed and should be replaced with an approach that bases the specialty weighted factors upon specialties that represent 95 percent of the total utilization of each respective service.
                    </P>
                    <P>
                        <E T="03">Response:</E>
                         This issue was fully addressed in the comment and response section of the CY 2007 PFS final rule with comment period (71 FR 69641), and we did not make any further proposals relating to this policy in the CY 2008 PFS proposed rule. Thus, these comments are outside the scope of the CY 2008 PFS proposed rule.
                    </P>
                    <P>
                        <E T="03">Comment:</E>
                         One commenter stated that the use of direct PEs in the allocation of indirect PEs unfairly penalizes PC only billers that do not have any direct costs. Additionally, this commenter contends that the use of only the work RVU in the allocation of indirect PEs for this situation underestimates the indirect PEs for PC only billers.
                    </P>
                    <P>
                        <E T="03">Response:</E>
                         The resource-based PE methodology uses both the work RVU and the direct cost PE RVU in the allocation of indirect PEs. For PC only billers, which do not have any direct costs, indirect costs will only be allocated based upon the work RVUs. There is no provision within the current methodology to allocate the indirect PEs differently, and we made no proposals in the CY 2008 PFS proposed rule regarding this allocation. Additionally, we note that a review of comments on past regulations confirms that the physician community believes that the work RVUs “over allocate” the indirect PEs. Thus, there appear to be differing views regarding the effect of this allocation. We will continue to allocate the indirect PEs of PC only services on the work RVUs.
                    </P>
                    <P>
                        <E T="03">Comment:</E>
                         One commenter recommended that, for procedures that have supply costs in excess of 40 to 50 percent of total direct costs, all supply costs be passed through and exempt from the direct adjustment factor.
                    </P>
                    <P>
                        <E T="03">Response:</E>
                         The resource-based PE methodology converts the direct costs for a service, obtained from the direct cost database, into PE RVUs by comparing the service specific aggregate costs to the aggregate pool of costs available for expenditure on direct costs. Because the aggregate direct costs for all services contained in the direct cost database exceed the aggregate pool of available direct dollars, a direct cost adjustment must be applied to scale the database to the pool. Irrespective of the percentage of total direct costs for a specific service represented by supplies, this adjustment will still be applied. If this adjustment were not applied to certain services, the system would either not be budget neutral or RVUs for all other services would have to be reduced to offset these exemptions. We did not make any proposals relating to this adjustment. Moreover, we see no methodological reason to exempt any services regardless of the percentage of their direct costs represented by supplies from the adjustments that apply to all direct costs. 
                    </P>
                    <HD SOURCE="HD3">g. Discussion of Equipment Usage Percentage</HD>
                    <P>In the CY 2008 PFS proposed rule (72 FR 38132), we included a discussion about our use of the equipment usage assumption of 50 percent, and stated that we continue to receive requests that we refine this usage percentage. Some groups and individuals state that this usage percentage should be in the range of 70 to 80 percent while others contend that the current utilization rate is too high at 50 percent and should be refined downward to a lower usage percentage.</P>
                    <P>If the equipment usage percentage is set too high, the result would be insufficient allowance at the service level for the practice costs associated with equipment. If the equipment usage percentage is set too low, the result would be an excessive allowance for the PE costs of equipment at the service level. Although we acknowledged the 50 percent across the board usage rate that we currently apply for all equipment does not capture the actual usage rates for all equipment, we indicated we do not believe that we have sufficient empirical evidence to justify an alternative proposal on this issue. Therefore, we requested that commenters submit information relating to alternative percentages and approaches that differentially classify equipment into mutually exclusive categories with category specific usage rate assumptions. In addition, we requested any empirical data that would assist us in these efforts.</P>
                    <HD SOURCE="HD3">h. Equipment Interest Rate</HD>
                    <P>As part of our calculation of the PE equipment costs, we consider several factors, for example, the useful life of each piece of equipment and the typical interest that would be incurred in the purchase of the equipment. We updated the assigned useful life for all the equipment in our PE input database in the CY 2005 PFS final rule with comment period. However, we have used the same interest rate of 11 percent since the inception of the resource based PE methodology in 1999. There has been much discussion regarding whether this is still the appropriate interest rate to utilize in the calculation of the equipment costs. The majority of comments on the CY 2007 PFS final rule with comment period requested an interest rate of prime plus 2 percent while a small number of commenters requested an interest rate significantly lower than prime plus 2 percent.</P>
                    <P>In the CY 2008 PFS proposed rule (72 FR 38132), we discussed the basis for the current interest rate of 11 percent and indicated that, based on our analysis of the revised SBA interest rate data, we believe 11 percent continues to be an appropriate assumption; therefore, we stated would retain the interest rate used in the calculation of equipment costs at 11 percent.</P>
                    <HD SOURCE="HD2">Comments Concerning Equipment Usage and Interest Rate</HD>
                    <P>
                        <E T="03">Comment:</E>
                         Several commenters, including several specialty societies, MedPAC, and the AMA RUC offered recommendations regarding the 11 percent interest rate and the 50 percent utilization rate used to calculate the 
                        <PRTPAGE P="66233"/>
                        price per minute for each piece of equipment. The recommendations received regarding the proposed 11 percent interest rate were generally favorable with the majority of commenters recommending that we monitor the interest rate annually to ensure that the appropriate percentage is utilized in the calculation of the equipment costs.
                    </P>
                    <P>The commenters' recommendations about making adjustments to the 50 percent utilization rate varied. Certain commenters recommended we do nothing until stronger empirical evidence is available, while other commenters recommended a decrease in the utilization assumptions, and some commenters recommended an increase in the utilization assumption. The particular changes recommended in the utilization assumptions were, in most cases, directly related to a specific code. Virtually all comments received support an on going process of obtaining reliable empirical data to utilize in the calculation of equipment costs in the future.</P>
                    <P>
                        <E T="03">Response:</E>
                         As discussed in detail in the CY 2007 PFS final rule with comment period (71 FR 69650), we agree with commenters that both the equipment interest rate and the equipment utilization rate should continue to be examined for accuracy. We are committed to working with all interested parties to define the most accurate utilization and interest rate information for equipment used in the provision of physicians’ services. Since we did not propose a specific change, we will maintain the assumptions of a 50-percent equipment utilization rate and an 11-percent equipment interest rate in the calculation of the PE RVUs published in Addendum B of this final rule with comment period. We will continue to monitor the appropriateness of these assumptions, and evaluate whether changes should be proposed in light of the data available.
                    </P>
                    <P>
                        <E T="03">Comment:</E>
                         A few commenters recommended that the equipment utilization rate associated with preventive services be reduced since much of the equipment associated with preventive services is procedure specific and thus not utilized at as high a rate as other medical equipment.
                    </P>
                    <P>
                        <E T="03">Response:</E>
                         Similar to our response regarding the equipment utilization rate associated with the entire universe of medical equipment, we do not believe that we have any strong empirical evidence to suggest a change in the current equipment utilization rate associated with preventive services. We are committed to continue working with all interested parties to identify the most accurate utilization rate information for equipment used in the provision of physicians' services.
                    </P>
                    <HD SOURCE="HD3">2. PE Proposals for CY 2008</HD>
                    <HD SOURCE="HD3">a. Radiology Practice Expense Per Hour</HD>
                    <P>The American College of Radiology (ACR) presented CMS with information regarding the PE/HR that was used in the PE methodology for radiology in the CY 2007 PFS final rule with comment period. ACR suggested that we change our methodology in a way that would weight the survey data to provide an alternative method of representing large and small practices. We agreed to take their approach to our contractor, the Lewin Group, for further analysis. (We note that the Lewin Group, in its initial analysis of the ACR survey data, had also raised concerns about the representation of small high cost entities in the ACR survey data.) The Lewin Group reviewed ACR's approach and concluded that weighting the ACR survey by practice size more appropriately accounts for the small high cost entities in the final PE/HR. After reviewing both the ACR inquiry and the Lewin response, we also agreed that ACR's approach more appropriately identifies the PE/HR for radiology.</P>
                    <P>For these reasons, we proposed to revise the PE/HR associated with radiology using the survey data weighted by practice size and included this revised PE/HR in Table 2 of the CY 2008 PFS proposed rule which identified the PE/HR for all specialties.</P>
                    <P>
                        <E T="03">Comment:</E>
                         Several commenters, including the AMA's RUC, expressed concern over the proposed increase in the PE/HR for radiology whereby the PE/HR associated with this specialty would be developed based upon a revised practice size weighting methodology. Commenters believed that it is inappropriate to refine the current weighting methodology because: (1) This weighting methodology was not done for all specialties; and (2) some specialties requested to survey their memberships after the deadline to submit supplemental survey data and were denied this opportunity by CMS. Several other commenters commended CMS on their ability to review this potential problem and offer a timely resolution to the affected specialty.
                    </P>
                    <P>
                        <E T="03">Response:</E>
                         The American College of Radiology approached CMS with questions regarding the weighting methodology that were used in the development of their PE/HR. Specifically, ACR believed that small high cost practices that primarily furnish professional only services were severely underrepresented in the published PE/HR. Therefore, we forwarded ACR's concerns to our contractor for further review. Upon review of ACR's concerns, our contractor concluded that their initial PE/HR recommendation to CMS was not fully representative of these smaller high cost practices. For this reason, our contractor recommended a revised weighting approach that would fairly represent these small high cost practices. We agree with both the ACR and our contractor and will finalize our proposal to use the revised PE/HR for radiology.
                    </P>
                    <P>Additionally, we do not believe that these revisions to the PE/HR for radiology constitute a submission of data after the deadline. No new data were submitted. Rather, we view this as a revision to the weighting methodology in order to address a unique situation.</P>
                    <P>
                        <E T="03">Comment:</E>
                         Several commenters recommended that all pain management services be crosswalked to the interventional pain management specialty as opposed to using the actual data which currently report the anesthesiology specialty furnishing a significant portion of the pain management services. According to the comments received, anesthesiology is listed as the primary specialty on many pain management services and since the PE/HR associated with anesthesiology is lower than interventional pain management, pain management services are being inappropriately valued.
                    </P>
                    <P>
                        <E T="03">Response:</E>
                         Physicians self-designate their respective specialty for purposes of Medicare enrollment. If commenters believe that physicians are incorrectly self-designating their specialty as anesthesiology when it would be more appropriate for them to designate interventional pain management, commenters should work with their respective specialty organizations to ensure physicians appropriately designate the correct specialty. If the specialty of a certain percentage of the physicians furnishing the pain management service is actually anesthesiology, we believe that weighting the various PE/HR for all specialties that furnish these services, as we currently do, is the appropriate methodology to establish the final PE/HR for pain management services.
                    </P>
                    <P>
                        <E T="03">Comment:</E>
                         One commenter recommends that only the PE/HR associated with ophthalmology be used in the establishment of RVUs for CPT code 66984, 
                        <E T="03">
                            Extracapsular cataract removal with insertion of intraocular lens prosthesis (one stage procedure), manual or mechanical technique (e.g., irrigation and aspiration or 
                            <PRTPAGE P="66234"/>
                            phacoemulsification).
                        </E>
                         The commenter contends that the 14 percent of the utilization that is associated with optometry is in error as optometrist would only be involved in the post-operative care of these patients and not the surgical procedure.
                    </P>
                    <P>
                        <E T="03">Response:</E>
                         Although we did not make any proposals in the CY 2008 PFS proposed rule regarding this issue, we agree that, generally, optometrists will not be involved in the surgical procedure. As stated by the commenter, and supported by the utilization data, there are a significant number of services for which optometrists are involved in the post-operative care of CPT code 66984. The resource-based PE methodology appropriately adjusts for those services identified with modifier 55 (post-operative care only). Since there are PEs associated with the post-operative care of CPT code 66984, and since we adjust the utilization for those services that are identified as the post-operative care only of CPT code 66984, we believe the current methodology appropriately reflects the correct weighted specialty mix associated with this service.
                    </P>
                    <P>
                        <E T="03">Comment:</E>
                         One commenter recommended that the PE/HR for CPT codes 22862, 
                        <E T="03">Revision including replacement of total disc arthroplasty (artificial disc) anterior approach, lumbar, single interspace,</E>
                         and 22865, 
                        <E T="03">Removal of total disc arthroplasty (artificial disc) anterior approach, lumbar, single interspace,</E>
                         be crosswalked to orthopedic surgery as opposed to the all physician PE/HR. The commenter contended this is similar to the crosswalk change from all physicians to orthopedic surgery that was reflected in the PE methodology in the proposed rule for CPT code 22857, 
                        <E T="03">Total disc arthroplasty (artificial disc), anterior approach, including discectomy to prepare interspace (other than for decompression), lumbar, single interspace.</E>
                    </P>
                    <P>
                        <E T="03">Response:</E>
                         CPT codes 22862 and 22865 were new for CY 2007 and absent specific information with respect to the specialty performing the services, we had crosswalked these codes to the all physician PE/HR. We agree with the commenter that these codes are of a similar nature to CPT code 22857. They are part of the same orthopedic family of codes and should be treated consistently when applying the PE methodology. Therefore, we will assign the orthopedic surgery PE/HR to CPT codes 22862 and 22865 as opposed to the all physician PE/HR.
                    </P>
                    <P>
                        <E T="03">Comment:</E>
                         Several commenters conveyed support for the Physician Practice Information Survey which is currently being administered throughout the nation and encouraged CMS to use this practice cost information to update the current PE/HR data that is being utilized in the development of resourced-based PE RVUs.
                    </P>
                    <P>
                        <E T="03">Response:</E>
                         The Physician Practice Information Survey is a practice cost survey that is being conducted by the AMA with support from various specialty societies and CMS. We look forward to analyzing the results of the AMA data collection efforts for possible inclusion in the resource-based PE methodology in future rulemaking cycles. 
                    </P>
                    <HD SOURCE="HD3">b. RUC Recommendations for Direct PE Inputs and Other PE Input Issues</HD>
                    <P>In the CY 2008 PFS proposed rule (72 FR 38133), we proposed the following concerning direct PE inputs.</P>
                    <HD SOURCE="HD3">(i) RUC Recommendations</HD>
                    <P>In 2004, the AMA's Relative Value Update Committee (RUC) established a new committee, the Practice Expense Review Committee (PERC), to assist the RUC in recommending direct PE inputs (clinical staff, supplies, and equipment) for new and existing CPT codes, a process that was previously accomplished by the Practice Expense Advisory Committee (PEAC).</P>
                    <P>The PERC reviewed the PE inputs for nearly 300 existing codes at its meetings held in February 2007 and April 2007. (A list of these reviewed codes can be found in Addendum C of the CY 2008 PFS proposed rule.)</P>
                    <P>In the CY 2007 PFS final rule with comment period, we addressed several issues concerning direct PE inputs and encouraged specialty societies to pursue further review of these inputs through the RUC/PERC process. The following discussions summarize the PERC recommendations regarding these issues:</P>
                    <HD SOURCE="HD2">Cardiac Catheterization Procedures</HD>
                    <P>As discussed in the CY 2008 PFS proposed rule, the PERC considered recommendations for new or updated PE inputs for the family of CPT codes 93501 through 93556 for cardiac catheterization. The American College of Cardiology (ACC), in cooperation with the Society of Cardiac Angiography and Interventions (SCA&amp;I) and the Cardiovascular Outpatient Center Alliance (COCA), developed PE inputs for the nonfacility setting for 13 of the 28 CPT codes in this family.</P>
                    <P>We proposed to accept the PERC recommendations for the direct PE inputs for the nonfacility setting for the CPT codes 93501, 93505, 93508, 93510, 93526, 93539, 93540, 93542, 93543, 93544, 93545, 93555, and 93556.</P>
                    <P>In addition, we proposed that the PE for the following CPT codes will not be valued or applicable to the nonfacility setting: 93503, 93511, 93514, 93524, 93527, 93528, 93529, 93530, 93531, 93532, 93533, 93561, 93562, 93571, and 93572.</P>
                    <P>
                        <E T="03">Comment:</E>
                         We received comments from the ACC and the SCA&amp;I thanking us for our consideration of the PERC recommendations for 13 CPT codes for cardiac catheterization procedures performed in the nonfacility setting and for accepting their request not to establish nonfacility PE RVUs for the remaining 15 procedures in the cardiac catheterization family.
                    </P>
                    <P>
                        <E T="03">Response:</E>
                         We appreciate the commenters' support and have accepted the PERC recommendations for the 13 cardiac catheterization procedures and have changed our PE database to reflect the PE inputs. For the 15 remaining codes, we will finalize the proposal and attach the “NA” indicator to them.
                    </P>
                    <P>
                        <E T="03">Comment:</E>
                         We received comments from COCA, a national organization representing nonfacility medical cardiology practices that conducted a “Direct Cost Study” purporting to demonstrate that the major problem with the 2006 RUC estimates of direct PE costs for nonfacility outpatient cardiac catheterization was an inadequate list of direct patient care activities. In addition, COCA contends that the total RUC estimates of clinical labor time were so low as to lack credibility. The commenter contends that a significant amount of the data from its Direct Cost Study were not incorporated into the PE recommendations that were jointly prepared and presented at the April 2007 RUC meeting with ACC and SCA&amp;I for the cardiac catheterization procedures. In addition to the inadequate clinical labor inputs, the commenter believes that the RUC process does not allow for the inclusion of safety devices, such as crash carts, as direct PE inputs because these are not used in the typical case; rather, these are considered indirect PE. COCA has requested that we review the data from the Direct Cost Study and revise the current proposed PE RVUs for these procedures to values that reflect more appropriately the direct and indirect costs of providing these services. As an alternative solution, COCA asks that we tie reimbursement for these services to a reasonable percentage of the hospital APC.
                    </P>
                    <P>
                        We also heard from many cardiology practices that provide cardiac catheterizations in the nonfacility 
                        <PRTPAGE P="66235"/>
                        setting. They had similar comments and indicated their support for COCA's request that we review the cost study data and revise the PE RVUs to more appropriately value the cardiac catheterization procedures when performed in the nonfacility setting.
                    </P>
                    <P>
                        <E T="03">Response:</E>
                         While we understand COCA's and the other commenters' concerns about the decrease in the PE RVUs for the cardiac catheterization procedures, we want to clarify that the PE inputs for these procedures were fully considered by the RUC process. The RUC has identified standard descriptions of clinical staff activities that the specialty societies follow as they prepare their recommendations for direct PE inputs believed to be typical to a service and the RUC has established standard values for some of these clinical activities. The RUC does not deviate from accepted standard unless the specialty society presents compelling evidence to substantiate that the variance is typical to the practice for each procedure. In the past, the RUC has recommended, and we agreed, that the crash cart would be included as equipment necessary to perform the services of cardiopulmonary resuscitation, CPT 92950, but is not necessary to perform other services, even though many physicians have purchased and maintain crash carts as part of their medical practices. Since the crash cart is only specified as required for use in CPT 92950, it is considered as indirect PE for all other procedures. We note that COCA's request in the alternative to make payment for these procedures based on a percentage of the OPPS APC is not feasible. The PFS and the OPPS APC payment amounts are determined by different payment methodologies that are specified in the statute. We rely on the RUC process to assist us in establishing the typical PE inputs that are necessary to provide physician services. This is because the specialty-developed PE recommendations that are presented to the RUC are all subject to the same multi-specialty scrutiny. We agree with the PERC's direct PE recommendations for the 13 cardiac catheterization codes in the nonfacility setting and we will accept the RUC PE recommendations for these 13 procedures. However, we are sympathetic to the concerns raised by COCA and echoed by other commenters about the extent to which the data from the Direct Cost Study were considered in the RUC process and we ask that the RUC provide another opportunity for the review of the direct PE inputs for these cardiac catheterization procedures to ensure that the data from the COCA Direct Cost Study is afforded appropriate and adequate consideration.
                    </P>
                    <HD SOURCE="HD2">Obstetric/Gynecologic PE</HD>
                    <P>As discussed in the CY 2008 PFS proposed rule, we agreed with the PERC recommendation to add a non-sterile sheet (drape) 40 in by 60 in (supply code SB006) priced at $0.222 to the pelvic exam pack resulting in the new price of $1.172. This change affected 236 CPT codes for obstetric/gynecologic services containing the pelvic exam pack. We also proposed to accept the PERC recommendations to standardize the equipment used in post-operative visits to include both a power table and fiberoptic light in the PE database for 70 obstetric/gynecologic codes.</P>
                    <P>
                        <E T="03">Comment:</E>
                         We received a comment from the society representing gynecologic oncologists commending us for making the above changes to the pelvic exam pack and for standardizing the equipment used in follow-up visits. The society believes these changes enable gynecologic oncologists to account for the additional costs incurred in their practice specialty.
                    </P>
                    <P>
                        <E T="03">Response:</E>
                         We appreciate the specialty society's comments and we will adopt the PERC recommended inputs as proposed.
                    </P>
                    <HD SOURCE="HD2">Dual Energy X-Ray Absorptiometry (DEXA)</HD>
                    <P>The PERC recommended revisions to the direct PE inputs for CPT codes 77080, 77081, and 77082 to comply with established PERC standards, and more appropriately reflect the resources used to furnish these services. We agreed with these PERC recommendations.</P>
                    <P>
                        <E T="03">Comment:</E>
                         We received several comments thanking us for accepting the RUC's PE recommendations for the DEXA codes. We also received comments from several device manufacturers and specialty societies representing gynecologists, endocrinologists, rheumatologists, and radiologists informing us that the PE recommendations passed by the RUC, which we had proposed to accept in the proposed rule, contained a mistake as to the correct DEXA equipment that is typically used to perform the procedure represented by CPT code 77080. The RUC's PE recommendations listed the DEXA equipment as that using a “pencil beam” technology, priced at $41,000. However, the correct DEXA equipment used for CPT 77080 uses the “fan-beam” technology and is priced at $85,000.
                    </P>
                    <P>
                        <E T="03">Response:</E>
                         We were sympathetic to the concerns expressed by the commenters about the listing of the incorrect DEXA equipment, and we worked with the RUC staff to arrange for this equipment error to be reconsidered by the RUC at its September 2007 meeting. The RUC agreed to the specialty society's recommended change in the DXA equipment for CPT 77080. We agree with the recommendations from the specialty societies and the RUC and we have corrected our PE database to reflect that the fan-beam DEXA equipment is typically used for CPT 77080. In addition, a price of $3,000, with documentation, was presented for the spinal phantom used in this procedure. We have also accepted this price and have changed the PE database accordingly.
                    </P>
                    <P>
                        <E T="03">Comment:</E>
                         We received many comments expressing concerns about the cuts to the PE RVUs for these DEXA services. These commenters believe the cuts are a result of the new PE methodology and may result in access problems for patients because physicians will no longer be able to afford to provide these services in the office setting. One commenter asked us to identify and make available to the public the inputs used to derive the indirect PE RVUs.
                    </P>
                    <P>
                        <E T="03">Response:</E>
                         We are aware that the PE RVUs for these DEXA services were negatively impacted by the change in the PE methodology, as were those for many other services in which the previous PE RVUs were not based on the PE resources used to furnish the service. Because the new PE methodology now utilizes these resources, it is important to make certain that the PE direct inputs actually reflect the typical resources that are used to provide each service. The methodology for determining the indirect PE RVUs, including a description of each step in the calculation, is detailed earlier in this section. We share the commenters concerns about beneficiary access to DEXA services and will continue to monitor this issue.
                    </P>
                    <HD SOURCE="HD2">Computer-Aided Detection (CAD) Codes</HD>
                    <P>The specialty society for radiological services reviewed the direct inputs for CPT codes 77051 and 77052 and recommended that no changes to the PE inputs were needed. The PERC concurred with this decision and we are in agreement.</P>
                    <P>
                        <E T="03">Comment:</E>
                         We received a comment from the society representing radiologists conveying their appreciation for accepting the unchanged direct PE inputs for CAD services.
                    </P>
                    <P>
                        <E T="03">Response:</E>
                         We appreciate the commenter's support and will maintain the PE inputs as proposed.
                        <PRTPAGE P="66236"/>
                    </P>
                    <HD SOURCE="HD2">Nuclear Medicine Services</HD>
                    <P>The specialty society representing nuclear medicine and the PERC recommended that the direct PE inputs for 2 CPT codes contained CPEP inputs and needed to be updated to agree with 2004 PEAC-approved inputs. However, in reviewing the PE database, we discovered that there were 4 other related codes which also had CPEP inputs which should be updated. We made the appropriate adjustments to substitute the PEAC inputs for the CPEP for CPT codes 78600, 78607, 78206, 78647, 78803 and 78807.</P>
                    <P>The specialty society also noted that for 7 CPT codes, revision of x-ray related supplies was required, including the number of x-ray films, developer solution, and film jackets. The PERC forwarded these recommendations and we made the appropriate changes to the PE database for the following CPT codes: 78600, 78601, 78605, 78606, 78607, 78610 and 78615.</P>
                    <P>
                        <E T="03">Comment:</E>
                         The specialty society representing nuclear medicine expressed appreciation for acceptance of their recommended inputs and indicated it will continue to monitor the nuclear medicine codes and provide inputs and refinements as necessary and appropriate.
                    </P>
                    <P>
                        <E T="03">Response:</E>
                         We appreciate the specialty society's comments and we will adopt the PERC recommended inputs as proposed.
                    </P>
                    <HD SOURCE="HD2">Transcatheter Placement of Stent(s)</HD>
                    <P>At the request of the specialty societies representing radiology and interventional radiology, the PERC considered and approved direct PE inputs for the nonfacility setting for 3 CPT codes, 37205, 37206, and 75960, for transcatheter placement of stent(s). Among the supplies, a “vascular stent deployment system”, valued at $1,645, was noted by the society as the typical stent used for CPT codes 37205 and 37206 requiring 2 such stents for the placement in the initial vessel and 1 stent for each subsequent vessel, respectively. We reviewed a published clinical research study that was forwarded by the specialty society. The study indicated that 1 stent was typical for the procedure of CPT code 37205. As discussed in the CY 2008 PFS proposed rule (72 FR 38134), absent any further verification from the specialty, we included only 1 stent in the PE database for this code.</P>
                    <P>
                        <E T="03">Comment:</E>
                         Commenters, representing specialty societies for radiology, interventional radiology and vascular surgery appreciated the proposal assigning direct PE inputs for the nonfacility setting for these three CPT codes. However, these commenters expressed concern that the number of stents had been reduced. One commenter agreed that two stents may not be typical but requested guidance on how the cost of the additional stent could be billed; another of the commenters asked that we reconsider this decision or at a minimum include the “average” of 1.5 stents. One of the commenters also noted that several studies clearly establish that these peripheral stent services are safely performed in the nonfacility environment, with nearly all of the procedures in the studies resulting in short observation stays, typically of less than 4 hours.
                    </P>
                    <P>
                        <E T="03">Response:</E>
                         Based on a review of the literature and other information provided by the commenters we will revise the PE database for CPT code 37205 to reflect 1.5 stents.
                    </P>
                    <P>
                        <E T="03">Comment:</E>
                         Two commenters, representing manufacturers, expressly urged us to consider the safety issues surrounding the proposal to value these procedures in the nonfacility setting and believe that this conflicts with the decision to exclude these procedures from the ambulatory surgical center (ASC) list. One of these commenters acknowledged that, while we have no specific policy to identify which procedures can be safely performed in a physician's office, we do have some safety standards for ASCs. The commenter requested that the ASC standards be extended to the physician office. This commenter also referenced studies that demonstrate complications can be associated with these procedures, and suggested that these risks need to be addressed by appropriate safety or quality standards.
                    </P>
                    <P>
                        <E T="03">Response:</E>
                         We appreciate the commenters' viewpoint. However, as the commenters acknowledged, we have no established policy to designate procedures that can be “safely” performed in the physician office setting. The purpose of the PFS is to establish proper payment for procedures furnished by physicians and other health professionals. Several medical specialty societies recommended the valuation of these services in the nonfacility setting, which suggests to us that these procedures are being furnished in nonfacility settings on a regular basis. These societies provided the recommended PE inputs involved in furnishing the typical service in a nonfacility setting, and these inputs were reviewed, accepted and recommended by the RUC. We also note that, as indicated in the previous comment, one commenter provided literature from studies to support that these services are safely performed in the nonfacility environment. Because it appears these procedures are being furnished regularly in nonfacility settings, we believe it is appropriate to value them for payment in those settings. Therefore, we will value these procedures in the nonfacility setting as proposed.
                    </P>
                    <P>
                        <E T="03">Comment:</E>
                         One commenter noted that payment for CPT code 75960, the supervision and interpretation service associated with the 2 CPT codes discussed above for the transcatheter placement of stent(s), is still shown as carrier-priced in the Addendum of the proposed rule.
                    </P>
                    <P>
                        <E T="03">Response:</E>
                         We regret the error. The Addendum and PFS database have been corrected to reflect the appropriate RVUs.
                    </P>
                    <HD SOURCE="HD3">(ii) Remote Cardiac Event Monitoring</HD>
                    <P>In the CY 2007 PFS final rule with comment period, direct PE inputs for remote cardiac event monitoring (CEM) services represented by CPT codes 93012, 93225, 93226, 93231, 93232, 93270, 93271, 93733, and 93736 were revised on an interim basis to reflect the unique circumstances surrounding the provision of these services. Unlike most physicians'  services, CEM services are furnished primarily by specialized IDTFs that, due to the nature of CEM services, must operate on a 24/7 basis. The specialty group representing suppliers that furnish CEM services believes that these services require additional direct PE inputs, such as telephone line charges associated with trans-telephonic transmissions and fees associated with providing Web access for storage and transmission of clinical information to the patient's physician. We continue to work with the specialty group regarding the specific direct PE inputs, as well as the components for the indirect PE allocation, based on surveys conducted by the specialty group. To clarify and further the results of our discussions with and information provided by, the specialty group, we requested comments in the CY 2008 PFS proposed rule on the appropriateness of the above-mentioned direct PE inputs. In addition, we invited comments on any additional direct inputs and components of the indirect PE allocations which would be appropriate for these services, along with supporting documentation to justify their inclusion for PE purposes.</P>
                    <P>
                        <E T="03">Comment:</E>
                         We received comments from medical societies, provider organizations and a device manufacturer thanking us for working with these organizations to develop direct PE for 
                        <PRTPAGE P="66237"/>
                        these services that do not fit the typical physician service model. Several comments supported the specific PE proposals supplied by the specialty group representing providers that furnish CEM services, and urged us to adopt them. A medical society representing cardiologists requested to work with us and the remote CEM provider groups to gather and review any additional necessary data prior to adoption of additional direct PE inputs.
                    </P>
                    <P>The CEM provider group specifically proposed that we add telephone transmission costs to the direct PE inputs for CPT codes for CEM, 93012 and 93271 and the CPT codes for pacemaker monitoring, 93733, and 93736. The group also identified expenses for Web-based storage, maintenance and access to clinical information to be allocated to the CEM and pacemaker monitoring CPT codes, as well as the holter monitoring CPT codes 93226 and 93232. In addition to these supply PE recommendations, the CEM provider group proposed equipment time-in-use increases for the holter monitors, cardiac event monitors and for INR monitors (which are discussed later in this section).</P>
                    <P>
                        <E T="03">Response:</E>
                         We carefully reviewed the information supplied by all of the commenters and believe that it would be valuable for the commenters to work together, including the cardiology specialty society, before we establish further direct PE inputs for these cardiac monitoring services. In addition, we would like to make the CEM providers aware that it appears the assignment we made in CY 2007 of 43,200 time-in-use minutes for the looping CEM monitor used in CPT code 93271 (typically used for a 30-day period) pays back the cost of this CEM monitor, that is valued at $995, in less than 5 months, even though the CEM monitor has an established 4-year useful life. As we discuss later in the Prothrombin Time, International Normalized Ratio (PT/INR) section, we believe that the time-in-use assigned to any one device should not exceed its useful life. We will review this time-in-use assignment for CEM monitors during our CY 2009 rulemaking.
                    </P>
                    <HD SOURCE="HD3">(iii) Prothrombin Time, International Normalized Ratio (PTI/NR)</HD>
                    <P>
                        As discussed in the CY 2008 PFS proposed rule, based on comments received and subsequent discussions with entities that furnish these PT/INR services, we adjusted the time in use for the home monitor equipment for G0249 
                        <E T="03">Provision of test materials and equipment for home INR monitoring to patient with mechanical heart valve(s) who meets Medicare coverage criteria; includes provision of materials for use in the home and reporting pwiof [prothrombin] test results to physician; per four tests</E>
                         to 1440 minutes to reflect that the monitor is dedicated for use 24 hours a day and unavailable for others receiving this service. We invited comments on this change, as well as comments on any additional direct inputs which would be appropriate to this service, along with supporting documentation to justify their inclusion for PE purposes.
                    </P>
                    <P>
                        <E T="03">Comment:</E>
                         We received comments from specialty societies, provider groups, and individuals expressing their appreciation of our attempt to correct the problem concerning the application of PE methodology for the PT/INR service, but noted their concern that changing the INR home monitor time-in-use minutes from 32 to 1440 does not have a rational basis nor does it provide for an adequate recoupment of the cost of the device. These commenters requested that we assign a more realistic figure to capture the 28-day period that the patient is required to use the monitor. One commenter noted that using the current 1440 minutes, it would take 11.7 years to recoup the $2000 price of the equipment which has an assigned life of 4 years. The commenters suggested several alternative methodologies to calculate the time-in-use for the INR monitor. One method suggests multiplying the 1-day time, 1440 minutes, by 4, which represents the number of tests conducted in the 28-day period, to equal 5,760 minutes. This method would take 3 years to get back the $2000 value of the INR monitor. Another proposal suggests multiplying the 1-day 1440 minutes by 28 days which is the actual time the patient has the equipment. This method yields 40,300 minutes and the commenter admittedly states this method greatly overestimates the value of the INR monitor because it would take just 5 months to recoup the $2000 price. One commenter suggested that we simply amortize the price of the equipment, $2,000, over the useful life of 4 years. Another commenter's suggestion uses the annual minutes figure of 150,000 that we use in our formula for deriving per minute equipment costs, and divides it by 28 (days) to arrive at 5,753 minutes. This method recoups the INR monitor price in 3 years.
                    </P>
                    <P>Other commenters voiced concerns about the valuation of the INR home monitor and offered alternatives to capture the cost of the device. One commenter suggested that we treat the cost of the INR home monitor as a one-time upfront cost and include this price in HCPCS code G0248 that is used to report the demonstration of the INR monitor to the patient, at the initial use. Another commenter recommended that the INR home monitor be removed from the PE for both G0248 and G0249 and be considered under the DME benefit.</P>
                    <P>
                        <E T="03">Response:</E>
                         We understand the concerns expressed by the commenters and appreciate their suggested alternatives that we could use to more appropriately cover the costs of the INR home monitor. Further, we agree that the 1440 minutes we assigned for CY 2007 seems too low considering that the patient uses the INR home monitor for 28 days, not just one. After reviewing all of the suggested alternatives, we eliminated the two proposals asking us to change the mechanism of payment for the INR home monitor. We, therefore, considered the various suggestions for establishing a more appropriate time-in-use value for the INR home monitor. We believe the proposal that best reflects the policy we use to determine the time-in-use for equipment items where the actual minutes-in-use exceed the assigned useful life is the commenter's suggestion to amortize the $2000 INR monitor over its 4-year life. Using this method, 4,315 minutes is the necessary time-in-use figure to recover the purchase price of the equipment in 4 years. We will replace the 1440 minutes assigned for CY 2007 with 4,315 minutes as the time-in-use for the INR home monitor and will change the PE database accordingly.
                    </P>
                    <HD SOURCE="HD3">(iv) Positron Emission Tomography (PET) Codes Clinical Labor Time</HD>
                    <P>We received comments from the specialty society representing nuclear medicine regarding a discrepancy in the clinical labor time for CPT codes 78811, 78812, and 78813 which are PET codes for tumor imaging. The specialty noted that the clinical labor time indicated in the PE database differs by 7 minutes from the time that was previously recommended by the PERC in April 2004. We agreed with the specialty society that the PE database labor inputs for these 3 PET codes are incorrect and we made the appropriate adjustments to the PE database.</P>
                    <P>
                        <E T="03">Comment:</E>
                         The specialty society representing nuclear medicine expressed appreciation for acceptance of its recommended inputs and indicated it will continue to monitor the nuclear medicine codes and provide inputs and refinements as necessary and appropriate.
                    </P>
                    <P>
                        <E T="03">Response:</E>
                         We thank the specialty society for reviewing the direct inputs for their related procedures in the PE 
                        <PRTPAGE P="66238"/>
                        database that we post as a download with each proposed and final rule on our Web site (
                        <E T="03">www.cms.hhs.gov/PhysicianFeeSchedule/PFSFRN</E>
                        ). We will adopt the recommended inputs as proposed.
                    </P>
                    <HD SOURCE="HD3">(v) Nuclear Medicine PE Supplies</HD>
                    <P>The specialty society representing nuclear medicine commented that the PE database currently contains supply items that are inappropriate for certain procedures and provided the information to make the corrections. For respiratory imaging procedures represented by CPT codes 78587, 78591, 78593, 78594, 78630, 78660, 78291, and 78195, the specialty society noted specific IV supply items to be deleted from procedures where they are not required. For a thyroid imaging procedure represented by CPT code 78020, x-ray supply items were recommended for deletion. In addition, the society recommended adding supply items for respiratory imaging procedures, including nose clips, masks, and nebulizer kits, as appropriate, to CPT codes 78584, 78585, 78591, 78593, 78594, 78586, 78587, 78588, and 78596. For a kidney function study represented by CPT code 78725, injection supply items were noted as missing and the specialty society requested that these be added. We proposed to accept these direct PE input corrections and revised our PE database accordingly.</P>
                    <P>
                        <E T="03">Comment:</E>
                         The specialty society voiced its gratitude for the acceptance of their recommended inputs.
                    </P>
                    <P>
                        <E T="03">Response:</E>
                         We thank the specialty society for its interest in assuring the accuracy of the PE inputs in the procedures provided by their members. We will adopt the PERC recommended inputs as proposed.
                    </P>
                    <HD SOURCE="HD3">(vi) Arthroscopic Procedure Nonfacility Inputs</HD>
                    <P>In the CY 2008 PFS proposed rule (72 FR 38135), we included a discussion about the establishment of nonfacility direct PE inputs for the arthroscopic procedures represented by CPT codes 29805, 29830, 29840, 29870, and 29900. Absent specific recommendations from the RUC and because some physicians are already performing these procedures in the office setting, we specifically requested comments regarding the appropriateness of establishing nonfacility PE inputs for these arthroscopic procedures when they are provided in the office setting. We also invited comments as to the specific direct PE inputs, following the RUC approved standardized format, that are typical in the provision of each above listed arthroscopic procedure furnished in the physician's office. We indicated we will review these comments to determine whether or not it is appropriate to propose on an interim basis PE inputs for these codes in the nonfacility setting in our final rule.</P>
                    <P>
                        <E T="03">Comment:</E>
                         We received comments from the specialty society representing orthopedic surgeons in opposition to the establishment of nonfacility PE for the arthroscopic procedures because they believe these procedures are not safely performed in the office setting. The specialty society indicated that one of these codes, CPT 29900, 
                        <E T="03">Arthroscopy, metacarpophalangeal joint, diagnostic, includes synovial biopsy,</E>
                         was surveyed by the RUC in April 2001 and, at that time, the RUC recommended this service only as a facility-based procedure. The RUC supported the AAOS concerns and recommended that the PE RVUs for the nonfacility setting remain designated as “NA.” The specialty society believes that if the arthroscopic procedures were valued in the nonfacility setting, untrained physicians may begin to perform them and, as a result, patients will face significant risks. The specialty society believes that only credentialed physicians should perform these procedures and that this process can only be ensured in the facility-based setting. The specialty society also asserts the facility-based setting is the safest setting for these procedures because it affords the physician more clinical options for dealing with any complications that may arise. In addition, if the procedure is furnished in the nonfacility setting, there would be no way to address any treatable lesion that is found and a patient would need to be seen in the facility setting to undergo a second procedure.
                    </P>
                    <P>Because the specialty society's position was established by an expert panel, the society states that it will reconsider its position if evidence is presented establishing the safety and efficacy of these procedures in the office setting and if a method is established to ensure that only qualified physicians perform these procedures in the office setting.</P>
                    <P>We also received comments from orthopedic practices and individual physicians—the majority of which indicated they are members of the orthopedic specialty society—all stating that they are currently performing these procedures in the nonfacility setting. These comments requested that we establish PE inputs for the arthroscopic procedures because this would allow patients greater access to these services in more convenient settings and, because it would establish payment that would more fairly compensate them for the resources they use to provide these services in the office location. A product manufacturer supported the views of the physicians who requested the establishment of nonfacility PE for the nonfacility setting.</P>
                    <P>These physicians note that the safety of the in-office procedures is well documented in the literature, and provided us with citations of articles going back to the mid-1990s. We also received suggested PE inputs including clinical labor, supplies and equipment that are typically used when these procedures are provided in the nonfacility setting.</P>
                    <P>
                        <E T="03">Response:</E>
                         We appreciate the concern expressed by the commenters opposing the establishment of PE for the office setting and are sympathetic to those supporting the assignment of PE for these codes. We are also dismayed that the parties involved on each side of this issue have not been able to resolve these issues to date. We have decided that the most prudent course of action is to defer proposing nonfacility inputs for these arthroscopic procedures in this final rule. We are hopeful that the specialty society and its physician colleagues who provide these services in the nonfacility setting will be able to discuss the issues of mutual concern regarding the safety of performing these procedures in the office setting. We are hopeful that this issue can be resolved and that the physicians performing these services in the nonfacility setting will be given the opportunity to have a multi-specialty review by the RUC. We are aware that this decision to refer this issue back to the specialty society and the RUC postpones the establishment of nonfacility PE values for these procedures until CY 2009, at the soonest, and that a review by the RUC process is not guaranteed. However, given the apparent level of dissension within the specialty, we believe that the specialty society, its physician colleagues, and the RUC should first be given an opportunity to resolve these important issues.
                    </P>
                    <HD SOURCE="HD3">(vii) Nonfacility Inputs for CPT Code 52327</HD>
                    <P>
                        As discussed in the CY 2008 PFS proposed rule we indicated that the society representing urologists requested that we remove all of the nonfacility PE inputs for CPT code 52327, 
                        <E T="03">Cystourethroscopy (including ureteral catheterization); with subureteric injection of implant material</E>
                        . The specialty society reasoned that the nonfacility PE value is inappropriate since the procedure is never performed in the physician office; 
                        <PRTPAGE P="66239"/>
                        it is specific to the pediatric population; and, as such, is always performed with general anesthesia. We agreed with the specialty society that this procedure is incorrectly valued for the nonfacility setting and proposed to accept its recommendation to remove the nonfacility direct PE inputs, revising the PE database accordingly.
                    </P>
                    <P>
                        <E T="03">Comment:</E>
                         The specialty society thanked us for accepting its recommendation to remove the nonfacility PE for this procedure. However, the society indicated that a review of the PE database on our Web site indicated that these inputs were still included and suggested that they be deleted.
                    </P>
                    <P>
                        <E T="03">Response:</E>
                         We appreciate the commenter's attention to detail and have removed the PE inputs from the PE database.
                    </P>
                    <HD SOURCE="HD3">(viii) Maxillofacial Prosthetics</HD>
                    <P>We have been working with the society representing maxillofacial prosthetists since 2005 to establish nonfacility direct inputs for the prosthetic services represented by the CPT code series, 21076 through 21087. The current PE database reflects the labor, supplies, and equipment needed to perform each procedure. However, we do not have pricing information and documentation for many supply items. The society provided information and documentation for equipment prices, but because specific time-in-use information was not provided, we developed time in use in 2006 for each equipment item in each procedure. For CY 2007, these equipment inputs were utilized under the new PE methodology to calculate the nonfacility PE RVUs for these procedures. Although we have asked the specialty society to provide the supply pricing information and time in use data for each equipment item for each procedure, we have not received the requested information to date. Consequently, unless such information is provided, the PE database will continue to have no prices associated with these supplies. Therefore, in the CY 2008 PFS proposed rule, we proposed to cap the time in use for each equipment item at 25 minutes until specific information is received regarding the actual time in use. Tables listing the needed information for were included in the proposed rule.</P>
                    <P>
                        <E T="03">Comment:</E>
                         The specialty society representing the maxillofacial prosthetists supplied us with some of the requested information. The society provided us with the time-in-use data for every piece of equipment for each of the procedures in the CPT code series 21076 through 21087. The specialty also provided prices for the supply items used in this code series; however, it did not provide any documentation to support these prices.
                    </P>
                    <P>
                        <E T="03">Response:</E>
                         We appreciate the information provided by the specialty, especially that in relation to the equipment time-in-use. The recommended equipment times were compared with the total clinical labor time for each procedure and times that were greater were reduced to equal the labor time, in accordance with our usual allocation policy. Capping the equipment time-in-use to match the labor time affected 4 pieces of equipment in every procedure including: the dental chair, ceiling light, air compressor, and delivery unit. For 3 of these codes, the time-in-use for a 5th piece of equipment, the washout and curing unit, was also capped. We will accept the specialty's equipment time-in-use information, with the aforementioned variances, and have changed the PE database accordingly.
                    </P>
                    <P>We regret that documentation for the supply prices was not forwarded. We did, however, receive a catalog documented pricing for articulating paper/ribbon that was submitted by a different specialty in reference to another CPT code, and have entered this price in the PE database for 8 of the 10 codes in this family, as appropriate. The specialty is reminded that our policy for accepting prices for supplies or equipment in the PE database requires the submission of acceptable documentation, the definition of which is specified below the table that appeared in the proposed rule listing the outstanding prices for supply items needing documentation. We will continue to work with the specialty as it collects and forwards this important information.</P>
                    <HD SOURCE="HD3">(ix) Requests for Increases in Supply Prices</HD>
                    <P>
                        We received a request from the specialty society for obstetrics and gynecology to increase the price of supply item (kit, hysteroscopic tubal implant for sterilization) for CPT code 58565, 
                        <E T="03">Hysteroscopy, surgical; with bilateral fallopian tube cannulation to induce occlusion by placement of permanent implants</E>
                         for this code which was created for CY 2005. This hysteroscopic implant kit is priced at $980 and the specialty is now requesting a price of $1,245, providing an invoice for documentation. The specialty reports that the higher price is attributed to a manufacturer change in design and materials, and submitted the manufacturer's documents supporting these changes that were used to secure FDA approval. Therefore, we proposed to accept the new price of $1,245 for the hysteroscopic implant kit due to the changes made in the modified model.
                    </P>
                    <P>
                        <E T="03">Comment:</E>
                         We did not receive comments on this proposal.
                    </P>
                    <P>
                        <E T="03">Response:</E>
                         We will finalize our proposed price of $1,245 for the hysteroscopic implant kit and will amend our PE database, as appropriate.
                    </P>
                    <HD SOURCE="HD3">(x) Supply and Equipment Items Needing Specialty Input</HD>
                    <P>We have identified certain supply and equipment items for which we were unable to verify the pricing information (see Table 2: Supply Items Needing Specialty Input for Pricing and Table 3: Equipment Items Needing Specialty Input for Pricing). In our CY 2008 PFS proposed rule, we listed both supply and equipment items for which pricing documentation was needed from the medical specialty societies and, for many of these items, we received sufficient documentation containing specific descriptors and pricing information in the form of catalog listings, vendor Web pages, invoices, and manufacturer quotes. We have accepted the documented prices for many of these items and these prices are reflected in the PE RVUs in Addendum B of this final rule with comment period. For the items listed in Tables 2 and 3, we are requesting that commenters provide pricing information on items in these tables along with acceptable documentation, as noted in the footnote to each table, to support recommended prices. For supplies or equipment that have previously appeared on this list, and for which we received no or inadequate documentation, we proposed to delete these items unless we receive adequate information to support current pricing by the conclusion of the comment period for this proposed rule.</P>
                    <P>
                        In Tables 4 and 5, we have listed new supplies and equipment from the new CPT codes for CY 2008 that are discussed elsewhere in this final rule with comment period. These items have been added to the PE database and, where priced, are reflected in the PE RVUs in Addendum B.
                        <PRTPAGE P="66240"/>
                    </P>
                    <GPOTABLE COLS="9" OPTS="L2,i1" CDEF="s25,r75,r25,8,r75,r50,xs40,r75,r20">
                        <TTITLE>Table 2.—Supply Items Needing Specialty Input for Pricing</TTITLE>
                        <BOXHD>
                            <CHED H="1">Code </CHED>
                            <CHED H="1">2006/7 Description</CHED>
                            <CHED H="1">Unit</CHED>
                            <CHED H="1">Unit price</CHED>
                            <CHED H="1">
                                Primary associated 
                                <LI>specialties </LI>
                            </CHED>
                            <CHED H="1">
                                Associated 
                                <LI>*CPT code(s)</LI>
                            </CHED>
                            <CHED H="1">
                                Prior item 
                                <LI>status on </LI>
                                <LI>table</LI>
                            </CHED>
                            <CHED H="1">
                                Commenter response 
                                <LI>and CMS action</LI>
                            </CHED>
                            <CHED H="1">
                                2008 
                                <LI>item </LI>
                                <LI>status </LI>
                                <LI>refer to </LI>
                                <LI>note(s)</LI>
                            </CHED>
                        </BOXHD>
                        <ROW>
                            <ENT I="01">SC088 </ENT>
                            <ENT>Fistula needle, dialysis, 17g</ENT>
                            <ENT>Item</ENT>
                            <ENT/>
                            <ENT>Dermatology</ENT>
                            <ENT>36522</ENT>
                            <ENT>Yes</ENT>
                            <ENT>Documentation received. Revised description per specialty's comments. Price accepted at $1.62</ENT>
                            <ENT>C</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="22"> </ENT>
                            <ENT>Gas, argon, cryoablation</ENT>
                            <ENT/>
                            <ENT/>
                            <ENT>Urology, Radiology, Interventional Radiology</ENT>
                            <ENT>50395</ENT>
                            <ENT>No</ENT>
                            <ENT>New Item</ENT>
                            <ENT>A, E</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="22"> </ENT>
                            <ENT>Gas, helium, cryoablation</ENT>
                            <ENT/>
                            <ENT/>
                            <ENT>Urology, Radiology, Interventional Radiology</ENT>
                            <ENT>50395</ENT>
                            <ENT>No</ENT>
                            <ENT>New Item</ENT>
                            <ENT>A, E</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">SD140</ENT>
                            <ENT>Pressure bag</ENT>
                            <ENT>item</ENT>
                            <ENT>8.925</ENT>
                            <ENT>Cardiology</ENT>
                            <ENT>93501, 93508, 93510, 93526</ENT>
                            <ENT>Yes</ENT>
                            <ENT>Documentation received. Price accepted at $19.00</ENT>
                            <ENT>C</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">SL119</ENT>
                            <ENT>Sealant spray</ENT>
                            <ENT>oz</ENT>
                            <ENT/>
                            <ENT>Radiation Oncology</ENT>
                            <ENT>77333</ENT>
                            <ENT>Yes</ENT>
                            <ENT>No comments received</ENT>
                            <ENT>B</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">SD213</ENT>
                            <ENT>Tubing, sterile, non-vented (fluid administration)</ENT>
                            <ENT>item</ENT>
                            <ENT>1.99</ENT>
                            <ENT>Cardiology</ENT>
                            <ENT>93501, 93508, 93510, 93526</ENT>
                            <ENT>Yes</ENT>
                            <ENT>Documentation received. Price accepted at $0.949</ENT>
                            <ENT>C</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="22"> </ENT>
                            <ENT>Stent, vascular, deployment system</ENT>
                            <ENT>Kit</ENT>
                            <ENT>$1,645</ENT>
                            <ENT>Radiology, Interventional Radiology</ENT>
                            <ENT>37205, 37206</ENT>
                            <ENT>Yes</ENT>
                            <ENT>Documentation received. Price retained at $1,645</ENT>
                            <ENT>C</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="22"> </ENT>
                            <ENT>Catheter, Kumpe </ENT>
                            <ENT>Item</ENT>
                            <ENT/>
                            <ENT>Radiology, Interventional Radiology</ENT>
                            <ENT>50385, 50386</ENT>
                            <ENT>No</ENT>
                            <ENT>New item</ENT>
                            <ENT>A, E</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="22"> </ENT>
                            <ENT>Disposable aspirating syringe</ENT>
                            <ENT/>
                            <ENT/>
                            <ENT>Oral and Maxillofacial Surgery</ENT>
                            <ENT>21073</ENT>
                            <ENT>No</ENT>
                            <ENT>New item</ENT>
                            <ENT>A, E</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="22"> </ENT>
                            <ENT>
                                Guidewire, angle tip (Terumo), 180 cm
                                <SU>1</SU>
                            </ENT>
                            <ENT/>
                            <ENT/>
                            <ENT>Radiology, Interventional Radiology</ENT>
                            <ENT>50385, 50386 </ENT>
                            <ENT>No</ENT>
                            <ENT>New item </ENT>
                            <ENT>A, E</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="22"> </ENT>
                            <ENT>Snare, Nitinol (Amplatz)</ENT>
                            <ENT>Item </ENT>
                            <ENT/>
                            <ENT>Radiology, Interventional Radiology</ENT>
                            <ENT>50385, 50386</ENT>
                            <ENT>No</ENT>
                            <ENT>New item</ENT>
                            <ENT>A, E</ENT>
                        </ROW>
                        <TNOTE>
                            <SU>*</SU>
                             CPT codes and descriptions only are copyright 2008 American Medical Association. All Rights Reserved. Applicable FARS/DFARS apply.
                        </TNOTE>
                        <TNOTE>Note: Acceptable documentation includes—Detailed description (including system components), source, and current pricing information, such as copies of catalog pages, hard copy from specific Web pages, invoices, and quotes (letter format okay) from manufacturer, vendors or distributors. Unacceptable documentation includes—phone numbers and addresses of manufacturer, vendors or distributors, Web site links without pricing information, etc.</TNOTE>
                        <TNOTE>Note A: Additional documentation required. Need detailed description (including kit contents), source, and current pricing information (including pricing per specified unit of measure in database). Accept copies of catalog pages or hard copy from specific Web pages. Phone numbers or addresses of manufacturer, vendors or distributors are not acceptable documentation.</TNOTE>
                        <TNOTE>Note B: No/Insufficient received. Retained price in database on an interim basis. Forward acceptable documentation promptly.</TNOTE>
                        <TNOTE>Note C: Submitted price accepted. </TNOTE>
                        <TNOTE>Note D: Deleted per comment or CMS.</TNOTE>
                        <TNOTE>Note E: 2007/8 price retained on an interim basis. Forward acceptable documentation promptly.</TNOTE>
                    </GPOTABLE>
                    <GPOTABLE COLS="8" OPTS="L2,i1" CDEF="xs32,r75,9,r75,r50,xs40,r75,xs48">
                        <TTITLE>Table 3.—Equipment Items Needing Specialty Input for Pricing and Proposed Deletions</TTITLE>
                        <BOXHD>
                            <CHED H="1">Code </CHED>
                            <CHED H="1">2006/7 Description </CHED>
                            <CHED H="1">2007/8 Price </CHED>
                            <CHED H="1">Primary specialties associated with item </CHED>
                            <CHED H="1">*CPT code(s) associated with item </CHED>
                            <CHED H="1">Prior status on table </CHED>
                            <CHED H="1">Commenter response and CMS action </CHED>
                            <CHED H="1">2008 Item status refer to note(s)</CHED>
                        </BOXHD>
                        <ROW>
                            <ENT I="01">EQ269</ENT>
                            <ENT>Ambulatory blood pressure monitor</ENT>
                            <ENT>3000</ENT>
                            <ENT>Cardiology</ENT>
                            <ENT>93784, 93786, 93788</ENT>
                            <ENT>Yes</ENT>
                            <ENT>Documentation provided. Price accepted is $1525 (Did not accept $395 warranty cost.)</ENT>
                            <ENT>C</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="22"> </ENT>
                            <ENT>Camera mount—floor</ENT>
                            <ENT>2300</ENT>
                            <ENT>Dermatology</ENT>
                            <ENT>96904</ENT>
                            <ENT>Yes</ENT>
                            <ENT>Specialty to submit, asap</ENT>
                            <ENT>A, E</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="22"> </ENT>
                            <ENT>Cross slide attachment</ENT>
                            <ENT>500</ENT>
                            <ENT>Dermatology</ENT>
                            <ENT>96904</ENT>
                            <ENT>Yes</ENT>
                            <ENT>Specialty to submit, asap</ENT>
                            <ENT>A, E</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="22"> </ENT>
                            <ENT>Dermal imaging software</ENT>
                            <ENT>4500</ENT>
                            <ENT>Dermatology</ENT>
                            <ENT>96904</ENT>
                            <ENT>Yes</ENT>
                            <ENT>Documentation provided. Price accepted at $4500</ENT>
                            <ENT>C</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="22"> </ENT>
                            <ENT>Dermoscopy attachments</ENT>
                            <ENT>650</ENT>
                            <ENT>Dermatology</ENT>
                            <ENT>96904</ENT>
                            <ENT>Yes</ENT>
                            <ENT>Documentation provided. Price accepted at $650 ( average of the cost of the two items provided)</ENT>
                            <ENT>C</ENT>
                        </ROW>
                        <ROW>
                            <PRTPAGE P="66241"/>
                            <ENT I="01">EQ008</ENT>
                            <ENT>ECG signal averaging system w-P waves and late potentials software</ENT>
                            <ENT>8,250</ENT>
                            <ENT>Cardiology, IM</ENT>
                            <ENT>93278</ENT>
                            <ENT>Yes</ENT>
                            <ENT>Documentation provided. Revised description to better describe system. Price accepted at 17,900</ENT>
                            <ENT>A, E</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="22"> </ENT>
                            <ENT>Instrument, microdissection</ENT>
                            <ENT/>
                            <ENT>Pathology</ENT>
                            <ENT>88380</ENT>
                            <ENT>No</ENT>
                            <ENT>New Item</ENT>
                            <ENT>A, E</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="22"> </ENT>
                            <ENT>Lens, macro, 35-70mm</ENT>
                            <ENT/>
                            <ENT>Dermatology</ENT>
                            <ENT>96904</ENT>
                            <ENT>Yes</ENT>
                            <ENT>Deleted item as price is less than $500 per documentation received</ENT>
                            <ENT>D </ENT>
                        </ROW>
                        <ROW>
                            <ENT I="22"> </ENT>
                            <ENT>Plasma pheresis machine</ENT>
                            <ENT>37,900</ENT>
                            <ENT>Radiology, Dermatology</ENT>
                            <ENT>36481, G0341</ENT>
                            <ENT>Yes</ENT>
                            <ENT>Revised description based on comments received that light source was not part of item. Documentation requested</ENT>
                            <ENT>B</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">ED039</ENT>
                            <ENT>Psychology Testing Equipment</ENT>
                            <ENT/>
                            <ENT>Psychology</ENT>
                            <ENT>96101, 96102</ENT>
                            <ENT>Yes</ENT>
                            <ENT>Specialty to submit, asap</ENT>
                            <ENT>B</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">ER070</ENT>
                            <ENT>Portal imaging system (w/PC work station and software)</ENT>
                            <ENT>377,319</ENT>
                            <ENT>Radiation oncology</ENT>
                            <ENT>77421</ENT>
                            <ENT>Yes</ENT>
                            <ENT>Documentation provided. Price accepted at $489,940 ( average of the cost of the two items provided)</ENT>
                            <ENT>C</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="22"> </ENT>
                            <ENT>Strobe, 400 watts (Studio) (2)</ENT>
                            <ENT>1500</ENT>
                            <ENT>Dermatology</ENT>
                            <ENT>96904</ENT>
                            <ENT>Yes</ENT>
                            <ENT>Documentation requested</ENT>
                            <ENT>B</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="22"> </ENT>
                            <ENT>
                                Cryosurgery system (for tumor ablation)
                                <SU>1</SU>
                            </ENT>
                            <ENT/>
                            <ENT>Urology, Radiology, Interventional Radiology </ENT>
                            <ENT>50593</ENT>
                            <ENT>No </ENT>
                            <ENT>New item</ENT>
                            <ENT>A, E</ENT>
                        </ROW>
                        <TNOTE>* CPT codes and descriptions only are copyright 2008 American Medical Association. All Rights Reserved. Applicable FARS/DFARS apply.</TNOTE>
                        <TNOTE>Note: Acceptable documentation includes—Detailed description (including system components), source, and current pricing information, such as copies of catalog pages, hard copy from specific Web pages, invoices, and quotes (letter format okay) from manufacturer, vendors or distributors. Unacceptable documentation includes—phone numbers and addresses of manufacturer, vendors or distributors, Web site links without pricing information, etc.</TNOTE>
                        <TNOTE>Note A: Additional documentation required. Need detailed description (including kit contents), source, and current pricing information (including pricing per specified unit of measure in database). Accept copies of catalog pages or hard copy from specific Web pages. Phone numbers or addresses of manufacturer, vendors or distributors are not acceptable documentation. </TNOTE>
                        <TNOTE>Note B: No/Insufficient received. Retained price in database on an interim basis. Forward acceptable documentation promptly.</TNOTE>
                        <TNOTE>Note C: Submitted price accepted. </TNOTE>
                        <TNOTE>Note D: Deleted per comment or CMS.</TNOTE>
                        <TNOTE>Note E: 2007/8 price, where specified, retained on an interim basis. Forward acceptable documentation promptly.</TNOTE>
                    </GPOTABLE>
                    <GPOTABLE COLS="6" OPTS="L2,i1" CDEF="xs32,r75,xs32,6.4,r25,r25">
                        <TTITLE>Table 4.—Practice Expense Supply Item Additions for CY 2008</TTITLE>
                        <BOXHD>
                            <CHED H="1">
                                Equip
                                <LI>code </LI>
                            </CHED>
                            <CHED H="1">Supply description </CHED>
                            <CHED H="1">Unit </CHED>
                            <CHED H="1">Unit price </CHED>
                            <CHED H="1">*CPT code(s) associated with item </CHED>
                            <CHED H="1">Supply category</CHED>
                        </BOXHD>
                        <ROW>
                            <ENT I="01">NA </ENT>
                            <ENT>Blade, sharp pointed surgical </ENT>
                            <ENT>item </ENT>
                            <ENT>0.73 </ENT>
                            <ENT>88381 </ENT>
                            <ENT>Cutters, closures.</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">NA </ENT>
                            <ENT>Buffer, lysis </ENT>
                            <ENT>ml </ENT>
                            <ENT>0.46 </ENT>
                            <ENT>88381 </ENT>
                            <ENT>Lab.</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">NA </ENT>
                            <ENT>Caps, Capsure Macro LCM </ENT>
                            <ENT>ml </ENT>
                            <ENT>4.54 </ENT>
                            <ENT>88380 </ENT>
                            <ENT>Lab.</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">NA </ENT>
                            <ENT>Catheter, balloon, lacrimal </ENT>
                            <ENT>item </ENT>
                            <ENT>306 </ENT>
                            <ENT>68816 </ENT>
                            <ENT>Accessory.</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">NA </ENT>
                            <ENT>
                                Catheter, Kumpe 
                                <SU>1</SU>
                            </ENT>
                            <ENT>item </ENT>
                            <ENT/>
                            <ENT>50385, 50386 </ENT>
                            <ENT>Accessory.</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">NA </ENT>
                            <ENT>
                                Disposable aspirating syringe 
                                <SU>1</SU>
                                  
                            </ENT>
                            <ENT/>
                            <ENT/>
                            <ENT>21073</ENT>
                            <ENT/>
                        </ROW>
                        <ROW>
                            <ENT I="01">NA </ENT>
                            <ENT>Ethanol, 95% </ENT>
                            <ENT>ml </ENT>
                            <ENT>0.0033 </ENT>
                            <ENT>88380, 88381 </ENT>
                            <ENT>Lab.</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">NA </ENT>
                            <ENT>Fee, image analysis </ENT>
                            <ENT>item </ENT>
                            <ENT>18 </ENT>
                            <ENT>99174 </ENT>
                            <ENT>Office supply.</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">NA </ENT>
                            <ENT>Gas, argon, cryoablation </ENT>
                            <ENT/>
                            <ENT/>
                            <ENT>50593 </ENT>
                            <ENT>Accessory.</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="22"> </ENT>
                            <ENT>Gas, helium, cryoablation</ENT>
                            <ENT/>
                            <ENT/>
                            <ENT>50593 </ENT>
                            <ENT>Accessory.</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">NA </ENT>
                            <ENT>Gastrostomy. Low profile replacement button (Mic-Key) </ENT>
                            <ENT>item </ENT>
                            <ENT>5 </ENT>
                            <ENT>43760 </ENT>
                            <ENT>Accessory.</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">NA </ENT>
                            <ENT>Gastrostomy. Stoma measuring device (Mic-Key) </ENT>
                            <ENT>item </ENT>
                            <ENT>10 </ENT>
                            <ENT>43760 </ENT>
                            <ENT>Accessory.</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">NA </ENT>
                            <ENT>Glycerol, 3% </ENT>
                            <ENT>ml </ENT>
                            <ENT>0.001 </ENT>
                            <ENT>88380, 88381 </ENT>
                            <ENT>Lab.</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">NA </ENT>
                            <ENT>
                                Guidewire, angle tip (Terumo), 180 cm 
                                <SU>1</SU>
                                  
                            </ENT>
                            <ENT>item </ENT>
                            <ENT/>
                            <ENT>50385, 50386 </ENT>
                            <ENT>Accessory.</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">NA </ENT>
                            <ENT>IV infusion set, Sof-set (Minimed) </ENT>
                            <ENT>item </ENT>
                            <ENT>11.50 </ENT>
                            <ENT>90769, 90771 </ENT>
                            <ENT>Hypodermic, IV.</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">NA </ENT>
                            <ENT>Methylene blue stain </ENT>
                            <ENT>ml </ENT>
                            <ENT>0.178 </ENT>
                            <ENT>88380 </ENT>
                            <ENT>Lab.</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">NA </ENT>
                            <ENT>Probe, cryoablation, renal </ENT>
                            <ENT>item </ENT>
                            <ENT>1175 </ENT>
                            <ENT>50593 </ENT>
                            <ENT>Accessory.</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">NA </ENT>
                            <ENT>Rnase-free water </ENT>
                            <ENT>ml </ENT>
                            <ENT>0.85 </ENT>
                            <ENT>88381 </ENT>
                            <ENT>Lab.</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">NA </ENT>
                            <ENT>Slide, microscope, sterile </ENT>
                            <ENT>item </ENT>
                            <ENT>1 </ENT>
                            <ENT>88380, 88381 </ENT>
                            <ENT>Lab.</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">NA </ENT>
                            <ENT>
                                Snare, Nitinol (Amplatz) 
                                <SU>1</SU>
                                  
                            </ENT>
                            <ENT>item</ENT>
                            <ENT/>
                            <ENT>50385, 50386 </ENT>
                            <ENT>Accessory.</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">NA </ENT>
                            <ENT>Swab, patient prep, 1.5 ml (chloraprep) </ENT>
                            <ENT>item </ENT>
                            <ENT>1.04 </ENT>
                            <ENT>36592 </ENT>
                            <ENT>Pharmacy, NonRx.</ENT>
                        </ROW>
                        <ROW>
                            <PRTPAGE P="66242"/>
                            <ENT I="01">NA </ENT>
                            <ENT>Tube, jejunsostomy </ENT>
                            <ENT>item </ENT>
                            <ENT>195 </ENT>
                            <ENT>49441, 49446, 49451 and 49452 </ENT>
                            <ENT>Accessory.</ENT>
                        </ROW>
                        <TNOTE>* CPT codes and descriptions only are copyright 2008 American Medical Association. All Rights Reserved. Applicable FARS/DFARS apply.</TNOTE>
                        <TNOTE>
                            <SU>1</SU>
                             Price verification needed. Item(s) added to table of supplies requiring specialty input.
                        </TNOTE>
                    </GPOTABLE>
                    <GPOTABLE COLS="6" OPTS="L2,i1" CDEF="xs32,r75,10,10,r25,r25">
                        <TTITLE>Table 5.—Practice Expense Equipment Item Additions for CY 2008</TTITLE>
                        <BOXHD>
                            <CHED H="1">
                                Equip
                                <LI>code </LI>
                            </CHED>
                            <CHED H="1">Equipment description </CHED>
                            <CHED H="1">Life </CHED>
                            <CHED H="1">Unit price </CHED>
                            <CHED H="1">*CPT code(s) associated with item </CHED>
                            <CHED H="1">
                                Equipment 
                                <LI>category</LI>
                            </CHED>
                        </BOXHD>
                        <ROW>
                            <ENT I="01">NA </ENT>
                            <ENT>
                                Cryosurgery system (for tumor ablation) 
                                <SU>1</SU>
                            </ENT>
                            <ENT>10 </ENT>
                            <ENT/>
                            <ENT>50593 </ENT>
                            <ENT>Other Equipment.</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">NA </ENT>
                            <ENT>Cardiac coil, 1.5T 8-channel (MR) </ENT>
                            <ENT>5 </ENT>
                            <ENT>35400 </ENT>
                            <ENT>7557, 7558 and 75559 </ENT>
                            <ENT>Imaging Equipment.</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="22"> </ENT>
                            <ENT>Instrument, Microdissection </ENT>
                            <ENT>7</ENT>
                            <ENT/>
                            <ENT>88381 </ENT>
                            <ENT>Laboratory.</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">NA </ENT>
                            <ENT>Pressure sensor, wireless (for implanted AAA sac sensor) </ENT>
                            <ENT>5 </ENT>
                            <ENT>25000 </ENT>
                            <ENT>93982 </ENT>
                            <ENT>Documentation.</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">NA </ENT>
                            <ENT>Camera, ocular photoscreening, w-laptop and software </ENT>
                            <ENT>5 </ENT>
                            <ENT>7000 </ENT>
                            <ENT>99174 </ENT>
                            <ENT>Documentation.</ENT>
                        </ROW>
                        <TNOTE>* CPT codes and descriptions only are copyright 2008 American Medical Association. All Rights Reserved. Applicable FARS/DFARS apply.</TNOTE>
                        <TNOTE>
                             
                            <SU>1</SU>
                             Price verification needed. Item(s) added to table of equipment requiring specialty input.
                        </TNOTE>
                    </GPOTABLE>
                    <HD SOURCE="HD3">(xi) Additional PE Issues Raised By Commenters</HD>
                    <P>
                        <E T="03">Comment:</E>
                         One commenter recommends that the direct inputs associated with all fee schedule services be made available to the public.
                    </P>
                    <P>
                        <E T="03">Response:</E>
                         Since the inception of resource based PEs, all direct input data has been made available to the public on the CMS Web page. The direct inputs associated with this final rule with comment period are also available to the public at the following Web site under CMS-1385-IFC: 
                        <E T="03">http://www.cms.hhs.gov/PhysicianFeeSched/PFSFRN/list.asp#TopOfPage</E>
                        .
                    </P>
                    <P>
                        <E T="03">Comment:</E>
                         Several commenters recommend that we reprice supply items over $200 in the PE direct input database annually. Additionally, commenters also requested that we establish individual J codes for these high cost supplies. Alternatively, several other commenters expressed concerns over this recommendation stating that utilization guidelines must be set up that would trigger repricing or an undue burden would be placed upon those specialties using these high cost supplies.
                    </P>
                    <P>
                        <E T="03">Response:</E>
                         Using an individual HCPCS code for each of these supplies would be difficult as there are multiple manufacturers, with multiple prices, associated with the majority of these codes. Having multiple manufacturers, and thus multiple prices, also makes it difficult to reprice these supplies within the PE methodology, which is why we continue to work with the AMA RUC to establish direct cost input data. Additionally, all direct inputs need to be budget neutralized within the PE methodology. Removing these high cost supplies from the standard PE methodology would unfairly advantage procedures that contain these supplies as they would not be subject to the same budget neutrality adjustments as would other supplies. Finally, we agree with those commenters that state that any annual repricing of these supplies would place undue burden on specific physician groups. For these reasons, we will continue to price these high cost supplies within the standard PE methodology.
                    </P>
                    <P>
                        <E T="03">Comment:</E>
                         A few comments were received that recommended that desktop computers be included as a direct PE cost.
                    </P>
                    <P>
                        <E T="03">Response:</E>
                         The direct PE database includes desktop computers with monitor when this computer is identified as being dedicated to a specific procedure. The costs associated with computers that are used for non-clinical purposes assigned to a specific procedure, for example, used for administrative procedures, are more appropriately captured in the indirect cost category.
                    </P>
                    <P>
                        <E T="03">Comment:</E>
                         One commenter representing home care physicians requested that travel time and other inherent costs related to mobile medical services such as vehicle operation and mobile communication should be accounted for in the PE calculation.
                    </P>
                    <P>
                        <E T="03">Response:</E>
                         To the extent that travel time is necessary to furnish physician services outside of the office setting, these expenses are not considered direct costs under the PE methodology. Although the mobile communication devices are not specifically included as direct PE inputs, 12 minutes of clinical labor time is assigned for each of the home visit E/M services, 6 minutes in the pre-time period and 6 minutes in the post time period. Phone calls are standardized at 3 minutes each for purposes of the direct PE inputs and would be included as part of this clinical labor time.
                    </P>
                    <P>
                        <E T="03">Comment:</E>
                         One commenter stated that adjustments need to be made to the PE database for certain dialysis codes and requested that for G0393 and G0392 an angioplasty balloon be added to the PE database and that for CPT code 36870 the PE database should be revised to include an angiographic room and a power table.
                    </P>
                    <P>
                        <E T="03">Response:</E>
                         The balloon catheters are reflected in the PE database, as supply number SD152, and the angiographic room and an exam table are included in the equipment for CPT code 36870.
                    </P>
                    <P>
                        <E T="03">Comment:</E>
                         Commenters expressed concern about the level of reimbursement for intrathecal pump management services for chronic pain patients and believe that the refill kit is not accounted for in the PE. In addition, commenters expressed concern that reimbursement did not cover the leasing costs for the equipment.
                    </P>
                    <P>
                        <E T="03">Response:</E>
                         We reviewed the PE database and have verified that a refill kit, priced at $28, is included as a supply in CPT codes 95990 and 95991. In our PE database, equipment costs are assigned based on the purchase price for each piece of equipment, regardless of whether the equipment is owned, rented or leased.
                    </P>
                    <P>
                        <E T="03">Comment:</E>
                         A manufacturer expressed concern that the PE RVUs for intranasal administration of vaccines (CPT codes 90467/8 and 90473/4) are inappropriately low and should be equalized to the injectable immunization administration PE RVUs. 
                        <PRTPAGE P="66243"/>
                        The commenter stated that when the codes were reevaluated in 2004 there was not enough experience in the office to fully understand the time associated with providing an intranasal vaccine. The commenter stated that specialty organizations have indicated that this issue is worth reexamining and indicated that they had been encouraged to communicate with the RUC in support of equalizing payment for the codes.
                    </P>
                    <P>
                        <E T="03">Response:</E>
                         We appreciate the commenter's concerns about the disparity in the PE RVUs for the intranasal and injectable immunization administration procedures. To the extent that these concerns relate to the direct PE inputs, we would encourage the commenter to work with the specialty organizations to determine if it is appropriate to bring these codes forward for further RUC review.
                    </P>
                    <P>
                        <E T="03">Comment:</E>
                         One commenter requested that we publish the RUC approved RVUs for all noncovered and carrier priced services, particularly for the positron emission tomography (PET) and PET/CT procedures.
                    </P>
                    <P>
                        <E T="03">Response:</E>
                         We have made it our policy to publish work and PE RVUs for services in instances where the information has been forwarded to us, with a few exceptions. One exception to this policy is for carrier priced codes. Our rationale for this policy is simply that any published values for carrier-priced codes would be in direct contradiction of our intentions with respect to this designation. As we state in Addendum A, a “C” status indicator means that carriers price this code establishing RVUs and payment amounts without direct guidance from CMS. Because the commenter did not provide us with information about specific noncovered services that do not have published RVUs, we are not able to address this particular aspect of the comment.
                    </P>
                    <P>
                        <E T="03">Comment:</E>
                         Commenters representing radiation oncologists expressed concern about the significant PE reductions in CPT code 77336 for continuing medical physics consults. The commenters noted this code was last reviewed by the PEAC in 2002 and the practice standard has changed significantly. Commenters recommended that the direct PE inputs for this code be reviewed and refined so that accurate PE data is reflected for this code.
                    </P>
                    <P>
                        <E T="03">Response:</E>
                         While we appreciate that the commenters expressed their concerns to us regarding a change in the practice standards for the services of CPT code 77336 which they believe results in the need to change the direct PE inputs, we believe that the appropriate course of action for the commenters is to work together with the RUC affiliated specialty society in order to determine if these concerns can be appropriately addressed by the RUC.
                    </P>
                    <P>
                        <E T="03">Comment:</E>
                         We received comments from individuals and associations with concerns about the new bottom-up PE methodology and the resulting effect of decreases in the PE RVUs for various services including, but not limited to the following: chemotherapy administration, endovenous ablation procedures, brachytherapy treatments, 3-D imaging services, and procedures for photopheresis and plasma pheresis.
                    </P>
                    <P>
                        <E T="03">Response:</E>
                         As we noted earlier in this section, we are aware that the PE RVUs for some services were negatively impacted by the change in our PE methodology. However, we will reiterate here that it is our policy to make certain, to the maximum extent possible, that the direct PE inputs used in the PE RVU calculation actually reflect the typical resources used to provide each service. To the extent that the current PE RVUs are lower than those determined under our previous methodology, the difference is likely attributable to a previous PE RVU that was based on charges that overvalued the service. Because the current methodology uses the direct PE inputs that are inherent and typical to each procedure, the resulting PE RVUs more accurately reflect the resources that are used to provide the service.
                    </P>
                    <P>
                        <E T="03">Comment:</E>
                         One commenter explained that, in the CY 2004 PFS final rule, we decided to set the values for the monthly ESRD-related services for home dialysis patients (for example, G0323) at the same rate as the monthly ESRD related services with 2 or 3 visits per month (for example, HCPCS code G0318) to provide an incentive for the increase use of home dialysis (as authorized under 1881(b)(3)(B) of the Act). The commenter notes that the current payment rate for ESRD related services, with 2 or 3 face-to-face visits per month is higher than ESRD related services for home dialysis patients, (due to a difference in PE). As such, the commenter is concerned that the differential in payment rates mitigates the incentives that we previously attempted to establish. The commenter suggested that incentives for using home dialysis should be strengthened by using a consistent PE value for MCP codes G0323 and G0318. However, the commenter prefers that we establish a new payment rate for the monthly management of home dialysis patients based on the weighted average of the MCP for patients who dialyze in a dialysis center or other outpatient facility.
                    </P>
                    <P>
                        <E T="03">Response:</E>
                         We appreciate the suggestions regarding our payment policy for the monthly management of home dialysis patients. We intend to consider the commenters suggestions as we continue to evaluate payment rates for the monthly management of patients on home dialysis.
                    </P>
                    <NOTE>
                        <HD SOURCE="HED">Note:</HD>
                        <P>We received comments regarding certain items and services that are not germane to the PE RVUs or other components of the PFS. These issues include comments regarding: revisions to the definition of pre-service work and time for certain global services; inadequate pricing of HCPCS code A4562 for pessaries, requests for payment adjustments for certain services under PFS to approximate payment amounts for these services established under OPPS and ASCs, inadequate payment for pharmacy costs and nursing services for drug administration codes, and concerns about the reduction of PE RVUs in the nonfacility setting due to the changes in the PE methodology along with requests to freeze payment amounts at the level of the CY 2006 transitional PE RVUs. Because these comments are outside the scope of the issues raised in the CY 2008 PFS proposed rule, we will not respond to these issues in this final rule with comment period.</P>
                    </NOTE>
                    <HD SOURCE="HD2">B. Geographic Practice Cost Indices (GPCIs)</HD>
                    <P>We are required by section 1848(e)(1)(A) and (C) of the Act to develop separate Geographic Practice Cost Indices (GPCIs) to measure resource cost differences among localities; and to review and, if necessary, adjust the GPCIs at least every 3 years. In the CY 2008 PFS proposed rule, we published the proposed GPCIs for CY 2008 in Addendum E, noting that the proposed GPCIs do not reflect the 1.000 floor that was in place during CY 2006 and CY 2007. This floor expires as of January 1, 2008 in accordance with section 102 of the MIEA-TRHCA.</P>
                    <P>
                        In developing a GPCI, section 1848(e)(1)(A)(i) and (ii) of the Act require that the PE and malpractice (MP) GPCIs reflect the full relative cost difference while section 1848(e)(1)(A)(iii) of the Act requires that the physician work GPCIs reflect only one quarter of the relative cost differences. Section 1848(e)(1)(C) of the Act also specifies that if more than 1 year has elapsed since the last GPCI revision, we must phase in the adjustment over 2 years, applying only one half of any adjustment in each year. All GPCIs are developed through a comparison to a national average for each component, and the RVUs for different services uniformly weight each component.
                        <PRTPAGE P="66244"/>
                    </P>
                    <HD SOURCE="HD3">1. GPCI Update</HD>
                    <P>A detailed description of the methodology used to develop and update the GPCIs can be found in the CY 2004 PFS proposed rule (68 FR 49039, August 15, 2003). There are three components of the GPCIs (physician work, PE, and MP) and each relies on its own data source. </P>
                    <HD SOURCE="HD3">a. Physician Work</HD>
                    <P>The physician work GPCI is developed using the median hourly earnings from the 2000 Census of workers in six professional specialty occupation categories which we use as a proxy for physician wages and calculate to reflect one quarter of the relative cost differences. Physician wages are not included in the occupation categories because Medicare payments are a key determinant of physicians' earnings; therefore, including physician wages in the physician work GPCI would, in effect, make the index dependent upon Medicare payments. The physician work GPCI was updated in 2001, 2003, and 2005 using data from the 2000 Census; the proposed CY 2008 physician work GPCI is also based on the 2000 Census data. Because all updates since 2001 have relied on the 2000 Census data, the changes observed in the physician work GPCI in the update years are due to minor changes in utilization and budget neutrality factors; for CY 2008, Addendum E shows that there have been small changes in the physician work GPCI. Section 102 of the MIEA-TRHCA required application of a 1.000 floor on the work GPCI in payment localities where the work GPCI was less than 1.000. This provision expires on December 31, 2007. The CY 2008 proposed physician work GPCI reflects the removal of this floor. </P>
                    <HD SOURCE="HD3">b. Practice Expense</HD>
                    <P>The PE GPCI is developed from three data sources:</P>
                    <P>
                        (i) 
                        <E T="03">Employee Wages:</E>
                         We use 2000 Census median hourly earnings of four occupation categories. The physician work GPCI was updated in 2001, 2003, and 2005 using data from the 2000 Census.
                    </P>
                    <P>
                        (ii) 
                        <E T="03">Office Rents:</E>
                         We use residential apartment rental data produced annually by the Department of Housing and Urban Development (HUD) as a proxy for physician office rents. In 2001, 2003, and 2005, we used rents in the HUD 40th percentile. For CY 2008, we have calculated the GPCI using rents in the 50th percentile for the physician office rent proxy. We proposed to use the 50th percentile because although HUD generally allows payment for subsidized housing up to the 40th percentile, in some areas it allows payment up to the 50th percentile. We made this change to reflect the trend toward higher rents across the country.
                    </P>
                    <P>Fair Market Rents (FMRs) are gross rent estimates including rent and utilities. HUD calculates the FMRs annually using: (1) Decennial Census data; (2) American Housing Surveys conducted by the Census Bureau for HUD to enable HUD to develop revisions between Census years; and (3) random digit dial surveys to enable HUD to develop gross rent change factors. The American Housing Surveys cover 11 areas annually, rotating among the 44 largest metropolitan areas. The random digit dial component surveys 60 FMR areas annually.</P>
                    <P>The FMR is set as a percentile point in the distribution of rents for standard housing occupied by people who moved within the previous 15 months. The current FMR definition is the 40th percentile rent (the amount below which 40 percent of units are rented). Each year, the 50th percentile rent is also calculated by HUD and available through the HUDUSER Web site.</P>
                    <P>In 2000, HUD changed its FMR policy to increase access to housing for families receiving Section 8 rent subsidy vouchers (65 FR 58870). To do so, HUD increased FMRs from the 40th percentile to the 50th percentile in areas where subsidized families were highly concentrated in certain census tracts, given evidence that affordable housing was not well distributed. Only metropolitan areas with more than 100 census tracts are considered for possible increase to the 50th percentile rent. FMRs can be moved from 40th to 50th percentile or back from 50th to 40th percentile.</P>
                    <P>In the case of the office rent index for the PE GPCI, FMRs have been used to capture geographic differences in rental costs, in the absence of a consistent commercial rent index that covers all metropolitan and nonmetropolitan areas in the U.S. It has been used as a measure of the “average rent” in a market. However, since 2000, the FMRs have been a mixture of the 40th percentile and 50th percentile rents. FMR areas move between the two cutoffs. For example, in California, 9 counties had FMRs set at the 50th percentile in 2004. In 2007, only 2 of these 9 counties were still at the 50th percentile level for the FMR, out of 4 total counties at the 50th percentile level.</P>
                    <P>As described above in this section (and as detailed in 65 FR 58870), the criteria for setting the FMR at the 40th or 50th percentile are based on concentrations of subsidized households. There is no reason to assume that commercial rents would follow the same patterns.</P>
                    <P>Therefore, we believe the 50th percentile, or median, rents calculated by HUD will be a more consistent, fair measure of geographic differences for the purpose of proxying for commercial rents.</P>
                    <P>Rent data produce the most significant changes because they are based on annual changes in HUD rents, and therefore, are more volatile than the wage (Census) data. While it has been suggested that we explore sources of commercial rental data for use in the GPCI, we do not believe there is a national data source better than the HUD data.</P>
                    <P>
                        (iii) 
                        <E T="03">Equipment and Supplies:</E>
                         We assume that items such as medical equipment and supplies have a national market and that input prices do not vary among geographic areas. As mentioned in previous updates, some price differences may exist, but we believe these differences are more likely to be based on volume discounts rather than on geographic market differences. Equipment and supplies are factored into the GPCIs with a component index of 1.000. 
                    </P>
                    <HD SOURCE="HD3">c. Malpractice</HD>
                    <P>The MP GPCI is calculated based on insurer rate filings of premium data for a $1 million to $3 million mature “claims made” policy along with premium or surcharge data for mandatory patient compensation funds (PCFs). The MP GPCI is the most volatile of the GPCIs. This GPCI was updated in 2001 and 2003 as scheduled with the physician work and PE GPCIs; but, there was an unscheduled update of the MP GPCI in 2004 (68 FR 49043) to reflect increases in MP premiums nationwide. The proposed CY 2008 MP update reflects the most recent premium data available. The physician work and PE GPCIs are being updated at the same time.</P>
                    <P>We received the following comments about our proposed GPCIs:</P>
                    <P>
                        <E T="03">Comment:</E>
                         We received several comments expressing the concern that San Benito County in California was placed in the wrong payment locality.
                    </P>
                    <P>
                        <E T="03">Response:</E>
                         In 2003, the U.S. Census Bureau moved San Benito County from the Rest of State Census category and placed it in the San Jose MSA. Our data and methodology do not accommodate mid-decennial changes in Census data, and therefore, our 2008 update reflects that San Benito County remains in the Rest of California payment locality.
                        <PRTPAGE P="66245"/>
                    </P>
                    <P>
                        <E T="03">Comment:</E>
                         We received several comments about the PE GPCI for Santa Clara County, California. In the proposed rule, the PE GPCI was lower for Santa Clara than it has been in previous years and commenters were concerned about why this happened.
                    </P>
                    <P>
                        <E T="03">Response:</E>
                         We recognize that there was a decrease in the proposed Santa Clara County PE GPCI. We have studied this issue including examining both the source data and the methodology for obtaining the PE GPCI in case there was a mistake in the proposed values. However, a close examination of the data showed that the GPCI is accurate and reflects a decrease in the value of HUD rentals in Santa Clara County.
                    </P>
                    <P>
                        <E T="03">Comment:</E>
                         One commenter suggested that a GPCI adjustment should not be applied to physician work, or that the physician work GPCI should be 1.000 for all localities.
                    </P>
                    <P>
                        <E T="03">Response:</E>
                         We are required to apply a GPCI adjustment to physician work in accordance with section 1848(e) of the Act. Therefore, we will continue to apply the physician work GPCI.
                    </P>
                    <P>
                        <E T="03">Comment:</E>
                         We received several comments suggesting that the PE GPCI is inaccurate due to our continued use of HUD rental data as a proxy for medical office space.
                    </P>
                    <P>
                        <E T="03">Response:</E>
                         Because Medicare is a national program, we believe it is important to use the best data that is available on a nationwide basis. We believe the HUD rental data is the most comprehensive and valid indicator of the national real estate rental market that is available. Additionally, as we stated most recently in the CY 2007 PFS final rule with comment period (71 FR 69656), we believe the HUD rental data remains the best data source to fulfill our requirements that the data be available for all areas, be updated annually, and retain consistency area-to-area and year-to-year. In the past, we have had both the GAO and the Research Triangle Institute examine available data sources for use in the PE GPCI, and both have found that available commercial data sets either have insufficient coverage nationally or are developed by suspect methodology. Therefore, we continue to believe the HUD rental data is the best nationally available data source to use as a proxy for physician office rents.
                    </P>
                    <P>
                        <E T="03">Comment:</E>
                         We received several comments suggesting that the GPCIs of Hawaii/Guam and Alaska need to be adjusted to accommodate the higher costs of transportation of supplies and equipment to these localities.
                    </P>
                    <P>
                        <E T="03">Response:</E>
                         The GPCIs are a proxy for costs associated with providing services to beneficiaries, not costs associated with living in a particular place. However, we will consider these comments as we evaluate possible changes to our methodology.
                    </P>
                    <P>
                        <E T="03">Comment:</E>
                         We received comments from the Medicare Payment Advisory Commission (MedPAC) suggesting an alternative method for calculating the PE GPCI. This alternative PE GPCI method excludes cost measures for equipment and supplies.
                    </P>
                    <P>
                        <E T="03">Response:</E>
                         We appreciate MedPAC suggesting an alternative method. We intend to evaluate the suggested change to the PE GPCI methodology and will propose any changes in future rulemaking.
                    </P>
                    <P>We will finalize the GPCIs shown in Addendum E. The GPCI values shown represent the first year of the two-year GPCI update transition and have been budget neutralized to ensure that nationwide total RVUs are not impacted by changes in locality GPCIs. Specifically, this is done by applying a weight that is derived from the difference between payments using the “old” GPCIs and the “new” GPCIs to the proposed GPCIs that insures that total payments would not be different. As we indicated above in this section, there is no 1.000 floor on the physician work GPCI in 2008. The GAFs are shown in Addendum D.</P>
                    <HD SOURCE="HD3">2. Payment Localities</HD>
                    <HD SOURCE="HD3">a. Background</HD>
                    <P>The Medicare statute requires that PFS payments be adjusted for certain differences in the relative costs among areas. The statute requires an adjustment which reflects differences among areas for the relative costs of the mix of goods and services comprising PEs (other than Malpractice expenses) compared to the national average. The statute also requires adjustment for the relative costs of MP expenses among areas compared to the national average. Finally, the statute requires adjustment for one quarter of the difference between the relative value of physicians' work effort among areas and the national average of such work effort.</P>
                    <P>The physician work component represents 52.466 percent of the national average fee schedule payment amount. Thus, the statutory requirement for geographic adjustment of only one-quarter of the differences in the physician work component means that, on average, only 13.117 percentage points of physician work are geographically-adjusted, and, on average 39.349 percentage points of the physician work component are not adjusted and represent a national fee schedule amount.</P>
                    <P>In addition, the PE component represents 43.669 percent of the national average fee schedule payment amount. PEs are comprised of nonphysician employee compensation, office expenses (including rent), medical equipment, drugs and supplies, and other expenses. As explained above in this section, we do not make a geographic adjustment relating to medical equipment, drugs, and supplies because there is a national market for these items. Thus, only the categories of nonphysician employee compensation and rents are geographically adjusted. These categories represent, on average, 30.862 percentage points of the total PE, and 12.807 percentage points of PEs are not geographically-adjusted.</P>
                    <P>In total, more than half (52.156 percent) of the average PFS amount is a national payment that is the same in all areas of the country; that is, 52.156 percent of the average fee is not geographically-adjusted.</P>
                    <P>There are two additional points about the geographic indices that are important to note. First, as described above in this section, the data used to measure cost differences among localities are proxies for physician work, employee compensation and office rents. That is, wage data for various categories of employees are used to proxy the actual wages of physician employees. Second, the data used for such proxies are based on actual Census data only for a limited number of counties. The geographic adjustment factors (GAFs) for more than 90 percent of counties are developed using proxies based on larger geographic areas (for example, data for all rural areas in a State are combined and used to proxy the values for each rural county in a State). This aggregation is necessary for areas where country level data are not available. Thus, the underlying data are proxies for actual costs, and the resulting GPCIs do not measure perfectly the cost differences among localities.</P>
                    <P>Currently, there are 89 Medicare physician payment localities to which GPCIs are applied. The payment locality structure under the PFS was established in 1996 and took effect January 1, 1997. The development of this structure is described in detail in both the CY 1997 PFS proposed (61 FR 34615) and final rules (61 FR 59494).</P>
                    <HD SOURCE="HD3">b. Revision of Payment Localities</HD>
                    <P>
                        Over time, changing demographics and local economic conditions may lead to increased variations in practice costs within payment locality boundaries. We are concerned about the potential impact of these variations and have 
                        <PRTPAGE P="66246"/>
                        been studying this issue and potential alternatives for a number of years. However, because changes to the GPCIs must be applied in a budget neutral manner (and under the current locality system, budget neutrality results in aggregate payments within each State remaining the same), there are significant redistributive effects to any change. Therefore, we are also concerned about the potential impact of locality revisions.
                    </P>
                    <P>For the past several years, we have been involved in discussions with California physicians and their representatives about recent shifts in relative demographics and economic conditions among a number of counties within the current California payment locality structure.</P>
                    <P>The California Medical Association (CMA) suggested that we use our demonstration authority to adopt an alternative locality configuration and avoid certain redistributive effects, but such an approach was not feasible (as discussed in the CY 2005 PFS final rule with comment period (70 FR 70151)). In the CY 2006 PFS proposed rule (70 FR 45784), we proposed to remove two counties from the “Rest of California” payment locality and create a new payment locality for each county. These two counties were the ones with the largest difference between the county and locality GAFs. However, there was much more opposition than support for this proposal, in large part because of its negative effect on payments for the counties that would have remained in the “Rest of California” locality. For example, the CMA commented on this proposal stating, “a nationwide legislative solution that would provide additional funding * * * is the only solution we are supporting at this time.” We did not finalize the proposal and described our reasons in the CY 2006 PFS final rule with comment period (70 FR 70151).</P>
                    <P>As indicated previously, we recognize that changing demographics and local economic conditions may lead to increased variations in practice costs within payment locality boundaries. We are concerned about the potential impact of these variations.</P>
                    <P>In considering potential changes in payment localities, we believe it is important to evaluate both the potential impact of intralocality practice cost variations and the redistributive impacts that would result from any revisions to the localities. We also indicated that we are concerned about the considerable administrative issues in making locality changes, particularly if such changes involve a transition, and if they occur when new GPCI data are being phased-in. As we noted in the response to the June 2007 General Accountability Office report on localities (GAO-07-466), changing localities requires reprogramming systems and extensive provider education, both of which are expensive and burdensome administrative activities that can last for a significant period of time. We receive claims for payment that cross calendar years and carriers must maintain payment files for the 2 different years.</P>
                    <P>In the proposed rule we solicited comments on three possible locality reconfigurations. We indicated that because of the importance of striking an appropriate balance between intralocality variations and redistributive impacts with any such locality revisions, we wanted to be cautious and evaluate the impacts in California before considering applying the policy more broadly in the future.</P>
                    <P>The three options from the proposed rule are described as follows:</P>
                    <P>
                        <E T="03">Option 1:</E>
                         Using the existing locality structure, apply a rule whereby if a county GAF is more than 5 percent greater than the GAF for the locality in which the county resides it would be removed from the current locality. A separate locality would be established for each county that is removed. Based on the new fully phased-in GPCI data (that is, for CY 2009), application of this approach in California would remove three counties (Santa Cruz, Monterey, and Sonoma) from the Rest of California payment locality and Marin county from the Marin/Napa/Solano payment locality and create separate payment localities for each of these four counties.
                    </P>
                    <P>This approach focuses on counties for which there is the biggest difference between the county GAF and the locality GAF.</P>
                    <P>This proposal is similar to the policy we previously proposed in the CY 2006 PFS proposed rule (70 FR 45784) but did not adopt to address the counties with GAFs that are most different from their current locality designation. Implementation of this option would lead to an increase in payment of 7.6 percent for Santa Cruz County (and average increase of 5 percent for the other counties involved) and a decrease in payment of 4.3 percent for Napa and Solano Counties.</P>
                    <P>
                        <E T="03">Option 2:</E>
                         This approach is similar to option 1, but the new localities would be structured differently. We would use the same 5 percent threshold methodology but instead of creating four new localities in which each county becomes its own new locality, the three counties that are removed from the Rest of California locality would become one new locality. Marin County would still be removed from the Marin/Napa/Solano locality to become its own locality. Application of this approach would remove three counties (Santa Cruz, Sonoma, and Monterey) from the Rest of California payment locality, and Marin County from the existing Marin/Napa/Solano payment locality. This approach groups together counties from the Rest of California locality that have the greatest difference between the county and locality GAF. (This option would lead to an increase of 6 percent for the new 3-county payment locality.) These counties have similar cost structures and grouping them together into one new locality is consistent with our goal of homogeneous resource costs within a locality.
                    </P>
                    <P>
                        <E T="03">Option 3:</E>
                         Apply a methodology similar to that used in the 1997 locality revisions (61 FR 59495), but applied at the county level rather than the “existing locality” level. That is, we sorted the counties by descending GAFs and compared the highest county to the second highest. If the difference is less than 5 percent, the counties were included in the same locality. The third highest is then compared to the highest county GAF. This process continues until a county has a GAF difference that is more than 5 percent. When this occurs, that county becomes the highest county in a new payment locality and the process is repeated for all counties in the State. This approach would group counties within a State into localities based on similarity of GAFs even if the counties were not geographically contiguous.
                    </P>
                    <P>This organizes payment localities based on costs, which would reduce the number of payment localities in California from 9 to 6 localities. This option alleviates the greatest variations in cost between counties in California. This proposal is unique in that the new localities are not contiguous. Currently, all localities encompass adjacent geographic areas.</P>
                    <P>The impacts associated with this option are significant. Depending on the tier, changes could reflect increases of as much as 7.6 percent or decreases of as much as 7.3 percent.</P>
                    <P>We received numerous comments on these options as discussed below:</P>
                    <P>We received similar comments from a number of individuals, State and local medical societies, and organizations, including the California Medical Association, on several significant issues and are addressing these together:</P>
                    <P>
                        <E T="03">Comment:</E>
                         Santa Cruz County should be removed from the Rest of California payment locality due to its higher costs.
                    </P>
                    <P>
                        <E T="03">Response:</E>
                         We recognize that Santa Cruz County has higher costs than other 
                        <PRTPAGE P="66247"/>
                        counties within the Rest of California locality, and the methodologies we presented in each of the options would result in Santa Cruz County being removed from the Rest of California payment locality.
                    </P>
                    <P>
                        <E T="03">Comment:</E>
                         Many commenters were concerned about the description of the methodology used for Options 1 and 2. Specifically, these comments directed us to adopt a methodology suggested by the California Medical Association. The methodology compares the highest GAF county to the weighted average (GAF) of the remaining counties of the locality.
                    </P>
                    <P>
                        <E T="03">Response:</E>
                         To clarify, the methodology we used identified counties where the county GAF was at least 5 percent higher than the GAF of the locality and then we either left that county as a payment locality itself or joined it with other counties into a payment locality. In Option 1, each of these counties became a separate locality; in Option 2, we combined several of these counties into a single payment locality. This approach is not the “iterative methodology” that some commenters suggested we should follow. We recognize that there are alternative methodologies that can be used to consider reconfigurations to locality structures. We will consider the suggestions of the commenters in the future.
                    </P>
                    <P>
                        <E T="03">Comment:</E>
                         There were concerns that combining several counties into a single payment locality in Option 2 was arbitrary and led to lower payments for these counties.
                    </P>
                    <P>
                        <E T="03">Response:</E>
                         As we stated in the proposed rule, there are trade-offs involved in making any changes to localities, and we recognize the importance of trying to achieve a reasonable balance among competing priorities. One of our goals was to keep the number of payment localities manageable. Although we recognize that there are effects on each of the individual counties, combining counties with very similar costs was a reasonable way to meet this goal.
                    </P>
                    <P>
                        <E T="03">Comment:</E>
                         Numerous commenters from California recommended that we implement Option 3 but suggested that we erred in describing the methodology used in the development of Table 9 of the proposed rule and recommended that if we implement it, we should use their suggested methodology. Commenters suggested that we really meant to insert a hierarchical approach and discussed how these are both acceptable ways to accomplish the restructuring of the counties. Other State societies expressed interest in this option as long as we use the alternative methodology suggested by the California commenters.
                    </P>
                    <P>
                        <E T="03">Response:</E>
                         In Option 3 in the proposed rule, we ranked the counties by GAF from highest to lowest. We then combined into a new payment locality the county with the highest GAF and the other counties that have a GAF within 5 percent of the highest GAF county. Then, we found the county with the highest GAF among the remaining counties. We combined that county and all the counties that have a GAF within 5 percent of the new highest GAF county into a payment locality. We continued this method until all counties were included in a locality. As previously mentioned, there are multiple approaches to reconfiguring the localities that result in similar outcomes. We will further study the suggestions provided by the commenters.
                    </P>
                    <P>
                        <E T="03">Comment:</E>
                         We received a number of comments requesting that we provide a wide variety of data, at the county level, from numerous sources covering the years 1999 through 2006.
                    </P>
                    <P>
                        <E T="03">Response:</E>
                         We believe we provided commenters sufficient information to fairly evaluate our proposals. We note that many of these requests involved county level data. There is very little county level data available nationwide. Most of our data sources are collected at the MSA or Consolidated MSA, or Non-Metropolitan Area level, and our methodology was designed to be used to develop GPCIs within a payment locality analysis, not a county level analysis. We do our best to provide requestors with sources for publicly available data and to provide any other data that is requested of CMS. However, we often simply do not have data available at other than the locality level.
                    </P>
                    <P>
                        <E T="03">Comment:</E>
                         Several commenters are concerned that the data used to develop the latest GPCI update are out of date or inaccurate.
                    </P>
                    <P>
                        <E T="03">Response:</E>
                         We used the most up-to-date data available for the GPCIs used in the calculation of the proposed options. Descriptions of the data sources we use can be found in previous regulations (69 FR 66261) but we will reiterate them here. For the physician work GPCI, we use data files from the latest decennial census (currently 2000) supplied to CMS by the Census Bureau. These data are available to any individual or group interested in obtaining them from the Census Bureau. Data for the rental portion of the PE GPCI update come from HUD rental files, and these data are available online to anyone wishing to obtain them. Wage data for the PE GPCI come from the 2000 Census files which are available from the Census Bureau. Data for the malpractice GPCI come from premium data that are filed by companies writing Professional Liability Insurance in each state. These filings are provided, upon request by our contractor, to CMS by each State Department of Insurance. Our latest update covers premium data for 2004, 2005 and 2006.
                    </P>
                    <P>
                        <E T="03">Comment:</E>
                         We received comments from certain physicians in Ohio requesting that we examine Ohio for a possible change in the current Statewide payment locality.
                    </P>
                    <P>
                        <E T="03">Response:</E>
                         We are currently examining alternatives to the current locality structure. As a part of our study we will revisit Statewide localities to determine if revisions are appropriate.
                    </P>
                    <P>
                        <E T="03">Comment:</E>
                         We received a number of comments from ambulance suppliers throughout the mid-West requesting that we make no changes that would have a negative impact on the GPCIs in rural areas. Other commenters expressed similar concerns about the impact of locality changes on rural physicians and beneficiaries.
                    </P>
                    <P>
                        <E T="03">Response:</E>
                         The vulnerability of rural areas to decreases in relative payments as a result of locality revisions is an issue that is of considerable concern to us and something we take very seriously. However, as previously noted we must find an acceptable balance between the multiple competing concerns when making changes in localities in order to best meet the needs of the entire program and this generally cannot be done without having any impact on rural areas.
                    </P>
                    <P>
                        <E T="03">Comment:</E>
                         MedPAC provided comments outlining two possible mechanisms for developing changes in the payment localities of the States. These methods are similar but differ in that one method begins at the locality level and the other starts with MSA level data. MedPAC also suggests that we determine whether those States that are currently single payment localities wish to remain single payment localities.
                    </P>
                    <P>
                        <E T="03">Response:</E>
                         As always, we value the input of MedPAC and we intend to analyze their suggested methods carefully as we discuss possible national policy changes.
                    </P>
                    <P>
                        <E T="03">Comment:</E>
                         Comments regarding changes in the payment localities in California were universally accompanied with a belief that we should implement these changes, without decreasing payments to any counties.
                    </P>
                    <P>
                        <E T="03">Response:</E>
                         We understand the desire to avoid the negative impact implementing any of these options might have on certain areas. However, 
                        <PRTPAGE P="66248"/>
                        the statute requires that geographic adjustments be established based upon an index of costs that is tied to national averages. As a result, when the average increases in one locality because of the addition of a higher cost county, the average in the locality that previously contained the higher cost county will necessarily decrease. Any changes in localities will necessarily produce changes in the underlying GPCIs, and we have no authority to assign or retain GPCIs that do not represent the actual values for a locality.
                    </P>
                    <P>
                        <E T="03">Comment:</E>
                         Many commenters suggested that we consider a national solution to payment locality structure problems, not focus on a single state.
                    </P>
                    <P>
                        <E T="03">Response:</E>
                         Our proposals attempted to address locality issues in an area of the country where the incongruity of certain GAFs within localities is particularly evident. In addition, these issues have been brought to our attention regularly over the past several years, and the California Medical Association has demonstrated its desire and willingness to work with us to develop ideas for resolving them. We viewed these proposals relating only to California as a starting point and, as we indicated in the proposed rule, we would consider applying any changes to additional States in the future.
                    </P>
                    <P>
                        <E T="03">Decision:</E>
                         We appreciate the thoughtful comments we received in response to the three options we included in the proposed rule. As mentioned above, we recognize that changing the locality structure is a complex undertaking and there are competing concerns, including budget neutrality that results in payments in certain areas decreasing whenever payments in other areas are increased, that must be carefully balanced to achieve the most appropriate results. Historically, to help us find the best balance in a particular state, we have looked to State medical societies to work with us to provide leadership and support on preferred approaches to locality reconfiguration in that particular State.
                    </P>
                    <P>The comments we received from California physicians, including the California Medical Association's indication that it does not support any of the options, and interested parties from other States have convinced us that this issue requires further study and analysis. Therefore, we will not be finalizing any of the three proposed options in this rule. Commenters have suggested some other methodologies that we find worthy of further exploration, including the use of Metropolitan Statistical Areas (MSAs). We do not necessarily believe that the county is the appropriate geographic unit on which we should be focusing for locality revisions. Commenters also made strong arguments for why any locality reconfiguration should be done on a nationwide basis and not just one State at a time. Therefore, we intend to conduct a thorough analysis of approaches to reconfiguring localities and will address this issue again in future rulemaking.</P>
                    <HD SOURCE="HD1">C. Malpractice RVUs (TC/PC Issue)</HD>
                    <P>In the CY 2008 PFS proposed rule (72 FR 38142), we included a discussion about the radiology codes for which the technical component malpractice RVUs are higher than the professional component malpractice RVUs. In the past, several organizations have requested that we examine these codes and make changes to this assignment of malpractice RVUs. We asked for information about how we could address this issue and obtain data on malpractice costs associated with these radiology codes.</P>
                    <P>We received the following comments on this issue.</P>
                    <P>
                        <E T="03">Comment:</E>
                         The Professional Liability Insurance (PLI) workgroup of the AMA/Specialty Society RVU update committee (RUC) supported by several other organizations recommended that we reduce the PLI technical component for these codes to zero. They suggest that there are no identifiable separate costs for professional liability for technical components. They also recommend that the PLI RVUs be redistributed across all physicians' services. The RUC is concerned that the Deficit Reduction Act of 2005 (Pub. L. 109-171) (DRA) cap on the TC payment for imaging services will remove an estimated $200 million from the Part B pool (as a result of the exemption of the reduced expenditures from the budget neutrality requirement at section 1848(c)(2)(B)(v)). The RUC believes that making the recommended changes will keep money that would be lost due to the DRA cap in the Part B pool. The RUC wants CMS to implement this change immediately and consider other changes to the PLI RVU assignment later.
                    </P>
                    <P>
                        <E T="03">Response:</E>
                         In the CY 2008 PFS proposed rule, we explained that these codes had not been reviewed due to a lack of suitable data on the cost of PLI for technical staff or imaging centers. The RUC believes that no such data are available because there are no identifiable separate costs. At this point in time, we are not able to evaluate whether sufficient data exists or to make a judgment on the RUC's assertion that such data are not available because there are no identifiable costs. We will continue to explore possible sources of information about these costs. We made no proposal regarding malpractice RVU assignment and we are still considering possible changes. If we identify in the future what we believe is a more appropriate way to pay for these services, we will propose changes through notice and comment rulemaking.
                    </P>
                    <P>
                        <E T="03">Comment:</E>
                         Some commenters stated that the malpractice RVUs in the technical component should not be zero. These commenters suggested that we either “flip” the malpractice RVU assignment between the professional and technical components or make them equal.
                    </P>
                    <P>
                        <E T="03">Response:</E>
                         As we stated in the CY 2008 PFS proposed rule, we do not believe it would be appropriate to “flip” the PC and TC RVU values because the professional part of the MP RVUs has undergone a resource based review, is derived from actual data, and is consistent with the resource based methodology for PFS payments. Further, we will not simply equalize the PC and TC RVU values because at this time we have no data to demonstrate that the malpractice costs for the technical portion of these services are the same as the professional portion. We will continue to study this issue and will propose any changes in future rulemaking.
                    </P>
                    <P>
                        <E T="03">Comment:</E>
                         We received several comments recommending that we make the PLI RVUs resource based for all codes and that we should continue to collect and analyze appropriate malpractice premium data before making changes to the RVU assignment.
                    </P>
                    <P>
                        <E T="03">Response:</E>
                         We will continue to solicit, collect, and analyze appropriate data on this subject. Once we have sufficient information, we will be better able to make a determination as to what, if any, changes should be made, and we will propose any changes in future rulemaking.
                    </P>
                    <HD SOURCE="HD2">D. Medicare Telehealth Services</HD>
                    <HD SOURCE="HD3">1. Requests for Adding Services to the List of Medicare Telehealth Services</HD>
                    <P>
                        As discussed in the CY 2008 PFS proposed rule (72 FR 38143), section 1834(m)(4)(F) of the Act defines telehealth services as professional consultations, office visits, and office psychiatry services, and any additional service specified by the Secretary. In addition, the statute required us to establish a process for adding services to or deleting services from the list of telehealth services on an annual basis.
                        <PRTPAGE P="66249"/>
                    </P>
                    <P>In the CY 2003 PFS final rule with comment period (67 FR 79988), we established a process for adding services to or deleting services from the list of Medicare telehealth services. This process provides the public an ongoing opportunity to submit requests for adding services. We assign any request to make additions to the list of Medicare telehealth services to one of the following categories:</P>
                    <P>• Category #1: Services that are similar to office and other outpatient visits, consultation, and office psychiatry services. In reviewing these requests, we look for similarities between the proposed and existing telehealth services for the roles of, and interactions among, the beneficiary, the physician (or other practitioner) at the distant site and, if necessary, the telepresenter. We also look for similarities in the telecommunications system used to deliver the proposed service, for example, the use of interactive audio and video equipment.</P>
                    <P>• Category #2: Services that are not similar to the current list of telehealth services. Our review of these requests includes an assessment of whether the use of a telecommunications system to deliver the service produces similar diagnostic findings or therapeutic interventions as compared with the face-to-face “hands on” delivery of the same service. Requestors should submit evidence showing that the use of a telecommunications system does not affect the diagnosis or treatment plan as compared to a face-to-face delivery of the requested service.</P>
                    <P>Since establishing the process, we have added the following to the list of Medicare telehealth services: psychiatric diagnostic interview examination; ESRD services furnished under the monthly capitation payment (MCP) with two to three visits per month and four or more visits per month (although we require at least one visit a month, in person “hands on”, by a physician, Certified Nurse Specialist, NP, or PA to examine the vascular access site); and individual medical nutrition therapy.</P>
                    <P>
                        Requests to add services to the list of Medicare telehealth services must be submitted and received no later than December 31 of each calendar year to be considered for the next rulemaking cycle. For example, requests submitted before the end of CY 2006 are considered for the CY 2008 proposed rule. For more information on submitting a request for an addition to the list of Medicare telehealth services, visit our Web site at 
                        <E T="03">www.cms.hhs.gov/telehealth/</E>
                        .
                    </P>
                    <P>We received the following requests for additional approved services in CY 2006: (1) Subsequent hospital care (as represented by HCPCS codes 99231 through 99233); (2) neurobehavioral status exam (HCPCS code 96116); and (3) neuropsychological testing (HCPCS codes 96118 through 96120).</P>
                    <P>After reviewing the public requests, we proposed to add neurobehavioral status exam as described by HCPCS code 96116 to the list of Medicare telehealth services in the CY 2008 PFS proposed rule. We also proposed to revise § 410.78 and § 414.65 to include neurobehavioral status exam as a Medicare telehealth service. We did not propose to add subsequent hospital care or neuropsychological testing but requested comments as to how we could determine when subsequent hospital care is actually a follow-up inpatient consultation and specific information on neuropsychological testing. For further information on our proposals, see the CY 2008 PFS proposed rule (72 FR 38143).</P>
                    <HD SOURCE="HD2">Subsequent Hospital Care</HD>
                    <P>The following is a summary of the comments we received regarding subsequent hospital care.</P>
                    <P>
                        <E T="03">Comment:</E>
                         We received two comments regarding the conditions (or requirements) we could apply to subsequent hospital care so that subsequent hospital care reflects a follow-up inpatient consultation. One commenter suggested that follow-up inpatient consultation should be approved as a telehealth service only if the initial inpatient consultation was performed via telehealth. The commenter does not believe we should approve a follow-up inpatient consultation for telehealth if the initial inpatient consultation was furnished in-person (because it might lead to a reduction in follow-up consultations furnished face-to-face). The commenter also agreed with our proposal not to approve subsequent hospital care for telehealth. Another commenter noted that follow-up inpatient consultation was previously on the list of Medicare telehealth services and asserts that the AMA's deletion of follow-up inpatient consultation (as described by CPT codes 99261 through 99263) created the need to approve the addition of subsequent hospital care to the list of Medicare telehealth services when used for follow-up inpatient consultation care. The commenter suggested that we create a special modifier to report follow-up inpatient consultation via telehealth.
                    </P>
                    <P>
                        <E T="03">Response:</E>
                         We appreciate the comments on the conditions (or requirements) we could apply to subsequent hospital care so that subsequent hospital care reflects a follow-up inpatient consultation. We intend to consider the suggestions raised by the commenters as we continue to evaluate whether subsequent hospital care should be approved for telehealth when it is used to furnish a follow-up inpatient consultation. With regard to the commenter who suggested the creation of a special modifier, we will assess whether it would be appropriate to use a modifier(s) to identify when a subsequent hospital care service is actually a follow-up inpatient consultation.
                    </P>
                    <P>
                        <E T="03">Comment:</E>
                         One commenter who supports approving subsequent hospital care for telehealth explained that recruiting specialists to North and South Dakota is difficult and that telehealth has helped hospital inpatients in these States to obtain access to various types of specialty care including pulmonology, endocrinology, pediatric gastroenterology, pediatric cardiology, and infectious disease specialties. The commenter also mentioned that inpatient consultations are frequently provided by infectious disease specialists for patients in the intensive care unit (ICU) and explained that once the patient has made progress and is moved from the ICU, the infectious disease specialist at the distant site continues to “follow” the patient until the patient is discharged from the hospital. The commenter recognized that access to on-going specialty care for outpatients is important but believes that obtaining access to specialty subsequent inpatient “follow-up” care is even more critical. Commenters submitted a comparative study between subsequent hospital care furnished as a telehealth service and furnished in-person.
                    </P>
                    <P>
                        <E T="03">Response:</E>
                         As discussed in the CY 2008 PFS proposed rule, given the potential acuity level of the patient in the hospital setting, we believe that many services furnished within the scope of the subsequent hospital service codes are not similar to the current telehealth services. As such, we indicated that subsequent hospital care is a category 2 service (which requires sufficient comparative analyses before approving it for telehealth). The commenters did submit one comparative analysis between subsequent hospital care furnished as a telehealth service and subsequent hospital care furnished in-person. However, the study submitted involved only continuing specialist care (for one specialty), not continuing inpatient care by the primary attending physician. In 
                        <PRTPAGE P="66250"/>
                        addition, the sample size was extremely small. Thus, the study findings are not generalizable.
                    </P>
                    <P>As such, we continue to have concerns about using a telecommunications system as a substitute for the on-going, day-to-day (in-person) evaluation and management of a hospital inpatient and believe further study is necessary. In the absence of sufficient, well-designed comparison studies showing that the use of a telecommunications system is an adequate substitute for the in-person delivery of subsequent hospital care, we are not adding subsequent hospital care to the list of Medicare telehealth services. As discussed above in this response, we will work with the industry organizations and groups to learn more about hospital care as a telehealth service when it is used for follow-up inpatient consultations.</P>
                    <P>
                        <E T="03">Comment:</E>
                         One commenter (who submitted the request to approve subsequent hospital care for telehealth) stated that the original request to add subsequent hospital care to the list of Medicare telehealth services was a request to “re-establish” subsequent inpatient visits (as a Medicare telehealth service). The commenter described two scenarios in which subsequent hospital care could be furnished as a telehealth service. The first scenario would involve a specialty physician who furnishes an inpatient consultation as a telehealth service (as requested by the attending physician). The second scenario involves an attending or admitting physician who furnishes initial hospital care in-person (not as telehealth) and provides subsequent hospital care as a telehealth service. The commenter believes that access to telehealth care is better than not having access to any care and that studies have shown that telehealth care provides better clinical outcomes than no care at all. Additionally, the commenter asserts that tertiary care trauma surgeons, neurologists (for initial and follow-up stroke evaluation), psychiatrists (for initial assessment and prescriptive safety orders), infectious disease physicians, and cardiologists can be made available through telehealth when these specialties are not available on-site. The commenter believes that not approving subsequent hospital care for telehealth will severely hinder access to specialty care in the inpatient hospital setting and will lead to grave consequences for patients when no specialists are available on-site (at the hospital).
                    </P>
                    <P>
                        <E T="03">Response:</E>
                         We agree that telehealth services may help provide greater access to specialty care, and therefore, better clinical outcomes where a shortage of medical professionals exist (or in situations when no care is available). As discussed in the CY 2008 PFS proposed rule, we are considering approving subsequent hospital care for telehealth when it is used for follow-up inpatient consultation. We believe that permitting follow-up inpatient consultations via telehealth will help provide greater access to specialty care in the inpatient hospital setting.
                    </P>
                    <P>Additionally, we note that, contrary to the commenter's assertion, subsequent inpatient hospital visits were not previously on the list of Medicare telehealth services. As mentioned by a previous commenter, the AMA deleted the codes for follow-up inpatient consultation (as described by CPT codes 99261 through 99263). Effective January 1, 2006, these CPT codes no longer exist and were removed from the PFS, and a conforming change was made to the list of Medicare telehealth services. Prior to January 1, 2006, the physician (or practitioner) at the distant site could have used these CPT codes to bill for follow-up inpatient consultations as a telehealth service. However, subsequent inpatient hospital visits were not on the list of Medicare telehealth services.</P>
                    <P>
                        <E T="03">Comment:</E>
                         One commenter cited the concerns we raised in the proposed rule regarding the acuity level of a hospital inpatient and the use of a telecommunications system to furnish on going evaluation and management services in the inpatient hospital setting. The commenter believes that patients in the emergency department typically have a higher acuity level, are in a more precarious physical state (as compared to a hospital inpatient) and may not have a diagnosis. The commenter explains that hospitalized patients have already been seen and admitted by a physician on site and have at least a preliminary diagnosis. Despite the higher acuity level of a patient in the emergency department, the commenter asserts that we reimburse for telehealth care in the emergency department (but not for inpatients).
                    </P>
                    <P>Additionally, the commenter discussed various scenarios involving the examination of acute stroke patients via telehealth in the emergency room and ICU. For example, the commenter provided a summary of a study that tested whether the use of an audio and video multimedia telecommunications system is a feasible and reliable means for delivering emergency stroke care (using the National Institute of Health Stroke Scale). This study concluded that “remote examination of acute stroke patients with a computer based telesupport system is feasible and reliable when applied in the emergency room”. The commenter also explained how telehealth is being used to provide 24 hour access to acute stroke care expertise for a number of hospitals in Massachusetts and that similar programs are being established throughout the United States, Canada, the United Kingdom, Scandinavia, and other parts of the world. The commenter also provided a discussion of a study that examined the fiscal impact of providing telehealth consultation (for acutely ill and injured children in the ICU) on rural hospitals. The study found that as a result of greater access to pediatric consultations, savings are realized from a reduction in patient transfers (to larger hospitals) and increased revenue for rural hospitals.</P>
                    <P>
                        <E T="03">Response:</E>
                         We appreciate the information the commenter has submitted on the remote evaluation of stroke patients and pediatric telehealth consultations in the emergency department or ICU. We intend to consider this information as we evaluate whether to approve subsequent hospital care for telehealth when it is used for follow up inpatient consultation. We would also mention that the nature of the comment indicates a misconception that we pay for emergency department services as a telehealth service. We note that only outpatient consultations (not visits) are approved as a Medicare telehealth service for a patient in the emergency department. If guidance or advice is needed in the emergency department (for example, for acute stroke care), an outpatient consultation may be requested from an appropriate source and may be furnished as a telehealth service. However, emergency department services (as described by CPT codes 99281 through 99285) are not on the list of Medicare telehealth services.
                    </P>
                    <P>
                        <E T="03">Comment:</E>
                         One commenter mentioned that we previously approved the psychiatric diagnostic interview examination and subsequent ESRD related visits furnished under the monthly capitation payment (MCP) for telehealth without comparative analyses and data showing patient satisfaction (which implies that subsequent hospital care could be approved for telehealth on the same basis). The commenter also cited the proposed regulatory impact analysis for telehealth stating that previous additions to the list of Medicare telehealth services have not resulted in a significant increase in Medicare program expenditures.
                    </P>
                    <P>
                        <E T="03">Response:</E>
                         In approving the psychiatric diagnostic interview examination for telehealth, we considered this service to be comparable 
                        <PRTPAGE P="66251"/>
                        to an initial office visit, or consultation service, which are currently Medicare telehealth services. Likewise, we considered the outpatient dialysis visits furnished under the MCP (except for one visit to examine the vascular access site) to be comparable to office and other outpatient visits currently on the list of Medicare telehealth services. Therefore, we considered these services to be category 1, and therefore, we were able to review and approve them for telehealth without reviewing additional research studies to support their approval. However, as discussed above in this section, because of the potential acuity of a hospital inpatient, we were not able to conclude that the entire scope of services described by the subsequent hospital care codes is similar to the existing list of telehealth services (for example, an office visit, office psychology service, or consultation). Therefore, we considered subsequent hospital care to be a category 2 service (which requires sufficient comparative analyses before approving for telehealth).
                    </P>
                    <P>For more information on the addition of the psychiatric diagnostic interview examination see the CY 2003 PFS proposed rule (67 FR 43863). For more information on the addition of ESRD-related visits furnished under the MCP, see the CY 2005 PFS proposed rule (69 FR 47511).</P>
                    <HD SOURCE="HD2">Neurobehavioral Status Exam</HD>
                    <P>
                        <E T="03">Comment:</E>
                         Several commenters expressed support for our proposal to add the neurobehavioral status exam to the list of Medicare telehealth services. Commenters agreed that because the neurobehavioral status exam is primarily a clinical interview (similar to the psychiatric diagnostic interview which is currently a Medicare telehealth service), it is logical and consistent to approve this service for telehealth.
                    </P>
                    <P>
                        <E T="03">Response:</E>
                         We agree with the commenters. As discussed in the proposed rule, the neurobehavioral status exam is furnished by a physician or psychologist and includes an initial assessment and evaluation of mental status for a psychiatric patient. In this regard, we believe the neurobehavioral status exam is similar to psychiatric diagnostic interview examination (which is currently approved as a Medicare telehealth service).
                    </P>
                    <P>
                        <E T="03">Comment:</E>
                         One commenter who supported our proposal to approve the neurobehavioral status exam for telehealth, stated that HCPCS code 96116 is a new code that replaced HCPCS code 96115 (the predecessor to HCPCS code 96116) in the 2006 CPT compendia. The commenter believes that neurobehavioral status exam (as described by HCPCS code 96115) was previously on the list of Medicare telehealth services and considers our proposal to add neurobehavioral status exam (as described by CPT code 96116) to be a restoration of the neurobehavioral status exam as a telehealth service.
                    </P>
                    <P>
                        <E T="03">Response:</E>
                         The commenter's assertion that our proposal to add the neurobehavioral status exam to the list of Medicare telehealth services is a restoration of the neurobehavioral status exam as a telehealth service is not correct. The neurobehavioral status exam (as previously described by CPT code 96115) was not on the list of Medicare telehealth services. The proposed addition of neurobehavioral status exam is a new proposal.
                    </P>
                    <P>
                        <E T="03">Comment:</E>
                         One commenter stated that the neurobehavioral status exam appears to require that the service be provided face to face (in person). Therefore, the commenter requested us to clarify that face to face services may qualify as telehealth services.
                    </P>
                    <P>
                        <E T="03">Response:</E>
                         As discussed in the CY 2005 PFS final rule with comment period, only services that traditionally require a face-to-face (in-person) physician or practitioner encounter are candidates for the list of Medicare telehealth services. Services not requiring a face-to-face encounter with the patient that may be furnished through the use of a telecommunications system are already covered under Medicare. For more information see the CY 2005 PFS final rule (69 FR 66278).
                    </P>
                    <HD SOURCE="HD2">Neuropsychological Testing</HD>
                    <P>
                        <E T="03">Comment:</E>
                         We received conflicting comments regarding neuropsychological testing. For example, one commenter agreed with the requestor that neuropsychological testing furnished via telehealth is not significantly different from being furnished in-person (especially when administered by a computer). Additionally, the commenter stated that existing telehealth services for psychiatric patients include office visits, consultation, and office psychiatry. The commenter believes that the patient-provider dynamics of these services would not appear to be so significantly different from those for neuropsychological testing as to justify not approving the services for telehealth. The commenter also believes that testing dynamics, such as the patient being blindfolded or having numbers assigned to his or her fingers, could be easily reproduced with the help of someone at the originating site.
                    </P>
                    <P>The same commenter also provided a discussion of the importance of early detection of dementia through neuropsychological testing. The commenter included a letter from the Armed Forces Epidemiological Board about brain injury in military service members with recommendations on handling these injuries. The commenter stated that although the Epidemiological Board addressed military patients, the principles of its findings apply to civilian assessment and treatment of brain injuries; that is, appropriate testing at earlier stages of brain injury or disease is likely to elicit a more accurate patient profile, leading to more targeted interventions and better patient outcomes.</P>
                    <P>In addition, the commenter stated that the administration of neuropsycho-logical testing may be more difficult for some patients than others; however, this is true in both the in-person and telehealth setting. The commenter believes that if the patient requires immediate in-person assistance, a telepresenter could be used to facilitate the testing and that the determination of patient suitability for testing should be up to the physician or practitioner at the distant site. Two commenters agreed that a telepresenter could assist the physician or psychologist at the distant site with the testing and that the physician or psychologist should determine which patients (and tests) are appropriate for telehealth.</P>
                    <P>
                        Another commenter who provides neuropsychological testing via telehealth explained that many standardized neuropsychological tests are available (literally hundreds) to the physician or psychologist (or technician) and that tests vary widely in terms of administrative procedure and the level of interaction between the patient and practitioner responsible for administering the test. The commenter believes that many tests could be effectively administered via telehealth and that it is not appropriate for us to issue a “global denial” of neuropsychological testing. For example, the commenter believes that neuropsychological testing administered via a computer should be approved for telehealth and that testing administered by a physician, psychologist, or qualified technician should be re-evaluated. The commenter also explained that an RN is often used as a telepresenter to assist the neuropsychologist or technician with testing. When testing cannot be administered in a “standardized fashion” via telehealth, a qualified technician could be present on-site with the patient to assist a psychologist who 
                        <PRTPAGE P="66252"/>
                        furnishes the test at the distant site. However, the commenter believes that some testing measures may not be appropriate for telehealth. The commenter estimated that “fewer than 35 percent of the hundreds of available measures do not lend themselves to standardized administration via telehealth”. The commenter also cited the American Psychological Association's Ethical Principles of Psychologists and Code of Conduct and stated these guidelines would prohibit administration of certain individual tests via telehealth.
                    </P>
                    <P>Other commenters believe that further study is necessary. The commenters urged us to seek additional information concerning the provision of neuropsychological testing before making a determination about these services for telehealth. One commenter believes that neuropsychological testing should be considered for telehealth approval stating, “however it is unclear whether the technology has advanced far enough to allow all neuropsychological testing to be provided via telehealth without compromising the quality of care”. Additionally, the commenter stated that more time is needed to assess how neuropsychological testing could be provided via telehealth and listed the following issues that need further consideration:</P>
                    <P>• The variety of disorders and diagnoses appropriate via telehealth;</P>
                    <P>• The physical assistance that patients may need to complete tests; and</P>
                    <P>• The impact of face-to-face interactions with a psychologist or trained psychological technician during testing on the interpretation of test results.</P>
                    <P>
                        <E T="03">Response:</E>
                         We appreciate the comments regarding the use of an interactive audio and video telecommunications system in furnishing neuropsychological testing services. Based on the comments received, we believe that further study is necessary before making a determination about neuropsychological testing for telehealth. As discussed above in this section, we received conflicting comments as to whether the administration of a neuropsychological test could be furnished adequately when the practitioner who is responsible for administering the test is not physically present with the patient.
                    </P>
                    <P>For example, some commenters believe that neuropsychological testing furnished via telehealth is not significantly different than when furnished in-person and that a telepresenter could be used to assist the physician or psychologist at the distant site if necessary. Other commenters believed that further study is necessary before approving neuropsychological testing for telehealth. One commenter believed that it is unclear whether the use of a telecommunications system for administering neuropsychological testing would compromise quality of care and listed specific issues that need greater exploration. Even a commenter who supports approving neuropsychological testing for telehealth indicated that many neuropsychological testing measures would not be appropriate for telehealth. As such, we continue to have concerns about using an interactive audio and video telecommunications system as a substitute for the face-to-face (in-person) requirements of neuropsychological testing.</P>
                    <P>
                        <E T="03">Comment:</E>
                         Two commenters believe that sufficient empirical evidence exists to support the approval of neuropsychological testing for telehealth. The commenters submitted summaries of two comparative analyses between neuropsychological testing furnished via an interactive audio and video telecommunications system and neuropsychological testing furnished in-person.
                    </P>
                    <P>
                        <E T="03">Response:</E>
                         As discussed above in this section, we believe that further study is necessary before approving neuropsychological testing for telehealth. Although the commenters did submit comparative analyses, in one of the studies cited, the same psychologist furnished neuropsychological testing in both conditions (face-to-face and via telehealth). In another study cited, study participants without neuropsychological or psychiatric disturbance were tested. Additionally, the studies cited had extremely small samples. As such, we believe it would be difficult to generalize any findings to a broader population.
                    </P>
                    <P>
                        <E T="03">Comment:</E>
                         One commenter questioned whether the regulatory impact analysis for telehealth was intended to provide a rationale to make reductions in Medicare payment for telehealth services in the future. The commenter urged us to continue to fund a wide variety of telehealth services.
                    </P>
                    <P>
                        <E T="03">Response:</E>
                         The regulatory impact analysis was not intended to be used as a rationale for making reductions in Medicare payment for telehealth services. The intent of the regulatory impact analysis on telehealth was to illustrate that the proposed addition of neurobehavioral status exam to the list of Medicare telehealth services should not have a significant budgetary impact on the Medicare program. For more information on our regulatory impact analysis for the proposed addition of neurobehavioral status exam to the list of Medicare telehealth services, see the CY 2008 PFS proposed rule (72 FR 38216).
                    </P>
                    <P>
                        <E T="03">Comment:</E>
                         One commenter stated that neuropsychological testing is ancillary to a neurobehavioral status exam and that neuropsychological testing would have little additional budgetary impact (beyond the impact of adding neurobehavioral status exam). To support this assertion, the commenter cited our proposed regulatory impact analysis on the addition of neurobehavioral status exam (as described by CPT code 96116).
                    </P>
                    <P>
                        <E T="03">Response:</E>
                         As discussed above in this section, we believe that further study is necessary before approving neuropsychological testing for telehealth.
                    </P>
                    <P>
                        <E T="03">Comment:</E>
                         A few commenters requested that we approve additional services for telehealth (for example, standardized performance testing as described by CPT code 96125).
                    </P>
                    <P>
                        <E T="03">Response:</E>
                         Requests for additions (including any supporting data analyses) should be submitted through our process for adding services and must be received by December 31 of each calendar year to be considered for the next proposed rule. For more information on how to submit a request for addition, please visit our Web site at 
                        <E T="03">http://www.cms.hhs.gov/telehealth.</E>
                    </P>
                    <HD SOURCE="HD2">Results of Evaluation of Comments</HD>
                    <P>We are adding the neurobehavioral status exam as represented by HCPCS code 96116 to the list of Medicare telehealth services. Additionally, we are revising § 410.78 and § 414.65 to include neurobehavioral status exam as a Medicare telehealth service.</P>
                    <P>
                        As discussed above, only services that traditionally require a face-to-face (in person) physician or practitioner encounter are candidates for the list of Medicare telehealth services. Services not requiring a face-to-face encounter with the patient that may be furnished through the use of a telecommunications system are already covered under Medicare. As discussed in chapter 15, section 30 of the Medicare Benefit Policy Manual, payment may be made for physicians' services delivered via a telecommunications system for services that do not require a face-to-face patient encounter. The interpretation of an x-ray, electrocardiogram, electroencephalogram and tissue samples are listed as examples of these services.
                        <PRTPAGE P="66253"/>
                    </P>
                    <P>After further review of the requested services for addition, neuropsychological testing administered by a computer (as described by HCPCS code 96120) is not a candidate for the list of Medicare telehealth services. Neuropsychological testing administered by a computer (HCPCS code 96120) does not require a face-to-face (in person) encounter between the patient and the physician or psychologist (or qualified technician) responsible for the administration and interpretation of the test results (for example, the patient is interfacing with the computer, not a physician or psychologist). As such, a telecommunications system may be used to facilitate neuropsychological testing administered by a computer (as described by HCPCS code 96120); for example, Web-based computer neuropsychological testing, and/or transmission of neuropsychological test results to an interpreting physician or psychologist via telecommunications system.</P>
                    <HD SOURCE="HD2">E. Specific Coding Issues Related to the PFS</HD>
                    <HD SOURCE="HD3">1. Reduction in the Technical Component (TC) for Imaging Services Under the PFS to the Outpatient Department (OPD)</HD>
                    <P>Effective January 1, 2007, section 5102(b)(1) of the Deficit Reduction Act of 2005 (Pub. L. 109-171) (DRA) amended section 1848 of the Act to require that, for imaging services, if— “(i) The technical component (including the technical component portion of a global fee) of the service established for a year under the fee schedule* * * without application of the geographic adjustment factor * * *, exceeds (ii) The Medicare OPD fee schedule amount established under the prospective payment system for hospital outpatient department services* * * for such service for such year, determined without regard to geographic adjustment * * *, the Secretary shall substitute the amount described in clause (ii), adjusted by the geographic adjustment factor [under the PFS], for the fee schedule amount for such technical component for such year.”</P>
                    <P>As required by the statute, for imaging services (described in this section) furnished on or after January 1, 2007, we cap the TC of the PFS payment amount for the year (prior to geographic adjustment) by the Outpatient Prospective Payment System (OPPS) payment amount for the service (prior to geographic adjustment). We then apply the PFS geographic adjustment to the capped payment amount.</P>
                    <P>Section 5102(b)(1) of the DRA defines imaging services as “imaging and computer-assisted imaging services, including X-ray, ultrasound (including echocardiography), nuclear medicine (including PET), magnetic resonance imaging (MRI),computed tomography (CT), and fluoroscopy, but excluding diagnostic and screening mammography.”</P>
                    <P>To apply section 5102(b) of the DRA, we needed to determine the CPT and alpha-numeric HCPCS codes that fall within the scope of “imaging services” defined by the DRA provision. In the CY 2008 PFS proposed rule, we explain in detail the process we used for establishing the list of codes that fall within the scope of this DRA provision. We also stated that upon further review, we have determined that certain ophthalmologic procedures meet the DRA definition of imaging procedures, but were not included in the original list of imaging services subject to the OPPS cap. Therefore, we proposed to add the following procedures to the list of procedures subject to the OPPS cap, effective January 1, 2008: </P>
                    <P>
                        • 92135, 
                        <E T="03">Scanning computerized ophthalmic diagnostic imaging (e.g., scanning laser) with interpretation and report.</E>
                    </P>
                    <P>
                        • 92235, 
                        <E T="03">Fluorscein angioscopy (includes multiframe imaging) with interpretation and report.</E>
                    </P>
                    <P>
                        • 92240, 
                        <E T="03">Indocyanine-green angiography (includes multiframe imaging) with interpretation and report.</E>
                    </P>
                    <P>
                        • 92250, 
                        <E T="03">Fundus photography with interpretation and report.</E>
                    </P>
                    <P>
                        • 92285, 
                        <E T="03">External ocular photography with interpretation and report for documentation of medical progress (e.g., close-up photography, slit lamp photography, goniophotography, stereo-photography).</E>
                    </P>
                    <P>
                        • 92286, 
                        <E T="03">Special anterior segment photography with interpretation and report; with specular endothelial microscopy and cell count.</E>
                    </P>
                    <P>A complete list of CPT codes that identify imaging services as defined by the DRA OPPS cap provision, amended to include these ophthalmologic procedures, was also published in Addendum F of the CY 2008 PFS proposed rule (72 FR 38369 through 38372). Payment for an individual service on this list will only be capped if the PFS TC payment amount exceeds the OPPS payment amount. </P>
                    <P>
                        <E T="03">Comment:</E>
                         Several commenters indicated that none of the six ophthalmologic CPT codes proposed for addition to the list of procedures subject to the OPPS cap meet the statutory definition of imaging under the DRA, that is, none of the procedures codes fall under the categories of x-rays, ultrasound, MRI, PET, CT or fluoroscopy. Specifically, they noted that CPT code 92250 utilizes a wide angle camera used primarily for detecting retinopathy in diabetics. Likewise, CPT codes 92235, 92240, and 92285 are all photos, using photographic equipment, or an angioscope. The commenters concluded that the Congress did not intend for any service that uses a camera or microscope, takes photographs, and produces negatives to be included in the DRA definition of imaging services. 
                    </P>
                    <P>Another commenter indicated that CPT codes 92250 and 92285 do not meet our criterion for including a procedure under the DRA provision, that is, services that provide visual information regarding areas of the body that are not normally visible, thereby assisting in the diagnosis or treatment of injury. The commenter noted that the subject procedures take traditional pictures of parts of the eye that are normally visualized with the naked eye. One commenter noted that the six CPT codes have not experienced dramatic increases in utilization, but rather, utilization has remained stable or decreased. </P>
                    <P>
                        <E T="03">Response:</E>
                         The DRA provision describes imaging services broadly as “imaging and computer-assisted imaging services,” and does not provide for the type of distinctions the commenters suggested. While it specifically includes certain imaging modalities (x-ray, ultrasound, MRI, PET, CT, and fluoroscopy), it does not exclude other imaging modalities. In fact, the DRA provision excludes only one imaging service, that is, diagnostic and screening mammography. Concerning CPT codes 92250 and 92285, we believe the images generated by these services may include information that requires the use of photographic or imaging equipment and is not normally visible by the unaided human eye. Finally, the description of imaging services to which the DRA provision applies is not limited to procedures that have experienced dramatic increases in utilization. We believe the six procedures meet the DRA definition of imagining services and are similar to other procedures already subject to the DRA provision. Therefore, we will include these CPT codes on the list of procedures subject to the OPPS cap. (
                        <E T="04">Note:</E>
                         This list of procedures is published in Addendum F of this final rule with comment period.) 
                    </P>
                    <P>
                        <E T="03">Comment:</E>
                         Many comments requested clarification of the application of the OPPS cap when there is no OPPS payment for comparison; where the code is bundled under OPPS; or where 
                        <PRTPAGE P="66254"/>
                        the OPPS payment includes items (for example, contrast agents or radiopharmaceuticals) that are paid separately under the PFS. 
                    </P>
                    <P>
                        <E T="03">Response:</E>
                         Where there is no OPPS payment for a procedure or where the OPPS for a procedure is bundled, there is no OPPS amount for the comparison with the PFS payment. Therefore, it is infeasible to apply an OPPS cap. The codes will remain on the list of codes subject to the OPPS cap, but will not be affected by the cap. Where the OPPS payment includes packaged services or items that are paid separately under the PFS, we can and do apply an OPPS cap. The physician can continue to bill separately for such services or items when furnished in a place of service, for example, a physician's office, where the item is paid separately. 
                    </P>
                    <HD SOURCE="HD3">2. Application of Multiple Procedure Reduction for Mohs Micrographic Surgery (CPT Codes 17311 Through 17315) </HD>
                    <P>Under the multiple procedure payment reduction policy, reimbursement for subsequent surgical procedures performed during the same operative session by the same physician is reduced by 50 percent. The Mohs surgery codes have been exempt from the multiple procedure payment reduction rules since the inception of the PFS (56 FR 59602, November 25, 1991). </P>
                    <P>The CPT Editorial Panel reviewed all of the codes on the list of codes exempt from the multiple procedure payment reduction (the “−51 modifier exempt list”) to identify which codes should be exempt from the multiple procedure payment reduction rules. Based on the revisions to the code descriptors and a clearer understanding regarding the technical elements of the procedure, in CY 2007, the CPT Editorial Panel removed the Mohs procedure from the −51 modifier exempt list. The codes for Mohs surgery were revised to take into account the different level of physician work intensity involved based on anatomic site. The RVUs associated with the codes for each anatomic location were recommended by the RUC, as they are for other procedures, after a thorough discussion by the RUC of all aspects of the service. Work RVUs were developed for each Mohs surgery base code based on an assumption that each code is performed separately. Because the work RVUs for these services do not take into account the efficiencies that occur when multiple procedures are performed in one session, we do not believe that these codes should continue to be exempt from the multiple procedure payment reduction. Therefore, we proposed to eliminate the modifier 51 exemption and apply the multiple procedure payment reduction rules to these codes. </P>
                    <P>
                        <E T="03">Comment:</E>
                         We received comments supporting our proposal and expressing the belief that our proposal is fair and consistent with our multiple procedure payment policies already affecting a wide range of procedures with codes in the Surgery/Integumentary System of CPT. Many commenters opposed our proposal to eliminate the modifier −51 exemption and apply the multiple procedure payment reduction to these codes. These commenters believed that eliminating these codes from the modifier −51 exempt list would negatively impact Medicare beneficiaries” access to timely and quality care, and could lead to increases in pathology charges and increase the amount spent on multiple facility fees, thereby raising the overall cost of treating an individual with skin cancer. In addition to these concerns, many of the commenters do not believe we have sufficient justification to make the change, and suggest that this is an arbitrary decision. Further, the commenters asserted that the AMA-RUC and CPT decisions were in error and should not be followed. 
                    </P>
                    <P>
                        <E T="03">Response:</E>
                         We verified with the CPT Editorial Panel that the application of the modifier −51 exempt status indicator, and subsequently, the inclusion of this series of codes (CPT codes 17311 through 17315) in Appendix E, Summary of CPT Codes Exempt from Modifier −51, of the 2008 CPT codebook would not be carried forward with the new series of codes created in 2007. The CPT panel confirmed with us that the exclusion of these codes from Appendix E was not an error. The AMA RUC reviewed and valued the new and existing codes for Mohs surgery. Upon completion of a thorough review and discussion of the Mohs codes, the RUC valued these codes with the full understanding these codes were removed from the modifier −51 exempt list and would be subject to the multiple procedure payment reduction as well. 
                    </P>
                    <P>We believe the CPT Editorial Panel and the Mohs workgroup on the CPT Editorial Panel gave considerable time, effort and discussion in the creation of the new and existing codes for Mohs surgery. We also believe the AMA-RUC carefully reviewed the rationale and deliberations which lead to the creation of new Mohs surgery codes. In addition, we believe the specialty society had ample time and opportunity to express its point of view to both the CPT Panel and the AMA-RUC. As a result of the revisions to these codes and their respective valuation, we do not believe they should continue to be treated differently from other codes in the Surgery/Integumentary System section of the CPT book and see no reason not to accept the recommendations provided by the CPT Panel and AMA-RUC. Therefore, we are finalizing our proposal to eliminate the modifier -51 exemption and apply the multiple surgery procedure payment reduction rules to these codes. </P>
                    <HD SOURCE="HD3">3. Payment for Intravenous Immune Globulin (IVIG) Add-On Code for Preadmission Related Services </HD>
                    <P>Intravenous immune globulin (IVIG) is a unique product derived from blood plasma. This drug is paid for under the ASP methodology and the administration of this drug is reported using the first hour and second hour infusion codes for therapeutic, prophylactic and diagnostic services under CPT. </P>
                    <P>We recognize the importance of IVIG to patients who require it and are concerned about reports of problems with IVIG access and availability. We have initiated several actions in response to concerns about the supply of IVIG. </P>
                    <P>In July 2007, we implemented new codes for reporting IVIG for liquid non-lyophilized IVIG. </P>
                    <P>In CY 2006 and 2007, we established payment, through the creation of a special G-code, G0332, for preadministration services furnished in connection with the procurement of IVIG in the physician's office. This code is designed to compensate physicians for the extra resources required to be expended due to market conditions to locate and obtain the appropriate IVIG products and to schedule patient infusions. </P>
                    <P>
                        <E T="03">Comment:</E>
                         We received several comments regarding our proposal to continue in CY 2008 the preadministration payment under the PFS for patients treated with IVIG in a physician's office. 
                    </P>
                    <P>The majority commenters supported our proposal and recommended that it be finalized, and recommended that this policy be made permanent. Commenters stated that if this code and payment are not made permanent, we would need to present a convincing evidence to terminate this payment. Commenters indicated that without continuation of the add on payment, access problems for Medicare beneficiaries in need of IVIG would be more severe. </P>
                    <P>
                        Many commenters indicated problems with the ASP payment methodology for IVIG stating that IVIG is a unique 
                        <PRTPAGE P="66255"/>
                        product for which market conditions are unlike all other drugs paid under ASP. Other commenters remarked that the addition of the four new billing codes for liquid IVIG adopted in July 2007 should improve market conditions and beneficiary access to IVIG. Some commenters asked that we consider making the liquid IVIG codes permanent J-codes. A few commenters asked that CMS consider establishing an add on payment for IVIG similar to the add on payment for clotting factor. 
                    </P>
                    <P>Two commenters indicated that Addendum B did not include the G-code for preadministration services and recommended that the code be included in Addendum B for the final rule. </P>
                    <P>
                        <E T="03">Response:</E>
                         Comments regarding the ASP pricing methodology for IVIG, the adoption of new drug codes for liquid IVIG in CY 2007, and the consideration of an add-on payment for IVIG similar to the add-on payment for blood clotting factor are beyond the scope of our proposal which focuses on payment for a service under the PFS. We will consider these comments in context of any proposed policies for drug payments made as part of the CY 2009 PFS proposed rule. 
                    </P>
                    <P>In terms of the preadministration service for IVIG, we will continue the CY 2007 payment policy for code G0332 through CY 2008. We will carefully consider all relevant information including the conditions of the IVIG drug market during CY 2008 when we address whether it would be appropriate to continue the payment policy as part of the CY 2009 PFS. </P>
                    <P>We appreciate the commenters alerting us that G0332 was omitted from Addendum B in the proposed rule and we will ensure that this code is listed in Addendum B of this final rule with comment period. </P>
                    <P>Therefore, we are finalizing the proposal to continue to recognize payment for preadministration services for IVIG furnished to patients in a physician's office in CY 2008. Payment for this service will be made based on the PE RVUs previously established for this service in CY 2007. Payment for preadminstration services for IVIG furnished to hospital outpatients is paid under the outpatient PPS (OPPS) and is addressed as part of that final rule. </P>
                    <HD SOURCE="HD3">4. Reporting of Cardiac Rehabilitation Services </HD>
                    <P>
                        For CY 2008, we proposed to assign a status indicator of “I” (invalid for Medicare purposes, Medicare recognizes another code for the billing of this service) to the current CPT codes for cardiac rehabilitation services, CPT codes 93797, 
                        <E T="03">Physician services for outpatient cardiac rehabilitation; without continuous ECG monitoring (per session)</E>
                        , and 93798, 
                        <E T="03">Physician services for outpatient cardiac rehabilitation; with continuous ECG monitoring (per session)</E>
                         and proposed to establish two new Level II HCPCS codes that we believe are more appropriate for specifically reporting cardiac rehabilitation services under the PFS. The proposed HCPCS codes are: GXXX1, 
                        <E T="03">Physician services for outpatient cardiac rehabilitation; without continuous ECG monitoring (per hour)</E>
                        , and GXXX2, 
                        <E T="03">Physician services for outpatient cardiac rehabilitation; with continuous ECG monitoring (per hour)</E>
                        . We also proposed to crosswalk the current RVUs associated with CPT codes 93797 and 93798 to HCPCS Codes Gxxx1 and Gxxx1. 
                    </P>
                    <P>
                        <E T="03">Comment:</E>
                         Many commenters, including physicians and providers of cardiac rehabilitation services, were generally supportive of the proposal for the specific G-codes. Commenters believed that this proposed coding change would allow for more appropriate coding and payment for cardiac rehabilitation services in those cases where intensive programs provide multiple sessions each day. In addition, commenters requested that we explicitly state that multiple sessions of cardiac rehabilitation can be paid for the same date of service when modifier 59 is reported. They also requested that we crosswalk the payments for both of the proposed G-codes to the higher cost CPT code 93798 to ensure that the full range of modalities provided in certain intensive cardiac rehabilitation programs are available. 
                    </P>
                    <P>Several of these commenters also requested that we provide additional guidance related to reporting of the cardiac rehabilitation G-codes, such as: (1) Explaining that it is likely to be reasonable and necessary to cover 72 cardiac rehab sessions when multiple sessions are provided in one day; (2) encouraging contractors to factor the “proven results” of a program into coverage decisions and that 72 sessions should be “presumptively covered” when they are furnished by a certain intensive cardiac rehabilitation program; and (3) providing further clarification and expansion of nutritional counseling by registered dieticians, indicating that they could independently bill for nutritional counseling within cardiac rehabilitation programs using the medical nutrition therapy codes because the NCD does not specifically mention these services. </P>
                    <P>Alternatively, a few commenters, including physician specialty groups, questioned the need for the proposed G-codes, indicating that no new data would be gained by a coding shift that changes a unit from a session to an hour. Commenters also suggested that we work with the AMA to address the issue of whether it would be appropriate to modify the CPT definition for this code from a per session to per hour basis. </P>
                    <P>Many commenters also expressed concern that the use of the term “physician services” and “MD services” in the G-code descriptors could be misinterpreted by Medicare contractors as requiring a physician to directly deliver the care or be in attendance during each service episode and requested that the code descriptor be revised. </P>
                    <P>
                        <E T="03">Response:</E>
                         We are aware of several intensive cardiac rehabilitation programs that provide multiple sessions in a day, lasting several hours total. The NCD for cardiac rehabilitation currently states that cardiac rehabilitation programs are covered for certain categories of patients and that the programs must be comprehensive. To be comprehensive the programs must include a medical evaluation, a program to modify cardiac risk factors (for example, nutritional counseling), prescribed exercise, education, and counseling. The NCD does not distinguish between different approaches to the delivery of cardiac rehabilitation services, whether the more common practice of two sessions per week or the more intensive programs of several sessions per day. In order to allow for flexibility and tailoring of cardiac rehabilitation programs based on patient needs, we have not been prescriptive regarding the precise amount of time that must be spent on each component of the program. Regarding intensity, we expect the intensity of cardiac rehabilitation programs to vary by patient and by program. 
                    </P>
                    <P>
                        We believe it is important that our payment policy provides appropriate payment for cardiac rehabilitation services. In order to minimize the administrative burden to physicians and providers, but permit accurate reporting and payment for cardiac rehabilitation programs that provide more than one session per day, we believe that continuing the use of CPT codes 93797 and 93798 and allowing physicians and providers to bill more than one session per day under some circumstances would be the most appropriate course. Therefore, based upon the comments received and upon further review of this issue, for CY 2008, we will allow physicians and providers to report more than one unit for a date of service if 
                        <PRTPAGE P="66256"/>
                        more than one cardiac rehabilitation session lasting at least 1 hour each is provided on the same day. 
                    </P>
                    <P>With respect to commenters' concerns about the use of the term “physician services” in the proposed G-code descriptors, we note that the descriptors for these codes were proposed to be parallel to the descriptors of the CPT codes for cardiac rehabilitation sessions which contain the term “physician services” in their descriptors. We are not aware that physicians and providers have problems with Medicare contractors” interpretation of the CPT code descriptors. </P>
                    <P>After consideration of all public comments received, we are not finalizing our proposal to establish two new G-codes for reporting cardiac rehabilitation services. Instead, we will continue to use the CPT codes 93797 and 93798 to report cardiac rehabilitation services under the CY 2008 PFS. </P>
                    <P>We will provide further guidance on coding and payment instructions for the cardiac rehabilitation services codes through program instructions. </P>
                    <P>We will not provide the additional coverage-related guidance requested by some commenters, such as the presumptive coverage and independent billing for registered dieticians. These recommendations effectively request changes to the NCD, and therefore, are outside of the scope of this final rule with comment period. </P>
                    <HD SOURCE="HD2">F. Part B Drug Payment </HD>
                    <HD SOURCE="HD3">1. Average Sales Price (ASP) Issues </HD>
                    <P>Medicare Part B covers a limited number of prescription drugs and biologicals. For the purposes of this proposed rule, the term “drugs” will hereafter refer to both drugs and biologicals, unless otherwise specified. Medicare Part B covered drugs not paid on a cost or prospective payment basis generally fall into the following three categories: </P>
                    <P>• Drugs furnished incident to a physician's service. </P>
                    <P>• DME drugs. </P>
                    <P>• Drugs specifically covered by statute (certain immunosuppressive drugs, for example). </P>
                    <P>Beginning in CY 2005, the vast majority of Medicare Part B drugs not paid on a cost or prospective payment basis are paid under the ASP methodology. The ASP methodology is based on data submitted to us quarterly by manufacturers. In addition to the payment for the drug, Medicare currently pays a furnishing fee for blood clotting factors, a dispensing fee for inhalation drugs, and a supplying fee to pharmacies for certain Part B drugs. </P>
                    <P>In January 2006, the drug coverage available to Medicare beneficiaries expanded with the implementation of Medicare Part D. The Medicare Part D program does not change Medicare Part B drug coverage. </P>
                    <P>In this section, we discuss changes and issues related to the determination of the payment amounts for covered Part B drugs and furnishing blood clotting factor. This section also discusses changes to how manufacturers calculate and report ASP data to us.</P>
                    <HD SOURCE="HD3">a. ASP Payment </HD>
                    <P>Section 303(c) of the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (Pub. L. 108-173) (MMA) amended Title XVIII of the Act by adding section 1847A. This section revised the payment methodology for the vast majority of drugs and biologicals not paid on a cost or prospective payment basis furnished on or after January 1, 2005. The ASP reporting requirements are set forth in section 1927(b) of the Act. Manufacturers must submit ASP data by 11-digit National Drug Code (NDC) to us quarterly. The manufacturers' submissions are due to us not later than 30 days after the last day of each calendar quarter. The methodology for developing Medicare drug payment allowances based on the manufacturers' submitted ASP data is specified in 42 CFR, part 414, subpart K. We update the Part B drug payment amounts quarterly based on the data we receive. In this section of the preamble, we discuss certain aspects of the calculation of manufacturers' ASP data, issues related to bundled price concessions, and other Part B drug payment issues. </P>
                    <P>
                        Further information on manufacturers' submission of ASP data for Medicare Part B drugs and biologicals is contained in prior rulemaking documents and other guidance accessible on the CMS Web page at (
                        <E T="03">http://www.cms.hhs.gov/McrPartBDrugAvgSalesPrice/</E>
                        ). Specifically refer to the April 6, 2004 ASP interim final rule with comment period (IFC) (69 FR 17935) and the CY 2007 PFS final rule with comment period (71 FR 69624), which finalized the ASP calculation and reporting requirements of the April 6, 2004 IFC, and the Frequently Asked Questions available on the CMS Web page.
                    </P>
                    <HD SOURCE="HD3">b. Bundled Price Concessions </HD>
                    <P>In the CY 2007 PFS proposed rule and final rule with comment period, we solicited and responded to comments regarding the issue of how to allocate price concessions across drugs that are sold under bundling arrangements for purposes of calculating the ASP. We did not establish a specific methodology that manufacturers must use for the treatment of bundled price concessions for purposes of the ASP calculation in the CY 2007 PFS final rule with comment period. In the absence of specific guidance, we maintained existing guidance that manufacturers may make reasonable assumptions in their calculation of ASP, consistent with the general requirements and the intent of the Act, Federal regulations, and their customary business practices. We also indicated that we would be closely monitoring this issue and may provide more specific guidance in the future if we determine it is warranted. </P>
                    <P>As stated in the CY 2008 PFS proposed rule (72 FR 38150), in its January 2007 Report to Congress, “Impact of Changes in Medicare Payments for Part B Drugs,” the MedPAC discussed the issue of allocation of bundled price concessions for purposes of calculating the ASP, noting that “some manufacturers offer provider discounts for one of their products contingent on purchases of one or more other products.” This report discusses two approaches for allocating bundled price concessions. </P>
                    <P>According to MedPAC, one option would be to require manufacturers to allocate bundled discounts in proportion to the sales of each drug sold under the bundled arrangement. For example, Drug A and Drug B are sold under a bundled arrangement and have a combined bundled discount equal to $200,000 on total sales of $1 million. If Drug A has sales of $600,000, the manufacturer would allocate 60 percent of the bundled discount to that drug when calculating ASP. Forty percent of the bundled discount would be allocated to Drug B. MedPAC states that this approach would parallel bundling requirements under Medicaid and would be simpler to administer. However, MedPAC notes that this method might not capture contingent discounts. </P>
                    <P>
                        The other approach discussed by MedPAC would be to require manufacturers to allocate bundled discounts to reflect the contingencies in the contract. That is, manufacturers would allocate any additional (or increased) discount to the sales of the drug (or drugs) that the discount is meant to increase. This approach would result in an ASP that more accurately reflects the transaction price of drugs when a discount for one drug or drugs is contingent in whole or in part on the purchase of another drug. For example, if a greater discount on the purchase price of Drug A is contingent on the 
                        <PRTPAGE P="66257"/>
                        purchase (or purchases) of Drug B, this additional discount would be allocated to sales of Drug B in the calculation of ASP. 
                    </P>
                    <P>In its discussion of bundling, MedPAC states that the goal should be to ensure that ASP reflects the average transaction price for drugs. To that end, MedPAC recommends that the Secretary clarify the ASP reporting requirements for bundled products to ensure that ASP calculations allocate discounts to reflect the transaction price for each drug. Further, MedPAC states that we should ensure that the reporting requirements for allocating discounts are clear and that they can be implemented by manufacturers in a timely fashion. </P>
                    <P>
                        In the CY 2008 PFS proposed rule (71 FR 77176), we also discussed the Medicaid Program: Prescription Drugs proposed rule published in the December 22, 2006 
                        <E T="04">Federal Register</E>
                         (hereinafter referred to as the December 22, 2006 proposed rule) concerning the calculation of manufacturers' average manufacturer price (AMP). In the December 22, 2006 proposed rule, we proposed that discounts associated with a bundled sale would be allocated proportionately according to the dollar value of the units of each drug sold under the bundled arrangement. For bundled sales where multiple drugs are discounted, the aggregate value of all the discounts would be proportionately allocated across all of the drugs in the bundle. For AMP purposes, a bundled sale would mean an arrangement regardless of physical packaging under which the rebate, discount, or other price concession is conditioned upon the purchase of the same drug or drugs of different types (that is, at the nine-digit NDC level) or some other performance requirement (for example, the achievement of market share, inclusion or tier placement on a formulary), or where the resulting discounts or other price concessions are greater than those which would have been available had the bundled drugs been purchased separately or outside of the bundled arrangement. In the December 22, 2006 proposed rule, we further proposed that the AMP should be adjusted for bundled sales by determining the total value of all the discounts on all drugs in the bundle and allocating those discounts proportionately to the respective AMP calculations. The aggregate discount is allocated proportionately to the dollar value of the units of each drug sold under the bundled arrangement. Where discounts are offered on multiple products in a bundle, the aggregated value of all of the discounts should be proportionately allocated across all of the drugs in the bundle. We received many comments on the many aspects of the December 22, 2006 proposed rule. However, the review of those comments and development of the final AMP calculation policies and rule were not complete at the time the CY 2008 PFS proposed rule was developed. 
                    </P>
                    <P>In light of MedPAC's recommendation that we clarify the ASP reporting requirements for bundled products and our discussion of bundled price concessions in the CY 2007 PFS rulemaking, we stated in the CY 2008 PFS proposed rule that we believe specific guidance in the ASP context is warranted to provide for greater consistency in ASP reporting across manufacturers and to enhance the accuracy of the ASP payment system. We stated that we found MedPAC's suggestion not to defer further guidance in this area compelling with respect to the potential that manufacturers may make differing assumptions in the absence of specific guidance on how to allocate bundled price concessions in the context of ASP. In addition, we stated that we believe it is appropriate at this time to establish a specified method for treating bundled price concessions in the calculation of ASP that is consistent with the treatment of such discounts for purposes of the AMP calculation, and that appropriate consistencies across the calculations of ASP and AMP will result in a lower potential for error and more accurate calculations of both prices. </P>
                    <P>As we noted in the CY 2008 PFS proposed rule, although ASP and AMP serve similar, but not identical, purposes, differences between these calculations provide a rationale for, and in some instances may require, minor differences between the final policies adopted in Medicaid and Medicare regulations. We believe any differences would be necessary to clarify certain aspects of a consistent approach for treatment of bundling, and would not result in significant policy differences on how bundling is addressed in the context of AMP and in the context of ASP. </P>
                    <P>Therefore, for purposes of calculating the ASP (beginning with the reporting period for the first calendar quarter of 2008 and thereafter), we proposed that the manufacturer must allocate the total value of all price concessions proportionately according to the dollar value of the units of each drug sold under a bundled arrangement to ensure that the ASP is adjusted for bundled arrangements as defined at proposed § 414.802. For a bundled arrangement, where multiple drugs are discounted, the aggregate value of all the discounts would be proportionately allocated across all of the drugs sold under the bundled arrangement. We proposed that a bundled arrangement, for ASP purposes, would mean an arrangement, regardless of physical packaging under which the rebate, discount, or other price concession is conditioned upon the purchase of the same drug or biological or other drugs or biologicals or some other performance requirement (for example, the achievement of market share, inclusion or tier placement on a formulary, purchasing patterns, prior purchases), or where the resulting discounts or other price concessions are greater than those that would have been available had the drugs or biologicals sold under the bundled arrangement been purchased separately or outside of the bundled arrangement. We proposed to specify at proposed § 414.804(a)(2)(iii) that all price concessions on drugs sold under a bundled arrangement must be allocated proportionately to the dollar value of the units of each drug sold under the bundled arrangement. </P>
                    <P>
                        In the CY 2008 PFS proposed rule, we also stated our intention to remain consistent, as appropriate, with the final policy adopted in the Medicaid Program: Prescription Drugs final rule with comment period published in the July 17, 2007 
                        <E T="04">Federal Register</E>
                         (72 FR 39142) (hereinafter referred to as the July 17, 2007 final rule with comment period), which was still under development at that time. We stated that the Medicaid policies on bundled sales may ultimately differ from our discussion of the topic in the CY 2008 PFS proposed rule as a result of the final policy adopted in the July 17, 2007 final rule with comment period and that our policies for ASP in this final rule with comment period may reflect the final Medicaid policy on bundled sales, but only to the extent that it is appropriate for ASP and the public has had the opportunity to comment on how the final Medicaid policy for bundled sales, if appropriately adopted for ASP purposes, would effect the calculation of ASP. The final Medicaid policy on bundled sales adopted in the July 17, 2007 final rule with comment period was consistent with the discussion of this issue in the December 22, 2006 proposed rule with certain clarifications. 
                    </P>
                    <P>
                        <E T="03">Comment:</E>
                         We received many comments on this issue. Most of these commenters noted that our proposal for the treatment of bundled price concessions in the ASP context was similar to the language finalized in the July 17, 2007 final rule with comment period. In general, most of the 
                        <PRTPAGE P="66258"/>
                        commenters supported an appropriately consistent approach for the treatment of bundled price concessions within both the AMP and ASP calculations. However, several commenters indicated that they were still reviewing the July 17, 2007 final rule with comment period and believe additional time may be needed to better understand how the proposed Medicare bundled arrangement definition is to be applied. Several commenters had questions about how the proposed bundling policies may apply to certain contracting arrangements, and because of these questions, recommended that we cease or delay implementation of our proposed method for treatment of bundled price concessions for purposes of ASP. 
                    </P>
                    <P>
                        <E T="03">Response:</E>
                         Based on comments recommending a delay and to better understand the concerns stated by the commenters, we are not finalizing the regulatory language changes we proposed in the CY 2008 PFS proposed rule at this time. Although we are not establishing a specific methodology that manufacturers must use for the treatment of bundled price concessions for purposes of calculating ASP at this time, we are clarifying that, in the absence of specific guidance, manufacturers may make reasonable assumptions in their calculation of ASP, consistent with the general requirements and the intent of the Act, Federal regulations, and their customary business practices. In making reasonable assumptions for purposes of calculating ASP, one method manufacturers could use is to reallocate price concessions that are conditioned upon other purchases or a performance requirement (for example, the achievement of market share, inclusion or tier placement on a formulary) so that the total value of all such price concessions are allocated proportionately according to the dollar value of the units of each drug sold. However, manufacturers may have other methods they could use to report bundled price concessions, so long as manufacturers apply reasonable assumptions consistent with the general requirements and the intent of the Act, Federal regulations, and their customary business practices. Manufacturers' reasonable assumptions consistent with our requirements, guidance and manufacturer's customary business practices remain an important aspect of ASP reporting. These assumptions should be submitted along with the ASP data and the signed certification form. 
                    </P>
                    <P>Recognizing that the treatment of bundled price concessions in the ASP calculation has implications for the integrity of the ASP payment methodology, we will continue to monitor this issue, will consider the comments on this issue, and may provide more specific guidance in the future through rulemaking or through program instruction or other guidance (consistent with our authority under section 1847A(c)(5)(C) of the Act) if we determine it is warranted. As we continue to review these issues, we want to be sure we are aware of concerns from all stakeholders, and thus we encourage the public to provide additional information or concerns to us on this issue as they may arise. </P>
                    <HD SOURCE="HD3">c. Clotting Factor Furnishing Fee </HD>
                    <P>Section 303(e)(1) of the MMA added section 1842(o)(5) of the Act which requires the Secretary, beginning in CY 2005, to pay a furnishing fee in an amount the Secretary determines to be appropriate to hemophilia treatment centers and homecare companies for the items and services associated with the furnishing of blood clotting factor. Section 1842(o)(5)(C) of the Act specifies that the furnishing fee for clotting factor for CY 2006 and subsequent years will be equal to the fee for the previous year increased by the percentage increase in the consumer price index (CPI) for medical care for the 12 month period ending with June of the previous year. </P>
                    <P>The furnishing fee for CY 2007 is $0.152 per unit clotting factor. The percent increase in the CPI for medical care for the 12-month period ending in June 2007 is 4.0 percent. Consequently, the furnishing fee will be $0.158 per unit of clotting factor for CY 2008. While the furnishing fee payment rate is calculated at 3 digits, the actual amount paid to providers and suppliers is rounded to 2 digits. </P>
                    <P>In the CY 2008 PFS proposed rule, we proposed to announce the annual update of the blood clotting factor furnishing fee, as specified in section 1842(o)(5)(C) of the Act, by issuing program instructions and postings on the CMS Web site in lieu of including a discussion of this issue in PFS rulemaking for CY 2009, and thereafter, until such time as the update methodology may be modified. We made our proposal because the update is statutorily determined, is based on an index not affected by administrative discretion or public comment, is based on the percentage increase in the CPI for medical care for the 12-month period ending with June of the previous year, and is not released by the Bureau of Labor Statistics until after our proposed rule is published. </P>
                    <P>As stated in the CY 2008 proposed rule, we believe that including a discussion of the furnishing fee update in annual rulemaking does not provide an advantage over other means of announcing this information, so long as the current statutory update methodology continues in effect. We believe that the public's need for information and adequate notice regarding the updated furnishing fee can be better met by issuing program instructions which will eliminate the discussion of the furnishing fee update annually in rulemaking. In addition, by communicating the updated furnishing fee in program instruction, the actual figure for the percent change in the applicable CPI and the updated furnishing fee calculated based on that figure can be announced more timely than when included as part of the PFS final rulemaking process. </P>
                    <P>
                        <E T="03">Comment:</E>
                         We received comments in support of our proposal to announce the update furnishing fee via program instructions beginning in CY 2009, and to continue updating the furnishing fee according to the consumer price index for medical care. Comments supported the continued use of our proposed approach until such time as the methodology is changed. 
                    </P>
                    <P>
                        <E T="03">Response:</E>
                         After consideration of the public comments, beginning for CY 2009, we will announce the updated blood clotting factor furnishing fee via program instructions and via a Web posting. In addition, we may include the updated blood clotting factor furnishing fee in the annual PFS final rules to promote broader dissemination of the announcement.
                    </P>
                    <HD SOURCE="HD3">d. Widely Available Market Prices (WAMP) and AMP Threshold </HD>
                    <P>Section 1847A(d)(1) of the Act states that “the Inspector General of HHS shall conduct studies, which may include surveys to determine the widely available market prices (WAMP) of drugs and biologicals to which this section applies, as the Inspector General, in consultation with the Secretary, determines to be appropriate.” Section 1847A(d)(2) of the Act states that, “Based upon such studies and other data for drugs and biologicals, the Inspector General shall compare the ASP under this section for drugs and biologicals with— </P>
                    <P>• The widely available market price (WAMP) for these drugs and biologicals (if any); and </P>
                    <P>• The AMP (as determined under section 1927(k)(1) of the Act for such drugs and biologicals.” </P>
                    <P>
                        Section 1847A(d)(3)(A) of the Act states that, “The Secretary may disregard the ASP for a drug or biological that exceeds the WAMP or 
                        <PRTPAGE P="66259"/>
                        the AMP for such drug or biological by the applicable threshold percentage (as defined in subparagraph (B)).” The applicable threshold is specified in the statute as 5 percent for CY 2005. For CY 2006 and subsequent years, section 1847A(d)(3)(B) of the Act establishes that the applicable threshold is “the percentage applied under this subparagraph subject to such adjustment as the Secretary may specify for the WAMP or the AMP, or both.” In CY 2006 and CY 2007, we specified an applicable threshold percentage of 5 percent for both the WAMP and AMP. We based this decision on the limited data available to support a change in the current threshold percentage. 
                    </P>
                    <P>For CY 2008, we proposed to specify an applicable threshold percentage of 5 percent for the WAMP and the AMP. At present, the OIG is continuing its comparison of both the WAMP and the AMP. Furthermore, information on how recent changes to the calculation of the AMP may affect the comparison of AMP to ASP is not available at this time. Since we do not have data that suggest another level is more appropriate at this time, we believe that continuing the 5 percent applicable threshold percentage for both the WAMP and AMP is appropriate for CY 2008. </P>
                    <P>As we noted in the CY 2007 PFS final rule with comment period (71 FR 69680), we understand that there are complicated operational issues associated with potential payment substitutions and will continue to proceed cautiously in this area and provide stakeholders, particularly manufacturers of drugs impacted by potential price substitutions, with adequate notice of our intentions regarding such, including the opportunity to provide input with regard to the processes for substituting the WAMP or the AMP for the ASP. As part of our approach, we intend to develop a better understanding of the issues that may be related to certain drugs for which the WAMP and AMP may be lower than the ASP over time. </P>
                    <P>
                        <E T="03">Comment:</E>
                         We received several comments regarding our proposal to maintain the threshold at 5 percent. Most commenters supported maintaining this threshold. One commenter suggested increasing the threshold but did not specify a percentage to which it should be increased. Another commenter suggested increasing the threshold for AMP to 10 percent while maintaining the 5 percent threshold for WAMP. 
                    </P>
                    <P>
                        <E T="03">Response:</E>
                         We recognize the public's concern regarding the establishment of an appropriate threshold for making price substitutions. We disagree with the commenter who recommended different thresholds for WAMP comparisons and for AMP comparisons because of current operational difficulties associated with maintaining and communicating different thresholds. At the current time, we also believe that maintaining two thresholds lessens stakeholders' ability to accurately predict the potential risk for price adjustments. After considering public comments on this issue, and as required by statute, we are finalizing our proposal to establish the WAMP/AMP threshold at 5 percent for CY 2008. 
                    </P>
                    <P>
                        <E T="03">Comment:</E>
                         We received many comments suggesting that caution be exercised in the determination of price substitutions and that we develop a formal process and criteria to be used to determine when substitutions are necessary. Commenters also recommended that we assure adequate notice is provided prior to making a price substitution. Several commenters indicated recent policy changes made to the Medicaid AMP calculation could impact the accuracy of the comparisons between AMP and ASP and stated that these changes should be carefully studied and considered before implementing any pricing changes. 
                    </P>
                    <P>Additionally, several commenters opposed any price substitutions for certain classes of providers or for certain specific drugs. The commenters noted that certain classes of providers may be subject to different cost structures making wholesale substitution of prices impractical. Some commenters asserted that certain drugs experience unique market forces that may be adversely affected by pricing substitutions. </P>
                    <P>
                        <E T="03">Response:</E>
                         We understand that complex operational issues, both within CMS and externally could impact potential payment rate substitutions. We acknowledge the recent changes to the AMP regulations and are studying such changes carefully. Furthermore, we recognize the variety of providers and the marketplace forces that impact drug pricing decisions under ASP. Therefore, we will proceed cautiously and provide stakeholders, particularly manufacturers of drugs impacted by potential price substitutions, with adequate notice of our intentions regarding such, including the opportunity to provide input with regard to the processes for substitution.
                    </P>
                    <HD SOURCE="HD3">e. Other Issues </HD>
                    <P>
                        <E T="03">Comment:</E>
                         A few commenters noted that we did not discuss the payment for separately billable ESRD drugs in the CY 2008 PFS proposed rule. These commenters supported continuation of the current policy of basing the payment on the ASP+6 percent. 
                    </P>
                    <P>
                        <E T="03">Response:</E>
                         We did not propose any policy changes to the approach that we currently use to pay for separately billed ESRD drugs. Therefore, for CY 2008 payment for separately billable drugs furnished by ESRD facilities will continue at ASP+6 percent in accordance with section 1847A of the Act. 
                    </P>
                    <P>
                        <E T="03">Comment:</E>
                         Several commenters noted that the billing and payment codes recently established for liquid IVIG to implement separate payment under section 1847A(b)(4) of the Act should improve beneficiary access to these products. 
                    </P>
                    <P>
                        <E T="03">Response:</E>
                         We thank the commenters for communicating their support. 
                    </P>
                    <P>
                        <E T="03">Comment:</E>
                         We received a few comments expressing concern that, because ASP based payment limit updates lag time by at least 2 calendar quarters, increases in market prices may not be reflected in a drug's payment limit for at least 6 months after a pricing adjustment. One commenter suggested that current technology should enable CMS to decrease the lag time from 6 months to 2 to 3 months. 
                    </P>
                    <P>
                        <E T="03">Response:</E>
                         By statute, the ASP based payment allowances are determined on a quarterly basis and are based on ASPs reported by manufacturers quarterly. Manufacturers must report to us no later than 30 days after the close of the calendar quarter. There is a necessary time frame after the close of a calendar quarter for manufacturers to calculate and submit the ASP data to CMS, for CMS to prepare and issue the payment rates, and for the claims processing contractors to implement the updated payment files. We implement these new payment limits through program instructions or otherwise at the first opportunity after we received the data, which is the calendar quarter after receipt. 
                    </P>
                    <P>
                        <E T="03">Comment:</E>
                         One commenter suggested that we modify the formula we use to calculate the payment amounts based on manufacturers' ASP data so that the formula is volume weighted as suggested by the OIG. 
                    </P>
                    <P>
                        <E T="03">Response:</E>
                         We discussed our formula for determining the payment amounts based on manufacturers' ASP data in the CY 2006 PFS final rule (70 FR 70217). As we stated in the CY 2006 PFS final rule, in establishing the formula used to calculate the payment amounts based on manufacturers' ASP data, we considered various approaches, including the alternative suggested by this commenter. If appropriate, we may consider revising the methodology in the future. We did not propose to change our current formula, and are not 
                        <PRTPAGE P="66260"/>
                        implementing changes to our formula at this time. 
                    </P>
                    <P>
                        <E T="03">Comment:</E>
                         We received a few requests to increase the pharmacy supplying fee for immunosuppressive, oral anticancer, and oral anti-emetic drugs for CY 2008 to reflect actual supplying costs. We also received comments expressing concerns that primarily because of the labor intensive Medicare Part B claims processing services provided by specialty transplant pharmacies, the current supplying fee payment for immunosuppressive drugs is substantially lower than reported actual supplying costs. One commenter requested that we eliminate the two-tiered pharmacy supplying fee for prescriptions filled within a 30-day period. 
                    </P>
                    <P>
                        <E T="03">Response:</E>
                         We are committed to assuring that our claims systems process claims as timely and accurately as possible and that their payment methodologies result in the determination of accurate payment amounts. We recognize the operational complexities under which certain providers operate and strive to develop systems and processes to minimize such complexities. We appreciate the comments that were provided and may consider the issue in future rulemaking if appropriate. Since we did not propose a change to these rates for CY 2008, they will continue to be in effect in CY 2008. We received several other comments on the use and potential impacts of the ASP payment methodology and other issues related to Part B drugs that are also outside the scope of this rulemaking and will not be addressed in this final rule with comment. These topics include the following: 
                    </P>
                    <P>• Requests for billing codes for specific products; </P>
                    <P>• Whether alternative payment methodologies or exceptions to the ASP based payment should be considered; </P>
                    <P>• Variation in local coverage and payment policies, including use of least costly alternative policies and invoice pricing for compounded drugs; </P>
                    <P>• Excluding prompt pay discounts from the calculation of ASP; and </P>
                    <P>• Whether coverage under Part B should be expanded to include certain vaccines. </P>
                    <HD SOURCE="HD2">2. Competitive Acquisition Program (CAP) Issues </HD>
                    <P>
                        Section 303(d) of the MMA required the implementation of a CAP for certain Medicare Part B drugs and biologicals not paid on a cost or PPS basis. The provisions for acquiring and billing drugs under the CAP were described in the Competitive Acquisition of Outpatient Drugs and Biologicals Under Part B proposed rule (published in the March 4, 2005 
                        <E T="04">Federal Register</E>
                        ; hereinafter referred to as the March 4, 2005 proposed rule) and interim final rule with comment period (published in the July 6, 2005 
                        <E T="04">Federal Register</E>
                        ; hereinafter referred to as the July 6, 2005 IFC) (70 FR 10746 and 70 FR 39022, respectively). Certain provisions were finalized in the CY 2006 PFS final rule with comment period (70 FR 70116). We specified a single CAP drug category to include a defined list of drugs furnished incident to a physician's service. 
                    </P>
                    <P>In this final rule with comment period, we discuss the impact of provisions in section 108 of the MIEA-TRHCA on administrative and operational aspects of the CAP. Topics include the implementation of a post-payment review process and the corresponding changes to claims processing procedures, and changes to other operational aspects of the CAP. This final rule with comment period implements conforming changes to the CAP regulations to reflect these provisions that made changes to the payment process of the CAP for Part B Drugs. </P>
                    <P>When the CAP program began on July 1, 2006, physicians were given a choice between obtaining these drugs from vendors selected through a competitive bidding process and approved by CMS, or directly purchasing these drugs and being paid under the ASP system. In this final rule with comment period, we discuss areas related to transporting CAP drugs and the administrative burden of the CAP submitted in response to the July 6, 2005 IFC. In addition, we are finalizing portions of the July 6, 2005 IFC that were not finalized in the CY 2006 PFS final rule with comment period and responding to the other timely comments we received on the July 6, 2005 IFC that we have not responded to previously. </P>
                    <HD SOURCE="HD3">a. MMA Operational Provisions </HD>
                    <P>Prior to the enactment of the MIEA-TRHCA, section 1847B(a)(3)(A) of the Act set forth specific requirements that have a direct impact on the administrative and operational parameters for instituting a CAP. This section of the statute required the following: </P>
                    <P>(1) Approved CAP vendors bill the Medicare program for the drug or biological supplied, and collect any applicable deductibles and coinsurance from the Medicare beneficiary. (For purposes of the preamble, the term “approved CAP vendor” means the term “contractor” as referred to in the statute.) </P>
                    <P>(2) Any applicable deductible and coinsurance may not be collected unless the drug was administered to the beneficiary. (For purposes of the preamble, the term “drug” refers to drugs and biologicals furnished under the CAP, unless the context specifies otherwise.) </P>
                    <P>(3) Medicare can make payments only to the approved CAP vendor, and these payments are conditioned upon the administration of the drug. </P>
                    <P>Section 108 of the MIEA-TRHCA amended this third element. </P>
                    <HD SOURCE="HD3">b. MIEA-TRHCA </HD>
                    <P>Section 108 of the MIEA-TRHCA made changes to the CAP payment methodology. Section 108(a)(1) of the MIEA-TRHCA amended section 1847B(a)(3)(A)(iii) of the Act by adding new language that requires that payment for drugs and biologicals be made upon receipt of a claim for a drug or biological supplied for administration to a beneficiary. This statutory change took effect on April 1, 2007. </P>
                    <P>Section 108(a)(2) of the MIEA-TRHCA requires the Secretary to establish (by program instruction or otherwise) a post-payment review process (which may include the use of statistical sampling) to assure that payment is made for a drug or biological only if the drug or biological has been administered to a beneficiary. The Secretary shall recoup, offset, or collect any overpayments determined by the Secretary under this process. </P>
                    <P>Section 108(b) of the MIEA-TRHCA states that nothing in this section shall be construed as requiring the conduct of any additional competition under section 1847B(b)(1) of the Act; or requiring an additional physician election process. </P>
                    <P>Section 108(c) of the MIEA-TRHCA states that the amendments of this section apply to payments for drugs and biologicals supplied: (1) On or after April 1, 2007; and (2) on or after July 1, 2006 and before April 1, 2007, for claims that are unpaid as of April 1, 2007. </P>
                    <P>
                        <E T="03">Comment:</E>
                         Some commenters suggested that any changes to the CAP be made only after the expiration of the current vendor contract. The commenters stated that implementation of changes before the next vendor contract would be unfair to bidders who chose not to participate in the CAP because of previously issued guidance. The commenters cited the CAP statutory reference about waiving the FAR in order to promote competition. The commenters believe that such changes would inappropriately favor the single 
                        <PRTPAGE P="66261"/>
                        existing vendor, and therefore, hurt competition. 
                    </P>
                    <P>
                        <E T="03">Response:</E>
                         We do not have the authority to delay implementing the claims processing changes required by the MIEA-TRHCA, which were effective April 1, 2007. Although some of our changes were not expressly required by the statute, we believe these conforming changes are necessary to allow the program to function in a manner that is consistent with, and required by, the statutory changes. Further, because the CAP is a new payment program, change that is consistent with operational experience and improves efficiency for participants is to be expected. Finally, we disagree that the FAR affects our ability to make changes in the program while the current contract is in force. Because these changes do not modify an approved CAP vendor's responsibilities under its contract with us, we do not believe the FAR is implicated. 
                    </P>
                    <P>Further, as we have discussed in prior rulemaking, the CAP statute authorizes the waiver of provisions of the FAR (other than provisions relating to confidentiality of information and such other provisions as the Secretary determines appropriate) as necessary for the efficient implementation of Section 1847B of the Act, in order to promote competition. </P>
                    <P>We have discussed our approach to conforming to the confidentiality provisions in the July 6, 2005 IFC (70 FR 39077), and we intend to comply with this approach during future vendor bidding periods. In implementing the CAP, we have waived all of the FAR except for the confidentiality and the conflict of interest provisions to promote competition and the efficient implementation of the program. We made the decision to waive the FAR (other than the provisions on confidentiality and conflict of interest) in order to increase the pool of qualified vendors available to participate in the program. It is our understanding that compliance with the FAR is not normally required of the companies that make up the pool of potential CAP vendors. It is also not required of other Medicare suppliers. We waived these provisions in order to structure CAP bidding in a manner consistent with established vendor bidding practices. </P>
                    <P>The FAR's confidentiality provisions, as well as the conflict of interest standards and requirements found in FAR subsection 9.5, apply to approved CAP vendors and applicants. All other provisions of the FAR have been waived for purposes of the CAP. However, we have used certain provisions of the FAR for guidance in implementing the CAP, and we may from time to time used other FAR provisions as a guide, even though they have been waived. For example, as we discussed in the July 6, 2005 IFC (70 FR 39063), we look to the provisions of the FAR to guide our assessment of bidder's financial solvency. </P>
                    <P>However, even if the FAR were implicated, we believe these changes promote competition because they make the program a more attractive option for physicians, which will provide physicians who compete among one another a more meaningful choice between the CAP and the ASP methodology. We further believe the changes we are implementing here are designed to improve the flexibility and administrative ease of the CAP. Therefore, we will proceed with implementing the provisions we are finalizing as indicated in this final rule with comment period. </P>
                    <HD SOURCE="HD3">c. CAP Claims Processing </HD>
                    <P>In the July 6, 2005 IFC (70 FR 39042), we initially implemented a claims processing system that enables selected approved CAP vendors to bill the Medicare program directly, and to bill the Medicare beneficiary and his or her third party payer after verification that the physician has administered the drug. When a participating CAP physician elects to join the program, he or she must agree to obtain all drugs on the CAP drug list from the approved CAP vendor, with only a few exceptions. For example in furnish as written (FAW) situations (that is, where a beneficiary needs a particular formulation of a drug not available from the approved CAP vendor) the participating CAP physician would be allowed to obtain that drug outside of the CAP. In the case of Medicare Secondary Payer (MSP) (that is, where a Medicare beneficiary may have another payer primary to Medicare), the participating CAP physicians must obtain physician administered drugs from entities approved by the primary plan and bill the primary payer. Detailed MSP instructions have been issued by CMS that allow the physician to bill under the ASP methodology for the portion of the drug not covered by the primary payer in this situation. </P>
                    <P>Prior to the MIEA-TRHCA, the claims processing procedures for the approved CAP vendor and the participating CAP physician were as follows: </P>
                    <P>• Once a shipment is received from the approved CAP vendor, the participating CAP physician stores the drug until the date of drug administration. </P>
                    <P>• When the drug is administered to the beneficiary, the participating CAP physician places the prescription order number for each drug administered on the claim form submitted to his or her regular Part B carrier. </P>
                    <P>Similarly, when the approved CAP vendor bills Medicare for the drug it shipped to the participating CAP physician, it places the relevant prescription order number on the claim form submitted to the designated carrier. The use of the prescription order number on both the participating CAP physician's claim and the approved CAP vendor's claim is intended to indicate drug administration to the beneficiary. The participating CAP physician's claim and the approved CAP vendor's claim are matched in the Medicare claims processing system so that drug administration can be verified and payment to the approved CAP vendor can be made. </P>
                    <HD SOURCE="HD3">d. Required Changes to CAP Claims Processing </HD>
                    <P>
                        As originally implemented, the claims matching process described above in this section was completed before payment was made. However, as of April 1, 2007, section 108 of the MIEA-TRHCA requires payment to be made to the CAP vendor for claims upon receipt. The statute also requires us to establish a post-payment review process to assure that payment is made for a drug only if the drug has been administered to a beneficiary. We are authorized under the statute to recoup, offset, or collect any overpayments by the Secretary. We are also authorized to conduct post-payment review using statistical sampling and to implement the post-payment review process by program instruction or otherwise. We implemented the necessary changes to our claims processing system and initiated the post-payment review process on April 1, 2007 via instructions to the CAP-designated claims processing contractor and Questions and Answers posted on the CMS competitive bidding Web site at 
                        <E T="03">http://www.cms.hhs.gov/CompetitiveAcquisforBios/15_Approved_Vendor.asp#TopOfPage</E>
                        . 
                    </P>
                    <P>
                        Under the post-payment review process, the CAP-designated carrier will use the CMS claims processing system to look for a match between the CAP prescription order number on the participating CAP physician's claim and the same prescription order number on the approved CAP vendor's claim to track drug administration on a dose by dose basis. If the CAP-designated carrier is able to find a match between the two claims, the carrier makes a determination that the beneficiary did receive the drug being billed for by the CAP physician. The participating CAP 
                        <PRTPAGE P="66262"/>
                        physician claim may also contain information on any determination of medical necessity and coverage made by the local carrier. 
                    </P>
                    <P>We will also use statistical sampling under the post-payment review process to determine whether drugs were medically necessary. All Medicare claims are subject to medical necessity determinations; however, under the changes required by the MIEA-TRHCA, CAP claims may not all have a chance to be reviewed for medical necessity before they are paid. Therefore, the post-payment review includes both verification of drug administration and a medical necessity review of a statistically valid sample of CAP claims. In conducting the post-payment review, we will continue to monitor for fraud, waste, and abuse. All CAP claims will remain eligible for review for medical necessity and verification of drug administration. We anticipate that the post-payment review process will provide us with additional opportunities to monitor for the appropriate payment of drugs furnished under this program. </P>
                    <P>To conduct post-payment review of claims, we may also ask for documentation of administration from the approved CAP vendor and for medical records from the participating CAP physician for any claim that is identified for review. While it is standard practice for CMS to require Medicare providers to submit medical records as part of claims review, we reserve the right to also specifically request any other records that verify the administration of a CAP drug. Furthermore, we want to make it very clear to the participating CAP physician that when electing to join the program that the physician may be asked to supply medical records for post-payment review. Therefore, in the CY 2008 PFS proposed rule (72 FR 38153), we proposed to revise § 414.908(a)(3)(xi) and the physician election agreement form to clarify that medical records and certain other information may be requested from the CAP physician during the post-payment review process. </P>
                    <P>The procedures used to verify valid claims and ensure proper payment for drugs supplied under the CAP are based on established post-payment review processes used in other parts of the Medicare program. The request for medical records as part of the claims payment process during CAP post-payment review is intended to work in conjunction with Item 12 on the Health Insurance Claim Form CMS-1500 which, when signed by a beneficiary, authorizes the release of “any medical information necessary to process a claim.” </P>
                    <P>When a claim is selected for review we notify the approved CAP vendor and request its records to verify administration. We also notify the approved CAP vendor that we will be requesting medical records from the participating CAP physician. If the medical record is not received within 30 days, the claim is denied because we will not have sufficient information to verify drug administration and medical necessity. </P>
                    <P>This review process is similar to those used elsewhere in the Medicare program such as clinical laboratory payment review or payment of radiology services. </P>
                    <P>As we specified in the July 6, 2005 IFC (70 FR 39038), the local carrier's medical review policies and coverage determinations will continue to apply in the CAP. Under our previous claims processing methodology, the local carrier made the coverage determination on the drug ordered by the participating CAP physician and furnished by the approved CAP vendor as part of the claim matching process prior to payment of the approved CAP vendor's claim. Under the new methodology, the drug claim will be paid upon receipt unless the local carrier has already made a coverage or medical necessity determination on the drug, and the match has already occurred showing that the drug claim should be denied. </P>
                    <P>As part of the post-payment review process, the CAP-designated carrier checks the CMS central claims processing system to determine whether the local carrier has made a coverage or medical necessity determination on the CAP drug indicated on the participating CAP physician's drug administration claim. If a coverage determination has been made, the CAP-designated carrier reflects the local carrier's decision in its post-payment review of the claim. If the local carrier has not reviewed the drug administration portion of the participating CAP physician's claim as of the date that the designated carrier processes the approved CAP vendor's drug claim, the CAP-designated carrier uses the local carrier's coverage determination policies when conducting medical review of the claim. </P>
                    <P>
                        <E T="03">Comment:</E>
                         One commenter stated that we had exceeded the scope of the statute because we were planning to conduct a medical necessity review on CAP drug claims that were selected for review as part of the statistical sample. 
                    </P>
                    <P>Another commenter recommended that we make detailed description of the claims sampling process available for public comment and asked that we design the process consistent with the Medicare Program Integrity Manual. The commenter also asked for more detail on the information necessary to include in the medical record to ensure that the participating CAP physician has appropriately documented the medical necessity of the drug administered. </P>
                    <P>One commenter questioned whether we needed to obtain additional information from the CAP participating physician on claims selected for post pay review based on the statistical sample and stated that the information contained on the claim form should be sufficient to verify administration. </P>
                    <P>Another commenter questioned why we were changing the CAP claims processing methodology to pay most claims upon receipt and to verify administration on a post pay basis. The commenter asked whether we would allow for extenuating circumstances if the medical record was not supplied by the participating CAP physician within the 30-day time period for situations such as bankruptcy, litigation, or closure of the practice. </P>
                    <P>
                        <E T="03">Response:</E>
                         As stated in the CY 2008 PFS proposed rule (72 FR 38153), we were required to make changes to the CAP claims processing methodology because section 108 of the MIEA-TRHCA  amended section 1847B(a)(3)(A)(iii) of the Act by adding new language that requires the payment for drugs and biologicals upon receipt of a claim for a drug or biological supplied for administration to a beneficiary. This change in the law was effective on April 1, 2007. Section 108(a)(2) of the MIEA-TRHCA  requires the Secretary to establish (by program instruction or otherwise) a post-payment review process (which may include the use of statistical sampling) to assure that payment is made for a drug or biological only if the drug or biological has been administered to a beneficiary. The Secretary is required to recoup, offset, or collect any overpayment determined by the Secretary under this process. We implemented the necessary changes to our claims processing system and initiated the post-payment review process on April 1, 2007, via instructions to the CAP-designated claims processing contractor and Questions and Answers posted the CMS competitive bidding Web site at 
                        <E T="03">http://www.cmsm.hhs.gov/CompetitiveAcquisforBios/15_Approved_Vendor.asp#TopOfPage.</E>
                         In the CY 2008 PFS proposed rule, we described the changes we had made to our claims processing system and proposed conforming changes to our regulations for additional items not covered by the MIEA-TRHCA. Because the MIEA-TRHCA  gave us authority to 
                        <PRTPAGE P="66263"/>
                        implement its provisions by program instructions or otherwise by April 1, 2007, the necessary changes have already been made to our claims processing system and the post-pay review process had been implemented. The post-payment review process includes verification of drug administration and a medical necessity review of a statistically-valid sample of CAP claims. This process was designed in conformance with the Medicare Program Integrity Manual and in consultation with CMS statistical sampling experts, consistent with our authority to establish these procedures by program instruction or otherwise. For additional information on the requirements of the Program Integrity Manual see 
                        <E T="03">http://www.cms.hhs.gov/manuals/downloads/pim83co2pdf.</E>
                    </P>
                    <P>All Medicare claims are subject to medical necessity determinations; however, under the changes required by the MIEA-TRHCA, there may not be sufficient time for all CAP claims to be reviewed for medical necessity before they are paid. Prior to paying the approved CAP vendor's claim, the designated carrier will check the claims processing system to determine whether the participating CAP physician has submitted the claim for the administration of the drug. If the physician has submitted the claim and the local carrier has made a determination that the drug is not payable because of a coverage or medical necessity denial, the drug claim will be denied by the designated carrier. However, if no determination has been made on the physician's claim, the designated carrier will pay the approved CAP vendor's claims for the drug under the MIEA-TRHCA, and the claim will be subject to statistical sampling on a post-pay basis. If the claim is selected for review, verification of drug administration and a medical necessity review will be conducted. As part of this process, the designated carrier will check the system to see whether the local carrier had denied the claim as not medically necessary. If a denial has been made, the designated carrier will deny the approved CAP vendor's claim on medical necessity grounds. The designated carrier will use the local carrier's policies when conducting the review. </P>
                    <P>Medical necessity review is always conducted based on medical records obtained from the physician and will be conducted in an effort to look behind the information on the claim form. As specified in chapter 3 of the Medicare Program Integrity Manual, standard data elements for post-pay medical review include signature requirements, diagnosis requirements, and documentation of orders for testing. The carrier may also specify additional information it will review to document that coverage and medical necessity requirements have been met. Under the current CAP post-pay review process, the designated carrier requests that all records be supplied by the physician within 30 days but allows for a limited amount of time beyond that period before the service will be considered not to have been administered. Participating CAP physicians are encouraged to send any information they can provide to the designated carrier within the timeframes provided. If the physician is unable to provide all of the requested information in a timely manner to the carrier, he or she may contact the carrier to determine if the contractor will grant an extension. There is also a provision in the Medicare Program Integrity Manual that allows contractors to grant additional time in the event of a natural disaster. As we indicated in the CY 2008 PFS proposed rule, it is standard practice for Medicare providers to be required to submit medical records to assist in claims review. Therefore, we are finalizing our proposal to revise § 414.908(a)(3)(xi) and the physician election agreement to make it very clear to the CAP participating physician that they may be asked to provide medical records for post-payment review in the CAP.</P>
                    <HD SOURCE="HD3">e. Provisions for Collection of Beneficiary Coinsurance </HD>
                    <P>In the CY 2006 PFS final rule with comment period, we specified at § 414.914(h)(1) that subsequent to receipt of final payment by Medicare, or the verification of drug administration by the participating CAP physician, the approved CAP vendor must bill any applicable supplemental insurance policies. If a balance remains after the supplemental insurer pays its share of the bill, or if there is no supplemental insurance, the approved CAP vendor may bill the beneficiary for the balance. In prior practice, a match in the claims system between the participating CAP physician's drug administration claim and the approved CAP vendor's drug claim and the subsequent payment by Medicare was used to indicate that the beneficiary received the drug. We also allowed voluntary information exchanges between the approved CAP vendor and the participating CAP physician's office to verify CAP drug administration. Additionally, we note that under the CAP regulations, the participating CAP physician has a responsibility to notify the approved CAP vendor when a drug is not administered or a smaller amount was administered than was originally ordered. </P>
                    <P>Because section 108 of the MIEA-TRHCA requires the payment of CAP claims upon receipt, payment of a claim by Medicare may occur before administration of the drug has been verified. However, section 1847B(a)(3)(A)(ii) of the Act, which states that deductible and coinsurance shall not be collected unless the drug or biological is administered, remains unchanged. Thus, because we have interpreted this provision as requiring verification of administration prior to the collection of applicable cost sharing amounts, the requirement for verification of administration similarly remains unchanged. However, because of the statutory change of section 108(a)(1) of the MIEA-TRHCA  and its resulting impact on our claims processing methodology, the claims processing system no longer provides a way for CMS to verify administration on the approved CAP vendor's behalf before the approved CAP vendor collects coinsurance from the beneficiary or the supplemental insurer. Verification of CAP drug administration is also conducted in the post-payment review process. The approved CAP vendor is expected to make information available to verify administration for post-payment review as necessary. </P>
                    <P>
                        We believe that an approved CAP vendor can verify whether a CAP drug was administered in a variety of ways. For example, an approved CAP vendor may enter into a voluntary agreement with a participating CAP physician to exchange such information as described in the CY 2006 PFS final rule with comment period (70 FR 70251). However, if a participating CAP physician is unwilling to enter into a voluntary agreement to verify administration, the approved CAP vendor may verify that the drug was administered by contacting the participating CAP physician's office to request verbal confirmation. In such an instance, the approved CAP vendor is expected to document the verbal confirmation of CAP drug administration, the identities of individuals who exchanged the information, and the date and time that the information was obtained. In addition to verifying administration through contact with the physician's office, we also suggest that the approved CAP vendor place a statement on beneficiaries’ bills informing the individual of the statutory requirement and suggesting that the beneficiary contact the participating CAP physician to verify that he or she received the dose 
                        <PRTPAGE P="66264"/>
                        of the drug for which he or she are being billed prior to paying any cost sharing amount. 
                    </P>
                    <P>For the reasons described above in this section, we believe that the verification of CAP drug administration remains a required element of the CAP; therefore, in the CY 2008 PFS proposed rule (72 FR 38155), we proposed to add § 414.906(a)(6) by specifying that all of the following elements are required to document the verification of CAP drug administration: </P>
                    <P>• Beneficiary's name. </P>
                    <P>• Health insurance number. </P>
                    <P>• Expected date of administration. </P>
                    <P>• Actual date of administration. </P>
                    <P>• Identity of the participating CAP physician. </P>
                    <P>• Prescription order number. </P>
                    <P>• Identity of the individuals who supply and receive the information. </P>
                    <P>• Dosage supplied. </P>
                    <P>• Dosage administered. </P>
                    <P>In the CY 2008 PFS proposed rule, these data elements were actually proposed in § 414.914 (72 FR 38226). We believe that the drug administration verification requirements best fit in § 414.914 since CAP vendors must collect this information as part of their terms of contract. Therefore, we are finalizing § 414.914 to include these provisions. </P>
                    <P>Also, as a result of changes mandated by section 108(a)(1) of the MIEA-TRHCA, we proposed to revise new § 414.914(i)(1) to remove the reference to “final payment by Medicare” and revise this language to state, “payment by Medicare.” The original language was written to indicate that an approved CAP vendor could not bill a beneficiary's supplemental insurer for applicable amounts of cost sharing until the CAP drug claim had matched the corresponding physician's drug administration claim. Under the post-payment review process, the final payment would not occur until a statistical review of the claims was complete, a process that may take several months. Removing the word final from this section of the regulation will clarify that the approved CAP vendor may bill the supplemental insurer immediately after the designated CAP carrier makes the initial payment on a CAP drug claim. Under our current regulations, the approved CAP vendor may also bill the beneficiary if drug administration is verified by the participating CAP physician. This provision remains unchanged. </P>
                    <P>Under the revised CAP claims payment process, the approved CAP vendor will bill Medicare for the CAP drug that has been provided. In most cases Medicare will pay the claim upon receipt. If the beneficiary has a supplemental insurance policy, and the supplemental insurer has a crossover agreement with Medicare, the claim automatically will cross over to the supplemental insurer for payment. The supplemental insurer will pay its share. Upon receipt of payment from the supplemental insurer, the approved CAP vendor may bill the beneficiary for any residual amount. For beneficiaries who do not have a supplemental insurance policy, the approved CAP vendor may bill the beneficiary after payment by Medicare. </P>
                    <P>However, in either case, the approved CAP vendor may not collect any coinsurance owed from the beneficiary or his or her supplemental insurer unless it has verified that the drug was administered. If the approved CAP vendor believes that the drug was administered but later learns that it was not, the approved CAP vendor must refund any coinsurance collected to the beneficiary and his or her supplemental insurer, as applicable. In addition, in § 414.914(i)(2), we proposed that the approved CAP vendor must promptly refund any payment made by CMS if the vendor has been paid for drugs that were not administered. We also proposed to interpret the word “promptly” to mean 2 weeks. Thus, the approved CAP vendor would have 2 weeks from the date it was notified that it had been paid for a drug that had not been administered to refund to the designated carrier any payment for the claim and refund any cost sharing collected to the beneficiary or his or her supplemental insurer. </P>
                    <P>
                        <E T="03">Comment:</E>
                         We received few comments on our proposal for provisions for collection of beneficiary coinsurance. One commenter was concerned about the administrative burden placed on the participating CAP physician if the approved CAP vendor calls the physician's office to verify that a drug was administered. Another commenter agreed with our proposal to require that the approved CAP vendor refund any cost sharing collected in error promptly to the beneficiary and or his or her supplemental insurance provider. The commenter also suggested that we require the approved CAP vendor to pay a penalty above the amount owed if it does not refund the cost sharing amount within the 2 week time frame. 
                    </P>
                    <P>
                        <E T="03">Response:</E>
                         Physicians and their staff are the best source of information for drug verification since they have direct contact with the beneficiary. We have structured the process for verification of CAP drug administration in the least burdensome way possible for the participating CAP physician that would still provide us with information to comply with the statutory mandate to assure that payment is made for a CAP drug only if it has been administered to a beneficiary. 
                    </P>
                    <P>Physicians have flexibility in how verification for drug administration occurs. The physician is free to enter into a voluntary agreement with the approved CAP vendor to verify drug administration and to specify the manner in which he or she would like the verification to occur. Alternatively, if the physician chooses not to enter into such an agreement and does not notify the vendor that a dose of a CAP drug has been administered, the approved CAP vendor will contact the physician to verify administration before collecting coinsurance from the beneficiary. </P>
                    <P>We believe that the degree of flexibility built into this procedure for drug administration verification minimizes the burden for participating CAP physicians within the confines of our statutory obligation to assure that payment is made for a CAP drug only if it has been administered to a beneficiary. Therefore, we are finalizing our proposal to add new § 414.914(h)(1) as described above in this section. </P>
                    <P>We are also finalizing our proposal to revise new § 414.914(i)(1) to remove the reference to “final payment by Medicare” and revise this language to state, “payment by Medicare.” Under the post-payment review process, the final payment will not occur until a statistical review of the claims was complete, a process that may take several months. Removing the word final from this section of the regulation will clarify that the approved CAP vendor may bill the supplemental insurer immediately after the designated CAP carrier makes the initial payment on a CAP drug claim. Under our current regulations, the approved CAP vendor may also bill the beneficiary if drug administration is verified by the participating CAP physician. This provision remains unchanged. </P>
                    <P>
                        Under the revised CAP claims payment process, the approved CAP vendor will bill Medicare for the CAP drug that has been provided. In most cases Medicare will pay the claim upon receipt. If the beneficiary has a supplemental insurance policy, and the supplemental insurer has a crossover agreement with Medicare, the claim automatically will cross over to the supplemental insurer for payment. The supplemental insurer will pay its share. Upon receipt of payment from the supplemental insurer the approved CAP vendor may bill the beneficiary for any residual amount. For beneficiaries who 
                        <PRTPAGE P="66265"/>
                        do not have a supplemental insurance policy, the approved CAP vendor may bill the beneficiary after payment by Medicare. 
                    </P>
                    <P>However, in either case, the approved CAP vendor may not collect any coinsurance owed from the beneficiary or his or her supplemental insurer unless it has verified that the drug was administered. If the approved CAP vendor believes that the drug was administered but later learns that it was not, the approved CAP vendor must refund any coinsurance collected to the beneficiary and his or her supplemental insurer, as applicable. </P>
                    <P>In addition, we are finalizing § 414.914(i)(2), so that the approved CAP vendor must promptly refund any payment made my CMS if the vendor has been paid for drugs that were not administered. We are implementing our proposal to interpret the term “promptly” to mean 2 weeks so that the approved CAP vendor would have 2 weeks from the date that they were notified that they had been paid for a drug that had not been administered to the beneficiary to refund any payment for the claim made to the designated carrier and refund any cost sharing collected to the beneficiary and his or her supplemental insurer. We are not implementing a penalty if the refund of any cost sharing collected in error exceeds the two week time frame because section 1847B of the Act does not provide for such a remedy.</P>
                    <HD SOURCE="HD3">f. Approved CAP Vendor Appeals for Denied Drug Claims </HD>
                    <P>In the March 4, 2005 proposed rule (70 FR 10757 through 10758) and the July 6, 2005 IFC (70 FR 39054 through 39057), we discussed the development of the CAP dispute resolution process and the limited applicability of the traditional Medicare fee for service appeals process to an approved CAP vendor's dispute of CAP drugs claims that are denied by the CAP-designated carrier. We stated that the approved CAP vendor could file appeals as a Medicare supplier consistent with the rules at 42 CFR part 405, subpart I. For the purposes of the appeals regulations at Part 405, Subpart I, we indicated that a local carrier's initial determination of the participating CAP physician's drug administration claim was an initial determination regarding payment of the approved CAP vendor's drug claim. Thus, the approved CAP vendor was to be considered a party to any redetermination of the drug administration claim by the local carrier. In addition, the approved CAP vendor would be considered a party to an initial determination on the claim for payment for the drug product that the approved CAP vendor filed with the CAP-designated carrier. </P>
                    <P>We also specified that appeals of either initial determination would be filed with the local carrier. We stated that the local carrier, rather than the designated carrier, possessed all information necessary to adjudicate an appeal in this situation. Such information included local coverage decisions, medical necessity determinations, and information regarding payment of drug administration claims. A dispute resolution process was set forth in § 414.916. </P>
                    <P>Under our initial implementation of the provision that authorized CAP, this alternative approach provided party status to the approved CAP vendor on the participating CAP physician's drug administration claim. This was necessary because an approved CAP vendor was not permitted to receive payment for a CAP drug until the corresponding drug administration claim was submitted by a participating CAP physician. Payment for the approved CAP vendor's claim was authorized when the participating CAP physician's claim and the approved CAP vendor's claim were matched in the system. </P>
                    <P>However, changes to the claims processing requirements and the addition of a post-payment review process required by section 108(a)(2) of the MIEA-TRHCA (discussed above in this section) eliminate the approved CAP vendor's dependency on a participating CAP physician's filing of a drug administration claim in order to receive payment for a CAP drug. Accordingly, the approved CAP vendor no longer needs party status on the drug administration claim submitted by the participating CAP physician. Instead, under the MIEA-TRHCA, the approved CAP vendor's drug claim may be paid by the CAP-designated carrier once it is received. This determination made on the claim constitutes an initial determination as defined in § 405.924. The approved CAP vendor is considered a party to this initial determination and may request a redetermination and subsequent appeals consistent with the process established under 42 CFR part 405, subpart I. </P>
                    <P>The changes to CAP claims processing in this final rule with comment period that conform to the MIEA-TRHCA result in two scenarios that create appeals rights for the approved CAP vendor with respect to their drug product claim: (1) Prepayment denials of the approved CAP vendor's claim made by the CAP-designated carrier (based on information from the local carrier that the payment for the drug should be denied as excluded or non-covered); and (2) post-payment denials by the CAP-designated carrier based on the post-payment review process established under the MIEA-TRHCA. </P>
                    <P>Therefore, as proposed in the CY 2008 PFS proposed rule (72 FR 38156), we are making the following clarifications regarding the CAP appeals process for an approved CAP vendor's denied drug claims: </P>
                    <P>• For prepayment denials, the approved CAP vendor, as a supplier, has a direct right to appeal the initial determination made by the designated carrier on its drug product claim. The local carrier will conduct the redetermination on prepayment denials. It is the most appropriate entity to review prepayment denials since it is most familiar with the relevant coverage policies for that jurisdiction. We acknowledge that this process differs from a traditional fee-for-service appeal since the redetermination will not be conducted by the contractor that issued the initial determination. </P>
                    <P>• For the post-payment review process, an initial determination will be considered re-opened if the CAP-designated carrier selects the drug claim for review. If the CAP-designated carrier cannot verify administration or cannot determine that the drug is covered or medically reasonable and necessary, the CAP-designated carrier will issue a revised determination to deny coverage of the drug product claim. The CAP-designated carrier will then determine whether an overpayment exists, and if so, will recover the overpayment. As a supplier, the approved CAP vendor would then have the right to request a redetermination of the revised coverage determination, and the overpayment assessment. The CAP-designated carrier will process the redetermination. </P>
                    <P>We received no comments on this topic; therefore, we are finalizing the proposed conforming changes to the CAP appeals process as described herein. </P>
                    <HD SOURCE="HD3">g. Definition of Exigent Circumstances </HD>
                    <P>Sections 1847B(a)(1)(A)(ii) and 1847B(a)(5)(A)(ii) of the Act require that each physician be given the opportunity annually to elect to obtain drugs and biologicals through the CAP and to select an approved CAP vendor. Section 1847B(a)(5)(A)(i) of the Act allows for selection of another approved CAP vendor more frequently than annually in exigent circumstances as defined by CMS. </P>
                    <P>
                        In the CY 2005 PFS final rule with comment period (70 FR 70258), we 
                        <PRTPAGE P="66266"/>
                        stated that participating CAP physicians would have the option of changing approved CAP vendors or opting out of the CAP program on an annual basis. We also provided the circumstances, as specified in § 414.908(a)(2), under which a participating CAP physician may choose a different approved CAP vendor mid-year or opt-out of the CAP. These circumstances are: (1) If the selected approved CAP vendor ceases to participate in the CAP; (2) if the participating CAP physician leaves the group practice that had selected the approved CAP vendor; (3) if the participating CAP physician relocates to another competitive acquisition area (if multiple CAP competitive areas are developed) or, (4) for other exigent circumstances defined by CMS. 
                    </P>
                    <P>We also identified a separate exigent circumstance relating to instances in which an approved CAP vendor declines to ship CAP drugs (when the conditions of new § 414.914(i) are met) in § 414.908(a)(5). We noted that in these cases, a physician may opt-out of his or her drug category, and because there is currently only one drug category for the CAP, then the participating CAP physician would be allowed to opt-out of the CAP altogether (70 FR 39081). </P>
                    <P>The CAP became operational on July 1, 2006. At that time, we believed that most issues raised by participating CAP physicians would relate to quality and service, which could be resolved through the approved CAP vendor's grievance process and the dispute resolution process conducted by the designated carrier. However, since then, we have been contacted by a few participating CAP physicians who have requested termination of their election agreement because they misunderstood the CAP program or determined that it was not a viable option for their practice. </P>
                    <P>These instances demonstrate that a practice might wish to leave the program for other business reasons that are unrelated to the approved CAP vendor's performance. However, we continue to believe that opportunities for leaving the CAP outside the annual election process should be limited because the CAP was designed as a program in which physicians would make an annual decision to participate, as consistent with sections 1847B(a)(1)(A)(ii) and 1847B(a)(5)(A) of the Act. </P>
                    <P>Therefore, in the CY 2008 PFS proposed rule (72 FR 38156), we proposed to define an additional exigent circumstance for opting out of the CAP. We proposed that within 30 days of the effective date of the election agreement, the participating CAP physician may submit a written request to terminate his or her participation in the CAP. The request would be sent to the designated carrier under the dispute resolution process, and the designated carrier would determine within 1 business day whether the request was related to the service provided by the approved CAP vendor. If so, the designated carrier would refer the participating CAP physician to his or her approved CAP vendor's grievance process to further determine whether any appropriate and reasonable steps could be taken to resolve the identified issue. </P>
                    <P>We proposed that the approved CAP vendor would have 2 business days to respond to the participating CAP physician's concern, consistent with § 414.914(f)(5). If the approved CAP vendor is unable to identify a solution for resolving the issue that is consistent with the CAP statute, regulations, contracts and guidance, and that is acceptable to the physician, then the participating CAP physician would be referred back to the designated carrier for assistance under the dispute resolution process. We also proposed that the participating CAP physician's request would be handled under the dispute resolution process because protocols and defined time frames have already been developed for handling participating CAP physician and approved CAP vendor complaints in this set of procedures. </P>
                    <P>We proposed that if the designated carrier does not believe that the participating CAP physician's request is related to an issue that could be resolved by the approved CAP vendor, then the designated carrier would conduct an investigation and attempt to resolve any issues identified in the physician's request to terminate his or her CAP election agreement. If the designated carrier is unable to resolve the situation to the physician's satisfaction within 2 business days, then it can either make a recommendation to CMS that the physician be permitted to terminate his or her CAP election agreement, or request a 2-day extension to continue examining the issue. We stated that we believed that 4 business days would be sufficient to conclude this process because it would give the designated carrier time to gather information from other affected parties, such as the participating CAP physician's local carrier, but still prepare a speedy summary of the issues involved in the physician's request. </P>
                    <P>Under our proposal, after the 2-day or 4-day period, as applicable, the designated carrier would forward its recommendation and the physician's request to CMS. We would then review the recommendation and make a final decision within 2 business days from the date that we received the request. </P>
                    <P>We proposed that if the participating CAP physician demonstrated that remaining in the CAP was a significant burden, then we would allow that physician to terminate his or her participation in the program. We would inform the designated carrier of our decision, which the designated carrier would then communicate to the participating CAP physician in writing. As part of this process, the physician's termination date for his or her CAP election agreement would be determined and communicated to all parties involved, including the physician's local carrier. </P>
                    <P>Conversely, if we did not believe that the physician demonstrated that CAP participation constituted a significant burden, then we would not allow the physician to terminate his or her CAP contract. Subsequently, we would inform the physician of our decision in writing via the designated carrier. We would also include a recommendation for corrective action. </P>
                    <P>In the CY 2008 PFS proposed rule, we also proposed that, even if we agreed to terminate the participating CAP physician's CAP election agreement, the physician would still be required to continue to cooperate in any post-payment review and appeal of claims for drugs that the approved CAP vendor had already provided and been paid for. The physician would also have to make arrangements with the approved CAP vendor for the return of any unused drugs that had not been administered to the beneficiary prior to the effective date of the physician's termination from the CAP. If the approved CAP vendor had billed CMS for drugs that had not yet been administered to a beneficiary, then the vendor would be required to correct the claim and return any overpayment. </P>
                    <P>
                        <E T="03">Comment:</E>
                         We received several comments that supported defining an additional exigent circumstance for leaving the CAP because of a burden on the practice. Several commenters addressed the timeframe for leaving the CAP. Of these comments, all supported a 30-day timeframe, though several encouraged a longer window. Commenters who encouraged a longer time period believe that 30 days was insufficient time to determine the suitability of the CAP for their practice. 
                    </P>
                    <P>
                        While most commenters agreed that a demonstration of burden should be required, one commenter stated that allowing physicians to opt-out for any reason would be desirable. One commenter suggested that physicians should be allowed to opt-out of the CAP 
                        <PRTPAGE P="66267"/>
                        at any time for any reason. Several commenters asked that the opt-out process be simplified. Another commenter requested that the process for determining whether to grant a physician's request to leave the CAP be outlined. 
                    </P>
                    <P>
                        <E T="03">Response:</E>
                         Based on the comments, we are revising our proposal to make it more flexible. While we recognize the concerns raised by commenters who recommended that we allow physicians to leave the CAP for any reason at any time, we continue to believe that there should be limits on a participating CAP physician's ability to leave the CAP. The CAP statute contemplates an annual election process. Our proposal to allow a 30-day period for opting out because of a burden is based on our authority to specify “exigent circumstances,” and we do not believe it would be appropriate to allow physicians to opt-out under this process without some exigency that makes termination of CAP participation necessary. However, in recognition of these comments, and because we agree that participating CAP physicians should have a sufficient opportunity to assess the suitability of the CAP for their practice, we are making the following changes to the opt-out process. 
                    </P>
                    <P>First, we note that we intend to take a broad view of what would constitute a burden to the practice resulting in an “exigent circumstance.” We believe that a broad view is appropriate because there may be many reasons why a participating CAP physician may find CAP participation more burdensome than he or she expected, and we do not wish at this time to place a limit on what those reasons may be. As we gain experience with this process, we may in a future rulemaking specify a list of “exigent circumstances” or prescribe more specific standards for what constitutes an “exigent circumstance” for purposes of the opt-out process; however, for now we will assess requests on a case-by-case basis under the process described in this preamble and set forth in the regulations at § 414.908. </P>
                    <P>In response to comments seeking greater flexibility in the process and a longer window in which to assess the CAP's suitability for the physician's practice, we are implementing a two-tiered process that would both expand the initial time frame for requesting to opt-out of the CAP and would allow for requests to opt-out at any time based on a change in circumstances that was not previously known to the participating CAP physician. We believe that such a process, which we outline below, strikes a balance between providing participating CAP physicians with flexibility to opt-out of the CAP when participation is burdensome, while still placing appropriate limits on a physician's ability to leave the CAP outside the annual election process. </P>
                    <P>Thus, under the two-tiered process we are finalizing in this rule, we are changing to 60 days the initial period during which a physician can request termination of his or her CAP participation agreement as a result of exigent circumstances. We agree with commenters that allowing physicians more time to determine whether the CAP is suitable for their practices is advisable. We believe that an initial 60-day period will allow the participating CAP physician time to make a more complete assessment of the CAP's suitability. Although certain burdens will be likely to be apparent immediately, the first 30 days may be a period with a steep learning curve for the practice as it adapts to the CAP drug ordering process, and the first 30 days may involve working out any “start up” issues within the practice or with the approved CAP vendor. For this reason, the first 30 days may not be a fully representative time period during which to assess ongoing CAP participation. We believe an additional 30 days of CAP participation would be sufficient to identify, in the vast majority of cases, whether participation will constitute a burden to the practice. </P>
                    <P>
                        Under this process, therefore, if a participating CAP physician's election agreement was effective on January 1, 2008, then he or she would have until March 1, 2008, to request to terminate participation in the program if CAP participation results in a burden to the practice. In addition, based on the concerns raised by commenters, we will allow physicians to leave the CAP at any time after the first 60 days if they can show that a change in circumstances that was not known to the practice 
                        <E T="03">previously</E>
                         results in a burden to the practice. As noted above, we believe that in the vast majority of cases participating CAP physicians will be able to identify a burden, if any, within the first 60 days. However, we also recognize that issues may arise during the course of the year that would result in an “exigent circumstance,” but that were not known to the participating CAP physician during the first 60 days of CAP participation. In such instances, we agree with commenters that physicians should have a longer window to request an opt-out. 
                    </P>
                    <P>For purposes of the two-tiered process, then, examples of burdens that we would expect a practice could identify within the first 60 days may include difficulties with CAP billing or drug ordering requirements, or documentation that the practice's initial understanding of these requirements was based on inaccurate information provided by a third party. Examples of burdens that might arise after the initial 60 days could include a change in practice personnel, patient population, computer systems, or vendor behavior that makes it harder to participate in the program. Where an opt-out request is submitted after the initial 60 days, we will require the participating CAP physician to demonstrate the request is based on information that he or she did not have within the first 60 days. </P>
                    <P>All requests to terminate participation, whether within the first 60 days or thereafter, would be submitted to the CAP-designated carrier and processed under the dispute resolution process. The request would need to document the physician's burden. Upon completion of the process outlined in proposed § 414.917, we would make the decision about whether the participating CAP physician's participation in the CAP will be terminated. </P>
                    <P>If the physician has not demonstrated that CAP participation represents a burden for his or her practice—either during the first 60 days or, if thereafter, as a result of a change in circumstances that was not known to the practice previously, then we would not allow the physician to terminate his or her participation in CAP because, as noted above, we continue to believe that a participating CAP physician's ability to opt-out of the CAP under this process should be limited to “exigent circumstances,” as contemplated by the statute and our regulations. </P>
                    <P>
                        We would inform the physician of our decision in writing via the designated carrier. We would also include a recommendation for corrective action, if appropriate. For example, if the reason that the CAP participating physician wanted to leave the program was that the approved CAP vendor was not delivering drugs timely, the designated carrier would investigate the situation. If it found that the approved CAP vendor was complying with our regulations on drug delivery at § 414.914(f) and § 414.902 but that the participating CAP physician was not ordering drugs consistent with the vendor's procedures, then the CAP-designated carrier could educate the physician about the proper drug ordering procedures and facilitate a discussion between the approved CAP vendor and the participating CAP physician about how the physician could order drugs in a way that met the 
                        <PRTPAGE P="66268"/>
                        needs of his or her practice and the drug ordering requirements of the CAP vendor. The CAP-designated carrier would document the result of that discussion in writing. The participating CAP physician would have the right to request a reconsideration of our decision as specified in § 414.916(c). We are revising § 414.916(c) to clarify that the physician reconsideration process would apply to reconsiderations of our decision on whether the participating CAP physician may opt-out of the CAP. 
                    </P>
                    <P>Based on our experience with the program, we continue to believe that handling all requests to terminate CAP election under the dispute resolution process is reasonable and straightforward. We further believe the use of our pre-existing process will not create unnecessary delays in processing opt-out requests, particularly in light of the short time frames we have specified for responding to opt-out requests. Moreover, we believe the dispute resolution process is sufficiently detailed that it provides an ample description of how a physician's request to terminate CAP participation will be assessed. </P>
                    <P>Physicians will still be required to return unused CAP drugs and to complete any required CAP claims processing activities as described in proposed § 414.917. The notification to a physician will also include the end date of CAP participation in order to facilitate an orderly and efficient changeover between the CAP and ASP payment systems. </P>
                    <P>Therefore, we are finalizing § 414.908 and § 414.917 as proposed, subject to the changes described in this section. (We are making an additional technical change to § 414.908 to consolidate the “additional opt-out” provision, currently set forth at § 414.908(a)(5), with the other opt-out provisions at § 414.908(a)(2). We believe this nonsubstantive change will improve the clarity of the regulations.) Finally, we also are finalizing § 414.916(c) as amended as described in this section.</P>
                    <HD SOURCE="HD3">h. Transporting CAP Drugs</HD>
                    <P>Although section 1847B((b)(4)(E) of the Act provides for the shipment of CAP drugs to settings other than a participating CAP physician's office under certain conditions, we did not propose to implement the CAP in alternative settings. In the July 6, 2005 IFC (70 FR 39047), we described both comments that supported the idea of allowing participating CAP physicians to transport drugs to multiple office locations, and comments that raised concerns about the risk of damaging a drug that has not been kept under appropriate conditions while being transported. </P>
                    <P>As stated in § 414.906(a)(4), we implemented the CAP with a restriction that CAP drugs be shipped directly to the location where they will be administered. However, we were aware that physicians may desire to administer drugs in alternative settings, especially in a home. We sought comment on how this could be accommodated under the CAP in a way that addresses the concerns about product integrity and damage to the approved CAP vendors' property expressed by the potential vendors. </P>
                    <P>Several comments submitted in response to the July 6, 2005 IFC suggested either narrowing or removing the restriction on transporting drugs to other locations. Commenters believed that physicians, particularly those who specialize in oncology, and their staff are knowledgeable about drug stability and handling, and therefore, were capable of assuming this responsibility. Other commenters indicated that transporting the drug to another office location may allow for flexibility in scheduling patient visits. It would allow practices with satellite operations that are not open every business day to receive shipments of CAP drugs at another practice location and then to administer the drugs in the satellite office. </P>
                    <P>We also received several comments discussing the impact of CAP-delivery times on rural clinics and offices with satellite locations. Many of these responses discussed how easing the restriction on transporting CAP drugs between locations would be welcome in rural areas and for satellite offices with limited hours. </P>
                    <P>These comments and our experience with the CAP thus far have caused us to consider revising our policy. Therefore, in the CY 2008 PFS proposed rule (72 FR 38157), we requested comments on the potential feasibility of narrowing the restriction on transporting CAP drugs where this is permitted by State law and other applicable laws and regulations. We asked commenters to consider how such a policy could be constructed so that the approved CAP vendor could retain control over how the drugs that it owns are handled. We also requested comments on other issues that we should take into account concerning transportation of CAP drugs between practice locations listed on a physician's CAP election agreement form. Additionally, we also solicited comments on the following areas that we could use in the development of future proposals: </P>
                    <P>• How to structure requirements so that drugs are not subjected to conditions that will jeopardize their integrity, stability or sterility while being transported and steps to keep transportation activities consistent with all applicable laws and regulations; </P>
                    <P>• Whether any agreement allowing participating CAP physicians to transport CAP drugs to alternate practice locations should be voluntary. This means that approved CAP vendors would not be required to offer such an agreement and physicians who participate in the CAP would not be required to accept such an offer; and </P>
                    <P>• Whether the agreement should be documented in writing, and whether it is necessary to create any restrictions on which CAP drugs could be transported. </P>
                    <P>We stated that we were not making a specific proposal at this time but that we would use any information received to structure a future proposal in the event we made one. </P>
                    <P>
                        <E T="03">Comment:</E>
                         Several commenters supported the concept of easing the restriction on transporting CAP drugs if this could be done safely, and if changes were consistent with applicable rules, regulations, and within the limitations of product stability and integrity. The restriction on transporting CAP drugs was perceived as a barrier to physician participation in the program. One commenter stated that elimination of the restriction would result in the same flexibility as the ASP (buy and bill) method of acquiring drugs. Another commenter expressed a strong desire to implement these changes promptly. 
                    </P>
                    <P>A few commenters also cautioned us to be certain that appropriate safeguards would be in place if we chose to ease the transportation restriction. One commenter asked that the safeguards be available for public scrutiny before they are implemented. Conversely, other commenters stated that a physician's certification or discretion were satisfactory. </P>
                    <P>
                        <E T="03">Response:</E>
                         We are sympathetic to the concerns expressed by the commenters and expect to issue a proposal in the CY 2009 PFS proposed rule that would allow the transportation of CAP drugs from one physician practice location in certain circumstances. We further expect that our proposal would propose to permit transport of CAP subject to voluntary agreements between the approved CAP vendor and the participating CAP physician that complied with all applicable State and Federal laws and regulations and product liability requirements. We welcome comments on how to structure such a proposal.
                        <PRTPAGE P="66269"/>
                    </P>
                    <HD SOURCE="HD3">i. Alternatives to the CAP Prescription Order Number </HD>
                    <P>In the July 6, 2005 IFC (70 FR 39043 and 39049), we responded to several comments regarding the administrative burden that the CAP ordering and claims payment process imposes upon participating CAP physicians; specifically, activities associated with using and tracking the prescription order number were mentioned. We received additional comments on this issue in response to the IFC as well. </P>
                    <P>After the close of the comment period, we also received an inquiry from the current approved CAP vendor about the potential length of the CAP prescription order number and whether it could present a burden to participating CAP physicians. A 30-byte field is currently available on the electronic claim form for prescription numbers; however, it is not necessary for the prescription order number to be 30 bytes long. Typically, 15 or fewer total characters have been used by the approved CAP vendor. </P>
                    <P>The requirements for developing the CAP prescription order number are as follows: The first 9 characters are the approved CAP vendor's ID and the HCPCS code of the drug that is being billed; the approved CAP vendor sets the remaining characters. The assigned CAP prescription order number is captured in Loop 2410, REF02 (REF01=XZ) of the ANSI 4010A1 electronic claims transaction. This segment of the electronic claims transaction is part of a specific data format that Medicare claims must adhere to in order to meet national electronic standards for the automated transfer of certain health care data as mandated by the Health Insurance Portability and Accountability Act of 1996 (Pub. L. 104-191) (HIPAA). </P>
                    <P>Each prescription order number is unique to a dose of a CAP drug that is being shipped for administration to a particular beneficiary. The prescription order number is generated by the approved CAP vendor and, as stated in the July 6, 2005 IFC (70 FR 39042), each dose of a CAP drug is required to have a separate prescription order number. After the drug is administered, the participating CAP physician's drug administration claim is submitted with a no-pay line containing the prescription order number. The approved CAP vendor's claim for the CAP drug also contains the prescription order number. </P>
                    <P>When the CAP was implemented, the prescription order number was used in the claims matching process to facilitate accurate payment of the approved CAP vendor. Prior to payment, this system paired an approved CAP vendor's drug claim to a participating CAP physician's drug administration claim using the prescription order number. A matching prescription order number between these two claims indicated that the drug had been administered. </P>
                    <P>Since the CAP began, the claims process has changed because of statutory changes. Section 108(a)(2) of the MIEA-TRHCA requires us to make payment upon receipt of an approved CAP vendor's drug claim and then to conduct a post-payment review of claims. As stated in the MIEA-TRHCA, the post-payment review process is intended to “assure that payment is made only for a drug or biological * * * if the drug or biological has been administered to a beneficiary.” </P>
                    <P>Under this new process, the prescription order number still plays a pivotal role. Prior to the payment of the approved CAP vendor's drug claim, the CAP-designated carrier uses the prescription order number to check the claims processing system to ascertain whether the local carrier has adjudicated the drug administration claim. If the local carrier has done so, then the CAP-designated carrier will look to see whether the local carrier has determined that the CAP drug administered by the participating CAP physician is covered and is medically necessary. The local carrier's decision determines whether the CAP-designated carrier will pay the approved CAP vendor's drug claim. If the participating CAP physician's local carrier has not made a determination on the physician's claim and the CAP drug claim, then the designated carrier will pay the approved CAP vendor's claim upon receipt and use the CAP prescription order number to help verify drug administration on a post-payment basis. </P>
                    <P>The prescription order number is also still used in other CAP processes. Each dose of a CAP drug that is shipped by the approved CAP vendor is tracked using the prescription order number. Moreover, the prescription order number is particularly useful in certain situations such as those that involve recurring cyclic drug treatment regimens. In these cases, the prescription order number minimizes the possibility of confusion by serving as a unique differentiating factor between highly similar drug claims. Also, the prescription order number is valuable during instances in which the anticipated day of service submitted by the participating CAP physician differs from the actual date of drug administration. In these situations, the prescription order number would clarify confusion stemming from discrepancies in dates. Overall, we believe that the prescription order number remains an appropriate and necessary tool to track the administration of a specific dose of a drug and for the accurate execution of the post-payment review process. </P>
                    <P>Although we believe that the use of the prescription order number is necessary to facilitate accurate review of CAP claims, we are aware that it may be considered an inconvenience by some potential participating CAP physicians and approved CAP vendors. Therefore, in the CY 2008 PFS proposed rule (72 FR 38158), we requested comments on alternative methods to accurately track the administration of specific doses of drugs in order to meet the requirements stated in section 108(a)(2) of the MIEA-TRHCA. These comments could then be used in the development of a proposal for future rulemaking. </P>
                    <P>
                        <E T="03">Comment:</E>
                         We received a few comments on this issue. One commenter suggested that the CAP-designated carrier should simply match vendor and physician claims but did not provide any details about how that could be accomplished without the prescription order number. Another commenter stated that the CAP prescription order number was no longer needed to verify drug administration and should be eliminated. Instead they recommended that we should rely on the approved e-CAP vendor's verification of drug administration and the physician's records of drug administrations. 
                    </P>
                    <P>
                        <E T="03">Response:</E>
                         While the records of participating CAP physicians and the CAP vendor are currently used in the post pay review process, the CAP prescription order number plays an important role in that it enables the designated carrier to identify the exact doses of a drug that was administered and provides a link between the approved CAP vendor's claim and the participating CAP physician's claim that is not available otherwise. 
                    </P>
                    <P>
                        We do not believe the suggestions that we have received thus far would allow us to discontinue the use of the prescription order number. The prescription order number allows us to better “assure that payment is made only for a drug or biological * * * if the drug or biological has been administered to a beneficiary” since it tracks the administration of a specific dose of a drug, which allows CMS to match the vendor and the physician claim in the post pay review process. However, we would appreciate receiving other suggestions that would allow drug administration verification on a dose specific basis. Since we did not make a specific proposal about this 
                        <PRTPAGE P="66270"/>
                        issue, we will not make any changes at this time to the requirement that the CAP prescription order number be supplied by the approved CAP vendor and included on claims from both the participating CAP physician and the approved CAP vendor. 
                    </P>
                    <HD SOURCE="HD3">j. Prefilled Syringes </HD>
                    <P>In the July 6, 2005 IFC (70 FR 39061), we described public comments which stated that participating CAP physicians could not vouch for the quality of products that were opened by an approved CAP vendor for repackaging, for mixing the drug with other drugs or injectable fluids (admixture), or for removing a part of the contents to supply the exact dose for a beneficiary. Several commenters recommended that approved CAP vendors deliver their products in the same form in which they are received from the manufacturer, without opening packaging or containers, mixing or reconstituting vials, or repackaging. Specifically, the commenters were concerned about the capabilities of individuals who mix the drug, as well as shipping conditions, storage, and stability. </P>
                    <P>We responded by stating that the CAP is not intended to require approved CAP vendors to perform pharmacy admixture services (for example, to furnish reconstituted or otherwise mixed drugs repackaged in IV bags, syringes, or other containers that are ready to be administered to a patient) when furnishing CAP drugs. Admixture services for injectable drugs require specialized staff, training, and equipment, and these services are subject to standards such as United States Pharmacopoeia Chapter 797, Pharmaceutical Compounding—Sterile Preparations. These requirements have significant impact on drug shipping, storage, and stability requirements, as well as system cost and complexity. As stated in § 414.906(a)(4), the approved CAP vendor must deliver “CAP drugs directly to the participating CAP physician in unopened vials or other original containers as supplied by the manufacturer or from a distributor that has acquired the products directly from the manufacturer.” </P>
                    <P>Since issuing the July 6, 2005 IFC, we have become aware that bevacizumab (Avastin®) is being used for the treatment of exudative age-related macular degeneration (wet AMD) in very small doses. Although this is an off label use, it is gaining acceptance among ophthalmologists who treat wet AMD, and this use has been the subject of several carriers' local coverage determinations. Bevacizumab is considerably less expensive than certain other drugs used in the treatment of wet AMD. </P>
                    <P>The smallest commercially-available package of bevacizumab is a 100mg single use vial, while a dose used to treat wet AMD is approximately 1mg. Some local carriers who have issued coverage instructions for the use of bevacizumab in the treatment of wet AMD allow physicians to obtain these small doses of drug from a pharmacy that is capable of preparing sterile products. We expect to issue instructions that will allow participating CAP physicians to use the furnish as written option, as appropriate, and to obtain small doses of bevacizumab outside of the CAP in prefilled syringes if their local carrier's coverage determinations allow such a practice and if it is consistent with applicable laws and regulations. We believe that this approach will minimize the waste associated with using a 100mg single use vial for the treatment of wet AMD and will increase the flexibility for participating CAP physicians by making an alternative quantity of this drug available to participating CAP physicians whose carriers have applicable policies. </P>
                    <P>However, this option is not available in all areas. Therefore, we stated that we are considering reassessing our policy on the use of prefilled syringes to determine whether it would be feasible to make the option of using prefilled syringes supplied by an approved CAP vendor available to all physicians who participate in the CAP, rather than requiring physicians to go outside the CAP in order to obtain CAP drugs in prefilled syringes. In the CY 2008 PFS proposed rule (72 FR 38159), we requested comments on whether allowing approved CAP vendors to repackage CAP drugs in certain situations may be beneficial to beneficiaries, the program, and to the physicians who participate in it. </P>
                    <P>In considering whether to propose a change to our regulations in the future, we also solicited comments on: </P>
                    <P>• Whether approved CAP vendors are likely to be pharmacies or have access to pharmacy services with trained personnel and facilities for the small scale preparation of sterile drug products in response to a specific prescription order for a specific patient; </P>
                    <P>• Whether an approved CAP vendor should be given an opportunity to supply bevacizumab under the CAP if it is repackaged in a patient-specific dose consistent with applicable state laws and regulations upon request from a participating CAP physician; </P>
                    <P>• Whether this sort of activity should be restricted to bevacizumab, or possibly phased-in for other CAP drugs. If we were to apply this sort of policy to other CAP drugs, we would also have to determine how phasing-in might occur, which drugs it should apply to and whether the preparation of admixtures (including the preparation of sterile syringes, minibags, and mixing of drugs and solutions intended for intravenous administration) should be allowed as well; </P>
                    <P>• How this sort of service could be limited to participating CAP physicians who voluntarily agree to use it, and whether such an agreement should be made in writing between the approved CAP vendor and the participating CAP physician; </P>
                    <P>• How such a program could be structured so that the service and staff engaged in providing the service would be required to meet all applicable laws (including Stark, Anti-kickback, and State pharmacy laws), as well as regulations for the preparation of sterile products, (including standards for product integrity and sterility); </P>
                    <P>• Whether the cost of preparing such product would be included in the CAP vendor's bid price; and </P>
                    <P>• Whether any other important elements should be evaluated if we consider changing CAP policy on prefilled syringes in the future. </P>
                    <P>
                        <E T="03">Comment:</E>
                         We received several comments on these issues. Overall, responses were generally equally divided among those who supported prefilled syringes, those who advocated a cautious approach, and those who opposed the practice. 
                    </P>
                    <P>Those who opposed making prefilled syringes available through the CAP cited stability and sterility concerns. Those commenters also raised concerns about whether the CAP vendor's preparation of a particular drug product for an off-label use by participating CAP physicians would violate existing drug law because of the potential scale of an approved CAP vendor's activities and because the drug was being prepared for use in a manner other than as described in its FDA-approved labeling. Several commenters urged that caution be used in developing changes to the aspects of the CAP that are discussed above in this section, but many of these commenters were not completely opposed to the preparation of prefilled syringes by approved CAP vendors. </P>
                    <P>
                        Several commenters were quite supportive of using prefilled syringes. One commenter stated that pharmacy preparation of prefilled syringes was regarded as a “convenient and safe practice” and would avoid both waste 
                        <PRTPAGE P="66271"/>
                        and some of the risk associated with transferring sterile products. Another commenter also recommended that a mechanism to pay for the preparation and waste associated with the process be established. 
                    </P>
                    <P>There was a general point of agreement between commenters who urged a cautious approach and those who agreed with the concept of prefilled syringes. These commenters agreed that that additional flexibility or enhancements to the CAP would be welcome provided that they did not affect beneficiary safety and were consistent with applicable laws, regulations, product stability, and product integrity requirements. </P>
                    <P>
                        <E T="03">Response:</E>
                         We appreciate the comments on prefilled syringes and we will consider whether to develop a proposal that is consistent with applicable laws, regulations, product stability, and product integrity concerns in future rulemaking. Because we did not propose a change to our current regulations on the use of prefilled syringes in the CAP, they remain unchanged for the present time. We may make a proposal in the future. 
                    </P>
                    <HD SOURCE="HD3">k. Contractual Provisions </HD>
                    <P>Section 1847B of the Act is generally silent on the subject of disputes surrounding the delivery of drugs and the denial of drug claims. However, section 1847B(b)(2)(A)(ii)(II) of the Act states that a grievance process is a quality and service requirement expected of approved CAP vendors. In the July 6, 2005 IFC (70 FR 39055 through 39058), we described the process for the resolution of approved CAP vendors' claims denials and the resolution of participating CAP physicians' drug quality and service complaints. We encouraged participating CAP physicians, beneficiaries, approved CAP vendors, and the designated carrier to use informal communication as a first step to resolve service-related administration issues. However, we recognized that certain disputes would require a more structured approach, and therefore, we established processes under § 414.916 and § 414.917. </P>
                    <P>Suspension and termination from the CAP were the only remedies described under the CAP dispute resolution processes. Having gained some experience with the CAP, we believe that having an intermediate level of remedy for less serious but persistent problems is desirable in order to bridge the gap between taking no action and suspension or termination of an approved CAP vendor. </P>
                    <P>We believe that additional contractual obligations, such as additional reporting requirements, could be useful, particularly if they provide an opportunity for the approved CAP vendor to come into compliance using objective goals and a set timeline. Therefore, in the CY 2008 PFS proposed rule (72 FR 38160), we requested comments on what types of potential contractual provisions could be used to encourage approved CAP vendors to comply with CAP requirements for less serious violations, such as missing reporting deadlines, or participation in inappropriate promotional strategies. We also requested comments on the following: </P>
                    <P>• The type of contractual provisions that would be suitable. For example, requests for specific or targeted reporting and monitoring activities in response to specific violations. </P>
                    <P>• Whether an approved CAP vendor's code of conduct could be used to address these types of less serious situations and how that could be accomplished; and </P>
                    <P>• Whether the CAP physician election agreement should be revised to include provisions to address participating CAP physicians' noncompliance with CAP rules or the CAP election agreement. </P>
                    <P>
                        <E T="03">Comment:</E>
                         One commenter agreed with the use of contractual provisions, including additional reporting requirements, as an intermediate form of remedy in response to a CAP vendor's noncompliance with CAP requirements. The commenter also noted that a vendor code of conduct would be useful. 
                    </P>
                    <P>
                        <E T="03">Response:</E>
                         We plan to develop a proposal for additional provisions that could be added to the CAP contract. These provisions would be used to encourage approved CAP vendors to comply with CAP requirements. We will propose such provisions in a future rulemaking period. 
                    </P>
                    <HD SOURCE="HD3">l. Finalizing Remaining Provisions of the July 6, 2005 Interim Final Rule with Comment Period </HD>
                    <P>In this PFS final rule with comment, we are finalizing the portions of the July 6, 2005 IFC that were not finalized in previous rulemaking. We are also responding to other timely comments we received on the July 6, 2005 IFC that we have not responded to previously. </P>
                    <P>
                        <E T="03">Comments that we will be addressing in this rule include the following:</E>
                    </P>
                    <P>• The use of e-prescribing in CAP. </P>
                    <P>• Updating CAP prices and data reporting. </P>
                    <P>• The application of Comprehensive Error Rate Testing (CERT) to CAP claims. </P>
                    <P>• The 14-day participating CAP physician billing requirement. </P>
                    <P>• The impact of CAP participation on clinical research. </P>
                    <P>• Licensure requirements for CAP pharmacies and distributors. </P>
                    <P>• Community mental health centers and participation in the CAP. </P>
                    <P>• Administrative and financial burden of CAP participation for physicians. </P>
                    <P>We have addressed drug transportation previously in this section of this final rule with comment period. </P>
                    <HD SOURCE="HD2">Basis and Scope (§ 414.900) </HD>
                    <P>These provisions provide that the regulations in this subpart implement sections 1847A and 1847B of the Act. We received no comments on these provisions and we are finalizing the corresponding regulatory text at § 414.900 in its entirety. </P>
                    <HD SOURCE="HD2">Definitions (§ 414.902) </HD>
                    <P>Section 414.902 lists the definitions used in 42 CFR Subpart K. We did not receive any comments about the revisions to this section that we made in the July 6, 2005 IFC (70 FR 39093). At this time, we are finalizing the regulatory text at § 414.902 as it currently reads. </P>
                    <HD SOURCE="HD2">Competitive Acquisition Program as the Basis for Payment (§ 414.906) </HD>
                    <P>Section 414.906 specifies how payment for CAP drugs is determined, including vendor responsibilities for billing, shipment and delivery; computation of the payment amount; substitution of CAP drugs and resupply of a participating CAP physician's drug inventory. </P>
                    <HD SOURCE="HD3">i. 2005 Comments </HD>
                    <P>In the July 6, 2005 IFC (70 FR 39074), we discussed the methodology used to update CAP drug prices during the bidding process. We responded to comments that suggested that single price updates for CAP drugs should be tied to changes in ASP prices. We stated that we did not believe that there had been enough experience with the ASP payment methodology to update the bids based on growth in the ASP. We also solicited comments on this method of updating single drug prices to the payment year in order to develop and refine the CAP in the future. </P>
                    <HD SOURCE="HD3">(a) Updating CAP Prices and Data Submission </HD>
                    <P>
                        <E T="03">Comment:</E>
                         We received comments about updating CAP drug prices more frequently than annually. One commenter suggested that we should consider quarterly data submissions and 
                        <PRTPAGE P="66272"/>
                        pricing updates even during the phase in period in order to produce greater savings in instances where vendors' overall costs for CAP drugs were declining, while providing greater protection for vendors in instances where vendors were experiencing cost increases. Another commenter encouraged us to compare CAP prices to ASP prices using the most recent data available and to account for manufacturer price adjustments in a timely manner. 
                    </P>
                    <P>
                        <E T="03">Response:</E>
                         In the July 6, 2005 IFC (70 FR 39076), we stated, “when the administrative mechanisms of the CAP are operational and vendors have more experience under the program, we will consider whether more frequent reporting (of reasonable net acquisition costs) would be appropriate.” Section 414.914 requires that the CAP contract must provide for the disclosure of the approved CAP vendor's reasonable, net acquisition costs for a specified period of time, not to exceed quarterly and provide for appropriate adjustments as described in § 414.906(c)(1). This section describes the computation of an annual update to the payment amount and allows updates more often than annually but no more often than quarterly in any of the following cases: introduction of new drugs; expiration of a drug patent or availability of a generic drug; material shortages that result in a significant price increase for the drug; and withdrawal of a drug from the market. Also, the CAP payment amount is limited by the weighted payment amount established under section 1847A of the Act across all drugs for which a composite bid is required in the category, and limited by the payment amount established under section 1847A of the Act for each other drug for which the approved CAP vendor submits a bid. It is not clear how the commenter is proposing that we account for changes in manufacturer's price adjustments in a more timely manner. Because the CAP has been operational for 15 months, we are still gaining experience with the reporting and update mechanisms already in place. At present, we believe these processes are sufficient to address the needs of the CAP; however, as the program grows, we may consider other options, including more frequent price updates. 
                    </P>
                    <HD SOURCE="HD3">(b) Impact of CAP on Clinical Research </HD>
                    <P>
                        <E T="03">Comment:</E>
                         Some commenters stated that they were concerned that CAP participation would conflict with the Medicare National Coverage Decision (NCD) on Clinical Trials. Since the NCD enables Medicare to reimburse physicians for the current standard of care drugs that are administered to beneficiaries in the control group of clinical trial protocols, commenters were concerned that physicians would not be able to enroll Medicare beneficiaries in clinical trials if drugs required in the protocol were not on the CAP drug list. In addition, some commenters expressed their concern that there was a lack of built in oversight in CAP to ensure that vendors would buy drugs directly from a manufacturer or wholesaler. The commenters were concerned that this could result in the acquisition of counterfeit product, and that as a result, such products could infiltrate clinical trials and compromise the results of cancer clinical research that a CAP physician might be participating in. 
                    </P>
                    <P>
                        <E T="03">Response:</E>
                         As a result of an executive memorandum issued by the President of the United States in June 2000, we instituted the NCD in September 2000 as explained in our “September 2000 Program Memorandum” on clinical trials available at 
                        <E T="03">http://www.cms.hhs.gov/ClinicalTrialPolicies/</E>
                        . The NCD stipulates that Medicare will provide payment for routine costs associated with qualifying clinical trials and for items or services needed to treat complications arising from participation in such trials. The NCD was revised in July 2007 as outlined in CAG-00071R, the “Decision Memorandum for the Clinical Trial Policy,” which may be found at 
                        <E T="03">https://www.cms.hhs.gov/mcd</E>
                        . More information about the National Coverage Decision on Clinical Trials can be found on the CMS Web site at 
                        <E T="03">http://www.cms.hhs.gov/ClinicalTrialPolicies/</E>
                         and through a Medicare Learning Network article at 
                        <E T="03">http://www.cms.hhs.gov/MLNMattersArticles/</E>
                        . 
                    </P>
                    <P>We are very aware of the importance of clinical trial research in the treatment of cancer, and we do not believe that CAP participation has imposed any undue hardships on participating CAP physicians or their Medicare patients who engage in such activities. Participating CAP physicians do not have to buy and bill for the medications they receive from the approved CAP vendor. The vendor is responsible for billing the designated carrier and the beneficiary. Thus, if the standard of care drug needed for the control group of a research protocol is on the CAP drug list, the participating CAP physician may order the medication from the approved CAP vendor. This should not affect the participating CAP physician's ability to enroll Medicare patients in clinical trials. Moreover, participating CAP physicians may still purchase and bill for medications that are not on the CAP drug list through the ASP system, which would allow them to obtain the non-CAP drugs required in a research protocol. If a particular NDC for a drug is not on the CAP drug list but is part of the research protocol, a participating CAP physician may buy the medication on their own and bill for it via the “furnish as written” provision, which allows the physician to bill for the drug under the ASP methodology in that instance, even though it is on the CAP drug list. </P>
                    <P>Though we have had no reports that CAP physicians have been prevented from engaging in clinical trial research because of their CAP participation, we are mindful that this could be an issue because of the way some studies are structured. In the event that we receive comments that demonstrate that this has become a problem in the future, we will address the issues accordingly and possibly propose mechanisms to facilitate participation in clinical trial research and the CAP. </P>
                    <P>We would also like to reemphasize that CAP is a voluntary program. If physicians do not believe that the “furnish as written” option and the CAP drug list are sufficient to meet their clinical research needs, then they may decline to join the CAP and continue to purchase and bill for medication under the ASP system. </P>
                    <P>
                        We also are cognizant of the importance of preserving drug quality and integrity in the CAP and have structured the program accordingly. The importance of drug quality and oversight are recognized in both the vendor bidding process and in the CAP dispute resolution process administered by the designated carrier. We have discussed our concern for maintaining CAP drug quality in the program as a whole on several occasions, most recently in the CY 2006 PFS final rule with comment period (70 FR 70244). Section 1847B of the Act and § 414.908(b) delineate several requirements that vendors must meet in order to be selected to participate in the CAP, including an ability to ensure product integrity, at least 3 years experience in furnishing Part B Injectable drugs, and acquisition of all CAP drugs directly from the manufacturer or from the distributor that has acquired the products directly from the manufacturers. After an entity has been awarded a contract, we work closely with the CAP-designated carrier and the approved CAP vendor to monitor and respond to any concerns that are raised by participating CAP physicians under the dispute resolution process. 
                        <PRTPAGE P="66273"/>
                    </P>
                    <P>We have not received any complaints regarding CAP drug quality and integrity. If such an event were to occur, it would be investigated and resolved promptly so that patient health and safety would not be jeopardized. In light of all of these requirements and protections, we do not believe that research and CAP participation are incompatible. </P>
                    <P>At this time, we are finalizing the remaining provisions of this section. </P>
                    <HD SOURCE="HD2">Competitive Acquisition Program (§ 414.908) </HD>
                    <P>This section specifies the process for a physician to select an approved CAP vendor. It also details the responsibilities of a participating CAP physician, such as including the specific information required on the prescription order, notifying the CAP vendor about changes in drug administration, and adhering to the timeframe for submission of claims. </P>
                    <P>Moreover, § 414.908 delineates the process for selecting approved CAP vendors. It also outlines additional factors that are considered both during and after the vendor selection process such as exclusion of entities from participation in Medicare or other Federal health care programs under section 1128 of the Act. </P>
                    <HD SOURCE="HD3">i. 2005 Comments </HD>
                    <HD SOURCE="HD3">(a) Physician Administrative and Financial Burden </HD>
                    <P>
                        <E T="03">Comment:</E>
                         We received several comments from individual physicians and physician groups expressing their concern that CAP could place a significant burden on physicians. Some commenters stated that the requirement to maintain a separate inventory of CAP drugs will increase physicians’ administrative burden and costs. Others indicated that physicians would have no incentive to participate in the CAP unless these extra administrative costs could be reimbursed. One commenter indicated that the program was impractical and economically unfeasible. 
                    </P>
                    <P>
                        <E T="03">Response:</E>
                         In the July 6, 2005 IFC (70 FR 39049), we discussed the issue of administrative burden. Although we agree that a physician may have to make some adjustments in his or her practice in order to comply with the requirements of the CAP, we believe that the relief from the financial burden of purchasing drugs and billing Medicare for them will be a substantial benefit for many physicians. We do not believe that the clerical and inventory resources associated with participation in the CAP exceed the clerical and inventory resources associated with buying and billing drugs under the ASP system. A physician is free to design his or her practice in a way that minimizes the extent of changes necessary to comply with the CAP requirements. For example, an electronic inventory of CAP drugs is required, but separate drug storage is not; it is a suggested option if such a procedure makes it easier on the physician's practice to track the CAP drugs. We recognize that although a physician's staff or their software vendor may need to make system changes to bill using the CAP format and to accommodate the CAP modifiers and prescription numbers, these initial changes would be a one-time occurrence. 
                    </P>
                    <P>In the ASP system, the payment for clerical and inventory resources associated with buying and billing for drugs is bundled into the drug administration payment under the physician fee schedule. We have adopted this same logic in the CAP and believe that the drug administration payment is sufficient to cover any associated expenses of participating in the CAP. </P>
                    <P>If a physician perceives that CAP participation would be more burdensome than the ASP system, then he or she is under no obligation to join the CAP because it is a voluntary program. Additionally, as described in other parts of this rule, participating CAP physicians may also petition to terminate their CAP election due to exigent circumstances through the dispute resolution process in the event that they find the participation in the program becomes a burden. </P>
                    <P>
                        <E T="03">Comment:</E>
                         One commenter expressed disappointment that community mental health centers (CMHCs) cannot elect to participate in the CAP. 
                    </P>
                    <P>
                        <E T="03">Response:</E>
                         As noted in the July 6, 2005 IFC (70 FR 39030), CMHCs can not elect to participate in the CAP for provision of Part B drugs. The CAP statute is clear that only physicians may elect to have section 1847B of the Act apply in lieu of the ASP payment methodology. 
                    </P>
                    <P>(b) E-Prescribing </P>
                    <P>
                        <E T="03">Comment:</E>
                         One commenter recommended that CAP vendors should be capable of accepting and submitting e-prescribing transactions in accordance with the final e-prescribing standards issued for Medicare Part D. The commenter reasoned that vendor compliance would not be an undue hardship because vendors already will have a fairly rigorous technical infrastructure in place. 
                    </P>
                    <P>
                        <E T="03">Response:</E>
                         Section 101 of the MMA amended title XVIII of the Act to establish a voluntary prescription drug benefit program. The MMA electronic prescription program provisions found in section 1860D-4(e) of the Act apply to the electronic transmission of prescription and certain prescription-related information for Medicare Part D drugs for Part D eligible individuals. The Part D e-prescribing requirements do not apply to the electronic transmission of prescriptions and prescription related information for Part B drugs unless those prescriptions are written for Part D eligible persons and the prescribed drug is a Part D drug. Prescription Drug Plan (PDP) sponsors Medicare Advantage (MA) organizations offering Medicare Advantage-Prescription Drug Plans (MA-PD) are required to establish electronic prescription drug programs to provide for electronic transmittal of certain information to the prescribing provider and dispensing pharmacy and pharmacist. Prescribers and dispensers of Part D drugs are not required to write prescriptions electronically, but those that do so would be required to comply with any applicable final e-prescribing standards that are in effect when they conduct electronic prescription transactions, or seek or transmit prescription information or certain other related information electronically. 
                    </P>
                    <P>
                        We responded to a comment on whether participating physicians would be required to incorporate e-prescribing technologies into the CAP in the July 6, 2005 IFC (70 FR 39039). At that time, we stated that we would monitor the development of the program to see if some aspects of it could be adapted to the CAP. Since publication of the IFC, we have adopted three foundation standards (70 FR 67568), recognized six initial standards in a Request for Applications (RFA) (Available through 
                        <E T="03">http://www.grants.nih.gov/grants/guide/rfa-files/FRA-HS-06-001.htm)</E>
                        , and conducted a pilot program in 2006 to test the six initial standards and their ability to interoperate with the foundation standards. More information about the MMA e-prescribing program and the outcome of the pilots can be found on the CMS Web site at 
                        <E T="03">http://www.cms.hhs.gov/EPrescribing/</E>
                        . The MMA requires the adoption of additional standards by the Secretary by April 1, 2008. We will continue to track the development of the e-prescribing program to see whether it would be appropriate to incorporate some of the program's elements into the CAP at a later date. 
                        <PRTPAGE P="66274"/>
                    </P>
                    <HD SOURCE="HD3">(c) The Comprehensive Error Rate Testing (CERT) Program and CAP Claims </HD>
                    <P>The purpose of the CERT program is to monitor and report the accuracy of Medicare fee for service payments. In the July 6, 2005 IFC (70 FR 39038), we discussed CERT and how it would apply to CAP claims. While we anticipated that CERT would apply to CAP, the process had not been determined at that point. We received no additional comments on this issue and have implemented CERT review of CAP claims since publication of the July 6, 2005 IFC. CAP claims paid by the designated carrier may be selected for review in a manner consistent with other claims the carrier processes. </P>
                    <HD SOURCE="HD3">(d) 14-Day Billing Requirement </HD>
                    <P>In the July 6, 2006 IFC (70 FR 39050), we summarized and responded to comments about the 14-day requirement for physicians to file claims for CAP drug administration. Although a number of commenters considered the time period to be too brief and were opposed to it, we decided to implement the 14-day requirement at § 414.908(a)(3)(x) because the approved CAP vendor's payment for drugs furnished under the CAP depended on a match between the vendor's drug claim and the physician's drug administration claim. Implementation of the post-payment review as mandated by section 108 of the MIEA-TRHCA has superseded our original implementation of CAP claims processing procedures, which had required a pre-payment claims matching process for CAP drug claims, and the 14-day billing requirement was not finalized in previous rules (70 FR 70260). </P>
                    <P>
                        <E T="03">Comment:</E>
                         In 2006 several commenters asked us to allow at least 30 days or more for physicians to submit CAP drug administration claims. During this comment period, we also received several comments stating that the 14-day requirement be withdrawn because changes to the claims processing system made it unnecessary and such an action would encourage physician participation in the CAP. 
                    </P>
                    <P>
                        <E T="03">Response:</E>
                         Our 14-day standard was based on a review of Medicare claims that showed approximately 75 percent of part B drug and drug administration claims were submitted within 14 days of the date of service. It was initially implemented as a means of facilitating the CAP claims matching process that was in effect prior to the implementation of the post-payment review process as mandated by section 108 of the MIEA TRHCA. As the commenters indicated, a 14-day requirement is less than is allowed under claim submission requirements used in other parts of the program. 
                    </P>
                    <P>We agree that the claims processing changes required by Section 108 of MIEA-TRHCA have altered the role of the claims submission standard. However, we do not believe that it has eliminated the need for a claims-matching process under the CAP. Under the new payment process that resulted from the MIEA-TRHCA, the CAP-designated carrier also conducts a pre-payment review in which it checks for any local carrier decisions about medical necessity prior to paying for drug claims submitted by the approved CAP vendor. Retaining a claims submission requirement for participating CAP physician drug administration claims may prevent the agency from paying for drugs that have been denied on a medical necessity basis by the local carrier because when the local carrier reviews the physician's claim it makes a determination on whether the CAP drug that was administered was medically necessary. We are not eliminating the requirement for prompt billing altogether, as requested by commenters, because it will continue to facilitate a quicker determination that the drug can be administered. </P>
                    <P>However, we acknowledge that a somewhat longer claims submission standard would not adversely affect the post-payment review process because it still would allow for a relatively quick match between the claim for a particular dose of a CAP drug and the claim for its administration. Also, separate analyses of previous claims submission data and CAP drug claims lead us to conclude that the overwhelming majority of participating CAP drug administration claims are submitted within 30 days of the date of service. We further believe that, in light of the comments, increasing the 14-day claims submission requirement would make the CAP more appealing to physicians and provide them with greater claims submission flexibility. </P>
                    <P>Therefore, we are increasing the requirement for timely CAP drug administration claim submission from 14 days to 30 days. We are finalizing the requirements at § 414.908 to include this revision. </P>
                    <HD SOURCE="HD3">ii. Regulatory Text </HD>
                    <P>At this time, we are finalizing § 414.908 as amended to reflect the changes discussed in this final rule with comment period. </P>
                    <HD SOURCE="HD2">The Bidding Process (§ 414.910) </HD>
                    <P>This section outlines the specific criteria for the submission of a bidding price for a CAP drug, and specifies what costs should be included in the bid price. We received no comments on this provision and are now finalizing the regulatory text for § 414.910. </P>
                    <HD SOURCE="HD2">Conflicts of Interest (§ 414.912) </HD>
                    <P>Section 414.912 states conflict of interest requirements and standards that vendor applicants and approved CAP vendors must meet in order to participate in CAP. We received no comments on this provision, and therefore, are finalizing § 414.912. </P>
                    <HD SOURCE="HD2">Terms of Contract (§ 414.914) </HD>
                    <P>Section 414.914 outlines the contract provisions between CMS and the approved CAP vendor such as contract length and termination, and specific requirements that the approved CAP vendor must comply with. </P>
                    <HD SOURCE="HD3">i. 2005 Comments </HD>
                    <HD SOURCE="HD3">(a) Licensure Requirements for Cap Pharmacies and Distributors </HD>
                    <P>
                        <E T="03">Comment:</E>
                         Some commenters requested clarification on the types of licenses that are required of CAP vendors. A few commenters also asked us to specify whether a CAP vendor will be operating as a pharmacy or as a wholesale distributor since licensing requirements and regulatory laws for these two types of entities can vary by state, and since pharmacies and distributors are two different models. 
                    </P>
                    <P>
                        <E T="03">Response:</E>
                         As specified in § 414.914, approved CAP vendors and their subcontractors must meet applicable licensure requirements in each State in which it supplies drugs under the CAP. This includes appropriate licensure in States that the CAP vendor ships drug to even though the vendor does not maintain a physical establishment in these States. In the July 6, 2005 IFC (70 FR 39066), we stated that a vendor, its subcontractor, or both must be licensed appropriately by each State to conduct its operations under the CAP. Therefore, a vendor under the CAP would be required to be licensed as a pharmacy, as well as a distributor if a State requires it. It is the CAP vendor's responsibility to determine which State and national requirements it must adhere to. Based on our experience with the CAP, we are not persuaded by the comments that any changes to this policy are necessary at this time. 
                    </P>
                    <HD SOURCE="HD3">ii. Regulatory Text </HD>
                    <P>
                        We finalized portions of § 414.914 in the CY 2006 PFS final rule with 
                        <PRTPAGE P="66275"/>
                        comment period (70 FR 70333) and are now finalizing the remainder of the regulatory text. 
                    </P>
                    <HD SOURCE="HD2">Dispute Resolution for Vendors and Beneficiaries (§ 414.916) </HD>
                    <P>This section discusses the steps, timeframes, and requirements of the dispute resolution process that are available to an approved CAP vendor and beneficiaries to address the issue of denied CAP drug claims. It also describes the protocol that physicians would utilize to appeal the suspension of their CAP contract. </P>
                    <P>We did not receive any comment on this comments on this provision in response to the CY 2006 PFS proposed rule. However, a revision to this section will be made in light of the exigent circumstance discussion in section (g) of this section of the preamble. We are revising § 414.916(c) to clarify that the physician reconsideration process would apply to reconsiderations of our decision on whether the participating CAP physician may opt out of the CAP. We are finalizing § 414.916 at this time. </P>
                    <HD SOURCE="HD2">Dispute Resolution and Process for Suspension or Termination of Approved CAP Contract (§ 414.917) </HD>
                    <P>This section discusses the steps and timeframes of the process available to participating CAP physicians for the resolution of quality or service issues concerning an approved CAP vendor. </P>
                    <P>We did not receive any comments on this section during the comment period for the July 6, 2005 IFC. Comments that we received on this section during the comment period for the CY 2008 PFS proposed rule are discussed above in this section. We are now finalizing the regulatory text for this section as described in this final rule with comment period. </P>
                    <HD SOURCE="HD2">Assignment (§ 414.918) </HD>
                    <P>Section 414.918 specifies that payment for a competitively biddable drug may be made only on an assignment related basis. We received no comments on this provision and are now finalizing § 414.918. </P>
                    <HD SOURCE="HD2">Judicial Review (§ 414.920) </HD>
                    <P>Section 414.920 outlines the areas under the CAP that are not subject to administrative or judicial review. We received no comments on this provision and are now finalizing this section. </P>
                    <HD SOURCE="HD3">m. Brief Summary of Comments We Are Not Addressing </HD>
                    <P>In response to the FY 2007 IPPS final rule with comment period (71 FR 47870), we received a comment related to the payment rate for intravenous immunoglobulin (IVIG) therapy in Medicare. We will not be addressing this comment since it is outside the scope of both the CY 2008 PFS proposed rule and the FY 2007 IPPS final rule with comment period. In addition, in response to the CY 2007 PFS proposed rule, one commenter recommended that we implement continuous open enrollment in the CAP and eliminate the requirement for annual physician election, and specify who are the appropriate people to sign the CAP election form. We are not addressing these comments because it is outside the scope of the proposed rule. </P>
                    <HD SOURCE="HD2">G. Issues Related to the Clinical Laboratory Fee Schedule </HD>
                    <HD SOURCE="HD3">1. Date of Service for the Technical Component of Physician Pathology Services (§ 414.510) </HD>
                    <P>In the CY 2007 PFS final rule with comment period (72 FR 69787), we added § 414.510 for the date of service of a clinical diagnostic laboratory test that uses a stored specimen. </P>
                    <P>When we added § 414.510, we indicated the provision applies to clinical diagnostic laboratory tests. For outpatients, clinical diagnostic laboratory tests are paid under the Medicare Part B clinical laboratory fee schedule. Upon further review, we believe the provision should also apply to the technical component (TC) of physician pathology services. In practice, the collection date for both clinical laboratory services and the TC of physician pathology services is similar. Therefore, we believe § 414.510 should apply to both types of services. This will improve claims processing and adjudication in relation to the clarity of dates of service, accuracy of payment, and detection of duplicate services. For outpatients, the TC of physician pathology services can be paid under the Physician Fee Schedule (PFS) or the hospital Outpatient prospective payment system (OPPS). As a result, for § 414.510, in the CY 2008 PFS proposed rule (72 FR 38160), we proposed to revise the section heading and introductory sentence to specify that the provision applies to both clinical laboratory and pathology specimens. We also proposed revising § 415.130(d) to include a reference to § 414.510. </P>
                    <P>
                        <E T="03">Comment:</E>
                         Some commenters supported our proposal to revise the section heading and introductory sentence for § 414.510 to specify that the provision applies to both clinical laboratory and pathology specimens. (We also proposed revising § 415.130(d) to include a reference to § 414.510.) One commenter asked that we clarify whether the provision applies to pathology tests where the technical component and the professional component (PC) are performed by the same lab and billed globally. 
                    </P>
                    <P>
                        <E T="03">Response:</E>
                         Concerning one line global billing, we would like to point out that the TC and the PC of a laboratory test should be on separate line items on the same claim when two different dates of service are involved, even when both services are performed by the same independent laboratory. One line global billing is not appropriate in this instance. Program instructions on this issue will be forthcoming. 
                    </P>
                    <P>
                        <E T="03">Comment:</E>
                         One commenter requested revisions to our regulations to specify that if the clinical laboratory test specimen is collected outside the hospital by nonhospital personnel, the beneficiary qualifies as a nonhospital patient. 
                    </P>
                    <P>
                        <E T="03">Response:</E>
                         We do recognize that the determination of whether the beneficiary qualifies as an inpatient, outpatient, or nonpatient is important for payment purposes. However, we do not agree that the laboratory date of service regulation should be amended to address the employment arrangements of the personnel performing the specimen collection. Furthermore, this comment is outside the scope of our proposal to broaden the clinical laboratory date of service rules we adopted last year. 
                    </P>
                    <P>We continue to believe the date of service should relate to clear calendar dates for the specimen collection and day of discharge from the hospital if the specimen was collected while the patient was undergoing a hospital procedure. </P>
                    <P>We are implementing our proposed regulation at § 414.510 on the date of service of the TC of the physician pathology service. </P>
                    <HD SOURCE="HD3">2. New Clinical Diagnostic Laboratory Test (§ 414.508) </HD>
                    <HD SOURCE="HD3">a. Background </HD>
                    <P>In the CY 2007 PFS final rule with comment period (71 FR 69701), we adopted a new subpart G under part 414 that implemented section 942(b) of the MMA requiring that we establish procedures for determining the basis for, and amount of payment for any clinical diagnostic laboratory test for which a new or substantially revised HCPCS code is assigned on or after January 1, 2005 (“new tests”). </P>
                    <P>
                        Under § 414.508, we use one of two bases for payment to establish a payment amount for a new test. Under § 414.508(a), the first basis, called 
                        <PRTPAGE P="66276"/>
                        “crosswalking,” is used if a new test is determined to be comparable to an existing test, multiple existing test codes, or a portion of an existing test code. If we use crosswalking, we assign to the new test code the local fee schedule amount and national limitation amount (NLA) of the existing test code or codes. If we crosswalk to multiple existing test codes, we determine the local fee schedule amount and NLA based on a blend of payment amounts for the existing test codes. The second basis for payment is “gapfilling.” Under § 414.508(b), we use gapfilling when no comparable existing test is available. We instruct each Medicare carrier or MAC to determine a carrier-specific amount for use in the 1st year that the new code is effective. The sources of information that these carriers or MACs examine in determining carrier-specific amounts include: 
                    </P>
                    <P>• Charges for the test and routine discounts to charges; </P>
                    <P>• Resources required to perform the test; </P>
                    <P>• Payment amounts determined by other payers; and </P>
                    <P>• Charges, payment amounts, and resources required for other tests that may be comparable (although not similar enough to justify crosswalking) or otherwise relevant. </P>
                    <P>After the first year, the carrier-specific amounts are used to calculate the NLA for subsequent years. Under § 414.508(b)(2), the test code is paid at the NLA, rather than the lesser of the NLA and the carrier-specific amounts. </P>
                    <P>We instruct our carriers or MACs to use the gapfill method through program instruction, which lists the specific new test code and the timeframes to establish carrier-specific amounts. During the first year a new test code is paid using the gapfill method, contractors are required to establish carrier-specific amounts on or before March 31. Contractors may revise their payment amounts, if necessary, on or before September 1. In this manner, a carrier or MAC may revise its carrier-specific amount based on additional information during the 1st year. </P>
                    <P>In the CY 2007 PFS final rule with comment period (71 FR 69702), we also described the timeframes for determining the amount of and basis for payment for new tests. The codes to be included in the upcoming year's fee schedule (effective January 1) are available as early as May. We then list the new clinical laboratory test codes on our Web site, usually in June, along with registration information for the public meeting. </P>
                    <P>
                        The public meeting is held no sooner than 30 days after we announce the meeting in the 
                        <E T="04">Federal Register</E>
                        . The public meeting is typically held in July. In September, we post our proposed determination of the basis for payment for each new code and seek public comment on these proposed determinations of the basis for payment. The updated clinical laboratory fee schedule is prepared in October for release to our contractors during the first week in November so that the updated clinical laboratory fee schedule is ready to pay claims effective January 1 of the following calendar year. 
                    </P>
                    <P>We received comments in response to the CY 2007 PFS proposed rule concerning information to be presented during the public meeting process. In responding to these comments in the CY 2007 PFS final rule, we stated that we did not believe that opportunities for information gathering on new tests have been fully utilized within the public meeting process. Payment recommendations from the public have sometimes lacked charge, cost, and clinically-detailed information for the new clinical laboratory tests. We also stated that when soliciting public input for the meeting we would recommend that all participants in the public meeting consultation process strive for transparency and try to provide as much supporting information as possible to assist us in evaluating their recommendations. </P>
                    <P>In addition, in the CY 2007 PFS final rule with comment period, in response to comments suggesting that the method used by contractors to determine their price for gapfilled tests should be more specific, we indicated that we would engage in discussions with our carrier contractors and laboratory industry representatives to explore their experiences with the gapfill process. We also agreed to host a forum to listen to suggestions from the public and said that we expected to solicit comments on a potential reconsideration process in a future rulemaking. </P>
                    <P>As explained in the CY 2008 PFS proposed rule, we discussed these issues with our contractors. We also solicited comments on the gapfill process in the July 16, 2007 clinical laboratory public meeting. </P>
                    <P>Discussions with our contractors and other interested parties revealed that the length of time we allow for a contractor to establish a carrier-specific amount may sometimes be insufficient for obtaining additional sources and data on a new test. However, our contractors and other interested parties were also concerned that if procedures and determinations were permitted to extend over too long a time frame, the uncertainty of the final payment amount would be detrimental for laboratories, practitioners, and patients for incorporating new technology tests and improving patient care. In the CY 2008 PFS proposed rule, we also encouraged the public to submit written comments on gapfilling and said that we would respond to them to the extent they related to a proposal in the rule. </P>
                    <P>In the CY 2008 PFS proposed rule, we proposed a reconsideration process for determining the basis for and amount of payment for any new test for which a new or substantially revised HCPCS code is assigned on or after January 1, 2008. This proposed change attempted to balance additional opportunities for public input against the necessity for establishing final fees for new clinical laboratory test codes. </P>
                    <P>Section 1833(h)(8)(A) of the Act provides broad authority to develop through regulation procedures for the method for determining the basis for and amount of payment for new tests. We believe that we have authority under section 1833(h)(8)(A) of the Act to establish procedures under which we may reconsider the basis for and amount of payment for a new test. Furthermore, under section 1833(h)(8)(D) of the Act, the Secretary may convene such other public meetings to receive public comments on payment amounts for new tests as the Secretary deems appropriate. </P>
                    <P>We note that, under both section 1833(h)(8)(B)(v) of the Act and § 414.506(d)(2), the Secretary must make available to the public a list of “final determinations.” We do not believe that these provisions preclude us from reconsidering our final determinations. It is not unusual for us to provide for discretionary reopening or reconsideration of final agency action. It is not unusual for us to provide for discretionary reopening or reconsideration of final agency action. For example, under § 405.1885, we may reopen a final agency determination regarding payment to a provider of services. </P>
                    <P>
                        <E T="03">Comment:</E>
                         Commenters were supportive of our proposal to add § 414.509 concerning a reconsideration process for new lab test payment determinations. Generally, commenters believed that in contrast to several other payment systems, which have been significantly revised in the last several years, the procedures for operating the clinical laboratory fee schedule have remained relatively static. They further commented that the implementation of a reconsideration process would be a significant step in helping assure reasonable pricing decisions for new 
                        <PRTPAGE P="66277"/>
                        tests, and they commended us for our actions in this regard. 
                    </P>
                    <P>
                        <E T="03">Response:</E>
                         We appreciate the support for our proposal for a reconsideration process for new lab test payment determinations. We believe this additional opportunity to revisit payment determinations for clinical laboratory test codes will foster accurate payment levels for new tests. We will discuss specific suggestions for revisions to § 414.509 below in this section. 
                    </P>
                    <HD SOURCE="HD3">b. Basis for Payment </HD>
                    <P>Under our existing procedures for determining the basis for payment of a new test, either to crosswalk or gapfill, we receive comments on the appropriate basis for payment for a new test both at the public meeting in July and after we announce our proposed determinations in September. In November, we post our determination on the basis for payment for the new test on the CMS Web site. This determination of the basis for payment is final, except in the case of a gapfilled test for which we later determine that gapfilling is not appropriate under § 414.508(b)(3). </P>
                    <P>In the CY 2008 PFS proposed rule, we proposed to create a reconsideration process for determinations of the basis, either crosswalking or gapfilling, for payment of a new clinical diagnostic laboratory test. Consistent with our existing process, we would make a determination using the information gathered from the public meeting process and post a determination of the basis for payment, either to crosswalk or gapfill, on the CMS Web site, likely in September. We would accept written comments asking for a reconsideration on this basis determination for 30 days after we posted the determination on the CMS Web site. If a commenter recommended that we switch from gapfilling to crosswalking for a new code, the commenter would also have the opportunity to recommend the code or codes to which to crosswalk the new test code. Under § 414.508, claims would be paid using this basis to calculate fees beginning January 1. </P>
                    <P>After considering the comments received and the information from the public meeting, we would post our decision on our Web site as to whether we elect to reconsider our determination of the basis for payment. If we elect to reconsider the basis for payment (that is, whether to crosswalk or gapfill a test), we would post our determination as to whether we would change the basis for payment on the CMS Web site. Our decision regarding the basis for payment would be final and not subject to further reconsideration. </P>
                    <P>If we change our prior determination of the basis for payment, the new determination would be effective on January 1. We would not reopen or otherwise reprocess claims with dates of service prior to the effective date of the revised determination. </P>
                    <P>We note that, under our proposed reconsideration processes (for both the basis for payment and amount of payment) we would make two separate decisions. First, we would decide whether to reconsider our prior determination. If we elect to reconsider our prior determination, we would then determine whether we should change our prior determination. </P>
                    <P>
                        <E T="03">Comment:</E>
                         One commenter suggested that the agenda for the public meeting should announce a list of requests received by CMS to reconsider the basis for and amount of payment for a new clinical laboratory test, and the agenda should invite comment, either written or orally, on the requests. The commenter stated that in this way, we will receive views on the validity of the requests for reconsideration. Another commenter indicated that more than one public meeting per year should be hosted by CMS to discuss comments under the reconsideration process, as well as the payment determination process. 
                    </P>
                    <P>
                        <E T="03">Response:</E>
                         We are receptive to suggestions on providing information about the public meeting agenda. We do not believe a revision to the regulatory text at subpart of § 414.509(a) is required in order to disseminate information on our meetings. We publish a public meeting notice in the 
                        <E T="04">Federal Register</E>
                         to announce the meeting. The notice includes many details about the purpose and registration process for the meeting and also refers to additional Web site information for the meeting. If we receive a request to reconsider the basis of payment for a new test within the 60-day window after we post our basis of payment on the CMS Web site, the requestor could also request to present his or her comment orally at the next clinical laboratory public meeting. We can include this information in the meeting agenda that will be posted on the CMS Web site. Members of the public who are interested in addressing a particular reconsideration request at the laboratory public meeting can let us know of their interest in doing so after they review the reconsideration requests that will be addressed at the laboratory public meeting. In addition, we will accept written comments on the reconsideration request after the public meeting. We will accept written comments during the same time period we set for accepting other comments after the clinical laboratory public meeting—usually 2 weeks. We note that, if the party that submitted the reconsideration request does not choose to present at the public meeting, members of the public may not comment on the reconsideration request and we will not accept written comments. 
                    </P>
                    <P>However, hosting more than one public meeting per year is a timing issue which is limited by the constraints of the process. Currently, there is a limited amount of time between the receipt of the new test codes for the upcoming year and the deadline to issue them via CMS instruction; therefore, we cannot accommodate two public meetings in a year. As a result, we are finalizing § 414.509(a) with revisions to specify that other commenters may speak about reconsideration requests on the laboratory public meeting agenda and that we will accept written comments on reconsideration requests addressed at the public meeting. </P>
                    <HD SOURCE="HD3">c. Amount of Payment </HD>
                    <HD SOURCE="HD3">i. Crosswalking </HD>
                    <P>Under our existing procedures, commenters recommend the code or codes to which to crosswalk a new clinical laboratory test both at the public meeting in July and during the comment period after we issue our proposed determination in September. We consider the appropriate basis for payment and the amount of payment at the same time. Therefore, commenters that recommend crosswalking as the basis for payment for a new test also make recommendations concerning the code or codes to which to crosswalk the new test. In November, we post the code or codes to which we will crosswalk the test and the payment amount for the test on the CMS Web site. This determination is final. </P>
                    <P>
                        In the CY 2008 PFS proposed rule (72 FR 38162), we proposed to create a reconsideration process under which we may reevaluate the code or codes and their corresponding fees to which we crosswalk a new test's fees. We would accept reconsideration requests and written comments on the crosswalked code or codes and the resulting amount of payment for the new code for 60 days after we posted the determination on the CMS Web site, sometime in November. In addition, we proposed that a commenter who had submitted a written comment within the 60-day comment period would also be given the opportunity to present its comment at the public meeting. After considering the comments received and the 
                        <PRTPAGE P="66278"/>
                        information of the public meeting, we would post our decision as to whether we had elected to reconsider our determination of the crosswalked code or codes and the resulting amount of payment on the CMS Web site. If we elect to reconsider the amount of payment and had determined that we should revise the amount of payment, we would post a new determination of the code or codes to which we would crosswalk the test on the CMS Web site. We proposed that, after we posted our determination of the code or codes to which the test would be crosswalked on the CMS Web site, we would pay claims on the basis of this determination beginning January 1. Our decision regarding the amount of payment would be final and not subject to further reconsideration. 
                    </P>
                    <P>If we change our prior determination of the amount of payment, the new determination would be effective January 1. We would not reopen or otherwise reprocess claims with dates of service prior to the effective date of the revised determination. </P>
                    <P>As discussed in section II.G.2.b., we may also change the basis for payment for a new test as the result of reconsideration. If we change the basis for payment from gapfilling to crosswalking, we would also determine the code or codes to which we would crosswalk the test. Because we believe it is important to establish final payment amounts within a reasonable amount of time, we also proposed that these determinations of crosswalked payment amounts would not be subject to reconsideration. </P>
                    <P>
                        <E T="03">Comment:</E>
                         Some commenters indicated that § 414.509(b)(1) should establish payment amounts at the national limitation amount (NLA) of the tests to which the new tests are crosswalked. The NLA should replace carrier-specific amounts below the NLA for new tests. The commenters believe that if the amount of payment is lower than the NLA in a carrier's geographic area, patient access to a new test will be limited in the geographic area. 
                    </P>
                    <P>
                        <E T="03">Response:</E>
                         In the CY 2008 PFS proposed rule, we did not make policy proposals regarding the level of payment for crosswalked tests. Rather, our policy proposals were limited to the reconsideration process. Accordingly, we believe that this comment is outside of the scope of this rulemaking 
                    </P>
                    <P>
                        <E T="03">Comment:</E>
                         One commenter suggested that a similar reconsideration process should also be available for existing laboratory tests. The commenter pointed out that the payment amounts determined for certain laboratory tests by one or another Medicare carrier or MAC now differ from the payment amounts determined for these same tests by other Medicare contractors and from the corresponding NLA. 
                    </P>
                    <P>
                        <E T="03">Response:</E>
                         Section 1833(h)(1) of the Act sets forth the calculation of the payment amounts for test codes included on the clinical laboratory fee schedule to be the lower of the charge submitted, the carrier-specific amount, or the NLA. We believe changes to payment amounts for tests that are not “new tests” under section 1833(h)(8)(A) of the Act would require a statutory change. 
                    </P>
                    <P>
                        <E T="03">Comment:</E>
                         One commenter recommended that CMS clarify how fee schedule amounts below the NLA will be adjusted as carriers are phased out and their functions are moved to MACs. 
                    </P>
                    <P>
                        <E T="03">Response:</E>
                         This comment is outside the scope of our proposal. If necessary we may address this comment in a future program memorandum. 
                    </P>
                    <P>We are finalizing § 414.509(b)(1). Consistent with the revisions we made to § 414.509(a), we are revising § 414.509(b)(1) to provide that other commenters may speak about reconsideration requests on the lab public meeting agenda and that we will accept written comments on reconsideration requests addressed at the public meeting. </P>
                    <HD SOURCE="HD3">ii. Gapfilling </HD>
                    <P>As discussed in this preamble and in accordance with § 414.508(b), after we determine that gapfilling will be the basis for payment for a new clinical diagnostic laboratory test, we instruct our carriers or MACs to determine carrier-specific gapfill amounts by April 1 and finalize carrier-specific amounts by September 30. We include the determinations of carrier-specific amounts and the NLA for the new test code in the clinical laboratory fee schedule the following November when we post our payment determinations on the CMS Web site. Except in the case of a gapfilled test for which we determine that gapfilling was not appropriate under § 414.508(b)(3), these determinations are final. </P>
                    <P>
                        We proposed to provide for a reconsideration process for gapfilled payment amounts. Under this process, by April 30, we would post the carrier-specific amounts on the CMS Web site at 
                        <E T="03">http://www.cms.hhs.gov/ClinicalLabFeeSched/02_clinlab.asp.</E>
                    </P>
                    <P>Interested parties would submit written comments to CMS (which we would provide to the carriers for their consideration) on the carrier-specific amounts within 60 days from the date of posting the carrier-specific amounts. </P>
                    <P>In the CY 2008 PFS proposed rule, we stated that carriers or MACs would finalize carrier-specific amounts by September 30 and that we would set the NLA at the median of the carrier-specific amounts, and we would post the carrier-specific amounts and the NLA on our Web site. In addition, we stated that the public would have 60 days to submit a reconsideration request. </P>
                    <P>We also proposed that if we elect to act on the reconsideration request to reconsider the carrier-specific amounts and decide to revise our prior determination, we would adjust the NLA based on comments received. We would post the revised NLA on the CMS Web site and payment for the test would be made at the NLA beginning January 1. This determination would be final and not subject to further reconsideration. </P>
                    <P>In addition we proposed that, if we change the basis of payment from crosswalking to gapfilling as the result of a reconsideration, the new gapfilled payment amount would be subject to reconsideration under proposed § 414.509(b)(2). Unlike a crosswalked test, the payment amount for a gapfilled test is not established when we determine the basis for payment because it takes approximately 9 months for our contractors to establish carrier-specific amounts. Thus providing for reconsideration of gapfilled payment amounts would not lengthen the period of time it would take to determine a final payment amount. </P>
                    <P>We proposed to amend § 414.508(b)(3) to provide that § 414.508(b)(3) applies to new tests for which a new or substantially revised HCPCS code assigned on or before December 31, 2007. We proposed that the more comprehensive reconsideration procedures would apply to new or substantially revised HCPCS codes assigned after December 31, 2007. </P>
                    <P>
                        <E T="03">Comment:</E>
                         One commenter suggested that we should accept comments after the carrier-specific amounts become final, which is currently on September 30. 
                    </P>
                    <P>
                        <E T="03">Response:</E>
                         We appreciate this commenter's input. We have decided to revise the reconsideration process that we proposed. Under the final policy we are adopting in this final rule with comment period, we will post interim determinations of carrier-specific amounts on the CMS Web site in April and, for 60 days, we will accept written comments that we will share with our carriers and MACs. However, we will not accept reconsideration requests on the interim carrier-specific amounts. In September, we will post final carrier-
                        <PRTPAGE P="66279"/>
                        specific amounts on the CMS Web site. Interested parties may request reconsideration of the final carrier-specific amounts within 30 days of when we post the final carrier-specific amounts on the CMS Web site. Based on the written reconsideration requests received, we would evaluate whether we should reconsider the carrier-specific amounts and NLA. 
                    </P>
                    <P>If we elect to reconsider the carrier-specific amounts and the NLA, we will process the request for reconsideration between the end of the 30-day comment period and the deadline for dissemination of the information to the Medicare carriers or MACs via CMS instruction so that we can finalize our determinations prior to January 1. A request for reconsideration can be denied or reconsidered for a different payment amount. </P>
                    <P>If we elect not to reconsider the carrier-specific amounts and the NLA, we will post the carrier-specific amounts and NLA on the CMS Web site on or before January 1. These amounts would be based on the carrier-specific amounts and NLA we had posted in September. Payment for the test would be made at the NLA on January 1. This determination would be final and not subject to further reconsideration. </P>
                    <P>In addition, after the final test codes and payment amounts are effective on January 1, there is no reconsideration process that occurs after that date. </P>
                    <P>
                        <E T="03">Comment:</E>
                         One commenter suggested that CMS provide a rationale for either accepting or declining a reconsideration after it is received and for deciding whether to change a prior determination. 
                    </P>
                    <P>
                        <E T="03">Response:</E>
                         We do not plan to post a rationale for our decision to accept or decline a reconsideration request. This is consistent with our policy in other areas of the Medicare program when we make a decision about whether to reopen a previous decision. 
                    </P>
                    <P>
                        <E T="03">Comment:</E>
                         One commenter suggested that we should convene an expert advisory committee, broadly representative of the laboratory industry, to advise CMS on pricing along with standardizing the sources and quality of charge and cost data. 
                    </P>
                    <P>
                        <E T="03">Response:</E>
                         The purpose of the Clinical Laboratory public meeting is to convene industry experts and entertain comments, both orally and in writing, as well as any charge and cost data that is available from the industry. In fact, we specifically asked, via public notice, those in the clinical laboratory industry to provide charge and cost data related to the agenda items at the annual public meeting. We welcome any related information that industry representatives would like to provide via the public meeting forum and during the associated comment period. 
                    </P>
                    <P>
                        <E T="03">Comment:</E>
                         There were specific concerns raised by commenters regarding varying payment amounts set by carriers when the gapfilling basis is utilized to determine payment amounts for a new test code. These commenters recommended that we establish formal procedures for carriers or MACs to apply when establishing payment amounts, including a formal appeals process. The commenters stated the payment amounts should be calculated using information on the following factors, resources needed to perform the test, staff expertise, time needed to perform the test and the test's potential value. In addition, the commenters suggested we should publish the gapfill payment amounts determined by carriers or MACs and an explanation of the payment amounts. 
                    </P>
                    <P>
                        <E T="03">Response:</E>
                         Although we appreciate the comments on the establishment of payment amounts for new clinical laboratory test codes using the gapfill basis and the suggested improvements to the way we set rates, these comments are outside the scope of this rulemaking. In the CY 2008 PFS proposed rule, we proposed policies and requested comment regarding our proposed reconsideration process. We made no policy proposals with respect to the methodology our contractors use to establish gapfilled payment amounts. However, in the interest of transparency we will instruct carriers or MACs to provide a rationale for their final carrier-specific amounts, which we will post on our Web site. 
                    </P>
                    <P>
                        <E T="03">Comment:</E>
                         One commenter suggested that we should establish a temporary NLA based on the carrier-specific amounts posted on April 30 within the first year of the gapfill process. 
                    </P>
                    <P>
                        <E T="03">Response:</E>
                         We appreciate the commenter's suggestion; however, we are concerned that establishing a temporary NLA within a 3 month time period is not possible due to our substantial program requirements each year. Currently, clinical laboratory fee schedule payment rates are established on a calendar year basis. During the year preceding each January 1, an extensive multi-step process is in place in order to bring those payment rates to fruition. Currently, that process does not allow for additional ratesetting procedures.
                    </P>
                    <HD SOURCE="HD3">d. Jurisdiction for Reconsideration Decisions </HD>
                    <P>In the CY 2008 PFS proposed rule (72 FR 38163), we proposed that jurisdiction for reconsideration would rest exclusively with the Secretary. A decision whether to reconsider a determination would be committed to the discretion of the Secretary. Accordingly, a refusal to reconsider an initial determination would not be subject to administrative or judicial review. We recognize that parties dissatisfied with an initial determination as to the amount of payment for a particular claim for laboratory services may appeal the initial determination under part 405, subpart I of our regulations. Under our proposal, a party could challenge under part 405, subpart I a determination regarding the amount of payment for a new test—regardless of whether the amount of payment was established as the result of a reconsideration—but a party could not challenge a decision not to reconsider. </P>
                    <P>
                        <E T="03">Comment:</E>
                         One commenter stated that comments should be allowed on the final payment determination amounts. 
                    </P>
                    <P>
                        <E T="03">Response:</E>
                         This comment appears to request an extension of the reconsideration process or a change in the jurisdiction as proposed in § 414.509. The commenter did not provide additional information on the circumstances that would warrant an extension of the reconsideration process. Also, the comment did not specify the length of time for an extension or procedures for an extension or change of jurisdiction. We believe § 414.506 through § 414.509 permit adequate opportunities for public participation in the process of establishing a payment amount and requesting a reconsideration. More than 2 years can elapse if all steps of these reconsideration procedures are necessary for the establishment of the basis and payment for a new test code. We do not agree that revisions to § 414.509(d) are warranted. 
                    </P>
                    <HD SOURCE="HD3">3. Technical Revisions </HD>
                    <P>We also proposed technical revisions to § 414.502, § 414.506, and § 414.508. Under section 1833(h)(8)(A) of the Act, the term “new tests” is defined as any clinical diagnostic laboratory test for which a new or substantially revised HCPCS code is assigned on or after January 1, 2005. However, our regulations do not define the term “new test.” Therefore, we proposed to define the term “new test” under § 414.502 using the statutory definition. In addition, under § 414.506 and § 414.508, we proposed to replace references to “new clinical diagnostic laboratory test that is assigned a new or substantially revised code on or after January 1, 2005” with references to “new test.” </P>
                    <P>
                        <E T="03">Response:</E>
                         We received one supportive comment on this subpart, 
                        <PRTPAGE P="66280"/>
                        and we appreciate the positive input received on our technical revisions. Therefore, we are finalizing the technical revisions as proposed. 
                    </P>
                    <HD SOURCE="HD2">H. Revisions Related to Payment for Renal Dialysis Services Furnished by End-Stage Renal Disease (ESRD) Facilities </HD>
                    <P>In the CY 2008 PFS proposed rule (72 FR 38163), we outlined the proposed updates to the case mix adjusted composite rate payment system established under section 1881(b)(12) of the Act, added by section 623 of the MMA. These included updates to the drug add-on component of the composite rate system, as well as the wage index values used to adjust the labor component of the composite rate. </P>
                    <P>Specifically, we proposed the following provisions which are described in more detail below in this section. </P>
                    <P>• A growth update to the drug add-on adjustment to the composite rates for 2008 required by section 1881(b)(12)(F) of the Act. </P>
                    <P>• An update to the wage index adjustments to reflect the latest hospital wage data, including a reduction to the wage index floor and a revised budget neutrality adjustment to the wage index for 2008. </P>
                    <P>We received approximately 7 comments on these proposed changes which are discussed in detail below in this section. </P>
                    <HD SOURCE="HD3">1. Growth Update to the Drug Add-On Adjustment to the Composite Rates </HD>
                    <P>Section 623(d) of the MMA added section 1881(b)(12)(B)(ii) of the Act which required the establishment of an add-on to the composite rate to account for changes in the drug payment methodology stemming from enactment of the MMA. Section 1881(b)(12)(C) of the Act provides that the drug add-on must reflect the difference in aggregate payments between the revised drug payment methodology for separately billable ESRD drugs and the AWP payment methodology. In 2005, we generally paid for ESRD drugs based on average acquisition costs. Thus the difference from AWP pricing was calculated using acquisition costs. However, in 2006 when we moved to ASP pricing for ESRD drugs, we recalculated the difference from AWP pricing using ASP prices. </P>
                    <P>
                        <E T="03">Comment:</E>
                         Two commenters supported our continued use of ASP+6 percent to pay for separately billable ESRD drugs. 
                    </P>
                    <P>
                        <E T="03">Response:</E>
                         Although these comments are outside the scope of the proposed rule, we appreciate the support of our previous decision to pay for separately billable ESRD drugs at ASP+6 percent. 
                    </P>
                    <P>In addition, section 1881(b)(12)(F) of the Act requires that beginning in CY 2006, we establish an annual update to the drug add-on to reflect the estimated growth in expenditures for separately billable drugs and biologicals furnished by ESRD facilities. This growth update applies only to the drug add-on portion of the case-mix adjusted payment system. </P>
                    <P>The CY 2007 drug add-on adjustment to the composite rate is 14.9 percent. The drug add-on adjustment for 2007 incorporates an inflation adjustment of 0.5 percent. This computation is explained in detail in the CY 2007 PFS final rule with comment period (71 FR 69682 through 69684). We note that the drug add-on adjustment of 15.1 percent that was published in the CY 2007 PFS final rule with comment period did not account for the 1.6 percent update to the composite rate portion of the basic case-mix adjustment payment system that was subsequently enacted by the MIEA-TRHCA, effective April 1, 2007. Since we compute the drug add-on adjustment as a percentage of the weighted average base composite rate, the drug add-on percentage was decreased to account for the higher composite payment rate resulting in a 14.9 percent add-on adjustment beginning April 1, 2007. This adjustment was necessary to ensure that the total drug add-on dollars remain constant. </P>
                    <HD SOURCE="HD3">(a) Estimating Growth in Expenditures for Drugs and Biologicals for CY 2008 </HD>
                    <P>In the CY 2007 PFS final rule with comment period (71 FR 69682), we established a methodology for annually estimating the growth in ESRD drugs and biological expenditures that uses the Producer Price Index (PPI) for pharmaceuticals as a proxy for pricing growth in conjunction with 2 years of ESRD drug data to estimate per patient utilization growth. </P>
                    <P>For CY 2008, we proposed to continue using this methodology to update the drug add-on adjustment, using expenditure data from CY 2005 and CY 2006 to estimate the growth in per patient utilization of drugs. However, we also proposed using only drug expenditure data from independent ESRD facilities because we were unable to determine utilization change in hospital-based dialysis facilities due to the changes in payment methodology for these types of dialysis facilities from CY 2005 to CY 2006. In 2005, payments to hospital-based facilities were based on cost (or a percentage of charges), whereas payments to those facilities in 2006 were based on ASP pricing. Because of the cost payment methodology, the “drug unit” fields on the 2005 hospital-based ESRD facility bills were not used for payment purposes, and therefore, the data may not have been accurately reported on those bills. As such, we were unable to accurately isolate the per unit payment differential for hospital-based ESRD facility drug expenditures between 2005 (cost payments) and 2006 (ASP payments) for purposes of estimating the residual utilization change between years. We proposed imputing the same utilization growth for hospital-based ESRD facilities as estimated for independent ESRD facilities. </P>
                    <P>
                        <E T="03">Comment:</E>
                         One comment urged us to reevaluate the data and methodology used to estimate utilization changes. The comment was specifically concerned about the timeliness of the data and that the exclusion of hospital-based drug data may significantly skew the accuracy of the utilization growth calculation. However, the comment did not suggest an alternative methodology. 
                    </P>
                    <P>
                        <E T="03">Response:</E>
                         The data from CY 2005 and CY 2006 represent the most up to date and latest full years of data available. Contrary to the commenter's suggestion, as we indicated in the CY 2008 PFS proposed rule, including hospital-based data in the computation would have resulted in a negative utilization growth. Therefore, we opted to exclude those data to avoid penalizing ESRD facilities because of the problems with the hospital-based ESRD facility drug data. We believe our approach provides the most reasonable result given the available data. 
                    </P>
                    <P>
                        <E T="03">Comment:</E>
                         One comment suggested that we adopt an index that would account for both price and utilization such as the National Health Expenditures (NHE) index. This would avoid the data issues associated with estimating utilization growth. 
                    </P>
                    <P>
                        <E T="03">Response:</E>
                         We do not believe that the NHE projections would be the best proxy for growth in ESRD drug expenditures. The NHE projections are based on the economic, demographic and Medicare spending projections contained in the Medicare Trustees Report as opposed to an independent forecast of economic assumptions, such as the Global Insights projections of the PPI for prescription drugs that are used in our Medicare market basket forecasts to update many of our payment systems. The NHE projection modeling approach is at an aggregate level and does not capture the nuances of both labor and economic markets as accurately as does the specific PPI forecast. We believe that, despite some of the limitations in the data, estimating utilization growth 
                        <PRTPAGE P="66281"/>
                        from reported ESRD claims data provides the most accurate measure of actual ESRD facility drug utilization. 
                    </P>
                    <P>
                        <E T="03">Comment:</E>
                         One comment suggested that the PPI may not result in an accurate assessment of prices for ESRD drugs and that there are other available indices that would provide more accurate data on ESRD drugs. In addition, they stated that should we choose to move forward with the PPI, the most up to date PPI forecast should be used. 
                    </P>
                    <P>
                        <E T="03">Response:</E>
                         We do not know of any better price index than the PPI for measuring price growth for ESRD drugs. However, we welcome any suggestion the industry may have on an alternative price index suitable for measuring price growth of ESRD drugs. Global Insight, Inc. is a nationally recognized economic and financial forecasting firm that contracts with CMS to forecast the components of our market baskets. The current projection of the PPI for prescription drugs is based on the 2007 second quarter forecast using historical data through the first quarter of 2007, the most current data available at this time. 
                    </P>
                    <P>
                        <E T="03">Comment:</E>
                         One comment recommended that a mechanism be established to provide for a forecasting error adjustment of prior estimates. 
                    </P>
                    <P>
                        <E T="03">Response:</E>
                         While we appreciate the concern related to the accuracy of an update based on proxy measures for price and the proposed utilization computations, the very nature of estimating future expenditures under a prospective payment system requires that those estimates are based on the best historical data available. As such, we believe we have met our obligation under the statute in estimating growth in ESRD drug expenditures for CY 2008. Moreover, forecast error adjustments are rarely made in our prospective payment systems. 
                    </P>
                    <HD SOURCE="HD3">(b) Estimating Growth in Per Patient Drug Utilization </HD>
                    <P>To isolate and project the growth in per patient utilization of ESRD drugs for CY 2008, we removed the enrollment and price growth components from the historical data and considered the residual to be utilization growth. As discussed previously, we proposed to use independent ESRD facility drug expenditure data from CY 2005 and CY 2006 to estimate per patient utilization growth for CY 2008. </P>
                    <P>We first estimated total drug expenditures. For the CY 2008 PFS proposed rule (72 FR 38165), we used the final CY 2005 ESRD facility claims data and the latest available CY 2006 ESRD facility claims data, updated through December 31, 2006. That is, for CY 2006 we used claims that were received, processed, paid, and passed to the National Claims History File as of December 31, 2006. For this final rule with comment period, we are using more updated CY 2006 claims with dates of service for the same time period. This updated CY 2006 data file includes all claims that were received, processed, paid, and passed to the National Claims History File as of June 30, 2007 for CY 2006. </P>
                    <P>For the CY 2008 PFS proposed rule, we adjusted the December 2006 file to reflect our estimate of what total drug expenditures would be using the final June 30, 2007 bill file for CY 2006. The net adjustment we applied to the CY 2006 claims data was an increase of 12 percent to the December 2006 claims file. For this final rule with comment period, we are using the CY 2006 claims file as of June 30, 2007, which represents the final claims file for that year. To calculate the proposed per patient utilization growth, we removed the enrollment component by using the growth in enrollment data between 2005 and 2006. This was approximately 3 percent. To remove the price effect, we calculated the weighted difference between 2005 average acquisition price (AAP) and 2006 ASP pricing for the original top ten drugs for which we had average acquisition prices. We weighted the differences by the 2006 independent ESRD facility drug expenditure data. This process led to an overall 3 percent reduction in price between 2005 and 2006 (72 FR 38165 through 38166). </P>
                    <P>After removing the enrollment and price effects from the expenditure data, the residual growth would reflect the per patient utilization growth. To do this, we divided the product of the enrollment growth of 3 percent (1.03) and the price reduction of 3 percent (1.00 − 0.03 = 0.97) into the total drug expenditure change between 2005 and 2006 of −0.2 percent (1.00 −0.00 = 1.00). The result is a proposed utilization growth factor equal to 1.00 (1.00/1.03 * 0.97) = 1.00. </P>
                    <P>Since we observed no growth in per patient utilization of drugs between 2005 and 2006, we proposed no projected growth in per patient utilization for all ESRD facilities for CY 2008. </P>
                    <HD SOURCE="HD3">c. Applying the Proposed Growth Update to the Drug Add-On Adjustment </HD>
                    <P>In the CY 2007 PFS final rule with comment period (71 FR 69684), we revised our update methodology by applying the growth update to the per treatment drug add-on amount. That is, for CY 2007, we applied the growth update factor of 4.03 percent to the $18.88 per treatment drug add-on amount for an updated amount of $19.64 per treatment. </P>
                    <P>For CY 2008, we proposed to update the per treatment drug add-on amount of $19.64 established in CY 2007 by converting the update into an adjustment factor as specified in section 1881(b)(12)(F) of the Act. </P>
                    <HD SOURCE="HD3">(i) Update to the Drug Add-On Adjustment </HD>
                    <P>In the CY 2008 PFS proposed rule (72 FR 38166), we estimated no growth in per patient utilization of ESRD drugs for CY 2008. Using the projected growth of the CY 2008 PPI for prescription drugs of 3.66 percent, we projected that the combined growth in per patient utilization and pricing for CY 2008 would result in an update equal to the PPI growth, or 3.66 percent (1.0 * 1.0366 = 1.0366). This proposed update factor was applied to the CY 2007 per treatment drug add-on amount of $19.64 (reflecting a 14.9 percent adjustment in CY 2007), resulting in a proposed weighted average increase to the composite rate of $0.72 for CY 2008 or a 0.5 percent increase in the drug add-on percentage. Thus, the total proposed drug add-on adjustment to the composite rate for CY 2008, including the growth update was 15.5 percent (1.149 * 1.005 = 1.155). </P>
                    <P>In addition, we proposed to continue to use this method to estimate the growth update to the drug add-on component of the case mix adjusted payment system until we have at least 3 years worth of ASP-based historical drug expenditure data that could be used to conduct a trend analysis to estimate the growth in drug expenditures. Given the time lag in the availability of ASP drug expenditure data, we expect that the earliest we could consider using trend analysis to update the drug add-on adjustment would be 2010. We intend to reevaluate our methodology for estimating the growth update at that time. </P>
                    <P>
                        <E T="03">Comment:</E>
                         One comment suggested that we should work with the kidney care community as we consider a CY 2010 transition to trend analysis using ASP-based historical data. The comment expressed concern that using actual historical ESRD drug expenditure data reflecting ASP pricing could adversely affect ESRD facilities due to changes in ASP pricing for EPO and Procrit. 
                    </P>
                    <P>
                        <E T="03">Response:</E>
                         Once we begin using trend analysis to update the drug add-on adjustment, we will provide details of that methodology in future rulemaking. 
                        <PRTPAGE P="66282"/>
                    </P>
                    <HD SOURCE="HD3">(ii) Final Growth Update to the Drug Add-On Adjustment for 2008 </HD>
                    <P>Similar to the proposed rule, we estimated no growth in per patient utilization of ESRD drugs for CY 2008. To remove the price effect, we used 2006 weights for each of the top ten ESRD drugs billed by independent ESRD facilities. These weights are shown in Table 6. </P>
                    <GPOTABLE COLS="2" OPTS="L2,i1" CDEF="s25,10">
                        <TTITLE>Table 6.—CY 2006 Drug Weights for Independent Facilities</TTITLE>
                        <BOXHD>
                            <CHED H="1">Independent drugs </CHED>
                            <CHED H="1">
                                2006 weights 
                                <LI>(percent)</LI>
                            </CHED>
                        </BOXHD>
                        <ROW>
                            <ENT I="01">EPO </ENT>
                            <ENT>75.2 </ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">Paricalcitol </ENT>
                            <ENT>11.6 </ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">Sodium_ferric_glut </ENT>
                            <ENT>2.9 </ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">Iron_sucrose </ENT>
                            <ENT>5.7 </ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">Levocarnitine </ENT>
                            <ENT>0.3 </ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">Doxercalciferol</ENT>
                            <ENT>3.1 </ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">Calcitriol </ENT>
                            <ENT>0.1 </ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">Iron_dextran </ENT>
                            <ENT>0.0 </ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">Vancomycin </ENT>
                            <ENT>0.1 </ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">Alteplase </ENT>
                            <ENT>0.9 </ENT>
                        </ROW>
                    </GPOTABLE>
                    <P>We removed the enrollment and price effects from the independent ESRD facility expenditure data to determine the per patient utilization growth. To do this we divided the product of the enrollment growth of 3 percent (1.03) and the price reduction of 3 percent (1.00−0.03 = 0.97) into the total drug expenditure change between 2005 and 2006 of −0.1 percent (1.00−0.00 = 1.00). The result is a utilization growth factor equal to 1.00 (1.00/1.03 * 0.97) = 1.00. </P>
                    <P>Using the latest projected growth of the CY 2008 PPI for prescription drugs of 3.5 percent, we project that the combined growth in per patient utilization and pricing of ESRD drugs for CY 2008 would result in an update equal to the PPI growth or 3.5 percent (1.00 * 1.035 = 1.035). This update factor was applied to the CY 2007 average per treatment drug add-on amount of $19.64 (reflecting a 14.9 percent adjustment for CY 2007), resulting in a weighted average increase to the composite rate of $0.69 for CY 2008 or a 0.5 percent increase in the drug add-on percentage for CY 2008. Thus, the total drug add-on adjustment to the composite rate for CY 2008, including the growth update is 15.5 percent (1.149 * 1.005 = 1.155). </P>
                    <HD SOURCE="HD3">2. Update to the Geographic Adjustment to the Composite Rates </HD>
                    <P>Section 1881(b)(12)(D) of the Act, as added by section 623(d) of the MMA, gives the Secretary the authority to revise the wage indexes previously applied to the ESRD composite rates. The wage index values are calculated for each urban and rural area. The purpose of the wage index is to adjust the composite rates for differing wage levels covering the areas in which ESRD facilities are located. </P>
                    <HD SOURCE="HD3">(a) Updates to Core-Based Statistical Area (CBSA) Definitions </HD>
                    <P>
                        In the CY 2008 PFS proposed rule (72 FR 38166), we clarified that this and all subsequent ESRD rules and notices are considered to incorporate the CBSA changes published in the most recent OMB bulletin that applies to the hospital wage data used to determine the current ESRD wage index. The OMB bulletins may be accessed online at 
                        <E T="03">http://www.whitehouse.gov/omb/bulletins/index.html.</E>
                    </P>
                    <HD SOURCE="HD3">(b) Updated Wage Index Values </HD>
                    <P>In the CY 2006 PFS final rule with comment period (70 FR 70167), we described that methodology for calculating the CY 2006 wage index values and stated that we intend to update the ESRD wage index values annually. Current wage index values for CY 2007 were developed from FY 2003 wage and employment data obtained from the Medicare hospital cost reports. The ESRD wage index values are calculated without regard to geographic reclassifications authorized under sections 1886(d)(8) and (d)(10) of the Act and utilize pre-floor hospital data that is unadjusted for occupational mix. </P>
                    <P>
                        We proposed to use the same methodology for CY 2008 (72 FR 38167), with the exception that FY 2004 hospital data will be used to develop the CY 2008 ESRD wage index values. For a detailed description of the development of the CY 2008 wage index values based on FY 2004 hospital data, see the FY 2008 IPPS final rule entitled “Changes to the Hospital Inpatient Prospective Payment Systems and Fiscal Year 2008 Rates” (72 FR 47320). Section G of the preamble to that final rule describes the cost report schedules, line items, data elements, adjustments, and wage index computations. The wage index data affecting ESRD composite rates for each urban and rural locale may also be accessed on the CMS Web site at 
                        <E T="03">http://www.cms.hhs.gov/AcuteInpatientPPS/WIFN/list.asp.</E>
                         The wage data are located in the section entitled “FY 2008 Final Rule Occupational Mix Adjusted and Unadjusted Average Hourly Wage and Pre-Reclassified Wage Index by CBSA.” 
                    </P>
                    <P>
                        <E T="03">Comment:</E>
                         One commenter expressed concern in regard to our use of acute care hospital wage data in the calculation of the wage index stating that the cost for hospital based facilities and ambulatory centers varies greatly. The commenter urged us to locate an alternative data source that reflects information directly tied to ESRD facilities. 
                    </P>
                    <P>
                        <E T="03">Response:</E>
                         At the present time, data that is specific to independent dialysis facilities is not available upon which to base the wage index. As described in the CY 2007 PFS final rule with comment period (71 FR 69685), given the similarity of the labor market for professional, technical, and nursing staff between hospitals and ESRD facilities, we believe our use of hospital wage and employment data obtained from the Medicare cost reports to develop the ESRD wage index is appropriate. In addition, several of our major prospective payment systems (PPS) utilize the same wage index (for example, Skilled Nursing Home PPS, Inpatient Psychiatric Facility PPS, Inpatient Rehabilitation Facility PPS, Home Health PPS, and Hospice PPS.) 
                    </P>
                    <HD SOURCE="HD3">(i) Third Year of the Transition </HD>
                    <P>In the CY 2006 PFS final rule with comment period (70 FR 70169), we indicated that we would apply a 4-year transition period to mitigate the impact on composite rates resulting from our adoption of CBSA-based geographic designations. Beginning January 1, 2006, during each year of the transition, an ESRD facility's wage-adjusted composite rate (that is, without regard to any case-mix adjustments) will be a blend of its old MSA-based wage-adjusted payment rate and its new CBSA-based wage-adjusted payment rate for the transition year involved. In addition, beginning in CY 2006 we provided a gradual reduction in the wage index floor. We indicated that we would reassess the need for a wage index floor for CY 2008. In the CY 2008 PFS proposed rule (72 FR 38167), we proposed a further reduction in the wage index floor. For each transition year, the share of the blended wage-adjusted base payment rate that is derived from the MSA-based and CBSA-based wage index values and the applicable wage index floor is as follows: </P>
                    <P>• In CY 2006, the first year of the transition, we implemented a 75/25 blend. The wage index floor was reduced from 0.9000 to 0.8500. </P>
                    <P>• In CY 2007, the second year of the transition, we implemented a 50/50 blend. The wage index floor was reduced from 0.8500 to 0.8000. </P>
                    <P>
                        • For CY 2008, consistent with the transition blends announced in the CY 2006 PFS final rule with comment period (70 FR 70170), we are implementing a 25/75 blend between an ESRD facility's MSA based composite 
                        <PRTPAGE P="66283"/>
                        rate, and its CY 2008 CBSA-based rate reflecting its revised wage index values. In addition, we proposed to continue the wage index floor, but to further reduce it from 0.8000 to 0.7500. 
                    </P>
                    <P>An example of how the wage-adjusted composite rates would be blended during CY 2008 and the additional subsequent transition year follows. </P>
                    <P>
                        <E T="03">Example:</E>
                         An ESRD facility has a wage-adjusted composite rate (without regard to any case-mix adjustments) of $135.00 per treatment in CY 2007. Using CBSA-based geographic area designations, the facility's CY 2008 wage-adjusted composite rate, reflecting its wage index value would be $145.00. During the remaining 2 years of the 4-year transition period to the new CBSA-based wage index values, this facility's blended rate through 2009 would be calculated as follows: 
                    </P>
                    <FP SOURCE="FP-1">CY 2008 = 0.25 × $135.00 + 0.75 × $145.00 = $142.50 </FP>
                    <FP SOURCE="FP-1">CY 2009 = 0 × $135.00 + 1.0 × $145.00 = $145.00 </FP>
                    <P>We note that this hypothetical example assumes that the calculated wage-adjusted composite rate of $145.00 for CY 2008 does not change in CY 2009. In actuality, the wage-adjusted composite rate for CY 2009 would change because of annual revisions to the wage index. However, the example serves only to demonstrate the effect on the composite rate of the CBSA-based wage index values which will be phased in during the remaining 2 years of the transition period. As noted above in this section, the 4-year transition period will expire and in CY 2009 and forward, we will be using CBSA-based wage index values. </P>
                    <P>
                        <E T="03">Comment:</E>
                         Several commenters expressed concern in regard to our proposal to decrease the wage index floor from 0.80 to 0.75. In addition, one commenter indicated that a defunct licensing board in Puerto Rico has inhibited licensing of dialysis technicians for a long period of time. As a result, registered nurses are the only group of licensed professional qualified to furnish dialysis within this area. 
                    </P>
                    <P>In addition, a commenter believes that decreasing the floor will make it difficult to recruit and retain qualified personnel in areas affected by the removal of the floor. The commenter also identified the recent transition to the ASP drug pricing methodology and increases in operating expense as factors that have compounded the impact of any further drop in the wage index floor. </P>
                    <P>
                        <E T="03">Response:</E>
                         As described in the CY 2007 PFS final rule with comment period (71 FR 69686 through 69687), the proposed wage index floor was substantially higher than the actual wage index values for urban locales in Puerto Rico, without application of any floor and prior to the application of the BN adjustment. Specifically, the proposed wage index floor was 0.80 whereas the actual wage index values ranged from 0.3241 to 0.4893. Similarly, the proposed wage index floor for CY 2008 is 0.75 whereas the actual wage index values for urban locales in Puerto Rico range from 0.3064 to 0.4729. Therefore, we believe that the CY 2008 wage index floor of 0.75 compared to actual wage levels is an appropriate level and the new floor would not impede the ability of ESRD facilities to recruit and retain staff. 
                    </P>
                    <HD SOURCE="HD3">(ii) Wage Index Values for Areas With No Hospital Data </HD>
                    <P>In CY 2006, while adopting the CBSA designations, we identified a small number of ESRD facilities in both urban and rural geographic areas where there is no hospital wage data from which to calculate ESRD wage index values. The affected areas were rural Massachusetts, rural Puerto Rico and the urban area of Hinesville, GA (CBSA 25980). For both CY 2006 and CY 2007, we calculated the ESRD wage index values for those areas as follows: </P>
                    <P>• For rural Massachusetts, because we had not determined a reasonable proxy for rural data in Massachusetts, we used the FY 2005 wage index value for rural Massachusetts. </P>
                    <P>• For rural Puerto Rico, the situation is similar to rural Massachusetts. However, since all geographic areas in Puerto Rico were subject to the wage index floor in CY 2006 and CY 2007, we applied the ESRD wage index floor to rural Puerto Rico as well. </P>
                    <P>•  For the urban area of Hinesville, GA, we calculated the CY 2006 and CY 2007 wage index value for Hinesville, GA (CBSA 25980) based on the average wage index value for all urban areas within the State of Georgia. </P>
                    <P>In the CY 2008 PFS proposed rule (72 FR 38168), we proposed an alternative methodology for establishing a wage index value for rural Massachusetts. Since we have used the same wage index value for two years with no updates, we believed it was appropriate to establish a methodology that uses reasonable proxy data for rural areas (including rural Massachusetts) and also permits annual updates to the wage index value based on that proxy data. Therefore, in cases where there is a rural area without hospital wage data, we proposed to use the average wage index values from all contiguous CBSAs to represent a reasonable proxy for that rural area. </P>
                    <P>In determining the imputed rural wage index, we interpret the term “contiguous” to mean sharing a border. In the case of Massachusetts, the entire rural area consists of Dukes and Nantucket Counties. We determined that the borders of Dukes and Nantucket counties are “contiguous” with Barnstable and Bristol counties. Under the proposed methodology, the wage index values for the counties of Barnstable (CBSA 12700, Barnstable Town, MA—(1.2539)) and Bristol (CBSA 39300, Providence-New Bedford-Fall River, RI-MA—(1.0783)) are averaged, resulting in a proposed imputed wage index value of 1.1665 for rural Massachusetts for CY 2008. </P>
                    <P>For rural Puerto Rico, we proposed to continue to apply the wage index floor in CY 2008. Since all areas in Puerto Rico that have a wage index are eligible for the proposed CY 2008 ESRD wage index floor of 0.7500, we proposed to also apply the floor to ESRD facilities located in rural Puerto Rico. </P>
                    <P>For Hinesville, GA (CBSA 25980) which is an urban area without specific hospital wage data, we proposed to continue using the same methodology used to impute a wage index value for that area as we used in CY 2006 and CY 2007. Specifically, we used the average wage index value for all urban areas within the State of Georgia for purposes of calculating the wage index value for Hinesville. Therefore, for CY 2008 we proposed that the wage index value for urban CBSA (25980) Hinesville-Fort Stewart, GA is calculated as the average of the wage index values of all urban areas in Georgia. </P>
                    <P>We solicited comments on these proposed approaches to calculate the wage index values for areas without hospital wage data for CY 2008 and subsequent years. We indicated that we would continue to evaluate existing hospital wage data and, possibly, wage data from other sources, such as the Bureau of Labor Statistics, to determine if other methodologies of imputing a wage index value for these areas may be feasible. We received one comment on this issue.</P>
                    <P>
                        <E T="03">Comment:</E>
                         One commenter was supportive of our methodology used in calculating wage index values for areas with no hospital wage data including rural Massachusetts, Puerto Rico, and an urban area in Georgia. However, the commenter requested that we carefully evaluate the extent to which these methodologies would be appropriate in other situations nationwide. 
                    </P>
                    <P>
                        <E T="03">Response:</E>
                         We agree with the commenter. As additional areas are 
                        <PRTPAGE P="66284"/>
                        identified for which hospital wage data does not exist, we will reevaluate the extent to which the methodologies used for Massachusetts, Puerto Rico, and Georgia would be appropriate and consider alternative methodologies on an as needed basis. 
                    </P>
                    <P>We are finalizing the ESRD wage index and associated policies as proposed for CY 2008. In addition, we note that we plan to evaluate any policies adopted in the FY 2008 IPPS final rule (72 FR 47130, 47337 through 47338) that affect the wage index, including how we treat certain New England hospitals under section 601(g) of the Social Security Amendments of 1983 (Pub. L. 98-21). </P>
                    <HD SOURCE="HD3">(iii) Budget Neutrality (BN) Adjustment </HD>
                    <P>Section 1881(b)(12)(E)(i) of the Act, as added by section 623(d) of the MMA, requires that any revisions to the ESRD composite rate payment system as a result of the MMA provision (including the geographic adjustment) be made in a budget neutral manner. This means that aggregate payments to ESRD facilities in CY 2007 should be the same as aggregate payments that would have been made if we had not made any changes to the geographic adjusters. We note that this BN adjustment only addresses the impact of changes in the geographic adjustments. A separate BN adjustment was developed for the case-mix adjustments, currently in effect. Since we are not proposing any changes to the case-mix measures for CY 2008, the current case-mix budget neutrality will remain in effect for CY 2008. For CY 2008, we again proposed to apply the BN adjustment directly to the ESRD wage index values, as we did in CY 2007. As we explained in the CY 2007 PFS final rule with comment period (71 FR 69687 through 69688), we believe this is the simplest approach because it allows us to maintain our base composite rates during the transition from the current wage adjustments to the revised wage adjustments described previously in this section. Because the ESRD wage index is only applied to the labor related portion of the composite rate, we computed the BN adjustment based on that proportion (53.711 percent). </P>
                    <P>To compute the proposed CY 2008 wage index BN adjustment, we used the proposed wage index values, 2006 outpatient claims (paid and processed as of December 31, 2006), and geographic location information for each facility. </P>
                    <P>Using the treatment counts from the 2006 claims and facility-specific CY 2007 composite rates, we computed the estimated total dollar amount each ESRD provider would have received in CY 2007 (the 2nd year of the 4-year transition). The total of these payments became the target amount of expenditures for all ESRD facilities for CY 2008. Next, we computed the estimated dollar amount that would have been paid to the same ESRD facilities using the proposed ESRD wage index for CY 2008 (the 3rd year of the 4-year transition). The total of these payments became the third year amount of wage-adjusted composite rate expenditures for all ESRD facilities. </P>
                    <P>After comparing these two dollar amounts (target amount divided by 3rd year new amount), we calculated an adjustment factor that, when multiplied by the applicable CY 2008 ESRD proposed wage index value would result in payments to each facility that remain within the target amount of composite rate expenditures when totaled for all ESRD facilities. The proposed BN adjustment for the CY 2008 wage index was 1.054955. </P>
                    <P>We also must apply the BN adjustment to the proposed wage index floor of 0.7500 which resulted in a proposed adjusted wage index floor of 0.7912 (0.7500 × 1.054955) for CY 2008. </P>
                    <P>
                        <E T="03">Comment:</E>
                         One commenter expressed concern in regard to the calculation of the BN adjustment for the geographic wage index stating that the methodology included in the proposed rule lacked transparency. The commenter urged us to provide the data and methodology used in calculating the BN adjustment. 
                    </P>
                    <P>
                        <E T="03">Response:</E>
                         The commenter did not identify where transparency was lacking or any missing elements that would enable the community to assess the impact of the proposed changes. However, we received a similar request for clarification during last year's rulemaking process and provided an extensive description of the manner in which budget neutrality is applied to the wage index in the CY 2007 PFS final rule with comment period (71 FR 69687 through 69688). While claims data have been updated since publication of that final rule with comment period, the methodology has not changed. 
                    </P>
                    <P>
                        During the CY 2008 PFS proposed rule comment period, we made available an ESRD Composite Rate Payment System File. This file contained select claims level data from the 2006 ESRD facility outpatient claims, updated through December 31, 2006. For more information on this file, see the following page on the CMS Web site at 
                        <E T="03">http://www.cms.hhs.gov/LimitedDataSets/06.asp#TopOfPage.</E>
                    </P>
                    <P>After publication of this final rule with comment period, we intend to provide the updated version of the CY 2006 outpatient claims (paid and processed as of June 30, 2007) that were used to compute the BN adjustment. </P>
                    <P>
                        To compute the final CY 2008 ESRD wage index BN adjustment, we used FY 2004 pre-floor, pre-reclassified, non-occupational mix-adjusted hospital wage data to compute the wage index values, 2006 outpatient claims (paid and processed as of June 30, 2007), and geographic location information for each ESRD facility which may be found through Dialysis Facility Compare. The FY 2004 hospital wage index data for each urban and rural locale by CBSA may also be accessed on the CMS Web site at: 
                        <E T="03">http://www.cms.hhs.gov/AcuteInpatientPPS/WIFN/list.asp.</E>
                         The wage index data are located in the section entitled “FY 2008 Final Rule Occupational Mix Adjusted and Unadjusted Average Hourly Wage and Pre-Reclassified Wage Index by CBSA.” 
                    </P>
                    <P>
                        Dialysis Facility Compare Information can be found on the CMS Web site at 
                        <E T="03">http://www.cms.hhs.gov/DialysisFacilityCompare/.</E>
                    </P>
                    <P>Using treatment data from the latest 2006 claims file and facility-specific CY 2007 composite rates, we computed the estimated total dollar amount each ESRD provider would have received in CY 2007 (the 2nd year of the 4-year transition). The total of these payments became the target amount of expenditures for all ESRD facilities for CY 2008. Next, we computed the estimated dollar amount that would have been paid to the same ESRD facilities using the ESRD wage index for CY 2008 (the 3rd year of the 4-year transition). The total of these payments became the 3rd year new amount of wage adjusted composite rate expenditures for all ESRD facilities.</P>
                    <P>After comparing these dollar amounts (target amount divided by 3rd year new amount), we calculated an adjustment factor that when multiplied by the applicable CY 2008 wage index value, will result in aggregate payments to ESRD facilities that will remain within the target amount of composite rate expenditures. When making this calculation, the ESRD wage index floor value of 0.7500 is used whenever appropriate. </P>
                    <P>The final BN adjustment for the CY 2008 wage index is 1.055473. </P>
                    <P>To ensure budget neutrality, we also must apply the BN adjustment to all index values, including the wage index floor of 0.7500, which results in an adjusted wage index floor of 0.7916 for CY 2008. </P>
                    <HD SOURCE="HD3">(iv) ESRD Wage Index Tables </HD>
                    <P>
                        The final CY 2008 wage index tables applicable to ESRD facilities are located 
                        <PRTPAGE P="66285"/>
                        in Addenda G and H of this final rule with comment period. 
                    </P>
                    <HD SOURCE="HD2">I. Independent Diagnostic Testing Facility (IDTF) Issues </HD>
                    <P>In the CY 2008 PFS proposed rule (72 FR 38169 through 38171), we clarified our interpretation of several of the existing performance standards at § 410.33(b), and § 410.33(g), proposed a new IDTF performance standard at § 410.33(g)(15), and a new proposed IDTF provision at § 410.33(i).</P>
                    <P>We received numerous comments concerning the revisions to existing performance standards and new provisions affecting IDTFs and have revised our proposed changes, where applicable, to reflect the issues brought forth by the commenters. We are adopting the provisions contained in the proposed rule as final with the following changes. </P>
                    <HD SOURCE="HD3">1. Revisions of Existing IDTF Performance Standards</HD>
                    <HD SOURCE="HD3">a. § 410.33(g)(6) </HD>
                    <P>In § 410.33(g)(6), we had proposed to revise this existing performance standard to include the requirement that an IDTF must list our designated contractor as a Certificate Holder on the comprehensive liability insurance policy by revising § 410.33(g)(6) to state, “Has a comprehensive liability insurance policy in the amount of at least $300,000 per location that covers both the supplier's place of business and all customers and employees of the supplier and ensures that this insurance policy must remain in force at all times. The policy must be carried by a nonrelative owned company. Failure to maintain required insurance at all times will result in revocation of the IDTF's billing privileges retroactive to the date the insurance lapsed. IDTF suppliers are responsible for providing the contact information for the issuing insurance agent and the underwriter. In addition, we proposed that the IDTF must: ensure that the insurance policy must remain in force at all times and provide coverage of at least $300,000 per incident; notify the CMS-designated contractor in writing of any policy changes or cancellations; and list the CMS-designated contractor as a Certificate Holder on the policy.” </P>
                    <P>
                        <E T="03">Comment:</E>
                         One commenter suggested that we amend the § 410.33(g)(6) provision on the comprehensive liability insurance policy to state that IDTFs should have a comprehensive liability insurance policy of at least $100,000 per incident, $300,000 aggregate and that CMS should require the IDTF to list Medicare contractors as certificate holders for notification purposes only. 
                    </P>
                    <P>
                        <E T="03">Response:</E>
                         After receiving numerous comments supporting the proposed figures, we are adopting the proposed figure of $300,000 per incident. 
                    </P>
                    <P>
                        <E T="03">Comment:</E>
                         Several commenters recommended that we revise the proposed performance standard found at § 410.33(g)(6) to remove the requirement that our designated contractor be listed as a Certificate Holder on the liability insurance policy. One commenter supported the proposed changes to the performance standard at § 410.33(g)(6), but expressed concerned about whether underwriters were willing to list the government as a certificate holder on an insurance policy. 
                    </P>
                    <P>Another commenter questioned whether insurance underwriters will be open to the idea of adding the government as a certificate holder on an insurance policy and suggested that CMS survey several insurance carriers which provide this type of coverage to determine if this performance standard is achievable. One commenter stated that the comprehensive liability insurance policy provision (§ 410.33(g)(6)) which requires the IDTF to list the Medicare contractor as the certificate holder on the policy is too burdensome and obtrusive on small business entities. They recommended using a comparable approach to the one required by DMEPOS supplier, and have the IDTF provide a copy of the annual renewal of the insurance coverage for the IDTF to the Medicare contractor (the renewal package would include information on the coverage levels, as well as the premiums paid). </P>
                    <P>One commenter suggested removing the contractor as the certificate holder for the comprehensive liability insurance policy, but if they are named as a certificate holder for the comprehensive liability insurance policy that it be only for notification purposes. </P>
                    <P>
                        <E T="03">Response:</E>
                         Given the concerns raised about the increased administrative burden, we agree that our designated contractor should not be included as a Certificate Holder on the IDTF's comprehensive liability insurance policy. We have revised the performance standard found at § 410.33(g)(6) to remove the requirement that our designated contractor be listed as a Certificate Holder on the IDTF's comprehensive liability insurance policy. However, we believe that it is essential that a Medicare fee for service (FFS) contractor be allowed to verify information contained in the comprehensive liability insurance policy. We believe that a Medicare contractor (that is, carrier or Part A/Part B Medicare Administrator Contractor) should be able to verify the issuance of a comprehensive liability insurance policy with an insurance agent or, as necessary, an underwriter. This approach will allow a Medicare FFS contractor to review and verify that a comprehensive liability insurance policy has been issued and is in effect at the time of enrollment and throughout the enrollment period. We have revised § 410.33(g)(6) to read, “Has a comprehensive liability insurance policy in the amount of at least $300,000 per location that covers both the supplier's place of business and all customers and employees of the IDTF. The policy must be carried by a nonrelative-owned company. Failure to maintain required insurance at all times will result in revocation of the IDTF's billing privileges retroactive to the date the insurance lapsed. IDTF suppliers are responsible for providing the contact information for the issuing insurance agent and the underwriter. In addition, the IDTF must— 
                    </P>
                    <P>• Ensure that the insurance policy must remain in force at all times and provide coverage of at least $300,000 per incident; and </P>
                    <P>• Notify the CMS designated contractor in writing of any policy changes or cancellations.”</P>
                    <HD SOURCE="HD3">b. § 410.33(g)(2) </HD>
                    <P>In § 410.33(g)(2), we proposed to establish a 30-day reporting period for certain reportable events and a 90-day reporting period for all other reportable events. </P>
                    <P>
                        <E T="03">Comment:</E>
                         One commenter asked that we define the term “nonrelative owned” while another commenter asked that we remove this term altogether because we are not precluding self insurance. 
                    </P>
                    <P>
                        <E T="03">Response:</E>
                         While we do not believe that it is necessary to define the term “nonrelative owned” in this rulemaking effort, a non-relative owned company applies to insurance policies obtained through a familial relationship, not a related organization or business partner. Therefore, we are not removing this term from the performance standard. 
                    </P>
                    <P>
                        <E T="03">Comment:</E>
                         Several commenters supported our proposal to revise the reporting requirements found in the performance standard found at § 410.33(g)(2). One commenter supported the CMS proposal to revise the reporting requirements found in performance standard at § 410.33(g)(2) to establish separate reporting periods for different reportable events. The proposed changes will provide the information desired by CMS in a timely 
                        <PRTPAGE P="66286"/>
                        manner while minimizing the administrative burdens on both IDTFs and the Medicare contractors caused by the current notification standard. 
                    </P>
                    <P>
                        <E T="03">Response:</E>
                         We appreciate these comments and agree that revising this standard will reduce the administrative burden on both IDTFs and our contractors. 
                    </P>
                    <P>
                        <E T="03">Comment:</E>
                         One commenter recommended that we revise the CMS-855B to list the specific changes that must be reported within 30 calendar days of the change. However, one commenter stated that requiring the reporting of changes depending on the type change in 30 or 90 days puts an unfair burden on IDTFs. 
                    </P>
                    <P>
                        <E T="03">Response:</E>
                         We agree that the CMS-855B should be revised and should list the specific changes that must be reported within 30 calendar days of the change. Currently, IDTFs are required to report all changes in 30 days. Our proposal would limit the number of reportable events that would need to be reported within 30 days of the change. We intend to revise the CMS-855B to clarify which reportable events must be reported within 30 and 90 days. We will use the Paperwork Reduction Act process to seek specific comments in seeking revisions to the CMS-855B. 
                    </P>
                    <P>
                        <E T="03">Comment:</E>
                         One commenter recommended that we allow IDTFs to make changes online. 
                    </P>
                    <P>
                        <E T="03">Response:</E>
                         We are developing the Provider Enrollment, Chain, and Ownership System (PECOS) Web, which will allow all providers and suppliers, including IDTFs, to enroll or report enrollment changes via the Internet. We are hoping to implement PECOS Web in most parts of the country by March 2008. 
                    </P>
                    <P>
                        <E T="03">Comment:</E>
                         One commenter suggested that all changes should be reported to CMS within 90 days or in the alternative. This commenter also recommended that IDTFs report any changes that have occurred in the preceding quarter on a quarterly basis. 
                    </P>
                    <P>Another commenter suggested that we should allow at least 90 days for reporting changes in contact information with the contractor. This commenter also suggested that we further define what the policy and coverage requirements for self insurance and the term “independent underwriter.” </P>
                    <P>
                        <E T="03">Response:</E>
                         Section 410.33(g)(2) requires IDTFs to report all changes in 30 days. By adopting our proposal, we limit the number of reportable events that would need to be reported within 30 days of the change. As stated above, we intend to revise the CMS-855B to clarify what items must be reported within 30 and 90 days. Since many IDTFs operate on different schedules, it would not be practical to implement a quarterly reporting requirement. 
                    </P>
                    <P>As a result of the issues raised by the commenters, we are revising § 410.33(g)(2) to read, “Provides complete and accurate information on its enrollment application. Changes in ownership, changes of location, changes in general supervision, and adverse legal actions must be reported to the Medicare FFS contractor on the Medicare enrollment application within 30 calendar days of the change. All other changes to the enrollment application must be reported within 90 days.”</P>
                    <HD SOURCE="HD3">c. § 410.33(g)(8) </HD>
                    <P>We received the following comments in response to our proposal at § 410.33(g)(8). </P>
                    <P>
                        <E T="03">Comment:</E>
                         Several commenters recommended that we consider limiting the types of beneficiary complaints that are subject to the performance standard found in § 410.33(g)(8). Another commenter recommended that the standard found in § 410.33(g)(8) apply only when a beneficiary formalizes their complaint in writing. Other commenters stated that the proposed change in § 410.33(g)(8) is unnecessary, not to mention ambiguous and labor intensive to implement. 
                    </P>
                    <P>One commenter recommended that we model the IDTF documentation requirement after standards established by the Food and Drug Administration. Specifically, this commenter recommends that IDTFs maintain a record for each serious complaint received by the facility for at least 3 years from the date the complaint was received. </P>
                    <P>Another commenter recommended that we clarify that IDTFs are required to monitor only those beneficiary complaints that relate to the quality of care the patient receives. </P>
                    <P>One commenter stated that the standard at § 410.33(g)(8) be clarified to eliminate the documentation of routine billing questions so there is no unnecessary burden on small business entities. </P>
                    <P>One commenter suggested that instead of adopting § 410.33(g)(8) as written for documenting a beneficiary's questions or complaints, IDTFs should be required to develop and adhere to a complaint policy that includes documentation of material medical or billing complaints, and that if CMS adopts the current provision, the word questions should be changed to complaints. The commenter also maintains that IDTFs should be allowed to keep documents that are older than 30 days at a site other than the IDTF's physical location and CMS should clarify how long the IDTFs are required to keep each complaint and whether an IDTF will be required to record the insurance claim number for each complaint. </P>
                    <P>Other commenters recommended that we clarify § 410.33(g)(8) to specifically state that this standard relates to complaints regarding the provision of service, because as written, it will impose a sweeping new recordkeeping requirement that drastically affects small business entities. </P>
                    <P>
                        <E T="03">Response:</E>
                         Based upon the comments received, we have revised this provision to clarify and limit the amount of documentation that is necessary when a clinical complaint is received in writing. We also are clarifying and limiting the amount of documentation that is necessary when a clinical complaint is received in writing. We believe that complaints should be readily available for examination and we will establish a time frame for maintaining this documentation. Therefore, we have revised § 410.33(g)(8) accordingly. 
                    </P>
                    <P>
                        <E T="03">Comment:</E>
                         One commenter recommended that we develop a standardized complaint form and an electronic Web-based platform for submitting complaints regarding an IDTF. 
                    </P>
                    <P>
                        <E T="03">Response:</E>
                         We believe that an IDTF can document any formal complaints it receives in the most convenient way possible for that IDTF. 
                    </P>
                    <P>After reviewing public comments regarding our proposed change to § 410.33(g)(8), we are adopting this proposed change with modifications. By revising this language, we believe that we are reducing the paperwork burden on IDTFs to maintain and respond to written clinical complaints, rather than all questions and complaints it receives from beneficiaries. Section 410.33(g)(8) is revised to read, “Answer, document, and maintain documentation of a beneficiary's written clinical complaint at the physical site of the IDTF (for mobile IDTFs, this documentation would be stored at their home office.) This includes, but is not limited to, the following: </P>
                    <P>• The name, address, telephone number, and health insurance claim number of the beneficiary. </P>
                    <P>• The date the complaint was received; the name of the person receiving the complaint; and a summary of actions taken to resolve the complaint. </P>
                    <P>
                        • If an investigation was not conducted, the name of the person 
                        <PRTPAGE P="66287"/>
                        making the decision and the reason for the decision.” 
                    </P>
                    <P>By making this change, we believe that we are reducing the paperwork burden on IDTFs by asking them to maintain and respond to written clinical complaints, rather than address all questions and complaints it receives from beneficiaries. </P>
                    <HD SOURCE="HD3">d. § 410.33(b)(1) </HD>
                    <P>We received the following comments in response to our proposal at § 410.33(b)(1). </P>
                    <P>
                        <E T="03">Comment:</E>
                         Several commenters agreed with our proposal to delete the requirement that the supervising physician is responsible for the overall operation and administration of an IDTF. 
                    </P>
                    <P>
                        <E T="03">Response:</E>
                         We appreciate these comments and are adopting this change in the final regulation. 
                    </P>
                    <P>
                        <E T="03">Comment:</E>
                         One commenter recommended that we delay the implementation of our clarification that a physician providing general supervision can oversee a maximum of three IDTF sites by noting that term, “sites” includes fixed, as well as mobile sites. 
                    </P>
                    <P>
                        <E T="03">Response:</E>
                         We believe that a physician providing general supervision can oversee a maximum of three IDTF sites which includes fixed as well as mobile sites. 
                    </P>
                    <P>
                        <E T="03">Comment:</E>
                         One commenter recommended that we clarify that the three site limitation only relates to the provision of general supervision. In addition, one commenter recommended that we clarify that while a physician may only provide general supervision to three IDTF sites, this provision does not apply to the number of interpreting physicians at an IDTF site. 
                    </P>
                    <P>
                        <E T="03">Response:</E>
                         We agree with this comment and will clarify that the supervision limitation only applies to general supervision. 
                    </P>
                    <P>
                        <E T="03">Comment:</E>
                         One commenter stated that our proposal to consider each mobile IDTF unit as one IDTF site was unreasonable. 
                    </P>
                    <P>
                        <E T="03">Response:</E>
                         We disagree and we believe that a physician providing general supervision can oversee a maximum of three IDTF sites. We maintain that fixed and mobile IDTFs essentially are furnishing the same services. We note that the term, “sites” includes fixed as well as mobile sites because there are three concurrent locations where testing may occur at a given time. 
                    </P>
                    <P>
                        <E T="03">Comment:</E>
                         One commenter stated individual locations should be counted only if they have separate Medicare PINs. 
                    </P>
                    <P>
                        <E T="03">Response:</E>
                         With Medicare's implementation of the National Provider Identifier (NPI) on or before May 23, 2008, Medicare contractors will no longer issue billing numbers to the public. Providers and suppliers will use their assigned NPI to submit claims to Medicare. As such, organizations may obtain one or many NPIs. Accordingly, we are not able to adopt this suggestion. 
                    </P>
                    <P>
                        <E T="03">Comment:</E>
                         One commenter suggested that it would be inappropriate to require that a mobile IDTF have a different supervising physician for every three office locations that it visits, therefore this provision should apply only to those IDTFs in a fixed location. 
                    </P>
                    <P>
                        <E T="03">Response:</E>
                         We believe that a physician providing general supervision can oversee a maximum of three IDTF sites and note that the term, “sites” includes fixed, as well as mobile sites, because there are three concurrent locations where testing may occur at a given time. A mobile IDTF may visit multiple locations and it would still be considered one mobile unit. The number of places a mobile IDTF visits does not change the fact that this is a single unit and up to three fixed base or mobile units may be under the general supervision of one physician. 
                    </P>
                    <P>
                        <E T="03">Comment:</E>
                         One commenter stated that the mobile unit described at § 410.33(b)(1) should be consistent with the language used on the CMS-855B enrollment application. 
                    </P>
                    <P>
                        <E T="03">Response:</E>
                         We will consider revising the CMS-855B to incorporate this recommendation. 
                    </P>
                    <P>
                        <E T="03">Comment:</E>
                         One commenter recommended treating fixed base sites and portable units on a comparable basis in that a supervising physician not be limited to supervising three portable units, but also could supervise three sites from which portable units are dispatched. 
                    </P>
                    <P>
                        <E T="03">Response:</E>
                         A mobile IDTF may visit multiple locations, and it would still be considered one mobile unit. The number of places a mobile IDTF visits does not change the fact that this is a single unit and up to three fixed base or mobile units may be under the general supervision of one physician. Under the commenter's scenario, any number of mobile units could be in use and a physician would not be able to provide general supervision to an infinite number of mobile units. 
                    </P>
                    <P>
                        <E T="03">Comment:</E>
                         One commenter recommended that we revise § 410.33(b) to move to a diagnostic equipment threshold limit instead of an IDTF site limit since, as proposed, the provision allowing fixed based IDTFs to run limitless testing procedures at the IDTF is equated with a mobile unit running one test at a time. Therefore the number of supervising physicians should be determined through testing volume and not location. 
                    </P>
                    <P>Another commenter recommended that a maximum threshold of 15 units per supervising physician would be advisable and that is should be made clear that this section applies to general supervision and not direct or personal supervision. </P>
                    <P>
                        <E T="03">Response:</E>
                         Due to the varied and ever changing equipment used by IDTFs, it would be impractical to establish such limits. 
                    </P>
                    <P>
                        <E T="03">Comment:</E>
                         One commenter recommended that we conduct additional audits, monitoring, and enforcement actions, where warranted, to address existing compliance problems. 
                    </P>
                    <P>
                        <E T="03">Response:</E>
                         We agree with the commenters that audits, monitoring, and enforcement efforts are effective ways to identify individual compliance issues. We already require that Medicare contractors conduct an onsite visit to verify the performance standards found in this section prior to initial enrollment. We will consider adding and/or redirecting existing resources to ensure that an IDTF remains in compliance with these standards. 
                    </P>
                    <P>
                        <E T="03">Comment:</E>
                         One commenter requested clarification to differentiate between fixed and mobile IDTFs business models and the differences by which IDTFs using these models provide services. 
                    </P>
                    <P>
                        <E T="03">Response:</E>
                         A fixed base IDTF performs all of its diagnostic testing at the practice location found on the Medicare enrollment application (CMS-855), whereas a mobile IDTF travels and performs its diagnostic tests at locations other than a single practice location. 
                    </P>
                    <P>
                        <E T="03">Comment:</E>
                         One commenter requested that we clarify the definition of “site” versus “testing locations” distinction. 
                    </P>
                    <P>
                        <E T="03">Response:</E>
                         We consider sites and testing locations to be a practice location for both fixed base and mobile IDTFs. 
                    </P>
                    <P>
                        <E T="03">Comment:</E>
                         One commenter suggested that the language at § 410.33(i)(3) is in error and was meant to be a definition, because it explains the first two parts of the effective date provision. The commenter stated that they believe that the date which a signed enrollment application is submitted should be considered the date of filing and that any time lag in contractor decisions should be excluded when determining the date of filing. 
                    </P>
                    <P>
                        <E T="03">Response:</E>
                         We agree with the commenter and are revising § 410.33(b)(1) accordingly. 
                    </P>
                    <P>
                        After reviewing the public comments, we are amending the provision to 
                        <PRTPAGE P="66288"/>
                        remove the following sentence from § 410.33(b)(1), “The IDTF supervising physician is responsible for the overall operation and administration of the IDTFs, including the employment of personnel who are competent to perform test procedures, record and report test results promptly, accurately and proficiently, and for assuring compliance with the applicable regulations”. 
                    </P>
                    <P>We are adopting the provision at § 410.33(b)(1) which clarifies the meaning of what constitutes three IDTF sites to include both fixed sites and mobile units. This includes moving portable diagnostic equipment to another location and used it to provide IDTF services. Accordingly, we believe that a physician providing general supervision as defined in § 410.32(b)(3)(i) can oversee a maximum of three sites (that is, fixed or mobile) where concurrent operations can be performed. In addition, we are clarifying that that this provision applies only to general supervision within an IDTF setting. Section 410.33(b)(1) is revised to read, “Each supervising physician must be limited to providing general supervision to no more than three IDTF sites. This provision applies to both fixed sites and mobile units where three concurrent operations are capable of performing tests.” </P>
                    <HD SOURCE="HD3">2. New IDTF Standards</HD>
                    <HD SOURCE="HD3">a. § 410.33(i) </HD>
                    <P>In § 410.33(i), we proposed to establish an initial enrollment date for IDTFs and to limit the retrospective period for which an IDTF can obtain payment for services after enrolling into the Medicare program. </P>
                    <P>
                        <E T="03">Comment:</E>
                         One commenter recommended that we adopt an accelerated rollout plan of the PECOS Web to facilitate the enrollment process for IDTFs. 
                    </P>
                    <P>
                        <E T="03">Response:</E>
                         We expect to implement PECOS Web in most parts of the country by March 2008. 
                    </P>
                    <P>
                        <E T="03">Comment:</E>
                         One commenter recommended that we ensure that Medicare contractors process enrollment applications in a timely manner so that beneficiaries will have access to quality and convenient healthcare delivery at an IDTF. 
                    </P>
                    <P>
                        <E T="03">Response:</E>
                         We will continue to work with all Medicare contractors to ensure that applications are processed in a timely and accurate manner. With the implementation of PECOS Web, we believe that many of the processing delays that have occurred within the last year will be corrected. Specifically, PECOS Web will facilitate the submission of a complete application and allow applicants to make any necessary changes to their enrollment application in a timely manner. 
                    </P>
                    <P>
                        <E T="03">Comment:</E>
                         Several commenters recommended that we revise our proposals to allow an IDTF to begin billing Medicare for claims with dates of service on or after the day on which the IDTF submits a “substantially correct” or “substantially complete” enrollment application or the date the IDTF first furnishes services at its location, whichever is later. 
                    </P>
                    <P>
                        <E T="03">Response:</E>
                         We disagree with the recommendation to permit an IDTF to submit claims with dates of service on or after the day which the IDTF submits a “substantially correct” enrollment application or the date the IDTF first furnishes services at its location, whichever is later. We believe that it is essential that all providers and suppliers, including IDTFs, submit a complete application at the time of filing or perfect the submission of their enrollment application in response to a contractor's request for information. Accordingly, an applicant who submits a complete application or responds in a timely manner to a request for additional information is not disadvantaged by this proposal. However, it is important to note that if an application is rejected in accordance with the provisions found at § 424.525, the applicant will need to submit a new application to enroll in the Medicare program. In this case, the applicant only will be able to seek payments for those services furnished on or after the date of filing or when the Medicare contractor has approved the second application request. 
                    </P>
                    <P>
                        <E T="03">Comment:</E>
                         One commenter recommended that retroactive billing (once approval has been determined) be allowed back to the time of the initial application (even if the first submission is rejected). 
                    </P>
                    <P>
                        <E T="03">Response:</E>
                         As stated above in this section, we disagree with this recommendation. We believe that an IDTF should be allowed to bill for services furnished on or after the date of filing or the date the practice location became operational. However, we do not believe that it is appropriate to allow an IDTF to bill for services back to the filing date of the initial application if the initial application was rejected due to the nonsubmission of information or denied because the applicant did not meet the program requirements to enroll as an IDTF. 
                    </P>
                    <P>
                        <E T="03">Comment:</E>
                         One commenter recommended that a 60-day period be allowed for retroactive billing before an IDTF is enrolled. 
                    </P>
                    <P>
                        <E T="03">Response:</E>
                         While we believe that an IDTF should be allowed to bill for services furnished on or after the date of filing or the date the practice location became operational, we do not believe that it is appropriate to allow an IDTF to bill for services prior to the filing date associated with when the application was submitted. 
                    </P>
                    <P>
                        <E T="03">Comment:</E>
                         One commenter recommended that Medicare contractors follow a protocol that outlines the items that will require a contractor to reject or deny an enrollment application. 
                    </P>
                    <P>
                        <E T="03">Response:</E>
                         Medicare contractors are bound by applicable enrollment regulations and CMS manual instructions. Specifically, all Medicare contractors are required to follow regulations found at § 424.525 and manual instructions found in publication 100-8, Chapter 10 of the Program Integrity Manual (PIM) when rejecting an enrollment application for insufficient information. In addition, Medicare contractors are required to follow regulations found at § 424.530 and manual instructions found in publication 100-8, Chapter 10 of the PIM when denying an enrollment application. 
                    </P>
                    <P>
                        <E T="03">Comment:</E>
                         One commenter recommended that we not implement our proposal to preclude an IDTF from being allowed to bill Medicare retroactively for services that are rendered prior to the provider being formally approved by the applicable Medicare contractor to participate in the Medicare program. 
                    </P>
                    <P>
                        <E T="03">Response:</E>
                         Since our proposal specifically allows an IDTF to receive reimbursement for services furnished on or after the filing or the date the IDTF opened a new practice location, whichever was later, we believe that we are allowing IDTFs a limited amount for retroactive billing. As stated in the preamble to the proposed rule, the purpose of this rulemaking effort is to establish a date of enrollment for IDTFs where we believe that the enrolling IDTF meets all of the program requirements to participate in the Medicare program. 
                    </P>
                    <P>
                        <E T="03">Comment:</E>
                         One commenter recommended that we clarify that our proposed change in billing be applied only to new or initial enrollment applications and would not affect existing operations when changes or additions are made to an enrollment application, such as the addition of a new physician or piece of equipment. 
                    </P>
                    <P>
                        <E T="03">Response:</E>
                         In general, we agree with this commenter in that the proposed change only will apply to new or initial enrollment applications. Since the provision is designed to limit 
                        <PRTPAGE P="66289"/>
                        retrospective billing prior to enrollment in the Medicare program, we do not believe this change will impact existing IDTFs who are making a change to an existing enrollment record for a fixed or mobile practice location. However, it is important to note that the limitations on retroactive billing will apply to existing IDTFs who are adding a new fixed or mobile practice location to their existing enrollment record. Moreover, a limitation on retroactive billing may apply when there is change of ownership.
                    </P>
                    <P>
                        <E T="03">Comment:</E>
                         One commenter stated that they had no issues with the effective date of the billing privileges provision. However, this commenter suggested that this provision be tied to a requirement that the CMS designated contractor process the application in a timely fashion. 
                    </P>
                    <P>
                        <E T="03">Response:</E>
                         We are also concerned about delays associated with the enrollment process. However, we recognize that many of the delays are the result of IDTF suppliers not submitting a complete application at the time of filing or failing to submit complete and timely responses to a contractor's request for information. 
                    </P>
                    <P>In addition, we believe that it is appropriate to expect meaningful Medicare contractor processing timeliness standards. As necessary, the agency can update or revise processing standards through the manual instructions and through contracts with Medicare Administrative Contractors. We fully expect that most enrollment applications will be processed in accordance with CMS processing requirements found in Publication 100-8, Chapter 10 of the PIM. The PIM establishes processing standards for initial applications, changes of information, and reassignments that all Medicare contractors must adhere to. Specifically, we currently require Medicare contractors to process 80 percent of initial applications within 60 days, 90 percent of initial applications within 120 days, and 99 percent of initial applications within 180 days. We also require Medicare contractors to process 80 percent of changes of information and reassignments within 45 days, 90 percent of changes of information and reassignments within 60 days, and 99 percent within 90 days. </P>
                    <P>With the implementation of PECOS Web, an internet version of the Medicare enrollment process, in FY 2008, we expect to establish more stringent contractor processing timeliness standards for applications submitted via PECOS Web. </P>
                    <P>
                        <E T="03">Comment:</E>
                         One commenter stated that the effective date of the billing privileges provision may economically affect small and medium sized business in that the IDTF must list the credentialed employees on the application itself in order for the application to be processed, and that these businesses cannot use or bill for their services during the time periods that they are not enrolled. Further, the commenter states that it would be impractical to hire these technicians if they cannot use them to perform the tests for the time it takes to get approved. 
                    </P>
                    <P>
                        <E T="03">Response:</E>
                         We disagree with the commenter because all IDTFs should have proper staffing, including credentialed technicians, at the time the IDTF practice location is applying to participate in the Medicare program or when the IDTF is operational. 
                    </P>
                    <P>
                        <E T="03">Comment:</E>
                         One commenter suggested that an IDTF that is enrolled and in good standing in the Medicare program at one location be able to enroll new sites retroactively to the first date of service at the new location. 
                    </P>
                    <P>
                        <E T="03">Response:</E>
                         We disagree with this recommendation because the approval of one practice location does not necessarily mean that a second practice location meets the requirements for approval. 
                    </P>
                    <P>
                        <E T="03">Comment:</E>
                         One commenter recommended that we require that applicants be notified of their enrollment status within 60 days of submitting their applications. 
                    </P>
                    <P>
                        <E T="03">Response:</E>
                         We believe that this comment is outside the scope of this final rule. However, given certain resource limitations, contractors are unable to respond to such status inquiries. With the implementation of PECOS Web, providers and suppliers, except DMEPOS suppliers, will be able to check the status of their applications via the Internet. 
                    </P>
                    <P>After reviewing the public comments we are finalizing the provision at § 410.33(i) to state that we will establish an initial enrollment date for an IDTF that would be the later of: (1) the date of filing of a Medicare enrollment application that was subsequently approved by Medicare FFS contractor; or (2) the date an IDTF first started furnishing services at its new practice location. We also adopted the “date of filing” as the date that the Medicare FFS contractor receives a signed provider enrollment application that the Medicare FFS contractor is able to process for approval. If the Medicare FFS contractor rejects or denies an enrollment application that is not later overturned during the appeals process, the new date of filing would be established when an IDTF submits a new enrollment application that the contractor is able to process to approval. </P>
                    <P>With the implementation of an Internet enrollment process referred to as the PECOS Web in 2008, the date of filing for applications submitted through PECOS Web will be the date the Medicare contractor receives all of the following: (1) A signed Certification Statement; (2) an electronic version of the enrollment application; and (3) a signature page that the Medicare contractor processes to approval. </P>
                    <P>While this change limits the retrospective payments that an IDTF may obtain from the Medicare program, we believe that this approach will ensure that a Medicare contractor is able to verify that an IDTF meets all program requirements at the time of filing, including the performance standards outlined in § 410.33(g) before payment for service occurs.</P>
                    <HD SOURCE="HD3">b. § 410.33(g)(3) </HD>
                    <P>We received the following comments regarding our proposal at § 410.33(g)(3) to expressly preclude hotels and motels from being considered an appropriate site for an IDTF setting. </P>
                    <P>
                        <E T="03">Comment:</E>
                         One commenter stated that many IDTFs have contracts directly with a hotel or motel where they rent space for studies and that they disagreed with the rules’ provision to ban such a situation. 
                    </P>
                    <P>
                        <E T="03">Response:</E>
                         We disagree with this comment because we believe that space located within a hotel or motel can easily be transferred to other uses other than providing sleep studies. 
                    </P>
                    <P>
                        <E T="03">Comment:</E>
                         Several commenters stated that a hotel or motel room is not appropriate places for diagnostic testing to take place. 
                    </P>
                    <P>
                        <E T="03">Response:</E>
                         We agree with these comments and have revised § 410.33(g)(3) accordingly. 
                    </P>
                    <P>
                        <E T="03">Comment:</E>
                         One commenter suggested that the provision at § 410.33(g)(3) be changed to state that the requirements for hand washing and patient privacy only apply to IDTFs that see patients and to clarify that being able to access records electronically fulfills the requirement of storing business and medical records. 
                    </P>
                    <P>
                        <E T="03">Response:</E>
                         We have amended § 410.33(g)(3) to state that the requirements for hand washing and patient privacy only apply to IDTFs that see patients and to clarify that being able to access records electronically fulfills the requirement of storing business and medical records. 
                    </P>
                    <P>
                        We are adopting a revision to § 410.33(g)(3) to expressly preclude hotels and motels from being considered an appropriate site for an IDTF setting. 
                        <PRTPAGE P="66290"/>
                        Based on public comments, we believe that a hotel or motel is not an appropriate place for diagnostic testing to take occur. Accordingly, we have revised § 410.33(g)(3) to read, “Maintain a physical facility on an appropriate site. For the purposes of this standard, a post office box, commercial mailbox, motel, or hotel are not considered an appropriate site. The physical facility, including mobile units, must contain space for equipment appropriate to the services designated on the enrollment application, facilities for hand washing, adequate patient privacy accommodations, and the storage of both business records and current medical records within the office setting of the IDTF, or IDTF home office, not within the actual mobile unit.” 
                    </P>
                    <P>Additionally, we have added an exception at § 410.33(g)(3)(ii), where IDTFs that do not see beneficiaries at their locations are exempt from providing hand washing and patient privacy accommodations. </P>
                    <HD SOURCE="HD3">c. § 410.33(g)(15) </HD>
                    <P>At § 410.33(g)(15), we proposed a new performance standard which stated, “Does not share space, equipment, or staff or sublease its operations to another individual or organization.” </P>
                    <P>
                        <E T="03">Comment:</E>
                         One commenter stated that they were concerned about the emergence of arrangements in which a physician practice leases a block of time from an imaging provider (such as an IDTF) or agrees to pay the provider a per service fee to use its facility. The group practice then refers its patients to the imaging provider for imaging tests and bills the insurer for the services, usually profiting from the difference between the insurer's payment rates and the fees the practice pays to the imaging provider. 
                    </P>
                    <P>
                        <E T="03">Response:</E>
                         We agree with the commenter and reiterate that our proposals are designed to prohibit such practices. 
                    </P>
                    <P>
                        <E T="03">Comment:</E>
                         Several commenters supported our proposal to prohibit IDTFs from sharing space, equipment, or staff, or subleasing their operations to another individual or organization. 
                    </P>
                    <P>
                        <E T="03">Response:</E>
                         We appreciate these comments and agree that there has been a proliferation of share use agreements between IDTFs and physicians and/or other organizations that have allowed the sharing of space and equipment. 
                    </P>
                    <P>
                        <E T="03">Comment:</E>
                         One commenter stated that they applauded our efforts to address an alarming proliferation of referring physicians entering into “lease” or similar purchased test arrangements with imaging centers for the primary purpose of enabling physicians to profit from their own referrals. 
                    </P>
                    <P>
                        <E T="03">Response:</E>
                         We appreciate these comments as our proposals are designed to prohibit such practices. 
                    </P>
                    <P>
                        <E T="03">Comment:</E>
                         Several commenters recommended that CMS not finalize § 410.33(g)(15) because it severely restricts the use of an IDTF's property and places unnecessary limitations on the entity. 
                    </P>
                    <P>
                        <E T="03">Response:</E>
                         We disagree with this comment. With the revisions we are making to § 410.33(g)(15), we believe that an IDTF's property is fully available for use solely by the IDTF. The adopted provision at § 410.33(g)(15) will allow an IDTF to conduct all of its approved diagnostic testing procedures. 
                    </P>
                    <P>
                        <E T="03">Comment:</E>
                         One commenter stated that the proposed rule would prohibit an IDTF from participating in any type of leasing arrangement. 
                    </P>
                    <P>
                        <E T="03">Response:</E>
                         In this final rule with comment period, we are prohibiting the leasing or subleasing of an IDTF practice location, as well as diagnostic equipment that are used in taking the initial diagnostic test. In addition, we are prohibiting leasing and subleasing to a third party. 
                    </P>
                    <P>
                        <E T="03">Comment:</E>
                         One commenter requested that we clarify whether the proposed performance standard found at § 433.10(g)(15) would permit a multi-specialty clinic and an IDTF to be enrolled as a clinic and an IDTF, and for portions of space and staff to be used for both clinic and IDTF activities. 
                    </P>
                    <P>
                        <E T="03">Response:</E>
                         While we understand the commenter's concern, we do not believe that it is appropriate to co-locate a multi-specialty clinic in the same practice location as an IDTF. Specifically, while we are not prohibiting the sharing common of hallways, parking, or common areas, we believe that a multi-specialty clinic cannot occupy or be co-located within the same practice location. For example, a multi-specialty clinic and an IDTF could not enroll or remain enrolled using the same suite number within the same office building. 
                    </P>
                    <P>
                        <E T="03">Comment:</E>
                         Some commenters recommended that we define the term, “individual or organization” to exclude hospitals and nonreferring radiologists, because hospitals and nonreferring radiologists are not in a position to self-refer. 
                    </P>
                    <P>
                        <E T="03">Response:</E>
                         We disagree that the terms “individual and organization” needs to be defined. For the purposes of this rule, an individual is a person, and an organization is any entity other than an individual. 
                    </P>
                    <P>
                        <E T="03">Comment:</E>
                         One commenter recommended that we permit an adjoining physician practice or a radiology group that is the owner of an IDTF to share space, equipment, and staff. 
                    </P>
                    <P>
                        <E T="03">Response:</E>
                         While we agree that it is common for IDTFs to share common areas (that is, waiting rooms) with the adjoining physician practice or radiology group that is an owner of the IDTF, we do not believe that it is appropriate for IDTFs to share common practice locations or diagnostic testing equipment. 
                    </P>
                    <P>
                        <E T="03">Comment:</E>
                         Several commenters recommended that we not extend the prohibition of sharing space, equipment, and staff to the mobile IDTF setting. 
                    </P>
                    <P>Another commenter recommended that the proposed restriction on sharing space, equipment, and staff should not apply to mobile IDTFs, as this would add both physical and financial burdens that mobile units simply could not meet. </P>
                    <P>
                        <E T="03">Response:</E>
                         We agree with these commenters that requiring mobile IDTFs to adhere to limitations regarding space, equipment, and staffing may limit beneficiary access to necessary mobile services and increase the costs of providing necessary diagnostic care. Accordingly, we are excluding mobile IDTFs from the provisions found at § 410.33(g)(15). 
                    </P>
                    <P>
                        <E T="03">Comment:</E>
                         One commenter recommended that we revise our proposals to account for certain practical implications concerning the imaging industry, including common and legitimate sharing practices between multiple IDTFs, between IDTFs and hospitals, and between IDTFs and radiologist. 
                    </P>
                    <P>
                        <E T="03">Response:</E>
                         While we agree that it reasonable for IDTFs located within a hospital to share practice locations and diagnostic testing equipment, we continue to have significant concerns regarding the sharing of space by IDTFs in a nonhospital setting. 
                    </P>
                    <P>
                        <E T="03">Comment:</E>
                         One commenter recommended that we revise the performance standard found at § 410.33(g)(15) to state, “Does not share space, equipment or staff or sublease its operations to another individual, organization, employee or contractor of such organizations, that refers Medicare patients to the IDTF for designated health services.” 
                    </P>
                    <P>
                        <E T="03">Response:</E>
                         We have considered this comment in revising the performance standard at § 410.33(g)(15). 
                    </P>
                    <P>
                        <E T="03">Comment:</E>
                         One commenter believed that the performance standard found in § 410.33(g)(15) applies to hospitals. 
                    </P>
                    <P>
                        <E T="03">Response:</E>
                         Upon review of the comments, we have revised § 410.33(g)(15) to exclude hospitals. 
                        <PRTPAGE P="66291"/>
                    </P>
                    <P>
                        <E T="03">Comment:</E>
                         Several commenters recommended that we clarify that the proposed performance standard found in § 410.33(g)(15) would apply only to newly enrolling IDTFs and not IDTFs already enrolled in the Medicare program. Specifically, these commenters requested that we clarify that this new standard would allow an IDTF to continue to lease personnel and equipment from third parties provided that the IDTF uses the personnel, space, and equipment exclusively throughout the lease term. 
                    </P>
                    <P>
                        <E T="03">Response:</E>
                         We maintain that the provision found in § 410.33(g)(15) applies to both newly enrolling IDTFs, as well as those IDTFs currently enrolled in the Medicare program. This provision does not prohibit an IDTF from leasing space or equipment that is used solely by that IDTF-party, such as a building management company or an equipment manufacturer. This does not preclude an IDTF from leasing any part of its practice location or equipment used in conducting the initial diagnostic procedure to another Medicare-enrolled individual or group to conduct diagnostic testing activities. 
                    </P>
                    <P>
                        <E T="03">Comment:</E>
                         One commenter recommended that we clarify that employees of affiliated employers under the Fair Labor Standards Act are not considered “shared staff” under this new standard. In addition, several commenters recommended that the prohibition on sharing “staff” be limited to sharing nonphysician personnel. 
                    </P>
                    <P>
                        <E T="03">Response:</E>
                         The new sharing provision has been modified to exclude the prohibition on the sharing of staff. 
                    </P>
                    <P>
                        <E T="03">Comment:</E>
                         One commenter recommended that if we adopt the proposed performance standard found in § 410.33(g)(15) that the implementation date be delayed for at least 12 months to provide IDTFs and physician practices with sufficient time to find new office space, recruit additional staff, notify their patients and generally restructure their existing relationships. Another commenter recommended that we clarify our proposed performance standard found in § 410.33(g)(15). 
                    </P>
                    <P>
                        <E T="03">Response:</E>
                         We agree with commenters and we are adopting a 1-year delay in implementation (effective January 1, 2009) of the space-sharing provision for IDTFs that are currently occupying a practice location with another Medicare-enrolled individual or organization that is found at § 410.33(g)(15)(i). 
                    </P>
                    <P>
                        <E T="03">Comment:</E>
                         One commenter recommended that we clarify whether the proposed prohibition on sharing space, equipment, and staff is intended to apply when the IDTF leases or subleases space from a hospital on a full-time, exclusive basis. Other commenters recommended that we exclude mobile IDTFs from the prohibition to share space because it is impractical in complying with this provision. One commenter stated that the sharing of staff standard is impractical to comply with and should not be extended to mobile IDTFs, because accredited and trained contracted personnel are sometimes necessary to contract with on a temporary basis. 
                    </P>
                    <P>Another commenter suggested that we not apply this provision to mobile IDTFs and instead, permit an IDTF to share space, equipment and staff with an entity that is related to the IDTF, such as through common control or ownership. Also, this commenter recommended that we should clarify in what situation an IDTF could not share staff, such as; supervising physician and nonphysician personnel. </P>
                    <P>
                        <E T="03">Response:</E>
                         This provision is not intended to restrict an IDTF from entering into a rental agreement for space or equipment, excluding hospitals, as long as that IDTF, or the owner of the IDTF are exclusively using that space or equipment. We are excluding mobile IDTFs from the prohibition on sharing space and staff. 
                    </P>
                    <P>
                        <E T="03">Comment:</E>
                         One commenter stated that the sharing of space provision should not apply to a Medicare-certified IDTF that leases or subleases space and/or qualified technical staff from a hospital on a full time, exclusive basis (they are not “shared” with the hospital). 
                    </P>
                    <P>
                        <E T="03">Response:</E>
                         We agree with the comment and the standard has been revised to reflect this concern. 
                    </P>
                    <P>
                        <E T="03">Comment:</E>
                         One commenter wanted clarification on whether we will permit an IDTF to utilize a common area in a building where an IDTF enters into a lease or sublease with a hospital for the full-time, exclusive use of the operation of the IDTF. 
                    </P>
                    <P>
                        <E T="03">Response:</E>
                         We will permit an IDTF to utilize a common area in a building where an IDTF enters into a lease or sublease with a hospital for the full-time exclusive use of the operation of the IDTF. However, the IDTF must have its own practice location that is only used by that IDTF. 
                    </P>
                    <P>
                        <E T="03">Comment:</E>
                         One commenter requested clarification on whether we intend to prohibit only new space, equipment, or staff sharing arrangements from the effective date of the rule or if it will apply to existing arrangements. If it applies to existing arrangements, then the commenter requests that the implementation be delayed by 1 year. 
                    </P>
                    <P>
                        <E T="03">Response:</E>
                         While we intend to prohibit the sharing of space at a practice location from the effective date of the rule for newly-enrolling IDTFs (including those with applications that are still pending as of January 1, 2008), we are adopting a 1-year delay in implementation (effective January 1, 2009) of the space-sharing provision for IDTFs that are currently occupying a practice location with another Medicare-enrolled individual or organization that is found at § 410.33(g)(15)(i). 
                    </P>
                    <P>
                        <E T="03">Comment:</E>
                         One commenter requested clarification as to whether we will permit an IDTF that leases or subleases space and/or staff from a hospital to purchase back-office services from the hospital. (These types of service may include, but are not limited to, transcription, billing, collection, recordkeeping, and computer access services, based upon a flat fee or at cost plus to the hospital). 
                    </P>
                    <P>
                        <E T="03">Response:</E>
                         We will permit an IDTF to lease or sublease space from a hospital and to purchase services from the hospital which may include, but are not limited to, transcription, billing, collection, recordkeeping, and computer access services, based upon a flat fee or at cost plus to the hospital. 
                    </P>
                    <P>
                        <E T="03">Comment:</E>
                         One commenter recommended that there should be an exception made at § 410.33(g)(15) for companies operating both an IDTF and portable x ray supplier, since both are surveyed and subject to multiple standards under the Medicare program. 
                    </P>
                    <P>
                        <E T="03">Response:</E>
                         While we understand this concern, we believe that an IDTF must have a practice location where only one Medicare-enrolled IDTF is furnishing services. If another Medicare-enrolled entity is using the same practice location space as an IDTF, especially for shortened periods of time, our designated contractor is not able to determine which entity is responsible for meeting performance standards at a given time. 
                    </P>
                    <P>
                        <E T="03">Comment:</E>
                         One commenter urged us to address the sharing of space, staff, and equipment provision by specifically excluding radiologists and radiology groups, who are not self-referring, from the sharing arrangements in IDTFs due to the increased costs and possible detriment to the beneficiary (numerous visits to different locations and increased stress) that may occur in this situation. 
                    </P>
                    <P>
                        <E T="03">Response:</E>
                         We believe that the practice location and equipment that an IDTF uses for its initial diagnostic testing cannot be used by another Medicare provider or supplier, and therefore, we 
                        <PRTPAGE P="66292"/>
                        are not excluding radiologists and radiology groups. 
                    </P>
                    <P>
                        <E T="03">Comment:</E>
                         One commenter agreed that it would be inappropriate to commingle the clinical staff listed on the CMS-855 enrollment application during the times that the IDTF is open; however, the commenter maintains that non-clinical space and staff (such as waiting rooms, receptionists, and schedulers) should be shared with other entities. 
                    </P>
                    <P>
                        <E T="03">Response:</E>
                         We agree with this comment and have amended the provision to reflect these concerns. 
                    </P>
                    <P>
                        <E T="03">Comment:</E>
                         One commenter recommends that the sharing of nonclinical space, equipment and personnel be allowed between an IDTF and an adjacent facility, because it does not offer the same potential for abuse as situations where the clinical operations of the IDTF would be commingled. 
                    </P>
                    <P>
                        <E T="03">Response:</E>
                         We have amended the provision found at § 410.33(g)(15) to address these concerns. 
                    </P>
                    <P>
                        <E T="03">Comment:</E>
                         One commenter recommends that the sharing of space between a group or a physician practice and its own IDTF should not be prohibited. Another commenter recommends changing the proposed § 410.33(g)(15) because they believe it would prohibit wholly-owned corporate subsidiaries and affiliated under common control from sharing space, equipment, and staff in a cost efficient manner. 
                    </P>
                    <P>
                        <E T="03">Response:</E>
                         We disagree with this recommendation since it is not feasible to distinguish between two different practices that are co-located at the same practice location. Also, this provision would not prohibit wholly-owned corporate subsidiaries and affiliated entities under common control from sharing equipment, as long as the change in equipment location is timely reported. In addition, the IDTF's practice location must be separately distinguishable and not commingled with another Medicare provider or supplier. 
                    </P>
                    <P>
                        <E T="03">Comment:</E>
                         One commenter recommends changing the proposed § 410.33(g)(15) to read as follows: “Does not share space, equipment, or staff or sublease it operations to another individual or organization, except for a subsidiary or affiliated IDTF that is wholly owned by, and under the complete control of, the IDTF.” 
                    </P>
                    <P>
                        <E T="03">Response:</E>
                         We understand the commenter's recommendation and we have amended § 410.33(g)(15) to address the commenter's concern. 
                    </P>
                    <P>
                        <E T="03">Comment:</E>
                         One commenter recommends that CMS specifically exempt IDTFs that have common ownership and common control from the definition of “individual or organization,” if CMS implements § 410.33(g)(15) as written. 
                    </P>
                    <P>
                        <E T="03">Response:</E>
                         We disagree with the commenter's recommendation. While IDTFs may have common ownership, each practice location is enrolled separately. 
                    </P>
                    <P>
                        <E T="03">Comment:</E>
                         One commenter offered support for our provision to prohibit fixed site IDTFs from sharing space, equipment, and staff or subleasing their operations to another individual or organization. 
                    </P>
                    <P>
                        <E T="03">Response:</E>
                         We appreciate the commenters support on the proposed provisions. 
                    </P>
                    <P>
                        <E T="03">Comment:</E>
                         One commenter suggested excluding radiologist and radiology groups from the definition of individual or organization in the regulatory language at § 410.33(g)(15) so that imaging IDTFs can share space, equipment, and staff with radiologists and radiology groups. 
                    </P>
                    <P>
                        <E T="03">Response:</E>
                         We disagree with this recommendation because IDTFs enroll each practice location separately. 
                    </P>
                    <P>
                        <E T="03">Comment:</E>
                         One commenter suggested that we clarify in the preamble that the prohibition does not preclude affiliated companies (which do not have any referring nonradiologist physicians as owners) that provide services integrally related to the operations of an imaging IDTF (such as interoperable information system, centralized credentialing, staff and billing) from sharing space, equipment and staff. 
                    </P>
                    <P>
                        <E T="03">Response:</E>
                         We modified § 410.33(g)(15) to reflect concerns about the sharing of space and equipment. Since Medicare enrolls each IDTF at a separate location, we believe that it is not necessary to address how affiliated companies interact with an IDTF as long as each IDTF is in compliance with the provisions of this final rule with comment period. 
                    </P>
                    <P>
                        <E T="03">Comment:</E>
                         One commenter suggested that CMS clarify that an ownership or investment interest held by radiologists and radiology groups in an imaging IDTF does not constitute sharing under § 410.33(g)(15). 
                    </P>
                    <P>
                        <E T="03">Response:</E>
                         We agree that an ownership or investment interest held by radiologists and radiology groups in an imaging IDTF does not constitute sharing under § 410.33(g)(15). 
                    </P>
                    <P>
                        <E T="03">Comment:</E>
                         One commenter suggested that we revise this provision to specify that an IDTF cannot share its space, equipment or staff with another individual or organization that has Medicare billing privileges, and that it is okay for another non-Medicare enrolled entity to use the IDTF's space, equipment, and staff. 
                    </P>
                    <P>
                        <E T="03">Response:</E>
                         We agree with the commenter. The IDTF may not share clinical space or the diagnostic equipment involved in the original diagnostic test with a Medicare-enrolled provider or supplier. 
                    </P>
                    <P>Based on public comments, we have removed the sharing of staff aspect of this provision, and we are revising § 410.33(g)(15) to read, “With the exception of hospital-based and mobile IDTFs, a fixed-base IDTF does not— </P>
                    <P>• Share a practice location with another Medicare-enrolled individual or organization; </P>
                    <P>• Lease or sublease its operations or its practice location to another Medicare-enrolled individual or organization; or </P>
                    <P>• Share diagnostic testing equipment used in the initial diagnostic test with another Medicare-enrolled individual or organization.” </P>
                    <P>We believe that it is inappropriate for a fixed-base (physical site) IDTF to commingle its practice location or the equipment used in conducting the initial diagnostic test with another individual or organization enrolled in the Medicare program. By sharing space and/or equipment, Medicare contractors are not able to determine if an IDTF meets all of enrollment requirements at § 424.500 through § 424.555 or whether each IDTF meets and maintains all performance standards and other requirements under § 410.33 and other applicable requirements. </P>
                    <P>After examining public comments, we believe that it is appropriate to establish two exceptions to the prohibition associated with sharing space and clinical equipment. These exceptions apply to mobile IDTFs or IDTFs that are co-located within a hospital. </P>
                    <P>A mobile IDTF, by its very nature, may share space with other Medicare-enrolled entities. As such, we believe that it would be detrimental to the IDTF industry to apply this new performance standard to mobile IDTFs, because this may limit beneficiary access to necessary mobile IDTF services and increase the costs of providing necessary diagnostic care. In addition, we believe that hospital-based IDTFs are inherently located within a larger facility type and based on the need of the hospital, may appropriately share space or clinical equipment to gain operating efficiencies with little additional risk to the Medicare program or its beneficiaries. </P>
                    <P>
                        Finally, while all IDTF provisions are effective on the implementation date of this final rule with comment period, we believe that additional time may be needed for some IDTFs to change their business model if they are sharing a 
                        <PRTPAGE P="66293"/>
                        practice location with another Medicare-enrolled individual or organization. Accordingly, we are adopting a 1-year transition period for IDTFs that are currently enrolled and are sharing a practice location with another Medicare individual or organization. While this 1-year transition period applies to the provision found at § 410.33(g)(15)(i) related to the sharing of space, it does not apply to the provisions found at § 410.33(g)(15)(ii) or § 410.33(g)(15)(iii). Accordingly, IDTFs are prohibited from maintaining or establishing leasing or subleasing agreements or the sharing of diagnostic testing equipment used in taking the initial diagnostic test, after the effective date of this rule. 
                    </P>
                    <P>3. Additional Comments and Responses </P>
                    <P>
                        <E T="03">Comment:</E>
                         One commenter recommended that our proposal to prohibit the sharing of space, equipment, and staff be applied consistently in all imaging centers, whether enrolled as an IDTF or as a physician-directed clinic. 
                    </P>
                    <P>Another commenter recommended that any policy initiative intended to eliminate certain suspect leasing or space sharing arrangements should be applied to all imaging providers, not just IDTF providers. </P>
                    <P>One commenter supported the proposed prohibition on shared equipment but urged us to apply this prohibition to all entities (including physician practices, mobile units, and hospitals) that provide imaging services. </P>
                    <P>Some commenters believe an exception should be made to include cardiologists that are certified for the interpretation of nuclear cardiology studies in an IDTF as well as allow interpretation of nuclear cardiology studies for an IDTF. </P>
                    <P>One commenter stated that since self-insurance is permitted, the requirement that the insurance be purchased from a “non-relative owned company” should be removed, or replaced with a provision that permits an alternate method of meeting the requirement by maintaining insurance through a relative-owned company that has been approved by a state department of insurance or comparable state agency or that can be validated by a placing broker. </P>
                    <P>Another commenter recommended that CMS should end payments to independent contractor physicians who are not board-certified in Sleep Disorders Medicine. </P>
                    <P>One commenter recommended that CMS require interpreting physicians to have board certification in Sleep Medicine in metropolitan areas. </P>
                    <P>One commenter recommended that we edit the location of service language at § 410.33(e)(2) to redefine the location from which a service is billed. </P>
                    <P>Another commenter recommended requiring a hospital licensed entity and actual radiology group to be the owners of entities that do not have to register as IDTFs and allow related entities of the hospital and radiology group to also own the imaging center. </P>
                    <P>
                        <E T="03">Response:</E>
                         We appreciate these comments and we will consider these recommendations in a future rulemaking effort. 
                    </P>
                    <HD SOURCE="HD2">J. Expiration of MMA Section 413 Provisions for Physician Scarcity Area (PSA) </HD>
                    <P>Section 413(a) of the MMA added a new section 1833(u) to the Act. That section provided a 5 percent incentive payment to physicians furnishing services in physician scarcity areas (PSAs) for physicians' services furnished on or after January 1, 2005, and before January 1, 2008. Specifically, section 1833(u) of the Act provided for payment of an additional 5 percent of the payment amount for services furnished by primary care physicians in a primary care scarcity area and by non-primary care physicians in a specialist care scarcity area. </P>
                    <P>Because the provisions of section 1833(u) of the Act do not apply to services furnished after December 31, 2007, in the CY 2008 PFS proposed rule, we provided notification that these 5 percent incentive payments will no longer be made for services furnished on or after January 1, 2008. </P>
                    <P>
                        The list of zip codes for both primary care and specialty PSAs can be found on the CMS Web site at 
                        <E T="03">http://www.cms.hhs.gov/hpsapsaphysicianbonuses/01_overview.asp</E>
                        . 
                    </P>
                    <P>
                        <E T="03">Comment:</E>
                         We received comments expressing concern over the expiration of this provision. Commenters stated that the expiration of this provision may exacerbate the problems beneficiaries in rural areas experience in accessing medical services. 
                    </P>
                    <P>
                        <E T="03">Response:</E>
                         We acknowledge the commenters' concerns regarding access to care, especially in rural areas. We provided notification of the pending expiration of this provision in the CY 2008 PFS proposed rule. We note that the Congress specifically established the PSA incentive program to apply only to claims for services furnished between January 1, 2005, and January 1, 2008. We do not have authority under the current statute to extend PSA bonus payments beyond this time frame. 
                    </P>
                    <HD SOURCE="HD2">K. Comprehensive Outpatient Rehabilitation Facility (CORF) Issues </HD>
                    <P>In the CY 2008 PFS proposed rule (72 FR 38171), we discussed Medicare payment for comprehensive outpatient rehabilitation facility (CORF) services, including nursing services delivered within a CORF, which are defined by HCPCS code (G0128) for such services. We also explained that we use the payment amount established by an existing fee schedule other than the PFS when the PFS does not establish a payment amount for the CORF service. Specifically, we use the existing fee schedules for prosthetic and orthotic devices, DME and supplies, and drugs and biologicals for prosthetics and orthotics devices, durable medical equipment (DME) and supplies, and drugs and biologicals, respectively, provided by CORFs that are considered CORF services. Covered DME, orthotic and prosthetic devices, and supplies provided by a CORF are paid under the DMEPOS fee schedule. </P>
                    <P>Drugs and biologicals that are not considered to be self-administered are specified as CORF services at section 1861(cc)(1)(F) of the Act. However, as discussed in the proposed rule, we believe that drugs and biologicals provided to CORF patients are not appropriately provided as part of a rehabilitation plan of treatment and, as such, we proposed to remove drugs and biologicals from the scope of CORF services as defined at § 410.100. After reviewing comments, we have decided to retain within the definition of CORF services drugs and biologicals that are not self-administered, as discussed below in section II.K.7. However, as we are not aware of any non-self-administered drugs and biologicals that appropriately may be included as part of a rehabilitation plan of treatment, we intend to closely track the provision of drugs and biologicals in the CORF setting and do not expect CORFs to bill for such drugs and biologicals. In addition, because we believe it is appropriate for pneumococcal, influenza, and hepatitis B vaccines to be administered to CORF patients in the CORF setting, even though such vaccines fall outside the scope of CORF services, we also proposed to revise the conditions of participation at § 485.51(a) to permit CORFs to provide to their patients pneumococcal, influenza, and hepatitis B vaccines in addition to CORF services. </P>
                    <P>
                        Because the regulations under 42 CFR parts 410 and 413 were never updated to reflect the change in CORF payment methodology from a “reasonable cost” basis to 80 percent of the lesser of a 
                        <PRTPAGE P="66294"/>
                        payment amount under an existing fee schedule or the CORF's actual charge, we proposed to add a new subpart M to 42 CFR part 414 to reflect the change in CORF payment methodology. 
                    </P>
                    <P>In addition, we proposed revisions to the definitions of certain CORF services under § 410.100, in order to limit the scope of such services and items to those appropriately provided by qualified CORF personnel and related to the rehabilitation goals of the plan of treatment established under § 410.105(c). Specifically, we proposed to clarify the definition of physician services; respiratory therapy services; psychological and social services; nursing services; drugs and biologicals; supplies, appliances, and equipment; and the home environment evaluation. We also proposed to add clarifying language to § 410.105(b)(3) to make clear that physical therapy, occupational therapy, and speech-language pathology services can be provided offsite in the patient's home. In § 410.105(c), we proposed to clarify that CORF services, that are not skilled rehabilitation services, must directly relate to the physical therapy or other rehabilitation plan of treatment and its associated goals. </P>
                    <HD SOURCE="HD3">1. Requirements for Coverage of CORF Services Plan of Treatment (§ 410.105(c)) </HD>
                    <P>In accordance with section 1861(cc)(1) of the Act, requiring that CORF services be furnished “under a plan (for furnishing such items and services to such individual) established and periodically reviewed by a physician,” § 410.105(c) provides that CORF services as defined under § 410.100 are covered only if furnished under a written plan of treatment. Specifically, the plan of treatment must: (1) Be established and signed by a physician prior to the commencement of treatment in the CORF setting; and (2) indicate the diagnosis and anticipated rehabilitation goals, and prescribe the type, amount, frequency, and duration of the services to be furnished. We interpret these provisions as requiring that the services furnished under the rehabilitation plan of treatment must relate directly to the rehabilitation of injured, disabled, or sick patients. Services provided in the CORF setting that do not relate directly to such rehabilitation goals and treatment plan are not covered as CORF services. </P>
                    <P>
                        Therefore, we proposed to revise § 410.105(c) to clarify our policy that CORF services are covered only if they relate directly to the rehabilitation of injured, disabled, or sick patients. We believe our policy is consistent with the statutory requirements under section 1861(cc) of the Act. Section 1861(cc)(1) of the Act specifies that CORF services must be furnished under a plan of treatment. Section 1861(cc)(1)(H) of the Act further states that “other items and services” are considered CORF services only if “medically necessary for the rehabilitation of the patient.” We believe the implication of this limitation for “other items of services” is that all other CORF services (that is, those listed under sections 1861(cc)(1)(A) through (G) of the Act) also must be necessary for the rehabilitation of the patient. In addition, we noted that section 1861(cc)(2)(A) of the Act specifies that a CORF facility is a facility “primarily engaged in providing * * * diagnostic, therapeutic, and restorative services to outpatients 
                        <E T="03">for the rehabilitation of injured, disabled, or sick persons</E>
                        ” (emphasis added). We believe this requirement further signals the Congress's intent that the services provided in a CORF setting be covered as CORF services only if such services relate directly to the rehabilitation of the patient. 
                    </P>
                    <P>
                        <E T="03">Comment:</E>
                         One commenter supported the proposal to clarify that all services provided in a CORF must be directly related to the rehabilitation treatment plan. The commenter noted that this proposal is directly aligned with the goals and purpose of physical therapy. 
                    </P>
                    <P>
                        <E T="03">Response:</E>
                         We appreciate the commenter's support of this clarification. Because the CORF is defined as a facility that is primarily engaged in providing diagnostic, therapeutic and restorative services to outpatients for the rehabilitation of injured, disabled or sick persons, we believe the intent of the statute is that all services rendered in a CORF must relate to the patient's rehabilitation needs which are stated in the patient's plan of treatment established by the physician. Section 1861(cc)(1) of the Act and § 410.100 clarify that physician services, and services of other qualified professionals, can be provided in a CORF; but, a physician must first certify that the patient requires skilled rehabilitation services, including physical therapy, occupational therapy, speech-language pathology, and respiratory therapy, and then establish the CORF patient's rehabilitation plan of treatment. 
                    </P>
                    <P>Therefore, we are finalizing § 410.105(c) as proposed with the exception that we have added language to clarify our policy that the rehabilitation plan of treatment, along with its goals, is specific to the skilled rehabilitation services for physical therapy, occupational therapy, speech-language pathology, or respiratory therapy and that these services are distinct from all other CORF services which, when provided, must directly relate to the goals of the rehabilitation treatment plan. </P>
                    <HD SOURCE="HD3">2. Included Services (§ 410.100) </HD>
                    <P>Section 410.100 establishes the services that are covered under the CORF services benefit, consistent with section 1861(cc)(1) of the Act. Because of the change in payment methodology from that based on cost to payment under the PFS and other existing fee schedules beginning in CY 1999, this section does not reflect our current payment policies. Therefore, we proposed to clarify our payment policy in the introductory paragraph of this section by including a cross reference to proposed § 414.1101, which sets forth the payment methodology for CORF services, including identifying the applicable fee schedule for each CORF service. In addition, we proposed to revise: </P>
                    <P>• The definition of physician services to reflect the change in payment methodology for CORF services; </P>
                    <P>• The definitions of physician services, respiratory therapy services, social and psychological services, and nursing services to ensure that these definitions include only those services appropriately provided by qualified nonphysician and physician personnel and related to the rehabilitation plan of treatment established under § 410.105(c); and </P>
                    <P>• The definition of supplies, equipment, and appliances to conform to the statutory provision at section 1861(cc)(1)(G) of the Act. </P>
                    <P>We also proposed to remove the provision for drugs and biologicals. Although vaccines are not included in the definition of CORF services at section 1861(cc)(1) and § 410.100, we proposed to make revisions to the CORF conditions of participation at § 485.51 to reflect current coverage and payment policy for vaccines provided in the CORF setting. </P>
                    <HD SOURCE="HD3">3. Physician Services (§ 410.100(a)) </HD>
                    <P>
                        Section 410.100(a) defines the physician services included within the scope of CORF services. Specifically, those services of a CORF physician described as administrative in nature are considered CORF services, to the exclusion of diagnostic and therapeutic services, which are physician services under section 1861(q) of the Act and separately billable as physician services under 42 CFR part 414, subpart B. Section 1861(cc)(1) of the Act excludes from the definition of CORF services 
                        <PRTPAGE P="66295"/>
                        any item or service that, if furnished to an inpatient of a hospital, would be excluded under section 1861(b) of the Act. Section 1861(b)(4) of the Act excludes from the definition of “inpatient hospital services” the “medical or surgical services provided by a physician,” which would include the diagnostic and therapeutic services of a physician. Consequently, diagnostic and therapeutic services provided in the CORF setting by a physician are not considered CORF services. In contrast, because those services of a CORF physician that are of an administrative nature are not “medical” services, such services are included in the definition of CORF services. 
                    </P>
                    <P>In accordance with section 1861(cc)(2)(B)(i) of the Act and § 485.70(a)(1), the CORF physician must be either a medical doctor (MD) or a Doctor of Osteopathy (DO). The conditions of participation at § 485.70(a)(2) and (3) further require that the physician have training or experience in the medical management of patients requiring rehabilitation services. The conditions of participation at § 485.58(a)(1)(i) also require the CORF facility physician to provide, in accordance with accepted principles of medical practice, medical direction, medical supervision, medical care services and consultation. In the CY 2008 PFS proposed rule, we proposed to revise § 410.100(a) to clarify that only those physician services required and provided by the CORF facility physician that are administrative in nature are considered CORF services, whereas diagnostic and therapeutic services provided by a physician to CORF patients are considered physician services under section 1861(q) of that Act. Specifically, we proposed to define CORF physician services as those services provided by a CORF facility physician that are administrative in nature, such as consultation with and medical supervision of nonphysician staff, patient case review conferences, utilization review, and the review of the therapy plan of treatment, as appropriate. </P>
                    <P>Services provided to a CORF patient by the CORF facility physician or other physician that are not administrative in nature but that are diagnostic or therapeutic services are considered physician services under section 1861(q) of the Act. Where these services are covered, they are separately payable to the physician as physician services under the PFS at the nonfacility payment amount. </P>
                    <P>In addition, § 410.100(a) currently provides that physician services included within the definition of CORF services are reimbursed on a reasonable cost basis under part 413, and that physician services to CORF patients not included within the definition of CORF services but billed as physician services are paid by the carrier on a reasonable charge basis subject to the provisions of subpart E of part 405 of this chapter. This description of the payment methodology for physician services provided in the CORF setting under § 410.100(a) is inconsistent with the payment methodology set forth under section 1834(k)(1) of the Act for CORF services and section 1848 of the Act for physician services, as well as the preamble discussion in the CY 1999 PFS final rule (63 FR 58860). In the CY 1999 PFS final rule, we stated that we would base payment for diagnostic and therapeutic physician services provided to individuals in the CORF setting on the PFS amount for the services. Therefore, we proposed to revise § 410.100(a) to remove the reference to reasonable cost based payments for CORF physician services and the reference to reasonable charge based payments for non CORF physician services. In place of these references, we proposed to revise § 410.100(a) to add a reference to 42 CFR part 414, subpart B, setting forth the payment methodology for non CORF physician services. </P>
                    <P>
                        <E T="03">Comment:</E>
                         One commenter stated that the nonfacility fee schedule amounts for CORF services fail to fairly compensate the CORF for services provided by a CORF physician that are administrative in nature. The commenter stated that the PFS nonfacility amounts, containing higher PE RVUs (than those for the facility setting) for CORFs, are inappropriately low to cover these costs for the CORF setting. The commenter believes that the required level of physician activity in a CORF is greater than that in a physician office. Since there is no separate facility payment to the CORF, the commenter requests that we develop a new set of codes with associated fees to pay for the required CORF administrative physician services in a manner similar to that we employed to establish G0128 in the CY 1999 PFS final rule to pay for CORF nursing services. 
                    </P>
                    <P>
                        <E T="03">Response:</E>
                         The 1997 BBA required CMS to establish prospectively determined payments for all outpatient physical therapy, occupational therapy and speech-language pathology services regardless of the site-of-service and additionally required that all other CORF services also be based on existing fee schedules. When we implemented these BBA requirements during the CY 1999 rulemaking process, we specifically addressed the issue of a site-of-service differential payment to institutional providers of outpatient therapy services, including CORFs. In the CY 1999 PFS final rule, we reasoned that a site-of-service differential payment to a facility provider would create payment incentives that favor one setting over another. In addition, we believe that the law intended the creation of a “level playing field” for these services and that we accomplished this with the selection of the PFS nonfacility rate to pay for all rehabilitation and CORF services. Therefore, we will continue to make payment at the PFS nonfacility rate for CORF services and will not change this policy to allow a separate site-of-service differential payment to the CORF. Accordingly, we are finalizing § 410.100(a) as proposed. 
                    </P>
                    <HD SOURCE="HD3">4. Clarifications of CORF Respiratory Therapy Services </HD>
                    <P>Section 1861(cc)(1)(B) of the Act states that CORF services include respiratory therapy services along with physical therapy, occupational therapy, and speech-language pathology services. Because respiratory therapists (RTs) are not recognized as independent practitioners in the Act or regulations, and respiratory therapy services are not specifically identified in a statutory benefit category except as specified in the CORF services benefit at section 1861(cc)(1)(B) of the Act, separate payment, except that made to the CORF provider, is not made for services provided by RTs. </P>
                    <P>The description of CORF respiratory therapy services currently includes some services that we believe are more appropriately provided by a physician rather than a RT. As discussed above in section II.K.3., diagnostic and other medical services provided in the CORF setting by a physician are not considered CORF services, and therefore may not be included in a respiratory therapy plan of treatment. In addition, the description of respiratory therapy services under § 410.100(e) currently includes services that in accordance with § 410.105(c) must be performed by a physician, and not a RT. For example, only the physician may indicate the clinical diagnosis and rehabilitation goals, and prescribe the type, amount, frequency, and duration of the services to be furnished under the rehabilitation plan of treatment. </P>
                    <P>
                        Therefore, we proposed to amend § 410.100(e) to revise the definition of respiratory therapy services to include only those services that can be appropriately provided to CORF patients by RTs under a physician-established respiratory therapy plan of 
                        <PRTPAGE P="66296"/>
                        treatment in accordance with current medical and clinical standards and the requirements of § 410.105(c). Specifically, we proposed to remove from the definition of CORF respiratory therapy services at § 410.100(e)(1) the terms “diagnostic evaluation”, “management”, and “assessment” because these services are performed by the physician to establish the medical and therapy-related diagnosis and the respiratory therapy plan of treatment. These services, referred to in the proposed rule as “evaluation and management (E/M)” services, may be provided by either the CORF facility physician, as CORF physician services or as non-CORF physician services, or by the patient's referring physician, as appropriate. We also proposed to remove diagnostic tests and periodic assessment at § 410.100(e)(2)(v) and (vi), respectively, from the description of CORF respiratory therapy services. As discussed above, we believe that under current medical standards, diagnostic tests that are or become necessary for patients receiving rehabilitation services should be provided by physicians. In addition, we believe that under current medical standards, periodic assessment of chronically ill patients in order to determine their need for respiratory services should be within the purview of the physician. We note that these services are covered under the physician services benefit category at section 1861(s)(2)(C) of the Act when provided by the physician to a CORF patient, and therefore, may be separately billable by the physician under the PFS. 
                    </P>
                    <P>In addition to RTs, we noted that the conditions of participation also recognize respiratory therapy technicians as CORF personnel; however, during the CY 1999 PFS rulemaking to recognize the 1997 BBA payment requirements, we did not include services performed by respiratory therapy technicians because we believed that current medical standards for skilled respiratory therapy services provided to patients in the CORF setting required the educational requirements possessed by RTs. This determination to only recognize the services of RTs, and not those provided by respiratory therapy technicians in carrying out the therapy plan of treatment was further supported in the CY 2002 and CY 2003 rulemaking (66 FR 55311 and 67 FR 79999), when we developed and discussed G codes for certain CORF respiratory therapy services and specifically recognized the RT as the appropriate level of personnel to provide these CORF services. The three HCPCS codes G0237, G0238, and G0239 are specific to services provided under the respiratory therapy treatment plan and, as such, are not designated as subject to the therapy caps. Therefore, in the CY 2008 PFS proposed rule, we proposed to revise the description of respiratory therapy services to include only those services that are appropriately provided under a respiratory therapy treatment plan. In so doing, we sought to clarify those services that we believe the physician should provide, such as E/M services, diagnostic tests, and establishing the rehabilitation plan of treatment. In addition, we stated that a condition of coverage for the respiratory therapy service is that it be provided by an individual meeting the educational and training level of the RT, rather than the RT technician. For these reasons, we indicated we would accept comments on the service description at § 410.100(e), and the personnel qualifications at § 485.70(j) and (k) for a respiratory therapist and a respiratory therapy technician, respectively. </P>
                    <P>
                        <E T="03">Comment:</E>
                         One commenter opposed the proposed revisions to the definition of CORF respiratory therapy services which removes diagnostic E/M services from the list of services at § 410.100(e)(1) and diagnostic tests from § 410.100(e)(2)(v). The commenter suggested that respiratory therapists, by virtue of their training and competency testing, can and do provide such services as part of their scope of work and asks us to add at § 410.100(e)(2) certain tests, specifically “pulmonary function tests, spirometry and blood gas analyses”, as well as services for “assessment, evaluation and monitoring of the patient's responses to the respiratory treatment plan.” The commenter also requested that we reinsert the term “assessment” in the definition of respiratory therapy services at § 410.100(e)(1) in order to bring consistency to the definitions of all other CORF therapy services, such as physical therapy, occupational therapy, and speech-language pathology. Lastly, the commenter objected to the CORF requirement that the respiratory therapy treatment plan be entirely established by the physician. 
                    </P>
                    <P>
                        <E T="03">Response:</E>
                         Section 1861(cc)(1) of the Act states that respiratory therapy can be provided in a CORF, by qualified professional personnel, only under a treatment plan established and reviewed by a physician. In order to determine the need for and to construct an appropriate CORF respiratory therapy plan of treatment, a physician provides E/M services and often uses diagnostic tests, such as pulmonary function and spirometry tests, in order to establish the patient's medical and therapy related diagnoses. These findings are then detailed in the patient's rehabilitation treatment plan which, in the CORF, the physician must wholly establish. 
                    </P>
                    <P>The plan of treatment is described at § 410.105(c) and must include services furnished under a written plan of treatment that: (1) Is established and signed by a physician before the treatment is begun; (2) prescribes the type, amount, frequency, and duration of the services to be furnished, and indicates the diagnosis and anticipated rehabilitation goals. The respiratory treatment plan must be reviewed at least every 60 days by the physician who must certify that the patient is making reasonable progress in attaining the treatment goals and that the treatment is having no harmful effects. Therefore, we believe that the E/M services and diagnostic services associated with establishing, periodically reviewing, and overseeing the respiratory therapy treatment plan are appropriately furnished by the physician. As discussed above, physician services, including E/M services and diagnostic services performed by the physician, are separate Medicare benefits, defined at sections 1861(q) and 1861(s)(3) of the Act, respectively. These therapeutic and diagnostic services are covered and separately paid to the physician, not the CORF, when they are furnished to a CORF patient in the CORF setting by the physician, as discussed previously in this section at II.K.3. </P>
                    <P>We agree with the commenter's request to reinsert the word “assessment” in the definition of respiratory therapy services at § 410.100(e)(1). Because assessments are conducted as an integral part of any service, we agree that revising the definition more accurately describes the services provided by RTs, as well as other qualified and recognized CORF personnel. As illustrated below, assessments can be made by the RT using the physiologic data gathered from the monitoring services that are inherent to CORF respiratory therapy services. </P>
                    <P>
                        Also, we would like to clarify the term “monitoring” as used in § 410.100(e)(1) specifically as it relates to the provision of CORF respiratory therapy services. As we stated in the CY 2003 PFS final rule with comment period (when we created 3 G-codes—G0237, G0238, and G0239—to better describe CORF respiratory therapy activities), we incorporated the term “monitoring” in to each of the 3 G-code descriptors. We further described this “monitoring” to include physiologic or 
                        <PRTPAGE P="66297"/>
                        other data about the patient during the period before, during, and after the activities. It can represent, for example, pulse oximetry readings, electrocardiography data, pulmonary testing measurements of strength or endurance performed to assess the status of the patient before, during and after the activities. In order to further illustrate and clarify our intention, we provided an example in which pursed lip breathing, used to create positive pressure in the upper respiratory tract and to improve respiratory muscle action and described as G0237, was identified as an included service in the patient's respiratory therapy treatment plan. 
                    </P>
                    <P>Before providing this service, the RT assesses the patient to determine the appropriateness of providing this pursed lip breathing activity and may check the patient's oxygen saturation level (via pulse oximetry). If appropriate, the RT then provides the initial training and necessary retraining in order to ensure that the patient can accurately perform this activity. After this session, the RT may again check the patient's oxygen saturation level, or perform peak respiratory flow, or other respiratory parameters. These services are considered “monitoring” and are bundled into the payment for G0237 (as well as HCPCS codes G0238 and G0239). </P>
                    <P>Another example of monitoring includes the provision of a 6-minute walk test that is typically conducted before the start of the patient's respiratory therapy activities. When this “test” is conducted, the RT uses this information to form an assessment of the patient's condition and uses it to guide and monitor the activities that are furnished as specified in the treatment plan. This assessment, determined by data from monitoring activities is included as part of the activities inherent to G0237. The time spent by the RT, face-to-face and one-on-one, with the patient to conduct these respiratory measures is counted as part of each of the respiratory therapy 15-minute G-codes. When provided as part of a CORF respiratory therapy treatment plan, payment for these monitoring activities is bundled into the payment for other services provided by the RT, including the three respiratory therapy specific G-codes. The bundling of these monitoring activities into each CORF respiratory therapy service is to acknowledge that these activities are inherent to the services we envisioned RTs would provide in the CORF setting. Similarly, assessment, including the use of monitoring data, is included as part of services provided by other rehabilitation therapists. The G-codes were specifically created to better describe the services provided as part of a respiratory therapy plan of care under the CORF benefit. </P>
                    <P>
                        <E T="03">Comment:</E>
                         One commenter indicated that the personnel qualifications in the regulations for RTs and RT technicians are out of date and that for over a decade the term respiratory therapist has been used to describe both respiratory therapy care professional categories currently defined in the CORF regulations. Rather, the commenter states that the certified respiratory therapist (CRT) and the registered respiratory therapist (RRT) have replaced the older terms, RT techs and RTs, respectively. The commenter explained that the CRT designation is awarded after successfully passing the entry-level examination, while qualifications to sit for the RRT examination include graduation from advanced levels of respiratory therapy educational programs and obtaining the CRT credential. Based on the newer terminology for respiratory therapists, along with information provided regarding the CRT and RRT credentialing processes, the commenter requested that we change the CORF conditions of participation to reflect the newer qualifications. In addition, the commenter requested that we change the coverage provisions to recognize both the CRT and RRT as qualified personnel to provide CORF respiratory therapy services. 
                    </P>
                    <P>
                        <E T="03">Response:</E>
                         Based on the information provided by the commenter, we will work within CMS to develop and update the personnel qualifications for RTs and RT technicians at § 485.70(j) and (k), respectively. This request involves changes to longstanding provisions for CORF personnel qualifications, and we believe that other organizations, individuals, and medical specialties should have the opportunity to comment on such changes. We will propose updated qualifications for the CRT and RRT in future rulemaking to seek and review comments from other interested parties, before finalizing any changes to these personnel qualifications. In that rulemaking, we will revisit the issue of the respiratory therapy professional(s) best qualified to provide services under the CORF respiratory therapy plan of treatment. Until such time, we expect that the RT, and not the RT technician, will provide the services of the respiratory therapy treatment plan as previously discussed in CY 2002 and CY 2003 rulemaking and, again, reinforced in this final rule. 
                    </P>
                    <P>We are finalizing our proposal to revise § 410.100(e)(1), with the exception that we will not remove the term “assessment” for the reasons discussed above. We will also adopt the revisions to § 410.100(e)(2), as proposed. </P>
                    <HD SOURCE="HD3">5. Social and Psychological Services </HD>
                    <P>In accordance with section 1861(cc)(1)(D) of the Act, social and psychological services are included within the definition of CORF services under § 410.100(h) and (i), respectively. In addition, § 485.58 specifies that the CORF must provide a coordinated rehabilitation program that includes, at a minimum, social or psychological services, along with physical therapy services and physician services, and that these services must be consistent with the therapy plan of treatment. </P>
                    <P>As discussed in the CY 2008 PFS proposed rule, the current description of social work services considered CORF services under § 410.100(h) includes: (1) Assessment of the social and emotional factors related to the individual's illness, need for care, response to treatment, and adjustment to care furnished by the facility; (2) casework services to assist in resolving social and emotional problems that may have an adverse effect on the beneficiary's ability to respond to treatment; and (3) assessment of the relationship of the individual's medical and nursing requirements to his or her home situation, financial resources, and the community resources available upon discharge from facility care. The current description of CORF psychological services under § 410.100(h) includes: </P>
                    <P>
                        (1) Assessment diagnosis and treatment of an individual's mental and emotional functioning as it relates to the individual's rehabilitation; (2) psychological evaluations of the individual's response to and rate of progression under the treatment plan; and (3) assessment of those aspects of an individual's family and home situation that affect the individual's rehabilitation treatment. We believe these current definitions of CORF social and psychological services are too broad. As discussed above in this section, we proposed to revise § 410.105 to clarify our policy that CORF services are covered only if they are provided under the rehabilitation plan of treatment and relate directly to the rehabilitation of the patient. As such, we are concerned that the current descriptions of CORF social and psychological services may be misconstrued to include social and psychological services for the treatment of mental illness, which we believe is outside the scope of coverage for CORF social and psychological services because these services do not relate directly to a rehabilitation plan of 
                        <PRTPAGE P="66298"/>
                        treatment and the associated rehabilitation goals. 
                    </P>
                    <P>In addition, we believe it unnecessary to distinguish between CORF social services and CORF psychological services given their similarities, and therefore, we proposed to merge the two definitions into a single definition of CORF social and psychological services. As noted at section 1861(cc)(2)(B) of the Act, we believe that CORFs are required to provide either social services or psychological services, and not both types of services. We believe that merging the § 410.100(h) and (i) into a single definition of CORF social and psychological services is warranted to clarify the similarities between them. </P>
                    <P>Therefore, we proposed to clarify the description of social and psychological services at § 410.100(h) to include only those services that address the patient's response and adjustment to the treatment plan; rate of improvement and progress towards the rehabilitation goals, or other services as they directly relate to the physical therapy, occupational therapy, speech-language pathology, or respiratory therapy plan of treatment. In addition, we proposed to change the heading at § 410.100(h) from “social services” to “social and psychological services,” and to eliminate the separate definition for psychological services under § 410.100(i). </P>
                    <P>Because we proposed to revise the description of social and psychological services in § 410.100(h), we also solicited comments concerning the CORF personnel qualifications in the conditions of participation at § 485.70(g) and (l) for psychologists and social workers, respectively, and comments relating to the appropriate CPT codes to represent these CORF services. </P>
                    <P>Due to the specificity of the purpose of CORF social and psychological services requiring that these covered services directly relate to the patient's rehabilitation treatment plan, we also invited comments on which CPT codes would be appropriate for CORF social and psychological services. We believe that the procedure codes for health and behavior assessment and treatment, represented by CPT codes 96150 through 96154, specific to the patient's physical health problems, best describe the social and psychological services required in the CORF setting. </P>
                    <P>
                        <E T="03">Comment:</E>
                         A commenter suggested that the proposed definition of social and psychological services is too restrictive. The commenter recommends including social work, biopsychosocial functioning, and discharge plans in the new proposed definition of social and psychological services. 
                    </P>
                    <P>One commenter is concerned that clarifying that CORFs are not intended to be used to treat mental illness may result in denial of the CORF benefit to persons who need CORF services, but who also suffer from a mental illness (for example, patient with schizophrenia suffers a stroke). A CORF patient's mental illness may need to be accounted for in developing a rehabilitation plan of treatment. The commenter urges us to avoid causing a “chilling effect” on those individuals providing social and psychological services in CORFs at the expense of allowing a patient to recover as fully as possible. </P>
                    <P>A CORF provider cautioned that by not treating social and psychological services as a stand-alone CORF service (like physical therapy or occupational therapy) may have an adverse effect on the patient's ability to make progress toward rehabilitation goals. They also state that social and psychological services may be needed even beyond the conclusion of other CORF services. </P>
                    <P>
                        <E T="03">Response:</E>
                         We believe that our proposal to combine the descriptions of social services and psychological services into one definition best describes the services that CORFs are required to provide to their patients, as an adjunct to the rehabilitation plan of treatment. A broader definition of these services could be interpreted to include treatment of mental illness which the CORF statute and regulations do not permit, thereby causing Medicare to pay for services that fall outside the clearly defined scope of the CORF benefit. 
                    </P>
                    <P>We proposed to combine the definitions of social services and psychological services to clarify and simplify the associated regulatory provisions. We believe that our proposal does not result in any actual change to either the social or psychological services, or the rehabilitation services, provided to CORF patients that relate directly to their rehabilitation plan of treatment and the associated rehabilitation goals. </P>
                    <P>Therefore, we will finalize our proposal to combine the descriptions of social services at § 410.100(h) and psychological services at § 410.100(i) into one definition for social and psychological services at new § 410.100(h) to make clear that these CORF services are the same, regardless of whether provided by a qualified social worker or a psychologist. </P>
                    <P>
                        <E T="03">Comment:</E>
                         One commenter stated that because there are several levels of social work education and licensure for social workers, a recommendation as to the qualifications for CORF social workers depends on whether we change our proposal to include the treatment of mental illness. As proposed, the commenter supports the Bachelor of Social Work (BSW) as the appropriate qualification educational level. However, if the scope of services is expanded to include the treatment of mental illnesses, then the commenter believes that the educational level of the Masters of Social Work (MSW) would be the appropriate qualification. 
                    </P>
                    <P>A CORF provider stated that the personnel qualifications to perform CORF social and psychological services should be either a licensed psychologist at a Masters or PhD level, or a licensed social worker. </P>
                    <P>A medical society representing psychiatrists suggested we use an existing set of qualifications for CORF psychologists and social workers, such as those established by the Office of Personnel Management. </P>
                    <P>
                        <E T="03">Response:</E>
                         We believe that the appropriate qualification for individuals providing social and psychological services in the CORF setting is a BSW for social workers and a Masters-level degree for psychologists. In response to the comment, the combination of social and psychological services into one definition was made for clarification and simplification, and does not result in any change to the scope of social and psychological services provided to CORF patients. Therefore, we believe it is appropriate to maintain the existing personnel qualifications for individuals providing these unique services in the CORF setting. 
                    </P>
                    <P>
                        <E T="03">Comment:</E>
                         In terms of what CPT codes might best describe the proposed CORF social and psychological services, one commenter suggested that CPT code 96155 should be added to the suggested list of CPT codes 96150 through 96154 in order to allow CORFs to bill for social and psychological services provided to a patient's family without the patient presence. 
                    </P>
                    <P>Another commenter suggested that limiting the services to those described by CPT codes 96150 through 96154 is potentially too restrictive because it may not describe all of the services provided by CORFs. The commenter believes that this restriction would not permit CORFs to code the social or psychological services provided to the highest specificity, although no specific CPT codes were offered for consideration. </P>
                    <P>
                        In addition, one commenter believes that using a full range of CPT codes to describe CORF social and psychological services is inappropriate because these codes were not intended to be used for providing non-clinical CORF services. This commenter specifically objects to the use of CPT codes 96150 through 
                        <PRTPAGE P="66299"/>
                        96154 because these services are specifically used by PhD level psychologists to provide clinical services. The commenter notes that other CPT codes are inappropriate to CORF use, including the CPT code range 90801 through 90899 that is used to treat mental illnesses, and the E/M CPT code series (CPT codes 99XXX), because all of these CPT codes represent clinical services. Rather, they believe that the social and psychological services provided in CORFs have “strong case management and patient assessment components” as they relate to the rehabilitation treatment plan. Instead of using existing CPT code(s), the commenter suggested we develop HCPCS code(s) specifically for CORF social and psychological services in order to keep case management services clearly distinguished from patient treatment. 
                    </P>
                    <P>
                        <E T="03">Response:</E>
                         In an effort to address the coding issues, at this time we believe that only CPT code 96152, 
                        <E T="03">Health and behavior intervention, each 15 minutes, face to-face; individual,</E>
                         best describes these unique CORF social and psychological services and should be used to bill for all social and psychological services provided in CORFs. 
                    </P>
                    <P>We are sensitive to the concerns expressed by the commenter that CPT codes 96150 through 96154 do not accurately represent the descriptions of CORF social and psychological services, and that there may be a need to develop a HCPCS code designed specifically for use in the CORF setting. However, in this final rule, we do not believe it is appropriate to create a HCPCS code to reflect the nonclinical nature of the CORF social and psychological services when we did not propose doing so in the proposed rule. However, we will consider the commenter's views in making the determination regarding the necessity to create a new HCPCS code to describe CORF social and psychological services in the future. </P>
                    <HD SOURCE="HD3">6. Nursing Care Services </HD>
                    <P>Because the PFS does not contain a CPT code for nursing services, we established in the CY 1999 PFS final rule a new HCPCS code (G0128) for direct face to face skilled nursing services delivered to a CORF patient by an RN as part of a rehabilitation therapy plan of treatment. In the CORF conditions of participation at § 485.70(b) and (h), qualified personnel for nursing services include an LPN or vocational nurse and an RN, respectively. However, when the HCPCS code G0128 was created for CORF nursing services we determined that a condition for coverage is that the nursing service be provided by an individual meeting the qualifications of an RN, rather than the LPN, for CORF clinical nursing services as they relate, or are part of, the therapy plan of treatment. Because we established coverage for CORF nursing services only when provided by an RN, in the CY 2008 PFS proposed rule, we proposed to revise new § 410.100(i) (that is, the current § 410.100(j) is redesignated as § 410.100(i)) to specifically reflect this coverage decision. We also requested comments on the appropriateness of the personnel qualification standards at § 485.79(b) and (h) for the LPN and for the RN, respectively. </P>
                    <P>
                        <E T="03">Comment:</E>
                         We received a comment that opposed the proposed revisions that would allow skilled nursing services to be performed only by registered nurses. The commenter suggested that the CORF nursing services provided by either a registered nurse or the licensed practice nurse should be determined by the legal scope of practice as outlined in State law by a State board of nursing. 
                    </P>
                    <P>
                        <E T="03">Response:</E>
                         During the CY 1999 final rule, we defined HCPCS code G0128 as a face-to-face nursing service delivered to a CORF patient that is directly related to a rehabilitation plan of treatment. We believe that the level of skill needed to render clinical nursing services as they relate to, or are supportive of the rehabilitation plan of treatment is more appropriately performed by registered nurses. 
                    </P>
                    <P>
                        <E T="03">Comment:</E>
                         One commenter asked us to provide an example of nursing services that would be appropriately furnished and separately payable as such in a CORF that also meets the criteria of directly relating to the rehabilitation treatment plan. This commenter also requests clarification as to whether an RN can provide services as part of the respiratory therapy treatment plan and if one of the HCPCS G-codes for respiratory therapy services, G0237, G0238, and G0239 can be used to bill for these services. 
                    </P>
                    <P>
                        <E T="03">Response:</E>
                         In the CY 1999 PFS final rule, we established coverage for CORF nursing services only when provided by an RN. HCPCS code G0128 is used to bill for services that are not included in the work or PEs of other therapy or physician services. Because of the advances in medical science since the inception of the CORF benefit in 1982, the need for nursing services necessary to be provided as an adjunct to the rehabilitation treatment plan has decreased significantly. In the CY 1999 PFS final rule, we used the example of a RN who instructs a patient in the proper procedure of “in and out” urethral catheterization to illustrate one such nursing service directly related to the rehabilitation treatment plan. At that time, nursing services might have been provided to patients receiving respiratory therapy services relating to tracheostomy tube suctioning. Another nursing service might be related to the cleaning instructions for ileostomy or colostomy bags for a patient receiving physical therapy services where the care is imminent to the start or completion of a therapy session. 
                    </P>
                    <P>
                        <E T="03">Comment:</E>
                         Another commenter noted that CORFs are required to provide the 3 core services, including physician services, physical therapy services, and social or psychological services, and asked that we clarify the amount that these other non-core services—specifically nursing services and respiratory therapy services—can comprise of the total CORF services. The commenter cites examples of CORFs where non-core services comprise the majority of services, sometimes as much as 90 percent or more, including wound care services where RNs are used to provide the majority of these services and other CORFs specializing predominantly in respiratory therapy services. Specifically, the commenter requested that we unambiguously address our intent as it relates to the provision of non-core services. 
                    </P>
                    <P>
                        <E T="03">Response:</E>
                         The CORF statutory provision at section 1861(cc)(2)(B) of the Act and § 485.58 require that the CORF, as a minimum condition of participation, provide three core services— physician services, physical therapy services, and social or psychological services. When a CORF provides only the three required core services, we expect that physical therapy services would comprise a clear majority of the total CORF services, since social and psychological services are provided only as an adjunct to the rehabilitation services and CORF physician services are administrative in nature and not easily identified. However, when a CORF provides physical therapy services and other skilled rehabilitation services, we expect that physical therapy services will be the predominant rehabilitation service provided. The case noted by the commenter where CORFs specialize in providing a preponderance of respiratory therapy services is counter to our expectations. 
                    </P>
                    <P>
                        The example cited by the commenter where the CORF is using RNs to provide wound care services, which together with other non-core services constitute the majority of services provided to a 
                        <PRTPAGE P="66300"/>
                        patient, exemplifies a situation in which the CORF is providing nursing services that are not in support of a rehabilitation plan of treatment. In this situation, the services provided by the RNs do not conform to the requirement that nursing services must directly relate to or further a rehabilitation treatment plan and its goals, and therefore, are noncovered. As we discussed previously in section II.K.6 of this final rule with comment period, we specifically define and require CORF nursing services to relate to the rehabilitation plan of treatment, with such nursing services necessary for the attainment of the rehabilitation goals of the physical therapy, occupational therapy, speech language pathology, or respiratory therapy plan of treatment. We believe only professional therapists/pathologists, such as PTs, OTs, SLPs, and RTs, may appropriately provide these rehabilitation services and that it is inappropriate for an RN to provide these services. Nursing services may not substitute for or supplant the services of these therapists/pathologists, but instead should lend support to or further the services provided by professional therapists/pathologists under the rehabilitation plan of treatment. Therefore, CORF nursing services are covered as CORF services only when provided by a RN and only to the extent that they support or are an adjunct to the rehabilitation services provided by professional therapists/pathologists under the rehabilitation plan of treatment. 
                    </P>
                    <P>In addition to above clarification regarding the coverage and provision of the listed CORF services, we would also like to clarify that CORFs cannot provide services that are not included in the definition of CORF services at § 410.100 (other than vaccines) and that those services included in the definition of CORF services are covered only to the extent that they support or further the rehabilitation plan of treatment. For example, we believe that CORF services do not include the provision of hyperbaric oxygen services, infusion therapy services, or diagnostic sleep studies because they do not meet the definition of CORF services at § 410.100 or they do not relate to the rehabilitation plan of treatment. We believe that these services and other services not specifically listed as CORF services may be covered under other categories of Medicare benefits, such as physician services and diagnostic services. </P>
                    <P>
                        <E T="03">Comment:</E>
                         One commenter asked us to clarify if a RN could perform respiratory therapy services in a CORF. 
                    </P>
                    <P>
                        <E T="03">Response:</E>
                         As we have discussed, we believe only professional therapists/pathologists, such as PTs, OTs, SLPs, and RTs, may appropriately provide rehabilitation services, such as respiratory therapy services, and that it is inappropriate for an RN to provide these services. Therefore, respiratory therapy services provided by an RN are not considered CORF services under § 410.100. Services performed by an RN may not substitute for or supplant the services of these therapists, but instead are covered as CORF services only to the extent that they support or are an adjunct to the rehabilitation services provided by professional therapists/pathologists under the rehabilitation plan of treatment. 
                    </P>
                    <P>We would like to clarify that any CORF nursing service must be provided by a RN and coded as G0128 indicating that CORF “nursing services” were provided. Services provided by an RN may only be billed as CORF nursing services, provided they meet the definition of CORF nursing services at § 410.100(i). We are aware that some CORFs have billed RN services inappropriately as E/M services, such as CPT code 99211. In addition, we believe some physicians have inappropriately billed the services of CORF RNs as incident to physician services. Because CORF services are a distinct benefit category, and because any therapeutic and diagnostic services (as opposed to administrative and supervisory services) furnished by physicians are not CORF services, any service furnished by CORF personnel, including RNs, PTs, OTs, SLPs, and RTs, are not considered to be furnished incident to physicians” services, and thus cannot be billed as services incident to physician services. Therefore, the CORF nursing services of RNs may only be billed using G0128, provided that such services meet the definition of CORF nursing services at § 410.100(i). </P>
                    <P>Therefore, we are finalizing § 410.100(i) as proposed. </P>
                    <HD SOURCE="HD3">7. Drugs and Biologicals </HD>
                    <P>Section 410.100(k) currently provides that drugs and biologicals included within the definition of CORF services includes drugs and biologicals that are prescribed by a physician and administered by a physician or a CORF RN and not otherwise excluded from Medicare Part B payment under § 410.29 (relating to self-administered drugs). In addition, in accordance with § 410.105(c), drugs and biologicals administered to a CORF patient will be covered as CORF services only if included as part of the rehabilitation plan of treatment. However, we are unable to identify any physician prescribed drugs or biologicals that are not self administered that would be appropriately provided under a patient's rehabilitation plan of treatment. We also expressed our concerns about the potential for duplicative billing for drugs and biologicals provided in the CORF setting because they could be billed by the CORF or the physician furnishing such drugs and biologicals. </P>
                    <P>Therefore, we proposed to remove § 410.100(k) and invited comments on this proposed revision, particularly on the appropriateness of including drugs and biologicals under a CORF patient's rehabilitation plan of treatment. </P>
                    <P>
                        <E T="03">Comment:</E>
                         One commenter objected to the proposed removal of the provision for drugs and biologicals from the CORF benefit and believes there is an inherent risk that neither the CORF nor the physician would be paid for drugs and biologicals provided to CORF patients when they are purchased by the CORF. The commenter explained that, under our proposal, the CORF would no longer be permitted to submit claims for the drugs and biologicals they purchase, and further stated that, under this scenario, the physician also could not be compensated because the drug or biological provided in this manner would not satisfy the CMS incident to rules. The commenter questioned our concerns about the possibility of duplicative billing permitted under the current payment methodologies although they believe that we might be justified in our proposal should we have proof that both the CORF and physician are being paid for the same drug and biological. Until such time, the commenter requested we continue to permit both the CORF and the physician to submit claims for the drugs and biologicals provided to CORF patients. 
                    </P>
                    <P>Another commenter also disagreed with our proposal to remove drugs and biologicals as a CORF service claiming that when the Congress created the CORF benefit, it “intended to create a new type of facility that could provide all of the services required by a patient in a coordinated fashion.” They also challenged our authority to remove this provision and believe that duplicative billing possibilities by the CORF and the physician administering the drug or biological is not cause for us to rewrite the statute. </P>
                    <P>
                        <E T="03">Response:</E>
                         The purpose of our proposal was not intended to deny patients access to or to avoid making payment for medically necessary drugs and biologicals. Because we proposed to make payment directly to physicians for the drugs and biologicals provided in the CORF setting, CORFs opting to continue purchasing these drugs and biologicals would not also be paid. 
                        <PRTPAGE P="66301"/>
                        Nevertheless, we are persuaded by the commenter challenging our legal authority to remove drugs and biologicals from our regulatory definition of CORF services § 410.100 in light of their inclusion in the statutory definition of CORF services under section 1861(cc)(1) of the Act. As explained in the legislative history of the CORF statute, the intent of this benefit was to simplify coordination of, and access to, “a broad array of rehabilitation services” (H.R. Rep. No. 96-1167, 96th Cong., 2nd Sess., at 375 (1980). Although as discussed in the proposed rule, we have been unable to identify among currently available drugs or biologicals that are not self-administered any such drugs or biologicals that appropriately may be included in as part of a rehabilitation plan of treatment, we cannot rule out the possibility that others will alert us to such drugs or biologicals or that future non self-administered drugs or biologicals appropriately may be included under a rehabilitation plan of treatment. Therefore, in order to ensure that, should we learn of any non self-administered drugs or biologicals that appropriately may be included in a rehabilitation plan of treatment, we may give effect to Congressional intent that CORFs be able to provide any such drugs or biologicals in coordination with other CORF rehabilitation services, we will not remove the reference to drugs and biologicals from the definition of CORF services under § 410.100 as proposed. 
                    </P>
                    <P>Instead, we will retain the existing definition of CORF-covered drugs and biologicals provided at new § 410.100(j) (that is, the current § 410.100(k) is redesignated as § 410.100(j)) with the exception of adding the word “by” to the new § 410.100(j)(1) to clarify our policy that, in accordance with existing professional standards, the administration of the drug can by provided by a RN but not by others under the supervision of an RN. As we are not aware of any non-self-administered drugs and biologicals that appropriately may be included in a rehabilitation plan of treatment, we intend to closely track the provision of drugs in the CORF setting. If in the future we learn that the administration of drugs or biologicals in the CORF setting is an appropriate service to include in the rehabilitation treatment plan, the regulatory framework will allow for coverage of such drugs or biologicals. In the mean time, we do not expect to see CORFs submitting claims for drugs and biologicals for the reasons noted above. </P>
                    <HD SOURCE="HD3">8. Supplies and DME </HD>
                    <P>
                        Payment for supplies and DME as part of CORF services is specified at § 410.100(l) as “[s]upplies, appliances and equipment” and includes nonreusable supplies, medical equipment and appliances, and DME as defined in § 410.38 (except for renal dialysis systems). These are CORF covered services when provided for the patient's use outside the CORF whether purchased or rented, and is paid under the DMEPOS fee schedule. We believe that the provision at § 410.100(l) is too broad, out of date, and inconsistent with current terminology used for covered services or items. The CORF provision at section 1861(cc)(1)(G) of the Act applies only to supplies and DME, yet the regulatory provision also encompasses medical equipment and appliances. Because we believe the requirements of § 410.100(l) are inconsistent with those of section 1861(cc)(1)(G) of the Act, we proposed to revise both the title and description at new § 410.100(k) (that is, the current § 410.100(l) is redesignated as § 410.100(k)) by deleting reference to medical equipment and appliances to reflect the CORF statutory provision by including only the items specified under section 1861(cc)(1)(G) of the Act. [
                        <E T="04">Note:</E>
                         The preamble discussion incorrectly noted this new section as § 410.100(k) instead of § 410.100(j). Section 410.100(k) is correct in this final rule with comment period.] We also noted that DME, as well as prosthetics, orthotics, and supplies, provided in the CORF setting requires the CORF's participation in the competitive bidding process, where applicable, in accordance with 42 CFR part 414 subpart F. In this final rule with comment period, we have added language at § 414.1105(c)(2) to clarify that payment for DME, prosthetics, orthotics, and supplies determined under the DMEPOS competitive bidding program is a single payment amount, rather than an amount determined under a fee schedule. While a payment amount determined under a competitive bidding program is not generally thought of as a “fee schedule” for purposes of section 1834(k)(3) of the Act we believe the term refers to a single payment amount determined through an existing prospective payment system. The Congress amended the Act to replace reasonable cost-based payment for CORF services with prospective payments. Therefore, we believe the reference to “fee schedule” at section 1834(k)(3) of the Act is meant to broadly refer to existing prospective payment systems for the CORF-covered services or items, including amounts determined prospectively under a competitive bidding program, and should not be referring only to “fee schedules” in the narrow sense. We did not receive comments, in support of or in opposition to, our proposal to specify the new § 410.100(k) to include only supplies and durable medical equipment as specified at section 1861(cc)(G) of the Act in the CORF benefit provision. 
                    </P>
                    <P>Therefore, we are finalizing § 410.100(k) as proposed with the exception that we will add the revision, discussed above, regarding the single payment amount determined under the DMEPOS competitive bidding program. </P>
                    <HD SOURCE="HD3">9. Clarifications and Payment Updates for Other CORF Services </HD>
                    <P>Section 4078 in the Omnibus Budget Reconciliation Act of 1987 (Pub. L. 100-203) (OBRA) amended section 1861(cc)(1) of the Act to provide that there is no requirement that any item or service furnished by a CORF in connection with physical therapy, occupational therapy, and speech pathology services under the plan of treatment be furnished at a single fixed location; however, such items and services are covered as CORF services only if payment is not otherwise made under Medicare. In the CY 2008 PFS proposed rule, we noted that such items and services may be covered under the Medicare home health benefit established under sections 1861(g), (m), and (p) of the Act. Accordingly, physical therapy, occupational therapy, and speech-language pathology services provided in the home are not covered as CORF services if such services and related items are covered under the Medicare home health benefit. Because the CORF regulations were not revised to reflect these changes in coverage and payment methodology, we proposed to clarify the regulations at new § 410.100(l) (that is, the current § 410.100(m) which is redesignated as § 410.100(l)) and § 410.105(b)(3) to reflect these requirements. </P>
                    <P>In § 410.105(b)(3), we proposed to clarify that physical therapy, occupational therapy, and speech-language pathology services can be furnished in the patient's home when payment for these therapy services is not otherwise made under the Medicare home health benefit. </P>
                    <P>
                        In addition, we proposed to revise § 410.100(l) to clarify that the patient must be present during the home environment evaluation that is performed by the PT, OT or SLP, as appropriate, because we believe that the patient's presence is necessary to fully 
                        <PRTPAGE P="66302"/>
                        evaluate the potential impact of the home situation on the patient's rehabilitation goals. 
                    </P>
                    <P>
                        <E T="03">Comment:</E>
                         Some commenters supported our proposal to clarify the CORF therapy services that can be provided in the home and who can provide these services. One of these commenters expressed concern about the requirement that the patient be present for the home environment evaluation and requested that we further clarify this proposal. 
                    </P>
                    <P>
                        <E T="03">Response:</E>
                         Section 1861(cc)(1)(H) of the Act states that there is no requirement for physical therapy, occupational therapy, or speech-language pathology services to be provided at a fixed location such as at the CORF's physical location. This provision was further clarified in section 4078 of OBRA 1987 to clearly permit that, so long as the physical therapy, occupational therapy, or speech language pathology services are not otherwise covered under the Medicare home health benefit, these therapy services can be provided in the patient's home. Section 410.105(b)(3) also provides that only physical therapy, occupational therapy, or speech-language pathology services can be provided offsite, in the patient's home, and that all other CORF services must be provided in the CORF facility. We also proposed to clarify the provision at the new § 410.100(l) (that is, the current § 410.100(m) is redesignated as § 410.100(l)) regarding the provision of a single home environment evaluation, to include the presence of the patient, which can be performed by a PT, OT, or SLP, as appropriate. [
                        <E T="04">Note:</E>
                         The preamble discussion incorrectly noted this new section as § 410.100(l) instead of section § 410.100(k). Section 410.100(l) is correct in this final rule with comment period.] 
                    </P>
                    <P>Therefore, we are finalizing the new § 410.100(l) (that is, the current § 410.100(m) is redesignated as § 410.100(l)), as proposed. </P>
                    <HD SOURCE="HD3">10. Cost Based Payment (§ 413.1) </HD>
                    <P>Section 413.1(a)(2)(iv) currently provides for cost-based payment for CORF services, which reflects the payment methodology provided for under section 1833(a) of the Act, requiring payment on the basis of the lesser of the provider's reasonable costs or customary charges. As discussed above, this payment methodology is inconsistent with section 1834(k) of the Act, requiring that the payment basis for outpatient physical therapy services (including outpatient speech-language pathology services), outpatient occupational therapy services, and all other CORF services provided on or after January 1, 1999 be 80 percent of the lesser of: (1) The actual charge for the services; or (2) the applicable fee schedule amount. Therefore, we proposed to remove § 413.1(a)(2)(iv) to clarify that cost based payment is not applicable to CORF services. We also proposed to remove § 413.1(a)(2)(vi) for OPTs or rehabilitation agencies as referenced at section 1861(p) of the Act, because these providers were also affected by the same payment changes required by the 1997 BBA for physical therapy, occupational therapy, and speech-language pathology services effective for CY 1999. </P>
                    <P>We did not receive comments to these technical corrections regarding the change in payment methodology for CORFs and OPTs that was effective CY 1999. Therefore, we are finalizing the technical corrections to remove references to cost-based payment for CORFs and OPTs at § 413.1(a)(2)(iv) and (vi). </P>
                    <HD SOURCE="HD3">11. Payment for Comprehensive Outpatient Rehabilitation Facility (CORF) Services </HD>
                    <P>In the CY 2008 PFS proposed rule, we proposed to establish a new regulatory subpart M at 42 CFR part 414 to specify the payment methodology for comprehensive outpatient rehabilitation services covered under Part B of Title XVIII of the Act that are described at section 1861(cc)(1) of the Act. Specifically, this proposed subpart would identify and describe how payment is determined for services included as CORF services under § 410.100. </P>
                    <P>Proposed § 414.1100 sets forth the basis and scope for payment for CORF services. Proposed § 414.1105 sets forth the payment methodology for CORF services, including identifying the applicable fee schedule for each type of CORF service identified in § 410.100. </P>
                    <P>Section 1834(k)(1)(B) of the Act provides that the payment basis for CORF services is 80 percent of the lesser of: (1) the actual charge for the services; or (2) the applicable fee schedule amount. The term “applicable fee schedule amount” is defined under section 1834(k)(3) of the Act to mean, for services furnished in a year, the payment amount determined under the PFS established under section 1848 of the Act for such services for the year “or, if there is no such fee schedule established for such services, the amount determined under the fee schedule established for such comparable services as the Secretary specifies.” Accordingly, we proposed at new § 414.1105(a) to base payment for a CORF service on 80 percent of the lesser of the actual charge or the PFS amount for the service when the PFS establishes a payment amount for such service. Payment for CORF services under the PFS is made for physical therapy, occupational therapy, speech-language pathology, and respiratory therapy services, as well as the related nursing and social and psychological services. In the CY 1999 PFS final rule (63 FR 58860), we explained that we interpret section 1834(k)(3) of the Act, defining the term “applicable fee schedule amount,” as requiring us to use the payment amount established by an existing fee schedule other than the PFS when the PFS does not establish a payment amount for the CORF service. Therefore, in the CY 2008 PFS proposed rule we proposed at new § 414.1105(c) that payment for covered DME, orthotic and prosthetic devices and supplies provided by a CORF be based on the lesser of 80 percent of actual charges or the payment amount established under the DMEPOS fee schedule under sections 1834 and 1847 of the Act and in 42 CFR part 414, subparts D and F. Finally, we proposed at new § 414.1105(d) that if there is no fee schedule amount established for a CORF service, payment shall be based on the lesser of 80 percent of actual charges or the amount determined under the fee schedule established for a comparable service, as specified by the Secretary. </P>
                    <P>
                        As discussed in section II.K.3., physician services included within the definition of CORF services under § 410.100(a) are limited to those services of a CORF physician described as administrative in nature, to the exclusion of diagnostic and therapeutic services which are considered separately billable physician services. Medicare generally does not permit providers to separately bill for their administrative costs; rather, such costs typically are subsumed in the payment amounts for covered medical services and items furnished to Medicare beneficiaries. Under the PFS these costs are included in the payment amount as part of the indirect PEs that are reflected in the PE RVUs for each service and also captured as part of the post-visit work RVU component. Similarly, we believe payment to CORFs for the administrative duties of a CORF physician, required as a condition of participation at § 485.58(a), such as participating in patient case review conferences is subsumed within PFS payments to CORFs for physical therapy, occupational therapy, speech-language pathology, and respiratory 
                        <PRTPAGE P="66303"/>
                        therapy services, and the related nursing, and social and psychological services. Generally, administrative costs associated with the provision of such services is incorporated into payment amounts established under the PFS through the PE RVUs representing the resources necessary to perform each service in the physician office or nonfacility setting. Therefore, we believe it unnecessary to separately compensate CORFs for CORF physician services given that such services are administrative in nature, and proposed at § 414.1105(b) not to separately pay CORFs for CORF physician services. 
                    </P>
                    <P>To ensure that CORFs are not paid twice for CORF services, we proposed at new § 414.1105 to base payment for a CORF service on the applicable fee schedule amount only to the extent that payment for such service is not included in the payment amount for other CORF services. Accordingly, under proposed § 414.1105(c) a CORF could not bill separately for supplies included in the PE RVU component of the payment amount established for a service under the PFS. However, we noted that CORFs could bill separately for certain splint and cast supplies for the application of casts and strapping because these supplies have been removed from the payment amounts established under the PFS. We also noted that Medicare makes separate payment for surgical dressings, which are also referenced at section 1861(s)(5) of the Act, only when used by the beneficiary in his or her home. No separate payment is made when these surgical dressings are used in the CORF setting; rather the dressings' costs are bundled into the payment amount established under the PFS for the provided services. </P>
                    <P>
                        For CORF services based on the payment amount determined under the PFS, we proposed at new § 414.1105(a)(2) to use the PFS amount applicable to services furnished in a nonfacility setting, with no separate payment made for facility costs. We proposed to use the PFS nonfacility amount for CORF services in order to offset any costs of providing such services in the CORF setting. [
                        <E T="04">Note</E>
                        : in the proposed rule we incorrectly referenced the codification of the regulation text under proposed subpart M as § 414.1001 or § 414.1101 rather than § 414.1105. However, the proposed regulation text was presented accurately as § 414.1105 in the “List of Subjects” under the proposed subpart.] 
                    </P>
                    <P>Other than the objection discussed above in section II.K.7 regarding the proposed removal of the CORF provision for drugs and biologicals, we did not receive other comments about our proposal to create a regulatory provision to specify the payment methodologies for the CORF services identified at section 1861(cc)(1) of the Act. Therefore, we are finalizing our proposal to add a new regulatory provision defining the payment methodologies used to pay for CORF services except that we also include a section for payment of drugs and biologicals included within the definition of CORF services under the new § 410.100(j), as explained in section II.K.7. We will implement this proposal, including the addition of the payment provision for drugs and biologicals included within the definition of CORF services under the new § 410.100(j), and revise, by adding a new subpart M to part 414. The basis and scope for payment for CORF services is set forth at § 414.1100 and § 414.1105 sets forth the payment methodology for CORF services, including identifying the applicable fee schedule for each type of CORF service identified in § 410.100. </P>
                    <HD SOURCE="HD3">12. Vaccines </HD>
                    <P>
                        Section 485.51(a) defines a CORF as a nonresidential facility that “is established and operated exclusively for the purpose of providing” rehabilitation services by or under the supervision of a physician. Because vaccines administered in the CORF setting are not rehabilitation services furnished under a plan of treatment relating directly to the rehabilitation of the patient (or, presumably, even medically necessary for the rehabilitation of the patient), in accordance with § 485.51(a), a CORF may not administer vaccines to its patients. However, in the CY 2008 PFS proposed rule we noted that nothing in the Medicare statute would prohibit a CORF from providing pneumococcal, influenza, and hepatitis B vaccines to its patients provided the facility is “
                        <E T="03">primarily</E>
                         engaged in providing * * * diagnostic, therapeutic, and restorative services to outpatients for the rehabilitation of injured, disabled, or sick persons” (section 1861(cc)(2)(A) of the Act). Accordingly, under the statute, such vaccines may be covered separately from the CORF services benefit under section 1861(s)(10) of the Act—defining the term “medical and other health services” to include the pneumococcal, influenza, and hepatitis B vaccines—provided the applicable conditions of coverage under § 410.58 and § 410.63 are met. In order to include coverage and payment for these vaccines when provided to CORF patients in the CORF setting, we proposed to amend the CORF conditions of participation at § 485.51 to permit CORFs to provide vaccines to their patients in addition to rehabilitation services. Such vaccines would be covered in the CORF setting provided the conditions of coverage under § 410.58 and § 410.63 are met. In accordance with sections 1833(a)(1) and 1842(o)(1) of the Act, payment for covered pneumococcal, influenza, and hepatitis B vaccines provided in the CORF setting is based on 95 percent of the average wholesale price (AWP). 
                    </P>
                    <P>
                        <E T="03">Comment</E>
                        : We received a few comments strongly supporting the proposal to permit vaccines to be provided in the CORF setting in addition to the CORF services. These commenters also strongly supported our proposal to clarify our policy regarding the administration of vaccines to CORF patients by revising the CORF conditions of participation to permit the provision of vaccines, in addition to CORF services. These commenters believe that increasing the number and types of providers where vaccinations can be furnished will not only help to ensure increased access to these vaccinations but will result in improved health outcomes and lower costs. 
                    </P>
                    <P>
                        <E T="03">Response</E>
                        : We agree with the commenters and will implement our proposal to revise the CORF conditions of participation, accordingly. 
                    </P>
                    <HD SOURCE="HD2">L. Compendia for Determination of Medically-Accepted Indications for Off-Label Uses of Drugs and Biologicals in an Anti-Cancer Chemotherapeutic Regimen (§ 414.930) </HD>
                    <HD SOURCE="HD3">1. Background</HD>
                    <HD SOURCE="HD3">a. Statutory Requirements </HD>
                    <P>Section 1861(t)(2)(B)(ii)(I) of the Act lists three drug compendia that may be used in determining the medically-accepted indications of drugs and biologicals used in an anti-cancer chemotherapeutic regimen. The three drug compendia listed are: </P>
                    <FP>• American Hospital Formulary Service-Drug Information (AHFS- DI) </FP>
                    <FP>• American Medical Association Drug Evaluations (AMA-DE) </FP>
                    <FP>• United States Pharmacopoeia Drug Information (USP-DI) </FP>
                    <P>
                        Section 1861(t)(2) of the Act provides the Secretary the authority to revise the list of compendia for determining medically-accepted indications for drugs. Due to changes in the pharmaceutical reference industry, fewer of the statutorily named compendia are available for our reference. (That is, AMA-DE is no longer in publication; USP-DI has been purchased by Thomson Micromedex and it is our understanding that the 
                        <PRTPAGE P="66304"/>
                        name “USP-DI” may not be used after 2007.) 
                    </P>
                    <P>Section 6001(f)(1) of the Deficit Reduction Act of 2005 (Pub. L. 109-171) (DRA) amends both “sections 1927(g)(1)(B)(i)(II) and 1861(t)(2)(B)(ii)(I) of the Act by inserting “(or its successor publications)” after ‘United States Pharmacopeia Drug Information’.” We interpret this DRA provision as explicitly authorizing the Secretary to continue recognition of the compendium currently known as USP-DI after its name change if the Secretary determines that it is in fact a successor publication rather than a substitute publication.</P>
                    <HD SOURCE="HD3">b. Requests To Amend the Compendia Listings</HD>
                    <P>We received requests from the stakeholder community for recognition of additional compendia under the following authorities: </P>
                    <P>• Section 1861(t)(2)(B) of the Act which allows the Secretary to identify additional authoritative compendia; and </P>
                    <P>• Section 1873 of the Act which allows the Secretary to recognize a successor publication if one of the statutorily-named compendia changes its name. </P>
                    <P>In contrast, others suggested that the Secretary consider elimination of certain listed compendia. However, as we stated in the CY 2008 PFS proposed rule (72 FR 38177), there was no established regulatory process by which we could accept and act definitively on such requests. In addition, we saw the need to increase transparency of decision making criteria. </P>
                    <HD SOURCE="HD3">c. Technology Assessment of Drug Compendia Used To Determine Medically-Accepted Uses of Drugs and Biologicals in an Anti-Cancer Chemotherapeutic Regimen </HD>
                    <P>
                        We commissioned a technology assessment (TA) from the Agency for Healthcare Research and Quality (AHRQ) on the currently listed compendia (AHFS and USP-DI), as well as other compendia (that is, National Comprehensive Cancer Network (NCCN), ClinPharm, DrugDex, Facts &amp; Comparisons (F&amp;C)) which might provide comparable information. AHRQ contracted the TA to the New England Medical Center (NEMC) and Duke Evidence-based Practice Centers (EPCs) and found little agreement in the evidence cited among drug compendia. In addition, the TA found little agreement between the EPCs’ independent identification of evidence on 14 example off-label indications and evidence cited in the drug compendia. The TA can be found at 
                        <E T="03">http://www.cms.hhs.gov/ mcd/viewtechassess.asp? where=index&amp;tid=46.</E>
                    </P>
                    <HD SOURCE="HD3">d. Medicare Evidence Development and Coverage Advisory Committee (MedCAC) </HD>
                    <P>
                        On March 30, 2006, the MedCAC (formerly the Medicare Coverage Advisory Committee (MCAC)) met in public session to advise CMS on the evidence about the desirable characteristics of compendia to determine medically-accepted indications of drugs and biologicals in anti-cancer therapy and the degree to which the currently listed and other available compendia display those characteristics. All information on this MedCAC meeting can be found on the CMS Web site at 
                        <E T="03">http://www.cms.hhs.gov/mcd/viewmcac.asp?where=index&amp;mid=33.</E>
                         The agenda included a presentation of the TA performed for AHRQ by staff of the NEMC and Duke EPCs, scheduled stakeholder presentations, as well as an opportunity to hear testimony from members of the audience. As is customary, the MedCAC panelists elicited additional information from the presenters and discussed the evidence in preparation for a formal vote. 
                    </P>
                    <P>The MedCAC identified the following desirable characteristics:</P>
                    <P>• Extensive breadth of listings. </P>
                    <P>• Quick processing from application for inclusion to listing. </P>
                    <P>• Detailed description of the evidence reviewed for every individual listing. </P>
                    <P>• Use of pre specified published criteria for weighing evidence. </P>
                    <P>• Use of prescribed published process for making recommendations. </P>
                    <P>• Publicly transparent process for evaluating therapies. </P>
                    <P>• Explicit “Not recommended” listing when validated evidence is appropriate. </P>
                    <P>• Explicit listing and recommendations regarding therapies, including sequential use or combination in relation to other therapies. </P>
                    <P>• Explicit “Equivocal” listing when validated evidence is equivocal. </P>
                    <P>• Process for public identification and notification of potential conflicts of interest of the compendia's parent and sibling organizations, reviewers, and committee members, with an established procedure to manage recognized conflicts. </P>
                    <P>The MedCAC concluded that none of the compendia fully display the desirable characteristics. The voting results can be viewed at the same Web site provided previously for the MedCAC meeting. In addition the MedCAC noted significant variability among the compendia. There was no agreement among the panel members that any particular predetermined number of compendia was desirable. </P>
                    <P>Participants in the meeting also discussed the clinical usefulness of drug compendia in the treatment of cancer. It was reported that oncologists do not rely on compendia when making treatment decisions, relying instead on published treatment guidelines, clinical trial protocols, or consultation with peers. </P>
                    <P>Prior to the CY 2008 PFS proposed rule, we received, and reviewed, unsolicited comments from professional societies regarding additions and deletions to the listing of compendia for purposes of section 1861(t) of the Act. We received 46 public comments regarding these provisions on the CY 2008 PFS proposed rule. </P>
                    <HD SOURCE="HD3">2. Process for Determining Changes to the Compendia List </HD>
                    <P>A compendium for the purpose of this section is defined as a comprehensive listing of FDA-approved drugs and biologicals or a comprehensive listing of a specific subset of drugs and biologicals in a specialty compendium, for example, a compendium of anti-cancer treatment. A compendium: (1) Includes a summary of the pharmacologic characteristics of each drug or biological and may include information on dosage, as well as recommended or endorsed uses in specific diseases; (2) is indexed by drug or biological; (3) differs from a disease treatment guideline, which is indexed by disease. We believe that the use of compendia to determine medically-accepted indications of drugs and biologicals in the manner specified in section 1861(t)(2)(B)(ii)(I) of the Act is more efficiently accomplished if the information contained is organized by the drug or biological and if the listings are comprehensive. </P>
                    <P>We proposed an annual process, incorporating public notice and comment, to receive and make determinations regarding requests for changes to the list of compendia used to determine medically-accepted indications for drugs and biologicals used in anti-cancer treatment as described in section 1861(t)(2)(B)(ii)(I) of the Act. The specific details of the proposed process were outlined in PFS CY 2008 proposed rule (72 FR 38118). We received the following comments on our proposed process. </P>
                    <P>
                        <E T="03">Comment:</E>
                         Several commenters remarked that we should correlate Part B and Part D compendia for consistency within the Medicare program. 
                    </P>
                    <P>
                        <E T="03">Response:</E>
                         The Social Security Act separately determines the Agency's use 
                        <PRTPAGE P="66305"/>
                        of authoritative compendia for specific programs. The use of any compendium for Part D or for Medicaid is beyond the scope of this regulation. 
                    </P>
                    <P>
                        <E T="03">Comment:</E>
                         Many commenters voiced concerns about the time line proposed by CMS to address requests for changes to the list of compendia. 
                    </P>
                    <P>
                        <E T="03">Response:</E>
                         We are striving to achieve a more expedient and predictable time line that will better serve the needs of those who care for Medicare beneficiaries. We have carefully considered the comments and made the following revisions: 
                    </P>
                    <P>(1) In order to shorten the proposed timeline, CMS will not publish an annual notice for formal requests. </P>
                    <P>(2) We expect to receive requests annually during a 30-day window starting January 15th. </P>
                    <P>(3) We expect to post these complete requests received by March 15th for public notice and comment on the CMS Web site. </P>
                    <P>(4) We will accept public comments for a 30 day period beginning on the day that the request is posted by CMS on the Web site. </P>
                    <P>
                        <E T="03">Comment:</E>
                         Some commenters suggested alternative review cycles including changing the annual review to: a rolling review process; an every 3-year review process; or an every 5-year review process.
                    </P>
                    <P>
                        <E T="03">Response:</E>
                         We appreciate the commenters' suggestions regarding alternative review cycles; however, at this time, we believe that an annual review cycle is the best balance of these suggestions to promote a publicly responsive review process. Due to the general stability of the compendium publishing market, an annual review process is sufficient. However, if we determine that the public interest would be served by an immediate compendia review, we reserve the right to internally generate a request at any time. 
                    </P>
                    <P>
                        <E T="03">Comment:</E>
                         Several commenters suggested specific additions to the list of compendia. 
                    </P>
                    <P>
                        <E T="03">Response:</E>
                         The addition or deletion of specific compendia is beyond the scope of this regulation. Formal requests for additions and deletions may be submitted during the annual open request period established in this final rule with comment period. 
                    </P>
                    <P>
                        <E T="03">Comment:</E>
                         The comments received from several associations and manufacturers stated that the language used for the individual desirable characteristics was not clear and that we did not give the appropriate consideration to quality concerns and the potential conflicts of interest. 
                    </P>
                    <P>
                        <E T="03">Response:</E>
                         We appreciate the commenters' concerns and strive to provide clarity on the MedCAC desirable characteristics that we will utilize in the compendia review process. The characteristics presented here represent an evidence-based consensus from the MedCAC panel on the desirability and priority of those characteristics. We recognize that different compendia might attempt to achieve these characteristics in individualized ways. CMS plans to use the desirable characteristics as framework and guidance in the review process. However, we believe that the public interest is best served by CMS attention to the quality and the integrity of each compendium's evidence evaluation process. 
                    </P>
                    <P>
                        <E T="03">Comment:</E>
                         A few commenters made the general suggestion for CMS to prioritize the desirable characteristics identified at the MedCAC meeting, March 2006. 
                    </P>
                    <P>
                        <E T="03">Response:</E>
                         We wish to clarify that the desirable characteristics recommended by the MedCAC will serve as guidance and a framework which will aid in the CMS review process. As stated in the CY 2008 PFS proposed rule, we “may consider additional reasonable factors in making a determination” as deemed appropriate. While we have decided not to rank the MedCAC desirable characteristics, we do consider the characteristics referencing transparency and conflict of interest to be of high priority to preserve the integrity and minimize bias during the review process. 
                    </P>
                    <P>
                        <E T="03">Comment:</E>
                         Some commenters stated that a deletion from the list of compendia could cause a beneficiary to lose coverage of an off-label treatment regimen already begun. 
                    </P>
                    <P>
                        <E T="03">Response:</E>
                         We understand the concern expressed by the commenters on a beneficiary's loss of coverage during the continuance of off-label treatment in the absence of compendium support; however local contractors have additional authority to make determinations regarding medically accepted indications. While we require local contractors to use the compendia as a reference in the determination of “medically-accepted” off-label treatment regimens, the compendia are not the sole reference for these determinations. Section 1861(t)(2)(B)(ii)(II) of the Act provides that local contractors use “supportive clinical evidence in peer-reviewed medical literature” to aid in making determinations of “medically-accepted” off-label treatment regimens when appropriate. 
                    </P>
                    <P>
                        <E T="03">Comment:</E>
                         Commenters asked that we recognize compendia indexed by disease. 
                    </P>
                    <P>
                        <E T="03">Response:</E>
                         In order to meet our criteria, a compendium should: (1) Include a summary of the pharmacologic characteristics of each drug or biological and may include information on dosage, as well as recommended or endorsed uses in specific diseases; (2) be indexed by drug or biological; (3) differ from a disease treatment guideline, which is indexed by disease. We believe that the use of compendia to determine medically-accepted indications of drugs and biologicals in the manner specified in section 1861(t)(2)(B)(ii)(I) of the Act is more efficiently accomplished if the information contained is organized by the drug or biological and if the listings are comprehensive. 
                    </P>
                    <P>
                        <E T="03">Comment:</E>
                         Several commenters suggested that we should regulate a time frame for compendia to update their recommendations. 
                    </P>
                    <P>
                        <E T="03">Response:</E>
                         We believe that the public interest is served if compendia generally update their recommendations in a timely manner when new evidence regarding the use of drugs warrants an update. We also believe that this is consistent with spirit of the MedCAC's recommendations. However, medical evidence on a particular use of a specific drug may at times be complex and inconsistent, and thus, merit a prolonged rather than an expedited analysis. We do not believe that we should establish in regulation a specific broad time line requirement at this time. However, we will consider public input regarding a compendium's timely updating of its recommendations as an additional criterion in our compendium review process. 
                    </P>
                    <P>
                        <E T="03">Comment:</E>
                         We received comments suggesting that a compendium's use of grades of evidence may add a confusing factor in determining whether a compendium citation supports a particular drug use. Commenters stated that it is desirable for a compendium to clarify in a summary recommendation whether it regards each drug use as medically-accepted. 
                    </P>
                    <P>
                        <E T="03">Response:</E>
                         We recognize and support the desirability of an explicit summary recommendation for each drug or biological cited in each compendium. This will facilitate the consistent interpretation of off-label recommendations by Medicare contractors. 
                    </P>
                    <P>
                        <E T="03">Comment:</E>
                         One commenter suggested that a recognized compendium should include and identify a well designed clinical trial that is pending FDA approval. 
                    </P>
                    <P>
                        <E T="03">Response:</E>
                         We do not believe that we can specify how a compendium 
                        <PRTPAGE P="66306"/>
                        references materials regarding clinical trials for a drug not yet FDA-approved. 
                    </P>
                    <P>
                        <E T="03">Comment:</E>
                         Two commenters claimed that section 1861(t)(2) of the Act mandates separate processes for adding and removing compendia. 
                    </P>
                    <P>
                        <E T="03">Response:</E>
                         While we appreciate the thoughtful interpretation of the language, we do not agree separate processes are required by the statute. 
                    </P>
                    <P>
                        <E T="03">Comment:</E>
                         One commenter suggested that the identity of the members of the compendium's advisory board and scientific review committee should become public record. The commenter also requested that we to establish a formal process to facilitate stakeholder/compendia communication. 
                    </P>
                    <P>
                        <E T="03">Response:</E>
                         Public identification of members of the compendium's advisory board and the scientific review committees and establishing a formal process for stakeholders/compendia communication is beyond our authority and scope of this regulation. 
                    </P>
                    <P>Based on the public comments received, we have made revisions to the proposed compendia review process. We appreciate the need for a more expedient process to provide a useful compendia list for Medicare providers and have made the necessary changes. </P>
                    <P>Requests may be submitted in two ways (no duplicates please). Electronic submissions are encouraged to facilitate administrative efficiency. We will identify the electronic address to be used for submissions. Hard copy requests can be sent to the Centers for Medicare &amp; Medicaid Services, Coverage and Analysis Group, Mailstop C1-09-06, 7500 Security Boulevard, Baltimore, MD, 21244. Please allow sufficient time for hard copies to be received prior to the close of the receipt period. </P>
                    <P>We may consider additional reasonable factors in making a determination. (For example, we may consider factors that are likely to impact the compendium's suitability for this use, such as but not restricted to a change in ownership or affiliation, suspension of publication, the standards applicable to the evidence considered by the compendium, and any relevant conflicts of interest. We may consider that broad accessibility by the general public to the information contained in the compendium may assist beneficiaries, their treating physicians, or both, in choosing among treatment options.) </P>
                    <P>• We will also consider a compendium's grading of evidence used in making recommendations regarding off-label uses and the process by which the compendium grades the evidence. </P>
                    <P>•  We may, at our discretion, combine and consider multiple requests that refer to the same compendium, even if those requests are for different actions. This facilitates administrative efficiency in our review of requests. </P>
                    <P>• We will notify the public of additions or deletions to the list of compendia on the CMS Web site. </P>
                    <P>• In keeping with our desire to shorten the compendia review time line, we will publish our decision no later than 90 days following the close of the public comment period. </P>
                    <HD SOURCE="HD1">M. Physician Self-Referral Issues </HD>
                    <HD SOURCE="HD3">1. General </HD>
                    <P>In the CY 2008 PFS proposed rule (72 FR 38122), we proposed several revisions to the physician self-referral regulations. We also solicited comments regarding potential changes to or limitations on the use of the in-office ancillary services exception in § 411.355(b). We received approximately 1100 pieces of timely correspondence in response to these proposals. </P>
                    <P>We received the following comments regarding finalizing our proposals:</P>
                    <P>
                        <E T="03">Comment:</E>
                         Many commenters were concerned about the perceived complexity and breadth of the physician self-referral proposals. Several commenters questioned our ability to analyze sufficiently, and give adequate consideration to, the public comments due to the brief time period between issuance of the CY 2008 PFS proposed rule (72 FR 38122) and the statutory deadline for publication of this final rule with comment period. Some commenters suggested that we not finalize any of the proposals at this time. Many of those commenters asserted that we should further contemplate the issues and propose revised regulatory provisions in the CY 2009 PFS proposed rule if we continue to believe that such revisions are necessary. 
                    </P>
                    <P>
                        <E T="03">Response:</E>
                         We are not inclined to follow the commenters' suggestion regarding reproposal of the physician self-referral provisions in the CY 2009 PFS proposed rule. However, given the number of physician self-referral proposals, the significance of the provisions both individually and in concert with each other, and the volume of public comments, we do not believe it is prudent to finalize any of the proposals in this rule (except for the proposal for anti-markup provisions for diagnostic tests, as discussed below in this section). Although we are not finalizing the proposed revisions to the other physician self-referral regulations in this final rule with comment period, we are confident that we have sufficient information, both from the commenters and our independent research, to finalize revisions to the physician self-referral regulations without the need for new proposals and additional public comment. We intend to publish a final rule that addresses the following proposals: 
                    </P>
                    <P>• Burden of proof; </P>
                    <P>• Obstetrical malpractice insurance subsidies; </P>
                    <P>• Unit-of-service (per-click) payments in lease arrangements; </P>
                    <P>• The period of disallowance for noncompliant financial relationships; </P>
                    <P>• Ownership or investment interests in retirement plans; </P>
                    <P>• “Set in advance” and percentage-based compensation arrangements; </P>
                    <P>• “Stand in the shoes” provisions; </P>
                    <P>• Alternative criteria for satisfying certain exceptions; and </P>
                    <P>• Services furnished “under arrangements.” Because we did not make a specific proposal regarding the in-office ancillary services exception, but rather merely solicited comments regarding its scope and application, any revisions to the exception in § 411.355(b) will be accomplished through a future notice of proposed rulemaking with provisions for public comment. </P>
                    <P>A measured, thoughtful approach to the final physician self-referral rules is critical. We believe that the future rulemaking will address the public comments and present a coordinated, comprehensive approach to accomplishing the goals described in the proposed rule, namely, minimizing the threat of program and patient abuse while providing sufficient flexibility to enable those who are parties to financial arrangements to satisfy the requirements of, and remain in compliance with, the physician self-referral law and the exceptions thereto. </P>
                    <HD SOURCE="HD3">2. Changes to Reassignment and Physician Self-Referral Rules Relating to Diagnostic Tests (Anti-Markup Provisions) </HD>
                    <P>
                        Medicare regulations currently prohibit the markup of the technical component (TC) of certain diagnostic tests that are performed by outside suppliers and billed to Medicare by a different individual or entity (§ 414.50). In addition, Medicare program instructions restrict who may bill for the professional component (PC) (the interpretation) of diagnostic tests (Section 30.2.9.1 of the CMS Internet-Only Manual, Publication 100-04, Medicare Claims Processing Manual, Chapter 1, general billing requirements, as amended or replaced from time to time). 
                        <PRTPAGE P="66307"/>
                    </P>
                    <P>In the CY 2007 PFS proposed rule (71 FR 48982), we stated that recent changes to our rules on reassignment concerning the right to receive Medicare payment may have led to some confusion as to whether the anti-markup and purchased interpretation requirements apply in certain situations where a reassignment has occurred pursuant to a contractual arrangement. In addition, we expressed concern about the existence of certain arrangements that we believe are not within the intended purpose of the physician self-referral exception for in-office ancillary services, which permits physician group practices to bill for certain services referred by group physicians and furnished by a contractor physician in a “centralized building.” We also expressed concern that allowing physician group practices or other suppliers to purchase or otherwise contract for the provision of diagnostic testing services and to then realize a profit when billing Medicare may: (1) Lead to program and patient abuse in the form of overutilization of services; and (2) result in higher costs to the Medicare program (71 FR 49054). In the CY 2007 PFS proposed rule, we proposed to amend § 424.80 to provide that, if the TC of a diagnostic test (other than a clinical diagnostic laboratory test paid under section 1833(a)(2)(D) of the Act, which is subject to the special rules set forth in section 1833(h)(5)(A) of the Act) is billed by a physician or medical group (the “billing entity”) under a reassignment involving a contractual arrangement with a physician or other supplier who performs the service, the amount billed to Medicare by the billing entity would be limited. We also proposed that, to bill for the TC, the billing entity would be required to perform the interpretation. In addition, we considered imposing certain conditions on when a physician or medical group can bill for the reassigned PC of a diagnostic test. For our physician self-referral rules, we proposed to modify the definition of “centralized building” at § 411.351. Finally, we solicited comments on the specific application of our proposals. (See the CY 2007 and CY 2008 PFS proposed rules for more information on these proposals (71 FR 49054 through 49057 and 72 FR 38179 through 38180, respectively).) </P>
                    <P>We received numerous comments on the proposals in the CY 2007 PFS proposed rule. Because we decided to study the issues further, we did not finalize our proposals in the CY 2007 PFS final rule with comment period. Rather, based on the comments received and other information that we considered, in the CY 2008 PFS proposed rule, we proposed to impose an anti-markup limitation on the TC and PC of diagnostic tests. We stated that we would apply the anti-markup provision irrespective of whether: (1) The billing entity outright purchases the TC or the PC; or (2) the physician or other supplier performing the TC or PC reassigns his or her right to bill the Medicare program to the billing entity (unless the performing supplier is a full-time employee of the billing entity). That is, we proposed to limit the payment to the billing entity to the lowest of: (1) The performing physician's or other supplier's net charge to the billing entity; (2) the billing entity's actual charge; or (3) the fee schedule amount for the service that would be allowed if the physician or other supplier performing the service billed directly. To prevent gaming, whereby the performing physician's or other supplier's net charge to the billing entity is inflated to cover the cost of equipment or space that is leased by the billing entity to the performing physician or other supplier, we stated that we would define “net charge” as exclusive of any amount that takes into consideration such charges. </P>
                    <P>We also stated that we were concerned that overutilization of diagnostic tests could continue despite our proposal to apply an anti-markup provision to TCs that are reassigned to, or outright purchased by, group practices. That is, we intended to address the situation in which the TC is performed by a part-time or leased employee of the group practice in a “centralized building,” and the group neither receives a reassignment from the employee technician (if the technician is not able to bill for the TC in his or her own right), nor purchases the TC outright from the technician. Therefore, we proposed to apply an anti-markup provision to TCs that are performed in a centralized building, and sought comments on whether we should have such a provision and, if so, how we should effect such a provision (for example, by amending the definition of “centralized building” or through some other means). We stated that we would except from the anti-markup provision PCs performed by a physician pursuant to an arrangement with an independent laboratory as we do not believe that such PCs ordered by an independent laboratory pose a significant risk of program abuse because the independent laboratory does not order the diagnostic test. We proposed revisions to § 424.80 (reassignments) and § 414.50 (purchased diagnostic tests). (We did not propose regulatory text revisions for our proposals to apply an anti-markup provision to TCs that are performed in a centralized building, and not apply the anti-markup provision to PCs billed by independent laboratories whose personnel do not order the diagnostic test.) </P>
                    <P>Many commenters supported our proposals to prohibit the markup of the TC and PC of diagnostic tests in order to prevent physicians, physician group practices, and medical groups from profiting through the ordering of such tests. Commenters that supported our proposals often cited a concern about overutilization. Many commenters were opposed to our proposals. These commenters stated that the Medicare program and its beneficiaries are better served by physicians who refer tests to specialists (such as pathologists who contract directly with group practices), instead of physicians who use large reference laboratories. These commenters asserted that, because physicians develop a working relationship with particular pathologists, and because the pathologists “specialize” in a particular type of biopsy (for example, prostate biopsies), results are obtained more quickly and quality is enhanced. Finally, most commenters who responded to our proposal to apply an anti-markup to reassignments from part-time employees, irrespective of whether they were in support generally of our proposals, opposed this specific proposal. </P>
                    <P>
                        After careful consideration of all of the comments, we are adopting our proposals, with modification. We are imposing an anti-markup provision on TCs of diagnostic tests that are ordered by the billing physician or other supplier (or ordered by a party related by common ownership or control to such billing supplier), if the TC is outright purchased or if the TC is performed at a site other than the office of the billing physician or other supplier.
                        <SU>1</SU>
                        <FTREF/>
                         (For purposes of the anti-markup provisions, the “office of the billing physician or other supplier” has its common meaning. The term is defined at revised § 414.50(a)(2)(iii) as space where the physician or other supplier regularly furnishes patient care. With respect to a billing physician or other supplier that is a physician 
                        <PRTPAGE P="66308"/>
                        organization (as defined at § 411.351 of this chapter), the “office of the billing physician or other supplier” is space in which the physician organization provides substantially the full range of patient care services that the physician organization provides generally.) We are also imposing an anti-markup provision on PCs of diagnostic tests that are ordered by the billing physician or other supplier (or ordered by a party related by common ownership or control to such billing supplier), if the PC is outright purchased or if the PC is not performed in the office of the billing physician or other supplier. Also, part-time employees are treated no differently than full-time employees or contractors who reassign benefits. 
                    </P>
                    <FTNT>
                        <P>
                            <SU>1</SU>
                             We note that, in our proposals, we used the term “billing entity” to refer to a billing physician or medical group.  In this final rule with comment period, the anti-markup provisions potentially apply to TCs and PCs billed by 
                            <E T="03">any supplier; therefore, we use the terms “billing physician or other supplier” and “billing supplier.”  These terms are used interchangeably.</E>
                        </P>
                    </FTNT>
                    <P>We are primarily revising § 414.50, although we have also revised § 424.80 by adding (d)(3) to alert the reader that, in the case of the reassignment of the TC or PC of a diagnostic test, the reader should consult § 414.50 to investigate whether the anti-markup provisions apply to the TC or PC. We are also revising our definition of “entity” at § 411.351, which is relevant to our rules on physician self-referral. Currently, the definition of “entity” provides an exception for a physician's practice when it bills Medicare for a diagnostic test in accordance with § 414.50. We are revising the definition of “entity” at § 411.351 to exclude a physician's practice when it bills Medicare for the TC or PC of a diagnostic test in accordance with § 414.50. </P>
                    <P>Examples of the application of the final provisions to particular facts appear immediately below, followed by a discussion of the specific comments we received on our proposals. We note that the following examples are intended only to illustrate the application of the anti-markup provisions of this final rule with comment period; they are not intended to address whether the physician self-referral rules would prohibit payment due to financial relationships that may exist between the billing supplier and any physician ordering a test or performing the TC or PC of a test. </P>
                    <EXAMPLE>
                        <HD SOURCE="HED">Example 1.</HD>
                        <P>A urology group practice contracts with a leasing company that supplies a technician and a pathologist to perform testing on prostate samples. The technician performs the tissue sampling and the pathologist reads the slides. All work is done outside of the office of the billing group practice, and instead is performed in space that is rented exclusively “24/7” by the group practice (thus meeting the definition of a “centralized building” at § 411.351) for the sole purpose of providing pathology services for the group's patients. Because the centralized building does not qualify as “the office of the billing physician or other supplier,” the anti-markup provisions apply to both the TC and the PC, and the group may bill Medicare the lowest of the following: (1) The leasing company's net charge to the group; (2) the group's actual charge; or (3) the fee schedule amounts for the TC and interpretation that would be allowed if the leasing company were enrolled in and billed Medicare directly.</P>
                    </EXAMPLE>
                    <EXAMPLE>
                        <HD SOURCE="HED">Example 2.</HD>
                        <P>Same as Example 1, except that the TC and PC are performed by the group practice's employee technician and a pathologist who is an independent contractor of the group practice, respectively. Here, the anti-markup provisions again apply to both the TC and the PC because the work was not done in the “office of the billing physician or other supplier” (that is, the office of the group practice). It does not matter that the technician is an employee and the pathologist is an independent contractor because the work was not performed in the office of the billing group practice.</P>
                    </EXAMPLE>
                    <EXAMPLE>
                        <HD SOURCE="HED">Example 3.</HD>
                        <P>A physician in a group practice orders a diagnostic test and a technician who is a part-time employee of the group performs the test in the group's office. A physician who is an independent contractor of the group performs the PC in the group's office and reassigns his or her right to payment to the group. The anti-markup provisions do not apply to the group's billing of the TC or the PC.</P>
                    </EXAMPLE>
                    <EXAMPLE>
                        <HD SOURCE="HED">Example 4.</HD>
                        <P>Same as Example 3, except that the independent contractor physician performs the PC in his or her home and reassigns his or her right to payment to the group. The group's billing of the TC is not subject to the anti-markup provision, but the group's billing of the PC is subject to the anti-markup provision because the work was not performed in the office of the billing supplier.</P>
                    </EXAMPLE>
                    <EXAMPLE>
                        <HD SOURCE="HED">Example 5.</HD>
                        <P>A group practice purchases both a diagnostic test and its interpretation from a laboratory and bills the TC and PC to Medicare. The anti-markup provisions apply to both the TC and the PC. Because the TC and the PC were purchased, the location(s) at which the TC and the PC were performed does not matter.</P>
                    </EXAMPLE>
                    <EXAMPLE>
                        <HD SOURCE="HED">Example 6.</HD>
                        <P>A group practice orders a diagnostic test from an independent laboratory. The laboratory performs the test and contracts with a physician to perform the PC. The laboratory bills Medicare for both the TC and the PC. The laboratory is not subject to the anti-markup provision for the PC, because the laboratory did not order the test.</P>
                    </EXAMPLE>
                    <EXAMPLE>
                        <HD SOURCE="HED">Example 7.</HD>
                        <P>Same as Example 6, except that a physician orders a diagnostic test from an independent diagnostic testing facility (IDTF). The IDTF bills Medicare for both the TC and the PC of the test. The anti-markup provisions do not apply because the IDTF did not order the test.</P>
                    </EXAMPLE>
                    <HD SOURCE="HD3">a. Authority </HD>
                    <P>
                        <E T="03">Comment:</E>
                         Several commenters questioned whether we have the authority pursuant to section 1842(n) of the Act to impose an anti-markup provision as described in the CY 2008 PFS proposed rule. The commenters specifically noted that, in section 1842(n) of the Act, the Congress directed the Secretary to impose an anti-markup on the TC of diagnostic tests, yet our proposal applied to the TC and the PC of diagnostic tests. Commenters stated that the interpretation of a diagnostic test is a physician service, and that section 1848 of the Act mandates that physician services be paid the lesser of the billing physician's actual charge or the fee schedule amount, and therefore, we have no authority to extend the anti-markup rule to physician services. 
                    </P>
                    <P>
                        <E T="03">Response:</E>
                         We believe that several provisions of the Medicare statute provide us with the requisite authority to impose anti-markup provisions on the TC and PC of certain diagnostic tests. Section 1842(n)(1)(A) of the Act, which was enacted as part of the Omnibus Budget Reconciliation Act of 1987, provides that, if the diagnostic test was not performed or supervised by the billing physician and also was not performed or supervised by a physician with whom the billing physician shares a practice, the Medicare payment is the lower of the costs (net of any discount) charged by the performing supplier to the billing physician, or the performing supplier's reasonable charge (or other applicable limit). This is commonly known as the anti-markup provision. Although, to date, this statutory provision has been implemented through the regulation in § 414.50 that imposes an anti-markup provision on the TC only of a diagnostic test, nothing in this section limits our authority to apply this section to the PC of a diagnostic test. 
                    </P>
                    <P>
                        Moreover, we believe that we can interpret the language “shares a practice” as giving us the authority to impose an anti-markup provision on the TC of tests that are outright purchased by a billing physician or group, as well as on the TC of tests for which payment is reassigned to the billing physician or group. Although we previously implemented this statutory provision through regulation in § 414.50 by enacting an anti-markup provision on the TC of “purchased” diagnostic tests from an outside supplier, the statutory provision does not speak in terms of “purchased” tests. In the intervening time since CMS promulgated the regulation in § 414.50, other changes to the Medicare program, in particular, the changes made by section 952 of the MMA to the reassignment exceptions authority, have created incentives for conduct that we believe increases the risk of overutilization and abuse of the Medicare program. We believe that the language “shares a practice” in section 1842(n)(1) of the Act can cover not just 
                        <PRTPAGE P="66309"/>
                        tests that are outright purchased, but also tests for which payment is reassigned to the billing supplier. We are amending § 414.50 in this final rule to provide that TCs and PCs that are not performed in the office of the billing physician or other supplier are subject to the anti-markup provision. We believe that, if the TC or PC is not purchased and is performed in the office of the billing supplier by an employee (whether full-time or part-time) or an independent contractor who reassigns benefits, a sufficient nexus with the practice of the billing supplier (that is, the billing physician or group) is established such that the employee or independent contractor may be viewed as “sharing a practice” with the billing supplier for purposes of section 1842(n)(1) of the Act. In addition, we believe that we have authority under sections 1102(a) and 1871(a) of the Act (our general rulemaking authority) to impose anti-markup provisions on the TC and PC of diagnostic tests in order to fully effectuate the Congress' intent in enacting section 1842(n)(1) of the Act. 
                    </P>
                    <P>
                        We find additional authority in section 1842(b)(6) of the Act. This section generally prohibits Medicare payment to anyone other than the Medicare beneficiary or the physician or other person who furnished the item or service to the beneficiary. We allow a physician or other supplier to bill for tests and test interpretations that are purchased from an outside supplier because we have deemed the test or interpretation to be performed by the billing supplier; however, we are not 
                        <E T="03">required</E>
                         to deem the test or interpretation as having been performed by the billing supplier, nor are we required to do so without placing limits on the amount the purchasing supplier may bill. Likewise, whereas section 1842(b)(6) of the Act also provides exceptions (known as the reassignment exceptions) to the general rule that payment may be made only to the beneficiary or the physician or other person who furnished the item or service, such exceptions allow us (“payment may be made”), but do not require us, to make payment to an individual or an entity other than the beneficiary or the physician or other person who furnished the item or service to the beneficiary. (We note that the Congress specifically provided for CMS to implement safeguards in the context of reassignments pursuant to a contractual arrangement. Section 952 of the MMA permitted Medicare to pay a physician or entity billing for an item or service as a result of a reassignment created pursuant to a contractual arrangement, regardless of the site of service. However, in section 952 of the MMA, the Congress specifically authorized the Secretary to subject such arrangements to “such program integrity and other safeguards as the Secretary may determine to be appropriate.”) Therefore, we believe that we have ample authority under section 1842(b)(6) of the Act to place restrictions on the billing of tests and interpretations when the tests or interpretations were performed by someone other than the billing supplier, particularly with respect to situations in which there is the potential for overutilization. 
                    </P>
                    <P>We do not view the application of the anti-markup provision to the PC of diagnostic tests as representing a conflict with section 1848 of the Act as stated by the commenters. Although section 1848 of the Act does outline how physician services will be paid in the typical situation, section 1848 of the Act does not preclude us from setting conditions on physician payment or from deviating from the payment methodology outlined in section 1848 of the Act where a physician or other supplier is seeking to take advantage of a special situation made available to physicians or other suppliers by CMS. Payment pursuant to the terms of section 1848 of the Act is available for all the diagnostic tests in question. Physicians and other suppliers are free not to take advantage of the purchased test option or the reassignment option, and bill and receive payment only for tests they have personally performed. Where physicians and other suppliers choose to take advantage of these options, for purposes of convenience or for other reasons, we have the authority under our general rulemaking authority in sections 1102(a) and 1871(a) of the Act, as well as under our authority to set conditions for the payment of purchased and reassigned tests in section 1842(b)(6) of the Act, to promulgate rules to ensure that these options do not increase the likelihood of Medicare program abuse.</P>
                    <HD SOURCE="HD2">b. Scope of Application of the Anti-Markup Provisions </HD>
                    <P>
                        <E T="03">Comment:</E>
                         One commenter offered alternatives to our proposals. The commenter stated that, at least initially, the anti-markup provisions should apply exclusively to gastroenterology, dermatology, and urology physician group practices because those specialties order a significant number of pathology tests. The commenter suggested that we could subsequently broaden application of the anti-markup provisions to the extent that “new abusive” arrangements develop. Alternatively, according to the commenter, CMS could define the specialties to which the anti-markup provisions would apply on the basis of objective criteria. For example, the anti-markup provisions could apply to group practices billing for pathology services where at least 75 percent of the members are from a single nonpathology specialty and where at least 75 percent of the pathology services billed by the group practice were ordered by members of the group. The commenter asserted that such a definition should cover most of the abusive arrangements that have developed in recent years. The commenter urged us to impose a broad prohibition on profiting from pathology tests, which would apply without regard to whether the histotechnologists are full-time employees or independent contractors of the group practice. According to the commenter, a prohibition on profiting could be accomplished by prohibiting any markup over the direct costs incurred by the group practice in providing such services, and direct costs should be limited to the compensation paid to the persons providing the services and the cost of the equipment and supplies utilized in performing the services. Finally, the commenter suggested the alternative of amending the requirements for “group practices” in § 411.352 to prohibit gastroenterology, dermatology and urology group practices from profiting from Medicare payments for pathology services performed within the group practice. 
                    </P>
                    <P>
                        <E T="03">Response:</E>
                         We decline to adopt any of the approaches suggested by the commenter. The anti-markup provisions in this final rule with comment period apply to group practices (as well as all other suppliers) regardless of specialty. We believe that making the rule applicable to all suppliers ensures fair and equitable treatment among types of suppliers and also ensures that the potential for overutilization is addressed regardless of the particular type of supplier involved. As we discuss in greater detail below, we agree with the commenter that it should not matter whether the person performing the TC is a full-time employee, part-time employee or independent contractor. If the TC (or PC) is purchased, or if it is performed in a place other than the office of the billing supplier, the anti-markup provision will apply, irrespective of the employment status of the person performing the TC (or PC). We are not revising the requirements for “group practices” at § 411.352 at this time. We did not propose to amend 
                        <PRTPAGE P="66310"/>
                        these provisions and believe that such a change would be outside the scope of the proposed rulemaking. 
                    </P>
                    <P>
                        <E T="03">Comment:</E>
                         A commenter suggested that we consider an anti-markup provision that would apply to any group practice where at least 90 percent of the practice is comprised of a single specialty other than pathology that orders the pathology tests billed by the group. The anti-markup rule should prohibit the markup of the direct costs incurred by the group (such as compensation paid to the histotechnologists and pathologists, and equipment and supplies utilized). 
                    </P>
                    <P>
                        <E T="03">Response:</E>
                         We believe that the commenter's suggestion would be cumbersome and difficult to administer, and therefore, we are not persuaded to adopt it. We believe that the anti-markup rules that we have finalized are much more practical and will be an effective deterrent to the ordering of medically unnecessary tests. 
                    </P>
                    <P>
                        <E T="03">Comment:</E>
                         One commenter stated that the anti-markup provisions should apply equally to all physicians, including pathologists. The commenter noted that, in some cases, a pathologist performing the PC purchases the TC from a hospital or another pathology laboratory and bills globally. In addition, the commenter asserted that it is a myth to say that pathologists do not order tests and, therefore, should be exempt from the proposed anti-markup provision applicable to the PC of a diagnostic test. Another commenter stated that there is no more likelihood of abuse in specialty physician-owned pathology laboratories than with pathology groups ordering expensive and unneeded special tests and stains on specimens that they then interpret in the pathology group-owned histology laboratory. 
                    </P>
                    <P>
                        <E T="03">Response:</E>
                         The revisions to § 414.50 and § 424.80 concerning the anti-markup requirements apply equally to all physicians, including pathologists. We recognize that, in some situations, a pathologist may order additional tests to be performed by an outside pathologist. Where a pathologist orders and bills for a test that he or she did not personally perform, the anti-markup provisions may apply to the TC or PC, or both (depending on whether the TC or PC was purchased or, if not, whether the TC or PC was performed in the pathologist's office). If the pathologist did not order the test, the anti-markup rules do not apply. 
                    </P>
                    <P>
                        <E T="03">Comment:</E>
                         One commenter requested clarification that § 414.50 applies only to physicians and medical groups, and not to suppliers, such as medical foundations, that, under State laws governing the corporate practice of medicine, are required to enroll in Part B as a clinic or group practice. The commenter asserted that, in States prohibiting the corporate practice of medicine, many suppliers enrolled as a clinic or group practice are unable to directly employ the radiologist or other physician who performs a test interpretation. 
                    </P>
                    <P>
                        <E T="03">Response:</E>
                         In this final rule with comment period, we are revising § 414.50 to apply to all suppliers. However, the anti-markup provisions do not apply to TCs and PCs that are not purchased and that are performed in the office of the billing physician or other supplier. Therefore, in the commenter's example, if clinic personnel order, for example, the TC and PC, and the TC and PC are performed in the clinic's office, neither the TC nor the PC will be subject to the anti-markup provisions. 
                    </P>
                    <P>
                        <E T="03">Comment:</E>
                         Two commenters asserted that IDTFs operate similarly to independent laboratories in that the tests are ordered by a financially independent physician. The commenters also said that the physician performing the interpretation sees the patient. Therefore, the commenters recommended that we provide an exception to the proposed anti-markup rules for purchased interpretations for imaging suppliers, such as IDTFs, if the current purchased interpretation rules are met. 
                    </P>
                    <P>
                        <E T="03">Response:</E>
                         We are not persuaded to provide an exception to the final anti-markup provisions for purchased interpretations for imaging suppliers if the current purchased interpretation rules are met. We note that, if the interpreting physician sees the patient, the purchased interpretation rules are not fully met. Therefore, the imaging supplier is not satisfying all of the purchased interpretation rules, and the imaging supplier should only bill for the TC portion of the test. 
                    </P>
                    <P>
                        <E T="03">Comment:</E>
                         One commenter requested clarification that the anti-markup proposals do not apply to radiologists who have contractual arrangements with IDTFs. The commenter asserted that radiologists and IDTFs are not in a position to refer to each other or to themselves because both are dependent upon referrals from other physicians in the community. Another commenter asked us to clarify that the anti-markup for the PC will not apply to an IDTF that purchases the PC from the interpreting physician, particularly in States in which the corporate practice of medicine doctrine applies. Another commenter stated that the anti-markup provision for the PC should not be applied to physicians or group practices that bill for the professional services performed by an independent contractor or part-time employee if those services were performed pursuant to the order of another practitioner who is independent of the group, and thus would not profit from his or her referral. 
                    </P>
                    <P>
                        <E T="03">Response:</E>
                         As finalized, the anti-markup provisions are applicable to all types of suppliers. However, in the situation in which an IDTF, radiology practice, or other supplier does not order the diagnostic test, the anti markup provisions do not apply. 
                    </P>
                    <P>
                        <E T="03">Comment:</E>
                         A few commenters questioned whether the proposed anti-markup provision, for the PC of diagnostic tests, would apply to IDTFs that purchase the PC from an interpreting physician, particularly in States where the corporate practice of medicine prohibits an IDTF from hiring the physician as an employee. 
                    </P>
                    <P>
                        <E T="03">Response:</E>
                         The anti-markup rules will not apply to entities that are enrolled as an IDTF where the IDTF does not order the test. If the IDTF orders the test, the anti markup provisions will apply to the same extent that they apply to other suppliers. 
                    </P>
                    <P>
                        <E T="03">Comment:</E>
                         A few commenters urged us to clarify in § 424.80 that the anti-markup provisions apply to reassignments under both the contractual arrangement exception as well as the employee reassignment exception. The commenters also suggested that § 424.80 and § 414.50 should state that the anti-markup provisions are limited to claims submitted by physicians and medical groups and do not apply to claims submitted by independent laboratories. The commenters were concerned that the preamble language on the applicability of the anti-markup provisions to independent laboratories was not carried over and included in the regulatory text in § 424.80 and § 414.50. 
                    </P>
                    <P>
                        <E T="03">Response:</E>
                         We have determined to revise § 414.50, with a cross reference in new § 424.80(d)(3). As finalized, the anti-markup provisions apply to reassignments under both the employee exception and the contractual arrangements exception, to the extent that the services for which payment is reassigned are not performed in the office of the billing physician or other supplier. The anti-markup provisions apply to a billing supplier only if the billing supplier orders the TC. Therefore, if an independent laboratory does not order the TC, the anti-markup provisions will not apply to the laboratory billing of the TC or the PC. 
                    </P>
                    <P>
                        <E T="03">Comment:</E>
                         Two commenters urged us to create an exception for entities that are located off-campus from a hospital 
                        <PRTPAGE P="66311"/>
                        which are jointly owned by radiologists and the hospital and which have an exclusive contract for the provision of professional interpretations to the hospital. According to the commenters, it is important to allow such joint ventures to exist, because the profits generated by the ventures give financial stability to community hospitals that otherwise would be financially impaired as outpatient imaging continues to migrate away from the hospital. In States in which the corporate practice of medicine doctrine exists, the joint ventures do not directly employ the physicians, but rather typically contract with the professional radiology practice to provide the PC. The commenter stated that the radiologists providing the professional reads are neither full-time employees nor exclusively employed by the joint venture imaging center to which they reassign their right to Medicare payment. 
                    </P>
                    <P>
                        <E T="03">Response:</E>
                         We do not believe that it is necessary to create such an exception. The comment is unclear as to which entity, the joint venture imaging center or the hospital, is billing for the service; however, if the imaging center is billing for the PC, the anti-markup provision will not apply if the physician performs the PC in the imaging center's office. If the imaging center, or an entity related to it by common ownership or control, orders the TC, and the physician does not perform the PC in the imaging center's office, the anti-markup provision will apply. 
                    </P>
                    <P>
                        <E T="03">Comment:</E>
                         Some commenters believed that the anti markup provisions should not apply to imaging suppliers that meet the purchased test rules in CMS manuals. 
                    </P>
                    <P>
                        <E T="03">Response:</E>
                         In the CY 2007 PFS proposed rule, we stated that we were considering placing restrictions on the ordering of PCs that would be similar to the purchased interpretation rules in our manuals. After giving the matter considerable thought, we believe that an anti-markup billing provision is necessary to guard against potential overutilization and that it would not be sufficient simply to require that billing entities meet the purchased interpretation rules in our manuals. 
                    </P>
                    <P>
                        <E T="03">Comment:</E>
                         In the proposed rule, we proposed to add new § 424.80(d)(3) to require that, in order to bill for the TC, the billing entity must directly perform the PC of the service. Two commenters asked that we clarify what we meant by “directly perform.” Other commenters recommended that we clarify in § 424.80 the requirement to bill for the TC of a diagnostic test, and clarify in § 414.50 the requirement that a billing entity must directly perform the PC of the service. 
                    </P>
                    <P>
                        <E T="03">Response:</E>
                         We are not finalizing the proposed change to § 424.80(d)(3). We note that the requirement continues to appear in our manuals at CMS Internet-Only Manual, Pub. 100-04, Chapter 1, section 30.2.9. Currently, we are considering whether to retain this requirement in the manuals or to withdraw it. 
                    </P>
                    <P>
                        <E T="03">Comment:</E>
                         One commenter supported generally the establishment of an anti-markup provision on purchased interpretations, but voiced concerns that our proposal to incorporate the billing rules for purchased diagnostic testing services to all reassigned services (unless performed by a full-time employee of the group) could adversely affect the billing practices of pathologists and pathology groups who often depend upon the reassignment rules to bill for services performed by independent contractor and part-time pathologists. Therefore, the commenter requested an exception from our proposed rules for independent laboratories and single-specialty pathology physician groups. 
                    </P>
                    <P>The commenter also asserted that reassignment arrangements between pathology groups do not raise the same threat of abuse because the vast majority of pathology services are initiated by a request for a consultation from a referring physician of another specialty, and the pathologist is not in a position to influence the referrals from ordering physicians. The commenter further stated that a broader exception for single-specialty pathology physician groups and independent laboratories that covers both the TC and PC of a pathology service is supported by the existing physician self-referral law and regulations. The commenter stated that, the “Congress recognized that certain physicians, specifically pathologists, diagnostic radiologists and radiation oncologists, who order certain services pursuant to a consultation with another physician do not have the same risk of abuse and, consequently, will not be treated as having made a restricted referral to an entity with which they have a financial interest.” The commenter urged us, for this same policy reason, to recognize an exception for single-specialty pathology physician groups and independent laboratories that bill for pathology services performed or supervised by another pathologist, whether an independent contractor or full-time or part-time employee. </P>
                    <P>
                        <E T="03">Response:</E>
                         In order to be fair and to avoid the appearance of giving preferential treatment to one physician specialty group over another, the anti-markup provisions on the TC and PC of diagnostic tests are potentially applicable to all physician specialty groups that order tests and wish to bill for the TC or PC, or both, performed by another person or group and billed as a purchased test or billed through a reassignment. (Whether the anti-markup provision for the TC or the anti-markup provision for the PC will, in fact, apply depends on whether the TC or the PC was purchased, or, if not purchased, whether the TC or the PC was performed in the office of the billing physician or other supplier.) Therefore, we are not recognizing an exception for single-specialty pathology physician groups that bill for pathology services performed or supervised by another pathologist, unless the single-specialty pathology physician group does not order the test. If a pathologist in the single-specialty pathology physician group orders and bills for the test performed by another supplier, the anti-markup rules apply. If the pathologist does not order the test and wishes to bill for the test, which is performed by another supplier, the anti-markup rules will not apply. Finally, we note that clinical diagnostic laboratory tests performed by independent laboratories and paid under section 1833(a)(2)(D) of the Act are not subject to the anti-markup provisions pertaining to diagnostic tests.
                    </P>
                    <HD SOURCE="HD3">c. Overutilization</HD>
                    <P>
                        <E T="03">Comment:</E>
                         Many commenters in favor of the proposed rulemaking cited overutilization as a concern in the existing billing and payment environment. Commenters opposed to our proposals denied that contractual arrangements for pathology services lead to overutilization. 
                    </P>
                    <P>
                        In support of their contention that current arrangements facilitate overutilization, some commenters cited various studies for the proposition that physician self-referral leads to increased utilization. For example, one commenter cited 1989 studies from the OIG and GAO that found that physicians who had an ownership or investment interest in a laboratory ordered more tests than those physicians who did not have such an interest. This commenter also noted that an analysis by the Florida Cost Containment Board in 1998 found that physician-owned clinical laboratories, diagnostic imaging centers, physical therapy centers, and rehabilitation centers performed more procedures on a per-patient basis than those facilities that were not physician-owned. The commenter also cited the 2007 study by 
                        <PRTPAGE P="66312"/>
                        the McKinsey Global Institute that found that the United States spends more of its wealth on health care than any other developed country, and that one reason for the difference in spending is due to profit incentives in physician ownership of medical facilities. Other commenters mentioned the 2007 OIG studies of three urology practices, which the commenters described as finding that all three practices substantially increased the number of biopsies ordered per patient after entering into an arrangement for contracted pathology services, and that, after entering into such an arrangement, all three practices billed significantly more biopsies than what their respective carriers paid on average to other suppliers. One commenter cited a study by the Center for Health Policy Studies that examined the effects of State “direct billing” laws. Under such laws, the pathologist or entity performing the ordered pathology services is required to bill for the services. This study found that laboratory charges per enrollee under private health insurance programs were 41 percent higher in non-direct billing States than in direct billing States. Another commenter stated that a study in the American Journal of Roentgenology in 2002 confirmed that physician self-referral may be contributing to the uncontrolled growth in imaging services. According to the commenter, that study reported that, when a managed care organization prohibited certain non-radiologist specialties from billing for imaging services, total billings for imaging declined 20 to 25 percent from the amount of billings that were expected based on the previous trend in imaging growth. 
                    </P>
                    <P>One commenter stated that it is unaware of any evidence of overutilization by gastroenterologists who have entered into contractual arrangements for pathology services. Another commenter stated that its managed “pod labs” are vital to the accurate detection and treatment of prostate cancer and do not expose Medicare to an undue risk of program abuse. The commenter asserted that no data supports the accusation that its managed laboratories facilitate the generation of medically unnecessary biopsies, and in any event, clinical indications for prostate biopsy are not subject to manipulation. </P>
                    <P>Another commenter stated that urological pathology volume is based upon objectively demonstrated medical necessity, and is not affected by profit margin or who is billing for services. This commenter suggested that specific requirements could be placed on contractual arrangements to address overutilization concerns, while preserving the benefits of these types of arrangements. The commenter stated that the best way to ensure that contractual arrangements are maximizing their potential for improving care and outcomes, while discouraging overutilization, is to prohibit arrangements that are merely passive investments of the treating physicians. The commenter asserted that physicians who own off-site pathology laboratories should be actively involved in their direction and supervision, and responsible for the services provided by the laboratory. The commenter offered several specific recommendations, including: (1) If a group practice intends to bill for the TC, it must also perform the PC; (2) consistent with CLIA regulations, a pathologist may not be the medical director of more than five laboratories; and (3) refined credentialing criteria for pathologists. In its comments to the CY 2008 PFS proposed rule, MedPAC stated that it agrees that allowing physicians to purchase or contract for the provision of diagnostic tests and to realize a profit when billing Medicare could lead to overuse of services and higher program costs. </P>
                    <P>One commenter discussed available types of diagnostic tests for prostate cancer and stated that there does not appear to be any added benefit to the patient from receiving a 12-part biopsy series instead of a smaller number. According to the commenter, this method of biopsy results only in increased diagnosis of minimal prostate disease or atypical small acinar proliferations, which leads only to further biopsies and increased medical costs. The commenter stated that the argument of urologists, that 12 biopsies is the standard of care, is shown to be fallacious by the fact that, when members of a particular urology group perform prostate biopsies in local hospitals, they are doing only two-part biopsies. However, another commenter stated that he knows of more than one urologist who routinely submitted two core biopsies for review, but after employing a pathologist, switched to 12 core biopsies. Another commenter stated that patient care improves with contractual arrangements because the test results are timelier and are of higher quality. Faster results, together with the opportunity to collaborate with pathologists, permit urologists to better manage their patients' care. According to the commenter, the number of cores taken for each prostate biopsy is a direct result of the evolving understanding of the nature of prostate cancer, rather than, as some state, the formation of urology specialty laboratory arrangements between urologists and pathologists. One commenter stated that, whereas it understood our concern of overutilization, the current malpractice system creates far more incentive to perform unnecessary tests. </P>
                    <P>Two commenters stated that the incessant complaints of profits being made at the expense of the Medicare program do not serve any purpose. The commenters claimed that, unless a profit can be achieved, no one will perform services needed by Medicare or any other program. The commenters suggested that, regardless of who collects the fees for pathology and laboratory services and makes a profit, whether an individual pathologist, a commercial laboratory, or a physician specialty practice, this should not be a focus of CMS. Rather, CMS should review the standards of care and hold suppliers to those standards. The commenters pointed out that the National Comprehensive Cancer Network developed standards for a patient with early prostate cancer. At first, the standard was only two cores. In the mid 1990s, the standard was increased to six cores, then, with additional research, the standard was increased to ten cores, and, recently, the recommendation was further increased to 12 cores. The research has shown a dramatic increase in prostate cancer detection with increased core sampling. The commenters stated that it is hypocritical that pathologists are claiming overutilization of services by physician specialty groups, when these same pathologists accepted 12 core biopsies without a whisper of discontent. These commenters asserted that overutilization would cease to be an issue if CMS actively pursued those practitioners, including pathologists, who do not follow the accepted and published standards of care. </P>
                    <P>
                        <E T="03">Response:</E>
                         It is difficult to determine whether and the extent to which overutilization is due to, or facilitated by, arrangements that allow the referring physician or group practice to bill for the TC and the PC of diagnostic tests. Our proposals were not predicated upon a belief that there was a correlation between the size of the group practice and the volume of diagnostic tests and the risk of program abuse. We appreciate that, for a particular practice specialty, an increase in biopsies ordered may be due to a change in business arrangements that produces profits for the referring physician or group practice, or it may be due to a change in the standard protocols (or in 
                        <PRTPAGE P="66313"/>
                        the referring physician's or group's perception of the appropriate standard of care). Nevertheless, studies have shown that, in the aggregate, utilization of diagnostic tests increases in the case of physician self-referral. We believe it is appropriate to guard against the potential for overutilization through an anti-markup provision on the TC and PC of diagnostic tests. We decline to use a specific number of prostate biopsies as a trigger point for application of the anti-markup provisions, as we believe the appropriate number of biopsies is largely patient-specific. 
                    </P>
                    <P>
                        <E T="03">Comment:</E>
                         Several commenters stated that contractual arrangements for anatomic pathology testing pose no risk of overutilization because Medicare patients would not be subjected to unnecessary testing due to the invasive nature of test procedures such as colon or prostate biopsies. 
                    </P>
                    <P>
                        <E T="03">Response:</E>
                         We are skeptical that the risk of overutilization for biopsies is appreciably less than that of other types of diagnostic tests. In any event, in enacting the anti-markup provision in section 1842(n)(1) of the Act, the Congress made no exception for biopsies or other minimally invasive tests, and in order to effectuate Congressional intent we are not providing for such an exception.
                    </P>
                    <HD SOURCE="HD1">d. Quality and Patient Access </HD>
                    <P>
                        <E T="03">Comment:</E>
                         Many commenters, both in favor of and against the proposed rulemaking, focused on the issue of the quality of the diagnostic testing, particularly pathology services. 
                    </P>
                    <P>Two commenters stated that the financial incentive inherent in some arrangements can result in physicians selecting laboratories not on the basis of quality but on the potential for profit from these arrangements. One commenter believes that “by reducing pathologists to the status of indentured servants of clinicians who `own' the patients and their biopsies, the autonomy and quality of the pathology services provided is fatally eroded.” According to one commenter, aspects of pathology practice, such as the adequacy of the biopsy, the sampling procedure, the need for deeper or additional sections, the severity of a process, the adequacy of margins, the need for re-excision, the appropriateness of special studies, and the need for outside expert consultation despite increased expense, ultimately are decided based on what provides the maximum economic benefit to the ordering and billing physician. The other commenter stated that a gastroenterology group practice that had been sending its pathology work to his pathology practice ended the relationship because it entered into an arrangement with another pathology group under which the gastroenterology group practice could bill for the TC. The commenter stated that the gastroenterology group said that there was no dissatisfaction with quality or the service of the commenter's work, but rather it was purely a business decision that enabled the gastroenterology group practice to capture additional revenue in an environment of shrinking reimbursement. Another commenter stated that he received a biopsy for review that was performed on a urologist who routinely sent his (the urologist's) patients' biopsies to his (the urologist's) employed pathologist. The commenter stated that what was good enough for the urologist's patients was not good enough for the urologist. </P>
                    <P>One commenter stated that captive pathology arrangements are detrimental to patient care. The commenter stated that a local gastroenterology group was able to locate a pathologist who was desperate for work and who reads the biopsies only once a week. The commenter called the turn-around time of once per week “atrocious.” The commenter claimed that pathologists who are not willing to work for less than fair market value are being put out of work by physicians who are ignorant of the value of quality pathology services and who hire anyone willing to read slides for any price under any condition. Another commenter asserted that, although gastroenterologists claim they get better service from pathologists who allow the gastroenterologists to bill for the pathology services, the “better service” is, in reality, more money for the gastroenterologists. </P>
                    <P>One commenter stated that surgeons and surgical pathologists need to work in close contact with each other, and that the pathologist in a “pod lab” has little or no interaction with surgeons and other clinicians. Hospital-based pathologists meet on a regular basis with surgeons and other clinicians to share insights and perspectives on cases, sometimes with immeasurable patient benefit. The “pod lab” arrangement impacts negatively upon the “pod” pathologist's professional growth. Another commenter suggested that we should be aware that the “current campaign” against so-called “pod labs” is led by a few self-interested private pathologists, some in leadership positions in their national organizations, who wish to monopolize the outpatient biopsy market. The commenter stated that these pathologists are using scare tactics to paint with the same brush any nontraditional pathology arrangement, without regard to any real demonstration of quality problems. The commenter suggested that, instead of focusing on the “straw man” of “pod labs,” we should require all suppliers of pathology services to demonstrate quality of service and appropriateness of utilization in order to end the ongoing abusive pathology practices that are occurring in traditional pathology groups, independent laboratories and academic medical centers. </P>
                    <P>One commenter asserted that the use of contractual arrangements allows specialization by pathologists that otherwise would be seen only in the largest medical centers or reference laboratories. Moreover, the commenter stated that pathologists who work together in contractual arrangements with various groups have the unique opportunity to consult with each other on a regular basis. An entity that manages “pod labs” stated that internal data generated by group practices that refer to their own managed laboratories show a higher positive incidence of prostate cancer now than before they contracted with the commenter. One commenter contended that most gastroenterologists who enter into contractual arrangements with pathology laboratories do so in order to achieve a higher quality of patient care through timely diagnoses and the use of pathology personnel who are experts in gastrointestinal and liver pathology. The commenter expressed certainty that our proposal would have an adverse effect on practice efficiency and the quality of patient care. </P>
                    <P>A commenter stated that large corporate laboratories do not always provide the highest level of care available. According to the commenter, large laboratories have an incentive to hire the cheapest physician labor in order to “churn out” a high volume of services. The commenter argued that the interaction between the urologists in a group practice and a dedicated pathologist in that practice will lead to better outcomes. Another commenter stated that some gastrointestinal group practices have opened their own pathology laboratories because they believed that the pathology reports they received from general laboratory companies were in some ways lacking. A commenter echoed that sentiment, and added that the fact that the pathologist was practicing in its office meant that the group can easily discuss the pathologist's findings with him and even review slides together. </P>
                    <P>
                        One commenter contended that, based on her experience gained from working for large, national laboratories, sections are poorly processed there and, often, 
                        <PRTPAGE P="66314"/>
                        much of the tissue is lost. According to the commenter, extra ribbons are not collected at these laboratories and immunostains often do not contain the area suspicious for carcinoma. There is no communication with the physician's office and usually no clinical information is exchanged. She further asserted that group practices that send tissue samples to large laboratories run the risk that an inexperienced pathologist could be performing the work. The commenter related a personal experience in which biopsies were read at a large national laboratory as showing HGPIN, a precursor to adenocarcinoma. The commenter stated that the slides she reviewed on re-biopsy showed no HGPIN, and, not only was the patient made to worry unnecessarily, but the mistaken biopsy review led to the expense of a re-biopsy and another reading. Another commenter stated that its clients say that it provides better quality services and in a timelier manner than do the national commercial laboratories. According to the commenter, this is because physician practices that send anatomic pathology specimens to large commercial laboratories do not choose the pathologists who interpret the slides and thus do not know the qualifications of the pathologist. 
                    </P>
                    <P>
                        <E T="03">Response</E>
                        : We believe that, everything else being equal, there can be some advantages to a physician or group practice referring to the same pathologist, if the referring physician or group practice chooses the pathologist on the basis of his or her qualifications and experience, and the service that he or she provides. However, we also believe that, where there is a financial reward for choosing a pathologist or other diagnostic specialist based on financial self-interest, there is the potential to disregard, or at least subordinate, quality considerations. This final rule with comment period eliminates the profit incentive in choosing a pathologist or other specialist while preserving the referring physician or group practice's right to continue to use the pathologist or other specialist of its choosing. That is, if a billing group practice currently has a contractual arrangement with a particular histotechnologist and particular pathologist because it believes that the histotechnologist and the pathologist provide superior quality and service, it may continue to refer to them; it only will be prevented from marking up the TC and PC (unless the TC and PC are not purchased and are provided in the office of the group practice). 
                    </P>
                    <P>
                        <E T="03">Comment</E>
                        : Many commenters asserted that there would be no adverse effect on patient access if the proposal was adopted. Other commenters stated that patient care would be significantly disrupted if the proposal was adopted. Specifically, commenters stated that the proposed changes would limit access to multiple urologic services in a local area, namely, radiation therapy, lithotripsy, and many in-office procedures such as thermal ablative procedures for prostate obstruction. These commenters contended that many in-office procedures are never performed in hospitals, and that, if the proposed changes to the reassignment and purchased diagnostic test rules become effective, it would be difficult, if not impossible, to provide these services to Medicare beneficiaries. 
                    </P>
                    <P>
                        <E T="03">Response</E>
                        : We are skeptical that our proposal would cause any patient access problem. There appear to be adequate choices throughout the country for physicians and group practices to obtain timely access to diagnostic testing. No evidence was brought to our attention that a patient access problem previously existed and was somehow alleviated when physicians and group practices began entering into contractual arrangements for the provision of pathology and other diagnostic services. In any event, as noted above, our proposal as finalized does not prohibit physicians and group practices from continuing to use the same diagnostic services that they have been using to date. 
                    </P>
                    <HD SOURCE="HD3">e. Purchased Tests as They Relate to Reassigned Tests </HD>
                    <P>
                        <E T="03">Comment</E>
                        : We received comments stating that physician contractual arrangements with pathologists constitute an attempt to evade the restrictions of the physician self-referral law. Several commenters stated that there is no practical distinction between a purchased service and a reassigned service. One commenter stated that the proposal effectively eliminates the reassignment rules. The commenter argued that, although CMS states that, under section 952 of the Act, it is required to recognize contractual reassignments only to the extent they meet program integrity and other standards determined by the Secretary, the commenter asserts that the Congress surely did not mean that this statutory provision could be administratively repealed by merging it into the already existing purchased diagnostic test rules. Another commenter stated that our proposal appears to be mixing the purchased diagnostic test policies with contractual reassignments, which could result in confusion for the imaging industry. 
                    </P>
                    <P>
                        <E T="03">Response</E>
                        : We are concerned that some current arrangements are not in accord with the spirit or the letter of the anti-markup provision in section 1842(n)(1) of the Act. Section 1842(n)(1)(A) of the Act, which was enacted as part of the Omnibus Budget Reconciliation Act of 1987 (Pub. L. 100-203), provides that, if a diagnostic test described in section 1861(s)(3) of the Act (other than a clinical diagnostic laboratory test) was not performed or supervised by the billing physician and also was not performed or supervised by a physician with whom the billing physician “shares a practice,” Medicare payment is the lower of the costs (net of any discount) charged by the performing supplier to the billing physician, or the performing supplier's reasonable charge (or other applicable limit). We implemented the anti-markup provision of section 1842(n)(1) of the Act by promulgating current § 414.50, “Physician billing for purchased diagnostic tests.” The current version of § 414.50 applies to TCs performed by an “outside supplier,” but that term is undefined. We acknowledge that some have understood § 414.50 as applying only to TCs that are outright purchased, instead of reassigned, but as we indicated in the CY 2007 PFS proposed rule (71 FR 49056), and as some commenters have noted, reassigned tests are functionally the equivalent of purchased tests. When section 1842(n)(1) of the Act was enacted, there was perhaps more of a difference between purchased tests and reassigned tests, but subsequent events have blurred the distinction between tests that are outright purchased and tests for which payment is reassigned. 
                    </P>
                    <P>
                        At the time section 1842(n)(1) of the Act was enacted, reassignments under the contractual arrangement reassignment exception in section 1842(b)(6)(A)(ii) of the Act were permitted only to the extent the work was performed on the premises of the billing supplier. Therefore, at that time, a physician reassigning benefits to another physician was either an employee of the billing supplier or a contractor who was furnishing the services on the premises of the billing supplier. However, in our January 4, 2001 (Phase I) final rule with comment period, we provided that, for purposes of our rules on physician self-referral, an independent contractor physician is a “physician in the group practice,” as defined at § 411.351, during the time the physician is providing care to the group practice's patients “in the group practice's facilities” (66 FR 885 through 
                        <PRTPAGE P="66315"/>
                        886, 955). Further, in that same rulemaking, we provided that a group practice's facilities (again, for purposes of our rules on physician self-referral) can include a “centralized building” (66 FR 888 through 889). As defined at § 411.351, space qualifies as a group practice's “centralized building” if it is leased “24/7” by the group practice, irrespective of the amount of square footage of the space and irrespective of the proximity (or lack thereof) to the group's facilities. Following that rulemaking, a group practice could, in compliance with our rules on physician self-referral, refer patients for designated health services (DHS) (such as diagnostic testing) to an independent contractor physician, and such physician could perform or supervise the performance of diagnostic tests in a centralized building, provided that all requirements of an exception were satisfied. Further, the independent contractor physician arguably satisfied the “on the premises” requirement of section 1842(b)(6)(A)(ii) of the Act and, thus, was permitted to reassign benefits to the group practice for the work performed in the centralized building, because we considered a centralized building to be the group practice's facilities. In any event, in section 952 of the MMA of 2003, the Congress amended section 1842(b)(6)(A)(ii) of the Act to remove the requirement that the services must be performed on the premises of the billing supplier in order to utilize the contractual arrangement exception. Therefore, following the MMA amendment, it is clear that independent contractor physicians who perform or supervise the performance of diagnostic tests in a centralized building may reassign payment for such tests to the group practice that owns or leases the centralized building. 
                    </P>
                    <P>Being mindful of the Congress’ intent to impose an anti-markup on the TC of diagnostic tests that are not performed or supervised by a physician who “shares a practice” with the billing physician, we are amending § 414.50 in this final rule with comment period to provide that TCs that are not performed in the office of the billing physician or other supplier are subject to the anti-markup provision. With respect to a physician organization (such as a group practice), we consider the “office of the billing physician or other supplier” to be medical office space in which the physician organization provides substantially the full range of patient care services that the physician organization provides generally. Therefore, with respect to group practices, we do not consider space to be the “office of the physician or other supplier” if that space does not meet the requirement regarding patient care services in revised § 414.50(a)(2)(iii) (for example, space that is utilized as a “centralized building” for purposes of the exceptions for physician services and in-office ancillary services in § 411.355(a) and (b), respectively, but in which the group practice provides diagnostic testing services only). </P>
                    <P>We believe that, if the TC is performed by an employee (full-time or part-time), or by an independent contractor who reassigns benefits, in the office of the billing physician or other supplier, a sufficient nexus with the practice of the billing supplier is established. (In this regard, we note that, if the TC is performed by someone other than an employee or a contractor who reassigns benefits, that is, someone who sells the test to the billing physician or other supplier, the anti-markup provision will apply regardless of where the service is performed.) Further, we see no reason to distinguish between the TC and the PC of diagnostic tests for purposes of the anti-markup provisions. Although the Congress did not establish an anti-markup provision in section 1842(n)(1) of the Act or elsewhere for the PC of diagnostic tests, the omission may have been inadvertent. That is, it is not immediately clear why the Congress, if it wished to prevent overutilization of diagnostic testing, would not have desired an anti-markup on the PC, because without such a provision, the incentive to order unnecessary tests (and profit on the PC) remains. We believe that, in order to fully effectuate the Congress’ intent to prevent or limit the ordering of unnecessary diagnostic tests, it is necessary to impose an anti-markup provision on the PC of diagnostic tests. Accordingly, our revisions to § 414.50 apply to PCs to the same extent as they apply to TCs. </P>
                    <P>We see no reason to distinguish between physicians and physician group practices on the one hand, and other types of suppliers on the other hand, that bill for diagnostic tests. In the proposed rule, we used the terminology “physician or medical group,” which we borrowed from the existing manual provisions on purchased tests and purchased test interpretations. However, the term “medical group” is not defined and is not commonly used elsewhere. We are amending § 414.50 so that it applies to a billing “physician or other supplier.” Any enrolled supplier that bills for a diagnostic test or its interpretation is potentially subject to the anti-markup provisions in § 414.50. </P>
                    <HD SOURCE="HD3">f. Definition of “Entity” </HD>
                    <P>
                        <E T="03">Comment:</E>
                         One commenter stated that, although we proposed to expand the purchased diagnostic test rule in § 414.50 to apply also to the purchased PC of a diagnostic test, it was not entirely clear whether we proposed to expand the scope of the exception in the definition of “entity” at § 411.351 for purposes of our rules on physician self-referral. The commenter noted that the definition of “entity” at § 411.351 provides that a physician's practice is not acting as an “entity” when it bills Medicare for “a diagnostic test in accordance with § 414.50.” The commenter contended that the phrase “diagnostic test” is currently interpreted to mean only the TC, in part because § 414.50 currently applies only to the TC. The commenter also stated that if the scope of § 414.50 is expanded to cover both the TC and the PC, one could interpret the phrase in § 411.351, “diagnostic test in accordance with § 414.50,” to mean that a physician practice is not an entity when it bills Medicare for either the TC or the PC in accordance with § 414.50. The commenter suggested that, if we finalize our proposal to apply an anti-markup provision to purchased TCs and PCs, we should revise the definition of “entity” at § 411.351 to clarify that the exception for purchased diagnostic tests applies to both the TC and the PC. Another commenter also supported changing the definition of “entity” at § 411.351 to except from that definition a supplier that is billing for the PC in accordance with the anti-markup provisions of § 414.50. 
                    </P>
                    <P>
                        <E T="03">Response:</E>
                         Under our physician self-referral rules in part 411, subpart J of this chapter, a physician may not refer a patient for certain designated health services (DHS) to an entity with which the physician (or an immediate family member) has a financial relationship, and the entity may not bill Medicare for such DHS, unless an exception applies. The definition of “entity” at § 411.351 “does not include a physician's practice when it bills Medicare for a diagnostic test in accordance with § 414.50.” The rationale for excluding from the definition of “entity,” and hence from the application of our physician self-referral rules, a physician practice that is billing for a TC that is subject to the anti-markup provision, is that there is no risk of overutilization arising from a financial relationship between the referring physician and the physician's practice billing for the service. We believe the same rationale should apply to PCs made subject to an anti-markup provision under this final rule with 
                        <PRTPAGE P="66316"/>
                        comment period. We are amending slightly the definition of “entity” at § 411.351 to make clear that the exclusion applies to both TCs and PCs. As amended, the pertinent language reads “does not include a physician's practice when it bills Medicare for the TC or the PC of a diagnostic test for which the anti-markup provision is applicable in accordance with § 414.50.” 
                    </P>
                    <P>We note that, under our physician self-referral rules, an independent contractor physician is a “physician in the group” for purposes of the physician services exception in § 411.355(a) and the in-office ancillary services exception in § 411.355(b), only with respect to services performed on the group's premises (including a “centralized building” as defined at § 411.351). Therefore, one practical effect of the change in the definition of “entity” is that a group practice that currently may not bill for a PC performed by an independent contractor physician, because the independent contractor physician is not performing the PC on the group's premises, will be able to do so without running afoul of the physician self-referral rules if the PC is billed in accordance with the anti-markup provisions of this final rule with comment period. </P>
                    <HD SOURCE="HD3">g. Employment Status </HD>
                    <P>
                        <E T="03">Comment:</E>
                         A commenter that supported our proposed changes to the reassignment rules pertaining to diagnostic tests stated that it was appropriate for CMS to focus on the billing of diagnostic tests performed by someone other than a full-time employee. The vast majority of commenters that addressed the employment status issue, however, opposed applying the anti-markup provisions to part-time employees and independent contractors based simply on their employment status. Three commenters asserted that the proposed changes are unnecessary and would negatively impact the way physicians provide care to patients, possibly resulting in the termination of part-time physicians or a prohibition on part-time physicians furnishing diagnostic tests. Many commenters claimed that, if the proposed changes to the purchased diagnostic test rules are implemented, physicians and group practices would not be able to provide certain routine medical procedures if limited to using full-time employees. One commenter requested that we exempt part-time employees and independent contractors from the anti-markup rules provided that the billing supplier satisfies a physician self-referral exception and the services are furnished in the billing supplier's office. A few commenters proposed that CMS not apply the anti-markup requirements to technicians who work on-site at the medical group and who work at least half-time for that specific group. 
                    </P>
                    <P>One commenter stated that limiting reimbursement for the PC of diagnostic tests performed by outside suppliers would create an incentive to hire full-time staff and then overutilize pathology services in an attempt to recoup the costs of such personnel. The commenter urged us not to penalize physician groups by having the anti-markup rules apply when using part-time employees or independent contractors who furnish services on less than a full-time basis. Two commenters considered our proposal to be premised on the unsupported belief that group practices that perform a lower volume of diagnostic tests and, therefore, need only employ pathologists on a part-time basis, present more risk of program abuse. Another commenter stated that forcing suppliers and their staff into full-time relationships will impose needless costs and will require forgoing efficiencies that are available through more flexible supplier-staff relationships. Several commenters believed that applying an anti-markup provision based upon the employment status of the technician or physician would unfairly disadvantage individuals who want to work only part-time (for example, mothers of young children). One of these commenters stated that we essentially placed a hurdle in front of group practices that wish to accommodate the professional and personal needs of its employees, and that, given the shortage of qualified health professionals in many areas, we should be making it easier, and not more difficult, for professionals to provide care. </P>
                    <P>
                        <E T="03">Response:</E>
                         We agree that it is not necessary or advisable to premise the application of the anti-markup provisions on the employment status of the person performing the TC or PC. We are revising the language in § 414.50 to clarify that an outside supplier is someone who is not an employee of the billing physician or other supplier and who does not furnish the test or interpretation to the billing supplier under a reassignment that meets the requirements of § 424.80. Therefore, diagnostic testing services furnished by part-time employees and independent contractors in the office of the billing supplier will not be subject to the anti-markup rules, unless the services of the independent contractor are billed as a purchased diagnostic test. 
                    </P>
                    <P>
                        <E T="03">Comment:</E>
                         One commenter stated that the anti-markup provisions should apply only when the diagnostic service is provided in a centralized building outside of the physician's primary office site where he or she provides his or her professional services, and should not apply based on the employment status of the individual performing the TC. 
                    </P>
                    <P>
                        <E T="03">Response:</E>
                         We agree generally and have revised § 414.50 and § 424.80 to specify that the anti-markup rules apply to purchased tests and interpretations (regardless of site of service) and to TCs and PCs performed at a site other than the office of the billing supplier. With respect to physician group practices, the group's “office” is the medical office space in which the physician organization provides substantially the full range of patient care services that the physician organization provides generally. The group's office does not include space utilized by the group as a “centralized building” (or other space) where only (or primarily) diagnostic testing is performed by radiologists or pathologists. 
                    </P>
                    <P>
                        <E T="03">Comment:</E>
                         One commenter found the proposed definition of an outside supplier as someone other than a full-time employee of the billing physician or medical group to be confusing and inconsistent with the definitions at § 411.351. Thus, the commenter recommended replacing the term “full-time employee of the billing physician or medical group” with the defined term “member of the group or member of a group practice.” 
                    </P>
                    <P>
                        <E T="03">Response:</E>
                         In the CY 2007 PFS proposed rule (71 FR 49054), we proposed that TCs and PCs that are reassigned under the contractual arrangements exception in section 1842(b)(6)(A)(ii) of the Act would be subject to an anti-markup provision. We received comments expressing concern that our proposals would be ineffective to the extent that contractors who performed TCs and PCs for multiple group practices would now become part-time employees of the same group practices. In response, in the CY 2008 PFS proposed rule, we proposed that the anti-markup provisions would apply to reassigned TCs and PCs that are not performed by full-time employees. However, we believe we can guard adequately against potential overutilization by imposing an anti-markup provision on purchased PCs and TCs, and, with respect to non-purchased TCs and PCs, imposing an anti-markup provision on the TCs and PCs that are performed outside of the office of the billing physician or other supplier, without regard to the employment status of the person 
                        <PRTPAGE P="66317"/>
                        performing the TC or PC, thus leaving intact the part-time employment arrangements that have traditionally existed. Therefore, we believe it is unnecessary and inadvisable to adopt the commenter's suggestion. 
                    </P>
                    <P>
                        <E T="03">Comment:</E>
                         Several commenters requested that we clarify what is meant by a “full-time employee.” They urged us to use the Department of Labor's Bureau of Labor Statistics standard, which is 35 hours per week. 
                    </P>
                    <P>
                        <E T="03">Response:</E>
                         For the reasons stated above, we do not believe it is necessary to define “full-time employee.” 
                    </P>
                    <P>
                        <E T="03">Comment:</E>
                         Several commenters suggested that we exempt TCs and PCs furnished by part-time employees of the billing supplier from the anti-markup provisions, provided that the employees are working exclusively for one billing supplier, such as a single health care organization. Other commenters suggested that, instead of providing that the anti-markup provisions would apply to the TCs and PCs performed by part-time employees, we apply an anti-markup provision to work performed by employees who work for more than a certain number of physician practices. 
                    </P>
                    <P>
                        <E T="03">Response:</E>
                         We considered creating an exception from the anti-markup provisions for services provided by part-time employees who work exclusively for one billing supplier. We also considered restricting the application of the anti-markup provision to work performed by employees who work for more than a certain number of physicians' practices. We rejected both approaches as unnecessary given our decision to base the application of the anti-markup primarily on the site of service, as well as because we believe that each approach would add undue complexity to the rule and would be difficult for both billing suppliers and for us to administer. We will monitor the effectiveness of our site-of-service approach in addressing our concerns regarding potential overutilization. If arrangements that currently are taking place at a site other than the office of the billing physician or other supplier simply migrate to the “office of the billing physician or other supplier” in order to escape the application of the anti-markup provisions, we may revisit the idea of imposing an anti-markup provision for services performed by a technician or physician who works for more than a certain number of physician practices. 
                    </P>
                    <HD SOURCE="HD3">h. Deductibles and Coinsurance </HD>
                    <P>
                        <E T="03">Comment:</E>
                         Several commenters observed that there appeared to be a drafting error regarding the application of deductibles and coinsurance to the anti-markup limits in proposed § 414.50 and § 424.80. In both sections, the maximum payment is set as an amount that is net of deductibles and coinsurance, that is, “less the applicable deductibles and coinsurance.” The commenters noted that the price limitation should represent the Medicare allowable amount, which should include any coinsurance or deductibles to be paid by the Medicare beneficiary. One of the commenters stated that the current language could be interpreted such that the combined Medicare and beneficiary payment to the physician could exceed the amount that a physician paid an outside supplier of a TC or PC by 20 percent, the applicable coinsurance for PFS services. The commenter recommended that the language be revised to read “the payment to the billing physician or medical group, 
                        <E T="03">including applicable deductibles and coinsurance,</E>
                         may not exceed the lowest of the following amounts.” 
                    </P>
                    <P>
                        <E T="03">Response:</E>
                         Proposed § 414.50 and proposed § 424.80 stated that, payment to the billing supplier, “less the applicable deductibles and coinsurance” may not exceed the lowest of the following amounts: (1) The supplier's net charge to the physician; (2) the physician's actual charge; or (3) the fee schedule amount for the test that would be allowed if the supplier billed directly. The quoted language referenced above is identical to that in current § 414.50 and is virtually identical to that in section 1842(n)(1) of the Act. We read the statute and regulations as saying that the contractor's payment to the billing supplier, in the situation in which the anti-markup provision applies, is the lowest of the performing supplier's net charge, or the billing supplier's actual charge, or the applicable fee schedule amount, 
                        <E T="03">less</E>
                         any applicable deductible and coinsurance amounts. 
                    </P>
                    <P>
                        We agree with the commenters that the 
                        <E T="03">total</E>
                         payment (that is, by the contractor and the beneficiary or third party payor on behalf of the beneficiary) is limited to the lowest of the three amounts specified above. This interpretation represents historical Medicare policy, and we believe that this policy has been implemented correctly by the carriers. However, we are refining the language of the regulation as suggested by the commenter for greater clarity. We do not consider this a substantive change. We are revising § 414.50 to read “the payment to the billing physician or other supplier (
                        <E T="03">including applicable deductibles and coinsurance paid by the beneficiary or on behalf of the beneficiary</E>
                        ) for the technical or professional component of the test may not exceed the lowest of the following amounts * * *” 
                    </P>
                    <HD SOURCE="HD3">i. Net Charge </HD>
                    <P>
                        <E T="03">Comment:</E>
                         Several commenters addressed the question of how to determine the net charge for purposes of applying the anti-markup provisions. Commenters asserted that most physicians are paid an aggregate monthly or annual amount for their services and therefore there is no “charge” to report on a claim. One commenter stated that independent contractors are frequently paid based on time spent furnishing the services, as opposed to a per-interpretation price. Alternatively, payment may be made at a fixed rate per month or year. Yet another model is a per-service price reflecting a blended rate of different payor pricing, not just the Medicare allowable amount. Employees, including part-time employees, are often salaried. Consequently, according to the commenter, there is no cost or charge per professional interpretation, and it would be impossible for a group practice to determine the unit price for purposes of the anti-markup provision. The commenter contended that all of the various types of employment relationships would have to be restructured, at great cost and administrative burden, to practices. 
                    </P>
                    <P>One commenter stated that it would not be administratively feasible to determine the net charge per test in order to apply the anti-markup provisions to part-time employees or independent contractors who are paid on an hourly basis or a per-diem rate. Other commenters complained that the proposed rules do not address how the billing entity is supposed to determine the net charge per service on the claim. According to these commenters, it causes confusion as well as the risk of false claims liability to require physician practices to include a charge for all diagnostic test services. Another commenter pointed to what it saw as difficulties in allocating charges between the TC and the PC when a billing supplier purchases both the TC and the PC. </P>
                    <P>
                        A few commenters urged us to provide guidance on how to determine the “net charge” for a service. One commenter requested that we clearly state that the billing entity must calculate its net unit price, which may reflect payments divided by the number of slides referred; for example, if the billing entity pays a supplier a set amount per month or per year to prepare and read all the slides that were 
                        <PRTPAGE P="66318"/>
                        referred. One commenter stated that it agreed with the proposed approach of not allowing the net charge to reflect the cost incurred by the performing supplier of leasing equipment or space from the billing supplier. The commenter expressed concern, however, that participants in some joint venture laboratories may inappropriately attempt to inflate the acquisition cost of the service, and suggested that we not permit other related costs, such as separately purchased or leased equipment, supplies, insurance, etc., to be included when determining the amount charged by the person performing the TC or PC. If these costs were included, it would have the effect of raising the net charge, and permit the billing suppliers to charge Medicare a higher price. 
                    </P>
                    <P>
                        <E T="03">Response:</E>
                         We are leaving the responsibility for determining the net charge for a test with the billing supplier. The anti-markup provision imposed on the PC through this final rule with comment period is similar to the longstanding provision for prohibiting a markup on the TC. Thus, we do not believe most suppliers will experience significant difficulty in calculating the net charge, despite the fact that some physicians are paid an aggregate monthly or annual amount for their services. Suppliers that incur difficulty in calculating the net charge may structure arrangements so that the anti-markup provisions do not apply (for example, by ensuring that tests and interpretations are not purchased and are performed in the office of the billing physician or other supplier), may allow the performing supplier to bill for the TC or PC, or may use a payment method (such as per-procedure) that yields an easily ascertainable net charge. Suppliers must calculate the net charge in a reasonable manner. This final rule with comment period does not prevent suppliers from using any particular method that yields an accurate net charge. For example, in some situations, it may be appropriate to divide a technician's weekly compensation by the number of procedures performed to arrive at the net charge for each procedure performed during that week. Because suppliers would have the burden of establishing that the charge billed was the net charge, suppliers should retain contemporaneous documentation of the methodology and information used to calculate the net charge. 
                    </P>
                    <P>We are not adopting at this time the commenter's suggestion that, to guard against parties artificially inflating the cost of the TC or PC, we specifically prohibit the performing supplier to take into account, when calculating its net charge, the costs of equipment or services (such as insurance), obtained from the billing supplier. However, we note that, to the extent that a billing supplier would sell goods or services at an inflated price so as to game the application of the anti-markup provisions, such excess compensation may constitute a violation of our rules on physician self-referral and may also be a violation of the anti-kickback statute (section 1128B(b) of the Act). We will monitor financial relationships between billing and performing suppliers and, if it appears that parties are attempting to evade application of the anti-markup provisions through the sale of goods and services, we may modify the provisions. </P>
                    <P>
                        <E T="03">Comment:</E>
                         One commenter expressed concern about expanding the anti-markup provision to cover the PC, noting that, because a per-interpretation price is not the most efficient method of compensation for purchased PCs, practices would likely develop a system of compensation that would pay the reading physician differently depending on the patient's payor. For example, practices might pay the reading physician on a salary basis for reads for patients of private and non-Medicare payors and on a per-read basis for Medicare patients. According to the commenter, this could result in lower costs associated with non-Medicare patients than with Medicare patients, depending on the way in which the physician and the practice negotiate payment for the different groups of patients. The commenter questioned whether it is appropriate to charge Medicare more on a per-procedure basis than other payors. 
                    </P>
                    <P>
                        <E T="03">Response:</E>
                         Nothing in this final rule with comment period requires practices to pay for professional services for Medicare patients on a per-procedure basis or using any particular payment method. What is important is that the practice calculates an accurate net charge for purposes of these regulations. In reviewing the accuracy of the net charges of a practice that pays differently for professional services based on the payor status of the patients, we would look to see whether the use of different payment structures results in inappropriate shifting of costs to Medicare (that is, by paying physicians more for Medicare reads than non-Medicare reads, the practice is able to collect more reimbursement under the anti-markup provisions). Moreover, we note that section 1128(b)(6)(A) of the Act provides for the permissive exclusion of providers or suppliers that submit bills or requests for payment based on charges or costs to Medicare that are substantially in excess of the party's usual charges or costs, absent a finding of good cause for the differential. Responsibility for that statute is delegated to the OIG. 
                    </P>
                    <P>
                        <E T="03">Comment:</E>
                         One commenter questioned whether the anti-markup provisions would apply to diagnostic tests performed through block lease arrangements. This commenter (and another commenter) also stated that it would be difficult to calculate the per-test charge on tests performed in block lease arrangements. 
                    </P>
                    <P>
                        <E T="03">Response:</E>
                         The anti-markup rules do apply to diagnostic tests performed through block lease arrangements, and the burden is on the billing entity to determine how to calculate its net charge per test. 
                    </P>
                    <P>
                        <E T="03">Comment:</E>
                         Several commenters urged us to ensure that the calculation of the payment level under the anti-markup rules will not impose new administrative burdens on the billing supplier. A few commenters stated that the billing supplier should be able to mark up the PC between 7 and 10 percent to cover the costs of billing. A few commenters asserted that the proposed anti-markup provisions will adversely affect group practices that wish to bill globally for interpretations performed by teleradiologists located outside of the billing group practice's office. The commenters were concerned that billing physicians or other suppliers would not be able to include administrative expenses in the price paid for the interpretation. One commenter stated that, by limiting reimbursement to a practice's actual acquisition cost, we are ignoring the role of the RBRVS system to appropriately establish a proper payment amount for services. 
                    </P>
                    <P>
                        <E T="03">Response:</E>
                         Where the anti-markup provisions are applicable, the billing supplier will be responsible for calculating the net charge. Suppliers that do not wish to contend with calculating the net charge will have to structure arrangements so that the anti-markup provisions do not apply (for example, by requiring the suppliers performing the TC and PC to bill for them, or by ensuring that the TC and PC are performed in the office of the billing physician or other supplier), or utilize a per-procedure method of payment or other method that yields an easily ascertainable net charge. Similarly, suppliers that do not wish to incur the cost of billing without being able to mark up the TC or PC, should structure arrangements so that the anti-markup provisions do not apply. 
                        <PRTPAGE P="66319"/>
                    </P>
                    <P>
                        <E T="03">Comment:</E>
                         One commenter contended that, in a medical foundation context, there is no way to determine the net charge to the foundation for the services of the interpreting physician. The commenter stated that the anti-markup proposal would result in the need to generate artificial invoices, greatly complicating and needlessly burdening medical foundations. 
                    </P>
                    <P>
                        <E T="03">Response:</E>
                         A medical foundation, or any other medical group practice, billing for the TC or PC of a diagnostic test that it did not perform will need to calculate its own net charge per test. We perceive no need to generate artificial invoices. The purpose of this requirement is to address potential program abuse where physicians and other suppliers order tests and bill for tests that they did not perform at a markup from the price paid for the test. 
                    </P>
                    <P>
                        <E T="03">Comment:</E>
                         Several commenters inquired how we would be able to verify the true cost of purchasing a TC or PC of a diagnostic test. The commenters questioned our rationale for this proposal and asserted that the proposal would be detrimental because it would have the effect of precluding suppliers from recouping overhead costs. The commenters voiced concerns that we are trying to eliminate purchased diagnostic tests entirely. 
                    </P>
                    <P>
                        <E T="03">Response:</E>
                         We can verify the true cost of a purchased TC or PC by requesting supporting documentation from the provider or supplier. The burden of proof in substantiating the validity of a claim rests with the billing provider or supplier. The anti-markup provisions finalized in this rule are not designed to prevent the billing supplier from recovering overhead expenses or to eliminate purchased diagnostic tests entirely, but rather to minimize program and patient abuse. Where the TC or PC is performed in the office of the billing physician or other supplier, the billing supplier will be able to recoup some or all of the overhead it incurs in the performance of the TC or PC by billing at the fee schedule amount (or at the Medicare limiting charge amount). If, however, the billing supplier has incurred overhead expenses for a TC or PC that was performed at a site other than the office of the billing supplier (such as in space leased by a billing group practice and utilized by the group practice as a “centralized building” that does not meet the definition of “office of the billing physician or other supplier” at § 414.50(a)(2)(iii)), the billing supplier will not be able to recoup the overhead, but rather will be limited to the lowest of the performing supplier's net charge, the billing supplier's actual charge, or the applicable fee schedule amount. (In the unlikely event that the lowest of the three amounts is either the billing supplier's actual charge or the applicable fee schedule amount, the billing supplier may be able to recoup its overhead but nevertheless would be receiving less payment than the performing supplier's net charge.) We believe that this result is appropriate. If billing suppliers were able to recoup overhead incurred for TCs and PCs that are performed at sites other than their offices, the effectiveness of the anti-markup provisions would be undermined, because there would be an incentive to overutilize to recover the overhead incurred for purchasing or leasing space. 
                    </P>
                    <P>
                        <E T="03">Comment:</E>
                         One commenter recommended that we require, as a condition for reassignment of a purchased interpretation, that the parties to the arrangement calculate a net charge for the service. The commenter stated that, if this condition applied, per-diem or other time-based arrangements, which are more susceptible to markups, would not be permitted. 
                    </P>
                    <P>
                        <E T="03">Response:</E>
                         We realize that, in most circumstances, a group practice would not want to pay an independent contractor more for a service than the payment it receives from an insurer for furnishing the service. However, we are under the impression that some physician group practices that have exclusive contracts with hospitals under which the group practice furnishes all PCs of inpatient and outpatient radiology services often hire independent contractors to provide PCs that are needed at night or on weekends. We have been informed that, in some of these cases, the group practice willingly pays its independent contractors more for their services than the group practice receives in reimbursement so that the group practice physicians do not have to provide services late at night. There may also be other reasons (for example, as an improper inducement for referrals) why parties could agree to an amount that does not accurately reflect the true net charge. 
                    </P>
                    <P>As explained above, we believe that a group practice may pay an independent contractor on a per-diem or hourly basis, and also arrive at an appropriate amount to bill Medicare for each service based on the number and differing work intensities of the services provided. </P>
                    <P>
                        <E T="03">Comment:</E>
                         One commenter recommended that we prohibit any mark-up over the direct costs incurred by the group practice in providing diagnostic testing services. Direct costs would be defined as limited to the compensation paid to the persons providing the services and the cost of equipment and supplies utilized in performing the services. One commenter asserted that the proposed restrictions would not allow a billing practice to be paid for its legitimate overhead costs. Two commenters requested that we permit employers to include in the calculation of a supplier's net charge the lower of the following: (1) A reasonable practice expense (PE) derived from its own relative value cost; or (2) the actual overhead costs attributable to the supplier. The commenters suggested that this would permit a group to utilize part-time diagnostic physicians without financially penalizing the employer, and at the same time safeguard against artificially inflated overhead costs. 
                    </P>
                    <P>
                        <E T="03">Response:</E>
                         In effect, the commenters requested that we adopt a “net charge plus” approach. In order for the anti-markup provisions to have real effect, it is necessary that payment by Medicare be limited to the lowest of: (1) The physician's or other supplier's net charge to the billing supplier; (2) the billing supplier's actual charge; or (3) the fee schedule amount for the service that would be allowed if the physician or other supplier billed directly. If we were to allow billing suppliers to include costs in addition to the performing supplier's net charge, we would defeat the purpose of the anti-markup provisions. 
                    </P>
                    <P>
                        <E T="03">Comment:</E>
                         A few commenters requested that we ensure consistency in the language in § 414.50 and § 424.80. For example, proposed § 414.50(a)(3)(i) states that net charge does not include “any charge that is intended to reflect the cost of equipment or space leased to the outside supplier,” whereas § 424.80 states that it does not include “any charge that is intended to cover or address the cost of this equipment.” 
                    </P>
                    <P>
                        <E T="03">Response:</E>
                         As noted above, we have effectuated the anti-markup provisions by revising § 414.50, and by placing a cross reference to that section in new § 424.80(d)(3). The language of proposed § 414.50(a)(3)(i), “reflect the cost of equipment or space leased” survives. 
                    </P>
                    <P>
                        <E T="03">Comment:</E>
                         One commenter recommended that we include in the net charge the costs incurred by the purchasing supplier to facilitate test interpretations, specifically, the cost of teleradiography to transmit images to the interpreting physician and the cost of producing a written report of the interpretation. 
                    </P>
                    <P>
                        <E T="03">Response:</E>
                         To the extent that costs such as those noted by the commenter are incurred by the billing supplier, as opposed to the performing supplier, we are not persuaded to permit the inflation 
                        <PRTPAGE P="66320"/>
                        of the net charge to include such costs. As discussed above with respect to the recoupment of overhead costs, we believe that allowing billing suppliers to recoup the costs suggested by the commenter would defeat the purpose of the anti-markup provisions.
                    </P>
                    <HD SOURCE="HD3">i. Miscellaneous </HD>
                    <P>
                        <E T="03">Comment:</E>
                         One commenter suggested that, as an alternative to an anti-markup provision, we prescribe a fixed dollar amount (for example, based on a percentage of what Medicare would pay for the PC if billed directly), as a ceiling for Medicare payment. The ceiling would be adjusted for certain PEs such as 
                        <E T="03">bona fide</E>
                         collection costs and bad debt. 
                    </P>
                    <P>
                        <E T="03">Response:</E>
                         We believe that setting a fixed dollar amount for diagnostic tests and interpretations performed under particular circumstances is problematic. There would be difficulties in determining what the fixed dollar amount should be, and what, if any, PEs should be taken into consideration to augment the fixed dollar amount. In addition, we did not propose such an approach, and believe it may be outside the logical outgrowth test for issuing final rules to adopt the commenter's approach in this final rule with comment period. Moreover, even if we were able to adopt such an approach without first specifically proposing one, it would take us considerable time to study the feasibility of prescribing a payment ceiling for TCs and PCs under particular circumstances, and we believe that it is important to issue a final rulemaking on this subject without further delay in order to address our current concerns with potential overutilization. 
                    </P>
                    <P>
                        <E T="03">Comment:</E>
                         Two commenters stated that, in addition to restrictions contained in the proposed rule, we should also require that: (1) A pathologist not be allowed to work for more than one physician group practice; (2) a pathologist not be allowed to work for, or have any arrangement with, independent reference laboratories; and (3) medical liability insurance for the pathologist should be paid by the physician group practice billing for the pathologist's services. (The commenters explained that the purpose of the second proposed requirement is to eliminate the possibility that a reference laboratory could provide a pathologist to a physician group practice in return for receiving the right to bill for the TC.) One of the commenters was also concerned that, if a single pathologist is performing work for the billing physician practice, appropriate or optimal quality assurance will not take place. The commenter stated that, in her pathology group practice, all malignancies are reviewed by at least two pathologists. 
                    </P>
                    <P>
                        <E T="03">Response:</E>
                         With respect to the commenters” first suggested requirement, we proposed that an anti-markup provision would apply to PCs that are reassigned by someone who is not a full-time employee of the supplier billing for the PC, because we were concerned with the potential for overutilization where a single physician performs interpretations for more than one group practice in contiguous centralized buildings (such as in “pod” or “condo” laboratories). Specifically, we were concerned that a physician who formerly reassigned benefits under the contractual arrangements reassignment exception could simply be made a part-time employee of a number of group practices. As noted above, in response to public comments, we are not imposing an anti-markup on the PC of a diagnostic test simply because the PC was performed by someone other than a full-time employee of the billing supplier. Rather, we are addressing our concerns regarding potential overutilization by imposing an anti-markup on the PC of a diagnostic test if it is purchased or if it is not performed in the office of the billing physician or other supplier. We believe our decision to impose an anti-markup provision on PCs that are ordered by the billing supplier and performed at a site other than the office of the billing supplier (for example, in space that the billing supplier utilizes as a “centralized building” but that does not meet the definition of “office of the billing physician or other supplier” in revised § 414.50(a)(2)(iii)), regardless of the employment status of the physician, will adequately address our concerns with overutilization. As for the other two proposed requirements and the second commenter's implied proposed requirement, we do not believe it is within the scope of this rule to attempt to restrict a pathologist from working for more than one supplier, or to require a group practice to pay for a pathologist's malpractice premiums, or to impose quality standards for pathologist performed PCs. 
                    </P>
                    <P>
                        <E T="03">Comment:</E>
                         A commenter recommended that we revise the definition of “centralized building” at § 411.351 to include the following language: “In the case of a space used for the performance of the [TC] of a diagnostic test, which is billed by a group practice, such space can qualify as a centralized building only if the group complies with the requirements of § 414.50 or § 424.80(d)(3) when billing for the [TC].” The commenter also suggested that, by changing the definition of “centralized building,” a physician or medical group would be prohibited from marking up what it paid for the TC of a test that was performed in a centralized building, unless it was performed by a full-time employee. 
                    </P>
                    <P>
                        <E T="03">Response:</E>
                         We are not revising the definition of “centralized building” in this rule. Because the anti-markup provisions will apply to all TCs and PCs that are both: (1) Ordered by a group practice (or an entity related to the group practice by common ownership or control; 
                        <E T="03">see</E>
                         § 413.17 regarding “common ownership or control”); and (2) performed at a site other than the office of the physician or other supplier, it is not necessary at this time to narrow the definition of a “centralized building” in order to guard against potential overutilization. 
                    </P>
                    <P>
                        <E T="03">Comment:</E>
                         One commenter expressed concern regarding physicians who have invested heavily in in-office equipment and have followed CMS guidelines established for the in-office ancillary services exception in § 411.355(b) for purposes of the physician self-referral rules. The commenter recommended that we regulate the usage of ancillary services through medical necessity guidelines and by requiring that the services be provided at fair market value, rather than by the proposed changes to the reassignment and purchased test rules. 
                    </P>
                    <P>
                        <E T="03">Response:</E>
                         As finalized, the anti-markup provisions do not apply to non-purchased TCs and PCs performed in the office of the billing physician or other supplier. We note that in the CY 2008 PFS proposed rule, we sought comments as to whether we should narrow the in-office ancillary services exception, including whether we should exclude certain types of services from the protection of the exception. We received many comments on this issue, and if we are inclined to make any changes to the in-office ancillary services exception we will first propose such changes in a notice of proposed rulemaking. 
                    </P>
                    <P>
                        <E T="03">Comment:</E>
                         One commenter urged us to require that imaging technology be provided only by physicians trained in modality-specific interpretation of imaging procedures who follow the guidelines of specialty organizations such as the American College of Cardiology and the American Society of Echocardiography. In addition, the commenter supported the accreditation of facilities that provide such imaging services, provided that we allow adequate time for practices to become accredited by relevant organizations that 
                        <PRTPAGE P="66321"/>
                        are dedicated to improving the quality of imaging services. 
                    </P>
                    <P>
                        <E T="03">Response:</E>
                         The comment is outside the scope of the proposed rule. Moreover, currently we do not have the statutory authority to restrict payment for these procedures to physicians who possess the training and accreditation recommended by the commenter. 
                    </P>
                    <P>
                        <E T="03">Comment:</E>
                         One commenter urged us to enforce the anti-markup requirements on purchased diagnostic tests by auditing pathology practices and laboratories. The commenter contended that there is widespread ordering of unnecessary tests by pathologists with no regulatory oversight by CMS. The commenter suggested that effective enforcement and application of current anti-markup rules to the pathology community would obviate the need to add new regulations that would limit physician practices from providing quality pathology services to their Medicare patients. The commenter also suggested that we adopt reasonable protocols and standards for the review of Pap smears, among other tests, which, according to the commenter, would significantly reduce unnecessary testing by pathologists and result in tremendous cost savings to the Medicare program. 
                    </P>
                    <P>
                        <E T="03">Response:</E>
                         Our contractors perform pre-pay and post-pay reviews of services, including reviews to determine if the services were reasonable and necessary. However, the extremely large number of claims that contractors must handle each year, as well as the difficulty in sometimes knowing whether services were reasonable and necessary, underscores the need to adopt rules to address the potential for overutilization in other ways, rather than relying solely on reviews for medical necessity. The proposed anti-markup provisions would apply equally to all physicians, including pathologists. However, section 1842(n)(1) of the Act does not authorize the anti-markup on diagnostic tests to apply to clinical laboratory tests, and we did not propose to extend the anti-markup provisions to such tests. We are concerned with preventing the billing supplier from ordering unnecessary tests for profit. Laboratories typically do not order tests, and therefore, there has not been a concern about abuse by laboratories in purchasing diagnostic tests. The comment that we should adopt protocols or standards for the review of Pap smears and other tests is outside the scope of the proposed rule. 
                    </P>
                    <P>
                        <E T="03">Comment:</E>
                         One commenter urged us to prohibit any markup of the TC of surgical pathology specimens and let each physician decide where the TC is performed in addition to where the PC is performed. 
                    </P>
                    <P>
                        <E T="03">Response:</E>
                         Section 414.50 and section 30.2.9 of Pub. 100-04, Chapter 1, CMS Internet-Only Manual, currently prohibit markups of the TC of a diagnostic test if the TC is performed by an outside supplier. As finalized, our revisions to § 414.50 will prohibit the markup of a TC if the TC is ordered by the billing supplier and is either purchased or performed somewhere other than the office of the billing supplier. Physicians are permitted to determine where the TC and PC are performed, provided that the arrangement is in compliance with the purchased test rules and physician self-referral rules. 
                    </P>
                    <P>
                        <E T="03">Comment:</E>
                         One commenter stated that the proposed anti-markup provisions are unfair and would interfere with existing business relationships. The commenter asserted that medical practices should have the freedom to hire in-house professionals or contract with other practices to perform services without fear of financial penalty. 
                    </P>
                    <P>
                        <E T="03">Response:</E>
                         We are not persuaded that our anti-markup proposals, as finalized in this final rule with comment, are unfair. The proposals as finalized are designed to reduce overutilization of diagnostic tests, so that tests are ordered because they are medically necessary and are not ordered because a profit can be made on each test. Practices can maintain relationships with other professionals on a part-time or contractual basis. If the services are furnished in the office of the billing supplier, the anti-markup rules will not apply, unless the services of an independent contractor are billed as a purchased test. 
                    </P>
                    <HD SOURCE="HD2">N. Beneficiary Signature for Ambulance Transport Services </HD>
                    <P>Section 424.36 requires that a beneficiary's signature must appear on all claims submitted for Medicare services, unless the beneficiary has died, or another exception applies. However, ambulance suppliers and providers have stated that, in emergency situations, it is often impossible or impractical for ambulance providers or suppliers to obtain a beneficiary's or other authorized person's signature on a claim to properly bill Medicare for ambulance transport services because: (1) Many beneficiaries are incapable of signing claims due to their medical condition at the time of transport; (2) another person authorized to sign the claim under § 424.36(b) is not available, or is unwilling to sign the claim at the time of transport; and (3) if an individual listed in § 424.36(b) is not available or is unwilling to sign a claim on behalf of the beneficiary at the time of transport, it is impractical later to locate the beneficiary (or the beneficiary's authorized representative) to obtain a signature on the claim form before submitting it to Medicare for payment. </P>
                    <P>
                        As stated in the CY 2008 PFS proposed rule (72 FR 38187), we are sympathetic to the concerns of ambulance providers and suppliers insofar as emergency transport services are involved. Therefore, we proposed to revise § 424.36 to provide that, for emergency ambulance transport services, where the ambulance provider or supplier documents that the beneficiary was physically or mentally incapable of signing a claim form at the time the service was provided and that none of the individuals listed in § 424.36(b)(1) through (b)(5) 
                        <SU>2</SU>
                        <FTREF/>
                         was available or willing to sign a claim on behalf of the beneficiary, the ambulance provider or supplier could submit the claim without a beneficiary signature. Under our proposal, such claim submission would be permitted only if: (1) The beneficiary was physically or mentally incapable of signing the claim form at the time the service was provided; (2) none of the individuals listed in § 424.36(b)(1) through (b)(4) was available or willing to sign the claim form on behalf of the beneficiary at the time the service was provided; and (3) the ambulance provider or supplier maintains in its files for a period of at least 4 years from the date of service certain documentation. Required documentation would include: (1) A signed contemporaneous statement, made by an ambulance employee present during the trip to the receiving facility, that the beneficiary was physically or mentally incapable of signing a claim form and that none of the individuals listed in § 424.36(b)(1) through (b)(4) was available or willing to sign the claim form on behalf of the beneficiary at the time the service was provided; (2) the date and time the beneficiary was transported, and the name and location of the facility where the beneficiary was received; and (3) a signed contemporaneous statement from a representative of the facility that received the beneficiary, which documents the name of the beneficiary and the time and date that the beneficiary was received by that facility. 
                    </P>
                    <FTNT>
                        <P>
                            <SU>2</SU>
                             We are making a technical change in the final rule. The references in the proposed rule to § 424.36(b)(5) were in error, as individuals are specified only in § 424.36(b)(1) through (b)(4).
                        </P>
                    </FTNT>
                    <P>
                        For non-emergency ambulance transport services, the ambulance 
                        <PRTPAGE P="66322"/>
                        provider or supplier would continue to be required to obtain a beneficiary's signature on a claim form (or the signature of someone who is authorized to sign on behalf of the beneficiary under § 424.36(b)(1) through (b)(4)) prior to submitting claims to Medicare. 
                    </P>
                    <P>We received comments from two national associations that represent providers and suppliers of ambulance services and hospitals. The remainder of the comments came from ambulance owners and employees. The commenters generally agreed that we should eliminate the beneficiary signature requirement entirely when a beneficiary is mentally or physically incapable of signing a claim and no other person authorized to sign a claim on behalf of the beneficiary is available or willing to sign at the time of transport. In addition, the commenters argued that the proposed documentation requirements would be costly and burdensome to ambulance providers and suppliers. </P>
                    <P>We are adopting our proposal, with modification. Specifically, we are allowing a secondary form of verification to be used in lieu of the proposed signed contemporaneous statement from a representative of the facility that received the beneficiary (which remains an alternative). We are also amending § 424.32(a) to clarify that the beneficiary signature requirement is satisfied if one of the exceptions in § 424.36 is satisfied. Finally, we are making a technical change to our proposal. In the proposed rule, we stated that ambulance providers and suppliers could utilize proposed § 424.36(b)(6) if none of the individuals listed in § 424.36(b)(1) through (b)(5) were available or willing to sign the claim on behalf of the beneficiary at the time the service was provided. The references to § 424.36(b)(5) were in error, as individuals are specified only in § 424.36(b)(1) through (b)(4). </P>
                    <P>
                        <E T="03">Comment:</E>
                         The majority of the commenters opposed our proposed changes to the beneficiary signature requirements in § 424.36. The commenters stated that the proposed changes would have the unintended effect of increasing the administrative and compliance burden on providers and suppliers of ambulance services and on the hospitals. 
                    </P>
                    <P>
                        <E T="03">Response:</E>
                         The proposal would not have imposed any additional burdens on providers and suppliers of ambulance services. Rather, the proposal, which we are adopting with some modification, set forth an alternate method of satisfying the beneficiary signature requirement for claims submitted for emergency ambulance services. Those ambulance providers and suppliers that believe that it is burdensome to comply with new § 424.36(b)(6), may avail themselves of the other means specified in § 424.36 for satisfying the beneficiary signature requirement. 
                    </P>
                    <P>
                        <E T="03">Comment:</E>
                         Commenters asserted that when a beneficiary is physically or mentally incapable of signing a claim, the ambulance industry has already been signing claims on behalf of such beneficiaries in accordance with the requirements listed in the CMS Internet-Only Manual (IOM), Pub. 100-02, Medicare Benefit Policy Manual, Chapter 10, Section 20.1.2 and IOM, Pub. 100-04, Medicare Claims Processing Manual, Chapter 1, Section 50.1.6(A)(3)(c), without any objections from CMS contractors. The commenters stated that the ambulance industry has also been relying on § 424.36(b)(5) as further authority to sign claims on behalf of beneficiaries when beneficiaries are incapable of signing and the requirements of § 424.36(b)(1) through (b)(4) have not been met. 
                    </P>
                    <P>
                        <E T="03">Response:</E>
                         Section 424.36(b)(5) applies only if the beneficiary is physically or mentally incapable of signing the claim and none of the persons listed in § 424.36(b)(1) through (b)(4) is available to sign the claim. Note that we interpret § 424.36(b), including § 424.36(b)(5), as meaning that neither the beneficiary nor any of the persons listed in § 424.36(b)(1) through (b)(4) is available at all, not just that none of them is available at the time the service is performed. Thus, even assuming that § 424.36(b)(5) applies to ambulance providers (and we believe that this subparagraph was intended to apply only to institutional providers such as a hospital), an ambulance provider would not be allowed to rely on § 424.36(b)(5) to sign a claim for ambulance services simply because the beneficiary was incapable of signing the claim at the time of delivery to the hospital or ESRD facility and none of the persons listed in § 424.36(b)(1) through (b)(4) was available and willing to sign the claim for ambulance services at the time of delivery. Instead, the provider would be required, in advance of submitting the claim, to make reasonable efforts to locate and obtain a signature from the beneficiary or, if the beneficiary is not capable of signing, one of the alternative individuals specified in § 424.36(b)(1) through (b)(4). It would make little sense to specify different categories of individuals in § 424.36(b)(1) through (b)(4) who could sign a claim on behalf of a beneficiary who is unable to sign, if a provider was allowed to file a claim without making an effort to obtain a signature from one of the other authorized individuals. To the extent that ambulance 
                        <E T="03">suppliers</E>
                         have been relying on § 424.36(b)(5) under any circumstances, such suppliers have been failing to follow the regulations, as this subparagraph does not pertain to suppliers. We are clarifying § 424.36(b)(5) to provide that, before a provider may avail itself of the exception in § 424.36(b)(5), it must make reasonable efforts (including over a reasonable period of time) to have either the beneficiary or one of the individuals specified in § 424.36(b)(1) through (b)(4) to sign the claim. Similarly, the sections of the CMS IOM cited by the commenters, Pub. 100-02, Chapter 10, section 20.1.2 and Pub. 100-04, Chapter 1, section 50.1.6(A)(3)(c) imply that reasonable efforts must be made to locate other individuals prior to submitting the claim. We plan to issue clarifying instructions in the near future, to ensure that our regulations and manual instructions on the beneficiary signature requirement are fully consistent with each other. 
                    </P>
                    <P>
                        In contrast, the proposal, as adopted with modification, allows ambulance providers and suppliers, in the case of emergency transport, to sign the claim, if certain documentation requirements are met, where the beneficiary is not capable of signing the claim 
                        <E T="03">at the time of transport</E>
                        . 
                    </P>
                    <P>
                        <E T="03">Comment:</E>
                         Most of the commenters agreed that some of our proposed documentation requirements are already being followed by ambulance providers and suppliers. However, they strongly objected to proposed § 424.36(b)(6)(ii)(C), which would have required a signed contemporaneous statement from a representative of the facility that received the beneficiary, documenting the name of the beneficiary, and the date and time the beneficiary was received by that facility. The commenters asserted that it is not practical or feasible to obtain a signed contemporaneous statement from a representative of the receiving facility documenting the name of the beneficiary and the date and time the beneficiary was received by that facility. The commenters stated that hospital personnel in emergency departments often are either too busy or refuse to sign any forms when receiving a patient. In addition, the commenters contended that attempting to obtain a signature from a representative of the hospital would decrease the amount of time available for ambulances to serve their respective communities. Therefore, the commenters recommended that CMS modify the proposed beneficiary 
                        <PRTPAGE P="66323"/>
                        signature requirements for ambulance services in § 424.36(b)(6) to include only proposed subsection § 424.36(b)(6)(i). One commenter stated that a signature from hospital staff does not add any more credibility to the ambulance provider or supplier's claim that the patient was unable to sign the claim than what is already present from the EMT's attestation that the patient was unable to sign. 
                    </P>
                    <P>
                        <E T="03">Response:</E>
                         We are not persuaded to modify the proposed alternative to the beneficiary signature requirement in § 424.36(b)(6) to include only § 424.36(b)(6)(i). The purpose of the proposed requirement to secure a signed contemporaneous statement from a representative of the facility that received the beneficiary, as a means of satisfying the alternative, was to ensure that someone other than an ambulance employee verifies the transport and receipt of the beneficiary; the purpose was not to obtain verification that the beneficiary was unable to sign the claim. We continue to believe that in many, if not most, cases the ambulance transport personnel will have no difficulty in securing a signature from personnel at the hospital or other facility that acknowledges receipt of the patient. Indeed, it is our understanding that, as protection from liability or for other purposes, some ambulance providers and suppliers routinely secure a signature from the receiving facility in order to document that the patient was transported. We note that our proposal would not have required the hospital or other receiving facility to do anything more than acknowledge receipt through a signature. That is, the ambulance provider or supplier could add a signature block and an attestation clause, acknowledging receipt, to its trip ticket or other form that would already contain the necessary patient information (that is, the beneficiary's name and the date and time of delivery). However, after further consideration, we are revising § 424.36(b)(6)(ii)(C) to provide an alternative to the requirement under § 424.36(b)(6) that ambulance providers or suppliers must obtain a signed contemporaneous statement from a representative of the facility that received the beneficiary, which documents the name of the beneficiary and the date and time the beneficiary was received by that facility. The final rule allows the ambulance provider or supplier to meet the condition specified in § 424.36(b)(6) by obtaining a secondary form of verification, prior to submitting the claim for payment. Secondary methods of verification may include the patient care or trip report, the patient medical record, the hospital registration/admissions sheet, the hospital log, or other internal hospital or facility records. Regardless of its specific form, the documentation must be from the receiving facility must indicate that the beneficiary in question was transported to the facility by the ambulance provider or supplier that is submitting the claim, and must be signed by a representative of the facility. 
                    </P>
                    <P>
                        <E T="03">Comment:</E>
                         One commenter stated that the proposal was fair and correct, would not create a heavy burden on the service provider and can be accomplished in a timely manner. A signed contemporaneous statement used on a limited basis and tightly controlled so that it will not become a routine event should help compliance in this area. A clear and standardized format for the contemporaneous statement should be issued to allow for proper compliance with the new rule. 
                    </P>
                    <P>
                        <E T="03">Response:</E>
                         We understand the commenter as supporting our proposal and as saying that ambulance providers and suppliers should not be entitled to routinely rely on proposed § 424.36(b)(6), but rather should be able to rely on this exception only when the beneficiary is, in fact, unable to sign the claim, and only when the proposed documentation requirements have been satisfied. We agree that in most cases an ambulance provider or supplier should not have difficulty in obtaining a signature from the hospital or other facility that acknowledges receipt of the beneficiary; however, we are modifying the proposal to provide for an alternate method of documenting that the beneficiary was transported to the facility. We do not believe that it is necessary to prescribe a specific form for ambulance providers and suppliers to use as a contemporaneous statement to document the transport of the beneficiary, but instead are allowing ambulance providers and suppliers to use existing forms of their own, or, where necessary, to modify their forms to comply with the requirements of the new § 424.36(b)(6)(ii). We again emphasize that ambulance providers and suppliers that do not wish to take advantage of the new exception in § 424.36(b)(6) to the beneficiary signature requirement, may instead obtain the beneficiary's signature prior to submitting the claim, satisfy one of the exceptions in § 424.36(b)(1) through (b)(5), or, where appropriate, bill the beneficiary. 
                    </P>
                    <P>
                        <E T="03">Comment:</E>
                         Several commenters recommended that we eliminate the beneficiary signature requirement entirely. They believe that the requirement is not necessary because, for every transport of a Medicare beneficiary, the ambulance crew completes a trip report that described the condition of the beneficiary, treatment, origin/destination, etc. Also, the origin and destination facilities complete their own records, which document that the beneficiary was sent or received. Commenters stated that if it becomes necessary to audit claims, CMS can obtain information from the transporting and receiving facilities in order to establish that the beneficiary was, in fact, transported as claimed by the ambulance provider or supplier. 
                    </P>
                    <P>
                        <E T="03">Response:</E>
                         We proposed an alternative, optional method of fulfilling the beneficiary signature requirement for claims for emergency transport services. We did not propose to eliminate the signature requirement and are not prepared to do so at this time. The beneficiary signature requirements help ensure that services were in fact rendered and were rendered as billed. Although we agree that documentation obtained from the transporting and (particularly) from the receiving facility may help to alleviate any concern whether services were furnished or were furnished as claimed, we do not believe that it is our responsibility to attempt to locate such documentation should claims be called into question (and it is also uncertain whether we would have the right to compel the transporting or receiving facility to provide us with such documentation). Therefore, to the extent that an ambulance provider or supplier wishes to use third-party documentation to demonstrate that a beneficiary was transported as claimed, instead of having the beneficiary sign the claim or meeting one of the exceptions in § 424.36(b)(1) through (b)(4), it must follow the procedures in new § 424.36(b)(6). 
                    </P>
                    <P>
                        <E T="03">Comment:</E>
                         Most of the commenters questioned the need for the beneficiary signature, because they asserted that the beneficiary signature is no longer necessary given that it is not required for the assignment of benefits or the authorization of records release to CMS or its contractors. In addition, the commenters stated that almost every covered ambulance transport is to or from a facility (that is, a hospital or skilled nursing facility) where a valid signature is already on file. These facilities typically obtain the beneficiary's signature at the time of admission, authorizing the release of medical records for their services, or any related services. The commenters believe that ambulance transport to a facility, for purposes of receiving treatment at that facility, constitutes a 
                        <PRTPAGE P="66324"/>
                        “related service,” because the ambulance transports the patient to or from that facility for treatment or admission. Commenters also noted that, with respect to beneficiaries who are eligible both for Medicare and Medicaid, a signature is already on file with the State Medicaid office. Therefore, they argued that duplicating the requirement for a signature is costly and burdensome on ambulance service providers. 
                    </P>
                    <P>
                        <E T="03">Response:</E>
                         The purpose of the assignment of benefits signature is different than the purpose of the beneficiary signature to file a claim. As stated above, the purpose of the beneficiary signature to file a claim is to ensure that services were furnished and were furnished as billed. Although the assignment of benefits signature is not required for services billed on mandatory assignment, the beneficiary signature is still required for submitting a claim to Medicare. 
                    </P>
                    <P>A beneficiary's signature on file at a hospital or a skilled nursing facility does not indicate that an ambulance provider or supplier was authorized to submit a claim for transport services on behalf of the beneficiary or that transport services in fact were furnished. Rather, the signature on file at a facility is used for claims filed by that facility for treatment the facility furnished to the beneficiary. Similarly, the fact that a beneficiary's signature may be on file with a State Medicaid office (or elsewhere) does not in any way speak to the issue of whether the ambulance provider or supplier was authorized to submit a claim for transport services on behalf of the beneficiary or that transport services in fact were furnished. </P>
                    <P>
                        <E T="03">Comment:</E>
                         A commenter stated that when submitting claims electronically, a provider or supplier must answer “Y” or “N” for the question of whether the provider or supplier has obtained a beneficiary signature. The commenter suggested that we should add language to the regulations to indicate that the beneficiary signature requirement will be met if one of the exceptions to the requirement is met. 
                    </P>
                    <P>
                        <E T="03">Response:</E>
                         We agree that it is proper and accurate to answer “Y” (for yes) to the question in the case where the beneficiary has not signed the claim but one of the alternatives in § 424.36(b) through § 424.36(e) has been satisfied. We are clarifying § 424.32(a)(3) (basic requirements of all claims) accordingly. 
                    </P>
                    <P>
                        <E T="03">Comment:</E>
                         Many commenters stated that the proposal would encourage ambulance providers and suppliers to seek signatures from patients who are in need of medical care and under mental duress. They stated that beneficiaries under duress should not be required to sign anything. 
                    </P>
                    <P>
                        <E T="03">Response:</E>
                         We agree that beneficiaries under duress should not be required to sign claims; in fact, we consider a beneficiary signature obtained under duress to be invalid. We do not agree, however, that our proposal encouraged ambulance providers and suppliers to obtain beneficiary signatures under duress. As stated above, the proposal was intended to provide ambulance providers and suppliers with another alternative to obtaining the beneficiary's signature. It was not, and the final rule is not, a narrowing of the available alternatives to ambulance providers and suppliers. Moreover, the commenters appear to assume that if ambulance providers and suppliers are to obtain a beneficiary's signature, they must do so at the time of transport. However, ambulance providers and suppliers have always been able to obtain the beneficiary's signature (or the signature of one of the persons specified in § 424.36(b)(1) through (b)(4)) at any time prior to submitting the claim. In fact, as noted above, before providers may avail themselves of the exception in § 424.36(b)(5), they are required to make reasonable efforts to have the beneficiary or one of the persons specified in § 424.36(b)(1) through (b)(4) sign the claim. With this final rule, ambulance providers and suppliers, in the case of emergency transport services, may submit the claim without making such reasonable efforts if they satisfy the documentation requirements of new § 424.36(b)(6). 
                    </P>
                    <HD SOURCE="HD2">O. Update to Fee Schedules for Class III Durable Medical Equipment (DME) for CYs 2007 and 2008 </HD>
                    <HD SOURCE="HD3">1. Background </HD>
                    <HD SOURCE="HD3">a. Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Classifications </HD>
                    <P>Under § 414.210, for Medicare payment purposes, fee schedules are determined for the following classes of equipment and devices: </P>
                    <P>• Inexpensive or routinely purchased items as specified in § 414.220. </P>
                    <P>• Items requiring frequent and substantial servicing, as specified in § 414.222. </P>
                    <P>• Certain customized items, as specified in § 414.224. </P>
                    <P>• Oxygen and oxygen equipment, as specified in § 414.226. </P>
                    <P>• Prosthetic and orthotic devices, as specified in § 414.228. </P>
                    <P>• Other DME (capped rental items), as specified in § 414.229. </P>
                    <P>• Transcutaneous electric nerve stimulators (TENS), as specified in § 414.232. </P>
                    <P>We designate the items in each class of equipment or device through our program instructions. </P>
                    <P>Under section 513 of the Federal Food, Drug, and Cosmetic Act (21 U.S.C. 360c), the Food and Drug Administration (FDA) must classify devices into one of three regulatory classes: Class I, class II, or class III. FDA classification of a device is determined by the amount of regulation necessary to provide a reasonable assurance of safety and effectiveness; class III devices typically posing the greatest risk. See the CY 2008 PFS proposed rule (72 FR 38188) for a specific explanation of the three regulatory classifications of devices. </P>
                    <HD SOURCE="HD3">b. DMEPOS Payment </HD>
                    <P>Section 302(b)(1) of the MMA amended section 1847 of the Act to require the Secretary to establish and implement competitive acquisition programs for the furnishing under Medicare Part B of certain types of DMEPOS. Section 1847(a)(2)(A) of the Act provides that devices determined by the FDA to be class III devices under the Federal Food, Drug, and Cosmetic Act (21 U.S.C. 301 et seq.) cannot be included in the competitive acquisition programs. As part of the transition to competitive acquisition, the Congress mandated in sections 1834(a)(14)(G) through (I) of the Act that the fee schedule amounts for DME, other than class III devices, be frozen at 2003 levels through 2008. </P>
                    <P>
                        For class III devices, section 1834(a)(14)(G)(i) of the Act mandates that an annual update factor based on the percentage change in the consumer price index for urban customers (CPI-U) be applied to the fee schedule amounts for CYs 2004 through 2006. Section 1834(a)(14)(H)(i) of the Act, as added by section 302 of the MMA, gives the Secretary discretion in determining the appropriate fee schedule update percentage for CY 2007 for DME which are class III medical devices described in section 513(a)(1)(C) of the Federal Food, Drug, and Cosmetic Act (21 U.S.C. 360c(a)(1)(C)).
                        <SU>3</SU>
                        <FTREF/>
                         Specifically, for 2007, the 2006 fee schedule amounts for class III devices are to be updated by the percentage change determined to be appropriate by the Secretary, taking into account recommendations contained in 
                        <PRTPAGE P="66325"/>
                        a report of the Comptroller General of the United States under section 302(c)(1)(B) of the MMA. Also mandated by section 1834(a)(14)(I)(i) of the Act, for 2008, the 2007 fee schedule amounts for class III devices are to be increased by an annual factor based on the percentage change in the CPI-U, as applied to the 2007 payment amount determined after application of the percentage change under section 1834(a)(14)(H)(i) of the Act. 
                    </P>
                    <FTNT>
                        <P>
                            <SU>3</SU>
                             Section 513(a)(1)(C) of the Federal Food, Drug, and Cosmetic Act has been codified as 21 U.S.C. 360c(a)(1)(C). Accordingly, we believe that the references to 21 U.S.C. 360(c)(1)(C) in sections 1834(a)(14)(G)(i), (H)(i), and (I)(i) of the Act are scrivener's errors.
                        </P>
                    </FTNT>
                    <P>As stated above in this section of this final rule with comment period, section 1834(a)(14)(H)(i) of the Act mandated that the Secretary take into account recommendations by the Comptroller General of the United States, who is the head of the Government Accountability Office (GAO), when determining the appropriate update percentage for class III devices for 2007. On March 1, 2006, the GAO published a report, “Class III Devices do not Warrant a Distinct Annual Payment Update” (GAO-06-62). The GAO concluded in that report, “because the initial payment rates for all classes of devices on the Medicare DME fee schedule are based on retail prices or an equivalent measure, they account for the costs of class III and similar class II devices in a consistent manner. Distinct updates for two different classes of devices are unwarranted.” The GAO recommended that the Secretary establish a uniform payment update to the DME fee schedule for 2007 for class II and class III devices. </P>
                    <P>
                        In the May 1, 2006 
                        <E T="04">Federal Register</E>
                        , we published the Competitive Acquisition for Certain Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) and Other Issues proposed rule (71 FR 25660). We solicited comments on how to determine the appropriate fee schedule percentage change for class III devices for 2007 and 2008. We stated that we would consider the comments received in conjunction with the recommendations in the GAO report in determining the appropriate update percentage for these devices for 2007 and 2008. 
                    </P>
                    <P>A majority of the submitted public comments indicated that the GAO report was flawed since it did not recommend a specific update factor or take into account changes over time in the costs of producing, supplying and servicing class III devices. Several commenters recommended that we continue to use the CPI-U to adjust fee schedule amounts for class III devices, but offered no substantive information that would otherwise support a distinct update factor for class III devices. Another commenter recommended that the class III proposal be included in a separate rulemaking procedure because it is not related to competitive acquisition. </P>
                    <HD SOURCE="HD3">2. Update to Fee Schedule </HD>
                    <P>We believe that the GAO has done a thorough job in reviewing Medicare payment rules and methods and issues associated with the costs of furnishing class III devices. Accordingly, we agree with the finding in the report that the costs of furnishing class II and class III DME devices have been factored into the fee schedule amounts calculated for these devices. We also agree with the GAO recommendation that a uniform payment update be established to the DME fee schedule for 2007 for class II and class III devices. For class II devices, the MMA provided for a zero percent payment update from 2004 through 2008. Accordingly, for 2007, in the CY 2008 PFS proposed rule we proposed a zero percent update for class III devices (72 FR 38188 through 38189). Also, in accordance with the MMA, we proposed to use the percent change in the CPI-U to update the class III device 2007 fee schedule amounts for 2008. </P>
                    <P>
                        <E T="03">Comment:</E>
                         One commenter supported an update based on the CPI-U but did not provide any additional information. A second commenter indicated that class III devices are innovative, beneficial, cost-effective devices and supported a reasonable payment update but did not recommend a specific update and also did not provide any information explaining why class III devices should receive a different update for 2007 than other DME. 
                    </P>
                    <P>
                        <E T="03">Response:</E>
                         We do not believe that the information submitted by the commenters provides any information that would indicate that class III devices warrant a different update than other DME. Accordingly, for 2007, we are adopting the proposed update methodology of applying a zero percent update for class III devices. Also, in accordance with the MMA, we are adopting the proposed methodology of applying the percent change in the CPI-U to update the class III device 2007 fee schedule amounts for 2008. The change in the CPI-U for the 12-month period ending with June 2007 was 2.7 percent. Therefore, a 2.7 percent increase will be applied to the 2007 fee schedule amounts for class III DME to determine the 2008 fee schedule amounts for these items. 
                    </P>
                    <HD SOURCE="HD2">P. Discussion of Chiropractic Services Demonstration </HD>
                    <P>In the CY 2006 PFS final rule with comment period (70 FR 70266) and the CY 2007 PFS final rule with comment period (71 FR 69707), we included a discussion of the 2-year chiropractic services demonstration that ended on March 31, 2007. This demonstration was authorized by section 651 of the MMA to evaluate the feasibility and advisability of covering chiropractic services under Medicare. These services extended beyond the current coverage for manipulation to care for neuromusculoskeletal conditions typical among eligible beneficiaries, and covered diagnostic and other services that a chiropractor was legally authorized to perform by the State or jurisdiction in which the treatment was provided. The demonstration was conducted in four sites, two rural and two urban. The demonstration was required to be budget neutral as the statute requires the Secretary to ensure that the aggregate payment made under the Medicare program does not exceed the amount which would be paid in the absence of the demonstration. </P>
                    <P>Ensuring budget neutrality requires that the Secretary develop a strategy for recouping funds should the demonstration result in costs higher than those that would occur in the absence of the demonstration. As we stated in the CY 2006 and CY 2007 PFS final rules with comment period, we would make adjustments to the chiropractor fees under the Medicare PFS to recover aggregate payments under the demonstration in excess of the amount estimated to yield budget neutrality. We will assess budget neutrality by determining the change in costs based on a pre- and post-comparison of aggregate payments and the rate of change for specific diagnoses that were treated by chiropractors and physicians in the demonstration sites and control sites. Because the aggregate payments under the expanded chiropractor services may have an impact on other Medicare expenditures, we will not limit our analysis to reviewing only chiropractor claims. </P>
                    <P>
                        Any needed reduction to chiropractor fees under the PFS would be made in the CY 2010 and CY 2011 physician fee schedules as it will take approximately 2 years after the demonstration ends to complete the claims analysis. If we determine that the adjustment for BN is greater than 2 percent of spending for the chiropractor fee schedule codes (comprised of the 3 currently covered CPT codes 98940, 98941, and 98942), we would implement the adjustment over a 2-year period. However, if the adjustment is less than 2 percent of spending under the chiropractor fee schedule codes, we would implement the adjustment over a 1-year period. We will include the detailed analysis of budget neutrality and the proposed 
                        <PRTPAGE P="66326"/>
                        offset during the CY 2009 PFS rulemaking process. 
                    </P>
                    <P>
                        <E T="03">Comment:</E>
                         We received a number of comments on the methodology for determining budget neutrality. One commenter indicated that it continues to oppose our methodology for assuring budget neutrality under the demonstration. Instead of the application of an adjustment to the national chiropractor fee schedule, the commenter recommends that CMS make an adjustment to the totality of services payable under the Part B Trust Fund. This would be consistent with the requirements in section 651(f)(1)(A) of the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (MMA). 
                    </P>
                    <P>Another commenter stated that CMS should apply budget neutrality only to the chiropractic codes used in the demonstration project. Because the demonstration did not require a physician referral, physicians should not be penalized for any utilization of chiropractic services. The commenter further noted that if budget neutrality is not limited to the chiropractic codes, CMS should incorporate estimates of the impact on other services into its SGR “law and regulation” factor estimates. </P>
                    <P>
                        <E T="03">Response:</E>
                         Section 651(f)(1)(B) of the MMA requires that “* * * the Secretary shall ensure that the aggregate payment made by the Secretary under the Medicare program do not exceed the amount which the Secretary would have paid under the Medicare program if the demonstration projects under this section were not implemented.” The statute does not specify a specific methodology for ensuring budget neutrality. Our methodology meets the statutory requirement for budget neutrality and appropriately impacts the chiropractic profession that is directly affected by the demonstration. The budget neutrality adjustment under the PFS will be limited to adjusting chiropractor fee schedule codes (comprised of the 3 currently covered CPT codes 98940, 98941, and 98942). No other codes would be affected. 
                    </P>
                    <P>
                        <E T="03">Comment:</E>
                         One commenter noted that there are numerous dimensions to the analysis of effectiveness of treatment. By restricting our analysis only to Medicare expenditure, CMS would miss the important dimension of the effect of care on the beneficiary. Combining claims data with a measurement of functional status would permit a more useful examination of the impact of expanding chiropractor services. The commenter recommends that if CMS undertakes any further examination of the effectiveness of any intervention for neuromuscular conditions, functional status be considered. 
                    </P>
                    <P>
                        <E T="03">Response:</E>
                         The budget neutrality analysis is only one part of a broader evaluation of the chiropractic services demonstration. A survey was conducted of beneficiaries who received chiropractic services under the demonstration to determine the benefits of treatment and satisfaction with the chiropractic care provided under the demonstration. These results will be included in a Report to Congress on the demonstration. 
                    </P>
                    <HD SOURCE="HD2">Q. Technical Corrections </HD>
                    <HD SOURCE="HD3">1. Particular Services Excluded From Coverage (§ 411.15) </HD>
                    <P>Sections 612 and 613 of the MMA added coverage under Part B for cardiovascular disease screening tests and diabetes screening tests, effective for services furnished on or after January 1, 2005, subject to certain eligibility and other limitations. These provisions were implemented in the CY 2005 PFS final rule with comment period (69 FR 66236) and were codified in § 410.17 and § 410.18, respectively. However, at the time we neglected to make additional conforming changes to § 411.15, which discusses particular services excluded from coverage, to reflect this expansion in coverage. </P>
                    <P>To conform the regulations to the MMA provisions, we proposed a technical correction to the provisions in § 411.15 by specifying additional exceptions to provide payment for cardiovascular disease screening tests and diabetes screening tests that meet the eligibility limitation and the conditions for coverage that we specified under § 410.17, Cardiovascular Disease Screening Tests, and § 410.18, Diabetes Screening Tests. </P>
                    <P>
                        <E T="03">Comment:</E>
                         One commenter suggested that the psychiatric screening examination should be included in the list of preventive health screenings and examinations exceptions from services that are excluded from Medicare coverage under proposed § 411.15. The commenter suggested the advantage for having Medicare cover psychiatric screening examination is that better patient outcomes and decreased use of services often occur as a result of early identification of psychiatric disorders. 
                    </P>
                    <P>
                        <E T="03">Response:</E>
                         The purpose of the proposed technical correction in § 411.15 was to conform that provision to the cardiovascular disease screening test and the diabetes screening test benefits that were established in § 410.17 and § 410.18, respectively. These two part B screening benefits were specifically authorized by sections 612 and 613 of the MMA. The proposed rule did not address the possibility of coverage of a psychiatric screening examination under Medicare Part B. There is no statutory provision that authorizes a benefit for psychiatric screening. Therefore, the commenter's suggestion in this regard falls outside the scope of this final rule. 
                    </P>
                    <HD SOURCE="HD3">2. Medical Nutrition Therapy (§ 410.132(a)) </HD>
                    <P>
                        In the CY 2006 PFS final rule with comment period (70 FR 70160), we added individual medical nutrition therapy, as represented by HCPCS/CPT codes G0270, G0271, 97802, 97803, and 97804 to the list of telehealth services. In the CY 2008 PFS proposed rule, we proposed a technical correction to § 410.132(a) to conform the regulations to include an exception for services provided at § 410.78. This revised paragraph reads as follows: “(a) 
                        <E T="03">Conditions for coverage of MNT services.</E>
                         Medicare Part B pays for MNT services provided by a registered dietitian or nutrition professional as defined in § 410.134 when the beneficiary is referred for the service by the treating physician. Except as provided at § 410.78, services covered consist of face to face nutritional assessments and interventions in accordance with nationally accepted dietary or nutritional protocols.” 
                    </P>
                    <P>
                        <E T="03">Comment:</E>
                         We received one comment concurring with the proposed technical correction. 
                    </P>
                    <P>
                        <E T="03">Response:</E>
                         We are finalizing the technical correction to § 410.132(a) as proposed. 
                    </P>
                    <HD SOURCE="HD3">3. Payment Exception: Pediatric Patient Mix (§ 413.184) </HD>
                    <P>In the CY 2006 PFS final rule with comment period (70 FR 70214), we revised § 413.180 through § 413.192 regarding criteria and the application procedures for requesting an exception to the ESRD composite rate payment. As part of the revisions we intended to amend the section heading of § 413.184 to reflect that, as specified in the statute, this exception only pertains to a pediatric ESRD facility. However, this change was not made. Therefore, we proposed to revise the section heading of § 413.184 to read as follows: “Payment exception: Pediatric patient mix.” </P>
                    <P>
                        We did not receive any comments regarding this proposal. Therefore, we are finalizing this provision as proposed. 
                        <PRTPAGE P="66327"/>
                    </P>
                    <HD SOURCE="HD3">4. Diagnostic X-Ray Tests, Diagnostic Laboratory Tests, and Other Diagnostic Tests: Conditions (§ 410.32(a)(1)) </HD>
                    <P>Section 1861(r)(5) of the Act was amended by section 4513(a) of the BBA to allow Medicare payment for a chiropractor's manual manipulation of the spine to correct subluxation, without requiring the subluxation to be demonstrated by an x-ray. The BBA provision was effective for services furnished on or after January 1, 2000. Prior to this statutory change, the subluxation was required to be demonstrated by an x-ray. Because chiropractors are limited by statute in the services they can provide under Medicare, it was necessary to create an exception to the requirement that diagnostic services (including x-rays) must be ordered by the treating physician as provided in § 410.32(a). This exception, which permits a physician who is not a treating physician to order and receive payment for an x-ray that is used by a chiropractor, is specified in § 410.32(a)(1). </P>
                    <P>Because of the BBA change, which removed the requirement that subluxation must be demonstrated by an x-ray, the so-called “chiropractic exception” at § 410.32(a)(1) is no longer warranted. We do not believe it is necessary or appropriate to continue to permit payment for an x-ray ordered by a nontreating physician when a chiropractor, not the ordering physician, will use that x-ray. Therefore, we proposed to revise § 410.32 by removing paragraph (a)(1) and redesignating paragraphs (a)(2) and (a)(3) as (a)(1) and (a)(2), respectively. </P>
                    <P>
                        <E T="03">Comment:</E>
                         We received several comments on this proposal. Some commenters noted that x-rays are not necessary to identify spinal subluxations, but stated that the ability to obtain an x-ray for Medicare beneficiaries is critical to providing responsible, safe, and medically prudent care. They stated that without this ability they fear beneficiaries and the chiropractic profession as a whole will be at a higher risk for receiving and providing the wrong type of care. The majority of commenters expressed concern that without the chiropractic exception at § 410.32(a)(1), the beneficiary may incur greater out of pocket expenses to obtain a noncovered x-ray when needed by the chiropractor. Other commenters believed that the overall costs for medical services may increase because a beneficiary wanting to seek chiropractic care directly may elect to first seek care for their condition from a medical doctor (MD) or doctor of osteopathy (DO) to obtain an order for a covered chiropractic x-ray, resulting in added costs for physician E/M services. Finally, many chiropractors commented that they are qualified to provide x-rays and other services that Medicare does not cover when furnished by a chiropractor and they believe that x-rays can be essential to rule out “red flags” and contraindications that may indicate the need for further diagnostic imaging or a referral to another health care professional. 
                    </P>
                    <P>
                        <E T="03">Response:</E>
                         We believe that retaining the chiropractic exception would be inconsistent with the statutory provision at section 1861(r)(5) of the Act which defines a chiropractor as a physician only for the purposes of sections 1861(s)(1) and 1861(s)(2)(A) of the Act and only with respect to treatment by means of manual manipulation of the spine (that is, to correct a subluxation). This statutory provision does not include diagnostic services at section 1861(s)(3) of the Act, which is the benefit category under which x-rays are covered under Medicare. In addition, commenters noted that x-rays are not required to identify subluxations; rather, commenters stated that they use the x-rays to rule out other conditions where manual manipulation of the spine would be contraindicated or for which further imaging studies are indicated. While the use of x-rays for this purpose is outside the scope of covered chiropractic services, it is also not addressed by the chiropractic exception at § 410.32(a)(1). The chiropractic exception only permits a non treating physician to order an x-ray to identify a subluxation. Therefore, we are finalizing our proposal to revise § 410.32 by removing paragraph (a)(1) and redesignating paragraphs (a)(2) and (a)(3) as (a)(1) and (a)(2), respectively, so that it is consistent and conforms to the statutory revisions mandated by the BBA. 
                    </P>
                    <HD SOURCE="HD2">R. Other Issues </HD>
                    <HD SOURCE="HD3">1. Recalls and Replacement Devices </HD>
                    <P>In the CY 2008 PFS proposed rule (72 FR 38191), we included a discussion about recent recalls of implantable cardioverter-defibrillator (ICDs) and cardiac resynchronization therapy defibrillators (CRT-Ds). These recalls, as well as previous recalls of ICDs and pacemakers in CY 2004 and CY 2005, raise issues both with regard to the additional costs of replacement devices and with regard to the additional physicians' services and diagnostic tests that beneficiaries who have these devices often need. </P>
                    <P>The impact of the costs of replacement devices for Medicare payment of inpatient and outpatient hospital services is addressed in separate rulemaking for the respective inpatient and outpatient hospital payment systems. However, in the CY 2008 PFS proposed rule, we also acknowledged there are costs associated with physician monitoring of patients treated with recalled devices. This could involve extra visits to physicians' offices or hospital outpatient departments, as well as additional diagnostic tests which might be needed to care for the beneficiaries who have the recalled devices. Based on our concern of the potential costs to both Medicare and the beneficiary for these unforeseen extra services, we solicited comments on how to identify and address additional health care costs and Medicare expenditures associated with device recall actions. </P>
                    <P>
                        <E T="03">Comment:</E>
                         We received several comments acknowledging the potential for additional costs that may result from recalled devices, particularly in light of the increases in technology. Commenters stated that such costs should be the responsibility of device manufacturers and not the Medicare program, private payers, or the general public. Some commenters expressed concern that we would impose a financial penalty on physicians who deal with the consequences of product recalls. Several of the commenters suggested alternatives that could be used to address this issue, such as development of a modifier or a specific “recall code” that could be used to track the additional time and work associated with these recalls, and urged us to ensure that these additional costs are accounted for in the SGR target. Commenters also stressed that any proposal should be “vetted” through the appropriate stakeholders. 
                    </P>
                    <P>
                        <E T="03">Response:</E>
                         We appreciate the suggestions that the commenters provided. It is not our intention to “penalize” physicians who care for patients affected by implantable device recalls. Rather, it is our intention to ensure that costs of the additional physicians' services and diagnostic tests associated with recalled devices are recognized and appropriately addressed. We will consider the concerns and suggestions provided by the commenters as we develop a plan to address this issue. 
                        <PRTPAGE P="66328"/>
                    </P>
                    <HD SOURCE="HD3">2. Therapy Standards and Requirements</HD>
                    <HD SOURCE="HD3">a. Revisions to Personnel Qualification Standards for Therapy Services </HD>
                    <P>In the CY 2005 PFS final rule with comment period (69 FR 66354), we amended § 410.59, § 410.60, and § 410.62 to refer to the qualifications for physical therapists (PTs), occupational therapists (OTs) and speech-language pathologists (SLPs) at § 484.4, which sets the personnel qualifications required under the HHA Conditions of Participation.</P>
                    <P>Section 484.4 contains requirements for persons furnishing services in HHAs that include physical therapists (PTs), physical therapist assistants (PTAs), occupational therapists (OTs), occupational therapy assistants (OTAs) and SLPs. The CY 2005 PFS final rule with comment period clarified that the personnel qualifications in § 484.4 are applicable to all outpatient PT, OT, and SLP services “in order to create consistent requirements for therapists and therapy assistants” (69 FR 66345). </P>
                    <P>In the CY 2008 PFS proposed rule (72 FR 38191), we proposed to update the personnel qualifications in § 484.4 for PTs, PTAs, OTs, and OTAs. We also proposed to revise the qualifications for SLPs to remove a reference to audiologists in the definition for speech-language pathologists because a speech-language pathologist would not have a Certificate of Clinical Competence in audiology, as implied by the regulation, unless that person was dually qualified as an audiologist. </P>
                    <P>We proposed these changes for the following reasons. </P>
                    <P>• The current regulations at § 484.4 contain outdated terminology relating to several of the relevant professional organizations. </P>
                    <P>• The standards that now exist in the fields of physical therapy and occupational therapy have changed since a substantial portion of these qualification requirements were developed. </P>
                    <P>• Some of the current qualification requirements do not address individuals who have been trained outside of the United States, or refer to outdated requirements. </P>
                    <P>• These revisions would have the benefit of establishing consistent standards across provider/supplier lines. </P>
                    <P>Although all States license PTs, some States have no licensing provisions for PTAs, OTs, OTAs, and SLPs. We proposed to revise our requirements to recognize as qualified PTs, OTs, PTAs, or OTAs who meet their respective State qualifications (or have received State recognition as PTs, OTs, PTAs or OTAs) before January 1, 2008. </P>
                    <P>We did not propose to allow those who, before January 1, 2008, meet only the State qualifications to practice physical therapy, and not the education requirements, to provide services under the Home Health PPS or the Hospice PPS. As we indicated in the CY 2008 PFS proposed rule, we did not expect that there are therapists furnishing services in a HHA or hospice that do not meet either the current or proposed revised qualifications. </P>
                    <HD SOURCE="HD2">Grandfathering Provision for Home Health </HD>
                    <P>
                        <E T="03">Comment:</E>
                         Commenters were concerned about the inconsistency in standards between settings, stating that there is no justification for the absence of a grandfathering provision for therapists and assistants practicing in Home Health settings. Many also indicated a concern that currently licensed or regulated professionals would not be allowed to continue to practice in a HHA or hospice, and recommended that sufficient time be allowed before implementation of the new standards for new professionals to meet their training. 
                    </P>
                    <P>
                        <E T="03">Response:</E>
                         The commenters make a compelling case for the grandfathering provisions to be applied uniformly across payment systems. We agree that it is important to apply consistent standards and we will apply the grandfathering provision in all settings as specified in part 484 of our regulations. Since all of part 484 describes personnel qualifications, we refer to part 484 in this rule rather than specifically to § 484.4. The cross-reference has also been changed in the regulation text from § 484.4 to part 484 in all applicable sections. Although we proposed that these grandfathering provisions would be included in revisions to § 409.17, § 409.23, § 410.43, § 410.59, § 410.60, § 482.56, § 485.70, § 485.705, § 491.9, the application of the grandfathering provisions to home health in part 484 makes some sections of proposed regulation text unnecessary and necessitates changes in the language of others. The changes proposed to sections § 485.705 and § 491.9 have been omitted, as they are no longer necessary. 
                    </P>
                    <HD SOURCE="HD2">Delay in Implementation of New Personnel Qualifications</HD>
                    <P>
                        <E T="03">Comment:</E>
                         Some commenters requested that we delay implementation of consistent therapy standards and qualifications until we can apply them consistently to SNF services, and provide education to providers and suppliers.
                    </P>
                    <P>
                        <E T="03">Response:</E>
                         We believe a 2-year delay in implementation of personnel qualifications will provide sufficient time for new personnel to come into compliance with the new standards. Therapists and assistants who met the qualifications of their State's practice act (in other words, who are licensed, certified or otherwise regulated by the State as a practitioner in the particular discipline) prior to December 31, 2009, will not be required to upgrade their qualifications. However, in States that have no regulations for practitioners in a particular discipline and for services furnished incident to the services of physicians where licensure does not apply, therapists and assistants must be qualified by education and examination as described in this final rule with comment period. Those who currently qualify to provide services without licensure by meeting the Medicare education or examination standards in effect at the time of the CY 2008 proposed rule will continue to qualify under those policies. On January 1, 2010, any individual who has not met the earlier requirements must meet the new requirements.
                    </P>
                    <HD SOURCE="HD2">Consistent Policy Standards </HD>
                    <P>
                        <E T="03">Comment:</E>
                         Many commenters indicated we have not provided a justification for applying the personnel and policy standards that we have articulated for Part B services consistently to Part A services. Most of these comments came from commenters who also support the right of States to create Medicare standards, who represent interest groups other than Medicare beneficiary/therapy users, and who believe we favor professional organizations in setting policies.
                    </P>
                    <P>
                        <E T="03">Response:</E>
                         Under both Medicare Part A and B, we must ensure that all services are described within a statutory benefit category. In order to do so, we frequently establish qualifications for health care professionals who furnish, or are involved in furnishing, Medicare services. In many Part A settings, we have historically relied on Medicare contractors to review facility records, State laws and local policies to determine that services have been furnished by qualified therapists. As a result of information provided by new contractors, which has been confirmed by numerous comments to the proposed rule, we have concluded that therapy is not always being furnished by individuals trained as therapists—even in some Part A settings. Therefore, we believe it is critical that we establish in regulations consistent standards for 
                        <PRTPAGE P="66329"/>
                        qualified therapists in the Medicare program. 
                    </P>
                    <P>
                        <E T="03">Comment:</E>
                         Some commenters objected to the use of the terms therapy and rehabilitation to mean physical therapy (PT), occupational therapy (OT), and speech-language pathology (SLP) services. The commenters recommended allowing any State licensed or authorized health professional to provide rehabilitation services if the provider's medical staff and State law would permit them to do so. The commenters recommended convening a work group to discuss the creation of rational personnel qualifications and scope of services. 
                    </P>
                    <P>
                        <E T="03">Response:</E>
                         The terms “therapy” and “rehabilitation”, as used in this section of this final rule with comment period, apply only to the Medicare benefit for PT, OT, and SLP services and to the qualified professionals who provide them. The qualifications have been established to assure that all of the personnel who provide these services are suitably trained in the discipline they practice. We see no reason to believe the skills and training required to furnish therapy and rehabilitation in Part A settings are less than those required in Part B settings, and therefore, qualifications for personnel in the inpatient setting should not be less stringent than in the outpatient setting. Therefore, we will adopt the proposed qualifications (with minor modifications), and these qualifications will be made applicable in Part A and Part B settings. 
                    </P>
                    <HD SOURCE="HD2">Grandfathering Provision</HD>
                    <P>
                        <E T="03">Comment:</E>
                         Many commenters believe that a grandfathering provision is not necessary for physical therapists and speech-language pathologists since the changes to their qualifications are not substantial. 
                    </P>
                    <P>
                        <E T="03">Response:</E>
                         We agree and have removed reference to physical therapists and speech-language pathologists from the relevant grandfather clauses in the final rule with comment period. 
                    </P>
                    <P>
                        <E T="03">Comment:</E>
                         Several commenters believe that our proposal to require those who were grandfathered to continue to practice at least part time without an interruption of more than 2 years is not necessary, and that the language is confusing. 
                    </P>
                    <P>
                        <E T="03">Response:</E>
                         We agree and have removed the requirement for continued practice from this final rule with comment period. 
                    </P>
                    <P>
                        <E T="03">Comment:</E>
                         We received many comments concerning application of a requirement for State licensure, registration, certification or other regulation to physical therapist assistants. The commenters indicate large numbers of PTAs in California and other States are licensed but do not meet the proposed education and examination requirements. The commenters report implementation of the proposed qualifications would cause severe access problems for beneficiaries and operational disruption for facilities. All commenters supported the adoption of a grandfather clause to allow currently practicing PTAs to continue furnishing services to Medicare patients, and many requested the grandfathering be implemented when the rule is finalized in November, rather than January 1, 2008. 
                    </P>
                    <P>
                        <E T="03">Response:</E>
                         We will recognize as qualified to provide Medicare services those therapists and assistants who are licensed or otherwise regulated by their States before December 31, 2009. Individuals who are not licensed or otherwise regulated as PTs, OTs, PTAs, and OTAs in their States may furnish services incident to a physician's service if they meet the education and examination requirements in this final rule with comment period. These changes will be effective on the date this final rule with comment period is effective. 
                    </P>
                    <HD SOURCE="HD2">Personnel Qualifications—General </HD>
                    <P>For therapists and assistants trained outside the United States or trained by the United States military, we proposed standards we considered comparable to those applied to therapists and assistants trained in the United States. However, we noted we would not recognize as qualified therapists or therapy assistants individuals trained in other disciplines for purposes of furnishing PT, OT, or SLP services to Medicare beneficiaries. </P>
                    <P>
                        <E T="03">Comment:</E>
                         APTA recommends the use of the term “substantially equivalent” to replace “comparable” to avoid confusion in the language concerning those trained outside the United States. 
                    </P>
                    <P>
                        <E T="03">Response:</E>
                         We have modified the language to substitute in regulations the term “substantially equivalent” for “comparable”. 
                    </P>
                    <P>
                        <E T="03">Comment:</E>
                         Several commenters believe that the qualifications for military trained OTs/OTAs (when applicable) and PTs/PTAs should be the same as for all OTs/OTAs and PTs/PTAs. 
                    </P>
                    <P>
                        <E T="03">Response:</E>
                         We agree that separate qualifications for U.S. military-trained therapy personnel are not necessary for PTs, OTs, and OTAs, since the training programs available in the military already meet the same standards as other U.S.-trained OTs and PTs and OTAs. For PTAs who may, in the future, be trained in the military, we will apply the standard of substantial equivalency consistent with those trained outside the United States, or the same standards as other United States trained PTAs, as appropriate. 
                    </P>
                    <P>
                        <E T="03">Comment:</E>
                         Some commenters recommended that licensure be the only qualification for PTs and OTs. The commenters recommended we defer to individual States or to the medical staff of a hospital to determine the qualifications for physical therapists and occupational therapists. 
                    </P>
                    <P>Commenters agreed generally that we should rely on State licensure in those States where it exists and for those settings where licensure is applicable. The commenters note that there have been attempts to deregulate health professions in the name of regulatory reform and they recommend inclusion (for OT) and continuation (for PT) of education and exam requirements to assure there will be standards in place when licensure does not apply. </P>
                    <P>
                        <E T="03">Response:</E>
                         We believe it is appropriate, as we proposed, to require qualifications related to education and examination to address those situations where licensure does not apply. We added language in regulations to indicate that when licensure or other regulation is not applicable for therapists and assistants, the education and examination requirements apply. 
                    </P>
                    <P>
                        <E T="03">Comment:</E>
                         Several commenters support applying the proposed qualifications and therapy standards for staff providing services incident to the services of physicians. Some continue to object to the implementation of section 1862(a)(20) of the Act. 
                    </P>
                    <P>
                        <E T="03">Response:</E>
                         Section 1862(a)(20) of the Act excludes from payment under Medicare Parts A and B any expenses for outpatient PT or OT services furnished incident to the services of a physician that do not meet the standards and conditions that apply to therapists, except “any licensing requirement specified by the Secretary.” Therefore, as we described in the proposed rule, we will not apply the requirement that therapists and assistants be licensed or otherwise regulated by a State in the case of services furnished incident to the services of physicians. We will apply education and examination requirements. 
                    </P>
                    <P>
                        In the proposed rule, we explained that when we referred to persons who are licensed, certified, and otherwise regulated by a State, we interpreted “otherwise regulated” to mean that, while a State may not regulate a profession by granting a license or certifying educational or training 
                        <PRTPAGE P="66330"/>
                        credentials, it may nevertheless regulate the practice of a profession by application of certain other requirements. 
                    </P>
                    <P>We received no comments on the use of this term, and therefore, we intend to use it as proposed. Because we believe the term “certification” is redundant to “otherwise regulated”, that term has been omitted. </P>
                    <HD SOURCE="HD2">Occupational Therapy </HD>
                    <P>We proposed to require that OTs beginning their practice after January 1, 2010, must be licensed, certified, registered or otherwise regulated as an OT, and have graduated from an occupational therapist curriculum accredited by the Accreditation Council for Occupational Therapy Education (ACOTE) of the American Occupational Therapy Association (AOTA), and also have successfully completed the certification examination developed and administered by the National Board for Certification in Occupational Therapy (NBCOT). We established that “successfully completed” means the individual must perform sufficiently well on the exam to receive (or be eligible to receive) certification. For services incident to a physician's or nonphysician practitioner's service where the licensure requirement does not apply, we proposed the education and examination requirements continue to apply. </P>
                    <HD SOURCE="HD2">OT Comments </HD>
                    <P>
                        <E T="03">Comment:</E>
                         AOTA recommended qualifications based on licensure or education and examination. 
                    </P>
                    <P>
                        <E T="03">Response:</E>
                         We require qualifications based both on licensure and on education and examination so that there are appropriate qualifications that apply where licensure is not applicable, for example, to therapy services furnished incident to the physician's service. 
                    </P>
                    <P>
                        <E T="03">Comment:</E>
                         The NBCOT recommended that qualified OTs be credentialed by their examination and be members in good standing of their organization. The AOTA recommended that AOTA approve any new credentialing body that might develop in the future. 
                    </P>
                    <P>
                        <E T="03">Response:</E>
                         We recognize that currently the ACOTE or the World Federation of Occupational Therapists (WFOT) credential education programs for OTs and/or OTAs and the NBCOT determines eligibility and furnishes examinations. We have modified the policy to approve those organizations and added “or successor organizations” to allow for changes in the ACOTE title. We do not agree membership in NBCOT should be a requirement. Since NBCOT is already approved by The American National Standards Institute (ANSI), the National Commission for Certifying Agencies and the National Organization for Competency Assurance, CMS does not believe it is necessary to grant AOTA's request to permit it to approve any future credentialing body. 
                    </P>
                    <HD SOURCE="HD2">International OT/OTA </HD>
                    <P>We also proposed that OTs who are educated outside the United States: (1) Be graduates of an occupational therapy curriculum accredited by the WFOT; (2) have successfully completed the NBCOT International Occupational Therapy Eligibility Determination (IOTED) review; and (3) have successfully completed the certification examination for Registered Occupational Therapist. We proposed to adopt similar standards for OTAs (but with an OTA curriculum) and requested comments on qualifications for internationally educated occupational therapy assistants. </P>
                    <P>
                        <E T="03">Comment:</E>
                         The AOTA and NBCOT support the proposal that the internationally educated OT standards should be comparable to United States trained OTs and that the NBCOT conduct the credentialing process for these OTs. The AOTA requests that there be a way to allow a professionally recognized credentialing body other than NBCOT to develop or administer the examination. 
                    </P>
                    <P>NBCOT reports there are no internationally trained OTAs and recommends qualifications for such OTAs be stricken from the rules. </P>
                    <P>
                        <E T="03">Response:</E>
                         This final rule with comment period recognizes the ACOTE, NBCOT or WFOT to contribute to credentialing internationally trained OTs and OTAs. Although NBCOT may not now recognize internationally trained OTAs, such OTAs do exist. In addition, we are adopting regulations in anticipation of any international programs that meet the qualifications in the future. 
                    </P>
                    <P>
                        <E T="03">Comment:</E>
                         AOTA commented that the proposals for those who began practice between December 31, 1977, and January 1, 2008, are archaic and cannot be directly applied to many professionals qualified by their States. 
                    </P>
                    <P>
                        <E T="03">Response:</E>
                         We agree that the current language is not applicable and we have updated this language for the new qualifications in this final rule with comment period, adding current credentialing bodies for United States trained and internationally trained OTs. To assure that no one covered under the existing qualifications is inadvertently disqualified, the prior language continues to apply for those who are not licensed but were qualified under the previous policy. 
                    </P>
                    <P>
                        <E T="03">Comment:</E>
                         Commenters note that many States allow graduate OTs and OTAs to furnish services under a temporary license or permit while eligible for examination. The commenters expressed concern that the qualifications in the proposed rule would limit new graduates from entering the workforce. 
                    </P>
                    <P>
                        <E T="03">Response:</E>
                         We agree that it is not necessary to change the current requirement of eligibility for the examination for United States trained OTs and OTAs when they are licensed or otherwise regulated by their States. However, we will require foreign trained OTs and OTAs (when applicable) to have passed the examination, and not merely be eligible for it. We believe this requirement is appropriate in the case of foreign trained individuals in order to ensure that they have acquired sufficient knowledge through their education program to pass the examination and, thus, are adequately prepared to begin furnishing services to Medicare beneficiaries. 
                    </P>
                    <HD SOURCE="HD2">Physical Therapy </HD>
                    <P>For PTs, we proposed the therapist must be licensed as a physical therapist by the State in which practicing and accredited by the CAPTE based on APTA guidelines. When the licensure requirement is not applicable (that is, for services furnished incident to the services of physicians and NPPs), we proposed to require that PTs must be accredited by the CAPTE. We requested comments on qualifications for PTs which include satisfactory completion of a curriculum and a national examination each approved by the APTA. </P>
                    <P>
                        <E T="03">Comment:</E>
                         APTA recommended that we remove the requirement that a PT pass a National Examination approved by the APTA. Since all States require a national licensing exam, APTA does not believe it is necessary for APTA to approve the exam. State Boards supported State licensing requirements, which include examination. 
                    </P>
                    <P>
                        <E T="03">Response:</E>
                         In cases where the licensing standards do not apply (for therapy services incident to a physician's service or in the event a State deregulates PT practice), we believe it is important to have standards in place to ensure that an individual is qualified to furnish physical therapy services. We will not finalize the requirement for APTA to approve the licensing exam. Instead, we will accept a national licensing exam used by State boards to qualify personnel who have 
                        <PRTPAGE P="66331"/>
                        been trained in a physical therapy curriculum. 
                    </P>
                    <P>We proposed that licensure or certification, or other regulation by the State in which services are furnished would be required for PTAs under our regulations. We also proposed that PTAs be accredited by the CAPTE. We requested comments on appropriate qualifications for PTAs. </P>
                    <P>
                        <E T="03">Comment:</E>
                         APTA believes it is critical that we require approval by APTA for foreign trained PTAs. The Commission on Accreditation of Physical Therapist Education (CAPTE) of the APTA has been nationally recognized since 1977 as the only organization that approves PT and PTA education programs; it has no financial interest in the credentialing bodies for PTs or PTAs. 
                    </P>
                    <P>Some commenters disagreed with our proposal to allow the APTA to approve the credentialing body that establishes qualifications for foreign trained PTs and/or PTAs. They suggest that the U.S. Citizenship and Immigration Services and the Department of Homeland Security approve credentialing bodies that set standards and credential individuals and the States decide whether to license that individual. The commenters note there are currently no approved foreign PTA programs. </P>
                    <P>
                        <E T="03">Response:</E>
                         While commenters tell us there are no foreign PTA programs that meet their credentialing standards, there may be PTA programs in foreign countries that meet the standards in the future. Therefore, this final rule with comment period addresses this future need. The CAPTE of the APTA is approved by the U.S. Department of Education (USDE) and the Council for Higher Education Accreditation (CHEA). We find no reason to doubt that CAPTE/APTA will make fair determinations on the appropriateness of educational programs in the United States or credentials evaluation organizations for foreign trained PTs and PTAs. However, in response to comments, we have recognized both CAPTE and a credentials evaluation organization identified in 8 CFR 212.15(e) (the Homeland Security Act) as it relates to physical therapists and assistants to determine an education program to be substantially equivalent to PT and PTA entry level education in the United States. We believe the additional requirement for passing a national examination will mitigate any variations in credentialing. 
                    </P>
                    <P>
                        <E T="03">Comment:</E>
                         Several commenters stated that adoption of the proposed qualifications for PTs would usurp the rights of State governments in licensing and determining the scope of practice for healthcare professionals, creating “a monopoly for curriculum approval”. 
                    </P>
                    <P>
                        <E T="03">Response:</E>
                         As we indicated in the proposed rule, we believe it is important to establish consistent and meaningful standards and conditions for the provision of Medicare covered services. Professional standards change periodically and these are often eventually adopted by State licensing boards, each of which has different language in its statutes. We believe the standards we proposed would not usurp or interfere with the adoption of standards by States. Rather, in most cases the standards incorporate the State standards. However, we believe it is necessary for CMS to address circumstances where State licensing or other regulation are not applicable. We are not creating a monopoly for curriculum approval by recognizing CAPTE. While it is the only existing credentialing body used by the States in their licensing process, we assess other credentialing qualifications if they are developed. Therefore, we are finalizing standards that include State standards (licensing or other regulation), as well as education and examination. We will assess other credentialing qualifications if they are developed. 
                    </P>
                    <HD SOURCE="HD3">b. Application of Consistent Therapy Standards </HD>
                    <HD SOURCE="HD3">(1) Personnel Qualifications </HD>
                    <P>We believe therapy services should be provided according to the same standards and policies in all settings, to the extent possible and consistent with statute. Therefore, we proposed to revise our regulations to cross-reference the personnel qualifications for therapists in § 484.4 to the personnel requirements for PTs, OTs, PTAs, OTAs, and SLPs in the following sections: </P>
                    <P>• § 409.10 and § 409.16 (Inpatient hospital services and inpatient critical access hospital services). </P>
                    <P>• § 409.23 (Posthospital SNF care). </P>
                    <P>• § 410.43 (Partial hospitalization services). </P>
                    <P>• § 410.59 (Outpatient occupational therapy services). </P>
                    <P>• § 410.60 (Outpatient physical therapy services). </P>
                    <P>• § 410.62 (Outpatient SLP services). </P>
                    <P>• § 418.92 (Hospice). </P>
                    <P>• § 482.56 (Optional hospital services, Rehabilitation services). </P>
                    <P>• § 485.70 (Specialized providers). </P>
                    <P>• § 485.705 (Clinics, Rehabilitation agencies, Public health agencies). </P>
                    <P>• § 491.9 (Rural health clinics and Federally qualified health centers (FQHCs)). </P>
                    <P>We also solicited comments on whether the personnel qualifications at § 484.4 should be made applicable in other settings. </P>
                    <HD SOURCE="HD2">Consistent Personnel Qualification Standards </HD>
                    <P>
                        <E T="03">Comment:</E>
                         Many commenters supported consistent personnel qualifications. Commenters indicated beneficiaries deserve to be treated by qualified professionals in both inpatient and outpatient settings. 
                    </P>
                    <P>We also heard from commenters who oppose the application of consistent qualifications for therapists in Part A settings. The commenters stated that if only qualified physical therapists provide physical therapy services in Part A settings, it will prevent hospitals from continuing to employ athletic trainers to provide physical medicine and rehabilitation services. The commenters suggest the medical staff should decide the qualifications for therapists at a hospital. </P>
                    <P>
                        <E T="03">Response:</E>
                         The policies outlined in the proposed rule apply only to therapy services. The State Operations Manual Appendix A Survey Protocol, Regulations and Interpretive Guidelines for Hospitals (Rev. 1, 05-21-04) § 482.56 Condition of Participation: Rehabilitation Services indicates that therapy services, if provided, must be in accordance with acceptable standards of practice which include compliance with any applicable Federal or State laws, regulations or guidelines, as well as standards and recommendations promoted by APTA, ASHA, and AOTA. In States where there are no personnel qualifications for therapists or assistants, hospitals should currently be following the personnel qualification standards set by those professional organizations. Most States and all of the professional organizations require graduation from approved education programs and a passing grade on a national examination. Therefore, we do not anticipate that adherence to the personnel qualifications in this final rule will cause any changes in hospital personnel. 
                    </P>
                    <P>
                        At the same time, we recognize that there may be athletic trainers (AT), lymphedema specialists, low vision specialists, nurses, physicians, and other staff employed in hospital settings who furnish other services for which they are qualified, and for which payment is included in the payment to the facility. Those services should be appropriately documented as, for example, athletic training or lymphedema services. Where the services of health care professionals who are not PTs, OTs, PTAs, OTAs, or SLPs are now being appropriately furnished, documented and reimbursed, 
                        <PRTPAGE P="66332"/>
                        we anticipate the application of consistent personnel qualifications relating to PT, OT and SLP services will have no effect on the appropriate provision of these other services. In settings where therapy services are separately billable, there will only be an impact on current practice if services that are being documented as PT, OT, or SLP services are being furnished by personnel who do not meet the requirements to be considered qualified therapists. Personnel who do not meet the applicable professional standards to be considered qualified therapists cannot furnish or be paid for PT, OT, and SLP services. 
                    </P>
                    <P>
                        <E T="03">Comment:</E>
                         Several commenters indicated that therapy services are not covered in rural health clinics. 
                    </P>
                    <P>
                        <E T="03">Response:</E>
                         Rural Health Clinics (RHCs) provide a core set of primary health care services as defined in statute. RHC services include the services that would commonly be furnished in a physician's office, (such as PT, OT, and SLP services), but only when directly provided by a Medicare approved RHC provider, such as a physician, nurse practitioner, or physician assistant. A certified nurse midwife, clinical psychologist, and or clinical social worker may provide RHC services, but not PT, OT, or SLP services, because PT, OT, and SLP services are not in their scope of practice. A face-to-face encounter with any other practitioner including, for example, a PT, OT, or SLP, athletic trainer, kinesiologist, or registered nurse is not covered as an RHC encounter, even if the service may be medically necessary, because these are not Medicare approved RHC providers (as defined in statute). Since therapists are not approved RHC providers, we will remove the reference in § 491.9 to personnel qualifications for therapists. 
                    </P>
                    <HD SOURCE="HD2">Consistent Policies </HD>
                    <HD SOURCE="HD3">(2) Application of Consistent Therapy Standards </HD>
                    <P>In tandem with cross-referencing Part A and Part B therapy personnel requirements in the regulations, we proposed to clarify our policies to improve consistency in the standards and conditions for Part A and Part B therapy services. Many, but not all, of the policies described for therapy services in Part B settings are also appropriate to Part A settings. </P>
                    <P>Specifically, in § 409.17, we proposed to clarify that hospital services include physical therapy, occupational therapy, and SLP. We also proposed to add regulations for inpatient hospital services to include a plan for therapy services consistent with the plan required for outpatient therapy services. We invited comment on PT, OT, and SLP plan of treatment policies that are appropriately applied to all therapy services, whether provided under Medicare Part A or B. </P>
                    <P>While the concept of consistent policies was strongly supported, many commenters were concerned about the application of specific Part B policies to Part A settings. </P>
                    <P>
                        <E T="03">Comment:</E>
                         Several commenters indicated concern that application of the Part B policies, especially plan and documentation polices, to the inpatient hospital setting would impact treatment and increase the paperwork burden to staff. 
                    </P>
                    <P>
                        <E T="03">Response:</E>
                         We are aware that inpatient stays are short. If clinically appropriate documentation is now provided, the new policies are unlikely to increase the burden. We have not delineated which of the Part B policies would apply in Part A specifically to allow some flexibility in the application of the general treatment guidelines as appropriate to the setting. We anticipate addressing these issues in manual instructions. 
                    </P>
                    <P>We note that we continue to believe the general concept that therapy services should be provided in a similar manner by qualified personnel in all settings is an appropriate one. </P>
                    <P>
                        <E T="03">Comment:</E>
                         The AOTA requests that any change to the therapy plan of care be incorporated “as soon as possible” rather than “immediately.” 
                    </P>
                    <P>
                        <E T="03">Response:</E>
                         We recognize that the term “immediately” could be relative. Therefore, we have substituted “as soon as possible” to refer to changes in the plan in § 424.24 and § 482.56. 
                    </P>
                    <P>
                        <E T="03">Comment:</E>
                         Commenters indicated concern that the outpatient plan of care certification requirement would be transferred to inpatient policy and that an ordered service that is being provided under the care of a hospital physician would also require certification for every change in the provision of treatment. 
                    </P>
                    <P>
                        <E T="03">Response:</E>
                         The policy at § 409.17 and § 482.56 is compatible with the concept of the therapy plan as part of the overall plan in a facility. Also, we defer to hospital policies and procedures for changes to the plan. Guidance will be provided in manuals concerning modifications in the provision of care that do not constitute changes to the plan. Requirements concerning orders for establishment of a therapy plan (development and implementation) in the hospital are not changed by this final rule with comment period. We anticipate clarifying further in manual instructions documentation requirements that are consistent with the care of inpatients and will take into account comments received. We believe that, in general, good practice would call for documentation of significant changes to the patient's response to treatment in all settings, even if the Medicare program does not specifically require it. 
                    </P>
                    <P>
                        <E T="03">Comment:</E>
                         AOTA asserts that in the inpatient setting, goal setting and treatment planning may not fit the mold of what is typically required by CMS in outpatient settings, that is, functional restoration. They indicate concern that therapy will not be provided consistent with their professional guidelines or scope of practice. 
                    </P>
                    <P>
                        <E T="03">Response:</E>
                         We recognize that some of the services furnished by therapists in the acute inpatient hospital setting may not achieve functional changes expected in other settings. We have noted in § 482.56 that the provision of care and the personnel qualifications must be in accordance with national acceptable standards of practice. Although documentation is not relevant to billing in this setting, it is still critical that the services furnished be accurately documented. We anticipate issuing further guidance regarding documentation for therapy services in hospital settings in Medicare manuals. 
                    </P>
                    <P>
                        <E T="03">Comment:</E>
                         AOTA requests removal of the reference to review of the plan prior to certification in § 409.17(e). APTA agrees that the review language is unnecessary. 
                    </P>
                    <P>
                        <E T="03">Response:</E>
                         We agree that it is unnecessary in the regulation to remind physicians or nonphysician practitioners to read the plan before they certify it and we have removed the paragraph from § 410.61(e) and § 409.17(e), and § 482.56(e). 
                    </P>
                    <P>
                        <E T="03">Comment:</E>
                         Several commenters agree with the proposal that in the hospital setting the physician's review and approval of a therapy plan should be implied in the physician's review and approval of a facility plan that includes therapy services. The commenters believe the same rationale applies to services furnished in skilled nursing facilities and urge CMS to state that, in the SNF Part A setting, review of the therapy plan is implied by the physician's review of the facility plan. 
                    </P>
                    <P>
                        <E T="03">Response:</E>
                         We agree with the commenters regarding the implied physician review and approval of the therapy plan in the Part A SNF setting. We have recognized this issue previously in the preamble to the Prospective Payment System and Consolidated Billing for Skilled Nursing Facilities; Update Notice (69 FR 45780), 
                        <PRTPAGE P="66333"/>
                        where we stated that “ * * *. It is not necessary for a SNF to obtain a separate physician signature on the therapy treatment plan itself prior to billing Part A for therapy services * * * .” 
                    </P>
                    <HD SOURCE="HD2">Delay in Implementing Policies </HD>
                    <P>
                        <E T="03">Comment:</E>
                         Many commenters requested delays in the implementation of the policies for Part A therapy services, indicating they want time to have input into the manual guidelines and may need time to learn new procedures. 
                    </P>
                    <P>
                        <E T="03">Response:</E>
                         We will delay the implementation of the policies pending the issuance of manual guidance which we anticipate that we will develop in mid 2008. 
                    </P>
                    <HD SOURCE="HD2">Students </HD>
                    <P>
                        <E T="03">Comment:</E>
                         Many commenters believe that it is imperative that we not inadvertently develop a policy that prevents students from receiving clinical training. APTA suggests we consider conforming the policies for students to the SNF policy for services provided by aides and students. The SNF policy allows services by aides and students in the “line of sight” of the therapist to count toward minutes accrued on the Minimum Data Set. 
                    </P>
                    <P>
                        <E T="03">Response:</E>
                         We will consider conforming all policies for student supervision to the SNF policy for line of sight supervision, and will address this issue in manual guidance. 
                    </P>
                    <HD SOURCE="HD3">c. Outpatient Therapy Certification Requirements </HD>
                    <P>In 1988, in an attempt to control the expanding utilization of therapy services, we added a 30-day recertification requirement for outpatient therapy services to our regulation at § 424.24. This requires that a physician certifies a plan of care for 30 days, regardless of the appropriate length of treatment. To continue treatment past 30 days, the physician is required to recertify the plan. As explained in the CY 2008 PFS proposed rule, after many years of experience with the current recertification requirements, we now believe that requiring recertification at 30-day intervals may not always provide sufficient flexibility to the physician to order the appropriate amount of therapy for the patient's needs. Therefore, we proposed to change the plan recertification schedule in § 424.24 to an episode length based on the patient's needs, not to exceed 90 days. </P>
                    <P>
                        <E T="03">Comment:</E>
                         We received strong support for changing the recertification schedule to a date determined by the physician (not to exceed 90 days) from the therapy associations, medical societies, facilities, and individuals. They emphasized that physician approval of a clinically appropriate length of treatment at the initial certification will improve the patients’ access to treatment, reduce administrative burden to physicians, therapists and office staff and reduce unnecessary visits for patients. Several indicated that a limit is not necessary since the physician should determine the episode length. MedPAC indicated a concern about reducing the number of physician reviews of the services in the context of the increasing utilization of therapy services 
                    </P>
                    <P>
                        <E T="03">Response:</E>
                         We agree that a physician is qualified to certify the appropriate length of care in the initial certification; and that recertification should be required as often as the individual's condition requires. However, we believe a 90-day limit is a reasonable modification of the policy at this time. We will continue to review the utilization of therapy services to assess any changes in the relative utilization patterns for beneficiaries or providers/suppliers that may suggest changes in practice related to this policy. As we proposed, after 2 years, if we determine that there are changes in relative utilization patterns that suggest inappropriate utilization of therapy services based on the certification timing, we will reconsider this policy. 
                    </P>
                    <P>
                        <E T="03">Comment:</E>
                         One commenter stated that a physician generally does not have statistical data from which to make a decision regarding the appropriateness of initiation or continuation of therapy, and, therefore, recertification of therapy by physicians seems meaningless. The commenter urges the use of risk-adjusted data based on gains in functional status relative to number of visits to inform physician decision making for appropriate utilization. 
                    </P>
                    <P>
                        <E T="03">Response:</E>
                         We agree that collection of data related to the patient's functional condition and relative utilization of services may be useful in our ongoing development of recommendations for alternatives to therapy caps. On September 6, 2007, we released a Request for Task Order Proposals to the pool of contractors under the CMS MRAD (Master Research And Development) contract vehicle. The goal of this request for proposals is to develop recommendations for alternatives to therapy caps for CMS covered Outpatient Therapy services. 
                    </P>
                    <P>
                        <E T="03">Comment:</E>
                         There was very strong support for extension of the 90 day recertification policy to CORF settings, consistent with the proposed policy for all other settings. There were no comments opposed to consistent recertification policy in the CORF. 
                    </P>
                    <P>
                        <E T="03">Response:</E>
                         We will apply this policy consistently across settings, including the CORF reference in § 410.105(c)(ii)(2) and 424.27(b). 
                    </P>
                    <HD SOURCE="HD2">Review of Plan </HD>
                    <P>We proposed that review of the plan as required in § 424.24 would continue to be required at certification and recertification. Since the plan may be established by a nurse practitioner, a clinical nurse specialist, or a physician assistant (nonphysician practitioners), as well as a physician, we proposed to modify the language in § 410.61 to include those professionals among those who may review the plan. Since the certification and recertification of the plan for Part B services requires a signature, we proposed to remove the current redundant requirement at § 410.61(e) to date and sign a review at the same time the plan is certified. In addition, we proposed to revise § 424.24 to remove reference to a certification “statement.” </P>
                    <P>
                        <E T="03">Comment:</E>
                         We received one comment supporting the changes to the review language and no dissenting comments. 
                    </P>
                    <P>
                        <E T="03">Response:</E>
                         We are finalizing the proposed changes to the review of plan language in this final rule with comment period. 
                    </P>
                    <HD SOURCE="HD3">3. Amendment of the Exemption for Computer-Generated Facsimile Transmission From the National Council for Prescription Drug Programs (NCPDP) SCRIPT Standard for Electronically Transmitting Prescription and Certain Prescription-Related Information for Part D Eligible Individuals </HD>
                    <HD SOURCE="HD3">a. Legislative History </HD>
                    <P>
                        Section 101 of the MMA amended title XVIII of the Act to establish a voluntary prescription drug benefit program. Prescription Drug Plan (PDP) sponsors and Medicare Advantage (MA) organizations offering Medicare Advantage—Prescription Drug Plans (MA-PD) are required to establish electronic prescription drug programs to provide for electronic transmittal of certain information to the prescribing provider and dispensing pharmacy and pharmacist. This would include information about eligibility, benefits (including drugs included in the applicable formulary, any tiered formulary structure and any requirements for prior authorization), the drug being prescribed or dispensed and other drugs listed in the medication history, as well as the availability of lower cost, therapeutically appropriate 
                        <PRTPAGE P="66334"/>
                        alternatives (if any) for the drug prescribed. The MMA directed the Secretary to issue uniform standards for the electronic transmission of such data. 
                    </P>
                    <P>There is no requirement that prescribers or dispensers implement e-prescribing. However, prescribers and dispensers who electronically transmit prescription and certain other prescription-related information for covered drugs prescribed for Medicare Part D eligible beneficiaries, directly or through an intermediary, would be required to comply with any applicable final standards that are in effect. </P>
                    <HD SOURCE="HD3">b. Foundation Standards and Exemption for Computer Generated Facsimiles (Faxes) </HD>
                    <P>In the E-Prescribing and the Prescription Drug Program final rule (70 FR 67568, November 7, 2005), we adopted the NCPDP SCRIPT standard, Implementation Guide, Version 5, Release 0 (Version 5.0), May 12, 2004, excluding the Prescription Fill Status Notification Transaction (and its three business cases; Prescription Fill Status Notification Transaction—Filled, Prescription Fill Status Notification Transaction—Not Filled, and Prescription Fill Status Notification Transaction—Partial Fill), hereafter referred to as NCPDP SCRIPT 5.0, as the standard for communicating prescriptions and prescription-related information between prescribers and dispensers. Subsequently, on June 23, 2006 (71 FR 36020), HHS published an interim final rule that maintained NCPDP SCRIPT 5.0 as the adopted standard, but allowed for the voluntary use of a subsequent backward compatible version of the standard, NCPDP SCRIPT 8.1. As use of either of these two named versions of the NCPDP SCRIPT standard is permitted, for ease of reference, we will simply refer to “NCPDP SCRIPT” in this rule. </P>
                    <P>The November 7, 2005 final rule also established an exemption to the requirement to utilize NCPDP SCRIPT for entities that transmit prescriptions or prescription-related information by means of computer generated facsimiles (faxes generated by one computer and electronically transmitted to another computer or fax machine which prints out or displays a image of the prescription or prescription-related information). Providers and dispensers who use this technology are not compliant with NCPDP SCRIPT. The exemption was intended to allow such providers and dispensers time to upgrade to software that utilizes the NCPDP SCRIPT standard, rather than forcing them to revert to paper prescribing. </P>
                    <HD SOURCE="HD3">c. Elimination of Exemption </HD>
                    <P>In the CY 2008 PFS proposed rule (72 FR 38194), we proposed to revise § 423.160(a)(3)(i) to eliminate the computer generated fax exemption to the NCPDP SCRIPT Standard for the communication of prescription or certain prescription related information between prescribers and dispensers for the transactions listed at § 423.160(b)(1)(i) through (xii). </P>
                    <P>Since computer-generated faxing retains some of the disadvantages of paper prescribing (for example, the administrative cost of keying the prescription into the pharmacy system and the related potential for data entry errors that may impact patient safety), we believed it was important to take steps to encourage prescribers and dispensers to move toward use of NCPDP SCRIPT. </P>
                    <P>In our November 7, 2005 final rule discussion of computer-generated faxing, we distinguished between cases where the prescriber's or dispenser's software has the ability to generate transactions utilizing the NCPDP SCRIPT, but the prescriber has not activated the feature on their software, and other cases where software (such as a word processing program) is used to create a document that can be sent as a fax that results in print out or displays a image of a prescription or response at the receiving end, but does not have true e-prescribing (electronic data interchange using NCPDP SCRIPT) capabilities. </P>
                    <P>We believed the elimination of the computer-generated fax exemption would encourage prescribers and dispensers using this computer-generated fax technology to, where available, utilize true e-prescribing capabilities. </P>
                    <P>It might also encourage those without such capabilities to upgrade their current software products, or, where upgrades are not available, to switch to new products that would enable true e-prescribing. </P>
                    <P>Because the elimination of the computer-generated facsimile exception would encourage those prescribers that are already using e-prescribing software that is capable of true e-prescribing to utilize those capabilities, we believed that the elimination of the computer-generated fax exemption would increase the number of NCPDP SCRIPT transactions fairly significantly in a relatively short time period, and that this could, in turn, create a “tipping point” that could create economic incentives for independent pharmacies to adopt NCPDP SCRIPT capable software to begin to exchange true e-prescribing transactions with their prescriber partners. </P>
                    <P>We proposed to eliminate the computer generated fax exemption effective 1 year after the effective date of the CY 2008 PFS final rule, on January 1, 2009. We believed that this would provide sufficient notice to prescribers and dispensers who would need to implement or upgrade e-prescribing software to look for products and upgrades that are capable of generating and receiving transactions that utilize NCPDP SCRIPT. It would also afford current e-prescribers time to work with their trading partners to eventually eliminate computer-to-fax transactions. </P>
                    <P>We believed the elimination of the exemption for computer-generated faxing would encourage e-prescribers and dispensers to move as quickly as possible to use of the NCPDP SCRIPT standard with what we perceived to be minimal impact. </P>
                    <P>We solicited comments on the impact of the proposed elimination of this exemption. </P>
                    <P>
                        <E T="03">Comment:</E>
                         Several commenters concurred with our proposal to eliminate the exemption for computer-generated faxes. These commenters indicated that lifting the exemption for computer generated faxes would act as an incentive to move prescribers and dispensers toward true e-prescribing (electronic data interchange using the NCPDP SCRIPT standard) and that once the benefits of true e-prescribing are realized by a core group of prescribers and dispensers, word of mouth would help foster more extensive adoption. 
                    </P>
                    <P>Less than half of all commenters disagreed with our proposal to eliminate the exemptions for computer-generated faxes, citing concerns about increased hardware/software costs, transaction fees, certification and other activation costs. Some commenters agreed that many prescribers who are already e-prescribing likely already possess the ability to generate NCPDP SCRIPT compliant transactions using their software or can comply by obtaining a version upgrade under their maintenance agreements. Some commenters also questioned whether lifting the exemption would move the industry forward toward, or raise barriers to, greater use of true e-prescribing. We also received comments from some individuals who erroneously thought that we had proposed the elimination of all faxes, including paper-to-paper faxes. </P>
                    <P>
                        <E T="03">Response:</E>
                         For new e-prescribers, the cost of implementing a product that can generate an NCPDP SCRIPT-compliant transaction would not differ from a 
                        <PRTPAGE P="66335"/>
                        product that could not, and we expect that, over time, the market will move toward the exclusive use of NCPDP SCRIPT-compliant transactions. Moreover, the adoption of the PQRI structural measure discussed section II.S.1. of this final rule with comment period will provide an incentive to providers to implement e-prescribing. We recognize that pharmacies that are not now conducting transactions that utilize NCPDP SCRIPT will incur costs to implement this capability, and that pharmacies will likely experience an increase in e-prescribing transaction volumes and costs. However, those costs would be balanced by administrative savings. We refer to the November 7, 2005 final rule (70 FR 67568) for a further discussion of potential costs associated with e-prescribing. 
                    </P>
                    <P>As more prescribers and dispensers embrace interoperable health information technology in general, and the use of e-prescribing standards in particular, they will see real value and realize costs savings. Dispenser data entry time and transcription errors due to data re-entry or illegible paper prescriptions will be reduced. Prescribers and dispensers will spend less time on the phone requesting and responding to refill requests. Improved workflow will free up staff time for patient counseling and other services. Patient safety will improve as providers are linked with medication history, allergy information and/or drug contraindications that will result in a reduction of adverse drug events. </P>
                    <P>
                        <E T="03">Comment:</E>
                         Many commenters agreed that the proposed compliance date of January 1, 2009 was a reasonable timeframe for those who needed to comply. Others urged us to extend the compliance date to April 1, 2009, to coincide with the projected effective date of the next set of e-prescribing standards, or to January 1, 2010, to give prospective e-prescribers more time to identify compliant products. Some commenters recommended that the requirement to use the adopted e-prescribing standards should only apply to those prescribers/dispensers who have software or applications that have the ability to generate transactions utilizing NCPDP SCRIPT. Others suggested that the use of computer-generated faxes continue to be permitted for those prescribers and dispensers who already have the functionality to engage in transactions utilizing NCPDP SCRIPT, and allow those who adopt software that generates transactions utilizing NCPDP SCRIPT after the compliance date of January 1, 2009, an additional 1 year to comply with the NCPDP SCRIPT requirement. 
                    </P>
                    <P>
                        <E T="03">Response:</E>
                         The 2006 CMS e-prescribing pilot noted that the majority of e-prescribing software currently being used by prescribers is already able to transmit information using NCPDP SCRIPT. Moreover, commenters agreed that most current e-prescribers could become compliant by installing an NCPDP SCRIPT-enabled version upgrade. Therefore, we believe that the January 1, 2009 compliance date provides adequate time for current e-prescribers in the industry to comply with the NCPDP SCRIPT e-prescribing standard provisions while encouraging other prescribers and dispensers to move closer toward true e-prescribing. We do not see a purpose in affording new e-prescribers an additional year to comply, since it should not take more time to implement an NCPDP SCRIPT-compliant product than a noncompliant product. 
                    </P>
                    <P>
                        <E T="03">Comment:</E>
                         Many commenters suggested that we continue to allow for the use of computer-generated faxes in the case of transmission failure and network outages. 
                    </P>
                    <P>
                        <E T="03">Response:</E>
                         Computer-generated faxes may be needed for prescriptions which fail in electronic data interchange (EDI) transmission. Allowing computer-generated faxes as a fall back measure would allow the prescription to be expedited to the pharmacy, ensuring timely dispensing of the medication, thus enhancing patient safety. We agree that there should be a viable contingency plan in the event that an EDI-transmitted prescription fails due to network transmission failures or similar, temporary communication problems that are episodic and non-repetitive in nature. We find the use of computer-generated faxes, but only in instances of the aforementioned transmission failures or similar communication problems of a temporary/transient nature, to be an acceptable and viable solution. We do not, however, consider it to be a permanent substitute for ongoing EDI transmission problems. As we will continue to allow computer-generated faxes as a fallback in cases of temporary/transient transmission failures and communications problems, we will not totally eliminate but instead amend the exemption for computer-generated facsimile transmission from the NCPDP SCRIPT Standard to account for this contingency. 
                    </P>
                    <P>
                        <E T="03">Comment:</E>
                         Approximately one-fourth of commenters from all sectors of the health care industry called for the delay of the elimination of the exemption for computer-generated faxes until such time as the Drug Enforcement Agency (DEA) changes its rules to allow the e-prescribing of controlled substances. Commenters believe that the current DEA position on disallowing e-prescribing of controlled substances creates a barrier to adoption, and the proposed CMS compliance date of January 2009 will only exacerbate the issue. 
                    </P>
                    <P>
                        <E T="03">Response:</E>
                         As we have no indication as to when the Drug Enforcement Agency will make a determination on the e-prescribing of controlled substances, it would be difficult for us to predicate eliminating the exemption for computer-generated faxes based upon such an unknown timetable. However, we concur with commenters who stated that the inability to prescribe these controlled substances electronically hampers e-prescribing adoption by providers. We continue to work with the DEA to help facilitate a solution that addresses both the enforcement requirements of the DEA with respect to prescribing of controlled substances, and the needs of the healthcare community for a solution that is scalable and commercially viable. 
                    </P>
                    <P>
                        <E T="03">Comment:</E>
                         One commenter suggested that we exempt controlled substances from this requirement. 
                    </P>
                    <P>
                        <E T="03">Response:</E>
                         The November 7, 2005 E-prescribing final rule (70 FR 67568) recognizes the DEA's role in the enforcement of the prescribing of controlled substances. As controlled substances cannot be legally e-prescribed, an exemption from the NCPDP SCRIPT standard for the e-prescribing of controlled substances would have no effect. 
                    </P>
                    <P>
                        <E T="03">Comment:</E>
                         Some commenters were confused as to whether the computer generated fax exemption would affect the exemption in the long term care setting, and requested that we clarify that prescribers and dispensers in the long term care setting were exempt from the requirement to use NCPDP SCRIPT despite the amendment of the exemption of the computer generated faxes. 
                    </P>
                    <P>
                        <E T="03">Response:</E>
                         Our amendment of the exemption for computer generated faxes does not apply at this time to the long term care industry as defined under Medicare Part D. At the time the CY 2008 PFS proposed rule (72 FR 38194) was published in the 
                        <E T="04">Federal Register</E>
                        , the long term care industry exemption for using adopted standards in e-prescribing (as contained in the November 7, 2005 final rule (70 FR 67568)) was, and remains, in place. Based on the comments we received, we are finalizing an amendment of the exemption for computer-generated faxes. 
                        <PRTPAGE P="66336"/>
                    </P>
                    <HD SOURCE="HD2">S. Division B of the Tax Relief and Health Care Act of 2006—Medicare Improvements and Extension Act of 2006 (Pub. L. 109-432) (MIEA-TRHCA) </HD>
                    <P>In addition to the provisions of the MIEA-TRHCA discussed in sections II.B. (GPCIs) and II.F. (CAP), additional provisions of the MIEA-TRHCA are discussed in this section of the final rule with comment period. </P>
                    <HD SOURCE="HD3">1. Section 101(b)—Physician Quality Reporting Initiative (PQRI) </HD>
                    <HD SOURCE="HD3">a. Background </HD>
                    <HD SOURCE="HD3">(i) Program Background and Statutory Basis </HD>
                    <P>Section 101(b) of the MIEA-TRHCA amended section 1848 of the Act by adding subsection (k). Section 1848(k)(1) of the Act requires the Secretary to implement a system for the reporting by eligible professionals of data on quality measures as described in section 1848(k)(2) of the Act. Section 1848(k)(3)(B) of the Act specifies that for the purpose of the quality reporting system, eligible professionals include physicians, other practitioners as described in section 1842(b)(18)(C) of the Act, physical and occupational therapists, and qualified speech-language pathologists. Section 101(c) of the MIEA-TRHCA authorizes “Transitional Bonus Incentive Payments for Quality Reporting” in 2007, specifically for satisfactory reporting of quality data, as defined by section 101(c)(2) of the MIEA-TRHCA. We have named this quality reporting system the “Physician Quality Reporting Initiative (PQRI)” for ease of reference. </P>
                    <P>
                        For 2007, section 1848(k)(2)(A)(i) of the Act, as added by the MIEA-TRHCA, provides that the quality measures for the PQRI shall be the 66 physician quality measures published as 2007 Physician Voluntary Reporting Program (PVRP) quality measures on the CMS web site as of the date of enactment of this subsection, except for any changes based on the results of a consensus-based process in January 2007. Based on actions approved at the AQA Alliance (formerly the Ambulatory Care Quality Alliance) meeting on January 22, 2007, 8 measures were added to the 66 measures from the PVRP. Thus, the final “2007 PQRI Quality Measures” comprise 74 measures, which are applicable to specific combinations of patient conditions and Medicare Physician Fee Schedule (PFS) covered professional services. The measure titles, descriptions, and specifications are available for download from the PQRI Measures/Codes page of the PQRI section of the CMS Web site at 
                        <E T="03">http://www.cms.hhs.gov/PQRI</E>
                        . 
                    </P>
                    <P>
                        Section 1848(k)(2)(A)(ii) of the Act does not allow for any further additions to or deletions from the 2007 PQRI Quality Measures after January 2007, and does not allow modifications or refinements (such as code additions, corrections, or revisions) to the detailed specifications for the 2007 PQRI quality measures after the July 1, 2007, beginning date of the reporting period. The final 2007 specifications for the 2007 PQRI quality measures are available as a download from the Measures/Codes page of the PQRI section of the CMS Web site at 
                        <E T="03">http://www.cms.hhs.gov/pqri</E>
                        . Additional information on the 2007 PQRI is also available from this section of the CMS Web site, including, but not limited to: 
                    </P>
                    <P>• Tools to help professionals select measures; </P>
                    <P>• Tools to help professionals capture data on 2007 PQRI quality measures; </P>
                    <P>• Explanations of the calculation of eligibility for and amount of bonus payment for satisfactory reporting; and </P>
                    <P>• A description of the methodology that we will use to validate whether professionals have satisfactorily reported the MIEA-TRHCA required minimum number of applicable measures. </P>
                    <P>
                        Section 1848(k)(2)(B) of the Act further requires that the Secretary publish in the 
                        <E T="04">Federal Register</E>
                         not later than August 15, 2007, proposed quality measures that would be appropriate for eligible professionals to use to submit data to the Secretary in 2008. The final 2008 PQRI quality measures must be determined and published by November 15, 2007, as specified in section 1848(k)(2)(B) of the Act as amended by the MIEA-TRHCA. 
                    </P>
                    <HD SOURCE="HD3">(ii) Overview of the PQRI Section in the Final Rule With Comment Period </HD>
                    <P>In the CY 2008 PFS proposed rule (72 FR 38196 through 38199), we provided a slightly longer summary of the MIEA-TRHCA requirements and the PQRI program than is provided immediately above in this section, and explained our interpretation of applicable statutory and government-wide policies relevant to defining a consensus organization and consensus-based measure development process, and our policy for determining which measures meet requirements for inclusion in PQRI. In satisfaction of the MIEA-TRHCA requirement to publish proposed 2008 PQRI measures by August 15th, we published 148 proposed 2008 PQRI quality measures in the CY 2008 PFS proposed rule (72 FR 38199 through 38202). We invited comments on the implications of including or not including any specific measure(s), and on our plans to explore mechanisms for submission of electronic clinical performance measurement information and/or summary measure results information extracted from electronic health records (EHRs) and/or clinical data registries. </P>
                    <P>In this PQRI section of the final rule with comment period, we first address the general or overview public comments. </P>
                    <HD SOURCE="HD3">(iii) General/Program Comments and Responses </HD>
                    <P>
                        <E T="03">Comment:</E>
                         We received a number of comments commending CMS and the PQRI program for being responsive to stakeholder concerns, focusing on health care quality and performance improvement, and consistently using accurate and inclusive terminology (for example, where appropriate, “eligible professionals” rather than “physicians”) while implementing on an aggressive timeline a functional program with an extensive and well-received education and outreach component. A number of commenters also expressed a desire to continue to work with us in a spirit of partnership to advance and improve the program and its utility to beneficiaries, professionals, and the industry at large. 
                    </P>
                    <P>
                        <E T="03">Response:</E>
                         We appreciate the constructive input of the wide variety of stakeholders who have provided insights, information, and partnered with us to disseminate informational materials about PQRI to the eligible professionals in the health care community. We plan to continue dialogue with stakeholder organizations and will consider their and PQRI participants’ input (including questions and comments submitted via informal, as well as formal, channels of inquiry) as we continue working to provide 2007 PQRI participants with reporting rate and clinical performance results feedback reports and (for those participants achieving satisfactory reporting per MIEA-TRHCA requirements) PQRI incentive payments in mid-2008, and as we develop and implement strategies for individual-clinician-level and related quality reporting and improvement initiatives for 2008 and beyond. 
                    </P>
                    <P>
                        <E T="03">Comment:</E>
                         We received numerous comments identifying specific ways in which commenters recommended we enhance the PQRI in the future. One theme was that, although defined per MIEA-TRHCA as professionals eligible to participate in PQRI, some clinicians may be unable to participate due to lack of PQRI measures applicable to their practices. A closely related concern was that some clinicians with otherwise applicable PQRI measures may be 
                        <PRTPAGE P="66337"/>
                        unable to participate due to data submission relying on the Part B PFS Fee-For-Service claims mechanism. These limitations include that some PQRI-eligible professionals (such as physical and occupational therapists) who cannot currently participate in PQRI because reimbursement for the MPFS covered professional services they furnish is claimed in a format (X12 837-I electronic transaction or the UB04 form) that does not allow for attribution of each service to the individual professional who furnished it. 
                    </P>
                    <P>Several commenters suggested that submission of electronic clinical information (ECI) from registries and/or electronic health records (EHRs) may potentially address the limitations of claims-based quality measures data submission. Other commenters simply urged us to find a mechanism, potentially a claims-based mechanism, to afford all eligible professionals the opportunity to participate prior to proceeding with PQRI subsequent to 2007. </P>
                    <P>
                        <E T="03">Response:</E>
                         We agree with the goal of offering the opportunity to participate in PQRI to as many eligible professionals as feasible and practical, consistent with the MIEA-TRHCA statutory requirements. In support of this goal, especially where there are gaps in available consensus measures for specific practitioners, we have worked to encourage and contract for the development of quality measures and to fund consensus projects. For 2008, we have supported via contract with Quality Insights of Pennsylvania (QIP) the development of structural measures and measures applicable to a broad cross-section of PQRI eligible professionals, including some nonphysician practitioners (NPPs) who had few or no measures available in 2007. We prioritized development of these measures based on the existing gaps in measures available or otherwise in development and on a need to address as broad a cross section of eligible professions or specialties as possible within the limited volume of measures for which we could support development in time for inclusion in the 2008 PQRI. 
                    </P>
                    <P>We plan to continue working to fill gaps in available consensus-endorsed or -adopted measures consistent with available time and resources. However, we largely depend on and encourage the development of measures by professional organizations and other measure developers. We note that MIEA-TRHCA includes a provision that requires the Secretary to include measures developed by specialty societies. Ideally, in the future CMS would not need to be closely involved in the development of clinician-level quality measures, but would select from measures that meet the MIEA-TRHCA requirements. </P>
                    <P>In regard to the potential use of nonclaims mechanisms for submission of electronic clinical information, we agree with this goal; however it is not feasible to implement for 2008. In regard to claims-based alternatives to enable participation by professionals for whose covered professional services payment is made under or based on the MPFS but claimed via institutional formats (X12 837-I electronic transaction or UB04 form), we have analyzed the possibilities and determined that the MIEA-TRHCA requirement that satisfactory reporting and amount of any incentive payment be determined at the individual-professional level cannot be satisfied without extensive modifications to the claims processing systems of CMS and providers, which would represent a material administrative burden to us and providers, and/or modifications to the industry standard claims formats, which would require substantial time to effect via established processes and structures that we do not maintain or control. </P>
                    <P>
                        <E T="03">Comment:</E>
                         Although most commenters acknowledged that we proposed and will finalize 2008 measures in response to MIEA-TRHCA statutory mandate, numerous commenters expressed concerns that we are proceeding with design and implementation of PQRI 2008 before we have been able to evaluate the 2007 PQRI. One such commenter specifically declined to comment on the 2007 PQRI in advance of public availability of 2007 PQRI evaluation information and requested that we solicit comments on the 2007 PQRI, and the 2007 PQRI evaluation information, in the CY 2009 PFS proposed rule. Specific examples of evaluation information that commenters requested CMS consider and publish include: 
                    </P>
                    <P>• Rates of participation by eligible professionals; </P>
                    <P>• Cost or administrative burden of the PQRI from the perspective of participating professionals and the Medicare program; </P>
                    <P>• The apparent impact of PQRI on professionals' clinical performance; and </P>
                    <P>• The impact on beneficiaries. </P>
                    <P>Some of these commenters, and several other commenters who did not specifically raise concerns about program-level evaluation, requested that we consider delaying the start of the 2008 reporting period until mid-2008 to give 2007 participants a chance to assess their 2008 results to identify process changes to improve their 2008 reporting rate and clinical performance results. </P>
                    <P>
                        <E T="03">Response:</E>
                         We are in the process of operationalizing, in a phased manner appropriate to data availability and analytic infrastructure implementation, a comprehensive ongoing program monitoring strategy that will provide interim indications, at the program level, of some of the same aspects of the program we will ultimately examine in our evaluation(s) of the impact of the 2007 program after the conclusion of the 2007 reporting period. To the extent feasible within the limits of available resources including, but not limited to, funding and sufficiently complete data, we anticipate conducting an evaluation of the 2007 PQRI. The aspects of PQRI impact we would expect to assess include participation rates by specialty/profession, associated trends in clinical performance and beneficiary outcomes, and other observable impacts on participants, the Medicare program, and beneficiaries. Although we have not yet finalized the operational details of our evaluation strategy, we do anticipate making the results of the evaluation, at the national level, available to the public. We may also make publicly available the results of such analyses aggregated at other meaningful levels (for example, State, specialty, or profession). We do not at this time plan to make results publicly available in a format or with content that would enable identification of individual professionals or specific practices' specific reporting or performance results. We have not made a determination as to the most appropriate venue(s) for making PQRI evaluation information available to the public. 
                    </P>
                    <P>This section of the final rule with comment period is specific to the establishment of measures appropriate for use by professionals to submit quality-of-care data in 2008, as we are directed to do by section 101(b) of the MIEA-TRHCA. The incentive bonus requirements and reporting period for PQRI in 2008 are addressed in section 101(d) of the MIEA-TRHCA, Physician Assistance and Quality Improvement (PAQI), section (II.S.5.) of this final rule with comment period. Such details of the 2008 bonus-incentive program are beyond the scope of this MIEA-TRHCA Section 101(b), PQRI section of this final rule with comment period. </P>
                    <P>
                        <E T="03">Comment:</E>
                         A number of comments requested or recommended that we make readily available on an ongoing basis more detailed information on the measure development process and measures in development. Numerous commenters also requested final 
                        <PRTPAGE P="66338"/>
                        measure specifications be published as far in advance of the beginning of the reporting period as possible, and that more detailed information about measures proposed or finalized for use in PQRI be published in, at the same time as, or in advance of future rulemaking. 
                    </P>
                    <P>
                        <E T="03">Response:</E>
                         We agree that it could be useful to our stakeholder partners in health care quality measurement and improvement, including but not limited to potential measure developers, to make available in a prominent place (such as the CMS PQRI Web site) additional information on measure development in context of PQRI, potentially including guidance to other publicly available sources of general information on health care quality measurement and development of specific metrics. We will consider our options to accomplish this in a practical and sustainable way and use various appropriate communications channels to notify stakeholder organizations and the community at large of our strategy once we have developed it. 
                    </P>
                    <P>We agree with the commenters that it is desirable to provide final measure specifications sufficiently in advance of the reporting period to allow reasonable time for professionals to analyze new or revised measures and implement any needed changes in their office workflows to accurately capture and successfully submit data on a selection of measures applicable to their practice on which they can act to improve the quality of the services they furnish. We are aware that such “lead time” should also help the eligible professionals' specialty or professional societies be better prepared to support the professionals' selection of relevant, actionable measures. Having detailed information on measures available in advance of the reporting period also enhances the ability of vendors (such as practice-management software, billing services, and electronic health records vendors) to support professionals' successful implementation of revised data-capture processes for the measures. </P>
                    <P>
                        The MIEA-TRHCA requires that we publish the final list of 2008 PQRI measures no later than November 15, 2007. We would expect to publish detailed specifications shortly after that date. Detailed measure specifications for measures new or revised for 2008 PQRI will be published on the Measures/Codes page of the CMS PQRI Web site at 
                        <E T="03">http://www.cms.hhs.gov/pqri</E>
                        . These detailed specifications will include instructions for reporting and identify the circumstances in which each measure is applicable. The detailed technical specifications for measures in the final listing for the 2008 PQRI remain potentially subject to corrections until the start of the 2008 reporting period, as we stated in the proposed rule. 
                    </P>
                    <P>
                        <E T="03">Comment:</E>
                         Many commenters expressed concerns that recent legal rulings raise concerns about whether the individual participating professionals' reporting and clinical performance results may constitute administrative data potentially subject to disclosure requirements of the Freedom of Information Act (FOIA). Commenters urged that any clinician performance program or system should remain voluntary and its results confidential. 
                    </P>
                    <P>
                        <E T="03">Response:</E>
                         Commenting on or otherwise addressing the legal standing of PQRI participants' reporting and performance results in context of FOIA, other applicable statutes, or case law is outside the scope of this rule. At this time, we have no plans to publish without participants' voluntary consent either 2007 or 2008 PQRI participants' reporting or performance results in a way that would be specifically identified or readily identifiable at the individual-professional, group practice-site, or billing unit (Taxpayer Identification Number) levels. As mentioned in response to comments urging us to share information resulting from its 2007 PQRI program-evaluation analyses, we do plan to make available information at various meaningful levels of aggregation other than the individual professional, practice, or billing unit. 
                    </P>
                    <P>
                        <E T="03">Comment:</E>
                         Several commenters recommended specific enhancements to PQRI participant feedback reporting including displays of additional analyses (beyond the measure calculation as specified) for specific measure(s) and/or provision of interim reporting and performance results during the 2008 reporting period. Some commenters recommended we conduct additional analyses of measure data but did not specifically tie that recommendation to the participant feedback report content. 
                    </P>
                    <P>
                        <E T="03">Response:</E>
                         Detailed design of the participant feedback reports and specific analyses of PQRI data for purposes other than calculating bonus payment eligibility or amount (for example, for future measure development or refinement) are outside the scope of this section of this final rule with comment period. However, we will consider these recommendations as part of the ongoing dialogue with the stakeholder and participant community in order to collaboratively identify ways to enhance the measures' and/or program's value to its participants and the Medicare program. We are currently assessing the feasible options and timeframe within which we may be able to provide meaningful interim feedback reports to 2008 PQRI participants. As a matter of practical, operational reality, it is highly probable that we will not be able to make any 2008 interim feedback reports available until after we make available the 2007 final feedback reports. The 2007 PQRI was unable to offer during the reporting period any interim feedback reports of participants' reporting and performance rates to date because the aggressive statutory timeframe for implementing the program did not allow for the necessary data infrastructure (including analytic programming and report access mechanisms) to be implemented in time to provide accurate, meaningful results feedback for 2007 in an appropriately secure/confidential report access environment prior to mid 2008. 
                    </P>
                    <P>
                        <E T="03">Comment:</E>
                         Some commenters requested specific or general clarifications or additional guidance on the PQRI program, and how to code its measures, in the implementation support tools (for example, a handbook, or worksheets) provided on the CMS PQRI Web site. 
                    </P>
                    <P>
                        <E T="03">Response:</E>
                         Although not directly applicable to the proposed rule content on which we sought comment, these comments are appreciated and will be taken into consideration along with other input that these materials' users have provided via less formal avenues of communication. 
                    </P>
                    <P>
                        <E T="03">Comment:</E>
                         Many commenters expressed concern that the burden of data collection and submission may be an obstacle to program participation for some practices. Some commenters further noted that the claims-based submission process may be particularly burdensome for those practices that are simultaneously implementing electronic health records or whose PQRI-eligible members already participate in a medical data registry. 
                    </P>
                    <P>
                        <E T="03">Response:</E>
                         To implement a data submission mechanism that was technically feasible for CMS and providers, and that is broadly available to and already used by the vast majority of PQRI-eligible professionals, we determined that claims-based data submission is the only possible mechanism for 2007 and the only viable mechanism for full operationalization in 2008. Thus, measures appropriate for use by professionals to submit quality-of-care data to CMS in 2008 must be specified for claims-based submission and analysis. We are, however, committed to exploring and supporting practical, effective mechanisms for quality-of-care data submission that 
                        <PRTPAGE P="66339"/>
                        promote efficiency by streamlining participants' and our data collection and handling. As discussed below in this section, in the registry- and EHR-based submission topics of this section of this final rule with comment period, we plan to test in 2008 registry- and EHR-based mechanisms for data submission, in order to develop the potential ability to fully implement such mechanisms in the future. Those professionals whose practices that have implemented the referenced HIT will have available EHR and e-prescribing structural measures for reporting in 2008, which would, if reported, count toward professionals' eligibility for the incentive payment discussed below in section II.S.5. of this final rule with comment period. 
                    </P>
                    <P>
                        <E T="03">Comment:</E>
                         Several comments recommended or urged us to consider using the group practice as the unit of analysis, and to consider developing and implementing sampling methodologies at the group level as a means of reducing reporting burden in the future. 
                    </P>
                    <P>
                        <E T="03">Response:</E>
                         The 2007 unit of analysis is established at the individual-professional level by MIEA-TRHCA, and we have not proposed to change that for 2008. As the 2007 PQRI evaluation results become available and further legislative action provides additional guidance, such alternatives may indeed prove important to explore or develop.
                    </P>
                    <HD SOURCE="HD3">b. MIEA-TRHCA Requirements for Measures Included in the 2008 PQRI </HD>
                    <HD SOURCE="HD3">(i) MIEA-TRHCA Requirements for 2008 Quality Measures </HD>
                    <HD SOURCE="HD3">(A) Overview and Summary </HD>
                    <P>As noted in the CY 2008 PFS proposed rule (72 FR 38196 through 38197), section 1848(k)(2)(B)(i) of the Act requires, “for purposes of reporting data on quality measures for covered professional services furnished during 2008, the quality measures specified under this paragraph for covered professional services shall be measures that have been adopted or endorsed by a consensus organization (such as the National Quality Forum or AQA), that include measures that have been submitted by a physician specialty, and that the Secretary identifies as having used a consensus-based process for developing such measures. Such measures shall include structural measures, such as the use of electronic health records and electronic prescribing technology.” </P>
                    <P>
                        Section 1848(k)(2)(B)(ii) of the Act requires that “[n]ot later than August 15, 2007, the Secretary shall publish in the 
                        <E T="04">Federal Register</E>
                         a proposed set of quality measures that the Secretary determines are described in clause (i) and would be appropriate for eligible professionals to use to submit data to the Secretary in 2008. The Secretary shall provide for a period of public comment on such set of measures.” 
                    </P>
                    <P>In the CY 2008 PFS proposed rule (72 FR 38197), we explained our interpretation of these statutory requirements and the policies used in selecting measures to propose as appropriate for professionals to use to submit data on the quality of covered professional services furnished to Medicare beneficiaries in 2008. </P>
                    <P>In examining the statutory requirements of section 1848(k)(2)(B)(i) of the Act, we believe that the requirement that measures be endorsed or adopted by a consensus organization applies to each measure that would be included in the measures set for submitting quality data on covered professional services furnished during 2008. Likewise, the requirement for measures to have been developed using a consensus based process applies to each measure. By contrast, we do not interpret the provision requiring inclusion of measures submitted by a specialty to apply to each measure. Rather, we believe this requirement means that in endorsing or adopting measures, a consensus organization must include in its consideration process at least some measures submitted by a physician or an organization representing a particular specialty. Similarly, we interpret the requirement that 2008 measures include structural measures, such as the use of EHRs and electronic prescribing technology, to mean that the 2008 measure set must include at least 2 structural measures. </P>
                    <P>In examining sections 1848(k)(2)(B) of the Act, we believe that the Secretary is given broad discretion to determine which quality measures meet the statutory requirements and are appropriate for inclusion in the final set of measures for 2008. We do not interpret the Act to require that all measures that meet the basic requirements of section 1848(k)(2)(B)(i) of the Act must be included in the 2008 set of quality measures. We next discuss the statutory requirements for consensus organizations and the use of a consensus-based process for developing quality measures as they relate to the requirements for the set of measures for 2008 in the context of other applicable Federal law and policy. </P>
                    <P>The MIEA-TRHCA requires that measures used for 2008 be identified by the Secretary as having been endorsed or adopted by a consensus organization and have been developed through the use of a consensus-based process. As stated in the proposed rule (72 FR 38197 through 38199), we believe that these requirements should be interpreted in the context of the National Institute of Standards and Technology Act (NISTA) (15 U.S.C. 271 et seq.) as amended by the National Technology Transfer and Advancement Act of 1995 (Pub. L. 104-113) (NTTAA) and implemented by Revised OMB Circular No. A-119 (OMB A-119) dated February 10, 1998. </P>
                    <P>
                        Per the NTTAA, except when it is inconsistent with applicable law or otherwise impractical, all Federal agencies and departments shall use standards that are developed or approved by voluntary consensus standards bodies. OMB A-119 provides specific policy guidance to agencies on the appropriate interpretation of agency responsibilities under the NTTAA. As we discussed in the proposed rule (72 FR 38197 through 38199), OMB A-119 establishes as government-wide policy that agencies “must use voluntary consensus standards, both domestic and international, in its regulatory and procurement activities in lieu of government unique standards, unless use of such standards would be inconsistent with applicable law or otherwise impractical.” OMB A-119 further explains that in determining whether use of existing voluntary consensus standards in its regulatory and procurement activities is otherwise impractical, “ `Impractical' includes circumstances in which such use would fail to serve the agency's program needs; would be infeasible; would be inadequate, ineffectual, inefficient, or inconsistent with agency mission; or would impose more burdens, or be less useful, than the use of another standard.” OMB A-119 also provides that “voluntary consensus standards” are standards developed or adopted by voluntary consensus standards bodies, and defines “voluntary consensus standards body” as an organization maintaining the following attributes: (1) Openness; (2) Balance of interest; (3) Due process; (4) An appeals process; (5) Consensus; which is defined as general agreement, but not necessarily unanimity, and also includes a process for attempting to resolve objections by interested parties. The process requires that, as long as all comments have been fairly considered, each objector is advised of the disposition of his or her objection(s) and the reasons for the disposition, and the consensus body members are given an opportunity to change their votes after reviewing the comments. Voluntary consensus 
                        <PRTPAGE P="66340"/>
                        standards must include provisions requiring that owners of relevant intellectual property have agreed to make that intellectual property available to all interested parties on a nondiscriminatory, royalty-free, or reasonable royalty basis. 
                    </P>
                    <P>Other types of standards that are distinct from voluntary consensus standards but that may be used by federal agencies when voluntary consensus standards are not available and practical to address the government's programmatic needs, include government-unique standards, industry standards, company standards, nonconsensus standards, or de facto standards which are developed in the private sector but not in the full consensus process of a voluntary consensus standards body. For further discussion of the NTTAA, OMB A-119, and their relevance to quality measures for use of professionals to submit quality-of-care data to the Secretary, please review the 2008 MPFS Proposed Rule PQRI section at 72 FR 38197-38199. </P>
                    <P>Two consensus organizations are referenced in section 1848(k)(2)(B): the National Quality Forum (NQF) and the AQA Alliance. The NQF has a formal organizational structure and established processes that are intentionally designed to comply with the NTTAA and OMB A-119. Membership is open and includes a broad cross-section of stakeholder perspectives. In determining whether or not to endorse a standard, the NQF uses a formal process that consists of five principal steps that follow a project's conceptualization, prioritization, and planning. The steps are: (1) Consensus Standard Development; (2) Widespread Review; (3) Member Voting and Member Council Approval; (4) Board of Directors Action; and (5) Evaluation that includes an appeals process. The NQF meets the NTTAA requirements for a voluntary consensus standards body within the meaning of the NTTAA and its endorsed healthcare quality measures constitute voluntary consensus standards within the meaning of NTTAA. </P>
                    <P>The AQA is also referenced in section 1848(k)(2)(B) of the Act as a consensus organization for the purpose of identifying measures that have successfully completed review by a consensus organization, though it does not feature all of the structural characteristics or processes of a voluntary consensus standards body per NTTAA and the OMB A-119. By citing AQA as an example of an acceptable consensus organization, section 1848(k)(2)(B) of the Act establishes that AQA adoption satisfies the requirement of section 1848(k)(2)(B) of the Act that PQRI quality measures be adopted or endorsed by a consensus organization. We believe it follows that the Congress did not intend to require all 2008 quality measures under section 1848(k)(2)(B) of the Act to meet the requirements to be considered voluntary consensus standards under the NTTAA. However, by giving NQF and AQA as examples of consensus organizations, we believe the Congress intended that consensus organizations should, in the context of section 1848(k)(2)(B) of the Act, have a breadth of stakeholder involvement and voting participation substantially comparable to that of the NQF or AQA. </P>
                    <P>Given the potential for apparent overlap of NQF and AQA as consensus organizations under the MIEA-TRHCA, it is important to distinguish their roles. As currently established, the principal purpose of AQA for physician quality measures is to select among NQF endorsed measures for coordinated implementation. However, during a time of rapid physician quality measures development and implementation, it is impractical to delay implementation of physician quality measures until the formal processes of NQF are completed. Therefore, AQA has been able to enable CMS to incorporate new measures into the quality reporting system by providing consensus review acceptable under MIEA-TRHCA for implementation of a measure prior to actual NQF endorsement. In the event of a determination by NQF to decline endorsement of a particular measure after it had been adopted by AQA, we anticipate that AQA would withdraw its adoption of such a measure. </P>
                    <P>Turning to the requirement of a consensus-based process for developing quality measures, we interpret this requirement in light of the NTTAA and the importance of broad consensus for health care quality measures used for regulatory purposes. In this context we have outlined in the proposed rule, and rather than cite the proposed rule, we will for readers' convenience reiterate below the process of health care quality measurement development and distinguish basic development steps from the completion of a consensus-based development process as required under MIEA-TRHCA. </P>
                    <P>Many organizations are involved in the development of health care quality measures. These organizations include physician organizations, health care providers, Federal agencies, accreditation organizations, disease-focused not-for-profit organizations, research organizations, and health plans. The basic development processes of leading health care quality measure developers generally use standardized methods that include identification of a quality goal or gap, literature and evidence review, expert and technical evaluation, specification development, testing, organizational review, and that may include public comment. </P>
                    <P>In the framework of the NTTAA, upon completion of the basic development work, healthcare quality measures do not constitute voluntary consensus standards, even though they may have utilized consensus as a mechanism of achieving agreement among the developer's participants or within the developer's organizational structure. Rather, to achieve the status as a voluntary consensus standard under NTTAA, the measure must go through the additional development that occurs through the broader consensus process of consensus endorsement. During this process, based on the need to achieve agreement, quality measures are often modified in order to achieve the necessary broad consensus. </P>
                    <P>Consistent with this concept, we interpret “consensus-based process for developing measures” as used in MIEA-TRHCA to encompass not only the basic development work of the formal measure developer, but also to include the achievement of consensus among stakeholders in the health care system based on at least a level of openness, balance of interest, and consensus reflected in the structures and processes of the NQF or the AQA as of the date of enactment of MIEA-TRHCA. </P>
                    <P>Based on the considerations previously discussed, we apply the following policies in identifying measures that meet the MIEA-TRHCA requirements for having used a consensus-based process for development and the requirement for having been endorsed or adopted by a consensus organization such as the NQF or AQA, and that are appropriate for inclusion as 2008 measures: </P>
                    <P>
                        (1) We interpret “a consensus-based development process” as meaning that in addition to the measure development, the measure has achieved adoption or endorsement by a consensus organization having at least the basic characteristics of the AQA as a consensus organization as of December 2006, when the MIEA-TRHCA incorporating reference to AQA was passed and signed into law. Those basic characteristics include a comparable level of openness, balance of interest, and consensus-based on voting participation. As discussed above in this section and further clarified in points (3) and (5) of this section, we do not 
                        <PRTPAGE P="66341"/>
                        interpret “consensus-based development process” per section 1848(k)(2)(B) of the Act to require that the consensus organization or process meet all of the criteria of the NTTAA and OMB A-119 definition of a voluntary consensus standards body. 
                    </P>
                    <P>(2) “Voluntary consensus standard” is interpreted to mean a voluntary consensus standard that has been endorsed as such by a consensus organization that meets the requirements of the NTTAA, and the provisions of OMB A-119, for a voluntary consensus standards body. </P>
                    <P>(3) Where there are available quality measures, and some of these measures meet the definition of “voluntary consensus standards” while others do not, those measures that meet the definition of “voluntary consensus standards” are preferred to other measures not meeting the requirements of the NTTAA. </P>
                    <P>(4) In view of the preference for voluntary consensus standards, if, as of the earlier of November 15, 2007, or the date of publication of this final rule, a measure has been specifically considered by NQF for possible endorsement but NQF has declined to endorse it, we proposed not to include it in the final set of 2008 PQRI Quality Measures, even if previously adopted by AQA. </P>
                    <P>(5) Although the AQA does not meet the requirements of the NTTAA for a voluntary consensus standards body, it is a consensus organization per section 1848(k)(2)(B) of the Act. In circumstances where no voluntary consensus standard (NQF-endorsed) measure is available, and the measure has not been specifically declined for endorsement by NQF, a quality measure that has been adopted by the AQA (or another consensus organization with comparable consensus-organization characteristics), will meet the requirements of MIEA-TRHCA if we determine that it is appropriate for eligible professionals to use to submit data. </P>
                    <P>(6) We are unaware of other consensus organizations that are comparable to the NQF in terms of meeting the formal requirements of the NTTAA, or of organizations other than AQA that do not strictly meet the requirements of the NISTA, as amended by the NTTAA, but that feature the breadth of stakeholder involvement in the consensus process necessary to meet the intent of the MIEA-TRHCA. However, the MIEA-TRHCA does not limit consensus organizations to the NQF or the AQA, nor restrict the field of potential consensus organizations. The MIEA-TRHCA, thereby, maintains flexibility in potential sources of measure consensus review, which is, like having multiple sources of measure development, key to maintaining a robust marketplace for development and review of quality measures. </P>
                    <P>(7) The basic steps for developing the physician level measures may be carried out by a variety of different organizations. We do not interpret the MIEA-TRHCA to place special restrictions on the type or make up of the organizations carrying out this basic development of physician measures, such as restricting the initial development to physician-controlled organizations. Any such restriction would unduly limit the basic development of physician quality measures and the scope and utility of measures that may be considered for endorsement as voluntary consensus standards. </P>
                    <P>(8) The policies we proposed were based on the preference as articulated in NTTAA and OMB A-119 for “voluntary consensus standards” to government-unique standards. However, the MIEA-TRHCA does not require that quality measures meet the NTTAA or OMB A-119 definition of “voluntary consensus standards” in order to be used for PQRI. Thus, though we prefer to use quality measures meeting the NTTAA and OMB A-119 criteria for voluntary consensus standards, neither this CMS preference nor the NTTA or OMB A-119 preclude CMS from exercising our discretion under the MIEA-TRHCA to select measures for PQRI meeting the less stringent consensus requirements of the MIEA-TRHCA, when necessary to meet our program needs as determined by the Secretary. </P>
                    <HD SOURCE="HD3">(B) Summary of Comments and CMS's Responses </HD>
                    <P>
                        <E T="03">Comment:</E>
                         Many commenters thanked us for clarifying the requirements for consensus-based development, consensus endorsement or adoption, and the basic, high level structure of the measure-development process. As discussed above in context of the PQRI program/overview content and comments topic, multiple commenters requested additional and more detailed information about measure development and related processes and organizations. In context of the consensus requirements, several commenters requested further explanation of the detailed definition or distinction between the stages of measure development. 
                    </P>
                    <P>
                        <E T="03">Response:</E>
                         We are pleased that many commenters that found our description of the measurement development processes useful and were supportive of our interpretation of the statutory requirements for consensus endorsement and adoption and consensus-based development process. In terms of providing additional clarification, the status for PQRI implementation of measures that have been approved by AQA but declined for endorsement by NQF is clarified in the final language. Measures approved by AQA are sufficient for inclusion in 2008 PQRI in terms of the statutory requirements for consensus-organization adoption or endorsement and consensus-based development requirements of MIEA-TRHCA. Measures, however, that have been specifically declined for endorsement by NQF, are not selected for use in 2008 PQRI, based on our preference for Voluntary Consensus Standards (72 FR 38198). 
                    </P>
                    <P>
                        <E T="03">Comment:</E>
                         Many commenters requested or recommended that measure development processes employ robust mechanisms for incorporation of broadly inclusive consensus and/or public comment during the initial, as well as final phase of development. However, some commenters expressed the counterbalancing concern that we should more specifically clarify that appropriate quality measures for PQRI should in fact be based on evidence interpreted in processes which include consensus methods and organizations, as opposed to measures that are based primarily on stakeholder consensus about measure need and design without a firm foundation in scientifically sound clinical evidence. 
                    </P>
                    <P>
                        <E T="03">Response:</E>
                         As described in the proposed rule (72 FR 38197 through 38198) the basic (initial) development processes of measure developers typically include various standardized processes that include both an evaluation of the evidence base for a measure and a public comment opportunity. We do not believe that we should delineate these processes via rulemaking, nor require a particular evidence base for a measure. Rather, the adequacy of measures from these and many other standpoints is subject to evaluation during the consensus process. 
                    </P>
                    <P>
                        <E T="03">Comment:</E>
                         Several commenters suggested we consider establishing as policy that quality measures to be used by, and analyzed at the level of, individual PQRI-eligible professionals, must be developed by clinician-controlled organizations to assure relevance and promote uptake by the eligible professional community. Multiple commenters suggested explicit preference be given for measures developed or endorsed by physician 
                        <PRTPAGE P="66342"/>
                        specialty societies, in context of consensus-organization review and CMS measure selection processes. Some commenters stated that the AMA-PCPI should be the sole source for physician-level measures. One commenter specifically presented an interpretation of the MIEA-TRHCA requirement for the 2008 PQRI measures to include measures submitted by a physician specialty as meaning that the 2008 PQRI should include only measures developed by physician organizations, to assure physician control of available measures applicable to assessing the clinical performance of individual physicians. Other commenters expressed differing viewpoints, commenting on the importance of an open process for initial measure development, and noting that no single organization stands ready to lead in the quality arena. Multiple commenters pointed to concerns about existing measure development and consensus organizations particularly in terms of structure and transparency, opposing any single organization controlling measurement development, opposing requiring PQRI measurement development to come solely from physician controlled organizations, and supporting alternatives to existing organizations. 
                    </P>
                    <P>
                        <E T="03">Response:</E>
                         Physician involvement and leadership is standard in the work of both measure developers and consensus organizations. As a result, physicians are actively involved at all levels of measurement development and consensus adoption and endorsement. We are in agreement that physician expertise is an important ingredient in measurement development and in the consensus process. We further recognize the leadership of physician organizations, as is reflected in the large number of physician quality measures included in PQRI which were developed by the AMA-PCPI and its participating specialty societies. 
                    </P>
                    <P>However, we do not agree that physicians should be in complete control of the process of measure development, as would be the case if measures were required to be developed solely by physician-controlled organizations. Any such restriction would unduly limit the basic development of physician quality measures and the scope and utility of measures that may be considered for endorsement as voluntary consensus standards. Rather, as we described in the proposed rule, the basic steps for developing the physician level measures are appropriately carried out by a variety of different organizations. We do not interpret the MIEA-TRHCA to place special restrictions on the type or make up of the organizations carrying out this basic development of physician measures, such as restricting the initial development to physician-controlled organizations. Similarly, we do not interpret MIEA-TRHCA to require that each measure included in the 2008 PQRI have been developed by a physician specialty. </P>
                    <P>Finally, we do not interpret MIEA-TRHCA to limit the field of potential consensus organizations to those it named as examples of acceptable organizations, so long as the requirements for broad consensus we articulated as required under MIEA-TRHCA is achieved. The MIEA-TRHCA, thereby, maintains flexibility in potential sources of measure consensus review, which is, like having multiple sources of measure development, key to maintaining a robust marketplace for development and review of quality measures. </P>
                    <P>
                        <E T="03">Comment:</E>
                         Many commenters suggested we establish a centralized process or structure to prioritize measure development in specific ways. Some commenters recommended priority be given to meaningful, actionable gaps in care or specific high-impact disease conditions. Others recommended that the first priority be assuring measure availability for all PQRI-eligible professions and specialties. Commenters recommended a centralized establishment of national priorities for measure development and suggested that such prioritization would help to align clinician-focused quality measures with measures used in other governmental and private-sector initiatives focused on other provider types, and advance measurement and close gaps in care for high-prevalence and/or high-cost conditions. 
                    </P>
                    <P>
                        <E T="03">Response:</E>
                         Health care quality measures are currently developed by a variety of organizations and used by a variety of governmental, nongovernmental, and public-private partnership initiatives which have various and at times differing programmatic needs for quality measures. Although a cooperative and voluntarily coordinated approach to agreeing upon quality goals which would guide development and selection of measures may be of value, the Secretary retains the authority to select from available measures meeting applicable statutory requirements those most appropriate for use in this program. 
                    </P>
                    <P>
                        <E T="03">Comment:</E>
                         Many commenters illustrated, directly or indirectly, that the proposed rule language (72 FR 38198 through 38199) reads to a material proportion of reviewers as meaning or implying that a measure must be both adopted by the AQA “and” endorsed by the NQF to be included in the PQRI for 2008. Several of these comments also specifically requested clarification of the status of measures that will, as of the date CMS finalizes the list of 2008 PQRI quality measures, be AQA-adopted but not yet reviewed by NQF. 
                    </P>
                    <P>
                        <E T="03">Response:</E>
                         In general, the consensus requirement under the MIEA-TRHCA is met if a measure is either NQF-endorsed or AQA-adopted. However, where an AQA-adopted measure has been specifically considered by NQF but declined for endorsement, we have not selected such measures for 2008. This derives from our stated preference for standards of a voluntary consensus standards organization (such as NQF) over an organization which does not (such as AQA). Also, as stated in the proposed rule (72 FR 38198), in the event of a determination by NQF to decline endorsement of a particular measure after it had been adopted by AQA, we anticipate that AQA would withdraw its adoption of that measure. Thus, a measure that has been AQA adopted and then reviewed by NQF with a decision to decline endorsement we would expect would, soon after the NQF decision, be 
                        <E T="03">neither</E>
                         NQF-endorsed 
                        <E T="03">nor</E>
                         AQA-adopted and therefore it would be undesirable to include a measure imminently destined to not retain approval of either consensus organization simply because we may have been identifying final 2008 measures during the brief period of lag between the NQF's decision to decline endorsement and the AQA's opportunity to reconsider its adoption of the measure. 
                    </P>
                    <P>To further clarify this point, of the measures proposed for 2008 (72 FR 38199 through 38202), the only ones that might be removed as a result of having been AQA adopted but then subsequently declined NQF endorsement are certain measures that were included in the 2007 PQRI on the basis of AQA adoption and that have since been declined for endorsement by NQF after specifically being considered. </P>
                    <P>For newly-proposed measures (those not part of the 2007 PQRI set), either NQF or AQA consensus endorsement or adoption is sufficient for PQRI. Most of these measures will have been adopted by the AQA but not yet reviewed by NQF. Others may have been endorsed by the NQF, but not yet adopted by the AQA. </P>
                    <P>
                        <E T="03">Comment:</E>
                         One commenter suggested that the entirety of the PQRI section of the proposed rule could potentially be 
                        <PRTPAGE P="66343"/>
                        construed to imply that there may be, based on which specific entities develop or own a measure, different levels of consensus-standard status required for measures to qualify for our consideration for inclusion in PQRI. 
                    </P>
                    <P>
                        <E T="03">Response:</E>
                         The measure developer was listed for identification purposes only. This was necessary for measures that when proposed were still under development. The remaining measures that had achieved consensus endorsement or adoption were sufficiently identified by consensus organization, without listing the developer. The statutory requirements for consensus-organization adoption or endorsement, consensus-based development and statutory and policy preferences for measures that have achieved the status of voluntary consensus standards apply equally to all potential PQRI quality measures regardless of the organization type or specific identity of any given measure's developer or owner. 
                    </P>
                    <P>
                        <E T="03">Comment:</E>
                         We received a large number of comments on the interpretation of the requirement of per Section 1848(k)(2)(B)(i) of the Act, that 2008 PQRI measures “shall be measures that have been adopted or endorsed by a consensus organization (such as the National Quality Forum or AQA)”. These comments reflected a diversity of opinion amongst various stakeholders on key conceptual points related to the balance between rigor and flexibility in measure review and approval, as well as on the suitability of specific organizations for their roles as we define them in the PFS rule. 
                    </P>
                    <P>Many commenters encouraged us to rely solely on highly structured, scientifically rigorous processes for measure approval to promote stability in measures over time. Many other comments advised against requiring a degree of formality or scientific rigor in the review process that would unduly slow the availability and implementation of new quality measures to fill current gaps in professionals or clinical foci for which applicable measures exist. </P>
                    <P>Several commenters closely related to the recommendation of reliance on more rigorous review processes further suggested we identify a single voluntary consensus standards body to be considered qualified to establish measures as PQRI measures. The rationales provided for this suggestion include enhanced probability of a cohesive or coordinated universe of endorsed measures and prevention of endorsement of duplicate or near duplicate (“competing” or “conflicting”) measures. </P>
                    <P>The value of having multiple consensus organizations available to approve measures was noted by many comments that were closely related to, or that were elaborating upon, maintaining flexibility and adaptability of the universe of available measures. These commenters included observations that setting requirements that limit the total available capacity for measure review will slow the development not only of specific additional quality measures but likely also innovative advancement in the science of health care quality measurement. Some of these commenters urged us to remain alert for the development of additional organizations into potential consensus organizations on par with the NQF or with the AQA as of the date MIEA-TRHCA was signed into law, and two commenters named two specific potential candidates that might choose to develop to that degree in the near future. </P>
                    <P>
                        <E T="03">Response:</E>
                         We believe the existence of multiple consensus organizations promotes availability of a broad array of measures from which we can select those most appropriate for use in PQRI based on program policy goals. The availability of the AQA as a consensus organization meeting the requirements of MIEA-TRHCA, though it does not meet the full NTTAA and OMB A-119 criteria for a voluntary consensus standards body (VCSB), has proven important to the consensus development of the 2008 PQRI measures. Specifically, the AQA's more flexible and expeditious processes have made measures available on a shorter timeline than would be possible within the more rigorous processes of a VCSB. At present, we are able to identify only the NQF and the AQA as satisfying the consensus organization requirements of MIEA-TRHCA. Should additional organizations develop to feature consensus characteristics at least comparable to the level of openness, balance of interest, and broadly representative voting membership demonstrated by the AQA as of the date MIEA-TRHCA became law, we would consider measures endorsed by those organizations eligible for consideration for inclusion in PQRI. 
                    </P>
                    <P>We concur with the commenters identifying the desirability of alignment or harmony of quality measures across settings to more effectively promote overall CMS quality goals. We strive to achieve synergy between measures used in various settings and quality related initiatives to the extent practical. </P>
                    <P>
                        <E T="03">Comment:</E>
                         Many commenters concurred with our interpretation that NQF is a VCSB per NTTAA and OMB A-119. Several commenters also commended NQF for the scientific rigor of its structure and review processes. Some commenters in favor of establishing a single consensus organization entity whose approval would qualify a measure for PQRI inclusion went on to name NQF as the leading or only named candidate for such an organization. Simultaneously, multiple concerns were raised about the uneven (project-driven) NQF funding stream and its resultant potentially long or uncertain review timeframes, and the potential for this to impede measure development. Several comments also raised concern that the NQF's processes for review of physician-applicable measures are not yet as developed and predictable as those measures applicable to other types of providers. A few commenters noted that the NQF determinations on physician-applicable measures apparently vary unpredictably between workgroups and that the appeals process is not clearly identifiable. 
                    </P>
                    <P>Some comments recommended that CMS or another agency should provide steady core funding to the NQF on an ongoing basis. </P>
                    <P>
                        <E T="03">Response:</E>
                         The NQF is currently the only organization we identified that reviews health care quality measures while simultaneously meeting the NTTAA and OMB A-119 definition of a VCSB. NQF processes for review and endorsement of physician-applicable measures are expected to develop and stabilize as it gains more experience with such measures. We will continue to monitor the NQF and its processes and work with NQF and its members to promote the prompt achievement of that growth. 
                    </P>
                    <P>The funding stream of the NQF is outside the scope of this rulemaking. The concerns raised over the current NQF funding mechanism and internal operational structures does, however, highlight the desirability of having an alternative source or multiple alternative sources of consensus-organization review of quality measures to assure that the measure has been vetted in a process that offers at least a reasonable degree of openness, balance of interests, and broad voting participation. </P>
                    <P>
                        <E T="03">Comment:</E>
                         Multiple comments expressed concerns about the AQA's structure and original intended purpose not being ideally suited to its current role in PQRI, and its role in the measure endorsement process being confusing or its role not clearly adding value to the process. Multiple other comments commended the AQA as currently 
                        <PRTPAGE P="66344"/>
                        structured, including its responsiveness, openness, breadth of participation, and utility as a forum for building consensus among stakeholders in quality measurement. Several comments also noted that the AQA is currently re-evaluating its structure, and recommended either that the AQA be required to restructure itself to meet the NTTAA and OMB A-119 criteria for a VCSB or that we reassess the AQA after any restructure to assure that it retains at least the comparable level of consensus-organization characteristics that it featured at the time MIEA-TRHCA became law. 
                    </P>
                    <P>
                        <E T="03">Response:</E>
                         As noted above in this section, we interpret that the AQA currently meets the MIEA-TRHCA intended definition of a consensus organization for purposes of measure approval, as its mention in MIEA-TRHCA as an example of a consensus organization confirms it did at the time the statute was enacted. Further, we have expressed what we understand its value to be for the purpose of making quality measures available for consideration for inclusion in the PQRI. We do not have direct control over the AQA; requiring the AQA to take any specific action or restructure in any specific way would be outside the scope of CMS authority. However, we are observing the AQA's re-evaluation of its structure and will consider altering its role in relation to approval of future PQRI measures based on its resultant structure. 
                    </P>
                    <P>
                        <E T="03">Comment:</E>
                         Several commenters requested we specifically define the minimum criteria to be a non-VCSB consensus organization meeting the requirements of MIEA-TRHCA. 
                    </P>
                    <P>
                        <E T="03">Response:</E>
                         We have defined the requirement as being that an organization must possess a level of consensus-organization characteristics at least comparable to those of the AQA as of the date MIEA-TRHCA became law. To attempt to quantify or score an organization's level of consensus characteristics would be difficult to do in a way that was not misleading or arbitrary. The key features, as stated in the proposed rule (at 72 FR 38198), include openness, balance of interest, and consensus based on voting participation. 
                    </P>
                    <HD SOURCE="HD3">c. The Final 2008 PQRI Quality Measures </HD>
                    <P>In the proposed rule (72 FR 38199), we solicited comments on the implications of including or excluding 148 specific quality measures in 7 broad categories. We received numerous comments both general and measure-specific, which are summarized and addressed as follows. </P>
                    <P>
                        <E T="03">Comment:</E>
                         Many comments on measure inclusion were general or conceptual and, in fact, mirrored comments on prioritization of measure development or endorsement. 
                    </P>
                    <P>Specific to measure selection, some commenters supported our including or excluding measures based on a targeted focus on specific gaps in care, while other commenters supported maximum inclusivity of conditions, services, and professionals. Some of the comments specific to measure selection stated two main perspectives: (1) We should set the priorities and/or prioritization process in collaboration with a maximally inclusive and representative cohort of stakeholders (to specifically include pharmaceutical, device, and information technology manufacturers and trade associations, as well as clinicians and consumers); and (2) the prioritization or selection of quality measures should be accomplished by a VCSB in a formal consensus process. </P>
                    <P>
                        <E T="03">Response:</E>
                         In selecting measures, we have sought to achieve a broad opportunity for eligible professionals to participate, and to promote the quality goals forming the basis for the measures themselves. The general quality goal underlying the measures as developed is a performance gap relating to important processes or outcomes of care. While we agree that prioritized themes for quality improvement can be useful in certain contexts, for PQRI the scope of practice of the various eligible professionals varies significantly. Therefore, it would be difficult to limit measures selected to a few specific prioritized quality goals without also limiting the opportunity to participate. With respect to the role of a VCSB under MIEA-TRHCA, it is to achieve consensus endorsement of particular measures, rather than to prioritize measures for PQRI. The responsibility for selection of measures for PQRI is directed to the Secretary, based on proposing measures, soliciting public comment, and then finalizing the measures. Public comment could include the views of a VCSB as to which measures are most appropriate for PQRI based on quality goals or other considerations. These could then be considered, in conjunction with the other public comments and the program needs as determined by the Secretary, in finalizing the measures. 
                    </P>
                    <P>
                        <E T="03">Comment:</E>
                         Several comments in context of measure selection urged us to select or prioritize for PQRI inclusion measures aligned or harmonized with those used in other governmental initiatives that focus other provider types in addition to or instead of individual PQRI-eligible professionals. 
                    </P>
                    <P>
                        <E T="03">Response:</E>
                         We concur with comments identifying the desirability of alignment or harmony of quality measures across settings to more effectively promote overall CMS quality goals. We strive to achieve such synergy among settings and initiatives to the extent practical. 
                    </P>
                    <P>
                        <E T="03">Comment:</E>
                         We received several comments specifically commending or recommending inclusion of specific quality measures, including, but not limited to: Specific eyecare measures; vaccination and preventive services measures; diabetic foot and ankle measures; and perioperative care measures including venous thromboembolism(VTE) prophylaxis. 
                    </P>
                    <P>
                        <E T="03">Response:</E>
                         All of the proposed measures strongly supported by multiple comments are included in the final 2008 measures listed below in this section. 
                    </P>
                    <P>
                        <E T="03">Comment:</E>
                         We received many comments expressing concern that the following 2007 PQRI measure that has achieved NQF endorsement was not included in measures proposed for 2008: “Age Related Macular Degeneration: Dilated Macular Examination”. 
                    </P>
                    <P>
                        <E T="03">Response:</E>
                         As noted in the proposed rule's correction notice (72 FR 43581), the omission of this measure was a technical/editorial error that was corrected via that notice. The measure titled “Age Related Macular Degeneration: Dilated Macular Examination” is included in the final list in Table 7. 
                    </P>
                    <P>
                        <E T="03">Comment:</E>
                         Several commenters recommended changes to specific quality measures' titles, definitions, and detailed specifications or coding. Many of these recommendations were based on alternative interpretations of clinical evidence or concerns about the utility of the measures. Some requests were specifically concerned that measures be expanded or constrained to include or exclude specific professionals from those to whom the measure may be applicable. 
                    </P>
                    <P>
                        <E T="03">Response:</E>
                         Quality measures that have completed the consensus processes of NQF or AQA have a designated party (generally the developer/owner) who has accepted responsibility for maintaining the measure. In general, it is the role of the measure owner, developer or maintainer to make any changes to the basic elements of a measure. Examples of such basic elements would be the particular process of care covered by the measure, professional services to which the measure applies, or the diagnosis (or diagnoses) defining the denominator 
                        <PRTPAGE P="66345"/>
                        population. A request to modify any basic elements of a measure should be addressed to the measure's maintainer. In addition, NQF has for its endorsed measures an established maintenance process which may be accessed. Measure maintenance and modification activities are conducted by the developers/owners and/or maintainers of measures outside the CMS rule-making process. In implementing the measures for PQRI, CMS may, when necessary, make certain technical modifications to assure that reporting and performance rates can be calculated. These technical modifications do not modify the basic elements of the measure and are carried out in collaboration with the measure developer/owner or maintainer. 
                    </P>
                    <P>
                        <E T="03">Comment:</E>
                         Many commenters requested the inclusion for 2008 of additional measures not proposed as PQRI measures in the proposed rule. Measures requested included additional structural measures, additional measures of medication use appropriateness and compliance, measures applicable to additional clinical topics, and the measures identified in the proposed rule as mandatory for erythropoietin stimulating agent reimbursement in 2008. 
                    </P>
                    <P>
                        <E T="03">Response:</E>
                         The MIEA-TRHCA requires that measures proposed for use in the 2008 PQRI be published in the 
                        <E T="04">Federal Register</E>
                         prior to August 15, 2007. We are also required by other applicable statutes to provide opportunity for public comment on provisions of policy or regulation that are established via notice and comment rulemaking. Measures that were not included in the proposed rule for inclusion in the 2008 PQRI that were recommended to CMS via comments on the proposed rule have not been placed before the public with opportunity for the public to comment on them within the rulemaking process. When measures have been published in the 
                        <E T="04">Federal Register</E>
                        , but in other contexts and not specifically proposed as PQRI measures, such publication does not provide true opportunity for public comment on those measures' potential inclusion in PQRI. Thus, such additional measures recommended via comments on the proposed rule cannot be included in the 2008 measures MIEA-TRHCA requires be finalized via publication in the 
                        <E T="04">Federal Register</E>
                         by November 15, 2007. However, we have captured these recommendations and will have them available for consideration in identifying measure sets for future years' PQRI and other initiatives to which those measures may be pertinent. 
                    </P>
                    <P>
                        The measures we identify for 2008 in this final rule with comment period will be final as of the effective date of this final rule, and no changes (no additions or deletions of measures) will be made after that date. However, as was done for 2007, we may make modifications or refinements, such as code additions, corrections, or revisions, to the detailed specifications for the 2008 measures until the beginning of the reporting period. Such specification modifications may be made through the last day preceding the beginning of the reporting period. The 2008 measures specifications will be available on the PQRI section of the CMS Web site at 
                        <E T="03">http://www.cms.hhs.gov/pqri</E>
                         when they are sufficiently developed or finalized, but in no event later than December 31, 2007. No further changes to the specifications will be made after the start of the 2008 reporting period. The measures' detailed specifications will include instructions for reporting and identify the circumstances in which each measure is applicable. 
                    </P>
                    <P>The final 2008 PQRI Quality Measures are listed in Tables 7 through 13, and fall into 7 broad categories. The final measures for 2008 were selected based upon the following: </P>
                    <P>• The achievement of NQF endorsement or AQA adoption by the earlier of November 15, 2007, or the date of publication of this final rule with comment period; </P>
                    <P>• Identification in the proposed rule for use in 2008 with opportunity for public comment via the rulemaking process; </P>
                    <P>• Development completion in a sufficiently timely manner that implementation for 2008 would be practical; </P>
                    <P>• Their importance in relation to quality goals; </P>
                    <P>• Their meaningfulness as measures of quality; </P>
                    <P>• Their utility in the PQRI program such as through augmenting the scope of services provided by eligible professionals to which PQRI measures apply; </P>
                    <P>• The degree to which they meet the needs of the Medicare program and their functionality in terms of ability to be collected and calculated in the PQRI program; </P>
                    <P>• Statutory requirement for inclusion in quality measures for 2008. </P>
                    <HD SOURCE="HD3">(i) Measures Selected From the 2007 PQRI Quality Measures </HD>
                    <P>We include in the final 2008 PQRI measures the following 2007 PQRI measures in Table 7, proposed as 2008 PQRI measures (72 FR 38199 through 38200). The measures in Table 7 include measures submitted by specialties, in compliance with section 1848(k)(2)(B) of the Act.  </P>
                    <GPOTABLE COLS="1" OPTS="L1,p1,8/9,i1" CDEF="xl200">
                          
                        <TTITLE>Table 7.—2007 PQRI Measures   </TTITLE>
                        <BOXHD>
                              
                            <CHED H="1">  </CHED>
                        </BOXHD>
                        <ROW>
                            <ENT I="01">Hemoglobin A1c Poor Control in Type 1 or 2 Diabetes Mellitus.</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">Low Density Lipoprotein Control in Type 1 or 2 Diabetes Mellitus. </ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">High Blood Pressure Control in Type 1 or 2 Diabetes Mellitus. </ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">Screening for Future Fall Risk. </ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">Heart Failure: Angiotensin-Converting Enzyme (ACE) Inhibitor or Angiotensin Receptor Blocker (ARB) Therapy for Left Ventricular Systolic Dysfunction (LVSD). </ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">Oral Antiplatelet Therapy Prescribed for Patients with Coronary Artery Disease. </ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">Beta-blocker Therapy for Coronary Artery Disease Patients with Prior Myocardial Infarction (MI). </ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">Heart Failure: Beta-blocker Therapy for Left Ventricular Systolic Dysfunction. </ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">Antidepressant Medication During Acute Phase for Patients with New Episode of Major Depression. </ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">Medication Reconciliation. </ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">Assessment of Presence or Absence of Urinary Incontinence in Women Aged 65 Years and Older. </ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">Characterization of Urinary Incontinence in Women Aged 65 Years and Older. </ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">Plan of Care for Urinary Incontinence in Women Aged 65 Years and Older. </ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">Chronic Obstructive Pulmonary Disease (COPD): Spirometry Evaluation. </ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">Chronic Obstructive Pulmonary Disease (COPD): Bronchodilator Therapy. </ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">Asthma: Pharmacologic Therapy. </ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">Stroke and Stroke Rehabilitation: Computed Tomography (CT) or Magnetic Resonance Imaging (MRI) Reports. </ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">Stroke and Stroke Rehabilitation: Carotid Imaging Reports. </ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">Primary Open Angle Glaucoma: Optic Nerve Evaluation. </ENT>
                        </ROW>
                        <ROW>
                            <PRTPAGE P="66346"/>
                            <ENT I="01">Age-Related Macular Degeneration: Dilated Macular Examination. </ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">Diabetic Retinopathy: Documentation of Presence or Absence of Macular Edema and Level of Severity of Retinopathy. </ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">Diabetic Retinopathy: Communication with the Physician Managing Ongoing Diabetes Care. </ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">Perioperative Care: Timing of Antibiotic Prophylaxis—Ordering Physician. </ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">Perioperative Care: Selection of Prophylactic Antibiotic—First OR Second Generation Cephalosporin. </ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">Perioperative Care: Discontinuation of Prophylactic Antibiotics (Non-Cardiac Procedures). </ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">Perioperative Care: Venous Thromboembolism (VTE) Prophylaxis (when indicated in All patients). </ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">Osteoporosis: Management Following Fracture. </ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">Osteoporosis: Communication with the Physician Managing Ongoing Care Post-Fracture. </ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">Aspirin at Arrival for Acute Myocardial Infarction (AMI). </ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">Electrocardiogram Performed for Non-Traumatic Chest Pain. </ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">Electrocardiogram Performed for Syncope. </ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">Vital Signs for Community-Acquired Bacterial Pneumonia. </ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">Assessment of Oxygen Saturation for Community-Acquired Bacterial Pneumonia. </ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">Assessment of Mental Status for Community-Acquired Bacterial Pneumonia. </ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">Empiric Antibiotic for Community-Acquired Bacterial Pneumonia. </ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">Asthma Assessment. </ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">Perioperative Care: Timing of Prophylactic Antibiotics—Administering Physician. </ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">Stroke and Stroke Rehabilitation: Deep Vein Thrombosis Prophylaxis (DVT) for Ischemic Stroke or Intracranial Hemorrhage. </ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">Stroke and Stroke Rehabilitation: Discharged on Antiplatelet Therapy. </ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">Stroke and Stroke Rehabilitation: Anticoagulant Therapy Prescribed for Atrial Fibrillation at Discharge. </ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">Stroke and Stroke Rehabilitation: Tissue Plasminogen Activator (t-PA) Considered. </ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">Stroke and Stroke Rehabilitation: Screening for Dysphagia. </ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">Stroke and Stroke Rehabilitation: Consideration of Rehabilitation Services. </ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">Screening or Therapy for Osteoporosis for Women Aged 65 Years and Older. </ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">Osteoporosis: Pharmacologic Therapy. </ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">Use of Internal Mammary Artery (IMA) in Coronary Artery Bypass Graft (CABG) Surgery. </ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">Preoperative Beta-blocker in Patients with Isolated Coronary Artery Bypass Graft (CABG) Surgery. </ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">Perioperative Care: Discontinuation of Prophylactic Antibiotics (Cardiac Procedures). </ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">Appropriate Treatment for Children with Upper Respiratory Infection (URI). </ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">Appropriate Testing for Children with Pharyngitis. </ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">Myelodysplastic Syndrome (MDS) and Acute Leukemias: Baseline Cytogenetic Testing Performed on Bone Marrow. </ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">Myelodysplastic Syndrome (MDS): Documentation of Iron Stores in Patients Receiving Erythropoietin Therapy. </ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">Multiple Myeloma: Treatment with Bisphosphonates. </ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">Chronic Lymphocytic Leukemia (CLL): Baseline Flow Cytometry. </ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">Hormonal Therapy for Stage IC-III ER/PR Positive Breast Cancer. </ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">Chemotherapy for Stage III Colon Cancer Patients. </ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">Plan for Chemotherapy Documented Before Chemotherapy Administered. </ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">Radiation Therapy Recommended for Invasive Breast Cancer Patients Who Have Undergone Breast Conserving Surgery. </ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">Advance Care Plan. </ENT>
                        </ROW>
                    </GPOTABLE>
                    <P>Please note that detailed specifications for some 2007 PQRI measures may have been updated or modified during the NQF endorsement process during 2007. The detailed 2008 PQRI measure specifications for any given measure may, therefore, be different from detailed specifications for the same measure used for 2007. All specifications for 2008 measures must be obtained from the specifications document for 2008 measures, which will be available on the CMS PQRI Web site on or before December 31, 2007. </P>
                    <P>The following measures proposed for 2008 (72 FR 38200) are not included in the final 2008 PQRI measures listed in Table 7 because they have been considered by NQF and did not achieve endorsement: </P>
                    <P>• Dialysis Dose in End Stage Renal Disease (ESRD) Patients. </P>
                    <P>• Hematocrit Level in ESRD Patients. </P>
                    <P>
                        <E T="03">Comment:</E>
                         We did not receive any comments specifically suggesting that any of the 2007 PQRI measures proposed for 2008 be removed from the 2008 PQRI measures. Some commenters suggested alternative measures apparently in addition to the measures we had proposed. 
                    </P>
                    <P>
                        <E T="03">Response:</E>
                         We have not included in final 2008 PQRI measures any measures that were not identified in the proposed rule as proposed 2008 measures for the reporting system as required by Section 1848(k)(1) and 1848(k)(2)(B) of the Act. As discussed above in this rule, we were obligated by MIEA-TRHCA and other applicable statutes to publish and provide opportunity for public comment on proposed PQRI quality measures. Measures recommended via comments on the proposed rule that were not included in the proposed rule have not been placed before the public with opportunity for the public to comment on their potential use in PQRI. Thus, such additional measures recommended via comments on the proposed rule cannot be included in the 2008 measures MIEA-TRHCA requires be finalized via publication in the 
                        <E T="04">Federal Register</E>
                         by November 15, 2007. However, we have captured these recommendations and will have them available for consideration in identifying measure sets for future years' PQRI and other initiatives to which those measures may be pertinent. 
                    </P>
                    <HD SOURCE="HD3">(ii) AMA—PCPI Measures </HD>
                    <P>The measures listed in Table 8, which were developed via the American Medical Association (AMA) Physicians Consortium for Performance Improvement (PCPI), are finalized as 2008 PQRI measures as of the date of publication of this final rule with comment period. All of these measures were proposed as 2008 PQRI measures (72 FR 38200 through 38201). The measures listed in Table 8 achieved AQA adoption or NQF endorsement on or before October 31, 2007. </P>
                    <P>
                        We will publish the detailed specifications for all final PQRI measures on the CMS PQRI Web site at 
                        <E T="03">http://www.cms.hhs.gov/pqri</E>
                         on or before December 31, 2007. 
                        <PRTPAGE P="66347"/>
                    </P>
                    <GPOTABLE COLS="1" OPTS="L1,p1,8/9,i1" CDEF="x1200">
                        <TTITLE>Table 8.—AMA/PCPI Measures Finalized for 2008 With Consensus-Organization Approval by 10/31/2007 </TTITLE>
                        <BOXHD>
                            <CHED H="1"> </CHED>
                        </BOXHD>
                        <ROW>
                            <ENT I="01">Prevention of Ventilator-Associated Pneumonia—Head elevation. </ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">Prevention of Catheter-Related Bloodstream Infections (CRBSI)—Central Venous Catheter Insertion Protocol. </ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">ACE Inhibitor or Angiotensin Receptor Blocker (ARB) Therapy in patients with CKD. </ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">Chronic Kidney Disease (CKD): Laboratory Testing (Calcium, Phosphorus, Intact Parathyroid Hormone (iPTH) and Lipid Profile). </ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">Influenza Vaccination in patients with End Stage Renal Disease (ESRD). </ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">Vascular Access for patients undergoing Hemodialysis. </ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">Plan of Care for ESRD patients with Anemia. </ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">Plan of Care for Inadequate Hemodialysis in ESRD patients. </ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">Plan of Care for Inadequate Peritoneal Dialysis. </ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">Assessment of GERD Symptoms in Patients Receiving Chronic Medication for GERD. </ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">Testing of patients with Chronic Hepatitis C (HCV) for Hepatitis C Viremia. </ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">Initial Hepatitis C RNA Testing. </ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">HCV Genotype Testing Prior to Therapy. </ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">Consideration for Antiviral Therapy in HCV Patients. </ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">HCV RNA Testing at Week 12 of Therapy. </ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">Hepatitis A and B Vaccination in patients with HCV. </ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">Counseling patients with HCV Regarding Use of Alcohol. </ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">Counseling of patients Regarding Use of Contraception Prior to Starting Antiviral Therapy. </ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">Patients who have Major Depression Disorder who meet DSM IV Criteria. </ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">Patients who have Major Depression Disorder who are assessed for suicide risks. </ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">Patients with Osteoarthritis who have an assessment of their pain and function. </ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">Acute Otitis Externa (AOE): Topical Therapy. </ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">Acute Otitis Externa (AOE): Pain Assessment. </ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">Acute Otitis Externa (AOE): Systemic Antimicrobial Therapy—Avoidance of Inappropriate Use. </ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">Otitis Media with Effusion (OME): Diagnostic Evaluation—Assessment of Tympanic Membrane Mobility. </ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">Otitis Media with Effusion (OME): Hearing Testing. </ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">Otitis Media with Effusion (OME): Antihistamines or Decongestants—Avoidance of Inappropriate Use. </ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">Otitis Media with Effusion (OME): Systemic Antimicrobials—Avoidance of Inappropriate Use. </ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">Otitis Media with Effusion (OME): Systemic Corticosteroids—Avoidance of Inappropriate Use. </ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">Breast cancer patients who have a pT and pN category and histologic grade for their cancer. </ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">Colorectal cancer patients who have a pT and pN category and histologic grade for their cancer. </ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">Appropriate initial evaluation of patients with Prostate Cancer. </ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">Inappropriate use of Bone Scan for staging Low-Risk Prostate Cancer patients. </ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">Review of treatment options in patients with clinically localized Prostate Cancer. </ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">Adjuvant Hormonal therapy for High-risk Prostate Cancer patients. </ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">Three-dimensional radiotherapy for patients with Prostate Cancer. </ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">Chronic Kidney Disease (CKD): Blood Pressure Management. </ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">Chronic Kidney Disease (CKD): Plan of Care: Elevated Hemoglobin for Patients Receiving Erythropoiesis—Stimulating Agents (ESA). </ENT>
                        </ROW>
                    </GPOTABLE>
                    <P>The AMA PCPI measures that were proposed in Table 17 of the proposed rule (72 FR 38200 through 38201) were under development at the time the proposed rule was published. Several of these measures did not complete development or did not complete development in a sufficiently timely manner to permit implementation in the 2008 PQRI program. We have not included in the final PQRI measures listed in Table 8 the following proposed 2008 measures (from Table 17 of the proposed rule, 72 FR 38200 through 38201) for which development was not completed or not completed in sufficient time for implementation for 2008: </P>
                    <FP SOURCE="FP-1">• Stress Ulcer Disease (SUD) Prophylaxis in Ventilated Patients </FP>
                    <FP SOURCE="FP-1">• Perioperative Temperature Management for Surgical Procedures Under General Anesthesia </FP>
                    <FP SOURCE="FP-1">• Assessment of Thromboembolic Risk Factors in patients with Atrial Fibrillation </FP>
                    <FP SOURCE="FP-1">• Chronic Anticoagulation in patients with Atrial Fibrillation </FP>
                    <FP SOURCE="FP-1">• Monthly INR Measurements in patients with Atrial Fibrillation </FP>
                    <FP SOURCE="FP-1">• GFR Calculation in patients with Chronic Kidney Disease (CKD) </FP>
                    <FP SOURCE="FP-1">• Permanent Catheter Vascular Access for patients Receiving Hemodialysis </FP>
                    <FP SOURCE="FP-1">• Patients with Osteoarthritis who receive Anti inflammatory or Analgesia Medication </FP>
                    <FP SOURCE="FP-1">• Documentation of hydration status in Pediatric Patients with Acute Gastroenteritis (PAG) </FP>
                    <FP SOURCE="FP-1">• Weight measurement in patients with PAG </FP>
                    <FP SOURCE="FP-1">• Recommendation of appropriate oral rehydration solution in PAG patients </FP>
                    <FP SOURCE="FP-1">• Education parents of PAG patients </FP>
                    <FP SOURCE="FP-1">• Perioperative Cardiac risk assessment (history) </FP>
                    <FP SOURCE="FP-1">• Perioperative Cardiac risk assessment (current symptoms) </FP>
                    <FP SOURCE="FP-1">• Perioperative Cardiac risk assessment (physical examination) </FP>
                    <FP SOURCE="FP-1">• Perioperative Cardiac risk assessment (electrocardiogram) </FP>
                    <FP SOURCE="FP-1">• Perioperative Cardiac risk assessment (continuation of Beta Blockers). </FP>
                    <P>During completion of the measure development process, the measure developer eliminated the restriction to ventilated patients of the proposed (72 FR 38201) measure titled, “Prevention of Catheter-Related Bloodstream Infections in Ventilated Patients—Catheter Insertion Protocol”. This measure is, therefore, listed in the Final 2008 PQRI measures in Table 8 as “Prevention of Catheter-Related Bloodstream Infections (CRBSI)—Central Venous Catheter Insertion Protocol”. </P>
                    <P>During completion of the measure development process, several of the measures proposed for 2008 in Table 17 of the proposed rule (72 FR 38200 through 38201) were combined into one measure by the measure developer. The final, combined measures contain the substantive components of each of the measures. The following is reflected in the Final 2008 PQRI Measures listed in Table 8: </P>
                    <P>• Proposed measures (72 FR 38201) titled “Blood Pressure Measurement in patients with CKD” and “Plan of Care for patients with CKD and Elevated Blood Pressure” were combined into the measure entitled “Chronic Kidney Disease (CKD): Blood Pressure Management.” </P>
                    <P>
                        • Proposed measures (72 FR 38201) “Calcium, Phosphorus and Intact 
                        <PRTPAGE P="66348"/>
                        Parathyroid Hormone Measurement in patients with CKD” and “Lipid Profile in patients with CKD” were combined into the measure in Table 8 entitled “Chronic Kidney Disease (CKD): Laboratory Testing (Calcium, Phosphorus, Intact Parathyroid Hormone (iPTH) and Lipid Profile).” 
                    </P>
                    <P>• Proposed measures (72 FR 38201) “Hemoglobin Monitoring in patients with CKD” and “Erythropoietin Overuse in patients with CKD and normal Hemoglobin” were combined into the measure in Table 8 entitled “Chronic Kidney Disease (CKD): Plan of Care: Elevated Hemoglobin for Patients Receiving Erythropoiesis-Stimulating Agents (ESA).” </P>
                    <P>During the measure development process, several measures listed in the proposed rule (72 FR 38201) as pertaining to the medical conditions Acute Otitis Externa (AOE) and Otitis Media with Effusion (OME) were narrowed to apply to only one or the other. The measure developer made these refinements as a result of more in-depth consideration of the evidence for the clinical relevance of each specific measure to each or either condition. Modifications to the measures' titles reflect these decisions. Otitis Media with Effusion (OME) was eliminated from the proposed 2008 measures below. The revised measure titles are listed in Table 8 for each proposed 2008 measures: </P>
                    <P>• Measure proposed (72 FR 38201) as “Patients with Acute Otitis Externa (AOE) or Otitis Media with Effusion (OME) who receive Topical Therapy” is now entitled “Acute Otitis Externa (AOE): Topical Therapy.” </P>
                    <P>• Measure proposed (72 FR 38201) as “Patients with AOE/OME who have a pain assessment” is now entitled “Acute Otitis Externa (AOE): Pain Assessment.” </P>
                    <P>• Measure proposed (72 FR 38201) as “Patients with AOE/OME who are inappropriately prescribed antimicrobials” is now entitled “Acute Otitis Externa (AOE): Systemic Antimicrobial Therapy—Avoidance of Inappropriate Use”. Acute Otitis Externa (AOE) was eliminated from the proposed (72 FR 38201) measures below. The revised measure titles are listed in Table J2 for each proposed 2008 measures.</P>
                    <P>• Measure proposed (72 FR 38201) as “Patients with AOE/OME who have an assessment of tympanic membrane mobility” is now entitled “Otitis Media with Effusion (OME): Diagnostic Evaluation—Assessment of Tympanic Membrane Mobility.” </P>
                    <P>• Measure proposed (72 FR 38201) as “Patients with AOE/OME who undergo hearing testing” is now entitled “Otitis Media with Effusion (OME): Hearing Testing.” </P>
                    <P>• Measure proposed (72 FR 38201) as “Patients with AOE/OME who inappropriately receive antihistamines/decongestants” is now entitled “Otitis Media with Effusion (OME): Antihistamines or Decongestants—Avoidance of Inappropriate Use.” </P>
                    <P>• Measure proposed (72 FR 38201) as “Patients with AOE/OME who inappropriately receive systemic antimicrobials” is now entitled “Otitis Media with Effusion (OME): Systemic Antimicrobials—Avoidance of Inappropriate Use.” </P>
                    <P>• Measure proposed (72 FR 38201) as “Patients with AOE/OME who inappropriately receive systemic steroids” is now entitled “Otitis Media with Effusion (OME): Systemic Corticosteroids—Avoidance of Inappropriate Use.” </P>
                    <P>
                        <E T="03">Comment:</E>
                         We received several comments from organizations involved in the measure development process noting that the measure titles as proposed in Table 17 of the proposed rule (72 FR 38200 through 38201) were incorrect or obsolete based on progress in measure development between the time the proposed rule went on display (July 2, 2007) and the date the commenters submitted their comment letters (various specific dates at the end of August, 2007). 
                    </P>
                    <P>
                        <E T="03">Response:</E>
                         As stated above, the measure titles in Table 8 reflect the correct titles as of the conclusion of the development process preparing these measures for consensus-organization review in the late summer and early fall of 2007. 
                    </P>
                    <P>
                        <E T="03">Comment:</E>
                         We received comments in support of certain measures listed in Table 8, such as the Chronic Kidney Disease measures. Other commenters suggested including additional measures not proposed as 2008 PQRI measures. No commenters opposed inclusion of any of the measures listed on Table 8. 
                    </P>
                    <P>
                        <E T="03">Response:</E>
                         The measures from Table 16 of the proposed rule (72 FR 38200 through 38201) that were sufficiently completed in time for use in the 2008 PQRI are included in Table 8. As discussed above, several of the CKD measures proposed in Table 16 of the proposed rule (72 FR 38201) have been combined into with one another as listed in Table 8. 
                    </P>
                    <P>
                        As iterated above in response to comments on measures in Table 7, we cannot include in the 2008 PQRI measures that were not published as proposed 2008 PQRI measures in the 
                        <E T="04">Federal Register</E>
                         by August 15, 2007. We have, however, made note of the measures suggested and may consider them for inclusion in future quality-reporting initiatives to which they may be relevant. 
                    </P>
                    <HD SOURCE="HD3">(iii) Nonphysician Measures </HD>
                    <P>
                        We include measures in the final 2008 PQRI quality measures listed in Table 9 developed by Quality Insights of Pennsylvania (under the Medicare Quality Improvement Organization (QIO) contract for the State of Pennsylvania) that were proposed as 2008 PQRI measures in Table 18 of the proposed rule (72 FR 38201 through 38202). These measures were developed primarily to afford expanded reporting opportunities for NPPs who had few or no measures available in 2007. Some may also be applicable to physicians. The clinicians who could report each measure are identified in the measure's detailed specifications, which will be available on the Measures/Codes page of the CMS PQRI Web site at 
                        <E T="03">http://www.cms.hhs.gov/pqri</E>
                         as far in advance of the 2008 reporting period as practical. We have not included in the final PQRI measures listed in Table 9 the following measures proposed in Table 18 of the proposed rule (72 FR 38201 through 38202) whose development was not completed in a sufficiently timely manner for implementation in the 2008 PQRI program: 
                    </P>
                    <P>• Universal Hypertension Screening. </P>
                    <P>• Universal Hypertension Screening Follow-up. </P>
                    <P>During completion of the measure development process, several of the measures proposed for 2008 in Table 18 of the proposed rule (72 FR 38201 through 38202) were combined into one measure by the measure developer. The final, combined measures contain the substantive components of each of the measures. The following is reflected in the Final 2008 PQRI Measures listed in Table 8: </P>
                    <P>• Proposed (72 FR 38201) measures titled “Universal Weight Screening (BMI)” and “Universal Weight Screening Follow-up (BMI)” were combined into the measure entitled “Universal Weight Screening and Follow-up.” </P>
                    <P>• Proposed (72 FR 38201) measures “Patient Co-development of Treatment Plan” and “Patient Co-development of Plan of Care” were combined into the measure in Table 8 entitled “Patient Co-development of Treatment Plan/Plan of Care.” </P>
                    <P>
                        <E T="03">Comment:</E>
                         We received numerous comments pertaining to the measures proposed in Table 18 of the proposed rule (72 FR 38201 through 38202), now listed in Table 9 of this final rule with 
                        <PRTPAGE P="66349"/>
                        comment period. Most of these comments addressed the scope of applicability of these measures to particular non-physician specialties, such as speech language pathologists (SLPs) and occupational therapists. 
                    </P>
                    <P>
                        <E T="03">Response:</E>
                         The applicability of the final 2008 PQRI measures is dependent on whether the given practitioner can bill for the services identified by the procedures or services represented by the Current Procedural Terminology (CPT) Category I codes in the measure's denominator per its detailed specifications. The inclusion of specific procedures or services in a measure's denominator is determined during the measure development and consensus process, based on the clinical relevance of the measure to particular services/procedures. The determination of services/procedures to which a specific measure is relevant and therefore applicable is not subject to change via the rulemaking process. The measures in Table 9 achieved AQA consensus adoption on or before October 19, 2007. These measures have not yet been reviewed by the NQF. 
                    </P>
                    <P>
                        We will publish the detailed specifications for all final PQRI measures, including these QIP nonphysician measures, on the CMS PQRI Web site at 
                        <E T="03">http://www.cms.hhs.gov/pqri</E>
                         on or before December 31, 2007. 
                    </P>
                    <GPOTABLE COLS="1" OPTS="L1,p1,8/9,i1" CDEF="xl100">
                        <TTITLE>Table 9.—Quality Insights of Pennsylvania Nonphysician Measures </TTITLE>
                        <BOXHD>
                            <CHED H="1"> </CHED>
                        </BOXHD>
                        <ROW>
                            <ENT I="01">Universal Weight Screening (BMI) and Follow-up. </ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">Universal Influenza Vaccine Screening and Counseling. </ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">Universal Documentation and Verification of Current Medications in the Medical Record. </ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">Screening for Clinical Depression.</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">Screening for Cognitive Impairment.</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">Patient Co-development of Treatment Plan/Plan of Care.</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">Pain Assessment Prior to Initiation of Patient Treatment.</ENT>
                        </ROW>
                    </GPOTABLE>
                    <HD SOURCE="HD3">(iv) Structural Measures Currently Under Development </HD>
                    <P>We include structural measures in the final 2008 PQRI measures listed in Table 10 developed by Quality Insights of Pennsylvania (under the Medicare Quality Improvement Organization (QIO) contract for the State of Pennsylvania), that were proposed as 2008 measures in Table 19 of the proposed rule (72 FR 38202). These measures meet the requirement of section 1848(k)(2)(B)(i) of the Act. </P>
                    <P>
                        <E T="03">Comment:</E>
                         Numerous comments expressed support of the measures listed in Table 10. Other commenters stated a belief that there is a lack of scientific evidence to support the benefits of e-prescribing. 
                    </P>
                    <P>
                        <E T="03">Response:</E>
                         As required by MIEA-TRHCA, the final 2008 PQRI measures shall include structural measures such as the use of EHRs and electronic prescribing technology. The determination of the sufficiency of the scientific basis for quality measures is part of the review and evaluation during the measure development and consensus processes. The measures are included in Table 10. These measures were adopted by the AQA on or before October 31, 2007. 
                    </P>
                    <GPOTABLE COLS="1" OPTS="L1,p1,8/9,i1" CDEF="xl100">
                        <TTITLE>Table 10.—Quality Insights of Pennsylvania Structural Measures</TTITLE>
                        <BOXHD>
                            <CHED H="1"> </CHED>
                        </BOXHD>
                        <ROW>
                            <ENT I="01">HIT—Adoption/Use of E-Prescribing.</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">HIT—Adoption/Use of Health Information Technology (Electronic Health Records).</ENT>
                        </ROW>
                    </GPOTABLE>
                    <HD SOURCE="HD3">(v) Additional AQA Starter-Set Measures </HD>
                    <P>We include measures in the final 2008 PQRI measures from the AQA starter set that were not included in the 2007 PQRI quality measures but that are relevant to Medicare beneficiaries and which we proposed as 2008 measures in Table 20 of the proposed rule (72 FR 38202). We have not included in the final 2008 measures listed in Table 11 the following measure that was listed in Table 20 of the proposed rule (72 FR 38202), because its adaptation to the claims-based provider-self-reported format was not found to be feasible: </P>
                    <P>• Beta Blocker Therapy (persistent for 6 months or more) Post MI. </P>
                    <P>We received several comments in support of the measures listed in Table 20 of the proposed rule (72 FR 38202) and now listed in Table 11, as preventive care measures and measures related to smoking cessation. </P>
                    <GPOTABLE COLS="1" OPTS="L1,p1,8/9,i1" CDEF="xl100">
                        <TTITLE>Table 11.—Additional AQA Starter-Set Measures</TTITLE>
                        <BOXHD>
                            <CHED H="1"> </CHED>
                        </BOXHD>
                        <ROW>
                            <ENT I="01">Dilated eye exam in diabetic patient.</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">Screening Mammography.</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">Colorectal Cancer Screening.</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">Inquiry regarding Tobacco Use.</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">Advising Smokers to Quit.</ENT>
                        </ROW>
                    </GPOTABLE>
                    <HD SOURCE="HD3">(vi) Other NQF-Endorsed Measures </HD>
                    <P>We include in the final 2008 PQRI measures other measures endorsed by the NQF that were not included in the 2007 PQRI quality measures but that were proposed as 2008 measures (72 FR 38202) and that are relevant to Medicare beneficiaries, address overuse/misuse of pharmacologic therapy, and/or that expand the specialty applicability and patient population. We have not included in the final PQRI measures listed in Table 12 the following proposed measure (72 FR 38202), because its adaptation to the PQRI format was subsequently not found to be feasible: </P>
                    <P>• Annual Therapeutic monitoring for patients on the following persistent medications: Angiotensin Converting Enzyme Inhibitor (ACE)/Angiotensin Receptor Blocker (ARB), Digoxin, Diuretics, Anticonvulsants; and Statins. </P>
                    <P>We received several comments in support of including the measures listed in Table 12. We did not receive any comments opposing the inclusion of any of the measures listed in Table 12. </P>
                    <GPOTABLE COLS="1" OPTS="L1,p1,8/9,i1" CDEF="xl200">
                        <TTITLE>Table 12.—Other NQF-Endorsed Measures</TTITLE>
                        <BOXHD>
                            <CHED H="1"/>
                        </BOXHD>
                        <ROW>
                            <ENT I="01">Inappropriate antibiotic treatment for adults with acute bronchitis. </ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">Disease Modifying Anti-rheumatic Drug Therapy in Rheumatoid Arthritis. </ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">Angiotensin Converting Enzyme Inhibitor (ACE) or Angiotensin Receptor Blocker (ARB) Therapy for patients with coronary artery disease and diabetes and/or left ventricular systolic dysfunction (LVSD). </ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">Urine screening for microalbumin or medical attention for nephropathy in diabetic patients. </ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">Influenza vaccination for patients ≥ 50 years old. </ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">Pneumonia vaccination for patients 65 years and older. </ENT>
                        </ROW>
                    </GPOTABLE>
                    <HD SOURCE="HD3">(vii) Podiatric Measures </HD>
                    <P>
                        We include measures in the final 2008 PQRI quality measures listed in Table 13 developed by the American Podiatric Medical Association (APMA). These two measures are finalized as 2008 PQRI measures as of the date of publication of this final rule with comment period. These measures were proposed as 2008 PQRI measures in Table 21 of the proposed rule (72 FR 38202), and were 
                        <PRTPAGE P="66350"/>
                        adopted by the AQA on or before October 31, 2007. 
                    </P>
                    <P>A third proposed measure (72 FR 38202), titled “Diabetic Foot and Ankle Care, Peripheral Arterial Disease: Ankle Brachial Index (ABI) Measurement” has not achieved AQA adoption or NQF endorsement in time to be included in this final rule with comment period, and is therefore not included in the final 2008 PQRI quality measures. </P>
                    <P>
                        <E T="03">Comment:</E>
                         A number of comments expressed support of these measures. We received comments requesting correction of the title of this topic and the substantive title/heading for the table from “Podiatric Measures” to “Diabetic Foot and Ankle Measures” to reflect the potential applicability of these measures beyond podiatrist. At the same time, we received comments that these measures are not applicable to orthopedic surgeons. 
                    </P>
                    <P>
                        <E T="03">Response:</E>
                         We have retained the original measure-category title to reflect the developer, and thus the origin of the measures, rather than the scope of applicability. This identification of nomenclature is aligned with the nomenclature used for other categories of measures, such as those in Table 11, which are identified as originating in the AQA Starter Set rather than by the type of services to which they pertain. MIEA-TRHCA makes no presumption as to applicability based solely on measure title or specifications, let alone the categorization that may be applied to various groups of measures for identification and ease of reference. Rather, measures are presumed applicable to a practitioner based on the scope and pattern of practice of the physician reporting the measure in combination with its specifications. 
                    </P>
                    <GPOTABLE COLS="1" OPTS="L1,p1,8/9,i1" CDEF="xl100">
                        <TTITLE>Table 13.—Podiatric Measures</TTITLE>
                        <BOXHD>
                            <CHED H="1"/>
                        </BOXHD>
                        <ROW>
                            <ENT I="01">Diabetic Foot and Ankle Care, Peripheral Neuropathy: Neurological Evaluation. </ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">Diabetic Foot and Ankle Care, Ulcer Prevention: Evaluation of Footwear. </ENT>
                        </ROW>
                    </GPOTABLE>
                    <HD SOURCE="HD3">d. Addressing a Mechanism for Submission of Data on Quality Measures via a Medical Registry or Electronic Health Record </HD>
                    <HD SOURCE="HD3">(i) Addressing a Mechanism for Submission of Data on Quality Measures via a Medical Registry—Background and Summary of Proposed Rule </HD>
                    <P>As explained in the proposed rule (72 FR 38202), section 1848(k)(4) of the Act, as amended by the MIEA-TRHCA, requires that “as part of the publication of proposed and final quality measures for 2008 under clauses (i) and (iii) of paragraph (2)(B), the Secretary shall address a mechanism whereby an eligible professional may provide data on quality measures through an appropriate medical registry”. </P>
                    <P>In the proposed rule, we discussed what constitutes a medical registry and the general desirability of registries serving as an alternative to claims based reporting. We proposed to address reporting from medical registries by testing one or more of five mechanisms for such reporting during 2008, and requested comment on five options for data submission by registries. These options vary as to whether individual beneficiary-level data is submitted by the registry, as well as the number and type of data elements needed from the registry. The five options were described in detail in the proposed rule (72 FR 38203 through 38204). </P>
                    <P>The 2008 registry reporting is only a test of the feasibility and accuracy for the two selected submission options (identified as Options 2 and 3 in the proposed rule (72 FR 38203 through 38204)) and described again, in summary, below in response to comments. In order to qualify for the incentive bonus for PQRI data submission, practitioners will need to continue their quality data codes through the claims process. </P>
                    <HD SOURCE="HD3">(ii) Addressing a Mechanism for Submission of Data on Quality Measures via a Medical Registry—Summary of Comments and CMS's Responses </HD>
                    <P>
                        <E T="03">Comment:</E>
                         The majority of the comments advocated the use of option 2, 3, or 5. There was not significant support for option 1 or option 4; instead the preponderance of comments on options 1 and 4 were in opposition to their implementation. 
                    </P>
                    <P>
                        <E T="03">Response:</E>
                         We have decided to test options 2 and 3 in 2008.
                    </P>
                    <P>We agree that option 1 should not be tested. Under this option only the quality data codes for selected PQRI measures would be reported by the registry without submission of associated diagnosis or service rendered. Under this option, the denominator information would have to be obtained from the claims and linked to the quality data codes submitted via the registry. This option would create an added administrative burden for the CMS systems that would need to link data from the two sources at the beneficiary or episode/encounter/procedure level. </P>
                    <P>We also agree that option 4 should not be tested. Option 4 would place significant burden upon practitioners, by requiring practitioners not only to submit claims to Medicare for the services provided, but also enter data obtained from the explanation of benefits into the registry. </P>
                    <P>Option 5, which calls for a “data dump” was supported by some commenters as this option would potentially provide the most complete and robust set of data for purposes of clinical improvement. It could also be beneficial in evaluating a physician's practice, particularly since it would not necessarily need to be limited to Medicare Part B beneficiaries or soley PQRI measures. Thus, while we agree that data submission via registry-based mechanisms in models such as Option 5 has significant potential over time because of the comprehensiveness of the data, we do not believe that this option is currently practical for implementation even on a test basis. We intend to continue to explore ways to enhance our ability to capture registry data so that it may be suitable for future use. </P>
                    <P>Under Option 2, the registry would provide the quality data codes and diagnosis codes and beneficiary identification (HIC) numbers or other limited beneficiary information for identification. Using the beneficiary information to match registry information to a submitted claim for a particular service, CMS would have the data needed to calculate a practitioner's reporting and performance rates. </P>
                    <P>Under Option 3 the registry will calculate and submit reporting and performance rates for various measures to CMS, rather than have CMS calculate the rates. While this is compatible with the role of a registry in providing feedback to the physician, for future PQRI implementation, a validation process for the registry calculations would need to be in place and provided to CMS. </P>
                    <P>
                        <E T="03">Comment:</E>
                         Many commenters requested that registry-based mechanisms for 2008 be made a fully operational alternative through which participants could achieve satisfactory reporting and quality for a 2008 PQRI incentive payment. Several commenters suggested we find a way to let participants in testing activities “get credit” toward PQRI reporting for their participation in the test. 
                    </P>
                    <P>
                        <E T="03">Response:</E>
                         We proposed a test of registry submission (72 FR 38203 through 38204). It is not feasible or practical to implement registry submission without such testing. Any registries and any of their subscribers participating in any testing activities in 2008 will be participating in this data-submission testing on a strictly voluntary basis. Any registry seeking to participate in the testing should notify their subscribers to continue submitting 
                        <PRTPAGE P="66351"/>
                        quality data codes on their Part B professional services claims in order to pursue PQRI bonus payments. 
                    </P>
                    <P>
                        <E T="03">Comment:</E>
                         We received several comments requesting that a specific organization's registry be deemed or “certified” to satisfy PQRI reporting. Additionally, it was suggested that we implement a mechanism to make those professionals submitting data to the registry potentially able to qualify for a 2008 PQRI bonus payment on the basis of participating in the registry. We received several related comments suggesting we consider deeming specialty boards’ maintenance of certification (MOC) programs so that successful participation in a deemed MOC would qualify a professional for a 2008 PQRI bonus payment. 
                    </P>
                    <P>
                        <E T="03">Response:</E>
                         We believe that, in the long run, registries having such deemed status may be a very suitable and desirable way for quality data submission and measures calculation to be conducted for physicians and other practitioners. However, at the present time we do not find it feasible or practical to implement such a suggestion. 
                    </P>
                    <P>
                        <E T="03">Comment:</E>
                         Several commenters encouraged us to maintain for the foreseeable future multiple options for PQRI participants to submit data, including claims based, as well as registry or EHR-based submission mechanisms. Some of these comments noted that the state of the art for medical registries is embryonic to nascent. Commenters also noted that the percentage of eligible professionals who use EHRs capable of successful data extraction and transmission to a CMS data warehouse is relatively low. Related comments recommended we develop a long term strategy that will be sufficiently flexible to allow for innovative developments in the registry field as it begins to grow in sophistication and market penetration. 
                    </P>
                    <P>
                        <E T="03">Response:</E>
                         For 2008, claims-based submission will remain the only mechanism of PQRI quality measure data submission. We hope in future years to make alternative ECI-based submission mechanisms available. However, we recognize that for the near future, claims-based submission is likely to be the only mechanism that will provide an avenue for virtually all eligible practitioners to participate within PQRI. As a result, we would anticipate that claims based submission would be maintained. 
                    </P>
                    <P>
                        <E T="03">Comment:</E>
                         Several commenters expressed concern that many registries are proprietary and charge a fee for using the registry. Commenters expressed concern about using proprietary registries, specifically that such use raises potential antitrust (barrier to competition) issues, as well as barriers to participation by professionals who would have to subscribe to a proprietary registry. Several commenters urged that any CMS registry-based mechanism be in the public domain and supported by a public domain registry available to individual professionals. 
                    </P>
                    <P>
                        <E T="03">Response:</E>
                         In the proposed rule, we discussed registry-based reporting as an alternative, not a requirement. We agree that physicians should not be required to use any particular proprietary service. Rather, the purpose in addressing registries is to allow physicians who find it desirable to submit data to registries to be able to avoid duplicate data submission to CMS through the claims process. 
                    </P>
                    <P>
                        <E T="03">Comment:</E>
                         A few commenters expressed concern that creating new registries or altering existing interfaces would be burdensome and costly. 
                    </P>
                    <P>
                        <E T="03">Response:</E>
                         We are not recommending developing new registries and any decision to do so should be made independently of PQRI. Nevertheless, there are currently various registries in existence which may, ultimately, be capable of interfacing with the CMS data warehouse. As has been previously discussed, for 2008, we will only be testing registry-based data submission. As envisioned for the future, registry-based submission of quality-measures data would be an alternative, not a requirement. 
                    </P>
                    <P>
                        <E T="03">Comment:</E>
                         Some comments expressed concerns about transmitting patient data through registries or EHRs in context of applicable statutes, regulations, and policies protecting patient privacy. 
                    </P>
                    <P>
                        <E T="03">Response:</E>
                         Preserving the confidentiality of patients' individually identifiable and protected health information is a high priority at CMS. Generally, personally identifiable data on individuals and/or their health are protected by the Privacy Act of 1974 and/or the Health Insurance Portability and Accountability Act of 1996 (Pub. L. 104-191) (HIPAA). HIPAA establishes protections specific to certain individually identifiable health information, and the Privacy Act establishes the protections specific to certain information that the government maintains which is individually identifiable. HIPAA and its extensive implementing regulations have established privacy and security standards for health care plans, health care clearinghouses, and providers that conduct electronic transactions covered by HIPAA. These entities are termed “covered entities”. All patient registries, EHRs, data transmission, and data storage done by or on behalf of a covered entity must be HIPAA compliant. The claims-based method of reporting currently uses patient identifiers for submission of quality data along with data required to process the provider's claim for payment. The use of registries or EHRs would require, for purposes of validation, the same information as currently used by the claims-based method of submitting quality-measures data. 
                    </P>
                    <HD SOURCE="HD3">(iii) Addressing a Mechanism for Submission of Data on Quality Measures Via a Medical Registry—Final Plan </HD>
                    <P>For 2008, we will test Options 2 and 3 on a voluntary basis, based on self-nomination by the registries. Each registry participating in the testing of each option must maintain compliance with all applicable statutory and regulatory requirements and any contractual obligations to the professionals/providers for processing, storing, and transmitting the data required by the option. </P>
                    <P>Functionally, the registry would act as a data submission vendor for the eligible professional. A “data submission vendor” is defined for purposes of this rule as an entity that has permission from the eligible professional to provide medical registry data to the Quality Reporting System developed per the MIEA-TRHCA. This definition parallels the definition of “data submission vendor” as used in other programs, such as the Hospital Compare data-submission process, where examples of such vendors include Joint Commission Oryx vendors. </P>
                    <P>In the testing process, again in parallel to similar mechanisms already implemented for other provider types by CMS, we anticipate the registry, acting as a data submission vendor, will submit data to the CMS clinical data warehouse, using a CMS-specified record layout based on the quality measures' specifications as published by CMS. For purposes of this rule, the term “CMS clinical data warehouse” is defined as a clinical data warehouse designated by CMS for use in this testing. The exact warehouse infrastructure may vary between the testing activity in 2008 and any full implementation of registry-based data submission that may in the future follow from that testing. </P>
                    <P>
                        Options 1 and 4 as described in the proposed rule will not be tested in 2008, and we do not envision any future consideration. Thus, they are not described in this rule. Option 5, while of potential interest for future consideration, is also not described 
                        <PRTPAGE P="66352"/>
                        below. As options 2 and 3 will be tested in 2008, they are described below. 
                    </P>
                    <P>
                        <E T="03">Option 2:</E>
                         Registries provide the quality codes and diagnosis codes. In testing this option, we will use claims data extracted from the National Claims History to capture the payment information at the NPI/Tax ID level. All PQRI reporting and performance calculations will be performed using registry data. The registries will, therefore, be required to include specific data elements in their databases in order to include the codes needed to calculate performance measures and to match registry data to claims data. Although not identified in the proposed rule, we have upon further technical analysis concluded that along with data elements previously identified, patient identifiers will also be needed from the registry under this option. Patient identifier data are needed specifically in order to allow matching of registry data with Medicare claims. It is our understanding that for many, if not all, registries, inclusion of at least the patient identifier data elements will represent an addition to their databases. 
                    </P>
                    <P>While developing and through the implementation of the testing phase we may discover additional data elements are needed to support reliably valid analyses. The following is a list of examples of the minimum data elements we believe will be needed from a registry under Option 2: </P>
                    <FP SOURCE="FP-1">• Beneficiary/procedure-level data (ICD 9 and CPT codes) </FP>
                    <FP SOURCE="FP-1">• HCPCS quality-data codes (G codes and CPT category II codes and modifiers) </FP>
                    <FP SOURCE="FP-1">• NPI and Tax ID </FP>
                    <FP SOURCE="FP-1">• Date of service </FP>
                    <FP SOURCE="FP-1">• Beneficiary Date of Birth </FP>
                    <FP SOURCE="FP-1">• HIC number </FP>
                    <P>
                        <E T="03">Option 3:</E>
                         Registries calculate the reporting and performance rates for Medicare beneficiaries only, and submit these rates to CMS (that is, aggregate information by NPI within a Tax ID). We assume no beneficiary level information will be shared. Registries will be required to include data elements in their databases to capture either quality-data codes or the clinical data needed to compute the quality-data codes. Registries will be required to perform the necessary calculations to be able to submit completed numerator/denominators for both reporting and performance rates. Additionally, the registries must have a validation strategy in place. 
                    </P>
                    <P>
                        For any option, the registry must maintain compliance with all applicable statutory or regulatory requirements and any contractual obligations to the providers for processing, storing, and transmitting the data required by the option. To be considered an appropriate registry from which we can accept and process data for the purposes of calculating PQRI measures, a registry must also comply with the interoperability standards recognized by the Secretary, and therefore, applicable to HHS initiatives. Examples of standards recognized by the Secretary include Consolidated Health Informatics Initiative (CHI) standards and standards subsequently recognized by the Secretary under Executive Order 13410 in place of CHI standards. A description of the specific health informatics standards adopted by the Federal government, as well as the specific interoperability standards recognized by the Secretary, is available on the HHS Office of the National Coordinator for Health Information Technology (ONC) Web site at 
                        <E T="03">http://www.hhs.gov/healthit/chiinitiative.html.</E>
                    </P>
                    <P>We will request that registries interested in participating in the testing of the registry based quality data submission project self nominate. A letter stating the registries interest should be received by CMS by 6 PM, Eastern time, on January 4, 2008. Self-nomination letters should be sent to: “PQRI IT Testing Nomination”, Centers for Medicare and Medicaid Services Office of Clinical Standards and Quality, Quality Measurement and Health Assessment Group, 7500 Security Boulevard, Mail Stop S3-02-01, Baltimore, MD 21244-8532. </P>
                    <P>We plan to select for testing, from the self nominees, a group of registries that comply with all applicable statutory and/or regulatory requirements, and any contractual obligations to the professionals/providers for processing, storing, and transmitting the data required by the option(s) tested. Registries selected must also comply with applicable system interoperability standards recognized by the Secretary and be technically capable of interfacing with the CMS clinical warehouse electronic data exchange interface. The number of registries selected for testing may be limited to those that are technically capable or those that already contain key minimum data elements for testing purposes. Additionally, the actual level of complexity and effort required for testing from the CMS data infrastructure may also limit registry participation in the testing phase. (Experience with other initiatives has suggested that some data submission vendors and their software are more easily interfaced and tested with the CMS data warehouse electronic data exchange interface than others.) </P>
                    <P>In addition to the requirements listed above in this section, any registry that self-nominates for 2008 testing must, at a minimum, have the following characteristics: </P>
                    <P>(1) Be able to separate and report information for Medicare beneficiaries only. </P>
                    <P>(2) Use at least 1 PQRI measure that is selected for 2008 inclusion. We will consider other measures recommended by specialty registries for possible future use in quality reporting and performance. </P>
                    <P>(3) Provide the data as outlined in the rule for the particular available option under which they are submitting data (that is, being able to report using option 2 and/or option 3). </P>
                    <P>(4) Have a validation process for their data. </P>
                    <P>(5) Have or have applied for a QualityNet Exchange account. </P>
                    <P>
                        We expect that information on the results of the testing in 2008 will be posted on the CMS PQRI Web site at 
                        <E T="03">http://www.cms.hhs.gov/pqri.</E>
                    </P>
                    <HD SOURCE="HD3">(iv) Electronic Health Records (EHRs) </HD>
                    <P>The proposed rule noted (72 FR 38204) that we would explore the operational feasibility of accepting clinical quality data for a limited number of PQRI measures from EHRs, and solicited comments on this concept. The summaries of, and our responses to, the numerous comments we received on this topic are presented at the end of this PQRI-specific section. </P>
                    <P>Having conducted further technical analyses and reviewed public comments received on the proposed rule, we have determined that we will, in 2008, partner with several self nominated EHR vendors/groups that we select to develop and test EHR clinical quality data submission. Since mechanisms for submission of electronic clinical data extracted from an EHR will only be for testing purposes in 2008, vendors should notify their clients that the practitioners will need to submit their quality data codes through the claims process to be eligible for a 2008 bonus payment. </P>
                    <P>
                        EHR vendors/groups who wish to participate in the development and testing process may self-nominate by sending a letter to CMS expressing their interest. Self-nomination letters should be sent to: “PQRI IT Testing Nomination”, Centers for Medicare and Medicaid Services Office of Clinical Standards and Quality, Quality Measurement and Health Assessment Group, 7500 Security Boulevard, Mail Stop S3-02-01, Baltimore, MD 21244-8532. 
                        <PRTPAGE P="66353"/>
                    </P>
                    <P>The letter must be received by CMS by 6 p.m., e.s.t., on January 4, 2008. Vendors who are selected for this process must: </P>
                    <P>(1) Be able to submit data according to the HL7 technical specifications for submission of data to the Outpatient Clinical Warehouse, as defined for the Doctor's Office Quality—Information Technology (DOQ-IT) Project; and </P>
                    <P>(2) Have or have applied for a QualityNet Exchange account. </P>
                    <P>As with registry-based mechanisms, vendors and their customers (eligible professionals) who choose to participate in the testing in 2008 will be doing so on a strictly voluntary basis. We will continue to express this, and will urge EHR vendors to explain this to their customers when seeking volunteers to participate in the testing with them. </P>
                    <P>
                        For more information on required capability (1), above, please see the QualityNet Exchange User's Guide, and the DOQ-IT measures' technical specifications (as implemented in the DOQ-IT project), both available for download free of charge from 
                        <E T="03">http://qualitynet.org.</E>
                         Additionally, 5 overlapping DOQ-IT and PQRI quality measures have been updated for potential use in the 2008 testing. The updated detailed technical specifications for these five DOQ-IT/PQRI overlapping measures are available for download from the 2008 PQRI Information page of the CMS PQRI Web site at 
                        <E T="03">http://www.cms.hhs.gov/pqri</E>
                        . 
                    </P>
                    <P>
                        <E T="03">Comment:</E>
                         Numerous comments were received regarding accepting clinical quality data from EHRs for use in PQRI. While some commenters opposed the idea of using EHR-derived data in PQRI, the majority of responses were in favor of accepting clinical quality data from an EHR. 
                    </P>
                    <P>
                        <E T="03">Response:</E>
                         Although we will be unable to offer EHR-based data submission mechanism on other than a test basis, we are encouraged by the generally positive response to the pursuit of this option due to its substantial potential to enhance data quality and reduce data collection burden on providers. 
                    </P>
                    <P>
                        <E T="03">Comment:</E>
                         Numerous comments expressed concerns about data security, especially as it pertains to patient privacy, and patient privacy as it relates to CMS use of the quality data, in the context of EHR-based data submission mechanisms. 
                    </P>
                    <P>
                        <E T="03">Response:</E>
                         Preservation of patient confidentiality is imperative. It is the inescapable responsibility of every party that collects, stores, handles, or uses patients' personally identifiable health information for any purpose. In order to participate in the 2008 testing, all participating parties must be able to ensure that uses and disclosures of protected health information EHRs, data transmission mechanisms, and data receipt and storage systems will be in compliance with all applicable statutes and regulations and any contractual obligations to the professionals/providers for processing, storing, and transmitting the data required by each option tested. Moreover, although EHR submission may involve identifiable personal health information, that information is limited to what is minimally necessary to be able to audit the data accuracy and completeness in addition to the particular clinical information (lab values, vital sign values, documentation of a procedure or test ordered or performed) necessary to calculate the performance measure. It does not involve submitting the entire patient medical record, and it is possible that the information as transmitted can have the patient's actual identifying information (for example, name, and HIC number) “masked” by using a practice-internal chart ID # or other method that still allows for accurate audit. 
                    </P>
                    <P>
                        <E T="03">Comment:</E>
                         Multiple comments urged us to develop and implement EHR-based data submission mechanisms in a way that minimizes the burden such submission might impose. 
                    </P>
                    <P>
                        <E T="03">Response:</E>
                         We agree that data submission burden is an important factor to consider in PQRI data submission. 
                    </P>
                    <P>
                        <E T="03">Comment:</E>
                         We received several comments expressing concern over professionals losing “control” of patient records as a result of EHR-based PQRI quality data submission. The comments appeared to assume that our plan was 
                        <E T="03">either</E>
                         to import and maintain within our data warehouse entire patient medical records 
                        <E T="03">or</E>
                         to implement an interface that would allow our warehouse to access and mine the data from patients' medical records. 
                    </P>
                    <P>
                        <E T="03">Response:</E>
                         The patient's health record is populated and maintained in a practitioner's office, regardless of whether its content is stored on paper or electronic format or media. Nothing in this rule affects the rights of patients or practitioners with respect to the information contained in a patient's health record. 
                    </P>
                    <P>We plan to accept clinical data that is extracted from medical records and then submitted to us by a professional (or a data-submission vendor acting on a professional's behalf). </P>
                    <P>We would not attempt to upload entire medical records into the data warehouse, only the data elements minimally necessary to accomplish the purposes of PQRI. We do not plan to enable our system to directly mine data from the practice's medical records database; that will need to be accomplished by the professional or a data vendor acting on the professional's behalf. The data submission requires an affirmative action on the part of the professional to submit the data or to instruct his or her data submission vendor to submit the data to our warehouse. </P>
                    <HD SOURCE="HD3">2. Section 110—Reporting of Hemoglobin or Hematocrit for Part B Cancer Anti-Anemia Drugs (§ 414.707(b)) </HD>
                    <P>Medicare Part B provides payment for certain drugs used to treat anemia. Anemia is common in cancer patients and may be caused by either the cancer itself or by various anti-cancer treatments, including chemotherapy, radiation therapy, and surgical therapy. Anemia occurs when the number of red blood cells is reduced by an anti-cancer treatment. This happens due to the effect of chemotherapy or radiation therapy on the bone marrow, wherein red blood cells are produced by dividing precursor cells. This chemotherapy effect is commonly referred to as “bone marrow suppression.” Anemia may also result from blood loss in association with surgical therapy for the cancer. </P>
                    <P>Anemia adversely impacts the quality of life for beneficiaries being treated for cancer. Fatigue and reduced performance capacity are the side effects of anemia that cancer patients report as the most disabling and contributing to poor quality of life. The treatment of anemia in cancer patients commonly includes the use of drugs, specifically erythropoiesis stimulating agents (ESAs) such as recombinant erythropoietin and darbepoietin. Although other pharmacologic interventions are available, ESAs are the most commonly used drugs to treat anemia in this setting. Notably, recent research has prompted a Black Boxed warnings in the labels for ESAs, noting significant adverse effects including a higher risk of mortality and tumor progression in some populations. </P>
                    <P>
                        In 2006, we implemented a revised ESA claims monitoring policy based on the last hemoglobin or hematocrit value from the preceding month on Medicare claims for payment of ESAs administered to beneficiaries with anemia due to end-stage renal disease (ESRD) receiving dialysis treatments in facilities. For many years prior, we have required the reporting of these red blood cell indicators on the Medicare claims by ESRD facilities to ensure that the beneficiaries' anemia was addressed. 
                        <PRTPAGE P="66354"/>
                    </P>
                    <P>Section 110 of the MIEA-TRHCA amends section 1842 of the Act by adding a new subsection (u) that reads as follows: “Each request for payment, or bill submitted, for a drug furnished to an individual for the treatment of anemia in connection with the treatment of cancer shall include (in a form and manner specified by the Secretary) information on the hemoglobin or hematocrit levels for the individual.” Section 110 of the MIEA-TRHCA requires such reporting for drugs furnished on or after January 1, 2008. In addition, subsection (b) directs the Secretary to use the rulemaking process under section 1848 of the Act to address the implementation of this requirement. </P>
                    <P>By requiring the reporting of anemia quality indicators for Medicare Part B anti-anemia drugs that are used in the context of cancer treatment, we will facilitate assessment of the quality of care for this condition. We will use the information reported to help determine the prevalence and severity of anemia associated with cancer therapy, the clinical and hematologic responses to the institution of anti-anemia therapy, and the outcomes associated with various doses of anti-anemia therapy. </P>
                    <P>While not specifically addressing other indications, the recent research on the adverse effects of ESAs in patients with cancer does raise concerns as to whether patients receiving ESAs for other conditions, such as in the treatment of HIV-AIDS and for some surgical patients, are also at higher risk. We solicited public comment on the potential of expanding this regulation to include all uses of ESAs. </P>
                    <HD SOURCE="HD2">Comments and Responses </HD>
                    <P>In general, commenters responded favorably to requiring the reporting of the most recent hemoglobin or hematocrit level on claims seeking payment for the administration of ESAs for all uses. One commenter supported broadening the requirement for reporting hemoglobin and hematocrit levels for all ESA claims and stated that such requirements would provide valuable data concerning reasonable care. The commenter stated that any new information on the use of ESAs for other, non-cancer diseases gained by the data collection would be helpful in understanding the effects of ESA use in different diseases. Another commenter supported the broad goal of gathering the information to improve the quality of care. Thus, in light of the potential adverse events from ESA use and in accordance with our reading of Congressional intent, we believe it is appropriate to require reporting of the hemoglobin or hematocrit with respect to all ESA claims, and therefore, we have revised the regulations text to reflect this policy in this final rule with comment period. </P>
                    <P>Most commenters' concerns were limited to the implementation of the requirement and possible subsequent undue administrative burden placed on providers. A few commenters addressed a recently published National Coverage Determination on the use of ESAs for certain patients and others included comments related to our ESAs claims monitoring policy (EMP). We are not addressing those comments in this final rule with comment period as the issues are outside the scope of this regulation. </P>
                    <P>
                        <E T="03">Comment:</E>
                         A commenter recommended that we exercise caution in implementing the anemia quality indicator secondary to a recent Food and Drug Association (FDA) Black Boxed Warning (BBW) on the use of ESAs. The commenter noted that anemia measures were removed from the Physician Consortium for Performance and Improvement ESRD measurement set pending further clarification by either the FDA or the National Kidney Foundation. 
                    </P>
                    <P>
                        <E T="03">Response:</E>
                         This final rule with comment period does not establish new or additional standards related to anemia or the administration of ESAs. It simply mandates the reporting of the most recent hemoglobin or hematocrit level on claims for payment of the administration of ESAs to treat anemia. Similar to claims for ESAs administered in renal dialysis facilities, the requirement to report a recent hemoglobin or hematocrit on claims for the administration of ESAs for any use is not a development of a clinical standard. Thus, we believe that collecting this information will not impact nor be impacted by any consensus standard organizations' development of practice standards, quality measures or new scientific evidence. 
                    </P>
                    <P>
                        <E T="03">Comment:</E>
                         A commenter asked that we clarify if the reporting requirement applies to all anemia treatment, which includes, but is not limited to, the use of ESAs. 
                    </P>
                    <P>
                        <E T="03">Response:</E>
                         The statutory requirement does not limit the scope to ESAs. We recognize that other drugs and vitamin and mineral supplements such as Vitamin B12, folic acid, and iron may also be used in the treatment of anemia. ESAs are only FDA approved for the treatment of anemia while the other agents are commonly used to treat a variety of conditions other than anemia. Vitamin and mineral supplements are commonly self administered and we expect that most uses of these agents would not result in claims for Medicare payment in the context of the treatment of anemia related to anti cancer therapy. However, if payment is requested for these anti-anemia drugs furnished to an individual for the treatment of anemia in connection with the treatment of cancer, we believe that they are within the scope of the statute. 
                    </P>
                    <P>We believe that the reporting of hemoglobin or hematocrit levels on claims for ESAs is consistent with Congressional intent that quality indicator data be submitted for patients receiving anti-anemia drugs and to ensure that anemia is addressed. </P>
                    <P>
                        <E T="03">Comment:</E>
                         Several commenters recommended that we provide clear instruction on the scope and reporting of the hemoglobin or hematocrit levels. 
                    </P>
                    <P>
                        <E T="03">Response:</E>
                         We will use the change request process to issue implementing instructions to Medicare contractors. Instructions to Medicare contractors include requirements for provider education. 
                    </P>
                    <P>
                        <E T="03">Comment:</E>
                         Several commenters expressed concern that the requirement will be burdensome for providers. One commenter asked that we delay the implementation of this requirement until the administrative burden to practitioners is understood. 
                    </P>
                    <P>
                        <E T="03">Response:</E>
                         We do not have the authority to delay the effective date of the statutory requirement. In addition, we believe that reporting the most recent hemoglobin or hematocrit level on a claim for ESA will not result in undue administrative burdens on providers. Many local Medicare contractors already require such reporting for claims submitting within their jurisdictions. ESRD providers have been reporting hemoglobin or hematocrit levels on claims for ESAs for several years. 
                    </P>
                    <P>
                        <E T="03">Comment:</E>
                         A commenter recommended that should we broaden the reporting requirement to all ESA use and that we should assess minimal data sets for understanding how beneficiaries with various underlying conditions respond to a particular course of anemia management. 
                    </P>
                    <P>
                        <E T="03">Response:</E>
                         We appreciate the recommendation and shall review available data sets when assessing responses to anemia management. 
                    </P>
                    <P>
                        <E T="03">Comment:</E>
                         A commenter recommended that we include anemia quality indicators in the Physician Quality Reporting Initiative (PQRI) data reporting. 
                    </P>
                    <P>
                        <E T="03">Response:</E>
                         This comment is addressed above in the section of this final rule specific to 2008 PQRI measures. The identification or establishment of PQRI 
                        <PRTPAGE P="66355"/>
                        measures is not within the scope of this section of this final rule with comment period. 
                    </P>
                    <P>
                        <E T="03">Comment:</E>
                         A commenter asked that retail pharmacies be exempt from this requirement. 
                    </P>
                    <P>
                        <E T="03">Response:</E>
                         The MIEA TRHCA does not provide for any exemption for retail pharmacies. 
                    </P>
                    <P>
                        <E T="03">Comment:</E>
                         One commenter asked that we clarify whether a provider may report a hematocrit or hemoglobin level. 
                    </P>
                    <P>
                        <E T="03">Response:</E>
                         A provider seeking payment for ESAs may report the patient's most recent hematocrit or hemoglobin level on the claim. 
                    </P>
                    <P>
                        <E T="03">Comment:</E>
                         Several commenters asked that we clarify the requirement to report “the most recent” hemoglobin or hematocrit level. They expressed concern that we may require a patient to have a hemoglobin or hematocrit level drawn each time an ESA is administered. 
                    </P>
                    <P>
                        <E T="03">Response:</E>
                         We are not determining in this regulation when a hematocrit or hemoglobin level should be drawn to inform a provider's decision to administer ESA therapy. The requirement is that “the most recent” hemoglobin or hematocrit level be reported on the claim. Thus, the provider should report the most recent level preceding the ESA administration. We recognize that in some instances the same hemoglobin or hematocrit value might be reported on more than one claim. 
                    </P>
                    <P>
                        <E T="03">Comment:</E>
                         Several commenters stated that we should permit providers to report hematocrit or hemoglobin levels in either box 19 or 24A of the CMS 1500 form. The CMS 1500 form was recently modified to allow reporting in box 24A; however, many providers utilize billing vendors that provide software and are unable to modify their product in time for the January 1, 2008 implementation. 
                    </P>
                    <P>
                        <E T="03">Response:</E>
                         We will consider this information when developing claims processing systems instructions. 
                    </P>
                    <P>
                        <E T="03">Comment:</E>
                         One commenter suggested that we employ Q codes for reporting the most recent hemoglobin or hematocrit levels. The commenter stated that permitting a provider to report the level in box 19 would not allow an automated extraction of the data element (the hemoglobin or hematocrit level) for data analysis. 
                    </P>
                    <P>
                        <E T="03">Response:</E>
                         We are working with claims processing systems to ensure appropriate retrieval of data sets. 
                    </P>
                    <HD SOURCE="HD3">3. Section 104—Extension of Treatment of Certain Physician Pathology Services Under Medicare </HD>
                    <P>The technical component (TC) of physician pathology services refers to the preparation of the slide involving tissue or cells that a pathologist will interpret. (In contrast, the pathologist's interpretation of the slide is the professional component (PC) service. If this service is furnished by the hospital pathologist for a hospital patient, it is separately billable. If the independent laboratory's pathologist furnishes the PC service, it is usually billed with the TC service as a combined service.) </P>
                    <P>In the CY 2000 PFS final rule with comment period (64 FR 59408 through 59409), we stated that we would implement a policy to pay only the hospital for the TC of physician pathology services furnished to hospital patients. Before that provision, any independent laboratory could bill the carrier under the PFS for the TC of physician pathology services for hospital patients. As stated in the CY 2000 PFS final rule with comment period (64 FR 59408 through 59409), this policy has contributed to the Medicare program paying twice for the TC service, first through the inpatient prospective payment rate to the hospital where the patient is an inpatient and again to the independent laboratory that bills the carrier, instead of the hospital, for the TC service. </P>
                    <P>Therefore, in the CY 2000 PFS final rule with comment period (64 FR 59408 through 59409), in § 415.130, we specified that for services furnished on or after January 1, 2001, the carriers would no longer pay claims to the independent laboratory under the PFS for the TC of physician pathology services for hospital patients. </P>
                    <P>Ordinarily, the provisions in the PFS final rule with comment period are implemented in the following year. However, in this case, the change to § 415.130 was delayed 1 year (until January 1, 2001), at the request of the industry, to allow independent laboratories and hospitals sufficient time to negotiate arrangements. Moreover, our full implementation of § 415.130 was further delayed by section 542 of the Medicare, Medicaid, and SCHIP Benefits Improvement and Protection Act of 2000 (Pub. L. 106-554) (BIPA) and section 732 of the MMA, which directed us to continue payment to independent laboratories for the TC of physician pathology services for hospital patients through CY 2006. </P>
                    <P>In the CY 2007 PFS final rule with comment period (71 FR 69700), we announced that beginning January 1, 2007, we would no longer allow the carriers to pay the independent laboratory for the TC of physician pathology services to hospital patients. In effect, we would be: (1) Implementing the provisions of the CY 2000 PFS final rule with comment period whose implementation had been delayed by section 542 of the BIPA and section 732 of the MMA; and (2) ensuring that the Medicare program does not make duplicate payments for the same service. </P>
                    <P>Subsequent to publication of the CY 2007 PFS final rule with comment period, the MIEA-TRHCA was enacted. Section 104 of the MIEA-TRHCA provided for an additional 1 year extension to allow carriers to continue to pay independent laboratories under the PFS for the TC portion of physician pathology services furnished to patients of a covered hospital. </P>
                    <P>Consistent with this legislative change, we are amending § 415.130(d) to specify that for services furnished after December 31, 2007, an independent laboratory may not bill the carrier for the TC of physician pathology services furnished to a hospital inpatient or outpatient. </P>
                    <P>
                        <E T="03">Comment:</E>
                         Many commenters asked us to implement the grandfather provision on a permanent basis, and if this cannot be accomplished administratively, the commenter requested that we implement this provision no earlier than July 1, 2008. The commenter indicated that this delay would allow the grandfathered independent laboratories the opportunity to implement new billing requirements and inform customers of this change. 
                    </P>
                    <P>
                        <E T="03">Response:</E>
                         We will delay implementation of this provision only if legislation is enacted requiring a further delay. Otherwise, we will, as explained in the CY 2008 PFS proposed rule, implement this provision effective for TC services furnished on or after January 1, 2008. 
                    </P>
                    <P>
                        <E T="03">Comment:</E>
                         A commenter indicated a potential problem in the preamble language of the CY 2008 PFS proposed rule that explains the implementation of the TC physician pathology provision effective January 1, 2008. In the CY 2008 PFS proposed rule, the preamble reads, “Consistent with this legislative change, we are amending § 415.130(d) to reflect that for services furnished after December 31, 2007, an independent laboratory may not bill the carrier for physician pathology services furnished to a hospital inpatient or outpatient” (72 FR 38205). As currently written, this language would mean that the independent laboratory cannot bill the carrier for the PC of physician pathology services for hospital patients, an unintended result. 
                    </P>
                    <P>
                        <E T="03">Response:</E>
                         The preamble inadvertently omitted the term “technical component” and should read, “For 
                        <PRTPAGE P="66356"/>
                        services furnished after December 31, 2007, an independent laboratory may not bill the carrier for the 
                        <E T="03">technical component</E>
                         of physician pathology services furnished to a hospital inpatient or outpatient.” We proposed this language in the regulations text of the proposed rule and are finalizing this language in this final rule with comment period. 
                    </P>
                    <HD SOURCE="HD3">4. Section 201—Extension of Therapy Cap Exception Process </HD>
                    <P>Section 1833(g)(1) of the Act applies an annual per beneficiary combined cap beginning January 1, 1999, on outpatient physical therapy and speech-language pathology services, and a similar separate cap on outpatient occupational therapy services. These caps apply to expenses incurred for the respective therapy services under Medicare Part B, with the exception of services furnished as outpatient hospital services. Section 1833(g)(2) of the Act provides that, for CY 1999 through CY 2001, the caps were $1500, and for the calendar years after 2001, the caps are equal to the preceding year's cap increased by the percentage increase in the Medicare Economic Index (MEI) (except that if an increase for a year is not a multiple of $10, it is rounded to the nearest multiple of $10). </P>
                    <P>The cap for CY 2008 will be $1810 per beneficiary for PT and SLP services combined, and $1810 for OT services. Therapy caps apply to expenses incurred for therapy services in all outpatient settings except the outpatient hospital department. As explained below in this section, the statute requires that we implement the therapy caps without providing for an exceptions process beginning on January 1, 2008. </P>
                    <P>Section 5107(a) of the DRA required the Secretary to develop an exceptions process for the therapy caps effective for expenses incurred during CY 2006. Details of the CY 2006 exceptions process were published in a manual change on February 13, 2006 (CR4364, which consists of Transmittal 855, Transmittal 47, and Transmittal 140). Section 201 of the MIEA-TRHCA extended the exceptions process to apply for expenses incurred through December 31, 2007. Therapy cap exception policies for 2007 were specified in Change Request 5478 which consists of three transmittals with current numbers of— </P>
                    <P>• Transmittal 1145CP, Pub. 100-04; </P>
                    <P>• Transmittal 63BP, Pub. 100-02; and </P>
                    <P>• Transmittal 181PI, Pub. 100-08. </P>
                    <P>
                        The transmittals are incorporated into the Internet Only Manuals available at 
                        <E T="03">http://www.cms.hhs.gov/Manuals</E>
                         and are also available on our Web site at 
                        <E T="03">http://www.cms.hhs.gov/Transmittals/</E>
                        . 
                    </P>
                    <P>In accordance with the statute as amended by the MIEA-TRHCA, we will continue to implement therapy caps, but the exceptions process will no longer be applicable for expenses incurred for services furnished beginning on January 1, 2008. As noted previously in this section, under current law, therapy caps will continue to apply to expenses incurred for therapy services after December 31, 2007, with one exception. That is, in accordance with section 1833(g) of the Act, the therapy caps will remain inapplicable to expenses incurred for therapy services furnished in the outpatient hospital setting. </P>
                    <P>We received several comments on this proposal. </P>
                    <P>
                        <E T="03">Comment:</E>
                         Most commenters understood that we have no authority to change therapy caps, but still commented in favor of repealing them. Some commenters supported the continuation of the exceptions process as a well-conceived method of eliminating unnecessary treatment. Some commenters objected to the inapplicability of the caps for therapy expenses incurred in the outpatient hospital setting. One commenter supported the repeal of therapy caps and stated it is not an effective cost control when a steady source of replacement patients is available. 
                    </P>
                    <P>Another commenter opposed the policy underlying the statutory provision to apply a financial cap on therapy services. The commenter cited other means of ensuring appropriate utilization of therapy services including CCI edits, edits required by the Deficit Reduction Act, local coverage determination policies, and Transmittal 63, which required greater documentation. The commenter indicated that we are effectively achieving the objective to assure appropriate utilization of therapy services without the financial caps. </P>
                    <P>
                        <E T="03">Response:</E>
                         We do not have the authority to repeal therapy caps, to change the exception to applicability of the caps for services provided in the outpatient hospital setting, or to extend the therapy cap exceptions process beyond the period for which was made applicable by statute (CYs 2006 and 2007). 
                    </P>
                    <P>
                        <E T="03">Comment:</E>
                         Several commenters urged CMS to implement the recommendations contained in the Computer Science Corporation (CSC) Outpatient Therapy Service Pilot Report of 2006 to collect patient-specific data using available measurement tools. Although they acknowledged that we may have concerns about the use of proprietary tools, the commenter urged the use of therapy-specific tools already on the market that were recommended by both CSC and MedPAC, including the National Outcomes Measurement System. 
                    </P>
                    <P>
                        <E T="03">Response:</E>
                         In evaluating alternative payment systems, we will consider all methods of obtaining the required patient-related information including reports of past and future contract deliverables. 
                    </P>
                    <P>
                        <E T="03">Comment:</E>
                         Many commenters are deeply concerned about the negative impact the caps would have, in the absence of the exceptions process, on an estimated 14.5 percent of the physical therapy (PT) users who would exceed the cap. The commenters commended CMS for progress made toward alternatives to the financial caps in recent years and urged a high priority in resources and funding to continuing research to identify alternatives that would also ensure access to medically necessary therapy services. The commenters support the collection of patient outcome data with patient assessment tools and use of risk adjustment to account for individual differences. They support the ongoing study for which CMS recently issued a Request for Task Order (RTOP-CMS-07-033) and look forward to participating in the study. 
                    </P>
                    <P>Many commenters reported that they will be collecting and reporting outcome data before January 1, 2008. They urged CMS to use clinical outcome data to determine the amount of care needed by individuals and offered assistance in data collection. </P>
                    <P>
                        <E T="03">Response:</E>
                         We recently issued a request for proposals (RTOP-CMS-07-033) to continue our study of therapy services. The study will: (1) Identify, collect and use therapy-related information that is tied to beneficiary needs and treatment effectiveness; and (2) develop payment method alternatives to the current cap on outpatient therapy services. 
                    </P>
                    <P>We welcome any information concerning clinical outcome data studies from providers or suppliers. If the information is applicable to our deliberations on payment alternatives, we will consider it along with the results of past and future contract deliverables. </P>
                    <P>
                        <E T="03">Comment:</E>
                         One commenter recommended that we continue to collect outpatient therapy utilization information for 2006 and 2007. 
                    </P>
                    <P>
                        <E T="03">Response:</E>
                         We contracted with the CSC (HHSM-500-2007-00322G) to extract 2006 therapy utilization data and provide a high level analysis. To the extent possible, we intend to further 
                        <PRTPAGE P="66357"/>
                        study the impact of therapy caps including the 2006 exceptions process. 
                    </P>
                    <HD SOURCE="HD3">5. Section 101(d)—Physician Assistance and Quality Initiative (PAQI) Fund </HD>
                    <P>Section 1848(l) of the Act, as added by section 101(d) of the MIEA-TRHCA requires the Secretary to establish a Physician Assistance and Quality Initiative (PAQI) Fund (the Fund) which shall be available for physician payment and quality improvement initiatives, and which may include application of an adjustment to the update of the PFS conversion factor (CF). The provision makes available $1.35 billion to the Fund for services furnished during CY 2008. Specifically, the provision directs the Secretary to provide for expenditures from the Fund in a manner designed to provide (to the maximum extent feasible) for the obligation of the entire $1.35 billion for payment for physicians' services furnished during CY 2008. The provision also requires that if expenditures from the Fund are applied to, or otherwise affect, a CF for a year, the CF for a subsequent year shall be computed as if the adjustment to the CF had never occurred. We note that the Transitional Medical Assistance, Abstinence Education, and Qualifying Individual Programs Extension Act of 2007 (Pub. L. 110-90) recently was signed into law and it provides an additional $325 million to be used as a part of the PAQI Fund for payment with regard to services furnished in 2009 and $60 million for payment for physicians' services furnished on or after January 1, 2013. The legislation does not make any other changes to the program, and therefore, remains as discussed in the proposed rule. </P>
                    <P>As the MIEA-TRHCA legislation indicates, this Fund can be used for physician payment and quality improvement, including application of an adjustment to the update of the conversion factor. In the CY 2007 PFS proposed rule, we proposed to use the $1.35 billion to fund bonus payments to be made during CY 2009 for physician reporting of measures during CY 2008. Specifically, we proposed that the physician quality initiative for CY 2008 be structured and implemented in the same manner as the 2007 PQRI with regard to the professionals eligible to participate in the program, reporting quality measures via claims submission, and the standards for satisfactory reporting. </P>
                    <P>
                        The differences between CY 2007 and CY 2008 that we currently anticipate are noted below in this section. As we monitor the implementation of the 2007 PQRI and possibly make refinements to the 2007 program, we anticipate that such refinements would also apply under the 2008 program. Such refinements, should they be needed, will be noted with guidance linked from the CMS quality reporting Web site at 
                        <E T="03">http://www.cms.hhs.gov/PQRI</E>
                        . 
                    </P>
                    <P>As with the 2007 PQRI, we proposed that eligible professionals who successfully report a designated set of quality measures in 2008 may earn a bonus payment of a percentage of total allowed charges for covered Medicare services, subject to a cap based on the volume of quality reporting. In contrast to 2007, we proposed that eligible professionals could report applicable measures for services furnished from January 1, 2008 through December 31, 2008, and allowed charges during such period would be the basis for calculating the bonus payments. We proposed that the CY 2008 measures that we finalize in this final rule with comment period would apply for CY 2008. We also proposed to estimate all of the bonus payments that would be payable to physicians using the same method as the one used for reporting during 2007 and to calculate the amount of the bonus payment, after the close of CY 2008 reporting period. Given that we proposed to use the PAQI Fund for the 2008 PQRI program, we also proposed that the bonus payments to individual physicians be subject to an aggregate cap of $1.35 billion. Because we proposed to scale aggregate payments to physicians in a manner such that Medicare would pay $1.35 billion during CY 2009 for measures reported for services furnished during CY 2008, we were unable to provide an exact percentage for the bonus payment. However, we anticipated that the bonus payments would be approximately 1.5 percent of allowed charges for participating professionals (and we did not expect that the ultimate percentage amount would exceed 2 percent). </P>
                    <P>
                        <E T="03">Comment:</E>
                         Comments received on the proposed rule were generally opposed to using the PAQI Fund for CY 2008 PQRI bonus payments. Almost all comments on this issue requested that we use the entire $1.35 billion to help offset the estimated negative 9.9 percent physician update for CY 2008. 
                    </P>
                    <P>
                        <E T="03">Response:</E>
                         In the CY 2007 PFS proposed rule, we acknowledged this alternative approach of using the $1.35 billion in some manner to reduce the update to the PFS of negative 9.9 percent that is projected for CY 2008. However, we noted that there are fundamental operational problems with this approach that make it not feasible. The $1.35 billion is a fixed dollar amount. Once the amount is reached, there is no authority to pay any more than that amount. Medicare is an entitlement program that covers medically necessary services for eligible beneficiaries, but such coverage is not limited to a fixed dollar amount for a year. While we estimate that the $1.35 billion would reduce the negative update by approximately 2 percentage points, actual spending could be above or below the estimate. To insure that we do not exceed the Fund amount, we would have to estimate an amount to reduce the update by that is low enough to ensure the $1.35 billion funding cap is not exceeded. While this approach might reduce the CY 2008 negative update, it could still leave money in the Fund. We are concerned that there may be potential oversight or other legal consequences in the event that we significantly exceed the Fund or do not apply the entire Fund. Therefore, we believe the best use of the Fund is to apply it to extend PQRI into CY 2008. 
                    </P>
                    <P>
                        <E T="03">Comment:</E>
                         Commenters asserted that use of the PAQI Fund for anything other than the physician update was inconsistent with Congressional intent. Commenters cited TRHCA language that the Fund “may include application of an adjustment to the update of the conversion factor.” Commenters further noted that this use must have been Congressional intent, since the legislation includes explicit language of how to deal with the update in subsequent years when the Fund is used towards the update: “[I]n the case that expenditures from the Fund are applied to, or otherwise affect, a conversion factor * * * the conversion factor under such subsection shall be computed for a subsequent year as if such application or effect had never occurred.” 
                    </P>
                    <P>Many commenters cited the Congressional Budget Office's cost estimate for the TRHCA legislation, which anticipated CMS developing a plan to use approximately 90 percent of the Fund in CY 2008 and the remaining funds in CY 2009. These comments cited section 101(d) of the MIEA-TRHCA, where the Congress stated that the Fund should be used “to the maximum extent feasible” for physicians' services during CY 2008, interpreting Congressional intent to be that CMS do its best to distribute most of the money in CY 2008, and any remaining monies in CY 2009. </P>
                    <P>
                        Commenters rejected the rationale that there were serious legal and operational barriers to applying the PAQI Fund to the physician update; they expressed confidence that we could find some way to use the Fund to offset the reduction. 
                        <PRTPAGE P="66358"/>
                    </P>
                    <P>Further, commenters noted that it was within our discretion to apply the PAQI Fund to the physician update, and they were highly critical of our unwillingness to take administrative steps to mitigate the negative 9.9 percent physician update. </P>
                    <P>
                        <E T="03">Response:</E>
                         Section 101(d) of the MIEA-TRHCA directs the Secretary to establish a PAQI Fund to be available to the Secretary for physician payment and quality improvement initiatives, which may include application of an adjustment to the update of the CF under that subsection. The legislation clearly indicates that the Secretary has the discretion to use the Fund for physician payment and quality improvement initiatives, including application of an adjustment to the update of the conversion factor. However, we are not required to use the funds for the update. 
                    </P>
                    <P>As noted above, there are fundamental operational problems with applying the PAQI Fund to the conversion factor update. We are concerned that there may be potential oversight or other legal consequences in the event the Agency significantly exceeds the Fund or does not apply the entire Fund. For the reasons previously discussed, we believe it is in the best interests of the program to apply this Fund to the extension of PQRI. </P>
                    <P>
                        <E T="03">Comment:</E>
                         Commenters rejected the notion that use of the $1.35 billion to fund the CY 2008 PQRI is the best way to insure physicians get the greatest benefit from the PAQI Fund's resources. Commenters stated that the PQRI does not provide all physicians with an opportunity to participate and that many specialties treat patients with conditions for which PQRI measures do not apply. In contrast, using the Fund to offset the negative update for CY 2008 would benefit all physicians. 
                    </P>
                    <P>
                        <E T="03">Response:</E>
                         Medicare payment systems need to encourage reliable, high quality and efficient care, rather than making payment simply based on the quantity of services provided and resources consumed. Applying the $1.35 billion to PQRI bonuses allows CMS to further the goal of improving quality and efficiency by utilizing the infrastructure that both physicians and Medicare have invested in for the CY 2007 PQRI. We believe implementing this Fund through an extension of the PQRI program is the best way to ensure that the Fund is being used to increase quality and efficiency of care for Medicare beneficiaries. 
                    </P>
                    <P>
                        <E T="03">Comment:</E>
                         Commenters rejected the notion that using the PAQI Fund for bonuses would improve quality. For most physicians, the proposed estimated 1.5 percent bonus payment is insufficient to cover the costs to institute such quality reporting measures. Commenters noted that if CMS truly wished to encourage more providers to participate in the PQRI, “new money” must be found to fund the initiative. Commenters suggested bonuses between 5 and 10 percent of allowed charges would more reasonably cover the costs of improving their infrastructure to appropriately report quality measures. 
                    </P>
                    <P>
                        <E T="03">Response:</E>
                         Funding the PQRI is consistent with the goal of improving quality and efficiency in Medicare. Eligible professional can participate in the PQRI by reporting the appropriate quality measure data on claims submitted to their Medicare claims processing contractor. We provide educational resources on the PQRI Web site that allow eligible professionals to integrate PQRI reporting into their care delivery process without significant changes in their infrastructures. 
                    </P>
                    <P>We appreciate the desire of eligible professionals to improve their infrastructure to better track quality of care. For many eligible professionals, such infrastructure is already in place for PQRI and will not require additional investment. However, we note that PQRI bonuses are financial incentives to participate in a voluntary quality reporting program and were not intended to cover the costs of significantly improving the infrastructure of eligible professionals. </P>
                    <P>
                        <E T="03">Comment:</E>
                         Many commenters noted that the PQRI has not been proven to have any positive effect on patient care or health outcomes. Rather than utilizing the $1.35 billion to support an unproven program, it would be better to directly improve physician reimbursement and better cover the costs of the necessary care they are currently providing to beneficiaries. 
                    </P>
                    <P>
                        <E T="03">Response:</E>
                         The PAQI Fund was made available to the Secretary for physician payment and quality improvement initiatives. We are actively engaged with the physician community in identifying ways to align Medicare's physician payment system with the goals of health professionals for high-quality care. Using the PAQI Fund to pay for the PQRI aligns reimbursement with quality and efficiency. We have worked collaboratively with the physician community to develop measures that capture the quality of care being provided to our Medicare beneficiaries. The PQRI encourages physicians to provide the type of care that is best suited for our beneficiaries: Care focused on prevention and treating complications; and care focused on the most effective, proven treatments available. 
                    </P>
                    <P>We acknowledge the relative newness of the PQRI. To that end, we are committed to continue working with the physician community in an open and transparent way to insure that the PQRI supports the best approaches to provide high quality health care services. </P>
                    <P>
                        <E T="03">Comment:</E>
                         Commenters noted that Congressional intent was to provide some relief and stability to the physician payment system during CY 2008. However, under the terms of the proposed rule, CMS cannot let physicians know the amount of the reporting bonus until well after the close of the CY 2008 reporting period, and physicians would not receive bonuses until some time in CY 2009. 
                    </P>
                    <P>
                        <E T="03">Response:</E>
                         Section 101(d) of the MIEA-TRHCA charges the Secretary with a timely obligation of all available funds for services furnished during CY 2008, directing the Secretary to provide for expenditures from the Fund in a manner designed to provide (to the maximum extent feasible) for the obligation of the entire $1.35 billion for physicians' services furnished during CY 2008. Although the legislation is clear that payment of the Fund is based on services furnished during CY 2008, the legislation does not limit the Secretary to paying from the PAQI Fund during CY 2008. 
                    </P>
                    <P>
                        <E T="03">Comment:</E>
                         One commenter stated that quality payments should not be geographically adjusted. The commenter suggested that PQRI payments should be based on RVUs, not allowed charges. 
                    </P>
                    <P>
                        <E T="03">Response:</E>
                         Section 101(c) of MIEA-TRHCA authorizes a financial incentive for eligible professionals to participate in a voluntary quality reporting program. Eligible professionals, who choose to participate and successfully report on a designated set of quality measures for services paid under the Medicare Physician Fee Schedule and provided between July 1 and December 31, 2007, may earn a bonus payment of 1.5 percent of their allowed charges during that period, subject to a cap. In the CY 2008 PFS proposed rule (72 FR 38206), we proposed that the physician quality initiative for CY 2008 be structured and implemented in the same manner as the 2007 PQRI, as described above. This includes calculating the amounts of the 2008 bonus payments based upon a percentage of allowed charges, as was statutorily required for 2007 bonus payments. By definition, allowed charges include the geographical adjustments in payments, as determined by the geographic practice cost indices (GPCIs), which 
                        <PRTPAGE P="66359"/>
                        reflect the variation in practice costs from area to area. 
                    </P>
                    <HD SOURCE="HD1">III. Revisions to the Payment Policies of Ambulance Services Under the Fee Schedule for Ambulance Services; Ambulatory Inflation Factor Update for CY 2007 </HD>
                    <P>As discussed in the CY 2008 PFS proposed rule (72 FR 38207), under the ambulance fee schedule, the Medicare program pays for transportation services for Medicare beneficiaries when other means of transportation are contraindicated. Ambulance services are classified into different levels of ground (including water) and air ambulance services based on the medically necessary treatment provided during transport. These services include the following levels of service: </P>
                    <P>For Ground— </P>
                    <P>• Basic Life Support (BLS).</P>
                    <P>• Advanced Life Support, Level 1 (ALS1).</P>
                    <P>• Advanced Life Support, Level 2 (ALS2).</P>
                    <P>• Specialty Care Transport (SCT).</P>
                    <P>• Paramedic ALS Intercept (PI).</P>
                    <P>For Air— </P>
                    <P>• Fixed Wing Air Ambulance (FW).</P>
                    <P>• Rotary Wing Air Ambulance (RW).</P>
                    <HD SOURCE="HD3">A. History of Medicare Ambulance Services </HD>
                    <HD SOURCE="HD3"/>
                    <P>1. Statutory Coverage of Ambulance Services </P>
                    <P>Under sections 1834(l) and 1861(s)(7) of the Act, Medicare Part B covers and pays for ambulance services, to the extent prescribed in regulations, when the use of other methods of transportation would be contraindicated by the beneficiary's medical condition. The House Ways and Means Committee and Senate Finance Committee Reports that accompanied the 1965 Social Security Amendments suggest that the Congress intended that— </P>
                    <P>• The ambulance benefit cover transportation services only if other means of transportation are contraindicated by the beneficiary's medical condition; and </P>
                    <P>• Only ambulance service to local facilities be covered unless necessary services are not available locally, in which case, transportation to the nearest facility furnishing those services is covered (H.R. Rep. No. 213, 89th Cong., 1st Sess. 37 and Rep. No. 404, 89th Cong., 1st Sess. Pt 1, 43 (1965)). </P>
                    <P>The reports indicate that transportation may also be provided from one hospital to another, to the beneficiary's home, or to an extended care facility. </P>
                    <HD SOURCE="HD3">2. Medicare Regulations for Ambulance Services </HD>
                    <P>Our regulations relating to ambulance services are set forth at 42 CFR part 410, subpart B and 42 CFR part 414, subpart H. Section 410.10(i) lists ambulance services as one of the covered medical and other health services under Medicare Part B. Therefore, ambulance services are subject to basic conditions and limitations set forth at § 410.12 and to specific conditions and limitations as specified in § 410.40. Part 414, subpart H, describes how payment is made for ambulance services covered by Medicare. </P>
                    <HD SOURCE="HD3">3. Transition to National Fee Schedule </HD>
                    <P>The national fee schedule for ambulance services was phased in over a 5-year transitional period beginning April 1, 2002, as specified in § 414.615. As of January 1, 2006, the total payment amount for air ambulance providers and suppliers is based on 100 percent of the national ambulance fee schedule. In accordance with section 414 of the MMA, we added § 414.617 which specifies that for ambulance services furnished during the period July 1, 2004, through December 31, 2009, the ground ambulance base rate is subject to a floor amount, which is determined by establishing nine fee schedules based on each of the nine census divisions, and using the same methodology as was used to establish the national fee schedule. If the regional fee schedule methodology for a given census division results in an amount that is lower than or equal to the national ground base rate, then it is not used, and the national fee schedule amount applies for all providers and suppliers in the census division. If the regional fee schedule methodology for a given census division results in an amount that is greater than the national ground base rate, then the fee schedule portion of the base rate for that census division is equal to a blend of the national rate and the regional rate through CY 2009. Thus, as of January 1, 2007, the total payment amount for ground ambulance providers and suppliers is based on either 100 percent of the national ambulance fee schedule amount, or a combination of 80 percent of the national ambulance fee schedule and 20 percent of the regional ambulance fee schedule. </P>
                    <HD SOURCE="HD2">B. Ambulance Inflation Factor (AIF) During the Transition Period </HD>
                    <P>As we noted in the previous section, the national fee schedule for ambulance services was phased in over a 5 year transition period beginning April 1, 2002, as specified in § 414.615. During the transition period, the ambulance inflation factor (AIF) was applied separately to both the fee schedule portion of the blended payment amount (regardless of whether a national or regional fee schedule applied) and to the supplier's reasonable charge or provider's reasonable cost portion of the blended payment amount, respectively, for each ambulance provider or supplier. Then, the two amounts were added together to determine the total payment amount for each provider or supplier. </P>
                    <HD SOURCE="HD2">C. Ambulance Inflation Factor (AIF) for CY 2008 </HD>
                    <P>Section 1834(l)(3)(B) of the Act provides the basis for updating payment amounts for ambulance services. Section 414.610(f) specifies that certain components of the ambulance fee schedule are updated by the AIF annually, based on the consumer price index for all urban consumers (CPI-U) (U.S. city average) for the 12-month period ending with June of the previous year. In the CY 2008 PFS proposed rule, we stated the AIF for CY 2008 would be announced as part of this final rule with comment period. For CY 2008, the percentage is 2.7 percent. In addition, as set forth in Section III.D., we also proposed to announce the AIF for CY 2009 and subsequent years via CMS instruction and on the CMS Web site. </P>
                    <HD SOURCE="HD2">D. Revisions to the Publication of the Ambulance Fee Schedule (§ 414.620) </HD>
                    <P>
                        Currently, § 414.620 specifies that changes in payment rates resulting from incorporation of the AIF will be announced by notice in the 
                        <E T="04">Federal Register</E>
                         without opportunity for prior comment. As explained in the CY 2008 PFS proposed rule, we believe it is unnecessary to undertake notice and comment rulemaking to update the AIF because the statute and regulations specify the methods of computation of annual inflation updates, and we have no discretion in that matter. Thus, the annual AIF notice does not change or establish policy, but merely applies the update methods specified in the statute and regulations. 
                    </P>
                    <P>
                        As discussed in the proposed rule, by mid-July of each year, we have the CPI-U for the 12-month period ending with June of such year. Therefore, we know what the AIF for the upcoming calendar year will be by mid-July of each year. However, § 414.620 currently states that the AIF will be announced in the 
                        <E T="04">Federal Register</E>
                        . Each document published in the 
                        <E T="04">Federal Register</E>
                         requires scheduling and a thorough review by CMS, HHS, and OMB prior to publication. Therefore, even though we 
                        <PRTPAGE P="66360"/>
                        know the AIF by mid-July of each year, the final rule announcing the AIF is not published until November. This publication timeframe does not allow Medicare contractors the optimal amount of time to update their systems to implement the proper payment for Medicare ambulance claims by January 1 of the coming year. In addition, it does not provide an optimal amount of time for either the Medicare contractors or the ambulance industry to take advantage of testing systems to make sure that the update is working properly as implemented. We believe that announcing the AIF via CMS instructions and on the CMS Web site would enable the AIF to be released earlier in the calendar year, allowing the Medicare contractors to test their data systems, and to timely effectuate and provide accurate payments on Medicare ambulance claims. 
                    </P>
                    <P>
                        Therefore, we proposed to revise § 414.620 to state that we will announce the AIF via CMS instruction and on the CMS Web site and to remove the language that states that we will announce the AIF by notice in the 
                        <E T="04">Federal Register</E>
                        . 
                    </P>
                    <P>
                        <E T="03">Comment:</E>
                         Comments received regarding the issue of announcing the AIF via CMS instruction and on the CMS Web site were very supportive of this proposal. 
                    </P>
                    <P>
                        <E T="03">Response:</E>
                         As we proposed, we are revising § 414.620 to state that CMS will announce the AIF via CMS instruction and on the CMS Web site, and to remove the language that states that we will announce the AIF by notice in the 
                        <E T="04">Federal Register</E>
                        . 
                    </P>
                    <HD SOURCE="HD1">IV. Refinement of RVUs for CY 2008 and Response to Public Comments on Interim RVUs for 2007 </HD>
                    <P>[If you choose to comment on issues in this section, please include the caption “Interim Relative Value Units” at the beginning of your comments.] </P>
                    <HD SOURCE="HD2">A. Summary of Issues Discussed Related to the Adjustment of Relative Value Units </HD>
                    <P>Section IV.B. and IV.C. of this final rule with comment describes the methodology used to review the comments received on the RVUs for physician work, including the additional codes from the 5-Year Review of work RVUs, and the process used to establish RVUs for new and revised CPT codes. Changes to the RVUs and billing status codes reflected in Addendum B are effective for services furnished beginning January 1, 2008.</P>
                    <HD SOURCE="HD2">B. Process for Establishing Work Relative Value Units for the Physician Fee Schedule </HD>
                    <P>The CY 2007 PFS final rule with comment period (71 FR 69624) contained the work RVUs for Medicare payment for existing procedure codes under the PFS and interim RVUs for new and revised codes beginning January 1, 2007. We considered the RVUs for the interim codes to be subject to public comment under the annual refinement process. In the CY 2008 PFS proposed rule we also proposed work RVUs for additional codes from the 5-Year Review of work RVUs. In this section, we address comments and summarize the refinements to the additional codes from the 5-Year Review of work RVUs, the interim work RVUs published in the CY 2007 PFS final rule with comment period, and our establishment of the work RVUs for new and revised codes for the CY 2008 PFS. </P>
                    <HD SOURCE="HD2">C. 5-Year Review of Work RVUS </HD>
                    <HD SOURCE="HD3">1. Additional Codes From the 5-Year Review of Work RVUs </HD>
                    <P>
                        The CY 2008 PFS proposed rule (72 FR 38146) discussed the RUC recommendations on work RVUs for a number of codes from the 5-Year Review that were deferred from the CY 2007 PFS rulemaking and listed the specific codes in Table 10. We proposed to accept all of the RUC recommendations, with the exception of CPT code 93325, 
                        <E T="03">Doppler echocardiography color flow velocity mapping (List separately in addition to codes for echocardiography),</E>
                         which we proposed to bundle. We also noted that CPT codes 92557, 92567, 92568, 92569, 92579, 92601, 92602, 92603 and 92604 previously had no work RVUs assigned to them. 
                    </P>
                    <P>Many commenters expressed support for our proposed valuations of many of the services. However, other commenters expressed specific concern or disagreement with the proposed valuation of approximately 17 codes. </P>
                    <P>
                        To evaluate these comments, we used a process similar to the process used since 1997. (See the CY 1998 PFS final rule published in the October 31, 1997 
                        <E T="04">Federal Register</E>
                         (62 FR 59084) for the discussion of refinement of CPT codes with interim work RVUs.) We convened a multi specialty panel of physicians to assist us in the review of the comments. The comments that we did not submit to panel review are discussed at the end of this section, as well as those that were reviewed by the panel, which are contained in Table 14: Work RVU Revisions for Additional 5-Year Review Codes. We invited representatives from the organizations from which we received substantive comments to attend a panel for discussion of the code on which they had commented. The panel was moderated by our medical staff, and consisted of the following voting members: 
                    </P>
                    <P>• Clinicians representing the commenting specialty(ies), based on our determination of those specialties which are most identified with the services in question. Although commenting specialties were welcomed to observe the entire refinement process, they were only involved in the discussion of those services for which they were invited to participate. </P>
                    <P>• Primary care clinicians nominated by the AAFP and the American College of Physicians. </P>
                    <P>• Carrier Medical Directors. </P>
                    <P>• Clinicians who practice in related specialties and have knowledge of the services under review. </P>
                    <P>The panel discussed the work involved in the procedure under review in comparison to the work associated with other services under the PFS. We assembled a set of reference services and asked the panel members to compare the clinical aspects of the work for the service a commenter believed was incorrectly valued to one or more of the reference services. In compiling the reference set, we attempted to include: (1) Services that are commonly furnished for which work RVUs are not controversial; (2) services that span the entire spectrum of work intensity from the easiest to the most difficult; and (3) at least three services furnished by each of the major specialties so that each specialty would be represented. The intent of the panel process was to capture each participant's independent judgment based on the discussion and his or her clinical experience. Following the discussion for each service, each participant rated the work for that procedure. Ratings were individual and confidential; there was no attempt to achieve consensus among the panel members. </P>
                    <P>We then analyzed the ratings based on a presumption that the interim RVUs were correct. To overcome that presumption, the inaccuracy of the interim RVUs had to be apparent to the broad range of physicians participating in each panel. </P>
                    <P>
                        Ratings of work were analyzed for consistency among the groups represented on each panel. In general terms, we used statistical tests to determine whether there was enough agreement among the groups on the panel and, if so, whether the agreed-upon work RVUs were significantly different from the proposed work RVUs 
                        <PRTPAGE P="66361"/>
                        in the CY 2008 PFS proposed rule to demonstrate that the proposed work RVUs should be modified. We did not modify the work RVUs unless there was a clear indication for a change. If there was agreement across groups for change, but the groups did not agree on what the new work RVUs should be, we eliminated the outlier group, and looked for agreement among the remaining groups as to the basis for new work RVUs. We used the same methodology in analyzing the ratings that we first used in the refinement process for the CY 1993 PFS final rule published in the November 25, 1992 
                        <E T="04">Federal Register</E>
                         which described the statistical tests in detail (57 FR 55938). Our decision to convene a multi-specialty panel of physicians and to apply the statistical tests described above in this section was based on our need to balance the interests of those who commented on the work RVUs against the redistributive effects that would occur in other specialties. 
                    </P>
                    <P>Table 14 lists the additional codes for the 5-Year Review on which we received comments. This table includes the following information: </P>
                    <P>
                        • 
                        <E T="03">CPT/HCPCS Code.</E>
                         This is the CPT or alphanumeric HCPCS code for a service. 
                    </P>
                    <P>
                        • 
                        <E T="03">Modifier.</E>
                         A modifier 26 is shown if the work RVUs represent the professional component (PC) of the service. 
                    </P>
                    <P>
                        • 
                        <E T="03">Description.</E>
                         This is an abbreviated version of the narrative description of the code. 
                    </P>
                    <P>
                        • 
                        <E T="03">Proposed Work RVUs.</E>
                         This column includes the work RVUs proposed in the CY 2008 PFS proposed rule for each reviewed code. 
                    </P>
                    <P>
                        • 
                        <E T="03">Requested Work RVUs.</E>
                         This column identifies the work RVUs requested by the commenters. If the commenters requested different RVUs, the table lists the highest requested RVUs. 
                    </P>
                    <P>
                        • 
                        <E T="03">RUC Recommendation.</E>
                         This column identifies the work RVUs recommended by the RUC that appeared in the CY 2008 PFS proposed rule. 
                    </P>
                    <P>
                        • 
                        <E T="03">2008 Work RVUs.</E>
                         This column contains the work RVUs for the CY 2008 PFS. 
                    </P>
                    <P>
                        • 
                        <E T="03">Basis for Decision.</E>
                         This column indicates whether the CY 2008 work RVUs resulted from comments received or the refinement panel process. 
                    </P>
                    <GPOTABLE COLS="8" OPTS="L2,i1" CDEF="xs48,10,r50,12,12,12,12,xs48">
                        <TTITLE>Table 14.—Work RVU Revisions for Additional 5-Year Review Codes</TTITLE>
                        <BOXHD>
                            <CHED H="1">
                                CPT/HCPCS code 
                                <SU>1</SU>
                            </CHED>
                            <CHED H="1">Mod </CHED>
                            <CHED H="1">Descriptor </CHED>
                            <CHED H="1">Proposed work RVU </CHED>
                            <CHED H="1">Work RVUs requested by commenters </CHED>
                            <CHED H="1">RUC rec </CHED>
                            <CHED H="1">2008 work RVU</CHED>
                            <CHED H="1">Basis for decision </CHED>
                        </BOXHD>
                        <ROW>
                            <ENT I="01">92557</ENT>
                            <ENT/>
                            <ENT>Comprehensive hearing test</ENT>
                            <ENT>0.60</ENT>
                            <ENT>1.40</ENT>
                            <ENT>0.60</ENT>
                            <ENT>0.60</ENT>
                            <ENT>Refinement.</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">92579</ENT>
                            <ENT/>
                            <ENT>Visual audiometry (vra)</ENT>
                            <ENT>0.70</ENT>
                            <ENT>1.70</ENT>
                            <ENT>0.70</ENT>
                            <ENT>0.70</ENT>
                            <ENT>Refinement.</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">99326</ENT>
                            <ENT/>
                            <ENT>Domicil/r-home visit new pat</ENT>
                            <ENT>2.27</ENT>
                            <ENT>2.85</ENT>
                            <ENT>2.27</ENT>
                            <ENT>2.63</ENT>
                            <ENT>Refinement.</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">99327</ENT>
                            <ENT/>
                            <ENT>Domicil/r-home visit new pat</ENT>
                            <ENT>3.03</ENT>
                            <ENT>3.75</ENT>
                            <ENT>3.03</ENT>
                            <ENT>3.46</ENT>
                            <ENT>Refinement.</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">99328</ENT>
                            <ENT/>
                            <ENT>Domicil/r-home visit new pat</ENT>
                            <ENT>3.78</ENT>
                            <ENT>4.26 </ENT>
                            <ENT>3.78</ENT>
                            <ENT>4.09</ENT>
                            <ENT>Refinement.</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">99334</ENT>
                            <ENT/>
                            <ENT>Domicil/r-home visit est pat</ENT>
                            <ENT>0.76</ENT>
                            <ENT>1.25</ENT>
                            <ENT>0.76</ENT>
                            <ENT>1.07</ENT>
                            <ENT>Refinement.</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">99335</ENT>
                            <ENT/>
                            <ENT>Domicil/r-home visit est pat</ENT>
                            <ENT>1.26</ENT>
                            <ENT>2.00</ENT>
                            <ENT>1.26</ENT>
                            <ENT>1.72</ENT>
                            <ENT>Refinement.</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">99336</ENT>
                            <ENT/>
                            <ENT>Domicil/r-home visit est pat</ENT>
                            <ENT>2.02</ENT>
                            <ENT>2.75</ENT>
                            <ENT>2.02</ENT>
                            <ENT>2.46</ENT>
                            <ENT>Refinement.</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">99337</ENT>
                            <ENT/>
                            <ENT>Domicil/r-home visit est pat</ENT>
                            <ENT>3.03</ENT>
                            <ENT>4.05</ENT>
                            <ENT>3.03</ENT>
                            <ENT>3.58</ENT>
                            <ENT>Refinement.</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">99343</ENT>
                            <ENT/>
                            <ENT>Home visit, new patient</ENT>
                            <ENT>2.27</ENT>
                            <ENT>2.65</ENT>
                            <ENT>2.27</ENT>
                            <ENT>2.53</ENT>
                            <ENT>Refinement.</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">99344</ENT>
                            <ENT/>
                            <ENT>Home visit, new patient</ENT>
                            <ENT>3.03</ENT>
                            <ENT>3.60</ENT>
                            <ENT>3.03</ENT>
                            <ENT>3.38</ENT>
                            <ENT>Refinement.</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">99345</ENT>
                            <ENT/>
                            <ENT>Home visit, new patient</ENT>
                            <ENT>3.78</ENT>
                            <ENT>4.26</ENT>
                            <ENT>3.78</ENT>
                            <ENT>4.09</ENT>
                            <ENT>Refinement.</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">99347</ENT>
                            <ENT/>
                            <ENT>Home visit, est patient</ENT>
                            <ENT>0.76</ENT>
                            <ENT>1.10</ENT>
                            <ENT>0.76</ENT>
                            <ENT>1.00</ENT>
                            <ENT>Refinement.</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">99348</ENT>
                            <ENT/>
                            <ENT>Home visit, est patient</ENT>
                            <ENT>1.26</ENT>
                            <ENT>1.70</ENT>
                            <ENT>1.26</ENT>
                            <ENT>1.56</ENT>
                            <ENT>Refinement.</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">99349</ENT>
                            <ENT/>
                            <ENT>Home visit, est patient</ENT>
                            <ENT>2.02</ENT>
                            <ENT>2.50</ENT>
                            <ENT>2.02</ENT>
                            <ENT>2.33</ENT>
                            <ENT>Refinement.</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">99350</ENT>
                            <ENT/>
                            <ENT>Home visit, est patient</ENT>
                            <ENT>3.03</ENT>
                            <ENT>3.45</ENT>
                            <ENT>3.03</ENT>
                            <ENT>3.28</ENT>
                            <ENT>Refinement.</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">93325</ENT>
                            <ENT/>
                            <ENT>Doppler color flow add-on</ENT>
                            <ENT>0.07</ENT>
                            <ENT>0.30</ENT>
                            <ENT>CPT</ENT>
                            <ENT>0.07</ENT>
                            <ENT>Comments.</ENT>
                        </ROW>
                        <TNOTE>
                            <SU>1</SU>
                             All CPT codes and descriptors copyright 2007 American Medical Association.
                        </TNOTE>
                    </GPOTABLE>
                    <HD SOURCE="HD2">Discussion of Comments by Clinical Area</HD>
                    <P>
                        For CPT code 92557, 
                        <E T="03">Comprehensive audiometry threshold evaluation and speech recognition</E>
                        , and CPT code 92579, 
                        <E T="03">Visual reinforcement audiometry (VRA)</E>
                        , the RUC recommended 0.60 work RVUs for CPT 92557 and 0.70 work RVUs for CPT code 92579, which we accepted. 
                    </P>
                    <P>
                        <E T="03">Comment:</E>
                         Commenters disagreed with the RUC-recommended work values for these services, which we had accepted. The commenters believed that the recommended values were not appropriate considering the time and intensity involved in performing these services. Based on these comments, we referred these codes to the multi-specialty validation panel for review. 
                    </P>
                    <P>
                        <E T="03">Response:</E>
                         As a result of the statistical analysis of the 2007 multi-specialty validation panel ratings, we have assigned 0.60 work RVUs to CPT code 92557 and 0.70 work RVUs to CPT code 92579. 
                    </P>
                    <P>
                        For CPT code 99326, 
                        <E T="03">Domiciliary or rest home visit for the evaluation and management of a new patient, which requires these three key components: A detailed history; a detailed examination; and medical decision making of moderate complexity;</E>
                         CPT code 99327, 
                        <E T="03">Domiciliary or rest home visit for the evaluation and management of a new patient, which requires these three key components: A comprehensive history; a comprehensive examination; and medical decision making of moderate complexity;</E>
                         CPT code 99328, 
                        <E T="03">Domiciliary or rest home visit for the evaluation and management of a new patient, which requires these three key components: A comprehensive history; a comprehensive examination; and medical decision making of high complexity;</E>
                         CPT code 99334, 
                        <E T="03">Domiciliary or rest home visit for the evaluation and management of an established patient, which requires at least two of these three key components: A problem focused interval history; a problem focused examination; straightforward medical decision making;</E>
                         CPT code 99335, 
                        <E T="03">Domiciliary or rest home visit for the evaluation and management of an established patient, which requires at least two of these three key components: An expanded problem focused interval history; an expanded problem focused examination; medical decision making of low complexity;</E>
                         CPT code 99336, 
                        <E T="03">
                            Domiciliary or rest home visit for the evaluation and management of an established patient, which requires at least two of these three key components: 
                            <PRTPAGE P="66362"/>
                            A detailed interval history; a detailed examination; medical decision making of moderate complexity;
                        </E>
                         CPT code 99337, 
                        <E T="03">Domiciliary or rest home visit for the evaluation and management of an established patient, which requires at least two of these three key components: A comprehensive interval history; a comprehensive examination; and medical decision making of moderate to high complexity;</E>
                         CPT code 99343, 
                        <E T="03">Home visit for the evaluation and management of a new patient, which requires these three key components: A detailed history; a detailed examination; and medical decision making of moderate complexity;</E>
                         CPT code 99344, 
                        <E T="03">Home visit for the evaluation and management of a new patient, which requires these three components: A comprehensive history; a comprehensive examination; and a medical decision making of moderate complexity;</E>
                         CPT code 99345, 
                        <E T="03">Home visit for the evaluation and management of a new patient, which requires these three key components: A comprehensive history; a comprehensive examination; and medical decision making of high complexity;</E>
                         CPT code 99347, 
                        <E T="03">Home visit for the evaluation and management of an established patient, which requires at least two of these three key components: A problem focused interval history; a problem focused examination; straightforward medical decision making;</E>
                         CPT code 99348, 
                        <E T="03">Home visit for the evaluation and management of an established patient, which requires at least two of these three key components: A problem focused interval history; a problem focused examination; straightforward medical decision making;</E>
                         CPT code 99349, 
                        <E T="03">Home visit for the evaluation and management of an established patient, which requires at least two of these three key components: A detailed interval history; a detailed examination; medical decision making of moderate complexity;</E>
                         and CPT code 99350, 
                        <E T="03">Home visit for the evaluation and management of an established patient, which requires at least tow of these three key components: A comprehensive interval history; a comprehensive examination; medical decision making of moderate to high complexity,</E>
                         the RUC recommended that the work RVUs for these codes be maintained at their current values: 2.27 work RVUs for CPT code 99326; 3.03 work RVUs for CPT code 99327; 3.78 work RVUs for CPT code 99328; 0.76 work RVUs for CPT code 99334; 1.26 work RVUs for CPT code 99335; 2.02 work RVUs for CPT code 99336; 3.03 work RVUs for CPT code 99337; 2.27 work RVUs for CPT code 99343; 3.03 for CPT code 99344; 3.78 work RVUs for CPT code 99345; 0.76 work RVUs for CPT code 99347; 1.26 work RVUs for CPT code 99348; 2.02 work RVUs for CPT code 99349; and 3.03 work RVUs for CPT code 99350, which we accepted. 
                    </P>
                    <P>
                        <E T="03">Comment:</E>
                         Commenters disagreed with the RUC-recommended work values for these services, which we had accepted. The commenters disagreed with the RUC-recommended work RVUs and believed the services were undervalued. The commenters also believed that the home visit work RVUs should remain “relatively” the same with respect to office visit codes as they did prior to the five-year review and requested that CMS reject the RUC recommended work RVUs and follow their survey values. Based on these comments, we referred these codes to the multi-specialty validation panel for review. 
                    </P>
                    <P>
                        <E T="03">Response:</E>
                         As a result of the statistical analysis of the 2007 multi-specialty validation panel ratings, we have assigned 2.63 work RVUs to CPT code 99326; 3.46 work RVUs to CPT code 99327; 4.09 work RVUs to CPT code 99328; 1.07 work RVUs to CPT code 99334; 1.72 work RVUs to CPT code 99335; 2.46 work RVUs to CPT code 99336; 3.58 work RVUs to CPT code 99337; 2.53 work RVUs to CPT code 99343; 3.38 work RVUs to CPT code 99344; 4.09 work RVUs to CPT code 99345; 1.00 work RVUs to CPT code 99347; 1.56 work RVUs to CPT code 99348; 2.33 work RVUs to CPT code 99349; and 3.28 work RVUs to CPT code 99350. 
                    </P>
                    <P>
                        For CPT code 93325, 
                        <E T="03">Doppler echocardiography color flow velocity mapping (List separately in addition to codes for echocardiography)</E>
                        , the RUC 5-Year Review workgroup recommended sending the code to the CPT Editorial Panel so that it could bundle CPT code 93325 into doppler echo code 93307. However, we believe that the technology of doppler imaging has evolved over the past 2 decades to enable color flow velocity and spectral analysis, both important components of doppler imaging, to be furnished concurrently or in concert to obtain more accurate interpretation and documentation of the anatomy and physiologic function of the structure(s) and organ being evaluated. Since the services described in 93325 have become intrinsic to the performance of other echocardiography services, we proposed to bundle 93325 into CPT codes 76825, 76826, 76827, 76828, 93303, 93304, 93307, 93308, 93312, 93314, 93315, 93317, 93320, 93321, 93350 and assign CPT code 93325 a status indicator of “B” (Bundled). 
                    </P>
                    <P>
                        <E T="03">Comment:</E>
                         Commenters uniformly opposed this proposal. They did not support the bundling of CPT codes 93325 into all of the codes we proposed. The commenters would prefer for CMS to adopt the new CPT code and not bundle CPT code 93325 with any other codes with CPT code 93325. The commenters believed we are circumventing the existing process to address bundling of these services and we should follow that process. Alternatively, the commenters believed that if we must bundle the codes, then we should increase the RVUs for the codes in which CPT code 93325 is being bundled to recognize the work, PE, and malpractice components that are unique to CPT code 93325. 
                    </P>
                    <P>
                        <E T="03">Response:</E>
                         Based on comments received, we have decided to accept the RUC recommendation and allow the RUC to value the new CPT code for CY 2009 for bundling CPT code 93325 with CPT codes 93320 and 93307. As a result of this decision, the work RVUs for CPT code 93325 will be maintained for CY 2008 at the 2007 work value of 0.07. The cardiology community has indicated to the RUC and CMS that the newly bundled CPT code represents the first of a series of coding changes they intend to propose over the course of the next year. These changes would result in the bundling of CPT code 93325 and other echocardiography codes to reflect the utilization of ultrasound services that are routinely performed together when providing care to a patient. We appreciate the initiative the cardiology community is taking on this issue, and we will reassess the echocardiography codes once this process is complete. 
                    </P>
                    <HD SOURCE="HD3">2. Anesthesia Coding (Part of 5-Year Review) </HD>
                    <P>Although anesthesia services are paid under the PFS, under section 1848(b)(2)(B) of the Act, they are paid on the basis of an anesthesia code specific base unit and time units that vary based on the actual anesthesia time of the case. Since anesthesia services do not have a work RVU per code as do other medical and surgical services, a work value must be imputed for each anesthesia code. The imputed value is determined by multiplying the national average allowed charge for each anesthesia service by its anesthesia work share and dividing this amount by the general PFS conversion factor (CF). This places the work of the anesthesia service on the same relative value scale as all other physicians' services.</P>
                    <P>
                        As discussed in the CY 2008 PFS proposed rule, in the second 5-Year Review of anesthesia work implemented in 2002, the AMA RUC and the 
                        <PRTPAGE P="66363"/>
                        American Society of Anesthesiologists (ASA) used a building block approach to estimate the value of anesthesia work and compared this value to the imputed work value to determine whether the work of anesthesia services is properly valued. Under the building block approach, each anesthesia code was uniformly divided into five components; pre anesthesia, equipment and supply preparation, induction, post induction anesthesia, and post anesthesia. Work is determined for each of the five components and summed to calculate total anesthesia work for the anesthesia code. The imputed value for the anesthesia code is compared to the building block estimate of work in order to assess whether, and if so, to what extent, the anesthesia code is not properly valued. 
                    </P>
                    <P>The most significant component of work for the anesthesia service is the intensity for the post-induction anesthesia time. The ASA thought that the RUC significantly misvalued this component in the second 5-Year Review. In addition, the ASA was dissatisfied that the RUC did not extend the analysis from the 19 high volume anesthesia codes reviewed by the RUC to all anesthesia codes. </P>
                    <P>In the CY 2007 PFS final rule with comment period, we addressed the issue of the work of anesthesia services under the third 5-Year Review of work. As explained in that rule, we made very modest adjustments to the work of the 19 anesthesia codes surveyed and analyzed by the RUC in the second 5-Year Review of work. These adjustments were made recognizing that the work of the pre- and post-anesthesia service components was linked to certain E/M services. Since we accepted the AMA RUC's recommendations for increased work values for certain E/M codes for the third 5-Year Review of work, we recalculated the work of the 19 anesthesia services to incorporate these higher work values. The adjustment in work was reflected by increasing the anesthesia CF by less than 1 percent. </P>
                    <P>However, on the more significant issue of the valuation of work in the post induction anesthesia period, we took no action. Rather, in the CY 2007 PFS final rule with comment period, we asked the RUC to review and consider this issue as part of the third 5-Year Review of work. We also asked the RUC to consider how increases in the work of pre- and post-anesthesia services could cause adjustments to the anesthesia services not specifically reviewed by the ASA and the RUC. </P>
                    <P>In January 2007, the ASA requested the AMA RUC to review the undervaluation of the work of the post-induction anesthesia period and to consider also an analytic approach, based on linear regression analysis, which could be used to evaluate the work of the entire anesthesia service. The linear regression model relates the work of the post-induction period time and the work of the entire anesthesia service to the base unit value for the anesthesia code. Under this model, the work of anesthesia services is undervalued by approximately 34 percent. </P>
                    <P>The RUC established an anesthesia workgroup to examine this proposal. The workgroup discussed this proposal extensively at its two teleconferences, prior to the April RUC meeting, and at the April RUC meeting itself. In May 2007, the AMA RUC, based on the analyses and recommendations of its workgroup, submitted a recommendation to CMS for a 32 percent increase in the work of anesthesia services. </P>
                    <P>The workgroup approved the ASA's use of the linear regression model to value only the work of the post-induction period time. In contrast to the ASA proposal, the workgroup considered an analytic approach different from the regression model developed by the ASA. This approach is based on a building block approach that could be used to evaluate the work of all anesthesia service components other than the post induction period time. For example, for pre-anesthesia time, the methodology is as shown in Table 15. </P>
                    <GPOTABLE COLS="1" OPTS="L2,p1,8/9,i1" CDEF="xl100">
                        <TTITLE>Table 15.—Pre-Anesthesia Time</TTITLE>
                        <BOXHD>
                            <CHED H="1"/>
                        </BOXHD>
                        <ROW>
                            <ENT I="01">All Anesthesia codes with 3 base units—linked to the work of 99201. </ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">All Anesthesia codes with 4 base units—linked to the blend of work for 99201 and 99202. </ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">All Anesthesia codes with 5 to 15 base units—linked to the work of 99202. </ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">All Anesthesia codes with 16 to 30 base units—linked to the work of 99252. </ENT>
                        </ROW>
                        <TNOTE>
                            <E T="02">Note:</E>
                             The source of the link for work is the pre anesthesia valuation from the 19 surveyed anesthesia codes whose base units varied from 3 units to 25 units. 
                        </TNOTE>
                    </GPOTABLE>
                    <P>Similar approaches are used for each anesthesia component: Preparation time, induction period time, and post-anesthesia time. Systematically, codes with lower anesthesia base unit values have lower work values for each component of the building block approach than do codes with higher anesthesia base unit values. For the given building block component, the work value of that component is the same for all anesthesia services that have the same base unit value. </P>
                    <P>According to the workgroup's revised methodology which is extended from the 19 surveyed codes to all CPT anesthesia codes, the work of anesthesia services is undervalued by approximately 32 percent. Thus, based on the acceptance of the workgroup and the RUC's recommendation, an adjustment of approximately 25 percent would be applied to the anesthesia CF. </P>
                    <P>Increases in the work of anesthesia services would have to be offset by additional adjustments to the PFS BN adjustor for work. We estimated that the increase in the anesthesia CF would result in an additional 1.0 percent increase in the BN adjuster for work. </P>
                    <P>Other adjustments also affect the anesthesia CF. For example, an increase in anesthesia work may have implications for PE because indirect PEs are allocated based on the sum of work and direct PEs. When we ran the PE RVU program, there was a 1 percent decrease in the aggregate anesthesia PEs for CY 2008. Thus, an adjustment was made to the PE share of the anesthesia service of the CY 2008 anesthesia CF for this component. </P>
                    <P>We proposed to accept the RUC's recommendation and increase the work of anesthesia services by 32 percent. </P>
                    <P>
                        <E T="03">Comment:</E>
                         Organizations and individual commenters supported our proposal and urged us to take action to implement this proposal in CY 2008. They commented that this proposal improves the valuation of the work of anesthesia services and will help ensure that Medicare beneficiaries have access to quality anesthesia care. One commenter indicated that three additional anesthesia codes, 00142, 00210 and 00562, have been identified as misvalued during the AMA RUC's evaluation of the work of anesthesia services. Both CMS and the AMA RUC agreed that the RUC would review the base units for 00142 at the September 2007 RUC meeting and that the other codes, as agreed by the ASA, would be referred to the CPT so that the codes descriptors could be clarified. The RUC reviewed and approved the ASA's request to support the current base unit value of four units for anesthesia code 00142. 
                    </P>
                    <P>
                        <E T="03">Response:</E>
                         We have decided to accept the RUC's recommendation and increase the work of anesthesia services by 32 percent. We have also accepted the RUC's recommendation to maintain the value of four base units for anesthesia code 00142. 
                    </P>
                    <HD SOURCE="HD3">3. Budget Neutrality Adjustment </HD>
                    <P>
                        Due to the proposed work RVU changes for the additional codes from the 5-Year Review of Work RVUs and 
                        <PRTPAGE P="66364"/>
                        the proposed increases in the work of anesthesia services, in the CY 2008 PFS proposed rule, we proposed to revise the work adjustor to maintain budget neutrality. Based upon the increases, the proposed revised work adjustor was estimated to be 0.8816. Further discussion of this work adjustor was included in the impact section of the CY 2008 PFS proposed rule (72 FR 38211 through 38220). 
                    </P>
                    <P>
                        <E T="03">Comment:</E>
                         Several commenters recommended that we reconsider applying the BN adjustment associated with the 5-Year Review of work RVUs to the CF rather than the work RVUs. 
                    </P>
                    <P>
                        <E T="03">Response:</E>
                         We appreciate the commenters' interest in this topic. However, this issue was fully addressed in the CY 2007 PFS final rule with comment period (71 FR 69735), and we made no further proposals regarding this issue in the CY 2008 PFS proposed rule. We continue to believe that it is most appropriate to apply the BN adjustment to work RVUs and refer the commenters to the CY 2007 PFS final rule for an explanation of our decision. 
                    </P>
                    <P>We note that as a result of the changes made in response to comments received and the work of the refinement panel, the separate work adjustor has changed from the proposed 0.8816. The separate work adjustor for CY 2008 will be 0.8806. </P>
                    <HD SOURCE="HD2">D. Work Relative Value Unit Refinements of Interim Relative Value Units</HD>
                    <HD SOURCE="HD3">1. Interim 2007 Codes </HD>
                    <P>Although the RVUs in the CY 2007 PFS final rule with comment period were used to calculate 2007 payment amounts, we considered the RVUs for the new or revised codes to be interim. We accepted comments for a period of 60 days. We received comments on the following CPT codes. </P>
                    <HD SOURCE="HD2">Anticoagulation Management Codes </HD>
                    <P>
                        The CPT Editorial Panel created two anticoagulation management codes in February 2006: CPT code 99363, 
                        <E T="03">Anticoagulant management for an outpatient taking warfarin, physician review and interpretation of International Normalized Ratio (INR) testing, patient instructions, dosage adjustment (as needed), and ordering of additional tests; initial 90 days of therapy (must include a minimum of 8 INR measurements),</E>
                         and CPT code 99364, 
                        <E T="03">Anticoagulant management for an outpatient taking warfarin, physician review and interpretation of International Normalized Ratio (INR) testing, patient instructions, dosage adjustment (as needed), and ordering of additional tests; each subsequent 90 days of therapy (must include a minimum of 3 INR measurements).</E>
                         The RUC reviewed the codes and recommended 1.65 work RVUs for code 99363 and 0.63 work RVUs for 99364. In the CY 2007 PFS final rule with comment period, we decided not to accept the RUC recommendation and decided that the services provided by 99363 and 99364 are bundled into existing E/M services. Hence, there is no separate payment under the PFS. Currently clinicians managing anticoagulation therapy may bill, if appropriate, the CPT code that best represents the level of outpatient E/M service provided on that day, including CPT code 99211. 
                    </P>
                    <P>
                        <E T="03">Comment:</E>
                         We received comments from commenters who strongly disagree with our decision to continue to consider anticoagulation management codes to be bundled into the work of E/M codes and noted that these CPT codes recognize the important work of managing serious disease. The commenters also requested that we not finalize our decision to consider these services bundled but instead change their status to separately payable, covered services. 
                    </P>
                    <P>
                        <E T="03">Response:</E>
                         We generally do not pay separately for disease-specific management services. We believe the services represented by CPT codes 99363 and 99364 are inherent in the services captured by the existing E/M codes. We will continue to recognize codes 99363 and 99364 as bundled services and continue to pay for E/M services as appropriate. 
                    </P>
                    <HD SOURCE="HD2">Medical Genetics and Genetic Counseling </HD>
                    <P>
                        CPT code 96040, 
                        <E T="03">Medical genetics and genetic counseling services, each 30 minutes face-to-face with patient/family,</E>
                         was reviewed in the CY 2007 PFS final rule with comment period and assigned status B (bundled service). 
                    </P>
                    <P>
                        <E T="03">Comment:</E>
                         Commenters disagree with the assigned status indicator of B (bundled service) for this service and urge CMS to reconsider its decision to make this a bundled service because they believe it is a separate and distinct procedure. 
                    </P>
                    <P>
                        <E T="03">Response:</E>
                         The procedure does not contain any physician work and is a code that is designed to capture clinical labor time and PE. To the extent that this service is covered, we believe this service like other counseling services, is incorporated into existing E/M services, and therefore, will maintain the status assignment of B. 
                    </P>
                    <HD SOURCE="HD3">Home Ventilator Management </HD>
                    <P>
                        For CPT code 94005, 
                        <E T="03">Home ventilator management care plan oversight of a patient (patient not present) in home, domiciliary or rest home (eg, assisted living) requiring review of status, review of laboratories and other studies and revision of orders and respiratory care plan (as appropriate), within a calendar month, 30 minutes or more,</E>
                         the RUC recommended 1.50 work RVUs. We assigned a status indicator of B (bundled service) to this service in the CY 2007 PFS final rule with comment period because: (1) The patient is not present when this service is rendered; and (2) we believe this service is captured in E/M services. 
                    </P>
                    <P>
                        <E T="03">Comment:</E>
                         Commenters believe this service should not be bundled and recommend that this code be separately payable. 
                    </P>
                    <P>
                        <E T="03">Response:</E>
                         We continue to believe this service should be assigned a status indicator of B (Bundled) for the reasons previously stated in the CY 2007 PFS final rule with comment period: (1) The patient is not present when the service is rendered; and (2) we believe this service is captured in the E/M services. (
                        <E T="04">Note:</E>
                         The RUC-recommended RVUs for this code will be reflected in Addendum B.) 
                    </P>
                    <P>In the CY 2007 PFS final rule with comment period (70 FR 66370), we also responded to the RUC recommendations on the PE inputs for the new and revised CPT codes for 2007. In addition to PE comments discussed in section II.A.2. of this final rule with comment period, concerning PE inputs: </P>
                    <P>
                        <E T="03">Comment:</E>
                         One commenter, representing a network of providers, requested that the PE inputs for CPT codes 35475 and 35476 be reviewed. These codes are used as the basis for the PE inputs for HCPCS codes G0392 and G0393 that were included in Addendum C. The commenter believes that the PE inputs have changed since the service was reviewed in 2004. The commenters also believed that items were missing from the PE database and included a list of these items.
                    </P>
                    <P>
                        <E T="03">Response:</E>
                         We suggest that the commenter work with the specialty group to determine if the PE inputs for CPT codes 35475 and 35476 should be reviewed by the RUC PE subcommittee. We have also reviewed the PE database regarding the missing PE items noted by the commenter and have verified that all PE inputs from CPT 35475 and 35476 have been crosswalked to G0392 and G0393, respectively. 
                    </P>
                    <P>
                        <E T="03">Comment:</E>
                         One commenter, representing the specialty of dermatology, requested that the Unna 
                        <PRTPAGE P="66365"/>
                        boot be removed from the PE database as a supply item and be assigned a HCPCS Q code so that it could be billed separately. 
                    </P>
                    <P>
                        <E T="03">Response:</E>
                         This issue was specifically addressed in the CY 2007 PFS final rule with comment period (71 FR 69644 through 69645). We clarified that the policy we finalized relating to splint and cast supplies did not change the HCPCS Q-code descriptors or their pairing with certain CPT codes for payment purposes. 
                    </P>
                    <P>
                        <E T="03">Comment:</E>
                         One commenter, representing the ophthalmology association, disagreed with our assessment that the specific topography equipment priced at $44,000 is not typically used with CPT code 92025, 
                        <E T="03">Computerized corneal topography, unilateral or bilateral, with interpretation and report,</E>
                         and questioned our substitution of the topography equipment priced at $13,495. The commenter pointed out that the $44,000 topography equipment is the only equipment that will provide the services of this procedure. 
                    </P>
                    <P>
                        <E T="03">Response:</E>
                         We have reviewed the request from the commenter and agree that the $13,495 topography unit we assigned for CY 2007 should be replaced with the $44,000 equipment that is specifically designed for the procedure inherent to CPT code 92025. 
                    </P>
                    <P>
                        <E T="03">Comment:</E>
                         One commenter, representing therapeutic radiology, requested that for CPT code 77371, 
                        <E T="03">Radiation treatment delivery, stereotactic radiosurgery (SRS), complete course of treatment of cerebral lesion(s) consisting of 1 session; multi-source Cobalt 60 based,</E>
                         we treat the radiation source (Cobalt 60), as a direct PE rather than an indirect one. Since Cobalt 60 is: (1) Purchased by the physician; (2) exceeds the $500 threshold (price is $15,000); and, (3) is clearly attributable to the procedure; it meets the established criteria for treatment as a direct expense. The commenter indicated that this radiation source must be replaced monthly, requiring a useful life assignment of 0.08 years. 
                    </P>
                    <P>
                        <E T="03">Response:</E>
                         Based on this comment, we have re-examined our assignment of the Cobalt 60 radiation source used in CPT code 77371 as indirect PE. While the radiation source may meet some of the criteria to be considered as a direct PE input for equipment (for example, that it is an expense to the physician and its price is above the $500 threshold), the commenter did not present information that is needed to verify the 1-month useful life that was requested. We lack the required evidence needed to determine the amount of viable radiation contained in the $15,000 source that is consumed through the provision of the radiation treatments versus the amount that was not utilized but could have been used, during the 1-month time period. This unused amount would be considered a wasted resource and cannot be accounted for as a direct PE input. Consequently, we will not include the Cobalt-60 radiation source as a direct PE input as the commenter requested. 
                    </P>
                    <HD SOURCE="HD2">E. Establishment of Interim Work Relative Value Units for New and Revised Physician's Current Procedural Terminology (CPT) Codes and New Healthcare Common Procedure Coding System Codes (HCPCS) for 2008 (Includes Table titled “American Medical Association Specialty Relative Value Update Committee and Health Care Professionals Advisory Committee Recommendations and CMS's Decisions for New and Revised 2008 CPT Codes”) </HD>
                    <P>One aspect of establishing RVUs for 2008 was to assign interim work RVUs for all new and revised CPT codes. As described in our November 25, 1992 notice on the 1993 PFS (57 FR 55951) and in section III.B. of the CY 1997 PFS final rule (61 FR 59505), we established a process, based on recommendations received from the AMA's RUC, for establishing interim work RVUs for new and revised codes. </P>
                    <P>This year we received work RVU recommendations for 169 new and revised CPT codes from the RUC. Our staff and medical officers reviewed the RUC recommendations by comparing them to our reference set or to other comparable services for which work RVUs had previously been established. We also considered the relationships among the new and revised codes for which we received RUC recommendations and agreed with the majority of the relative relationships reflected in the RUC values. In some instances, although we agreed with the relationships, we nonetheless revised the work RVUs to achieve work neutrality within families of codes. That is, the work RVUs were adjusted so that the sum of the new or revised work RVUs (weighted by projected frequency of use) for a family will be the same as the sum of the current work RVUs (weighted by projected frequency of use) for the family of codes.</P>
                    <P>We received approximately 7 recommendations from the Health Care Professional Advisory Committee (HCPAC). </P>
                    <P>Table 16: AMA RUC and HCPAC Recommendations and CMS Decisions for New and Revised 2008 CPT Codes lists the new or revised CPT codes, and their associated work RVUs, that will be interim in 2008. Table 16 includes the following information: </P>
                    <P>• A “#” identifies a new code for CY 2008. </P>
                    <P>• CPT code. This is the CPT code for a service. </P>
                    <P>• Modifier. A “26” in this column indicates that the work RVUs are for the PC of the code. </P>
                    <P>• Description. This is an abbreviated version of the narrative description of the code. </P>
                    <P>• RUC recommendations. This column identifies the work RVUs recommended by the RUC. </P>
                    <P>• HCPAC recommendations. This column identifies the work RVUs recommended by the HCPAC. </P>
                    <P>• CMS decision. This column indicates whether we agreed or we disagreed with the RUC recommendation. Codes for which we did not accept the RUC recommendation are discussed in greater detail following this table. </P>
                    <P>• 2008 Work RVUs. This column establishes the interim 2008 work RVUs for physician work.</P>
                    <GPOTABLE COLS="7" OPTS="L2,i1" CDEF="xs40,xs30,r100,r40,r30,r30,xs60">
                        <TTITLE>Table 16.—AMA RUC and HCPAC Recommendations and CMS' Decisions for New and Revised 2008 CPT Codes</TTITLE>
                        <BOXHD>
                            <CHED H="1">
                                CPT 
                                <SU>1</SU>
                                 code 
                            </CHED>
                            <CHED H="1">Mod </CHED>
                            <CHED H="1">Descriptor </CHED>
                            <CHED H="1">
                                RUC 
                                <LI>recommendation </LI>
                            </CHED>
                            <CHED H="1">
                                HCPAC
                                <LI>recommendation</LI>
                            </CHED>
                            <CHED H="1">
                                CMS 
                                <LI>decision </LI>
                            </CHED>
                            <CHED H="1">2008 work  RVU</CHED>
                        </BOXHD>
                        <ROW>
                            <ENT I="01"># 20555 </ENT>
                            <ENT/>
                            <ENT>PLACE NDL MUSC/TIS FOR RT </ENT>
                            <ENT>6.00 </ENT>
                            <ENT/>
                            <ENT>Agree </ENT>
                            <ENT>6.00 </ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">20660 </ENT>
                            <ENT/>
                            <ENT>APPLY, REM FIXATION DEVICE </ENT>
                            <ENT>4.00 </ENT>
                            <ENT/>
                            <ENT>Agree </ENT>
                            <ENT>4.00 </ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">20690 </ENT>
                            <ENT/>
                            <ENT>APPLY BONE FIXATION DEVICE </ENT>
                            <ENT>8.65 </ENT>
                            <ENT/>
                            <ENT>Agree </ENT>
                            <ENT>8.65 </ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">20692 </ENT>
                            <ENT/>
                            <ENT>APPLY BONE FIXATION DEVICE </ENT>
                            <ENT>16.00 </ENT>
                            <ENT/>
                            <ENT>Agree </ENT>
                            <ENT>16.00 </ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01"># 20985 * </ENT>
                            <ENT/>
                            <ENT>CPTR-ASST DIR MS PX </ENT>
                            <ENT>2.50 </ENT>
                            <ENT/>
                            <ENT>Agree </ENT>
                            <ENT>2.50 </ENT>
                        </ROW>
                        <ROW>
                            <PRTPAGE P="66366"/>
                            <ENT I="01"># 20986 * </ENT>
                            <ENT/>
                            <ENT>CPTR-ASST DIR MS PX IO IMG </ENT>
                            <ENT>Carrier Priced </ENT>
                            <ENT/>
                            <ENT>Agree </ENT>
                            <ENT>Carrier Priced. </ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01"># 20987 * </ENT>
                            <ENT/>
                            <ENT>CPTR-ASST DIR MS PX PRE IMG </ENT>
                            <ENT>Carrier Priced </ENT>
                            <ENT/>
                            <ENT>Agree </ENT>
                            <ENT>Carrier Priced. </ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01"># 21073 </ENT>
                            <ENT/>
                            <ENT>MNPJ OF TMJ W/ANESTH </ENT>
                            <ENT>3.33 </ENT>
                            <ENT/>
                            <ENT>Agree </ENT>
                            <ENT>3.33 </ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01"># 22206 </ENT>
                            <ENT/>
                            <ENT>CUT SPINE 3 COL, THOR </ENT>
                            <ENT>37.00 </ENT>
                            <ENT/>
                            <ENT>Agree </ENT>
                            <ENT>37.00 </ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01"># 22207 </ENT>
                            <ENT/>
                            <ENT>CUT SPINE 3 COL, LUMB </ENT>
                            <ENT>36.50 </ENT>
                            <ENT/>
                            <ENT>Agree </ENT>
                            <ENT>36.50 </ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01"># 22208 </ENT>
                            <ENT/>
                            <ENT>CUT SPINE 3 COL, ADDL SEG </ENT>
                            <ENT>9.66 </ENT>
                            <ENT/>
                            <ENT>Agree </ENT>
                            <ENT>9.66 </ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">23515 </ENT>
                            <ENT/>
                            <ENT>TREAT CLAVICLE FRACTURE </ENT>
                            <ENT>11.00 </ENT>
                            <ENT/>
                            <ENT>Disagree </ENT>
                            <ENT>9.53 </ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">23585 </ENT>
                            <ENT/>
                            <ENT>TREAT SCAPULA FRACTURE</ENT>
                            <ENT>16.25</ENT>
                            <ENT/>
                            <ENT>Disagree </ENT>
                            <ENT>14.07 </ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">23615 </ENT>
                            <ENT/>
                            <ENT>TREAT HUMERUS FRACTURE </ENT>
                            <ENT>14.00 </ENT>
                            <ENT/>
                            <ENT>Disagree </ENT>
                            <ENT>12.12 </ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">23616 </ENT>
                            <ENT/>
                            <ENT>TREAT HUMERUS FRACTURE </ENT>
                            <ENT>21.00 </ENT>
                            <ENT/>
                            <ENT>Disagree </ENT>
                            <ENT>18.19 </ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">23630 </ENT>
                            <ENT/>
                            <ENT>TREAT HUMERUS FRACTURE </ENT>
                            <ENT>12.00 </ENT>
                            <ENT/>
                            <ENT>Disagree </ENT>
                            <ENT>10.39 </ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">23670 </ENT>
                            <ENT/>
                            <ENT>TREAT DISLOCATION/FRACTURE </ENT>
                            <ENT>14.00 </ENT>
                            <ENT/>
                            <ENT>Disagree </ENT>
                            <ENT>12.12 </ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">23680 </ENT>
                            <ENT/>
                            <ENT>TREAT DISLOCATION/FRACTURE </ENT>
                            <ENT>15.00 </ENT>
                            <ENT/>
                            <ENT>Disagree </ENT>
                            <ENT>12.99 </ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01"># 24357 </ENT>
                            <ENT/>
                            <ENT>REPAIR ELBOW, PERC </ENT>
                            <ENT>5.32 </ENT>
                            <ENT/>
                            <ENT>Agree </ENT>
                            <ENT>5.32 </ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01"># 24358 </ENT>
                            <ENT/>
                            <ENT>REPAIR ELBOW W/DEB, OPEN </ENT>
                            <ENT>6.54 </ENT>
                            <ENT/>
                            <ENT>Agree </ENT>
                            <ENT>6.54 </ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01"># 24359 </ENT>
                            <ENT/>
                            <ENT>REPAIR ELBOW DEB/ATTCH OPEN </ENT>
                            <ENT>8.86 </ENT>
                            <ENT/>
                            <ENT>Agree </ENT>
                            <ENT>8.86 </ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">24545 </ENT>
                            <ENT/>
                            <ENT>TREAT HUMERUS FRACTURE </ENT>
                            <ENT>15.00 </ENT>
                            <ENT/>
                            <ENT>Disagree </ENT>
                            <ENT>12.99 </ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">24546 </ENT>
                            <ENT/>
                            <ENT>TREAT HUMERUS FRACTURE </ENT>
                            <ENT>17.01 </ENT>
                            <ENT/>
                            <ENT>Disagree </ENT>
                            <ENT>14.73 </ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">24575 </ENT>
                            <ENT/>
                            <ENT>TREAT HUMERUS FRACTURE </ENT>
                            <ENT>11.00 </ENT>
                            <ENT/>
                            <ENT>Disagree </ENT>
                            <ENT>9.53 </ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">24579 </ENT>
                            <ENT/>
                            <ENT>TREAT HUMERUS FRACTURE </ENT>
                            <ENT>13.00 </ENT>
                            <ENT/>
                            <ENT>Disagree </ENT>
                            <ENT>11.26 </ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">24635 </ENT>
                            <ENT/>
                            <ENT>TREAT ELBOW FRACTURE </ENT>
                            <ENT>10.00 </ENT>
                            <ENT/>
                            <ENT>Disagree </ENT>
                            <ENT>8.64 </ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">24665 </ENT>
                            <ENT/>
                            <ENT>TREAT RADIUS FRACTURE </ENT>
                            <ENT>Referred to CPT</ENT>
                            <ENT/>
                            <ENT>CPT </ENT>
                            <ENT>8.22 </ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">24666 </ENT>
                            <ENT/>
                            <ENT>TREAT RADIUS FRACTURE </ENT>
                            <ENT>Referred to CPT </ENT>
                            <ENT/>
                            <ENT>CPT </ENT>
                            <ENT>9.74 </ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">24685 </ENT>
                            <ENT/>
                            <ENT>TREAT ULNAR FRACTURE </ENT>
                            <ENT>9.50 </ENT>
                            <ENT/>
                            <ENT>Disagree </ENT>
                            <ENT>8.21 </ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">25515 </ENT>
                            <ENT/>
                            <ENT>TREAT FRACTURE OF RADIUS </ENT>
                            <ENT>10.00 </ENT>
                            <ENT/>
                            <ENT>Disagree </ENT>
                            <ENT>8.64 </ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">25525 </ENT>
                            <ENT/>
                            <ENT>TREAT FRACTURE OF RADIUS </ENT>
                            <ENT>12.00 </ENT>
                            <ENT/>
                            <ENT>Disagree </ENT>
                            <ENT>10.37 </ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">25526 </ENT>
                            <ENT/>
                            <ENT>TREAT FRACTURE OF RADIUS </ENT>
                            <ENT>15.00 </ENT>
                            <ENT/>
                            <ENT>Disagree </ENT>
                            <ENT>12.96 </ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">25545 </ENT>
                            <ENT/>
                            <ENT>TREAT FRACTURE OF ULNA </ENT>
                            <ENT>9.00 </ENT>
                            <ENT/>
                            <ENT>Disagree </ENT>
                            <ENT>7.78 </ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">25574 </ENT>
                            <ENT/>
                            <ENT>TREAT FRACTURE RADIUS &amp; ULNA </ENT>
                            <ENT>10.00 </ENT>
                            <ENT/>
                            <ENT>Disagree </ENT>
                            <ENT>8.64 </ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">25575 </ENT>
                            <ENT/>
                            <ENT>TREAT FRACTURE RADIUS/ULNA </ENT>
                            <ENT>14.00 </ENT>
                            <ENT/>
                            <ENT>Disagree </ENT>
                            <ENT>12.10 </ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">25628 </ENT>
                            <ENT/>
                            <ENT>TREAT WRIST BONE FRACTURE </ENT>
                            <ENT>11.00 </ENT>
                            <ENT/>
                            <ENT>Disagree </ENT>
                            <ENT>9.51 </ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">26615 </ENT>
                            <ENT/>
                            <ENT>TREAT METACARPAL FRACTURE </ENT>
                            <ENT>8.00 </ENT>
                            <ENT/>
                            <ENT>Disagree </ENT>
                            <ENT>6.91 </ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">26650 </ENT>
                            <ENT/>
                            <ENT>TREAT THUMB FRACTURE </ENT>
                            <ENT>6.00 </ENT>
                            <ENT/>
                            <ENT>Disagree </ENT>
                            <ENT>5.19 </ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">26665 </ENT>
                            <ENT/>
                            <ENT>TREAT THUMB FRACTURE </ENT>
                            <ENT>9.00 </ENT>
                            <ENT/>
                            <ENT>Disagree </ENT>
                            <ENT>7.78 </ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">26685 </ENT>
                            <ENT/>
                            <ENT>TREAT HAND DISLOCATION </ENT>
                            <ENT>8.00 </ENT>
                            <ENT/>
                            <ENT>Disagree </ENT>
                            <ENT>6.91 </ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">26715 </ENT>
                            <ENT/>
                            <ENT>TREAT KNUCKLE DISLOCATION </ENT>
                            <ENT>7.95 </ENT>
                            <ENT/>
                            <ENT>Disagree </ENT>
                            <ENT>6.87 </ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">26735 </ENT>
                            <ENT/>
                            <ENT>TREAT FINGER FRACTURE, EACH </ENT>
                            <ENT>8.40 </ENT>
                            <ENT/>
                            <ENT>Disagree </ENT>
                            <ENT>7.26 </ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">26746 </ENT>
                            <ENT/>
                            <ENT>TREAT FINGER FRACTURE, EACH </ENT>
                            <ENT>11.10 </ENT>
                            <ENT/>
                            <ENT>Disagree </ENT>
                            <ENT>9.59 </ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">26765 </ENT>
                            <ENT/>
                            <ENT>TREAT FINGER FRACTURE, EACH </ENT>
                            <ENT>6.60 </ENT>
                            <ENT/>
                            <ENT>Disagree </ENT>
                            <ENT>5.70 </ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">26785 </ENT>
                            <ENT/>
                            <ENT>TREAT FINGER DISLOCATION </ENT>
                            <ENT>7.45 </ENT>
                            <ENT/>
                            <ENT>Disagree </ENT>
                            <ENT>6.44 </ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">27248 </ENT>
                            <ENT/>
                            <ENT>TREAT THIGH FRACTURE </ENT>
                            <ENT>12.83 </ENT>
                            <ENT/>
                            <ENT>Disagree </ENT>
                            <ENT>10.64 </ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01"># 27267 </ENT>
                            <ENT/>
                            <ENT>CLTX THIGH FX </ENT>
                            <ENT>5.38 </ENT>
                            <ENT/>
                            <ENT>Agree </ENT>
                            <ENT>5.38 </ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01"># 27268 </ENT>
                            <ENT/>
                            <ENT>CLTX THIGH FX W/MNPJ </ENT>
                            <ENT>7.00 </ENT>
                            <ENT/>
                            <ENT>Agree </ENT>
                            <ENT>7.00 </ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01"># 27269 </ENT>
                            <ENT/>
                            <ENT>OPTX THIGH FX </ENT>
                            <ENT>18.75 </ENT>
                            <ENT/>
                            <ENT>Agree </ENT>
                            <ENT>18.75 </ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01"># 27416 </ENT>
                            <ENT/>
                            <ENT>OSTEOCHONDRAL KNEE AUTOGRAFT </ENT>
                            <ENT>14.00 </ENT>
                            <ENT/>
                            <ENT>Agree </ENT>
                            <ENT>14.00 </ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">27511 </ENT>
                            <ENT/>
                            <ENT>TREATMENT OF THIGH FRACTURE </ENT>
                            <ENT>18.05 </ENT>
                            <ENT/>
                            <ENT>Disagree </ENT>
                            <ENT>14.97 </ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">27513 </ENT>
                            <ENT/>
                            <ENT>TREATMENT OF THIGH FRACTURE </ENT>
                            <ENT>23.04 </ENT>
                            <ENT/>
                            <ENT>Disagree </ENT>
                            <ENT>19.11 </ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">27514 </ENT>
                            <ENT/>
                            <ENT>TREATMENT OF THIGH FRACTURE </ENT>
                            <ENT>17.43 </ENT>
                            <ENT/>
                            <ENT>Disagree </ENT>
                            <ENT>14.46 </ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">27519 </ENT>
                            <ENT/>
                            <ENT>TREAT THIGH FX GROWTH PLATE </ENT>
                            <ENT>15.80 </ENT>
                            <ENT/>
                            <ENT>Disagree </ENT>
                            <ENT>13.11 </ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">27535 </ENT>
                            <ENT/>
                            <ENT>TREAT KNEE FRACTURE </ENT>
                            <ENT>16.00 </ENT>
                            <ENT/>
                            <ENT>Disagree </ENT>
                            <ENT>13.27 </ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">27540 </ENT>
                            <ENT/>
                            <ENT>TREAT KNEE FRACTURE </ENT>
                            <ENT>13.45 </ENT>
                            <ENT/>
                            <ENT>Disagree </ENT>
                            <ENT>11.16 </ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">27556 </ENT>
                            <ENT/>
                            <ENT>TREAT KNEE DISLOCATION </ENT>
                            <ENT>15.50 </ENT>
                            <ENT/>
                            <ENT>Disagree </ENT>
                            <ENT>12.86 </ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">27557 </ENT>
                            <ENT/>
                            <ENT>TREAT KNEE DISLOCATION </ENT>
                            <ENT>19.00 </ENT>
                            <ENT/>
                            <ENT>Disagree </ENT>
                            <ENT>15.76 </ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">27558 </ENT>
                            <ENT/>
                            <ENT>TREAT KNEE DISLOCATION </ENT>
                            <ENT>22.00 </ENT>
                            <ENT/>
                            <ENT>Disagree </ENT>
                            <ENT>18.25 </ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01"># 27726 </ENT>
                            <ENT/>
                            <ENT>REPAIR FIBULA NONUNION </ENT>
                            <ENT>14.20 </ENT>
                            <ENT/>
                            <ENT>Agree </ENT>
                            <ENT>14.20 </ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">27766 </ENT>
                            <ENT/>
                            <ENT>OPTX MEDIAL ANKLE FX </ENT>
                            <ENT>8.50 </ENT>
                            <ENT/>
                            <ENT>Disagree </ENT>
                            <ENT>7.73 </ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01"># 27767 </ENT>
                            <ENT/>
                            <ENT>CLTX POST ANKLE FX </ENT>
                            <ENT>2.50 </ENT>
                            <ENT/>
                            <ENT>Agree </ENT>
                            <ENT>2.50 </ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01"># 27768 </ENT>
                            <ENT/>
                            <ENT>CLTX POST ANKLE FX W/MNPJ </ENT>
                            <ENT>5.00 </ENT>
                            <ENT/>
                            <ENT>Agree </ENT>
                            <ENT>5.00 </ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01"># 27769 </ENT>
                            <ENT/>
                            <ENT>OPTX POST ANKLE FX </ENT>
                            <ENT>10.00 </ENT>
                            <ENT/>
                            <ENT>Agree </ENT>
                            <ENT>10.00 </ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">27784 </ENT>
                            <ENT/>
                            <ENT>TREATMENT OF FIBULA FRACTURE </ENT>
                            <ENT>10.45 </ENT>
                            <ENT/>
                            <ENT>Disagree </ENT>
                            <ENT>9.51 </ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">27792 </ENT>
                            <ENT/>
                            <ENT>TREATMENT OF ANKLE FRACTURE </ENT>
                            <ENT>10.50 </ENT>
                            <ENT/>
                            <ENT>Disagree </ENT>
                            <ENT>9.55 </ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">27814 </ENT>
                            <ENT/>
                            <ENT>TREATMENT OF ANKLE FRACTURE </ENT>
                            <ENT>11.50 </ENT>
                            <ENT/>
                            <ENT>Disagree </ENT>
                            <ENT>10.46 </ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">27822 </ENT>
                            <ENT/>
                            <ENT>TREATMENT OF ANKLE FRACTURE </ENT>
                            <ENT>12.12 </ENT>
                            <ENT/>
                            <ENT>Disagree </ENT>
                            <ENT>11.03 </ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">27823 </ENT>
                            <ENT/>
                            <ENT>TREATMENT OF ANKLE FRACTURE </ENT>
                            <ENT>14.26 </ENT>
                            <ENT/>
                            <ENT>Disagree </ENT>
                            <ENT>12.98 </ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">27826 </ENT>
                            <ENT/>
                            <ENT>TREAT LOWER LEG FRACTURE </ENT>
                            <ENT>12.00 </ENT>
                            <ENT/>
                            <ENT>Disagree </ENT>
                            <ENT>10.92 </ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">27827 </ENT>
                            <ENT/>
                            <ENT>TREAT LOWER LEG FRACTURE </ENT>
                            <ENT>16.00 </ENT>
                            <ENT/>
                            <ENT>Disagree </ENT>
                            <ENT>14.56 </ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">27828 </ENT>
                            <ENT/>
                            <ENT>TREAT LOWER LEG FRACTURE </ENT>
                            <ENT>20.00 </ENT>
                            <ENT/>
                            <ENT>Disagree </ENT>
                            <ENT>18.20 </ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">27829 </ENT>
                            <ENT/>
                            <ENT>TREAT LOWER LEG JOINT </ENT>
                            <ENT>9.50 </ENT>
                            <ENT/>
                            <ENT>Disagree </ENT>
                            <ENT>8.64 </ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">27832 </ENT>
                            <ENT/>
                            <ENT>TREAT LOWER LEG DISLOCATION </ENT>
                            <ENT>11.00 </ENT>
                            <ENT/>
                            <ENT>Disagree </ENT>
                            <ENT>10.01 </ENT>
                        </ROW>
                        <ROW>
                            <PRTPAGE P="66367"/>
                            <ENT I="01">28415 </ENT>
                            <ENT/>
                            <ENT>TREAT HEEL FRACTURE </ENT>
                            <ENT>17.54 </ENT>
                            <ENT/>
                            <ENT>Disagree </ENT>
                            <ENT>15.96 </ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">28420 </ENT>
                            <ENT/>
                            <ENT>TREAT/GRAFT HEEL FRACTURE </ENT>
                            <ENT>19.00 </ENT>
                            <ENT/>
                            <ENT>Disagree </ENT>
                            <ENT>17.29 </ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">28445 </ENT>
                            <ENT/>
                            <ENT>TREAT ANKLE FRACTURE </ENT>
                            <ENT>17.07 </ENT>
                            <ENT/>
                            <ENT>Disagree </ENT>
                            <ENT>15.53 </ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01"># 28446 </ENT>
                            <ENT/>
                            <ENT>OSTEOCHONDRAL TALUS AUTOGRFT </ENT>
                            <ENT>17.50 </ENT>
                            <ENT/>
                            <ENT>Agree </ENT>
                            <ENT>17.50 </ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">28465 </ENT>
                            <ENT/>
                            <ENT>TREAT MIDFOOT FRACTURE, EACH </ENT>
                            <ENT>9.50 </ENT>
                            <ENT/>
                            <ENT>Disagree </ENT>
                            <ENT>8.64 </ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">28485 </ENT>
                            <ENT/>
                            <ENT>TREAT METATARSAL FRACTURE </ENT>
                            <ENT>8.00 </ENT>
                            <ENT/>
                            <ENT>Disagree </ENT>
                            <ENT>7.28 </ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">28505 </ENT>
                            <ENT/>
                            <ENT>TREAT BIG TOE FRACTURE </ENT>
                            <ENT>8.00 </ENT>
                            <ENT/>
                            <ENT>Disagree </ENT>
                            <ENT>7.28 </ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">28525 </ENT>
                            <ENT/>
                            <ENT>TREAT TOE FRACTURE </ENT>
                            <ENT>6.00 </ENT>
                            <ENT/>
                            <ENT>Disagree </ENT>
                            <ENT>5.46 </ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">28555 </ENT>
                            <ENT/>
                            <ENT>REPAIR FOOT DISLOCATION </ENT>
                            <ENT>10.43 </ENT>
                            <ENT/>
                            <ENT>Disagree </ENT>
                            <ENT>9.49 </ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">28585 </ENT>
                            <ENT/>
                            <ENT>REPAIR FOOT DISLOCATION </ENT>
                            <ENT>12.00 </ENT>
                            <ENT/>
                            <ENT>Disagree </ENT>
                            <ENT>10.92 </ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">28615 </ENT>
                            <ENT/>
                            <ENT>REPAIR FOOT DISLOCATION </ENT>
                            <ENT>11.50 </ENT>
                            <ENT/>
                            <ENT>Disagree </ENT>
                            <ENT>10.46 </ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">28645 </ENT>
                            <ENT/>
                            <ENT>REPAIR TOE DISLOCATION </ENT>
                            <ENT>8.00 </ENT>
                            <ENT/>
                            <ENT>Disagree </ENT>
                            <ENT>7.28 </ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">28675 </ENT>
                            <ENT/>
                            <ENT>REPAIR OF TOE DISLOCATION </ENT>
                            <ENT>6.00 </ENT>
                            <ENT/>
                            <ENT>Disagree </ENT>
                            <ENT>5.46 </ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01"># 29828 * </ENT>
                            <ENT/>
                            <ENT>ARTHROSCOPY BICEPS TENODESIS </ENT>
                            <ENT>13.00 </ENT>
                            <ENT/>
                            <ENT>Agree </ENT>
                            <ENT>13.00 </ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01"># 29904 </ENT>
                            <ENT/>
                            <ENT>SUBTALAR ARTHRO W/FB RMVL </ENT>
                            <ENT>8.50 </ENT>
                            <ENT/>
                            <ENT>Agree </ENT>
                            <ENT>8.50 </ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01"># 29905 </ENT>
                            <ENT/>
                            <ENT>SUBTALAR ARTHRO W/EXC </ENT>
                            <ENT>9.00 </ENT>
                            <ENT/>
                            <ENT>Agree </ENT>
                            <ENT>9.00 </ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01"># 29906 </ENT>
                            <ENT/>
                            <ENT>SUBTALAR ARTHRO W/DEB </ENT>
                            <ENT>9.47 </ENT>
                            <ENT/>
                            <ENT>Agree </ENT>
                            <ENT>9.47 </ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01"># 29907 </ENT>
                            <ENT/>
                            <ENT>SUBTALAR ARTHRO W/FUSION </ENT>
                            <ENT>12.00 </ENT>
                            <ENT/>
                            <ENT>Agree </ENT>
                            <ENT>12.00 </ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">31500 </ENT>
                            <ENT/>
                            <ENT>INSERT EMERGENCY AIRWAY </ENT>
                            <ENT>2.33 </ENT>
                            <ENT/>
                            <ENT>Agree </ENT>
                            <ENT>2.33 </ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01"># 33257 * </ENT>
                            <ENT/>
                            <ENT>ABLATE ATRIA, LMTD, ADD-ON </ENT>
                            <ENT>9.63 </ENT>
                            <ENT/>
                            <ENT>Agree </ENT>
                            <ENT>9.63 </ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01"># 33258 * </ENT>
                            <ENT/>
                            <ENT>ABLATE ATRIA, X10SV, ADD-ON </ENT>
                            <ENT>11.00 </ENT>
                            <ENT/>
                            <ENT>Agree </ENT>
                            <ENT>11.00 </ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01"># 33259 * </ENT>
                            <ENT/>
                            <ENT>ABLATE ATRIA W/BYPASS ADD-ON </ENT>
                            <ENT>14.14 </ENT>
                            <ENT/>
                            <ENT>Agree </ENT>
                            <ENT>14.14 </ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01"># 33864 * </ENT>
                            <ENT/>
                            <ENT>ASCENDING AORTIC GRAFT </ENT>
                            <ENT>60.00 </ENT>
                            <ENT/>
                            <ENT>Agree </ENT>
                            <ENT>60.00 </ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01"># 34806 * </ENT>
                            <ENT/>
                            <ENT>ANEURYSM PRESS SENSOR ADD-ON </ENT>
                            <ENT>2.06 </ENT>
                            <ENT/>
                            <ENT>Agree </ENT>
                            <ENT>2.06 </ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01"># 35523 </ENT>
                            <ENT/>
                            <ENT>ARTERY BYPASS GRAFT </ENT>
                            <ENT>24.00 </ENT>
                            <ENT/>
                            <ENT>Agree </ENT>
                            <ENT>24.00 </ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">36620 </ENT>
                            <ENT/>
                            <ENT>INSERTION CATHETER, ARTERY </ENT>
                            <ENT>1.15 </ENT>
                            <ENT/>
                            <ENT>Agree </ENT>
                            <ENT>1.15 </ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01"># 41019 </ENT>
                            <ENT/>
                            <ENT>PLACE NEEDLES H&amp;N FOR RT </ENT>
                            <ENT>8.84 </ENT>
                            <ENT/>
                            <ENT>Agree </ENT>
                            <ENT>8.84 </ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">43760 </ENT>
                            <ENT/>
                            <ENT>CHANGE GASTROSTOMY TUBE </ENT>
                            <ENT>0.90 </ENT>
                            <ENT/>
                            <ENT>Agree </ENT>
                            <ENT>0.90 </ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01"># 49203 </ENT>
                            <ENT/>
                            <ENT>EXC ABD TUM 5 CM OR LESS </ENT>
                            <ENT>20.00 </ENT>
                            <ENT/>
                            <ENT>Agree </ENT>
                            <ENT>20.00 </ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01"># 49204 </ENT>
                            <ENT/>
                            <ENT>EXC ABD TUM OVER 5 CM </ENT>
                            <ENT>26.00 </ENT>
                            <ENT/>
                            <ENT>Agree </ENT>
                            <ENT>26.00 </ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01"># 49205 </ENT>
                            <ENT/>
                            <ENT>EXC ABD TUM OVER 10 CM </ENT>
                            <ENT>30.00 </ENT>
                            <ENT/>
                            <ENT>Agree </ENT>
                            <ENT>30.00 </ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01"># 49440 </ENT>
                            <ENT/>
                            <ENT>PLACE GASTROSTOMY TUBE PERC </ENT>
                            <ENT>4.18 </ENT>
                            <ENT/>
                            <ENT>Agree </ENT>
                            <ENT>4.18 </ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01"># 49441 </ENT>
                            <ENT/>
                            <ENT>PLACE DUOD/JEJ TUBE PERC </ENT>
                            <ENT>4.77 </ENT>
                            <ENT/>
                            <ENT>Agree </ENT>
                            <ENT>4.77 </ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01"># 49442 </ENT>
                            <ENT/>
                            <ENT>PLACE CECOSTOMY TUBE PERC </ENT>
                            <ENT>4.00 </ENT>
                            <ENT/>
                            <ENT>Agree </ENT>
                            <ENT>4.00 </ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01"># 49446 </ENT>
                            <ENT/>
                            <ENT>CHANGE G-TUBE TO G-J PERC </ENT>
                            <ENT>3.31 </ENT>
                            <ENT/>
                            <ENT>Agree </ENT>
                            <ENT>3.31 </ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01"># 49450 </ENT>
                            <ENT/>
                            <ENT>REPLACE G/C TUBE PERC </ENT>
                            <ENT>1.36 </ENT>
                            <ENT/>
                            <ENT>Agree </ENT>
                            <ENT>1.36 </ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01"># 49451 </ENT>
                            <ENT/>
                            <ENT>REPLACE DUOD/JEJ TUBE PERC </ENT>
                            <ENT>1.84 </ENT>
                            <ENT/>
                            <ENT>Agree </ENT>
                            <ENT>1.84 </ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01"># 49452 </ENT>
                            <ENT/>
                            <ENT>REPLACE G-J TUBE PERC </ENT>
                            <ENT>2.86 </ENT>
                            <ENT/>
                            <ENT>Agree </ENT>
                            <ENT>2.86 </ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01"># 49460 </ENT>
                            <ENT/>
                            <ENT>FIX G/COLON TUBE W/DEVICE </ENT>
                            <ENT>0.96 </ENT>
                            <ENT/>
                            <ENT>Agree </ENT>
                            <ENT>0.96 </ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01"># 49465 </ENT>
                            <ENT/>
                            <ENT>FLUORO EXAM OF G/COLON TUBE </ENT>
                            <ENT>0.62 </ENT>
                            <ENT/>
                            <ENT>Agree </ENT>
                            <ENT>0.62 </ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01"># 50385 </ENT>
                            <ENT/>
                            <ENT>CHANGE STENT VIA TRANSURETH </ENT>
                            <ENT>4.44 </ENT>
                            <ENT/>
                            <ENT>Agree </ENT>
                            <ENT>4.44 </ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01"># 50386 </ENT>
                            <ENT/>
                            <ENT>REMOVE STENT VIA TRANSURETH </ENT>
                            <ENT>3.30 </ENT>
                            <ENT/>
                            <ENT>Agree </ENT>
                            <ENT>3.30 </ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01"># 50593 * </ENT>
                            <ENT/>
                            <ENT>PERC CRYO ABLATE RENAL TUM </ENT>
                            <ENT>9.08 </ENT>
                            <ENT/>
                            <ENT>Agree </ENT>
                            <ENT>9.08 </ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">51797 </ENT>
                            <ENT/>
                            <ENT>INTRAABDOMINAL PRESSURE TEST </ENT>
                            <ENT>0.80 </ENT>
                            <ENT/>
                            <ENT>Agree </ENT>
                            <ENT>0.80 </ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01"># 52649 </ENT>
                            <ENT/>
                            <ENT>PROSTATE LASER ENUCLEATION </ENT>
                            <ENT>17.16 </ENT>
                            <ENT/>
                            <ENT>Agree </ENT>
                            <ENT>17.16 </ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01"># 55920 </ENT>
                            <ENT/>
                            <ENT>PLACE NEEDLES PELVIC FOR RT </ENT>
                            <ENT>8.31 </ENT>
                            <ENT/>
                            <ENT>Agree </ENT>
                            <ENT>8.31 </ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">57284 </ENT>
                            <ENT/>
                            <ENT>REPAIR PARAVAG DEFECT, OPEN </ENT>
                            <ENT>14.25 </ENT>
                            <ENT/>
                            <ENT>Agree </ENT>
                            <ENT>14.25 </ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01"># 57285 </ENT>
                            <ENT/>
                            <ENT>REPAIR PARAVAG DEFECT, VAG </ENT>
                            <ENT>11.52 </ENT>
                            <ENT/>
                            <ENT>Agree </ENT>
                            <ENT>11.52 </ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01"># 57423 * </ENT>
                            <ENT/>
                            <ENT>REPAIR PARAVAG DEFECT, LAP </ENT>
                            <ENT>16.00 </ENT>
                            <ENT/>
                            <ENT>Agree </ENT>
                            <ENT>16.00 </ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01"># 58570 * </ENT>
                            <ENT/>
                            <ENT>TLH, UTERUS 250 G OR LESS </ENT>
                            <ENT>15.75 </ENT>
                            <ENT/>
                            <ENT>Agree </ENT>
                            <ENT>15.75 </ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01"># 58571 * </ENT>
                            <ENT/>
                            <ENT>TLH W/T/O 250 G OR LESS </ENT>
                            <ENT>17.56 </ENT>
                            <ENT/>
                            <ENT>Agree </ENT>
                            <ENT>17.56 </ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01"># 58572 * </ENT>
                            <ENT/>
                            <ENT>TLH, UTERUS OVER 250 G </ENT>
                            <ENT>19.96 </ENT>
                            <ENT/>
                            <ENT>Agree </ENT>
                            <ENT>19.96 </ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01"># 58573 * </ENT>
                            <ENT/>
                            <ENT>TLH W/T/O UTERUS OVER 250 G </ENT>
                            <ENT>22.98 </ENT>
                            <ENT/>
                            <ENT>Agree </ENT>
                            <ENT>22.98 </ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01"># 67041 </ENT>
                            <ENT/>
                            <ENT>VIT FOR MACULAR PUCKER </ENT>
                            <ENT>19.00 </ENT>
                            <ENT/>
                            <ENT>Agree </ENT>
                            <ENT>19.00 </ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01"># 67042 </ENT>
                            <ENT/>
                            <ENT>VIT FOR MACULAR HOLE </ENT>
                            <ENT>22.13 </ENT>
                            <ENT/>
                            <ENT>Agree </ENT>
                            <ENT>22.13 </ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01"># 67043 </ENT>
                            <ENT/>
                            <ENT>VIT FOR MEMBRANE DISSECT </ENT>
                            <ENT>22.94 </ENT>
                            <ENT/>
                            <ENT>Agree </ENT>
                            <ENT>22.94 </ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01"># 67113 </ENT>
                            <ENT/>
                            <ENT>REPAIR RETINAL DETACH, CPLX </ENT>
                            <ENT>25.00 </ENT>
                            <ENT/>
                            <ENT>Agree </ENT>
                            <ENT>25.00 </ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01"># 67229 </ENT>
                            <ENT/>
                            <ENT>TR RETINAL LES PRETERM INF </ENT>
                            <ENT>16.00 </ENT>
                            <ENT/>
                            <ENT>Agree </ENT>
                            <ENT>16.00 </ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01"># 68816 * </ENT>
                            <ENT/>
                            <ENT>PROBE NL DUCT W/BALLOON </ENT>
                            <ENT>3.00 </ENT>
                            <ENT/>
                            <ENT>Agree </ENT>
                            <ENT>3.00 </ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01"># 75557 * </ENT>
                            <ENT>26 </ENT>
                            <ENT>CARDIAC MRI FOR MORPH </ENT>
                            <ENT>2.35 </ENT>
                            <ENT/>
                            <ENT>Agree </ENT>
                            <ENT>2.35 </ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01"># 75558 * </ENT>
                            <ENT>26 </ENT>
                            <ENT>CARDIAC MRI FLOW/VELOCITY </ENT>
                            <ENT>2.60 </ENT>
                            <ENT/>
                            <ENT>Agree (c) </ENT>
                            <ENT>2.60 </ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01"># 75559 * </ENT>
                            <ENT>26 </ENT>
                            <ENT>CARDIAC MRI W/STRESS IMG </ENT>
                            <ENT>2.95 </ENT>
                            <ENT/>
                            <ENT>Agree </ENT>
                            <ENT>2.95 </ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01"># 75560 * </ENT>
                            <ENT>26 </ENT>
                            <ENT>CARDIAC MRI FLOW/VEL/STRESS </ENT>
                            <ENT>3.00 </ENT>
                            <ENT/>
                            <ENT>Agree (c) </ENT>
                            <ENT>3.00 </ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01"># 75561 * </ENT>
                            <ENT>26 </ENT>
                            <ENT>CARDIAC MRI FOR MORPH W/DYE </ENT>
                            <ENT>2.60 </ENT>
                            <ENT/>
                            <ENT>Agree </ENT>
                            <ENT>2.60 </ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01"># 75562 * </ENT>
                            <ENT>26 </ENT>
                            <ENT>CARD MRI FLOW/VEL W/DYE </ENT>
                            <ENT>2.86 </ENT>
                            <ENT/>
                            <ENT>Agree (c) </ENT>
                            <ENT>2.86 </ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01"># 75563 * </ENT>
                            <ENT>26 </ENT>
                            <ENT>CARD MRI W/STRESS IMG &amp; DYE </ENT>
                            <ENT>3.00 </ENT>
                            <ENT/>
                            <ENT>Agree </ENT>
                            <ENT>3.00 </ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01"># 75564 * </ENT>
                            <ENT>26 </ENT>
                            <ENT>HT MRI W/FLO/VEL/STRS &amp; DYE </ENT>
                            <ENT>3.35 </ENT>
                            <ENT/>
                            <ENT>Agree (c) </ENT>
                            <ENT>3.35 </ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">78811 * </ENT>
                            <ENT>26 </ENT>
                            <ENT>PET IMAGE, LTD AREA </ENT>
                            <ENT>1.54 </ENT>
                            <ENT/>
                            <ENT>Agree </ENT>
                            <ENT>1.54 </ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">78812 * </ENT>
                            <ENT>26 </ENT>
                            <ENT>PET IMAGE, SKULL-THIGH </ENT>
                            <ENT>1.93 </ENT>
                            <ENT/>
                            <ENT>Agree </ENT>
                            <ENT>1.93 </ENT>
                        </ROW>
                        <ROW>
                            <PRTPAGE P="66368"/>
                            <ENT I="01">78813 * </ENT>
                            <ENT>26 </ENT>
                            <ENT>PET IMAGE, FULL BODY </ENT>
                            <ENT>2.00 </ENT>
                            <ENT/>
                            <ENT>Agree </ENT>
                            <ENT>2.00 </ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">78814 * </ENT>
                            <ENT>26 </ENT>
                            <ENT>PET IMAGE W/CT, LMTD </ENT>
                            <ENT>2.20 </ENT>
                            <ENT/>
                            <ENT>Agree </ENT>
                            <ENT>2.20 </ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">78815 * </ENT>
                            <ENT>26 </ENT>
                            <ENT>PET IMAGE W/CT, SKULL-THIGH </ENT>
                            <ENT>2.44 </ENT>
                            <ENT/>
                            <ENT>Agree </ENT>
                            <ENT>2.44 </ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">78816 * </ENT>
                            <ENT>26 </ENT>
                            <ENT>PET IMAGE W/CT, FULL BODY </ENT>
                            <ENT>2.50 </ENT>
                            <ENT/>
                            <ENT>Agree </ENT>
                            <ENT>2.50 </ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">86486 </ENT>
                            <ENT/>
                            <ENT>SKIN TEST, NOS ANTIGEN </ENT>
                            <ENT>(a) </ENT>
                            <ENT/>
                            <ENT>(a)* </ENT>
                            <ENT>0.00 </ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">88380 * </ENT>
                            <ENT/>
                            <ENT>MICRODISSECTION, LASER </ENT>
                            <ENT>1.56 </ENT>
                            <ENT/>
                            <ENT>Agree </ENT>
                            <ENT>1.56 </ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01"># 88381 * </ENT>
                            <ENT/>
                            <ENT>MICRODISSECTION, MANUAL </ENT>
                            <ENT>1.18 </ENT>
                            <ENT/>
                            <ENT>Agree </ENT>
                            <ENT>1.18 </ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01"># 90769 * </ENT>
                            <ENT/>
                            <ENT>SC THER INFUSION, UP TO 1 HR </ENT>
                            <ENT>0.21 </ENT>
                            <ENT/>
                            <ENT>Agree </ENT>
                            <ENT>0.21 </ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01"># 90770 * </ENT>
                            <ENT/>
                            <ENT>SC THER INFUSION, ADDL HR </ENT>
                            <ENT>0.18 </ENT>
                            <ENT/>
                            <ENT>Agree </ENT>
                            <ENT>0.18 </ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">93503 </ENT>
                            <ENT>26 </ENT>
                            <ENT>INSERT/PLACE HEART CATHETER </ENT>
                            <ENT>2.91 </ENT>
                            <ENT/>
                            <ENT>Agree </ENT>
                            <ENT>2.91 </ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01"># 93982 * ** </ENT>
                            <ENT/>
                            <ENT>ANEURYSM PRESSURE SENS STUDY </ENT>
                            <ENT>0.30 </ENT>
                            <ENT/>
                            <ENT>Agree </ENT>
                            <ENT>0.30 </ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">95004 </ENT>
                            <ENT/>
                            <ENT>PERCUT ALLERGY SKIN TESTS </ENT>
                            <ENT>0.01 </ENT>
                            <ENT/>
                            <ENT>Agree </ENT>
                            <ENT>0.01 </ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">95024 </ENT>
                            <ENT/>
                            <ENT>ID ALLERGY TEST, DRUG/BUG </ENT>
                            <ENT>0.01 </ENT>
                            <ENT/>
                            <ENT>Agree </ENT>
                            <ENT>0.01 </ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">95027 </ENT>
                            <ENT/>
                            <ENT>ID ALLERGY TITRATE-AIRBORNE </ENT>
                            <ENT>0.01 </ENT>
                            <ENT/>
                            <ENT>Agree </ENT>
                            <ENT>0.01 </ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01"># 95980 * </ENT>
                            <ENT/>
                            <ENT>IO ANAL GAST N-STIM INIT </ENT>
                            <ENT>0.80 </ENT>
                            <ENT/>
                            <ENT>Agree </ENT>
                            <ENT>0.80 </ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01"># 95981 * </ENT>
                            <ENT/>
                            <ENT>IO ANAL GAST N-STIM SUBSQ </ENT>
                            <ENT>0.30 </ENT>
                            <ENT/>
                            <ENT>Agree </ENT>
                            <ENT>0.30 </ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01"># 95982 * </ENT>
                            <ENT/>
                            <ENT>IO GA N-STIM SUBSQ W/REPROG </ENT>
                            <ENT>0.65 </ENT>
                            <ENT/>
                            <ENT>Agree </ENT>
                            <ENT>0.65 </ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01"># 96125 </ENT>
                            <ENT/>
                            <ENT>COGNITIVE TEST BY HC PRO </ENT>
                            <ENT/>
                            <ENT>1.70</ENT>
                            <ENT>Agree </ENT>
                            <ENT>1.70 </ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01"># 98966 * </ENT>
                            <ENT/>
                            <ENT>HC PRO PHONE CALL 5-10 MIN </ENT>
                            <ENT/>
                            <ENT>0.25</ENT>
                            <ENT>Agree (c) </ENT>
                            <ENT>0.25 </ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01"># 98967 * </ENT>
                            <ENT/>
                            <ENT>HC PRO PHONE CALL 11-20 MIN </ENT>
                            <ENT/>
                            <ENT>0.50</ENT>
                            <ENT>Agree (c) </ENT>
                            <ENT>0.50 </ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01"># 98968 * </ENT>
                            <ENT/>
                            <ENT>HC PRO PHONE CALL 21-30 MIN </ENT>
                            <ENT/>
                            <ENT>0.75</ENT>
                            <ENT>Agree (c) </ENT>
                            <ENT>0.75 </ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01"># 98969 </ENT>
                            <ENT/>
                            <ENT>ONLINE SERVICE BY HC PRO </ENT>
                            <ENT/>
                            <ENT>Carrier Priced</ENT>
                            <ENT>Agree (c) </ENT>
                            <ENT>Carrier Priced. </ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01"># 99174 </ENT>
                            <ENT/>
                            <ENT>OCULAR PHOTOSCREENING </ENT>
                            <ENT>(a)</ENT>
                            <ENT/>
                            <ENT>(a)* </ENT>
                            <ENT>0.00 </ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01"># 99366 </ENT>
                            <ENT/>
                            <ENT>TEAM CONF W/PAT BY HC PRO </ENT>
                            <ENT/>
                            <ENT>0.82</ENT>
                            <ENT>Agree (b) </ENT>
                            <ENT>0.82 </ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01"># 99367 </ENT>
                            <ENT/>
                            <ENT>TEAM CONF W/O PAT BY PHYS </ENT>
                            <ENT>1.10 </ENT>
                            <ENT/>
                            <ENT>Agree (b) </ENT>
                            <ENT>1.10 </ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01"># 99368 </ENT>
                            <ENT/>
                            <ENT>TEAM CONF W/O PAT BY HC PRO</ENT>
                            <ENT/>
                            <ENT>0.72 </ENT>
                            <ENT>Agree (b) </ENT>
                            <ENT>0.72 </ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01"># 99406 </ENT>
                            <ENT/>
                            <ENT>BEHAV CHNG SMOKING 3-10 MIN </ENT>
                            <ENT>0.24 </ENT>
                            <ENT/>
                            <ENT>Agree </ENT>
                            <ENT>0.24 </ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01"># 99407 </ENT>
                            <ENT/>
                            <ENT>BEHAV CHNG SMOKING &lt; 10 MIN </ENT>
                            <ENT>0.50 </ENT>
                            <ENT/>
                            <ENT>Agree </ENT>
                            <ENT>0.50 </ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01"># 99408 </ENT>
                            <ENT/>
                            <ENT>AUDIT/DAST, 15-30 MIN </ENT>
                            <ENT>0.65 </ENT>
                            <ENT/>
                            <ENT>Agree (c) </ENT>
                            <ENT>0.65 </ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01"># 99409 </ENT>
                            <ENT/>
                            <ENT>AUDIT/DAST, OVER 30 MIN </ENT>
                            <ENT>1.30 </ENT>
                            <ENT/>
                            <ENT>Agree (c) </ENT>
                            <ENT>1.30 </ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01"># 99441 * </ENT>
                            <ENT/>
                            <ENT>PHONE E/M BY PHYS 5-10 MIN </ENT>
                            <ENT>0.25 </ENT>
                            <ENT/>
                            <ENT>Agree (c) </ENT>
                            <ENT>0.25 </ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01"># 99442 * </ENT>
                            <ENT/>
                            <ENT>PHONE E/M BY PHYS 11-20 MIN </ENT>
                            <ENT>0.50 </ENT>
                            <ENT/>
                            <ENT>Agree (c) </ENT>
                            <ENT>0.50 </ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01"># 99443 * </ENT>
                            <ENT/>
                            <ENT>PHONE E/M BY PHYS 21-30 MIN </ENT>
                            <ENT>0.75 </ENT>
                            <ENT/>
                            <ENT>Agree (c) </ENT>
                            <ENT>0.75 </ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01"># 99444 </ENT>
                            <ENT/>
                            <ENT>ONLINE E/M BY PHYS </ENT>
                            <ENT>Carrier Priced </ENT>
                            <ENT/>
                            <ENT>Agree (c) </ENT>
                            <ENT>Carrier Priced. </ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01"># 99477 </ENT>
                            <ENT/>
                            <ENT>INIT DAY HOSP NEONATE CARE </ENT>
                            <ENT>7.00 </ENT>
                            <ENT/>
                            <ENT>Agree </ENT>
                            <ENT>7.00 </ENT>
                        </ROW>
                        <TNOTE># New CPT code. </TNOTE>
                        <TNOTE>
                            <SU>1</SU>
                             All CPT codes copyright 2007 AMA. 
                        </TNOTE>
                        <TNOTE>* New Code for Re-Examination at the next 5-Year Review. </TNOTE>
                        <TNOTE>** Denotes restricted coverage of code. </TNOTE>
                        <TNOTE>(a) No RUC work RVU recommendation. </TNOTE>
                        <TNOTE>(a) * See code discussion in Section F, Discussion of Codes and RUC/HCPAC Recommendations. </TNOTE>
                        <TNOTE>(b) RUC-recommended work RVU accepted but coverage status of code is Bundled. </TNOTE>
                        <TNOTE>(c) RUC-recommended work RVU accepted but coverage status of code is Noncovered.</TNOTE>
                    </GPOTABLE>
                    <P>Table 17: AMA RUC Anesthesia Recommendations and CMS Decisions for New and Revised 2008 CPT Codes lists the new or revised CPT codes for anesthesia and their base units that will be interim in CY 2008. Table 17 includes the following information: </P>
                    <P>• CPT code. This is the CPT code for a service. </P>
                    <P>• Description. This is an abbreviated version of the narrative description of the code. </P>
                    <P>• RUC recommendations. This column identifies the base units recommended by the RUC. </P>
                    <P>• CMS decision. This column indicates whether we agreed or we disagreed with the RUC recommendation. Codes for which we did not accept the RUC recommendation are discussed in greater detail following this table. </P>
                    <P>• 2008 Base Units. This column establishes the CY 2007 base units for these services. </P>
                    <GPOTABLE COLS="5" OPTS="L2,i1" CDEF="xs48,r50,10,xs40,10">
                        <TTITLE>Table 17.—AMA RUC Anesthesia Recommendations and CMS Decisions for New and Revised/Reviewed CPT Codes </TTITLE>
                        <BOXHD>
                            <CHED H="1">
                                * CPT 
                                <SU>1</SU>
                                 code
                            </CHED>
                            <CHED H="1">Description</CHED>
                            <CHED H="1">
                                RUC
                                <LI>recommendation </LI>
                            </CHED>
                            <CHED H="1">
                                CMS
                                <LI>decision</LI>
                            </CHED>
                            <CHED H="1">2008 base units </CHED>
                        </BOXHD>
                        <ROW>
                            <ENT I="01">## 00142</ENT>
                            <ENT>ANESTH, LENS SURGERY</ENT>
                            <ENT>4.00</ENT>
                            <ENT>Agree</ENT>
                            <ENT>4.00 </ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01"># 01935</ENT>
                            <ENT>ANESTH, PERC IMG DX SP PROC</ENT>
                            <ENT>5.00</ENT>
                            <ENT>Agree</ENT>
                            <ENT>5.00 </ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01"># 01936</ENT>
                            <ENT>ANESTH, PERC IMG TX SP PROC</ENT>
                            <ENT>5.00</ENT>
                            <ENT>Agree</ENT>
                            <ENT>5.00 </ENT>
                        </ROW>
                        <TNOTE>
                            <SU>1</SU>
                             All CPT codes copyright 2007 AMA. 
                            <PRTPAGE P="66369"/>
                        </TNOTE>
                        <TNOTE># New CPT code. </TNOTE>
                        <TNOTE>
                            ## 
                            <E T="02">Note:</E>
                             CPT code 00142 is neither a new nor revised code for 2008. However, the RUC reviewed the base unit values for this code for 2008 and recommended that the value be maintained. 
                        </TNOTE>
                    </GPOTABLE>
                    <HD SOURCE="HD2">F. Discussion of Codes and RUC/HCPAC Recommendations </HD>
                    <P>The following is a summary of our rationale for not accepting particular RUC work RVUs. It is arranged by type of service in CPT order. This summary refers only to work RVUs. </P>
                    <P>1. Internal Fixation Codes—Shoulder/Elbow (CPT codes 23515, 23585, 23615, 23616, 23680, 23670, 23680, 24545, 24546, 24575 and 24579), Elbow/Hand (CPT codes 24635, 24685, 25515, 25525, 25526, 25545, 25574, 25575, 25628, 26615, 26650, 26665, 26685, 26715, 26735, 26746, 26765, 26785), Hip and Knee (CPT codes 27248, 27511, 27513, 27514, 27519, 27535, 27540, 27556, 27557 and 27558) and Foot and Ankle (CPT codes 27766, 27784, 27792, 27814, 27822, 27823, 27826, 27827, 27828, 27829, 27832, 28415, 28420, 28445, 28465, 28485, 28505, 28525, 28555, 28585, 28615, 28645 and 28675) </P>
                    <P>These codes were originally part of the 5-Year Review of work RVUs and were referred to the CPT Editorial Panel by the RUC for further clarification because it was unclear whether the previous valuation for these codes included the situation when internal and external fixation is applied to the fracture site. The CPT Editorial Panel agreed that these codes needed to be clarified and removed reference to external fixation from these codes. As a result of this editorial change, the RUC reexamined these families of codes and recommended increased work RVUs. The RUC recommended 11.00 work RVUs for CPT code 23515; 16.25 work RVUs for CPT code 25385; 14.00 work RVUs for CPT code 23615; 21.00 work RVUs for CPT code 23616; 12.00 work RVUs for CPT code 23680; 14.00 work RVUs for CPT code 23670; 15.00 work RVUs for CPT code 23680; 15.00 work RVUs for CPT code 24545; 17.01 work RVUs for CPT code 24546; 11.00 work RVUs for CPT code 24575; 13.00 work RVUs for CPT code 24579; 10.00 work RVUs for CPT code 24635; 9.50 work RVUs for CPT code 24685; 10.00 work RVUs for CPT code 25515; 12.00 work RVUs for CPT code 25525; 15.00 work RVUs for CPT code 25526; 9.00 work RVUs for CPT code 25545; 10.00 work RVUs for CPT code 25574; 14.00 work RVUs for CPT code 25575; 11.00 work RVUs for CPT code 25628; 8.00 work RVUs for CPT code 26615; 6.00 work RVUs for CPT code 26650; 9.00 work RVUs for CPT code 26665; 8.00 work RVUs for CPT code 26685; 7.95 work RVUs for CPT code 26715; 8.40 work RVUs for CPT code 26735; 11.10 work RVUs for CPT code 26746; 6.60 work RVUs for CPT code 26765; 7.45 work RVUs for CPT code 26785; 12.83 work RVUs for CPT code 27248; 18.05 work RVUs for CPT code 27511; 23.04 work RVUs for CPT code 27513; 17.43 work RVUs for CPT code 27514; 15.80 work RVUs for CPT code 27519; 16.00 work RVUs for CPT code 27535; 13.45 work RVUs for CPT code 27540; 15.50 work RVUs for CPT code 27556; 19.00 work RVUs for CPT code 27557; 22.00 work RVUs for CPT code 27558; 8.50 work RVUs for CPT code 27766; 10.45 work RVUs for CPT code 27784; 10.50 work RVUs for CPT code 27792; 11.50 work RVUs for CPT code 27814; 12.12 work RVUs for CPT code 27822; 14.26 work RVUs for CPT code 27823; 12.00 work RVUs for CPT code 27826; 16.00 work RVUs for CPT code 27827; 20.00 work RVUs for CPT code 27828; 9.50 work RVUs for CPT code 27829; 11.00 work RVUs for CPT code 27832; 17.54 work RVUs for CPT code 28415; 19.00 work RVUs for CPT code 28420; 17.07 work RVUs for CPT code 28445; 9.50 work RVUs for CPT code 28465; 8.00 work RVUs for CPT code 28485; 8.00 work RVUs for CPT code 28505; 6.00 work RVUs for CPT code 28525; 10.43 work RVUs for CPT code 28555; 12.00 work RVUs for CPT code 28585; 11.50 work RVUs for CPT code 28615; 8.00 work RVUs for CPT code 28645; and 6.00 work RVUs for CPT code 28675. Although we agree with the relationships, the increases in work RVUs reestablish the relativity of the services in these families and in doing so created BN issues. In order to retain BN within these families of codes, the work RVUs associated with each code had to be adjusted. That is, the work RVUs were adjusted so that the sum of the new or revised work RVUs (weighted by projected frequency of use) for each family will be the same as the sum of the current work RVUs (weighted by projected frequency of use) for each family of codes. The adjusted work RVUs are as follows: 9.53 work RVUs for CPT code 23515; 14.07 work RVUs for CPT code 25385; 12.12 work RVUs for CPT code 23615; 18.19 work RVUs for CPT code 23616; 10.39 work RVUs for CPT code 23680; 12.12 work RVUs for CPT code 23670; 12.99 work RVUs for CPT code 23680; 12.99 work RVUs for CPT code 24545; 14.73 work RVUs for CPT code 24546; 9.53 work RVUs for CPT code 24575; 11.26 work RVUs for CPT code 24579; 8.64 work RVUs for CPT code 24635; 8.21 work RVUs for CPT code 24685; 8.64 work RVUs for CPT code 25515; 10.37 work RVUs for CPT code 25525; 12.96 work RVUs for CPT code 25526; 7.78 work RVUs for CPT code 25545; 8.64 work RVUs for CPT code 25574; 12.10 work RVUs for CPT code 25575; 9.51 work RVUs for CPT code 25628; 6.91 work RVUs for CPT code 26615; 5.19 work RVUs for CPT code 26650; 7.78 work RVUs for CPT code 26665; 6.91 work RVUs for CPT code 26685; 6.87 work RVUs for CPT code 26715; 7.26 work RVUs for CPT code 26735; 9.59 work RVUs for CPT code 26746; 5.70 work RVUs for CPT code 26765; 6.44 work RVUs for CPT code 26785; 10.64 work RVUs for CPT code 27248; 14.97 work RVUs for CPT code 27511; 19.11 work RVUs for CPT code 27513; 14.46 work RVUs for CPT code 27514; 13.11 work RVUs for CPT code 27519; 13.27 work RVUs for CPT code 27535; 11.16 work RVUs for CPT code 27540; 12.86 work RVUs for CPT code 27556; 15.76 work RVUs for CPT code 27557; 18.25 work RVUs for CPT code 27558; 7.73 work RVUs for CPT code 27766; 9.51 work RVUs for CPT code 27784; 9.55 work RVUs for CPT code 27792; 10.46 work RVUs for CPT code 27814; 11.03 work RVUs for CPT code 27822; 12.98 work RVUs for CPT code 27823; 10.92 work RVUs for CPT code 27826; 14.56 work RVUs for CPT code 27827; 18.20 work RVUs for CPT code 27828; 8.64 work RVUs for CPT code 27829; 10.01 work RVUs for CPT code 27832; 15.96 work RVUs for CPT code 28415; 17.29 work RVUs for CPT code 28420; 15.53 work RVUs for CPT code 28445; 8.64 work RVUs for CPT code 28465; 7.28 work RVUs for CPT code 28485; 7.28 work RVUs for CPT code 28505; 5.46 work RVUs for CPT code 28525; 9.49 work RVUs for CPT code 28555; 10.92 work RVUs for CPT code 28585; 10.46 work RVUs for CPT code 28615; 7.28 work RVUs for CPT code 28645; and 5.46 work RVUs for CPT code 28675.</P>
                    <HD SOURCE="HD3">2. Cardiac MRI Codes </HD>
                    <P>
                        Cardiac MRI services have evolved over the past decade from providing primarily anatomic information to providing both anatomic and physiologic information. We have had a national noncoverage determination in place for Magnetic Resonance Imaging (MRI) that provides blood flow measurement since March 1994. This NCD provides that CPT code 75556, 
                        <PRTPAGE P="66370"/>
                        <E T="03">Cardiac magnetic resonance imaging for velocity flow</E>
                        , is not covered. 
                    </P>
                    <P>
                        As a result of the technological changes in MRI scanning, the CPT Editorial Panel created eight new Cardiac MRI codes and deleted five existing Cardiac MRI codes. The new codes are: CPT code 75557, 
                        <E T="03">Cardiac magnetic resonance imaging for morphology and function without contrast material;</E>
                         CPT code 75558, 
                        <E T="03">Cardiac magnetic resonance imaging for morphology and function without contrast material; with flow/velocity quantification;</E>
                         CPT code 75559, 
                        <E T="03">Cardiac magnetic resonance imaging for morphology and function without contrast material; with stress imaging;</E>
                         CPT code 75560, 
                        <E T="03">Cardiac magnetic resonance imaging for morphology and function without contrast material; with flow/velocity quantification and stress;</E>
                         CPT code 75561, 
                        <E T="03">Cardiac magnetic resonance imaging for morphology and function without contrast material(s), followed by contrast material(s) and further sequences;</E>
                         CPT code 75562, 
                        <E T="03">Cardiac magnetic resonance imaging for morphology and function without contrast material(s), followed by contrast material(s) and further sequences; with flow/velocity quantification;</E>
                         CPT code 75563, 
                        <E T="03">Cardiac magnetic resonance imaging for morphology and function without contrast material(s), followed by contrast material(s) and further sequences; with stress imaging;</E>
                         and CPT code 75564, 
                        <E T="03">Cardiac magnetic resonance imaging for morphology and function without contrast material(s), followed by contrast material(s) and further sequences; with flow/velocity quantification and stress</E>
                        . The RUC recommended 2.35 work RVUs for CPT code 75557; 2.60 work RVUs for CPT code 75558; 2.95 work RVUs for CPT code 75559; 3.00 work RVUs for CPT code 75560; 2.60 work RVUs for CPT code 75561; 2.86 work RVUs for CPT code 75562; 3.00 work RVUs for CPT code 75563; and 3.35 work RVUs for CPT code 75564. 
                    </P>
                    <P>
                        The deleted codes are: CPT code 75552, 
                        <E T="03">Cardiac magnetic resonance imaging for function, without contrast material;</E>
                         CPT code 75553, 
                        <E T="03">Cardiac magnetic resonance imaging for function, without contrast material with contrast material;</E>
                         CPT code 75554, 
                        <E T="03">Cardiac magnetic resonance imaging for function, with or without morphology; complete study;</E>
                         CPT code 75555, 
                        <E T="03">Cardiac magnetic resonance imaging for function, with or without morphology; limited study;</E>
                         and CPT code 75556 
                        <E T="03">Cardiac magnetic resonance imaging for velocity flow mapping</E>
                        . 
                    </P>
                    <P>Upon review of the new cardiac MRI codes, we recognize that four of the new codes incorporate blood flow measurement, which remains one of the nationally noncovered indications for MRI in the Medicare program. Due to a national non-coverage determination for MRI that provides blood flow measurement, CPT codes 75558, 75560, 75562 and 75564 will not be recognized by the Medicare program and have been assigned a status indicator of “N” (Noncovered) on the Medicare physician fee schedule. (Note: The RUC-recommended RVUs for these codes will be reflected in Addendum B.) </P>
                    <P>The remaining codes in this family (CPT codes 75557, 75559, 75561 and 75563) will be recognized as active on the Medicare PFS. </P>
                    <HD SOURCE="HD3">3. Skin Test, Unlisted Antigen </HD>
                    <P>
                        For CPT code 86486, 
                        <E T="03">Skin test; unlisted antigen</E>
                        , the RUC did not make a work RVU recommendation. During our 2007 public meeting for new clinical laboratory tests held in accordance with § 414.506, we received approximately four comments. The commenters indicated the code belongs in the skin test code series included in the PFS with a payment crosswalk to CPT code 86490 
                        <E T="03">Skin test; coccidioidomycosis</E>
                        . We agree with the recommendations. We are assigning the code a status indicator of A (Active code). The status indicator does not mean that Medicare has made a national coverage determination regarding this service. Contractors may develop local coverage determinations. CPT also deleted predecessor CPT code 86586 effective January 1, 2008; thus, CPT code 86586 will be deleted from the 2008 clinical laboratory fee schedule. 
                    </P>
                    <HD SOURCE="HD3">4. Wireless Pressure Sensor Implantation and Study </HD>
                    <P>
                        For CPT code 93982, 
                        <E T="03">Noninvasive physiologic study of implanted wireless pressure sensor in aneursymal sac following endovascular repair, complete study including recording, analysis of pressure and waveform tracings, interpretation and report</E>
                        , the RUC recommended 0.30 work RVUs. We have assigned a status indicator of R (Restricted) to this service because the sensor used in this procedure is FDA approved for pressure interpretation at the time of an endovascular aneurysm repair only and is currently not FDA approved for the follow-up evaluation of pressure analysis in the office or outpatient setting once the patient is discharged from the hospital.
                    </P>
                    <HD SOURCE="HD3">5. Non-Face-to-Face Physician and Qualified Healthcare Professional Services </HD>
                    <P>
                        For CPT code 98966, 
                        <E T="03">Telephone assessment and management service provided by a qualified non-physician health care professional to an established patient, parent, or guardian not originating from a related assessment and management service provided within the previous seven days nor leading to an assessment and management service or procedure within the next 24 hours or soonest available appointment; 5-10 minutes of medical discussion;</E>
                         CPT code 98967, 
                        <E T="03">Telephone assessment and management service provided by a qualified non-physician health care professional to an established patient, parent, or guardian not originating from a related assessment and management service provided within the previous seven days nor leading to an assessment and management service or procedure within the next 24 hours or soonest available appointment; 11-20 minutes of medical discussion;</E>
                         CPT code 98968, 
                        <E T="03">Telephone assessment and management service provided by a qualified non-physician health care professional to an established patient, parent, or guardian not originating from a related assessment and management service provided within the previous seven days nor leading to an assessment and management service or procedure within the next 24 hours or soonest available appointment; 21-30 minutes of medical discussion;</E>
                         CPT code 98969, 
                        <E T="03">Online evaluation and management service provided by a qualified non-physician health care professional to an established patient, guardian or health care provider not originating from a related assessment and management service provided within the previous 7 days, using the Internet or similar electronic communications network;</E>
                         CPT code 99441, 
                        <E T="03">Telephone evaluation and management service provided by a physician to an established patient, parent, or guardian not originating from a related E/M service provided within the previous seven days nor leading to an E/M service or procedure within the next 24 hours or soonest available appointment; 5-10 minutes of medical discussion;</E>
                         CPT code 99442, 
                        <E T="03">Telephone evaluation and management service provided by a physician to an established patient, parent, or guardian not originating from a related E/M service provided within the previous seven days nor leading to an E/M service or procedure within the next 24 hours or soonest available appointment; 11-20 minutes of medical discussion;</E>
                        <PRTPAGE P="66371"/>
                         CPT code 99443, 
                        <E T="03">Telephone evaluation and management service provided by a physician to an established patient, parent, or guardian not originating from a related E/M service provided within the previous seven days nor leading to an E/M service or procedure within the next 24 hours or soonest available appointment; 21-30 minutes of medical discussion;</E>
                         and CPT code 99444, 
                        <E T="03">Online evaluation and management service provided by a physician to an established patient, guardian or health care provider not originating from a related E/M service provided within the previous 7 days, using the Internet or similar electronic communications network</E>
                        , the HCPAC recommended 0.25 work RVUs for CPT code 98966; 0.50 work RVUs for CPT code 98967; 0.75 work RVUs for CPT code 98968; carrier pricing for CPT code 98969; and the RUC recommended 0.25 work RVUs for CPT code 99441; 0.50 work RVUs for CPT code 99442; 0.75 work RVUs for CPT code 99443; and carrier pricing for CPT code 99444. We are assigning a status indicator of “N” (Non-covered service) to these services because: (1) These services are non-face-to-face; and (2) the code descriptor includes language that recognizes the provision of services to parties other than the beneficiary and for whom Medicare does not provide coverage (for example, guardian). (
                        <E T="04">Note</E>
                        : The RUC or HCPAC recommended RVUs for these codes will be reflected in Addendum B.) 
                    </P>
                    <HD SOURCE="HD3">6. Team Conference </HD>
                    <P>
                        For CPT code 99366, 
                        <E T="03">Medical team conference with interdisciplinary team of health care professionals, face-to-face with patient and/or family, 30 minutes or more; participation by non-physician qualified health care professional;</E>
                         CPT code 99367, 
                        <E T="03">Medical team conference with interdisciplinary team of health care professionals, patient and/or family not present, 30 minutes or more; participation by physician;</E>
                         and CPT code 99368, 
                        <E T="03">Medical team conference with interdisciplinary team of health care professionals, patient and/or family not present, 30 minutes or more; participation by non-physician qualified health care professional</E>
                        , the HCPAC recommended 0.82 work RVUs for CPT code 99366; the RUC recommended 1.10 work RVUs for CPT code 99367; and the HCPAC recommended 0.72 work RVUs for CPT code 99368. We are assigning a status indicator of “B” (Bundled) to these services because to the extent that these services are covered, we believe these services like other counseling services are incorporated into existing E/M services. (
                        <E T="04">Note:</E>
                         The RUC or HCPAC recommended RVUs for these codes will be reflected in Addendum B.) 
                    </P>
                    <HD SOURCE="HD3">7. Reporting of Alcohol and/or Substance Abuse Assessment and Intervention Services </HD>
                    <P>
                        For CY 2008, the CPT Editorial Panel has created two new Category I CPT codes for reporting alcohol and/or substance abuse screening. They are CPT code 99408, 
                        <E T="03">Alcohol and/or substance (other than tobacco) abuse structured screening (e.g., AUDIT, DAST), and brief intervention (SBI) services; 15 to 30 minutes</E>
                        , and CPT code 99409, 
                        <E T="03">Alcohol and/or substance (other than tobacco) abuse structured screening (e.g., AUDIT, DAST), and brief intervention (SBI) services; greater than 30 minutes</E>
                        . 
                    </P>
                    <P>The code descriptions for these CPT codes suggest that these CPT codes may describe services that include screening services. In general, screening services under Medicare are considered to be those services provided to beneficiaries in the absence of signs or symptoms of illness or injury; therefore, to the extent that the services described by these two CPT codes have a screening element, the screening component would not meet the statutory requirements for coverage under section 1862(a)(1)(A) of the Act. Screening services are not covered by Medicare without specific statutory authority, such as has been provided for mammography, diabetes, and colorectal cancer screening. Accordingly, we will not recognize these CPT codes that incorporate screening for payment under the PFS. </P>
                    <P>
                        Instead, we have created two parallel G-codes to allow for appropriate Medicare reporting and payment for alcohol and substance abuse assessment and intervention services that are not provided as screening services, but that are performed in the context of the diagnosis or treatment of illness or injury. The codes are HCPCS code G0396, 
                        <E T="03">Alcohol and/or substance (other than tobacco) abuse structured assessment (e.g., AUDIT, DAST) and brief intervention, 15 to 30 minutes</E>
                         and HCPCS code G0397, 
                        <E T="03">Alcohol and/or substance (other than tobacco) abuse structured assessment (e.g., AUDIT, DAST) and intervention greater than 30 minutes</E>
                        . We will instruct Medicare contractors to pay for these codes only when considered reasonable and necessary. We will also provide coding and payment instructions for these assessment and intervention services in the program instructions implementing the CY 2008 PFS. 
                    </P>
                    <P>We are assigning a status indicator of “N” (Noncovered) to CPT codes 99408 and 99409. However, the work RVUs and PE inputs for 99408 will be crosswalked to G0396 and the work RVUs and PE inputs for 99409 will be crosswalked to G0397. </P>
                    <HD SOURCE="HD3">8. Ocular Photoscreening </HD>
                    <P>
                        For CPT code 99174, 
                        <E T="03">Ocular photoscreening with interpretation and report, bilateral</E>
                        , the RUC did not provide a recommendation. We are assigning a status indicator of “N” (Noncovered) to this service because it is a screening service that is not covered under the Medicare statute. 
                    </P>
                    <HD SOURCE="HD2">G. Additional Coding Issues </HD>
                    <HD SOURCE="HD3">1. Modifier −51 Exempt List </HD>
                    <P>The CPT Editorial Panel reviewed all of the codes on the modifier −51 exempt list to identify which codes should be exempt from the multiple procedure payment reduction rules and which codes should be removed from the exemption list. We have reviewed all codes recommended for removal from the exemption list and agree with the CPT Editorial Panel's recommendations. We have updated payment modifiers where applicable. </P>
                    <HD SOURCE="HD3">2. New Codes for Re-Examination at the Next 5-Year Review </HD>
                    <P>As part of its annual recommendations, the RUC includes a list identifying new CPT codes for reexamination at the next 5-Year Review of Work RVUs. New CPT codes that have been added to this list are identified with an asterisk (*) on Table 16: AMA RUC and HCPAC Recommendations and CMS' Decisions for New and Revised 2008 CPT Codes. </P>
                    <HD SOURCE="HD2">H. Establishment of Interim PE RVUs for New and Revised Physician's Current Procedural Terminology (CPT) Codes and New Healthcare Common Procedure Coding System (HCPCS) Codes for 2008 </HD>
                    <P>
                        We have developed a process for establishing interim PE RVUs for new and revised codes that is similar to that used for work RVUs. Under this process, the RUC recommends the PE direct inputs (the staff time, supplies and equipment) associated with each new code. We then review the recommendations in a manner similar to our evaluation of the recommended work RVUs. The RUC recommendations on the PE inputs for the new and revised CY 2008 codes were submitted to us as interim recommendations. We have accepted, in the interim, the PE recommendations submitted by the RUC for the codes listed in Table 16: AMA RUC and HCPAC Recommendations and CMS' Decisions for New and Revised 
                        <PRTPAGE P="66372"/>
                        2008 CPT Codes except as noted below in this section. 
                    </P>
                    <HD SOURCE="HD1">CPT Code Series 49450 Through 49465 </HD>
                    <P>In this series of nine G-, J-, and G-J Tubes CPT codes, 49440, 49441, 49442, 49446, 49450, 49451, 49452, 49460 and 49465, we made revisions to the clinical labor time to conform to the RUC-established standard under which the time assigned to any one labor type for the “intra” time, based on the physician's time to perform the procedure, can not exceed 100 percent of the physician time. These revisions affected the service period times for the angio-tech/RT for each code. For each CPT code, the angio-tech/RT time to assist the physician in performing the procedure was allocated at 67 percent of the physician time and the angio-tech/RT time to assist the physician with image acquisition during the procedure was allocated the remaining 33 percent of the physician time. </P>
                    <P>We also made minor revisions to the supply list for this family of codes in order to match the number of requested needles with the number of syringes. We allocated one needle for each saline flush syringe and 1 additional needle to administer the lidocaine. Each needle was assigned the supply category “SC029, needle, 18-27g” to encompass both the 18g and 25g needles requested. In addition, we added a 10-12 ml syringe that could be used to administer the lidocaine. </P>
                    <HD SOURCE="HD1">CPT Code 50593 </HD>
                    <P>We disagreed with the RUC recommended number of renal cryoablation probes typically needed to perform this procedure. Instead of 4 probes, we believe that an average of 2.5 probes is typical to this procedure based on 2005 clinical data (collected at Karmonos Cancer Institute) that was included as an attachment to information provided by the manufacturer. Therefore, we have assigned 2.5 probes for renal cryoablation, at $1,175 each, for CPT 50593. </P>
                    <HD SOURCE="HD1">V. Physician Self-Referral Prohibition: Annual Update to List of CPT/HCPCS Codes </HD>
                    <HD SOURCE="HD2">A. General </HD>
                    <P>Section 1877 of the Act prohibits a physician from referring a Medicare beneficiary for certain designated health services (DHS) to a health care entity with which the physician (or a member of the physician's immediate family) has a financial relationship, unless an exception applies. Section 1877 of the Act also prohibits the DHS entity from submitting claims to Medicare or billing the beneficiary or any other entity for Medicare DHS that are furnished as a result of a prohibited referral. </P>
                    <P>As specified in our regulations at § 411.351, the following services are DHS: </P>
                    <P>• Clinical laboratory services. </P>
                    <P>• Physical therapy, occupational therapy, and speech-language pathology services. </P>
                    <P>• Radiology and certain other imaging services. </P>
                    <P>• Radiation therapy services and supplies. </P>
                    <P>• Durable medical equipment and supplies. </P>
                    <P>• Parenteral and enteral nutrients, equipment, and supplies. </P>
                    <P>• Prosthetics, orthotics, and prosthetic devices and supplies. </P>
                    <P>• Home health services. </P>
                    <P>• Outpatient prescription drugs. </P>
                    <P>• Inpatient and outpatient hospital services. </P>
                    <HD SOURCE="HD2">B. Annual Update to the Code List </HD>
                    <HD SOURCE="HD3">1. Background </HD>
                    <P>In § 411.351, we specify that the entire scope of four DHS categories is defined in a list of CPT/HCPCS codes (the Code List), which is updated annually to account for changes in the most recent CPT and HCPCS publications. The DHS categories defined and updated in this manner are: </P>
                    <P>• Clinical laboratory services. </P>
                    <P>• Physical therapy, occupational therapy, and speech-language pathology services. </P>
                    <P>• Radiology and certain other imaging services. </P>
                    <P>• Radiation therapy services and supplies. </P>
                    <P>The Code List also identifies those items and services that may qualify for either of the following two exceptions to the physician self-referral prohibition: </P>
                    <P>• EPO and other dialysis-related drugs furnished in or by an ESRD facility (§ 411.355(g)). </P>
                    <P>• Preventive screening tests, immunizations or vaccines (§ 411.355(h)). </P>
                    <P>The Code List was last updated in the CY 2007 PFS final rule with comment period (71 FR 69624) and in a subsequent correction notice (72 FR 18909). </P>
                    <HD SOURCE="HD3">2. Response to Comments </HD>
                    <P>We received only one public comment relating to the Code List that became effective January 1, 2007. The commenter was supportive of our additions and deletions. </P>
                    <HD SOURCE="HD3">3. Revisions Effective for 2008 </HD>
                    <P>
                        The updated, comprehensive Code List effective January 1, 2008, appears as Addendum x in this final rule with comment period and is available on our Web site at 
                        <E T="03">http://www.cms.hhs.gov/PhysicianSelfReferral/11_List_of_Codes.asp#TopOfPage.</E>
                    </P>
                    <P>Tables 19 and 20 identify the additions and deletions, respectively, to the comprehensive Code List that was published in Addendum J of the CY 2007 PFS final rule (71 FR 70247 through 70251) and revised in a subsequent correction notice (72 FR 18909). Tables 19 and 20 also identify the additions and deletions to the lists of codes used to identify the items and services that may qualify for the exceptions in § 411.355(g) (regarding EPO and other dialysis-related outpatient prescription drugs furnished in or by an ESRD facility) and § 411.355(h) (regarding preventive screening tests, immunizations and vaccines). </P>
                    <P>The additions and deletions specified in Tables 19 and 20 are necessary to conform the Code List to the most recent publications of CPT and HCPCS and to changes in Medicare payment policies. </P>
                    <P>We will consider comments regarding the codes listed in Tables 19 and 20. Comments will be considered if we receive them by the date specified in the DATES section of this final rule with comment period. We will not consider any comment that advocates a substantive change to any of the DHS defined in § 411.351. </P>
                    <GPOTABLE COLS="02" OPTS="L2,p1,8/9" CDEF="i1,xs60,r30">
                        <TTITLE>
                            Table 19.—Additions to the Physician Self-Referral List of CPT 
                            <SU>1</SU>
                             HCPCS Codes
                        </TTITLE>
                        <BOXHD>
                            <CHED H="1"> </CHED>
                            <CHED H="1"> </CHED>
                        </BOXHD>
                        <ROW EXPSTB="01" RUL="s">
                            <ENT I="21">
                                <E T="02">CLINICAL LABORATORY SERVICES</E>
                            </ENT>
                        </ROW>
                        <ROW RUL="s">
                            <ENT I="22">[no additions]</ENT>
                        </ROW>
                        <ROW EXPSTB="00" EXPSTB1="01" RUL="s">
                            <ENT I="21">
                                <E T="02">PHYSICAL THERAPY, OCCUPATIONAL THERAPY, AND SPEECH-LANGUAGE PATHOLOGY SERVICES</E>
                            </ENT>
                        </ROW>
                        <ROW EXPSTB="00" RUL="s">
                            <ENT I="01">96125</ENT>
                            <ENT>Cognitive test by HC pro.</ENT>
                        </ROW>
                        <ROW EXPSTB="01" RUL="s">
                            <ENT I="21">
                                <E T="02">RADIOLOGY AND CERTAIN OTHER IMAGING SERVICES</E>
                            </ENT>
                        </ROW>
                        <ROW EXPSTB="00">
                            <ENT I="01">75557</ENT>
                            <ENT>Cardiac mri for morph.</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">75558</ENT>
                            <ENT>Cardiac mri flow/velocity.</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">75559</ENT>
                            <ENT>Cardiac mri w/stress img.</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">75560</ENT>
                            <ENT>Cardiac mri flow/vel/stress.</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">75561</ENT>
                            <ENT>Cardiac mri for morph w/dye.</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">75562</ENT>
                            <ENT>Card mri flow/vel w/dye.</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">75563</ENT>
                            <ENT>Card mri w/stress img &amp; dye.</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">75564</ENT>
                            <ENT>Ht mri w/flo/vel/strs &amp; dye.</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">A9501</ENT>
                            <ENT>Technetium TC-99m teboroxime.</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">A9509</ENT>
                            <ENT>Iodine I-123 sod iodide mil.</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">A9569</ENT>
                            <ENT>Technetium TC-99m auto WBC.</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">A9570</ENT>
                            <ENT>Indium In-111 auto WBC.</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">A9571</ENT>
                            <ENT>Indium In-111 auto platelet.</ENT>
                        </ROW>
                        <ROW>
                            <PRTPAGE P="66373"/>
                            <ENT I="01">A9572</ENT>
                            <ENT>Indium In-111 pentetreotide.</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">A9576</ENT>
                            <ENT>Inj prohance multipack.</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">A9577</ENT>
                            <ENT>Inj multihance.</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">A9578</ENT>
                            <ENT>Inj multihance multipack.</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">A9579</ENT>
                            <ENT>Gad-base MR contrast NOS, 1ml.</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">Q9965</ENT>
                            <ENT>LOCM 100-199mg/ml iodine, 1ml.</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">Q9966</ENT>
                            <ENT>LOCM 200-299mg/ml iodine, 1ml.</ENT>
                        </ROW>
                        <ROW RUL="s">
                            <ENT I="01">Q9967</ENT>
                            <ENT>LOCM 300-399mg/ml iodine, 1ml.</ENT>
                        </ROW>
                        <ROW EXPSTB="01" RUL="s">
                            <ENT I="21">
                                <E T="02">RADIATION THERAPY SERVICES AND SUPPLIES</E>
                            </ENT>
                        </ROW>
                        <ROW EXPSTB="00">
                            <ENT I="01">0182T</ENT>
                            <ENT>HDR elect brachytherapy.</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">20555</ENT>
                            <ENT>Place ndl musc/tis for rt.</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">41019</ENT>
                            <ENT>Place needles h&amp;n for rt.</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">55920</ENT>
                            <ENT>Place needles pelvic for rt.</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">C1716</ENT>
                            <ENT>Brachytx source, Gold 198.</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">C1717</ENT>
                            <ENT>Brachytx source, HDR Ir-192.</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">C1719</ENT>
                            <ENT>Brachytx source, Non-HDR Ir-192.</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">C2616</ENT>
                            <ENT>Brachytx source, Yttrium-9.</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">C2634</ENT>
                            <ENT>Brachytx source, HA, I-125.</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">C2635</ENT>
                            <ENT>Brachytx source, HA, P-13.</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">C2636</ENT>
                            <ENT>Brachytx linear source, P-13.</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">C2637</ENT>
                            <ENT>Brachytx, Ytterbium-169.</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">C2638</ENT>
                            <ENT>Brachytx, stranded, I-125.</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">C2639</ENT>
                            <ENT>Brachytx, non-stranded, I-125.</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">C2640</ENT>
                            <ENT>Brachytx, stranded, P-13.</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">C2641</ENT>
                            <ENT>Brachytx, non-stranded, P-13.</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">C2642</ENT>
                            <ENT>Brachytx, stranded, C-131.</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">C2643</ENT>
                            <ENT>Brachytx, non-stranded, C-131.</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">C2698</ENT>
                            <ENT>Brachytx, stranded, NOS.</ENT>
                        </ROW>
                        <ROW RUL="s">
                            <ENT I="01">C2699</ENT>
                            <ENT>Brachytx, non-stranded, NOS.</ENT>
                        </ROW>
                        <ROW EXPSTB="01" RUL="s">
                            <ENT I="21">
                                <E T="02">DRUGS USED BY PATIENTS UNDERGOING DIALYSIS</E>
                            </ENT>
                        </ROW>
                        <ROW RUL="s">
                            <ENT I="22">[no additions]</ENT>
                        </ROW>
                        <ROW EXPSTB="00" EXPSTB1="01" RUL="s">
                            <ENT I="21">
                                <E T="02">PREVENTIVE SCREENING TESTS, IMMUNIZATIONS AND VACCINES</E>
                            </ENT>
                        </ROW>
                        <ROW EXPSTB="00">
                            <ENT I="01">90669</ENT>
                            <ENT>Pneumococcal vacc, ped &lt;5.</ENT>
                        </ROW>
                        <TNOTE>
                            <SU>1</SU>
                             CPT codes and descriptions only are copyright 2007 AMA. All rights are reserved and applicable FARS/DFARS clauses apply.
                        </TNOTE>
                    </GPOTABLE>
                    <GPOTABLE COLS="02" OPTS="L2,p1,8/9,i1" CDEF="xs48,r30">
                        <TTITLE>
                            Table 20.—Deletions to the Physician Self-Referral List of CPT
                            <SU>1</SU>
                            /HCPCS Codes
                        </TTITLE>
                        <BOXHD>
                            <CHED H="1"> </CHED>
                            <CHED H="1"> </CHED>
                        </BOXHD>
                        <ROW EXPSTB="01" RUL="s">
                            <ENT I="21">
                                <E T="02">CLINICAL LABORATORY SERVICES</E>
                            </ENT>
                        </ROW>
                        <ROW RUL="s">
                            <ENT I="22">[no deletions]</ENT>
                        </ROW>
                        <ROW EXPSTB="01" RUL="s">
                            <ENT I="21">
                                <E T="02">PHYSICAL THERAPY, OCCUPATIONAL THERAPY, AND SPEECH-LANGUAGE PATHOLOGY SERVICES</E>
                            </ENT>
                        </ROW>
                        <ROW RUL="s">
                            <ENT I="22">[no deletions]</ENT>
                        </ROW>
                        <ROW EXPSTB="01" RUL="s">
                            <ENT I="21">
                                <E T="02">RADIOLOGY AND CERTAIN OTHER IMAGING SERVICES</E>
                            </ENT>
                        </ROW>
                        <ROW EXPSTB="00">
                            <ENT I="01">75552</ENT>
                            <ENT>Heart mri for morph w/o dye.</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">75553</ENT>
                            <ENT>Heart mri for morph w/dye.</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">75554</ENT>
                            <ENT>Cardiac MRI/function.</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">75555</ENT>
                            <ENT>Cardiac MRI/limited study.</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">78609</ENT>
                            <ENT>Brain imaging (PET).</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">78615</ENT>
                            <ENT>Cerebral vascular flow image.</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">A9565</ENT>
                            <ENT>In111 pentetreotide.</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">Q9945</ENT>
                            <ENT>LOCM≤149mg/ml iodine, 1ml.</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">Q9946</ENT>
                            <ENT>LOCM 150-199mg/ml iodine, 1ml.</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">Q9947</ENT>
                            <ENT>LOCM 200-249mg/ml iodine, 1ml.</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">Q9948</ENT>
                            <ENT>LOCM 250-299mg/ml iodine, 1ml.</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">Q9949</ENT>
                            <ENT>LOCM 300-349mg/ml iodine, 1ml.</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">Q9950</ENT>
                            <ENT>LOCM 350-399mg/ml iodine, 1ml.</ENT>
                        </ROW>
                        <ROW RUL="s">
                            <ENT I="01">Q9952</ENT>
                            <ENT>Inj Gad-base MR contrast, 1ml.</ENT>
                        </ROW>
                        <ROW EXPSTB="01" RUL="s">
                            <ENT I="21">
                                <E T="02">RADIATION THERAPY SERVICES AND SUPPLIES</E>
                            </ENT>
                        </ROW>
                        <ROW RUL="s">
                            <ENT I="22">[no deletions]</ENT>
                        </ROW>
                        <ROW EXPSTB="01" RUL="s">
                            <ENT I="21">
                                <E T="02">DRUGS USED BY PATIENTS UNDERGOING DIALYSIS</E>
                            </ENT>
                        </ROW>
                        <ROW RUL="s">
                            <ENT I="22">[no deletions]</ENT>
                        </ROW>
                        <ROW EXPSTB="01" RUL="s">
                            <ENT I="21">
                                <E T="02">PREVENTIVE SCREENING TESTS, IMMUNIZATIONS AND VACCINES</E>
                            </ENT>
                        </ROW>
                        <ROW>
                            <ENT I="22">[no deletions]</ENT>
                        </ROW>
                        <TNOTE>
                            <SU>1</SU>
                             CPT codes and descriptions only are copyright 2007 AMA. All rights are reserved and applicable FARS/DFARS clauses apply.
                        </TNOTE>
                    </GPOTABLE>
                    <HD SOURCE="HD1">VI. Physician Fee Schedule Update for CY 2008 </HD>
                    <HD SOURCE="HD2">A. Physician Fee Schedule Update </HD>
                    <P>The PFS update is set under a formula specified in section 1848(d)(4) of the Act, as amended by the MIEA-TRHCA. Section 101 of the MIEA-TRHCA provided a 1 year increase in the CY 2007 conversion factor and specified that the conversion factor for CY 2008 must be computed as if the 1-year increase had never applied. Consistent with this requirement, the update for CY 2008 is equal to the product of 1 plus the CY 2007 update (as published in the CY 2007 PFS final rule with comment period (71 FR 69751)), 1 plus the percentage increase in the MEI (divided by 100), and 1 plus the UAF. As stated in the CY 2007 PFS final rule with comment period, if section 101 of the MIEA-TRHCA had not subsequently been enacted, the CY 2007 update would have been −5.0 percent (0.94953). For CY 2008, the MEI is equal to 1.8 percent (1.018). The UAF is −7.0 percent (0.930). The product of the published CY 2007 update (0.94953), MEI (1.018), and the UAF (0.930) equals the CY 2008 update of −10.1 percent (0.89896). </P>
                    <P>Our calculations of these figures are explained in this section. </P>
                    <HD SOURCE="HD2">B. The Percentage Change in the Medicare Economic Index (MEI)</HD>
                    <P>The Medicare Economic Index (MEI) is authorized by section 1842(b)(3) of the Act, which states that prevailing charge levels beginning after June 30, 1973 may not exceed the level from the previous year except to the extent that the Secretary finds, on the basis of appropriate economic index data, that the higher level is justified by year-to-year economic changes. </P>
                    <P>The MEI measures the weighted-average annual price change for various inputs needed to produce physicians' services. The MEI is a fixed-weight input price index, with an adjustment for the change in economy-wide multifactor productivity. This index, which has CY 2000 base year weights, is comprised of two broad categories: (1) Physician's own time; and (2) physician's PE. </P>
                    <P>The physician's own time component represents the net income portion of business receipts and primarily reflects the input of the physician's own time into the production of physicians' services in physicians' offices. This category consists of two subcomponents: (1) Wages and salaries; and (2) fringe benefits. </P>
                    <P>The physician's PE category represents nonphysician inputs used in the production of services in physicians' offices. This category consists of wages and salaries and fringe benefits for nonphysician staff and other nonlabor inputs. The physician's PE component also includes the following categories of nonlabor inputs: Office expense; medical materials and supplies; professional liability insurance; medical equipment; prescription drugs; and other expenses. The components are adjusted to reflect productivity growth in physicians' offices by the 10-year moving average of productivity in the private nonfarm business sector. </P>
                    <P>
                        In the CY 2008 PFS proposed rule (72 FR 38190), we presented a listing of the cost categories with the associated cost weights. We also explained that the Bureau of Labor Statistics (BLS) has discontinued production and publication of the white collar 
                        <PRTPAGE P="66374"/>
                        occupation employment cost index (ECI) series which was used as the price proxy for nonphysician benefits in the MEI. There was no other comparable published series that was a suitable replacement for the white collar benefit ECI. Therefore, a nationally recognized economic and financial forecasting firm, Global Insight, Inc. (GII), and CMS jointly developed a composite series which is composed of four published ECI series and weighted by November 2004 National Industry Specific Occupational Employment and Wage Estimates for NAICS 6211, Office of Physicians. We proposed to replace the ECI white collar benefit series with this composite benefit index effective for the CY 2008 MEI update (See the CY 2008 PFS proposed rule (72 FR 38190) for a more detailed explanation of the specific proposal). In addition, we also published a preliminary estimate of the expected MEI update. 
                    </P>
                    <P>Table 21 presents a listing of the MEI cost categories with associated weights and percent changes for price proxies for the 2008 update. For CY 2008, the increase in the MEI is 1.8 percent, which includes a 1.4 percent productivity offset based on the 10-year moving average of multifactor productivity. This is the result of a 3.7 percent increase in physician's own time and a 2.7 percent increase in physician's PE. Within the physician's PE, the largest increase occurred in prescription drugs, which increased 4.2 percent, and professional and technical wages, which increased 4.0 percent.</P>
                    <GPOTABLE COLS="3" OPTS="L2,i1" CDEF="s100,12,12">
                        <TTITLE>
                            Table 21.—Increase in the Medicare Economic Index Update for CY 2008 
                            <SU>1</SU>
                        </TTITLE>
                        <BOXHD>
                            <CHED H="1">Cost categories and price measures </CHED>
                            <CHED H="1">
                                CY 2000 weights 
                                <SU>2</SU>
                            </CHED>
                            <CHED H="1">
                                CY 2008
                                <LI>percent</LI>
                                <LI>changes </LI>
                            </CHED>
                        </BOXHD>
                        <ROW>
                            <ENT I="01">
                                Medicare Economic Index Total, productivity adjusted 
                                <SU>3</SU>
                                  
                            </ENT>
                            <ENT>N/A </ENT>
                            <ENT>1.8 </ENT>
                        </ROW>
                        <ROW>
                            <ENT I="03">
                                Productivity: 10-year moving average of multifactor productivity, private nonfarm business sector 
                                <E T="51">3 4</E>
                            </ENT>
                            <ENT>N/A </ENT>
                            <ENT>1.4 </ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">
                                Medicare Economic Index Total, without productivity adjustment 
                                <SU>4</SU>
                            </ENT>
                            <ENT>100.000 </ENT>
                            <ENT>3.2 </ENT>
                        </ROW>
                        <ROW>
                            <ENT I="05">
                                1. Physician's Own Time 
                                <SU>5</SU>
                            </ENT>
                            <ENT>52.466 </ENT>
                            <ENT>3.7 </ENT>
                        </ROW>
                        <ROW>
                            <ENT I="07">a. Wages and Salaries: Average Hourly Earnings, private Nonfarm </ENT>
                            <ENT>42.730 </ENT>
                            <ENT>4.0 </ENT>
                        </ROW>
                        <ROW>
                            <ENT I="07">b. Fringe Benefits: Employment Cost Index, benefits, private nonfarm </ENT>
                            <ENT>9.735 </ENT>
                            <ENT>2.7 </ENT>
                        </ROW>
                        <ROW>
                            <ENT I="05">
                                2. Physician's Practice Expense 
                                <SU>5</SU>
                            </ENT>
                            <ENT>47.534 </ENT>
                            <ENT>2.7 </ENT>
                        </ROW>
                        <ROW>
                            <ENT I="07">a. Nonphysician Employee Compensation </ENT>
                            <ENT>18.653 </ENT>
                            <ENT>3.6 </ENT>
                        </ROW>
                        <ROW>
                            <ENT I="09">(1) Wages and Salaries: Employment Cost Index, wages and salaries, weighted by occupation </ENT>
                            <ENT>13.808 </ENT>
                            <ENT>3.6 </ENT>
                        </ROW>
                        <ROW>
                            <ENT I="09">
                                (2) Fringe Benefits: Employment Cost Index, fringe benefits, weighted by occupation 
                                <SU>7</SU>
                            </ENT>
                            <ENT>4.845 </ENT>
                            <ENT>3.7 </ENT>
                        </ROW>
                        <ROW>
                            <ENT I="07">b. Office Expense: Consumer Price Index for Urban Areas (CPI-U), housing </ENT>
                            <ENT>12.209 </ENT>
                            <ENT>3.5 </ENT>
                        </ROW>
                        <ROW>
                            <ENT I="07">c. Drugs and Medical Materials and Supplies </ENT>
                            <ENT>4.319 </ENT>
                            <ENT>2.9 </ENT>
                        </ROW>
                        <ROW>
                            <ENT I="09">(1) Medical Materials and Supplies: Producer Price Index (PPI), surgical appliances and supplies/CPI-U, medical equipment and supplies (equally weighted) </ENT>
                            <ENT>2.011 </ENT>
                            <ENT>1.0 </ENT>
                        </ROW>
                        <ROW>
                            <ENT I="09">(2) Pharmaceuticals: Producer Price Index (PPI ethical prescription drugs) </ENT>
                            <ENT>2.308 </ENT>
                            <ENT>4.2 </ENT>
                        </ROW>
                        <ROW>
                            <ENT I="07">
                                d. Professional Liability Insurance: Professional liability insurance Premiums 
                                <SU>6</SU>
                            </ENT>
                            <ENT>3.865 </ENT>
                            <ENT>−0.8 </ENT>
                        </ROW>
                        <ROW>
                            <ENT I="07">e. Medical Equipment: PPI, medical instruments and equipment </ENT>
                            <ENT>2.055 </ENT>
                            <ENT>−0.4 </ENT>
                        </ROW>
                        <ROW>
                            <ENT I="07">f. Other Expenses </ENT>
                            <ENT>6.433 </ENT>
                            <ENT>2.6 </ENT>
                        </ROW>
                        <TNOTE>
                            <SU>1</SU>
                             The rates of historical change are estimated for the 12-month period ending June 30, 2007, which is the period used for computing the CY 2008 update. The price proxy values are based upon the latest available Bureau of Labor Statistics data as of August 31, 2007. 
                        </TNOTE>
                        <TNOTE>
                            <SU>2</SU>
                             The weights shown for the MEI components are the 2000 base year weights, which may not sum to subtotals or totals because of rounding. The MEI is a fixed weight, Laspeyres-type input price index whose category weights indicate the distribution of expenditures among the inputs to physicians' services for CY 2000. To determine the MEI level for a given year, the price proxy level for each component is multiplied by its 2000 weight. The sum of these products (weights multiplied by the price index levels) over all cost categories yields the composite MEI level for a given year. The annual percent change in the MEI levels is an estimate of price change over time for a fixed market basket of inputs to physicians' services. 
                        </TNOTE>
                        <TNOTE>
                            <SU>3</SU>
                             These numbers may not sum due to rounding and the multiplicative nature of their relationship. 
                        </TNOTE>
                        <TNOTE>
                            <SU>4</SU>
                             On March 23, 2006, Bureau of Labor Statistics introduced a new Multi Factor Productivity (MFP) series based on the 1997 NAICS classification system to replace its SIC based series published until 2005 (the last historical value was for 2002). The new series differs historically from the old MFP series and adds two new historical values through 2004. Therefore, we used the most recently available information (thru CY 2006) to develop the productivity adjustment for the CY 2008 update. 
                        </TNOTE>
                        <TNOTE>
                            <SU>5</SU>
                             The measures of productivity, average hourly earnings, Employment Cost Indexes, as well as the various Producer and CPIs can be found on the BLS Web site at 
                            <E T="03">http://stats.bls.gov.</E>
                        </TNOTE>
                        <TNOTE>
                            <SU>6</SU>
                             Derived from data collected from several major insurers (the latest available historical percent change data are for the period ending second quarter of 2007). 
                        </TNOTE>
                        <TNOTE>
                            <SU>7</SU>
                             In April 2007, with their March 2007 publication, Bureau of Labor Statistics (BLS) discontinued production and publication of the white collar occupation employment cost index (ECI) series. CMS replaced this proxy with a composite benefit series. The historical percent changes for the non physician employee benefits match the BLS white collar benefit series through 2006Q4, and from 2007Q1 forward, the percent changes reflect those of the composite benefit series. For more detail on the composite benefit series see the CY 2008 PFS proposed rule (72 FR 38190). 
                        </TNOTE>
                    </GPOTABLE>
                    <P>
                        <E T="03">Comment:</E>
                         Many commenters proposed that we should reduce the productivity adjustment to the MEI to 0.65 percentage points from the proposed productivity adjustment of 1.5 percentage points. They believe the MEI should be subject to the same productivity adjustment as the recommended productivity adjustment for hospital, hospice, and ambulance care providers, which they state was recommended in the President's Budget proposal. The commenters also note that it is not logical for CMS to believe that physician's productivity is increasing at twice the rate of other health care providers. 
                    </P>
                    <P>
                        <E T="03">Response:</E>
                         We disagree that the productivity adjustment to the MEI should be changed based on the proposals made in the FY 2008 President's Budget.
                        <SU>4</SU>
                        <FTREF/>
                         The MEI has contained a productivity adjustment since its inception in 1973. The rationale for, and technical appropriateness of the current MEI productivity adjustment has been well documented in the 
                        <E T="04">Federal Register</E>
                         (for example, 67 FR 80020 through 80023). Moreover, we recently partnered with 
                        <PRTPAGE P="66375"/>
                        the Assistant Secretary of Planning and Evaluation of the Department of Health and Human Services to sponsor an analysis of physician-specific productivity. The results of this effort were presented at a conference of stakeholders in October 2006. A highly respected panel of experts concluded that the use of the 10-year moving average for private, nonfarm business sector multifactor productivity was not an unreasonable proxy for physician-specific productivity. Papers from this research effort are expected to be published in the forthcoming Winter 2007/2008 edition of the 
                        <E T="03">Health Care Financing Review</E>
                        . We will continue to monitor, on an ongoing basis, the appropriateness of the use of this economy-wide measure of multifactor productivity for purposes of adjusting the MEI. 
                    </P>
                    <FTNT>
                        <P>
                            <SU>4</SU>
                             
                            <E T="03">http://www.whitehouse.gov/omb/budget/fy2008/hhs.html</E>
                            .
                        </P>
                    </FTNT>
                    <P>With respect to historical productivity achievement in other health care sectors, there is comparatively little on this topic in the literature. We intend to continue to research various health-related productivity measures and would welcome the provision of data or completed studies on this topic. </P>
                    <P>
                        <E T="03">Comment:</E>
                         One commenter questioned why other providers receive a 0.65 percent adjustment while physicians face an adjustment of more than twice that amount. 
                    </P>
                    <P>
                        <E T="03">Response:</E>
                         To date, there are no laws in place requiring productivity adjustments for other PPS-reimbursed providers such as hospitals, and skilled nursing facilities. However, the MEI has contained an explicit productivity adjustment since its inception in 1973. The rationale and technical appropriateness of the current MEI productivity adjustment was addressed in the CY 2003 PFS final rule with comment period (67 FR 80019). 
                    </P>
                    <P>
                        <E T="03">Comment:</E>
                         Several commenters requested that we address the broader issue that the MEI only measures changes in the specific types of practice costs that existed in 1973. They note that inputs to the MEI are vastly different now than when the MEI was first developed in the 1970s, and suggest additional inputs may be needed to ensure that the current MEI adequately measures the costs of practicing medicine. 
                    </P>
                    <P>
                        <E T="03">Response:</E>
                         We disagree with the commenters' claim that the MEI only measures changes in specific types of practice costs that existed in 1973. The current MEI is based on costs reported by physicians for the year 2000. The 2000-based cost weights are derived from the 
                        <E T="03">2003 AMA Physician Socioeconomic Characteristics</E>
                         publication (2003 Patient Care Physician Survey data), which measures physicians' earnings and overall PEs for 2000. This is the latest available data on the breakdown of physician expenses. 
                    </P>
                    <P>Although cost weights in the various market baskets do not tend to change dramatically over short periods of time, we do recognize that they can change over long periods of time. We are presently researching alternative data sources for a forthcoming rebasing of the MEI, including the potential use of an AMA-sponsored Physician Practice Information Survey that was fielded in 2007. We have also considered data from the Census Bureau's Business Expenditure Survey (BES). This survey is the most comprehensive source of periodic national industry statistics on major economic inputs by type. Data are published every 5 years for years ending in “2” and “7”. Currently the most recent data is reported for 2002. We compared the cost weights we derived from the 2002 BES data for NAICS 6211, Offices of Physicians and found that the overall cost weights for compensation and all other costs are quite similar to the cost weights for the current MEI market basket as shown in Table 22. We are optimistic that the new data from AMA or the Census Bureau will be sufficiently robust for the purpose of updating the MEI's input cost weights. </P>
                    <GPOTABLE COLS="3" OPTS="L2,i1" CDEF="s30,10,10">
                        <TTITLE>Table 22.—A Comparison of Major Cost Category MEI Market Basket Weights Using AMA and BES Data </TTITLE>
                        <BOXHD>
                            <CHED H="1"> </CHED>
                            <CHED H="1">
                                MB 2000 weights 
                                <LI>(percent)</LI>
                            </CHED>
                            <CHED H="1">
                                2002 BES (excluding capital) 
                                <LI>(percent)</LI>
                            </CHED>
                        </BOXHD>
                        <ROW>
                            <ENT I="01">Compensation </ENT>
                            <ENT>71.2 </ENT>
                            <ENT>73.5 </ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">Other </ENT>
                            <ENT>28.8 </ENT>
                            <ENT>26.5</ENT>
                        </ROW>
                    </GPOTABLE>
                    <P>
                        <E T="03">Comment:</E>
                         Several commenters believe that the MEI does not adequately account for the costs related to the multitude of regulations and requirements that physicians must comply with in their practices. For example, they note that the physician quality reporting initiative (PQRI) has reduced productivity in physician's offices. Similarly, a commenter had concerns that employee wages used in the MEI formula do not capture the wages of highly skilled professionals such as nurse practitioners, physician assistants, certified nurse specialists, nurse midwives, therapists, computer professional, and other types of professional occupations. 
                    </P>
                    <P>
                        <E T="03">Response:</E>
                         The current MEI cost weights are based on input costs reported by physicians for 2000, which would reflect changes in the distributions of the cost weights associated with new government-imposed regulatory requirements up to that point. These cost weights are derived from the 
                        <E T="03">2003 AMA Physician Socioeconomic Characteristics</E>
                         publication (2003 Patient Care Physician Survey data), which measures physicians' earnings and overall PEs for CY 2000. While we understand that more recent data would better measure relative input costs, we presently lack a viable alternative data source with which to compute new cost weights. The data used as the basis for the current MEI market basket cost weights represent the latest available data on physician expenses. As stated previously, we are awaiting the data from the 2007 AMA Physician Practice Information Survey and are hopeful that this source will be sufficiently robust for use in rebasing the cost weights found in the MEI. We would expect that any relative cost changes related to regulatory changes would be reflected in this new data. 
                    </P>
                    <P>
                        <E T="03">Comment:</E>
                         One commenter suggested we should discontinue use of the MEI to measure physician input price pressures and switch to the same market basket update used by the hospital outpatient prospective payment system (OPPS). 
                    </P>
                    <P>
                        <E T="03">Response:</E>
                         We disagree with the commenter that physicians and outpatient hospital departments face the same input costs. 
                    </P>
                    <P>The MEI reflects the cost structure and price changes associated with the inputs used in furnishing physicians' services while the hospital market basket reflects the cost structure and price changes associated with the inputs used in providing hospital services. </P>
                    <P>
                        <E T="03">Comment:</E>
                         One commenter noted that input expenses for recruiting and employing trained personnel and other PEs in the physician's office are identical to those in a hospital. 
                    </P>
                    <P>
                        <E T="03">Response:</E>
                         The expenses for trained personnel are captured in the PE portion of the MEI. These PE cost weights are derived from the 
                        <E T="03">2003 AMA Physician Socioeconomic Characteristics</E>
                         publication (2003 Patient Care Physician Survey data), which measures physicians' earnings and overall PEs for CY 2000. As indicated above in this section, while we understand that more recent data would better measure relative input costs, we presently lack a viable alternative data source with which to compute new cost weights. The data used as the basis for the current MEI market basket cost weights represent the latest available data on physician expenses. We are awaiting the 
                        <PRTPAGE P="66376"/>
                        data from the 2007 AMA Physician Practice Information Survey and are hopeful that this source will be sufficiently robust for use in rebasing the cost weights found in the MEI. We would expect that any relative cost changes related to PE costs would be reflected in this new data. 
                    </P>
                    <P>
                        <E T="03">Comment:</E>
                         One commenter disagreed with the price proxy used for office expenses in the MEI noting that the growth in office rents differ from apartment rents. The commenter also suggested that we get data from a contractor comparing the cost of building medical office space to that of residential living space. 
                    </P>
                    <P>
                        <E T="03">Response:</E>
                         We agree that the construction costs of a physician's office differ from the construction costs of a residential dwelling; however, the cost category for office expenses is not designed to measure the changes in initial construction costs. Instead, we attempt to measure the rate of price changes related to a monthly office expense payment. The majority of monthly office expenses are related to rent or mortgage for commercial space. As we are not aware of a publicly-available proxy that measures the price changes in rental costs of commercial space, we use what we believe to be the best, technically appropriate alternative; the consumer price index (CPI) for housing. Other major office expenses, such as medical equipment, are broken out in greater detail. Once data is available for the next rebasing of the MEI, we will explore the feasibility of breaking office expenses into more comprehensive cost categories. 
                    </P>
                    <P>
                        <E T="03">Comment:</E>
                         One commenter has concerns that the forecasts of the MEI have been and continue to be declining (from over 3 percent to below 2 percent) for the foreseeable future. The commenter would like for CMS to examine in more detail the assumptions of the price proxy forecasts produced by Global Insight Inc. (GII). 
                    </P>
                    <P>
                        <E T="03">Response:</E>
                         It is important to note that the MEI update is based on historical data rather than on forecasted data. For example, the CY 2008 update is based on the actual measured price inflation through the second quarter of 2007. Since the MEI update is based on historical data, not on a forecast, the concern that GII's work does not involve forecasting the price proxies for compensation and PEs accurately is not relevant. Table 23 shows the MEI updates for the past 5 years and the current CY 2008 update. While the MEI update for CY 2003 through CY 2006 was closer to 3.0 percent, the MEI update for CY 2007 and CY 2008 is closer to 2.0 percent. These lower updates are not, however, a function of an incorrect forecast. The recent lower overall MEI updates are a function of both a deceleration in input price pressures and relatively higher gains in multifactor productivity. 
                    </P>
                    <GPOTABLE COLS="4" OPTS="L2,i1" CDEF="s100,12,12,12">
                        <TTITLE>Table 23.—MEI Updates for the Past 5 Years and the Current CY 2008 Update * </TTITLE>
                        <BOXHD>
                            <CHED H="1">MEI final updates </CHED>
                            <CHED H="1">Adjusted </CHED>
                            <CHED H="1">Unadjusted </CHED>
                            <CHED H="1">Productivity </CHED>
                        </BOXHD>
                        <ROW>
                            <ENT I="01">CY 2003 </ENT>
                            <ENT>3.0 </ENT>
                            <ENT>3.8 </ENT>
                            <ENT>0.8 </ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">CY 2004 </ENT>
                            <ENT>2.9 </ENT>
                            <ENT>3.8 </ENT>
                            <ENT>0.9 </ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">CY 2005 </ENT>
                            <ENT>3.1 </ENT>
                            <ENT>4.0 </ENT>
                            <ENT>0.9 </ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">CY 2006 </ENT>
                            <ENT>2.8 </ENT>
                            <ENT>3.8 </ENT>
                            <ENT>1.0 </ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">CY 2007 </ENT>
                            <ENT>2.1 </ENT>
                            <ENT>3.5 </ENT>
                            <ENT>1.3 </ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">CY 2008 </ENT>
                            <ENT>1.8 </ENT>
                            <ENT>3.2 </ENT>
                            <ENT>1.4 </ENT>
                        </ROW>
                        <TNOTE>* Prior to the update for CY 2003 the MEI was adjusted for Labor productivity rather than by private non-farm multifactor productivity. </TNOTE>
                    </GPOTABLE>
                    <P>
                        <E T="03">Comment:</E>
                         One commenter stated that the only solution the commenter would support at this time would be a nationwide legislative solution that would provide additional funding for fair and equitable payment to Medicare participating physicians in 
                        <E T="03">every</E>
                         State. 
                    </P>
                    <P>
                        <E T="03">Response:</E>
                         We do not have the administrative authority to make such a legislative change. More so, this comment is beyond the scope of the MEI proposals of the CY 2008 PFS proposed rule. 
                    </P>
                    <HD SOURCE="HD2">C. The Update Adjustment Factor (UAF) </HD>
                    <P>Section 1848(d) of the Act provides that the PFS update is equal to the product of the MEI and the UAF. The UAF is applied to make actual and target expenditures (referred to in the statute as “allowed expenditures”) equal. Allowed expenditures are equal to actual expenditures in a base period updated each year by the sustainable growth rate (SGR). The SGR sets the annual rate of growth in allowed expenditures and is determined by a formula specified in section 1848(f) of the Act. </P>
                    <P>Section 101 of the MIEA TRHCA provided a 1 year increase in the CY 2007 conversion factor. The provision specified that the CF for CY 2008 must be computed as if the 1 year increase for CY 2007 had never applied. </P>
                    <HD SOURCE="HD3">1. Calculation Under Current Law </HD>
                    <P>Under section 1848(d)(4)(B) of the Act, the UAF for a year beginning with CY 2001 is equal to the sum of the following— </P>
                    <P>
                        • 
                        <E T="03">Prior Year Adjustment Component</E>
                        . An amount determined by— 
                    </P>
                    <P>+ Computing the difference (which may be positive or negative) between the amount of the allowed expenditures for physicians' services for the prior year (the year prior to the year for which the update is being determined) and the amount of the actual expenditures for those services for that year; </P>
                    <P>+ Dividing that difference by the amount of the actual expenditures for those services for that year; and </P>
                    <P>+ Multiplying that quotient by 0.75. </P>
                    <P>
                        • 
                        <E T="03">Cumulative Adjustment Component</E>
                        . An amount determined by— 
                    </P>
                    <P>+ Computing the difference (which may be positive or negative) between the amount of the allowed expenditures for physicians' services from April 1, 1996, through the end of the prior year and the amount of the actual expenditures for those services during that period; </P>
                    <P>+ Dividing that difference by actual expenditures for those services for the prior year as increased by the SGR for the year for which the UAF is to be determined; and </P>
                    <P>+ Multiplying that quotient by 0.33. </P>
                    <P>
                        Section 1848(d)(4)(E) of the Act requires the Secretary to recalculate allowed expenditures consistent with section 1848(f)(3) of the Act. Section 1848(f)(3) specifies that the SGR (and, in turn, allowed expenditures) for the upcoming CY (CY 2008 in this case), the current CY (that is, CY 2007) and the preceding CY (that is, CY 2006) are to be determined on the basis of the best data available as of September 1 of the current year. Allowed expenditures for a year are initially estimated and subsequently revised twice. The second revision occurs after the CY has ended 
                        <PRTPAGE P="66377"/>
                        (that is, we are making the final revision to 2006 allowed expenditures in this final rule with comment). Once the SGR and allowed expenditures for a year have been revised twice, they are final. 
                    </P>
                    <P>Table 24 shows annual and cumulative allowed and actual expenditures for physicians' services from April 1, 1996 through the end of the current CY, including the short periods in 1999 when we transitioned to a CY system. Also shown is the SGR corresponding with each period. The calculation of the SGR is discussed in detail below in this section. </P>
                    <GPOTABLE COLS="6" OPTS="L2,i1" CDEF="s50,14,14,14,14,xls60">
                        <TTITLE>Table 24.—Annual and Cumulative Allowed and Actual Expenditures for Physicians' Services From April 1, 1996 Through the End of the Current Calendar Year </TTITLE>
                        <BOXHD>
                            <CHED H="1">Period </CHED>
                            <CHED H="1">
                                Annual
                                <LI>allowed </LI>
                                <LI>expenditures </LI>
                                <LI>($ in billions) </LI>
                            </CHED>
                            <CHED H="1">
                                Annual 
                                <LI>actual</LI>
                                <LI>expenditures </LI>
                                <LI>($ in billions) </LI>
                            </CHED>
                            <CHED H="1">
                                Cumulative 
                                <LI>allowed </LI>
                                <LI>expenditures </LI>
                                <LI>($ in billions) </LI>
                            </CHED>
                            <CHED H="1">
                                Cumulative 
                                <LI>actual </LI>
                                <LI>expenditures </LI>
                                <LI>($ in billions) </LI>
                            </CHED>
                            <CHED H="1">FY/CY SGR </CHED>
                        </BOXHD>
                        <ROW>
                            <ENT I="01">4/1/96-3/31/97 </ENT>
                            <ENT>
                                <SU>1</SU>
                                 $48.9 
                            </ENT>
                            <ENT>$48.9 </ENT>
                            <ENT>$48.9 </ENT>
                            <ENT>$48.9 </ENT>
                            <ENT>N/A </ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">4/1/97-3/31/98 </ENT>
                            <ENT>50.5 </ENT>
                            <ENT>49.4 </ENT>
                            <ENT>99.4 </ENT>
                            <ENT>98.4 </ENT>
                            <ENT>FY 1998=3.2% </ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">4/1/98-3/31/99 </ENT>
                            <ENT>52.6 </ENT>
                            <ENT>50.5 </ENT>
                            <ENT>152.0 </ENT>
                            <ENT>148.9 </ENT>
                            <ENT>FY 1999=4.2% </ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">1/1/99-3/31/99 </ENT>
                            <ENT>13.3 </ENT>
                            <ENT>13.1 </ENT>
                            <ENT>
                                (
                                <SU>2</SU>
                                ) 
                            </ENT>
                            <ENT>148.9 </ENT>
                            <ENT>FY 1999=4.2% </ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">4/1/99-12/31/99 </ENT>
                            <ENT>42.1 </ENT>
                            <ENT>39.5 </ENT>
                            <ENT>
                                (
                                <SU>3</SU>
                                ) 
                            </ENT>
                            <ENT>188.4 </ENT>
                            <ENT>FY 2000=6.9% </ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">1/1/99-12/31/99 </ENT>
                            <ENT>55.3 </ENT>
                            <ENT>52.6 </ENT>
                            <ENT>194.0 </ENT>
                            <ENT>188.4 </ENT>
                            <ENT>FY 1999/2000 </ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">1/1/00-12/31/00 </ENT>
                            <ENT>59.3 </ENT>
                            <ENT>58.1 </ENT>
                            <ENT>253.4 </ENT>
                            <ENT>246.5 </ENT>
                            <ENT>CY 2000=7.3% </ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">1/1/01-12/31/01 </ENT>
                            <ENT>62.0 </ENT>
                            <ENT>66.3 </ENT>
                            <ENT>315.4 </ENT>
                            <ENT>312.8 </ENT>
                            <ENT>CY 2001=4.5% </ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">1/1/02-12/31/02 </ENT>
                            <ENT>67.2 </ENT>
                            <ENT>70.9 </ENT>
                            <ENT>382.6 </ENT>
                            <ENT>383.7 </ENT>
                            <ENT>CY 2002=8.3% </ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">1/1/03-12/31/03 </ENT>
                            <ENT>72.1 </ENT>
                            <ENT>78.2 </ENT>
                            <ENT>454.6 </ENT>
                            <ENT>461.9 </ENT>
                            <ENT>CY 2003=7.3% </ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">1/1/04-12/31/04 </ENT>
                            <ENT>76.8 </ENT>
                            <ENT>87.1 </ENT>
                            <ENT>531.5 </ENT>
                            <ENT>549.0 </ENT>
                            <ENT>CY 2004=6.6% </ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">1/1/05-12/31/05 </ENT>
                            <ENT>80.1 </ENT>
                            <ENT>91.8 </ENT>
                            <ENT>611.5 </ENT>
                            <ENT>640.8 </ENT>
                            <ENT>CY 2005=4.2% </ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">1/1/06-12/31/06 </ENT>
                            <ENT>81.3 </ENT>
                            <ENT>93.4 </ENT>
                            <ENT>692.8 </ENT>
                            <ENT>734.2 </ENT>
                            <ENT>CY 2006=1.5% </ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">1/1/07-12/31/07 </ENT>
                            <ENT>83.9 </ENT>
                            <ENT>94.6 </ENT>
                            <ENT>776.6 </ENT>
                            <ENT>828.8 </ENT>
                            <ENT>CY 2007=3.2% </ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">1/1/08-12/31/08 </ENT>
                            <ENT>83.8 </ENT>
                            <ENT>NA </ENT>
                            <ENT>860.4 </ENT>
                            <ENT>NA </ENT>
                            <ENT>CY 2008= 0.1% </ENT>
                        </ROW>
                        <TNOTE>
                            <SU>1</SU>
                             Allowed expenditures in the first year (April 1, 1996-March 31, 1997) are equal to actual expenditures. All subsequent figures are equal to quarterly allowed expenditure figures increased by the applicable SGR. Cumulative allowed expenditures are equal to the sum of annual allowed expenditures. We provide more detailed quarterly allowed and actual expenditure data on our Web site at the following address: 
                            <E T="03">http://www.cms.hhs.gov/SustainableGRatesConFact/</E>
                            . We expect to update the Web site with the most current information later this month. 
                        </TNOTE>
                        <TNOTE>
                            <SU>2</SU>
                             Allowed expenditures for the first quarter of 1999 are based on the FY 1999 SGR. 
                        </TNOTE>
                        <TNOTE>
                            <SU>3</SU>
                             Allowed expenditures for the last three quarters of 1999 are based on the FY 2000 SGR. 
                        </TNOTE>
                    </GPOTABLE>
                    <P>Consistent with section 1848(d)(4)(E) of the Act, Table 24 includes our final revision of allowed expenditures for CY 2006, a recalculation of allowed expenditures for CY 2007, and our initial estimate of allowed expenditures for CY 2008. To determine the UAF for CY 2008, the statute requires that we use allowed and actual expenditures from April 1, 1996 through December 31, 2007 and the CY 2008 SGR. Consistent with section 1848(d)(4)(E) of the Act, we will be making revisions to the CY 2007 and CY 2008 SGRs and CY 2007 and CY 2008 allowed expenditures. Because we have incomplete actual expenditure data for CY 2007, we are using an estimate for this period. Any difference between current estimates and final figures will be taken into account in determining the UAF for future years. </P>
                    <P>We are using figures from Table 24 in the following statutory formula: </P>
                    <MATH SPAN="3" DEEP="30">
                        <MID>ER27NO07.000</MID>
                    </MATH>
                    <EXTRACT>
                        <FP SOURCE="FP-2">
                            UAF
                            <E T="52">08</E>
                             = Update Adjustment Factor for CY 2008 = −26.7 percent 
                        </FP>
                        <FP SOURCE="FP-2">
                            Target
                            <E T="52">07</E>
                             = Allowed Expenditures for CY 2007 = $83.9 billion 
                        </FP>
                        <FP SOURCE="FP-2">
                            Actual
                            <E T="52">07</E>
                             = Estimated Actual Expenditures for CY 2007 = $94.6 billion 
                        </FP>
                        <FP SOURCE="FP-2">
                            Target 
                            <E T="52">4/96-12/07</E>
                             = Allowed Expenditures from 4/1/1996-12/31/2007 = $776.6 billion 
                        </FP>
                        <FP SOURCE="FP-2">
                            Actual 
                            <E T="52">4/96-12/07</E>
                             = Estimated Actual Expenditures from 4/1/1996-12/31/2007 = $828.8 billion 
                        </FP>
                        <FP SOURCE="FP-2">
                            SGR
                            <E T="52">08</E>
                             = −0.1 percent (0.999) 
                        </FP>
                    </EXTRACT>
                    <MATH SPAN="3" DEEP="28">
                        <MID>ER27NO07.001</MID>
                    </MATH>
                    <P>Section 1848(d)(4)(D) of the Act indicates that the UAF determined under section 1848(d)(4)(B) of the Act for a year may not be less than −0.070 or greater than 0.03. Since −0.267 is less than −0.070, the UAF for CY 2008 will be −0.070. </P>
                    <P>Section 1848(d)(4)(A)(ii) of the Act indicates that 1.0 should be added to the UAF determined under section 1848(d)(4)(B) of the Act. Thus, adding 1.0 to −0.070 makes the UAF equal to 0.930. </P>
                    <HD SOURCE="HD1">VII. Allowed Expenditures for Physicians' Services and the Sustainable Growth Rate </HD>
                    <HD SOURCE="HD2">A. Medicare Sustainable Growth Rate </HD>
                    <P>
                        The SGR is an annual growth rate that applies to physicians’ services paid by Medicare. The use of the SGR is intended to control growth in aggregate Medicare expenditures for physicians' 
                        <PRTPAGE P="66378"/>
                        services. Payments for services are not withheld if the percentage increase in actual expenditures exceeds the SGR. Rather, the PFS update, as specified in section 1848(d)(4) of the Act, is adjusted based on a comparison of allowed expenditures (determined using the SGR) and actual expenditures. If actual expenditures exceed allowed expenditures, the update is reduced. If actual expenditures are less than allowed expenditures, the update is increased. 
                    </P>
                    <P>Section 1848(f)(2) of the Act specifies that the SGR for a year (beginning with CY 2001) is equal to the product of the following four factors: </P>
                    <P>(1) The estimated change in fees for physicians' services; </P>
                    <P>(2) The estimated change in the average number of Medicare fee-for-service beneficiaries; </P>
                    <P>(3) The estimated projected growth in real GDP per capita; and </P>
                    <P>(4) The estimated change in expenditures due to changes in statute or regulations. </P>
                    <P>
                        In general, section 1848(f)(3) of the Act requires us to publish SGRs for 3 different time periods, no later than November 1 of each year, using the best data available as of September 1 of each year. Under section 1848(f)(3)(C)(i) of the Act, the SGR is estimated and subsequently revised twice (beginning with the FY and CY 2000 SGRs) based on later data. (The Act also provides for adjustments to be made to the SGRs for FY 1998 and FY 1999. See the February 28, 2003 
                        <E T="04">Federal Register</E>
                         (68 FR 9567) for a discussion of these SGRs). Under section 1848(f)(3)(C)(ii) of the Act, there are no further revisions to the SGR once it has been estimated and subsequently revised in each of the 2 years following the preliminary estimate. In this final rule with comment, we are making our preliminary estimate of the CY 2008 SGR, a revision to the CY 2007 SGR, and our final revision to the CY 2006 SGR. 
                    </P>
                    <HD SOURCE="HD2">B. Physicians' Services </HD>
                    <P>
                        Section 1848(f)(4)(A) of the Act defines the scope of physicians' services covered by the SGR. The statute indicates that “the term physicians' services includes other items and services (such as clinical diagnostic laboratory tests and radiology services), specified by the Secretary, that are commonly performed or furnished by a physician or in a physician's office, but does not include services furnished to a Medicare+Choice plan enrollee.” We published a definition of physicians' services for use in the SGR in the November 1, 2001 
                        <E T="04">Federal Register</E>
                         (66 FR 55316). We defined physicians' services to include many of the medical and other health services listed in section 1861(s) of the Act. For purposes of determining allowed expenditures, actual expenditures, and SGRs, we have specified that physicians' services include the following medical and other health services if bills for the items and services are processed and paid by Medicare carriers (and those paid through intermediaries where specified): 
                    </P>
                    <P>• Physicians' services. </P>
                    <P>• Services and supplies furnished incident to physicians' services. </P>
                    <P>• Outpatient physical therapy services and outpatient occupational therapy services. </P>
                    <P>• Antigens prepared by, or under the direct supervision of, a physician. </P>
                    <P>• Services of PAs, certified registered nurse anesthetists, certified nurse midwives, clinical psychologists, clinical social workers, NPs, and certified nurse specialists. </P>
                    <P>• Screening tests for prostate cancer, colorectal cancer, and glaucoma. </P>
                    <P>• Screening mammography, screening pap smears, and screening pelvic exams. </P>
                    <P>• Diabetes outpatient self-management training (DSMT) services. </P>
                    <P>• MNT services. </P>
                    <P>• Diagnostic x-ray tests, diagnostic laboratory tests, and other diagnostic tests (including outpatient diagnostic laboratory tests paid through intermediaries). </P>
                    <P>• X-ray, radium, and radioactive isotope therapy. </P>
                    <P>• Surgical dressings, splints, casts, and other devices used for the reduction of fractures and dislocations. </P>
                    <P>• Bone mass measurements. </P>
                    <P>• An initial preventive physical exam. </P>
                    <P>• Cardiovascular screening blood tests. </P>
                    <P>• Diabetes screening tests. </P>
                    <P>• Telehealth services. </P>
                    <P>• Physician work and resources to establish and document the need for a power mobility device (70 FR 50940). </P>
                    <P>Telehealth services and the power mobility device related services were added because they meet the statutory criteria for services to be included in the SGR (that is, these services are commonly performed or furnished by a physician or in a physician's office) (70 FR 70305). </P>
                    <HD SOURCE="HD2">Summary of Comments on the Physician Update and the SGR </HD>
                    <P>We appreciate the comments we received expressing concern about the negative update for CY 2008 and the SGR formula. These comments and our responses are summarized here. </P>
                    <P>
                        <E T="03">Comment:</E>
                         The 2007 Medicare Trustees Report projected an approximate 10 percent reduction in payment for physicians' services in CY 2008 and about a 5 percent reduction in each subsequent year through CY 2016. The cumulative impact of the projected reductions from CY 2008 to CY 2016 is estimated to be about −40 percent. In contrast, the MEI increase over this same period is projected to be about 15 percent. 
                    </P>
                    <P>Commenters noted that Medicare reimbursement does not reflect the actual costs of delivering services to Medicare beneficiaries. The commenters stated the reimbursement system has been unstable, and physicians cannot plan for the future in an unpredictable reimbursement environment that fails to keep pace with the costs of labor and supplies. Commenters also stated that practitioners unable to absorb the sustained losses will refuse or limit Medicare patients, resulting in reduced access to care. Commenters believe that beneficiaries will be forced to seek care in inpatient settings, which will be more costly for Medicare, less efficient in delivering care, and yield worse health outcomes for beneficiaries. </P>
                    <P>Commenters recommended that the SGR be replaced with a more equitable and sustainable formula, such as an appropriate inflation rate linked to changes in the actual costs of medical practice. Many commenters suggested the MEI as an appropriate measure. Commenters requested that we assume the leadership in pushing the Congress to enact legislation preventing a negative update for CY 2008, and to replace the SGR with a more sustainable system. </P>
                    <P>
                        <E T="03">Response:</E>
                         We understand the potential implications of more than 9 years of negative physician updates. We remain concerned regarding these trends, and we are closely monitoring physicians' participation in the Medicare program, as well as beneficiaries' access to care. 
                    </P>
                    <P>
                        It is a top priority at CMS to transform Medicare from a passive payor to an active purchaser of high quality, efficient health care services. We are studying and implementing value based purchasing initiatives for Medicare payment systems, including physicians' services. In addition, the FY 2008 President's Budget supports budget neutral physician payment reform and states that “an important component of improving quality is encouraging more efficient and high-quality physician services.” (For further discussion of the President's FY 2008 Budget initiatives to improve the quality, efficiency and transparency of health care, see 
                        <E T="03">http://www.whitehouse.gov/omb/budget/fy2008/hhs.html</E>
                        .) 
                        <PRTPAGE P="66379"/>
                    </P>
                    <P>Ultimately, the formula for the SGR and the physician update are dictated by statute. We are required to follow this methodology when calculating the payment rates under the PFS. We look forward to working with the Congress, the physician community, and other interested parties as we continue to analyze appropriate alternatives to the current system that could ensure appropriate payments while promoting high quality care, without increasing Medicare costs. </P>
                    <P>
                        <E T="03">Comment:</E>
                         Commenters noted that only physicians and other practitioners under the PFS face steep cuts under the SGR formula. The commenters also noted that other health care providers have payment updates that reflect the cost of inflation. Further, the commenters stated the approximately 10 percent cut in payment rates is in stark contrast to providers enrolled in Medicare Advantage (MA) plans, who are paid on average 112 percent above the cost of traditional Medicare. 
                    </P>
                    <P>
                        <E T="03">Response:</E>
                         As noted previously, the formula for the SGR and the physician update are dictated by statute. We are required to follow this methodology when calculating the payment rates under the PFS. Other Medicare payment systems have their own update formulas. 
                    </P>
                    <P>
                        <E T="03">Comment:</E>
                         Many commenters requested that we use our administrative authority to reduce the negative physician update for CY 2008. Many commenters stated that we are authorized to remove the cost of Medicare-covered physician-administered drugs from the SGR on a retrospective basis. They stated that we must also adjust the SGR target to reflect the impact of National and Local Coverage Decisions on physician spending. Commenters noted that the current formula does not account for costs and savings associated with new technologies. The commenters stated that if we make such administrative changes now, then the cost of legislation revising the payment methodology for physicians' services will drop, and the likelihood of Congressional action to fix the SGR permanently will increase. Commenters expressed frustration that these administrative adjustments have been requested numerous times, yet we have never implemented the changes. 
                    </P>
                    <P>
                        <E T="03">Response:</E>
                         We indicated in the past (most recently in the CY 2007 PFS final rule with comment period (71 FR 69756)) that many of these administrative changes are statutorily difficult, and according to our current estimates, making such changes would not provide relief from the projected negative updates for the next several years. As indicated above in this section, we are working with the Congress and health professional organizations on potential reforms that would improve the effectiveness of the payment methodology for physicians without increasing overall Medicare costs. 
                    </P>
                    <P>
                        <E T="03">Comment:</E>
                         Commenters noted that payment updates under the SGR are tied to the gross domestic product (GDP), which bears little relationship to Medicare beneficiaries’ health care needs or physician practice costs. Commenters noted that medical needs of individual patients are not related to the growth of the overall economy, and beneficiaries’ medical needs do not decline during economic downturns. Commenters stated that MEI is a better reflection than GDP of the growth in health care costs. 
                    </P>
                    <P>
                        <E T="03">Response:</E>
                         As discussed in the CY 2007 PFS final rule with comment period (71 FR 69756), the percentage change in the MEI is one of the key components used to update the PFS CF. GDP is a general measure of economic growth. It is not intended to reflect factors specific to operating a medical practice because these factors are captured in the MEI. The statute requires that GDP be used as a component of the SGR, which is then used to calculate the target level of expenditures. Although both MEI and GDP are factors that affect the calculation of the CF, the MEI has a more direct and greater impact on the physician update than GDP. 
                    </P>
                    <P>
                        <E T="03">Comment:</E>
                         Commenters stated that additional funds need to be added to the SGR allowed expenditures for all the ancillary costs associated with new benefits. New benefits adjust the target, but they generate other services whose costs are not added to the targeted allowed expenditures. 
                    </P>
                    <P>
                        <E T="03">Response:</E>
                         As discussed in the CY 2007 PFS final rule with comment period (71 FR 69756 through 69757), our estimate of changes in expenditures arising from changes in laws and regulations includes induced spending impacts, when applicable and material. Our estimate of the additional expenditures associated with any new benefit, like all of the figures used to determine a particular year's SGR, is an estimate that will be revised based on subsequent data. A 2-year look back window allows adjustments to the estimates to reflect actual impacts. Any differences between these estimates and the actual measurement of these figures will be included in future revisions of the SGR and allowed expenditures and incorporated into subsequent PFS updates. (See below in this section for a discussion of all the new benefits that were considered in estimating the change in expenditures due to changes in law and regulation in 2006, 2007, and 2008.) 
                    </P>
                    <HD SOURCE="HD2">C. Preliminary Estimate of the SGR for 2008 </HD>
                    <P>Our preliminary estimate of the CY 2008 SGR is −0.1 percent. We first estimated the CY 2008 SGR in March 2007, and made the estimate available to the MedPAC and on our Web site. Table 25 shows the March 2007 estimate and our current estimates of the factors included in the CY 2008 SGR. </P>
                    <GPOTABLE COLS="03" OPTS="L2,i1" CDEF="s50,r75,xs100">
                        <TTITLE>Table 25.—2008 SGR Calculation </TTITLE>
                        <BOXHD>
                            <CHED H="1">Statutory factors </CHED>
                            <CHED H="1">March estimate </CHED>
                            <CHED H="1">Current estimate </CHED>
                        </BOXHD>
                        <ROW>
                            <ENT I="01">Fees </ENT>
                            <ENT>2.0 percent (1.020) </ENT>
                            <ENT>1.9 percent (1.019).</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">Enrollment </ENT>
                            <ENT>−0.2 percent (0.998) </ENT>
                            <ENT>−0.7 percent (0.993).</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">Real Per Capita GDP</ENT>
                            <ENT>1.9 percent (1.019)</ENT>
                            <ENT>1.7 percent (1.017). </ENT>
                        </ROW>
                        <ROW RUL="n,s">
                            <ENT I="01">Law and Regulation</ENT>
                            <ENT>−1.5 percent (0.985)</ENT>
                            <ENT>−2.9 percent (0.971). </ENT>
                        </ROW>
                        <ROW>
                            <ENT I="03">Total </ENT>
                            <ENT>2.2 percent (1.022) </ENT>
                            <ENT>−0.1 percent (0.999).</ENT>
                        </ROW>
                        <TNOTE>
                            <E T="02">Note:</E>
                             Consistent with section 1848(f)(2) of the Act, the statutory factors are multiplied, not added, to produce the total (that is, 1.019 × 0.993 × 1.017 × 0.971 = 0.999). A more detailed explanation of each figure is provided in section VII.F.1 of this preamble.
                        </TNOTE>
                    </GPOTABLE>
                    <PRTPAGE P="66380"/>
                    <HD SOURCE="HD2">D. Revised Sustainable Growth Rate for 2007 </HD>
                    <P>Our current estimate of the CY 2007 SGR is 3.2 percent. Table 26 shows our preliminary estimate of the CY 2007 SGR that was published in the CY 2007 PFS final rule with comment period (71 FR 69757) and our current estimate. </P>
                    <GPOTABLE COLS="03" OPTS="L2,i1" CDEF="s100,xs100,xs100">
                        <TTITLE>Table 26.—2007 SGR Calculation </TTITLE>
                        <BOXHD>
                            <CHED H="1">Statutory factors </CHED>
                            <CHED H="1">Estimate from CY 2006 final rule </CHED>
                            <CHED H="1">Current estimate </CHED>
                        </BOXHD>
                        <ROW>
                            <ENT I="01">Fees </ENT>
                            <ENT>2.2 percent (1.022) </ENT>
                            <ENT>1.9 percent (1.019). </ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">Enrollment </ENT>
                            <ENT>−0.9 percent (0.991) </ENT>
                            <ENT>−2.6 percent (0.974). </ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">Real Per Capita GDP </ENT>
                            <ENT>2.0 percent (1.020) </ENT>
                            <ENT>1.9 percent (1.019). </ENT>
                        </ROW>
                        <ROW RUL="n,s">
                            <ENT I="01">Law and Regulation </ENT>
                            <ENT>−1.5 percent (0.985) </ENT>
                            <ENT>2.0 percent (1.020). </ENT>
                        </ROW>
                        <ROW>
                            <ENT I="03">Total </ENT>
                            <ENT>1.8 percent (1.018) </ENT>
                            <ENT>3.2 percent (1.032). </ENT>
                        </ROW>
                    </GPOTABLE>
                    <P>A more detailed explanation of each figure is provided in section VIII.F.2 of this preamble. </P>
                    <HD SOURCE="HD2">E. Final Sustainable Growth Rate for 2006 </HD>
                    <P>The SGR for 2006 is 1.5 percent. Table 27 shows our preliminary estimate of the 2006 SGR from the CY 2006 PFS final rule with comment period (70 FR 70309), our revised estimate from the CY 2007 PFS final rule with comment period (71 FR 69757) and the final figures determined using the best available data as of September 1, 2007. </P>
                    <GPOTABLE COLS="04" OPTS="L2,i1" CDEF="s50,xs100,xs100,xs100">
                        <TTITLE>Table 27.—2006 SGR Calculation </TTITLE>
                        <BOXHD>
                            <CHED H="1">Statutory factors </CHED>
                            <CHED H="1">Estimate from CY 2006 final rule </CHED>
                            <CHED H="1">Estimate from CY 2007 final rule </CHED>
                            <CHED H="1">Final</CHED>
                        </BOXHD>
                        <ROW>
                            <ENT I="01">Fees </ENT>
                            <ENT>2.7 percent (1.027) </ENT>
                            <ENT>2.2 percent (1.022) </ENT>
                            <ENT>2.1 percent (1.021).</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">Enrollment </ENT>
                            <ENT>−3.1 percent (0.969) </ENT>
                            <ENT>−2.2 percent (0.978) </ENT>
                            <ENT>−2.6 percent (0.974).</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">Real Per Capita GDP </ENT>
                            <ENT>2.2 percent (1.022) </ENT>
                            <ENT>2.1 percent (1.021) </ENT>
                            <ENT>2.1 percent (1.021).</ENT>
                        </ROW>
                        <ROW RUL="n,s">
                            <ENT I="01">Law and Reg </ENT>
                            <ENT>0.0 percent (1.000) </ENT>
                            <ENT>0.0 percent (1.000) </ENT>
                            <ENT>0.0 percent (1.000).</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="03">Total </ENT>
                            <ENT>1.7 percent (1.017) </ENT>
                            <ENT>2.1 percent (1.021) </ENT>
                            <ENT>1.5 percent (1.015).</ENT>
                        </ROW>
                    </GPOTABLE>
                    <P>A more detailed explanation of each figure is provided in section VIII.F.3. </P>
                    <HD SOURCE="HD2">F. Calculation of CY 2008, CY 2007, and CY 2006 Sustainable Growth Rates </HD>
                    <HD SOURCE="HD3">1. Detail on the CY 2008 SGR </HD>
                    <P>All of the figures used to determine the CY 2008 SGR are estimates that will be revised based on subsequent data. Any differences between these estimates and the actual measurement of these figures will be included in future revisions of the SGR and allowed expenditures and incorporated into subsequent PFS updates. </P>
                    <HD SOURCE="HD3">• Factor 1—Changes in Fees for Physicians' Services (Before Applying Legislative Adjustments) for CY 2008 </HD>
                    <P>This factor is calculated as a weighted-average of the CY 2008 changes in fees for the different types of services included in the definition of physicians' services for the SGR. Medical and other health services paid using the PFS are estimated to account for approximately 80.4 percent of total allowed charges included in the SGR in CY 2008 and are updated using the MEI. The MEI for CY 2008 is 1.8 percent. Diagnostic laboratory tests are estimated to represent approximately 7.6 percent of Medicare allowed charges included in the SGR for CY 2008. Medicare payments for these tests are updated by the Consumer Price Index for Urban Areas (CPI-U). However, section 629 of the MMA specifies that diagnostic laboratory services will receive an update of 0.0 percent from CY 2004 through CY 2008. </P>
                    <P>Drugs are estimated to represent 12.0 percent of Medicare allowed charges included in the SGR in CY 2008. We estimated a weighted average change in fees for drugs included in the SGR (using the ASP + 6 percent pricing methodology) of 4.0 percent for CY 2008. </P>
                    <P>Table 28 shows the weighted average of the MEI, laboratory, and drug price changes for CY 2008. </P>
                    <GPOTABLE COLS="03" OPTS="L2,i1" CDEF="s50,8,8">
                        <TTITLE>Table 28.—Weighted Average of the MEI, Laboratory, and Drug Price Changes for CY 2008 </TTITLE>
                        <BOXHD>
                            <CHED H="1"> </CHED>
                            <CHED H="1">Weight</CHED>
                            <CHED H="1">Update </CHED>
                        </BOXHD>
                        <ROW>
                            <ENT I="01">Physician </ENT>
                            <ENT>0.804 </ENT>
                            <ENT>1.8 </ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">Laboratory </ENT>
                            <ENT>0.076 </ENT>
                            <ENT>0.0 </ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">Drugs </ENT>
                            <ENT>0.120 </ENT>
                            <ENT>4.0 </ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">Weighted-average </ENT>
                            <ENT>1.000 </ENT>
                            <ENT>1.9 </ENT>
                        </ROW>
                    </GPOTABLE>
                    <P>We estimate that the weighted average increase in fees for physicians' services in CY 2008 under the SGR (before applying any legislative adjustments) will be 1.9 percent. </P>
                    <HD SOURCE="HD3">• Factor 2—The Percentage Change in the Average Number of Part B Enrollees From CY 2007 to CY 2008 </HD>
                    <P>
                        This factor is our estimate of the percent change in the average number of fee-for-service enrollees from CY 2007 to CY 2008. Services provided to Medicare Advantage (MA) plan enrollees are outside the scope of the SGR and are excluded from this estimate. OACT estimates that the average number of Medicare Part B fee-for-service enrollees will decrease by 0.7 percent from CY 2007 to CY 2008. Table 29 illustrates how this figure was determined. 
                        <PRTPAGE P="66381"/>
                    </P>
                    <GPOTABLE COLS="03" OPTS="L2,i1" CDEF="s50,xs72,xs72">
                        <TTITLE>Table 29.—Average Number of Medicare Part B Fee-for-Service Enrollees </TTITLE>
                        <TDESC>[(Excluding beneficiaries enrolled in MA plans) from CY 2007 to CY 2008] </TDESC>
                        <BOXHD>
                            <CHED H="1">  </CHED>
                            <CHED H="1">2007 </CHED>
                            <CHED H="1">2008 </CHED>
                        </BOXHD>
                        <ROW>
                            <ENT I="01">Overall </ENT>
                            <ENT>40.726 million </ENT>
                            <ENT>41.480 million.</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">Medicare Advantage (MA) </ENT>
                            <ENT>7.890 million </ENT>
                            <ENT>8.888 million.</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">Net </ENT>
                            <ENT>32.836 million </ENT>
                            <ENT>32.592 million.</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">Percent Increase </ENT>
                            <ENT>  </ENT>
                            <ENT>−0.7 percent.</ENT>
                        </ROW>
                    </GPOTABLE>
                    <P>An important factor affecting fee-for-service enrollment is beneficiary enrollment in Medicare Advantage (MA) plans. Because it is difficult to estimate the size of the MA enrollee population before the start of a CY, at this time we do not know how actual enrollment in MA plans will compare to current estimates. For this reason, the estimate may change substantially as actual Medicare fee-for-service enrollment for CY 2008 becomes known. </P>
                    <HD SOURCE="HD3">• Factor 3—Estimated Real Gross Domestic Product Per Capita Growth in 2008 </HD>
                    <P>We estimate that the growth in real GDP per capita from CY 2007 to CY 2008 will be 1.7 percent (based on the 10-year average GDP over the 10-years of 1999-2008). Our past experience indicates that there have also been changes in estimates of real per capita GDP growth made before the year begins and the actual change in GDP computed after the year is complete. Thus, it is possible that this figure will change as actual information on economic performance becomes available to us in 2008. </P>
                    <HD SOURCE="HD3">• Factor 4—Percentage Change in Expenditures for Physicians' Services Resulting From Changes in Statute or Regulations in CY 2008 Compared With CY 2007 </HD>
                    <P>The statutory and regulatory provisions that will affect expenditures in CY 2008 relative to CY 2007 are estimated to have an impact on expenditures of −2.9 percent. These provisions include the expiration of the MMA provisions for the work GPCI floor and HPSA bonuses, the DRA provision reducing payments for imaging services, and the MIEA-TRHCA provisions regarding the conversion factor and the 2007 PQRI reporting bonuses payable in 2008. The details of these provisions are discussed elsewhere in this final rule with comment. </P>
                    <HD SOURCE="HD3">2. Detail on the 2007 SGR </HD>
                    <P>A more detailed discussion of our revised estimates of the four elements of the 2007 SGR follows. </P>
                    <HD SOURCE="HD3">• Factor 1—Changes in Fees for Physicians' Services (Before Applying Legislative Adjustments) for 2007 </HD>
                    <P>This factor was calculated as a weighted-average of the 2007 changes in fees that apply for the different types of services included in the definition of physicians' services for the SGR.</P>
                    <P>We estimate that services paid using the PFS account for approximately 82.5 percent of total allowed charges included in the SGR in CY 2007. These services were updated using the CY 2007 MEI of 2.1 percent. We estimate that diagnostic laboratory tests represent approximately 7.3 percent of total allowed charges included in the SGR in CY 2007. Medicare payments for these tests are updated by the CPI-U. However, section 629 of the MMA specifies that diagnostic laboratory services will receive an update of 0.0 percent from CY 2004 through CY 2008. We estimate that drugs represent 10.2 percent of Medicare-allowed charges included in the SGR in CY 2007. We estimate a weighted-average change in fees for drugs included in the SGR of 1.3 percent for CY 2007. </P>
                    <P>Table 30 shows the weighted-average of the MEI, laboratory, and drug price changes for CY 2007.</P>
                    <GPOTABLE COLS="3" OPTS="L2,i1" CDEF="s50,8,8">
                        <TTITLE>Table 30.—Weighted Average of the MEI, Laboratory, and Drug Price Changes for CY 2007 </TTITLE>
                        <BOXHD>
                            <CHED H="1"> </CHED>
                            <CHED H="1">Weight</CHED>
                            <CHED H="1">Update </CHED>
                        </BOXHD>
                        <ROW>
                            <ENT I="01">Physician</ENT>
                            <ENT>0.825</ENT>
                            <ENT>2.1 </ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">Laboratory</ENT>
                            <ENT>0.073</ENT>
                            <ENT>0.0 </ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">Drugs</ENT>
                            <ENT>0.102</ENT>
                            <ENT>1.3 </ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">Weighted-average</ENT>
                            <ENT>1.000</ENT>
                            <ENT>1.9 </ENT>
                        </ROW>
                    </GPOTABLE>
                    <P>After taking into account the elements described in Table 30, we estimate that the weighted-average increase in fees for physicians' services in 2007 under the SGR (before applying any legislative adjustments) will be 1.9 percent. Our estimate of this factor in the CY 2007 PFS final rule with comment period was 2.2 percent. The decrease in the estimate is due to the availability of some actual data. </P>
                    <HD SOURCE="HD3">• Factor 2—The Percentage Change in the Average Number of Part B Enrollees from CY 2006 to CY 2007 </HD>
                    <P>OACT estimates that the average number of Medicare Part B fee-for-service enrollees (excluding beneficiaries enrolled in Medicare Advantage plans) decreased by 2.6 percent in CY 2007. Table 31 illustrates how we determined this figure. </P>
                    <GPOTABLE COLS="3" OPTS="L2,i1" CDEF="s50,r50,r50">
                        <TTITLE>Table 31.—Average Number of Medicare Part B Fee-for-Service Enrollees </TTITLE>
                        <TDESC>[(Excluding beneficiaries enrolled in MA plans) from CY 2006 to CY 2007] </TDESC>
                        <BOXHD>
                            <CHED H="1"> </CHED>
                            <CHED H="1">2006</CHED>
                            <CHED H="1">2007 </CHED>
                        </BOXHD>
                        <ROW>
                            <ENT I="01">Overall</ENT>
                            <ENT>40.271 million</ENT>
                            <ENT>40.726 million. </ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">Medicare Advantage (MA)</ENT>
                            <ENT>6.550 million</ENT>
                            <ENT>7.890 million. </ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">Net</ENT>
                            <ENT>33.721 million</ENT>
                            <ENT>32.836 million. </ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">Percent Increase</ENT>
                            <ENT> </ENT>
                            <ENT>−2.6 percent. </ENT>
                        </ROW>
                    </GPOTABLE>
                    <P>
                        OACT's estimate of the −2.6 percentage change in the number of fee-for-service enrollees, net of Medicare Advantage enrollment for CY 2007 compared to CY 2006, is lower than our original estimate of −0.9 percent in the CY 2007 PFS final rule with comment period (71 FR 69758). While our current projection based on data from 8 months of 2007 is lower than our original estimate of −0.9 percent when we had no actual data, it is still possible that 
                        <PRTPAGE P="66382"/>
                        our final estimate of this figure will be different once we have complete information on CY 2007 fee-for-service enrollment. 
                    </P>
                    <HD SOURCE="HD3">• Factor 3—Estimated Real Gross Domestic Product Per Capita Growth in CY 2007 </HD>
                    <P>We estimate that the growth in real GDP per capita will be 1.9 percent for CY 2007 (based on the 10-year average GDP over the 10 years of CY 1998 through CY 2007). Our past experience indicates that there have also been differences between our estimates of real per capita GDP growth made prior to the year's end and the actual change in this factor. Thus, it is possible that this figure will change further as complete actual information on CY 2007 economic performance becomes available to us in 2008. </P>
                    <HD SOURCE="HD3">• Factor 4—Percentage Change in Expenditures for Physicians' Services Resulting From Changes in Statute or regulations in CY 2007 Compared With CY 2006 </HD>
                    <P>The statutory and regulatory provisions that will affect expenditures in CY 2007 relative to CY 2006 are estimated to have an impact on expenditures of 2.0 percent. These provisions include the DRA provisions adding the AAA ultrasound test to the Welcome to Medicare visit as a preventive benefit and reducing payments for imaging services. Also included is the MIEA-TRHCA 1-year adjustment to the conversion factor. The details of these provisions are discussed elsewhere in this final rule with comment.</P>
                    <HD SOURCE="HD3">3. Detail on the CY 2006 SGR </HD>
                    <P>A more detailed discussion of our final revised estimates of the four elements of the CY 2006 SGR follows. </P>
                    <HD SOURCE="HD3">• Factor 1—Changes in Fees for Physicians' Services (Before Applying Legislative Adjustments) for 2006 </HD>
                    <P>This factor was calculated as a weighted average of the CY 2006 changes in fees that apply for the different types of services included in the definition of physicians' services for the SGR. </P>
                    <P>Services paid using the PFS accounted for approximately 83.8 percent of total Medicare-allowed charges included in the SGR for CY 2006 and are updated using the MEI. The MEI for CY 2006 was 2.8 percent. Diagnostic laboratory tests represented approximately 7.2 percent of total CY 2006 Medicare allowed charges included in the SGR and are updated by the CPI-U. However, section 629 of the MMA specifies that diagnostic laboratory services will receive an update of 0.0 percent from CY 2004 through CY 2008. Drugs represented approximately 9.1 percent of total Medicare-allowed charges included in the SGR for CY 2006. We estimate a weighted-average change in fees for drugs included in the SGR of −2.8 percent for 2006. Table 32 shows the weighted average of the MEI, laboratory, and drug price changes for CY 2006. </P>
                    <GPOTABLE COLS="3" OPTS="L2,i1" CDEF="s50,8,8">
                        <TTITLE>Table 32.—Weighted Average of the MEI, Laboratory, and Drug Price Changes for CY 2006 </TTITLE>
                        <BOXHD>
                            <CHED H="1"> </CHED>
                            <CHED H="1">Weight</CHED>
                            <CHED H="1">Update </CHED>
                        </BOXHD>
                        <ROW>
                            <ENT I="01">Physician</ENT>
                            <ENT>0.838</ENT>
                            <ENT>2.8 </ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">Laboratory</ENT>
                            <ENT>0.072</ENT>
                            <ENT>0.0 </ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">Drugs</ENT>
                            <ENT>0.091</ENT>
                            <ENT>−2.8 </ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">Weighted-average</ENT>
                            <ENT>1.000</ENT>
                            <ENT>2.1 </ENT>
                        </ROW>
                    </GPOTABLE>
                    <P>After taking into account the elements described in Table 32, we estimate that the weighted-average increase in fees for physicians' services in CY 2006 under the SGR (before applying any legislative adjustments) was 2.1 percent. This figure is a final one based on complete data for CY 2006. </P>
                    <HD SOURCE="HD3">• Factor 2—The Percentage Change in the Average Number of Part B Enrollees from CY 2005 to CY 2006 </HD>
                    <P>We estimate the decrease in the number of fee-for-service enrollees (excluding beneficiaries enrolled in MA plans) from CY 2005 to CY 2006 was 2.6 percent. Our calculation of this factor is based on complete data from CY 2006. Table 33 illustrates the calculation of this factor. </P>
                    <GPOTABLE COLS="3" OPTS="L2,i1" CDEF="s50,r50,r50">
                        <TTITLE>Table 33.—Average Number of Medicare Part B Fee-for-Service Enrollees </TTITLE>
                        <TDESC>[(Excluding beneficiaries enrolled in MA plans) from CY 2005 to CY 2006] </TDESC>
                        <BOXHD>
                            <CHED H="1"> </CHED>
                            <CHED H="1">2005</CHED>
                            <CHED H="1">2006 </CHED>
                        </BOXHD>
                        <ROW>
                            <ENT I="01">Overall</ENT>
                            <ENT>39.698 million</ENT>
                            <ENT>40.271 million. </ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">Medicare Advantage (MA)</ENT>
                            <ENT>5.084 million</ENT>
                            <ENT>6.550 million. </ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">Net</ENT>
                            <ENT>34.615 million</ENT>
                            <ENT>33.721 million. </ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">Percent Increase</ENT>
                            <ENT> </ENT>
                            <ENT>−2.6 percent. </ENT>
                        </ROW>
                    </GPOTABLE>
                    <HD SOURCE="HD3">• Factor 3—Estimated Real Gross Domestic Product Per Capita Growth in 2006 </HD>
                    <P>We estimate that the growth in real per capita GDP was 2.1 percent in 2006 (based on the 10-year average GDP over the 10 years of CY 1997 through CY 2006). This figure is a final one based on complete data for CY 2006. </P>
                    <HD SOURCE="HD3">• Factor 4—Percentage Change in Expenditures for Physicians' Services Resulting From Changes in Statute or Regulations in CY 2006 Compared With CY 2005 </HD>
                    <P>Our final estimate for the net impact on expenditures from the statutory and regulatory provisions that affect expenditures in CY 2006 relative to CY 2005 is less than 0.05 percent. These provisions include the expiration of the temporary higher payments to physicians in Alaska, the new power wheelchair code for physicians, and the IVIG pre-administration fee.</P>
                    <HD SOURCE="HD1">VIII. Anesthesia and Physician Fee Schedule Conversion Factors for CY 2008 </HD>
                    <P>The CY 2008 PFS CF will be $34.0682. The CY 2008 national average anesthesia CF is $16.3176. Both CFs will be subject to a separate, independent BN adjustor, as described below. </P>
                    <HD SOURCE="HD2">A. Physician Fee Schedule Conversion Factor </HD>
                    <P>Under section 1848(d)(1)(A) of the Act, the PFS CF is equal to the CF for the previous year timesplied by the update determined under section 1848(d)(4) of the Act, as amended by the MIEA-TRHCA. Section 101 of the MIEA-TRHCA provided a 1-year increase in the CY 2007 CF and specified that the CF for CY 2008 must be computed as if the 1-year increase had never applied. </P>
                    <P>
                        The PFS update for CY 2008 is determined by timesplying the CY 2007 conversion factor update that would have occurred in the absence of the MIEA-TRHCA (as published in 71 FR 69760), the estimated MEI, and the 
                        <PRTPAGE P="66383"/>
                        estimated update adjustment factor, as shown in Table 34 (0.89896 = 0.94953 × 1.018 × 0.930). To determine the estimated CY 2008 CF, the Pre-MIEA-TRHCA CY 2007 CF update is applied to the CY 2006 CF of $37.8975 to produce the Pre-MIEA-TRHCA CY 2007 CF of $35.9848. Then applying the estimated MEI for CY 2008 and the estimated UAF for CY 2008 to the Pre-MIEA-TRHCA CY 2007 a CF produces an estimated CF for CY 2008 of $34.0682. We illustrate the calculation for the 2008 PFS CF in Table 34. 
                    </P>
                    <GPOTABLE COLS="02" OPTS="L2,p1,8/9,i1" CDEF="s100,xs100">
                        <TTITLE>Table 34.—Calculation of the CY 2008 Conversion Factor</TTITLE>
                        <BOXHD>
                            <CHED H="1"> </CHED>
                            <CHED H="1"> </CHED>
                        </BOXHD>
                        <ROW>
                            <ENT I="01">CY 2006 Conversion Factor</ENT>
                            <ENT>$37.8975.</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">Pre-MIEA-TRHCA CY 2007 CF Update</ENT>
                            <ENT>−5.0 percent (0.94953).</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">CY 2007 Pre-MIEA-TRHCA Conversion Factor</ENT>
                            <ENT>$35.9848.</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">2008 MEI</ENT>
                            <ENT>1.8 percent (1.018).</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">2008 Update adjustment factor</ENT>
                            <ENT>−7.0 percent (0.930).</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">CY 2008 Update</ENT>
                            <ENT>−5.3 percent (0.94674).</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">CY 2008 Conversion Factor Update</ENT>
                            <ENT>−10.1 percent (0.89896).</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">CY 2008 Conversion Factor</ENT>
                            <ENT>$34.0682.</ENT>
                        </ROW>
                    </GPOTABLE>
                    <P>Section 1848(c)(2)(B)(ii)(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 BN. </P>
                    <P>The 5-Year Review of work RVUs, including the refinement to the work RVU changes for the additional codes and the increases in the work of anesthesia services, would result in a change in expenditures that would exceed $20 million if we made no offsetting adjustments to either the CF or RVUs. As discussed in section IV.C.3 of this final rule with comment period, we are applying the following BN adjustor to the work RVUs in order to calculate payment for a service: </P>
                    <P>2008 Work Adjustor: 11.94 percent (0.8806) </P>
                    <P>Payment for services under the PFS will be calculated as follows: </P>
                    <P>Payment = [(RVU work × BN adjustor (round product to two decimal places) × GPCI work) + (RVU PE × GPCI PE) + (RVU malpractice × GPCI malpractice)] × CF </P>
                    <HD SOURCE="HD2">B. Anesthesia Fee Schedule Conversion Factor </HD>
                    <P>We calculate the physician anesthesia CF similar to the general PFS CF in Table 34. As noted, section 101 of the TRCHA provided for a 1-year increase in the CY 2007 conversion factor and specified the conversion factor for 2008 must be computed as if the 1-year increase had never applied. The PFS update for CY 2008 is determined by timesplying the CY 2007 conversion factor that would have occurred in the absence of TRCHA by the estimated MEI and the estimated update adjustment factor for 2008. </P>
                    <P>Anesthesia services do not have RVUs like other PFS services. Therefore, we account for any necessary RVU adjustments through an adjustment to the anesthesia fee schedule CF to simulate changes to RVUs. We modeled the resource based PE methodology using imputed anesthesia RVUs that were made comparable to other PFS services. The 2008 adjustment factor in Table 35 includes the combined effect of the PE adjustment, the increase in work of anesthesia services under the recent five year review and the BN adjustment. </P>
                    <P>We illustrate the calculation for the 2008 anesthesia CF in Table 35. </P>
                    <GPOTABLE COLS="2" OPTS="L2,p1,8/9,i1" CDEF="s100,xs100">
                        <TTITLE>Table 35.—Calculation for the 2008 Anesthesia Conversion Factor</TTITLE>
                        <BOXHD>
                            <CHED H="1"> </CHED>
                            <CHED H="1"> </CHED>
                        </BOXHD>
                        <ROW>
                            <ENT I="01">CY 2006 Anesthesia Conversion Factor</ENT>
                            <ENT>$17.7663.</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">Pre-TRHCA CY 2007 CF Update</ENT>
                            <ENT>−5.0 percent (0.94953).</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">2007 Combined Adjustment for PE and BN</ENT>
                            <ENT>0.9089.</ENT>
                        </ROW>
                        <ROW RUL="s">
                            <ENT I="01">CY 2007 Pre-TRHCA Anesthesia Conversion Factor</ENT>
                            <ENT>$15.3328.</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">2008 MEI</ENT>
                            <ENT>1.8 percent (1.018).</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">2008 Update adjustment factor</ENT>
                            <ENT>−7.0 percent (0.930).</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">CY 2008 Anesthesia CF after MEI and 2008 Adjustment Factor</ENT>
                            <ENT>$14.5162.</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">2008 Combined Adjustment for PE and BN</ENT>
                            <ENT>1.1250.</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">CY 2008 Anesthesia Conversion Factor</ENT>
                            <ENT>$16.3307.</ENT>
                        </ROW>
                    </GPOTABLE>
                    <HD SOURCE="HD1">IX. Telehealth Originating Site Facility Fee Payment Amount Update </HD>
                    <P>Section 1834(m) of the Act establishes the payment amount for the Medicare telehealth originating site facility fee for telehealth services provided from October 1, 2001 through December 31 2002, at $20. For telehealth services provided on or after January 1 of each subsequent calendar year, the telehealth originating site facility fee is increased by the percentage increase in the MEI as defined in section 1842(i)(3) of the Act. The MEI increase for 2008 is 1.8 percent. </P>
                    <P>
                        Therefore, for CY 2007, the payment amount for HCPCS code Q3014, Telehealth originating site facility fee, is 80 percent of the lesser of the actual charge or $23.35. The Medicare telehealth originating site facility fee and MEI increase by the applicable time period is shown in Table 36. 
                        <PRTPAGE P="66384"/>
                    </P>
                    <GPOTABLE COLS="3" OPTS="L2,i1" CDEF="s100,14,22">
                        <TTITLE>Table 36.—The Medicare Telehealth Originating Site Facility Fee and MEI Increase by the Applicable Time Period </TTITLE>
                        <BOXHD>
                            <CHED H="1">Facility fee </CHED>
                            <CHED H="1">
                                MEI increase 
                                <LI>(percent) </LI>
                            </CHED>
                            <CHED H="1">Period </CHED>
                        </BOXHD>
                        <ROW>
                            <ENT I="01">$20.00 </ENT>
                            <ENT>N/A </ENT>
                            <ENT>10/01/2001-12/31/2002 </ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">$20.60 </ENT>
                            <ENT>3.0 </ENT>
                            <ENT>01/01/2003-12/31/2003 </ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">$21.20 </ENT>
                            <ENT>2.9 </ENT>
                            <ENT>01/01/2004-12/31/2004 </ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">$21.86 </ENT>
                            <ENT>3.1 </ENT>
                            <ENT>01/01/2005-12/31/2005 </ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">$22.47 </ENT>
                            <ENT>2.8 </ENT>
                            <ENT>01/01/2006-12/31/2006 </ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">$22.94 </ENT>
                            <ENT>2.1 </ENT>
                            <ENT>01/01/2007-12/31/2007 </ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">$23.35 </ENT>
                            <ENT>1.8 </ENT>
                            <ENT>01/01/2008-12/31/2008 </ENT>
                        </ROW>
                    </GPOTABLE>
                    <HD SOURCE="HD1">X. Provisions of the Final Rule </HD>
                    <P>The provisions of this final rule with comment restate the provisions of the CY 2008 PFS proposed rule, except as noted elsewhere in the preamble. </P>
                    <HD SOURCE="HD1">XI. Waiver of Proposed Rulemaking and Delay in Effective Date </HD>
                    <P>
                        We ordinarily publish a notice of proposed rulemaking in the 
                        <E T="04">Federal Register</E>
                         and invite public comment on the proposed rule. The notice of proposed rulemaking includes a reference to the legal authority under which the rule is proposed, and the terms and substances of the proposed rule or a description of the subjects and issues involved. This procedure can be waived, however, if an agency finds good cause that a notice-and-comment procedure is impracticable, unnecessary, or contrary to the public interest and incorporates a statement of the finding and its reasons in the rule issued.
                    </P>
                    <P>We utilize HCPCS codes for Medicare payment purposes. The HCPCS is a national drug coding system comprised of Level I (CPT) codes and Level II (HCPCS National Codes) that are intended to provide uniformity to coding procedures, services, and supplies across all types of medical providers and suppliers. Level I (CPT) codes are copyrighted by the AMA and consist of several categories, including Category I codes which are 5-digit numeric codes, and Category III codes which are temporary codes to track emerging technology, services and procedures. </P>
                    <P>The AMA issues an annual update of the CPT code set each Fall, with January 1 as the effective date for implementing the updated CPT codes. The HCPCS, including both Level I and Level II codes, is similarly updated annually on a CY basis. Annual coding changes are not available to the public until the Fall immediately preceding the annual January update of the PFS. Because of the timing of the release of these new codes, it is impracticable for CMS to provide prior notice and solicit comment on these codes and the RVUs assigned to them in advance of publication of the final rule that implements the PFS. Yet, it is imperative that these coding changes be accounted for and recognized timely under the PFS for payment because services represented by these codes will be provided to Medicare beneficiaries by physicians during the CY in which they become effective. Moreover, regulations implementing HIPAA (42 CFR parts 160 and 162) require that the HCPCS be used to report health care services, including services paid under the PFS. We also assign interim RVUs to any new codes based on a review of the RUC recommendations for valuing these services. By reviewing these RUC recommendations for the new codes, we are able to assign RVUs to services based on input from the medical community and to establish payment for them, on an interim basis, that corresponds to the relative resources associated with providing the services. If we did not assign RVUs to new codes on an interim basis, the alternative would be to either not pay for these services during the initial CY or have each carrier establish a payment rate for these new codes. We believe both of these alternatives are contrary to the public interest, particularly since the RUC process allows for an assessment of the valuation of these services by the medical community prior to our establishing payment for these codes on an interim basis. Therefore, we believe it would be contrary to the public interest to delay establishment of fee schedule payment amounts for these codes. </P>
                    <P>For the reasons outlined above in this section, we find good cause to waive the notice of proposed rulemaking for the interim RVUs for selected procedure codes identified in Addendum C and to establish RVUs for these codes on an interim final basis. We are providing a 60-day public comment period.</P>
                    <P>
                        In addition, we ordinarily publish a notice of proposed rulemaking in the 
                        <E T="04">Federal Register</E>
                         and provide a period for public comment before we make final the provisions of the notice. We can waive this procedure, however, if we find good cause that notice-and-comment procedure is impracticable, unnecessary, or contrary to the public interest and we incorporate a statement of finding and its reasons in the notice issued. We find it unnecessary to undertake notice and comment rulemaking in this instance for the ambulance inflation factor because the law specifies the method of computation of annual updates, and we have no discretion in this matter. Further, we are merely applying the update method specified in statute and regulation. Therefore, under 5 U.S.C. 553(b)(B), for good cause, we waive notice and comment procedures for this ambulance inflation factor update. 
                    </P>
                    <HD SOURCE="HD1">XII. Collection of Information Requirements </HD>
                    <P>
                        Under the Paperwork Reduction Act of 1995, we are required to provide 60-day notice in the 
                        <E T="04">Federal Register</E>
                         and solicit public comment before a collection of information requirement is submitted to the Office of Management and Budget (OMB) for review and approval. In order to fairly evaluate whether an information collection should be approved by OMB, section 3506(c)(2)(A) of the Paperwork Reduction Act of 1995 requires that we solicit comment on the following issues: 
                    </P>
                    <P>• The need for the information collection and its usefulness in carrying out the proper functions of our agency. </P>
                    <P>• The accuracy of our estimate of the information collection burden. </P>
                    <P>• The quality, utility, and clarity of the information to be collected. </P>
                    <P>• Recommendations to minimize the information collection burden on the affected public, including automated collection techniques. </P>
                    <P>
                        This final rule with comment period does not contain any new information collection requirements. However, we are republishing the discussion of the information collection requirements as it appeared in the CY 2008 PFS 
                        <PRTPAGE P="66385"/>
                        proposed rule (72 FR 38122). We are soliciting public comment on each of these issues for the following sections of this document that contain information collection requirements. 
                    </P>
                    <HD SOURCE="HD1">Independent Diagnostic Testing Facility (§ 410.33) </HD>
                    <P>Section 410.33(g)(2) states that an independent diagnostic testing facility (IDTF) should provide complete and accurate information on its Medicare enrollment application. In addition, an IDTF is required to notify its designated fee-for-service contractor within 30-days of any changes in ownership, changes of location, changes in general supervision, and any adverse legal actions. The notification must be made on the Medicare enrollment application. All of the changes to the enrollment application must be reported within 90 days. </P>
                    <P>The aforementioned requirements are not new. The burden associated with completing the Medicare enrollment application is currently approved under OMB control number 0938-0685. The collection has an expiration date of April 30, 2009. </P>
                    <P>Section 410.33(g)(6) states the comprehensive liability insurance requirements for IDTFs. Specifically, § 410.33(g)(6)(1) states they must have a comprehensive insurance policy to notify the CMS designated contractor, in writing, of any policy changes or cancellations. The burden associated with this requirement is the time and effort necessary to draft and submit the written notification to the CMS designated contractor. While this requirement is subject to the PRA, we believe it is exempt from the PRA as stipulated under 5 CFR 1320.3(h)(6). This information will be collected on case by case basis. </P>
                    <P>Section 410.33(g)(8) requires an IDTF to answer, document, maintain documentation of beneficiaries questions and responses to beneficiary complaints at the physical site of the IDTF. Sections 410.33(g)(8) (i through iii) list the minimum amount of documentation needed to comply with this requirement. The burden associated with these requirements is the time and effort associated with responding to beneficiary questions and complaints, documenting the actions taken in response to the questions and complaints, and maintaining the documentation. While this requirement is subject to the PRA, we believe the associated burden is exempt under 5 CFR 1320.3(b)(2). The burden associated with documenting and maintaining the documentation of the corrective actions is a usual and customary business practice. The time, effort, and financial resources necessary to comply this information collection requirement would be incurred by persons in the normal course of their activities (for example, in compiling and maintaining business records) and is not subject to the PRA. </P>
                    <HD SOURCE="HD1">Basis of Payment (§ 414.707) </HD>
                    <P>Section 414.707(c) states that effective January 1, 2008, each request for payment for anti-anemia drugs furnished to treat anemia resulting from the treatment of cancer must report the beneficiary's most recent hemoglobin or hematocrit level. The burden associated with this requirement is the time and effort associated with obtaining the most recent hemoglobin or hematocrit levels and documenting it on the request for payment. The requirement and its associated burden are not subject to the PRA under 5 CFR 1320.3(h)(5). The interpretation of biological analyses of body fluids, tissues, or other specimens, or the identification or classification of such specimens is not subject to the PRA. </P>
                    <HD SOURCE="HD1">Term of Contract (§ 414.914) </HD>
                    <P>Section 414.914(h) states that the approved CAP vendor must verify drug administration prior to the collection of any applicable cost sharing amount. As part of the verification process, § 414.914(h)(1) through (2) states lists the documentation that is required as part of the verification process. Section 414.914(h)(3) states that the approved CAP vendor must provide this information to CMS or the beneficiary upon request. </P>
                    <P>The burden associated with the requirements in § 414.914(1) through (3) is the time and effort needed to verify the drug administration. When obtaining written verification, the CAP vendor must document the elements listed in § 414.914(h)(1)(i) through (vi). When obtaining verbal verification, the CAP vendor must document the elements listed in § 414.914(h)(2)(i) through (ii). We believe the requirements and their associated burden are not subject to the PRA; they are part of the CAP vendor's usual and customary business practices as stipulated under 5 CFR 1320.3(h)(5). </P>
                    <P>In addition, § 414.914(h)(3) imposes both recordkeeping and reporting requirements. We believe that the burden associated with the recordkeeping requirement imposed by § 414.914(h)(3) is not subject to the PRA under 5 CFR 1320.3(c)(4) because it would affect less than 10 persons. </P>
                    <P>The reporting requirement places burden on the CAP vendor to provide the information listed in § 414.914(h) (1-2) to a beneficiary upon request. We estimate that the CAP vendor will receive 72 requests per year from beneficiaries. We believe it will take 15 minutes per request for the vendor to provide this information to the beneficiary. The total annual burden associated with this requirement is 1080 minutes or 18 burden hours. However, we believe this information collection requirement and the associated burden is not subject to the PRA as defined in 5 CFR 1320.3(c)(4) because it would affect less than 10 persons. </P>
                    <HD SOURCE="HD1">Compendia for Determination of Medically-Accepted Indications for Off-Label Uses of Drugs and Biologicals in an Anti-Cancer Chemotherapeutic Regimen (§ 414.930) </HD>
                    <P>Section 414.930(b) states the process for listing compendia for determining medically-accepted uses of drugs and biologicals in anti-cancer treatment. We will annually provide an annual opportunity to request changes to the list of compendia. As stated in § 414.930(c)(1), CMS will review a complete written request that is submitted in writing, electronically or via hard copy. A complete written request must contain the following information as stated in § 414.930(c)(1)(i) through (vi): Full name and contact information for the requestor; full identification of the compendium in question; a complete written copy of the compendium in question; the specific action requested of CMS; supporting documentation for the requested action; address a single compendium per request. </P>
                    <P>The burden associated with the requirements contained in § 414.930(b) through (c) is the time and effort required to draft and submit to CMS a complete written request for changes to the list of compendia. While these requirements are subject to the PRA, we believe the burden is exempt under 5 CFR 1320.3(c)(4) because it would affect less than 10 persons or entities. There are only 6 compendia that could reasonably be expected to be the subject of a request, so 6 requests is a likely maximum. </P>
                    <HD SOURCE="HD1">Signature Requirements (§ 424.36) </HD>
                    <P>
                        Section 424.36(a) requires the beneficiary's signature on a claim for payment of services unless the beneficiary has died or the provisions of § 424.36(b), (c), or (d) apply. Section 424.36(b) states that if the beneficiary is physically or mentally incapable of signing the claim, the claim may be signed by one of the parties specified in § 424.36(b)(1) through (5). Proposed 
                        <PRTPAGE P="66386"/>
                        § 424.36(b)(6) states that, for emergency ambulance transport services, if certain conditions and documentation requirements are met, an ambulance provider or supplier would be permitted to sign the claim on behalf of the beneficiary. Specifically, § 424.36(b)(6)(ii)(A) through (C) lists the documentation that would be required, all of which would have to be maintained by the ambulance provider or supplier in its files for a period of at least 4 years from the date of service. An ambulance provider or supplier would be required to obtain a signed, contemporaneous statement from an ambulance employee present during transport of the patient that, at the time the service was provided, the beneficiary was physically or mentally incapable of signing the claim and that none of the other qualified parties listed in § 424.36(b)(1) through (5) were available or willing to sign the claim on behalf of the beneficiary. 
                    </P>
                    <P>The ambulance provider or supplier would also be required to maintain documentation of the date and time that the beneficiary was transported and the name and location of the facility that received the beneficiary. In addition, the ambulance provider or supplier would be required to obtain and maintain a signed contemporaneous statement from a representative of the facility that received the beneficiary. The statement would have to contain the name of the beneficiary and the date and time the beneficiary was received at the facility. </P>
                    <P>The burden associated with the recordkeeping requirements contained in § 424.36(b)(6) is the time and effort associated with drafting, obtaining, and maintaining written statements from both employees of the ambulance provider or supplier transporting the beneficiary and employees of the facility receiving the beneficiary. We estimate that 9,000 ambulance providers or suppliers will comply with these requirements. We estimate that it will take no more than five minutes for each provider or supplier to comply with the recordkeeping requirements. Based on the best available data at this time, we estimate the total annual burden associated with the requirements in § 424.36(b)(6) to be 541,667 hours nationwide. The annual total number of burden hours was arrived at by multiplying five minutes by the total estimated number of emergency ambulance transports of 6,500,000. We note that the total number of burden hours may be overstated, because not every beneficiary who receives emergency ambulance transport services is unable to sign the claim. However, we also note that the 6.5 million figure for emergency transports is the estimated number of ALS1-emergency and BLS-emergency ambulance claims processed by Part B carriers, incurred in 2006 and processed through April of 2007, and thus does not include the number of emergency ambulance transport services billed to fiscal intermediaries by ambulance providers (which number is not available to us). In any event, we believe our proposal will benefit ambulance providers and suppliers by allowing them an alternative procedure for submitting claims to Medicare. In the absence of the proposed procedure for signing claims on behalf of beneficiaries for emergency ambulance transport services, ambulance suppliers and providers would be required to track down beneficiaries after the emergency transport services have been rendered, in an attempt to have the beneficiary sign the claim. Moreover, such attempts may prove fruitless, thereby preventing the ambulance suppliers and providers from submitting the claim to Medicare. </P>
                    <HD SOURCE="HD1">Additional Information Collection Requirements </HD>
                    <P>This final rule with comment period imposes collection of information requirements as outlined in the regulation text and specified above. However, this final rule with comment period also makes reference to several associated information collections that are not discussed in the regulation text. The following is a discussion of these collections, which have already received OMB approval. </P>
                    <HD SOURCE="HD1">Part B Drug Payment </HD>
                    <P>Section II.F.1 of the preamble discusses payment for Medicare Part B drugs and biologicals under the ASP methodology. Drug manufacturers are required to submit ASP data to us on a quarterly basis. As stated in section II.F.1.a of the preamble, the ASP reporting requirements are set forth in section 1927(b) of the Act. </P>
                    <P>The collection of ASP data imposes a reporting requirement on the public. The burden associated with this requirement is the time and effort required by manufacturers of Medicare Part B drugs and biologicals to calculate, record, and submit the required data to CMS. While the burden associated with this requirement is subject to the PRA, it is currently approved under OMB control number 0938-0921, with an expiration date of May 31, 2009. </P>
                    <HD SOURCE="HD1">Competitive Acquisition Program (CAP) </HD>
                    <P>In section II.F.2.d of the preamble, we propose to revise the CAP physician election agreement. In conjunction with post-payment review process, we are revising the CAP physician election agreement to reflect the physician's obligation to provide medical records to assist with claims review. The CAP physician election agreement is currently approved under 0938-0955 with an expiration date of August 31, 2009. Under a separate notice, we will make the revised instrument available for public comment prior to submitting the revised information collection request to OMB for approval. </P>
                    <P>Section II.F.2.f of the preamble discusses details of the competitive acquisition program. Each year, physicians are given the option to elect to obtain Medicare Part B drugs and biologicals through the CAP. In addition, physicians are also given an opportunity to select an approved CAP vendor. The burden associated with these election requirements is the time and effort necessary for a physician to make an election and notify CMS. The burden associated with election requirements for participating in the CAP and selecting an approved CAP vendor is subject to the PRA. However, it is currently approved under OMB control numbers 0938-0955 and 0938-0987 with expiration dates of August 31, 2009 and April 30, 2009, respectively. </P>
                    <P>Section II.F.2.g. of the preamble also discusses the exigent circumstances exception for leaving the CAP outside of the annual election process. A physician may request a release from the CAP within the first 60 days of his or her participation if he or she can show that CAP participation imposes a burden on the practice, or later if he or she can show that a change in circumstances that was not known to the practice previously results in a burden to the practice. Specifically, the physician must submit a release request to the CAP-designated carrier. </P>
                    <P>While this burden is subject to the PRA, we believe it is exempt under 5 CFR 1320.3(h)(6). Facts or opinions collected from a single person or entity are not subject to the PRA. The aforementioned information collection request will be reviewed individually on a case by cases basis. </P>
                    <P>
                        If the designated carrier receives an exigent circumstance removal request related to the approved CAP vendor's service, it is required to refer the physician to his or her approved CAP vendor within 1 business day of its receipt of the request. As part of the grievance process, the CAP vendor will try to work with the physician to address their concerns with respect to participation in the program. The designated carrier can alternatively continue to investigate, and within 2 
                        <PRTPAGE P="66387"/>
                        business days of its receipt of the request, can request a single 2-business day extension (after which it must submit findings and a recommendation to CMS), submit findings and a recommendation to CMS that the physician be permitted to terminate his or her CAP participation, or submit findings and a recommendation to CMS that the physician not be permitted to terminate his or her CAP participation. 
                    </P>
                    <P>Requests from physicians will be reviewed by CAP vendors on an individual, case by case basis. We will continue to monitor the process. If we believe that we will receive 10 or more requests, we will submit an information collection request to OMB. </P>
                    <HD SOURCE="HD1">Physician Quality Reporting Initiative (PQRI) </HD>
                    <P>Section II.U.1.a of the preamble discusses the background of the reporting initiative and provides information about the measures available to eligible professionals who choose to participate in PQRI. Section 1848(k)(1) of the Act requires the Secretary to implement a system for eligible professionals to submit data pertaining to certain quality measures. As stated in section II.U.1.a, eligible professionals, for the purpose of the quality reporting system, include physicians, other practitioners as described in section 1842(b)(18)(c) of the Act, physical and occupational therapists, and qualified speech-language pathologists. As also stated in section II.U.1.a, this is a voluntary initiative. Eligible professionals may choose whether to participate and, to the extent they satisfactorily submit data on quality measures for covered professional services, they can qualify to receive a bonus incentive payment. </P>
                    <P>
                        Specifically, to qualify to receive a bonus incentive payment for satisfactory reporting of quality data on covered professional services furnished in 2007, an eligible professional must submit data on 1, 2, or 3 measures selected from the 74 PQRI 2007 quality measures. The minimum number of measures each professional must report in order to qualify for the bonus payment is determined by how many available measures are applicable to the services that professional furnishes to Medicare beneficiaries. For a majority of the eligible professionals, the requirement, per 1848(k) of the Act, will be that they satisfactorily report on at least three measures. An eligible professional could meet the satisfactory reporting requirement, and thus be eligible for the bonus incentive payment, by reporting fewer than three measures only if his or her practice has fewer than three applicable measures. The quality measures are posted and available for download on the CMS Web site at 
                        <E T="03">http://www.cms.hhs.gov/pqri.</E>
                    </P>
                    <P>The burden associated with this requirement is the time and effort associated with eligible professionals identifying applicable PQRI quality measures for which they can report the necessary information. In addition, they must gather the required information, select the appropriate quality data codes, and include the appropriate quality-data codes on the claims they submit for payment. </P>
                    <P>In 2007, the PQRI will collect quality-data codes exclusively as additional (optional) line items on the existing HIPAA transaction 837-P and/or CMS Form 1500. There will be no new forms and no modifications to the existing transaction or form in support of 2007 PQRI. CMS also does not anticipate changes to the 837-P or CMS Form 1500 for 2008. </P>
                    <P>Because this is a voluntary program, it is impossible to estimate with any degree of accuracy how many eligible professionals will opt to participate in the PQRI in 2008. Moreover, the time needed for an eligible professional to review the quality measures and other information, select measures applicable to his or her patients and the services he or she furnishes to them, and incorporate the use of quality data codes into the office work flows is expected to vary along with the number of measures that are potentially applicable to a given professional's practice. We estimate that the additional time required to put quality data codes on each claim is not a material increment to the time required to code the claim for payment. The total estimated annual burden for this requirement will also vary along with the volume of claims on which quality data is reported.</P>
                    <GPOTABLE COLS="5" OPTS="L2,i1" CDEF="s50,12,12,12,12">
                        <TTITLE>Table 37.—Estimated Annual Reporting and Recordkeeping Burden </TTITLE>
                        <BOXHD>
                            <CHED H="1">Regulation section(s)</CHED>
                            <CHED H="1">OMB control No.</CHED>
                            <CHED H="1">Respondents</CHED>
                            <CHED H="1">Responses</CHED>
                            <CHED H="1">
                                Total annual burden 
                                <LI>(hours) </LI>
                            </CHED>
                        </BOXHD>
                        <ROW>
                            <ENT I="01">Preamble section II.F.1</ENT>
                            <ENT>0938-0921</ENT>
                            <ENT>120</ENT>
                            <ENT>480</ENT>
                            <ENT>17,760 </ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">Preamble section II.F.2.f</ENT>
                            <ENT>0938-0955</ENT>
                            <ENT>12</ENT>
                            <ENT>12</ENT>
                            <ENT>480 </ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">§ 410.33</ENT>
                            <ENT>0938-0685</ENT>
                            <ENT>400,000</ENT>
                            <ENT>400,000</ENT>
                            <ENT>1,000,000 </ENT>
                        </ROW>
                        <ROW RUL="n,s">
                            <ENT I="01">§ 424.36</ENT>
                            <ENT>0938-New</ENT>
                            <ENT>9,000</ENT>
                            <ENT>6,500,000</ENT>
                            <ENT>541,667</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="03">Total</ENT>
                            <ENT/>
                            <ENT/>
                            <ENT/>
                            <ENT>1,579,907 </ENT>
                        </ROW>
                    </GPOTABLE>
                    <P>
                        If you comment on these information collection and recordkeeping requirements, please mail copies directly to the following: Centers for Medicare &amp; Medicaid Services, Office of Strategic Operations and Regulatory Affairs, Regulations Development Group, Attn: William N. Parham, III, CMS-1385-FC, Room C4-26-05, 7500 Security Boulevard, Baltimore, MD 21244-1850; and Office of Information and Regulatory Affairs, Office of Management and Budget, Room 10235, New Executive Office Building, Washington, DC 20503, Attn: Carolyn Lovett, CMS Desk Officer, [CMS-1385-P], 
                        <E T="03">carolyn_lovett@omb.eop.gov.</E>
                         Fax (202) 395 6974. 
                    </P>
                    <HD SOURCE="HD1">XIII. Response to Comments </HD>
                    <P>
                        Because of the large number of public comments we normally receive on 
                        <E T="04">Federal Register</E>
                         documents, we are not able to acknowledge or respond to them individually. We will consider all comments we receive by the date and time specified in the 
                        <E T="02">DATES</E>
                         section of this preamble, and, when we proceed with a subsequent document, we will respond to the comments in the preamble to that document. 
                    </P>
                    <HD SOURCE="HD1">XIV. Regulatory Impact Analysis </HD>
                    <P>We have examined the impact of this rule 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. </P>
                    <P>
                        Executive Order 12866 (as amended by Executive Order 13258, which 
                        <PRTPAGE P="66388"/>
                        merely reassigns responsibilities of duties) directs agencies to assess all costs and benefits of available regulatory alternatives and, when 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 must be prepared for final rules with economically significant effects (that is, a final rule that would have an annual effect on the economy of $100 million or more in any one year, or would adversely affect in a material way the economy, a sector of the economy, productivity, competition, jobs, the environment, public health or safety, or State, local, or tribal governments or communities). As indicated in more detail below in this regulatory impact analysis, we estimate that the PFS provisions included in this final rule with comment period rule will redistribute more than $100 million in 1 year. We are considering this final rule with comment period rule 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 final rule with comment period is a major rule and we have prepared a regulatory impact analysis. 
                    </P>
                    <P>The RFA requires agencies to analyze options for regulatory relief of small entities. For purposes of the RFA, small entities include small businesses, 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 $6.5 million to $31.5 million in any 1 year (For further information, see the Small Business Administration's regulation at 70 FR 72577, December 6, 2003.) Individuals and States are not included in the definition of a small entity. The RFA requires that we analyze regulatory options for small businesses and other entities. 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.</P>
                    <P>For purposes of the RFA, physicians, NPPs, and suppliers, including IDTFs, are considered small businesses if they generate revenues of $6.5 million or less. Approximately 95 percent of physicians are considered to be small entities. There are about 980,000 physicians, other practitioners and medical suppliers that receive Medicare payment under the PFS. </P>
                    <P>The CAP provides alternatives to physicians who do not wish to purchase drugs directly or collect coinsurance. The impact of the CAP provisions on an individual physician is dependent on whether the drugs they furnish to Medicare beneficiaries are included in the list of CAP drugs, whether the physician chooses to obtain drugs administered to Medicare beneficiaries through the CAP. The CAP provisions in this final rule with comment period will also have a potential impact on entities that are involved in the dispensing or distribution of drugs, plan to become approved CAP vendors, or are approved CAP vendors. </P>
                    <P>For purposes of the RFA, approximately 80 percent of clinical diagnostic laboratories are considered small businesses according to the Small Business Administration's size standards. Ambulance providers and suppliers for purposes of the RFA are also considered to be small entities. </P>
                    <P>In addition, most ESRD facilities are considered small entities, either based on nonprofit status or by having revenues of $31.5 million or less in any year. We consider a substantial number of entities to be affected if the rule is estimated to impact more than 5 percent of the total number of small entities. Based on our analysis of the 915 nonprofit ESRD facilities considered small entities in accordance with the above definitions, we estimate that the combined impact of the changes to payment for renal dialysis services included in this final rule with comment period will have a 0.9 percent increase in overall payments to nonprofit ESRD facilities relative to current overall payments. The analysis and discussion provided in this section, as well as elsewhere in this final rule with comment period, complies with the RFA requirements. </P>
                    <P>For the e-prescribing provisions, physician practices and independent pharmacies are considered small entities. </P>
                    <P>Because we acknowledge that many of the affected entities are small entities, the analysis discussed throughout the preamble of this final rule with comment period constitutes our regulatory flexibility analysis for the remaining provisions. </P>
                    <P>Section 1102(b) of the Act requires us to prepare a regulatory impact analysis for any final rule with comment period that 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 604 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. We have determined that this final rule with comment period would have minimal impact on small hospitals located in rural areas. Of the 202 hospital based ESRD facilities located in rural areas, only 40 are affiliated with hospitals with fewer than 100 beds. </P>
                    <P>Section 202 of the Unfunded Mandates Reform Act of 1995 also requires that agencies assess anticipated costs and benefits before issuing any rule that may result in expenditures in any year by State, local, or tribal governments, in the aggregate, or by the private sector, of $127 million. This final rule with comment period will not mandate any requirements for State, local, or tribal governments. Medicare beneficiaries are considered to be part of the private sector for this purpose. A discussion concerning the impact of this rule on beneficiaries is found later in this section. </P>
                    <P>We have examined this final rule with comment period 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. </P>
                    <P>
                        We have prepared the following analysis, which, together with the information provided in the rest of this preamble, meets all assessment requirements. The analysis explains the rationale for and purposes of this final rule with comment period rule; details the costs and benefits of the rule; analyzes alternatives; and presents the measures we use to minimize the burden on small entities. As indicated elsewhere in this final rule with comment period, we are making a variety of changes to our regulations, payments, or payment policies to ensure that our payment systems reflect changes in medical practice and the relative value of services. We provide information for each of the policy changes in the relevant sections of this final rule with comment period. We are unaware of any relevant Federal rules that duplicate, overlap or conflict with this final rule with comment period. The relevant sections of this final rule with comment period contain a description of significant alternatives if applicable. 
                        <PRTPAGE P="66389"/>
                    </P>
                    <HD SOURCE="HD2">A. RVU Impacts </HD>
                    <HD SOURCE="HD3">1. Resource-Based Work and PE RVUs </HD>
                    <P>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 BN. In the CY 2007 PFS final rule with comment period, the $4 billion impact of changes in work RVUs resulting from the 5-Year Review required that a BN adjustment be made. </P>
                    <P>As discussed in section IV.D.3 of the CY 2007 PFS final rule with comment period (71 FR 69735), we carefully reviewed the comments received concerning the BN adjustment needed to offset the $4 billion impact of changes in work RVUs resulting from the 5-Year Review. To meet the requirements set forth in section 1848(c)(2)(B)(ii)(II) of the Act, we implemented a BN adjustor of 0.8994 or 10.1 percent to be applied to the work RVUs. </P>
                    <P>Subsequent to the publication of the CY 2007 PFS final rule with comment period and the announcement of the 0.8994 BN adjustment to the work RVUs, the AMA RUC supplied work RVU recommendations on additional CPT codes from the 5-Year Review and recommendations for an increase in the work of anesthesia services. As stated in the CY 2007 PFS final rule with comment period, these additional codes are still considered part of the 5-Year Review. The impact of these additional recommendations and increases in the work of anesthesia services on the BN adjustment must be accounted for by revising the current work adjustor of 0.8994. The work adjustor for CY 2008, based upon the final work RVUs for these additional CPT codes and increases in the work of anesthesia services, is approximately 0.8806. Table 38 shows the specialty-level impact of the work and PE RVU changes. </P>
                    <P>Our estimates of changes in Medicare revenues for PFS services compare payment rates for CY 2007 with payment rates for CY 2008 using CY 2006 Medicare utilization for all years. 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 in Table 38. 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. </P>
                    <P>Table 38 shows only the payment impact on PFS services. The following is an explanation of the information represented in Table 38. </P>
                    <P>• Specialty: The physician specialty or type of practitioner/supplier. </P>
                    <P>• Allowed charges: Allowed charges are the Medicare Fee Schedule amounts for covered services and include copayments and deductibles (which are the financial responsibility of the beneficiary.) These amounts have been summed across all services furnished by physicians, practitioners, or suppliers within a specialty to arrive at the total allowed charges for the specialty. </P>
                    <P>• Impact of Work RVU Changes for additional changes in work RVUs from the 5-Year Review. </P>
                    <P>• Impact of PE RVU changes. The impact is shown for both 2008 which is the second year of the 4-year transition using the new methodology and the fully implemented 2010 PE RVUs. </P>
                    <P>• Combined impact of the finalized work RVUs and PE RVUs for both 2008 and the fully implemented 2010 PE RVUs.</P>
                    <GPOTABLE COLS="7" OPTS="L2,i1" CDEF="s75,10,10,10,10,10,10">
                        <TTITLE>Table 38.—Combined Total Allowed Charge Impact for Work and Practice Expense RVU Changes </TTITLE>
                        <BOXHD>
                            <CHED H="1">Specialty </CHED>
                            <CHED H="1">Allowed charges (mil) </CHED>
                            <CHED H="1">
                                Impact of work RVU changes 
                                <LI>(percent)</LI>
                            </CHED>
                            <CHED H="1">
                                Impact of PE RVU changes
                                <LI>(percent)</LI>
                            </CHED>
                            <CHED H="2">
                                2008
                                <LI>(PE trans. year 2)</LI>
                                <LI>(percent)</LI>
                            </CHED>
                            <CHED H="2">
                                2010
                                <LI>(PE full implement.)</LI>
                                <LI>(percent)</LI>
                            </CHED>
                            <CHED H="1">Combined impact of PE and work changes* </CHED>
                            <CHED H="2">
                                2008
                                <LI>(PE trans. year 2)</LI>
                                <LI>(percent)</LI>
                            </CHED>
                            <CHED H="2">
                                2010
                                <LI>(PE full implement.)</LI>
                                <LI>(percent)</LI>
                            </CHED>
                        </BOXHD>
                        <ROW>
                            <ENT I="01">TOTAL </ENT>
                            <ENT>$76,551 </ENT>
                            <ENT>0 </ENT>
                            <ENT>0 </ENT>
                            <ENT>0 </ENT>
                            <ENT>0 </ENT>
                            <ENT>0</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">ALLERGY/IMMUNOLOGY </ENT>
                            <ENT>173 </ENT>
                            <ENT>1 </ENT>
                            <ENT>1 </ENT>
                            <ENT>3 </ENT>
                            <ENT>2 </ENT>
                            <ENT>4 </ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">ANESTHESIOLOGY </ENT>
                            <ENT>1,579 </ENT>
                            <ENT>15 </ENT>
                            <ENT>−1 </ENT>
                            <ENT>−3 </ENT>
                            <ENT>14 </ENT>
                            <ENT>12 </ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">CARDIAC SURGERY </ENT>
                            <ENT>396 </ENT>
                            <ENT>−1 </ENT>
                            <ENT>−1 </ENT>
                            <ENT>−2 </ENT>
                            <ENT>−2 </ENT>
                            <ENT>−3 </ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">CARDIOLOGY </ENT>
                            <ENT>7,519 </ENT>
                            <ENT>−1 </ENT>
                            <ENT>−1 </ENT>
                            <ENT>−3 </ENT>
                            <ENT>−2 </ENT>
                            <ENT>−4 </ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">COLON AND RECTAL SURGERY </ENT>
                            <ENT>122 </ENT>
                            <ENT>−1 </ENT>
                            <ENT>1 </ENT>
                            <ENT>2 </ENT>
                            <ENT>0 </ENT>
                            <ENT>2 </ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">CRITICAL CARE </ENT>
                            <ENT>199 </ENT>
                            <ENT>−1 </ENT>
                            <ENT>0 </ENT>
                            <ENT>0 </ENT>
                            <ENT>−1 </ENT>
                            <ENT>−2 </ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">DERMATOLOGY </ENT>
                            <ENT>2,248 </ENT>
                            <ENT>−1 </ENT>
                            <ENT>2 </ENT>
                            <ENT>7 </ENT>
                            <ENT>2 </ENT>
                            <ENT>7 </ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">EMERGENCY MEDICINE </ENT>
                            <ENT>2,203 </ENT>
                            <ENT>−2 </ENT>
                            <ENT>0 </ENT>
                            <ENT>−1 </ENT>
                            <ENT>−2 </ENT>
                            <ENT>−2 </ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">ENDOCRINOLOGY </ENT>
                            <ENT>350 </ENT>
                            <ENT>−1 </ENT>
                            <ENT>0 </ENT>
                            <ENT>0 </ENT>
                            <ENT>−1 </ENT>
                            <ENT>−1 </ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">FAMILY PRACTICE </ENT>
                            <ENT>5,060 </ENT>
                            <ENT>0 </ENT>
                            <ENT>0 </ENT>
                            <ENT>1 </ENT>
                            <ENT>0 </ENT>
                            <ENT>1 </ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">GASTROENTEROLOGY </ENT>
                            <ENT>1,750 </ENT>
                            <ENT>−1 </ENT>
                            <ENT>1 </ENT>
                            <ENT>4 </ENT>
                            <ENT>0 </ENT>
                            <ENT>3 </ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">GENERAL PRACTICE </ENT>
                            <ENT>974 </ENT>
                            <ENT>0 </ENT>
                            <ENT>0 </ENT>
                            <ENT>0 </ENT>
                            <ENT>0 </ENT>
                            <ENT>0 </ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">GENERAL SURGERY </ENT>
                            <ENT>2,309 </ENT>
                            <ENT>−1 </ENT>
                            <ENT>0 </ENT>
                            <ENT>0 </ENT>
                            <ENT>−1 </ENT>
                            <ENT>0 </ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">GERIATRICS </ENT>
                            <ENT>147 </ENT>
                            <ENT>3 </ENT>
                            <ENT>0 </ENT>
                            <ENT>1 </ENT>
                            <ENT>3 </ENT>
                            <ENT>4 </ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">HAND SURGERY </ENT>
                            <ENT>80 </ENT>
                            <ENT>−1 </ENT>
                            <ENT>−1 </ENT>
                            <ENT>−3 </ENT>
                            <ENT>−2 </ENT>
                            <ENT>−4 </ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">HEMATOLOGY/ONCOLOGY </ENT>
                            <ENT>1,917 </ENT>
                            <ENT>−1 </ENT>
                            <ENT>0 </ENT>
                            <ENT>0 </ENT>
                            <ENT>−1 </ENT>
                            <ENT>−1 </ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">INFECTIOUS DISEASE </ENT>
                            <ENT>504 </ENT>
                            <ENT>−1 </ENT>
                            <ENT>0 </ENT>
                            <ENT>1 </ENT>
                            <ENT>−1 </ENT>
                            <ENT>0 </ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">INTERNAL MEDICINE </ENT>
                            <ENT>9,981 </ENT>
                            <ENT>1 </ENT>
                            <ENT>0 </ENT>
                            <ENT>0 </ENT>
                            <ENT>0 </ENT>
                            <ENT>0 </ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">INTERVENTIONAL RADIOLOGY </ENT>
                            <ENT>244 </ENT>
                            <ENT>−1 </ENT>
                            <ENT>−1 </ENT>
                            <ENT>−3 </ENT>
                            <ENT>−2 </ENT>
                            <ENT>−4 </ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">NEPHROLOGY </ENT>
                            <ENT>1,664 </ENT>
                            <ENT>−1 </ENT>
                            <ENT>−1 </ENT>
                            <ENT>−4 </ENT>
                            <ENT>−3 </ENT>
                            <ENT>−5 </ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">NEUROLOGY </ENT>
                            <ENT>1,398 </ENT>
                            <ENT>−1 </ENT>
                            <ENT>0 </ENT>
                            <ENT>−1 </ENT>
                            <ENT>−1 </ENT>
                            <ENT>−2 </ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">NEUROSURGERY </ENT>
                            <ENT>576 </ENT>
                            <ENT>−1 </ENT>
                            <ENT>−1 </ENT>
                            <ENT>−2 </ENT>
                            <ENT>−2 </ENT>
                            <ENT>−3 </ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">NUCLEAR MEDICINE </ENT>
                            <ENT>78 </ENT>
                            <ENT>−1 </ENT>
                            <ENT>5 </ENT>
                            <ENT>14 </ENT>
                            <ENT>4 </ENT>
                            <ENT>14 </ENT>
                        </ROW>
                        <ROW>
                            <PRTPAGE P="66390"/>
                            <ENT I="01">OBSTETRICS/GYNECOLOGY </ENT>
                            <ENT>628 </ENT>
                            <ENT>−1 </ENT>
                            <ENT>0 </ENT>
                            <ENT>−1 </ENT>
                            <ENT>−1 </ENT>
                            <ENT>−1 </ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">OPHTHALMOLOGY </ENT>
                            <ENT>4,664 </ENT>
                            <ENT>2 </ENT>
                            <ENT>−1 </ENT>
                            <ENT>−3 </ENT>
                            <ENT>1 </ENT>
                            <ENT>−1 </ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">ORTHOPEDIC SURGERY </ENT>
                            <ENT>3,248 </ENT>
                            <ENT>−1 </ENT>
                            <ENT>0 </ENT>
                            <ENT>−1 </ENT>
                            <ENT>−1 </ENT>
                            <ENT>−2 </ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">OTOLARNGOLOGY </ENT>
                            <ENT>913 </ENT>
                            <ENT>2 </ENT>
                            <ENT>−1 </ENT>
                            <ENT>−3 </ENT>
                            <ENT>1 </ENT>
                            <ENT>−1 </ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">PATHOLOGY </ENT>
                            <ENT>948 </ENT>
                            <ENT>−1 </ENT>
                            <ENT>−1 </ENT>
                            <ENT>−3 </ENT>
                            <ENT>−2 </ENT>
                            <ENT>−4 </ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">PEDIATRICS </ENT>
                            <ENT>74 </ENT>
                            <ENT>0 </ENT>
                            <ENT>0 </ENT>
                            <ENT>0 </ENT>
                            <ENT>0 </ENT>
                            <ENT>0 </ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">PHYSICAL MEDICINE </ENT>
                            <ENT>784 </ENT>
                            <ENT>1 </ENT>
                            <ENT>−1 </ENT>
                            <ENT>−2 </ENT>
                            <ENT>−1 </ENT>
                            <ENT>−2 </ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">PLASTIC SURGERY </ENT>
                            <ENT>272 </ENT>
                            <ENT>−1 </ENT>
                            <ENT>0 </ENT>
                            <ENT>1 </ENT>
                            <ENT>−1 </ENT>
                            <ENT>0 </ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">PSYCHIATRY </ENT>
                            <ENT>1,099 </ENT>
                            <ENT>−1 </ENT>
                            <ENT>1 </ENT>
                            <ENT>2 </ENT>
                            <ENT>0 </ENT>
                            <ENT>1 </ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">PULMONARY DISEASE </ENT>
                            <ENT>1,691 </ENT>
                            <ENT>−1 </ENT>
                            <ENT>0 </ENT>
                            <ENT>1 </ENT>
                            <ENT>−1 </ENT>
                            <ENT>0 </ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">RADIATION ONCOLOGY </ENT>
                            <ENT>1,612 </ENT>
                            <ENT>−1 </ENT>
                            <ENT>1 </ENT>
                            <ENT>2 </ENT>
                            <ENT>0 </ENT>
                            <ENT>1 </ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">RADIOLOGY </ENT>
                            <ENT>5,245 </ENT>
                            <ENT>−1 </ENT>
                            <ENT>1 </ENT>
                            <ENT>2 </ENT>
                            <ENT>0 </ENT>
                            <ENT>1 </ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">RHEUMATOLOGY </ENT>
                            <ENT>494 </ENT>
                            <ENT>−1 </ENT>
                            <ENT>0 </ENT>
                            <ENT>−1 </ENT>
                            <ENT>−1 </ENT>
                            <ENT>−2 </ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">THORACIC SURGERY </ENT>
                            <ENT>436 </ENT>
                            <ENT>−1 </ENT>
                            <ENT>−1 </ENT>
                            <ENT>−2 </ENT>
                            <ENT>−2 </ENT>
                            <ENT>−3 </ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">UROLOGY </ENT>
                            <ENT>2,033 </ENT>
                            <ENT>−1 </ENT>
                            <ENT>0 </ENT>
                            <ENT>0 </ENT>
                            <ENT>−1 </ENT>
                            <ENT>−1 </ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">VASCULAR SURGERY </ENT>
                            <ENT>641 </ENT>
                            <ENT>−1 </ENT>
                            <ENT>0 </ENT>
                            <ENT>0 </ENT>
                            <ENT>−1 </ENT>
                            <ENT>−1 </ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">AUDIOLOGIST </ENT>
                            <ENT>31 </ENT>
                            <ENT>26 </ENT>
                            <ENT>−14 </ENT>
                            <ENT>−43 </ENT>
                            <ENT>12 </ENT>
                            <ENT>−17 </ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">CHIROPRACTOR </ENT>
                            <ENT>725 </ENT>
                            <ENT>−1 </ENT>
                            <ENT>−1 </ENT>
                            <ENT>−2 </ENT>
                            <ENT>−2 </ENT>
                            <ENT>−3 </ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">CLINICAL PSYCHOLOGIST </ENT>
                            <ENT>531 </ENT>
                            <ENT>−1 </ENT>
                            <ENT>−2 </ENT>
                            <ENT>−6 </ENT>
                            <ENT>−3 </ENT>
                            <ENT>−7 </ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">CLINICAL SOCIAL WORKER </ENT>
                            <ENT>354 </ENT>
                            <ENT>−1 </ENT>
                            <ENT>−2 </ENT>
                            <ENT>−5 </ENT>
                            <ENT>−3 </ENT>
                            <ENT>−6 </ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">NURSE ANESTHETIST </ENT>
                            <ENT>608 </ENT>
                            <ENT>22 </ENT>
                            <ENT>0 </ENT>
                            <ENT>0 </ENT>
                            <ENT>22 </ENT>
                            <ENT>21 </ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">NURSE PRACTITIONER </ENT>
                            <ENT>796 </ENT>
                            <ENT>2 </ENT>
                            <ENT>0 </ENT>
                            <ENT>1 </ENT>
                            <ENT>2 </ENT>
                            <ENT>3 </ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">OPTOMETRY </ENT>
                            <ENT>790 </ENT>
                            <ENT>4 </ENT>
                            <ENT>0 </ENT>
                            <ENT>−1 </ENT>
                            <ENT>4 </ENT>
                            <ENT>3 </ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">ORAL/MAXILLOFACIAL SURGERY </ENT>
                            <ENT>37 </ENT>
                            <ENT>−1 </ENT>
                            <ENT>1 </ENT>
                            <ENT>3 </ENT>
                            <ENT>1 </ENT>
                            <ENT>3 </ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">PHYSICAL/OCCUPATIONAL THERAPY </ENT>
                            <ENT>1,391 </ENT>
                            <ENT>−1 </ENT>
                            <ENT>1 </ENT>
                            <ENT>4 </ENT>
                            <ENT>1 </ENT>
                            <ENT>4 </ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">PHYSICIAN ASSISTANT </ENT>
                            <ENT>600 </ENT>
                            <ENT>0 </ENT>
                            <ENT>0 </ENT>
                            <ENT>1 </ENT>
                            <ENT>0 </ENT>
                            <ENT>0 </ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">PODIATRY </ENT>
                            <ENT>1,575 </ENT>
                            <ENT>0 </ENT>
                            <ENT>2 </ENT>
                            <ENT>5 </ENT>
                            <ENT>2 </ENT>
                            <ENT>5 </ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">DIAGNOSTIC TESTING FACILITY </ENT>
                            <ENT>1,191 </ENT>
                            <ENT>0 </ENT>
                            <ENT>0 </ENT>
                            <ENT>1 </ENT>
                            <ENT>0 </ENT>
                            <ENT>1 </ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">INDEPENDENT LABORATORY </ENT>
                            <ENT>1,087 </ENT>
                            <ENT>0 </ENT>
                            <ENT>3 </ENT>
                            <ENT>10 </ENT>
                            <ENT>3 </ENT>
                            <ENT>10 </ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">PORTABLE X-RAY SUPPLIER </ENT>
                            <ENT>81 </ENT>
                            <ENT>0 </ENT>
                            <ENT>2 </ENT>
                            <ENT>7 </ENT>
                            <ENT>2 </ENT>
                            <ENT>7 </ENT>
                        </ROW>
                        <TNOTE>* Components may not sum to total due to rounding.</TNOTE>
                    </GPOTABLE>
                    <HD SOURCE="HD3">2. Adjustments for Payments for Imaging Services </HD>
                    <P>Section 1848(c)(2)(B)(iv)(II) of the Act as added by section 5102 of the Deficit Reduction Act of 2005 (Pub. L. 109-171) (DRA) exempts the estimated savings from the application of the OPPS based payment limitation on PFS imaging services from the PFS BN requirement. We estimate that the combined impact of the current BN exemptions instituted by such section, the addition of 6 codes to the list of services subject to the DRA OPPS cap (discussed in section II.E.1.), and the payment revisions to OPPS cap amounts would result in no measurable changes in the specialty specific impacts of the DRA provisions with the exception of vascular surgery in CY 2008. </P>
                    <HD SOURCE="HD3">3. Combined Impact</HD>
                    <P>Table 39 shows the specialty-level impact of the work and PE RVU changes, section 5102 of the DRA (including the additional 6 services that were added to the list of services subject to the DRA OPPS cap and the revision to OPPS payment amounts), and our most recent estimate (−10.1 percent) of the CY 2008 Medicare PFS update. Additionally, the impacts in this final rule with comment period rule reflect the use of updated physician time data from the AMA-RUC. </P>
                    <P>As indicated in Table 39, our estimates of changes in Medicare revenues for PFS services compare payment rates for CY 2007 with payment rates for CY 2008 using CY 2006 Medicare utilization crosswalked to 2008 services. To the extent that there are year-to-year changes in the volume and mix of services furnished by physicians, the actual impact on total Medicare revenues will be different than those shown in Table 39. 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 furnishes. </P>
                    <P>Table 39 shows only the payment impact on PFS services. The following is an explanation of the information represented in Table 39. </P>
                    <P>• Specialty: The physician specialty or type of practitioner/supplier. </P>
                    <P>• Allowed Charges: Allowed charges are the Medicare Fee Schedule amounts for covered services and include copayments and deductibles (which are the financial responsibility of the beneficiary.) These amounts have been summed across all services furnished by physicians, practitioners, or suppliers within a specialty to arrive at the total allowed charges for the specialty. </P>
                    <P>• Impact of the CY 2008 Work and PE RVU changes using the methodology finalized in the CY 2007 PFS final rule with comment period and the revised data sources discussed in this final rule with comment period. </P>
                    <P>
                        • Impact of section 5102 of the DRA: The CY 2008 percentage decrease in allowed charges attributed to section 5102 of the DRA with the addition of six codes to the OPPS cap list and revisions to the OPPS payment amounts. 
                        <PRTPAGE P="66391"/>
                    </P>
                    <P>• Combined impact of the finalized work and PE RVUs, section 5102 of the DRA and the addition of six codes to the OPPS cap list, and the revisions to OPPS payment amounts. </P>
                    <P>• CY 2008 Update: The percentage decrease in allowed charges attributed to the estimated CY 2008 PFS conversion factor update of −10.1 percent. </P>
                    <P>• Combined impact with CY 2008 update: The CY 2008 percentage decrease in allowed charges attributed to the impact of the work and PE RVU changes, section 5102 of the DRA (plus six additions to OPPS cap list), revisions to OPPS payment amounts, and the CY 2008 update. </P>
                    <GPOTABLE COLS="7" OPTS="L2,i1" CDEF="s75,10,10,10,10,10,10">
                        <TTITLE>Table 39.—Combined CY 2008 Total Allowed Charge Impact for the Remaining 5-Year Review of Work RVUs and Practice Expense Changes, OPPS Imaging Cap, and the CY 2008 Update </TTITLE>
                        <BOXHD>
                            <CHED H="1">Specialty</CHED>
                            <CHED H="1">Allowed charges (mil)</CHED>
                            <CHED H="1">
                                Impact of work and PE RVU changes *
                                <LI>(percent)</LI>
                            </CHED>
                            <CHED H="1">
                                Impact of DRA 5102
                                <LI>(percent)</LI>
                            </CHED>
                            <CHED H="1">
                                Combined impact RVU and DRA 5102 **
                                <LI>(percent)</LI>
                            </CHED>
                            <CHED H="1">
                                CY 2008 update
                                <LI>(percent)</LI>
                            </CHED>
                            <CHED H="1">
                                Combined impact with CY 2008 update **
                                <LI>(percent) </LI>
                            </CHED>
                        </BOXHD>
                        <ROW>
                            <ENT I="01">TOTAL</ENT>
                            <ENT>$76,551</ENT>
                            <ENT>0</ENT>
                            <ENT>0</ENT>
                            <ENT>0</ENT>
                            <ENT>−10</ENT>
                            <ENT>−10</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">ALLERGY/IMMUNOLOGY</ENT>
                            <ENT>173</ENT>
                            <ENT>2</ENT>
                            <ENT>0</ENT>
                            <ENT>2</ENT>
                            <ENT>−10</ENT>
                            <ENT>−8 </ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">ANESTHESIOLOGY</ENT>
                            <ENT>1,579</ENT>
                            <ENT>14</ENT>
                            <ENT>0</ENT>
                            <ENT>14</ENT>
                            <ENT>−10</ENT>
                            <ENT>4 </ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">CARDIAC SURGERY</ENT>
                            <ENT>396</ENT>
                            <ENT>−2</ENT>
                            <ENT>0</ENT>
                            <ENT>−2</ENT>
                            <ENT>−10</ENT>
                            <ENT>−12 </ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">CARDIOLOGY</ENT>
                            <ENT>7,519</ENT>
                            <ENT>−2</ENT>
                            <ENT>0</ENT>
                            <ENT>−2</ENT>
                            <ENT>−10</ENT>
                            <ENT>−12 </ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">COLON AND RECTAL SURGERY</ENT>
                            <ENT>122</ENT>
                            <ENT>0</ENT>
                            <ENT>0</ENT>
                            <ENT>0</ENT>
                            <ENT>−10</ENT>
                            <ENT>−10</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">CRITICAL CARE</ENT>
                            <ENT>199</ENT>
                            <ENT>−1</ENT>
                            <ENT>0</ENT>
                            <ENT>−1</ENT>
                            <ENT>−10</ENT>
                            <ENT>−11 </ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">DERMATOLOGY</ENT>
                            <ENT>2,248</ENT>
                            <ENT>2</ENT>
                            <ENT>0</ENT>
                            <ENT>2</ENT>
                            <ENT>−10</ENT>
                            <ENT>−8 </ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">EMERGENCY MEDICINE</ENT>
                            <ENT>2,203</ENT>
                            <ENT>−2</ENT>
                            <ENT>0</ENT>
                            <ENT>−2</ENT>
                            <ENT>−10</ENT>
                            <ENT>−12 </ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">ENDOCRINOLOGY</ENT>
                            <ENT>350</ENT>
                            <ENT>−1</ENT>
                            <ENT>0</ENT>
                            <ENT>−1</ENT>
                            <ENT>−10</ENT>
                            <ENT>−11 </ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">FAMILY PRACTICE</ENT>
                            <ENT>5,060</ENT>
                            <ENT>0</ENT>
                            <ENT>0</ENT>
                            <ENT>0</ENT>
                            <ENT>−10</ENT>
                            <ENT>−10 </ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">GASTROENTEROLOGY</ENT>
                            <ENT>1,750</ENT>
                            <ENT>0</ENT>
                            <ENT>0</ENT>
                            <ENT>0</ENT>
                            <ENT>−10</ENT>
                            <ENT>−10 </ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">GENERAL PRACTICE</ENT>
                            <ENT>974</ENT>
                            <ENT>0</ENT>
                            <ENT>0</ENT>
                            <ENT>0</ENT>
                            <ENT>−10</ENT>
                            <ENT>−10 </ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">GENERAL SURGERY</ENT>
                            <ENT>2,309</ENT>
                            <ENT>−1</ENT>
                            <ENT>0</ENT>
                            <ENT>−1</ENT>
                            <ENT>−10</ENT>
                            <ENT>−11 </ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">GERIATRICS</ENT>
                            <ENT>147</ENT>
                            <ENT>3</ENT>
                            <ENT>0</ENT>
                            <ENT>3</ENT>
                            <ENT>−10</ENT>
                            <ENT>−7 </ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">HAND SURGERY</ENT>
                            <ENT>80</ENT>
                            <ENT>−2</ENT>
                            <ENT>0</ENT>
                            <ENT>−2</ENT>
                            <ENT>−10</ENT>
                            <ENT>−12 </ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">HEMATOLOGY/ONCOLOGY</ENT>
                            <ENT>1,917</ENT>
                            <ENT>−1</ENT>
                            <ENT>0</ENT>
                            <ENT>−1</ENT>
                            <ENT>−10</ENT>
                            <ENT>−11 </ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">INFECTIOUS DISEASE</ENT>
                            <ENT>504</ENT>
                            <ENT>−1</ENT>
                            <ENT>0</ENT>
                            <ENT>−1</ENT>
                            <ENT>−10</ENT>
                            <ENT>−11 </ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">INTERNAL MEDICINE</ENT>
                            <ENT>9,981</ENT>
                            <ENT>0</ENT>
                            <ENT>0</ENT>
                            <ENT>0</ENT>
                            <ENT>−10</ENT>
                            <ENT>−10 </ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">INTERVENTIONAL RADIOLOGY</ENT>
                            <ENT>244</ENT>
                            <ENT>−2</ENT>
                            <ENT>0</ENT>
                            <ENT>−2</ENT>
                            <ENT>−10</ENT>
                            <ENT>−12 </ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">NEPHROLOGY</ENT>
                            <ENT>1,664</ENT>
                            <ENT>−3</ENT>
                            <ENT>0</ENT>
                            <ENT>−3</ENT>
                            <ENT>−10</ENT>
                            <ENT>−13 </ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">NEUROLOGY</ENT>
                            <ENT>1,398</ENT>
                            <ENT>−1</ENT>
                            <ENT>0</ENT>
                            <ENT>−1</ENT>
                            <ENT>−10</ENT>
                            <ENT>−11 </ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">NEUROSURGERY</ENT>
                            <ENT>576</ENT>
                            <ENT>−2</ENT>
                            <ENT>0</ENT>
                            <ENT>−2</ENT>
                            <ENT>−10</ENT>
                            <ENT>−12 </ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">NUCLEAR MEDICINE</ENT>
                            <ENT>78</ENT>
                            <ENT>4</ENT>
                            <ENT>0</ENT>
                            <ENT>5</ENT>
                            <ENT>−10</ENT>
                            <ENT>−5</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">OBSTETRICS/GYNECOLOGY</ENT>
                            <ENT>628</ENT>
                            <ENT>−1</ENT>
                            <ENT>0</ENT>
                            <ENT>−1</ENT>
                            <ENT>−10</ENT>
                            <ENT>−11 </ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">OPHTHALMOLOGY</ENT>
                            <ENT>4,664</ENT>
                            <ENT>1</ENT>
                            <ENT>0</ENT>
                            <ENT>1</ENT>
                            <ENT>−10</ENT>
                            <ENT>−9 </ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">ORTHOPEDIC SURGERY</ENT>
                            <ENT>3,248</ENT>
                            <ENT>−1</ENT>
                            <ENT>0</ENT>
                            <ENT>−1</ENT>
                            <ENT>−10</ENT>
                            <ENT>−11 </ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">OTOLARNGOLOGY</ENT>
                            <ENT>913</ENT>
                            <ENT>1</ENT>
                            <ENT>0</ENT>
                            <ENT>1</ENT>
                            <ENT>−10</ENT>
                            <ENT>−9</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">PATHOLOGY</ENT>
                            <ENT>948</ENT>
                            <ENT>−2</ENT>
                            <ENT>0</ENT>
                            <ENT>−2</ENT>
                            <ENT>−10</ENT>
                            <ENT>−12 </ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">PEDIATRICS</ENT>
                            <ENT>74</ENT>
                            <ENT>0</ENT>
                            <ENT>0</ENT>
                            <ENT>0</ENT>
                            <ENT>−10</ENT>
                            <ENT>−10</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">PHYSICAL MEDICINE</ENT>
                            <ENT>784</ENT>
                            <ENT>−1</ENT>
                            <ENT>0</ENT>
                            <ENT>−1</ENT>
                            <ENT>−10</ENT>
                            <ENT>−11</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">PLASTIC SURGERY</ENT>
                            <ENT>272</ENT>
                            <ENT>−1</ENT>
                            <ENT>0</ENT>
                            <ENT>−1</ENT>
                            <ENT>−10</ENT>
                            <ENT>−11 </ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">PSYCHIATRY</ENT>
                            <ENT>1,099</ENT>
                            <ENT>0</ENT>
                            <ENT>0</ENT>
                            <ENT>0</ENT>
                            <ENT>−10</ENT>
                            <ENT>−10</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">PULMONARY DISEASE</ENT>
                            <ENT>1,691</ENT>
                            <ENT>−1</ENT>
                            <ENT>0</ENT>
                            <ENT>−1</ENT>
                            <ENT>−10</ENT>
                            <ENT>−11 </ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">RADIATION ONCOLOGY</ENT>
                            <ENT>1,612</ENT>
                            <ENT>0</ENT>
                            <ENT>0</ENT>
                            <ENT>0</ENT>
                            <ENT>−10</ENT>
                            <ENT>−10 </ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">RADIOLOGY</ENT>
                            <ENT>5,245</ENT>
                            <ENT>0</ENT>
                            <ENT>0</ENT>
                            <ENT>0</ENT>
                            <ENT>−10</ENT>
                            <ENT>−10 </ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">RHEUMATOLOGY</ENT>
                            <ENT>494</ENT>
                            <ENT>−1</ENT>
                            <ENT>0</ENT>
                            <ENT>−1</ENT>
                            <ENT>−10</ENT>
                            <ENT>−11</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">THORACIC SURGERY</ENT>
                            <ENT>436</ENT>
                            <ENT>−2</ENT>
                            <ENT>0</ENT>
                            <ENT>−2</ENT>
                            <ENT>−10</ENT>
                            <ENT>−12</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">UROLOGY</ENT>
                            <ENT>2,033</ENT>
                            <ENT>−1</ENT>
                            <ENT>0</ENT>
                            <ENT>−1</ENT>
                            <ENT>−10</ENT>
                            <ENT>−11</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">VASCULAR SURGERY</ENT>
                            <ENT>641</ENT>
                            <ENT>−1</ENT>
                            <ENT>−1</ENT>
                            <ENT>−1</ENT>
                            <ENT>−10</ENT>
                            <ENT>−11 </ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">AUDIOLOGIST</ENT>
                            <ENT>31</ENT>
                            <ENT>12</ENT>
                            <ENT>0</ENT>
                            <ENT>12</ENT>
                            <ENT>−10</ENT>
                            <ENT>2 </ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">CHIROPRACTOR</ENT>
                            <ENT>725</ENT>
                            <ENT>−2</ENT>
                            <ENT>0</ENT>
                            <ENT>−2</ENT>
                            <ENT>−10</ENT>
                            <ENT>−12 </ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">CLINICAL PSYCHOLOGIST</ENT>
                            <ENT>531</ENT>
                            <ENT>−3</ENT>
                            <ENT>0</ENT>
                            <ENT>−3</ENT>
                            <ENT>−10</ENT>
                            <ENT>−13 </ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">CLINICAL SOCIAL WORKER</ENT>
                            <ENT>354</ENT>
                            <ENT>−3</ENT>
                            <ENT>0</ENT>
                            <ENT>−3</ENT>
                            <ENT>−10</ENT>
                            <ENT>−13 </ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">NURSE ANESTHETIST</ENT>
                            <ENT>608</ENT>
                            <ENT>22</ENT>
                            <ENT>0</ENT>
                            <ENT>22</ENT>
                            <ENT>−10</ENT>
                            <ENT>12</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">NURSE PRACTITIONER</ENT>
                            <ENT>796</ENT>
                            <ENT>2</ENT>
                            <ENT>0</ENT>
                            <ENT>2</ENT>
                            <ENT>−10</ENT>
                            <ENT>−8 </ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">OPTOMETRY</ENT>
                            <ENT>790</ENT>
                            <ENT>4</ENT>
                            <ENT>0</ENT>
                            <ENT>4</ENT>
                            <ENT>−10</ENT>
                            <ENT>−6</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">ORAL/MAXILLOFACIAL SURGERY</ENT>
                            <ENT>37</ENT>
                            <ENT>1</ENT>
                            <ENT>0</ENT>
                            <ENT>1</ENT>
                            <ENT>−10</ENT>
                            <ENT>−9 </ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">PHYSICAL/OCCUPATIONAL THERAPY</ENT>
                            <ENT>1,391</ENT>
                            <ENT>1</ENT>
                            <ENT>0</ENT>
                            <ENT>1</ENT>
                            <ENT>−10</ENT>
                            <ENT>−9</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">PHYSICIAN ASSISTANT</ENT>
                            <ENT>600</ENT>
                            <ENT>0</ENT>
                            <ENT>0</ENT>
                            <ENT>0</ENT>
                            <ENT>−10</ENT>
                            <ENT>−10</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">PODIATRY</ENT>
                            <ENT>1,575</ENT>
                            <ENT>2</ENT>
                            <ENT>0</ENT>
                            <ENT>2</ENT>
                            <ENT>−10</ENT>
                            <ENT>−8 </ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">DIAGNOSTIC TESTING FACILITY</ENT>
                            <ENT>1,191</ENT>
                            <ENT>0</ENT>
                            <ENT>0 </ENT>
                            <ENT>0 </ENT>
                            <ENT>−10 </ENT>
                            <ENT>−10 </ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">INDEPENDENT LABORATORY</ENT>
                            <ENT>1,087</ENT>
                            <ENT>3</ENT>
                            <ENT>0</ENT>
                            <ENT>3</ENT>
                            <ENT>−10</ENT>
                            <ENT>−7 </ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">PORTABLE X-RAY SUPPLIER</ENT>
                            <ENT>81</ENT>
                            <ENT>2</ENT>
                            <ENT>0</ENT>
                            <ENT>2</ENT>
                            <ENT>−10</ENT>
                            <ENT>−8 </ENT>
                        </ROW>
                        <TNOTE>* PE changes are CY 2008 second year transition changes. For fully implemented CY 2010 PE changes see Table 1. </TNOTE>
                        <TNOTE>** Components may not sum to total due to rounding. </TNOTE>
                    </GPOTABLE>
                    <PRTPAGE P="66392"/>
                    <P>Table 40 shows the estimated impact on total payments for selected high volume procedures of all of the changes discussed previously. We selected these procedures because they are the most commonly furnished by a broad spectrum of physician specialties. There are separate columns that show the change in the facility rates and the nonfacility rates. For an explanation of facility and nonfacility PE refer to Addendum A of this final rule with comment period rule. </P>
                    <GPOTABLE COLS="9" OPTS="L2,i1" CDEF="xs48,6,r75,8,8,8,8,8,8">
                        <TTITLE>Table 40.—Impact of Final Rule With Comment Period and Estimated Physician Update on 2008 Payment for Selected Procedures</TTITLE>
                        <BOXHD>
                            <CHED H="1">CPT/HCPCS</CHED>
                            <CHED H="1">MOD</CHED>
                            <CHED H="1">Description</CHED>
                            <CHED H="1">Facility</CHED>
                            <CHED H="2">2007</CHED>
                            <CHED H="2">2008</CHED>
                            <CHED H="2">Percent change</CHED>
                            <CHED H="1">Non-facility</CHED>
                            <CHED H="2">2007</CHED>
                            <CHED H="2">2008</CHED>
                            <CHED H="2">Percent change</CHED>
                        </BOXHD>
                        <ROW>
                            <ENT I="01">11721</ENT>
                            <ENT/>
                            <ENT>Debride nail, 6 or more</ENT>
                            <ENT>$28.80</ENT>
                            <ENT>$24.53</ENT>
                            <ENT>−15</ENT>
                            <ENT>$39.03</ENT>
                            <ENT>$35.43</ENT>
                            <ENT>−9</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">17000</ENT>
                            <ENT/>
                            <ENT>Destruct premalg lesion</ENT>
                            <ENT>44.72</ENT>
                            <ENT>41.56</ENT>
                            <ENT>−7</ENT>
                            <ENT>63.29</ENT>
                            <ENT>60.30</ENT>
                            <ENT>−5 </ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">27130</ENT>
                            <ENT/>
                            <ENT>Total hip arthroplasty</ENT>
                            <ENT>1,360.52</ENT>
                            <ENT>1,194.77</ENT>
                            <ENT>−12</ENT>
                            <ENT>na</ENT>
                            <ENT>na</ENT>
                            <ENT>na </ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">27244</ENT>
                            <ENT/>
                            <ENT>Treat thigh fracture</ENT>
                            <ENT>1,100.92</ENT>
                            <ENT>963.11</ENT>
                            <ENT>−13</ENT>
                            <ENT>na</ENT>
                            <ENT>na</ENT>
                            <ENT>na </ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">27447</ENT>
                            <ENT/>
                            <ENT>Total knee arthroplasty</ENT>
                            <ENT>1,464.74</ENT>
                            <ENT>1,283.35</ENT>
                            <ENT>−12</ENT>
                            <ENT>na</ENT>
                            <ENT>na</ENT>
                            <ENT>na </ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">33533</ENT>
                            <ENT/>
                            <ENT>CABG, arterial, single</ENT>
                            <ENT>1,908.52</ENT>
                            <ENT>1,658.44</ENT>
                            <ENT>−13</ENT>
                            <ENT>na</ENT>
                            <ENT>na</ENT>
                            <ENT>na </ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">35301</ENT>
                            <ENT/>
                            <ENT>Rechanneling of artery</ENT>
                            <ENT>1,071.74</ENT>
                            <ENT>934.49</ENT>
                            <ENT>−13</ENT>
                            <ENT>na</ENT>
                            <ENT>na</ENT>
                            <ENT>na </ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">43239</ENT>
                            <ENT/>
                            <ENT>Upper GI endoscopy, biopsy</ENT>
                            <ENT>155.00</ENT>
                            <ENT>140.36</ENT>
                            <ENT>−9</ENT>
                            <ENT>325.16</ENT>
                            <ENT>294.01</ENT>
                            <ENT>−10</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">66821</ENT>
                            <ENT/>
                            <ENT>After cataract laser surgery </ENT>
                            <ENT>253.53 </ENT>
                            <ENT>222.81 </ENT>
                            <ENT>−12</ENT>
                            <ENT>270.97</ENT>
                            <ENT>237.80</ENT>
                            <ENT>−12</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">66984</ENT>
                            <ENT/>
                            <ENT>Cataract surg w/iol, 1 stage</ENT>
                            <ENT>641.98</ENT>
                            <ENT>560.08</ENT>
                            <ENT>−13</ENT>
                            <ENT>na</ENT>
                            <ENT>na</ENT>
                            <ENT>na </ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">67210</ENT>
                            <ENT/>
                            <ENT>Treatment of retinal lesion</ENT>
                            <ENT>556.34</ENT>
                            <ENT>487.86</ENT>
                            <ENT>−12</ENT>
                            <ENT>580.59</ENT>
                            <ENT>507.96</ENT>
                            <ENT>−13</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">71010</ENT>
                            <ENT/>
                            <ENT>Chest x-ray</ENT>
                            <ENT>na</ENT>
                            <ENT>na</ENT>
                            <ENT>na</ENT>
                            <ENT>26.15</ENT>
                            <ENT>22.83</ENT>
                            <ENT>−13 </ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">71010</ENT>
                            <ENT>26</ENT>
                            <ENT>Chest x-ray</ENT>
                            <ENT>8.72</ENT>
                            <ENT>7.84</ENT>
                            <ENT>−10</ENT>
                            <ENT>8.72</ENT>
                            <ENT>7.84</ENT>
                            <ENT>−10 </ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">77056</ENT>
                            <ENT/>
                            <ENT>Mammogram, both breasts</ENT>
                            <ENT>na</ENT>
                            <ENT>na</ENT>
                            <ENT>na</ENT>
                            <ENT>97.40</ENT>
                            <ENT>93.35</ENT>
                            <ENT>−4 </ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">77056</ENT>
                            <ENT>26</ENT>
                            <ENT>Mammogram, both breasts</ENT>
                            <ENT>41.31</ENT>
                            <ENT> 37.48</ENT>
                            <ENT>−9</ENT>
                            <ENT>41.31</ENT>
                            <ENT>37.48</ENT>
                            <ENT>−9</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">77057</ENT>
                            <ENT/>
                            <ENT>Mammogram, screening</ENT>
                            <ENT>na</ENT>
                            <ENT>na</ENT>
                            <ENT>na</ENT>
                            <ENT>81.86</ENT>
                            <ENT>73.93</ENT>
                            <ENT>−10 </ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">77057</ENT>
                            <ENT>26</ENT>
                            <ENT>Mammogram, screening</ENT>
                            <ENT>33.35</ENT>
                            <ENT>30.32</ENT>
                            <ENT>−9</ENT>
                            <ENT>33.35</ENT>
                            <ENT>30.32</ENT>
                            <ENT>−9</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">77427</ENT>
                            <ENT/>
                            <ENT>Radiation tx management, x5</ENT>
                            <ENT>176.22</ENT>
                            <ENT>158.42</ENT>
                            <ENT>−10</ENT>
                            <ENT>176.22</ENT>
                            <ENT>158.42</ENT>
                            <ENT>−10 </ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">78465</ENT>
                            <ENT>26</ENT>
                            <ENT>Heart image (3d), multiple</ENT>
                            <ENT>73.14</ENT>
                            <ENT>66.43</ENT>
                            <ENT>−9</ENT>
                            <ENT>73.14</ENT>
                            <ENT>66.43</ENT>
                            <ENT>−9</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">88305</ENT>
                            <ENT>26 </ENT>
                            <ENT>Tissue exam by pathologist</ENT>
                            <ENT>37.90</ENT>
                            <ENT>32.36</ENT>
                            <ENT>−15</ENT>
                            <ENT>37.90</ENT>
                            <ENT>32.36</ENT>
                            <ENT>−15</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">90801</ENT>
                            <ENT/>
                            <ENT>Psy dx interview</ENT>
                            <ENT>129.99 </ENT>
                            <ENT>112.08</ENT>
                            <ENT>−14</ENT>
                            <ENT>145.15</ENT>
                            <ENT>131.50</ENT>
                            <ENT>−9</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">90862</ENT>
                            <ENT/>
                            <ENT>Medication management</ENT>
                            <ENT>44.72</ENT>
                            <ENT>39.18</ENT>
                            <ENT>−12</ENT>
                            <ENT>50.40</ENT>
                            <ENT>46.67</ENT>
                            <ENT>−7</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">90935 </ENT>
                            <ENT/>
                            <ENT>Hemodialysis, one evaluation</ENT>
                            <ENT>67.46</ENT>
                            <ENT>58.26</ENT>
                            <ENT>−14</ENT>
                            <ENT>na</ENT>
                            <ENT>na</ENT>
                            <ENT>na </ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">92012</ENT>
                            <ENT/>
                            <ENT>Eye exam established pat</ENT>
                            <ENT>34.11</ENT>
                            <ENT>38.50</ENT>
                            <ENT>13</ENT>
                            <ENT>61.77</ENT>
                            <ENT>62.69</ENT>
                            <ENT>1</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">92014</ENT>
                            <ENT/>
                            <ENT>Eye exam &amp; treatment</ENT>
                            <ENT>55.71</ENT>
                            <ENT>59.28</ENT>
                            <ENT>6</ENT>
                            <ENT>91.33</ENT>
                            <ENT>90.96</ENT>
                            <ENT>0</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">92980</ENT>
                            <ENT/>
                            <ENT>Insert intracoronary stent</ENT>
                            <ENT>795.85</ENT>
                            <ENT>720.88</ENT>
                            <ENT>−9</ENT>
                            <ENT>na</ENT>
                            <ENT>na</ENT>
                            <ENT>na</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">93000</ENT>
                            <ENT/>
                            <ENT>Electrocardiogram, complete</ENT>
                            <ENT>24.63</ENT>
                            <ENT>20.78</ENT>
                            <ENT>−16</ENT>
                            <ENT>24.63</ENT>
                            <ENT>20.78</ENT>
                            <ENT>−16</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">93010</ENT>
                            <ENT/>
                            <ENT>Electrocardiogram report</ENT>
                            <ENT>8.34</ENT>
                            <ENT>7.50</ENT>
                            <ENT>−10</ENT>
                            <ENT>8.34</ENT>
                            <ENT>7.50</ENT>
                            <ENT>−10</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">93015 </ENT>
                            <ENT/>
                            <ENT>Cardiovascular stress test</ENT>
                            <ENT>104.22</ENT>
                            <ENT>93.01</ENT>
                            <ENT>−11</ENT>
                            <ENT>104.22</ENT>
                            <ENT>93.01</ENT>
                            <ENT>−11</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">93307</ENT>
                            <ENT>26</ENT>
                            <ENT>Echo exam of heart</ENT>
                            <ENT>46.99</ENT>
                            <ENT>42.24</ENT>
                            <ENT>−10</ENT>
                            <ENT>46.99</ENT>
                            <ENT>42.24</ENT>
                            <ENT>−10</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">93510</ENT>
                            <ENT>26</ENT>
                            <ENT>Left heart catheterization</ENT>
                            <ENT>242.92</ENT>
                            <ENT>215.31</ENT>
                            <ENT>−11</ENT>
                            <ENT>242.92</ENT>
                            <ENT>215.31</ENT>
                            <ENT>−11</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">98941</ENT>
                            <ENT/>
                            <ENT>Chiropractic manipulation</ENT>
                            <ENT>28.80</ENT>
                            <ENT>25.55</ENT>
                            <ENT>−11</ENT>
                            <ENT>33.35</ENT>
                            <ENT>29.64</ENT>
                            <ENT>−11</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">99203</ENT>
                            <ENT/>
                            <ENT>Office/outpatient visit, new</ENT>
                            <ENT>67.08</ENT>
                            <ENT>58.60</ENT>
                            <ENT>−13</ENT>
                            <ENT>91.71</ENT>
                            <ENT>81.42</ENT>
                            <ENT>−11</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">99213</ENT>
                            <ENT/>
                            <ENT>Office/outpatient visit, est</ENT>
                            <ENT>42.07</ENT>
                            <ENT>37.48</ENT>
                            <ENT>−11</ENT>
                            <ENT>59.50</ENT>
                            <ENT>53.15</ENT>
                            <ENT>−11 </ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">99214</ENT>
                            <ENT/>
                            <ENT>Office/outpatient visit, est</ENT>
                            <ENT>66.32</ENT>
                            <ENT>58.60</ENT>
                            <ENT>−12</ENT>
                            <ENT>90.20</ENT>
                            <ENT>80.40</ENT>
                            <ENT>−11</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">99222 </ENT>
                            <ENT/>
                            <ENT>Initial hospital care</ENT>
                            <ENT>119.00</ENT>
                            <ENT>104.59</ENT>
                            <ENT>−12</ENT>
                            <ENT>na</ENT>
                            <ENT>na</ENT>
                            <ENT>na</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">99223</ENT>
                            <ENT/>
                            <ENT>Initial hospital care</ENT>
                            <ENT>173.57</ENT>
                            <ENT>153.65</ENT>
                            <ENT>−11</ENT>
                            <ENT>na</ENT>
                            <ENT>na</ENT>
                            <ENT>na </ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">99231</ENT>
                            <ENT/>
                            <ENT>Subsequent hospital care</ENT>
                            <ENT>35.62</ENT>
                            <ENT>31.68</ENT>
                            <ENT>−11</ENT>
                            <ENT>na</ENT>
                            <ENT>na</ENT>
                            <ENT>na</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">99232</ENT>
                            <ENT/>
                            <ENT>Subsequent hospital care</ENT>
                            <ENT>63.67</ENT>
                            <ENT>56.55</ENT>
                            <ENT>−11</ENT>
                            <ENT>na</ENT>
                            <ENT>na</ENT>
                            <ENT>na</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">99233 </ENT>
                            <ENT/>
                            <ENT>Subsequent hospital care</ENT>
                            <ENT>90.95</ENT>
                            <ENT>81.08</ENT>
                            <ENT>−11</ENT>
                            <ENT>na</ENT>
                            <ENT>na</ENT>
                            <ENT>na</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">99236</ENT>
                            <ENT/>
                            <ENT>Observ/hosp same date</ENT>
                            <ENT>205.40</ENT>
                            <ENT>179.20</ENT>
                            <ENT>−13</ENT>
                            <ENT>na</ENT>
                            <ENT>na</ENT>
                            <ENT>na</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">99239</ENT>
                            <ENT/>
                            <ENT>Hospital discharge day</ENT>
                            <ENT>94.74</ENT>
                            <ENT>83.13</ENT>
                            <ENT>−12</ENT>
                            <ENT>na</ENT>
                            <ENT>na</ENT>
                            <ENT>na</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">99243</ENT>
                            <ENT/>
                            <ENT>Office consultation</ENT>
                            <ENT>93.23</ENT>
                            <ENT>83.13</ENT>
                            <ENT>−11</ENT>
                            <ENT>122.41</ENT>
                            <ENT>109.36</ENT>
                            <ENT>−11</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">99244</ENT>
                            <ENT/>
                            <ENT>Office consultation</ENT>
                            <ENT>145.91</ENT>
                            <ENT>130.14</ENT>
                            <ENT>−11 </ENT>
                            <ENT>179.26</ENT>
                            <ENT>160.12</ENT>
                            <ENT>−11</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">99253</ENT>
                            <ENT/>
                            <ENT>Inpatient consultation</ENT>
                            <ENT>108.77</ENT>
                            <ENT>97.09</ENT>
                            <ENT>−11</ENT>
                            <ENT>na</ENT>
                            <ENT>na </ENT>
                            <ENT>na </ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">99254 </ENT>
                            <ENT/>
                            <ENT>Inpatient consultation</ENT>
                            <ENT>156.52</ENT>
                            <ENT>140.02</ENT>
                            <ENT>−11</ENT>
                            <ENT>na</ENT>
                            <ENT>na</ENT>
                            <ENT>na</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">99283 </ENT>
                            <ENT/>
                            <ENT>Emergency dept visit </ENT>
                            <ENT>60.64</ENT>
                            <ENT>52.81</ENT>
                            <ENT>−13</ENT>
                            <ENT>na</ENT>
                            <ENT>na</ENT>
                            <ENT>na </ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">99284</ENT>
                            <ENT/>
                            <ENT>Emergency dept visit</ENT>
                            <ENT>110.28</ENT>
                            <ENT>97.44</ENT>
                            <ENT>−12</ENT>
                            <ENT>na </ENT>
                            <ENT>na</ENT>
                            <ENT>na </ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">99291 </ENT>
                            <ENT/>
                            <ENT>Critical care, first hour</ENT>
                            <ENT>208.82</ENT>
                            <ENT>182.61</ENT>
                            <ENT>−13</ENT>
                            <ENT>256.19</ENT>
                            <ENT>224.17</ENT>
                            <ENT>−12</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">99292 </ENT>
                            <ENT/>
                            <ENT>Critical care, addtl 30 min</ENT>
                            <ENT>104.60</ENT>
                            <ENT>91.64</ENT>
                            <ENT>−12</ENT>
                            <ENT>114.45</ENT>
                            <ENT>100.16</ENT>
                            <ENT>−12</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">99348 </ENT>
                            <ENT/>
                            <ENT>Home visit, est patient</ENT>
                            <ENT>na</ENT>
                            <ENT>na</ENT>
                            <ENT>na</ENT>
                            <ENT>66.32</ENT>
                            <ENT>68.14</ENT>
                            <ENT>2 </ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">99350 </ENT>
                            <ENT/>
                            <ENT>Home visit, est patient</ENT>
                            <ENT>na</ENT>
                            <ENT>na </ENT>
                            <ENT>na</ENT>
                            <ENT>150.83</ENT>
                            <ENT>139.34</ENT>
                            <ENT>−8</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">G0008 </ENT>
                            <ENT/>
                            <ENT>Admin influenza virus vac</ENT>
                            <ENT>na</ENT>
                            <ENT>na</ENT>
                            <ENT>na</ENT>
                            <ENT>18.95</ENT>
                            <ENT>18.40</ENT>
                            <ENT>−3</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">G0317 </ENT>
                            <ENT/>
                            <ENT>ESRD related svs 4+mo 20+yrs</ENT>
                            <ENT>283.09</ENT>
                            <ENT>245.29</ENT>
                            <ENT>−13</ENT>
                            <ENT>283.09</ENT>
                            <ENT>245.29</ENT>
                            <ENT>−13 </ENT>
                        </ROW>
                    </GPOTABLE>
                    <PRTPAGE P="66393"/>
                    <HD SOURCE="HD2">B. Geographic Practice Cost Index Changes </HD>
                    <P>Section 1848(e)(1)(A) of the Act requires that payments under the Medicare physician fee schedule vary among payment areas only to the extent that area costs vary as reflected by the area GPCIs. The GPCIs measure area cost differences in the three components of the physician fee schedule: Physician work, PEs (employee wages, rent, medical supplies, and equipment), and malpractice insurance. Section 1848(e)(1)(C) of the Act requires that the GPCIs be reviewed and, if necessary, revised at least every 3 years. The first GPCI revision occurred in 1993. The second revision was implemented in 1998, the next in 2001, and the last in 2005. We are implementing the next GPCI update in this rule and the 2008 updated, budget neutralized values are shown in Addendum E. These values reflect the removal of the 1.000 floor on physician work as mandated by the MIEA-TRHCA law of December 2006. As required by law, the GPCIs are phased in over a two year period; therefore the 2008 GPCI values are calculated as one-half the difference between the fully implemented 2007 GPCIs and the fully implemented 2009 (updated) GPCIs. </P>
                    <P>An estimate of the overall effects of GPCI changes on fee schedule area payments can be demonstrated by a comparison of area geographic adjustment factors (GAFs). The GAFs are a weighted composite of each area's work, PE, and malpractice expense GPCIs using the national GPCI cost share weights. While we do not actually use the GAFs in computing the fee schedule payment for a specific service, they are useful in comparing overall area costs and payments. The actual effect on payment for any actual service will deviate from the GAF to the extent that the services proportions of work, PE, and malpractice expense RVUs differ from those of the GAF. The GAFs reflect the removal of the 1.000 floor on physician work as mandated by the MIEA-TRHCA law of December 2006. </P>
                    <P>The most significant positive changes occur in seven payment localities where the GAF moves up between 5.91 percent (Rest of Maine) and 2.05 percent (Ventura, Calif.). Nineteen payment localities show an increase in GAF of between 1.99 percent (Rest of Texas) to 1.05 percent (New Hampshire). Twenty-two payment localities have increases of less than 1 percent. </P>
                    <P>The Detroit, Michigan payment locality shows a drop in the GAF value of 4.32 percent, the largest, and eight other payment localities (including Santa Clara, California, Atlanta, Georgia, Fort Worth, Texas, and Chicago, Illinois) decrease between 3.8 percent and 2.16 percent in the GAF value. Fourteen payment localities show decreases between 1.10 percent (Rest of Michigan) and 1.92 percent (Miami, Florida). Twenty-two payment localities show decreases between 0.01 percent (Anaheim, California) and 0.90 percent (Seattle, Washington). </P>
                    <P>Increases or decreases in GPCI values do not necessarily reflect increases or decreases in the actual costs associated with a specific locality, but rather reflect the relative costs compared to a national average. As an example, when rents go up in Wisconsin or Ohio, the index for California or New York goes down, even if actual costs for California or New York stay the same or even increase. Other factors also play a part in the overall GPCI picture. We do not have sufficient data to undertake a sensitivity analysis of exact elements of the change but we can make some generalized assumptions. For example, the changes in GAF values for several areas of California reflect significant changes in the malpractice GPCIs; and, a lowering of the PE GPCI in many urban settings is offset by increases in the PE GPCI of more rural settings. </P>
                    <P>The 2008 GPCIs are budget neutralized so the update does not result in an increase in spending as a result of the changes. </P>
                    <HD SOURCE="HD2">C. Telehealth </HD>
                    <P>
                        In section II.D of this rule, we are adding neurobehavioral status exam as represented by HCPCS code 96116 to the list of telehealth services. To date, Medicare expenditures for telehealth services have been extremely low. For instance, in CY 2006, the 
                        <E T="03">total</E>
                         Medicare payment amount for telehealth services (including the originating site facility fee) was approximately $2 million. Moreover, previous additions to the list of Medicare telehealth services have not resulted in a significant increase in Medicare program expenditures. For example, the psychiatric diagnostic interview examination (as described by CPT code 90801) was added to the list of Medicare telehealth services in CY 2003. The addition of CPT code 90801 resulted in an increase in Medicare payment amounts of approximately $100,000 in CY 2006. 
                    </P>
                    <P>The neurobehavioral status exam (CPT code 96116) includes an initial assessment and evaluation of the mental status for a psychiatric patient. In this regard, the neurobehavioral status exam is similar to the psychiatric diagnostic interview examination (CPT code 90801). However, the utilization rate of psychiatric diagnostic interview examination is much greater than the neurobehavioral status exam. For instance, in CY 2006, the total allowed services for CPT code 90801 was approximately 1.3 million while total allowed services for neurobehavioral status exam in CY 2006 was approximately 105,000. Because utilization of neurobehavioral status exam is substantially less than the psychiatric diagnostic interview examination, we believe the budgetary impact of adding neurobehavioral status exam to the list of Medicare telehealth services will be even less than the previously added psychiatric diagnostic interview examination. </P>
                    <P>While we believe that addition of this service to the telehealth service list will enable more beneficiaries to access to these services, we do not anticipate that this change will have a significant budgetary impact on the Medicare program. </P>
                    <HD SOURCE="HD2">D. Payment for Covered Outpatient Drugs and Biologicals </HD>
                    <HD SOURCE="HD3">1. ASP Issues </HD>
                    <P>The issues discussed in section II.F.1. with respect to payment for covered outpatient drugs and biologicals, are estimated to have no impact on Medicare expenditures. However, we believe the policies we are adopting will assist in clarifying existing policy with respect to ASP payment. </P>
                    <HD SOURCE="HD3">2. CAP issues </HD>
                    <P>
                        This final rule describes a significant change in how CAP drug claims are paid due to the implementation of section 108(a)(2) of the MIEA-TRHCA. This rule also addresses comments and finalizes regulations on certain approaches to refining the CAP that seek to improve service by improving compliance, increasing flexibility, and increasing choices available to participating CAP physicians. The finalized CAP provisions will also have a potential impact on entities that are involved in the dispensing or distribution of drugs, that plan to become approved CAP vendors, or are approved CAP vendors. Changes associated with section 108(a)(2) of the MIEA-TRHCA, especially the provision for payment to vendors upon receipt of a claim, will almost certainly be perceived as a positive step. Other finalized changes seek to improve service by improving compliance and increasing flexibility under the CAP. At this time, we anticipate that these changes will result in no significant additional cost savings or increases 
                        <PRTPAGE P="66394"/>
                        associated with the CAP, relative to the ASP payment system. 
                    </P>
                    <HD SOURCE="HD2">E. Clinical Laboratory Fee Schedule Issues </HD>
                    <P>As discussed in section II.G of this final rule, we are adopting § 414.509 for establishing payment for a new clinical diagnostic laboratory paid under the Medicare Part B clinical laboratory fee schedule. Also, we are clarifying dates in § 414.502 and § 414.508. These changes will not increase or decrease payments for current clinical diagnostic laboratory tests. For newly developed tests, we will permit an opportunity for the public to request a reconsideration of a payment amount. Because any new laboratory tests to undergo a reconsideration request of a payment amount are unknown to us at the current time, we do not have any data to estimate the impact. However, we anticipate that the reconsideration process will apply to fewer than five new tests per year so that no significant additional costs to the clinical laboratory payment system will occur. </P>
                    <HD SOURCE="HD2">F. Provisions Related to Payment for Renal Dialysis Services Furnished by End State Renal Disease (ESRD) Facilities </HD>
                    <P>The ESRD-related provisions in this final rule are discussed in section II.H. To understand the impact of the changes affecting payments to different categories of ESRD facilities, it is necessary to compare estimated payments under the current year (CY 2007 payments) to estimated payments under the revisions to the composite rate payment system as discussed in II.H. of this final rule with comment period (2008 payments). To estimate the impact among various classes of ESRD facilities, it is imperative that the estimates of current payments and projected payments contain similar inputs. Therefore, we simulated payments only for those ESRD facilities that we are able to calculate both current 2007 payments and projected 2008 payments.</P>
                    <P>ESRD providers were grouped into the categories based on characteristics furnished in the Online Survey and Certification and Reporting (OSCAR) file and the most recent cost report data from the Healthcare Cost Report Information System (HCRIS). We also used the June 2007 update of CY 2006 National Claims History file as a basis for Medicare dialysis treatments and separately billable drugs and biologicals. Due to data limitations, we are unable to estimate current 2007 payments and projected 2008 payments for 153 of the 4,813 ESRD facilities that billed for ESRD dialysis treatments in CY 2006. </P>
                    <P>Table 41 shows the impact of this year's changes to CY 2008 payments to hospital-based and independent ESRD facilities. The first column of Table 41 identifies the type of ESRD provider, the second column indicates the number of ESRD facilities for each type, and the third column indicates the number of dialysis treatments. </P>
                    <P>The fourth column shows the effect of the change to the wage index floor as it affects the composite rate payments to ESRD facilities for CY 2008. The fourth column compares aggregate ESRD wage adjusted composite rate payments in the third year of the transition (CY 2008) using the CY 2008 wage index with a 0.80 floor compared to aggregate ESRD wage adjusted composite rate payments in the third year of the transition (CY 2008) using the CY 2008 wage index with a 0.75 floor. Note that the fourth column only includes the effect of the change to the wage index floor and does not include the effects of other wage index changes, such as, moving from the second to third year of the transition and updated wage index values from CY 2007 to CY 2008. </P>
                    <P>The fifth column shows the effect of all changes to the ESRD wage index for CY 2008 as it affects the composite rate payments to ESRD facilities. It is inclusive of the changes in the fourth column. The fifth column compares aggregate ESRD wage adjusted composite rate payments in the third year of the transition (CY 2008) to aggregate ESRD wage adjusted composite rate payments in the second year of the transition (CY 2007). In the third year of the transition (CY 2008), ESRD facilities receive 75 percent of the CBSA wage adjusted composite rate and 25 percent of the MSA wage adjusted composite rate. In the second year of the transition, ESRD facilities receive 50 percent of the CBSA wage adjusted composite rate and 50 percent of the MSA wage adjusted composite rate. The overall effect to all ESRD providers in aggregate is zero because the CY 2008 ESRD wage index has been multiplied by a BN adjustment factor to comply with the statutory requirement that any wage index revisions be done in a manner that results in the same aggregate amount of expenditures as would have been made without any changes in the wage index. The decreases shown among census regions is primarily due to reducing the wage index floor, as there were areas in these areas with wage index values below the reduced floor. </P>
                    <P>The sixth column shows the overall effect of the changes in composite rate payments to ESRD providers. The overall effect is measured as the difference between the projected CY 2008 payment with all changes in this final rule and CY 2007 payment. This payment amount is computed by multiplying the wage adjusted composite rate with the drug add-on for each provider times the number of dialysis treatments from the CY 2006 claims. The projected CY 2008 payment is the transition year 3 wage-adjusted composite rate for each provider (with the 15.5 percent drug add-on) times dialysis treatments from CY 2006 claims. The CY 2007 current payment is the transition year 2 wage-adjusted composite rate for each provider (with the current 14.9 percent drug add-on) times dialysis treatments from CY 2006 claims. </P>
                    <P>The overall impact to ESRD providers in aggregate is 0.5 percent. This increase corresponds to the 0.5 percent increase to the drug add-on. The variation shown in column 6 is due to variation in changes in the wage index (column 5). All provider types receive the same 0.5 percent increase to the drug add-on. </P>
                    <GPOTABLE COLS="6" OPTS="L2,i1" CDEF="s75,10,10,10,10,10">
                        <TTITLE>Table 41.—Impact of CY 2008 Changes in Payments to Hospital Based and Independent ESRD Facilities </TTITLE>
                        <TDESC>[Percent change in composite rate payments to ESRD facilities (both program and beneficiaries)] </TDESC>
                        <BOXHD>
                            <CHED H="1"> </CHED>
                            <CHED H="1">Number of facilities </CHED>
                            <CHED H="1">
                                Number of dialysis treatments 
                                <LI>(in millions) </LI>
                            </CHED>
                            <CHED H="1">
                                Effect of changes in floor only 
                                <SU>1</SU>
                            </CHED>
                            <CHED H="1">
                                Effect of changes in wage index 
                                <SU>2</SU>
                            </CHED>
                            <CHED H="1">
                                Overall
                                <LI>
                                    effect 
                                    <SU>3</SU>
                                </LI>
                            </CHED>
                        </BOXHD>
                        <ROW>
                            <ENT I="01">All Providers </ENT>
                            <ENT>4,660 </ENT>
                            <ENT>35.5 </ENT>
                            <ENT>0.0 </ENT>
                            <ENT>0.0 </ENT>
                            <ENT>0.5 </ENT>
                        </ROW>
                        <ROW>
                            <ENT I="03">Independent </ENT>
                            <ENT>4,101 </ENT>
                            <ENT>31.8 </ENT>
                            <ENT>0.0 </ENT>
                            <ENT>−0.1 </ENT>
                            <ENT>0.5 </ENT>
                        </ROW>
                        <ROW>
                            <ENT I="03">Hospital Based </ENT>
                            <ENT>559 </ENT>
                            <ENT>3.7 </ENT>
                            <ENT>0.0 </ENT>
                            <ENT>0.5 </ENT>
                            <ENT>1.0 </ENT>
                        </ROW>
                        <ROW>
                            <ENT I="22">By Facility Size </ENT>
                        </ROW>
                        <ROW>
                            <ENT I="03">Less than 5000 treatments </ENT>
                            <ENT>1,650 </ENT>
                            <ENT>4.7 </ENT>
                            <ENT>−0.1 </ENT>
                            <ENT>−0.3 </ENT>
                            <ENT>0.3 </ENT>
                        </ROW>
                        <ROW>
                            <PRTPAGE P="66395"/>
                            <ENT I="03">5000 to 9999 treatments </ENT>
                            <ENT>1,800 </ENT>
                            <ENT>13.0 </ENT>
                            <ENT>0.0 </ENT>
                            <ENT>0.0 </ENT>
                            <ENT>0.5 </ENT>
                        </ROW>
                        <ROW>
                            <ENT I="03">Greater than 9999 treatments </ENT>
                            <ENT>1,210 </ENT>
                            <ENT>17.7 </ENT>
                            <ENT>0.0 </ENT>
                            <ENT>0.1 </ENT>
                            <ENT>0.6 </ENT>
                        </ROW>
                        <ROW>
                            <ENT I="22">Type of Ownership </ENT>
                        </ROW>
                        <ROW>
                            <ENT I="03">Profit </ENT>
                            <ENT>3,745 </ENT>
                            <ENT>28.9 </ENT>
                            <ENT>0.0 </ENT>
                            <ENT>−0.1 </ENT>
                            <ENT>0.4 </ENT>
                        </ROW>
                        <ROW>
                            <ENT I="03">Nonprofit </ENT>
                            <ENT>915 </ENT>
                            <ENT>6.5 </ENT>
                            <ENT>0.0 </ENT>
                            <ENT>0.3 </ENT>
                            <ENT>0.9 </ENT>
                        </ROW>
                        <ROW>
                            <ENT I="22">By Geographic Location </ENT>
                        </ROW>
                        <ROW>
                            <ENT I="03">Rural </ENT>
                            <ENT>1,261 </ENT>
                            <ENT>7.3 </ENT>
                            <ENT>−0.4 </ENT>
                            <ENT>−0.6 </ENT>
                            <ENT>0.0 </ENT>
                        </ROW>
                        <ROW>
                            <ENT I="03">Urban </ENT>
                            <ENT>3,399 </ENT>
                            <ENT>28.1 </ENT>
                            <ENT>0.1 </ENT>
                            <ENT>0.1 </ENT>
                            <ENT>0.7 </ENT>
                        </ROW>
                        <ROW>
                            <ENT I="22">By Region </ENT>
                        </ROW>
                        <ROW>
                            <ENT I="03">New England </ENT>
                            <ENT>141 </ENT>
                            <ENT>1.1 </ENT>
                            <ENT>0.1 </ENT>
                            <ENT>1.4 </ENT>
                            <ENT>2.0 </ENT>
                        </ROW>
                        <ROW>
                            <ENT I="03">Middle Atlantic </ENT>
                            <ENT>553 </ENT>
                            <ENT>4.5 </ENT>
                            <ENT>0.1 </ENT>
                            <ENT>0.5 </ENT>
                            <ENT>1.0 </ENT>
                        </ROW>
                        <ROW>
                            <ENT I="03">East North Central </ENT>
                            <ENT>727 </ENT>
                            <ENT>5.7 </ENT>
                            <ENT>0.1 </ENT>
                            <ENT>−0.6 </ENT>
                            <ENT>−0.1 </ENT>
                        </ROW>
                        <ROW>
                            <ENT I="03">West North Central </ENT>
                            <ENT>358 </ENT>
                            <ENT>1.9 </ENT>
                            <ENT>0.1 </ENT>
                            <ENT>−0.3 </ENT>
                            <ENT>0.3 </ENT>
                        </ROW>
                        <ROW>
                            <ENT I="03">South Atlantic </ENT>
                            <ENT>1,063 </ENT>
                            <ENT>8.1 </ENT>
                            <ENT>0.0 </ENT>
                            <ENT>0.0 </ENT>
                            <ENT>0.6 </ENT>
                        </ROW>
                        <ROW>
                            <ENT I="03">East South Central </ENT>
                            <ENT>365 </ENT>
                            <ENT>2.6 </ENT>
                            <ENT>−0.5 </ENT>
                            <ENT>−1.4 </ENT>
                            <ENT>−0.8 </ENT>
                        </ROW>
                        <ROW>
                            <ENT I="03">West South Central </ENT>
                            <ENT>646 </ENT>
                            <ENT>5.0 </ENT>
                            <ENT>−0.1 </ENT>
                            <ENT>−0.7 </ENT>
                            <ENT>−0.2 </ENT>
                        </ROW>
                        <ROW>
                            <ENT I="03">Mountain </ENT>
                            <ENT>254 </ENT>
                            <ENT>1.6 </ENT>
                            <ENT>0.1 </ENT>
                            <ENT>0.3 </ENT>
                            <ENT>0.8 </ENT>
                        </ROW>
                        <ROW>
                            <ENT I="03">Pacific </ENT>
                            <ENT>523 </ENT>
                            <ENT>4.4 </ENT>
                            <ENT>0.1 </ENT>
                            <ENT>1.4 </ENT>
                            <ENT>2.0 </ENT>
                        </ROW>
                        <ROW>
                            <ENT I="03">Puerto Rico </ENT>
                            <ENT>30 </ENT>
                            <ENT>0.4 </ENT>
                            <ENT>−2.1 </ENT>
                            <ENT>−3.0 </ENT>
                            <ENT>−2.5 </ENT>
                        </ROW>
                        <TNOTE>
                            <SU>1</SU>
                             This column shows the effect of the wage index floor changes on ESRD providers. Composite rate payments computed using the CY 2008 wage index with a 0.80 floor are compared to composite rate payments using the CY 2008 wage index with a 0.75 floor. 
                        </TNOTE>
                        <TNOTE>
                            <SU>2</SU>
                             This column shows the overall effect of wage index changes on ESRD providers. Composite rate payments computed using the current wage index are compared to composite rate payments using the CY 2008 wage index changes. 
                        </TNOTE>
                        <TNOTE>
                            <SU>3</SU>
                             This column shows the percent change between CY 2008 and CY 2007 composite rate payments to ESRD facilities. The CY 2008 payments include the CY 2008 wage adjusted composite rate, and the 15.5% drug add-on times treatments The CY 2007 payments to ESRD facilities includes the CY 2007 wage adjusted composite rate and the 14.9% drug add-on times treatments. 
                        </TNOTE>
                    </GPOTABLE>
                    <HD SOURCE="HD2">G. IDTF Changes </HD>
                    <P>We believe that our provisions regarding IDTFs as discussed in section II.I. of this final rule with comment period would have no budgetary impact. However, we believe that these changes are necessary to ensure that only legitimate IDTFs are enrolled into the program. In addition, we believe that the IDTF provisions contained in this final rule will help ensure that beneficiaries receive quality care. Therefore, we expect to have an impact on an unknown number of persons and entities who will be denied enrollment into the Medicare program. </P>
                    <HD SOURCE="HD2">H. CORF Issues </HD>
                    <P>The revisions to the CORF regulations discussed in section II.K. update the regulations for consistency with the PFS payment rules. These revisions will help to clarify payment for CORF services and are expected to have minimal impact on Medicare expenditures. </P>
                    <HD SOURCE="HD2">I. Compendia for Determination of Medically-Accepted Indications for Off-Label Use of Drugs and Biologicals in an Anti-Cancer Chemotherapeutic Regimen. </HD>
                    <P>We anticipate that the changes related to the compendia discussed in section II.L. of this final rule with comment period will have a negligible cost to the Medicare program. The changes will enable CMS to respond quickly should changes in the number and quality of the compendia indicate a need to amend the list. </P>
                    <HD SOURCE="HD2">J. Physician Self-Referral Provisions </HD>
                    <P>We anticipate that our provisions in section II.M. of this final rule with comment period for the reassignment and anti-markup provisions, and the physician self-referral provisions will result in savings to the program by reducing overutilization and anti-competitive business arrangements. We cannot gauge with any certainty the extent of these savings to the Medicare program. </P>
                    <HD SOURCE="HD2">K. Beneficiary Signature for Ambulance Transport Services </HD>
                    <P>We believe that our provision in section II.N. of this final rule with comment period for allowing the ambulance provider or supplier to sign the claim on behalf of the beneficiary with respect to emergency transport services, provided that certain conditions are satisfied, will have no budget impact. </P>
                    <HD SOURCE="HD2">L. Update to Fee Schedules for Class III DME for CYs 2007 and 2008 </HD>
                    <P>In section II.O. of this final rule with comment period, we discuss the update to the fee schedules for class III DME for CYs 2007 and 2008. Total allowed charges for class III devices in 2005 were $71 million. Accordingly, with a zero percent increase for DME, other than class III devices, for 2005 and 2006 and with the establishment of an update for 2007 of zero percent for class III devices, rather than 4.3 percent based on the CPI-U, this results in a savings to the Medicare program of approximately $2 million in FY 2007, $4 million in FY 2008, $4 million in FY 2009, $5 million in FY 2010, $5 million in FY 2011, and $5 million in FY 2012. </P>
                    <HD SOURCE="HD2">M. Therapy Services </HD>
                    <P>
                        In section II.R.2., we are changing the certification requirement for the plan of care, for outpatient physical therapy, occupational therapy and speech-language pathology services from every 30 days to an appropriate length, based on the patient's needs, limited to 90 days. As we stated in the proposed rule, analysis of Medicare claims data shows negative or no impact for this change and this was also supported by commenters. In most cases, the appropriate length of treatment will be 
                        <PRTPAGE P="66396"/>
                        less than 30 days. Certification of the appropriate length of treatment will discourage the practice of billing for re-evaluations prior to recertification regardless of need. 
                    </P>
                    <P>The 30-day recertification allows treatment under a plan of care for 30 days after initial certification, regardless of the appropriate length of treatment. The initial certification cannot assure that a physician reviews the plan or follows the patient's progress. </P>
                    <P>We will review the utilization of therapy services after a 2-year trial to assess any changes that might be related to certification of a plan of care for an appropriate length of treatment. At that time, if we determine that this change has caused an increase in inappropriate utilization, we will reconsider the 30-day certification requirement. </P>
                    <HD SOURCE="HD2">N. TRHCA 101(b) Physician Quality Reporting Initiative </HD>
                    <P>
                        As discussed section II.S.1. of this rule, the final 2008 PQRI measures satisfy the requirement of section 1848(k)(2)(B)(ii) of the Act that the Secretary publish in the 
                        <E T="04">Federal Register</E>
                         by August 15, 2007, measures that the Secretary proposes as appropriate for eligible professionals to use to submit data to the Secretary in 2008. We also expect to address registry- and EHR-based data submission on a test basis in 2008, as discussed in section II.T.1. of this rule. Although there may be some cost incurred for maintaining the measures and their associated code sets, and for enhancing an existing clinical data warehouse to accommodate the registry- and EHR-based data submission, we do not anticipate a significant cost impact on the Medicare program. 
                    </P>
                    <HD SOURCE="HD2">O. TRHCA 101(d) Physician Assistance and Quality Initiative Fund </HD>
                    <P>As discussed in section II.S.5. of this final rule with comment period, section 101(d) of the MIEA-TRHCA created the Physician Assistance and Quality Initiative Fund (PAQI) which provides $1.35 billion for physician payment and quality improvement initiatives. The legislation directs the Secretary to provide for expenditures from the Fund in a manner designed to provide (to the maximum extent feasible) for the obligation of the entire $1.35 billion for payment for physicians’ services furnished during 2008. As discussed in section II.S.5. of this final rule with comment period, we will scale aggregate payments to physicians in a manner such that Medicare would pay $1.35 billion during CY 2009 for measures reported for services furnished during CY 2008. We are unable to provide an exact percentage for the bonus payment, but we anticipate that the bonus payments will be approximately 1.5 percent of allowed charges for participating professionals (and we do not expect that the ultimate percentage amount would exceed 2 percent). We also note that the Transitional Medical Assistance, Abstinence Education, and Qualifying Individual Programs Extension Act of 2007 (Pub. L. 110-90) provided an additional $325 million to be used as a part of the PAQI Fund for payment with regard to services furnished in 2009 and $60,000,000 for payment with respect to physicians’ services furnished on or after January 1, 2013. </P>
                    <HD SOURCE="HD2">P. TRHCA 110 Reporting of Anemia Quality Indicators </HD>
                    <P>As discussed in section II.S.2. of this final rule with comment period, there are no program cost savings or increased expenditures associated with this change; however, we expect that the regulation will have a positive impact on patient care. </P>
                    <HD SOURCE="HD2">Q. Amendment of the Exemption From NCPDP SCRIPT Standard for Computer-Generated Facsimile Transmissions Under Medicare Part D </HD>
                    <P>The amendment of the exemption for computer-generated fax transactions under Medicare Part D is discussed in section II.R.3. of this rule. E-prescribing is voluntary for providers and pharmacies. This amendment only affects providers and pharmacies that already conduct e-prescribing using products that generate faxes rather than SCRIPT transactions. </P>
                    <P>We believe that providers and pharmacies that are now e-prescribing using products that generate faxes generally already possess the hardware necessary to e-prescribe. Many would need to obtain software upgrades to send and receive the SCRIPT transaction. This software will generally be available to providers through automatic version upgrades built into annual software vendor maintenance fees. However, providers currently using software that cannot be upgraded to generate SCRIPT transactions would need to purchase and install new e-prescribing software or revert to sending paper fax transactions to pharmacies. </P>
                    <P>Dispensers that currently e-prescribe but have not established the connectivity necessary to receive and send SCRIPT transactions would need to connect to a network, and may need to install software upgrades, which will generally be covered under annual fees. Because pharmacies customarily bear the cost of transaction fees for the SCRIPT transactions they receive and send, these costs would increase as the rate of e-prescribing increases. </P>
                    <P>The amendment of this exemption will have indirect benefits in that it will help to encourage e-prescribing using electronic data interchange, which will ultimately result in improved patient safety. We also will continue to allow computer-generated faxes as a fallback in cases of temporary/transient transmission failures and communications problems. </P>
                    <P>Because of the voluntary nature of e-prescribing for physicians and pharmacies, the relatively small number of entities currently e-prescribing, and the minimal nature of the anticipated costs, we believe this provision does not constitute a major rule for purposes of this analysis. </P>
                    <HD SOURCE="HD2">R. Revisions to Payment Policies Under the Ambulance Fee Schedule and the Ambulance Inflation Factor Update for CY 2008 </HD>
                    <P>
                        For the purposes of the RFA, ambulance providers and suppliers are considered to be small entities. Removing the requirement that the AIF be published annually via 
                        <E T="04">Federal Register</E>
                         notice has no monetary impact on small entities or small businesses. It merely allows for the earlier dissemination of necessary information to the ambulance industry, the Medicare contractors, and the general public. 
                    </P>
                    <P>We estimate that the total program expenditure for CY 2007 for ambulance services covered by the Medicare program is approximately $5.2 billion. Application of an AIF of 2.7 percent will result in an additional total program expenditure for CY 2008 of approximately $140 million over CY 2007 expenditures. </P>
                    <HD SOURCE="HD2">S. Alternatives Considered </HD>
                    <P>This final rule with comment period contains a range of policies, including some provisions related to specific MMA provisions. The preamble provides descriptions of the statutory provisions that are addressed, identifies those policies when discretion has been exercised, presents rationale for our decisions and, where relevant, alternatives that were considered. </P>
                    <HD SOURCE="HD2">T. Impact on Beneficiaries </HD>
                    <P>
                        There are a number of changes made in this final rule with comment period that would have an effect on beneficiaries. In general, we believe these changes, particularly the implementation of the PQRI with its continuing focus on measuring, submitting, and analyzing quality data, will have a positive impact and improve 
                        <PRTPAGE P="66397"/>
                        the quality and value of care furnished to Medicare beneficiaries. 
                    </P>
                    <P>We do not believe that beneficiaries will experience drug access issues as a result of the changes with respect to Part B drugs and CAP. </P>
                    <P>As explained in more detail subsequently in this section, the regulatory provisions may affect beneficiary liability in some cases. Most changes in aggregate beneficiary liability from a particular provision would be a function of the coinsurance (20 percent if applicable for the particular provision after the beneficiary has met the deductible) and the effect of the aggregate cost (savings) of the provision on the calculation of the Medicare Part B premium rate (generally 25 percent of the provision's cost or savings). In 2008, total cost sharing (coinsurance and deductible) per Part B enrollee associated with physician fee schedule services is estimated to be $590. In addition, the portion of the 2008 standard monthly Part B premium attributable to PFS services is estimated to be $38.60. </P>
                    <P>To illustrate this point, as shown in Table 40, the 2007 national payment amount in the nonfacility setting for CPT code 99203 (Office/outpatient visit, new), is $91.71 which means that currently a beneficiary is responsible for 20 percent of this amount, or $18.34. Based on this final rule with comment period, the 2008 national payment amount in the nonfacility setting for CPT code 99203, as shown in Table 40, is $81.42 which means that, in 2008, the beneficiary coinsurance for this service would be $16.28. </P>
                    <P>Policies discussed in this rule that do affect overall spending, such as the additions to the list of codes that are subject to section 5102 of the DRA imaging provisions, would similarly impact beneficiaries” coinsurance. </P>
                    <HD SOURCE="HD2">U. Accounting Statement </HD>
                    <P>
                        As required by OMB Circular A-4 (available at 
                        <E T="03">http://www.whitehouse.gov/omb/circulars/a004/a-4.pdf),</E>
                         in Table 42, we have prepared an accounting statement showing the classification of the expenditures associated with this final rule with comment period. This estimate includes the incurred benefit impact associated with the estimated CY 2008 PFS update, shown in this final rule with comment period, based on the 2007 Trustees Report baseline. All estimated impacts are classified as transfers. 
                    </P>
                    <GPOTABLE COLS="2" OPTS="L2,i1" CDEF="xs100,r100">
                        <TTITLE>Table 42.—Accounting Statement: Classification of Estimated Expenditures for CY 2008</TTITLE>
                        <TDESC>[In billions]</TDESC>
                        <BOXHD>
                            <CHED H="1">Category</CHED>
                            <CHED H="1">Transfers</CHED>
                        </BOXHD>
                        <ROW>
                            <ENT I="01">Annualized Monetized Transfers</ENT>
                            <ENT>−$6.0.</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">From Whom To Whom?</ENT>
                            <ENT>Federal Government to physicians, other practitioners and suppliers who receive payment under the Medicare Physician Fee Schedule; ESRD Medicare Providers; ambulance suppliers, DME suppliers, and Medicare suppliers billing for Part B drugs.</ENT>
                        </ROW>
                    </GPOTABLE>
                    <P>In accordance with the provisions of Executive Order 12866, this final rule with comment period was reviewed by the Office of Management and Budget.</P>
                    <LSTSUB>
                        <HD SOURCE="HED">List of Subjects </HD>
                        <CFR>42 CFR Part 409 </CFR>
                        <P>Health facilities, Medicare. </P>
                        <CFR>42 CFR Part 410 </CFR>
                        <P>Health facilities, Health professions, Kidney diseases, Laboratories, Medicare, Reporting and recordkeeping requirements, Rural areas, X-rays. </P>
                        <CFR>42 CFR Part 411 </CFR>
                        <P>Kidney diseases, Medicare, Physician Referral, Reporting and recordkeeping requirements. </P>
                        <CFR>42 CFR Part 413 </CFR>
                        <P>Health facilities, Kidney diseases, Medicare, Reporting and recordkeeping requirements. </P>
                        <CFR>42 CFR Part 414 </CFR>
                        <P>Administrative practice and procedure, Health facilities, Health professions, Kidney diseases, Medicare, Reporting and recordkeeping. </P>
                        <CFR>42 CFR Part 415 </CFR>
                        <P>Health facilities, Health professions, Medicare, Reporting and recordkeeping requirements. </P>
                        <CFR>42 CFR Part 418 </CFR>
                        <P>Health facilities, Hospice care, Medicare, Reporting and recordkeeping requirements. </P>
                        <CFR>42 CFR Part 423 </CFR>
                        <P>Administrative practice and procedure, Emergency medical services, Health facilities, Health maintenance organizations (HMO), Health Professionals, Medicare, Penalties, Privacy, Reporting and recordkeeping requirements. </P>
                        <CFR>42 CFR Part 424 </CFR>
                        <P>Emergency medical services, Health facilities, Health professions, Medicare, Reporting and recordkeeping requirements. </P>
                        <CFR>42 CFR Part 482 </CFR>
                        <P>Grant programs—health, Hospitals, Medicaid, Medicare, Reporting and recordkeeping requirements. </P>
                        <CFR>42 CFR Part 484 </CFR>
                        <P>Grant programs—health, Health facilities, Health professions, Health records, Medicaid, Medicare, Nursing homes, Nutrition, Reporting and recordkeeping requirements, Safety. </P>
                        <CFR>42 CFR Part 485 </CFR>
                        <P>Grant programs—health, Health facilities, Medicaid, Medicare, Reporting and recordkeeping requirements. </P>
                    </LSTSUB>
                    <REGTEXT TITLE="42" PART="409">
                        <AMDPAR>For the reasons set forth in the preamble, the Centers for Medicare &amp; Medicaid Services amends 42 CFR chapter IV as set forth below: </AMDPAR>
                        <PART>
                            <HD SOURCE="HED">PART 409—HOSPITAL INSURANCE BENEFITS </HD>
                        </PART>
                        <AMDPAR>1. The authority citation for part 409 continues to read as follows: </AMDPAR>
                        <AUTH>
                            <HD SOURCE="HED">Authority:</HD>
                            <P>Secs. 1102 and 1871 of the Social Security Act (42 U.S.C. 1302 and 1395hh). </P>
                        </AUTH>
                    </REGTEXT>
                    <REGTEXT TITLE="42" PART="409">
                        <SUBPART>
                            <HD SOURCE="HED">Subpart B—Inpatient Hospital Services and Inpatient Critical Access Hospital Services </HD>
                        </SUBPART>
                        <AMDPAR>2. Section 409.17 is added to read as follows: </AMDPAR>
                        <SECTION>
                            <SECTNO>§ 409.17 </SECTNO>
                            <SUBJECT>Physical therapy, occupational therapy, and speech-language pathology services. </SUBJECT>
                            <P>
                                (a) 
                                <E T="03">General rules.</E>
                                 (1) Except as specified in paragraph (a)(1)(ii) of this section, physical therapy, occupational 
                                <PRTPAGE P="66398"/>
                                therapy or speech-language pathology services must be furnished by qualified physical therapists, physical therapist assistants, occupational therapists, occupational therapy assistants or speech-language pathologists who meet the requirements specified part 484 of this chapter. 
                            </P>
                            <P>(2) Physical therapy, occupational therapy or speech-language pathology services must be furnished under a plan that meets the requirements of paragraphs (b) through (d) of this section, or plan requirements specific to the payment policy under which the services are rendered, if applicable. </P>
                            <P>
                                (b) 
                                <E T="03">Establishment of the plan.</E>
                                 The plan must be established before treatment begins by one of the following: 
                            </P>
                            <P>(1) A physician. </P>
                            <P>(2) A nurse practitioner, a clinical nurse specialist or a physician assistant. </P>
                            <P>(3) The physical therapist furnishing the physical therapy services. </P>
                            <P>(4) A speech-language pathologist furnishing the speech-language pathology services. </P>
                            <P>(5) An occupational therapist furnishing the occupational therapy services. </P>
                            <P>
                                (c) 
                                <E T="03">Content of the plan.</E>
                                 The plan: 
                            </P>
                            <P>(1) Prescribes the type, amount, frequency, and duration of the physical therapy, occupational therapy, or speech-language pathology services to be furnished to the individual; and </P>
                            <P>(2) Indicates the diagnosis and anticipated goals. </P>
                            <P>
                                (d) 
                                <E T="03">Changes in the plan.</E>
                                 Any changes in the plan are implemented in accordance with hospital policies and procedures.
                            </P>
                        </SECTION>
                        <SUBPART>
                            <HD SOURCE="HED">Subpart C—Posthospital SNF Care </HD>
                        </SUBPART>
                        <AMDPAR>3. Section 409.23 is amended by adding paragraph (c) to read as follows: </AMDPAR>
                        <SECTION>
                            <SECTNO>§ 409.23 </SECTNO>
                            <SUBJECT>Physical, occupational, and speech therapy. </SUBJECT>
                            <STARS/>
                            <P>(c) Except as specified in paragraph (c)(1)(ii) of this section, physical therapy, occupational therapy or speech-language pathology services must be furnished— </P>
                            <P>(1) By qualified physical therapists, physical therapist assistants, occupational therapists, occupational therapy assistants or speech-language pathologists as defined in part 484 of this chapter </P>
                            <P>(2) In accordance with a plan that meets the requirements of § 409.17(b) through (d) of this part. </P>
                        </SECTION>
                    </REGTEXT>
                    <REGTEXT TITLE="42" PART="410">
                        <PART>
                            <HD SOURCE="HED">PART 410—SUPPLEMENTARY MEDICAL INSURANCE (SMI) BENEFITS </HD>
                        </PART>
                        <AMDPAR>4. The authority citation for part 410 continues to read as follows: </AMDPAR>
                        <AUTH>
                            <HD SOURCE="HED">Authority:</HD>
                            <P>Secs. 1102, 1834, 1871, and 1893 of the Social Security Act (42 U.S.C. 1302, 1395m, 1395hh, and 1395ddd). </P>
                        </AUTH>
                    </REGTEXT>
                    <REGTEXT TITLE="42" PART="410">
                        <SUBPART>
                            <HD SOURCE="HED">Subpart B—Medical and Other Health Services </HD>
                            <SECTION>
                                <SECTNO>§ 410.32 </SECTNO>
                                <SUBJECT>[Amended] </SUBJECT>
                            </SECTION>
                        </SUBPART>
                        <AMDPAR>5. Section 410.32 is amended by— </AMDPAR>
                        <AMDPAR>A. Removing paragraph (a)(1). </AMDPAR>
                        <AMDPAR>B. Redesignating paragraphs (a)(2) and (a)(3) as paragraphs (a)(1) and (a)(2).</AMDPAR>
                    </REGTEXT>
                    <REGTEXT TITLE="42" PART="410">
                        <AMDPAR>6. Section 410.33 is amended by— </AMDPAR>
                        <AMDPAR>A. Revising paragraphs (b)(1), (g)(2), (g)(3), (g)(6), and (g)(8). </AMDPAR>
                        <AMDPAR>B. Adding paragraphs (g)(15) and (i). </AMDPAR>
                        <P>The revisions and addition read as follows: </P>
                        <SECTION>
                            <SECTNO>§ 410.33 </SECTNO>
                            <SUBJECT>Independent diagnostic testing facility. </SUBJECT>
                            <STARS/>
                            <P>(b) * * * </P>
                            <P>(1) Each supervising physician must be limited to providing general supervision to no more than three IDTF sites. This applies to both fixed sites and mobile units where three concurrent operations are capable of performing tests. </P>
                            <STARS/>
                            <P>(g) * * * </P>
                            <P>(2) Provides complete and accurate information on its enrollment application. Changes in ownership, changes of location, changes in general supervision, and adverse legal actions must be reported to the Medicare fee-for-service contractor on the Medicare enrollment application within 30 calendar days of the change. All other changes to the enrollment application must be reported within 90 days. </P>
                            <P>(3) Maintain a physical facility on an appropriate site. For the purposes of this standard, a post office box, commercial mailbox, hotel, or motel is not considered an appropriate site. </P>
                            <P>(i) The physical facility, including mobile units, must contain space for equipment appropriate to the services designated on the enrollment application, facilities for hand washing, adequate patient privacy accommodations, and the storage of both business records and current medical records within the office setting of the IDTF, or IDTF home office, not within the actual mobile unit. </P>
                            <P>(ii) IDTF suppliers that provide services remotely and do not see beneficiaries at their practice location are exempt from providing hand washing and adequate patient privacy accommodations. </P>
                            <STARS/>
                            <P>(6) Have a comprehensive liability insurance policy of at least $300,000 per location that covers both the place of business and all customers and employees of the IDTF. The policy must be carried by a nonrelative-owned company. Failure to maintain required insurance at all times will result in revocation of the IDTF's billing privileges retroactive to the date the insurance lapsed. IDTF suppliers are responsible for providing the contact information for the issuing insurance agent and the underwriter. In addition, the IDTF must— </P>
                            <P>(i) Ensure that the insurance policy must remain in force at all times and provide coverage of at least $300,000 per incident; and </P>
                            <P>(ii) Notify the CMS designated contractor in writing of any policy changes or cancellations. </P>
                            <STARS/>
                            <P>(8) Answer, document, and maintain documentation of a beneficiary's written clinical complaint at the physical site of the IDTF (For mobile IDTFs, this documentation would be stored at their home office.) This includes, but is not limited to, the following: </P>
                            <P>(i) The name, address, telephone number, and health insurance claim number of the beneficiary. </P>
                            <P>(ii) The date the complaint was received; the name of the person receiving the complaint; and a summary of actions taken to resolve the complaint. </P>
                            <P>(iii) If an investigation was not conducted, the name of the person making the decision and the reason for the decision. </P>
                            <STARS/>
                            <P>(15) With the exception of hospital-based and mobile IDTFs, a fixed-base IDTF does not include the following: </P>
                            <P>(i) Sharing a practice location with another Medicare-enrolled individual or organization; </P>
                            <P>(ii) Leasing or subleasing its operations or its practice location to another Medicare-enrolled individual or organization; or </P>
                            <P>(iii) Sharing diagnostic testing equipment used in the initial diagnostic test with another Medicare-enrolled individual or organization. </P>
                            <STARS/>
                            <P>
                                (i) 
                                <E T="03">Effective date of billing privileges</E>
                                . The filing date of the Medicare enrollment application is the date that the Medicare contractor receives a signed provider enrollment application that it is able to process to approval. The effective date of billing privileges for a 
                                <PRTPAGE P="66399"/>
                                newly enrolled IDTF is the later of the following: 
                            </P>
                            <P>(1) The filing date of the Medicare enrollment application that was subsequently approved by a Medicare fee-for-service contractor; or </P>
                            <P>(2) The date the IDTF first started furnishing services at its new practice location. </P>
                        </SECTION>
                    </REGTEXT>
                    <REGTEXT TITLE="42" PART="410">
                        <AMDPAR>7. Section 410.43 is amended by revising paragraph (a)(3)(ii) to read as follows: </AMDPAR>
                        <SECTION>
                            <SECTNO>§ 410.43 </SECTNO>
                            <SUBJECT>Partial hospitalization services: Conditions and exclusions. </SUBJECT>
                            <P>(a) * * * </P>
                            <P>(3) * * * </P>
                            <P>(ii) Occupational therapy requiring the skills of a qualified occupational therapist, provided by an occupational therapist, or under appropriate supervision of a qualified occupational therapist by an occupational therapy assistant as specified in part 484 of this chapter. </P>
                        </SECTION>
                    </REGTEXT>
                    <REGTEXT TITLE="42" PART="410">
                        <AMDPAR>8. Section 410.59 is amended by revising the introductory text to paragraph (a) to read as follows: </AMDPAR>
                        <SECTION>
                            <SECTNO>§ 410.59 </SECTNO>
                            <SUBJECT>Outpatient occupational therapy services: Conditions. </SUBJECT>
                            <P>
                                (a) 
                                <E T="03">Basic rule</E>
                                . Except as specified in paragraph (a)(3)(iii) of this section, Medicare Part B pays for outpatient occupational therapy services only if they are furnished by an individual meeting the qualifications in part 484 of this chapter for an occupational therapist or an appropriately supervised occupational therapy assistant but only under the following conditions: 
                            </P>
                        </SECTION>
                    </REGTEXT>
                    <REGTEXT TITLE="42" PART="410">
                        <STARS/>
                        <AMDPAR>9. Section 410.60 is amended by revising the introductory text of paragraph (a) to read as follows: </AMDPAR>
                        <SECTION>
                            <SECTNO>§ 410.60 </SECTNO>
                            <SUBJECT>Outpatient physical therapy services: Conditions. </SUBJECT>
                            <STARS/>
                            <P>
                                (a) 
                                <E T="03">Basic rule</E>
                                . Except as specified in paragraph (a)(3)(iii) of this section, Medicare Part B pays for outpatient physical therapy services only if they are furnished by an individual meeting the qualifications in part 484 of this chapter for a physical therapist or an appropriately supervised physical therapist assistant but only under the following conditions: 
                            </P>
                            <STARS/>
                        </SECTION>
                        <SECTION>
                            <SECTNO>§ 410.61 </SECTNO>
                            <SUBJECT>[Amended] </SUBJECT>
                        </SECTION>
                    </REGTEXT>
                    <REGTEXT TITLE="42" PART="410">
                        <AMDPAR>10. Section 410.61 is amended by removing paragraph (e). </AMDPAR>
                    </REGTEXT>
                    <REGTEXT TITLE="42" PART="410">
                        <AMDPAR>11. Section 410.78 is amended by revising the introductory text of paragraph (b) to read as follows: </AMDPAR>
                        <SECTION>
                            <SECTNO>§ 410.78 </SECTNO>
                            <SUBJECT>Telehealth services. </SUBJECT>
                            <STARS/>
                            <P>
                                (b) 
                                <E T="03">General rule</E>
                                . Medicare Part B pays for office and other outpatient visits, professional consultation, psychiatric diagnostic interview examination, individual psychotherapy, pharmacologic management, end stage renal disease related services included in the monthly capitation payment (except for one visit per month to examine the access site), individual medical nutrition therapy, and neurobehavioral status exam furnished by an interactive telecommunications system if the following conditions are met: 
                            </P>
                            <STARS/>
                        </SECTION>
                        <SUBPART>
                            <HD SOURCE="HED">Subpart D—Comprehensive Outpatient Rehabilitation Facility (CORF) Services </HD>
                        </SUBPART>
                    </REGTEXT>
                    <REGTEXT TITLE="42" PART="10">
                        <AMDPAR>12. Section 410.100 is amended by— </AMDPAR>
                        <AMDPAR>A. Revising the introductory text and paragraphs (a), (e), and (h). </AMDPAR>
                        <AMDPAR>B. Removing paragraph (i). </AMDPAR>
                        <AMDPAR>C. Redesignating paragraphs (j), (k), (l), and (m) to (i), (j), (k), and (l) respectively. </AMDPAR>
                        <AMDPAR>D. Revising new paragraphs (i), (j), (k), and (l). </AMDPAR>
                        <P>The revisions read as follows:</P>
                        <SECTION>
                            <SECTNO>§ 410.100 </SECTNO>
                            <SUBJECT>Included services. </SUBJECT>
                            <P>Subject to the conditions and limitations set forth in § 410.102 and § 410.105, CORF services means the following services furnished to an outpatient of the CORF by personnel that meet the qualifications set forth in § 485.70 of this chapter. Payment for CORF services are made in accordance with § 414.1105. </P>
                            <P>
                                (a) 
                                <E T="03">Physician's services</E>
                                . CORF facility physician services are administrative in nature and include consultation with and medical supervision of nonphysician staff, participation in plan of treatment reviews and patient care review conferences, and other medical and facility administration activities. Diagnostic and therapeutic services furnished to an individual CORF patient by a physician in a CORF facility are not CORF physician services. These services, if covered, are physician services under § 410.20 with payment for these services made to the physician in accordance with part 414 subpart B. 
                            </P>
                            <STARS/>
                            <P>
                                (e) 
                                <E T="03">Respiratory therapy services</E>
                                . (1) Respiratory therapy services are for the assessment, treatment, and monitoring of patients with deficiencies or abnormalities of cardiopulmonary function. 
                            </P>
                            <P>(2) Respiratory therapy services include the following: </P>
                            <P>(i) Application of techniques for support of oxygenation and ventilation of the patient. </P>
                            <P>(ii) Therapeutic use and monitoring of gases, mists, and aerosols and related equipment. </P>
                            <P>(iii) Bronchial hygiene therapy. </P>
                            <P>(iv) Pulmonary rehabilitation techniques to develop strength and endurance of respiratory muscles and other techniques to increase respiratory function, such as graded activity services; these services include physiologic monitoring and patient education. </P>
                            <STARS/>
                            <P>
                                (h) 
                                <E T="03">Social and psychological services</E>
                                . Social and psychological services include the assessment and treatment of an individual's mental and emotional functioning and the response to and rate of progress as it relates to the individual's rehabilitation plan of treatment, including physical therapy services, occupational therapy services, speech-language pathology services and respiratory therapy services. 
                            </P>
                            <P>
                                (i) 
                                <E T="03">Nursing care services</E>
                                . Nursing care services include nursing services provided by a registered nurse that are prescribed by a physician and are specified in or directly related to the rehabilitation treatment plan and necessary for the attainment of the rehabilitation goals of the physical therapy, occupational therapy, speech-language pathology, or respiratory therapy plan of treatment. 
                            </P>
                            <P>
                                (j) 
                                <E T="03">Drugs and biologicals</E>
                                . These are drugs and biologicals that are the following: 
                            </P>
                            <P>(1) Prescribed by a physician and administered by or under the supervision of a physician or by a registered professional nurse; and</P>
                            <P>(2) Not excluded from Medicare Part B payment for reasons specified in § 410.29. </P>
                            <P>
                                (k) 
                                <E T="03">Supplies and durable medical equipment</E>
                                . Supplies and durable medical equipment include the following: 
                            </P>
                            <P>(1) Disposable supplies. </P>
                            <P>(2) Durable medical equipment of the type specified in § 410.38 (except for renal dialysis systems) for a patient's use outside the CORF, whether purchased or rented. </P>
                            <P>
                                (l) 
                                <E T="03">Home environment evaluation</E>
                                . A home environment evaluation— 
                            </P>
                            <P>(1) Is a single home visit to evaluate the potential impact of the home situation on the patient's rehabilitation goals. </P>
                            <P>(2) Requires the presence of the patient and the physical therapist, occupational therapist, or speech-language pathologist, as appropriate. </P>
                        </SECTION>
                    </REGTEXT>
                    <REGTEXT TITLE="42" PART="410">
                        <PRTPAGE P="66400"/>
                        <AMDPAR>13. Section 410.105 is amended by revising paragraphs (b)(3)(i), (b)(3)(ii), (c)(1) introductory text, and (c)(2) to read as follows: </AMDPAR>
                        <SECTION>
                            <SECTNO>§ 410.105 </SECTNO>
                            <SUBJECT>Requirements for coverage of CORF services. </SUBJECT>
                            <STARS/>
                            <P>(b) * * * </P>
                            <P>(3) * * * </P>
                            <P>(i) Physical therapy, occupational therapy, and speech-language pathology services may be furnished away from the premises of the CORF including the individual's home when payment is not otherwise made under Title XVIII of the Act. </P>
                            <P>(ii) The single home environment evaluation visit specified in § 410.100(m) is also covered. </P>
                            <P>(c) * * * </P>
                            <P>(1) The service must be furnished under a written plan of treatment that— </P>
                            <P>(i) * * * </P>
                            <P>(ii) Indicates the diagnosis and rehabilitation goals, and prescribes the type, amount, frequency, and duration of the skilled rehabilitation services, including physical therapy, occupational therapy, speech-language pathology and respiratory therapy services, and indicates the other CORF services to be furnished that relate directly to such rehabilitation goals. </P>
                            <P>(2) The plan must be reviewed at least every 60 days for respiratory therapy services and every 90 days for physical therapy, occupational therapy and speech-language pathology services by a facility physician or the referring physician who, when appropriate, consults with the professional personnel providing the services. </P>
                            <STARS/>
                        </SECTION>
                        <SUBPART>
                            <HD SOURCE="HED">Subpart G—Medical Nutrition Therapy </HD>
                        </SUBPART>
                    </REGTEXT>
                    <REGTEXT TITLE="42" PART="410">
                        <AMDPAR>14. Section 410.132 is amended by revising paragraph (a) to read as follows: </AMDPAR>
                        <SECTION>
                            <SECTNO>§ 410.132 </SECTNO>
                            <SUBJECT>Medical nutrition therapy. </SUBJECT>
                            <P>
                                (a) 
                                <E T="03">Conditions for coverage of MNT services</E>
                                . Medicare Part B pays for MNT services provided by a registered dietitian or nutrition professional as defined in § 410.134 when the beneficiary is referred for the service by the treating physician. Except as provided at § 410.78, services covered consist of face-to-face nutritional assessments and interventions in accordance with nationally-accepted dietary or nutritional protocols. 
                            </P>
                            <STARS/>
                        </SECTION>
                    </REGTEXT>
                    <REGTEXT TITLE="42" PART="411">
                        <PART>
                            <HD SOURCE="HED">PART 411—EXCLUSIONS FROM MEDICARE AND LIMITATIONS ON MEDICARE PAYMENT </HD>
                        </PART>
                        <AMDPAR>15. The authority citation for part 411 continues to read as follows: </AMDPAR>
                        <AUTH>
                            <HD SOURCE="HED">Authority:</HD>
                            <P>Secs. 1102, 1860D-1 through 1860D-42, 1871, and 1877 of the Social Security Act (42 U.S.C. 1302, 1395w-101 through 1395w-152, 1395hh, and 1395nn). </P>
                        </AUTH>
                        <SUBPART>
                            <HD SOURCE="HED">Subpart A—General Exclusions and Exclusion of Particular Services </HD>
                        </SUBPART>
                    </REGTEXT>
                    <REGTEXT TITLE="42" PART="411">
                        <AMDPAR>16. Section 411.15 is amended by—</AMDPAR>
                        <AMDPAR>A. Revising paragraph (a)(1). </AMDPAR>
                        <AMDPAR>B. Adding paragraphs (k)(13) and (k)(14). </AMDPAR>
                        <P>The revision and additions read as follows:</P>
                        <SECTION>
                            <SECTNO>§ 411.15 </SECTNO>
                            <SUBJECT>Particular services excluded from coverage. </SUBJECT>
                            <STARS/>
                            <P>(a) * * * </P>
                            <P>(1) Examinations performed for a purpose other than treatment or diagnosis of a specific illness, symptoms, complaint, or injury, except for screening mammography, colorectal cancer screening tests, screening pelvic exams, prostate cancer screening tests, glaucoma screening exams, initial preventive physical exams, ultrasound screening for abdominal aortic aneurysms (AAA), cardiovascular disease screening tests, or diabetes screening tests that meet the criteria specified in paragraphs (k)(6) through (k)(14) of this section. </P>
                            <STARS/>
                            <P>(k) * * * </P>
                            <P>(13) In the case of cardiovascular disease screening tests for the early detection of cardiovascular disease or abnormalities associated with an elevated risk for that disease, subject to the conditions specified in § 410.17 of this chapter. </P>
                            <P>(14) In the case of diabetes screening tests furnished to an individual at risk for diabetes for the purpose of the early detection of that disease, subject to the conditions specified in § 410.18 of this chapter. </P>
                            <STARS/>
                        </SECTION>
                        <SUBPART>
                            <HD SOURCE="HED">Subpart J—Financial Relationships Between Physicians and Entities Furnishing Designated Health Services </HD>
                        </SUBPART>
                    </REGTEXT>
                    <REGTEXT TITLE="42" PART="411">
                        <AMDPAR>17. Section 411.351 is amended by revising the definition of “entity” to read as follows: </AMDPAR>
                        <SECTION>
                            <SECTNO>§ 411.351 </SECTNO>
                            <SUBJECT>Definitions. </SUBJECT>
                            <STARS/>
                            <P>
                                <E T="03">Entity</E>
                                 means— 
                            </P>
                            <STARS/>
                            <P>(3) For purposes of this subpart, “entity” does not include a physician's practice when it bills Medicare for the technical component or professional component of a diagnostic test for which the anti-markup provision is applicable in accordance with § 414.50 of this chapter and section 30.2.9 of the CMS Internet-only Manual, publication 100-04, Claims Processing Manual, Chapter 1 (general billing requirements). </P>
                        </SECTION>
                    </REGTEXT>
                    <REGTEXT TITLE="42" PART="411">
                        <PART>
                            <HD SOURCE="HED">PART 413—PRINCIPLES OF REASONABLE COST REIMBURSEMENT; PAYMENT FOR END-STAGE RENAL DISEASE SERVICES; PROSPECTIVELY DETERMINED PAYMENT RATES FOR SKILLED NURSING FACILITIES </HD>
                        </PART>
                    </REGTEXT>
                    <REGTEXT TITLE="42" PART="411">
                        <AMDPAR>18. The authority citation for part 413 continues to read as follows: </AMDPAR>
                        <AUTH>
                            <HD SOURCE="HED">Authority:</HD>
                            <P>Secs. 1102, 1812(d), 1814(b), 1815, 1833(a), (i), and (n), 1861(v), 1871, 1881, 1883, and 1886 of the Social Security Act (42 U.S.C. 1302, 1395d(d), 1395f(b), 1395g, 1395l(a), (i), and (n), 1395x(v), 1395hh, 1395rr, 1395tt, and 1395ww); and sec. 124 of Pub. L. 106-133 (113 Stat. 1501A-332). </P>
                        </AUTH>
                        <SUBPART>
                            <HD SOURCE="HED">Subpart A—Introduction and General Rules </HD>
                            <SECTION>
                                <SECTNO>§ 413.1 </SECTNO>
                                <SUBJECT>[Amended] </SUBJECT>
                            </SECTION>
                        </SUBPART>
                    </REGTEXT>
                    <REGTEXT TITLE="42" PART="411">
                        <AMDPAR>19. Section 413.1 is amended by— </AMDPAR>
                        <AMDPAR>A. Removing paragraphs (a)(2)(iv) and (vi). </AMDPAR>
                        <AMDPAR>B. Redesignating paragraphs (a)(2)(v) and (vii) as paragraphs (a)(2)(iv) and (v), respectively. </AMDPAR>
                        <SUBPART>
                            <HD SOURCE="HED">Subpart H—Payment for End-Stage Renal Disease (ESRD) Services and Organ Procurement Costs </HD>
                        </SUBPART>
                    </REGTEXT>
                    <REGTEXT TITLE="42" PART="411">
                        <AMDPAR>20. Section 413.184 is amended by revising the section heading as set forth below: </AMDPAR>
                        <SECTION>
                            <SECTNO>§ 413.184 </SECTNO>
                            <SUBJECT>Payment exception: Pediatric patient mix. </SUBJECT>
                        </SECTION>
                    </REGTEXT>
                    <REGTEXT TITLE="42" PART="414">
                        <STARS/>
                        <PART>
                            <HD SOURCE="HED">PART 414—PAYMENT FOR PART B MEDICAL AND OTHER HEALTH SERVICES </HD>
                        </PART>
                        <AMDPAR>21. The authority citation for part 414 continues to read as follows:</AMDPAR>
                        <AUTH>
                            <HD SOURCE="HED">Authority:</HD>
                            <P>Secs. 1102, 1871, and 1881(b)(l) of the Social Security Act (42 U.S.C. 1302, 1395hh, and 1395rr(b)(l)). </P>
                        </AUTH>
                        <SUBPART>
                            <HD SOURCE="HED">Subpart B—Physicians and Other Practitioners </HD>
                        </SUBPART>
                    </REGTEXT>
                    <REGTEXT TITLE="42" PART="414">
                        <AMDPAR>22. Section 414.50 is revised to read as follows: </AMDPAR>
                        <SECTION>
                            <PRTPAGE P="66401"/>
                            <SECTNO>§ 414.50 </SECTNO>
                            <SUBJECT>Physician or other supplier billing for diagnostic tests performed or interpreted by an outside supplier or at a site other than the office of the billing physician or other supplier. </SUBJECT>
                            <P>
                                (a) 
                                <E T="03">General rules.</E>
                                 (1) The services covered under section 1861(s)(3) of the Act and paid for under part 414 of this chapter (other than clinical diagnostic laboratory tests paid under section 1833(a)(2)(D) of the Act, which are subject to the special billing rules set forth in section 1833(h)(5)(A) of the Act), if a physician or other supplier bills for the technical component or professional component of a diagnostic test that was ordered by the physician or other supplier (or ordered by a party related to such physician or other supplier through common ownership or control as described in § 413.17 of this chapter) and the diagnostic test is either purchased from an outside supplier or performed at a site other than the office of the billing physician or other supplier, the payment to the billing physician or other supplier (less the applicable deductibles and coinsurance paid by the beneficiary or on behalf of the beneficiary) for the technical component or professional component of the diagnostic test may not exceed the lowest of the following amounts: 
                            </P>
                            <P>(i) The performing supplier's net charge to the billing physician or other supplier. </P>
                            <P>(ii) The billing physician or other supplier's actual charge. </P>
                            <P>(iii) The fee schedule amount for the test that would be allowed if the performing supplier billed directly. </P>
                            <P>(2) The following requirements are applicable for purposes of paragraph (a) of this section: </P>
                            <P>(i) The net charge must be determined without regard to any charge that is intended to reflect the cost of equipment or space leased to the performing supplier by or through the billing physician or other supplier. </P>
                            <P>(ii) An “outside supplier” is someone who is not an employee of the billing physician or other supplier and who does not furnish the test or interpretation to the billing physician or other supplier under a reassignment that meets the requirements of § 424.80. </P>
                            <P>(iii) The “office of the billing physician or other supplier” is medical office space where the physician or other supplier regularly furnishes patient care. With respect to a billing physician or other supplier that is a physician organization (as defined at § 411.351 of this chapter), the “office of the billing physician or other supplier” is space in which the physician organization provides substantially the full range of patient care services that the physician organization provides generally. </P>
                            <P>
                                (b) 
                                <E T="03">Restriction on payment.</E>
                                 (1) The billing physician or other supplier must identify the performing supplier and indicate the performing supplier's net charge for the test. If the billing physician or other supplier fails to provide this information, CMS makes no payment to the billing physician or other supplier and the billing physician or other supplier may not bill the beneficiary. 
                            </P>
                            <P>(2) Physicians and other suppliers that accept Medicare assignment may bill beneficiaries for only the applicable deductibles and coinsurance. </P>
                            <P>(3) Physicians and other suppliers that do not accept Medicare assignment may not bill the beneficiary more than the payment amount described in paragraph (a) of this section. </P>
                        </SECTION>
                    </REGTEXT>
                    <REGTEXT TITLE="42" PART="414">
                        <AMDPAR>23. Section 414.65 is amended by revising paragraph (a)(1) to read as follows: </AMDPAR>
                        <SECTION>
                            <SECTNO>§ 414.65 </SECTNO>
                            <SUBJECT>Payment for telehealth services. </SUBJECT>
                            <P>(a) * * * </P>
                            <P>(1) The Medicare payment amount for office or other outpatient visits, consultation, individual psychotherapy, psychiatric diagnostic interview examination, pharmacologic management, end stage renal disease related services included in the monthly capitation payment (except for one visit per month to examine the access site), individual medical nutrition therapy, and neurobehavioral status exam furnished via an interactive telecommunications system is equal to the current fee schedule amount applicable for the service of the physician or practitioner. </P>
                            <STARS/>
                        </SECTION>
                        <SUBPART>
                            <HD SOURCE="HED">Subpart G—Payment for New Clinical Diagnostic Laboratory Tests </HD>
                        </SUBPART>
                    </REGTEXT>
                    <REGTEXT TITLE="42" PART="414">
                        <AMDPAR>24. Section § 414.502 is amended by adding the definition, “New test” in alphabetical order to read as follows: </AMDPAR>
                        <SECTION>
                            <SECTNO>§ 414.502 </SECTNO>
                            <SUBJECT>Definitions. </SUBJECT>
                            <STARS/>
                            <P>
                                <E T="03">New test</E>
                                 means any clinical diagnostic laboratory test for which a new or substantially revised Healthcare Common Procedure Coding System Code is assigned on or after January 1, 2005. 
                            </P>
                        </SECTION>
                    </REGTEXT>
                    <REGTEXT TITLE="42" PART="414">
                        <AMDPAR>25. Section 414.506 is amended by revising the introductory text to read as follows: </AMDPAR>
                        <SECTION>
                            <SECTNO>§ 414.506 </SECTNO>
                            <SUBJECT>Procedures for public consultation for payment for a new clinical diagnostic laboratory test. </SUBJECT>
                            <P>For a new test, CMS determines the basis for and amount of payment after performance of the following: </P>
                        </SECTION>
                    </REGTEXT>
                    <REGTEXT TITLE="42" PART="414">
                        <STARS/>
                        <AMDPAR>26. Section 414.508 is amended by revising paragraph (b)(3) to read as follows: </AMDPAR>
                        <SECTION>
                            <SECTNO>§ 414.508 </SECTNO>
                            <SUBJECT>Payment for a new clinical diagnostic laboratory test. </SUBJECT>
                            <STARS/>
                            <P>(b) * * * </P>
                            <P>(3) For a new test for which a new or substantially revised HCPCS code was assigned on or before December 31, 2007, after the first year of gapfilling, CMS determines whether the carrier-specific amounts will pay for the test appropriately. If CMS determines that the carrier-specific amounts will not pay for the test appropriately, CMS may crosswalk the test. </P>
                        </SECTION>
                    </REGTEXT>
                    <REGTEXT TITLE="42" PART="414">
                        <AMDPAR>27. Section 414.509 is added to read as follows: </AMDPAR>
                        <SECTION>
                            <SECTNO>§ 414.509 </SECTNO>
                            <SUBJECT>Reconsideration of basis for and amount of payment for a new clinical diagnostic laboratory test. </SUBJECT>
                            <P>For a new test for which a new or substantially revised HCPCS code was assigned on or after January 1, 2008, the following reconsideration procedures apply: </P>
                            <P>
                                (a) 
                                <E T="03">Reconsideration of basis for payment.</E>
                                 (1) CMS will receive reconsideration requests in written format for 60 days after making a determination of the basis for payment under § 414.506(d)(2) regarding whether CMS should reconsider the basis for payment and why a different basis for payment would be more appropriate. If a requestor recommends that the basis for payment should be changed from gapfilling to crosswalking, the requestor may also recommend the code or codes to which to crosswalk the new test. 
                            </P>
                            <P>(2)(i) A requestor that submitted a request under paragraph (a)(1) of this section may also present its reconsideration request at the public meeting convened under § 414.506(c), provided that the requestor requests an opportunity to present at the public meeting as part of its written submission under paragraph (a)(1) of this section. </P>
                            <P>
                                (ii) If the requestor presents its reconsideration request at the public meeting convened under § 414.506(c), members of public may comment on the reconsideration request verbally at the public meeting and may submit written comments after the public meeting (within the timeframe for public comments established by CMS). 
                                <PRTPAGE P="66402"/>
                            </P>
                            <P>(3) Considering reconsideration requests and other comments received, CMS may reconsider its determination of the basis for payment. As the result of such a reconsideration, CMS may change the basis for payment from crosswalking to gapfilling or from gapfilling to crosswalking. </P>
                            <P>(4) If the basis for payment is revised as the result of a reconsideration, the new basis for payment is final and is not subject to further reconsideration. </P>
                            <P>
                                (b) 
                                <E T="03">Reconsideration of amount of payment</E>
                                —(1) 
                                <E T="03">Crosswalking.</E>
                                 (i) For 60 days after making a determination under § 414.506(d)(2) of the code or codes to which a new test will be crosswalked, CMS receives reconsideration requests in written format regarding whether CMS should reconsider its determination and the recommended code or codes to which to crosswalk the new test. 
                            </P>
                            <P>(ii)(A) A requestor that submitted a request under paragraph (b)(1)(i) of this section may also present its reconsideration request at the public meeting convened under § 414.506(c), provided that the requestor requests an opportunity to present at the public meeting as part of its written submission under paragraph (b)(1)(i) of this section. </P>
                            <P>(B) If a requestor presents its reconsideration request at the public meeting convened under § 414.506(c), members of public may comment on the reconsideration request verbally at the public meeting and may submit written comments after the public meeting (within the timeframe for public comments established by CMS). </P>
                            <P>(iii) Considering comments received, CMS may reconsider its determination of the amount of payment. As the result of such a reconsideration, CMS may change the code or codes to which the new test is crosswalked. </P>
                            <P>(iv) If CMS changes the basis for payment from gapfilling to crosswalking as a result of a reconsideration, the crosswalked amount of payment is not subject to reconsideration. </P>
                            <P>
                                (2) 
                                <E T="03">Gapfilling.</E>
                                 (i) By April 30 of the year after CMS makes a determination under § 414.506(d)(2) or § 414.509(a)(3) that the basis for payment for a new test will be gapfilling, CMS posts interim carrier-specific amounts on the CMS Web site.
                            </P>
                            <P>(ii) For 60 days after CMS posts interim carrier-specific amounts on the CMS Web site, CMS will receive public comments in written format regarding the interim carrier-specific amounts. </P>
                            <P>(iii) After considering the public comments, CMS will post final carrier-specific amounts on the CMS Web site. </P>
                            <P>(iv) For 30 days after CMS posts final carrier-specific amounts on the CMS Web site, CMS will receive reconsideration requests in written format regarding whether CMS should reconsider the final payment amounts and the appropriate national limitation amount for the new test. </P>
                            <P>(v) Considering reconsideration requests received, CMS may reconsider its determination of the amount of payment. As the result of a reconsideration, CMS may revise the national limitation amount for the new test. </P>
                            <P>(3) For both gapfilled and crosswalked new tests, if CMS revises the amount of payment as the result of a reconsideration, the new amount of payment is final and is not subject to further reconsideration. </P>
                            <P>
                                (c) 
                                <E T="03">Effective date.</E>
                                 If CMS changes a determination as the result of a reconsideration, the new determination regarding the basis for or amount of payment is effective January 1 of the year following reconsideration. Claims for services with dates of service prior to the effective date will not be reopened or otherwise reprocessed. 
                            </P>
                            <P>
                                (d) 
                                <E T="03">Jurisdiction for Reconsideration Decisions.</E>
                                 Jurisdiction for reconsidering a determination rests exclusively with the Secretary. A decision whether to reconsider a determination is committed to the discretion of the Secretary. A decision not to reconsider an initial determination is not subject to administrative or judicial review. 
                            </P>
                        </SECTION>
                    </REGTEXT>
                    <REGTEXT TITLE="42" PART="414">
                        <AMDPAR>28. Section 414.510 is amended by— </AMDPAR>
                        <AMDPAR>A. Revising the section heading to read as set forth below. </AMDPAR>
                        <AMDPAR>B. Revising the introductory text. </AMDPAR>
                        <P>The revisions read as follows: </P>
                        <SECTION>
                            <SECTNO>§ 414.510 </SECTNO>
                            <SUBJECT>Laboratory date of service for clinical laboratory and pathology specimens. </SUBJECT>
                            <P>The date of service for either a clinical laboratory test or the technical component of physician pathology service is as follows: </P>
                            <STARS/>
                        </SECTION>
                        <SUBPART>
                            <HD SOURCE="HED">Subpart H—Fee Schedule for Ambulance Services </HD>
                            <SECTION>
                                <SECTNO>§ 414.620 </SECTNO>
                                <SUBJECT>[Amended] </SUBJECT>
                            </SECTION>
                        </SUBPART>
                    </REGTEXT>
                    <REGTEXT TITLE="42" PART="414">
                        <AMDPAR>
                            29. In § 414.620, the phrase “notice in the 
                            <E T="04">Federal Register</E>
                             without opportunity for prior comment” is removed and the phrase “CMS by instruction and on the CMS Web site” is added in its place. 
                        </AMDPAR>
                        <SUBPART>
                            <HD SOURCE="HED">Subpart I—Payment for Drugs and Biologicals </HD>
                        </SUBPART>
                    </REGTEXT>
                    <REGTEXT TITLE="42" PART="414">
                        <AMDPAR>30. Section 414.707 is amended by adding paragraph (c) to read as follows: </AMDPAR>
                        <SECTION>
                            <SECTNO>§ 414.707 </SECTNO>
                            <SUBJECT>Basis of payment </SUBJECT>
                            <STARS/>
                            <P>
                                (c) 
                                <E T="03">Mandatory reporting of anemia quality indicators.</E>
                                 The following provisions are effective January 1, 2008: 
                            </P>
                            <P>(1) Each request for payment for anti-anemia drugs furnished to treat anemia resulting from the treatment of cancer must report the beneficiary's most recent hemoglobin or hematocrit level; </P>
                            <P>(2) Each request for payment for use of erythropoiesis stimulating agents must report the beneficiary's most recent hemoglobin or hematocrit level. </P>
                        </SECTION>
                        <SUBPART>
                            <HD SOURCE="HED">Subpart K—Payment for Drugs and Biologicals Under Part B </HD>
                        </SUBPART>
                    </REGTEXT>
                    <REGTEXT TITLE="42" PART="414">
                        <AMDPAR>31. Section 414.904 is amended by revising paragraph (d)(3) to read as follows: </AMDPAR>
                        <SECTION>
                            <SECTNO>§ 414.904 </SECTNO>
                            <SUBJECT>Average sales price as the basis for payment. </SUBJECT>
                            <STARS/>
                            <P>(d) * * * </P>
                            <P>
                                (3) 
                                <E T="03">Widely available market price and average manufacturer price.</E>
                                 If the Inspector General finds that the average sales price exceeds the widely available market price or the average manufacturer price by 5 percent or more in CY 2005, 2006, 2007 or 2008, the payment limit in the quarter following the transmittal of this information to the Secretary is the lesser of the widely available market price or 103 percent of the average manufacturer price. 
                            </P>
                            <STARS/>
                        </SECTION>
                    </REGTEXT>
                    <REGTEXT TITLE="42" PART="414">
                        <AMDPAR>32. Section 414.908 is amended by— </AMDPAR>
                        <AMDPAR>A. Revising paragraphs (a)(2)(iv), (a)(3)(x), and (a)(3)(xi). </AMDPAR>
                        <AMDPAR>B. Adding paragraph (a)(2)(v). </AMDPAR>
                        <AMDPAR>C. Removing paragraph (a)(5). </AMDPAR>
                        <P>The revisions and addition read as follows: </P>
                        <SECTION>
                            <SECTNO>§ 414.908 </SECTNO>
                            <SUBJECT>Competitive acquisition program. </SUBJECT>
                            <P>(a) * * * </P>
                            <P>(2) * * * </P>
                            <P>(iv) The approved CAP vendor refuses to ship to the participating CAP physician because the conditions of § 414.914(i) have been met (if this subparagraph (a)(2)(iv) applies, the physician can withdraw from the CAP category for the remainder of the year immediately upon notice to CMS and the approved CAP vendor); or </P>
                            <P>(v) Other exigent circumstances defined by CMS are present, including— </P>
                            <P>
                                (A) If, up to and including 60 days after the effective date of the physician's CAP election agreement, the participating CAP physician submits a written request to the designated carrier to terminate the CAP election agreement 
                                <PRTPAGE P="66403"/>
                                because CAP participation imposes a burden on the physician's practice. The written request must document the burden. The designated carrier will process the participating CAP physician's request and CMS will approve or deny the request under the dispute resolution process as specified under § 414.917 of this subpart. 
                            </P>
                            <P>(B) If, more than 60 days after the effective date of the physician's CAP election agreement, the participating CAP physician submits a written request to the designated carrier to terminate the CAP election agreement because, based on a change in circumstances of which the participating CAP physician was not previously aware, CAP participation imposes a burden on the physician's practice. The written request must document the burden. The designated carrier will process the participating CAP physician's request and CMS will approve or deny the request under the dispute resolution process as specified under § 414.917 of this subpart. </P>
                            <P>(3) * * * </P>
                            <P>(x) Agrees to file the Medicare claim within 30 calendar days of the date of drug administration. </P>
                            <P>(xi) Agrees to submit documentation such as medical records or certification, as necessary, to support payment for a CAP drug; </P>
                            <STARS/>
                        </SECTION>
                    </REGTEXT>
                    <REGTEXT TITLE="42" PART="414">
                        <AMDPAR>33. Section 414.914 is amended by— </AMDPAR>
                        <AMDPAR>A. Redesignating paragraph (h) as (i) </AMDPAR>
                        <AMDPAR>B. Adding new paragraph (h). </AMDPAR>
                        <AMDPAR>C. Revising new paragraphs (i)(1) and (2). </AMDPAR>
                        <AMDPAR>D. Removing the reference “§ 414.914(h)” in paragraph (f)(12) and adding in its place the reference “§ 414.914(i)”. </AMDPAR>
                        <AMDPAR>E. Revising new paragraph (i)(5). </AMDPAR>
                        <P>The addition and revision read as follows: </P>
                        <SECTION>
                            <SECTNO>§ 414.914 </SECTNO>
                            <SUBJECT>Terms of contract. </SUBJECT>
                            <STARS/>
                            <P>(h) The approved CAP vendor must verify drug administration prior to collection of any applicable cost sharing amount. </P>
                            <P>(1) The approved CAP vendor documents, in writing, the following information necessary to verify drug administration: </P>
                            <P>(i) Beneficiary name. </P>
                            <P>(ii) Health insurance number. </P>
                            <P>(iii) Expected date of administration. </P>
                            <P>(iv) Actual date of administration. </P>
                            <P>(v) Identity of the participating CAP physician. </P>
                            <P>(vi) Prescription order number. </P>
                            <P>(vii) Identity of the individuals who supply and receive the information. </P>
                            <P>(viii) Dosage supplied. </P>
                            <P>(ix) Dosage administered. </P>
                            <STARS/>
                            <P>(2) If the information is obtained verbally, the approved CAP vendor must also maintain the following information: </P>
                            <P>(i) The identities of individuals who exchanged the information. </P>
                            <P>(ii) The date and time that the information was obtained. </P>
                            <P>(3) The approved CAP vendor must provide this information to CMS or the beneficiary upon request. </P>
                            <P>(i) * * * </P>
                            <P>(1) Subsequent to receipt of payment by Medicare, or the verification of drug administration by the participating CAP physician, the approved CAP vendor must bill any applicable supplemental insurance policies. </P>
                            <P>(2) An approved CAP vendor that has received payment from the designated carrier for CAP drugs that have not been administered must promptly refund payment for such drugs to the designated carrier and must refund any coinsurance and deductible collected from the beneficiary and his or her supplemental insurer. </P>
                            <STARS/>
                            <P>(5) For purposes of paragraph (i) of this section delivery means postmark date, or the date the coinsurance bill or notice was presented to the beneficiary by the participating CAP physician on behalf of the approved CAP vendor. </P>
                            <P>(i) Except as specified in paragraph (i)(5)(ii) of this section, if after 45 days from delivery of the approved CAP vendor's bill to the beneficiary, the beneficiary's cost-sharing obligation remains unpaid, the approved CAP vendor may refuse further shipments to the participating CAP physician for that beneficiary. </P>
                            <P>(ii) If the beneficiary has requested cost-sharing assistance within 45 days of receiving delivery of the approved CAP vendor's bill, provisions of paragraphs (i)(6), (i)(7), or (i)(8) of this section, apply. </P>
                        </SECTION>
                    </REGTEXT>
                    <REGTEXT TITLE="42" PART="414">
                        <AMDPAR>34. Section 414.916 is amended by revising paragraph (c)(1) to read as follows: </AMDPAR>
                        <SECTION>
                            <SECTNO>§ 414.916 </SECTNO>
                            <SUBJECT>Dispute resolution for vendors and beneficiaries. </SUBJECT>
                            <STARS/>
                            <P>(c) * * * </P>
                            <P>
                                (1) 
                                <E T="03">Right to a reconsideration.</E>
                                 A participating CAP physician dissatisfied with a determination that his or her CAP election agreement has been suspended by CMS or a determination under § 414.917(d) denying the participating CAP physician's request to terminate participation in the CAP under § 414.908(a)(v) is entitled to a reconsideration as provided in this subpart. 
                            </P>
                        </SECTION>
                    </REGTEXT>
                    <REGTEXT TITLE="42" PART="414">
                        <STARS/>
                        <AMDPAR>35. Section 414.917 is amended by— </AMDPAR>
                        <AMDPAR>A. Revising the section heading as set forth below. </AMDPAR>
                        <AMDPAR>B. Adding paragraph (d). </AMDPAR>
                        <P>The revision and addition read as follows: </P>
                        <SECTION>
                            <SECTNO>§ 414.917 </SECTNO>
                            <SUBJECT>Dispute resolution and process for suspension or termination of approved CAP contract and termination of physician participation under exigent circumstances. </SUBJECT>
                            <STARS/>
                            <P>
                                (d) 
                                <E T="03">CAP participating physicians' exigent circumstances provision.</E>
                                 The following process must be completed for participating CAP physicians' requests to terminate their participation in the program under exigent circumstances provisions described in § 414.908(a)(2)(v): 
                            </P>
                            <P>(1) The designated carrier must— </P>
                            <P>(i) Determine whether a request to terminate CAP participation was related to approved CAP vendor service, and if so, forward the issue to the approved CAP vendor's grievance process within 1 business day of the receipt of the request; or </P>
                            <P>(ii) Continue to investigate, consistent with § 414.916(b)(2) of this chapter, and within 2 business days of receipt, do any of the following: </P>
                            <P>(A) Request a single, 2-business day extension. No later than the end of any 2-business day extension, the designated carrier must make findings and a recommendation as provided in subparagraph (B) or (C). </P>
                            <P>(B) Submit a recommendation and relevant findings to CMS that the requesting participating CAP physician be permitted to terminate his or her participation in the CAP. </P>
                            <P>(C) Submit a recommendation and relevant findings to CMS that the requesting participating CAP physician not be permitted to terminate his or her participation in the CAP. </P>
                            <P>(ii) In the case of a request made under § 414.908(a)(2)(v)(B), the designated carrier also shall include in its recommendation its finding with respect to whether the request is based on a change in circumstances of which the participating CAP physician was previously unaware. </P>
                            <P>(2) CMS will consider the carrier's findings and recommendation and may also make its own findings. As a result, CMS will— </P>
                            <P>
                                (i) Approve or deny the request to terminate participation in the CAP within 2 business days of receipt of the recommendation. 
                                <PRTPAGE P="66404"/>
                            </P>
                            <P>(ii) Communicate the decision to the appropriate Medicare contractors and the participating CAP physician. </P>
                            <P>(3) A denial of the participating CAP physician's request to terminate participation in the CAP must include written notification of the right to request reconsideration under § 414.916(c). </P>
                            <P>(4) Upon termination of participation in the CAP a physician must— </P>
                            <P>(i) Continue to submit claims for drugs supplied and administered under the CAP prior to the effective date of the physician's termination from the CAP consistent with § 414.908(a) until all such claims are timely submitted. </P>
                            <P>(ii) Return any unused CAP drugs that had not been administered to the beneficiary prior to the effective date of the physician's termination from the CAP to the approved CAP vendor consistent with applicable law and regulation and any agreement with the approved CAP vendor. </P>
                            <P>(iii) Cooperate in any post-payment review activities on claims submitted under the CAP, as required under section 1847B(a)(3) of the Act. </P>
                            <P>(5) An approved CAP vendor that has billed and been paid for CAP drugs that have not been administered must refund any payments made by CMS or the beneficiary and his or her supplemental insurer in accordance with § 414.914(h)(3)(i)(2) of this chapter.</P>
                        </SECTION>
                    </REGTEXT>
                    <REGTEXT TITLE="42" PART="414">
                        <AMDPAR>36. Section 414.930 is added to subpart K to read as follows: </AMDPAR>
                        <SECTION>
                            <SECTNO>§ 414.930 </SECTNO>
                            <SUBJECT>Compendia for determination of medically-accepted indications for off-label uses of drugs and biologicals in an anti-cancer chemotherapeutic regimen. </SUBJECT>
                            <P>
                                (a) 
                                <E T="03">Definition.</E>
                                 For purposes of this section, 
                                <E T="03">compendium</E>
                                 means a comprehensive listing of FDA-approved drugs and biologicals or a comprehensive listing of a specific subset of drugs and biologicals in a specialty compendium, for example a compendium of anti-cancer treatment. A compendium includes a summary of the pharmacologic characteristics of each drug or biological and may include information on dosage, as well as recommended or endorsed uses in specific diseases. A compendium is indexed by drug or biological. 
                            </P>
                            <P>
                                (b) 
                                <E T="03">Process for listing compendia for determining medically-accepted uses of drugs and biologicals in anti-cancer treatment.</E>
                                 (1) The CMS process— 
                            </P>
                            <P>(i) Receives formal written requests for changes to the list of compendia during a 30 day window beginning January 15 each year. </P>
                            <P>(ii) Publishes a listing of the timely, complete requests by March 15th and solicits public comment on the requests for 30 days. The listing identifies the requestor and the requested action. </P>
                            <P>(iii) Considers a compendium's attainment of the MedCAC (Medicare Evidence Development and Coverage Advisory Committee, previously known as the MCAC—Medicare Coverage Advisory Committee) recommended desirable characteristics of compendia (including explicit listing and recommendations) in reviewing requests. CMS may consider additional reasonable factors. </P>
                            <P>(iv) Considers a compendium's grading of evidence used in making recommendations regarding off-label uses and the process by which the compendium grades the evidence. </P>
                            <P>(v) Publishes its decision no later than 90 days after the close of the public comment period. </P>
                            <P>
                                (2) 
                                <E T="03">Exception.</E>
                                 In addition to the annual process outlined in paragraph (b)(1) of this section, CMS may internally generate a request for changes to the list of compendia at any time. 
                            </P>
                            <P>
                                (c) 
                                <E T="03">Written request for review.</E>
                                 (1) CMS will review a complete, written request that is submitted in writing, electronically or via hard copy (no duplicate submissions) and includes the following: 
                            </P>
                            <P>(i) The full name and contact information of the requestor. </P>
                            <P>(ii) The full identification of the compendium that is the subject of the request, including name, publisher, edition if applicable, date of publication, and any other information needed for the accurate and precise identification of the specific compendium.</P>
                            <P>(iii) A complete written copy of the compendium that is the subject of the request. </P>
                            <P>(iv) The specific action that is requested of CMS. </P>
                            <P>(v) Materials that the requestor must submit for CMS review in support of the requested action. </P>
                            <P>(vi) A single compendium as its subject. </P>
                            <P>(d) CMS may at its discretion combine and consider multiple requests that refer to the same compendium. </P>
                            <P>(e) For the purposes of this section, publication by CMS may be accomplished by posting on the CMS Web site. </P>
                        </SECTION>
                    </REGTEXT>
                    <REGTEXT TITLE="42" PART="414">
                        <AMDPAR>37. Subpart M is added to read as follows: </AMDPAR>
                        <SUBPART>
                            <HD SOURCE="HED">Subpart M—Payment for Comprehensive Outpatient Rehabilitation Facility (CORF) Services </HD>
                            <SECTION>
                                <SECTNO>§ 414.1100 </SECTNO>
                                <SUBJECT>Basis and Scope. </SUBJECT>
                                <P>This subpart implements sections 1834(k)(1) and (k)(3) of the Act by specifying the payment methodology for comprehensive outpatient rehabilitation facility services covered under Part B of Title XVIII of the Act that are described at section 1861(cc)(1) of the Act. </P>
                            </SECTION>
                            <SECTION>
                                <SECTNO>§ 414.1105 </SECTNO>
                                <SUBJECT>Payment for Comprehensive Outpatient Rehabilitation Facility (CORF) Services. </SUBJECT>
                                <P>
                                    (a) 
                                    <E T="03">Payment under the physician fee schedule.</E>
                                     Except as otherwise specified under paragraphs (b), (c), (d), and (e) of this section payment for CORF services, as defined under § 410.100 of this chapter, is paid the lesser of 80 percent of the following: 
                                </P>
                                <P>(1) The actual charge for the item or service; or </P>
                                <P>(2) The nonfacility amount determined under the physician fee schedule established under section 1848(b) of the Act for the item or service. </P>
                                <P>
                                    (b) 
                                    <E T="03">Payment for physician services.</E>
                                     No separate payment for physician services that are CORF services under § 410.100(a) of this chapter will be made. 
                                </P>
                                <P>
                                    (c) 
                                    <E T="03">Payment for supplies and durable medical equipment, prosthetic and orthotic devices, and drugs and biologicals.</E>
                                     Supplies and durable medical equipment that are CORF services under § 410.100(l) of this chapter, prosthetic device services that are CORF services under § 410.100(f), orthotic devices that are CORF services under § 410.100(g) of this chapter and drugs and biologicals that are CORF services under § 410.100(k) of this chapter are paid the lesser of 80 percent of the following:
                                </P>
                                <P>(1) The actual charge for the service provided that payment for such item is not included in the payment amount for other CORF services paid under paragraphs (a) or (d); or </P>
                                <P>(2) The amount determined under the DMEPOS fee schedule established under part 414 subparts D and F for the item or the single payment amount established under the DMEPOS competitive bidding program provided that payment for such item is not included in the payment amount for other CORF services paid under paragraphs (a) or (d). </P>
                                <P>
                                    (d) 
                                    <E T="03">Payment for drugs and biologicals.</E>
                                     Drugs and biologicals that are CORF services under § 410.100(j) of this chapter, are paid the lesser of 80 percent of the following: 
                                </P>
                                <P>(1) The actual charge for the service provided that payment for such item is not included in the payment amount for other CORF services paid under paragraphs (a) or (c); or </P>
                                <P>
                                    (2) The amount determined using the same methodology for drugs (as defined 
                                    <PRTPAGE P="66405"/>
                                    in § 414.704 of this chapter) described in section 1842(o)(1) of the Act provided that payment for such 
                                    <E T="03">drug</E>
                                     is not included in the payment amount for other CORF services paid under paragraphs (a) or (c). 
                                </P>
                                <P>
                                    (e) 
                                    <E T="03">Payment for CORF services when no fee schedule amount for the service.</E>
                                     If there is no fee schedule amount established for a CORF service, payment for the item or service will be the lesser of 80 percent of: 
                                </P>
                                <P>(i) The actual charge for the service provided that payment for such item or service is not included in the payment amount for other CORF services paid under paragraphs (a), (c), or (d) of this section. </P>
                                <P>(ii) The amount determined under the fee schedule established for a comparable service as specified by the Secretary provided that payment for such item or service is not included in the payment amount for other CORF services paid under paragraphs (a), (c), or (d) of this section.</P>
                            </SECTION>
                        </SUBPART>
                    </REGTEXT>
                    <REGTEXT TITLE="42" PART="415">
                        <PART>
                            <HD SOURCE="HED">PART 415—SERVICES FURNISHED BY PHYSICIANS IN PROVIDERS, SUPERVISING PHYSICIANS IN TEACHING SETTINGS, AND RESIDENTS IN CERTAIN SETTINGS </HD>
                        </PART>
                        <AMDPAR>38. The authority citation for part 415 continues to read as follows: </AMDPAR>
                        <AUTH>
                            <HD SOURCE="HED">Authority:</HD>
                            <P>Secs. 1102 and 1871 of the Social Security Act (42 U.S.C. 1302 and 1395hh). </P>
                        </AUTH>
                    </REGTEXT>
                    <REGTEXT TITLE="42" PART="415">
                        <SUBPART>
                            <HD SOURCE="HED">Subpart C—Part B Carrier Payments for Physician Services to Beneficiaries in Providers </HD>
                        </SUBPART>
                        <AMDPAR>39. Section 415.130 is amended by revising paragraph (d) to read as follows: </AMDPAR>
                        <SECTION>
                            <SECTNO>§ 415.130 </SECTNO>
                            <SUBJECT>Conditions for payment: Physician pathology services. </SUBJECT>
                            <STARS/>
                            <P>
                                (d) 
                                <E T="03">Physician pathology services furnished by an independent laboratory.</E>
                                 The technical component of physician pathology services furnished by an independent laboratory to a hospital inpatient or outpatient on or before December 31, 2007, may be paid to the laboratory by the carrier under the physician fee schedule if the Medicare beneficiary is a patient of a covered hospital as defined in paragraph (a)(1) of this section. For services furnished after December 31, 2007, an independent laboratory may not bill the carrier for the technical component of physician pathology services furnished to a hospital inpatient or outpatient. For services furnished on or after January 1, 2008, the date of service policy in § 414.510 of this chapter applies for the technical component of specimens for physician pathology services. 
                            </P>
                        </SECTION>
                    </REGTEXT>
                    <REGTEXT TITLE="42" PART="418">
                        <PART>
                            <HD SOURCE="HED">PART 418—HOSPICE CARE </HD>
                        </PART>
                        <AMDPAR>40. The authority citation for part 418 continues to read as follows: </AMDPAR>
                        <AUTH>
                            <HD SOURCE="HED">Authority:</HD>
                            <P>Secs. 1102 and 1871 of the Social Security Act (42 U.S.C. 1302 and 1395hh). </P>
                        </AUTH>
                        <SUBPART>
                            <HD SOURCE="HED">Subpart E—Condition of Participation: Other Services </HD>
                        </SUBPART>
                    </REGTEXT>
                    <REGTEXT TITLE="42" PART="418">
                        <AMDPAR>41. Section 418.92 is amended by revising paragraph (a) to read as follows: </AMDPAR>
                        <SECTION>
                            <SECTNO>§ 418.92 </SECTNO>
                            <SUBJECT>Condition of participation—Physical therapy, occupational therapy, and speech-language pathology. </SUBJECT>
                            <P>(a) Physical therapy, occupational therapy, and speech-language pathology services must be— </P>
                            <P>(1) Available, and when provided, offered in a manner consistent with accepted standards of practice; and </P>
                            <P>(2) Furnished by personnel who meet the qualifications specified in part 484 of this chapter. </P>
                            <STARS/>
                        </SECTION>
                    </REGTEXT>
                    <REGTEXT TITLE="42" PART="423">
                        <PART>
                            <HD SOURCE="HED">PART 423—VOLUNTARY MEDICARE PRESCRIPTION DRUG BENEFIT</HD>
                        </PART>
                        <AMDPAR>42. The authority citation for part 423 continues to read as follows: </AMDPAR>
                        <AUTH>
                            <HD SOURCE="HED">Authority:</HD>
                            <P>Secs 1102, 1860D-1 through 1860D-42, and 1871 of the Social Security Act (42 U.S.C. 1302, 1395w-101 through 1395w-152, and 1395hh). </P>
                        </AUTH>
                    </REGTEXT>
                    <REGTEXT TITLE="42" PART="423">
                        <SUBPART>
                            <HD SOURCE="HED">Subpart D—Cost Control and Quality Improvement Requirements </HD>
                        </SUBPART>
                        <AMDPAR>43. Section 423.160 is amended by— </AMDPAR>
                        <AMDPAR>A. Revising paragraph (a)(3)(i). </AMDPAR>
                        <AMDPAR>B. Redesignating paragraphs (a)(3)(ii) and (iii) to (a)(3)(iii) and (iv), respectively. </AMDPAR>
                        <AMDPAR>C. Adding new paragraph (a)(3)(ii). The revision and addition reads as follows: </AMDPAR>
                        <SECTION>
                            <SECTNO>§ 423.160 </SECTNO>
                            <SUBJECT>Standards for electronic prescribing. </SUBJECT>
                            <P>(a) * * * </P>
                            <P>(3) * * *</P>
                            <P>(i) Entities transmitting prescriptions or prescription-related information by means of computer-generated facsimile are exempt from the requirement to use the NCPDP SCRIPT Standard adopted by this section in transmitting such prescriptions or prescription-related information until January 1, 2009; </P>
                            <P>(ii) After January 1, 2009, electronic transmission of prescriptions or prescription-related information by means of computer-generated facsimile is only permitted in instances of temporary/transient transmission failure and communication problems that would preclude the use of the NCPDP SCRIPT Standard adopted by this section. </P>
                            <STARS/>
                        </SECTION>
                    </REGTEXT>
                    <REGTEXT TITLE="42" PART="424">
                        <PART>
                            <HD SOURCE="HED">PART 424—CONDITIONS FOR MEDICARE PAYMENT </HD>
                        </PART>
                        <AMDPAR>44. The authority citation for part 424 continues to read as follows: </AMDPAR>
                        <AUTH>
                            <HD SOURCE="HED">Authority:</HD>
                            <P>Secs. 1102 and 1871 of the Social Security Act (42 U.S.C. 1302 and 1395hh). </P>
                        </AUTH>
                    </REGTEXT>
                    <REGTEXT TITLE="42" PART="424">
                        <AMDPAR>45. The heading for subpart B is revised to read as set forth below. </AMDPAR>
                        <SUBPART>
                            <HD SOURCE="HED">Subpart B—Certification and Plan Requirements </HD>
                        </SUBPART>
                    </REGTEXT>
                    <REGTEXT TITLE="42" PART="424">
                        <AMDPAR>46. Section 424.24 is amended by revising paragraphs (c)(2) and (c)(4) to read as follows: </AMDPAR>
                        <SECTION>
                            <SECTNO>§ 424.24 </SECTNO>
                            <SUBJECT>Requirements for medical and other health services furnished by providers under Medicare Part B. </SUBJECT>
                            <STARS/>
                            <P>(c) * * *</P>
                            <P>
                                (2) 
                                <E T="03">Timing.</E>
                                 The initial certification must be obtained as soon as possible after the plan is established. 
                            </P>
                            <P>
                                (4) 
                                <E T="03">Recertification.</E>
                                 (i) 
                                <E T="03">Timing.</E>
                                 Recertification is required at least every 90 days. 
                            </P>
                            <P>
                                (ii) 
                                <E T="03">Content.</E>
                                 When it is recertified, the plan or other documentation in the patient's record must indicate the continuing need for physical therapy, occupational therapy or speech-language pathology services. 
                            </P>
                            <P>
                                (iii) 
                                <E T="03">Signature.</E>
                                 The physician, nurse practitioner, clinical nurse specialist, or physician assistant who reviews the plan must recertify the plan by signing the medical record. 
                            </P>
                            <STARS/>
                        </SECTION>
                    </REGTEXT>
                    <REGTEXT TITLE="42" PART="424">
                        <AMDPAR>47. Section 424.27 is amended by revising paragraph (b)(1) to read as follows: </AMDPAR>
                        <SECTION>
                            <SECTNO>§ 424.27 </SECTNO>
                            <SUBJECT>Requirements for comprehensive outpatient rehabilitation facility (CORF) services </SUBJECT>
                            <STARS/>
                            <P>(b) * * *</P>
                            <P>
                                (1) 
                                <E T="03">Timing.</E>
                                 Recertification is required at least every 60 days for respiratory therapy services and every 90 days for physical therapy, occupational therapy, and speech-language pathology services based on review by a facility physician or the referring physician who, when appropriate, consults with the professional personnel who furnish the services. 
                            </P>
                            <STARS/>
                        </SECTION>
                    </REGTEXT>
                    <REGTEXT TITLE="42" PART="424">
                        <AMDPAR>48. In § 424.32, paragraph (a)(3) is revised to read as follows: </AMDPAR>
                        <SECTION>
                            <PRTPAGE P="66406"/>
                            <SECTNO>§ 424.32 </SECTNO>
                            <SUBJECT>Basic requirements for all claims. </SUBJECT>
                            <P>(a) * * *</P>
                            <P>(3) A claim must be signed by the beneficiary or on behalf of the beneficiary (in accordance with § 424.36). </P>
                            <STARS/>
                        </SECTION>
                        <SUBPART>
                            <HD SOURCE="HED">Subpart C—Claims for Payment </HD>
                        </SUBPART>
                    </REGTEXT>
                    <REGTEXT TITLE="42" PART="424">
                        <AMDPAR>49. Section 424.36 is amended by— </AMDPAR>
                        <AMDPAR>A. Revising paragraph (b)(5). </AMDPAR>
                        <AMDPAR>B. Adding paragraph (b)(6). </AMDPAR>
                        <P>The revision and addition read as follows:</P>
                        <SECTION>
                            <SECTNO>§ 424.36 </SECTNO>
                            <SUBJECT>Signature requirements. </SUBJECT>
                            <STARS/>
                            <P>(b) * * *</P>
                            <P>(5) A representative of the provider or of the nonparticipating hospital claiming payment for services it has furnished if the provider or nonparticipating hospital is unable to have the claim signed in accordance with paragraph (b)(1), (2), (3), or (4) of this section after making reasonable efforts to locate and obtain the signature of one of the individuals specified in paragraph (b)(1), (2), (3), or (4) of this section.</P>
                            <P>(6) An ambulance provider or supplier with respect to emergency ambulance transport services, if the following conditions and documentation requirements are met. </P>
                            <P>(i) None of the individuals listed in paragraph (b)(1), (2), (3), or (4) of this section was available or willing to sign the claim on behalf of the beneficiary at the time the service was provided; </P>
                            <P>(ii) The ambulance provider or supplier maintains in its files the following information and documentation for a period of at least four years from the date of service: </P>
                            <P>(A) A contemporaneous statement, signed by an ambulance employee present during the trip to the receiving facility, that, at the time the service was provided, the beneficiary was physically or mentally incapable of signing the claim and that none of the individuals listed in paragraph (b)(1), (2), (3), or (4) of this section were available or willing to sign the claim on behalf of the beneficiary, and </P>
                            <P>(B) Documentation with the date and time the beneficiary was transported, and the name and location of the facility that received the beneficiary, and </P>
                            <P>(C) Either of the following: </P>
                            <P>
                                (
                                <E T="03">1</E>
                                ) A signed contemporaneous statement from a representative of the facility that received the beneficiary, which documents the name of the beneficiary and the date and time the beneficiary was received by that facility; or 
                            </P>
                            <P>
                                (
                                <E T="03">2</E>
                                ) The requested information from a representative of the facility using a secondary form of verification obtained at a later date, but prior to submitting the claim to Medicare for payment. Secondary forms of verification include a copy of any of the following— 
                            </P>
                            <P>
                                (
                                <E T="03">i</E>
                                ) The signed patient care/trip report; 
                            </P>
                            <P>
                                (
                                <E T="03">ii</E>
                                ) The hospital registration/admissions sheet; 
                            </P>
                            <P>
                                (
                                <E T="03">iii</E>
                                ) The patient medical record; 
                            </P>
                            <P>
                                (
                                <E T="03">iv</E>
                                ) The hospital log; or 
                            </P>
                            <P>
                                (
                                <E T="03">v</E>
                                ) Other internal hospital records. 
                            </P>
                            <STARS/>
                        </SECTION>
                        <SUBPART>
                            <HD SOURCE="HED">Subpart F—Limitations on Assignment and Reassignment of Claims </HD>
                        </SUBPART>
                    </REGTEXT>
                    <REGTEXT TITLE="42" PART="424">
                        <AMDPAR>50. Section 424.80 is amended by adding paragraph (d)(3) to read as follows: </AMDPAR>
                        <SECTION>
                            <SECTNO>§ 424.80 </SECTNO>
                            <SUBJECT>Prohibition of reassignment of claims by suppliers. </SUBJECT>
                            <STARS/>
                            <P>(d) * * * </P>
                            <P>
                                (3) 
                                <E T="03">Reassignment of the technical or professional component of a diagnostic test.</E>
                                 If a physician or other supplier bills for the technical or professional component of a diagnostic test covered under section 1861(s)(3) of the Act and paid for under part 414 of this chapter (other than clinical diagnostic laboratory tests paid under section 1833(a)(2)(D) of the Act, which are subject to the special rules set forth in section 1833(h)(5)(A) of the Act) following a reassignment from a physician or other supplier who performed the technical or professional component, the amount payable to the billing physician or other supplier may be subject to the limits specified in § 414.50 of this chapter. 
                            </P>
                        </SECTION>
                    </REGTEXT>
                    <REGTEXT TITLE="42" PART="424">
                        <PART>
                            <HD SOURCE="HED">PART 482—CONDITIONS OF PARTICIPATION FOR HOSPITALS </HD>
                        </PART>
                        <AMDPAR>51. The authority citation for part 482 continues to read as follows: </AMDPAR>
                        <AUTH>
                            <HD SOURCE="HED">Authority:</HD>
                            <P>Secs. 1102 and 1871 of the Social Security Act (42 U.S.C. 1302 and 1395hh). </P>
                        </AUTH>
                        <AMDPAR>52. Section 482.56 is amended by revising paragraphs (a)(2) and (b) to read as follows: </AMDPAR>
                        <SECTION>
                            <SECTNO>§ 482.56 </SECTNO>
                            <SUBJECT>Condition of participation: Rehabilitation services. </SUBJECT>
                            <P>(a) * * * </P>
                            <P>(2) Physical therapy, occupational therapy, speech-language pathology or audiology services, if provided, must be provided by qualified physical therapists, physical therapist assistants, occupational therapists, occupational therapy assistants, speech-language pathologists, or audiologists as defined in part 484 of this chapter. </P>
                            <P>
                                (b) 
                                <E T="03">Standard: Delivery of services.</E>
                                 Services must be given in accordance with orders of practitioners who are authorized by the medical staff to order the services, and the orders must be incorporated in the patient's record. The provision of care and the personnel qualifications must be in accordance with national acceptable standards of practice and must also meet the requirements of § 409.17 
                            </P>
                        </SECTION>
                    </REGTEXT>
                    <REGTEXT TITLE="42" PART="484">
                        <PART>
                            <HD SOURCE="HED">PART 484—HOME HEALTH SERVICES </HD>
                        </PART>
                        <AMDPAR>53. The authority citation for part 484 continues to read as follows: </AMDPAR>
                        <AUTH>
                            <HD SOURCE="HED">Authority:</HD>
                            <P>Secs. 1102 and 1871 of the Social Security Act (42 U.S.C. 1302 and 1395(hh)) unless otherwise indicated. </P>
                        </AUTH>
                    </REGTEXT>
                    <REGTEXT TITLE="42" PART="484">
                        <SUBPART>
                            <HD SOURCE="HED">Subpart A—General Provisions </HD>
                        </SUBPART>
                        <AMDPAR>54. Section 484.4 is amended by revising the definitions of “Occupational therapist,” “Occupational therapy assistant,” “Physical therapist,” “Physical therapist assistant” and “Speech language pathologist” to read as follows: </AMDPAR>
                        <SECTION>
                            <SECTNO>§ 484.4 </SECTNO>
                            <SUBJECT>Personnel Qualifications. </SUBJECT>
                            <STARS/>
                            <P>
                                <E T="03">Occupational therapist.</E>
                                 A person who— 
                            </P>
                            <P>(a)(1) Is licensed or otherwise regulated, if applicable, as an occupational therapist by the State in which practicing, unless licensure does not apply; </P>
                            <P>(2) Graduated after successful completion of an occupational therapist education program accredited by the Accreditation Council for Occupational Therapy Education (ACOTE) of the American Occupational Therapy Association, Inc. (AOTA), or successor organizations of ACOTE; and </P>
                            <P>(3) Is eligible to take, or has successfully completed the entry-level certification examination for occupational therapists developed and administered by the National Board for Certification in Occupational Therapy, Inc. (NBCOT). </P>
                            <P>(b) On or before December 31, 2009— </P>
                            <P>(1) Is licensed or otherwise regulated, if applicable, as an occupational therapist by the State in which practicing; or </P>
                            <P>(2) When licensure or other regulation does not apply— </P>
                            <P>
                                (i) Graduated after successful completion of an occupational therapist education program accredited by the Accreditation Council for Occupational Therapy Education (ACOTE) of the American Occupational Therapy Association, Inc. (AOTA) or successor organizations of ACOTE; and 
                                <PRTPAGE P="66407"/>
                            </P>
                            <P>(ii) Is eligible to take, or has successfully completed the entry-level certification examination for occupational therapists developed and administered by the National Board for Certification in Occupational Therapy, Inc., (NBCOT). </P>
                            <P>(c) On or before January 1, 2008— </P>
                            <P>(1) Graduated after successful completion of an occupational therapy program accredited jointly by the committee on Allied Health Education and Accreditation of the American Medical Association and the American Occupational Therapy Association; or </P>
                            <P>(2) Is eligible for the National Registration Examination of the American Occupational Therapy Association or the National Board for Certification in Occupational Therapy. </P>
                            <P>(d) On or before December 31, 1977— </P>
                            <P>(1) Had 2 years of appropriate experience as an occupational therapist; and </P>
                            <P>(2) Had achieved a satisfactory grade on an occupational therapist proficiency examination conducted, approved, or sponsored by the U.S. Public Health Service. </P>
                            <P>(e) If educated outside the United States— </P>
                            <P>(1) Must meet both of the following: </P>
                            <P>(i) Graduated after successful completion of an occupational therapist education program accredited as substantially equivalent to occupational therapist assistant entry level education in the United States by one of the following: </P>
                            <P>(A) The Accreditation Council for Occupational Therapy Education (ACOTE). </P>
                            <P>(B) Successor organizations of ACOTE. </P>
                            <P>(C) The World Federation of Occupational Therapists. </P>
                            <P>(D) A credentialing body approved by the American Occupational Therapy Association. </P>
                            <P>(ii) Successfully completed the entry-level certification examination for occupational therapists developed and administered by the National Board for Certification in Occupational Therapy, Inc. (NBCOT). </P>
                            <P>(2) On or before December 31, 2009, is licensed or otherwise regulated, if applicable, as an occupational therapist by the State in which practicing. </P>
                            <P>
                                <E T="03">Occupational therapy assistant.</E>
                                 A person who— 
                            </P>
                            <P>(a) Meets all of the following: </P>
                            <P>(1) Is licensed or otherwise regulated, if applicable, as an occupational therapy assistant by the State in which practicing, unless licensure does apply. </P>
                            <P>(2) Graduated after successful completion of an occupational therapy assistant education program accredited by the Accreditation Council for Occupational Therapy Education, (ACOTE) of the American Occupational Therapy Association, Inc. (AOTA) or its successor organizations. </P>
                            <P>(3) Is eligible to take or successfully completed the entry-level certification examination for occupational therapy assistants developed and administered by the National Board for Certification in Occupational Therapy, Inc. (NBCOT). </P>
                            <P>(b) On or before December 31, 2009— </P>
                            <P>(1) Is licensed or otherwise regulated as an occupational therapy assistant, if applicable, by the State in which practicing; or any qualifications defined by the State in which practicing, unless licensure does not apply; or </P>
                            <P>(2) Must meet both of the following: </P>
                            <P>(i) Completed certification requirements to practice as an occupational therapy assistant established by a credentialing organization approved by the American Occupational Therapy Association. </P>
                            <P>(ii) After January 1, 2010, meets the requirements in paragraph (a) of this section. </P>
                            <P>(c) After December 31, 1977 and on or before December 31, 2007—</P>
                            <P>(1) Completed certification requirements to practice as an occupational therapy assistant established by a credentialing organization approved by the American Occupational Therapy Association; or </P>
                            <P>(2) Completed the requirements to practice as an occupational therapy assistant applicable in the State in which practicing. </P>
                            <P>(d) On or before December 31, 1977— </P>
                            <P>(1) Had 2 years of appropriate experience as an occupational therapy assistant; and </P>
                            <P>(2) Had achieved a satisfactory grade on an occupational therapy assistant proficiency examination conducted, approved, or sponsored by the U.S. Public Health Service. </P>
                            <P>(e) If educated outside the United States, on or after January 1, 2008— </P>
                            <P>(1) Graduated after successful completion of an occupational therapy assistant education program that is accredited as substantially equivalent to occupational therapist assistant entry level education in the United States by— </P>
                            <P>(i) The Accreditation Council for Occupational Therapy Education (ACOTE). </P>
                            <P>(ii) Its successor organizations. </P>
                            <P>(iii) The World Federation of Occupational Therapists. </P>
                            <P>(iv) By a credentialing body approved by the American Occupational Therapy Association; and </P>
                            <P>(2) Successfully completed the entry-level certification examination for occupational therapy assistants developed and administered by the National Board for Certification in Occupational Therapy, Inc. (NBCOT). </P>
                            <P>
                                <E T="03">Physical therapist.</E>
                                 A person who is licensed, if applicable, by the State in which practicing, unless licensure does not apply and meets one of the following requirements: 
                            </P>
                            <P>(a)(1) Graduated after successful completion of one of a physical therapist eduction program approved by one of the following: </P>
                            <P>(i) The Commission on Accreditation in Physical Therapy Education (CAPTE). </P>
                            <P>(ii) Successor organizations of CAPTE. </P>
                            <P>(iii) An education program outside the United States determined to be substantially equivalent to physical therapist entry level education in the United States by a credentials evaluation organization approved by the American Physical Therapy Association or an organization identified in 8 CFR 212.15(e) as it relates to physical therapists. </P>
                            <P>(2) Passed an examination for physical therapists approved by the State in which physical therapy services are provided. </P>
                            <P>(b) On or before December 31, 2009— </P>
                            <P>(1) Graduated after successful completion of a physical therapy curriculum approved by the Commission on Accreditation in Physical Therapy Education (CAPTE); or </P>
                            <P>(2) Meets both of the following: </P>
                            <P>(i) Graduated after successful completion of an education program determined to be substantially equivalent to physical therapist entry level education in the United States by a credentials evaluation organization approved by the American Physical Therapy Association or identified in 8 CFR 212.15(e) as it relates to physical therapists. </P>
                            <P>(ii) Passed an examination for physical therapists approved by the State in which physical therapy services are provided. </P>
                            <P>(c) Before January 1, 2008— </P>
                            <P>(1) Graduated from a physical therapy curriculum approved by one of the following: </P>
                            <P>(i) The American Physical Therapy Association. </P>
                            <P>(ii) The Committee on Allied Health Education and Accreditation of the American Medical Association.</P>
                            <P>(iii) The Council on Medical Education of the American Medical Association and the American Physical Therapy Association. </P>
                            <P>
                                (d) On or before December 31, 1977 was licensed or qualified as a physical therapist and meets both of the following: 
                                <PRTPAGE P="66408"/>
                            </P>
                            <P>(1) Has 2 years of appropriate experience as a physical therapist. </P>
                            <P>(2) Has achieved a satisfactory grade on a proficiency examination conducted, approved, or sponsored by the U.S. Public Health Service. </P>
                            <P>(e) Before January 1, 1966— </P>
                            <P>(1) Was admitted to membership by the American Physical Therapy Association; </P>
                            <P>(2) Was admitted to registration by the American Registry of Physical Therapists; and </P>
                            <P>(3) Graduated from a physical therapy curriculum in a 4-year college or university approved by a State department of education. </P>
                            <P>(f) Before January 1, 1966 was licensed or registered, and before January 1, 1970, had 15 years of full-time experience in the treatment of illness or injury through the practice of physical therapy in which services were rendered under the order and direction of attending and referring doctors of medicine or osteopathy. </P>
                            <P>(g) If trained outside the United States before January 1, 2008, meets the following requirements: </P>
                            <P>(1) Was graduated since 1928 from a physical therapy curriculum approved in the country in which the curriculum was located and in which there is a member organization of the World Confederation for Physical Therapy. </P>
                            <P>(2) Meets the requirements for membership in a member organization of the World Confederation for Physical Therapy. </P>
                            <P>
                                <E T="03">Physical therapist assistant.</E>
                                 A person who is licensed, registered or certified as a physical therapist assistant, if applicable, by the State in which practicing, unless licensure does not apply and meets one of the following requirements: 
                            </P>
                            <P>(a)(1)(i) Graduated from a physical therapist assistant curriculum approved by the Commission on Accreditation in Physical Therapy Education of the American Physical Therapy Association; or if educated outside the United States or trained in the United States military, graduated from an education program determined to be substantially equivalent to physical therapist assistant entry level education in the United States by a credentials evaluation organization approved by the American Physical Therapy Association or identified at 8 CFR 212.15(e); and </P>
                            <P>(ii) Passed a national examination for physical therapist assistants. </P>
                            <P>(b) On or before December 31, 2009, meets one of the following: </P>
                            <P>(1) Is licensed, or otherwise regulated in the State in which practicing. </P>
                            <P>(2) In States where licensure or other regulations do not apply, graduated before December 31, 2009, from a 2-year college-level program approved by the American Physical Therapy Association and after January 1, 2010, meets the requirements of paragraph (a) of this definition. </P>
                            <P>(c) Before January 1, 2008, where licensure or other regulation does not apply, graduated from a 2-year college-level program approved by the American Physical Therapy Association. </P>
                            <P>(d) On or before December 31, 1977, was licensed or qualified as a physical therapist assistant and has achieved a satisfactory grade on a proficiency examination conducted, approved, or sponsored by the U.S. Public Health Service. </P>
                            <STARS/>
                            <P>
                                <E T="03">Speech-language pathologist.</E>
                                 A person who meets either of the following requirements: 
                            </P>
                            <P>(a) The education and experience requirements for a Certificate of Clinical Competence in speech-language pathology granted by the American Speech-Language-Hearing Association. </P>
                            <P>(b) The educational requirements for certification and is in the process of accumulating the supervised experience required for certification. </P>
                        </SECTION>
                    </REGTEXT>
                    <REGTEXT TITLE="42" PART="485">
                        <PART>
                            <HD SOURCE="HED">PART 485—CONDITIONS OF PARTICIPATION: SPECIALIZED PROVIDERS </HD>
                        </PART>
                        <AMDPAR>55. The authority citation for part 485 continues to read as follows: </AMDPAR>
                        <AUTH>
                            <HD SOURCE="HED">Authority:</HD>
                            <P>Secs. 1102 and 1871 of the Social Security Act (42 U.S.C. 1302 and 1395(hh)). </P>
                        </AUTH>
                    </REGTEXT>
                    <REGTEXT TITLE="42" PART="485">
                        <SUBPART>
                            <HD SOURCE="HED">Subpart B—Conditions of Participation: Comprehensive Outpatient Rehabilitation Facilities </HD>
                        </SUBPART>
                        <AMDPAR>56. Section 485.51 is amended by— </AMDPAR>
                        <AMDPAR>A. Revising paragraph (a). </AMDPAR>
                        <AMDPAR>B. Adding paragraph (c). </AMDPAR>
                        <P>The revision and addition read as follows:</P>
                        <SECTION>
                            <SECTNO>§ 485.51 </SECTNO>
                            <SUBJECT>Definition. </SUBJECT>
                            <STARS/>
                            <P>(a) Is established and operated exclusively for the purpose of providing diagnostic, therapeutic, and restorative services to outpatients for the rehabilitation of injured, disabled, or sick persons, at a single fixed location, by or under the supervision of a physician except as provided in paragraph (c) of this section; </P>
                            <STARS/>
                            <P>
                                (c) 
                                <E T="03">Exception.</E>
                                 May provide influenza, pneumococcal and Hepatitis B vaccines provided the applicable conditions of coverage under § 410.58 and § 410.63 of this chapter are met. 
                            </P>
                        </SECTION>
                    </REGTEXT>
                    <REGTEXT TITLE="42" PART="485">
                        <AMDPAR>57. Section 485.70 is amended by revising paragraphs (c), (e), and (m) to read as follows: </AMDPAR>
                        <SECTION>
                            <SECTNO>§ 485.70 </SECTNO>
                            <SUBJECT>Personnel qualifications. </SUBJECT>
                            <STARS/>
                            <P>(c) An occupational therapist and an occupational therapy assistant must meet the qualifications in part 484 of this chapter. </P>
                            <STARS/>
                            <P>(e) A physical therapist and a physical therapist assistant must meet the qualifications in part 484 of this chapter. </P>
                            <STARS/>
                            <P>(m) A speech-language pathologist must meet the qualifications set forth in part 484 of this chapter. </P>
                        </SECTION>
                        <SUBPART>
                            <HD SOURCE="HED">Subpart F—Conditions of Participation: Critical Access Hospitals (CAHs) </HD>
                        </SUBPART>
                        <AMDPAR>58. Section 485.635 is amended by adding paragraph (e) to read as follows: </AMDPAR>
                    </REGTEXT>
                    <REGTEXT TITLE="42" PART="485">
                        <SECTION>
                            <SECTNO>§ 485.635 </SECTNO>
                            <SUBJECT>Condition of participation: Provision of services. </SUBJECT>
                            <STARS/>
                            <P>(e) Standard: Rehabilitation Therapy Services. Physical therapy, occupational therapy, and speech-language pathology services furnished at the CAH, if provided, are provided as direct services by staff qualified under State law, and consistent with the requirements for therapy services in 409.17. </P>
                        </SECTION>
                    </REGTEXT>
                    <SIG>
                        <FP>(Catalog of Federal Domestic Assistance Program No. 93.774, Medicare—Supplementary Medical Insurance Program) </FP>
                        <DATED>Dated: October 23, 2007. </DATED>
                        <NAME>Kerry Weems, </NAME>
                        <TITLE>Acting Administrator, Centers for Medicare &amp; Medicaid Services. </TITLE>
                        <DATED>Approved: October 31, 2007. </DATED>
                        <NAME>Michael O. Leavitt,</NAME>
                        <TITLE>Secretary. </TITLE>
                    </SIG>
                    <HD SOURCE="HD1">Addendum A: </HD>
                    <NOTE>
                        <HD SOURCE="HED">Note:</HD>
                        <P>These addenda will not appear in the Code of Federal Regulations. Addendum A: Explanation and Use of Addendum B. </P>
                    </NOTE>
                    <EXTRACT>
                        <P>The addenda on the following pages provide various data pertaining to the Medicare fee schedule for physicians' services furnished in 2008. 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. </P>
                        <P>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 or the alphanumeric codes (Healthcare Common Procedure Coding System (HCPCS) codes not included in CPT) not paid under the PFS in Addendum B. </P>
                    </EXTRACT>
                    <PRTPAGE P="66409"/>
                    <HD SOURCE="HD1">Addendum B—2008 Relative Value Units and Related Information Used in Determining Medicare Payments for 2008 </HD>
                    <EXTRACT>
                        <P>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. Please also note the following: </P>
                        <P>• 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). If there is an “NA” in the non-facility PE RVU column, and the contractor determines that this service can be performed in the non-facility setting, the service will be paid at the facility PE RVU rate. </P>
                        <P>• 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. </P>
                        <P>
                            1. 
                            <E T="03">CPT/HCPCS code</E>
                            . This is the CPT or alphanumeric HCPCS number for the service. Alphanumeric HCPCS codes are included at the end of this addendum. 
                        </P>
                        <P>
                            2. 
                            <E T="03">Modifier</E>
                            . 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. 
                        </P>
                        <P>Modifier-53 is shown for a discontinued procedure, for example, a colonoscopy that is not completed. There will be RVUs for a code with this modifier. </P>
                        <P>
                            3. 
                            <E T="03">Status indicator</E>
                            . This indicator shows whether the CPT/HCPCS code is in the PFS and whether it is separately payable if the service is covered. 
                        </P>
                        <P>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. </P>
                        <P>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). </P>
                        <P>C = Carriers price the 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. </P>
                        <P>D* = Deleted/discontinued code. </P>
                        <P>E = Excluded from the PFS by regulation. These codes are for items and services that CMS chose to exclude from the fee schedule payment 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. </P>
                        <P>F = Deleted/discontinued codes. (Code not subject to a 90-day grace period.) These codes are deleted effective with the beginning of the year and are never subject to a grace period. This indicator is no longer effective beginning with the 2005 fee schedule as of January 1, 2005.</P>
                        <P>G = Code not valid for Medicare purposes. 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 2005 PFS as of January 1, 2005. </P>
                        <P>H* = Deleted modifier. For 2000 and later years, either the TC or PC component shown for the code has been deleted and the deleted component is shown in the database with the H status indicator. </P>
                        <P>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.) </P>
                        <P>L = Local codes. Carriers will apply this status to all local codes in effect on January 1, 1998 or subsequently approved by central office for use. Carriers will complete the RVUs and payment amounts for these codes. </P>
                        <P>M = Measurement codes, used for reporting purposes only. There are no RVUs and no payment amounts for these codes. Medicare uses them to aid with performance measurement. No separate payment is made. These codes should be billed with a zero (($0.00) charge and are denied) on the MPFSDB. </P>
                        <P>N = Non-covered 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>
                        <P>R = Restricted coverage. Special coverage instructions apply. If the service is covered and no RVUs are shown, it is carrier-priced. </P>
                        <P>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. </P>
                        <P>X = Statutory exclusion. These codes represent an item or service that is not within the statutory 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.) </P>
                        <P>
                            4. 
                            <E T="03">Description of code</E>
                            . This is an abbreviated version of the narrative description of the code. 
                        </P>
                        <P>
                            5. 
                            <E T="03">Physician work RVUs</E>
                            . These are the RVUs for the physician work for this service in 2008. 
                        </P>
                        <NOTE>
                            <HD SOURCE="HED">Note:</HD>
                            <P>
                                The separate budget neutrality adjustor is 
                                <E T="03">not</E>
                                 reflected in these physician work RVUs. 
                            </P>
                        </NOTE>
                        <P>
                            6. 
                            <E T="03">Fully implemented non-facility practice expense RVUs</E>
                            . These are the fully implemented resource-based PE RVUs for non-facility settings. 
                        </P>
                        <P>
                            7. 
                            <E T="03">Year 2008 Transitional Non-facility practice expense RVUs</E>
                            . These are the 2008 resource-based PE RVUs for non-facility settings. 
                        </P>
                        <P>
                            8. 
                            <E T="03">Fully implemented facility practice expense RVUs</E>
                            . These are the fully implemented resource-based PE RVUs for facility settings. 
                        </P>
                        <P>
                            9. 
                            <E T="03">Year 2008 Transitional facility practice expense RVUs</E>
                            . These are the 2008 resource-based PE RVUs for facility settings. 
                        </P>
                        <P>
                            10. 
                            <E T="03">Malpractice expense RVUs</E>
                            . These are the RVUs for the malpractice expense for the service for 2008. 
                        </P>
                        <P>
                            11. 
                            <E T="03">Global period</E>
                            . This indicator shows the number of days in the global period for the code (0, 10, or 90 days). 
                        </P>
                        <P>An explanation of the alpha codes follows: </P>
                        <P>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' Current Procedural Terminology for specific definitions. </P>
                        <P>XXX = The global concept does not apply. </P>
                        <P>YYY = The global period is to be set by the carrier (for example, unlisted surgery codes). </P>
                        <P>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 in the post service time. </P>
                        <P>*Codes with these indicators had a 90 day grace period before January 1, 2005.</P>
                    </EXTRACT>
                    <PRTPAGE P="66410"/>
                    <P> </P>
                    <P> </P>
                    <P> </P>
                    <OLPAGES/>
                    <OLNOTES>
                        <FNRUL>——————————</FNRUL>
                        <OLNOTE1>
                            <SU>1</SU>
                             CPT codes and descriptions only are copyright 2007 American Medical Association. All Rights Reserved. Applicable FARS/DFARS apply.
                        </OLNOTE1>
                        <OLNOTE1 SOURCE="OLNOTE2">
                            <SU>2</SU>
                             If values are reflected for codes not payable by Medicare, please note that these values have been established as a courtesy to the general public and are not used for Medicare payment.
                        </OLNOTE1>
                    </OLNOTES>
                    <GPOTABLE COLS="11" OPTS="L2,p7,7/8,i1" CDEF="xs30,xs24,xs24,r50,9,9,9,9,9,9,9">
                        <TTITLE>Addendum B.—Relative Value Units and Related Information Used in Determining Medicare Payments for 2008</TTITLE>
                        <BOXHD>
                            <CHED H="1">
                                CPT 
                                <SU>1</SU>
                                /HCPCS
                            </CHED>
                            <CHED H="1">Mod</CHED>
                            <CHED H="1">Status</CHED>
                            <CHED H="1">Description</CHED>
                            <CHED H="1">
                                Physician work RVUs 
                                <SU>2</SU>
                            </CHED>
                            <CHED H="1">
                                Fully imple- 
                                <LI>
                                    mented non-facility PE RVUs 
                                    <SU>2</SU>
                                </LI>
                            </CHED>
                            <CHED H="1">
                                Year 2008 transi- 
                                <LI>
                                    tional non-facility PE RVUs 
                                    <SU>2</SU>
                                </LI>
                            </CHED>
                            <CHED H="1">
                                Fully imple- 
                                <LI>
                                    mented facility PE RVUs 
                                    <SU>2</SU>
                                </LI>
                            </CHED>
                            <CHED H="1">
                                Year 2008 transi- 
                                <LI>
                                    tional facility PE RVUs 
                                    <SU>2</SU>
                                </LI>
                            </CHED>
                            <CHED H="1">
                                Mal-
                                <LI>
                                    practice RVUs 
                                    <SU>2</SU>
                                </LI>
                            </CHED>
                            <CHED H="1">Global</CHED>
                        </BOXHD>
                        <ROW>
                            <ENT I="01">0016T</ENT>
                            <ENT/>
                            <ENT>C</ENT>
                            <ENT>Thermotx choroid vasc lesion</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>XXX</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">0017T</ENT>
                            <ENT/>
                            <ENT>C</ENT>
                            <ENT>Photocoagulat macular drusen</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>XXX</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">0019T</ENT>
                            <ENT/>
                            <ENT>C</ENT>
                            <ENT>Extracorp shock wv tx,ms nos</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>XXX</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">0026T</ENT>
                            <ENT/>
                            <ENT>C</ENT>
                            <ENT>Measure remnant lipoproteins</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>XXX</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">0027T</ENT>
                            <ENT/>
                            <ENT>C</ENT>
                            <ENT>Endoscopic epidural lysis</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>XXX</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">0028T</ENT>
                            <ENT/>
                            <ENT>C</ENT>
                            <ENT>Dexa body composition study</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>XXX</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">0029T</ENT>
                            <ENT/>
                            <ENT>C</ENT>
                            <ENT>Magnetic tx for incontinence</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>XXX</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">0030T</ENT>
                            <ENT/>
                            <ENT>C</ENT>
                            <ENT>Antiprothrombin antibody</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>XXX</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">0031T</ENT>
                            <ENT/>
                            <ENT>C</ENT>
                            <ENT>Speculoscopy</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>XXX</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">0032T</ENT>
                            <ENT/>
                            <ENT>C</ENT>
                            <ENT>Speculoscopy w/direct sample</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>XXX</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">0041T</ENT>
                            <ENT/>
                            <ENT>C</ENT>
                            <ENT>Detect ur infect agnt w/cpas</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>XXX</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">0042T</ENT>
                            <ENT/>
                            <ENT>C</ENT>
                            <ENT>Ct perfusion w/contrast, cbf</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>XXX</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">0043T</ENT>
                            <ENT/>
                            <ENT>C</ENT>
                            <ENT>Co expired gas analysis</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>XXX</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">0046T</ENT>
                            <ENT/>
                            <ENT>C</ENT>
                            <ENT>Cath lavage, mammary duct(s)</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>XXX</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">0047T</ENT>
                            <ENT/>
                            <ENT>C</ENT>
                            <ENT>Cath lavage, mammary duct(s)</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>XXX</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">0048T</ENT>
                            <ENT/>
                            <ENT>C</ENT>
                            <ENT>Implant ventricular device</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>XXX</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">0049T</ENT>
                            <ENT/>
                            <ENT>C</ENT>
                            <ENT>External circulation assist</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>XXX</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">0050T</ENT>
                            <ENT/>
                            <ENT>C</ENT>
                            <ENT>Removal circulation assist</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>XXX</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">0051T</ENT>
                            <ENT/>
                            <ENT>C</ENT>
                            <ENT>Implant total heart system</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>XXX</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">0052T</ENT>
                            <ENT/>
                            <ENT>C</ENT>
                            <ENT>Replace component heart syst</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>XXX</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">0053T</ENT>
                            <ENT/>
                            <ENT>C</ENT>
                            <ENT>Replace component heart syst</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>XXX</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">0058T</ENT>
                            <ENT/>
                            <ENT>C</ENT>
                            <ENT>Cryopreservation, ovary tiss</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>XXX</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">0059T</ENT>
                            <ENT/>
                            <ENT>C</ENT>
                            <ENT>Cryopreservation, oocyte</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>XXX</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">0060T</ENT>
                            <ENT/>
                            <ENT>C</ENT>
                            <ENT>Electrical impedance scan</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>XXX</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">0061T</ENT>
                            <ENT/>
                            <ENT>C</ENT>
                            <ENT>Destruction of tumor, breast</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>XXX</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">0062T</ENT>
                            <ENT/>
                            <ENT>C</ENT>
                            <ENT>Rep intradisc annulus;1 lev</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>XXX</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">0063T</ENT>
                            <ENT/>
                            <ENT>C</ENT>
                            <ENT>Rep intradisc annulus;&gt;1lev</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>XXX</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">0064T</ENT>
                            <ENT/>
                            <ENT>C</ENT>
                            <ENT>Spectroscop eval expired gas</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>XXX</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">0066T</ENT>
                            <ENT/>
                            <ENT>N</ENT>
                            <ENT>Ct colonography;screen</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>0.00</ENT>
                            <ENT>XXX</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">0066T</ENT>
                            <ENT>TC</ENT>
                            <ENT>N</ENT>
                            <ENT>Ct colonography;screen</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>0.00</ENT>
                            <ENT>XXX</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">0066T</ENT>
                            <ENT>26</ENT>
                            <ENT>N</ENT>
                            <ENT>Ct colonography;screen</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>XXX</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">0067T</ENT>
                            <ENT/>
                            <ENT>C</ENT>
                            <ENT>Ct colonography;dx</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>0.00</ENT>
                            <ENT>XXX</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">0067T</ENT>
                            <ENT>TC</ENT>
                            <ENT>C</ENT>
                            <ENT>Ct colonography;dx</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>0.00</ENT>
                            <ENT>XXX</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">0067T</ENT>
                            <ENT>26</ENT>
                            <ENT>C</ENT>
                            <ENT>Ct colonography;dx</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>XXX</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">0068T</ENT>
                            <ENT/>
                            <ENT>C</ENT>
                            <ENT>Interp/rept heart sound</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>XXX</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">0069T</ENT>
                            <ENT/>
                            <ENT>C</ENT>
                            <ENT>Analysis only heart sound</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>XXX</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">0070T</ENT>
                            <ENT/>
                            <ENT>C</ENT>
                            <ENT>Interp only heart sound</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>XXX</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">0071T</ENT>
                            <ENT/>
                            <ENT>C</ENT>
                            <ENT>U/s leiomyomata ablate &lt;200</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>XXX</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">0072T</ENT>
                            <ENT/>
                            <ENT>C</ENT>
                            <ENT>U/s leiomyomata ablate &gt;200</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>XXX</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">0073T</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Delivery, comp imrt</ENT>
                            <ENT>0.00</ENT>
                            <ENT>13.15</ENT>
                            <ENT>15.58</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>0.13</ENT>
                            <ENT>XXX</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">0075T</ENT>
                            <ENT/>
                            <ENT>C</ENT>
                            <ENT>Perq stent/chest vert art</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>0.00</ENT>
                            <ENT>XXX</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">0075T</ENT>
                            <ENT>TC</ENT>
                            <ENT>C</ENT>
                            <ENT>Perq stent/chest vert art</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>0.00</ENT>
                            <ENT>XXX</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">0075T</ENT>
                            <ENT>26</ENT>
                            <ENT>C</ENT>
                            <ENT>Perq stent/chest vert art</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>XXX</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">0076T</ENT>
                            <ENT/>
                            <ENT>C</ENT>
                            <ENT>S&amp;i stent/chest vert art</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>0.00</ENT>
                            <ENT>XXX</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">0076T</ENT>
                            <ENT>TC</ENT>
                            <ENT>C</ENT>
                            <ENT>S&amp;i stent/chest vert art</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>0.00</ENT>
                            <ENT>XXX</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">0076T</ENT>
                            <ENT>26</ENT>
                            <ENT>C</ENT>
                            <ENT>S&amp;i stent/chest vert art</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>XXX</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">0077T</ENT>
                            <ENT/>
                            <ENT>C</ENT>
                            <ENT>Cereb therm perfusion probe</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>XXX</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">0078T</ENT>
                            <ENT/>
                            <ENT>C</ENT>
                            <ENT>Endovasc aort repr w/device</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>XXX</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">0079T</ENT>
                            <ENT/>
                            <ENT>C</ENT>
                            <ENT>Endovasc visc extnsn repr</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>XXX</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">0080T</ENT>
                            <ENT/>
                            <ENT>C</ENT>
                            <ENT>Endovasc aort repr rad s&amp;i</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>XXX</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">0081T</ENT>
                            <ENT/>
                            <ENT>C</ENT>
                            <ENT>Endovasc visc extnsn s&amp;i</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>XXX</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">0084T</ENT>
                            <ENT/>
                            <ENT>C</ENT>
                            <ENT>Temp prostate urethral stent</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>XXX</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">0085T</ENT>
                            <ENT/>
                            <ENT>C</ENT>
                            <ENT>Breath test heart reject</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>XXX</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">0086T</ENT>
                            <ENT/>
                            <ENT>C</ENT>
                            <ENT>L ventricle fill pressure</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>XXX</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">0087T</ENT>
                            <ENT/>
                            <ENT>C</ENT>
                            <ENT>Sperm eval hyaluronan</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>XXX</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">0088T</ENT>
                            <ENT/>
                            <ENT>C</ENT>
                            <ENT>Rf tongue base vol reduxn</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>XXX</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">0089T</ENT>
                            <ENT/>
                            <ENT>C</ENT>
                            <ENT>Actigraphy testing, 3-day</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>XXX</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">0090T</ENT>
                            <ENT/>
                            <ENT>C</ENT>
                            <ENT>Cervical artific disc</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>XXX</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">0092T</ENT>
                            <ENT/>
                            <ENT>C</ENT>
                            <ENT>Artific disc addl</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>XXX</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">0093T</ENT>
                            <ENT/>
                            <ENT>C</ENT>
                            <ENT>Cervical artific diskectomy</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>XXX</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">0095T</ENT>
                            <ENT/>
                            <ENT>C</ENT>
                            <ENT>Artific diskectomy addl</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>XXX</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">0096T</ENT>
                            <ENT/>
                            <ENT>C</ENT>
                            <ENT>Rev cervical artific disc</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>XXX</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">0098T</ENT>
                            <ENT/>
                            <ENT>C</ENT>
                            <ENT>Rev artific disc addl</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>XXX</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">0099T</ENT>
                            <ENT/>
                            <ENT>C</ENT>
                            <ENT>Implant corneal ring</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>XXX</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">0100T</ENT>
                            <ENT/>
                            <ENT>C</ENT>
                            <ENT>Prosth retina receive&amp;gen</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>XXX</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">0101T</ENT>
                            <ENT/>
                            <ENT>C</ENT>
                            <ENT>Extracorp shockwv tx,hi enrg</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>XXX</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">0102T</ENT>
                            <ENT/>
                            <ENT>C</ENT>
                            <ENT>Extracorp shockwv tx,anesth</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>XXX</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">0103T</ENT>
                            <ENT/>
                            <ENT>C</ENT>
                            <ENT>Holotranscobalamin</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>XXX</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">0104T</ENT>
                            <ENT/>
                            <ENT>C</ENT>
                            <ENT>At rest cardio gas rebreathe</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>XXX</ENT>
                        </ROW>
                        <ROW>
                            <PRTPAGE P="66411"/>
                            <ENT I="01">0105T</ENT>
                            <ENT/>
                            <ENT>C</ENT>
                            <ENT>Exerc cardio gas rebreathe</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>XXX</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">0106T</ENT>
                            <ENT/>
                            <ENT>C</ENT>
                            <ENT>Touch quant sensory test</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>XXX</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">0107T</ENT>
                            <ENT/>
                            <ENT>C</ENT>
                            <ENT>Vibrate quant sensory test</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>XXX</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">0108T</ENT>
                            <ENT/>
                            <ENT>C</ENT>
                            <ENT>Cool quant sensory test</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>XXX</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">0109T</ENT>
                            <ENT/>
                            <ENT>C</ENT>
                            <ENT>Heat quant sensory test</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>XXX</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">0110T</ENT>
                            <ENT/>
                            <ENT>C</ENT>
                            <ENT>Nos quant sensory test</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>XXX</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">0111T</ENT>
                            <ENT/>
                            <ENT>C</ENT>
                            <ENT>Rbc membranes fatty acids</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>XXX</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">0123T</ENT>
                            <ENT/>
                            <ENT>C</ENT>
                            <ENT>Scleral fistulization</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>XXX</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">0124T</ENT>
                            <ENT/>
                            <ENT>C</ENT>
                            <ENT>Conjunctival drug placement</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>XXX</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">0126T</ENT>
                            <ENT/>
                            <ENT>C</ENT>
                            <ENT>Chd risk imt study</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>XXX</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">0130T</ENT>
                            <ENT/>
                            <ENT>C</ENT>
                            <ENT>Chron care drug investigatn</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>XXX</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">0137T</ENT>
                            <ENT/>
                            <ENT>C</ENT>
                            <ENT>Prostate saturation sampling</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>XXX</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">0140T</ENT>
                            <ENT/>
                            <ENT>C</ENT>
                            <ENT>Exhaled breath condensate ph</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>XXX</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">0141T</ENT>
                            <ENT/>
                            <ENT>I</ENT>
                            <ENT>Perq islet transplant</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>XXX</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">0142T</ENT>
                            <ENT/>
                            <ENT>I</ENT>
                            <ENT>Open islet transplant</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>XXX</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">0143T</ENT>
                            <ENT/>
                            <ENT>I</ENT>
                            <ENT>Laparoscopic islet transplnt</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>XXX</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">0144T</ENT>
                            <ENT/>
                            <ENT>C</ENT>
                            <ENT>CT heart wo dye; qual calc</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>0.00</ENT>
                            <ENT>XXX</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">0144T</ENT>
                            <ENT>TC</ENT>
                            <ENT>C</ENT>
                            <ENT>CT heart wo dye; qual calc</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>0.00</ENT>
                            <ENT>XXX</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">0144T</ENT>
                            <ENT>26</ENT>
                            <ENT>C</ENT>
                            <ENT>CT heart wo dye; qual calc</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>XXX</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">0145T</ENT>
                            <ENT/>
                            <ENT>C</ENT>
                            <ENT>CT heart w/wo dye funct</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>0.00</ENT>
                            <ENT>XXX</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">0145T</ENT>
                            <ENT>TC</ENT>
                            <ENT>C</ENT>
                            <ENT>CT heart w/wo dye funct</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>0.00</ENT>
                            <ENT>XXX</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">0145T</ENT>
                            <ENT>26</ENT>
                            <ENT>C</ENT>
                            <ENT>CT heart w/wo dye funct</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>XXX</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">0146T</ENT>
                            <ENT/>
                            <ENT>C</ENT>
                            <ENT>CCTA w/wo dye</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>0.00</ENT>
                            <ENT>XXX</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">0146T</ENT>
                            <ENT>TC</ENT>
                            <ENT>C</ENT>
                            <ENT>CCTA w/wo dye</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>0.00</ENT>
                            <ENT>XXX</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">0146T</ENT>
                            <ENT>26</ENT>
                            <ENT>C</ENT>
                            <ENT>CCTA w/wo dye</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>XXX</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">0147T</ENT>
                            <ENT/>
                            <ENT>C</ENT>
                            <ENT>CCTA w/wo, quan calcium</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>0.00</ENT>
                            <ENT>XXX</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">0147T</ENT>
                            <ENT>TC</ENT>
                            <ENT>C</ENT>
                            <ENT>CCTA w/wo, quan calcium</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>0.00</ENT>
                            <ENT>XXX</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">0147T</ENT>
                            <ENT>26</ENT>
                            <ENT>C</ENT>
                            <ENT>CCTA w/wo, quan calcium</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>XXX</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">0148T</ENT>
                            <ENT/>
                            <ENT>C</ENT>
                            <ENT>CCTA w/wo, strxr</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>0.00</ENT>
                            <ENT>XXX</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">0148T</ENT>
                            <ENT>TC</ENT>
                            <ENT>C</ENT>
                            <ENT>CCTA w/wo, strxr</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>0.00</ENT>
                            <ENT>XXX</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">0148T</ENT>
                            <ENT>26</ENT>
                            <ENT>C</ENT>
                            <ENT>CCTA w/wo, strxr</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>XXX</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">0149T</ENT>
                            <ENT/>
                            <ENT>C</ENT>
                            <ENT>CCTA w/wo, strxr quan calc</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>0.00</ENT>
                            <ENT>XXX</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">0149T</ENT>
                            <ENT>TC</ENT>
                            <ENT>C</ENT>
                            <ENT>CCTA w/wo, strxr quan calc</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>0.00</ENT>
                            <ENT>XXX</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">0149T</ENT>
                            <ENT>26</ENT>
                            <ENT>C</ENT>
                            <ENT>CCTA w/wo, strxr quan calc</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>XXX</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">0150T</ENT>
                            <ENT/>
                            <ENT>C</ENT>
                            <ENT>CCTA w/wo, disease strxr</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>0.00</ENT>
                            <ENT>XXX</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">0150T</ENT>
                            <ENT>TC</ENT>
                            <ENT>C</ENT>
                            <ENT>CCTA w/wo, disease strxr</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>0.00</ENT>
                            <ENT>XXX</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">0150T</ENT>
                            <ENT>26</ENT>
                            <ENT>C</ENT>
                            <ENT>CCTA w/wo, disease strxr</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>XXX</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">0151T</ENT>
                            <ENT/>
                            <ENT>C</ENT>
                            <ENT>CT heart funct add-on</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>0.00</ENT>
                            <ENT>XXX</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">0151T</ENT>
                            <ENT>TC</ENT>
                            <ENT>C</ENT>
                            <ENT>CT heart funct add-on</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>0.00</ENT>
                            <ENT>XXX</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">0151T</ENT>
                            <ENT>26</ENT>
                            <ENT>C</ENT>
                            <ENT>CT heart funct add-on</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>XXX</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">0155T</ENT>
                            <ENT/>
                            <ENT>C</ENT>
                            <ENT>Lap impl gast curve electrd</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>XXX</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">0156T</ENT>
                            <ENT/>
                            <ENT>C</ENT>
                            <ENT>Lap remv gast curve electrd</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>XXX</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">0157T</ENT>
                            <ENT/>
                            <ENT>C</ENT>
                            <ENT>Open impl gast curve electrd</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>XXX</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">0158T</ENT>
                            <ENT/>
                            <ENT>C</ENT>
                            <ENT>Open remv gast curve electrd</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>XXX</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">0159T</ENT>
                            <ENT/>
                            <ENT>C</ENT>
                            <ENT>Cad breast mri</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>0.00</ENT>
                            <ENT>ZZZ</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">0159T</ENT>
                            <ENT>TC</ENT>
                            <ENT>C</ENT>
                            <ENT>Cad breast mri</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>0.00</ENT>
                            <ENT>ZZZ</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">0159T</ENT>
                            <ENT>26</ENT>
                            <ENT>C</ENT>
                            <ENT>Cad breast mri</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>ZZZ</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">0160T</ENT>
                            <ENT/>
                            <ENT>C</ENT>
                            <ENT>Tcranial magn stim tx plan</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>XXX</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">0161T</ENT>
                            <ENT/>
                            <ENT>C</ENT>
                            <ENT>Tcranial magn stim tx deliv</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>XXX</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">0162T</ENT>
                            <ENT/>
                            <ENT>C</ENT>
                            <ENT>Anal program gast neurostim</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>XXX</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">0163T</ENT>
                            <ENT/>
                            <ENT>C</ENT>
                            <ENT>Lumb artif diskectomy addl</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>YYY</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">0164T</ENT>
                            <ENT/>
                            <ENT>C</ENT>
                            <ENT>Remove lumb artif disc addl</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>YYY</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">0165T</ENT>
                            <ENT/>
                            <ENT>C</ENT>
                            <ENT>Revise lumb artif disc addl</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>YYY</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">0166T</ENT>
                            <ENT/>
                            <ENT>C</ENT>
                            <ENT>Tcath vsd close w/o bypass</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>XXX</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">0167T</ENT>
                            <ENT/>
                            <ENT>C</ENT>
                            <ENT>Tcath vsd close w bypass</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>XXX</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">0168T</ENT>
                            <ENT/>
                            <ENT>C</ENT>
                            <ENT>Rhinophototx light app bilat</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>XXX</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">0169T</ENT>
                            <ENT/>
                            <ENT>C</ENT>
                            <ENT>Place stereo cath brain</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>XXX</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">0170T</ENT>
                            <ENT/>
                            <ENT>C</ENT>
                            <ENT>Anorectal fistula plug rpr</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>XXX</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">0171T</ENT>
                            <ENT/>
                            <ENT>C</ENT>
                            <ENT>Lumbar spine proces distract</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>XXX</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">0172T</ENT>
                            <ENT/>
                            <ENT>C</ENT>
                            <ENT>Lumbar spine process addl</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>XXX</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">0173T</ENT>
                            <ENT/>
                            <ENT>C</ENT>
                            <ENT>Iop monit io pressure</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>XXX</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">0174T</ENT>
                            <ENT/>
                            <ENT>C</ENT>
                            <ENT>Cad cxr with interp</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>XXX</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">0175T</ENT>
                            <ENT/>
                            <ENT>C</ENT>
                            <ENT>Cad cxr remote</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>XXX</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">0176T</ENT>
                            <ENT/>
                            <ENT>C</ENT>
                            <ENT>Aqu canal dilat w/o retent</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>XXX</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">0177T</ENT>
                            <ENT/>
                            <ENT>C</ENT>
                            <ENT>Aqu canal dilat w retent</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>XXX</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">0178T</ENT>
                            <ENT/>
                            <ENT>C</ENT>
                            <ENT>64 lead ecg w i&amp;r</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>XXX</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">0179T</ENT>
                            <ENT/>
                            <ENT>C</ENT>
                            <ENT>64 lead ecg w tracing</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>XXX</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">0180T</ENT>
                            <ENT/>
                            <ENT>C</ENT>
                            <ENT>64 lead ecg w i&amp;r only</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>XXX</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">0181T</ENT>
                            <ENT/>
                            <ENT>C</ENT>
                            <ENT>Corneal hysteresis</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>XXX</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">0182T</ENT>
                            <ENT/>
                            <ENT>C</ENT>
                            <ENT>Hdr elect brachytherapy</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>XXX</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">0183T</ENT>
                            <ENT/>
                            <ENT>C</ENT>
                            <ENT>Wound ultrasound</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>XXX</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">0184T</ENT>
                            <ENT/>
                            <ENT>C</ENT>
                            <ENT>Exc rectal tumor endoscopic</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>XXX</ENT>
                        </ROW>
                        <ROW>
                            <PRTPAGE P="66412"/>
                            <ENT I="01">0185T</ENT>
                            <ENT/>
                            <ENT>C</ENT>
                            <ENT>Comptr probability analysis</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>XXX</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">0186T</ENT>
                            <ENT/>
                            <ENT>C</ENT>
                            <ENT>Suprachoroidal drug delivery</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>XXX</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">0187T</ENT>
                            <ENT/>
                            <ENT>C</ENT>
                            <ENT>Ophthalmic dx image anterior</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>XXX</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">10021</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Fna w/o image</ENT>
                            <ENT>1.27</ENT>
                            <ENT>2.18</ENT>
                            <ENT>2.17</ENT>
                            <ENT>0.37</ENT>
                            <ENT>0.46</ENT>
                            <ENT>0.10</ENT>
                            <ENT>XXX</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">10022</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Fna w/image</ENT>
                            <ENT>1.27</ENT>
                            <ENT>2.15</ENT>
                            <ENT>2.35</ENT>
                            <ENT>0.41</ENT>
                            <ENT>0.41</ENT>
                            <ENT>0.08</ENT>
                            <ENT>XXX</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">10040</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Acne surgery</ENT>
                            <ENT>1.19</ENT>
                            <ENT>1.33</ENT>
                            <ENT>1.17</ENT>
                            <ENT>0.98</ENT>
                            <ENT>0.88</ENT>
                            <ENT>0.05</ENT>
                            <ENT>010</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">10060</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Drainage of skin abscess</ENT>
                            <ENT>1.19</ENT>
                            <ENT>1.50</ENT>
                            <ENT>1.35</ENT>
                            <ENT>1.08</ENT>
                            <ENT>1.01</ENT>
                            <ENT>0.12</ENT>
                            <ENT>010</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">10061</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Drainage of skin abscess</ENT>
                            <ENT>2.42</ENT>
                            <ENT>2.06</ENT>
                            <ENT>1.94</ENT>
                            <ENT>1.51</ENT>
                            <ENT>1.50</ENT>
                            <ENT>0.26</ENT>
                            <ENT>010</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">10080</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Drainage of pilonidal cyst</ENT>
                            <ENT>1.19</ENT>
                            <ENT>2.68</ENT>
                            <ENT>2.89</ENT>
                            <ENT>1.10</ENT>
                            <ENT>1.10</ENT>
                            <ENT>0.11</ENT>
                            <ENT>010</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">10081</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Drainage of pilonidal cyst</ENT>
                            <ENT>2.47</ENT>
                            <ENT>3.48</ENT>
                            <ENT>3.77</ENT>
                            <ENT>1.45</ENT>
                            <ENT>1.47</ENT>
                            <ENT>0.24</ENT>
                            <ENT>010</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">10120</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Remove foreign body</ENT>
                            <ENT>1.23</ENT>
                            <ENT>1.95</ENT>
                            <ENT>2.06</ENT>
                            <ENT>0.94</ENT>
                            <ENT>0.95</ENT>
                            <ENT>0.12</ENT>
                            <ENT>010</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">10121</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Remove foreign body</ENT>
                            <ENT>2.71</ENT>
                            <ENT>3.51</ENT>
                            <ENT>3.51</ENT>
                            <ENT>1.65</ENT>
                            <ENT>1.72</ENT>
                            <ENT>0.33</ENT>
                            <ENT>010</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">10140</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Drainage of hematoma/fluid</ENT>
                            <ENT>1.55</ENT>
                            <ENT>2.26</ENT>
                            <ENT>2.01</ENT>
                            <ENT>1.29</ENT>
                            <ENT>1.29</ENT>
                            <ENT>0.19</ENT>
                            <ENT>010</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">10160</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Puncture drainage of lesion</ENT>
                            <ENT>1.22</ENT>
                            <ENT>1.85</ENT>
                            <ENT>1.72</ENT>
                            <ENT>1.07</ENT>
                            <ENT>1.08</ENT>
                            <ENT>0.14</ENT>
                            <ENT>010</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">10180</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Complex drainage, wound</ENT>
                            <ENT>2.27</ENT>
                            <ENT>3.25</ENT>
                            <ENT>3.11</ENT>
                            <ENT>1.80</ENT>
                            <ENT>1.89</ENT>
                            <ENT>0.35</ENT>
                            <ENT>010</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">11000</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Debride infected skin</ENT>
                            <ENT>0.60</ENT>
                            <ENT>0.72</ENT>
                            <ENT>0.65</ENT>
                            <ENT>0.16</ENT>
                            <ENT>0.19</ENT>
                            <ENT>0.07</ENT>
                            <ENT>000</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">11001</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Debride infected skin add-on</ENT>
                            <ENT>0.30</ENT>
                            <ENT>0.23</ENT>
                            <ENT>0.23</ENT>
                            <ENT>0.08</ENT>
                            <ENT>0.10</ENT>
                            <ENT>0.04</ENT>
                            <ENT>ZZZ</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">11004</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Debride genitalia &amp; perineum</ENT>
                            <ENT>10.80</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>3.20</ENT>
                            <ENT>3.55</ENT>
                            <ENT>0.67</ENT>
                            <ENT>000</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">11005</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Debride abdom wall</ENT>
                            <ENT>14.24</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>3.78</ENT>
                            <ENT>4.67</ENT>
                            <ENT>0.96</ENT>
                            <ENT>000</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">11006</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Debride genit/per/abdom wall</ENT>
                            <ENT>13.10</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>3.95</ENT>
                            <ENT>4.40</ENT>
                            <ENT>1.28</ENT>
                            <ENT>000</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">11008</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Remove mesh from abd wall</ENT>
                            <ENT>5.00</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>1.29</ENT>
                            <ENT>1.66</ENT>
                            <ENT>0.61</ENT>
                            <ENT>ZZZ</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">11010</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Debride skin, fx</ENT>
                            <ENT>4.19</ENT>
                            <ENT>6.80</ENT>
                            <ENT>6.83</ENT>
                            <ENT>2.34</ENT>
                            <ENT>2.48</ENT>
                            <ENT>0.66</ENT>
                            <ENT>010</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">11011</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Debride skin/muscle, fx</ENT>
                            <ENT>4.94</ENT>
                            <ENT>7.03</ENT>
                            <ENT>7.59</ENT>
                            <ENT>2.01</ENT>
                            <ENT>2.18</ENT>
                            <ENT>0.74</ENT>
                            <ENT>000</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">11012</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Debride skin/muscle/bone, fx</ENT>
                            <ENT>6.87</ENT>
                            <ENT>9.00</ENT>
                            <ENT>10.55</ENT>
                            <ENT>3.10</ENT>
                            <ENT>3.47</ENT>
                            <ENT>1.16</ENT>
                            <ENT>000</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">11040</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Debride skin, partial</ENT>
                            <ENT>0.50</ENT>
                            <ENT>0.68</ENT>
                            <ENT>0.60</ENT>
                            <ENT>0.16</ENT>
                            <ENT>0.18</ENT>
                            <ENT>0.06</ENT>
                            <ENT>000</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">11041</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Debride skin, full</ENT>
                            <ENT>0.60</ENT>
                            <ENT>0.72</ENT>
                            <ENT>0.69</ENT>
                            <ENT>0.19</ENT>
                            <ENT>0.26</ENT>
                            <ENT>0.10</ENT>
                            <ENT>000</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">11042</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Debride skin/tissue</ENT>
                            <ENT>0.80</ENT>
                            <ENT>0.95</ENT>
                            <ENT>0.96</ENT>
                            <ENT>0.24</ENT>
                            <ENT>0.34</ENT>
                            <ENT>0.13</ENT>
                            <ENT>000</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">11043</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Debride tissue/muscle</ENT>
                            <ENT>3.04</ENT>
                            <ENT>3.50</ENT>
                            <ENT>3.44</ENT>
                            <ENT>2.60</ENT>
                            <ENT>2.59</ENT>
                            <ENT>0.32</ENT>
                            <ENT>010</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">11044</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Debride tissue/muscle/bone</ENT>
                            <ENT>4.11</ENT>
                            <ENT>4.84</ENT>
                            <ENT>4.64</ENT>
                            <ENT>3.58</ENT>
                            <ENT>3.66</ENT>
                            <ENT>0.43</ENT>
                            <ENT>010</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">11055</ENT>
                            <ENT/>
                            <ENT>R</ENT>
                            <ENT>Trim skin lesion</ENT>
                            <ENT>0.43</ENT>
                            <ENT>0.81</ENT>
                            <ENT>0.68</ENT>
                            <ENT>0.11</ENT>
                            <ENT>0.14</ENT>
                            <ENT>0.05</ENT>
                            <ENT>000</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">11056</ENT>
                            <ENT/>
                            <ENT>R</ENT>
                            <ENT>Trim skin lesions, 2 to 4</ENT>
                            <ENT>0.61</ENT>
                            <ENT>0.88</ENT>
                            <ENT>0.76</ENT>
                            <ENT>0.16</ENT>
                            <ENT>0.19</ENT>
                            <ENT>0.07</ENT>
                            <ENT>000</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">11057</ENT>
                            <ENT/>
                            <ENT>R</ENT>
                            <ENT>Trim skin lesions, over 4</ENT>
                            <ENT>0.79</ENT>
                            <ENT>0.99</ENT>
                            <ENT>0.86</ENT>
                            <ENT>0.20</ENT>
                            <ENT>0.25</ENT>
                            <ENT>0.10</ENT>
                            <ENT>000</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">11100</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Biopsy, skin lesion</ENT>
                            <ENT>0.81</ENT>
                            <ENT>1.88</ENT>
                            <ENT>1.56</ENT>
                            <ENT>0.38</ENT>
                            <ENT>0.38</ENT>
                            <ENT>0.03</ENT>
                            <ENT>000</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">11101</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Biopsy, skin add-on</ENT>
                            <ENT>0.41</ENT>
                            <ENT>0.41</ENT>
                            <ENT>0.37</ENT>
                            <ENT>0.20</ENT>
                            <ENT>0.19</ENT>
                            <ENT>0.02</ENT>
                            <ENT>ZZZ</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">11200</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Removal of skin tags</ENT>
                            <ENT>0.79</ENT>
                            <ENT>1.23</ENT>
                            <ENT>1.13</ENT>
                            <ENT>0.90</ENT>
                            <ENT>0.83</ENT>
                            <ENT>0.04</ENT>
                            <ENT>010</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">11201</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Remove skin tags add-on</ENT>
                            <ENT>0.29</ENT>
                            <ENT>0.16</ENT>
                            <ENT>0.16</ENT>
                            <ENT>0.11</ENT>
                            <ENT>0.12</ENT>
                            <ENT>0.02</ENT>
                            <ENT>ZZZ</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">11300</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Shave skin lesion</ENT>
                            <ENT>0.51</ENT>
                            <ENT>1.19</ENT>
                            <ENT>1.09</ENT>
                            <ENT>0.21</ENT>
                            <ENT>0.21</ENT>
                            <ENT>0.03</ENT>
                            <ENT>000</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">11301</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Shave skin lesion</ENT>
                            <ENT>0.85</ENT>
                            <ENT>1.51</ENT>
                            <ENT>1.31</ENT>
                            <ENT>0.38</ENT>
                            <ENT>0.38</ENT>
                            <ENT>0.04</ENT>
                            <ENT>000</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">11302</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Shave skin lesion</ENT>
                            <ENT>1.05</ENT>
                            <ENT>1.76</ENT>
                            <ENT>1.53</ENT>
                            <ENT>0.48</ENT>
                            <ENT>0.47</ENT>
                            <ENT>0.05</ENT>
                            <ENT>000</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">11303</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Shave skin lesion</ENT>
                            <ENT>1.24</ENT>
                            <ENT>2.03</ENT>
                            <ENT>1.80</ENT>
                            <ENT>0.55</ENT>
                            <ENT>0.53</ENT>
                            <ENT>0.07</ENT>
                            <ENT>000</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">11305</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Shave skin lesion</ENT>
                            <ENT>0.67</ENT>
                            <ENT>1.06</ENT>
                            <ENT>0.96</ENT>
                            <ENT>0.20</ENT>
                            <ENT>0.24</ENT>
                            <ENT>0.07</ENT>
                            <ENT>000</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">11306</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Shave skin lesion</ENT>
                            <ENT>0.99</ENT>
                            <ENT>1.42</ENT>
                            <ENT>1.26</ENT>
                            <ENT>0.38</ENT>
                            <ENT>0.40</ENT>
                            <ENT>0.07</ENT>
                            <ENT>000</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">11307</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Shave skin lesion</ENT>
                            <ENT>1.14</ENT>
                            <ENT>1.70</ENT>
                            <ENT>1.49</ENT>
                            <ENT>0.47</ENT>
                            <ENT>0.48</ENT>
                            <ENT>0.07</ENT>
                            <ENT>000</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">11308</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Shave skin lesion</ENT>
                            <ENT>1.41</ENT>
                            <ENT>1.70</ENT>
                            <ENT>1.57</ENT>
                            <ENT>0.49</ENT>
                            <ENT>0.54</ENT>
                            <ENT>0.13</ENT>
                            <ENT>000</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">11310</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Shave skin lesion</ENT>
                            <ENT>0.73</ENT>
                            <ENT>1.38</ENT>
                            <ENT>1.24</ENT>
                            <ENT>0.31</ENT>
                            <ENT>0.32</ENT>
                            <ENT>0.04</ENT>
                            <ENT>000</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">11311</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Shave skin lesion</ENT>
                            <ENT>1.05</ENT>
                            <ENT>1.64</ENT>
                            <ENT>1.43</ENT>
                            <ENT>0.48</ENT>
                            <ENT>0.48</ENT>
                            <ENT>0.05</ENT>
                            <ENT>000</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">11312</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Shave skin lesion</ENT>
                            <ENT>1.20</ENT>
                            <ENT>1.92</ENT>
                            <ENT>1.67</ENT>
                            <ENT>0.56</ENT>
                            <ENT>0.55</ENT>
                            <ENT>0.06</ENT>
                            <ENT>000</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">11313</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Shave skin lesion</ENT>
                            <ENT>1.62</ENT>
                            <ENT>2.18</ENT>
                            <ENT>1.99</ENT>
                            <ENT>0.73</ENT>
                            <ENT>0.72</ENT>
                            <ENT>0.10</ENT>
                            <ENT>000</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">11400</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Exc tr-ext b9+marg 0.5 &lt; cm</ENT>
                            <ENT>0.87</ENT>
                            <ENT>1.88</ENT>
                            <ENT>1.94</ENT>
                            <ENT>0.93</ENT>
                            <ENT>0.91</ENT>
                            <ENT>0.06</ENT>
                            <ENT>010</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">11401</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Exc tr-ext b9+marg 0.6-1 cm</ENT>
                            <ENT>1.25</ENT>
                            <ENT>2.19</ENT>
                            <ENT>2.12</ENT>
                            <ENT>1.15</ENT>
                            <ENT>1.08</ENT>
                            <ENT>0.10</ENT>
                            <ENT>010</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">11402</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Exc tr-ext b9+marg 1.1-2 cm</ENT>
                            <ENT>1.42</ENT>
                            <ENT>2.40</ENT>
                            <ENT>2.31</ENT>
                            <ENT>1.21</ENT>
                            <ENT>1.14</ENT>
                            <ENT>0.13</ENT>
                            <ENT>010</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">11403</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Exc tr-ext b9+marg 2.1-3 cm</ENT>
                            <ENT>1.81</ENT>
                            <ENT>2.55</ENT>
                            <ENT>2.47</ENT>
                            <ENT>1.56</ENT>
                            <ENT>1.44</ENT>
                            <ENT>0.17</ENT>
                            <ENT>010</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">11404</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Exc tr-ext b9+marg 3.1-4 cm</ENT>
                            <ENT>2.08</ENT>
                            <ENT>2.85</ENT>
                            <ENT>2.78</ENT>
                            <ENT>1.63</ENT>
                            <ENT>1.51</ENT>
                            <ENT>0.21</ENT>
                            <ENT>010</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">11406</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Exc tr-ext b9+marg &gt; 4.0 cm</ENT>
                            <ENT>3.47</ENT>
                            <ENT>3.53</ENT>
                            <ENT>3.30</ENT>
                            <ENT>2.10</ENT>
                            <ENT>1.87</ENT>
                            <ENT>0.32</ENT>
                            <ENT>010</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">11420</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Exc h-f-nk-sp b9+marg 0.5 &lt;</ENT>
                            <ENT>1.00</ENT>
                            <ENT>1.83</ENT>
                            <ENT>1.79</ENT>
                            <ENT>0.93</ENT>
                            <ENT>0.93</ENT>
                            <ENT>0.09</ENT>
                            <ENT>010</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">11421</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Exc h-f-nk-sp b9+marg 0.6-1</ENT>
                            <ENT>1.44</ENT>
                            <ENT>2.21</ENT>
                            <ENT>2.14</ENT>
                            <ENT>1.16</ENT>
                            <ENT>1.13</ENT>
                            <ENT>0.13</ENT>
                            <ENT>010</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">11422</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Exc h-f-nk-sp b9+marg 1.1-2</ENT>
                            <ENT>1.65</ENT>
                            <ENT>2.43</ENT>
                            <ENT>2.34</ENT>
                            <ENT>1.53</ENT>
                            <ENT>1.43</ENT>
                            <ENT>0.16</ENT>
                            <ENT>010</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">11423</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Exc h-f-nk-sp b9+marg 2.1-3</ENT>
                            <ENT>2.03</ENT>
                            <ENT>2.67</ENT>
                            <ENT>2.62</ENT>
                            <ENT>1.66</ENT>
                            <ENT>1.55</ENT>
                            <ENT>0.20</ENT>
                            <ENT>010</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">11424</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Exc h-f-nk-sp b9+marg 3.1-4</ENT>
                            <ENT>2.45</ENT>
                            <ENT>2.97</ENT>
                            <ENT>2.89</ENT>
                            <ENT>1.77</ENT>
                            <ENT>1.68</ENT>
                            <ENT>0.25</ENT>
                            <ENT>010</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">11426</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Exc h-f-nk-sp b9+marg &gt; 4 cm</ENT>
                            <ENT>4.04</ENT>
                            <ENT>3.59</ENT>
                            <ENT>3.53</ENT>
                            <ENT>2.31</ENT>
                            <ENT>2.20</ENT>
                            <ENT>0.44</ENT>
                            <ENT>010</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">11440</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Exc face-mm b9+marg 0.5 &lt; cm</ENT>
                            <ENT>1.02</ENT>
                            <ENT>2.00</ENT>
                            <ENT>2.10</ENT>
                            <ENT>1.31</ENT>
                            <ENT>1.31</ENT>
                            <ENT>0.08</ENT>
                            <ENT>010</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">11441</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Exc face-mm b9+marg 0.6-1 cm</ENT>
                            <ENT>1.50</ENT>
                            <ENT>2.38</ENT>
                            <ENT>2.35</ENT>
                            <ENT>1.55</ENT>
                            <ENT>1.52</ENT>
                            <ENT>0.13</ENT>
                            <ENT>010</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">11442</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Exc face-mm b9+marg 1.1-2 cm</ENT>
                            <ENT>1.74</ENT>
                            <ENT>2.64</ENT>
                            <ENT>2.59</ENT>
                            <ENT>1.66</ENT>
                            <ENT>1.61</ENT>
                            <ENT>0.16</ENT>
                            <ENT>010</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">11443</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Exc face-mm b9+marg 2.1-3 cm</ENT>
                            <ENT>2.31</ENT>
                            <ENT>2.88</ENT>
                            <ENT>2.90</ENT>
                            <ENT>1.84</ENT>
                            <ENT>1.83</ENT>
                            <ENT>0.22</ENT>
                            <ENT>010</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">11444</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Exc face-mm b9+marg 3.1-4 cm</ENT>
                            <ENT>3.16</ENT>
                            <ENT>3.31</ENT>
                            <ENT>3.39</ENT>
                            <ENT>2.10</ENT>
                            <ENT>2.14</ENT>
                            <ENT>0.30</ENT>
                            <ENT>010</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">11446</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Exc face-mm b9+marg &gt; 4 cm</ENT>
                            <ENT>4.75</ENT>
                            <ENT>4.09</ENT>
                            <ENT>4.06</ENT>
                            <ENT>2.68</ENT>
                            <ENT>2.73</ENT>
                            <ENT>0.43</ENT>
                            <ENT>010</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">11450</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Removal, sweat gland lesion</ENT>
                            <ENT>3.14</ENT>
                            <ENT>5.12</ENT>
                            <ENT>5.07</ENT>
                            <ENT>2.41</ENT>
                            <ENT>2.22</ENT>
                            <ENT>0.34</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">11451</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Removal, sweat gland lesion</ENT>
                            <ENT>4.35</ENT>
                            <ENT>6.37</ENT>
                            <ENT>6.49</ENT>
                            <ENT>2.91</ENT>
                            <ENT>2.73</ENT>
                            <ENT>0.53</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">11462</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Removal, sweat gland lesion</ENT>
                            <ENT>2.92</ENT>
                            <ENT>5.32</ENT>
                            <ENT>5.21</ENT>
                            <ENT>2.47</ENT>
                            <ENT>2.24</ENT>
                            <ENT>0.32</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">11463</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Removal, sweat gland lesion</ENT>
                            <ENT>4.35</ENT>
                            <ENT>6.52</ENT>
                            <ENT>6.67</ENT>
                            <ENT>2.94</ENT>
                            <ENT>2.81</ENT>
                            <ENT>0.54</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">11470</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Removal, sweat gland lesion</ENT>
                            <ENT>3.66</ENT>
                            <ENT>5.47</ENT>
                            <ENT>5.26</ENT>
                            <ENT>2.62</ENT>
                            <ENT>2.44</ENT>
                            <ENT>0.40</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">11471</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Removal, sweat gland lesion</ENT>
                            <ENT>4.81</ENT>
                            <ENT>6.50</ENT>
                            <ENT>6.60</ENT>
                            <ENT>3.01</ENT>
                            <ENT>2.88</ENT>
                            <ENT>0.58</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <PRTPAGE P="66413"/>
                            <ENT I="01">11600</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Exc tr-ext mlg+marg 0.5 &lt; cm</ENT>
                            <ENT>1.58</ENT>
                            <ENT>2.74</ENT>
                            <ENT>2.69</ENT>
                            <ENT>1.14</ENT>
                            <ENT>1.05</ENT>
                            <ENT>0.10</ENT>
                            <ENT>010</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">11601</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Exc tr-ext mlg+marg 0.6-1 cm</ENT>
                            <ENT>2.02</ENT>
                            <ENT>3.44</ENT>
                            <ENT>3.07</ENT>
                            <ENT>1.51</ENT>
                            <ENT>1.36</ENT>
                            <ENT>0.12</ENT>
                            <ENT>010</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">11602</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Exc tr-ext mlg+marg 1.1-2 cm</ENT>
                            <ENT>2.22</ENT>
                            <ENT>3.84</ENT>
                            <ENT>3.33</ENT>
                            <ENT>1.69</ENT>
                            <ENT>1.47</ENT>
                            <ENT>0.12</ENT>
                            <ENT>010</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">11603</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Exc tr-ext mlg+marg 2.1-3 cm</ENT>
                            <ENT>2.77</ENT>
                            <ENT>4.05</ENT>
                            <ENT>3.56</ENT>
                            <ENT>1.87</ENT>
                            <ENT>1.60</ENT>
                            <ENT>0.16</ENT>
                            <ENT>010</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">11604</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Exc tr-ext mlg+marg 3.1-4 cm</ENT>
                            <ENT>3.12</ENT>
                            <ENT>4.33</ENT>
                            <ENT>3.85</ENT>
                            <ENT>1.93</ENT>
                            <ENT>1.66</ENT>
                            <ENT>0.20</ENT>
                            <ENT>010</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">11606</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Exc tr-ext mlg+marg &gt; 4 cm</ENT>
                            <ENT>4.97</ENT>
                            <ENT>5.49</ENT>
                            <ENT>4.77</ENT>
                            <ENT>2.46</ENT>
                            <ENT>2.10</ENT>
                            <ENT>0.36</ENT>
                            <ENT>010</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">11620</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Exc h-f-nk-sp mlg+marg 0.5 &lt;</ENT>
                            <ENT>1.59</ENT>
                            <ENT>2.85</ENT>
                            <ENT>2.72</ENT>
                            <ENT>1.19</ENT>
                            <ENT>1.07</ENT>
                            <ENT>0.09</ENT>
                            <ENT>010</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">11621</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Exc h-f-nk-sp mlg+marg 0.6-1</ENT>
                            <ENT>2.03</ENT>
                            <ENT>3.50</ENT>
                            <ENT>3.10</ENT>
                            <ENT>1.54</ENT>
                            <ENT>1.39</ENT>
                            <ENT>0.12</ENT>
                            <ENT>010</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">11622</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Exc h-f-nk-sp mlg+marg 1.1-2</ENT>
                            <ENT>2.36</ENT>
                            <ENT>3.90</ENT>
                            <ENT>3.43</ENT>
                            <ENT>1.75</ENT>
                            <ENT>1.57</ENT>
                            <ENT>0.14</ENT>
                            <ENT>010</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">11623</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Exc h-f-nk-sp mlg+marg 2.1-3</ENT>
                            <ENT>3.06</ENT>
                            <ENT>4.11</ENT>
                            <ENT>3.72</ENT>
                            <ENT>1.95</ENT>
                            <ENT>1.76</ENT>
                            <ENT>0.20</ENT>
                            <ENT>010</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">11624</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Exc h-f-nk-sp mlg+marg 3.1-4</ENT>
                            <ENT>3.57</ENT>
                            <ENT>4.43</ENT>
                            <ENT>4.08</ENT>
                            <ENT>2.08</ENT>
                            <ENT>1.93</ENT>
                            <ENT>0.27</ENT>
                            <ENT>010</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">11626</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Exc h-f-nk-sp mlg+mar &gt; 4 cm</ENT>
                            <ENT>4.56</ENT>
                            <ENT>4.96</ENT>
                            <ENT>4.79</ENT>
                            <ENT>2.32</ENT>
                            <ENT>2.36</ENT>
                            <ENT>0.45</ENT>
                            <ENT>010</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">11640</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Exc face-mm malig+marg 0.5 &lt;</ENT>
                            <ENT>1.62</ENT>
                            <ENT>3.05</ENT>
                            <ENT>2.85</ENT>
                            <ENT>1.29</ENT>
                            <ENT>1.20</ENT>
                            <ENT>0.11</ENT>
                            <ENT>010</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">11641</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Exc face-mm malig+marg 0.6-1</ENT>
                            <ENT>2.12</ENT>
                            <ENT>3.63</ENT>
                            <ENT>3.33</ENT>
                            <ENT>1.61</ENT>
                            <ENT>1.57</ENT>
                            <ENT>0.16</ENT>
                            <ENT>010</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">11642</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Exc face-mm malig+marg 1.1-2</ENT>
                            <ENT>2.57</ENT>
                            <ENT>4.04</ENT>
                            <ENT>3.72</ENT>
                            <ENT>1.84</ENT>
                            <ENT>1.77</ENT>
                            <ENT>0.19</ENT>
                            <ENT>010</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">11643</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Exc face-mm malig+marg 2.1-3</ENT>
                            <ENT>3.37</ENT>
                            <ENT>4.28</ENT>
                            <ENT>4.04</ENT>
                            <ENT>2.11</ENT>
                            <ENT>2.04</ENT>
                            <ENT>0.26</ENT>
                            <ENT>010</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">11644</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Exc face-mm malig+marg 3.1-4</ENT>
                            <ENT>4.29</ENT>
                            <ENT>5.07</ENT>
                            <ENT>4.87</ENT>
                            <ENT>2.46</ENT>
                            <ENT>2.46</ENT>
                            <ENT>0.37</ENT>
                            <ENT>010</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">11646</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Exc face-mm mlg+marg &gt; 4 cm</ENT>
                            <ENT>6.21</ENT>
                            <ENT>5.90</ENT>
                            <ENT>5.83</ENT>
                            <ENT>3.13</ENT>
                            <ENT>3.30</ENT>
                            <ENT>0.61</ENT>
                            <ENT>010</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">11719</ENT>
                            <ENT/>
                            <ENT>R</ENT>
                            <ENT>Trim nail(s)</ENT>
                            <ENT>0.17</ENT>
                            <ENT>0.38</ENT>
                            <ENT>0.31</ENT>
                            <ENT>0.04</ENT>
                            <ENT>0.06</ENT>
                            <ENT>0.02</ENT>
                            <ENT>000</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">11720</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Debride nail, 1-5</ENT>
                            <ENT>0.32</ENT>
                            <ENT>0.47</ENT>
                            <ENT>0.40</ENT>
                            <ENT>0.08</ENT>
                            <ENT>0.10</ENT>
                            <ENT>0.04</ENT>
                            <ENT>000</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">11721</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Debride nail, 6 or more</ENT>
                            <ENT>0.54</ENT>
                            <ENT>0.55</ENT>
                            <ENT>0.49</ENT>
                            <ENT>0.14</ENT>
                            <ENT>0.17</ENT>
                            <ENT>0.07</ENT>
                            <ENT>000</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">11730</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Removal of nail plate</ENT>
                            <ENT>1.10</ENT>
                            <ENT>1.33</ENT>
                            <ENT>1.18</ENT>
                            <ENT>0.28</ENT>
                            <ENT>0.36</ENT>
                            <ENT>0.14</ENT>
                            <ENT>000</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">11732</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Remove nail plate, add-on</ENT>
                            <ENT>0.57</ENT>
                            <ENT>0.54</ENT>
                            <ENT>0.49</ENT>
                            <ENT>0.15</ENT>
                            <ENT>0.18</ENT>
                            <ENT>0.07</ENT>
                            <ENT>ZZZ</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">11740</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Drain blood from under nail</ENT>
                            <ENT>0.37</ENT>
                            <ENT>0.80</ENT>
                            <ENT>0.67</ENT>
                            <ENT>0.43</ENT>
                            <ENT>0.39</ENT>
                            <ENT>0.04</ENT>
                            <ENT>000</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">11750</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Removal of nail bed</ENT>
                            <ENT>2.40</ENT>
                            <ENT>2.95</ENT>
                            <ENT>2.56</ENT>
                            <ENT>1.88</ENT>
                            <ENT>1.82</ENT>
                            <ENT>0.22</ENT>
                            <ENT>010</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">11752</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Remove nail bed/finger tip</ENT>
                            <ENT>3.48</ENT>
                            <ENT>4.06</ENT>
                            <ENT>3.52</ENT>
                            <ENT>2.77</ENT>
                            <ENT>2.88</ENT>
                            <ENT>0.35</ENT>
                            <ENT>010</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">11755</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Biopsy, nail unit</ENT>
                            <ENT>1.31</ENT>
                            <ENT>2.02</ENT>
                            <ENT>1.79</ENT>
                            <ENT>0.76</ENT>
                            <ENT>0.76</ENT>
                            <ENT>0.14</ENT>
                            <ENT>000</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">11760</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Repair of nail bed</ENT>
                            <ENT>1.60</ENT>
                            <ENT>3.40</ENT>
                            <ENT>3.01</ENT>
                            <ENT>1.43</ENT>
                            <ENT>1.61</ENT>
                            <ENT>0.21</ENT>
                            <ENT>010</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">11762</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Reconstruction of nail bed</ENT>
                            <ENT>2.91</ENT>
                            <ENT>3.70</ENT>
                            <ENT>3.29</ENT>
                            <ENT>1.68</ENT>
                            <ENT>2.01</ENT>
                            <ENT>0.36</ENT>
                            <ENT>010</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">11765</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Excision of nail fold, toe</ENT>
                            <ENT>0.71</ENT>
                            <ENT>2.67</ENT>
                            <ENT>2.23</ENT>
                            <ENT>1.01</ENT>
                            <ENT>0.88</ENT>
                            <ENT>0.08</ENT>
                            <ENT>010</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">11770</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Removal of pilonidal lesion</ENT>
                            <ENT>2.63</ENT>
                            <ENT>3.45</ENT>
                            <ENT>3.47</ENT>
                            <ENT>1.52</ENT>
                            <ENT>1.51</ENT>
                            <ENT>0.33</ENT>
                            <ENT>010</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">11771</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Removal of pilonidal lesion</ENT>
                            <ENT>5.98</ENT>
                            <ENT>6.63</ENT>
                            <ENT>6.14</ENT>
                            <ENT>3.69</ENT>
                            <ENT>3.50</ENT>
                            <ENT>0.74</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">11772</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Removal of pilonidal lesion</ENT>
                            <ENT>7.23</ENT>
                            <ENT>8.03</ENT>
                            <ENT>7.76</ENT>
                            <ENT>5.55</ENT>
                            <ENT>5.31</ENT>
                            <ENT>0.89</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">11900</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Injection into skin lesions</ENT>
                            <ENT>0.52</ENT>
                            <ENT>0.92</ENT>
                            <ENT>0.78</ENT>
                            <ENT>0.25</ENT>
                            <ENT>0.23</ENT>
                            <ENT>0.02</ENT>
                            <ENT>000</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">11901</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Added skin lesions injection</ENT>
                            <ENT>0.80</ENT>
                            <ENT>1.01</ENT>
                            <ENT>0.83</ENT>
                            <ENT>0.39</ENT>
                            <ENT>0.37</ENT>
                            <ENT>0.03</ENT>
                            <ENT>000</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">11920</ENT>
                            <ENT/>
                            <ENT>R</ENT>
                            <ENT>Correct skin color defects</ENT>
                            <ENT>1.61</ENT>
                            <ENT>2.34</ENT>
                            <ENT>3.02</ENT>
                            <ENT>1.09</ENT>
                            <ENT>1.09</ENT>
                            <ENT>0.24</ENT>
                            <ENT>000</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">11921</ENT>
                            <ENT/>
                            <ENT>R</ENT>
                            <ENT>Correct skin color defects</ENT>
                            <ENT>1.93</ENT>
                            <ENT>2.66</ENT>
                            <ENT>3.31</ENT>
                            <ENT>1.25</ENT>
                            <ENT>1.26</ENT>
                            <ENT>0.29</ENT>
                            <ENT>000</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">11922</ENT>
                            <ENT/>
                            <ENT>R</ENT>
                            <ENT>Correct skin color defects</ENT>
                            <ENT>0.49</ENT>
                            <ENT>0.92</ENT>
                            <ENT>1.03</ENT>
                            <ENT>0.22</ENT>
                            <ENT>0.24</ENT>
                            <ENT>0.07</ENT>
                            <ENT>ZZZ</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">11950</ENT>
                            <ENT/>
                            <ENT>R</ENT>
                            <ENT>Therapy for contour defects</ENT>
                            <ENT>0.84</ENT>
                            <ENT>0.88</ENT>
                            <ENT>1.01</ENT>
                            <ENT>0.36</ENT>
                            <ENT>0.37</ENT>
                            <ENT>0.06</ENT>
                            <ENT>000</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">11951</ENT>
                            <ENT/>
                            <ENT>R</ENT>
                            <ENT>Therapy for contour defects</ENT>
                            <ENT>1.19</ENT>
                            <ENT>0.90</ENT>
                            <ENT>1.19</ENT>
                            <ENT>0.36</ENT>
                            <ENT>0.43</ENT>
                            <ENT>0.11</ENT>
                            <ENT>000</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">11952</ENT>
                            <ENT/>
                            <ENT>R</ENT>
                            <ENT>Therapy for contour defects</ENT>
                            <ENT>1.69</ENT>
                            <ENT>1.63</ENT>
                            <ENT>1.74</ENT>
                            <ENT>0.77</ENT>
                            <ENT>0.72</ENT>
                            <ENT>0.16</ENT>
                            <ENT>000</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">11954</ENT>
                            <ENT/>
                            <ENT>R</ENT>
                            <ENT>Therapy for contour defects</ENT>
                            <ENT>1.85</ENT>
                            <ENT>1.79</ENT>
                            <ENT>2.11</ENT>
                            <ENT>0.77</ENT>
                            <ENT>0.83</ENT>
                            <ENT>0.25</ENT>
                            <ENT>000</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">11960</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Insert tissue expander(s)</ENT>
                            <ENT>11.01</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>10.56</ENT>
                            <ENT>10.47</ENT>
                            <ENT>1.31</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">11970</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Replace tissue expander</ENT>
                            <ENT>7.86</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>6.16</ENT>
                            <ENT>6.15</ENT>
                            <ENT>1.05</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">11971</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Remove tissue expander(s)</ENT>
                            <ENT>3.21</ENT>
                            <ENT>7.39</ENT>
                            <ENT>8.25</ENT>
                            <ENT>4.01</ENT>
                            <ENT>3.90</ENT>
                            <ENT>0.32</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">11975</ENT>
                            <ENT/>
                            <ENT>N</ENT>
                            <ENT>Insert contraceptive cap</ENT>
                            <ENT>1.48</ENT>
                            <ENT>1.53</ENT>
                            <ENT>1.47</ENT>
                            <ENT>0.34</ENT>
                            <ENT>0.45</ENT>
                            <ENT>0.17</ENT>
                            <ENT>XXX</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">11976</ENT>
                            <ENT/>
                            <ENT>R</ENT>
                            <ENT>Removal of contraceptive cap</ENT>
                            <ENT>1.78</ENT>
                            <ENT>1.72</ENT>
                            <ENT>1.72</ENT>
                            <ENT>0.47</ENT>
                            <ENT>0.58</ENT>
                            <ENT>0.21</ENT>
                            <ENT>000</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">11977</ENT>
                            <ENT/>
                            <ENT>N</ENT>
                            <ENT>Removal/reinsert contra cap</ENT>
                            <ENT>3.30</ENT>
                            <ENT>1.98</ENT>
                            <ENT>2.13</ENT>
                            <ENT>0.76</ENT>
                            <ENT>1.01</ENT>
                            <ENT>0.37</ENT>
                            <ENT>XXX</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">11980</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Implant hormone pellet(s)</ENT>
                            <ENT>1.48</ENT>
                            <ENT>1.07</ENT>
                            <ENT>1.07</ENT>
                            <ENT>0.49</ENT>
                            <ENT>0.51</ENT>
                            <ENT>0.13</ENT>
                            <ENT>000</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">11981</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Insert drug implant device</ENT>
                            <ENT>1.48</ENT>
                            <ENT>1.89</ENT>
                            <ENT>1.79</ENT>
                            <ENT>0.58</ENT>
                            <ENT>0.63</ENT>
                            <ENT>0.12</ENT>
                            <ENT>XXX</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">11982</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Remove drug implant device</ENT>
                            <ENT>1.78</ENT>
                            <ENT>2.02</ENT>
                            <ENT>1.98</ENT>
                            <ENT>0.70</ENT>
                            <ENT>0.76</ENT>
                            <ENT>0.17</ENT>
                            <ENT>XXX</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">11983</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Remove/insert drug implant</ENT>
                            <ENT>3.30</ENT>
                            <ENT>2.63</ENT>
                            <ENT>2.46</ENT>
                            <ENT>1.32</ENT>
                            <ENT>1.39</ENT>
                            <ENT>0.23</ENT>
                            <ENT>XXX</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">12001</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Repair superficial wound(s)</ENT>
                            <ENT>1.72</ENT>
                            <ENT>1.73</ENT>
                            <ENT>1.86</ENT>
                            <ENT>0.73</ENT>
                            <ENT>0.75</ENT>
                            <ENT>0.15</ENT>
                            <ENT>010</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">12002</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Repair superficial wound(s)</ENT>
                            <ENT>1.88</ENT>
                            <ENT>1.80</ENT>
                            <ENT>1.92</ENT>
                            <ENT>0.84</ENT>
                            <ENT>0.87</ENT>
                            <ENT>0.17</ENT>
                            <ENT>010</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">12004</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Repair superficial wound(s)</ENT>
                            <ENT>2.26</ENT>
                            <ENT>2.08</ENT>
                            <ENT>2.20</ENT>
                            <ENT>0.92</ENT>
                            <ENT>0.96</ENT>
                            <ENT>0.21</ENT>
                            <ENT>010</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">12005</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Repair superficial wound(s)</ENT>
                            <ENT>2.88</ENT>
                            <ENT>2.52</ENT>
                            <ENT>2.67</ENT>
                            <ENT>1.06</ENT>
                            <ENT>1.13</ENT>
                            <ENT>0.27</ENT>
                            <ENT>010</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">12006</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Repair superficial wound(s)</ENT>
                            <ENT>3.68</ENT>
                            <ENT>3.06</ENT>
                            <ENT>3.22</ENT>
                            <ENT>1.30</ENT>
                            <ENT>1.40</ENT>
                            <ENT>0.35</ENT>
                            <ENT>010</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">12007</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Repair superficial wound(s)</ENT>
                            <ENT>4.13</ENT>
                            <ENT>3.35</ENT>
                            <ENT>3.58</ENT>
                            <ENT>1.46</ENT>
                            <ENT>1.64</ENT>
                            <ENT>0.45</ENT>
                            <ENT>010</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">12011</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Repair superficial wound(s)</ENT>
                            <ENT>1.78</ENT>
                            <ENT>1.91</ENT>
                            <ENT>2.02</ENT>
                            <ENT>0.76</ENT>
                            <ENT>0.77</ENT>
                            <ENT>0.16</ENT>
                            <ENT>010</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">12013</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Repair superficial wound(s)</ENT>
                            <ENT>2.01</ENT>
                            <ENT>2.06</ENT>
                            <ENT>2.17</ENT>
                            <ENT>0.89</ENT>
                            <ENT>0.91</ENT>
                            <ENT>0.18</ENT>
                            <ENT>010</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">12014</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Repair superficial wound(s)</ENT>
                            <ENT>2.48</ENT>
                            <ENT>2.29</ENT>
                            <ENT>2.43</ENT>
                            <ENT>0.98</ENT>
                            <ENT>1.02</ENT>
                            <ENT>0.23</ENT>
                            <ENT>010</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">12015</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Repair superficial wound(s)</ENT>
                            <ENT>3.21</ENT>
                            <ENT>2.79</ENT>
                            <ENT>2.96</ENT>
                            <ENT>1.12</ENT>
                            <ENT>1.18</ENT>
                            <ENT>0.29</ENT>
                            <ENT>010</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">12016</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Repair superficial wound(s)</ENT>
                            <ENT>3.94</ENT>
                            <ENT>3.17</ENT>
                            <ENT>3.36</ENT>
                            <ENT>1.28</ENT>
                            <ENT>1.40</ENT>
                            <ENT>0.37</ENT>
                            <ENT>010</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">12017</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Repair superficial wound(s)</ENT>
                            <ENT>4.72</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>1.52</ENT>
                            <ENT>1.71</ENT>
                            <ENT>0.47</ENT>
                            <ENT>010</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">12018</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Repair superficial wound(s)</ENT>
                            <ENT>5.54</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>1.92</ENT>
                            <ENT>2.09</ENT>
                            <ENT>0.64</ENT>
                            <ENT>010</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">12020</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Closure of split wound</ENT>
                            <ENT>2.64</ENT>
                            <ENT>3.69</ENT>
                            <ENT>3.75</ENT>
                            <ENT>1.75</ENT>
                            <ENT>1.84</ENT>
                            <ENT>0.30</ENT>
                            <ENT>010</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">12021</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Closure of split wound</ENT>
                            <ENT>1.86</ENT>
                            <ENT>1.85</ENT>
                            <ENT>1.83</ENT>
                            <ENT>1.33</ENT>
                            <ENT>1.37</ENT>
                            <ENT>0.24</ENT>
                            <ENT>010</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">12031</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Layer closure of wound(s)</ENT>
                            <ENT>2.17</ENT>
                            <ENT>3.89</ENT>
                            <ENT>3.09</ENT>
                            <ENT>1.77</ENT>
                            <ENT>1.36</ENT>
                            <ENT>0.17</ENT>
                            <ENT>010</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">12032</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Layer closure of wound(s)</ENT>
                            <ENT>2.49</ENT>
                            <ENT>5.21</ENT>
                            <ENT>4.52</ENT>
                            <ENT>2.28</ENT>
                            <ENT>2.04</ENT>
                            <ENT>0.16</ENT>
                            <ENT>010</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">12034</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Layer closure of wound(s)</ENT>
                            <ENT>2.94</ENT>
                            <ENT>4.61</ENT>
                            <ENT>3.90</ENT>
                            <ENT>1.99</ENT>
                            <ENT>1.72</ENT>
                            <ENT>0.25</ENT>
                            <ENT>010</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">12035</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Layer closure of wound(s)</ENT>
                            <ENT>3.44</ENT>
                            <ENT>5.29</ENT>
                            <ENT>5.24</ENT>
                            <ENT>2.11</ENT>
                            <ENT>2.13</ENT>
                            <ENT>0.39</ENT>
                            <ENT>010</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">12036</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Layer closure of wound(s)</ENT>
                            <ENT>4.06</ENT>
                            <ENT>5.40</ENT>
                            <ENT>5.48</ENT>
                            <ENT>2.23</ENT>
                            <ENT>2.39</ENT>
                            <ENT>0.55</ENT>
                            <ENT>010</ENT>
                        </ROW>
                        <ROW>
                            <PRTPAGE P="66414"/>
                            <ENT I="01">12037</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Layer closure of wound(s)</ENT>
                            <ENT>4.68</ENT>
                            <ENT>5.98</ENT>
                            <ENT>6.04</ENT>
                            <ENT>2.63</ENT>
                            <ENT>2.80</ENT>
                            <ENT>0.66</ENT>
                            <ENT>010</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">12041</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Layer closure of wound(s)</ENT>
                            <ENT>2.39</ENT>
                            <ENT>3.87</ENT>
                            <ENT>3.20</ENT>
                            <ENT>1.77</ENT>
                            <ENT>1.45</ENT>
                            <ENT>0.19</ENT>
                            <ENT>010</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">12042</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Layer closure of wound(s)</ENT>
                            <ENT>2.76</ENT>
                            <ENT>4.49</ENT>
                            <ENT>3.88</ENT>
                            <ENT>2.12</ENT>
                            <ENT>1.79</ENT>
                            <ENT>0.17</ENT>
                            <ENT>010</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">12044</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Layer closure of wound(s)</ENT>
                            <ENT>3.16</ENT>
                            <ENT>5.40</ENT>
                            <ENT>4.31</ENT>
                            <ENT>1.95</ENT>
                            <ENT>1.77</ENT>
                            <ENT>0.27</ENT>
                            <ENT>010</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">12045</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Layer closure of wound(s)</ENT>
                            <ENT>3.65</ENT>
                            <ENT>5.03</ENT>
                            <ENT>5.14</ENT>
                            <ENT>2.06</ENT>
                            <ENT>2.17</ENT>
                            <ENT>0.41</ENT>
                            <ENT>010</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">12046</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Layer closure of wound(s)</ENT>
                            <ENT>4.26</ENT>
                            <ENT>5.65</ENT>
                            <ENT>6.08</ENT>
                            <ENT>2.29</ENT>
                            <ENT>2.52</ENT>
                            <ENT>0.54</ENT>
                            <ENT>010</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">12047</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Layer closure of wound(s)</ENT>
                            <ENT>4.66</ENT>
                            <ENT>6.49</ENT>
                            <ENT>6.41</ENT>
                            <ENT>2.66</ENT>
                            <ENT>2.87</ENT>
                            <ENT>0.58</ENT>
                            <ENT>010</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">12051</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Layer closure of wound(s)</ENT>
                            <ENT>2.49</ENT>
                            <ENT>4.11</ENT>
                            <ENT>3.69</ENT>
                            <ENT>1.92</ENT>
                            <ENT>1.68</ENT>
                            <ENT>0.20</ENT>
                            <ENT>010</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">12052</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Layer closure of wound(s)</ENT>
                            <ENT>2.81</ENT>
                            <ENT>4.86</ENT>
                            <ENT>4.04</ENT>
                            <ENT>2.56</ENT>
                            <ENT>1.99</ENT>
                            <ENT>0.17</ENT>
                            <ENT>010</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">12053</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Layer closure of wound(s)</ENT>
                            <ENT>3.14</ENT>
                            <ENT>5.38</ENT>
                            <ENT>4.31</ENT>
                            <ENT>2.12</ENT>
                            <ENT>1.82</ENT>
                            <ENT>0.23</ENT>
                            <ENT>010</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">12054</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Layer closure of wound(s)</ENT>
                            <ENT>3.47</ENT>
                            <ENT>5.42</ENT>
                            <ENT>4.49</ENT>
                            <ENT>2.05</ENT>
                            <ENT>1.84</ENT>
                            <ENT>0.30</ENT>
                            <ENT>010</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">12055</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Layer closure of wound(s)</ENT>
                            <ENT>4.44</ENT>
                            <ENT>6.01</ENT>
                            <ENT>5.24</ENT>
                            <ENT>2.09</ENT>
                            <ENT>2.11</ENT>
                            <ENT>0.45</ENT>
                            <ENT>010</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">12056</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Layer closure of wound(s)</ENT>
                            <ENT>5.25</ENT>
                            <ENT>6.56</ENT>
                            <ENT>6.65</ENT>
                            <ENT>2.58</ENT>
                            <ENT>2.81</ENT>
                            <ENT>0.59</ENT>
                            <ENT>010</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">12057</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Layer closure of wound(s)</ENT>
                            <ENT>5.97</ENT>
                            <ENT>7.75</ENT>
                            <ENT>6.94</ENT>
                            <ENT>2.93</ENT>
                            <ENT>3.34</ENT>
                            <ENT>0.56</ENT>
                            <ENT>010</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">13100</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Repair of wound or lesion</ENT>
                            <ENT>3.14</ENT>
                            <ENT>4.42</ENT>
                            <ENT>4.23</ENT>
                            <ENT>2.46</ENT>
                            <ENT>2.38</ENT>
                            <ENT>0.26</ENT>
                            <ENT>010</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">13101</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Repair of wound or lesion</ENT>
                            <ENT>3.93</ENT>
                            <ENT>5.94</ENT>
                            <ENT>5.30</ENT>
                            <ENT>2.97</ENT>
                            <ENT>2.83</ENT>
                            <ENT>0.26</ENT>
                            <ENT>010</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">13102</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Repair wound/lesion add-on</ENT>
                            <ENT>1.24</ENT>
                            <ENT>1.35</ENT>
                            <ENT>1.26</ENT>
                            <ENT>0.53</ENT>
                            <ENT>0.55</ENT>
                            <ENT>0.13</ENT>
                            <ENT>ZZZ</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">13120</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Repair of wound or lesion</ENT>
                            <ENT>3.32</ENT>
                            <ENT>4.58</ENT>
                            <ENT>4.36</ENT>
                            <ENT>2.57</ENT>
                            <ENT>2.46</ENT>
                            <ENT>0.26</ENT>
                            <ENT>010</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">13121</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Repair of wound or lesion</ENT>
                            <ENT>4.36</ENT>
                            <ENT>6.71</ENT>
                            <ENT>5.78</ENT>
                            <ENT>3.64</ENT>
                            <ENT>3.21</ENT>
                            <ENT>0.25</ENT>
                            <ENT>010</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">13122</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Repair wound/lesion add-on</ENT>
                            <ENT>1.44</ENT>
                            <ENT>1.37</ENT>
                            <ENT>1.44</ENT>
                            <ENT>0.58</ENT>
                            <ENT>0.60</ENT>
                            <ENT>0.15</ENT>
                            <ENT>ZZZ</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">13131</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Repair of wound or lesion</ENT>
                            <ENT>3.80</ENT>
                            <ENT>5.01</ENT>
                            <ENT>4.68</ENT>
                            <ENT>2.88</ENT>
                            <ENT>2.78</ENT>
                            <ENT>0.26</ENT>
                            <ENT>010</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">13132</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Repair of wound or lesion</ENT>
                            <ENT>6.48</ENT>
                            <ENT>7.88</ENT>
                            <ENT>6.89</ENT>
                            <ENT>4.95</ENT>
                            <ENT>4.55</ENT>
                            <ENT>0.32</ENT>
                            <ENT>010</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">13133</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Repair wound/lesion add-on</ENT>
                            <ENT>2.19</ENT>
                            <ENT>1.87</ENT>
                            <ENT>1.76</ENT>
                            <ENT>0.98</ENT>
                            <ENT>1.00</ENT>
                            <ENT>0.18</ENT>
                            <ENT>ZZZ</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">13150</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Repair of wound or lesion</ENT>
                            <ENT>3.82</ENT>
                            <ENT>4.72</ENT>
                            <ENT>4.79</ENT>
                            <ENT>2.72</ENT>
                            <ENT>2.74</ENT>
                            <ENT>0.34</ENT>
                            <ENT>010</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">13151</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Repair of wound or lesion</ENT>
                            <ENT>4.46</ENT>
                            <ENT>5.51</ENT>
                            <ENT>5.15</ENT>
                            <ENT>3.22</ENT>
                            <ENT>3.18</ENT>
                            <ENT>0.31</ENT>
                            <ENT>010</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">13152</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Repair of wound or lesion</ENT>
                            <ENT>6.34</ENT>
                            <ENT>7.53</ENT>
                            <ENT>6.78</ENT>
                            <ENT>3.91</ENT>
                            <ENT>3.97</ENT>
                            <ENT>0.40</ENT>
                            <ENT>010</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">13153</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Repair wound/lesion add-on</ENT>
                            <ENT>2.38</ENT>
                            <ENT>2.05</ENT>
                            <ENT>1.99</ENT>
                            <ENT>1.03</ENT>
                            <ENT>1.08</ENT>
                            <ENT>0.24</ENT>
                            <ENT>ZZZ</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">13160</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Late closure of wound</ENT>
                            <ENT>11.84</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>7.02</ENT>
                            <ENT>7.09</ENT>
                            <ENT>1.54</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">14000</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Skin tissue rearrangement</ENT>
                            <ENT>6.83</ENT>
                            <ENT>8.94</ENT>
                            <ENT>8.39</ENT>
                            <ENT>6.04</ENT>
                            <ENT>5.75</ENT>
                            <ENT>0.59</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">14001</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Skin tissue rearrangement</ENT>
                            <ENT>9.60</ENT>
                            <ENT>11.01</ENT>
                            <ENT>10.21</ENT>
                            <ENT>7.48</ENT>
                            <ENT>7.27</ENT>
                            <ENT>0.82</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">14020</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Skin tissue rearrangement</ENT>
                            <ENT>7.66</ENT>
                            <ENT>10.02</ENT>
                            <ENT>9.31</ENT>
                            <ENT>6.88</ENT>
                            <ENT>6.70</ENT>
                            <ENT>0.64</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">14021</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Skin tissue rearrangement</ENT>
                            <ENT>11.18</ENT>
                            <ENT>12.45</ENT>
                            <ENT>11.21</ENT>
                            <ENT>8.65</ENT>
                            <ENT>8.46</ENT>
                            <ENT>0.81</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">14040</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Skin tissue rearrangement</ENT>
                            <ENT>8.44</ENT>
                            <ENT>10.19</ENT>
                            <ENT>9.49</ENT>
                            <ENT>6.98</ENT>
                            <ENT>7.09</ENT>
                            <ENT>0.62</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">14041</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Skin tissue rearrangement</ENT>
                            <ENT>12.67</ENT>
                            <ENT>13.56</ENT>
                            <ENT>12.07</ENT>
                            <ENT>9.34</ENT>
                            <ENT>9.00</ENT>
                            <ENT>0.73</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">14060</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Skin tissue rearrangement</ENT>
                            <ENT>9.07</ENT>
                            <ENT>9.68</ENT>
                            <ENT>9.23</ENT>
                            <ENT>7.17</ENT>
                            <ENT>7.30</ENT>
                            <ENT>0.68</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">14061</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Skin tissue rearrangement</ENT>
                            <ENT>13.67</ENT>
                            <ENT>14.82</ENT>
                            <ENT>13.21</ENT>
                            <ENT>10.17</ENT>
                            <ENT>9.83</ENT>
                            <ENT>0.76</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">14300</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Skin tissue rearrangement</ENT>
                            <ENT>13.26</ENT>
                            <ENT>13.51</ENT>
                            <ENT>12.32</ENT>
                            <ENT>9.44</ENT>
                            <ENT>9.30</ENT>
                            <ENT>1.16</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">14350</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Skin tissue rearrangement</ENT>
                            <ENT>10.82</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>6.89</ENT>
                            <ENT>7.01</ENT>
                            <ENT>1.34</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">15002</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Wnd prep, ch/inf, trk/arm/lg</ENT>
                            <ENT>3.65</ENT>
                            <ENT>4.21</ENT>
                            <ENT>4.21</ENT>
                            <ENT>1.68</ENT>
                            <ENT>1.68</ENT>
                            <ENT>0.49</ENT>
                            <ENT>000</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">15003</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Wnd prep, ch/inf addl 100 cm</ENT>
                            <ENT>0.80</ENT>
                            <ENT>0.90</ENT>
                            <ENT>0.90</ENT>
                            <ENT>0.26</ENT>
                            <ENT>0.26</ENT>
                            <ENT>0.11</ENT>
                            <ENT>ZZZ</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">15004</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Wnd prep ch/inf, f/n/hf/g</ENT>
                            <ENT>4.58</ENT>
                            <ENT>4.87</ENT>
                            <ENT>4.87</ENT>
                            <ENT>2.01</ENT>
                            <ENT>2.01</ENT>
                            <ENT>0.62</ENT>
                            <ENT>000</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">15005</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Wnd prep, f/n/hf/g, addl cm</ENT>
                            <ENT>1.60</ENT>
                            <ENT>1.24</ENT>
                            <ENT>1.24</ENT>
                            <ENT>0.52</ENT>
                            <ENT>0.52</ENT>
                            <ENT>0.22</ENT>
                            <ENT>ZZZ</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">15040</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Harvest cultured skin graft</ENT>
                            <ENT>2.00</ENT>
                            <ENT>3.93</ENT>
                            <ENT>4.24</ENT>
                            <ENT>1.05</ENT>
                            <ENT>1.09</ENT>
                            <ENT>0.24</ENT>
                            <ENT>000</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">15050</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Skin pinch graft</ENT>
                            <ENT>5.37</ENT>
                            <ENT>7.62</ENT>
                            <ENT>7.26</ENT>
                            <ENT>5.00</ENT>
                            <ENT>5.05</ENT>
                            <ENT>0.57</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">15100</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Skin splt grft, trnk/arm/leg</ENT>
                            <ENT>9.74</ENT>
                            <ENT>9.76</ENT>
                            <ENT>11.17</ENT>
                            <ENT>6.67</ENT>
                            <ENT>7.24</ENT>
                            <ENT>1.28</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">15101</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Skin splt grft t/a/l, add-on</ENT>
                            <ENT>1.72</ENT>
                            <ENT>2.47</ENT>
                            <ENT>3.10</ENT>
                            <ENT>0.85</ENT>
                            <ENT>1.01</ENT>
                            <ENT>0.24</ENT>
                            <ENT>ZZZ</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">15110</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Epidrm autogrft trnk/arm/leg</ENT>
                            <ENT>10.88</ENT>
                            <ENT>8.74</ENT>
                            <ENT>9.70</ENT>
                            <ENT>6.36</ENT>
                            <ENT>6.68</ENT>
                            <ENT>1.31</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">15111</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Epidrm autogrft t/a/l add-on</ENT>
                            <ENT>1.85</ENT>
                            <ENT>0.87</ENT>
                            <ENT>1.08</ENT>
                            <ENT>0.62</ENT>
                            <ENT>0.70</ENT>
                            <ENT>0.26</ENT>
                            <ENT>ZZZ</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">15115</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Epidrm a-grft face/nck/hf/g</ENT>
                            <ENT>11.19</ENT>
                            <ENT>9.22</ENT>
                            <ENT>9.22</ENT>
                            <ENT>6.73</ENT>
                            <ENT>7.04</ENT>
                            <ENT>1.15</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">15116</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Epidrm a-grft f/n/hf/g addl</ENT>
                            <ENT>2.50</ENT>
                            <ENT>1.19</ENT>
                            <ENT>1.38</ENT>
                            <ENT>0.86</ENT>
                            <ENT>0.99</ENT>
                            <ENT>0.33</ENT>
                            <ENT>ZZZ</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">15120</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Skn splt a-grft fac/nck/hf/g</ENT>
                            <ENT>10.96</ENT>
                            <ENT>11.34</ENT>
                            <ENT>11.03</ENT>
                            <ENT>7.45</ENT>
                            <ENT>7.61</ENT>
                            <ENT>1.16</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">15121</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Skn splt a-grft f/n/hf/g add</ENT>
                            <ENT>2.67</ENT>
                            <ENT>3.43</ENT>
                            <ENT>3.96</ENT>
                            <ENT>1.29</ENT>
                            <ENT>1.57</ENT>
                            <ENT>0.36</ENT>
                            <ENT>ZZZ</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">15130</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Derm autograft, trnk/arm/leg</ENT>
                            <ENT>7.41</ENT>
                            <ENT>7.95</ENT>
                            <ENT>8.90</ENT>
                            <ENT>5.57</ENT>
                            <ENT>5.95</ENT>
                            <ENT>0.97</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">15131</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Derm autograft t/a/l add-on</ENT>
                            <ENT>1.50</ENT>
                            <ENT>0.65</ENT>
                            <ENT>0.86</ENT>
                            <ENT>0.48</ENT>
                            <ENT>0.56</ENT>
                            <ENT>0.21</ENT>
                            <ENT>ZZZ</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">15135</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Derm autograft face/nck/hf/g</ENT>
                            <ENT>10.91</ENT>
                            <ENT>9.48</ENT>
                            <ENT>9.67</ENT>
                            <ENT>7.04</ENT>
                            <ENT>7.58</ENT>
                            <ENT>1.23</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">15136</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Derm autograft, f/n/hf/g add</ENT>
                            <ENT>1.50</ENT>
                            <ENT>0.66</ENT>
                            <ENT>0.77</ENT>
                            <ENT>0.51</ENT>
                            <ENT>0.59</ENT>
                            <ENT>0.20</ENT>
                            <ENT>ZZZ</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">15150</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Cult epiderm grft t/arm/leg</ENT>
                            <ENT>9.30</ENT>
                            <ENT>7.04</ENT>
                            <ENT>7.74</ENT>
                            <ENT>5.75</ENT>
                            <ENT>6.10</ENT>
                            <ENT>1.14</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">15151</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Cult epiderm grft t/a/l addl</ENT>
                            <ENT>2.00</ENT>
                            <ENT>0.88</ENT>
                            <ENT>1.09</ENT>
                            <ENT>0.67</ENT>
                            <ENT>0.76</ENT>
                            <ENT>0.28</ENT>
                            <ENT>ZZZ</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">15152</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Cult epiderm graft t/a/l +%</ENT>
                            <ENT>2.50</ENT>
                            <ENT>1.05</ENT>
                            <ENT>1.30</ENT>
                            <ENT>0.84</ENT>
                            <ENT>0.95</ENT>
                            <ENT>0.35</ENT>
                            <ENT>ZZZ</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">15155</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Cult epiderm graft, f/n/hf/g</ENT>
                            <ENT>10.05</ENT>
                            <ENT>7.65</ENT>
                            <ENT>7.73</ENT>
                            <ENT>6.30</ENT>
                            <ENT>6.63</ENT>
                            <ENT>1.05</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">15156</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Cult epidrm grft f/n/hfg add</ENT>
                            <ENT>2.75</ENT>
                            <ENT>1.15</ENT>
                            <ENT>1.35</ENT>
                            <ENT>0.94</ENT>
                            <ENT>1.09</ENT>
                            <ENT>0.36</ENT>
                            <ENT>ZZZ</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">15157</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Cult epiderm grft f/n/hfg +%</ENT>
                            <ENT>3.00</ENT>
                            <ENT>1.33</ENT>
                            <ENT>1.55</ENT>
                            <ENT>1.03</ENT>
                            <ENT>1.19</ENT>
                            <ENT>0.39</ENT>
                            <ENT>ZZZ</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">15170</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Acell graft trunk/arms/legs</ENT>
                            <ENT>5.99</ENT>
                            <ENT>4.01</ENT>
                            <ENT>3.92</ENT>
                            <ENT>2.60</ENT>
                            <ENT>2.48</ENT>
                            <ENT>0.55</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">15171</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Acell graft t/arm/leg add-on</ENT>
                            <ENT>1.55</ENT>
                            <ENT>0.60</ENT>
                            <ENT>0.64</ENT>
                            <ENT>0.46</ENT>
                            <ENT>0.54</ENT>
                            <ENT>0.19</ENT>
                            <ENT>ZZZ</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">15175</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Acellular graft, f/n/hf/g</ENT>
                            <ENT>7.99</ENT>
                            <ENT>4.46</ENT>
                            <ENT>4.94</ENT>
                            <ENT>3.14</ENT>
                            <ENT>3.57</ENT>
                            <ENT>0.82</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">15176</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Acell graft, f/n/hf/g add-on</ENT>
                            <ENT>2.45</ENT>
                            <ENT>1.04</ENT>
                            <ENT>1.07</ENT>
                            <ENT>0.79</ENT>
                            <ENT>0.89</ENT>
                            <ENT>0.29</ENT>
                            <ENT>ZZZ</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">15200</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Skin full graft, trunk</ENT>
                            <ENT>8.97</ENT>
                            <ENT>9.90</ENT>
                            <ENT>9.65</ENT>
                            <ENT>6.34</ENT>
                            <ENT>6.27</ENT>
                            <ENT>0.98</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">15201</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Skin full graft trunk add-on</ENT>
                            <ENT>1.32</ENT>
                            <ENT>2.02</ENT>
                            <ENT>2.29</ENT>
                            <ENT>0.47</ENT>
                            <ENT>0.54</ENT>
                            <ENT>0.19</ENT>
                            <ENT>ZZZ</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">15220</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Skin full graft sclp/arm/leg</ENT>
                            <ENT>7.95</ENT>
                            <ENT>10.45</ENT>
                            <ENT>9.82</ENT>
                            <ENT>6.69</ENT>
                            <ENT>6.68</ENT>
                            <ENT>0.84</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">15221</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Skin full graft add-on</ENT>
                            <ENT>1.19</ENT>
                            <ENT>2.00</ENT>
                            <ENT>2.16</ENT>
                            <ENT>0.50</ENT>
                            <ENT>0.53</ENT>
                            <ENT>0.16</ENT>
                            <ENT>ZZZ</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">15240</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Skin full grft face/genit/hf</ENT>
                            <ENT>10.15</ENT>
                            <ENT>12.03</ENT>
                            <ENT>11.11</ENT>
                            <ENT>8.89</ENT>
                            <ENT>8.42</ENT>
                            <ENT>0.92</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">15241</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Skin full graft add-on</ENT>
                            <ENT>1.86</ENT>
                            <ENT>2.54</ENT>
                            <ENT>2.49</ENT>
                            <ENT>0.81</ENT>
                            <ENT>0.86</ENT>
                            <ENT>0.23</ENT>
                            <ENT>ZZZ</ENT>
                        </ROW>
                        <ROW>
                            <PRTPAGE P="66415"/>
                            <ENT I="01">15260</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Skin full graft een &amp; lips</ENT>
                            <ENT>11.39</ENT>
                            <ENT>13.00</ENT>
                            <ENT>11.60</ENT>
                            <ENT>9.33</ENT>
                            <ENT>8.95</ENT>
                            <ENT>0.69</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">15261</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Skin full graft add-on</ENT>
                            <ENT>2.23</ENT>
                            <ENT>2.97</ENT>
                            <ENT>2.83</ENT>
                            <ENT>1.15</ENT>
                            <ENT>1.28</ENT>
                            <ENT>0.21</ENT>
                            <ENT>ZZZ</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">15300</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Apply skinallogrft, t/arm/lg</ENT>
                            <ENT>4.65</ENT>
                            <ENT>3.44</ENT>
                            <ENT>3.32</ENT>
                            <ENT>2.15</ENT>
                            <ENT>2.19</ENT>
                            <ENT>0.49</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">15301</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Apply sknallogrft t/a/l addl</ENT>
                            <ENT>1.00</ENT>
                            <ENT>0.46</ENT>
                            <ENT>0.46</ENT>
                            <ENT>0.32</ENT>
                            <ENT>0.36</ENT>
                            <ENT>0.14</ENT>
                            <ENT>ZZZ</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">15320</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Apply skin allogrft f/n/hf/g</ENT>
                            <ENT>5.36</ENT>
                            <ENT>3.78</ENT>
                            <ENT>3.70</ENT>
                            <ENT>2.35</ENT>
                            <ENT>2.44</ENT>
                            <ENT>0.58</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">15321</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Aply sknallogrft f/n/hfg add</ENT>
                            <ENT>1.50</ENT>
                            <ENT>0.69</ENT>
                            <ENT>0.69</ENT>
                            <ENT>0.51</ENT>
                            <ENT>0.55</ENT>
                            <ENT>0.21</ENT>
                            <ENT>ZZZ</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">15330</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Aply acell alogrft t/arm/leg</ENT>
                            <ENT>3.99</ENT>
                            <ENT>3.49</ENT>
                            <ENT>3.34</ENT>
                            <ENT>2.14</ENT>
                            <ENT>2.18</ENT>
                            <ENT>0.49</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">15331</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Aply acell grft t/a/l add-on</ENT>
                            <ENT>1.00</ENT>
                            <ENT>0.49</ENT>
                            <ENT>0.47</ENT>
                            <ENT>0.36</ENT>
                            <ENT>0.38</ENT>
                            <ENT>0.14</ENT>
                            <ENT>ZZZ</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">15335</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Apply acell graft, f/n/hf/g</ENT>
                            <ENT>4.50</ENT>
                            <ENT>3.32</ENT>
                            <ENT>3.39</ENT>
                            <ENT>2.01</ENT>
                            <ENT>2.22</ENT>
                            <ENT>0.55</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">15336</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Aply acell grft f/n/hf/g add</ENT>
                            <ENT>1.43</ENT>
                            <ENT>0.74</ENT>
                            <ENT>0.71</ENT>
                            <ENT>0.51</ENT>
                            <ENT>0.54</ENT>
                            <ENT>0.20</ENT>
                            <ENT>ZZZ</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">15340</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Apply cult skin substitute</ENT>
                            <ENT>3.76</ENT>
                            <ENT>3.68</ENT>
                            <ENT>3.84</ENT>
                            <ENT>2.64</ENT>
                            <ENT>2.69</ENT>
                            <ENT>0.41</ENT>
                            <ENT>010</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">15341</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Apply cult skin sub add-on</ENT>
                            <ENT>0.50</ENT>
                            <ENT>0.64</ENT>
                            <ENT>0.62</ENT>
                            <ENT>0.13</ENT>
                            <ENT>0.17</ENT>
                            <ENT>0.06</ENT>
                            <ENT>ZZZ</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">15360</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Apply cult derm sub, t/a/l</ENT>
                            <ENT>3.93</ENT>
                            <ENT>4.85</ENT>
                            <ENT>4.66</ENT>
                            <ENT>3.53</ENT>
                            <ENT>3.31</ENT>
                            <ENT>0.43</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">15361</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Aply cult derm sub t/a/l add</ENT>
                            <ENT>1.15</ENT>
                            <ENT>0.50</ENT>
                            <ENT>0.54</ENT>
                            <ENT>0.32</ENT>
                            <ENT>0.39</ENT>
                            <ENT>0.14</ENT>
                            <ENT>ZZZ</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">15365</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Apply cult derm sub f/n/hf/g</ENT>
                            <ENT>4.21</ENT>
                            <ENT>4.21</ENT>
                            <ENT>4.38</ENT>
                            <ENT>3.09</ENT>
                            <ENT>3.14</ENT>
                            <ENT>0.46</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">15366</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Apply cult derm f/hf/g add</ENT>
                            <ENT>1.45</ENT>
                            <ENT>0.67</ENT>
                            <ENT>0.68</ENT>
                            <ENT>0.47</ENT>
                            <ENT>0.53</ENT>
                            <ENT>0.17</ENT>
                            <ENT>ZZZ</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">15400</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Apply skin xenograft, t/a/l</ENT>
                            <ENT>4.38</ENT>
                            <ENT>4.99</ENT>
                            <ENT>4.50</ENT>
                            <ENT>3.76</ENT>
                            <ENT>3.88</ENT>
                            <ENT>0.47</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">15401</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Apply skn xenogrft t/a/l add</ENT>
                            <ENT>1.00</ENT>
                            <ENT>1.01</ENT>
                            <ENT>1.45</ENT>
                            <ENT>0.33</ENT>
                            <ENT>0.39</ENT>
                            <ENT>0.14</ENT>
                            <ENT>ZZZ</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">15420</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Apply skin xgraft, f/n/hf/g</ENT>
                            <ENT>4.89</ENT>
                            <ENT>5.43</ENT>
                            <ENT>5.10</ENT>
                            <ENT>4.17</ENT>
                            <ENT>3.98</ENT>
                            <ENT>0.52</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">15421</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Apply skn xgrft f/n/hf/g add</ENT>
                            <ENT>1.50</ENT>
                            <ENT>1.16</ENT>
                            <ENT>1.24</ENT>
                            <ENT>0.48</ENT>
                            <ENT>0.55</ENT>
                            <ENT>0.21</ENT>
                            <ENT>ZZZ</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">15430</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Apply acellular xenograft</ENT>
                            <ENT>5.93</ENT>
                            <ENT>6.60</ENT>
                            <ENT>6.75</ENT>
                            <ENT>6.05</ENT>
                            <ENT>6.33</ENT>
                            <ENT>0.66</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">15431</ENT>
                            <ENT/>
                            <ENT>C</ENT>
                            <ENT>Apply acellular xgraft add</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>ZZZ</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">15570</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Form skin pedicle flap</ENT>
                            <ENT>10.00</ENT>
                            <ENT>10.08</ENT>
                            <ENT>10.69</ENT>
                            <ENT>6.27</ENT>
                            <ENT>6.51</ENT>
                            <ENT>1.34</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">15572</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Form skin pedicle flap</ENT>
                            <ENT>9.94</ENT>
                            <ENT>9.78</ENT>
                            <ENT>9.63</ENT>
                            <ENT>6.66</ENT>
                            <ENT>6.55</ENT>
                            <ENT>1.20</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">15574</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Form skin pedicle flap</ENT>
                            <ENT>10.52</ENT>
                            <ENT>10.54</ENT>
                            <ENT>10.61</ENT>
                            <ENT>7.03</ENT>
                            <ENT>7.41</ENT>
                            <ENT>1.20</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">15576</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Form skin pedicle flap</ENT>
                            <ENT>9.24</ENT>
                            <ENT>9.66</ENT>
                            <ENT>9.70</ENT>
                            <ENT>6.51</ENT>
                            <ENT>6.70</ENT>
                            <ENT>0.87</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">15600</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Skin graft</ENT>
                            <ENT>1.95</ENT>
                            <ENT>5.31</ENT>
                            <ENT>6.45</ENT>
                            <ENT>2.75</ENT>
                            <ENT>2.90</ENT>
                            <ENT>0.27</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">15610</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Skin graft</ENT>
                            <ENT>2.46</ENT>
                            <ENT>5.56</ENT>
                            <ENT>5.12</ENT>
                            <ENT>3.04</ENT>
                            <ENT>3.23</ENT>
                            <ENT>0.35</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">15620</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Skin graft</ENT>
                            <ENT>3.62</ENT>
                            <ENT>6.47</ENT>
                            <ENT>7.12</ENT>
                            <ENT>3.90</ENT>
                            <ENT>3.89</ENT>
                            <ENT>0.35</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">15630</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Skin graft</ENT>
                            <ENT>3.95</ENT>
                            <ENT>7.07</ENT>
                            <ENT>7.05</ENT>
                            <ENT>4.31</ENT>
                            <ENT>4.23</ENT>
                            <ENT>0.34</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">15650</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Transfer skin pedicle flap</ENT>
                            <ENT>4.64</ENT>
                            <ENT>7.27</ENT>
                            <ENT>7.20</ENT>
                            <ENT>4.38</ENT>
                            <ENT>4.29</ENT>
                            <ENT>0.42</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">15731</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Forehead flap w/vasc pedicle</ENT>
                            <ENT>14.12</ENT>
                            <ENT>11.89</ENT>
                            <ENT>11.89</ENT>
                            <ENT>9.33</ENT>
                            <ENT>9.33</ENT>
                            <ENT>1.28</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">15732</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Muscle-skin graft, head/neck</ENT>
                            <ENT>19.70</ENT>
                            <ENT>14.64</ENT>
                            <ENT>16.34</ENT>
                            <ENT>11.09</ENT>
                            <ENT>11.65</ENT>
                            <ENT>2.00</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">15734</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Muscle-skin graft, trunk</ENT>
                            <ENT>19.62</ENT>
                            <ENT>15.68</ENT>
                            <ENT>16.89</ENT>
                            <ENT>11.84</ENT>
                            <ENT>12.10</ENT>
                            <ENT>2.62</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">15736</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Muscle-skin graft, arm</ENT>
                            <ENT>16.92</ENT>
                            <ENT>13.39</ENT>
                            <ENT>15.80</ENT>
                            <ENT>9.59</ENT>
                            <ENT>10.40</ENT>
                            <ENT>2.46</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">15738</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Muscle-skin graft, leg</ENT>
                            <ENT>18.92</ENT>
                            <ENT>13.76</ENT>
                            <ENT>15.86</ENT>
                            <ENT>10.18</ENT>
                            <ENT>10.95</ENT>
                            <ENT>2.66</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">15740</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Island pedicle flap graft</ENT>
                            <ENT>11.57</ENT>
                            <ENT>13.56</ENT>
                            <ENT>11.84</ENT>
                            <ENT>9.41</ENT>
                            <ENT>8.83</ENT>
                            <ENT>0.63</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">15750</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Neurovascular pedicle graft</ENT>
                            <ENT>12.73</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>8.85</ENT>
                            <ENT>8.94</ENT>
                            <ENT>1.42</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">15756</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Free myo/skin flap microvasc</ENT>
                            <ENT>36.74</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>18.55</ENT>
                            <ENT>19.55</ENT>
                            <ENT>4.62</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">15757</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Free skin flap, microvasc</ENT>
                            <ENT>36.95</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>17.85</ENT>
                            <ENT>19.71</ENT>
                            <ENT>3.90</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">15758</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Free fascial flap, microvasc</ENT>
                            <ENT>36.70</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>17.56</ENT>
                            <ENT>19.56</ENT>
                            <ENT>4.24</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">15760</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Composite skin graft</ENT>
                            <ENT>9.68</ENT>
                            <ENT>10.41</ENT>
                            <ENT>10.21</ENT>
                            <ENT>7.05</ENT>
                            <ENT>7.15</ENT>
                            <ENT>0.85</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">15770</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Derma-fat-fascia graft</ENT>
                            <ENT>8.73</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>6.63</ENT>
                            <ENT>6.66</ENT>
                            <ENT>1.05</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">15775</ENT>
                            <ENT/>
                            <ENT>R</ENT>
                            <ENT>Hair transplant punch grafts</ENT>
                            <ENT>3.95</ENT>
                            <ENT>2.88</ENT>
                            <ENT>3.55</ENT>
                            <ENT>1.23</ENT>
                            <ENT>1.26</ENT>
                            <ENT>0.52</ENT>
                            <ENT>000</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">15776</ENT>
                            <ENT/>
                            <ENT>R</ENT>
                            <ENT>Hair transplant punch grafts</ENT>
                            <ENT>5.53</ENT>
                            <ENT>4.85</ENT>
                            <ENT>5.10</ENT>
                            <ENT>2.14</ENT>
                            <ENT>2.47</ENT>
                            <ENT>0.72</ENT>
                            <ENT>000</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">15780</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Abrasion treatment of skin</ENT>
                            <ENT>8.50</ENT>
                            <ENT>11.23</ENT>
                            <ENT>11.37</ENT>
                            <ENT>6.52</ENT>
                            <ENT>7.38</ENT>
                            <ENT>0.67</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">15781</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Abrasion treatment of skin</ENT>
                            <ENT>4.91</ENT>
                            <ENT>8.67</ENT>
                            <ENT>7.79</ENT>
                            <ENT>5.64</ENT>
                            <ENT>5.50</ENT>
                            <ENT>0.34</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">15782</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Abrasion treatment of skin</ENT>
                            <ENT>4.36</ENT>
                            <ENT>8.70</ENT>
                            <ENT>9.28</ENT>
                            <ENT>4.96</ENT>
                            <ENT>5.75</ENT>
                            <ENT>0.34</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">15783</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Abrasion treatment of skin</ENT>
                            <ENT>4.33</ENT>
                            <ENT>7.91</ENT>
                            <ENT>7.39</ENT>
                            <ENT>4.96</ENT>
                            <ENT>4.57</ENT>
                            <ENT>0.28</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">15786</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Abrasion, lesion, single</ENT>
                            <ENT>2.05</ENT>
                            <ENT>3.89</ENT>
                            <ENT>3.62</ENT>
                            <ENT>1.24</ENT>
                            <ENT>1.28</ENT>
                            <ENT>0.11</ENT>
                            <ENT>010</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">15787</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Abrasion, lesions, add-on</ENT>
                            <ENT>0.33</ENT>
                            <ENT>0.83</ENT>
                            <ENT>0.96</ENT>
                            <ENT>0.08</ENT>
                            <ENT>0.12</ENT>
                            <ENT>0.04</ENT>
                            <ENT>ZZZ</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">15788</ENT>
                            <ENT/>
                            <ENT>R</ENT>
                            <ENT>Chemical peel, face, epiderm</ENT>
                            <ENT>2.09</ENT>
                            <ENT>9.45</ENT>
                            <ENT>8.08</ENT>
                            <ENT>4.12</ENT>
                            <ENT>3.60</ENT>
                            <ENT>0.11</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">15789</ENT>
                            <ENT/>
                            <ENT>R</ENT>
                            <ENT>Chemical peel, face, dermal</ENT>
                            <ENT>4.91</ENT>
                            <ENT>9.42</ENT>
                            <ENT>8.75</ENT>
                            <ENT>5.83</ENT>
                            <ENT>5.31</ENT>
                            <ENT>0.20</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">15792</ENT>
                            <ENT/>
                            <ENT>R</ENT>
                            <ENT>Chemical peel, nonfacial</ENT>
                            <ENT>1.86</ENT>
                            <ENT>8.97</ENT>
                            <ENT>8.03</ENT>
                            <ENT>4.58</ENT>
                            <ENT>4.51</ENT>
                            <ENT>0.13</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">15793</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Chemical peel, nonfacial</ENT>
                            <ENT>3.82</ENT>
                            <ENT>8.09</ENT>
                            <ENT>7.19</ENT>
                            <ENT>4.90</ENT>
                            <ENT>4.64</ENT>
                            <ENT>0.19</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">15819</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Plastic surgery, neck</ENT>
                            <ENT>10.45</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>6.68</ENT>
                            <ENT>6.93</ENT>
                            <ENT>0.97</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">15820</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Revision of lower eyelid</ENT>
                            <ENT>6.09</ENT>
                            <ENT>6.39</ENT>
                            <ENT>6.68</ENT>
                            <ENT>5.19</ENT>
                            <ENT>5.38</ENT>
                            <ENT>0.40</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">15821</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Revision of lower eyelid</ENT>
                            <ENT>6.66</ENT>
                            <ENT>6.56</ENT>
                            <ENT>6.95</ENT>
                            <ENT>5.28</ENT>
                            <ENT>5.49</ENT>
                            <ENT>0.45</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">15822</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Revision of upper eyelid</ENT>
                            <ENT>4.51</ENT>
                            <ENT>5.23</ENT>
                            <ENT>5.53</ENT>
                            <ENT>4.09</ENT>
                            <ENT>4.29</ENT>
                            <ENT>0.37</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">15823</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Revision of upper eyelid</ENT>
                            <ENT>8.12</ENT>
                            <ENT>7.38</ENT>
                            <ENT>7.61</ENT>
                            <ENT>6.10</ENT>
                            <ENT>6.27</ENT>
                            <ENT>0.50</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">15824</ENT>
                            <ENT/>
                            <ENT>R</ENT>
                            <ENT>Removal of forehead wrinkles</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>000</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">15825</ENT>
                            <ENT/>
                            <ENT>R</ENT>
                            <ENT>Removal of neck wrinkles</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>000</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">15826</ENT>
                            <ENT/>
                            <ENT>R</ENT>
                            <ENT>Removal of brow wrinkles</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>000</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">15828</ENT>
                            <ENT/>
                            <ENT>R</ENT>
                            <ENT>Removal of face wrinkles</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>000</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">15829</ENT>
                            <ENT/>
                            <ENT>R</ENT>
                            <ENT>Removal of skin wrinkles</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>000</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">15830</ENT>
                            <ENT/>
                            <ENT>R</ENT>
                            <ENT>Exc skin abd</ENT>
                            <ENT>16.90</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>9.81</ENT>
                            <ENT>9.81</ENT>
                            <ENT>2.93</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">15832</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Excise excessive skin tissue</ENT>
                            <ENT>12.65</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>8.27</ENT>
                            <ENT>8.30</ENT>
                            <ENT>1.66</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">15833</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Excise excessive skin tissue</ENT>
                            <ENT>11.70</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>7.50</ENT>
                            <ENT>7.85</ENT>
                            <ENT>1.49</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">15834</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Excise excessive skin tissue</ENT>
                            <ENT>11.97</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>8.15</ENT>
                            <ENT>7.92</ENT>
                            <ENT>1.61</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">15835</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Excise excessive skin tissue</ENT>
                            <ENT>12.79</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>7.85</ENT>
                            <ENT>7.69</ENT>
                            <ENT>1.60</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">15836</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Excise excessive skin tissue</ENT>
                            <ENT>10.41</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>6.82</ENT>
                            <ENT>6.80</ENT>
                            <ENT>1.34</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">15837</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Excise excessive skin tissue</ENT>
                            <ENT>9.37</ENT>
                            <ENT>8.67</ENT>
                            <ENT>8.61</ENT>
                            <ENT>5.78</ENT>
                            <ENT>6.57</ENT>
                            <ENT>1.18</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <PRTPAGE P="66416"/>
                            <ENT I="01">15838</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Excise excessive skin tissue</ENT>
                            <ENT>8.07</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>5.44</ENT>
                            <ENT>5.75</ENT>
                            <ENT>0.58</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">15839</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Excise excessive skin tissue</ENT>
                            <ENT>10.32</ENT>
                            <ENT>9.75</ENT>
                            <ENT>9.29</ENT>
                            <ENT>6.46</ENT>
                            <ENT>6.42</ENT>
                            <ENT>1.22</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">15840</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Graft for face nerve palsy</ENT>
                            <ENT>14.76</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>8.91</ENT>
                            <ENT>9.44</ENT>
                            <ENT>1.32</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">15841</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Graft for face nerve palsy</ENT>
                            <ENT>25.69</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>13.52</ENT>
                            <ENT>14.25</ENT>
                            <ENT>2.55</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">15842</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Flap for face nerve palsy</ENT>
                            <ENT>40.68</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>20.86</ENT>
                            <ENT>21.88</ENT>
                            <ENT>4.94</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">15845</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Skin and muscle repair, face</ENT>
                            <ENT>14.04</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>8.35</ENT>
                            <ENT>8.83</ENT>
                            <ENT>0.81</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">15847</ENT>
                            <ENT/>
                            <ENT>C</ENT>
                            <ENT>Exc skin abd add-on</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>YYY</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">15850</ENT>
                            <ENT/>
                            <ENT>B</ENT>
                            <ENT>Removal of sutures</ENT>
                            <ENT>0.78</ENT>
                            <ENT>1.20</ENT>
                            <ENT>1.38</ENT>
                            <ENT>0.18</ENT>
                            <ENT>0.24</ENT>
                            <ENT>0.05</ENT>
                            <ENT>XXX</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">15851</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Removal of sutures</ENT>
                            <ENT>0.86</ENT>
                            <ENT>1.33</ENT>
                            <ENT>1.50</ENT>
                            <ENT>0.24</ENT>
                            <ENT>0.27</ENT>
                            <ENT>0.06</ENT>
                            <ENT>000</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">15852</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Dressing change not for burn</ENT>
                            <ENT>0.86</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>0.25</ENT>
                            <ENT>0.29</ENT>
                            <ENT>0.09</ENT>
                            <ENT>000</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">15860</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Test for blood flow in graft</ENT>
                            <ENT>1.95</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>0.64</ENT>
                            <ENT>0.71</ENT>
                            <ENT>0.27</ENT>
                            <ENT>000</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">15876</ENT>
                            <ENT/>
                            <ENT>R</ENT>
                            <ENT>Suction assisted lipectomy</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>000</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">15877</ENT>
                            <ENT/>
                            <ENT>R</ENT>
                            <ENT>Suction assisted lipectomy</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>000</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">15878</ENT>
                            <ENT/>
                            <ENT>R</ENT>
                            <ENT>Suction assisted lipectomy</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>000</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">15879</ENT>
                            <ENT/>
                            <ENT>R</ENT>
                            <ENT>Suction assisted lipectomy</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>000</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">15920</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Removal of tail bone ulcer</ENT>
                            <ENT>8.15</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>5.34</ENT>
                            <ENT>5.45</ENT>
                            <ENT>1.04</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">15922</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Removal of tail bone ulcer</ENT>
                            <ENT>10.23</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>7.16</ENT>
                            <ENT>7.18</ENT>
                            <ENT>1.42</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">15931</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Remove sacrum pressure sore</ENT>
                            <ENT>9.96</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>5.56</ENT>
                            <ENT>5.62</ENT>
                            <ENT>1.25</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">15933</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Remove sacrum pressure sore</ENT>
                            <ENT>11.60</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>7.30</ENT>
                            <ENT>7.57</ENT>
                            <ENT>1.52</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">15934</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Remove sacrum pressure sore</ENT>
                            <ENT>13.54</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>7.72</ENT>
                            <ENT>7.87</ENT>
                            <ENT>1.79</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">15935</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Remove sacrum pressure sore</ENT>
                            <ENT>15.58</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>9.17</ENT>
                            <ENT>9.74</ENT>
                            <ENT>2.10</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">15936</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Remove sacrum pressure sore</ENT>
                            <ENT>13.04</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>7.41</ENT>
                            <ENT>7.81</ENT>
                            <ENT>1.77</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">15937</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Remove sacrum pressure sore</ENT>
                            <ENT>15.00</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>8.93</ENT>
                            <ENT>9.37</ENT>
                            <ENT>2.07</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">15940</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Remove hip pressure sore</ENT>
                            <ENT>10.11</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>5.80</ENT>
                            <ENT>5.99</ENT>
                            <ENT>1.31</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">15941</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Remove hip pressure sore</ENT>
                            <ENT>12.24</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>8.42</ENT>
                            <ENT>8.93</ENT>
                            <ENT>1.66</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">15944</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Remove hip pressure sore</ENT>
                            <ENT>12.27</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>8.13</ENT>
                            <ENT>8.36</ENT>
                            <ENT>1.65</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">15945</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Remove hip pressure sore</ENT>
                            <ENT>13.57</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>8.80</ENT>
                            <ENT>9.22</ENT>
                            <ENT>1.85</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">15946</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Remove hip pressure sore</ENT>
                            <ENT>23.80</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>13.69</ENT>
                            <ENT>14.03</ENT>
                            <ENT>3.17</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">15950</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Remove thigh pressure sore</ENT>
                            <ENT>7.91</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>5.40</ENT>
                            <ENT>5.40</ENT>
                            <ENT>1.04</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">15951</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Remove thigh pressure sore</ENT>
                            <ENT>11.41</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>7.33</ENT>
                            <ENT>7.59</ENT>
                            <ENT>1.49</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">15952</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Remove thigh pressure sore</ENT>
                            <ENT>12.14</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>7.45</ENT>
                            <ENT>7.60</ENT>
                            <ENT>1.60</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">15953</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Remove thigh pressure sore</ENT>
                            <ENT>13.39</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>8.22</ENT>
                            <ENT>8.61</ENT>
                            <ENT>1.80</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">15956</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Remove thigh pressure sore</ENT>
                            <ENT>16.59</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>9.54</ENT>
                            <ENT>10.15</ENT>
                            <ENT>2.22</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">15958</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Remove thigh pressure sore</ENT>
                            <ENT>16.55</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>10.42</ENT>
                            <ENT>10.72</ENT>
                            <ENT>2.26</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">15999</ENT>
                            <ENT/>
                            <ENT>C</ENT>
                            <ENT>Removal of pressure sore</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>YYY</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">16000</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Initial treatment of burn(s)</ENT>
                            <ENT>0.89</ENT>
                            <ENT>0.72</ENT>
                            <ENT>0.79</ENT>
                            <ENT>0.23</ENT>
                            <ENT>0.25</ENT>
                            <ENT>0.08</ENT>
                            <ENT>000</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">16020</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Dress/debrid p-thick burn, s</ENT>
                            <ENT>0.80</ENT>
                            <ENT>1.11</ENT>
                            <ENT>1.20</ENT>
                            <ENT>0.56</ENT>
                            <ENT>0.57</ENT>
                            <ENT>0.08</ENT>
                            <ENT>000</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">16025</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Dress/debrid p-thick burn, m</ENT>
                            <ENT>1.85</ENT>
                            <ENT>1.57</ENT>
                            <ENT>1.67</ENT>
                            <ENT>0.86</ENT>
                            <ENT>0.91</ENT>
                            <ENT>0.19</ENT>
                            <ENT>000</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">16030</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Dress/debrid p-thick burn, l</ENT>
                            <ENT>2.08</ENT>
                            <ENT>2.08</ENT>
                            <ENT>2.13</ENT>
                            <ENT>1.02</ENT>
                            <ENT>1.07</ENT>
                            <ENT>0.24</ENT>
                            <ENT>000</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">16035</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Incision of burn scab, initi</ENT>
                            <ENT>3.74</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>1.22</ENT>
                            <ENT>1.40</ENT>
                            <ENT>0.46</ENT>
                            <ENT>000</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">16036</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Escharotomy; add'l incision</ENT>
                            <ENT>1.50</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>0.46</ENT>
                            <ENT>0.53</ENT>
                            <ENT>0.20</ENT>
                            <ENT>ZZZ</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">17000</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Destruct premalg lesion</ENT>
                            <ENT>0.62</ENT>
                            <ENT>1.41</ENT>
                            <ENT>1.19</ENT>
                            <ENT>0.74</ENT>
                            <ENT>0.64</ENT>
                            <ENT>0.03</ENT>
                            <ENT>010</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">17003</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Destruct premalg les, 2-14</ENT>
                            <ENT>0.07</ENT>
                            <ENT>0.10</ENT>
                            <ENT>0.11</ENT>
                            <ENT>0.03</ENT>
                            <ENT>0.05</ENT>
                            <ENT>0.01</ENT>
                            <ENT>ZZZ</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">17004</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Destroy premlg lesions 15+</ENT>
                            <ENT>1.82</ENT>
                            <ENT>2.44</ENT>
                            <ENT>2.37</ENT>
                            <ENT>1.38</ENT>
                            <ENT>1.48</ENT>
                            <ENT>0.11</ENT>
                            <ENT>010</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">17106</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Destruction of skin lesions</ENT>
                            <ENT>4.62</ENT>
                            <ENT>4.69</ENT>
                            <ENT>4.64</ENT>
                            <ENT>3.28</ENT>
                            <ENT>3.30</ENT>
                            <ENT>0.35</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">17107</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Destruction of skin lesions</ENT>
                            <ENT>9.19</ENT>
                            <ENT>6.97</ENT>
                            <ENT>7.08</ENT>
                            <ENT>4.94</ENT>
                            <ENT>5.20</ENT>
                            <ENT>0.63</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">17108</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Destruction of skin lesions</ENT>
                            <ENT>13.22</ENT>
                            <ENT>8.86</ENT>
                            <ENT>9.06</ENT>
                            <ENT>6.38</ENT>
                            <ENT>7.02</ENT>
                            <ENT>0.54</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">17110</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Destruct b9 lesion, 1-14</ENT>
                            <ENT>0.67</ENT>
                            <ENT>1.79</ENT>
                            <ENT>1.70</ENT>
                            <ENT>0.88</ENT>
                            <ENT>0.79</ENT>
                            <ENT>0.05</ENT>
                            <ENT>010</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">17111</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Destruct lesion, 15 or more</ENT>
                            <ENT>0.94</ENT>
                            <ENT>2.25</ENT>
                            <ENT>1.96</ENT>
                            <ENT>1.11</ENT>
                            <ENT>0.96</ENT>
                            <ENT>0.05</ENT>
                            <ENT>010</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">17250</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Chemical cautery, tissue</ENT>
                            <ENT>0.50</ENT>
                            <ENT>1.32</ENT>
                            <ENT>1.27</ENT>
                            <ENT>0.38</ENT>
                            <ENT>0.36</ENT>
                            <ENT>0.06</ENT>
                            <ENT>000</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">17260</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Destruction of skin lesions</ENT>
                            <ENT>0.93</ENT>
                            <ENT>1.41</ENT>
                            <ENT>1.34</ENT>
                            <ENT>0.71</ENT>
                            <ENT>0.69</ENT>
                            <ENT>0.04</ENT>
                            <ENT>010</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">17261</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Destruction of skin lesions</ENT>
                            <ENT>1.19</ENT>
                            <ENT>2.49</ENT>
                            <ENT>2.05</ENT>
                            <ENT>1.07</ENT>
                            <ENT>0.95</ENT>
                            <ENT>0.05</ENT>
                            <ENT>010</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">17262</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Destruction of skin lesions</ENT>
                            <ENT>1.60</ENT>
                            <ENT>2.83</ENT>
                            <ENT>2.36</ENT>
                            <ENT>1.27</ENT>
                            <ENT>1.14</ENT>
                            <ENT>0.06</ENT>
                            <ENT>010</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">17263</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Destruction of skin lesions</ENT>
                            <ENT>1.81</ENT>
                            <ENT>3.06</ENT>
                            <ENT>2.56</ENT>
                            <ENT>1.37</ENT>
                            <ENT>1.23</ENT>
                            <ENT>0.07</ENT>
                            <ENT>010</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">17264</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Destruction of skin lesions</ENT>
                            <ENT>1.96</ENT>
                            <ENT>3.27</ENT>
                            <ENT>2.74</ENT>
                            <ENT>1.43</ENT>
                            <ENT>1.28</ENT>
                            <ENT>0.08</ENT>
                            <ENT>010</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">17266</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Destruction of skin lesions</ENT>
                            <ENT>2.36</ENT>
                            <ENT>3.50</ENT>
                            <ENT>3.00</ENT>
                            <ENT>1.59</ENT>
                            <ENT>1.40</ENT>
                            <ENT>0.09</ENT>
                            <ENT>010</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">17270</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Destruction of skin lesions</ENT>
                            <ENT>1.34</ENT>
                            <ENT>2.43</ENT>
                            <ENT>2.06</ENT>
                            <ENT>1.10</ENT>
                            <ENT>0.98</ENT>
                            <ENT>0.05</ENT>
                            <ENT>010</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">17271</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Destruction of skin lesions</ENT>
                            <ENT>1.51</ENT>
                            <ENT>2.66</ENT>
                            <ENT>2.22</ENT>
                            <ENT>1.22</ENT>
                            <ENT>1.10</ENT>
                            <ENT>0.06</ENT>
                            <ENT>010</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">17272</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Destruction of skin lesions</ENT>
                            <ENT>1.79</ENT>
                            <ENT>2.97</ENT>
                            <ENT>2.48</ENT>
                            <ENT>1.36</ENT>
                            <ENT>1.24</ENT>
                            <ENT>0.07</ENT>
                            <ENT>010</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">17273</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Destruction of skin lesions</ENT>
                            <ENT>2.07</ENT>
                            <ENT>3.21</ENT>
                            <ENT>2.71</ENT>
                            <ENT>1.49</ENT>
                            <ENT>1.35</ENT>
                            <ENT>0.08</ENT>
                            <ENT>010</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">17274</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Destruction of skin lesions</ENT>
                            <ENT>2.61</ENT>
                            <ENT>3.60</ENT>
                            <ENT>3.08</ENT>
                            <ENT>1.74</ENT>
                            <ENT>1.59</ENT>
                            <ENT>0.10</ENT>
                            <ENT>010</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">17276</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Destruction of skin lesions</ENT>
                            <ENT>3.22</ENT>
                            <ENT>3.88</ENT>
                            <ENT>3.41</ENT>
                            <ENT>1.97</ENT>
                            <ENT>1.82</ENT>
                            <ENT>0.16</ENT>
                            <ENT>010</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">17280</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Destruction of skin lesions</ENT>
                            <ENT>1.19</ENT>
                            <ENT>2.36</ENT>
                            <ENT>1.98</ENT>
                            <ENT>1.03</ENT>
                            <ENT>0.92</ENT>
                            <ENT>0.05</ENT>
                            <ENT>010</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">17281</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Destruction of skin lesions</ENT>
                            <ENT>1.74</ENT>
                            <ENT>2.73</ENT>
                            <ENT>2.32</ENT>
                            <ENT>1.33</ENT>
                            <ENT>1.21</ENT>
                            <ENT>0.07</ENT>
                            <ENT>010</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">17282</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Destruction of skin lesions</ENT>
                            <ENT>2.06</ENT>
                            <ENT>3.14</ENT>
                            <ENT>2.64</ENT>
                            <ENT>1.49</ENT>
                            <ENT>1.36</ENT>
                            <ENT>0.08</ENT>
                            <ENT>010</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">17283</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Destruction of skin lesions</ENT>
                            <ENT>2.66</ENT>
                            <ENT>3.55</ENT>
                            <ENT>3.05</ENT>
                            <ENT>1.76</ENT>
                            <ENT>1.62</ENT>
                            <ENT>0.11</ENT>
                            <ENT>010</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">17284</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Destruction of skin lesions</ENT>
                            <ENT>3.23</ENT>
                            <ENT>3.97</ENT>
                            <ENT>3.44</ENT>
                            <ENT>2.02</ENT>
                            <ENT>1.89</ENT>
                            <ENT>0.13</ENT>
                            <ENT>010</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">17286</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Destruction of skin lesions</ENT>
                            <ENT>4.45</ENT>
                            <ENT>4.44</ENT>
                            <ENT>4.06</ENT>
                            <ENT>2.49</ENT>
                            <ENT>2.46</ENT>
                            <ENT>0.23</ENT>
                            <ENT>010</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">17311</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Mohs, 1 stage, h/n/hf/g</ENT>
                            <ENT>6.20</ENT>
                            <ENT>10.70</ENT>
                            <ENT>10.70</ENT>
                            <ENT>3.05</ENT>
                            <ENT>3.05</ENT>
                            <ENT>0.24</ENT>
                            <ENT>000</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">17312</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Mohs addl stage</ENT>
                            <ENT>3.30</ENT>
                            <ENT>6.88</ENT>
                            <ENT>6.88</ENT>
                            <ENT>1.62</ENT>
                            <ENT>1.62</ENT>
                            <ENT>0.13</ENT>
                            <ENT>ZZZ</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">17313</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Mohs, 1 stage, t/a/l</ENT>
                            <ENT>5.56</ENT>
                            <ENT>9.87</ENT>
                            <ENT>9.87</ENT>
                            <ENT>2.73</ENT>
                            <ENT>2.73</ENT>
                            <ENT>0.22</ENT>
                            <ENT>000</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">17314</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Mohs, addl stage, t/a/l</ENT>
                            <ENT>3.06</ENT>
                            <ENT>6.37</ENT>
                            <ENT>6.37</ENT>
                            <ENT>1.50</ENT>
                            <ENT>1.50</ENT>
                            <ENT>0.12</ENT>
                            <ENT>ZZZ</ENT>
                        </ROW>
                        <ROW>
                            <PRTPAGE P="66417"/>
                            <ENT I="01">17315</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Mohs surg, addl block</ENT>
                            <ENT>0.87</ENT>
                            <ENT>1.14</ENT>
                            <ENT>1.14</ENT>
                            <ENT>0.43</ENT>
                            <ENT>0.43</ENT>
                            <ENT>0.03</ENT>
                            <ENT>ZZZ</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">17340</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Cryotherapy of skin</ENT>
                            <ENT>0.76</ENT>
                            <ENT>0.35</ENT>
                            <ENT>0.36</ENT>
                            <ENT>0.38</ENT>
                            <ENT>0.37</ENT>
                            <ENT>0.05</ENT>
                            <ENT>010</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">17360</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Skin peel therapy</ENT>
                            <ENT>1.44</ENT>
                            <ENT>1.86</ENT>
                            <ENT>1.65</ENT>
                            <ENT>1.01</ENT>
                            <ENT>0.94</ENT>
                            <ENT>0.06</ENT>
                            <ENT>010</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">17380</ENT>
                            <ENT/>
                            <ENT>R</ENT>
                            <ENT>Hair removal by electrolysis</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>000</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">17999</ENT>
                            <ENT/>
                            <ENT>C</ENT>
                            <ENT>Skin tissue procedure</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>YYY</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">19000</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Drainage of breast lesion</ENT>
                            <ENT>0.84</ENT>
                            <ENT>1.91</ENT>
                            <ENT>1.95</ENT>
                            <ENT>0.26</ENT>
                            <ENT>0.29</ENT>
                            <ENT>0.08</ENT>
                            <ENT>000</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">19001</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Drain breast lesion add-on</ENT>
                            <ENT>0.42</ENT>
                            <ENT>0.25</ENT>
                            <ENT>0.25</ENT>
                            <ENT>0.14</ENT>
                            <ENT>0.14</ENT>
                            <ENT>0.04</ENT>
                            <ENT>ZZZ</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">19020</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Incision of breast lesion</ENT>
                            <ENT>3.74</ENT>
                            <ENT>6.62</ENT>
                            <ENT>6.48</ENT>
                            <ENT>3.03</ENT>
                            <ENT>2.85</ENT>
                            <ENT>0.45</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">19030</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Injection for breast x-ray</ENT>
                            <ENT>1.53</ENT>
                            <ENT>2.66</ENT>
                            <ENT>2.76</ENT>
                            <ENT>0.54</ENT>
                            <ENT>0.52</ENT>
                            <ENT>0.09</ENT>
                            <ENT>000</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">19100</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Bx breast percut w/o image</ENT>
                            <ENT>1.27</ENT>
                            <ENT>2.08</ENT>
                            <ENT>2.08</ENT>
                            <ENT>0.33</ENT>
                            <ENT>0.37</ENT>
                            <ENT>0.16</ENT>
                            <ENT>000</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">19101</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Biopsy of breast, open</ENT>
                            <ENT>3.20</ENT>
                            <ENT>4.37</ENT>
                            <ENT>4.43</ENT>
                            <ENT>1.78</ENT>
                            <ENT>1.85</ENT>
                            <ENT>0.39</ENT>
                            <ENT>010</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">19102</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Bx breast percut w/image</ENT>
                            <ENT>2.00</ENT>
                            <ENT>3.46</ENT>
                            <ENT>3.64</ENT>
                            <ENT>0.68</ENT>
                            <ENT>0.67</ENT>
                            <ENT>0.14</ENT>
                            <ENT>000</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">19103</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Bx breast percut w/device</ENT>
                            <ENT>3.69</ENT>
                            <ENT>10.09</ENT>
                            <ENT>10.79</ENT>
                            <ENT>1.19</ENT>
                            <ENT>1.21</ENT>
                            <ENT>0.30</ENT>
                            <ENT>000</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">19105</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Cryosurg ablate fa, each</ENT>
                            <ENT>3.69</ENT>
                            <ENT>46.46</ENT>
                            <ENT>46.46</ENT>
                            <ENT>0.99</ENT>
                            <ENT>0.99</ENT>
                            <ENT>0.30</ENT>
                            <ENT>000</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">19110</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Nipple exploration</ENT>
                            <ENT>4.35</ENT>
                            <ENT>6.06</ENT>
                            <ENT>5.93</ENT>
                            <ENT>3.09</ENT>
                            <ENT>2.98</ENT>
                            <ENT>0.57</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">19112</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Excise breast duct fistula</ENT>
                            <ENT>3.72</ENT>
                            <ENT>6.22</ENT>
                            <ENT>6.14</ENT>
                            <ENT>3.12</ENT>
                            <ENT>2.90</ENT>
                            <ENT>0.48</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">19120</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Removal of breast lesion</ENT>
                            <ENT>5.84</ENT>
                            <ENT>5.08</ENT>
                            <ENT>4.81</ENT>
                            <ENT>3.36</ENT>
                            <ENT>3.21</ENT>
                            <ENT>0.73</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">19125</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Excision, breast lesion</ENT>
                            <ENT>6.59</ENT>
                            <ENT>5.55</ENT>
                            <ENT>5.16</ENT>
                            <ENT>3.64</ENT>
                            <ENT>3.46</ENT>
                            <ENT>0.80</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">19126</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Excision, addl breast lesion</ENT>
                            <ENT>2.93</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>0.75</ENT>
                            <ENT>0.87</ENT>
                            <ENT>0.38</ENT>
                            <ENT>ZZZ</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">19260</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Removal of chest wall lesion</ENT>
                            <ENT>17.60</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>10.14</ENT>
                            <ENT>10.64</ENT>
                            <ENT>2.14</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">19271</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Revision of chest wall</ENT>
                            <ENT>21.86</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>15.81</ENT>
                            <ENT>16.87</ENT>
                            <ENT>2.63</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">19272</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Extensive chest wall surgery</ENT>
                            <ENT>24.82</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>16.95</ENT>
                            <ENT>17.93</ENT>
                            <ENT>3.00</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">19290</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Place needle wire, breast</ENT>
                            <ENT>1.27</ENT>
                            <ENT>2.89</ENT>
                            <ENT>2.87</ENT>
                            <ENT>0.45</ENT>
                            <ENT>0.43</ENT>
                            <ENT>0.07</ENT>
                            <ENT>000</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">19291</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Place needle wire, breast</ENT>
                            <ENT>0.63</ENT>
                            <ENT>1.14</ENT>
                            <ENT>1.17</ENT>
                            <ENT>0.22</ENT>
                            <ENT>0.21</ENT>
                            <ENT>0.04</ENT>
                            <ENT>ZZZ</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">19295</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Place breast clip, percut</ENT>
                            <ENT>0.00</ENT>
                            <ENT>2.28</ENT>
                            <ENT>2.48</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>0.01</ENT>
                            <ENT>ZZZ</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">19296</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Place po breast cath for rad</ENT>
                            <ENT>3.63</ENT>
                            <ENT>85.92</ENT>
                            <ENT>105.62</ENT>
                            <ENT>1.19</ENT>
                            <ENT>1.36</ENT>
                            <ENT>0.36</ENT>
                            <ENT>000</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">19297</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Place breast cath for rad</ENT>
                            <ENT>1.72</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>0.44</ENT>
                            <ENT>0.54</ENT>
                            <ENT>0.17</ENT>
                            <ENT>ZZZ</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">19298</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Place breast rad tube/caths</ENT>
                            <ENT>6.00</ENT>
                            <ENT>21.99</ENT>
                            <ENT>32.06</ENT>
                            <ENT>2.10</ENT>
                            <ENT>2.26</ENT>
                            <ENT>0.43</ENT>
                            <ENT>000</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">19300</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Removal of breast tissue</ENT>
                            <ENT>5.20</ENT>
                            <ENT>8.05</ENT>
                            <ENT>7.59</ENT>
                            <ENT>3.85</ENT>
                            <ENT>3.62</ENT>
                            <ENT>0.69</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">19301</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Partical mastectomy</ENT>
                            <ENT>10.00</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>4.62</ENT>
                            <ENT>4.02</ENT>
                            <ENT>0.79</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">19302</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>P-mastectomy w/ln removal</ENT>
                            <ENT>13.88</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>6.14</ENT>
                            <ENT>6.23</ENT>
                            <ENT>1.80</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">19303</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Mast, simple, complete</ENT>
                            <ENT>15.67</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>6.99</ENT>
                            <ENT>6.00</ENT>
                            <ENT>1.18</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">19304</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Mast, subq</ENT>
                            <ENT>7.81</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>4.93</ENT>
                            <ENT>4.84</ENT>
                            <ENT>1.04</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">19305</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Mast, radical</ENT>
                            <ENT>17.23</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>8.11</ENT>
                            <ENT>8.03</ENT>
                            <ENT>1.93</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">19306</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Mast, rad, urban type</ENT>
                            <ENT>17.85</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>8.71</ENT>
                            <ENT>8.47</ENT>
                            <ENT>2.08</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">19307</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Mast, mod rad</ENT>
                            <ENT>17.95</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>8.76</ENT>
                            <ENT>8.48</ENT>
                            <ENT>2.13</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">19316</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Suspension of breast</ENT>
                            <ENT>10.98</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>6.94</ENT>
                            <ENT>7.22</ENT>
                            <ENT>1.64</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">19318</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Reduction of large breast</ENT>
                            <ENT>15.91</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>9.90</ENT>
                            <ENT>10.53</ENT>
                            <ENT>2.93</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">19324</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Enlarge breast</ENT>
                            <ENT>6.65</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>4.46</ENT>
                            <ENT>4.67</ENT>
                            <ENT>0.84</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">19325</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Enlarge breast with implant</ENT>
                            <ENT>8.52</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>6.40</ENT>
                            <ENT>6.46</ENT>
                            <ENT>1.33</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">19328</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Removal of breast implant</ENT>
                            <ENT>6.35</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>4.99</ENT>
                            <ENT>5.00</ENT>
                            <ENT>0.91</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">19330</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Removal of implant material</ENT>
                            <ENT>8.39</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>5.95</ENT>
                            <ENT>5.99</ENT>
                            <ENT>1.26</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">19340</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Immediate breast prosthesis</ENT>
                            <ENT>6.32</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>2.81</ENT>
                            <ENT>2.96</ENT>
                            <ENT>1.06</ENT>
                            <ENT>ZZZ</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">19342</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Delayed breast prosthesis</ENT>
                            <ENT>12.40</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>8.92</ENT>
                            <ENT>8.92</ENT>
                            <ENT>1.84</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">19350</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Breast reconstruction</ENT>
                            <ENT>8.99</ENT>
                            <ENT>9.88</ENT>
                            <ENT>11.86</ENT>
                            <ENT>6.58</ENT>
                            <ENT>6.87</ENT>
                            <ENT>1.41</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">19355</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Correct inverted nipple(s)</ENT>
                            <ENT>8.37</ENT>
                            <ENT>7.40</ENT>
                            <ENT>8.82</ENT>
                            <ENT>4.67</ENT>
                            <ENT>4.68</ENT>
                            <ENT>0.92</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">19357</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Breast reconstruction</ENT>
                            <ENT>20.57</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>15.37</ENT>
                            <ENT>15.49</ENT>
                            <ENT>2.94</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">19361</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Breast reconstr w/lat flap</ENT>
                            <ENT>23.17</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>16.78</ENT>
                            <ENT>14.60</ENT>
                            <ENT>2.93</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">19364</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Breast reconstruction</ENT>
                            <ENT>42.40</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>22.15</ENT>
                            <ENT>22.84</ENT>
                            <ENT>6.24</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">19366</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Breast reconstruction</ENT>
                            <ENT>21.70</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>9.90</ENT>
                            <ENT>10.73</ENT>
                            <ENT>3.25</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">19367</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Breast reconstruction</ENT>
                            <ENT>26.59</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>15.17</ENT>
                            <ENT>15.93</ENT>
                            <ENT>4.04</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">19368</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Breast reconstruction</ENT>
                            <ENT>33.61</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>18.01</ENT>
                            <ENT>18.46</ENT>
                            <ENT>5.54</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">19369</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Breast reconstruction</ENT>
                            <ENT>31.02</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>16.31</ENT>
                            <ENT>17.35</ENT>
                            <ENT>4.51</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">19370</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Surgery of breast capsule</ENT>
                            <ENT>8.99</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>6.78</ENT>
                            <ENT>6.84</ENT>
                            <ENT>1.29</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">19371</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Removal of breast capsule</ENT>
                            <ENT>10.42</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>7.68</ENT>
                            <ENT>7.75</ENT>
                            <ENT>1.62</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">19380</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Revise breast reconstruction</ENT>
                            <ENT>10.21</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>7.60</ENT>
                            <ENT>7.65</ENT>
                            <ENT>1.44</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">19396</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Design custom breast implant</ENT>
                            <ENT>2.17</ENT>
                            <ENT>4.53</ENT>
                            <ENT>2.80</ENT>
                            <ENT>1.28</ENT>
                            <ENT>1.13</ENT>
                            <ENT>0.30</ENT>
                            <ENT>000</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">19499</ENT>
                            <ENT/>
                            <ENT>C</ENT>
                            <ENT>Breast surgery procedure</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>YYY</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">20000</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Incision of abscess</ENT>
                            <ENT>2.14</ENT>
                            <ENT>2.78</ENT>
                            <ENT>2.74</ENT>
                            <ENT>1.52</ENT>
                            <ENT>1.63</ENT>
                            <ENT>0.25</ENT>
                            <ENT>010</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">20005</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Incision of deep abscess</ENT>
                            <ENT>3.55</ENT>
                            <ENT>3.66</ENT>
                            <ENT>3.58</ENT>
                            <ENT>2.01</ENT>
                            <ENT>2.13</ENT>
                            <ENT>0.46</ENT>
                            <ENT>010</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">20100</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Explore wound, neck</ENT>
                            <ENT>10.33</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>3.58</ENT>
                            <ENT>4.02</ENT>
                            <ENT>1.21</ENT>
                            <ENT>010</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">20101</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Explore wound, chest</ENT>
                            <ENT>3.22</ENT>
                            <ENT>6.59</ENT>
                            <ENT>6.26</ENT>
                            <ENT>1.53</ENT>
                            <ENT>1.57</ENT>
                            <ENT>0.44</ENT>
                            <ENT>010</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">20102</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Explore wound, abdomen</ENT>
                            <ENT>3.95</ENT>
                            <ENT>6.94</ENT>
                            <ENT>7.20</ENT>
                            <ENT>1.84</ENT>
                            <ENT>1.87</ENT>
                            <ENT>0.49</ENT>
                            <ENT>010</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">20103</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Explore wound, extremity</ENT>
                            <ENT>5.31</ENT>
                            <ENT>7.80</ENT>
                            <ENT>8.19</ENT>
                            <ENT>2.78</ENT>
                            <ENT>3.09</ENT>
                            <ENT>0.75</ENT>
                            <ENT>010</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">20150</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Excise epiphyseal bar</ENT>
                            <ENT>14.60</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>7.64</ENT>
                            <ENT>7.33</ENT>
                            <ENT>2.04</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">20200</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Muscle biopsy</ENT>
                            <ENT>1.46</ENT>
                            <ENT>3.09</ENT>
                            <ENT>3.06</ENT>
                            <ENT>0.69</ENT>
                            <ENT>0.72</ENT>
                            <ENT>0.23</ENT>
                            <ENT>000</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">20205</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Deep muscle biopsy</ENT>
                            <ENT>2.35</ENT>
                            <ENT>3.82</ENT>
                            <ENT>3.85</ENT>
                            <ENT>1.10</ENT>
                            <ENT>1.14</ENT>
                            <ENT>0.33</ENT>
                            <ENT>000</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">20206</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Needle biopsy, muscle</ENT>
                            <ENT>0.99</ENT>
                            <ENT>5.22</ENT>
                            <ENT>5.86</ENT>
                            <ENT>0.57</ENT>
                            <ENT>0.60</ENT>
                            <ENT>0.07</ENT>
                            <ENT>000</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">20220</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Bone biopsy, trocar/needle</ENT>
                            <ENT>1.27</ENT>
                            <ENT>2.71</ENT>
                            <ENT>3.63</ENT>
                            <ENT>0.68</ENT>
                            <ENT>0.73</ENT>
                            <ENT>0.08</ENT>
                            <ENT>000</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">20225</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Bone biopsy, trocar/needle</ENT>
                            <ENT>1.87</ENT>
                            <ENT>11.99</ENT>
                            <ENT>18.21</ENT>
                            <ENT>1.02</ENT>
                            <ENT>1.07</ENT>
                            <ENT>0.22</ENT>
                            <ENT>000</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">20240</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Bone biopsy, excisional</ENT>
                            <ENT>3.25</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>2.02</ENT>
                            <ENT>2.29</ENT>
                            <ENT>0.44</ENT>
                            <ENT>010</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">20245</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Bone biopsy, excisional</ENT>
                            <ENT>8.77</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>5.74</ENT>
                            <ENT>6.15</ENT>
                            <ENT>1.31</ENT>
                            <ENT>010</ENT>
                        </ROW>
                        <ROW>
                            <PRTPAGE P="66418"/>
                            <ENT I="01">20250</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Open bone biopsy</ENT>
                            <ENT>5.16</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>3.63</ENT>
                            <ENT>3.56</ENT>
                            <ENT>1.02</ENT>
                            <ENT>010</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">20251</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Open bone biopsy</ENT>
                            <ENT>5.69</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>3.84</ENT>
                            <ENT>4.00</ENT>
                            <ENT>1.15</ENT>
                            <ENT>010</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">20500</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Injection of sinus tract</ENT>
                            <ENT>1.25</ENT>
                            <ENT>1.34</ENT>
                            <ENT>1.80</ENT>
                            <ENT>0.88</ENT>
                            <ENT>1.20</ENT>
                            <ENT>0.12</ENT>
                            <ENT>010</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">20501</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Inject sinus tract for x-ray</ENT>
                            <ENT>0.76</ENT>
                            <ENT>2.36</ENT>
                            <ENT>2.64</ENT>
                            <ENT>0.27</ENT>
                            <ENT>0.26</ENT>
                            <ENT>0.04</ENT>
                            <ENT>000</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">20520</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Removal of foreign body</ENT>
                            <ENT>1.87</ENT>
                            <ENT>2.60</ENT>
                            <ENT>2.76</ENT>
                            <ENT>1.45</ENT>
                            <ENT>1.61</ENT>
                            <ENT>0.21</ENT>
                            <ENT>010</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">20525</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Removal of foreign body</ENT>
                            <ENT>3.51</ENT>
                            <ENT>7.11</ENT>
                            <ENT>8.12</ENT>
                            <ENT>2.21</ENT>
                            <ENT>2.41</ENT>
                            <ENT>0.51</ENT>
                            <ENT>010</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">20526</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Ther injection, carp tunnel</ENT>
                            <ENT>0.94</ENT>
                            <ENT>0.81</ENT>
                            <ENT>0.89</ENT>
                            <ENT>0.41</ENT>
                            <ENT>0.46</ENT>
                            <ENT>0.13</ENT>
                            <ENT>000</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">20550</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Inj tendon sheath/ligament</ENT>
                            <ENT>0.75</ENT>
                            <ENT>0.63</ENT>
                            <ENT>0.67</ENT>
                            <ENT>0.28</ENT>
                            <ENT>0.25</ENT>
                            <ENT>0.09</ENT>
                            <ENT>000</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">20551</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Inj tendon origin/insertion</ENT>
                            <ENT>0.75</ENT>
                            <ENT>0.64</ENT>
                            <ENT>0.66</ENT>
                            <ENT>0.29</ENT>
                            <ENT>0.31</ENT>
                            <ENT>0.08</ENT>
                            <ENT>000</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">20552</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Inj trigger point, 1/2 muscl</ENT>
                            <ENT>0.66</ENT>
                            <ENT>0.58</ENT>
                            <ENT>0.65</ENT>
                            <ENT>0.24</ENT>
                            <ENT>0.22</ENT>
                            <ENT>0.05</ENT>
                            <ENT>000</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">20553</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Inject trigger points, =/&gt; 3</ENT>
                            <ENT>0.75</ENT>
                            <ENT>0.64</ENT>
                            <ENT>0.73</ENT>
                            <ENT>0.26</ENT>
                            <ENT>0.24</ENT>
                            <ENT>0.04</ENT>
                            <ENT>000</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">20555</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Place ndl musc/tis for rt</ENT>
                            <ENT>6.00</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>2.18</ENT>
                            <ENT>2.18</ENT>
                            <ENT>0.43</ENT>
                            <ENT>000</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">20600</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Drain/inject, joint/bursa</ENT>
                            <ENT>0.66</ENT>
                            <ENT>0.66</ENT>
                            <ENT>0.66</ENT>
                            <ENT>0.31</ENT>
                            <ENT>0.33</ENT>
                            <ENT>0.08</ENT>
                            <ENT>000</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">20605</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Drain/inject, joint/bursa</ENT>
                            <ENT>0.68</ENT>
                            <ENT>0.74</ENT>
                            <ENT>0.75</ENT>
                            <ENT>0.32</ENT>
                            <ENT>0.34</ENT>
                            <ENT>0.08</ENT>
                            <ENT>000</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">20610</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Drain/inject, joint/bursa</ENT>
                            <ENT>0.79</ENT>
                            <ENT>1.06</ENT>
                            <ENT>1.01</ENT>
                            <ENT>0.40</ENT>
                            <ENT>0.41</ENT>
                            <ENT>0.11</ENT>
                            <ENT>000</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">20612</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Aspirate/inj ganglion cyst</ENT>
                            <ENT>0.70</ENT>
                            <ENT>0.70</ENT>
                            <ENT>0.70</ENT>
                            <ENT>0.32</ENT>
                            <ENT>0.34</ENT>
                            <ENT>0.10</ENT>
                            <ENT>000</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">20615</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Treatment of bone cyst</ENT>
                            <ENT>2.30</ENT>
                            <ENT>2.71</ENT>
                            <ENT>3.11</ENT>
                            <ENT>1.41</ENT>
                            <ENT>1.63</ENT>
                            <ENT>0.20</ENT>
                            <ENT>010</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">20650</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Insert and remove bone pin</ENT>
                            <ENT>2.25</ENT>
                            <ENT>2.46</ENT>
                            <ENT>2.41</ENT>
                            <ENT>1.45</ENT>
                            <ENT>1.50</ENT>
                            <ENT>0.31</ENT>
                            <ENT>010</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">20660</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Apply, rem fixation device</ENT>
                            <ENT>4.00</ENT>
                            <ENT>1.50</ENT>
                            <ENT>2.27</ENT>
                            <ENT>1.50</ENT>
                            <ENT>1.55</ENT>
                            <ENT>0.59</ENT>
                            <ENT>000</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">20661</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Application of head brace</ENT>
                            <ENT>5.14</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>6.04</ENT>
                            <ENT>5.47</ENT>
                            <ENT>1.14</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">20662</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Application of pelvis brace</ENT>
                            <ENT>6.26</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>4.80</ENT>
                            <ENT>5.16</ENT>
                            <ENT>0.56</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">20663</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Application of thigh brace</ENT>
                            <ENT>5.62</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>4.85</ENT>
                            <ENT>4.84</ENT>
                            <ENT>0.94</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">20664</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Halo brace application</ENT>
                            <ENT>9.86</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>7.80</ENT>
                            <ENT>7.42</ENT>
                            <ENT>1.75</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">20665</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Removal of fixation device</ENT>
                            <ENT>1.33</ENT>
                            <ENT>1.37</ENT>
                            <ENT>1.76</ENT>
                            <ENT>0.98</ENT>
                            <ENT>1.16</ENT>
                            <ENT>0.19</ENT>
                            <ENT>010</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">20670</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Removal of support implant</ENT>
                            <ENT>1.76</ENT>
                            <ENT>6.62</ENT>
                            <ENT>9.07</ENT>
                            <ENT>1.67</ENT>
                            <ENT>1.88</ENT>
                            <ENT>0.28</ENT>
                            <ENT>010</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">20680</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Removal of support implant</ENT>
                            <ENT>5.90</ENT>
                            <ENT>8.13</ENT>
                            <ENT>8.46</ENT>
                            <ENT>4.06</ENT>
                            <ENT>3.89</ENT>
                            <ENT>0.56</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">20690</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Apply bone fixation device</ENT>
                            <ENT>8.65</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>4.91</ENT>
                            <ENT>3.71</ENT>
                            <ENT>0.59</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">20692</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Apply bone fixation device</ENT>
                            <ENT>16.00</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>9.79</ENT>
                            <ENT>6.78</ENT>
                            <ENT>1.05</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">20693</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Adjust bone fixation device</ENT>
                            <ENT>5.97</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>4.49</ENT>
                            <ENT>4.96</ENT>
                            <ENT>0.98</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">20694</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Remove bone fixation device</ENT>
                            <ENT>4.20</ENT>
                            <ENT>5.31</ENT>
                            <ENT>6.22</ENT>
                            <ENT>3.52</ENT>
                            <ENT>3.78</ENT>
                            <ENT>0.71</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">20802</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Replantation, arm, complete</ENT>
                            <ENT>42.30</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>13.22</ENT>
                            <ENT>17.08</ENT>
                            <ENT>3.82</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">20805</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Replant forearm, complete</ENT>
                            <ENT>51.14</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>17.97</ENT>
                            <ENT>26.13</ENT>
                            <ENT>4.85</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">20808</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Replantation hand, complete</ENT>
                            <ENT>62.77</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>30.31</ENT>
                            <ENT>36.25</ENT>
                            <ENT>6.88</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">20816</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Replantation digit, complete</ENT>
                            <ENT>31.74</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>16.35</ENT>
                            <ENT>27.06</ENT>
                            <ENT>4.53</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">20822</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Replantation digit, complete</ENT>
                            <ENT>26.42</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>15.05</ENT>
                            <ENT>24.81</ENT>
                            <ENT>4.19</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">20824</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Replantation thumb, complete</ENT>
                            <ENT>31.74</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>16.19</ENT>
                            <ENT>26.36</ENT>
                            <ENT>4.62</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">20827</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Replantation thumb, complete</ENT>
                            <ENT>27.24</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>14.73</ENT>
                            <ENT>25.59</ENT>
                            <ENT>3.67</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">20838</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Replantation foot, complete</ENT>
                            <ENT>42.56</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>14.01</ENT>
                            <ENT>18.14</ENT>
                            <ENT>1.12</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">20900</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Removal of bone for graft</ENT>
                            <ENT>5.77</ENT>
                            <ENT>9.22</ENT>
                            <ENT>8.82</ENT>
                            <ENT>4.90</ENT>
                            <ENT>5.28</ENT>
                            <ENT>0.94</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">20902</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Removal of bone for graft</ENT>
                            <ENT>7.98</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>5.98</ENT>
                            <ENT>6.43</ENT>
                            <ENT>1.30</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">20910</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Remove cartilage for graft</ENT>
                            <ENT>5.41</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>4.56</ENT>
                            <ENT>4.87</ENT>
                            <ENT>0.71</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">20912</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Remove cartilage for graft</ENT>
                            <ENT>6.42</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>4.94</ENT>
                            <ENT>5.37</ENT>
                            <ENT>0.69</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">20920</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Removal of fascia for graft</ENT>
                            <ENT>5.42</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>4.33</ENT>
                            <ENT>4.28</ENT>
                            <ENT>0.66</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">20922</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Removal of fascia for graft</ENT>
                            <ENT>6.84</ENT>
                            <ENT>7.56</ENT>
                            <ENT>7.54</ENT>
                            <ENT>4.99</ENT>
                            <ENT>4.93</ENT>
                            <ENT>0.70</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">20924</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Removal of tendon for graft</ENT>
                            <ENT>6.59</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>4.97</ENT>
                            <ENT>5.42</ENT>
                            <ENT>1.04</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">20926</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Removal of tissue for graft</ENT>
                            <ENT>5.70</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>4.49</ENT>
                            <ENT>4.62</ENT>
                            <ENT>0.87</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">20930</ENT>
                            <ENT/>
                            <ENT>B</ENT>
                            <ENT>Sp bone algrft morsel add-on</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>XXX</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">20931</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Sp bone algrft struct add-on</ENT>
                            <ENT>1.81</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>0.68</ENT>
                            <ENT>0.80</ENT>
                            <ENT>0.43</ENT>
                            <ENT>ZZZ</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">20936</ENT>
                            <ENT/>
                            <ENT>B</ENT>
                            <ENT>Sp bone agrft local add-on</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>XXX</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">20937</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Sp bone agrft morsel add-on</ENT>
                            <ENT>2.79</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>1.08</ENT>
                            <ENT>1.26</ENT>
                            <ENT>0.54</ENT>
                            <ENT>ZZZ</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">20938</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Sp bone agrft struct add-on</ENT>
                            <ENT>3.02</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>1.15</ENT>
                            <ENT>1.35</ENT>
                            <ENT>0.64</ENT>
                            <ENT>ZZZ</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">20950</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Fluid pressure, muscle</ENT>
                            <ENT>1.26</ENT>
                            <ENT>4.23</ENT>
                            <ENT>5.53</ENT>
                            <ENT>0.88</ENT>
                            <ENT>0.93</ENT>
                            <ENT>0.20</ENT>
                            <ENT>000</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">20955</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Fibula bone graft, microvasc</ENT>
                            <ENT>40.02</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>18.53</ENT>
                            <ENT>21.39</ENT>
                            <ENT>4.90</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">20956</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Iliac bone graft, microvasc</ENT>
                            <ENT>40.93</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>20.31</ENT>
                            <ENT>22.52</ENT>
                            <ENT>7.03</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">20957</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Mt bone graft, microvasc</ENT>
                            <ENT>42.33</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>15.87</ENT>
                            <ENT>17.40</ENT>
                            <ENT>7.07</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">20962</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Other bone graft, microvasc</ENT>
                            <ENT>39.21</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>21.29</ENT>
                            <ENT>23.90</ENT>
                            <ENT>6.57</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">20969</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Bone/skin graft, microvasc</ENT>
                            <ENT>45.11</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>21.09</ENT>
                            <ENT>23.85</ENT>
                            <ENT>4.80</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">20970</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Bone/skin graft, iliac crest</ENT>
                            <ENT>44.26</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>20.89</ENT>
                            <ENT>23.13</ENT>
                            <ENT>6.62</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">20972</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Bone/skin graft, metatarsal</ENT>
                            <ENT>44.19</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>14.92</ENT>
                            <ENT>17.74</ENT>
                            <ENT>5.32</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">20973</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Bone/skin graft, great toe</ENT>
                            <ENT>46.95</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>14.15</ENT>
                            <ENT>19.64</ENT>
                            <ENT>5.56</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">20974</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Electrical bone stimulation</ENT>
                            <ENT>0.62</ENT>
                            <ENT>0.98</ENT>
                            <ENT>0.83</ENT>
                            <ENT>0.48</ENT>
                            <ENT>0.51</ENT>
                            <ENT>0.11</ENT>
                            <ENT>000</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">20975</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Electrical bone stimulation</ENT>
                            <ENT>2.60</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>1.46</ENT>
                            <ENT>1.58</ENT>
                            <ENT>0.51</ENT>
                            <ENT>000</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">20979</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Us bone stimulation</ENT>
                            <ENT>0.62</ENT>
                            <ENT>0.61</ENT>
                            <ENT>0.71</ENT>
                            <ENT>0.20</ENT>
                            <ENT>0.27</ENT>
                            <ENT>0.09</ENT>
                            <ENT>000</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">20982</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Ablate, bone tumor(s) perq</ENT>
                            <ENT>7.27</ENT>
                            <ENT>79.99</ENT>
                            <ENT>94.74</ENT>
                            <ENT>2.68</ENT>
                            <ENT>2.83</ENT>
                            <ENT>0.69</ENT>
                            <ENT>000</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">20985</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Cptr-asst dir ms px</ENT>
                            <ENT>2.50</ENT>
                            <ENT>0.99</ENT>
                            <ENT>0.99</ENT>
                            <ENT>0.99</ENT>
                            <ENT>0.99</ENT>
                            <ENT>0.48</ENT>
                            <ENT>ZZZ</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">20986</ENT>
                            <ENT/>
                            <ENT>C</ENT>
                            <ENT>Cptr-asst dir ms px io img</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>ZZZ</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">20987</ENT>
                            <ENT/>
                            <ENT>C</ENT>
                            <ENT>Cptr-asst dir ms px  pre img</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>ZZZ</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">20999</ENT>
                            <ENT/>
                            <ENT>C</ENT>
                            <ENT>Musculoskeletal surgery</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>YYY</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">21010</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Incision of jaw joint</ENT>
                            <ENT>10.90</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>6.29</ENT>
                            <ENT>6.69</ENT>
                            <ENT>1.11</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">21015</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Resection of facial tumor</ENT>
                            <ENT>5.59</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>4.30</ENT>
                            <ENT>4.65</ENT>
                            <ENT>0.70</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">21025</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Excision of bone, lower jaw</ENT>
                            <ENT>11.07</ENT>
                            <ENT>12.54</ENT>
                            <ENT>12.39</ENT>
                            <ENT>8.74</ENT>
                            <ENT>9.04</ENT>
                            <ENT>1.32</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">21026</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Excision of facial bone(s)</ENT>
                            <ENT>5.54</ENT>
                            <ENT>8.82</ENT>
                            <ENT>8.34</ENT>
                            <ENT>5.93</ENT>
                            <ENT>6.12</ENT>
                            <ENT>0.60</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <PRTPAGE P="66419"/>
                            <ENT I="01">21029</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Contour of face bone lesion</ENT>
                            <ENT>8.26</ENT>
                            <ENT>9.55</ENT>
                            <ENT>9.46</ENT>
                            <ENT>6.52</ENT>
                            <ENT>6.76</ENT>
                            <ENT>0.94</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">21030</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Excise max/zygoma b9 tumor</ENT>
                            <ENT>4.80</ENT>
                            <ENT>7.19</ENT>
                            <ENT>6.76</ENT>
                            <ENT>4.68</ENT>
                            <ENT>4.85</ENT>
                            <ENT>0.54</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">21031</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Remove exostosis, mandible</ENT>
                            <ENT>3.26</ENT>
                            <ENT>5.91</ENT>
                            <ENT>5.54</ENT>
                            <ENT>3.47</ENT>
                            <ENT>3.54</ENT>
                            <ENT>0.48</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">21032</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Remove exostosis, maxilla</ENT>
                            <ENT>3.28</ENT>
                            <ENT>6.04</ENT>
                            <ENT>5.69</ENT>
                            <ENT>3.36</ENT>
                            <ENT>3.43</ENT>
                            <ENT>0.47</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">21034</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Excise max/zygoma mlg tumor</ENT>
                            <ENT>17.17</ENT>
                            <ENT>13.92</ENT>
                            <ENT>14.92</ENT>
                            <ENT>10.11</ENT>
                            <ENT>11.38</ENT>
                            <ENT>1.72</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">21040</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Excise mandible lesion</ENT>
                            <ENT>4.80</ENT>
                            <ENT>7.19</ENT>
                            <ENT>6.79</ENT>
                            <ENT>4.64</ENT>
                            <ENT>4.68</ENT>
                            <ENT>0.54</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">21044</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Removal of jaw bone lesion</ENT>
                            <ENT>12.61</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>8.10</ENT>
                            <ENT>8.73</ENT>
                            <ENT>1.12</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">21045</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Extensive jaw surgery</ENT>
                            <ENT>18.13</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>10.78</ENT>
                            <ENT>11.56</ENT>
                            <ENT>1.52</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">21046</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Remove mandible cyst complex</ENT>
                            <ENT>13.97</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>11.48</ENT>
                            <ENT>11.69</ENT>
                            <ENT>1.86</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">21047</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Excise lwr jaw cyst w/repair</ENT>
                            <ENT>19.83</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>10.21</ENT>
                            <ENT>11.82</ENT>
                            <ENT>2.13</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">21048</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Remove maxilla cyst complex</ENT>
                            <ENT>14.47</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>11.38</ENT>
                            <ENT>11.75</ENT>
                            <ENT>1.77</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">21049</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Excis uppr jaw cyst w/repair</ENT>
                            <ENT>19.08</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>10.28</ENT>
                            <ENT>11.65</ENT>
                            <ENT>1.59</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">21050</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Removal of jaw joint</ENT>
                            <ENT>11.54</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>8.20</ENT>
                            <ENT>8.82</ENT>
                            <ENT>1.47</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">21060</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Remove jaw joint cartilage</ENT>
                            <ENT>10.91</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>7.19</ENT>
                            <ENT>7.89</ENT>
                            <ENT>1.38</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">21070</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Remove coronoid process</ENT>
                            <ENT>8.50</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>6.26</ENT>
                            <ENT>6.68</ENT>
                            <ENT>1.27</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">21073</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Mnpj of tmj w/anesth</ENT>
                            <ENT>3.33</ENT>
                            <ENT>5.50</ENT>
                            <ENT>5.50</ENT>
                            <ENT>2.31</ENT>
                            <ENT>2.31</ENT>
                            <ENT>0.43</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">21076</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Prepare face/oral prosthesis</ENT>
                            <ENT>13.40</ENT>
                            <ENT>8.01</ENT>
                            <ENT>10.18</ENT>
                            <ENT>4.68</ENT>
                            <ENT>7.34</ENT>
                            <ENT>2.00</ENT>
                            <ENT>010</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">21077</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Prepare face/oral prosthesis</ENT>
                            <ENT>33.70</ENT>
                            <ENT>18.42</ENT>
                            <ENT>24.86</ENT>
                            <ENT>11.82</ENT>
                            <ENT>18.90</ENT>
                            <ENT>4.56</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">21079</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Prepare face/oral prosthesis</ENT>
                            <ENT>22.31</ENT>
                            <ENT>13.95</ENT>
                            <ENT>17.72</ENT>
                            <ENT>8.09</ENT>
                            <ENT>12.62</ENT>
                            <ENT>3.16</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">21080</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Prepare face/oral prosthesis</ENT>
                            <ENT>25.06</ENT>
                            <ENT>16.14</ENT>
                            <ENT>20.31</ENT>
                            <ENT>9.01</ENT>
                            <ENT>14.18</ENT>
                            <ENT>3.75</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">21081</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Prepare face/oral prosthesis</ENT>
                            <ENT>22.85</ENT>
                            <ENT>15.01</ENT>
                            <ENT>18.65</ENT>
                            <ENT>8.40</ENT>
                            <ENT>12.94</ENT>
                            <ENT>3.21</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">21082</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Prepare face/oral prosthesis</ENT>
                            <ENT>20.84</ENT>
                            <ENT>14.89</ENT>
                            <ENT>17.11</ENT>
                            <ENT>8.26</ENT>
                            <ENT>11.99</ENT>
                            <ENT>3.12</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">21083</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Prepare face/oral prosthesis</ENT>
                            <ENT>19.27</ENT>
                            <ENT>14.89</ENT>
                            <ENT>16.83</ENT>
                            <ENT>7.77</ENT>
                            <ENT>11.10</ENT>
                            <ENT>2.89</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">21084</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Prepare face/oral prosthesis</ENT>
                            <ENT>22.48</ENT>
                            <ENT>16.83</ENT>
                            <ENT>19.63</ENT>
                            <ENT>8.94</ENT>
                            <ENT>13.31</ENT>
                            <ENT>2.19</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">21085</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Prepare face/oral prosthesis</ENT>
                            <ENT>8.99</ENT>
                            <ENT>6.92</ENT>
                            <ENT>7.60</ENT>
                            <ENT>3.51</ENT>
                            <ENT>5.14</ENT>
                            <ENT>1.27</ENT>
                            <ENT>010</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">21086</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Prepare face/oral prosthesis</ENT>
                            <ENT>24.88</ENT>
                            <ENT>12.90</ENT>
                            <ENT>18.31</ENT>
                            <ENT>8.44</ENT>
                            <ENT>13.93</ENT>
                            <ENT>3.72</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">21087</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Prepare face/oral prosthesis</ENT>
                            <ENT>24.88</ENT>
                            <ENT>13.03</ENT>
                            <ENT>18.15</ENT>
                            <ENT>8.54</ENT>
                            <ENT>13.86</ENT>
                            <ENT>3.45</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">21088</ENT>
                            <ENT/>
                            <ENT>C</ENT>
                            <ENT>Prepare face/oral prosthesis</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">21089</ENT>
                            <ENT/>
                            <ENT>C</ENT>
                            <ENT>Prepare face/oral prosthesis</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">21100</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Maxillofacial fixation</ENT>
                            <ENT>4.56</ENT>
                            <ENT>14.86</ENT>
                            <ENT>13.19</ENT>
                            <ENT>5.53</ENT>
                            <ENT>5.13</ENT>
                            <ENT>0.34</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">21110</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Interdental fixation</ENT>
                            <ENT>5.80</ENT>
                            <ENT>13.04</ENT>
                            <ENT>11.30</ENT>
                            <ENT>9.73</ENT>
                            <ENT>9.04</ENT>
                            <ENT>0.72</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">21116</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Injection, jaw joint x-ray</ENT>
                            <ENT>0.81</ENT>
                            <ENT>2.52</ENT>
                            <ENT>3.42</ENT>
                            <ENT>0.23</ENT>
                            <ENT>0.28</ENT>
                            <ENT>0.06</ENT>
                            <ENT>000</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">21120</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Reconstruction of chin</ENT>
                            <ENT>4.99</ENT>
                            <ENT>9.64</ENT>
                            <ENT>10.11</ENT>
                            <ENT>6.64</ENT>
                            <ENT>7.06</ENT>
                            <ENT>0.60</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">21121</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Reconstruction of chin</ENT>
                            <ENT>7.70</ENT>
                            <ENT>10.63</ENT>
                            <ENT>10.18</ENT>
                            <ENT>7.58</ENT>
                            <ENT>7.70</ENT>
                            <ENT>0.90</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">21122</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Reconstruction of chin</ENT>
                            <ENT>8.59</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>8.45</ENT>
                            <ENT>8.53</ENT>
                            <ENT>1.07</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">21123</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Reconstruction of chin</ENT>
                            <ENT>11.22</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>7.03</ENT>
                            <ENT>8.91</ENT>
                            <ENT>1.40</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">21125</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Augmentation, lower jaw bone</ENT>
                            <ENT>10.68</ENT>
                            <ENT>63.93</ENT>
                            <ENT>59.56</ENT>
                            <ENT>6.42</ENT>
                            <ENT>7.37</ENT>
                            <ENT>0.79</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">21127</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Augmentation, lower jaw bone</ENT>
                            <ENT>12.24</ENT>
                            <ENT>84.93</ENT>
                            <ENT>63.85</ENT>
                            <ENT>7.49</ENT>
                            <ENT>8.47</ENT>
                            <ENT>1.52</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">21137</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Reduction of forehead</ENT>
                            <ENT>10.12</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>7.43</ENT>
                            <ENT>7.58</ENT>
                            <ENT>1.32</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">21138</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Reduction of forehead</ENT>
                            <ENT>12.73</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>7.78</ENT>
                            <ENT>8.65</ENT>
                            <ENT>1.75</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">21139</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Reduction of forehead</ENT>
                            <ENT>14.90</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>6.98</ENT>
                            <ENT>9.02</ENT>
                            <ENT>1.18</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">21141</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Reconstruct midface, lefort</ENT>
                            <ENT>19.27</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>11.85</ENT>
                            <ENT>12.75</ENT>
                            <ENT>2.36</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">21142</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Reconstruct midface, lefort</ENT>
                            <ENT>19.98</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>10.07</ENT>
                            <ENT>11.44</ENT>
                            <ENT>2.39</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">21143</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Reconstruct midface, lefort</ENT>
                            <ENT>20.75</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>11.80</ENT>
                            <ENT>13.05</ENT>
                            <ENT>1.66</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">21145</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Reconstruct midface, lefort</ENT>
                            <ENT>23.64</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>12.96</ENT>
                            <ENT>13.43</ENT>
                            <ENT>2.85</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">21146</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Reconstruct midface, lefort</ENT>
                            <ENT>24.54</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>9.17</ENT>
                            <ENT>12.25</ENT>
                            <ENT>3.10</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">21147</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Reconstruct midface, lefort</ENT>
                            <ENT>26.14</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>14.29</ENT>
                            <ENT>14.67</ENT>
                            <ENT>1.85</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">21150</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Reconstruct midface, lefort</ENT>
                            <ENT>25.78</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>16.90</ENT>
                            <ENT>16.83</ENT>
                            <ENT>2.56</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">21151</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Reconstruct midface, lefort</ENT>
                            <ENT>28.84</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>11.60</ENT>
                            <ENT>17.27</ENT>
                            <ENT>2.31</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">21154</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Reconstruct midface, lefort</ENT>
                            <ENT>31.05</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>17.87</ENT>
                            <ENT>20.49</ENT>
                            <ENT>2.49</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">21155</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Reconstruct midface, lefort</ENT>
                            <ENT>34.98</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>18.15</ENT>
                            <ENT>21.02</ENT>
                            <ENT>6.66</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">21159</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Reconstruct midface, lefort</ENT>
                            <ENT>42.90</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>15.12</ENT>
                            <ENT>22.09</ENT>
                            <ENT>8.20</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">21160</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Reconstruct midface, lefort</ENT>
                            <ENT>46.95</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>23.21</ENT>
                            <ENT>25.33</ENT>
                            <ENT>4.14</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">21172</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Reconstruct orbit/forehead</ENT>
                            <ENT>28.07</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>13.73</ENT>
                            <ENT>13.74</ENT>
                            <ENT>3.56</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">21175</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Reconstruct orbit/forehead</ENT>
                            <ENT>33.43</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>13.51</ENT>
                            <ENT>15.65</ENT>
                            <ENT>4.84</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">21179</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Reconstruct entire forehead</ENT>
                            <ENT>22.53</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>11.21</ENT>
                            <ENT>12.66</ENT>
                            <ENT>2.81</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">21180</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Reconstruct entire forehead</ENT>
                            <ENT>25.46</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>12.98</ENT>
                            <ENT>14.18</ENT>
                            <ENT>3.49</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">21181</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Contour cranial bone lesion</ENT>
                            <ENT>10.18</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>6.82</ENT>
                            <ENT>7.14</ENT>
                            <ENT>1.32</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">21182</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Reconstruct cranial bone</ENT>
                            <ENT>32.45</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>15.26</ENT>
                            <ENT>17.18</ENT>
                            <ENT>2.81</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">21183</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Reconstruct cranial bone</ENT>
                            <ENT>35.57</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>19.20</ENT>
                            <ENT>20.01</ENT>
                            <ENT>4.48</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">21184</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Reconstruct cranial bone</ENT>
                            <ENT>38.49</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>15.61</ENT>
                            <ENT>18.77</ENT>
                            <ENT>5.72</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">21188</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Reconstruction of midface</ENT>
                            <ENT>22.97</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>15.63</ENT>
                            <ENT>17.24</ENT>
                            <ENT>1.70</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">21193</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Reconst lwr jaw w/o graft</ENT>
                            <ENT>18.65</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>9.80</ENT>
                            <ENT>11.23</ENT>
                            <ENT>2.24</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">21194</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Reconst lwr jaw w/graft</ENT>
                            <ENT>21.54</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>12.12</ENT>
                            <ENT>12.93</ENT>
                            <ENT>2.03</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">21195</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Reconst lwr jaw w/o fixation</ENT>
                            <ENT>18.88</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>13.06</ENT>
                            <ENT>13.94</ENT>
                            <ENT>1.64</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">21196</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Reconst lwr jaw w/fixation</ENT>
                            <ENT>20.55</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>13.93</ENT>
                            <ENT>14.81</ENT>
                            <ENT>2.08</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">21198</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Reconstr lwr jaw segment</ENT>
                            <ENT>15.48</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>11.88</ENT>
                            <ENT>12.29</ENT>
                            <ENT>1.44</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">21199</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Reconstr lwr jaw w/advance</ENT>
                            <ENT>16.62</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>7.56</ENT>
                            <ENT>8.34</ENT>
                            <ENT>1.39</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">21206</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Reconstruct upper jaw bone</ENT>
                            <ENT>15.36</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>10.88</ENT>
                            <ENT>11.75</ENT>
                            <ENT>1.33</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">21208</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Augmentation of facial bones</ENT>
                            <ENT>11.15</ENT>
                            <ENT>33.14</ENT>
                            <ENT>27.73</ENT>
                            <ENT>8.00</ENT>
                            <ENT>8.79</ENT>
                            <ENT>1.09</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">21209</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Reduction of facial bones</ENT>
                            <ENT>7.58</ENT>
                            <ENT>12.19</ENT>
                            <ENT>11.49</ENT>
                            <ENT>7.39</ENT>
                            <ENT>7.72</ENT>
                            <ENT>0.90</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">21210</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Face bone graft</ENT>
                            <ENT>11.40</ENT>
                            <ENT>43.44</ENT>
                            <ENT>34.15</ENT>
                            <ENT>7.63</ENT>
                            <ENT>8.49</ENT>
                            <ENT>1.30</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <PRTPAGE P="66420"/>
                            <ENT I="01">21215</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Lower jaw bone graft</ENT>
                            <ENT>11.94</ENT>
                            <ENT>86.03</ENT>
                            <ENT>63.95</ENT>
                            <ENT>7.96</ENT>
                            <ENT>8.66</ENT>
                            <ENT>1.53</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">21230</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Rib cartilage graft</ENT>
                            <ENT>11.06</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>7.01</ENT>
                            <ENT>7.52</ENT>
                            <ENT>1.29</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">21235</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Ear cartilage graft</ENT>
                            <ENT>7.31</ENT>
                            <ENT>10.10</ENT>
                            <ENT>9.97</ENT>
                            <ENT>6.18</ENT>
                            <ENT>6.29</ENT>
                            <ENT>0.61</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">21240</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Reconstruction of jaw joint</ENT>
                            <ENT>15.77</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>9.43</ENT>
                            <ENT>10.73</ENT>
                            <ENT>2.25</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">21242</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Reconstruction of jaw joint</ENT>
                            <ENT>14.32</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>9.01</ENT>
                            <ENT>10.25</ENT>
                            <ENT>1.79</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">21243</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Reconstruction of jaw joint</ENT>
                            <ENT>24.03</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>14.14</ENT>
                            <ENT>15.78</ENT>
                            <ENT>3.26</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">21244</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Reconstruction of lower jaw</ENT>
                            <ENT>13.35</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>11.51</ENT>
                            <ENT>11.80</ENT>
                            <ENT>1.25</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">21245</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Reconstruction of jaw</ENT>
                            <ENT>12.88</ENT>
                            <ENT>14.20</ENT>
                            <ENT>14.30</ENT>
                            <ENT>8.61</ENT>
                            <ENT>9.23</ENT>
                            <ENT>1.19</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">21246</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Reconstruction of jaw</ENT>
                            <ENT>12.78</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>7.42</ENT>
                            <ENT>8.23</ENT>
                            <ENT>1.35</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">21247</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Reconstruct lower jaw bone</ENT>
                            <ENT>24.05</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>12.69</ENT>
                            <ENT>15.01</ENT>
                            <ENT>2.84</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">21248</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Reconstruction of jaw</ENT>
                            <ENT>12.54</ENT>
                            <ENT>12.60</ENT>
                            <ENT>12.36</ENT>
                            <ENT>7.51</ENT>
                            <ENT>8.45</ENT>
                            <ENT>1.55</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">21249</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Reconstruction of jaw</ENT>
                            <ENT>18.57</ENT>
                            <ENT>15.72</ENT>
                            <ENT>16.22</ENT>
                            <ENT>9.61</ENT>
                            <ENT>11.15</ENT>
                            <ENT>2.49</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">21255</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Reconstruct lower jaw bone</ENT>
                            <ENT>18.14</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>14.03</ENT>
                            <ENT>15.08</ENT>
                            <ENT>2.39</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">21256</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Reconstruction of orbit</ENT>
                            <ENT>17.42</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>9.57</ENT>
                            <ENT>10.69</ENT>
                            <ENT>1.50</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">21260</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Revise eye sockets</ENT>
                            <ENT>17.74</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>12.95</ENT>
                            <ENT>12.85</ENT>
                            <ENT>0.97</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">21261</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Revise eye sockets</ENT>
                            <ENT>33.78</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>14.74</ENT>
                            <ENT>19.48</ENT>
                            <ENT>3.43</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">21263</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Revise eye sockets</ENT>
                            <ENT>30.72</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>14.03</ENT>
                            <ENT>16.55</ENT>
                            <ENT>2.63</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">21267</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Revise eye sockets</ENT>
                            <ENT>20.45</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>16.03</ENT>
                            <ENT>17.90</ENT>
                            <ENT>1.71</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">21268</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Revise eye sockets</ENT>
                            <ENT>26.78</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>13.13</ENT>
                            <ENT>16.66</ENT>
                            <ENT>3.66</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">21270</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Augmentation, cheek bone</ENT>
                            <ENT>10.52</ENT>
                            <ENT>11.15</ENT>
                            <ENT>11.39</ENT>
                            <ENT>5.90</ENT>
                            <ENT>6.57</ENT>
                            <ENT>0.72</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">21275</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Revision, orbitofacial bones</ENT>
                            <ENT>11.65</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>7.15</ENT>
                            <ENT>7.65</ENT>
                            <ENT>1.29</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">21280</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Revision of eyelid</ENT>
                            <ENT>6.92</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>5.66</ENT>
                            <ENT>5.79</ENT>
                            <ENT>0.42</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">21282</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Revision of eyelid</ENT>
                            <ENT>4.11</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>4.16</ENT>
                            <ENT>4.32</ENT>
                            <ENT>0.26</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">21295</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Revision of jaw muscle/bone</ENT>
                            <ENT>1.82</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>2.23</ENT>
                            <ENT>2.38</ENT>
                            <ENT>0.16</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">21296</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Revision of jaw muscle/bone</ENT>
                            <ENT>4.67</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>5.43</ENT>
                            <ENT>5.16</ENT>
                            <ENT>0.34</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">21299</ENT>
                            <ENT/>
                            <ENT>C</ENT>
                            <ENT>Cranio/maxillofacial surgery</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>YYY</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">21310</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Treatment of nose fracture</ENT>
                            <ENT>0.58</ENT>
                            <ENT>1.99</ENT>
                            <ENT>2.14</ENT>
                            <ENT>0.11</ENT>
                            <ENT>0.13</ENT>
                            <ENT>0.05</ENT>
                            <ENT>000</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">21315</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Treatment of nose fracture</ENT>
                            <ENT>1.78</ENT>
                            <ENT>4.71</ENT>
                            <ENT>4.47</ENT>
                            <ENT>1.78</ENT>
                            <ENT>1.83</ENT>
                            <ENT>0.14</ENT>
                            <ENT>010</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">21320</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Treatment of nose fracture</ENT>
                            <ENT>1.86</ENT>
                            <ENT>4.29</ENT>
                            <ENT>4.10</ENT>
                            <ENT>1.36</ENT>
                            <ENT>1.49</ENT>
                            <ENT>0.18</ENT>
                            <ENT>010</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">21325</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Treatment of nose fracture</ENT>
                            <ENT>4.07</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>6.97</ENT>
                            <ENT>7.79</ENT>
                            <ENT>0.31</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">21330</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Treatment of nose fracture</ENT>
                            <ENT>5.68</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>7.62</ENT>
                            <ENT>8.66</ENT>
                            <ENT>0.56</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">21335</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Treatment of nose fracture</ENT>
                            <ENT>8.91</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>8.47</ENT>
                            <ENT>9.04</ENT>
                            <ENT>0.74</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">21336</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Treat nasal septal fracture</ENT>
                            <ENT>6.56</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>8.66</ENT>
                            <ENT>9.13</ENT>
                            <ENT>0.55</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">21337</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Treat nasal septal fracture</ENT>
                            <ENT>3.26</ENT>
                            <ENT>6.14</ENT>
                            <ENT>6.13</ENT>
                            <ENT>3.56</ENT>
                            <ENT>3.56</ENT>
                            <ENT>0.28</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">21338</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Treat nasoethmoid fracture</ENT>
                            <ENT>6.76</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>9.92</ENT>
                            <ENT>11.97</ENT>
                            <ENT>0.82</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">21339</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Treat nasoethmoid fracture</ENT>
                            <ENT>8.39</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>9.82</ENT>
                            <ENT>11.86</ENT>
                            <ENT>0.96</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">21340</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Treatment of nose fracture</ENT>
                            <ENT>11.33</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>7.24</ENT>
                            <ENT>7.82</ENT>
                            <ENT>1.15</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">21343</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Treatment of sinus fracture</ENT>
                            <ENT>14.11</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>12.79</ENT>
                            <ENT>14.12</ENT>
                            <ENT>1.47</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">21344</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Treatment of sinus fracture</ENT>
                            <ENT>21.36</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>13.05</ENT>
                            <ENT>14.77</ENT>
                            <ENT>2.44</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">21345</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Treat nose/jaw fracture</ENT>
                            <ENT>8.87</ENT>
                            <ENT>10.48</ENT>
                            <ENT>10.16</ENT>
                            <ENT>6.55</ENT>
                            <ENT>6.86</ENT>
                            <ENT>0.92</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">21346</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Treat nose/jaw fracture</ENT>
                            <ENT>11.29</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>10.82</ENT>
                            <ENT>11.51</ENT>
                            <ENT>1.21</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">21347</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Treat nose/jaw fracture</ENT>
                            <ENT>13.37</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>11.73</ENT>
                            <ENT>13.96</ENT>
                            <ENT>1.47</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">21348</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Treat nose/jaw fracture</ENT>
                            <ENT>17.36</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>10.99</ENT>
                            <ENT>11.05</ENT>
                            <ENT>2.49</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">21355</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Treat cheek bone fracture</ENT>
                            <ENT>4.32</ENT>
                            <ENT>5.90</ENT>
                            <ENT>6.07</ENT>
                            <ENT>3.25</ENT>
                            <ENT>3.36</ENT>
                            <ENT>0.34</ENT>
                            <ENT>010</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">21356</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Treat cheek bone fracture</ENT>
                            <ENT>4.70</ENT>
                            <ENT>6.97</ENT>
                            <ENT>7.04</ENT>
                            <ENT>4.05</ENT>
                            <ENT>4.30</ENT>
                            <ENT>0.46</ENT>
                            <ENT>010</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">21360</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Treat cheek bone fracture</ENT>
                            <ENT>7.03</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>5.39</ENT>
                            <ENT>5.66</ENT>
                            <ENT>0.74</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">21365</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Treat cheek bone fracture</ENT>
                            <ENT>16.52</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>9.09</ENT>
                            <ENT>9.95</ENT>
                            <ENT>1.70</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">21366</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Treat cheek bone fracture</ENT>
                            <ENT>18.44</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>10.50</ENT>
                            <ENT>10.91</ENT>
                            <ENT>2.50</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">21385</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Treat eye socket fracture</ENT>
                            <ENT>9.46</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>7.13</ENT>
                            <ENT>7.70</ENT>
                            <ENT>0.97</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">21386</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Treat eye socket fracture</ENT>
                            <ENT>9.46</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>6.00</ENT>
                            <ENT>6.53</ENT>
                            <ENT>0.97</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">21387</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Treat eye socket fracture</ENT>
                            <ENT>10.00</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>7.44</ENT>
                            <ENT>8.20</ENT>
                            <ENT>1.08</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">21390</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Treat eye socket fracture</ENT>
                            <ENT>11.07</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>7.01</ENT>
                            <ENT>7.40</ENT>
                            <ENT>0.90</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">21395</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Treat eye socket fracture</ENT>
                            <ENT>14.62</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>8.33</ENT>
                            <ENT>8.68</ENT>
                            <ENT>1.44</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">21400</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Treat eye socket fracture</ENT>
                            <ENT>1.44</ENT>
                            <ENT>2.70</ENT>
                            <ENT>2.66</ENT>
                            <ENT>1.96</ENT>
                            <ENT>1.92</ENT>
                            <ENT>0.15</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">21401</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Treat eye socket fracture</ENT>
                            <ENT>3.57</ENT>
                            <ENT>7.03</ENT>
                            <ENT>7.51</ENT>
                            <ENT>3.04</ENT>
                            <ENT>3.27</ENT>
                            <ENT>0.38</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">21406</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Treat eye socket fracture</ENT>
                            <ENT>7.31</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>5.29</ENT>
                            <ENT>5.68</ENT>
                            <ENT>0.73</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">21407</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Treat eye socket fracture</ENT>
                            <ENT>8.91</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>5.92</ENT>
                            <ENT>6.39</ENT>
                            <ENT>0.94</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">21408</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Treat eye socket fracture</ENT>
                            <ENT>12.67</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>7.44</ENT>
                            <ENT>8.16</ENT>
                            <ENT>1.44</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">21421</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Treat mouth roof fracture</ENT>
                            <ENT>5.80</ENT>
                            <ENT>12.45</ENT>
                            <ENT>10.89</ENT>
                            <ENT>9.20</ENT>
                            <ENT>8.75</ENT>
                            <ENT>0.73</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">21422</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Treat mouth roof fracture</ENT>
                            <ENT>8.62</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>7.04</ENT>
                            <ENT>7.56</ENT>
                            <ENT>0.99</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">21423</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Treat mouth roof fracture</ENT>
                            <ENT>10.71</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>7.39</ENT>
                            <ENT>8.36</ENT>
                            <ENT>1.27</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">21431</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Treat craniofacial fracture</ENT>
                            <ENT>7.74</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>10.83</ENT>
                            <ENT>10.18</ENT>
                            <ENT>0.70</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">21432</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Treat craniofacial fracture</ENT>
                            <ENT>8.76</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>6.81</ENT>
                            <ENT>7.43</ENT>
                            <ENT>0.81</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">21433</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Treat craniofacial fracture</ENT>
                            <ENT>26.13</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>12.13</ENT>
                            <ENT>14.26</ENT>
                            <ENT>2.79</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">21435</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Treat craniofacial fracture</ENT>
                            <ENT>20.02</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>11.07</ENT>
                            <ENT>11.88</ENT>
                            <ENT>1.99</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">21436</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Treat craniofacial fracture</ENT>
                            <ENT>30.01</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>13.13</ENT>
                            <ENT>15.67</ENT>
                            <ENT>3.10</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">21440</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Treat dental ridge fracture</ENT>
                            <ENT>3.28</ENT>
                            <ENT>10.06</ENT>
                            <ENT>8.58</ENT>
                            <ENT>7.45</ENT>
                            <ENT>6.80</ENT>
                            <ENT>0.38</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">21445</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Treat dental ridge fracture</ENT>
                            <ENT>6.04</ENT>
                            <ENT>12.27</ENT>
                            <ENT>11.01</ENT>
                            <ENT>8.46</ENT>
                            <ENT>8.41</ENT>
                            <ENT>0.78</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">21450</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Treat lower jaw fracture</ENT>
                            <ENT>3.55</ENT>
                            <ENT>10.50</ENT>
                            <ENT>8.94</ENT>
                            <ENT>7.71</ENT>
                            <ENT>7.29</ENT>
                            <ENT>0.33</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">21451</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Treat lower jaw fracture</ENT>
                            <ENT>5.46</ENT>
                            <ENT>12.97</ENT>
                            <ENT>11.16</ENT>
                            <ENT>9.67</ENT>
                            <ENT>9.03</ENT>
                            <ENT>0.63</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">21452</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Treat lower jaw fracture</ENT>
                            <ENT>2.29</ENT>
                            <ENT>12.02</ENT>
                            <ENT>12.52</ENT>
                            <ENT>6.05</ENT>
                            <ENT>5.33</ENT>
                            <ENT>0.27</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">21453</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Treat lower jaw fracture</ENT>
                            <ENT>6.40</ENT>
                            <ENT>14.80</ENT>
                            <ENT>12.76</ENT>
                            <ENT>11.64</ENT>
                            <ENT>11.18</ENT>
                            <ENT>0.74</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <PRTPAGE P="66421"/>
                            <ENT I="01">21454</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Treat lower jaw fracture</ENT>
                            <ENT>7.17</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>5.72</ENT>
                            <ENT>5.99</ENT>
                            <ENT>0.82</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">21461</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Treat lower jaw fracture</ENT>
                            <ENT>9.07</ENT>
                            <ENT>41.68</ENT>
                            <ENT>33.06</ENT>
                            <ENT>12.80</ENT>
                            <ENT>12.73</ENT>
                            <ENT>0.98</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">21462</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Treat lower jaw fracture</ENT>
                            <ENT>10.77</ENT>
                            <ENT>42.97</ENT>
                            <ENT>35.28</ENT>
                            <ENT>13.40</ENT>
                            <ENT>13.05</ENT>
                            <ENT>1.27</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">21465</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Treat lower jaw fracture</ENT>
                            <ENT>12.88</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>8.11</ENT>
                            <ENT>8.96</ENT>
                            <ENT>1.50</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">21470</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Treat lower jaw fracture</ENT>
                            <ENT>17.24</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>10.17</ENT>
                            <ENT>11.09</ENT>
                            <ENT>1.97</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">21480</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Reset dislocated jaw</ENT>
                            <ENT>0.61</ENT>
                            <ENT>1.52</ENT>
                            <ENT>1.64</ENT>
                            <ENT>0.18</ENT>
                            <ENT>0.18</ENT>
                            <ENT>0.06</ENT>
                            <ENT>000</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">21485</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Reset dislocated jaw</ENT>
                            <ENT>4.58</ENT>
                            <ENT>12.09</ENT>
                            <ENT>10.15</ENT>
                            <ENT>9.10</ENT>
                            <ENT>8.38</ENT>
                            <ENT>0.51</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">21490</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Repair dislocated jaw</ENT>
                            <ENT>12.71</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>8.12</ENT>
                            <ENT>8.90</ENT>
                            <ENT>1.97</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">21495</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Treat hyoid bone fracture</ENT>
                            <ENT>6.55</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>10.47</ENT>
                            <ENT>9.44</ENT>
                            <ENT>0.46</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">21497</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Interdental wiring</ENT>
                            <ENT>4.45</ENT>
                            <ENT>12.21</ENT>
                            <ENT>10.33</ENT>
                            <ENT>9.34</ENT>
                            <ENT>8.49</ENT>
                            <ENT>0.50</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">21499</ENT>
                            <ENT/>
                            <ENT>C</ENT>
                            <ENT>Head surgery procedure</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>YYY</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">21501</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Drain neck/chest lesion</ENT>
                            <ENT>3.87</ENT>
                            <ENT>6.55</ENT>
                            <ENT>6.49</ENT>
                            <ENT>3.52</ENT>
                            <ENT>3.67</ENT>
                            <ENT>0.43</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">21502</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Drain chest lesion</ENT>
                            <ENT>7.43</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>4.56</ENT>
                            <ENT>5.09</ENT>
                            <ENT>0.97</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">21510</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Drainage of bone lesion</ENT>
                            <ENT>6.06</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>4.80</ENT>
                            <ENT>5.23</ENT>
                            <ENT>0.80</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">21550</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Biopsy of neck/chest</ENT>
                            <ENT>2.08</ENT>
                            <ENT>4.35</ENT>
                            <ENT>3.97</ENT>
                            <ENT>1.78</ENT>
                            <ENT>1.75</ENT>
                            <ENT>0.16</ENT>
                            <ENT>010</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">21555</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Remove lesion, neck/chest</ENT>
                            <ENT>4.40</ENT>
                            <ENT>5.78</ENT>
                            <ENT>5.65</ENT>
                            <ENT>3.43</ENT>
                            <ENT>3.31</ENT>
                            <ENT>0.56</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">21556</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Remove lesion, neck/chest</ENT>
                            <ENT>5.63</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>4.14</ENT>
                            <ENT>4.12</ENT>
                            <ENT>0.65</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">21557</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Remove tumor, neck/chest</ENT>
                            <ENT>8.91</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>4.51</ENT>
                            <ENT>4.93</ENT>
                            <ENT>1.08</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">21600</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Partial removal of rib</ENT>
                            <ENT>7.14</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>5.96</ENT>
                            <ENT>5.85</ENT>
                            <ENT>0.99</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">21610</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Partial removal of rib</ENT>
                            <ENT>15.76</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>8.89</ENT>
                            <ENT>8.88</ENT>
                            <ENT>3.08</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">21615</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Removal of rib</ENT>
                            <ENT>10.31</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>5.16</ENT>
                            <ENT>5.92</ENT>
                            <ENT>1.45</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">21616</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Removal of rib and nerves</ENT>
                            <ENT>12.54</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>6.51</ENT>
                            <ENT>7.26</ENT>
                            <ENT>1.87</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">21620</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Partial removal of sternum</ENT>
                            <ENT>7.16</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>4.76</ENT>
                            <ENT>5.36</ENT>
                            <ENT>0.98</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">21627</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Sternal debridement</ENT>
                            <ENT>7.18</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>5.54</ENT>
                            <ENT>5.92</ENT>
                            <ENT>1.02</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">21630</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Extensive sternum surgery</ENT>
                            <ENT>19.01</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>10.34</ENT>
                            <ENT>11.09</ENT>
                            <ENT>2.59</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">21632</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Extensive sternum surgery</ENT>
                            <ENT>19.51</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>9.42</ENT>
                            <ENT>10.26</ENT>
                            <ENT>2.66</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">21685</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Hyoid myotomy &amp; suspension</ENT>
                            <ENT>14.89</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>8.76</ENT>
                            <ENT>9.36</ENT>
                            <ENT>1.06</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">21700</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Revision of neck muscle</ENT>
                            <ENT>6.23</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>4.39</ENT>
                            <ENT>4.41</ENT>
                            <ENT>0.32</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">21705</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Revision of neck muscle/rib</ENT>
                            <ENT>9.83</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>4.35</ENT>
                            <ENT>4.97</ENT>
                            <ENT>1.43</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">21720</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Revision of neck muscle</ENT>
                            <ENT>5.72</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>4.10</ENT>
                            <ENT>3.28</ENT>
                            <ENT>0.91</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">21725</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Revision of neck muscle</ENT>
                            <ENT>7.10</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>5.14</ENT>
                            <ENT>5.29</ENT>
                            <ENT>1.21</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">21740</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Reconstruction of sternum</ENT>
                            <ENT>17.47</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>8.20</ENT>
                            <ENT>8.35</ENT>
                            <ENT>2.37</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">21742</ENT>
                            <ENT/>
                            <ENT>C</ENT>
                            <ENT>Repair stern/nuss w/o scope</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">21743</ENT>
                            <ENT/>
                            <ENT>C</ENT>
                            <ENT>Repair sternum/nuss w/scope</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">21750</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Repair of sternum separation</ENT>
                            <ENT>11.35</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>5.31</ENT>
                            <ENT>5.71</ENT>
                            <ENT>1.63</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">21800</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Treatment of rib fracture</ENT>
                            <ENT>0.98</ENT>
                            <ENT>1.36</ENT>
                            <ENT>1.35</ENT>
                            <ENT>1.43</ENT>
                            <ENT>1.38</ENT>
                            <ENT>0.09</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">21805</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Treatment of rib fracture</ENT>
                            <ENT>2.80</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>3.27</ENT>
                            <ENT>3.23</ENT>
                            <ENT>0.38</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">21810</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Treatment of rib fracture(s)</ENT>
                            <ENT>6.92</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>5.37</ENT>
                            <ENT>5.17</ENT>
                            <ENT>0.94</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">21820</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Treat sternum fracture</ENT>
                            <ENT>1.31</ENT>
                            <ENT>1.82</ENT>
                            <ENT>1.82</ENT>
                            <ENT>1.89</ENT>
                            <ENT>1.83</ENT>
                            <ENT>0.16</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">21825</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Treat sternum fracture</ENT>
                            <ENT>7.65</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>5.37</ENT>
                            <ENT>5.88</ENT>
                            <ENT>1.11</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">21899</ENT>
                            <ENT/>
                            <ENT>C</ENT>
                            <ENT>Neck/chest surgery procedure</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>YYY</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">21920</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Biopsy soft tissue of back</ENT>
                            <ENT>2.08</ENT>
                            <ENT>4.43</ENT>
                            <ENT>3.86</ENT>
                            <ENT>1.88</ENT>
                            <ENT>1.67</ENT>
                            <ENT>0.14</ENT>
                            <ENT>010</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">21925</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Biopsy soft tissue of back</ENT>
                            <ENT>4.54</ENT>
                            <ENT>5.34</ENT>
                            <ENT>5.25</ENT>
                            <ENT>3.36</ENT>
                            <ENT>3.30</ENT>
                            <ENT>0.60</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">21930</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Remove lesion, back or flank</ENT>
                            <ENT>5.06</ENT>
                            <ENT>6.04</ENT>
                            <ENT>5.88</ENT>
                            <ENT>3.77</ENT>
                            <ENT>3.58</ENT>
                            <ENT>0.66</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">21935</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Remove tumor, back</ENT>
                            <ENT>18.38</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>8.44</ENT>
                            <ENT>9.03</ENT>
                            <ENT>2.48</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">22010</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>I&amp;d, p-spine, c/t/cerv-thor</ENT>
                            <ENT>12.57</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>8.35</ENT>
                            <ENT>8.61</ENT>
                            <ENT>1.74</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">22015</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>I&amp;d, p-spine, l/s/ls</ENT>
                            <ENT>12.46</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>8.33</ENT>
                            <ENT>8.58</ENT>
                            <ENT>1.72</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">22100</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Remove part of neck vertebra</ENT>
                            <ENT>10.80</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>8.19</ENT>
                            <ENT>7.86</ENT>
                            <ENT>2.14</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">22101</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Remove part, thorax vertebra</ENT>
                            <ENT>10.88</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>8.11</ENT>
                            <ENT>7.93</ENT>
                            <ENT>1.91</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">22102</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Remove part, lumbar vertebra</ENT>
                            <ENT>10.88</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>7.92</ENT>
                            <ENT>8.01</ENT>
                            <ENT>1.88</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">22103</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Remove extra spine segment</ENT>
                            <ENT>2.34</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>0.90</ENT>
                            <ENT>1.05</ENT>
                            <ENT>0.44</ENT>
                            <ENT>ZZZ</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">22110</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Remove part of neck vertebra</ENT>
                            <ENT>13.80</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>9.11</ENT>
                            <ENT>9.14</ENT>
                            <ENT>2.77</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">22112</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Remove part, thorax vertebra</ENT>
                            <ENT>13.87</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>9.02</ENT>
                            <ENT>9.15</ENT>
                            <ENT>2.53</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">22114</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Remove part, lumbar vertebra</ENT>
                            <ENT>13.87</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>9.00</ENT>
                            <ENT>9.13</ENT>
                            <ENT>2.64</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">22116</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Remove extra spine segment</ENT>
                            <ENT>2.32</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>0.89</ENT>
                            <ENT>1.03</ENT>
                            <ENT>0.50</ENT>
                            <ENT>ZZZ</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">22206</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Cut spine 3 col, thor</ENT>
                            <ENT>37.00</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>17.71</ENT>
                            <ENT>17.71</ENT>
                            <ENT>6.23</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">22207</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Cut spine 3 col, lumb</ENT>
                            <ENT>36.50</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>17.59</ENT>
                            <ENT>17.59</ENT>
                            <ENT>6.07</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">22208</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Cut spine 3 col, addl seg</ENT>
                            <ENT>9.66</ENT>
                            <ENT>3.72</ENT>
                            <ENT>3.72</ENT>
                            <ENT>3.72</ENT>
                            <ENT>3.72</ENT>
                            <ENT>2.07</ENT>
                            <ENT>ZZZ</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">22210</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Revision of neck spine</ENT>
                            <ENT>25.13</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>14.54</ENT>
                            <ENT>14.97</ENT>
                            <ENT>5.46</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">22212</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Revision of thorax spine</ENT>
                            <ENT>20.74</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>12.44</ENT>
                            <ENT>12.85</ENT>
                            <ENT>3.91</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">22214</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Revision of lumbar spine</ENT>
                            <ENT>20.77</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>12.53</ENT>
                            <ENT>13.17</ENT>
                            <ENT>3.92</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">22216</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Revise, extra spine segment</ENT>
                            <ENT>6.03</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>2.32</ENT>
                            <ENT>2.73</ENT>
                            <ENT>1.29</ENT>
                            <ENT>ZZZ</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">22220</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Revision of neck spine</ENT>
                            <ENT>22.69</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>13.35</ENT>
                            <ENT>13.48</ENT>
                            <ENT>5.08</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">22222</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Revision of thorax spine</ENT>
                            <ENT>22.84</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>10.46</ENT>
                            <ENT>10.79</ENT>
                            <ENT>4.13</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">22224</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Revision of lumbar spine</ENT>
                            <ENT>22.84</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>12.89</ENT>
                            <ENT>13.55</ENT>
                            <ENT>4.19</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">22226</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Revise, extra spine segment</ENT>
                            <ENT>6.03</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>2.28</ENT>
                            <ENT>2.68</ENT>
                            <ENT>1.29</ENT>
                            <ENT>ZZZ</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">22305</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Treat spine process fracture</ENT>
                            <ENT>2.08</ENT>
                            <ENT>2.15</ENT>
                            <ENT>2.23</ENT>
                            <ENT>1.80</ENT>
                            <ENT>1.86</ENT>
                            <ENT>0.39</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">22310</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Treat spine fracture</ENT>
                            <ENT>3.69</ENT>
                            <ENT>2.98</ENT>
                            <ENT>2.89</ENT>
                            <ENT>2.50</ENT>
                            <ENT>2.42</ENT>
                            <ENT>0.50</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">22315</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Treat spine fracture</ENT>
                            <ENT>9.91</ENT>
                            <ENT>9.88</ENT>
                            <ENT>9.78</ENT>
                            <ENT>7.43</ENT>
                            <ENT>7.38</ENT>
                            <ENT>1.86</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">22318</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Treat odontoid fx w/o graft</ENT>
                            <ENT>22.54</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>13.25</ENT>
                            <ENT>13.31</ENT>
                            <ENT>5.30</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">22319</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Treat odontoid fx w/graft</ENT>
                            <ENT>25.15</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>13.45</ENT>
                            <ENT>14.07</ENT>
                            <ENT>6.05</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">22325</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Treat spine fracture</ENT>
                            <ENT>19.62</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>12.13</ENT>
                            <ENT>12.10</ENT>
                            <ENT>3.88</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <PRTPAGE P="66422"/>
                            <ENT I="01">22326</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Treat neck spine fracture</ENT>
                            <ENT>20.64</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>12.02</ENT>
                            <ENT>12.36</ENT>
                            <ENT>4.43</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">22327</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Treat thorax spine fracture</ENT>
                            <ENT>20.52</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>12.32</ENT>
                            <ENT>12.34</ENT>
                            <ENT>3.99</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">22328</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Treat each add spine fx</ENT>
                            <ENT>4.60</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>1.76</ENT>
                            <ENT>2.01</ENT>
                            <ENT>0.94</ENT>
                            <ENT>ZZZ</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">22505</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Manipulation of spine</ENT>
                            <ENT>1.87</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>1.10</ENT>
                            <ENT>1.02</ENT>
                            <ENT>0.36</ENT>
                            <ENT>010</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">22520</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Percut vertebroplasty thor</ENT>
                            <ENT>9.17</ENT>
                            <ENT>43.78</ENT>
                            <ENT>52.71</ENT>
                            <ENT>4.58</ENT>
                            <ENT>4.84</ENT>
                            <ENT>1.72</ENT>
                            <ENT>010</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">22521</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Percut vertebroplasty lumb</ENT>
                            <ENT>8.60</ENT>
                            <ENT>44.96</ENT>
                            <ENT>50.45</ENT>
                            <ENT>4.36</ENT>
                            <ENT>4.65</ENT>
                            <ENT>1.60</ENT>
                            <ENT>010</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">22522</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Percut vertebroplasty add'l</ENT>
                            <ENT>4.30</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>1.51</ENT>
                            <ENT>1.59</ENT>
                            <ENT>0.82</ENT>
                            <ENT>ZZZ</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">22523</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Percut kyphoplasty, thor</ENT>
                            <ENT>9.21</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>4.67</ENT>
                            <ENT>5.28</ENT>
                            <ENT>1.72</ENT>
                            <ENT>010</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">22524</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Percut kyphoplasty, lumbar</ENT>
                            <ENT>8.81</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>4.52</ENT>
                            <ENT>5.11</ENT>
                            <ENT>1.60</ENT>
                            <ENT>010</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">22525</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Percut kyphoplasty, add-on</ENT>
                            <ENT>4.47</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>1.69</ENT>
                            <ENT>1.98</ENT>
                            <ENT>0.82</ENT>
                            <ENT>ZZZ</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">22526</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Idet, single level</ENT>
                            <ENT>6.07</ENT>
                            <ENT>46.67</ENT>
                            <ENT>46.67</ENT>
                            <ENT>2.04</ENT>
                            <ENT>2.04</ENT>
                            <ENT>1.16</ENT>
                            <ENT>010</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">22527</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Idet, 1 or more levels</ENT>
                            <ENT>3.03</ENT>
                            <ENT>40.35</ENT>
                            <ENT>40.35</ENT>
                            <ENT>0.70</ENT>
                            <ENT>0.70</ENT>
                            <ENT>0.58</ENT>
                            <ENT>ZZZ</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">22532</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Lat thorax spine fusion</ENT>
                            <ENT>25.81</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>13.77</ENT>
                            <ENT>14.29</ENT>
                            <ENT>4.35</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">22533</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Lat lumbar spine fusion</ENT>
                            <ENT>24.61</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>13.56</ENT>
                            <ENT>13.57</ENT>
                            <ENT>3.16</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">22534</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Lat thor/lumb, add'l seg</ENT>
                            <ENT>5.99</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>2.28</ENT>
                            <ENT>2.65</ENT>
                            <ENT>1.25</ENT>
                            <ENT>ZZZ</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">22548</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Neck spine fusion</ENT>
                            <ENT>26.86</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>14.92</ENT>
                            <ENT>15.36</ENT>
                            <ENT>5.61</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">22554</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Neck spine fusion</ENT>
                            <ENT>17.54</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>10.64</ENT>
                            <ENT>11.49</ENT>
                            <ENT>4.46</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">22556</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Thorax spine fusion</ENT>
                            <ENT>24.50</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>12.95</ENT>
                            <ENT>13.83</ENT>
                            <ENT>4.35</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">22558</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Lumbar spine fusion</ENT>
                            <ENT>23.33</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>11.42</ENT>
                            <ENT>12.35</ENT>
                            <ENT>3.16</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">22585</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Additional spinal fusion</ENT>
                            <ENT>5.52</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>2.05</ENT>
                            <ENT>2.42</ENT>
                            <ENT>1.25</ENT>
                            <ENT>ZZZ</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">22590</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Spine &amp; skull spinal fusion</ENT>
                            <ENT>21.56</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>13.07</ENT>
                            <ENT>13.19</ENT>
                            <ENT>4.79</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">22595</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Neck spinal fusion</ENT>
                            <ENT>20.44</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>12.63</ENT>
                            <ENT>12.73</ENT>
                            <ENT>4.41</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">22600</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Neck spine fusion</ENT>
                            <ENT>17.20</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>11.19</ENT>
                            <ENT>11.19</ENT>
                            <ENT>3.73</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">22610</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Thorax spine fusion</ENT>
                            <ENT>17.08</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>10.81</ENT>
                            <ENT>11.11</ENT>
                            <ENT>3.53</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">22612</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Lumbar spine fusion</ENT>
                            <ENT>23.38</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>12.49</ENT>
                            <ENT>13.34</ENT>
                            <ENT>4.47</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">22614</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Spine fusion, extra segment</ENT>
                            <ENT>6.43</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>2.45</ENT>
                            <ENT>2.90</ENT>
                            <ENT>1.38</ENT>
                            <ENT>ZZZ</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">22630</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Lumbar spine fusion</ENT>
                            <ENT>21.89</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>12.53</ENT>
                            <ENT>13.06</ENT>
                            <ENT>4.73</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">22632</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Spine fusion, extra segment</ENT>
                            <ENT>5.22</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>1.99</ENT>
                            <ENT>2.32</ENT>
                            <ENT>1.16</ENT>
                            <ENT>ZZZ</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">22800</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Fusion of spine</ENT>
                            <ENT>19.30</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>11.15</ENT>
                            <ENT>11.96</ENT>
                            <ENT>3.76</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">22802</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Fusion of spine</ENT>
                            <ENT>31.91</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>15.98</ENT>
                            <ENT>17.78</ENT>
                            <ENT>6.17</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">22804</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Fusion of spine</ENT>
                            <ENT>37.30</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>18.11</ENT>
                            <ENT>20.40</ENT>
                            <ENT>7.00</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">22808</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Fusion of spine</ENT>
                            <ENT>27.31</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>14.05</ENT>
                            <ENT>15.17</ENT>
                            <ENT>4.93</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">22810</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Fusion of spine</ENT>
                            <ENT>31.30</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>14.90</ENT>
                            <ENT>16.62</ENT>
                            <ENT>5.15</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">22812</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Fusion of spine</ENT>
                            <ENT>34.00</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>17.37</ENT>
                            <ENT>18.71</ENT>
                            <ENT>5.30</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">22818</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Kyphectomy, 1-2 segments</ENT>
                            <ENT>34.18</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>16.61</ENT>
                            <ENT>17.73</ENT>
                            <ENT>6.47</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">22819</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Kyphectomy, 3 or more</ENT>
                            <ENT>39.18</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>18.86</ENT>
                            <ENT>19.45</ENT>
                            <ENT>7.67</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">22830</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Exploration of spinal fusion</ENT>
                            <ENT>11.13</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>7.05</ENT>
                            <ENT>7.50</ENT>
                            <ENT>2.30</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">22840</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Insert spine fixation device</ENT>
                            <ENT>12.52</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>4.77</ENT>
                            <ENT>5.63</ENT>
                            <ENT>2.79</ENT>
                            <ENT>ZZZ</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">22841</ENT>
                            <ENT/>
                            <ENT>B</ENT>
                            <ENT>Insert spine fixation device</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>XXX</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">22842</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Insert spine fixation device</ENT>
                            <ENT>12.56</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>4.79</ENT>
                            <ENT>5.64</ENT>
                            <ENT>2.75</ENT>
                            <ENT>ZZZ</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">22843</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Insert spine fixation device</ENT>
                            <ENT>13.44</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>5.15</ENT>
                            <ENT>5.88</ENT>
                            <ENT>2.86</ENT>
                            <ENT>ZZZ</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">22844</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Insert spine fixation device</ENT>
                            <ENT>16.42</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>6.40</ENT>
                            <ENT>7.57</ENT>
                            <ENT>3.19</ENT>
                            <ENT>ZZZ</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">22845</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Insert spine fixation device</ENT>
                            <ENT>11.94</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>4.48</ENT>
                            <ENT>5.27</ENT>
                            <ENT>2.86</ENT>
                            <ENT>ZZZ</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">22846</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Insert spine fixation device</ENT>
                            <ENT>12.40</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>4.66</ENT>
                            <ENT>5.49</ENT>
                            <ENT>2.96</ENT>
                            <ENT>ZZZ</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">22847</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Insert spine fixation device</ENT>
                            <ENT>13.78</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>5.19</ENT>
                            <ENT>6.10</ENT>
                            <ENT>3.00</ENT>
                            <ENT>ZZZ</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">22848</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Insert pelv fixation device</ENT>
                            <ENT>5.99</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>2.33</ENT>
                            <ENT>2.76</ENT>
                            <ENT>1.15</ENT>
                            <ENT>ZZZ</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">22849</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Reinsert spinal fixation</ENT>
                            <ENT>19.08</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>10.16</ENT>
                            <ENT>10.94</ENT>
                            <ENT>3.90</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">22850</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Remove spine fixation device</ENT>
                            <ENT>9.74</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>6.40</ENT>
                            <ENT>6.69</ENT>
                            <ENT>2.05</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">22851</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Apply spine prosth device</ENT>
                            <ENT>6.70</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>2.54</ENT>
                            <ENT>2.95</ENT>
                            <ENT>1.49</ENT>
                            <ENT>ZZZ</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">22852</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Remove spine fixation device</ENT>
                            <ENT>9.29</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>6.17</ENT>
                            <ENT>6.48</ENT>
                            <ENT>1.90</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">22855</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Remove spine fixation device</ENT>
                            <ENT>15.77</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>9.17</ENT>
                            <ENT>9.41</ENT>
                            <ENT>3.52</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">22857</ENT>
                            <ENT/>
                            <ENT>R</ENT>
                            <ENT>Lumbar artif diskectomy</ENT>
                            <ENT>26.93</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>14.80</ENT>
                            <ENT>14.80</ENT>
                            <ENT>3.56</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">22862</ENT>
                            <ENT/>
                            <ENT>R</ENT>
                            <ENT>Revise lumbar artif disc</ENT>
                            <ENT>32.43</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>10.06</ENT>
                            <ENT>10.06</ENT>
                            <ENT>5.36</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">22865</ENT>
                            <ENT/>
                            <ENT>R</ENT>
                            <ENT>Remove lumb artif disc</ENT>
                            <ENT>31.55</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>9.86</ENT>
                            <ENT>9.86</ENT>
                            <ENT>5.18</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">22899</ENT>
                            <ENT/>
                            <ENT>C</ENT>
                            <ENT>Spine surgery procedure</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>YYY</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">22900</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Remove abdominal wall lesion</ENT>
                            <ENT>6.14</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>3.53</ENT>
                            <ENT>3.38</ENT>
                            <ENT>0.76</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">22999</ENT>
                            <ENT/>
                            <ENT>C</ENT>
                            <ENT>Abdomen surgery procedure</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>YYY</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">23000</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Removal of calcium deposits</ENT>
                            <ENT>4.40</ENT>
                            <ENT>7.88</ENT>
                            <ENT>8.20</ENT>
                            <ENT>3.73</ENT>
                            <ENT>4.07</ENT>
                            <ENT>0.68</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">23020</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Release shoulder joint</ENT>
                            <ENT>9.24</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>6.48</ENT>
                            <ENT>7.02</ENT>
                            <ENT>1.54</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">23030</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Drain shoulder lesion</ENT>
                            <ENT>3.44</ENT>
                            <ENT>6.28</ENT>
                            <ENT>6.83</ENT>
                            <ENT>2.40</ENT>
                            <ENT>2.65</ENT>
                            <ENT>0.57</ENT>
                            <ENT>010</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">23031</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Drain shoulder bursa</ENT>
                            <ENT>2.76</ENT>
                            <ENT>6.51</ENT>
                            <ENT>7.18</ENT>
                            <ENT>2.21</ENT>
                            <ENT>2.47</ENT>
                            <ENT>0.46</ENT>
                            <ENT>010</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">23035</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Drain shoulder bone lesion</ENT>
                            <ENT>9.04</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>6.45</ENT>
                            <ENT>7.35</ENT>
                            <ENT>1.47</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">23040</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Exploratory shoulder surgery</ENT>
                            <ENT>9.63</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>6.74</ENT>
                            <ENT>7.30</ENT>
                            <ENT>1.60</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">23044</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Exploratory shoulder surgery</ENT>
                            <ENT>7.48</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>5.51</ENT>
                            <ENT>5.97</ENT>
                            <ENT>1.24</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">23065</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Biopsy shoulder tissues</ENT>
                            <ENT>2.28</ENT>
                            <ENT>2.95</ENT>
                            <ENT>2.72</ENT>
                            <ENT>1.74</ENT>
                            <ENT>1.68</ENT>
                            <ENT>0.20</ENT>
                            <ENT>010</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">23066</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Biopsy shoulder tissues</ENT>
                            <ENT>4.21</ENT>
                            <ENT>7.75</ENT>
                            <ENT>7.71</ENT>
                            <ENT>3.61</ENT>
                            <ENT>3.79</ENT>
                            <ENT>0.63</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">23075</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Removal of shoulder lesion</ENT>
                            <ENT>2.41</ENT>
                            <ENT>3.70</ENT>
                            <ENT>3.68</ENT>
                            <ENT>1.72</ENT>
                            <ENT>1.75</ENT>
                            <ENT>0.34</ENT>
                            <ENT>010</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">23076</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Removal of shoulder lesion</ENT>
                            <ENT>7.77</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>5.32</ENT>
                            <ENT>5.43</ENT>
                            <ENT>1.13</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">23077</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Remove tumor of shoulder</ENT>
                            <ENT>18.08</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>9.60</ENT>
                            <ENT>9.90</ENT>
                            <ENT>2.34</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">23100</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Biopsy of shoulder joint</ENT>
                            <ENT>6.09</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>4.99</ENT>
                            <ENT>5.32</ENT>
                            <ENT>1.04</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">23101</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Shoulder joint surgery</ENT>
                            <ENT>5.63</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>4.53</ENT>
                            <ENT>4.93</ENT>
                            <ENT>0.96</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">23105</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Remove shoulder joint lining</ENT>
                            <ENT>8.36</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>6.09</ENT>
                            <ENT>6.60</ENT>
                            <ENT>1.42</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <PRTPAGE P="66423"/>
                            <ENT I="01">23106</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Incision of collarbone joint</ENT>
                            <ENT>6.02</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>4.78</ENT>
                            <ENT>5.24</ENT>
                            <ENT>0.99</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">23107</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Explore treat shoulder joint</ENT>
                            <ENT>8.75</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>6.25</ENT>
                            <ENT>6.82</ENT>
                            <ENT>1.49</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">23120</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Partial removal, collar bone</ENT>
                            <ENT>7.23</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>5.47</ENT>
                            <ENT>5.96</ENT>
                            <ENT>1.23</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">23125</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Removal of collar bone</ENT>
                            <ENT>9.52</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>6.39</ENT>
                            <ENT>6.97</ENT>
                            <ENT>1.62</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">23130</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Remove shoulder bone, part</ENT>
                            <ENT>7.63</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>6.07</ENT>
                            <ENT>6.60</ENT>
                            <ENT>1.30</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">23140</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Removal of bone lesion</ENT>
                            <ENT>7.01</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>4.90</ENT>
                            <ENT>5.06</ENT>
                            <ENT>1.08</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">23145</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Removal of bone lesion</ENT>
                            <ENT>9.28</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>6.49</ENT>
                            <ENT>6.96</ENT>
                            <ENT>1.49</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">23146</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Removal of bone lesion</ENT>
                            <ENT>7.96</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>5.91</ENT>
                            <ENT>6.51</ENT>
                            <ENT>1.35</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">23150</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Removal of humerus lesion</ENT>
                            <ENT>8.79</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>6.25</ENT>
                            <ENT>6.58</ENT>
                            <ENT>1.32</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">23155</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Removal of humerus lesion</ENT>
                            <ENT>10.72</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>7.25</ENT>
                            <ENT>7.78</ENT>
                            <ENT>1.81</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">23156</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Removal of humerus lesion</ENT>
                            <ENT>8.99</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>6.28</ENT>
                            <ENT>6.83</ENT>
                            <ENT>1.50</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">23170</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Remove collar bone lesion</ENT>
                            <ENT>7.10</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>5.00</ENT>
                            <ENT>5.51</ENT>
                            <ENT>1.12</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">23172</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Remove shoulder blade lesion</ENT>
                            <ENT>7.20</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>5.51</ENT>
                            <ENT>5.90</ENT>
                            <ENT>1.01</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">23174</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Remove humerus lesion</ENT>
                            <ENT>9.90</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>7.17</ENT>
                            <ENT>7.76</ENT>
                            <ENT>1.65</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">23180</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Remove collar bone lesion</ENT>
                            <ENT>8.85</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>6.41</ENT>
                            <ENT>7.70</ENT>
                            <ENT>1.47</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">23182</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Remove shoulder blade lesion</ENT>
                            <ENT>8.47</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>6.42</ENT>
                            <ENT>7.48</ENT>
                            <ENT>1.37</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">23184</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Remove humerus lesion</ENT>
                            <ENT>9.76</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>6.92</ENT>
                            <ENT>8.12</ENT>
                            <ENT>1.63</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">23190</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Partial removal of scapula</ENT>
                            <ENT>7.36</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>5.31</ENT>
                            <ENT>5.74</ENT>
                            <ENT>1.17</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">23195</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Removal of head of humerus</ENT>
                            <ENT>10.24</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>6.91</ENT>
                            <ENT>7.32</ENT>
                            <ENT>1.71</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">23200</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Removal of collar bone</ENT>
                            <ENT>12.69</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>7.11</ENT>
                            <ENT>7.92</ENT>
                            <ENT>1.94</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">23210</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Removal of shoulder blade</ENT>
                            <ENT>13.16</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>7.80</ENT>
                            <ENT>8.40</ENT>
                            <ENT>2.03</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">23220</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Partial removal of humerus</ENT>
                            <ENT>15.36</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>9.14</ENT>
                            <ENT>9.98</ENT>
                            <ENT>2.49</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">23221</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Partial removal of humerus</ENT>
                            <ENT>18.41</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>10.61</ENT>
                            <ENT>11.16</ENT>
                            <ENT>3.06</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">23222</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Partial removal of humerus</ENT>
                            <ENT>25.44</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>13.33</ENT>
                            <ENT>14.55</ENT>
                            <ENT>3.95</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">23330</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Remove shoulder foreign body</ENT>
                            <ENT>1.87</ENT>
                            <ENT>3.35</ENT>
                            <ENT>3.52</ENT>
                            <ENT>1.51</ENT>
                            <ENT>1.70</ENT>
                            <ENT>0.24</ENT>
                            <ENT>010</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">23331</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Remove shoulder foreign body</ENT>
                            <ENT>7.51</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>5.83</ENT>
                            <ENT>6.31</ENT>
                            <ENT>1.27</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">23332</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Remove shoulder foreign body</ENT>
                            <ENT>12.23</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>7.96</ENT>
                            <ENT>8.64</ENT>
                            <ENT>2.03</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">23350</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Injection for shoulder x-ray</ENT>
                            <ENT>1.00</ENT>
                            <ENT>2.73</ENT>
                            <ENT>3.09</ENT>
                            <ENT>0.35</ENT>
                            <ENT>0.34</ENT>
                            <ENT>0.06</ENT>
                            <ENT>000</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">23395</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Muscle transfer,shoulder/arm</ENT>
                            <ENT>18.29</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>11.20</ENT>
                            <ENT>12.03</ENT>
                            <ENT>2.94</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">23397</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Muscle transfers</ENT>
                            <ENT>16.62</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>9.54</ENT>
                            <ENT>10.45</ENT>
                            <ENT>2.74</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">23400</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Fixation of shoulder blade</ENT>
                            <ENT>13.73</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>8.54</ENT>
                            <ENT>9.30</ENT>
                            <ENT>2.30</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">23405</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Incision of tendon &amp; muscle</ENT>
                            <ENT>8.43</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>5.92</ENT>
                            <ENT>6.42</ENT>
                            <ENT>1.45</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">23406</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Incise tendon(s) &amp; muscle(s)</ENT>
                            <ENT>10.90</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>6.90</ENT>
                            <ENT>7.62</ENT>
                            <ENT>1.88</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">23410</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Repair rotator cuff, acute</ENT>
                            <ENT>12.63</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>7.77</ENT>
                            <ENT>8.59</ENT>
                            <ENT>2.17</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">23412</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Repair rotator cuff, chronic</ENT>
                            <ENT>13.55</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>8.15</ENT>
                            <ENT>9.02</ENT>
                            <ENT>2.32</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">23415</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Release of shoulder ligament</ENT>
                            <ENT>10.09</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>6.58</ENT>
                            <ENT>7.28</ENT>
                            <ENT>1.74</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">23420</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Repair of shoulder</ENT>
                            <ENT>14.75</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>9.70</ENT>
                            <ENT>10.27</ENT>
                            <ENT>2.32</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">23430</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Repair biceps tendon</ENT>
                            <ENT>10.05</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>6.77</ENT>
                            <ENT>7.43</ENT>
                            <ENT>1.74</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">23440</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Remove/transplant tendon</ENT>
                            <ENT>10.53</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>6.77</ENT>
                            <ENT>7.51</ENT>
                            <ENT>1.83</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">23450</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Repair shoulder capsule</ENT>
                            <ENT>13.58</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>8.17</ENT>
                            <ENT>9.00</ENT>
                            <ENT>2.33</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">23455</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Repair shoulder capsule</ENT>
                            <ENT>14.55</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>8.55</ENT>
                            <ENT>9.49</ENT>
                            <ENT>2.50</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">23460</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Repair shoulder capsule</ENT>
                            <ENT>15.68</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>9.36</ENT>
                            <ENT>10.36</ENT>
                            <ENT>2.67</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">23462</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Repair shoulder capsule</ENT>
                            <ENT>15.60</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>9.07</ENT>
                            <ENT>9.91</ENT>
                            <ENT>2.60</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">23465</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Repair shoulder capsule</ENT>
                            <ENT>16.16</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>9.49</ENT>
                            <ENT>10.33</ENT>
                            <ENT>2.77</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">23466</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Repair shoulder capsule</ENT>
                            <ENT>15.55</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>9.99</ENT>
                            <ENT>10.67</ENT>
                            <ENT>2.47</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">23470</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Reconstruct shoulder joint</ENT>
                            <ENT>17.75</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>10.11</ENT>
                            <ENT>11.18</ENT>
                            <ENT>2.99</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">23472</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Reconstruct shoulder joint</ENT>
                            <ENT>22.47</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>12.14</ENT>
                            <ENT>13.27</ENT>
                            <ENT>3.67</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">23480</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Revision of collar bone</ENT>
                            <ENT>11.42</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>7.29</ENT>
                            <ENT>8.03</ENT>
                            <ENT>1.95</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">23485</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Revision of collar bone</ENT>
                            <ENT>13.79</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>8.20</ENT>
                            <ENT>9.04</ENT>
                            <ENT>2.34</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">23490</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Reinforce clavicle</ENT>
                            <ENT>12.04</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>6.74</ENT>
                            <ENT>7.72</ENT>
                            <ENT>1.47</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">23491</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Reinforce shoulder bones</ENT>
                            <ENT>14.40</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>8.71</ENT>
                            <ENT>9.71</ENT>
                            <ENT>2.47</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">23500</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Treat clavicle fracture</ENT>
                            <ENT>2.13</ENT>
                            <ENT>2.64</ENT>
                            <ENT>2.76</ENT>
                            <ENT>2.71</ENT>
                            <ENT>2.62</ENT>
                            <ENT>0.30</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">23505</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Treat clavicle fracture</ENT>
                            <ENT>3.74</ENT>
                            <ENT>4.01</ENT>
                            <ENT>4.21</ENT>
                            <ENT>3.61</ENT>
                            <ENT>3.73</ENT>
                            <ENT>0.61</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">23515</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Treat clavicle fracture</ENT>
                            <ENT>9.53</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>7.00</ENT>
                            <ENT>6.77</ENT>
                            <ENT>1.28</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">23520</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Treat clavicle dislocation</ENT>
                            <ENT>2.21</ENT>
                            <ENT>2.77</ENT>
                            <ENT>2.81</ENT>
                            <ENT>2.84</ENT>
                            <ENT>2.79</ENT>
                            <ENT>0.34</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">23525</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Treat clavicle dislocation</ENT>
                            <ENT>3.67</ENT>
                            <ENT>4.16</ENT>
                            <ENT>4.35</ENT>
                            <ENT>3.64</ENT>
                            <ENT>3.79</ENT>
                            <ENT>0.46</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">23530</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Treat clavicle dislocation</ENT>
                            <ENT>7.37</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>5.30</ENT>
                            <ENT>5.62</ENT>
                            <ENT>1.20</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">23532</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Treat clavicle dislocation</ENT>
                            <ENT>8.08</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>6.01</ENT>
                            <ENT>6.49</ENT>
                            <ENT>1.38</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">23540</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Treat clavicle dislocation</ENT>
                            <ENT>2.28</ENT>
                            <ENT>2.66</ENT>
                            <ENT>2.76</ENT>
                            <ENT>2.73</ENT>
                            <ENT>2.55</ENT>
                            <ENT>0.29</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">23545</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Treat clavicle dislocation</ENT>
                            <ENT>3.32</ENT>
                            <ENT>3.74</ENT>
                            <ENT>3.96</ENT>
                            <ENT>3.26</ENT>
                            <ENT>3.31</ENT>
                            <ENT>0.35</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">23550</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Treat clavicle dislocation</ENT>
                            <ENT>7.48</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>5.54</ENT>
                            <ENT>5.95</ENT>
                            <ENT>1.25</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">23552</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Treat clavicle dislocation</ENT>
                            <ENT>8.70</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>6.25</ENT>
                            <ENT>6.78</ENT>
                            <ENT>1.46</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">23570</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Treat shoulder blade fx</ENT>
                            <ENT>2.28</ENT>
                            <ENT>2.78</ENT>
                            <ENT>2.89</ENT>
                            <ENT>2.92</ENT>
                            <ENT>2.91</ENT>
                            <ENT>0.36</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">23575</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Treat shoulder blade fx</ENT>
                            <ENT>4.12</ENT>
                            <ENT>4.59</ENT>
                            <ENT>4.73</ENT>
                            <ENT>4.08</ENT>
                            <ENT>4.19</ENT>
                            <ENT>0.59</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">23585</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Treat scapula fracture</ENT>
                            <ENT>14.07</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>8.50</ENT>
                            <ENT>8.07</ENT>
                            <ENT>1.54</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">23600</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Treat humerus fracture</ENT>
                            <ENT>3.00</ENT>
                            <ENT>4.07</ENT>
                            <ENT>4.31</ENT>
                            <ENT>3.65</ENT>
                            <ENT>3.60</ENT>
                            <ENT>0.48</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">23605</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Treat humerus fracture</ENT>
                            <ENT>4.94</ENT>
                            <ENT>5.38</ENT>
                            <ENT>5.76</ENT>
                            <ENT>4.59</ENT>
                            <ENT>4.85</ENT>
                            <ENT>0.84</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">23615</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Treat humerus fracture</ENT>
                            <ENT>12.12</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>8.05</ENT>
                            <ENT>8.44</ENT>
                            <ENT>1.62</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">23616</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Treat humerus fracture</ENT>
                            <ENT>18.19</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>10.45</ENT>
                            <ENT>12.29</ENT>
                            <ENT>3.70</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">23620</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Treat humerus fracture</ENT>
                            <ENT>2.46</ENT>
                            <ENT>3.41</ENT>
                            <ENT>3.51</ENT>
                            <ENT>3.14</ENT>
                            <ENT>3.06</ENT>
                            <ENT>0.40</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">23625</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Treat humerus fracture</ENT>
                            <ENT>3.99</ENT>
                            <ENT>4.44</ENT>
                            <ENT>4.69</ENT>
                            <ENT>3.91</ENT>
                            <ENT>4.09</ENT>
                            <ENT>0.67</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">23630</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Treat humerus fracture</ENT>
                            <ENT>10.39</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>7.36</ENT>
                            <ENT>7.00</ENT>
                            <ENT>1.27</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <PRTPAGE P="66424"/>
                            <ENT I="01">23650</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Treat shoulder dislocation</ENT>
                            <ENT>3.44</ENT>
                            <ENT>3.29</ENT>
                            <ENT>3.53</ENT>
                            <ENT>2.82</ENT>
                            <ENT>2.79</ENT>
                            <ENT>0.30</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">23655</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Treat shoulder dislocation</ENT>
                            <ENT>4.64</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>4.15</ENT>
                            <ENT>4.16</ENT>
                            <ENT>0.69</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">23660</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Treat shoulder dislocation</ENT>
                            <ENT>7.55</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>5.68</ENT>
                            <ENT>6.03</ENT>
                            <ENT>1.29</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">23665</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Treat dislocation/fracture</ENT>
                            <ENT>4.54</ENT>
                            <ENT>4.85</ENT>
                            <ENT>5.09</ENT>
                            <ENT>4.26</ENT>
                            <ENT>4.49</ENT>
                            <ENT>0.71</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">23670</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Treat dislocation/fracture</ENT>
                            <ENT>12.12</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>7.92</ENT>
                            <ENT>7.37</ENT>
                            <ENT>1.36</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">23675</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Treat dislocation/fracture</ENT>
                            <ENT>6.13</ENT>
                            <ENT>6.12</ENT>
                            <ENT>6.47</ENT>
                            <ENT>5.13</ENT>
                            <ENT>5.48</ENT>
                            <ENT>1.01</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">23680</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Treat dislocation/fracture</ENT>
                            <ENT>12.99</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>8.23</ENT>
                            <ENT>8.16</ENT>
                            <ENT>1.76</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">23700</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Fixation of shoulder</ENT>
                            <ENT>2.54</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>1.90</ENT>
                            <ENT>2.04</ENT>
                            <ENT>0.44</ENT>
                            <ENT>010</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">23800</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Fusion of shoulder joint</ENT>
                            <ENT>14.59</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>8.86</ENT>
                            <ENT>9.63</ENT>
                            <ENT>2.36</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">23802</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Fusion of shoulder joint</ENT>
                            <ENT>18.17</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>11.20</ENT>
                            <ENT>10.68</ENT>
                            <ENT>2.71</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">23900</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Amputation of arm &amp; girdle</ENT>
                            <ENT>20.57</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>10.41</ENT>
                            <ENT>11.06</ENT>
                            <ENT>3.19</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">23920</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Amputation at shoulder joint</ENT>
                            <ENT>16.03</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>9.21</ENT>
                            <ENT>9.56</ENT>
                            <ENT>2.47</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">23921</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Amputation follow-up surgery</ENT>
                            <ENT>5.61</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>4.85</ENT>
                            <ENT>4.96</ENT>
                            <ENT>0.78</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">23929</ENT>
                            <ENT/>
                            <ENT>C</ENT>
                            <ENT>Shoulder surgery procedure</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>YYY</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">23930</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Drainage of arm lesion</ENT>
                            <ENT>2.96</ENT>
                            <ENT>4.98</ENT>
                            <ENT>5.65</ENT>
                            <ENT>1.98</ENT>
                            <ENT>2.14</ENT>
                            <ENT>0.43</ENT>
                            <ENT>010</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">23931</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Drainage of arm bursa</ENT>
                            <ENT>1.81</ENT>
                            <ENT>4.35</ENT>
                            <ENT>5.13</ENT>
                            <ENT>1.75</ENT>
                            <ENT>1.96</ENT>
                            <ENT>0.28</ENT>
                            <ENT>010</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">23935</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Drain arm/elbow bone lesion</ENT>
                            <ENT>6.27</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>5.09</ENT>
                            <ENT>5.50</ENT>
                            <ENT>1.05</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">24000</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Exploratory elbow surgery</ENT>
                            <ENT>5.99</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>4.75</ENT>
                            <ENT>5.08</ENT>
                            <ENT>0.97</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">24006</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Release elbow joint</ENT>
                            <ENT>9.62</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>6.59</ENT>
                            <ENT>7.17</ENT>
                            <ENT>1.50</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">24065</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Biopsy arm/elbow soft tissue</ENT>
                            <ENT>2.10</ENT>
                            <ENT>4.15</ENT>
                            <ENT>3.68</ENT>
                            <ENT>1.92</ENT>
                            <ENT>1.83</ENT>
                            <ENT>0.17</ENT>
                            <ENT>010</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">24066</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Biopsy arm/elbow soft tissue</ENT>
                            <ENT>5.26</ENT>
                            <ENT>8.26</ENT>
                            <ENT>8.60</ENT>
                            <ENT>3.92</ENT>
                            <ENT>4.02</ENT>
                            <ENT>0.80</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">24075</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Remove arm/elbow lesion</ENT>
                            <ENT>3.96</ENT>
                            <ENT>7.18</ENT>
                            <ENT>7.26</ENT>
                            <ENT>3.26</ENT>
                            <ENT>3.33</ENT>
                            <ENT>0.56</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">24076</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Remove arm/elbow lesion</ENT>
                            <ENT>6.36</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>4.59</ENT>
                            <ENT>4.72</ENT>
                            <ENT>0.95</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">24077</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Remove tumor of arm/elbow</ENT>
                            <ENT>11.95</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>6.85</ENT>
                            <ENT>7.29</ENT>
                            <ENT>1.73</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">24100</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Biopsy elbow joint lining</ENT>
                            <ENT>4.98</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>4.09</ENT>
                            <ENT>4.30</ENT>
                            <ENT>0.85</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">24101</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Explore/treat elbow joint</ENT>
                            <ENT>6.19</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>5.04</ENT>
                            <ENT>5.49</ENT>
                            <ENT>1.03</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">24102</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Remove elbow joint lining</ENT>
                            <ENT>8.15</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>5.80</ENT>
                            <ENT>6.33</ENT>
                            <ENT>1.33</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">24105</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Removal of elbow bursa</ENT>
                            <ENT>3.67</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>4.02</ENT>
                            <ENT>4.20</ENT>
                            <ENT>0.61</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">24110</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Remove humerus lesion</ENT>
                            <ENT>7.46</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>5.65</ENT>
                            <ENT>6.15</ENT>
                            <ENT>1.28</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">24115</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Remove/graft bone lesion</ENT>
                            <ENT>10.00</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>4.32</ENT>
                            <ENT>5.76</ENT>
                            <ENT>1.68</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">24116</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Remove/graft bone lesion</ENT>
                            <ENT>12.11</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>7.67</ENT>
                            <ENT>8.37</ENT>
                            <ENT>2.06</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">24120</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Remove elbow lesion</ENT>
                            <ENT>6.71</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>5.17</ENT>
                            <ENT>5.55</ENT>
                            <ENT>1.10</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">24125</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Remove/graft bone lesion</ENT>
                            <ENT>8.02</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>5.99</ENT>
                            <ENT>6.07</ENT>
                            <ENT>1.06</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">24126</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Remove/graft bone lesion</ENT>
                            <ENT>8.50</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>6.00</ENT>
                            <ENT>6.51</ENT>
                            <ENT>1.16</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">24130</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Removal of head of radius</ENT>
                            <ENT>6.31</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>5.12</ENT>
                            <ENT>5.57</ENT>
                            <ENT>1.04</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">24134</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Removal of arm bone lesion</ENT>
                            <ENT>10.10</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>6.90</ENT>
                            <ENT>7.87</ENT>
                            <ENT>1.64</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">24136</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Remove radius bone lesion</ENT>
                            <ENT>8.29</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>5.76</ENT>
                            <ENT>6.49</ENT>
                            <ENT>1.38</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">24138</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Remove elbow bone lesion</ENT>
                            <ENT>8.33</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>6.48</ENT>
                            <ENT>7.13</ENT>
                            <ENT>1.34</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">24140</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Partial removal of arm bone</ENT>
                            <ENT>9.43</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>6.57</ENT>
                            <ENT>7.83</ENT>
                            <ENT>1.51</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">24145</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Partial removal of radius</ENT>
                            <ENT>7.70</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>5.64</ENT>
                            <ENT>6.84</ENT>
                            <ENT>1.25</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">24147</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Partial removal of elbow</ENT>
                            <ENT>7.69</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>6.28</ENT>
                            <ENT>7.43</ENT>
                            <ENT>1.30</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">24149</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Radical resection of elbow</ENT>
                            <ENT>15.92</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>10.76</ENT>
                            <ENT>11.19</ENT>
                            <ENT>2.35</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">24150</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Extensive humerus surgery</ENT>
                            <ENT>13.70</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>8.49</ENT>
                            <ENT>9.24</ENT>
                            <ENT>2.33</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">24151</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Extensive humerus surgery</ENT>
                            <ENT>16.08</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>9.68</ENT>
                            <ENT>10.59</ENT>
                            <ENT>2.60</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">24152</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Extensive radius surgery</ENT>
                            <ENT>10.24</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>6.16</ENT>
                            <ENT>6.94</ENT>
                            <ENT>1.48</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">24153</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Extensive radius surgery</ENT>
                            <ENT>11.73</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>4.87</ENT>
                            <ENT>5.22</ENT>
                            <ENT>0.74</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">24155</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Removal of elbow joint</ENT>
                            <ENT>11.97</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>7.41</ENT>
                            <ENT>7.90</ENT>
                            <ENT>1.93</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">24160</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Remove elbow joint implant</ENT>
                            <ENT>7.89</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>5.82</ENT>
                            <ENT>6.35</ENT>
                            <ENT>1.30</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">24164</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Remove radius head implant</ENT>
                            <ENT>6.34</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>4.89</ENT>
                            <ENT>5.33</ENT>
                            <ENT>1.03</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">24200</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Removal of arm foreign body</ENT>
                            <ENT>1.78</ENT>
                            <ENT>2.74</ENT>
                            <ENT>3.07</ENT>
                            <ENT>1.36</ENT>
                            <ENT>1.49</ENT>
                            <ENT>0.20</ENT>
                            <ENT>010</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">24201</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Removal of arm foreign body</ENT>
                            <ENT>4.61</ENT>
                            <ENT>7.79</ENT>
                            <ENT>8.80</ENT>
                            <ENT>3.66</ENT>
                            <ENT>3.94</ENT>
                            <ENT>0.72</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">24220</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Injection for elbow x-ray</ENT>
                            <ENT>1.31</ENT>
                            <ENT>2.66</ENT>
                            <ENT>3.14</ENT>
                            <ENT>0.46</ENT>
                            <ENT>0.45</ENT>
                            <ENT>0.08</ENT>
                            <ENT>000</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">24300</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Manipulate elbow w/anesth</ENT>
                            <ENT>3.86</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>5.16</ENT>
                            <ENT>5.43</ENT>
                            <ENT>0.65</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">24301</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Muscle/tendon transfer</ENT>
                            <ENT>10.26</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>6.83</ENT>
                            <ENT>7.50</ENT>
                            <ENT>1.66</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">24305</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Arm tendon lengthening</ENT>
                            <ENT>7.51</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>5.65</ENT>
                            <ENT>6.18</ENT>
                            <ENT>1.15</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">24310</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Revision of arm tendon</ENT>
                            <ENT>6.03</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>4.73</ENT>
                            <ENT>5.15</ENT>
                            <ENT>0.96</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">24320</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Repair of arm tendon</ENT>
                            <ENT>10.74</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>7.02</ENT>
                            <ENT>7.27</ENT>
                            <ENT>1.74</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">24330</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Revision of arm muscles</ENT>
                            <ENT>9.67</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>6.63</ENT>
                            <ENT>7.25</ENT>
                            <ENT>1.60</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">24331</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Revision of arm muscles</ENT>
                            <ENT>10.83</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>6.94</ENT>
                            <ENT>7.81</ENT>
                            <ENT>1.78</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">24332</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Tenolysis, triceps</ENT>
                            <ENT>7.77</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>5.91</ENT>
                            <ENT>6.34</ENT>
                            <ENT>1.23</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">24340</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Repair of biceps tendon</ENT>
                            <ENT>7.96</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>5.96</ENT>
                            <ENT>6.47</ENT>
                            <ENT>1.36</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">24341</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Repair arm tendon/muscle</ENT>
                            <ENT>9.24</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>7.52</ENT>
                            <ENT>7.71</ENT>
                            <ENT>1.36</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">24342</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Repair of ruptured tendon</ENT>
                            <ENT>10.74</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>7.06</ENT>
                            <ENT>7.79</ENT>
                            <ENT>1.86</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">24343</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Repr elbow lat ligmnt w/tiss</ENT>
                            <ENT>8.99</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>6.98</ENT>
                            <ENT>7.56</ENT>
                            <ENT>1.43</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">24344</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Reconstruct elbow lat ligmnt</ENT>
                            <ENT>14.97</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>9.95</ENT>
                            <ENT>10.73</ENT>
                            <ENT>2.37</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">24345</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Repr elbw med ligmnt w/tissu</ENT>
                            <ENT>8.99</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>6.93</ENT>
                            <ENT>7.47</ENT>
                            <ENT>1.44</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">24346</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Reconstruct elbow med ligmnt</ENT>
                            <ENT>14.97</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>10.03</ENT>
                            <ENT>10.68</ENT>
                            <ENT>2.34</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">24357</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Repair elbow, perc</ENT>
                            <ENT>5.32</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>4.72</ENT>
                            <ENT>5.15</ENT>
                            <ENT>0.87</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">24358</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Repair elbow w/deb, open</ENT>
                            <ENT>6.54</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>5.27</ENT>
                            <ENT>5.73</ENT>
                            <ENT>1.07</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">24359</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Repair elbow deb/attch open</ENT>
                            <ENT>8.86</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>6.19</ENT>
                            <ENT>6.19</ENT>
                            <ENT>1.41</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">24360</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Reconstruct elbow joint</ENT>
                            <ENT>12.53</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>7.84</ENT>
                            <ENT>8.65</ENT>
                            <ENT>2.06</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">24361</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Reconstruct elbow joint</ENT>
                            <ENT>14.27</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>8.75</ENT>
                            <ENT>9.66</ENT>
                            <ENT>2.19</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <PRTPAGE P="66425"/>
                            <ENT I="01">24362</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Reconstruct elbow joint</ENT>
                            <ENT>15.18</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>5.73</ENT>
                            <ENT>7.88</ENT>
                            <ENT>2.61</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">24363</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Replace elbow joint</ENT>
                            <ENT>22.47</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>12.16</ENT>
                            <ENT>12.93</ENT>
                            <ENT>3.02</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">24365</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Reconstruct head of radius</ENT>
                            <ENT>8.51</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>5.96</ENT>
                            <ENT>6.58</ENT>
                            <ENT>1.41</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">24366</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Reconstruct head of radius</ENT>
                            <ENT>9.25</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>6.30</ENT>
                            <ENT>6.92</ENT>
                            <ENT>1.52</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">24400</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Revision of humerus</ENT>
                            <ENT>11.19</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>7.49</ENT>
                            <ENT>8.17</ENT>
                            <ENT>1.93</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">24410</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Revision of humerus</ENT>
                            <ENT>14.96</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>9.24</ENT>
                            <ENT>9.77</ENT>
                            <ENT>2.58</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">24420</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Revision of humerus</ENT>
                            <ENT>13.58</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>8.50</ENT>
                            <ENT>9.52</ENT>
                            <ENT>2.18</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">24430</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Repair of humerus</ENT>
                            <ENT>15.07</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>9.22</ENT>
                            <ENT>9.48</ENT>
                            <ENT>2.22</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">24435</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Repair humerus with graft</ENT>
                            <ENT>14.74</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>9.80</ENT>
                            <ENT>10.34</ENT>
                            <ENT>2.28</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">24470</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Revision of elbow joint</ENT>
                            <ENT>8.81</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>5.65</ENT>
                            <ENT>6.68</ENT>
                            <ENT>1.48</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">24495</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Decompression of forearm</ENT>
                            <ENT>8.30</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>6.41</ENT>
                            <ENT>7.57</ENT>
                            <ENT>1.18</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">24498</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Reinforce humerus</ENT>
                            <ENT>12.16</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>7.66</ENT>
                            <ENT>8.46</ENT>
                            <ENT>2.07</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">24500</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Treat humerus fracture</ENT>
                            <ENT>3.29</ENT>
                            <ENT>4.45</ENT>
                            <ENT>4.64</ENT>
                            <ENT>3.80</ENT>
                            <ENT>3.74</ENT>
                            <ENT>0.50</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">24505</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Treat humerus fracture</ENT>
                            <ENT>5.25</ENT>
                            <ENT>5.83</ENT>
                            <ENT>6.21</ENT>
                            <ENT>4.87</ENT>
                            <ENT>5.13</ENT>
                            <ENT>0.89</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">24515</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Treat humerus fracture</ENT>
                            <ENT>11.97</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>8.03</ENT>
                            <ENT>8.71</ENT>
                            <ENT>2.03</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">24516</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Treat humerus fracture</ENT>
                            <ENT>12.07</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>7.64</ENT>
                            <ENT>8.37</ENT>
                            <ENT>2.03</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">24530</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Treat humerus fracture</ENT>
                            <ENT>3.57</ENT>
                            <ENT>4.73</ENT>
                            <ENT>4.97</ENT>
                            <ENT>4.00</ENT>
                            <ENT>4.02</ENT>
                            <ENT>0.57</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">24535</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Treat humerus fracture</ENT>
                            <ENT>6.96</ENT>
                            <ENT>6.81</ENT>
                            <ENT>7.32</ENT>
                            <ENT>5.86</ENT>
                            <ENT>6.24</ENT>
                            <ENT>1.18</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">24538</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Treat humerus fracture</ENT>
                            <ENT>9.63</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>7.18</ENT>
                            <ENT>7.94</ENT>
                            <ENT>1.64</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">24545</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Treat humerus fracture</ENT>
                            <ENT>12.99</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>8.27</ENT>
                            <ENT>8.36</ENT>
                            <ENT>1.83</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">24546</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Treat humerus fracture</ENT>
                            <ENT>14.73</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>9.10</ENT>
                            <ENT>10.20</ENT>
                            <ENT>2.74</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">24560</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Treat humerus fracture</ENT>
                            <ENT>2.87</ENT>
                            <ENT>4.11</ENT>
                            <ENT>4.29</ENT>
                            <ENT>3.43</ENT>
                            <ENT>3.31</ENT>
                            <ENT>0.44</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">24565</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Treat humerus fracture</ENT>
                            <ENT>5.64</ENT>
                            <ENT>5.93</ENT>
                            <ENT>6.27</ENT>
                            <ENT>5.04</ENT>
                            <ENT>5.28</ENT>
                            <ENT>0.93</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">24566</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Treat humerus fracture</ENT>
                            <ENT>8.86</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>6.79</ENT>
                            <ENT>7.47</ENT>
                            <ENT>1.30</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">24575</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Treat humerus fracture</ENT>
                            <ENT>9.53</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>6.96</ENT>
                            <ENT>7.68</ENT>
                            <ENT>1.87</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">24576</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Treat humerus fracture</ENT>
                            <ENT>2.94</ENT>
                            <ENT>4.41</ENT>
                            <ENT>4.58</ENT>
                            <ENT>3.71</ENT>
                            <ENT>3.71</ENT>
                            <ENT>0.46</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">24577</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Treat humerus fracture</ENT>
                            <ENT>5.87</ENT>
                            <ENT>6.03</ENT>
                            <ENT>6.48</ENT>
                            <ENT>5.08</ENT>
                            <ENT>5.46</ENT>
                            <ENT>0.95</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">24579</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Treat humerus fracture</ENT>
                            <ENT>11.26</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>7.74</ENT>
                            <ENT>8.28</ENT>
                            <ENT>2.03</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">24582</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Treat humerus fracture</ENT>
                            <ENT>9.89</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>8.17</ENT>
                            <ENT>8.64</ENT>
                            <ENT>1.48</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">24586</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Treat elbow fracture</ENT>
                            <ENT>15.64</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>9.31</ENT>
                            <ENT>10.27</ENT>
                            <ENT>2.65</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">24587</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Treat elbow fracture</ENT>
                            <ENT>15.65</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>9.31</ENT>
                            <ENT>10.16</ENT>
                            <ENT>2.53</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">24600</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Treat elbow dislocation</ENT>
                            <ENT>4.28</ENT>
                            <ENT>3.86</ENT>
                            <ENT>4.36</ENT>
                            <ENT>3.28</ENT>
                            <ENT>3.39</ENT>
                            <ENT>0.50</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">24605</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Treat elbow dislocation</ENT>
                            <ENT>5.50</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>4.91</ENT>
                            <ENT>5.13</ENT>
                            <ENT>0.89</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">24615</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Treat elbow dislocation</ENT>
                            <ENT>9.72</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>6.55</ENT>
                            <ENT>7.18</ENT>
                            <ENT>1.60</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">24620</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Treat elbow fracture</ENT>
                            <ENT>7.07</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>5.48</ENT>
                            <ENT>5.87</ENT>
                            <ENT>1.07</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">24635</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Treat elbow fracture</ENT>
                            <ENT>8.64</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>6.55</ENT>
                            <ENT>10.29</ENT>
                            <ENT>2.29</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">24640</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Treat elbow dislocation</ENT>
                            <ENT>1.22</ENT>
                            <ENT>1.52</ENT>
                            <ENT>1.68</ENT>
                            <ENT>0.83</ENT>
                            <ENT>0.81</ENT>
                            <ENT>0.12</ENT>
                            <ENT>010</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">24650</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Treat radius fracture</ENT>
                            <ENT>2.22</ENT>
                            <ENT>3.42</ENT>
                            <ENT>3.60</ENT>
                            <ENT>2.99</ENT>
                            <ENT>2.87</ENT>
                            <ENT>0.35</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">24655</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Treat radius fracture</ENT>
                            <ENT>4.48</ENT>
                            <ENT>5.18</ENT>
                            <ENT>5.56</ENT>
                            <ENT>4.40</ENT>
                            <ENT>4.59</ENT>
                            <ENT>0.70</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">24665</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Treat radius fracture</ENT>
                            <ENT>8.22</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>6.51</ENT>
                            <ENT>7.01</ENT>
                            <ENT>1.41</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">24666</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Treat radius fracture</ENT>
                            <ENT>9.74</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>6.95</ENT>
                            <ENT>7.50</ENT>
                            <ENT>1.62</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">24670</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Treat ulnar fracture</ENT>
                            <ENT>2.60</ENT>
                            <ENT>3.72</ENT>
                            <ENT>3.91</ENT>
                            <ENT>3.15</ENT>
                            <ENT>3.11</ENT>
                            <ENT>0.41</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">24675</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Treat ulnar fracture</ENT>
                            <ENT>4.79</ENT>
                            <ENT>5.37</ENT>
                            <ENT>5.68</ENT>
                            <ENT>4.57</ENT>
                            <ENT>4.77</ENT>
                            <ENT>0.81</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">24685</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Treat ulnar fracture</ENT>
                            <ENT>8.21</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>6.51</ENT>
                            <ENT>7.01</ENT>
                            <ENT>1.52</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">24800</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Fusion of elbow joint</ENT>
                            <ENT>11.27</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>6.88</ENT>
                            <ENT>7.81</ENT>
                            <ENT>1.63</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">24802</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Fusion/graft of elbow joint</ENT>
                            <ENT>14.18</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>8.02</ENT>
                            <ENT>9.20</ENT>
                            <ENT>2.38</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">24900</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Amputation of upper arm</ENT>
                            <ENT>10.04</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>6.41</ENT>
                            <ENT>6.73</ENT>
                            <ENT>1.53</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">24920</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Amputation of upper arm</ENT>
                            <ENT>10.02</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>6.03</ENT>
                            <ENT>6.48</ENT>
                            <ENT>1.61</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">24925</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Amputation follow-up surgery</ENT>
                            <ENT>7.19</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>4.94</ENT>
                            <ENT>5.51</ENT>
                            <ENT>1.14</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">24930</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Amputation follow-up surgery</ENT>
                            <ENT>10.72</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>6.19</ENT>
                            <ENT>6.71</ENT>
                            <ENT>1.68</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">24931</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Amputate upper arm &amp; implant</ENT>
                            <ENT>13.32</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>5.07</ENT>
                            <ENT>5.40</ENT>
                            <ENT>1.90</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">24935</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Revision of amputation</ENT>
                            <ENT>16.30</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>10.46</ENT>
                            <ENT>9.24</ENT>
                            <ENT>2.14</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">24940</ENT>
                            <ENT/>
                            <ENT>C</ENT>
                            <ENT>Revision of upper arm</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">24999</ENT>
                            <ENT/>
                            <ENT>C</ENT>
                            <ENT>Upper arm/elbow surgery</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>YYY</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">25000</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Incision of tendon sheath</ENT>
                            <ENT>3.44</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>3.98</ENT>
                            <ENT>5.42</ENT>
                            <ENT>0.55</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">25001</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Incise flexor carpi radialis</ENT>
                            <ENT>3.68</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>3.94</ENT>
                            <ENT>4.08</ENT>
                            <ENT>0.55</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">25020</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Decompress forearm 1 space</ENT>
                            <ENT>5.97</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>6.94</ENT>
                            <ENT>8.25</ENT>
                            <ENT>0.93</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">25023</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Decompress forearm 1 space</ENT>
                            <ENT>13.69</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>11.32</ENT>
                            <ENT>13.12</ENT>
                            <ENT>2.04</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">25024</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Decompress forearm 2 spaces</ENT>
                            <ENT>10.62</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>7.08</ENT>
                            <ENT>7.27</ENT>
                            <ENT>1.36</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">25025</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Decompress forearm 2 spaces</ENT>
                            <ENT>17.77</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>9.69</ENT>
                            <ENT>9.83</ENT>
                            <ENT>1.83</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">25028</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Drainage of forearm lesion</ENT>
                            <ENT>5.30</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>6.19</ENT>
                            <ENT>7.17</ENT>
                            <ENT>0.81</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">25031</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Drainage of forearm bursa</ENT>
                            <ENT>4.18</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>3.49</ENT>
                            <ENT>5.70</ENT>
                            <ENT>0.63</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">25035</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Treat forearm bone lesion</ENT>
                            <ENT>7.54</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>5.62</ENT>
                            <ENT>9.60</ENT>
                            <ENT>1.24</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">25040</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Explore/treat wrist joint</ENT>
                            <ENT>7.41</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>5.39</ENT>
                            <ENT>6.34</ENT>
                            <ENT>1.15</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">25065</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Biopsy forearm soft tissues</ENT>
                            <ENT>2.01</ENT>
                            <ENT>4.33</ENT>
                            <ENT>3.77</ENT>
                            <ENT>1.98</ENT>
                            <ENT>1.94</ENT>
                            <ENT>0.15</ENT>
                            <ENT>010</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">25066</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Biopsy forearm soft tissues</ENT>
                            <ENT>4.18</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>3.83</ENT>
                            <ENT>5.45</ENT>
                            <ENT>0.64</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">25075</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Removal forearm lesion subcu</ENT>
                            <ENT>3.78</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>3.31</ENT>
                            <ENT>4.60</ENT>
                            <ENT>0.55</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">25076</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Removal forearm lesion deep</ENT>
                            <ENT>4.97</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>4.11</ENT>
                            <ENT>6.82</ENT>
                            <ENT>0.74</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">25077</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Remove tumor, forearm/wrist</ENT>
                            <ENT>9.90</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>6.17</ENT>
                            <ENT>9.13</ENT>
                            <ENT>1.42</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">25085</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Incision of wrist capsule</ENT>
                            <ENT>5.55</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>4.61</ENT>
                            <ENT>5.86</ENT>
                            <ENT>0.85</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">25100</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Biopsy of wrist joint</ENT>
                            <ENT>3.94</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>3.77</ENT>
                            <ENT>4.52</ENT>
                            <ENT>0.59</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">25101</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Explore/treat wrist joint</ENT>
                            <ENT>4.74</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>4.35</ENT>
                            <ENT>5.12</ENT>
                            <ENT>0.75</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <PRTPAGE P="66426"/>
                            <ENT I="01">25105</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Remove wrist joint lining</ENT>
                            <ENT>5.91</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>4.97</ENT>
                            <ENT>6.13</ENT>
                            <ENT>0.92</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">25107</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Remove wrist joint cartilage</ENT>
                            <ENT>7.50</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>6.24</ENT>
                            <ENT>7.28</ENT>
                            <ENT>0.99</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">25109</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Excise tendon forearm/wrist</ENT>
                            <ENT>6.81</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>5.23</ENT>
                            <ENT>5.23</ENT>
                            <ENT>0.96</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">25110</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Remove wrist tendon lesion</ENT>
                            <ENT>3.96</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>3.62</ENT>
                            <ENT>5.33</ENT>
                            <ENT>0.62</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">25111</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Remove wrist tendon lesion</ENT>
                            <ENT>3.44</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>3.61</ENT>
                            <ENT>4.15</ENT>
                            <ENT>0.53</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">25112</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Reremove wrist tendon lesion</ENT>
                            <ENT>4.58</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>4.07</ENT>
                            <ENT>4.66</ENT>
                            <ENT>0.70</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">25115</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Remove wrist/forearm lesion</ENT>
                            <ENT>9.89</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>7.33</ENT>
                            <ENT>10.68</ENT>
                            <ENT>1.31</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">25116</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Remove wrist/forearm lesion</ENT>
                            <ENT>7.38</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>6.18</ENT>
                            <ENT>9.66</ENT>
                            <ENT>1.11</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">25118</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Excise wrist tendon sheath</ENT>
                            <ENT>4.42</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>4.14</ENT>
                            <ENT>4.94</ENT>
                            <ENT>0.68</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">25119</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Partial removal of ulna</ENT>
                            <ENT>6.10</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>5.06</ENT>
                            <ENT>6.33</ENT>
                            <ENT>0.96</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">25120</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Removal of forearm lesion</ENT>
                            <ENT>6.16</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>5.09</ENT>
                            <ENT>8.58</ENT>
                            <ENT>1.00</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">25125</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Remove/graft forearm lesion</ENT>
                            <ENT>7.55</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>5.68</ENT>
                            <ENT>9.26</ENT>
                            <ENT>1.06</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">25126</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Remove/graft forearm lesion</ENT>
                            <ENT>7.62</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>5.86</ENT>
                            <ENT>9.43</ENT>
                            <ENT>1.27</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">25130</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Removal of wrist lesion</ENT>
                            <ENT>5.32</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>4.72</ENT>
                            <ENT>5.57</ENT>
                            <ENT>0.80</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">25135</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Remove &amp; graft wrist lesion</ENT>
                            <ENT>6.96</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>5.62</ENT>
                            <ENT>6.56</ENT>
                            <ENT>1.02</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">25136</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Remove &amp; graft wrist lesion</ENT>
                            <ENT>6.03</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>5.09</ENT>
                            <ENT>5.84</ENT>
                            <ENT>1.03</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">25145</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Remove forearm bone lesion</ENT>
                            <ENT>6.43</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>5.21</ENT>
                            <ENT>8.63</ENT>
                            <ENT>1.01</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">25150</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Partial removal of ulna</ENT>
                            <ENT>7.27</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>5.53</ENT>
                            <ENT>6.86</ENT>
                            <ENT>1.14</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">25151</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Partial removal of radius</ENT>
                            <ENT>7.57</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>5.64</ENT>
                            <ENT>9.18</ENT>
                            <ENT>1.18</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">25170</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Extensive forearm surgery</ENT>
                            <ENT>11.34</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>7.36</ENT>
                            <ENT>11.25</ENT>
                            <ENT>1.78</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">25210</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Removal of wrist bone</ENT>
                            <ENT>6.01</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>5.04</ENT>
                            <ENT>5.91</ENT>
                            <ENT>0.88</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">25215</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Removal of wrist bones</ENT>
                            <ENT>8.02</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>6.02</ENT>
                            <ENT>7.39</ENT>
                            <ENT>1.19</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">25230</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Partial removal of radius</ENT>
                            <ENT>5.28</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>4.49</ENT>
                            <ENT>5.32</ENT>
                            <ENT>0.79</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">25240</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Partial removal of ulna</ENT>
                            <ENT>5.22</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>4.46</ENT>
                            <ENT>5.70</ENT>
                            <ENT>0.81</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">25246</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Injection for wrist x-ray</ENT>
                            <ENT>1.45</ENT>
                            <ENT>2.73</ENT>
                            <ENT>3.08</ENT>
                            <ENT>0.53</ENT>
                            <ENT>0.50</ENT>
                            <ENT>0.09</ENT>
                            <ENT>000</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">25248</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Remove forearm foreign body</ENT>
                            <ENT>5.20</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>4.04</ENT>
                            <ENT>6.28</ENT>
                            <ENT>0.72</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">25250</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Removal of wrist prosthesis</ENT>
                            <ENT>6.66</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>5.27</ENT>
                            <ENT>5.68</ENT>
                            <ENT>1.01</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">25251</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Removal of wrist prosthesis</ENT>
                            <ENT>9.70</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>6.74</ENT>
                            <ENT>7.33</ENT>
                            <ENT>1.26</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">25259</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Manipulate wrist w/anesthes</ENT>
                            <ENT>3.86</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>5.15</ENT>
                            <ENT>5.43</ENT>
                            <ENT>0.62</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">25260</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Repair forearm tendon/muscle</ENT>
                            <ENT>7.89</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>6.37</ENT>
                            <ENT>9.84</ENT>
                            <ENT>1.19</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">25263</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Repair forearm tendon/muscle</ENT>
                            <ENT>7.90</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>6.09</ENT>
                            <ENT>9.67</ENT>
                            <ENT>1.18</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">25265</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Repair forearm tendon/muscle</ENT>
                            <ENT>9.96</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>7.10</ENT>
                            <ENT>10.70</ENT>
                            <ENT>1.47</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">25270</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Repair forearm tendon/muscle</ENT>
                            <ENT>6.06</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>4.97</ENT>
                            <ENT>8.49</ENT>
                            <ENT>0.95</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">25272</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Repair forearm tendon/muscle</ENT>
                            <ENT>7.10</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>5.48</ENT>
                            <ENT>9.13</ENT>
                            <ENT>1.11</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">25274</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Repair forearm tendon/muscle</ENT>
                            <ENT>8.82</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>6.37</ENT>
                            <ENT>9.99</ENT>
                            <ENT>1.36</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">25275</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Repair forearm tendon sheath</ENT>
                            <ENT>8.82</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>6.48</ENT>
                            <ENT>7.02</ENT>
                            <ENT>1.31</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">25280</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Revise wrist/forearm tendon</ENT>
                            <ENT>7.28</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>5.55</ENT>
                            <ENT>9.09</ENT>
                            <ENT>1.08</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">25290</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Incise wrist/forearm tendon</ENT>
                            <ENT>5.34</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>4.50</ENT>
                            <ENT>9.74</ENT>
                            <ENT>0.82</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">25295</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Release wrist/forearm tendon</ENT>
                            <ENT>6.61</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>5.29</ENT>
                            <ENT>8.72</ENT>
                            <ENT>1.00</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">25300</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Fusion of tendons at wrist</ENT>
                            <ENT>8.88</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>6.65</ENT>
                            <ENT>7.55</ENT>
                            <ENT>1.26</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">25301</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Fusion of tendons at wrist</ENT>
                            <ENT>8.47</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>6.18</ENT>
                            <ENT>7.12</ENT>
                            <ENT>1.29</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">25310</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Transplant forearm tendon</ENT>
                            <ENT>8.26</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>5.93</ENT>
                            <ENT>9.48</ENT>
                            <ENT>1.21</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">25312</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Transplant forearm tendon</ENT>
                            <ENT>9.70</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>6.70</ENT>
                            <ENT>10.32</ENT>
                            <ENT>1.41</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">25315</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Revise palsy hand tendon(s)</ENT>
                            <ENT>10.56</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>7.10</ENT>
                            <ENT>10.74</ENT>
                            <ENT>1.58</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">25316</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Revise palsy hand tendon(s)</ENT>
                            <ENT>12.76</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>7.81</ENT>
                            <ENT>12.01</ENT>
                            <ENT>1.75</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">25320</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Repair/revise wrist joint</ENT>
                            <ENT>12.38</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>9.86</ENT>
                            <ENT>10.62</ENT>
                            <ENT>1.61</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">25332</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Revise wrist joint</ENT>
                            <ENT>11.60</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>7.60</ENT>
                            <ENT>8.39</ENT>
                            <ENT>1.84</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">25335</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Realignment of hand</ENT>
                            <ENT>13.25</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>8.30</ENT>
                            <ENT>9.94</ENT>
                            <ENT>1.93</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">25337</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Reconstruct ulna/radioulnar</ENT>
                            <ENT>11.44</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>8.62</ENT>
                            <ENT>9.85</ENT>
                            <ENT>1.61</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">25350</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Revision of radius</ENT>
                            <ENT>8.97</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>6.34</ENT>
                            <ENT>10.15</ENT>
                            <ENT>1.46</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">25355</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Revision of radius</ENT>
                            <ENT>10.41</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>6.74</ENT>
                            <ENT>10.67</ENT>
                            <ENT>1.74</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">25360</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Revision of ulna</ENT>
                            <ENT>8.62</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>6.23</ENT>
                            <ENT>10.05</ENT>
                            <ENT>1.41</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">25365</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Revise radius &amp; ulna</ENT>
                            <ENT>12.77</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>8.17</ENT>
                            <ENT>11.90</ENT>
                            <ENT>2.16</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">25370</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Revise radius or ulna</ENT>
                            <ENT>13.93</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>9.00</ENT>
                            <ENT>12.53</ENT>
                            <ENT>2.29</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">25375</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Revise radius &amp; ulna</ENT>
                            <ENT>13.41</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>8.36</ENT>
                            <ENT>12.39</ENT>
                            <ENT>2.27</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">25390</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Shorten radius or ulna</ENT>
                            <ENT>10.58</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>7.06</ENT>
                            <ENT>10.82</ENT>
                            <ENT>1.65</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">25391</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Lengthen radius or ulna</ENT>
                            <ENT>14.14</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>8.66</ENT>
                            <ENT>12.60</ENT>
                            <ENT>2.22</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">25392</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Shorten radius &amp; ulna</ENT>
                            <ENT>14.44</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>8.90</ENT>
                            <ENT>12.43</ENT>
                            <ENT>2.11</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">25393</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Lengthen radius &amp; ulna</ENT>
                            <ENT>16.42</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>9.55</ENT>
                            <ENT>13.56</ENT>
                            <ENT>2.77</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">25394</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Repair carpal bone, shorten</ENT>
                            <ENT>10.71</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>6.94</ENT>
                            <ENT>7.50</ENT>
                            <ENT>1.59</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">25400</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Repair radius or ulna</ENT>
                            <ENT>11.16</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>7.26</ENT>
                            <ENT>11.22</ENT>
                            <ENT>1.83</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">25405</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Repair/graft radius or ulna</ENT>
                            <ENT>14.87</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>8.92</ENT>
                            <ENT>13.09</ENT>
                            <ENT>2.33</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">25415</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Repair radius &amp; ulna</ENT>
                            <ENT>13.66</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>8.79</ENT>
                            <ENT>12.64</ENT>
                            <ENT>2.18</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">25420</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Repair/graft radius &amp; ulna</ENT>
                            <ENT>16.89</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>9.92</ENT>
                            <ENT>14.09</ENT>
                            <ENT>2.62</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">25425</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Repair/graft radius or ulna</ENT>
                            <ENT>13.58</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>8.48</ENT>
                            <ENT>14.93</ENT>
                            <ENT>2.09</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">25426</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Repair/graft radius &amp; ulna</ENT>
                            <ENT>16.31</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>9.19</ENT>
                            <ENT>12.86</ENT>
                            <ENT>2.55</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">25430</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Vasc graft into carpal bone</ENT>
                            <ENT>9.57</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>7.03</ENT>
                            <ENT>7.18</ENT>
                            <ENT>1.27</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">25431</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Repair nonunion carpal bone</ENT>
                            <ENT>10.75</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>7.15</ENT>
                            <ENT>7.77</ENT>
                            <ENT>1.91</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">25440</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Repair/graft wrist bone</ENT>
                            <ENT>10.56</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>6.89</ENT>
                            <ENT>8.14</ENT>
                            <ENT>1.63</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">25441</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Reconstruct wrist joint</ENT>
                            <ENT>13.15</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>8.10</ENT>
                            <ENT>9.05</ENT>
                            <ENT>2.08</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">25442</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Reconstruct wrist joint</ENT>
                            <ENT>10.98</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>7.50</ENT>
                            <ENT>8.19</ENT>
                            <ENT>1.53</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">25443</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Reconstruct wrist joint</ENT>
                            <ENT>10.52</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>7.21</ENT>
                            <ENT>7.99</ENT>
                            <ENT>1.37</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <PRTPAGE P="66427"/>
                            <ENT I="01">25444</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Reconstruct wrist joint</ENT>
                            <ENT>11.28</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>7.43</ENT>
                            <ENT>8.23</ENT>
                            <ENT>1.72</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">25445</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Reconstruct wrist joint</ENT>
                            <ENT>9.76</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>6.69</ENT>
                            <ENT>7.34</ENT>
                            <ENT>1.55</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">25446</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Wrist replacement</ENT>
                            <ENT>17.16</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>9.98</ENT>
                            <ENT>10.94</ENT>
                            <ENT>2.48</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">25447</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Repair wrist joint(s)</ENT>
                            <ENT>10.95</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>7.86</ENT>
                            <ENT>8.26</ENT>
                            <ENT>1.61</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">25449</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Remove wrist joint implant</ENT>
                            <ENT>14.80</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>8.95</ENT>
                            <ENT>9.81</ENT>
                            <ENT>2.22</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">25450</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Revision of wrist joint</ENT>
                            <ENT>7.94</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>3.84</ENT>
                            <ENT>7.01</ENT>
                            <ENT>1.36</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">25455</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Revision of wrist joint</ENT>
                            <ENT>9.57</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>6.84</ENT>
                            <ENT>8.85</ENT>
                            <ENT>0.96</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">25490</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Reinforce radius</ENT>
                            <ENT>9.61</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>6.57</ENT>
                            <ENT>10.15</ENT>
                            <ENT>1.43</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">25491</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Reinforce ulna</ENT>
                            <ENT>10.03</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>6.78</ENT>
                            <ENT>10.62</ENT>
                            <ENT>1.60</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">25492</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Reinforce radius and ulna</ENT>
                            <ENT>12.52</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>8.33</ENT>
                            <ENT>11.81</ENT>
                            <ENT>2.15</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">25500</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Treat fracture of radius</ENT>
                            <ENT>2.51</ENT>
                            <ENT>3.30</ENT>
                            <ENT>3.44</ENT>
                            <ENT>2.86</ENT>
                            <ENT>2.79</ENT>
                            <ENT>0.35</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">25505</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Treat fracture of radius</ENT>
                            <ENT>5.30</ENT>
                            <ENT>5.82</ENT>
                            <ENT>6.18</ENT>
                            <ENT>4.98</ENT>
                            <ENT>5.20</ENT>
                            <ENT>0.90</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">25515</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Treat fracture of radius</ENT>
                            <ENT>8.64</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>6.46</ENT>
                            <ENT>6.96</ENT>
                            <ENT>1.59</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">25520</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Treat fracture of radius</ENT>
                            <ENT>6.35</ENT>
                            <ENT>5.69</ENT>
                            <ENT>6.27</ENT>
                            <ENT>5.14</ENT>
                            <ENT>5.60</ENT>
                            <ENT>1.08</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">25525</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Treat fracture of radius</ENT>
                            <ENT>10.37</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>7.41</ENT>
                            <ENT>8.70</ENT>
                            <ENT>2.13</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">25526</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Treat fracture of radius</ENT>
                            <ENT>12.96</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>8.68</ENT>
                            <ENT>11.09</ENT>
                            <ENT>2.20</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">25530</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Treat fracture of ulna</ENT>
                            <ENT>2.15</ENT>
                            <ENT>3.48</ENT>
                            <ENT>3.62</ENT>
                            <ENT>2.97</ENT>
                            <ENT>2.92</ENT>
                            <ENT>0.34</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">25535</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Treat fracture of ulna</ENT>
                            <ENT>5.22</ENT>
                            <ENT>5.57</ENT>
                            <ENT>5.79</ENT>
                            <ENT>4.83</ENT>
                            <ENT>5.06</ENT>
                            <ENT>0.89</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">25545</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Treat fracture of ulna</ENT>
                            <ENT>7.78</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>6.23</ENT>
                            <ENT>6.94</ENT>
                            <ENT>1.53</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">25560</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Treat fracture radius &amp; ulna</ENT>
                            <ENT>2.50</ENT>
                            <ENT>3.36</ENT>
                            <ENT>3.53</ENT>
                            <ENT>2.85</ENT>
                            <ENT>2.73</ENT>
                            <ENT>0.35</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">25565</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Treat fracture radius &amp; ulna</ENT>
                            <ENT>5.71</ENT>
                            <ENT>5.90</ENT>
                            <ENT>6.30</ENT>
                            <ENT>4.92</ENT>
                            <ENT>5.17</ENT>
                            <ENT>0.93</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">25574</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Treat fracture radius &amp; ulna</ENT>
                            <ENT>8.64</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>6.55</ENT>
                            <ENT>6.87</ENT>
                            <ENT>1.21</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">25575</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Treat fracture radius/ulna</ENT>
                            <ENT>12.10</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>8.36</ENT>
                            <ENT>8.93</ENT>
                            <ENT>1.82</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">25600</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Treat fracture radius/ulna</ENT>
                            <ENT>2.69</ENT>
                            <ENT>3.68</ENT>
                            <ENT>3.88</ENT>
                            <ENT>3.17</ENT>
                            <ENT>3.07</ENT>
                            <ENT>0.42</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">25605</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Treat fracture radius/ulna</ENT>
                            <ENT>7.02</ENT>
                            <ENT>6.86</ENT>
                            <ENT>7.04</ENT>
                            <ENT>6.13</ENT>
                            <ENT>6.17</ENT>
                            <ENT>1.00</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">25606</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Treat fx distal radial</ENT>
                            <ENT>8.10</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>6.69</ENT>
                            <ENT>7.82</ENT>
                            <ENT>1.26</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">25607</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Treat fx rad extra-articul</ENT>
                            <ENT>9.35</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>7.19</ENT>
                            <ENT>7.19</ENT>
                            <ENT>1.36</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">25608</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Treat fx rad intra-articul</ENT>
                            <ENT>10.86</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>7.79</ENT>
                            <ENT>7.79</ENT>
                            <ENT>1.84</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">25609</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Treat fx radial 3+ frag</ENT>
                            <ENT>14.12</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>9.65</ENT>
                            <ENT>9.65</ENT>
                            <ENT>2.38</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">25622</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Treat wrist bone fracture</ENT>
                            <ENT>2.68</ENT>
                            <ENT>3.90</ENT>
                            <ENT>4.08</ENT>
                            <ENT>3.35</ENT>
                            <ENT>3.23</ENT>
                            <ENT>0.41</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">25624</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Treat wrist bone fracture</ENT>
                            <ENT>4.62</ENT>
                            <ENT>5.63</ENT>
                            <ENT>5.96</ENT>
                            <ENT>4.77</ENT>
                            <ENT>4.92</ENT>
                            <ENT>0.76</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">25628</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Treat wrist bone fracture</ENT>
                            <ENT>9.51</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>6.84</ENT>
                            <ENT>7.33</ENT>
                            <ENT>1.37</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">25630</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Treat wrist bone fracture</ENT>
                            <ENT>2.94</ENT>
                            <ENT>3.75</ENT>
                            <ENT>3.96</ENT>
                            <ENT>3.25</ENT>
                            <ENT>3.09</ENT>
                            <ENT>0.45</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">25635</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Treat wrist bone fracture</ENT>
                            <ENT>4.47</ENT>
                            <ENT>5.11</ENT>
                            <ENT>5.53</ENT>
                            <ENT>4.34</ENT>
                            <ENT>4.12</ENT>
                            <ENT>0.74</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">25645</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Treat wrist bone fracture</ENT>
                            <ENT>7.31</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>5.55</ENT>
                            <ENT>6.09</ENT>
                            <ENT>1.20</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">25650</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Treat wrist bone fracture</ENT>
                            <ENT>3.12</ENT>
                            <ENT>3.84</ENT>
                            <ENT>4.07</ENT>
                            <ENT>3.44</ENT>
                            <ENT>3.31</ENT>
                            <ENT>0.45</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">25651</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Pin ulnar styloid fracture</ENT>
                            <ENT>5.68</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>5.15</ENT>
                            <ENT>5.31</ENT>
                            <ENT>0.86</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">25652</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Treat fracture ulnar styloid</ENT>
                            <ENT>7.92</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>6.16</ENT>
                            <ENT>6.58</ENT>
                            <ENT>1.21</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">25660</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Treat wrist dislocation</ENT>
                            <ENT>4.84</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>4.32</ENT>
                            <ENT>4.51</ENT>
                            <ENT>0.58</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">25670</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Treat wrist dislocation</ENT>
                            <ENT>7.98</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>5.81</ENT>
                            <ENT>6.40</ENT>
                            <ENT>1.28</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">25671</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Pin radioulnar dislocation</ENT>
                            <ENT>6.32</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>5.53</ENT>
                            <ENT>5.84</ENT>
                            <ENT>1.00</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">25675</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Treat wrist dislocation</ENT>
                            <ENT>4.75</ENT>
                            <ENT>4.71</ENT>
                            <ENT>5.18</ENT>
                            <ENT>3.99</ENT>
                            <ENT>4.32</ENT>
                            <ENT>0.62</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">25676</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Treat wrist dislocation</ENT>
                            <ENT>8.17</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>6.13</ENT>
                            <ENT>6.71</ENT>
                            <ENT>1.34</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">25680</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Treat wrist fracture</ENT>
                            <ENT>6.08</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>4.38</ENT>
                            <ENT>4.56</ENT>
                            <ENT>0.78</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">25685</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Treat wrist fracture</ENT>
                            <ENT>9.97</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>6.62</ENT>
                            <ENT>7.21</ENT>
                            <ENT>1.60</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">25690</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Treat wrist dislocation</ENT>
                            <ENT>5.58</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>4.85</ENT>
                            <ENT>5.17</ENT>
                            <ENT>0.88</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">25695</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Treat wrist dislocation</ENT>
                            <ENT>8.40</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>6.00</ENT>
                            <ENT>6.54</ENT>
                            <ENT>1.32</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">25800</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Fusion of wrist joint</ENT>
                            <ENT>9.95</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>6.79</ENT>
                            <ENT>7.94</ENT>
                            <ENT>1.57</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">25805</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Fusion/graft of wrist joint</ENT>
                            <ENT>11.59</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>7.67</ENT>
                            <ENT>8.96</ENT>
                            <ENT>1.81</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">25810</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Fusion/graft of wrist joint</ENT>
                            <ENT>11.75</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>8.03</ENT>
                            <ENT>8.97</ENT>
                            <ENT>1.68</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">25820</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Fusion of hand bones</ENT>
                            <ENT>7.52</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>6.41</ENT>
                            <ENT>7.12</ENT>
                            <ENT>1.22</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">25825</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Fuse hand bones with graft</ENT>
                            <ENT>9.54</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>7.65</ENT>
                            <ENT>8.44</ENT>
                            <ENT>1.41</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">25830</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Fusion, radioulnar jnt/ulna</ENT>
                            <ENT>10.69</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>10.57</ENT>
                            <ENT>12.49</ENT>
                            <ENT>1.55</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">25900</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Amputation of forearm</ENT>
                            <ENT>9.46</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>6.73</ENT>
                            <ENT>9.64</ENT>
                            <ENT>1.30</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">25905</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Amputation of forearm</ENT>
                            <ENT>9.48</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>6.06</ENT>
                            <ENT>9.17</ENT>
                            <ENT>1.40</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">25907</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Amputation follow-up surgery</ENT>
                            <ENT>7.98</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>5.77</ENT>
                            <ENT>8.76</ENT>
                            <ENT>1.10</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">25909</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Amputation follow-up surgery</ENT>
                            <ENT>9.20</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>6.32</ENT>
                            <ENT>9.30</ENT>
                            <ENT>1.44</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">25915</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Amputation of forearm</ENT>
                            <ENT>17.38</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>5.97</ENT>
                            <ENT>12.42</ENT>
                            <ENT>2.94</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">25920</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Amputate hand at wrist</ENT>
                            <ENT>8.92</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>6.59</ENT>
                            <ENT>7.21</ENT>
                            <ENT>1.35</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">25922</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Amputate hand at wrist</ENT>
                            <ENT>7.54</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>6.27</ENT>
                            <ENT>6.66</ENT>
                            <ENT>1.12</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">25924</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Amputation follow-up surgery</ENT>
                            <ENT>8.70</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>6.12</ENT>
                            <ENT>7.10</ENT>
                            <ENT>1.32</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">25927</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Amputation of hand</ENT>
                            <ENT>8.98</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>8.65</ENT>
                            <ENT>10.16</ENT>
                            <ENT>1.27</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">25929</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Amputation follow-up surgery</ENT>
                            <ENT>7.71</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>5.66</ENT>
                            <ENT>5.77</ENT>
                            <ENT>1.14</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">25931</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Amputation follow-up surgery</ENT>
                            <ENT>7.93</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>8.32</ENT>
                            <ENT>9.89</ENT>
                            <ENT>1.15</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">25999</ENT>
                            <ENT/>
                            <ENT>C</ENT>
                            <ENT>Forearm or wrist surgery</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>YYY</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">26010</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Drainage of finger abscess</ENT>
                            <ENT>1.56</ENT>
                            <ENT>4.06</ENT>
                            <ENT>4.81</ENT>
                            <ENT>1.52</ENT>
                            <ENT>1.57</ENT>
                            <ENT>0.18</ENT>
                            <ENT>010</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">26011</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Drainage of finger abscess</ENT>
                            <ENT>2.21</ENT>
                            <ENT>6.24</ENT>
                            <ENT>7.53</ENT>
                            <ENT>1.96</ENT>
                            <ENT>2.14</ENT>
                            <ENT>0.33</ENT>
                            <ENT>010</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">26020</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Drain hand tendon sheath</ENT>
                            <ENT>4.97</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>4.74</ENT>
                            <ENT>5.05</ENT>
                            <ENT>0.73</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">26025</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Drainage of palm bursa</ENT>
                            <ENT>4.99</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>4.46</ENT>
                            <ENT>4.78</ENT>
                            <ENT>0.76</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">26030</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Drainage of palm bursa(s)</ENT>
                            <ENT>6.16</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>5.00</ENT>
                            <ENT>5.36</ENT>
                            <ENT>0.92</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">26034</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Treat hand bone lesion</ENT>
                            <ENT>6.49</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>5.57</ENT>
                            <ENT>5.96</ENT>
                            <ENT>1.01</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">26035</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Decompress fingers/hand</ENT>
                            <ENT>11.14</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>8.12</ENT>
                            <ENT>7.99</ENT>
                            <ENT>1.47</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <PRTPAGE P="66428"/>
                            <ENT I="01">26037</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Decompress fingers/hand</ENT>
                            <ENT>7.48</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>5.49</ENT>
                            <ENT>5.91</ENT>
                            <ENT>1.13</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">26040</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Release palm contracture</ENT>
                            <ENT>3.38</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>3.60</ENT>
                            <ENT>3.82</ENT>
                            <ENT>0.53</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">26045</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Release palm contracture</ENT>
                            <ENT>5.62</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>4.88</ENT>
                            <ENT>5.26</ENT>
                            <ENT>0.93</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">26055</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Incise finger tendon sheath</ENT>
                            <ENT>3.00</ENT>
                            <ENT>9.04</ENT>
                            <ENT>11.69</ENT>
                            <ENT>3.82</ENT>
                            <ENT>3.88</ENT>
                            <ENT>0.43</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">26060</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Incision of finger tendon</ENT>
                            <ENT>2.85</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>3.05</ENT>
                            <ENT>3.28</ENT>
                            <ENT>0.45</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">26070</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Explore/treat hand joint</ENT>
                            <ENT>3.73</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>3.05</ENT>
                            <ENT>3.21</ENT>
                            <ENT>0.48</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">26075</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Explore/treat finger joint</ENT>
                            <ENT>3.83</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>3.37</ENT>
                            <ENT>3.57</ENT>
                            <ENT>0.53</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">26080</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Explore/treat finger joint</ENT>
                            <ENT>4.36</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>4.32</ENT>
                            <ENT>4.58</ENT>
                            <ENT>0.66</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">26100</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Biopsy hand joint lining</ENT>
                            <ENT>3.71</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>3.66</ENT>
                            <ENT>3.89</ENT>
                            <ENT>0.54</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">26105</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Biopsy finger joint lining</ENT>
                            <ENT>3.75</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>3.68</ENT>
                            <ENT>3.95</ENT>
                            <ENT>0.59</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">26110</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Biopsy finger joint lining</ENT>
                            <ENT>3.57</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>3.60</ENT>
                            <ENT>3.82</ENT>
                            <ENT>0.53</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">26115</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Removal hand lesion subcut</ENT>
                            <ENT>3.92</ENT>
                            <ENT>9.83</ENT>
                            <ENT>11.46</ENT>
                            <ENT>4.23</ENT>
                            <ENT>4.49</ENT>
                            <ENT>0.59</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">26116</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Removal hand lesion, deep</ENT>
                            <ENT>5.61</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>5.30</ENT>
                            <ENT>5.65</ENT>
                            <ENT>0.84</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">26117</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Remove tumor, hand/finger</ENT>
                            <ENT>8.62</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>6.18</ENT>
                            <ENT>6.62</ENT>
                            <ENT>1.26</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">26121</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Release palm contracture</ENT>
                            <ENT>7.61</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>5.92</ENT>
                            <ENT>6.44</ENT>
                            <ENT>1.17</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">26123</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Release palm contracture</ENT>
                            <ENT>10.63</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>8.21</ENT>
                            <ENT>8.53</ENT>
                            <ENT>1.43</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">26125</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Release palm contracture</ENT>
                            <ENT>4.60</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>1.87</ENT>
                            <ENT>2.15</ENT>
                            <ENT>0.70</ENT>
                            <ENT>ZZZ</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">26130</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Remove wrist joint lining</ENT>
                            <ENT>5.48</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>4.88</ENT>
                            <ENT>5.11</ENT>
                            <ENT>0.94</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">26135</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Revise finger joint, each</ENT>
                            <ENT>7.02</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>5.47</ENT>
                            <ENT>5.96</ENT>
                            <ENT>1.07</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">26140</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Revise finger joint, each</ENT>
                            <ENT>6.23</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>5.16</ENT>
                            <ENT>5.60</ENT>
                            <ENT>0.92</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">26145</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Tendon excision, palm/finger</ENT>
                            <ENT>6.38</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>5.18</ENT>
                            <ENT>5.62</ENT>
                            <ENT>0.97</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">26160</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Remove tendon sheath lesion</ENT>
                            <ENT>3.46</ENT>
                            <ENT>9.03</ENT>
                            <ENT>10.70</ENT>
                            <ENT>3.94</ENT>
                            <ENT>4.03</ENT>
                            <ENT>0.49</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">26170</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Removal of palm tendon, each</ENT>
                            <ENT>4.82</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>4.37</ENT>
                            <ENT>4.65</ENT>
                            <ENT>0.69</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">26180</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Removal of finger tendon</ENT>
                            <ENT>5.24</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>4.71</ENT>
                            <ENT>5.06</ENT>
                            <ENT>0.78</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">26185</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Remove finger bone</ENT>
                            <ENT>6.32</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>5.73</ENT>
                            <ENT>5.88</ENT>
                            <ENT>0.81</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">26200</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Remove hand bone lesion</ENT>
                            <ENT>5.56</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>4.55</ENT>
                            <ENT>4.95</ENT>
                            <ENT>0.88</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">26205</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Remove/graft bone lesion</ENT>
                            <ENT>7.82</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>5.85</ENT>
                            <ENT>6.37</ENT>
                            <ENT>1.20</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">26210</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Removal of finger lesion</ENT>
                            <ENT>5.21</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>4.73</ENT>
                            <ENT>5.08</ENT>
                            <ENT>0.79</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">26215</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Remove/graft finger lesion</ENT>
                            <ENT>7.16</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>5.54</ENT>
                            <ENT>5.92</ENT>
                            <ENT>0.98</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">26230</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Partial removal of hand bone</ENT>
                            <ENT>6.38</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>4.95</ENT>
                            <ENT>5.43</ENT>
                            <ENT>1.01</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">26235</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Partial removal, finger bone</ENT>
                            <ENT>6.24</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>4.94</ENT>
                            <ENT>5.38</ENT>
                            <ENT>0.95</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">26236</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Partial removal, finger bone</ENT>
                            <ENT>5.37</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>4.57</ENT>
                            <ENT>4.95</ENT>
                            <ENT>0.81</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">26250</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Extensive hand surgery</ENT>
                            <ENT>7.61</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>5.71</ENT>
                            <ENT>6.07</ENT>
                            <ENT>1.07</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">26255</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Extensive hand surgery</ENT>
                            <ENT>12.80</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>8.28</ENT>
                            <ENT>8.82</ENT>
                            <ENT>1.69</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">26260</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Extensive finger surgery</ENT>
                            <ENT>7.09</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>5.46</ENT>
                            <ENT>5.82</ENT>
                            <ENT>1.01</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">26261</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Extensive finger surgery</ENT>
                            <ENT>9.28</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>6.72</ENT>
                            <ENT>6.44</ENT>
                            <ENT>1.14</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">26262</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Partial removal of finger</ENT>
                            <ENT>5.72</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>4.74</ENT>
                            <ENT>5.04</ENT>
                            <ENT>0.88</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">26320</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Removal of implant from hand</ENT>
                            <ENT>4.02</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>3.79</ENT>
                            <ENT>4.05</ENT>
                            <ENT>0.59</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">26340</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Manipulate finger w/anesth</ENT>
                            <ENT>2.62</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>4.60</ENT>
                            <ENT>4.74</ENT>
                            <ENT>0.39</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">26350</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Repair finger/hand tendon</ENT>
                            <ENT>6.07</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>9.52</ENT>
                            <ENT>12.06</ENT>
                            <ENT>0.93</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">26352</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Repair/graft hand tendon</ENT>
                            <ENT>7.75</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>10.06</ENT>
                            <ENT>12.70</ENT>
                            <ENT>1.13</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">26356</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Repair finger/hand tendon</ENT>
                            <ENT>10.22</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>13.70</ENT>
                            <ENT>16.03</ENT>
                            <ENT>1.21</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">26357</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Repair finger/hand tendon</ENT>
                            <ENT>8.65</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>10.35</ENT>
                            <ENT>12.99</ENT>
                            <ENT>1.33</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">26358</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Repair/graft hand tendon</ENT>
                            <ENT>9.22</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>10.94</ENT>
                            <ENT>13.79</ENT>
                            <ENT>1.38</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">26370</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Repair finger/hand tendon</ENT>
                            <ENT>7.17</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>9.50</ENT>
                            <ENT>12.30</ENT>
                            <ENT>1.12</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">26372</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Repair/graft hand tendon</ENT>
                            <ENT>8.89</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>10.53</ENT>
                            <ENT>13.52</ENT>
                            <ENT>1.40</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">26373</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Repair finger/hand tendon</ENT>
                            <ENT>8.29</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>10.16</ENT>
                            <ENT>13.10</ENT>
                            <ENT>1.23</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">26390</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Revise hand/finger tendon</ENT>
                            <ENT>9.31</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>9.20</ENT>
                            <ENT>11.24</ENT>
                            <ENT>1.40</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">26392</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Repair/graft hand tendon</ENT>
                            <ENT>10.38</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>11.16</ENT>
                            <ENT>13.94</ENT>
                            <ENT>1.57</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">26410</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Repair hand tendon</ENT>
                            <ENT>4.68</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>7.63</ENT>
                            <ENT>9.78</ENT>
                            <ENT>0.73</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">26412</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Repair/graft hand tendon</ENT>
                            <ENT>6.37</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>8.62</ENT>
                            <ENT>10.94</ENT>
                            <ENT>0.97</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">26415</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Excision, hand/finger tendon</ENT>
                            <ENT>8.40</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>7.46</ENT>
                            <ENT>9.62</ENT>
                            <ENT>0.98</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">26416</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Graft hand or finger tendon</ENT>
                            <ENT>9.44</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>9.04</ENT>
                            <ENT>11.81</ENT>
                            <ENT>0.79</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">26418</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Repair finger tendon</ENT>
                            <ENT>4.33</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>8.14</ENT>
                            <ENT>10.23</ENT>
                            <ENT>0.67</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">26420</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Repair/graft finger tendon</ENT>
                            <ENT>6.83</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>8.80</ENT>
                            <ENT>11.21</ENT>
                            <ENT>1.07</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">26426</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Repair finger/hand tendon</ENT>
                            <ENT>6.21</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>5.11</ENT>
                            <ENT>9.13</ENT>
                            <ENT>0.95</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">26428</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Repair/graft finger tendon</ENT>
                            <ENT>7.28</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>9.25</ENT>
                            <ENT>11.55</ENT>
                            <ENT>1.09</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">26432</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Repair finger tendon</ENT>
                            <ENT>4.07</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>6.78</ENT>
                            <ENT>8.52</ENT>
                            <ENT>0.64</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">26433</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Repair finger tendon</ENT>
                            <ENT>4.61</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>7.01</ENT>
                            <ENT>8.90</ENT>
                            <ENT>0.72</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">26434</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Repair/graft finger tendon</ENT>
                            <ENT>6.15</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>7.93</ENT>
                            <ENT>9.73</ENT>
                            <ENT>0.93</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">26437</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Realignment of tendons</ENT>
                            <ENT>5.88</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>7.81</ENT>
                            <ENT>9.68</ENT>
                            <ENT>0.89</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">26440</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Release palm/finger tendon</ENT>
                            <ENT>5.07</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>8.48</ENT>
                            <ENT>10.95</ENT>
                            <ENT>0.75</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">26442</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Release palm &amp; finger tendon</ENT>
                            <ENT>9.50</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>11.81</ENT>
                            <ENT>13.87</ENT>
                            <ENT>1.20</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">26445</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Release hand/finger tendon</ENT>
                            <ENT>4.36</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>8.23</ENT>
                            <ENT>10.68</ENT>
                            <ENT>0.65</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">26449</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Release forearm/hand tendon</ENT>
                            <ENT>8.34</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>7.27</ENT>
                            <ENT>11.52</ENT>
                            <ENT>1.06</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">26450</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Incision of palm tendon</ENT>
                            <ENT>3.71</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>5.19</ENT>
                            <ENT>6.26</ENT>
                            <ENT>0.59</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">26455</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Incision of finger tendon</ENT>
                            <ENT>3.68</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>5.15</ENT>
                            <ENT>6.21</ENT>
                            <ENT>0.58</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">26460</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Incise hand/finger tendon</ENT>
                            <ENT>3.50</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>5.11</ENT>
                            <ENT>6.12</ENT>
                            <ENT>0.55</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">26471</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Fusion of finger tendons</ENT>
                            <ENT>5.79</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>7.79</ENT>
                            <ENT>9.51</ENT>
                            <ENT>0.88</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">26474</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Fusion of finger tendons</ENT>
                            <ENT>5.38</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>7.60</ENT>
                            <ENT>9.49</ENT>
                            <ENT>0.76</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">26476</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Tendon lengthening</ENT>
                            <ENT>5.24</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>7.35</ENT>
                            <ENT>9.14</ENT>
                            <ENT>0.79</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">26477</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Tendon shortening</ENT>
                            <ENT>5.21</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>7.57</ENT>
                            <ENT>9.31</ENT>
                            <ENT>0.81</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <PRTPAGE P="66429"/>
                            <ENT I="01">26478</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Lengthening of hand tendon</ENT>
                            <ENT>5.86</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>7.78</ENT>
                            <ENT>9.80</ENT>
                            <ENT>0.90</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">26479</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Shortening of hand tendon</ENT>
                            <ENT>5.80</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>7.73</ENT>
                            <ENT>9.64</ENT>
                            <ENT>0.92</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">26480</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Transplant hand tendon</ENT>
                            <ENT>6.76</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>9.65</ENT>
                            <ENT>12.34</ENT>
                            <ENT>1.02</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">26483</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Transplant/graft hand tendon</ENT>
                            <ENT>8.36</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>10.22</ENT>
                            <ENT>12.85</ENT>
                            <ENT>1.26</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">26485</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Transplant palm tendon</ENT>
                            <ENT>7.77</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>10.07</ENT>
                            <ENT>12.71</ENT>
                            <ENT>1.15</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">26489</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Transplant/graft palm tendon</ENT>
                            <ENT>9.74</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>10.82</ENT>
                            <ENT>11.43</ENT>
                            <ENT>1.26</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">26490</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Revise thumb tendon</ENT>
                            <ENT>8.48</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>8.87</ENT>
                            <ENT>10.84</ENT>
                            <ENT>1.21</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">26492</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Tendon transfer with graft</ENT>
                            <ENT>9.70</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>9.82</ENT>
                            <ENT>11.71</ENT>
                            <ENT>1.40</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">26494</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Hand tendon/muscle transfer</ENT>
                            <ENT>8.54</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>9.23</ENT>
                            <ENT>11.10</ENT>
                            <ENT>1.28</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">26496</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Revise thumb tendon</ENT>
                            <ENT>9.66</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>9.57</ENT>
                            <ENT>11.40</ENT>
                            <ENT>1.45</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">26497</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Finger tendon transfer</ENT>
                            <ENT>9.64</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>9.52</ENT>
                            <ENT>11.54</ENT>
                            <ENT>1.41</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">26498</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Finger tendon transfer</ENT>
                            <ENT>14.07</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>11.65</ENT>
                            <ENT>13.90</ENT>
                            <ENT>2.11</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">26499</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Revision of finger</ENT>
                            <ENT>9.05</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>8.84</ENT>
                            <ENT>10.94</ENT>
                            <ENT>1.35</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">26500</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Hand tendon reconstruction</ENT>
                            <ENT>6.02</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>7.74</ENT>
                            <ENT>9.59</ENT>
                            <ENT>0.90</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">26502</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Hand tendon reconstruction</ENT>
                            <ENT>7.20</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>8.32</ENT>
                            <ENT>10.17</ENT>
                            <ENT>1.13</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">26508</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Release thumb contracture</ENT>
                            <ENT>6.07</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>7.80</ENT>
                            <ENT>9.73</ENT>
                            <ENT>0.98</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">26510</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Thumb tendon transfer</ENT>
                            <ENT>5.49</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>7.63</ENT>
                            <ENT>9.48</ENT>
                            <ENT>0.79</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">26516</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Fusion of knuckle joint</ENT>
                            <ENT>7.21</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>8.30</ENT>
                            <ENT>10.26</ENT>
                            <ENT>1.10</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">26517</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Fusion of knuckle joints</ENT>
                            <ENT>8.96</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>8.99</ENT>
                            <ENT>11.24</ENT>
                            <ENT>1.41</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">26518</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Fusion of knuckle joints</ENT>
                            <ENT>9.15</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>8.96</ENT>
                            <ENT>11.17</ENT>
                            <ENT>1.35</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">26520</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Release knuckle contracture</ENT>
                            <ENT>5.36</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>8.86</ENT>
                            <ENT>11.37</ENT>
                            <ENT>0.80</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">26525</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Release finger contracture</ENT>
                            <ENT>5.39</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>8.88</ENT>
                            <ENT>11.42</ENT>
                            <ENT>0.81</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">26530</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Revise knuckle joint</ENT>
                            <ENT>6.76</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>5.41</ENT>
                            <ENT>5.77</ENT>
                            <ENT>1.04</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">26531</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Revise knuckle with implant</ENT>
                            <ENT>7.99</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>6.16</ENT>
                            <ENT>6.64</ENT>
                            <ENT>1.17</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">26535</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Revise finger joint</ENT>
                            <ENT>5.30</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>4.09</ENT>
                            <ENT>3.91</ENT>
                            <ENT>0.71</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">26536</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Revise/implant finger joint</ENT>
                            <ENT>6.44</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>9.24</ENT>
                            <ENT>9.44</ENT>
                            <ENT>0.96</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">26540</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Repair hand joint</ENT>
                            <ENT>6.49</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>8.05</ENT>
                            <ENT>9.96</ENT>
                            <ENT>0.99</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">26541</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Repair hand joint with graft</ENT>
                            <ENT>8.69</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>9.11</ENT>
                            <ENT>11.25</ENT>
                            <ENT>1.28</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">26542</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Repair hand joint with graft</ENT>
                            <ENT>6.84</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>8.19</ENT>
                            <ENT>10.11</ENT>
                            <ENT>1.02</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">26545</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Reconstruct finger joint</ENT>
                            <ENT>6.99</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>8.45</ENT>
                            <ENT>10.29</ENT>
                            <ENT>1.05</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">26546</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Repair nonunion hand</ENT>
                            <ENT>10.53</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>11.42</ENT>
                            <ENT>13.22</ENT>
                            <ENT>1.44</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">26548</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Reconstruct finger joint</ENT>
                            <ENT>8.10</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>8.80</ENT>
                            <ENT>10.82</ENT>
                            <ENT>1.20</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">26550</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Construct thumb replacement</ENT>
                            <ENT>21.54</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>14.53</ENT>
                            <ENT>16.05</ENT>
                            <ENT>2.46</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">26551</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Great toe-hand transfer</ENT>
                            <ENT>48.23</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>17.15</ENT>
                            <ENT>24.79</ENT>
                            <ENT>7.98</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">26553</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Single transfer, toe-hand</ENT>
                            <ENT>47.92</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>27.34</ENT>
                            <ENT>25.01</ENT>
                            <ENT>2.42</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">26554</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Double transfer, toe-hand</ENT>
                            <ENT>56.73</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>35.78</ENT>
                            <ENT>36.65</ENT>
                            <ENT>9.44</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">26555</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Positional change of finger</ENT>
                            <ENT>16.94</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>13.99</ENT>
                            <ENT>16.08</ENT>
                            <ENT>2.49</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">26556</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Toe joint transfer</ENT>
                            <ENT>49.43</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>18.03</ENT>
                            <ENT>25.67</ENT>
                            <ENT>2.58</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">26560</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Repair of web finger</ENT>
                            <ENT>5.43</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>6.65</ENT>
                            <ENT>8.22</ENT>
                            <ENT>0.85</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">26561</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Repair of web finger</ENT>
                            <ENT>10.98</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>9.50</ENT>
                            <ENT>10.92</ENT>
                            <ENT>1.45</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">26562</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Repair of web finger</ENT>
                            <ENT>16.40</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>8.76</ENT>
                            <ENT>12.95</ENT>
                            <ENT>2.24</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">26565</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Correct metacarpal flaw</ENT>
                            <ENT>6.80</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>8.15</ENT>
                            <ENT>10.07</ENT>
                            <ENT>1.00</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">26567</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Correct finger deformity</ENT>
                            <ENT>6.88</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>8.11</ENT>
                            <ENT>10.03</ENT>
                            <ENT>1.04</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">26568</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Lengthen metacarpal/finger</ENT>
                            <ENT>9.15</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>10.69</ENT>
                            <ENT>13.05</ENT>
                            <ENT>1.49</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">26580</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Repair hand deformity</ENT>
                            <ENT>19.50</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>9.73</ENT>
                            <ENT>11.68</ENT>
                            <ENT>2.29</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">26587</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Reconstruct extra finger</ENT>
                            <ENT>14.36</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>8.01</ENT>
                            <ENT>8.61</ENT>
                            <ENT>1.53</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">26590</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Repair finger deformity</ENT>
                            <ENT>18.51</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>12.41</ENT>
                            <ENT>13.17</ENT>
                            <ENT>2.78</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">26591</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Repair muscles of hand</ENT>
                            <ENT>3.30</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>6.21</ENT>
                            <ENT>7.91</ENT>
                            <ENT>0.48</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">26593</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Release muscles of hand</ENT>
                            <ENT>5.38</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>7.79</ENT>
                            <ENT>9.46</ENT>
                            <ENT>0.78</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">26596</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Excision constricting tissue</ENT>
                            <ENT>9.02</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>7.48</ENT>
                            <ENT>8.15</ENT>
                            <ENT>1.43</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">26600</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Treat metacarpal fracture</ENT>
                            <ENT>2.48</ENT>
                            <ENT>3.83</ENT>
                            <ENT>3.72</ENT>
                            <ENT>3.49</ENT>
                            <ENT>3.07</ENT>
                            <ENT>0.30</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">26605</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Treat metacarpal fracture</ENT>
                            <ENT>2.92</ENT>
                            <ENT>4.08</ENT>
                            <ENT>4.32</ENT>
                            <ENT>3.50</ENT>
                            <ENT>3.58</ENT>
                            <ENT>0.49</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">26607</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Treat metacarpal fracture</ENT>
                            <ENT>5.40</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>4.88</ENT>
                            <ENT>5.58</ENT>
                            <ENT>0.87</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">26608</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Treat metacarpal fracture</ENT>
                            <ENT>5.43</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>5.22</ENT>
                            <ENT>5.74</ENT>
                            <ENT>0.88</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">26615</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Treat metacarpal fracture</ENT>
                            <ENT>6.91</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>6.01</ENT>
                            <ENT>5.66</ENT>
                            <ENT>0.86</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">26641</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Treat thumb dislocation</ENT>
                            <ENT>4.01</ENT>
                            <ENT>4.03</ENT>
                            <ENT>4.30</ENT>
                            <ENT>3.40</ENT>
                            <ENT>3.46</ENT>
                            <ENT>0.39</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">26645</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Treat thumb fracture</ENT>
                            <ENT>4.47</ENT>
                            <ENT>4.60</ENT>
                            <ENT>4.88</ENT>
                            <ENT>3.92</ENT>
                            <ENT>4.05</ENT>
                            <ENT>0.67</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">26650</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Treat thumb fracture</ENT>
                            <ENT>5.19</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>4.88</ENT>
                            <ENT>5.78</ENT>
                            <ENT>0.94</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">26665</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Treat thumb fracture</ENT>
                            <ENT>7.78</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>6.31</ENT>
                            <ENT>6.46</ENT>
                            <ENT>0.90</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">26670</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Treat hand dislocation</ENT>
                            <ENT>3.74</ENT>
                            <ENT>3.62</ENT>
                            <ENT>3.94</ENT>
                            <ENT>3.03</ENT>
                            <ENT>2.99</ENT>
                            <ENT>0.39</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">26675</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Treat hand dislocation</ENT>
                            <ENT>4.71</ENT>
                            <ENT>5.25</ENT>
                            <ENT>5.36</ENT>
                            <ENT>4.51</ENT>
                            <ENT>4.49</ENT>
                            <ENT>0.77</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">26676</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Pin hand dislocation</ENT>
                            <ENT>5.60</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>5.56</ENT>
                            <ENT>6.12</ENT>
                            <ENT>0.91</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">26685</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Treat hand dislocation</ENT>
                            <ENT>6.91</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>5.97</ENT>
                            <ENT>6.05</ENT>
                            <ENT>1.09</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">26686</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Treat hand dislocation</ENT>
                            <ENT>8.06</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>6.07</ENT>
                            <ENT>6.48</ENT>
                            <ENT>1.24</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">26700</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Treat knuckle dislocation</ENT>
                            <ENT>3.74</ENT>
                            <ENT>3.30</ENT>
                            <ENT>3.53</ENT>
                            <ENT>2.93</ENT>
                            <ENT>2.89</ENT>
                            <ENT>0.35</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">26705</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Treat knuckle dislocation</ENT>
                            <ENT>4.26</ENT>
                            <ENT>4.74</ENT>
                            <ENT>5.04</ENT>
                            <ENT>4.04</ENT>
                            <ENT>4.17</ENT>
                            <ENT>0.66</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">26706</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Pin knuckle dislocation</ENT>
                            <ENT>5.19</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>4.70</ENT>
                            <ENT>4.89</ENT>
                            <ENT>0.81</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">26715</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Treat knuckle dislocation</ENT>
                            <ENT>6.87</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>5.99</ENT>
                            <ENT>5.75</ENT>
                            <ENT>0.91</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">26720</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Treat finger fracture, each</ENT>
                            <ENT>1.70</ENT>
                            <ENT>2.58</ENT>
                            <ENT>2.68</ENT>
                            <ENT>2.30</ENT>
                            <ENT>2.18</ENT>
                            <ENT>0.24</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">26725</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Treat finger fracture, each</ENT>
                            <ENT>3.39</ENT>
                            <ENT>4.08</ENT>
                            <ENT>4.42</ENT>
                            <ENT>3.41</ENT>
                            <ENT>3.45</ENT>
                            <ENT>0.53</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">26727</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Treat finger fracture, each</ENT>
                            <ENT>5.30</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>5.18</ENT>
                            <ENT>5.70</ENT>
                            <ENT>0.84</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">26735</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Treat finger fracture, each</ENT>
                            <ENT>7.26</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>6.12</ENT>
                            <ENT>5.84</ENT>
                            <ENT>0.95</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <PRTPAGE P="66430"/>
                            <ENT I="01">26740</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Treat finger fracture, each</ENT>
                            <ENT>1.99</ENT>
                            <ENT>3.01</ENT>
                            <ENT>3.07</ENT>
                            <ENT>2.71</ENT>
                            <ENT>2.71</ENT>
                            <ENT>0.31</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">26742</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Treat finger fracture, each</ENT>
                            <ENT>3.90</ENT>
                            <ENT>4.26</ENT>
                            <ENT>4.62</ENT>
                            <ENT>3.56</ENT>
                            <ENT>3.72</ENT>
                            <ENT>0.58</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">26746</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Treat finger fracture, each</ENT>
                            <ENT>9.59</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>7.19</ENT>
                            <ENT>6.38</ENT>
                            <ENT>0.91</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">26750</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Treat finger fracture, each</ENT>
                            <ENT>1.74</ENT>
                            <ENT>2.25</ENT>
                            <ENT>2.36</ENT>
                            <ENT>2.26</ENT>
                            <ENT>2.14</ENT>
                            <ENT>0.22</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">26755</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Treat finger fracture, each</ENT>
                            <ENT>3.15</ENT>
                            <ENT>3.74</ENT>
                            <ENT>4.08</ENT>
                            <ENT>2.94</ENT>
                            <ENT>2.97</ENT>
                            <ENT>0.42</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">26756</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Pin finger fracture, each</ENT>
                            <ENT>4.46</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>4.86</ENT>
                            <ENT>5.29</ENT>
                            <ENT>0.71</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">26765</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Treat finger fracture, each</ENT>
                            <ENT>5.70</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>5.47</ENT>
                            <ENT>4.93</ENT>
                            <ENT>0.66</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">26770</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Treat finger dislocation</ENT>
                            <ENT>3.07</ENT>
                            <ENT>2.92</ENT>
                            <ENT>3.17</ENT>
                            <ENT>2.54</ENT>
                            <ENT>2.48</ENT>
                            <ENT>0.27</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">26775</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Treat finger dislocation</ENT>
                            <ENT>3.78</ENT>
                            <ENT>4.62</ENT>
                            <ENT>4.90</ENT>
                            <ENT>3.88</ENT>
                            <ENT>3.84</ENT>
                            <ENT>0.54</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">26776</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Pin finger dislocation</ENT>
                            <ENT>4.87</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>4.98</ENT>
                            <ENT>5.49</ENT>
                            <ENT>0.77</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">26785</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Treat finger dislocation</ENT>
                            <ENT>6.44</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>5.77</ENT>
                            <ENT>5.15</ENT>
                            <ENT>0.68</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">26820</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Thumb fusion with graft</ENT>
                            <ENT>8.33</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>8.96</ENT>
                            <ENT>11.10</ENT>
                            <ENT>1.30</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">26841</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Fusion of thumb</ENT>
                            <ENT>7.21</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>8.76</ENT>
                            <ENT>10.99</ENT>
                            <ENT>1.18</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">26842</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Thumb fusion with graft</ENT>
                            <ENT>8.37</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>9.01</ENT>
                            <ENT>11.19</ENT>
                            <ENT>1.32</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">26843</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Fusion of hand joint</ENT>
                            <ENT>7.67</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>8.56</ENT>
                            <ENT>10.45</ENT>
                            <ENT>1.15</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">26844</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Fusion/graft of hand joint</ENT>
                            <ENT>8.86</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>9.15</ENT>
                            <ENT>11.25</ENT>
                            <ENT>1.33</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">26850</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Fusion of knuckle</ENT>
                            <ENT>7.03</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>8.26</ENT>
                            <ENT>10.23</ENT>
                            <ENT>1.06</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">26852</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Fusion of knuckle with graft</ENT>
                            <ENT>8.59</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>9.13</ENT>
                            <ENT>11.01</ENT>
                            <ENT>1.22</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">26860</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Fusion of finger joint</ENT>
                            <ENT>4.76</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>7.53</ENT>
                            <ENT>9.35</ENT>
                            <ENT>0.73</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">26861</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Fusion of finger jnt, add-on</ENT>
                            <ENT>1.74</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>0.70</ENT>
                            <ENT>0.81</ENT>
                            <ENT>0.27</ENT>
                            <ENT>ZZZ</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">26862</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Fusion/graft of finger joint</ENT>
                            <ENT>7.44</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>8.66</ENT>
                            <ENT>10.50</ENT>
                            <ENT>1.10</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">26863</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Fuse/graft added joint</ENT>
                            <ENT>3.89</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>1.58</ENT>
                            <ENT>1.85</ENT>
                            <ENT>0.56</ENT>
                            <ENT>ZZZ</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">26910</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Amputate metacarpal bone</ENT>
                            <ENT>7.67</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>8.27</ENT>
                            <ENT>9.74</ENT>
                            <ENT>1.16</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">26951</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Amputation of finger/thumb</ENT>
                            <ENT>5.85</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>8.39</ENT>
                            <ENT>9.27</ENT>
                            <ENT>0.71</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">26952</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Amputation of finger/thumb</ENT>
                            <ENT>6.37</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>7.90</ENT>
                            <ENT>9.78</ENT>
                            <ENT>0.95</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">26989</ENT>
                            <ENT/>
                            <ENT>C</ENT>
                            <ENT>Hand/finger surgery</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>YYY</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">26990</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Drainage of pelvis lesion</ENT>
                            <ENT>7.84</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>6.20</ENT>
                            <ENT>6.70</ENT>
                            <ENT>1.22</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">26991</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Drainage of pelvis bursa</ENT>
                            <ENT>6.97</ENT>
                            <ENT>8.61</ENT>
                            <ENT>9.88</ENT>
                            <ENT>4.88</ENT>
                            <ENT>5.15</ENT>
                            <ENT>1.11</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">26992</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Drainage of bone lesion</ENT>
                            <ENT>13.37</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>8.41</ENT>
                            <ENT>9.39</ENT>
                            <ENT>2.17</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">27000</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Incision of hip tendon</ENT>
                            <ENT>5.66</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>4.51</ENT>
                            <ENT>4.90</ENT>
                            <ENT>0.98</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">27001</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Incision of hip tendon</ENT>
                            <ENT>7.05</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>5.22</ENT>
                            <ENT>5.66</ENT>
                            <ENT>1.24</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">27003</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Incision of hip tendon</ENT>
                            <ENT>7.70</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>5.72</ENT>
                            <ENT>6.10</ENT>
                            <ENT>1.12</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">27005</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Incision of hip tendon</ENT>
                            <ENT>9.96</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>6.48</ENT>
                            <ENT>7.15</ENT>
                            <ENT>1.73</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">27006</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Incision of hip tendons</ENT>
                            <ENT>9.99</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>6.75</ENT>
                            <ENT>7.36</ENT>
                            <ENT>1.70</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">27025</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Incision of hip/thigh fascia</ENT>
                            <ENT>12.66</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>8.20</ENT>
                            <ENT>8.37</ENT>
                            <ENT>1.85</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">27030</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Drainage of hip joint</ENT>
                            <ENT>13.54</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>8.03</ENT>
                            <ENT>8.83</ENT>
                            <ENT>2.27</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">27033</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Exploration of hip joint</ENT>
                            <ENT>13.99</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>8.39</ENT>
                            <ENT>9.15</ENT>
                            <ENT>2.33</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">27035</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Denervation of hip joint</ENT>
                            <ENT>17.23</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>8.52</ENT>
                            <ENT>9.87</ENT>
                            <ENT>2.16</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">27036</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Excision of hip joint/muscle</ENT>
                            <ENT>14.18</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>8.91</ENT>
                            <ENT>9.45</ENT>
                            <ENT>2.27</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">27040</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Biopsy of soft tissues</ENT>
                            <ENT>2.89</ENT>
                            <ENT>5.19</ENT>
                            <ENT>5.21</ENT>
                            <ENT>1.87</ENT>
                            <ENT>1.94</ENT>
                            <ENT>0.27</ENT>
                            <ENT>010</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">27041</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Biopsy of soft tissues</ENT>
                            <ENT>10.07</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>5.73</ENT>
                            <ENT>6.18</ENT>
                            <ENT>1.35</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">27047</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Remove hip/pelvis lesion</ENT>
                            <ENT>7.51</ENT>
                            <ENT>7.02</ENT>
                            <ENT>7.06</ENT>
                            <ENT>4.49</ENT>
                            <ENT>4.63</ENT>
                            <ENT>1.03</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">27048</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Remove hip/pelvis lesion</ENT>
                            <ENT>6.44</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>4.60</ENT>
                            <ENT>4.70</ENT>
                            <ENT>0.92</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">27049</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Remove tumor, hip/pelvis</ENT>
                            <ENT>15.20</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>8.16</ENT>
                            <ENT>8.28</ENT>
                            <ENT>2.07</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">27050</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Biopsy of sacroiliac joint</ENT>
                            <ENT>4.65</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>3.01</ENT>
                            <ENT>3.71</ENT>
                            <ENT>0.60</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">27052</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Biopsy of hip joint</ENT>
                            <ENT>7.27</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>5.64</ENT>
                            <ENT>5.76</ENT>
                            <ENT>1.08</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">27054</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Removal of hip joint lining</ENT>
                            <ENT>9.09</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>6.49</ENT>
                            <ENT>6.91</ENT>
                            <ENT>1.47</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">27060</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Removal of ischial bursa</ENT>
                            <ENT>5.78</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>4.36</ENT>
                            <ENT>4.37</ENT>
                            <ENT>0.80</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">27062</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Remove femur lesion/bursa</ENT>
                            <ENT>5.66</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>4.60</ENT>
                            <ENT>4.89</ENT>
                            <ENT>0.93</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">27065</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Removal of hip bone lesion</ENT>
                            <ENT>6.44</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>4.99</ENT>
                            <ENT>5.21</ENT>
                            <ENT>1.01</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">27066</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Removal of hip bone lesion</ENT>
                            <ENT>11.06</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>7.43</ENT>
                            <ENT>7.93</ENT>
                            <ENT>1.80</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">27067</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Remove/graft hip bone lesion</ENT>
                            <ENT>14.57</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>8.83</ENT>
                            <ENT>9.74</ENT>
                            <ENT>1.85</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">27070</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Partial removal of hip bone</ENT>
                            <ENT>11.44</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>8.02</ENT>
                            <ENT>8.58</ENT>
                            <ENT>1.75</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">27071</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Partial removal of hip bone</ENT>
                            <ENT>12.25</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>8.47</ENT>
                            <ENT>9.29</ENT>
                            <ENT>1.93</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">27075</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Extensive hip surgery</ENT>
                            <ENT>36.77</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>16.13</ENT>
                            <ENT>17.66</ENT>
                            <ENT>5.66</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">27076</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Extensive hip surgery</ENT>
                            <ENT>24.25</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>12.82</ENT>
                            <ENT>13.66</ENT>
                            <ENT>3.71</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">27077</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Extensive hip surgery</ENT>
                            <ENT>42.54</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>19.92</ENT>
                            <ENT>21.29</ENT>
                            <ENT>6.14</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">27078</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Extensive hip surgery</ENT>
                            <ENT>14.54</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>8.81</ENT>
                            <ENT>9.37</ENT>
                            <ENT>2.23</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">27079</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Extensive hip surgery</ENT>
                            <ENT>14.91</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>8.00</ENT>
                            <ENT>8.77</ENT>
                            <ENT>1.95</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">27080</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Removal of tail bone</ENT>
                            <ENT>6.80</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>4.58</ENT>
                            <ENT>4.70</ENT>
                            <ENT>0.93</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">27086</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Remove hip foreign body</ENT>
                            <ENT>1.89</ENT>
                            <ENT>3.66</ENT>
                            <ENT>4.10</ENT>
                            <ENT>1.48</ENT>
                            <ENT>1.65</ENT>
                            <ENT>0.25</ENT>
                            <ENT>010</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">27087</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Remove hip foreign body</ENT>
                            <ENT>8.72</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>5.65</ENT>
                            <ENT>6.15</ENT>
                            <ENT>1.35</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">27090</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Removal of hip prosthesis</ENT>
                            <ENT>11.57</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>7.40</ENT>
                            <ENT>8.09</ENT>
                            <ENT>1.95</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">27091</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Removal of hip prosthesis</ENT>
                            <ENT>24.15</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>12.90</ENT>
                            <ENT>13.44</ENT>
                            <ENT>3.85</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">27093</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Injection for hip x-ray</ENT>
                            <ENT>1.30</ENT>
                            <ENT>3.15</ENT>
                            <ENT>3.80</ENT>
                            <ENT>0.47</ENT>
                            <ENT>0.48</ENT>
                            <ENT>0.13</ENT>
                            <ENT>000</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">27095</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Injection for hip x-ray</ENT>
                            <ENT>1.50</ENT>
                            <ENT>3.71</ENT>
                            <ENT>4.71</ENT>
                            <ENT>0.51</ENT>
                            <ENT>0.51</ENT>
                            <ENT>0.14</ENT>
                            <ENT>000</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">27096</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Inject sacroiliac joint</ENT>
                            <ENT>1.40</ENT>
                            <ENT>2.52</ENT>
                            <ENT>3.43</ENT>
                            <ENT>0.33</ENT>
                            <ENT>0.33</ENT>
                            <ENT>0.08</ENT>
                            <ENT>000</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">27097</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Revision of hip tendon</ENT>
                            <ENT>9.16</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>6.33</ENT>
                            <ENT>6.37</ENT>
                            <ENT>1.57</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">27098</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Transfer tendon to pelvis</ENT>
                            <ENT>9.20</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>4.91</ENT>
                            <ENT>5.96</ENT>
                            <ENT>0.95</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">27100</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Transfer of abdominal muscle</ENT>
                            <ENT>11.21</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>7.39</ENT>
                            <ENT>8.03</ENT>
                            <ENT>1.86</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">27105</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Transfer of spinal muscle</ENT>
                            <ENT>11.90</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>7.35</ENT>
                            <ENT>8.25</ENT>
                            <ENT>1.73</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">27110</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Transfer of iliopsoas muscle</ENT>
                            <ENT>13.63</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>8.27</ENT>
                            <ENT>8.69</ENT>
                            <ENT>2.19</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <PRTPAGE P="66431"/>
                            <ENT I="01">27111</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Transfer of iliopsoas muscle</ENT>
                            <ENT>12.46</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>8.06</ENT>
                            <ENT>8.60</ENT>
                            <ENT>1.95</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">27120</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Reconstruction of hip socket</ENT>
                            <ENT>19.10</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>10.81</ENT>
                            <ENT>11.32</ENT>
                            <ENT>3.09</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">27122</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Reconstruction of hip socket</ENT>
                            <ENT>15.95</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>9.43</ENT>
                            <ENT>10.23</ENT>
                            <ENT>2.62</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">27125</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Partial hip replacement</ENT>
                            <ENT>16.46</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>9.59</ENT>
                            <ENT>10.10</ENT>
                            <ENT>2.55</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">27130</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Total hip arthroplasty</ENT>
                            <ENT>21.61</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>11.76</ENT>
                            <ENT>12.53</ENT>
                            <ENT>3.51</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">27132</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Total hip arthroplasty</ENT>
                            <ENT>25.49</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>13.42</ENT>
                            <ENT>14.52</ENT>
                            <ENT>4.05</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">27134</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Revise hip joint replacement</ENT>
                            <ENT>30.13</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>14.67</ENT>
                            <ENT>16.23</ENT>
                            <ENT>4.95</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">27137</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Revise hip joint replacement</ENT>
                            <ENT>22.55</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>11.72</ENT>
                            <ENT>12.82</ENT>
                            <ENT>3.68</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">27138</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Revise hip joint replacement</ENT>
                            <ENT>23.55</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>12.10</ENT>
                            <ENT>13.24</ENT>
                            <ENT>3.85</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">27140</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Transplant femur ridge</ENT>
                            <ENT>12.66</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>7.87</ENT>
                            <ENT>8.64</ENT>
                            <ENT>2.12</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">27146</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Incision of hip bone</ENT>
                            <ENT>18.72</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>10.68</ENT>
                            <ENT>11.40</ENT>
                            <ENT>2.97</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">27147</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Revision of hip bone</ENT>
                            <ENT>21.87</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>12.00</ENT>
                            <ENT>12.62</ENT>
                            <ENT>3.58</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">27151</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Incision of hip bones</ENT>
                            <ENT>23.92</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>12.87</ENT>
                            <ENT>10.41</ENT>
                            <ENT>3.92</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">27156</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Revision of hip bones</ENT>
                            <ENT>26.03</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>13.71</ENT>
                            <ENT>14.88</ENT>
                            <ENT>4.22</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">27158</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Revision of pelvis</ENT>
                            <ENT>20.89</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>11.51</ENT>
                            <ENT>11.23</ENT>
                            <ENT>3.17</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">27161</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Incision of neck of femur</ENT>
                            <ENT>17.74</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>10.35</ENT>
                            <ENT>11.22</ENT>
                            <ENT>2.95</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">27165</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Incision/fixation of femur</ENT>
                            <ENT>20.06</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>11.56</ENT>
                            <ENT>12.23</ENT>
                            <ENT>3.11</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">27170</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Repair/graft femur head/neck</ENT>
                            <ENT>17.46</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>9.75</ENT>
                            <ENT>10.52</ENT>
                            <ENT>2.82</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">27175</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Treat slipped epiphysis</ENT>
                            <ENT>9.29</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>5.16</ENT>
                            <ENT>5.91</ENT>
                            <ENT>1.46</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">27176</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Treat slipped epiphysis</ENT>
                            <ENT>12.78</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>8.17</ENT>
                            <ENT>8.59</ENT>
                            <ENT>2.23</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">27177</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Treat slipped epiphysis</ENT>
                            <ENT>15.94</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>9.63</ENT>
                            <ENT>10.26</ENT>
                            <ENT>2.62</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">27178</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Treat slipped epiphysis</ENT>
                            <ENT>12.78</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>7.97</ENT>
                            <ENT>8.19</ENT>
                            <ENT>2.09</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">27179</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Revise head/neck of femur</ENT>
                            <ENT>13.83</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>8.56</ENT>
                            <ENT>9.27</ENT>
                            <ENT>2.26</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">27181</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Treat slipped epiphysis</ENT>
                            <ENT>15.98</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>9.73</ENT>
                            <ENT>9.96</ENT>
                            <ENT>1.57</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">27185</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Revision of femur epiphysis</ENT>
                            <ENT>9.67</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>6.64</ENT>
                            <ENT>7.08</ENT>
                            <ENT>2.40</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">27187</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Reinforce hip bones</ENT>
                            <ENT>14.09</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>8.68</ENT>
                            <ENT>9.50</ENT>
                            <ENT>2.38</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">27193</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Treat pelvic ring fracture</ENT>
                            <ENT>5.98</ENT>
                            <ENT>4.62</ENT>
                            <ENT>4.85</ENT>
                            <ENT>4.75</ENT>
                            <ENT>4.92</ENT>
                            <ENT>0.96</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">27194</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Treat pelvic ring fracture</ENT>
                            <ENT>10.08</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>6.60</ENT>
                            <ENT>7.12</ENT>
                            <ENT>1.65</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">27200</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Treat tail bone fracture</ENT>
                            <ENT>1.87</ENT>
                            <ENT>2.07</ENT>
                            <ENT>2.15</ENT>
                            <ENT>2.22</ENT>
                            <ENT>2.19</ENT>
                            <ENT>0.28</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">27202</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Treat tail bone fracture</ENT>
                            <ENT>7.25</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>4.90</ENT>
                            <ENT>10.88</ENT>
                            <ENT>1.06</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">27215</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Treat pelvic fracture(s)</ENT>
                            <ENT>10.45</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>6.54</ENT>
                            <ENT>6.81</ENT>
                            <ENT>1.98</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">27216</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Treat pelvic ring fracture</ENT>
                            <ENT>15.73</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>9.13</ENT>
                            <ENT>9.36</ENT>
                            <ENT>2.64</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">27217</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Treat pelvic ring fracture</ENT>
                            <ENT>14.65</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>8.62</ENT>
                            <ENT>9.38</ENT>
                            <ENT>2.42</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">27218</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Treat pelvic ring fracture</ENT>
                            <ENT>20.93</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>11.32</ENT>
                            <ENT>11.35</ENT>
                            <ENT>3.49</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">27220</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Treat hip socket fracture</ENT>
                            <ENT>6.72</ENT>
                            <ENT>5.24</ENT>
                            <ENT>5.48</ENT>
                            <ENT>5.14</ENT>
                            <ENT>5.39</ENT>
                            <ENT>1.07</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">27222</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Treat hip socket fracture</ENT>
                            <ENT>13.97</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>8.51</ENT>
                            <ENT>9.24</ENT>
                            <ENT>2.20</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">27226</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Treat hip wall fracture</ENT>
                            <ENT>15.45</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>8.92</ENT>
                            <ENT>8.36</ENT>
                            <ENT>2.49</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">27227</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Treat hip fracture(s)</ENT>
                            <ENT>25.21</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>13.37</ENT>
                            <ENT>14.38</ENT>
                            <ENT>4.06</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">27228</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Treat hip fracture(s)</ENT>
                            <ENT>29.13</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>14.83</ENT>
                            <ENT>16.22</ENT>
                            <ENT>4.67</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">27230</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Treat thigh fracture</ENT>
                            <ENT>5.69</ENT>
                            <ENT>4.93</ENT>
                            <ENT>5.22</ENT>
                            <ENT>4.86</ENT>
                            <ENT>4.98</ENT>
                            <ENT>0.95</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">27232</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Treat thigh fracture</ENT>
                            <ENT>11.66</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>6.09</ENT>
                            <ENT>6.63</ENT>
                            <ENT>1.86</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">27235</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Treat thigh fracture</ENT>
                            <ENT>12.88</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>7.97</ENT>
                            <ENT>8.71</ENT>
                            <ENT>2.12</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">27236</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Treat thigh fracture</ENT>
                            <ENT>17.43</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>10.13</ENT>
                            <ENT>10.58</ENT>
                            <ENT>2.72</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">27238</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Treat thigh fracture</ENT>
                            <ENT>5.64</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>4.65</ENT>
                            <ENT>4.89</ENT>
                            <ENT>0.89</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">27240</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Treat thigh fracture</ENT>
                            <ENT>13.66</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>8.20</ENT>
                            <ENT>8.83</ENT>
                            <ENT>2.17</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">27244</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Treat thigh fracture</ENT>
                            <ENT>17.08</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>9.61</ENT>
                            <ENT>10.45</ENT>
                            <ENT>2.78</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">27245</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Treat thigh fracture</ENT>
                            <ENT>21.09</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>11.33</ENT>
                            <ENT>12.53</ENT>
                            <ENT>3.53</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">27246</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Treat thigh fracture</ENT>
                            <ENT>4.75</ENT>
                            <ENT>3.91</ENT>
                            <ENT>4.18</ENT>
                            <ENT>3.94</ENT>
                            <ENT>4.18</ENT>
                            <ENT>0.81</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">27248</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Treat thigh fracture</ENT>
                            <ENT>10.64</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>6.37</ENT>
                            <ENT>7.29</ENT>
                            <ENT>1.82</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">27250</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Treat hip dislocation</ENT>
                            <ENT>7.21</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>4.29</ENT>
                            <ENT>4.45</ENT>
                            <ENT>0.62</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">27252</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Treat hip dislocation</ENT>
                            <ENT>10.92</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>6.48</ENT>
                            <ENT>6.95</ENT>
                            <ENT>1.66</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">27253</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Treat hip dislocation</ENT>
                            <ENT>13.46</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>8.16</ENT>
                            <ENT>8.97</ENT>
                            <ENT>2.25</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">27254</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Treat hip dislocation</ENT>
                            <ENT>18.80</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>10.53</ENT>
                            <ENT>11.27</ENT>
                            <ENT>3.18</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">27256</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Treat hip dislocation</ENT>
                            <ENT>4.25</ENT>
                            <ENT>2.52</ENT>
                            <ENT>3.02</ENT>
                            <ENT>1.41</ENT>
                            <ENT>1.74</ENT>
                            <ENT>0.46</ENT>
                            <ENT>010</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">27257</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Treat hip dislocation</ENT>
                            <ENT>5.35</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>2.54</ENT>
                            <ENT>2.67</ENT>
                            <ENT>0.69</ENT>
                            <ENT>010</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">27258</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Treat hip dislocation</ENT>
                            <ENT>16.04</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>9.47</ENT>
                            <ENT>10.17</ENT>
                            <ENT>2.65</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">27259</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Treat hip dislocation</ENT>
                            <ENT>23.03</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>12.77</ENT>
                            <ENT>13.44</ENT>
                            <ENT>3.75</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">27265</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Treat hip dislocation</ENT>
                            <ENT>5.12</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>3.94</ENT>
                            <ENT>4.36</ENT>
                            <ENT>0.63</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">27266</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Treat hip dislocation</ENT>
                            <ENT>7.67</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>5.50</ENT>
                            <ENT>5.92</ENT>
                            <ENT>1.29</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">27267</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Cltx thigh fx</ENT>
                            <ENT>5.38</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>4.39</ENT>
                            <ENT>4.39</ENT>
                            <ENT>0.89</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">27268</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Cltx thigh fx w/mnpj</ENT>
                            <ENT>7.00</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>5.02</ENT>
                            <ENT>5.02</ENT>
                            <ENT>1.16</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">27269</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Optx thigh fx</ENT>
                            <ENT>18.75</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>9.88</ENT>
                            <ENT>9.88</ENT>
                            <ENT>2.93</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">27275</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Manipulation of hip joint</ENT>
                            <ENT>2.29</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>1.85</ENT>
                            <ENT>1.97</ENT>
                            <ENT>0.39</ENT>
                            <ENT>010</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">27280</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Fusion of sacroiliac joint</ENT>
                            <ENT>14.49</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>8.87</ENT>
                            <ENT>9.56</ENT>
                            <ENT>2.54</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">27282</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Fusion of pubic bones</ENT>
                            <ENT>11.71</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>7.77</ENT>
                            <ENT>7.88</ENT>
                            <ENT>1.87</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">27284</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Fusion of hip joint</ENT>
                            <ENT>24.91</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>12.00</ENT>
                            <ENT>13.37</ENT>
                            <ENT>3.93</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">27286</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Fusion of hip joint</ENT>
                            <ENT>24.97</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>12.60</ENT>
                            <ENT>14.19</ENT>
                            <ENT>3.13</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">27290</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Amputation of leg at hip</ENT>
                            <ENT>24.38</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>12.10</ENT>
                            <ENT>13.07</ENT>
                            <ENT>3.44</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">27295</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Amputation of leg at hip</ENT>
                            <ENT>19.54</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>9.57</ENT>
                            <ENT>10.44</ENT>
                            <ENT>2.96</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">27299</ENT>
                            <ENT/>
                            <ENT>C</ENT>
                            <ENT>Pelvis/hip joint surgery</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>YYY</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">27301</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Drain thigh/knee lesion</ENT>
                            <ENT>6.67</ENT>
                            <ENT>8.19</ENT>
                            <ENT>9.13</ENT>
                            <ENT>4.64</ENT>
                            <ENT>4.89</ENT>
                            <ENT>1.04</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">27303</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Drainage of bone lesion</ENT>
                            <ENT>8.52</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>5.99</ENT>
                            <ENT>6.48</ENT>
                            <ENT>1.43</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <PRTPAGE P="66432"/>
                            <ENT I="01">27305</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Incise thigh tendon &amp; fascia</ENT>
                            <ENT>6.09</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>4.68</ENT>
                            <ENT>4.93</ENT>
                            <ENT>1.01</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">27306</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Incision of thigh tendon</ENT>
                            <ENT>4.66</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>4.07</ENT>
                            <ENT>4.39</ENT>
                            <ENT>0.85</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">27307</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Incision of thigh tendons</ENT>
                            <ENT>5.97</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>4.74</ENT>
                            <ENT>5.06</ENT>
                            <ENT>1.04</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">27310</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Exploration of knee joint</ENT>
                            <ENT>9.88</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>6.77</ENT>
                            <ENT>7.17</ENT>
                            <ENT>1.61</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">27323</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Biopsy, thigh soft tissues</ENT>
                            <ENT>2.30</ENT>
                            <ENT>4.19</ENT>
                            <ENT>3.85</ENT>
                            <ENT>1.93</ENT>
                            <ENT>1.90</ENT>
                            <ENT>0.24</ENT>
                            <ENT>010</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">27324</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Biopsy, thigh soft tissues</ENT>
                            <ENT>4.95</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>3.82</ENT>
                            <ENT>4.00</ENT>
                            <ENT>0.75</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">27325</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Neurectomy, hamstring</ENT>
                            <ENT>7.09</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>4.99</ENT>
                            <ENT>4.96</ENT>
                            <ENT>1.09</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">27326</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Neurectomy, popliteal</ENT>
                            <ENT>6.36</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>5.12</ENT>
                            <ENT>5.17</ENT>
                            <ENT>1.06</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">27327</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Removal of thigh lesion</ENT>
                            <ENT>4.52</ENT>
                            <ENT>6.03</ENT>
                            <ENT>6.01</ENT>
                            <ENT>3.57</ENT>
                            <ENT>3.65</ENT>
                            <ENT>0.64</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">27328</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Removal of thigh lesion</ENT>
                            <ENT>5.62</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>4.06</ENT>
                            <ENT>4.21</ENT>
                            <ENT>0.84</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">27329</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Remove tumor, thigh/knee</ENT>
                            <ENT>15.68</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>8.46</ENT>
                            <ENT>8.74</ENT>
                            <ENT>2.15</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">27330</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Biopsy, knee joint lining</ENT>
                            <ENT>5.02</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>4.26</ENT>
                            <ENT>4.41</ENT>
                            <ENT>0.86</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">27331</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Explore/treat knee joint</ENT>
                            <ENT>5.93</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>4.79</ENT>
                            <ENT>5.16</ENT>
                            <ENT>1.02</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">27332</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Removal of knee cartilage</ENT>
                            <ENT>8.34</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>6.12</ENT>
                            <ENT>6.62</ENT>
                            <ENT>1.43</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">27333</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Removal of knee cartilage</ENT>
                            <ENT>7.43</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>5.68</ENT>
                            <ENT>6.17</ENT>
                            <ENT>1.26</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">27334</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Remove knee joint lining</ENT>
                            <ENT>9.07</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>6.43</ENT>
                            <ENT>6.92</ENT>
                            <ENT>1.51</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">27335</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Remove knee joint lining</ENT>
                            <ENT>10.43</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>7.01</ENT>
                            <ENT>7.61</ENT>
                            <ENT>1.75</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">27340</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Removal of kneecap bursa</ENT>
                            <ENT>4.23</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>4.03</ENT>
                            <ENT>4.29</ENT>
                            <ENT>0.72</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">27345</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Removal of knee cyst</ENT>
                            <ENT>5.98</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>4.88</ENT>
                            <ENT>5.25</ENT>
                            <ENT>1.00</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">27347</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Remove knee cyst</ENT>
                            <ENT>6.58</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>5.25</ENT>
                            <ENT>5.34</ENT>
                            <ENT>0.98</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">27350</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Removal of kneecap</ENT>
                            <ENT>8.54</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>6.24</ENT>
                            <ENT>6.74</ENT>
                            <ENT>1.41</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">27355</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Remove femur lesion</ENT>
                            <ENT>7.89</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>5.80</ENT>
                            <ENT>6.29</ENT>
                            <ENT>1.32</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">27356</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Remove femur lesion/graft</ENT>
                            <ENT>9.97</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>6.83</ENT>
                            <ENT>7.34</ENT>
                            <ENT>1.65</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">27357</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Remove femur lesion/graft</ENT>
                            <ENT>11.02</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>7.47</ENT>
                            <ENT>8.08</ENT>
                            <ENT>1.96</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">27358</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Remove femur lesion/fixation</ENT>
                            <ENT>4.73</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>1.81</ENT>
                            <ENT>2.16</ENT>
                            <ENT>0.82</ENT>
                            <ENT>ZZZ</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">27360</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Partial removal, leg bone(s)</ENT>
                            <ENT>11.34</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>8.04</ENT>
                            <ENT>8.79</ENT>
                            <ENT>1.84</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">27365</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Extensive leg surgery</ENT>
                            <ENT>17.93</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>10.40</ENT>
                            <ENT>11.04</ENT>
                            <ENT>2.80</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">27370</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Injection for knee x-ray</ENT>
                            <ENT>0.96</ENT>
                            <ENT>2.99</ENT>
                            <ENT>3.36</ENT>
                            <ENT>0.36</ENT>
                            <ENT>0.34</ENT>
                            <ENT>0.08</ENT>
                            <ENT>000</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">27372</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Removal of foreign body</ENT>
                            <ENT>5.12</ENT>
                            <ENT>8.30</ENT>
                            <ENT>9.17</ENT>
                            <ENT>4.04</ENT>
                            <ENT>4.36</ENT>
                            <ENT>0.84</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">27380</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Repair of kneecap tendon</ENT>
                            <ENT>7.34</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>6.05</ENT>
                            <ENT>6.66</ENT>
                            <ENT>1.24</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">27381</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Repair/graft kneecap tendon</ENT>
                            <ENT>10.64</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>7.56</ENT>
                            <ENT>8.32</ENT>
                            <ENT>1.80</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">27385</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Repair of thigh muscle</ENT>
                            <ENT>8.00</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>6.30</ENT>
                            <ENT>6.96</ENT>
                            <ENT>1.36</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">27386</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Repair/graft of thigh muscle</ENT>
                            <ENT>10.99</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>7.92</ENT>
                            <ENT>8.71</ENT>
                            <ENT>1.86</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">27390</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Incision of thigh tendon</ENT>
                            <ENT>5.44</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>4.46</ENT>
                            <ENT>4.78</ENT>
                            <ENT>0.92</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">27391</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Incision of thigh tendons</ENT>
                            <ENT>7.38</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>5.54</ENT>
                            <ENT>6.05</ENT>
                            <ENT>1.23</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">27392</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Incision of thigh tendons</ENT>
                            <ENT>9.51</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>6.66</ENT>
                            <ENT>7.12</ENT>
                            <ENT>1.57</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">27393</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Lengthening of thigh tendon</ENT>
                            <ENT>6.50</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>4.95</ENT>
                            <ENT>5.39</ENT>
                            <ENT>1.10</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">27394</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Lengthening of thigh tendons</ENT>
                            <ENT>8.68</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>6.14</ENT>
                            <ENT>6.68</ENT>
                            <ENT>1.47</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">27395</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Lengthening of thigh tendons</ENT>
                            <ENT>12.10</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>7.92</ENT>
                            <ENT>8.62</ENT>
                            <ENT>2.05</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">27396</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Transplant of thigh tendon</ENT>
                            <ENT>8.04</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>5.82</ENT>
                            <ENT>6.41</ENT>
                            <ENT>1.34</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">27397</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Transplants of thigh tendons</ENT>
                            <ENT>12.46</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>8.34</ENT>
                            <ENT>8.69</ENT>
                            <ENT>1.83</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">27400</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Revise thigh muscles/tendons</ENT>
                            <ENT>9.21</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>6.51</ENT>
                            <ENT>6.88</ENT>
                            <ENT>1.31</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">27403</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Repair of knee cartilage</ENT>
                            <ENT>8.51</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>6.02</ENT>
                            <ENT>6.60</ENT>
                            <ENT>1.44</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">27405</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Repair of knee ligament</ENT>
                            <ENT>8.96</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>6.38</ENT>
                            <ENT>6.93</ENT>
                            <ENT>1.51</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">27407</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Repair of knee ligament</ENT>
                            <ENT>10.71</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>6.82</ENT>
                            <ENT>7.57</ENT>
                            <ENT>1.79</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">27409</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Repair of knee ligaments</ENT>
                            <ENT>13.57</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>8.25</ENT>
                            <ENT>9.10</ENT>
                            <ENT>2.25</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">27412</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Autochondrocyte implant knee</ENT>
                            <ENT>24.53</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>13.64</ENT>
                            <ENT>14.22</ENT>
                            <ENT>4.36</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">27415</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Osteochondral knee allograft</ENT>
                            <ENT>19.79</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>11.77</ENT>
                            <ENT>12.16</ENT>
                            <ENT>4.36</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">27416</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Osteochondral knee autograft</ENT>
                            <ENT>14.00</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>8.38</ENT>
                            <ENT>8.38</ENT>
                            <ENT>2.32</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">27418</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Repair degenerated kneecap</ENT>
                            <ENT>11.46</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>7.57</ENT>
                            <ENT>8.23</ENT>
                            <ENT>1.89</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">27420</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Revision of unstable kneecap</ENT>
                            <ENT>10.14</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>6.90</ENT>
                            <ENT>7.50</ENT>
                            <ENT>1.72</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">27422</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Revision of unstable kneecap</ENT>
                            <ENT>10.09</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>6.87</ENT>
                            <ENT>7.49</ENT>
                            <ENT>1.71</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">27424</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Revision/removal of kneecap</ENT>
                            <ENT>10.12</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>6.89</ENT>
                            <ENT>7.49</ENT>
                            <ENT>1.71</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">27425</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Lat retinacular release open</ENT>
                            <ENT>5.28</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>4.70</ENT>
                            <ENT>5.11</ENT>
                            <ENT>0.90</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">27427</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Reconstruction, knee</ENT>
                            <ENT>9.67</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>6.69</ENT>
                            <ENT>7.24</ENT>
                            <ENT>1.63</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">27428</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Reconstruction, knee</ENT>
                            <ENT>15.33</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>10.03</ENT>
                            <ENT>10.63</ENT>
                            <ENT>2.43</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">27429</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Reconstruction, knee</ENT>
                            <ENT>17.24</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>11.25</ENT>
                            <ENT>11.83</ENT>
                            <ENT>2.71</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">27430</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Revision of thigh muscles</ENT>
                            <ENT>10.04</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>6.84</ENT>
                            <ENT>7.41</ENT>
                            <ENT>1.70</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">27435</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Incision of knee joint</ENT>
                            <ENT>10.68</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>7.58</ENT>
                            <ENT>8.03</ENT>
                            <ENT>1.70</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">27437</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Revise kneecap</ENT>
                            <ENT>8.82</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>6.18</ENT>
                            <ENT>6.71</ENT>
                            <ENT>1.49</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">27438</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Revise kneecap with implant</ENT>
                            <ENT>11.77</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>7.49</ENT>
                            <ENT>8.01</ENT>
                            <ENT>1.96</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">27440</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Revision of knee joint</ENT>
                            <ENT>10.97</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>6.99</ENT>
                            <ENT>6.49</ENT>
                            <ENT>1.82</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">27441</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Revision of knee joint</ENT>
                            <ENT>11.42</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>7.35</ENT>
                            <ENT>7.03</ENT>
                            <ENT>1.89</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">27442</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Revision of knee joint</ENT>
                            <ENT>12.25</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>7.64</ENT>
                            <ENT>8.27</ENT>
                            <ENT>2.10</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">27443</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Revision of knee joint</ENT>
                            <ENT>11.29</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>7.34</ENT>
                            <ENT>8.03</ENT>
                            <ENT>1.91</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">27445</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Revision of knee joint</ENT>
                            <ENT>18.52</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>10.40</ENT>
                            <ENT>11.38</ENT>
                            <ENT>3.09</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">27446</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Revision of knee joint</ENT>
                            <ENT>16.26</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>9.28</ENT>
                            <ENT>10.27</ENT>
                            <ENT>2.81</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">27447</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Total knee arthroplasty</ENT>
                            <ENT>23.04</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>12.56</ENT>
                            <ENT>13.58</ENT>
                            <ENT>3.80</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">27448</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Incision of thigh</ENT>
                            <ENT>11.48</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>7.31</ENT>
                            <ENT>7.95</ENT>
                            <ENT>1.95</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">27450</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Incision of thigh</ENT>
                            <ENT>14.47</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>8.83</ENT>
                            <ENT>9.70</ENT>
                            <ENT>2.43</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">27454</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Realignment of thigh bone</ENT>
                            <ENT>18.97</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>10.72</ENT>
                            <ENT>11.61</ENT>
                            <ENT>3.13</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">27455</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Realignment of knee</ENT>
                            <ENT>13.24</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>8.30</ENT>
                            <ENT>9.09</ENT>
                            <ENT>2.25</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <PRTPAGE P="66433"/>
                            <ENT I="01">27457</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Realignment of knee</ENT>
                            <ENT>13.92</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>8.22</ENT>
                            <ENT>9.07</ENT>
                            <ENT>2.35</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">27465</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Shortening of thigh bone</ENT>
                            <ENT>18.44</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>10.28</ENT>
                            <ENT>10.25</ENT>
                            <ENT>2.48</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">27466</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Lengthening of thigh bone</ENT>
                            <ENT>17.13</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>10.05</ENT>
                            <ENT>10.94</ENT>
                            <ENT>2.78</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">27468</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Shorten/lengthen thighs</ENT>
                            <ENT>19.82</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>11.16</ENT>
                            <ENT>11.75</ENT>
                            <ENT>3.31</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">27470</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Repair of thigh</ENT>
                            <ENT>16.97</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>10.15</ENT>
                            <ENT>10.96</ENT>
                            <ENT>2.80</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">27472</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Repair/graft of thigh</ENT>
                            <ENT>18.57</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>10.63</ENT>
                            <ENT>11.65</ENT>
                            <ENT>3.08</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">27475</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Surgery to stop leg growth</ENT>
                            <ENT>8.82</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>6.19</ENT>
                            <ENT>6.70</ENT>
                            <ENT>1.36</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">27477</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Surgery to stop leg growth</ENT>
                            <ENT>10.03</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>6.59</ENT>
                            <ENT>7.16</ENT>
                            <ENT>1.74</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">27479</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Surgery to stop leg growth</ENT>
                            <ENT>13.04</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>8.84</ENT>
                            <ENT>9.24</ENT>
                            <ENT>2.79</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">27485</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Surgery to stop leg growth</ENT>
                            <ENT>9.02</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>6.21</ENT>
                            <ENT>6.80</ENT>
                            <ENT>1.53</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">27486</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Revise/replace knee joint</ENT>
                            <ENT>20.92</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>11.62</ENT>
                            <ENT>12.55</ENT>
                            <ENT>3.37</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">27487</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Revise/replace knee joint</ENT>
                            <ENT>26.91</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>13.97</ENT>
                            <ENT>15.25</ENT>
                            <ENT>4.40</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">27488</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Removal of knee prosthesis</ENT>
                            <ENT>17.40</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>10.24</ENT>
                            <ENT>10.96</ENT>
                            <ENT>2.75</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">27495</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Reinforce thigh</ENT>
                            <ENT>16.40</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>9.59</ENT>
                            <ENT>10.49</ENT>
                            <ENT>2.72</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">27496</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Decompression of thigh/knee</ENT>
                            <ENT>6.66</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>4.97</ENT>
                            <ENT>5.29</ENT>
                            <ENT>0.99</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">27497</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Decompression of thigh/knee</ENT>
                            <ENT>7.70</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>4.98</ENT>
                            <ENT>5.21</ENT>
                            <ENT>1.15</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">27498</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Decompression of thigh/knee</ENT>
                            <ENT>8.54</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>5.18</ENT>
                            <ENT>5.57</ENT>
                            <ENT>1.24</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">27499</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Decompression of thigh/knee</ENT>
                            <ENT>9.31</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>5.98</ENT>
                            <ENT>6.40</ENT>
                            <ENT>1.47</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">27500</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Treatment of thigh fracture</ENT>
                            <ENT>6.21</ENT>
                            <ENT>5.36</ENT>
                            <ENT>5.74</ENT>
                            <ENT>4.58</ENT>
                            <ENT>4.78</ENT>
                            <ENT>1.02</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">27501</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Treatment of thigh fracture</ENT>
                            <ENT>6.34</ENT>
                            <ENT>5.00</ENT>
                            <ENT>5.40</ENT>
                            <ENT>4.91</ENT>
                            <ENT>5.15</ENT>
                            <ENT>1.03</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">27502</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Treatment of thigh fracture</ENT>
                            <ENT>11.24</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>6.85</ENT>
                            <ENT>7.48</ENT>
                            <ENT>1.79</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">27503</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Treatment of thigh fracture</ENT>
                            <ENT>11.13</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>7.21</ENT>
                            <ENT>7.74</ENT>
                            <ENT>1.85</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">27506</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Treatment of thigh fracture</ENT>
                            <ENT>19.42</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>11.35</ENT>
                            <ENT>12.07</ENT>
                            <ENT>3.04</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">27507</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Treatment of thigh fracture</ENT>
                            <ENT>14.39</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>8.12</ENT>
                            <ENT>8.98</ENT>
                            <ENT>2.43</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">27508</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Treatment of thigh fracture</ENT>
                            <ENT>6.08</ENT>
                            <ENT>5.68</ENT>
                            <ENT>6.07</ENT>
                            <ENT>5.05</ENT>
                            <ENT>5.26</ENT>
                            <ENT>0.97</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">27509</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Treatment of thigh fracture</ENT>
                            <ENT>8.02</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>6.53</ENT>
                            <ENT>7.24</ENT>
                            <ENT>1.34</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">27510</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Treatment of thigh fracture</ENT>
                            <ENT>9.68</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>6.26</ENT>
                            <ENT>6.79</ENT>
                            <ENT>1.53</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">27511</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Treatment of thigh fracture</ENT>
                            <ENT>14.97</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>8.10</ENT>
                            <ENT>9.65</ENT>
                            <ENT>2.38</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">27513</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Treatment of thigh fracture</ENT>
                            <ENT>19.11</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>9.74</ENT>
                            <ENT>11.81</ENT>
                            <ENT>3.13</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">27514</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Treatment of thigh fracture</ENT>
                            <ENT>14.46</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>7.88</ENT>
                            <ENT>10.61</ENT>
                            <ENT>3.01</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">27516</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Treat thigh fx growth plate</ENT>
                            <ENT>5.45</ENT>
                            <ENT>5.71</ENT>
                            <ENT>6.03</ENT>
                            <ENT>5.07</ENT>
                            <ENT>5.29</ENT>
                            <ENT>0.81</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">27517</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Treat thigh fx growth plate</ENT>
                            <ENT>8.98</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>6.41</ENT>
                            <ENT>6.93</ENT>
                            <ENT>1.22</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">27519</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Treat thigh fx growth plate</ENT>
                            <ENT>13.11</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>7.38</ENT>
                            <ENT>9.48</ENT>
                            <ENT>2.56</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">27520</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Treat kneecap fracture</ENT>
                            <ENT>2.93</ENT>
                            <ENT>4.10</ENT>
                            <ENT>4.31</ENT>
                            <ENT>3.52</ENT>
                            <ENT>3.48</ENT>
                            <ENT>0.47</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">27524</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Treat kneecap fracture</ENT>
                            <ENT>10.25</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>6.93</ENT>
                            <ENT>7.58</ENT>
                            <ENT>1.75</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">27530</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Treat knee fracture</ENT>
                            <ENT>3.97</ENT>
                            <ENT>4.82</ENT>
                            <ENT>5.06</ENT>
                            <ENT>4.26</ENT>
                            <ENT>4.34</ENT>
                            <ENT>0.65</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">27532</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Treat knee fracture</ENT>
                            <ENT>7.43</ENT>
                            <ENT>6.39</ENT>
                            <ENT>6.87</ENT>
                            <ENT>5.62</ENT>
                            <ENT>6.03</ENT>
                            <ENT>1.26</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">27535</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Treat knee fracture</ENT>
                            <ENT>13.27</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>7.44</ENT>
                            <ENT>8.77</ENT>
                            <ENT>2.01</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">27536</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Treat knee fracture</ENT>
                            <ENT>17.19</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>10.19</ENT>
                            <ENT>10.89</ENT>
                            <ENT>2.74</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">27538</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Treat knee fracture(s)</ENT>
                            <ENT>4.95</ENT>
                            <ENT>5.51</ENT>
                            <ENT>5.82</ENT>
                            <ENT>4.89</ENT>
                            <ENT>5.04</ENT>
                            <ENT>0.84</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">27540</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Treat knee fracture</ENT>
                            <ENT>11.16</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>7.38</ENT>
                            <ENT>8.44</ENT>
                            <ENT>2.28</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">27550</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Treat knee dislocation</ENT>
                            <ENT>5.84</ENT>
                            <ENT>5.21</ENT>
                            <ENT>5.61</ENT>
                            <ENT>4.50</ENT>
                            <ENT>4.71</ENT>
                            <ENT>0.76</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">27552</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Treat knee dislocation</ENT>
                            <ENT>8.04</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>6.08</ENT>
                            <ENT>6.51</ENT>
                            <ENT>1.36</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">27556</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Treat knee dislocation</ENT>
                            <ENT>12.86</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>7.25</ENT>
                            <ENT>9.45</ENT>
                            <ENT>2.51</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">27557</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Treat knee dislocation</ENT>
                            <ENT>15.76</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>8.44</ENT>
                            <ENT>10.78</ENT>
                            <ENT>2.98</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">27558</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Treat knee dislocation</ENT>
                            <ENT>18.25</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>9.28</ENT>
                            <ENT>11.16</ENT>
                            <ENT>3.09</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">27560</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Treat kneecap dislocation</ENT>
                            <ENT>3.88</ENT>
                            <ENT>4.24</ENT>
                            <ENT>4.54</ENT>
                            <ENT>3.71</ENT>
                            <ENT>3.45</ENT>
                            <ENT>0.40</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">27562</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Treat kneecap dislocation</ENT>
                            <ENT>5.86</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>4.61</ENT>
                            <ENT>4.69</ENT>
                            <ENT>0.94</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">27566</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Treat kneecap dislocation</ENT>
                            <ENT>12.59</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>7.88</ENT>
                            <ENT>8.60</ENT>
                            <ENT>2.13</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">27570</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Fixation of knee joint</ENT>
                            <ENT>1.76</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>1.61</ENT>
                            <ENT>1.69</ENT>
                            <ENT>0.30</ENT>
                            <ENT>010</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">27580</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Fusion of knee</ENT>
                            <ENT>20.90</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>12.17</ENT>
                            <ENT>13.48</ENT>
                            <ENT>3.38</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">27590</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Amputate leg at thigh</ENT>
                            <ENT>13.35</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>6.01</ENT>
                            <ENT>6.34</ENT>
                            <ENT>1.75</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">27591</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Amputate leg at thigh</ENT>
                            <ENT>13.82</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>7.34</ENT>
                            <ENT>7.99</ENT>
                            <ENT>2.03</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">27592</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Amputate leg at thigh</ENT>
                            <ENT>10.86</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>5.45</ENT>
                            <ENT>5.81</ENT>
                            <ENT>1.45</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">27594</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Amputation follow-up surgery</ENT>
                            <ENT>7.17</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>4.72</ENT>
                            <ENT>4.94</ENT>
                            <ENT>1.02</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">27596</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Amputation follow-up surgery</ENT>
                            <ENT>11.15</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>5.97</ENT>
                            <ENT>6.39</ENT>
                            <ENT>1.57</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">27598</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Amputate lower leg at knee</ENT>
                            <ENT>11.08</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>6.19</ENT>
                            <ENT>6.60</ENT>
                            <ENT>1.65</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">27599</ENT>
                            <ENT/>
                            <ENT>C</ENT>
                            <ENT>Leg surgery procedure</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>YYY</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">27600</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Decompression of lower leg</ENT>
                            <ENT>5.94</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>3.79</ENT>
                            <ENT>4.16</ENT>
                            <ENT>0.86</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">27601</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Decompression of lower leg</ENT>
                            <ENT>5.94</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>4.17</ENT>
                            <ENT>4.51</ENT>
                            <ENT>0.80</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">27602</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Decompression of lower leg</ENT>
                            <ENT>7.71</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>4.29</ENT>
                            <ENT>4.71</ENT>
                            <ENT>1.10</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">27603</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Drain lower leg lesion</ENT>
                            <ENT>5.12</ENT>
                            <ENT>7.04</ENT>
                            <ENT>7.26</ENT>
                            <ENT>3.90</ENT>
                            <ENT>4.03</ENT>
                            <ENT>0.74</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">27604</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Drain lower leg bursa</ENT>
                            <ENT>4.51</ENT>
                            <ENT>6.48</ENT>
                            <ENT>6.28</ENT>
                            <ENT>3.42</ENT>
                            <ENT>3.69</ENT>
                            <ENT>0.69</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">27605</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Incision of achilles tendon</ENT>
                            <ENT>2.89</ENT>
                            <ENT>5.15</ENT>
                            <ENT>6.41</ENT>
                            <ENT>1.74</ENT>
                            <ENT>2.03</ENT>
                            <ENT>0.41</ENT>
                            <ENT>010</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">27606</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Incision of achilles tendon</ENT>
                            <ENT>4.15</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>2.62</ENT>
                            <ENT>2.99</ENT>
                            <ENT>0.69</ENT>
                            <ENT>010</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">27607</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Treat lower leg bone lesion</ENT>
                            <ENT>8.51</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>5.70</ENT>
                            <ENT>5.93</ENT>
                            <ENT>1.31</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">27610</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Explore/treat ankle joint</ENT>
                            <ENT>9.01</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>6.10</ENT>
                            <ENT>6.55</ENT>
                            <ENT>1.40</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">27612</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Exploration of ankle joint</ENT>
                            <ENT>8.01</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>5.17</ENT>
                            <ENT>5.63</ENT>
                            <ENT>1.13</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">27613</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Biopsy lower leg soft tissue</ENT>
                            <ENT>2.19</ENT>
                            <ENT>3.91</ENT>
                            <ENT>3.57</ENT>
                            <ENT>1.77</ENT>
                            <ENT>1.79</ENT>
                            <ENT>0.20</ENT>
                            <ENT>010</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">27614</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Biopsy lower leg soft tissue</ENT>
                            <ENT>5.71</ENT>
                            <ENT>7.75</ENT>
                            <ENT>7.44</ENT>
                            <ENT>3.93</ENT>
                            <ENT>4.18</ENT>
                            <ENT>0.78</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">27615</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Remove tumor, lower leg</ENT>
                            <ENT>12.93</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>7.27</ENT>
                            <ENT>8.33</ENT>
                            <ENT>1.84</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">27618</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Remove lower leg lesion</ENT>
                            <ENT>5.14</ENT>
                            <ENT>6.43</ENT>
                            <ENT>6.22</ENT>
                            <ENT>3.80</ENT>
                            <ENT>3.89</ENT>
                            <ENT>0.72</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <PRTPAGE P="66434"/>
                            <ENT I="01">27619</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Remove lower leg lesion</ENT>
                            <ENT>8.47</ENT>
                            <ENT>9.99</ENT>
                            <ENT>9.75</ENT>
                            <ENT>5.27</ENT>
                            <ENT>5.61</ENT>
                            <ENT>1.25</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">27620</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Explore/treat ankle joint</ENT>
                            <ENT>6.04</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>4.56</ENT>
                            <ENT>5.01</ENT>
                            <ENT>0.97</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">27625</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Remove ankle joint lining</ENT>
                            <ENT>8.37</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>5.49</ENT>
                            <ENT>5.98</ENT>
                            <ENT>1.28</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">27626</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Remove ankle joint lining</ENT>
                            <ENT>8.98</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>5.77</ENT>
                            <ENT>6.34</ENT>
                            <ENT>1.48</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">27630</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Removal of tendon lesion</ENT>
                            <ENT>4.85</ENT>
                            <ENT>7.98</ENT>
                            <ENT>7.76</ENT>
                            <ENT>3.80</ENT>
                            <ENT>4.09</ENT>
                            <ENT>0.74</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">27635</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Remove lower leg bone lesion</ENT>
                            <ENT>7.91</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>5.63</ENT>
                            <ENT>6.18</ENT>
                            <ENT>1.31</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">27637</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Remove/graft leg bone lesion</ENT>
                            <ENT>10.17</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>6.90</ENT>
                            <ENT>7.59</ENT>
                            <ENT>1.66</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">27638</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Remove/graft leg bone lesion</ENT>
                            <ENT>10.87</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>7.04</ENT>
                            <ENT>7.66</ENT>
                            <ENT>1.85</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">27640</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Partial removal of tibia</ENT>
                            <ENT>12.10</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>7.46</ENT>
                            <ENT>8.88</ENT>
                            <ENT>1.89</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">27641</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Partial removal of fibula</ENT>
                            <ENT>9.73</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>6.09</ENT>
                            <ENT>7.21</ENT>
                            <ENT>1.46</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">27645</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Extensive lower leg surgery</ENT>
                            <ENT>14.78</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>8.73</ENT>
                            <ENT>10.38</ENT>
                            <ENT>2.42</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">27646</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Extensive lower leg surgery</ENT>
                            <ENT>13.21</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>7.64</ENT>
                            <ENT>9.33</ENT>
                            <ENT>2.06</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">27647</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Extensive ankle/heel surgery</ENT>
                            <ENT>12.85</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>6.54</ENT>
                            <ENT>7.07</ENT>
                            <ENT>1.76</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">27648</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Injection for ankle x-ray</ENT>
                            <ENT>0.96</ENT>
                            <ENT>2.88</ENT>
                            <ENT>3.20</ENT>
                            <ENT>0.34</ENT>
                            <ENT>0.34</ENT>
                            <ENT>0.08</ENT>
                            <ENT>000</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">27650</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Repair achilles tendon</ENT>
                            <ENT>9.94</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>6.15</ENT>
                            <ENT>6.83</ENT>
                            <ENT>1.59</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">27652</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Repair/graft achilles tendon</ENT>
                            <ENT>10.64</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>6.44</ENT>
                            <ENT>7.23</ENT>
                            <ENT>1.72</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">27654</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Repair of achilles tendon</ENT>
                            <ENT>10.32</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>5.98</ENT>
                            <ENT>6.56</ENT>
                            <ENT>1.58</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">27656</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Repair leg fascia defect</ENT>
                            <ENT>4.62</ENT>
                            <ENT>7.95</ENT>
                            <ENT>8.24</ENT>
                            <ENT>3.58</ENT>
                            <ENT>3.67</ENT>
                            <ENT>0.69</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">27658</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Repair of leg tendon, each</ENT>
                            <ENT>5.03</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>3.88</ENT>
                            <ENT>4.22</ENT>
                            <ENT>0.79</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">27659</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Repair of leg tendon, each</ENT>
                            <ENT>6.99</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>4.67</ENT>
                            <ENT>5.16</ENT>
                            <ENT>1.09</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">27664</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Repair of leg tendon, each</ENT>
                            <ENT>4.64</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>3.88</ENT>
                            <ENT>4.21</ENT>
                            <ENT>0.76</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">27665</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Repair of leg tendon, each</ENT>
                            <ENT>5.46</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>4.32</ENT>
                            <ENT>4.64</ENT>
                            <ENT>0.89</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">27675</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Repair lower leg tendons</ENT>
                            <ENT>7.24</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>4.67</ENT>
                            <ENT>5.20</ENT>
                            <ENT>1.11</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">27676</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Repair lower leg tendons</ENT>
                            <ENT>8.61</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>5.72</ENT>
                            <ENT>6.23</ENT>
                            <ENT>1.37</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">27680</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Release of lower leg tendon</ENT>
                            <ENT>5.79</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>4.16</ENT>
                            <ENT>4.63</ENT>
                            <ENT>0.93</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">27681</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Release of lower leg tendons</ENT>
                            <ENT>6.94</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>5.09</ENT>
                            <ENT>5.50</ENT>
                            <ENT>1.15</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">27685</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Revision of lower leg tendon</ENT>
                            <ENT>6.57</ENT>
                            <ENT>8.77</ENT>
                            <ENT>8.03</ENT>
                            <ENT>4.57</ENT>
                            <ENT>5.02</ENT>
                            <ENT>0.97</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">27686</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Revise lower leg tendons</ENT>
                            <ENT>7.64</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>5.28</ENT>
                            <ENT>5.89</ENT>
                            <ENT>1.24</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">27687</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Revision of calf tendon</ENT>
                            <ENT>6.30</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>4.47</ENT>
                            <ENT>4.89</ENT>
                            <ENT>1.00</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">27690</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Revise lower leg tendon</ENT>
                            <ENT>8.96</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>5.37</ENT>
                            <ENT>5.86</ENT>
                            <ENT>1.33</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">27691</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Revise lower leg tendon</ENT>
                            <ENT>10.28</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>6.65</ENT>
                            <ENT>7.20</ENT>
                            <ENT>1.64</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">27692</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Revise additional leg tendon</ENT>
                            <ENT>1.87</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>0.71</ENT>
                            <ENT>0.82</ENT>
                            <ENT>0.32</ENT>
                            <ENT>ZZZ</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">27695</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Repair of ankle ligament</ENT>
                            <ENT>6.58</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>4.87</ENT>
                            <ENT>5.37</ENT>
                            <ENT>1.05</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">27696</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Repair of ankle ligaments</ENT>
                            <ENT>8.46</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>5.25</ENT>
                            <ENT>5.84</ENT>
                            <ENT>1.28</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">27698</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Repair of ankle ligament</ENT>
                            <ENT>9.49</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>5.87</ENT>
                            <ENT>6.40</ENT>
                            <ENT>1.47</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">27700</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Revision of ankle joint</ENT>
                            <ENT>9.54</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>5.20</ENT>
                            <ENT>5.44</ENT>
                            <ENT>1.30</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">27702</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Reconstruct ankle joint</ENT>
                            <ENT>14.28</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>8.64</ENT>
                            <ENT>9.55</ENT>
                            <ENT>2.38</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">27703</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Reconstruction, ankle joint</ENT>
                            <ENT>16.79</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>9.77</ENT>
                            <ENT>10.50</ENT>
                            <ENT>2.77</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">27704</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Removal of ankle implant</ENT>
                            <ENT>7.69</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>5.61</ENT>
                            <ENT>5.60</ENT>
                            <ENT>1.27</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">27705</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Incision of tibia</ENT>
                            <ENT>10.74</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>6.95</ENT>
                            <ENT>7.56</ENT>
                            <ENT>1.81</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">27707</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Incision of fibula</ENT>
                            <ENT>4.67</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>4.48</ENT>
                            <ENT>4.71</ENT>
                            <ENT>0.76</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">27709</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Incision of tibia &amp; fibula</ENT>
                            <ENT>17.32</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>9.95</ENT>
                            <ENT>9.04</ENT>
                            <ENT>1.74</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">27712</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Realignment of lower leg</ENT>
                            <ENT>15.67</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>9.44</ENT>
                            <ENT>10.09</ENT>
                            <ENT>2.48</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">27715</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Revision of lower leg</ENT>
                            <ENT>15.36</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>9.03</ENT>
                            <ENT>9.89</ENT>
                            <ENT>2.50</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">27720</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Repair of tibia</ENT>
                            <ENT>12.22</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>7.92</ENT>
                            <ENT>8.66</ENT>
                            <ENT>2.05</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">27722</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Repair/graft of tibia</ENT>
                            <ENT>12.31</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>7.88</ENT>
                            <ENT>8.50</ENT>
                            <ENT>2.06</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">27724</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Repair/graft of tibia</ENT>
                            <ENT>19.18</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>10.28</ENT>
                            <ENT>11.32</ENT>
                            <ENT>3.17</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">27725</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Repair of lower leg</ENT>
                            <ENT>17.15</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>10.58</ENT>
                            <ENT>11.24</ENT>
                            <ENT>2.72</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">27726</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Repair fibula nonunion</ENT>
                            <ENT>14.20</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>7.67</ENT>
                            <ENT>7.67</ENT>
                            <ENT>1.43</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">27727</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Repair of lower leg</ENT>
                            <ENT>14.69</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>9.06</ENT>
                            <ENT>9.70</ENT>
                            <ENT>2.44</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">27730</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Repair of tibia epiphysis</ENT>
                            <ENT>7.59</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>5.30</ENT>
                            <ENT>5.86</ENT>
                            <ENT>1.73</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">27732</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Repair of fibula epiphysis</ENT>
                            <ENT>5.37</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>4.16</ENT>
                            <ENT>4.54</ENT>
                            <ENT>0.77</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">27734</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Repair lower leg epiphyses</ENT>
                            <ENT>8.72</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>6.16</ENT>
                            <ENT>6.22</ENT>
                            <ENT>1.35</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">27740</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Repair of leg epiphyses</ENT>
                            <ENT>9.49</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>6.60</ENT>
                            <ENT>7.29</ENT>
                            <ENT>1.62</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">27742</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Repair of leg epiphyses</ENT>
                            <ENT>10.49</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>4.60</ENT>
                            <ENT>5.08</ENT>
                            <ENT>1.80</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">27745</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Reinforce tibia</ENT>
                            <ENT>10.37</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>6.99</ENT>
                            <ENT>7.58</ENT>
                            <ENT>1.76</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">27750</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Treatment of tibia fracture</ENT>
                            <ENT>3.26</ENT>
                            <ENT>4.32</ENT>
                            <ENT>4.54</ENT>
                            <ENT>3.73</ENT>
                            <ENT>3.79</ENT>
                            <ENT>0.55</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">27752</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Treatment of tibia fracture</ENT>
                            <ENT>6.15</ENT>
                            <ENT>5.94</ENT>
                            <ENT>6.29</ENT>
                            <ENT>5.10</ENT>
                            <ENT>5.39</ENT>
                            <ENT>1.01</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">27756</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Treatment of tibia fracture</ENT>
                            <ENT>7.33</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>5.75</ENT>
                            <ENT>6.10</ENT>
                            <ENT>1.17</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">27758</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Treatment of tibia fracture</ENT>
                            <ENT>12.40</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>8.02</ENT>
                            <ENT>8.60</ENT>
                            <ENT>2.04</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">27759</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Treatment of tibia fracture</ENT>
                            <ENT>14.31</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>8.66</ENT>
                            <ENT>9.48</ENT>
                            <ENT>2.39</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">27760</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Cltx medial ankle fx</ENT>
                            <ENT>3.09</ENT>
                            <ENT>4.28</ENT>
                            <ENT>4.47</ENT>
                            <ENT>3.67</ENT>
                            <ENT>3.63</ENT>
                            <ENT>0.48</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">27762</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Cltx med ankle fx w/mnpj</ENT>
                            <ENT>5.33</ENT>
                            <ENT>5.47</ENT>
                            <ENT>5.90</ENT>
                            <ENT>4.65</ENT>
                            <ENT>4.96</ENT>
                            <ENT>0.85</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">27766</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Optx medial ankle fx</ENT>
                            <ENT>7.73</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>6.12</ENT>
                            <ENT>6.67</ENT>
                            <ENT>1.44</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">27767</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Cltx post ankle fx</ENT>
                            <ENT>2.50</ENT>
                            <ENT>3.62</ENT>
                            <ENT>3.62</ENT>
                            <ENT>3.65</ENT>
                            <ENT>3.65</ENT>
                            <ENT>0.30</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">27768</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Cltx post ankle fx w/mnpj</ENT>
                            <ENT>5.00</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>4.29</ENT>
                            <ENT>4.29</ENT>
                            <ENT>0.79</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">27769</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Optx post ankle fx</ENT>
                            <ENT>10.00</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>6.07</ENT>
                            <ENT>6.07</ENT>
                            <ENT>1.45</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">27780</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Treatment of fibula fracture</ENT>
                            <ENT>2.72</ENT>
                            <ENT>3.86</ENT>
                            <ENT>4.02</ENT>
                            <ENT>3.31</ENT>
                            <ENT>3.26</ENT>
                            <ENT>0.41</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">27781</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Treatment of fibula fracture</ENT>
                            <ENT>4.47</ENT>
                            <ENT>4.87</ENT>
                            <ENT>5.18</ENT>
                            <ENT>4.26</ENT>
                            <ENT>4.45</ENT>
                            <ENT>0.73</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">27784</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Treatment of fibula fracture</ENT>
                            <ENT>9.51</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>6.84</ENT>
                            <ENT>6.65</ENT>
                            <ENT>1.23</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">27786</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Treatment of ankle fracture</ENT>
                            <ENT>2.91</ENT>
                            <ENT>4.05</ENT>
                            <ENT>4.25</ENT>
                            <ENT>3.43</ENT>
                            <ENT>3.38</ENT>
                            <ENT>0.46</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">27788</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Treatment of ankle fracture</ENT>
                            <ENT>4.52</ENT>
                            <ENT>4.96</ENT>
                            <ENT>5.30</ENT>
                            <ENT>4.23</ENT>
                            <ENT>4.44</ENT>
                            <ENT>0.74</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <PRTPAGE P="66435"/>
                            <ENT I="01">27792</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Treatment of ankle fracture</ENT>
                            <ENT>9.55</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>6.80</ENT>
                            <ENT>6.88</ENT>
                            <ENT>1.32</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">27808</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Treatment of ankle fracture</ENT>
                            <ENT>2.91</ENT>
                            <ENT>4.39</ENT>
                            <ENT>4.59</ENT>
                            <ENT>3.70</ENT>
                            <ENT>3.70</ENT>
                            <ENT>0.46</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">27810</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Treatment of ankle fracture</ENT>
                            <ENT>5.20</ENT>
                            <ENT>5.40</ENT>
                            <ENT>5.82</ENT>
                            <ENT>4.55</ENT>
                            <ENT>4.85</ENT>
                            <ENT>0.82</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">27814</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Treatment of ankle fracture</ENT>
                            <ENT>10.46</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>7.23</ENT>
                            <ENT>7.89</ENT>
                            <ENT>1.86</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">27816</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Treatment of ankle fracture</ENT>
                            <ENT>2.96</ENT>
                            <ENT>3.99</ENT>
                            <ENT>4.18</ENT>
                            <ENT>3.33</ENT>
                            <ENT>3.37</ENT>
                            <ENT>0.43</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">27818</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Treatment of ankle fracture</ENT>
                            <ENT>5.57</ENT>
                            <ENT>5.41</ENT>
                            <ENT>5.89</ENT>
                            <ENT>4.44</ENT>
                            <ENT>4.80</ENT>
                            <ENT>0.82</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">27822</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Treatment of ankle fracture</ENT>
                            <ENT>11.03</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>8.20</ENT>
                            <ENT>9.42</ENT>
                            <ENT>1.92</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">27823</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Treatment of ankle fracture</ENT>
                            <ENT>12.98</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>8.93</ENT>
                            <ENT>10.19</ENT>
                            <ENT>2.26</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">27824</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Treat lower leg fracture</ENT>
                            <ENT>3.20</ENT>
                            <ENT>3.65</ENT>
                            <ENT>3.85</ENT>
                            <ENT>3.47</ENT>
                            <ENT>3.51</ENT>
                            <ENT>0.45</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">27825</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Treat lower leg fracture</ENT>
                            <ENT>6.60</ENT>
                            <ENT>5.78</ENT>
                            <ENT>6.19</ENT>
                            <ENT>4.75</ENT>
                            <ENT>5.07</ENT>
                            <ENT>1.02</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">27826</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Treat lower leg fracture</ENT>
                            <ENT>10.92</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>8.20</ENT>
                            <ENT>8.51</ENT>
                            <ENT>1.47</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">27827</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Treat lower leg fracture</ENT>
                            <ENT>14.56</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>10.17</ENT>
                            <ENT>11.47</ENT>
                            <ENT>2.44</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">27828</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Treat lower leg fracture</ENT>
                            <ENT>18.20</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>11.56</ENT>
                            <ENT>12.74</ENT>
                            <ENT>2.82</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">27829</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Treat lower leg joint</ENT>
                            <ENT>8.64</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>6.97</ENT>
                            <ENT>6.87</ENT>
                            <ENT>0.95</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">27830</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Treat lower leg dislocation</ENT>
                            <ENT>3.85</ENT>
                            <ENT>4.09</ENT>
                            <ENT>4.24</ENT>
                            <ENT>3.56</ENT>
                            <ENT>3.70</ENT>
                            <ENT>0.54</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">27831</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Treat lower leg dislocation</ENT>
                            <ENT>4.62</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>4.05</ENT>
                            <ENT>4.25</ENT>
                            <ENT>0.73</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">27832</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Treat lower leg dislocation</ENT>
                            <ENT>10.01</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>6.83</ENT>
                            <ENT>6.50</ENT>
                            <ENT>1.03</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">27840</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Treat ankle dislocation</ENT>
                            <ENT>4.65</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>3.65</ENT>
                            <ENT>3.70</ENT>
                            <ENT>0.46</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">27842</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Treat ankle dislocation</ENT>
                            <ENT>6.34</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>4.85</ENT>
                            <ENT>4.98</ENT>
                            <ENT>1.00</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">27846</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Treat ankle dislocation</ENT>
                            <ENT>10.16</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>6.76</ENT>
                            <ENT>7.34</ENT>
                            <ENT>1.71</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">27848</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Treat ankle dislocation</ENT>
                            <ENT>11.56</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>7.31</ENT>
                            <ENT>8.51</ENT>
                            <ENT>1.95</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">27860</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Fixation of ankle joint</ENT>
                            <ENT>2.36</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>1.68</ENT>
                            <ENT>1.83</ENT>
                            <ENT>0.39</ENT>
                            <ENT>010</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">27870</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Fusion of ankle joint, open</ENT>
                            <ENT>15.21</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>9.07</ENT>
                            <ENT>9.79</ENT>
                            <ENT>2.37</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">27871</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Fusion of tibiofibular joint</ENT>
                            <ENT>9.42</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>6.53</ENT>
                            <ENT>7.05</ENT>
                            <ENT>1.59</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">27880</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Amputation of lower leg</ENT>
                            <ENT>15.24</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>6.64</ENT>
                            <ENT>6.88</ENT>
                            <ENT>1.76</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">27881</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Amputation of lower leg</ENT>
                            <ENT>13.32</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>7.37</ENT>
                            <ENT>8.11</ENT>
                            <ENT>1.99</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">27882</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Amputation of lower leg</ENT>
                            <ENT>9.67</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>4.90</ENT>
                            <ENT>5.69</ENT>
                            <ENT>1.29</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">27884</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Amputation follow-up surgery</ENT>
                            <ENT>8.64</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>5.10</ENT>
                            <ENT>5.43</ENT>
                            <ENT>1.22</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">27886</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Amputation follow-up surgery</ENT>
                            <ENT>9.88</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>5.65</ENT>
                            <ENT>6.08</ENT>
                            <ENT>1.40</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">27888</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Amputation of foot at ankle</ENT>
                            <ENT>10.23</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>6.00</ENT>
                            <ENT>6.75</ENT>
                            <ENT>1.51</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">27889</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Amputation of foot at ankle</ENT>
                            <ENT>10.72</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>5.43</ENT>
                            <ENT>5.95</ENT>
                            <ENT>1.46</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">27892</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Decompression of leg</ENT>
                            <ENT>7.82</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>5.09</ENT>
                            <ENT>5.34</ENT>
                            <ENT>1.10</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">27893</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Decompression of leg</ENT>
                            <ENT>7.78</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>5.12</ENT>
                            <ENT>5.29</ENT>
                            <ENT>1.10</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">27894</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Decompression of leg</ENT>
                            <ENT>12.42</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>7.33</ENT>
                            <ENT>7.55</ENT>
                            <ENT>1.65</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">27899</ENT>
                            <ENT/>
                            <ENT>C</ENT>
                            <ENT>Leg/ankle surgery procedure</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>YYY</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">28001</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Drainage of bursa of foot</ENT>
                            <ENT>2.75</ENT>
                            <ENT>4.00</ENT>
                            <ENT>3.49</ENT>
                            <ENT>1.61</ENT>
                            <ENT>1.78</ENT>
                            <ENT>0.33</ENT>
                            <ENT>010</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">28002</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Treatment of foot infection</ENT>
                            <ENT>5.78</ENT>
                            <ENT>6.67</ENT>
                            <ENT>5.83</ENT>
                            <ENT>3.57</ENT>
                            <ENT>3.67</ENT>
                            <ENT>0.61</ENT>
                            <ENT>010</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">28003</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Treatment of foot infection</ENT>
                            <ENT>8.95</ENT>
                            <ENT>7.77</ENT>
                            <ENT>7.00</ENT>
                            <ENT>4.55</ENT>
                            <ENT>4.89</ENT>
                            <ENT>1.12</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">28005</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Treat foot bone lesion</ENT>
                            <ENT>9.30</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>5.52</ENT>
                            <ENT>5.78</ENT>
                            <ENT>1.16</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">28008</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Incision of foot fascia</ENT>
                            <ENT>4.50</ENT>
                            <ENT>6.17</ENT>
                            <ENT>5.36</ENT>
                            <ENT>3.00</ENT>
                            <ENT>3.10</ENT>
                            <ENT>0.57</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">28010</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Incision of toe tendon</ENT>
                            <ENT>2.89</ENT>
                            <ENT>2.86</ENT>
                            <ENT>2.62</ENT>
                            <ENT>2.35</ENT>
                            <ENT>2.36</ENT>
                            <ENT>0.36</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">28011</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Incision of toe tendons</ENT>
                            <ENT>4.19</ENT>
                            <ENT>3.79</ENT>
                            <ENT>3.55</ENT>
                            <ENT>3.03</ENT>
                            <ENT>3.16</ENT>
                            <ENT>0.59</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">28020</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Exploration of foot joint</ENT>
                            <ENT>5.06</ENT>
                            <ENT>7.36</ENT>
                            <ENT>6.68</ENT>
                            <ENT>3.58</ENT>
                            <ENT>3.85</ENT>
                            <ENT>0.72</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">28022</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Exploration of foot joint</ENT>
                            <ENT>4.72</ENT>
                            <ENT>6.92</ENT>
                            <ENT>6.06</ENT>
                            <ENT>3.33</ENT>
                            <ENT>3.59</ENT>
                            <ENT>0.62</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">28024</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Exploration of toe joint</ENT>
                            <ENT>4.43</ENT>
                            <ENT>6.55</ENT>
                            <ENT>5.88</ENT>
                            <ENT>3.11</ENT>
                            <ENT>3.52</ENT>
                            <ENT>0.58</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">28035</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Decompression of tibia nerve</ENT>
                            <ENT>5.14</ENT>
                            <ENT>7.27</ENT>
                            <ENT>6.56</ENT>
                            <ENT>3.54</ENT>
                            <ENT>3.81</ENT>
                            <ENT>0.70</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">28043</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Excision of foot lesion</ENT>
                            <ENT>3.58</ENT>
                            <ENT>4.78</ENT>
                            <ENT>4.29</ENT>
                            <ENT>2.73</ENT>
                            <ENT>2.95</ENT>
                            <ENT>0.46</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">28045</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Excision of foot lesion</ENT>
                            <ENT>4.77</ENT>
                            <ENT>7.02</ENT>
                            <ENT>6.20</ENT>
                            <ENT>3.24</ENT>
                            <ENT>3.42</ENT>
                            <ENT>0.63</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">28046</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Resection of tumor, foot</ENT>
                            <ENT>10.55</ENT>
                            <ENT>10.36</ENT>
                            <ENT>9.56</ENT>
                            <ENT>5.76</ENT>
                            <ENT>6.11</ENT>
                            <ENT>1.36</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">28050</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Biopsy of foot joint lining</ENT>
                            <ENT>4.30</ENT>
                            <ENT>6.94</ENT>
                            <ENT>5.91</ENT>
                            <ENT>3.29</ENT>
                            <ENT>3.44</ENT>
                            <ENT>0.60</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">28052</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Biopsy of foot joint lining</ENT>
                            <ENT>3.98</ENT>
                            <ENT>6.30</ENT>
                            <ENT>5.60</ENT>
                            <ENT>2.87</ENT>
                            <ENT>3.15</ENT>
                            <ENT>0.53</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">28054</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Biopsy of toe joint lining</ENT>
                            <ENT>3.49</ENT>
                            <ENT>6.25</ENT>
                            <ENT>5.48</ENT>
                            <ENT>2.79</ENT>
                            <ENT>3.01</ENT>
                            <ENT>0.46</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">28055</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Neurectomy, foot</ENT>
                            <ENT>6.20</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>3.44</ENT>
                            <ENT>3.54</ENT>
                            <ENT>0.74</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">28060</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Partial removal, foot fascia</ENT>
                            <ENT>5.29</ENT>
                            <ENT>7.07</ENT>
                            <ENT>6.27</ENT>
                            <ENT>3.54</ENT>
                            <ENT>3.70</ENT>
                            <ENT>0.70</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">28062</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Removal of foot fascia</ENT>
                            <ENT>6.58</ENT>
                            <ENT>7.82</ENT>
                            <ENT>7.17</ENT>
                            <ENT>3.82</ENT>
                            <ENT>3.91</ENT>
                            <ENT>0.83</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">28070</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Removal of foot joint lining</ENT>
                            <ENT>5.15</ENT>
                            <ENT>7.36</ENT>
                            <ENT>6.29</ENT>
                            <ENT>3.54</ENT>
                            <ENT>3.67</ENT>
                            <ENT>0.73</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">28072</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Removal of foot joint lining</ENT>
                            <ENT>4.63</ENT>
                            <ENT>7.56</ENT>
                            <ENT>6.54</ENT>
                            <ENT>3.60</ENT>
                            <ENT>3.95</ENT>
                            <ENT>0.68</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">28080</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Removal of foot lesion</ENT>
                            <ENT>4.65</ENT>
                            <ENT>7.66</ENT>
                            <ENT>6.38</ENT>
                            <ENT>4.19</ENT>
                            <ENT>3.93</ENT>
                            <ENT>0.47</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">28086</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Excise foot tendon sheath</ENT>
                            <ENT>4.83</ENT>
                            <ENT>7.86</ENT>
                            <ENT>7.92</ENT>
                            <ENT>3.81</ENT>
                            <ENT>4.24</ENT>
                            <ENT>0.76</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">28088</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Excise foot tendon sheath</ENT>
                            <ENT>3.90</ENT>
                            <ENT>7.00</ENT>
                            <ENT>6.37</ENT>
                            <ENT>3.19</ENT>
                            <ENT>3.54</ENT>
                            <ENT>0.61</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">28090</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Removal of foot lesion</ENT>
                            <ENT>4.46</ENT>
                            <ENT>6.77</ENT>
                            <ENT>5.95</ENT>
                            <ENT>3.18</ENT>
                            <ENT>3.31</ENT>
                            <ENT>0.59</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">28092</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Removal of toe lesions</ENT>
                            <ENT>3.69</ENT>
                            <ENT>6.46</ENT>
                            <ENT>5.84</ENT>
                            <ENT>2.98</ENT>
                            <ENT>3.25</ENT>
                            <ENT>0.49</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">28100</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Removal of ankle/heel lesion</ENT>
                            <ENT>5.72</ENT>
                            <ENT>8.09</ENT>
                            <ENT>8.02</ENT>
                            <ENT>3.99</ENT>
                            <ENT>4.34</ENT>
                            <ENT>0.82</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">28102</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Remove/graft foot lesion</ENT>
                            <ENT>7.80</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>4.84</ENT>
                            <ENT>5.39</ENT>
                            <ENT>1.14</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">28103</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Remove/graft foot lesion</ENT>
                            <ENT>6.56</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>4.02</ENT>
                            <ENT>4.31</ENT>
                            <ENT>0.91</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">28104</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Removal of foot lesion</ENT>
                            <ENT>5.17</ENT>
                            <ENT>7.23</ENT>
                            <ENT>6.35</ENT>
                            <ENT>3.46</ENT>
                            <ENT>3.69</ENT>
                            <ENT>0.70</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">28106</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Remove/graft foot lesion</ENT>
                            <ENT>7.23</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>4.22</ENT>
                            <ENT>4.32</ENT>
                            <ENT>0.97</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">28107</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Remove/graft foot lesion</ENT>
                            <ENT>5.62</ENT>
                            <ENT>7.69</ENT>
                            <ENT>7.11</ENT>
                            <ENT>3.66</ENT>
                            <ENT>3.93</ENT>
                            <ENT>0.74</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">28108</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Removal of toe lesions</ENT>
                            <ENT>4.21</ENT>
                            <ENT>6.35</ENT>
                            <ENT>5.46</ENT>
                            <ENT>2.98</ENT>
                            <ENT>3.12</ENT>
                            <ENT>0.53</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">28110</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Part removal of metatarsal</ENT>
                            <ENT>4.13</ENT>
                            <ENT>6.92</ENT>
                            <ENT>6.07</ENT>
                            <ENT>3.06</ENT>
                            <ENT>3.14</ENT>
                            <ENT>0.54</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">28111</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Part removal of metatarsal</ENT>
                            <ENT>5.06</ENT>
                            <ENT>7.09</ENT>
                            <ENT>6.68</ENT>
                            <ENT>3.20</ENT>
                            <ENT>3.42</ENT>
                            <ENT>0.67</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">28112</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Part removal of metatarsal</ENT>
                            <ENT>4.54</ENT>
                            <ENT>7.18</ENT>
                            <ENT>6.49</ENT>
                            <ENT>3.24</ENT>
                            <ENT>3.40</ENT>
                            <ENT>0.61</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <PRTPAGE P="66436"/>
                            <ENT I="01">28113</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Part removal of metatarsal</ENT>
                            <ENT>5.88</ENT>
                            <ENT>8.36</ENT>
                            <ENT>7.20</ENT>
                            <ENT>4.61</ENT>
                            <ENT>4.46</ENT>
                            <ENT>0.63</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">28114</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Removal of metatarsal heads</ENT>
                            <ENT>11.61</ENT>
                            <ENT>13.38</ENT>
                            <ENT>12.49</ENT>
                            <ENT>8.29</ENT>
                            <ENT>8.33</ENT>
                            <ENT>1.42</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">28116</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Revision of foot</ENT>
                            <ENT>8.94</ENT>
                            <ENT>9.44</ENT>
                            <ENT>8.11</ENT>
                            <ENT>5.34</ENT>
                            <ENT>5.25</ENT>
                            <ENT>1.03</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">28118</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Removal of heel bone</ENT>
                            <ENT>6.02</ENT>
                            <ENT>7.92</ENT>
                            <ENT>7.08</ENT>
                            <ENT>4.02</ENT>
                            <ENT>4.18</ENT>
                            <ENT>0.84</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">28119</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Removal of heel spur</ENT>
                            <ENT>5.45</ENT>
                            <ENT>7.21</ENT>
                            <ENT>6.31</ENT>
                            <ENT>3.57</ENT>
                            <ENT>3.65</ENT>
                            <ENT>0.70</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">28120</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Part removal of ankle/heel</ENT>
                            <ENT>5.64</ENT>
                            <ENT>8.08</ENT>
                            <ENT>7.68</ENT>
                            <ENT>3.96</ENT>
                            <ENT>4.18</ENT>
                            <ENT>0.77</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">28122</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Partial removal of foot bone</ENT>
                            <ENT>7.56</ENT>
                            <ENT>8.46</ENT>
                            <ENT>7.64</ENT>
                            <ENT>4.77</ENT>
                            <ENT>5.02</ENT>
                            <ENT>0.98</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">28124</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Partial removal of toe</ENT>
                            <ENT>4.88</ENT>
                            <ENT>6.77</ENT>
                            <ENT>5.88</ENT>
                            <ENT>3.46</ENT>
                            <ENT>3.55</ENT>
                            <ENT>0.60</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">28126</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Partial removal of toe</ENT>
                            <ENT>3.56</ENT>
                            <ENT>5.96</ENT>
                            <ENT>5.08</ENT>
                            <ENT>2.66</ENT>
                            <ENT>2.82</ENT>
                            <ENT>0.45</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">28130</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Removal of ankle bone</ENT>
                            <ENT>9.30</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>6.15</ENT>
                            <ENT>6.43</ENT>
                            <ENT>1.26</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">28140</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Removal of metatarsal</ENT>
                            <ENT>7.03</ENT>
                            <ENT>7.81</ENT>
                            <ENT>7.51</ENT>
                            <ENT>4.11</ENT>
                            <ENT>4.43</ENT>
                            <ENT>0.92</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">28150</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Removal of toe</ENT>
                            <ENT>4.14</ENT>
                            <ENT>6.35</ENT>
                            <ENT>5.59</ENT>
                            <ENT>2.97</ENT>
                            <ENT>3.13</ENT>
                            <ENT>0.53</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">28153</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Partial removal of toe</ENT>
                            <ENT>3.71</ENT>
                            <ENT>6.21</ENT>
                            <ENT>5.26</ENT>
                            <ENT>2.89</ENT>
                            <ENT>2.78</ENT>
                            <ENT>0.47</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">28160</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Partial removal of toe</ENT>
                            <ENT>3.79</ENT>
                            <ENT>6.31</ENT>
                            <ENT>5.43</ENT>
                            <ENT>2.92</ENT>
                            <ENT>3.13</ENT>
                            <ENT>0.49</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">28171</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Extensive foot surgery</ENT>
                            <ENT>9.85</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>5.25</ENT>
                            <ENT>5.34</ENT>
                            <ENT>1.33</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">28173</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Extensive foot surgery</ENT>
                            <ENT>9.05</ENT>
                            <ENT>8.72</ENT>
                            <ENT>8.15</ENT>
                            <ENT>4.61</ENT>
                            <ENT>4.90</ENT>
                            <ENT>1.12</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">28175</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Extensive foot surgery</ENT>
                            <ENT>6.17</ENT>
                            <ENT>7.14</ENT>
                            <ENT>6.42</ENT>
                            <ENT>3.62</ENT>
                            <ENT>3.66</ENT>
                            <ENT>0.73</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">28190</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Removal of foot foreign body</ENT>
                            <ENT>1.98</ENT>
                            <ENT>4.01</ENT>
                            <ENT>3.70</ENT>
                            <ENT>1.34</ENT>
                            <ENT>1.41</ENT>
                            <ENT>0.22</ENT>
                            <ENT>010</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">28192</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Removal of foot foreign body</ENT>
                            <ENT>4.69</ENT>
                            <ENT>6.71</ENT>
                            <ENT>6.09</ENT>
                            <ENT>3.19</ENT>
                            <ENT>3.41</ENT>
                            <ENT>0.61</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">28193</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Removal of foot foreign body</ENT>
                            <ENT>5.79</ENT>
                            <ENT>7.33</ENT>
                            <ENT>6.47</ENT>
                            <ENT>3.63</ENT>
                            <ENT>3.77</ENT>
                            <ENT>0.73</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">28200</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Repair of foot tendon</ENT>
                            <ENT>4.65</ENT>
                            <ENT>6.87</ENT>
                            <ENT>5.98</ENT>
                            <ENT>3.23</ENT>
                            <ENT>3.39</ENT>
                            <ENT>0.61</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">28202</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Repair/graft of foot tendon</ENT>
                            <ENT>6.96</ENT>
                            <ENT>7.76</ENT>
                            <ENT>7.48</ENT>
                            <ENT>3.93</ENT>
                            <ENT>4.21</ENT>
                            <ENT>0.91</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">28208</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Repair of foot tendon</ENT>
                            <ENT>4.42</ENT>
                            <ENT>6.69</ENT>
                            <ENT>5.75</ENT>
                            <ENT>3.18</ENT>
                            <ENT>3.24</ENT>
                            <ENT>0.58</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">28210</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Repair/graft of foot tendon</ENT>
                            <ENT>6.41</ENT>
                            <ENT>7.62</ENT>
                            <ENT>6.91</ENT>
                            <ENT>3.93</ENT>
                            <ENT>3.97</ENT>
                            <ENT>0.81</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">28220</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Release of foot tendon</ENT>
                            <ENT>4.58</ENT>
                            <ENT>6.41</ENT>
                            <ENT>5.54</ENT>
                            <ENT>3.07</ENT>
                            <ENT>3.25</ENT>
                            <ENT>0.57</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">28222</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Release of foot tendons</ENT>
                            <ENT>5.67</ENT>
                            <ENT>6.92</ENT>
                            <ENT>6.08</ENT>
                            <ENT>3.34</ENT>
                            <ENT>3.73</ENT>
                            <ENT>0.69</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">28225</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Release of foot tendon</ENT>
                            <ENT>3.70</ENT>
                            <ENT>6.01</ENT>
                            <ENT>5.14</ENT>
                            <ENT>2.71</ENT>
                            <ENT>2.81</ENT>
                            <ENT>0.46</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">28226</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Release of foot tendons</ENT>
                            <ENT>4.58</ENT>
                            <ENT>6.88</ENT>
                            <ENT>5.83</ENT>
                            <ENT>3.25</ENT>
                            <ENT>3.49</ENT>
                            <ENT>0.58</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">28230</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Incision of foot tendon(s)</ENT>
                            <ENT>4.28</ENT>
                            <ENT>6.26</ENT>
                            <ENT>5.46</ENT>
                            <ENT>2.87</ENT>
                            <ENT>3.27</ENT>
                            <ENT>0.55</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">28232</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Incision of toe tendon</ENT>
                            <ENT>3.43</ENT>
                            <ENT>5.93</ENT>
                            <ENT>5.22</ENT>
                            <ENT>2.67</ENT>
                            <ENT>2.99</ENT>
                            <ENT>0.44</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">28234</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Incision of foot tendon</ENT>
                            <ENT>3.43</ENT>
                            <ENT>6.29</ENT>
                            <ENT>5.48</ENT>
                            <ENT>3.05</ENT>
                            <ENT>3.20</ENT>
                            <ENT>0.44</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">28238</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Revision of foot tendon</ENT>
                            <ENT>7.85</ENT>
                            <ENT>8.38</ENT>
                            <ENT>7.81</ENT>
                            <ENT>4.37</ENT>
                            <ENT>4.64</ENT>
                            <ENT>1.06</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">28240</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Release of big toe</ENT>
                            <ENT>4.40</ENT>
                            <ENT>6.35</ENT>
                            <ENT>5.49</ENT>
                            <ENT>2.95</ENT>
                            <ENT>3.21</ENT>
                            <ENT>0.58</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">28250</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Revision of foot fascia</ENT>
                            <ENT>5.97</ENT>
                            <ENT>7.55</ENT>
                            <ENT>6.58</ENT>
                            <ENT>3.82</ENT>
                            <ENT>3.97</ENT>
                            <ENT>0.82</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">28260</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Release of midfoot joint</ENT>
                            <ENT>8.08</ENT>
                            <ENT>8.44</ENT>
                            <ENT>7.38</ENT>
                            <ENT>4.61</ENT>
                            <ENT>4.80</ENT>
                            <ENT>1.14</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">28261</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Revision of foot tendon</ENT>
                            <ENT>12.91</ENT>
                            <ENT>10.66</ENT>
                            <ENT>9.63</ENT>
                            <ENT>6.33</ENT>
                            <ENT>6.81</ENT>
                            <ENT>1.57</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">28262</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Revision of foot and ankle</ENT>
                            <ENT>17.01</ENT>
                            <ENT>15.52</ENT>
                            <ENT>14.53</ENT>
                            <ENT>9.72</ENT>
                            <ENT>10.31</ENT>
                            <ENT>2.60</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">28264</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Release of midfoot joint</ENT>
                            <ENT>10.53</ENT>
                            <ENT>10.31</ENT>
                            <ENT>9.02</ENT>
                            <ENT>5.95</ENT>
                            <ENT>6.61</ENT>
                            <ENT>1.54</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">28270</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Release of foot contracture</ENT>
                            <ENT>4.82</ENT>
                            <ENT>6.91</ENT>
                            <ENT>5.90</ENT>
                            <ENT>3.44</ENT>
                            <ENT>3.58</ENT>
                            <ENT>0.62</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">28272</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Release of toe joint, each</ENT>
                            <ENT>3.84</ENT>
                            <ENT>5.83</ENT>
                            <ENT>5.00</ENT>
                            <ENT>2.65</ENT>
                            <ENT>2.75</ENT>
                            <ENT>0.46</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">28280</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Fusion of toes</ENT>
                            <ENT>5.24</ENT>
                            <ENT>7.28</ENT>
                            <ENT>6.76</ENT>
                            <ENT>3.54</ENT>
                            <ENT>4.01</ENT>
                            <ENT>0.73</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">28285</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Repair of hammertoe</ENT>
                            <ENT>4.65</ENT>
                            <ENT>6.70</ENT>
                            <ENT>5.78</ENT>
                            <ENT>3.34</ENT>
                            <ENT>3.38</ENT>
                            <ENT>0.59</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">28286</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Repair of hammertoe</ENT>
                            <ENT>4.61</ENT>
                            <ENT>6.52</ENT>
                            <ENT>5.65</ENT>
                            <ENT>3.06</ENT>
                            <ENT>3.15</ENT>
                            <ENT>0.57</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">28288</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Partial removal of foot bone</ENT>
                            <ENT>5.81</ENT>
                            <ENT>8.59</ENT>
                            <ENT>7.26</ENT>
                            <ENT>4.69</ENT>
                            <ENT>4.78</ENT>
                            <ENT>0.65</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">28289</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Repair hallux rigidus</ENT>
                            <ENT>8.11</ENT>
                            <ENT>9.42</ENT>
                            <ENT>8.70</ENT>
                            <ENT>5.33</ENT>
                            <ENT>5.55</ENT>
                            <ENT>1.02</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">28290</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Correction of bunion</ENT>
                            <ENT>5.72</ENT>
                            <ENT>8.18</ENT>
                            <ENT>7.21</ENT>
                            <ENT>3.96</ENT>
                            <ENT>4.34</ENT>
                            <ENT>0.82</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">28292</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Correction of bunion</ENT>
                            <ENT>8.72</ENT>
                            <ENT>10.33</ENT>
                            <ENT>8.89</ENT>
                            <ENT>6.15</ENT>
                            <ENT>5.84</ENT>
                            <ENT>0.91</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">28293</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Correction of bunion</ENT>
                            <ENT>11.10</ENT>
                            <ENT>14.46</ENT>
                            <ENT>12.60</ENT>
                            <ENT>6.91</ENT>
                            <ENT>6.50</ENT>
                            <ENT>1.13</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">28294</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Correction of bunion</ENT>
                            <ENT>8.63</ENT>
                            <ENT>9.45</ENT>
                            <ENT>8.44</ENT>
                            <ENT>4.77</ENT>
                            <ENT>4.74</ENT>
                            <ENT>1.09</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">28296</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Correction of bunion</ENT>
                            <ENT>9.31</ENT>
                            <ENT>9.57</ENT>
                            <ENT>8.86</ENT>
                            <ENT>4.79</ENT>
                            <ENT>5.10</ENT>
                            <ENT>1.19</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">28297</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Correction of bunion</ENT>
                            <ENT>9.31</ENT>
                            <ENT>10.46</ENT>
                            <ENT>9.70</ENT>
                            <ENT>5.33</ENT>
                            <ENT>5.79</ENT>
                            <ENT>1.32</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">28298</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Correction of bunion</ENT>
                            <ENT>8.01</ENT>
                            <ENT>9.29</ENT>
                            <ENT>8.25</ENT>
                            <ENT>4.59</ENT>
                            <ENT>4.79</ENT>
                            <ENT>1.05</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">28299</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Correction of bunion</ENT>
                            <ENT>11.39</ENT>
                            <ENT>10.54</ENT>
                            <ENT>9.65</ENT>
                            <ENT>5.72</ENT>
                            <ENT>5.89</ENT>
                            <ENT>1.37</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">28300</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Incision of heel bone</ENT>
                            <ENT>9.61</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>6.03</ENT>
                            <ENT>6.53</ENT>
                            <ENT>1.54</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">28302</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Incision of ankle bone</ENT>
                            <ENT>9.62</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>6.21</ENT>
                            <ENT>6.54</ENT>
                            <ENT>1.42</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">28304</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Incision of midfoot bones</ENT>
                            <ENT>9.29</ENT>
                            <ENT>9.55</ENT>
                            <ENT>8.74</ENT>
                            <ENT>5.08</ENT>
                            <ENT>5.40</ENT>
                            <ENT>1.27</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">28305</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Incise/graft midfoot bones</ENT>
                            <ENT>10.63</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>5.78</ENT>
                            <ENT>6.25</ENT>
                            <ENT>1.27</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">28306</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Incision of metatarsal</ENT>
                            <ENT>5.91</ENT>
                            <ENT>8.41</ENT>
                            <ENT>7.62</ENT>
                            <ENT>3.89</ENT>
                            <ENT>4.03</ENT>
                            <ENT>0.84</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">28307</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Incision of metatarsal</ENT>
                            <ENT>6.39</ENT>
                            <ENT>9.27</ENT>
                            <ENT>10.14</ENT>
                            <ENT>4.33</ENT>
                            <ENT>4.81</ENT>
                            <ENT>0.90</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">28308</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Incision of metatarsal</ENT>
                            <ENT>5.36</ENT>
                            <ENT>7.91</ENT>
                            <ENT>6.83</ENT>
                            <ENT>3.82</ENT>
                            <ENT>3.75</ENT>
                            <ENT>0.70</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">28309</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Incision of metatarsals</ENT>
                            <ENT>13.96</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>7.68</ENT>
                            <ENT>7.81</ENT>
                            <ENT>2.05</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">28310</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Revision of big toe</ENT>
                            <ENT>5.48</ENT>
                            <ENT>7.54</ENT>
                            <ENT>6.64</ENT>
                            <ENT>3.42</ENT>
                            <ENT>3.48</ENT>
                            <ENT>0.70</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">28312</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Revision of toe</ENT>
                            <ENT>4.60</ENT>
                            <ENT>7.37</ENT>
                            <ENT>6.40</ENT>
                            <ENT>3.23</ENT>
                            <ENT>3.43</ENT>
                            <ENT>0.63</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">28313</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Repair deformity of toe</ENT>
                            <ENT>5.06</ENT>
                            <ENT>7.26</ENT>
                            <ENT>6.27</ENT>
                            <ENT>3.60</ENT>
                            <ENT>4.21</ENT>
                            <ENT>0.73</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">28315</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Removal of sesamoid bone</ENT>
                            <ENT>4.91</ENT>
                            <ENT>6.67</ENT>
                            <ENT>5.78</ENT>
                            <ENT>3.22</ENT>
                            <ENT>3.27</ENT>
                            <ENT>0.63</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">28320</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Repair of foot bones</ENT>
                            <ENT>9.25</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>5.68</ENT>
                            <ENT>6.19</ENT>
                            <ENT>1.43</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">28322</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Repair of metatarsals</ENT>
                            <ENT>8.41</ENT>
                            <ENT>9.74</ENT>
                            <ENT>9.45</ENT>
                            <ENT>5.31</ENT>
                            <ENT>5.82</ENT>
                            <ENT>1.27</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">28340</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Resect enlarged toe tissue</ENT>
                            <ENT>7.04</ENT>
                            <ENT>8.09</ENT>
                            <ENT>7.26</ENT>
                            <ENT>4.07</ENT>
                            <ENT>4.15</ENT>
                            <ENT>0.84</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">28341</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Resect enlarged toe</ENT>
                            <ENT>8.60</ENT>
                            <ENT>8.59</ENT>
                            <ENT>7.76</ENT>
                            <ENT>4.42</ENT>
                            <ENT>4.61</ENT>
                            <ENT>1.01</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">28344</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Repair extra toe(s)</ENT>
                            <ENT>4.31</ENT>
                            <ENT>6.41</ENT>
                            <ENT>6.07</ENT>
                            <ENT>2.93</ENT>
                            <ENT>3.28</ENT>
                            <ENT>0.51</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">28345</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Repair webbed toe(s)</ENT>
                            <ENT>5.98</ENT>
                            <ENT>7.61</ENT>
                            <ENT>6.90</ENT>
                            <ENT>3.78</ENT>
                            <ENT>4.23</ENT>
                            <ENT>0.80</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">28360</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Reconstruct cleft foot</ENT>
                            <ENT>14.67</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>6.34</ENT>
                            <ENT>8.41</ENT>
                            <ENT>2.29</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <PRTPAGE P="66437"/>
                            <ENT I="01">28400</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Treatment of heel fracture</ENT>
                            <ENT>2.22</ENT>
                            <ENT>3.36</ENT>
                            <ENT>3.49</ENT>
                            <ENT>2.91</ENT>
                            <ENT>2.98</ENT>
                            <ENT>0.35</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">28405</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Treatment of heel fracture</ENT>
                            <ENT>4.63</ENT>
                            <ENT>4.42</ENT>
                            <ENT>4.62</ENT>
                            <ENT>3.67</ENT>
                            <ENT>4.14</ENT>
                            <ENT>0.73</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">28406</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Treatment of heel fracture</ENT>
                            <ENT>6.44</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>5.55</ENT>
                            <ENT>6.17</ENT>
                            <ENT>1.11</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">28415</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Treat heel fracture</ENT>
                            <ENT>15.96</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>10.23</ENT>
                            <ENT>11.75</ENT>
                            <ENT>2.67</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">28420</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Treat/graft heel fracture</ENT>
                            <ENT>17.29</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>10.27</ENT>
                            <ENT>11.59</ENT>
                            <ENT>2.81</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">28430</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Treatment of ankle fracture</ENT>
                            <ENT>2.14</ENT>
                            <ENT>3.12</ENT>
                            <ENT>3.25</ENT>
                            <ENT>2.57</ENT>
                            <ENT>2.57</ENT>
                            <ENT>0.31</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">28435</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Treatment of ankle fracture</ENT>
                            <ENT>3.45</ENT>
                            <ENT>3.98</ENT>
                            <ENT>3.93</ENT>
                            <ENT>3.26</ENT>
                            <ENT>3.50</ENT>
                            <ENT>0.55</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">28436</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Treatment of ankle fracture</ENT>
                            <ENT>4.78</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>4.74</ENT>
                            <ENT>5.32</ENT>
                            <ENT>0.81</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">28445</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Treat ankle fracture</ENT>
                            <ENT>15.53</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>9.48</ENT>
                            <ENT>10.25</ENT>
                            <ENT>2.59</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">28446</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Osteochondral talus autogrft</ENT>
                            <ENT>17.50</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>10.34</ENT>
                            <ENT>10.34</ENT>
                            <ENT>2.45</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">28450</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Treat midfoot fracture, each</ENT>
                            <ENT>1.95</ENT>
                            <ENT>2.91</ENT>
                            <ENT>3.01</ENT>
                            <ENT>2.41</ENT>
                            <ENT>2.44</ENT>
                            <ENT>0.28</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">28455</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Treat midfoot fracture, each</ENT>
                            <ENT>3.15</ENT>
                            <ENT>3.74</ENT>
                            <ENT>3.58</ENT>
                            <ENT>3.10</ENT>
                            <ENT>3.26</ENT>
                            <ENT>0.44</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">28456</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Treat midfoot fracture</ENT>
                            <ENT>2.75</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>3.72</ENT>
                            <ENT>3.94</ENT>
                            <ENT>0.44</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">28465</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Treat midfoot fracture, each</ENT>
                            <ENT>8.64</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>6.06</ENT>
                            <ENT>6.18</ENT>
                            <ENT>1.10</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">28470</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Treat metatarsal fracture</ENT>
                            <ENT>1.99</ENT>
                            <ENT>2.80</ENT>
                            <ENT>2.96</ENT>
                            <ENT>2.36</ENT>
                            <ENT>2.40</ENT>
                            <ENT>0.30</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">28475</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Treat metatarsal fracture</ENT>
                            <ENT>2.97</ENT>
                            <ENT>3.13</ENT>
                            <ENT>3.23</ENT>
                            <ENT>2.51</ENT>
                            <ENT>2.86</ENT>
                            <ENT>0.44</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">28476</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Treat metatarsal fracture</ENT>
                            <ENT>3.46</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>4.32</ENT>
                            <ENT>4.65</ENT>
                            <ENT>0.54</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">28485</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Treat metatarsal fracture</ENT>
                            <ENT>7.28</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>5.56</ENT>
                            <ENT>5.50</ENT>
                            <ENT>0.83</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">28490</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Treat big toe fracture</ENT>
                            <ENT>1.12</ENT>
                            <ENT>2.09</ENT>
                            <ENT>2.05</ENT>
                            <ENT>1.67</ENT>
                            <ENT>1.65</ENT>
                            <ENT>0.14</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">28495</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Treat big toe fracture</ENT>
                            <ENT>1.62</ENT>
                            <ENT>2.46</ENT>
                            <ENT>2.32</ENT>
                            <ENT>1.86</ENT>
                            <ENT>1.96</ENT>
                            <ENT>0.20</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">28496</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Treat big toe fracture</ENT>
                            <ENT>2.39</ENT>
                            <ENT>7.41</ENT>
                            <ENT>7.83</ENT>
                            <ENT>2.99</ENT>
                            <ENT>3.09</ENT>
                            <ENT>0.36</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">28505</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Treat big toe fracture</ENT>
                            <ENT>7.28</ENT>
                            <ENT>8.45</ENT>
                            <ENT>8.27</ENT>
                            <ENT>4.81</ENT>
                            <ENT>4.36</ENT>
                            <ENT>0.56</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">28510</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Treatment of toe fracture</ENT>
                            <ENT>1.12</ENT>
                            <ENT>1.68</ENT>
                            <ENT>1.60</ENT>
                            <ENT>1.61</ENT>
                            <ENT>1.57</ENT>
                            <ENT>0.14</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">28515</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Treatment of toe fracture</ENT>
                            <ENT>1.50</ENT>
                            <ENT>2.22</ENT>
                            <ENT>2.06</ENT>
                            <ENT>1.82</ENT>
                            <ENT>1.86</ENT>
                            <ENT>0.18</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">28525</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Treat toe fracture</ENT>
                            <ENT>5.46</ENT>
                            <ENT>8.11</ENT>
                            <ENT>7.81</ENT>
                            <ENT>4.31</ENT>
                            <ENT>3.87</ENT>
                            <ENT>0.49</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">28530</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Treat sesamoid bone fracture</ENT>
                            <ENT>1.08</ENT>
                            <ENT>1.62</ENT>
                            <ENT>1.53</ENT>
                            <ENT>1.34</ENT>
                            <ENT>1.39</ENT>
                            <ENT>0.14</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">28531</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Treat sesamoid bone fracture</ENT>
                            <ENT>2.51</ENT>
                            <ENT>6.54</ENT>
                            <ENT>6.90</ENT>
                            <ENT>2.42</ENT>
                            <ENT>2.24</ENT>
                            <ENT>0.34</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">28540</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Treat foot dislocation</ENT>
                            <ENT>2.10</ENT>
                            <ENT>2.74</ENT>
                            <ENT>2.57</ENT>
                            <ENT>2.30</ENT>
                            <ENT>2.35</ENT>
                            <ENT>0.26</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">28545</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Treat foot dislocation</ENT>
                            <ENT>2.51</ENT>
                            <ENT>3.43</ENT>
                            <ENT>2.88</ENT>
                            <ENT>2.81</ENT>
                            <ENT>2.57</ENT>
                            <ENT>0.37</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">28546</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Treat foot dislocation</ENT>
                            <ENT>3.28</ENT>
                            <ENT>8.05</ENT>
                            <ENT>7.48</ENT>
                            <ENT>3.64</ENT>
                            <ENT>4.01</ENT>
                            <ENT>0.52</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">28555</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Repair foot dislocation</ENT>
                            <ENT>9.49</ENT>
                            <ENT>10.80</ENT>
                            <ENT>10.35</ENT>
                            <ENT>6.29</ENT>
                            <ENT>5.98</ENT>
                            <ENT>1.04</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">28570</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Treat foot dislocation</ENT>
                            <ENT>1.70</ENT>
                            <ENT>2.49</ENT>
                            <ENT>2.45</ENT>
                            <ENT>1.91</ENT>
                            <ENT>2.12</ENT>
                            <ENT>0.23</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">28575</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Treat foot dislocation</ENT>
                            <ENT>3.38</ENT>
                            <ENT>4.41</ENT>
                            <ENT>4.06</ENT>
                            <ENT>3.71</ENT>
                            <ENT>3.71</ENT>
                            <ENT>0.56</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">28576</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Treat foot dislocation</ENT>
                            <ENT>4.48</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>4.06</ENT>
                            <ENT>4.11</ENT>
                            <ENT>0.69</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">28585</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Repair foot dislocation</ENT>
                            <ENT>10.92</ENT>
                            <ENT>11.56</ENT>
                            <ENT>9.44</ENT>
                            <ENT>6.96</ENT>
                            <ENT>6.40</ENT>
                            <ENT>1.25</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">28600</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Treat foot dislocation</ENT>
                            <ENT>1.94</ENT>
                            <ENT>3.02</ENT>
                            <ENT>2.92</ENT>
                            <ENT>2.37</ENT>
                            <ENT>2.53</ENT>
                            <ENT>0.27</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">28605</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Treat foot dislocation</ENT>
                            <ENT>2.78</ENT>
                            <ENT>3.89</ENT>
                            <ENT>3.50</ENT>
                            <ENT>3.27</ENT>
                            <ENT>3.19</ENT>
                            <ENT>0.40</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">28606</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Treat foot dislocation</ENT>
                            <ENT>4.97</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>4.11</ENT>
                            <ENT>4.40</ENT>
                            <ENT>0.82</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">28615</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Repair foot dislocation</ENT>
                            <ENT>10.46</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>8.13</ENT>
                            <ENT>8.08</ENT>
                            <ENT>1.30</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">28630</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Treat toe dislocation</ENT>
                            <ENT>1.72</ENT>
                            <ENT>1.84</ENT>
                            <ENT>1.70</ENT>
                            <ENT>0.91</ENT>
                            <ENT>0.95</ENT>
                            <ENT>0.20</ENT>
                            <ENT>010</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">28635</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Treat toe dislocation</ENT>
                            <ENT>1.93</ENT>
                            <ENT>2.27</ENT>
                            <ENT>2.15</ENT>
                            <ENT>1.33</ENT>
                            <ENT>1.43</ENT>
                            <ENT>0.26</ENT>
                            <ENT>010</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">28636</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Treat toe dislocation</ENT>
                            <ENT>2.77</ENT>
                            <ENT>4.38</ENT>
                            <ENT>4.12</ENT>
                            <ENT>2.05</ENT>
                            <ENT>2.34</ENT>
                            <ENT>0.43</ENT>
                            <ENT>010</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">28645</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Repair toe dislocation</ENT>
                            <ENT>7.28</ENT>
                            <ENT>8.33</ENT>
                            <ENT>6.64</ENT>
                            <ENT>4.61</ENT>
                            <ENT>3.94</ENT>
                            <ENT>0.57</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">28660</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Treat toe dislocation</ENT>
                            <ENT>1.25</ENT>
                            <ENT>1.30</ENT>
                            <ENT>1.28</ENT>
                            <ENT>0.78</ENT>
                            <ENT>0.78</ENT>
                            <ENT>0.13</ENT>
                            <ENT>010</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">28665</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Treat toe dislocation</ENT>
                            <ENT>1.94</ENT>
                            <ENT>1.82</ENT>
                            <ENT>1.62</ENT>
                            <ENT>1.32</ENT>
                            <ENT>1.37</ENT>
                            <ENT>0.26</ENT>
                            <ENT>010</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">28666</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Treat toe dislocation</ENT>
                            <ENT>2.66</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>1.82</ENT>
                            <ENT>2.20</ENT>
                            <ENT>0.43</ENT>
                            <ENT>010</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">28675</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Repair of toe dislocation</ENT>
                            <ENT>5.46</ENT>
                            <ENT>8.23</ENT>
                            <ENT>7.68</ENT>
                            <ENT>4.44</ENT>
                            <ENT>3.90</ENT>
                            <ENT>0.45</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">28705</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Fusion of foot bones</ENT>
                            <ENT>20.12</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>10.64</ENT>
                            <ENT>11.54</ENT>
                            <ENT>3.09</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">28715</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Fusion of foot bones</ENT>
                            <ENT>14.40</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>8.48</ENT>
                            <ENT>9.11</ENT>
                            <ENT>2.17</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">28725</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Fusion of foot bones</ENT>
                            <ENT>11.97</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>6.82</ENT>
                            <ENT>7.52</ENT>
                            <ENT>1.87</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">28730</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Fusion of foot bones</ENT>
                            <ENT>12.21</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>7.75</ENT>
                            <ENT>8.11</ENT>
                            <ENT>1.71</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">28735</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Fusion of foot bones</ENT>
                            <ENT>12.03</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>6.96</ENT>
                            <ENT>7.39</ENT>
                            <ENT>1.69</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">28737</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Revision of foot bones</ENT>
                            <ENT>10.83</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>6.06</ENT>
                            <ENT>6.43</ENT>
                            <ENT>1.47</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">28740</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Fusion of foot bones</ENT>
                            <ENT>9.09</ENT>
                            <ENT>10.86</ENT>
                            <ENT>10.86</ENT>
                            <ENT>5.98</ENT>
                            <ENT>6.22</ENT>
                            <ENT>1.22</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">28750</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Fusion of big toe joint</ENT>
                            <ENT>8.37</ENT>
                            <ENT>10.76</ENT>
                            <ENT>11.33</ENT>
                            <ENT>5.88</ENT>
                            <ENT>6.27</ENT>
                            <ENT>1.13</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">28755</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Fusion of big toe joint</ENT>
                            <ENT>4.79</ENT>
                            <ENT>7.25</ENT>
                            <ENT>6.67</ENT>
                            <ENT>3.35</ENT>
                            <ENT>3.55</ENT>
                            <ENT>0.65</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">28760</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Fusion of big toe joint</ENT>
                            <ENT>8.94</ENT>
                            <ENT>9.86</ENT>
                            <ENT>8.91</ENT>
                            <ENT>5.26</ENT>
                            <ENT>5.39</ENT>
                            <ENT>1.05</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">28800</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Amputation of midfoot</ENT>
                            <ENT>8.65</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>5.00</ENT>
                            <ENT>5.40</ENT>
                            <ENT>1.15</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">28805</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Amputation thru metatarsal</ENT>
                            <ENT>12.55</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>5.89</ENT>
                            <ENT>5.77</ENT>
                            <ENT>1.18</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">28810</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Amputation toe &amp; metatarsal</ENT>
                            <ENT>6.52</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>4.06</ENT>
                            <ENT>4.26</ENT>
                            <ENT>0.86</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">28820</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Amputation of toe</ENT>
                            <ENT>4.89</ENT>
                            <ENT>7.64</ENT>
                            <ENT>7.59</ENT>
                            <ENT>3.55</ENT>
                            <ENT>3.66</ENT>
                            <ENT>0.61</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">28825</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Partial amputation of toe</ENT>
                            <ENT>3.71</ENT>
                            <ENT>7.13</ENT>
                            <ENT>7.06</ENT>
                            <ENT>3.12</ENT>
                            <ENT>3.30</ENT>
                            <ENT>0.50</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">28890</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>High energy eswt, plantar f</ENT>
                            <ENT>3.36</ENT>
                            <ENT>4.56</ENT>
                            <ENT>5.14</ENT>
                            <ENT>2.20</ENT>
                            <ENT>2.14</ENT>
                            <ENT>0.41</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">28899</ENT>
                            <ENT/>
                            <ENT>C</ENT>
                            <ENT>Foot/toes surgery procedure</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>YYY</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">29000</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Application of body cast</ENT>
                            <ENT>2.25</ENT>
                            <ENT>4.00</ENT>
                            <ENT>3.48</ENT>
                            <ENT>1.64</ENT>
                            <ENT>1.69</ENT>
                            <ENT>0.41</ENT>
                            <ENT>000</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">29010</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Application of body cast</ENT>
                            <ENT>2.06</ENT>
                            <ENT>4.38</ENT>
                            <ENT>3.83</ENT>
                            <ENT>1.62</ENT>
                            <ENT>1.70</ENT>
                            <ENT>0.45</ENT>
                            <ENT>000</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">29015</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Application of body cast</ENT>
                            <ENT>2.41</ENT>
                            <ENT>3.61</ENT>
                            <ENT>3.29</ENT>
                            <ENT>1.56</ENT>
                            <ENT>1.58</ENT>
                            <ENT>0.28</ENT>
                            <ENT>000</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">29020</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Application of body cast</ENT>
                            <ENT>2.11</ENT>
                            <ENT>3.81</ENT>
                            <ENT>3.49</ENT>
                            <ENT>1.41</ENT>
                            <ENT>1.41</ENT>
                            <ENT>0.28</ENT>
                            <ENT>000</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">29025</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Application of body cast</ENT>
                            <ENT>2.40</ENT>
                            <ENT>4.04</ENT>
                            <ENT>3.59</ENT>
                            <ENT>1.76</ENT>
                            <ENT>1.81</ENT>
                            <ENT>0.44</ENT>
                            <ENT>000</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">29035</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Application of body cast</ENT>
                            <ENT>1.77</ENT>
                            <ENT>3.70</ENT>
                            <ENT>3.65</ENT>
                            <ENT>1.48</ENT>
                            <ENT>1.53</ENT>
                            <ENT>0.28</ENT>
                            <ENT>000</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">29040</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Application of body cast</ENT>
                            <ENT>2.22</ENT>
                            <ENT>3.28</ENT>
                            <ENT>2.87</ENT>
                            <ENT>1.34</ENT>
                            <ENT>1.42</ENT>
                            <ENT>0.36</ENT>
                            <ENT>000</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">29044</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Application of body cast</ENT>
                            <ENT>2.12</ENT>
                            <ENT>3.57</ENT>
                            <ENT>3.77</ENT>
                            <ENT>1.47</ENT>
                            <ENT>1.69</ENT>
                            <ENT>0.35</ENT>
                            <ENT>000</ENT>
                        </ROW>
                        <ROW>
                            <PRTPAGE P="66438"/>
                            <ENT I="01">29046</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Application of body cast</ENT>
                            <ENT>2.41</ENT>
                            <ENT>4.49</ENT>
                            <ENT>3.86</ENT>
                            <ENT>1.91</ENT>
                            <ENT>2.00</ENT>
                            <ENT>0.42</ENT>
                            <ENT>000</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">29049</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Application of figure eight</ENT>
                            <ENT>0.89</ENT>
                            <ENT>1.11</ENT>
                            <ENT>1.21</ENT>
                            <ENT>0.59</ENT>
                            <ENT>0.56</ENT>
                            <ENT>0.13</ENT>
                            <ENT>000</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">29055</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Application of shoulder cast</ENT>
                            <ENT>1.78</ENT>
                            <ENT>2.82</ENT>
                            <ENT>2.90</ENT>
                            <ENT>1.23</ENT>
                            <ENT>1.35</ENT>
                            <ENT>0.30</ENT>
                            <ENT>000</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">29058</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Application of shoulder cast</ENT>
                            <ENT>1.31</ENT>
                            <ENT>1.26</ENT>
                            <ENT>1.41</ENT>
                            <ENT>0.67</ENT>
                            <ENT>0.70</ENT>
                            <ENT>0.17</ENT>
                            <ENT>000</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">29065</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Application of long arm cast</ENT>
                            <ENT>0.87</ENT>
                            <ENT>1.28</ENT>
                            <ENT>1.30</ENT>
                            <ENT>0.70</ENT>
                            <ENT>0.73</ENT>
                            <ENT>0.15</ENT>
                            <ENT>000</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">29075</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Application of forearm cast</ENT>
                            <ENT>0.77</ENT>
                            <ENT>1.23</ENT>
                            <ENT>1.24</ENT>
                            <ENT>0.66</ENT>
                            <ENT>0.67</ENT>
                            <ENT>0.13</ENT>
                            <ENT>000</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">29085</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Apply hand/wrist cast</ENT>
                            <ENT>0.87</ENT>
                            <ENT>1.26</ENT>
                            <ENT>1.27</ENT>
                            <ENT>0.68</ENT>
                            <ENT>0.66</ENT>
                            <ENT>0.14</ENT>
                            <ENT>000</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">29086</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Apply finger cast</ENT>
                            <ENT>0.62</ENT>
                            <ENT>1.07</ENT>
                            <ENT>1.02</ENT>
                            <ENT>0.55</ENT>
                            <ENT>0.52</ENT>
                            <ENT>0.07</ENT>
                            <ENT>000</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">29105</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Apply long arm splint</ENT>
                            <ENT>0.87</ENT>
                            <ENT>1.09</ENT>
                            <ENT>1.16</ENT>
                            <ENT>0.53</ENT>
                            <ENT>0.52</ENT>
                            <ENT>0.12</ENT>
                            <ENT>000</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">29125</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Apply forearm splint</ENT>
                            <ENT>0.59</ENT>
                            <ENT>0.97</ENT>
                            <ENT>0.99</ENT>
                            <ENT>0.42</ENT>
                            <ENT>0.41</ENT>
                            <ENT>0.07</ENT>
                            <ENT>000</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">29126</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Apply forearm splint</ENT>
                            <ENT>0.77</ENT>
                            <ENT>1.01</ENT>
                            <ENT>1.11</ENT>
                            <ENT>0.48</ENT>
                            <ENT>0.47</ENT>
                            <ENT>0.07</ENT>
                            <ENT>000</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">29130</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Application of finger splint</ENT>
                            <ENT>0.50</ENT>
                            <ENT>0.43</ENT>
                            <ENT>0.45</ENT>
                            <ENT>0.18</ENT>
                            <ENT>0.18</ENT>
                            <ENT>0.06</ENT>
                            <ENT>000</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">29131</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Application of finger splint</ENT>
                            <ENT>0.55</ENT>
                            <ENT>0.59</ENT>
                            <ENT>0.66</ENT>
                            <ENT>0.24</ENT>
                            <ENT>0.24</ENT>
                            <ENT>0.03</ENT>
                            <ENT>000</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">29200</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Strapping of chest</ENT>
                            <ENT>0.65</ENT>
                            <ENT>0.60</ENT>
                            <ENT>0.66</ENT>
                            <ENT>0.34</ENT>
                            <ENT>0.34</ENT>
                            <ENT>0.04</ENT>
                            <ENT>000</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">29220</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Strapping of low back</ENT>
                            <ENT>0.64</ENT>
                            <ENT>0.65</ENT>
                            <ENT>0.68</ENT>
                            <ENT>0.38</ENT>
                            <ENT>0.38</ENT>
                            <ENT>0.04</ENT>
                            <ENT>000</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">29240</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Strapping of shoulder</ENT>
                            <ENT>0.71</ENT>
                            <ENT>0.68</ENT>
                            <ENT>0.76</ENT>
                            <ENT>0.40</ENT>
                            <ENT>0.38</ENT>
                            <ENT>0.06</ENT>
                            <ENT>000</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">29260</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Strapping of elbow or wrist</ENT>
                            <ENT>0.55</ENT>
                            <ENT>0.67</ENT>
                            <ENT>0.70</ENT>
                            <ENT>0.37</ENT>
                            <ENT>0.35</ENT>
                            <ENT>0.05</ENT>
                            <ENT>000</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">29280</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Strapping of hand or finger</ENT>
                            <ENT>0.51</ENT>
                            <ENT>0.67</ENT>
                            <ENT>0.73</ENT>
                            <ENT>0.37</ENT>
                            <ENT>0.35</ENT>
                            <ENT>0.03</ENT>
                            <ENT>000</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">29305</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Application of hip cast</ENT>
                            <ENT>2.03</ENT>
                            <ENT>3.28</ENT>
                            <ENT>3.31</ENT>
                            <ENT>1.56</ENT>
                            <ENT>1.66</ENT>
                            <ENT>0.35</ENT>
                            <ENT>000</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">29325</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Application of hip casts</ENT>
                            <ENT>2.32</ENT>
                            <ENT>3.33</ENT>
                            <ENT>3.43</ENT>
                            <ENT>1.58</ENT>
                            <ENT>1.77</ENT>
                            <ENT>0.40</ENT>
                            <ENT>000</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">29345</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Application of long leg cast</ENT>
                            <ENT>1.40</ENT>
                            <ENT>1.66</ENT>
                            <ENT>1.71</ENT>
                            <ENT>0.94</ENT>
                            <ENT>1.00</ENT>
                            <ENT>0.24</ENT>
                            <ENT>000</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">29355</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Application of long leg cast</ENT>
                            <ENT>1.53</ENT>
                            <ENT>1.62</ENT>
                            <ENT>1.66</ENT>
                            <ENT>0.93</ENT>
                            <ENT>1.03</ENT>
                            <ENT>0.26</ENT>
                            <ENT>000</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">29358</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Apply long leg cast brace</ENT>
                            <ENT>1.43</ENT>
                            <ENT>2.01</ENT>
                            <ENT>2.03</ENT>
                            <ENT>0.91</ENT>
                            <ENT>1.00</ENT>
                            <ENT>0.25</ENT>
                            <ENT>000</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">29365</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Application of long leg cast</ENT>
                            <ENT>1.18</ENT>
                            <ENT>1.58</ENT>
                            <ENT>1.62</ENT>
                            <ENT>0.85</ENT>
                            <ENT>0.90</ENT>
                            <ENT>0.20</ENT>
                            <ENT>000</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">29405</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Apply short leg cast</ENT>
                            <ENT>0.86</ENT>
                            <ENT>1.19</ENT>
                            <ENT>1.20</ENT>
                            <ENT>0.65</ENT>
                            <ENT>0.68</ENT>
                            <ENT>0.14</ENT>
                            <ENT>000</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">29425</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Apply short leg cast</ENT>
                            <ENT>1.01</ENT>
                            <ENT>1.22</ENT>
                            <ENT>1.22</ENT>
                            <ENT>0.65</ENT>
                            <ENT>0.70</ENT>
                            <ENT>0.15</ENT>
                            <ENT>000</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">29435</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Apply short leg cast</ENT>
                            <ENT>1.18</ENT>
                            <ENT>1.52</ENT>
                            <ENT>1.54</ENT>
                            <ENT>0.81</ENT>
                            <ENT>0.87</ENT>
                            <ENT>0.20</ENT>
                            <ENT>000</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">29440</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Addition of walker to cast</ENT>
                            <ENT>0.57</ENT>
                            <ENT>0.64</ENT>
                            <ENT>0.67</ENT>
                            <ENT>0.26</ENT>
                            <ENT>0.26</ENT>
                            <ENT>0.08</ENT>
                            <ENT>000</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">29445</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Apply rigid leg cast</ENT>
                            <ENT>1.78</ENT>
                            <ENT>1.56</ENT>
                            <ENT>1.68</ENT>
                            <ENT>0.89</ENT>
                            <ENT>0.92</ENT>
                            <ENT>0.27</ENT>
                            <ENT>000</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">29450</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Application of leg cast</ENT>
                            <ENT>2.08</ENT>
                            <ENT>1.59</ENT>
                            <ENT>1.53</ENT>
                            <ENT>0.90</ENT>
                            <ENT>0.99</ENT>
                            <ENT>0.27</ENT>
                            <ENT>000</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">29505</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Application, long leg splint</ENT>
                            <ENT>0.69</ENT>
                            <ENT>1.07</ENT>
                            <ENT>1.12</ENT>
                            <ENT>0.45</ENT>
                            <ENT>0.45</ENT>
                            <ENT>0.08</ENT>
                            <ENT>000</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">29515</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Application lower leg splint</ENT>
                            <ENT>0.73</ENT>
                            <ENT>0.96</ENT>
                            <ENT>0.91</ENT>
                            <ENT>0.46</ENT>
                            <ENT>0.46</ENT>
                            <ENT>0.09</ENT>
                            <ENT>000</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">29520</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Strapping of hip</ENT>
                            <ENT>0.54</ENT>
                            <ENT>0.66</ENT>
                            <ENT>0.75</ENT>
                            <ENT>0.37</ENT>
                            <ENT>0.42</ENT>
                            <ENT>0.03</ENT>
                            <ENT>000</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">29530</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Strapping of knee</ENT>
                            <ENT>0.57</ENT>
                            <ENT>0.65</ENT>
                            <ENT>0.72</ENT>
                            <ENT>0.36</ENT>
                            <ENT>0.35</ENT>
                            <ENT>0.05</ENT>
                            <ENT>000</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">29540</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Strapping of ankle and/or ft</ENT>
                            <ENT>0.51</ENT>
                            <ENT>0.55</ENT>
                            <ENT>0.48</ENT>
                            <ENT>0.31</ENT>
                            <ENT>0.31</ENT>
                            <ENT>0.06</ENT>
                            <ENT>000</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">29550</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Strapping of toes</ENT>
                            <ENT>0.47</ENT>
                            <ENT>0.56</ENT>
                            <ENT>0.49</ENT>
                            <ENT>0.30</ENT>
                            <ENT>0.29</ENT>
                            <ENT>0.06</ENT>
                            <ENT>000</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">29580</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Application of paste boot</ENT>
                            <ENT>0.55</ENT>
                            <ENT>0.71</ENT>
                            <ENT>0.68</ENT>
                            <ENT>0.33</ENT>
                            <ENT>0.34</ENT>
                            <ENT>0.07</ENT>
                            <ENT>000</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">29590</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Application of foot splint</ENT>
                            <ENT>0.76</ENT>
                            <ENT>0.59</ENT>
                            <ENT>0.55</ENT>
                            <ENT>0.26</ENT>
                            <ENT>0.27</ENT>
                            <ENT>0.09</ENT>
                            <ENT>000</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">29700</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Removal/revision of cast</ENT>
                            <ENT>0.57</ENT>
                            <ENT>0.95</ENT>
                            <ENT>0.92</ENT>
                            <ENT>0.25</ENT>
                            <ENT>0.26</ENT>
                            <ENT>0.08</ENT>
                            <ENT>000</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">29705</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Removal/revision of cast</ENT>
                            <ENT>0.76</ENT>
                            <ENT>0.76</ENT>
                            <ENT>0.79</ENT>
                            <ENT>0.36</ENT>
                            <ENT>0.37</ENT>
                            <ENT>0.13</ENT>
                            <ENT>000</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">29710</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Removal/revision of cast</ENT>
                            <ENT>1.34</ENT>
                            <ENT>1.32</ENT>
                            <ENT>1.42</ENT>
                            <ENT>0.55</ENT>
                            <ENT>0.62</ENT>
                            <ENT>0.20</ENT>
                            <ENT>000</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">29715</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Removal/revision of cast</ENT>
                            <ENT>0.94</ENT>
                            <ENT>1.20</ENT>
                            <ENT>1.18</ENT>
                            <ENT>0.43</ENT>
                            <ENT>0.42</ENT>
                            <ENT>0.09</ENT>
                            <ENT>000</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">29720</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Repair of body cast</ENT>
                            <ENT>0.68</ENT>
                            <ENT>1.17</ENT>
                            <ENT>1.16</ENT>
                            <ENT>0.35</ENT>
                            <ENT>0.37</ENT>
                            <ENT>0.12</ENT>
                            <ENT>000</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">29730</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Windowing of cast</ENT>
                            <ENT>0.75</ENT>
                            <ENT>0.74</ENT>
                            <ENT>0.77</ENT>
                            <ENT>0.34</ENT>
                            <ENT>0.34</ENT>
                            <ENT>0.12</ENT>
                            <ENT>000</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">29740</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Wedging of cast</ENT>
                            <ENT>1.12</ENT>
                            <ENT>1.03</ENT>
                            <ENT>1.09</ENT>
                            <ENT>0.47</ENT>
                            <ENT>0.48</ENT>
                            <ENT>0.18</ENT>
                            <ENT>000</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">29750</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Wedging of clubfoot cast</ENT>
                            <ENT>1.26</ENT>
                            <ENT>1.06</ENT>
                            <ENT>1.06</ENT>
                            <ENT>0.52</ENT>
                            <ENT>0.55</ENT>
                            <ENT>0.21</ENT>
                            <ENT>000</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">29799</ENT>
                            <ENT/>
                            <ENT>C</ENT>
                            <ENT>Casting/strapping procedure</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>YYY</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">29800</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Jaw arthroscopy/surgery</ENT>
                            <ENT>6.73</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>4.62</ENT>
                            <ENT>5.79</ENT>
                            <ENT>0.99</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">29804</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Jaw arthroscopy/surgery</ENT>
                            <ENT>8.71</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>5.69</ENT>
                            <ENT>6.65</ENT>
                            <ENT>1.38</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">29805</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Shoulder arthroscopy, dx</ENT>
                            <ENT>5.94</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>4.71</ENT>
                            <ENT>5.19</ENT>
                            <ENT>1.02</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">29806</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Shoulder arthroscopy/surgery</ENT>
                            <ENT>14.95</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>9.35</ENT>
                            <ENT>10.25</ENT>
                            <ENT>2.50</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">29807</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Shoulder arthroscopy/surgery</ENT>
                            <ENT>14.48</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>9.19</ENT>
                            <ENT>10.09</ENT>
                            <ENT>2.42</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">29819</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Shoulder arthroscopy/surgery</ENT>
                            <ENT>7.68</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>5.62</ENT>
                            <ENT>6.20</ENT>
                            <ENT>1.32</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">29820</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Shoulder arthroscopy/surgery</ENT>
                            <ENT>7.12</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>5.17</ENT>
                            <ENT>5.70</ENT>
                            <ENT>1.22</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">29821</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Shoulder arthroscopy/surgery</ENT>
                            <ENT>7.78</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>5.65</ENT>
                            <ENT>6.22</ENT>
                            <ENT>1.33</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">29822</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Shoulder arthroscopy/surgery</ENT>
                            <ENT>7.49</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>5.57</ENT>
                            <ENT>6.13</ENT>
                            <ENT>1.28</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">29823</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Shoulder arthroscopy/surgery</ENT>
                            <ENT>8.24</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>6.04</ENT>
                            <ENT>6.63</ENT>
                            <ENT>1.41</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">29824</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Shoulder arthroscopy/surgery</ENT>
                            <ENT>8.82</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>6.53</ENT>
                            <ENT>7.03</ENT>
                            <ENT>1.42</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">29825</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Shoulder arthroscopy/surgery</ENT>
                            <ENT>7.68</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>5.63</ENT>
                            <ENT>6.19</ENT>
                            <ENT>1.32</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">29826</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Shoulder arthroscopy/surgery</ENT>
                            <ENT>9.05</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>6.18</ENT>
                            <ENT>6.85</ENT>
                            <ENT>1.55</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">29827</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Arthroscop rotator cuff repr</ENT>
                            <ENT>15.44</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>9.31</ENT>
                            <ENT>10.41</ENT>
                            <ENT>2.67</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">29828</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Arthroscopy biceps tenodesis</ENT>
                            <ENT>13.00</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>8.17</ENT>
                            <ENT>8.17</ENT>
                            <ENT>2.17</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">29830</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Elbow arthroscopy</ENT>
                            <ENT>5.80</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>4.48</ENT>
                            <ENT>4.91</ENT>
                            <ENT>0.99</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">29834</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Elbow arthroscopy/surgery</ENT>
                            <ENT>6.33</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>4.85</ENT>
                            <ENT>5.34</ENT>
                            <ENT>1.08</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">29835</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Elbow arthroscopy/surgery</ENT>
                            <ENT>6.53</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>4.96</ENT>
                            <ENT>5.42</ENT>
                            <ENT>1.13</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">29836</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Elbow arthroscopy/surgery</ENT>
                            <ENT>7.61</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>5.54</ENT>
                            <ENT>6.16</ENT>
                            <ENT>1.22</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">29837</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Elbow arthroscopy/surgery</ENT>
                            <ENT>6.92</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>5.06</ENT>
                            <ENT>5.59</ENT>
                            <ENT>1.19</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">29838</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Elbow arthroscopy/surgery</ENT>
                            <ENT>7.77</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>5.65</ENT>
                            <ENT>6.27</ENT>
                            <ENT>1.30</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">29840</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Wrist arthroscopy</ENT>
                            <ENT>5.59</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>4.62</ENT>
                            <ENT>4.97</ENT>
                            <ENT>0.84</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">29843</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Wrist arthroscopy/surgery</ENT>
                            <ENT>6.06</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>4.80</ENT>
                            <ENT>5.21</ENT>
                            <ENT>0.92</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">29844</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Wrist arthroscopy/surgery</ENT>
                            <ENT>6.42</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>4.87</ENT>
                            <ENT>5.35</ENT>
                            <ENT>1.04</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">29845</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Wrist arthroscopy/surgery</ENT>
                            <ENT>7.58</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>5.59</ENT>
                            <ENT>6.03</ENT>
                            <ENT>0.99</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <PRTPAGE P="66439"/>
                            <ENT I="01">29846</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Wrist arthroscopy/surgery</ENT>
                            <ENT>6.80</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>5.11</ENT>
                            <ENT>5.58</ENT>
                            <ENT>1.07</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">29847</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Wrist arthroscopy/surgery</ENT>
                            <ENT>7.13</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>5.27</ENT>
                            <ENT>5.73</ENT>
                            <ENT>1.08</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">29848</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Wrist endoscopy/surgery</ENT>
                            <ENT>6.24</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>5.27</ENT>
                            <ENT>5.44</ENT>
                            <ENT>0.86</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">29850</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Knee arthroscopy/surgery</ENT>
                            <ENT>8.18</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>4.72</ENT>
                            <ENT>4.88</ENT>
                            <ENT>1.25</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">29851</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Knee arthroscopy/surgery</ENT>
                            <ENT>13.08</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>8.21</ENT>
                            <ENT>9.00</ENT>
                            <ENT>2.35</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">29855</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Tibial arthroscopy/surgery</ENT>
                            <ENT>10.60</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>7.27</ENT>
                            <ENT>8.02</ENT>
                            <ENT>1.85</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">29856</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Tibial arthroscopy/surgery</ENT>
                            <ENT>14.12</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>8.69</ENT>
                            <ENT>9.67</ENT>
                            <ENT>2.40</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">29860</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Hip arthroscopy, dx</ENT>
                            <ENT>8.85</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>6.24</ENT>
                            <ENT>6.60</ENT>
                            <ENT>1.36</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">29861</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Hip arthroscopy/surgery</ENT>
                            <ENT>9.95</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>6.39</ENT>
                            <ENT>6.86</ENT>
                            <ENT>1.59</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">29862</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Hip arthroscopy/surgery</ENT>
                            <ENT>10.97</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>7.57</ENT>
                            <ENT>8.06</ENT>
                            <ENT>1.62</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">29863</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Hip arthroscopy/surgery</ENT>
                            <ENT>10.97</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>7.48</ENT>
                            <ENT>7.99</ENT>
                            <ENT>1.42</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">29866</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Autgrft implnt, knee w/scope</ENT>
                            <ENT>14.48</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>9.46</ENT>
                            <ENT>10.40</ENT>
                            <ENT>2.40</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">29867</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Allgrft implnt, knee w/scope</ENT>
                            <ENT>18.18</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>11.03</ENT>
                            <ENT>12.12</ENT>
                            <ENT>2.79</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">29868</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Meniscal trnspl, knee w/scpe</ENT>
                            <ENT>24.89</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>13.79</ENT>
                            <ENT>15.29</ENT>
                            <ENT>4.36</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">29870</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Knee arthroscopy, dx</ENT>
                            <ENT>5.11</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>4.18</ENT>
                            <ENT>4.53</ENT>
                            <ENT>0.85</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">29871</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Knee arthroscopy/drainage</ENT>
                            <ENT>6.60</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>5.05</ENT>
                            <ENT>5.46</ENT>
                            <ENT>1.14</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">29873</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Knee arthroscopy/surgery</ENT>
                            <ENT>6.09</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>5.59</ENT>
                            <ENT>6.08</ENT>
                            <ENT>1.04</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">29874</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Knee arthroscopy/surgery</ENT>
                            <ENT>7.10</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>5.08</ENT>
                            <ENT>5.58</ENT>
                            <ENT>1.11</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">29875</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Knee arthroscopy/surgery</ENT>
                            <ENT>6.36</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>4.88</ENT>
                            <ENT>5.37</ENT>
                            <ENT>1.09</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">29876</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Knee arthroscopy/surgery</ENT>
                            <ENT>8.72</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>6.18</ENT>
                            <ENT>6.60</ENT>
                            <ENT>1.37</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">29877</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Knee arthroscopy/surgery</ENT>
                            <ENT>8.15</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>5.97</ENT>
                            <ENT>6.36</ENT>
                            <ENT>1.28</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">29879</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Knee arthroscopy/surgery</ENT>
                            <ENT>8.84</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>6.23</ENT>
                            <ENT>6.67</ENT>
                            <ENT>1.39</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">29880</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Knee arthroscopy/surgery</ENT>
                            <ENT>9.30</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>6.42</ENT>
                            <ENT>6.89</ENT>
                            <ENT>1.47</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">29881</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Knee arthroscopy/surgery</ENT>
                            <ENT>8.56</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>6.13</ENT>
                            <ENT>6.55</ENT>
                            <ENT>1.34</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">29882</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Knee arthroscopy/surgery</ENT>
                            <ENT>9.45</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>6.45</ENT>
                            <ENT>6.84</ENT>
                            <ENT>1.50</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">29883</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Knee arthroscopy/surgery</ENT>
                            <ENT>11.61</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>7.58</ENT>
                            <ENT>8.32</ENT>
                            <ENT>1.93</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">29884</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Knee arthroscopy/surgery</ENT>
                            <ENT>8.13</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>5.96</ENT>
                            <ENT>6.33</ENT>
                            <ENT>1.27</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">29885</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Knee arthroscopy/surgery</ENT>
                            <ENT>10.03</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>7.03</ENT>
                            <ENT>7.49</ENT>
                            <ENT>1.58</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">29886</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Knee arthroscopy/surgery</ENT>
                            <ENT>8.34</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>6.03</ENT>
                            <ENT>6.44</ENT>
                            <ENT>1.30</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">29887</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Knee arthroscopy/surgery</ENT>
                            <ENT>9.98</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>6.96</ENT>
                            <ENT>7.44</ENT>
                            <ENT>1.57</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">29888</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Knee arthroscopy/surgery</ENT>
                            <ENT>14.14</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>8.26</ENT>
                            <ENT>9.23</ENT>
                            <ENT>2.42</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">29889</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Knee arthroscopy/surgery</ENT>
                            <ENT>17.15</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>10.61</ENT>
                            <ENT>11.52</ENT>
                            <ENT>2.79</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">29891</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Ankle arthroscopy/surgery</ENT>
                            <ENT>9.47</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>6.64</ENT>
                            <ENT>7.07</ENT>
                            <ENT>1.39</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">29892</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Ankle arthroscopy/surgery</ENT>
                            <ENT>10.07</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>6.38</ENT>
                            <ENT>7.06</ENT>
                            <ENT>1.41</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">29893</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Scope, plantar fasciotomy</ENT>
                            <ENT>6.08</ENT>
                            <ENT>8.83</ENT>
                            <ENT>7.56</ENT>
                            <ENT>4.66</ENT>
                            <ENT>4.32</ENT>
                            <ENT>0.63</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">29894</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Ankle arthroscopy/surgery</ENT>
                            <ENT>7.26</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>4.72</ENT>
                            <ENT>5.09</ENT>
                            <ENT>1.15</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">29895</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Ankle arthroscopy/surgery</ENT>
                            <ENT>7.04</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>4.51</ENT>
                            <ENT>4.99</ENT>
                            <ENT>1.11</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">29897</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Ankle arthroscopy/surgery</ENT>
                            <ENT>7.23</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>4.81</ENT>
                            <ENT>5.35</ENT>
                            <ENT>1.17</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">29898</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Ankle arthroscopy/surgery</ENT>
                            <ENT>8.38</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>5.24</ENT>
                            <ENT>5.71</ENT>
                            <ENT>1.28</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">29899</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Ankle arthroscopy/surgery</ENT>
                            <ENT>15.21</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>9.20</ENT>
                            <ENT>9.87</ENT>
                            <ENT>2.41</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">29900</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Mcp joint arthroscopy, dx</ENT>
                            <ENT>5.74</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>4.66</ENT>
                            <ENT>5.26</ENT>
                            <ENT>0.94</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">29901</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Mcp joint arthroscopy, surg</ENT>
                            <ENT>6.45</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>5.09</ENT>
                            <ENT>5.68</ENT>
                            <ENT>1.06</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">29902</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Mcp joint arthroscopy, surg</ENT>
                            <ENT>7.02</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>4.70</ENT>
                            <ENT>5.62</ENT>
                            <ENT>1.12</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">29904</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Subtalar arthro w/fb rmvl</ENT>
                            <ENT>8.50</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>5.89</ENT>
                            <ENT>5.89</ENT>
                            <ENT>1.25</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">29905</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Subtalar arthro w/exc</ENT>
                            <ENT>9.00</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>6.51</ENT>
                            <ENT>6.51</ENT>
                            <ENT>1.32</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">29906</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Subtalar arthro w/deb</ENT>
                            <ENT>9.47</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>6.87</ENT>
                            <ENT>6.87</ENT>
                            <ENT>1.39</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">29907</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Subtalar arthro w/fusion</ENT>
                            <ENT>12.00</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>7.86</ENT>
                            <ENT>7.86</ENT>
                            <ENT>1.90</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">29999</ENT>
                            <ENT/>
                            <ENT>C</ENT>
                            <ENT>Arthroscopy of joint</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>YYY</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">30000</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Drainage of nose lesion</ENT>
                            <ENT>1.45</ENT>
                            <ENT>4.01</ENT>
                            <ENT>4.04</ENT>
                            <ENT>1.34</ENT>
                            <ENT>1.36</ENT>
                            <ENT>0.12</ENT>
                            <ENT>010</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">30020</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Drainage of nose lesion</ENT>
                            <ENT>1.45</ENT>
                            <ENT>4.16</ENT>
                            <ENT>3.72</ENT>
                            <ENT>1.39</ENT>
                            <ENT>1.43</ENT>
                            <ENT>0.12</ENT>
                            <ENT>010</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">30100</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Intranasal biopsy</ENT>
                            <ENT>0.94</ENT>
                            <ENT>2.58</ENT>
                            <ENT>2.28</ENT>
                            <ENT>0.75</ENT>
                            <ENT>0.78</ENT>
                            <ENT>0.07</ENT>
                            <ENT>000</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">30110</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Removal of nose polyp(s)</ENT>
                            <ENT>1.65</ENT>
                            <ENT>3.90</ENT>
                            <ENT>3.57</ENT>
                            <ENT>1.45</ENT>
                            <ENT>1.51</ENT>
                            <ENT>0.14</ENT>
                            <ENT>010</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">30115</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Removal of nose polyp(s)</ENT>
                            <ENT>4.38</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>5.99</ENT>
                            <ENT>5.87</ENT>
                            <ENT>0.41</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">30117</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Removal of intranasal lesion</ENT>
                            <ENT>3.20</ENT>
                            <ENT>18.15</ENT>
                            <ENT>15.64</ENT>
                            <ENT>4.91</ENT>
                            <ENT>4.77</ENT>
                            <ENT>0.26</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">30118</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Removal of intranasal lesion</ENT>
                            <ENT>9.81</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>8.55</ENT>
                            <ENT>8.87</ENT>
                            <ENT>0.78</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">30120</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Revision of nose</ENT>
                            <ENT>5.31</ENT>
                            <ENT>7.07</ENT>
                            <ENT>6.78</ENT>
                            <ENT>5.09</ENT>
                            <ENT>5.54</ENT>
                            <ENT>0.52</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">30124</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Removal of nose lesion</ENT>
                            <ENT>3.14</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>3.68</ENT>
                            <ENT>3.64</ENT>
                            <ENT>0.25</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">30125</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Removal of nose lesion</ENT>
                            <ENT>7.21</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>7.40</ENT>
                            <ENT>7.86</ENT>
                            <ENT>0.63</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">30130</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Excise inferior turbinate</ENT>
                            <ENT>3.41</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>5.63</ENT>
                            <ENT>5.61</ENT>
                            <ENT>0.31</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">30140</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Resect inferior turbinate</ENT>
                            <ENT>3.48</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>7.10</ENT>
                            <ENT>6.64</ENT>
                            <ENT>0.35</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">30150</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Partial removal of nose</ENT>
                            <ENT>9.44</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>9.02</ENT>
                            <ENT>10.01</ENT>
                            <ENT>0.93</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">30160</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Removal of nose</ENT>
                            <ENT>9.88</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>8.87</ENT>
                            <ENT>9.54</ENT>
                            <ENT>0.88</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">30200</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Injection treatment of nose</ENT>
                            <ENT>0.78</ENT>
                            <ENT>2.02</ENT>
                            <ENT>1.82</ENT>
                            <ENT>0.67</ENT>
                            <ENT>0.70</ENT>
                            <ENT>0.06</ENT>
                            <ENT>000</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">30210</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Nasal sinus therapy</ENT>
                            <ENT>1.10</ENT>
                            <ENT>2.51</ENT>
                            <ENT>2.30</ENT>
                            <ENT>1.27</ENT>
                            <ENT>1.29</ENT>
                            <ENT>0.09</ENT>
                            <ENT>010</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">30220</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Insert nasal septal button</ENT>
                            <ENT>1.56</ENT>
                            <ENT>5.81</ENT>
                            <ENT>5.02</ENT>
                            <ENT>1.42</ENT>
                            <ENT>1.47</ENT>
                            <ENT>0.12</ENT>
                            <ENT>010</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">30300</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Remove nasal foreign body</ENT>
                            <ENT>1.06</ENT>
                            <ENT>4.29</ENT>
                            <ENT>4.46</ENT>
                            <ENT>1.87</ENT>
                            <ENT>1.89</ENT>
                            <ENT>0.08</ENT>
                            <ENT>010</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">30310</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Remove nasal foreign body</ENT>
                            <ENT>1.98</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>2.91</ENT>
                            <ENT>3.00</ENT>
                            <ENT>0.16</ENT>
                            <ENT>010</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">30320</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Remove nasal foreign body</ENT>
                            <ENT>4.56</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>6.35</ENT>
                            <ENT>6.69</ENT>
                            <ENT>0.39</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">30400</ENT>
                            <ENT/>
                            <ENT>R</ENT>
                            <ENT>Reconstruction of nose</ENT>
                            <ENT>10.58</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>13.90</ENT>
                            <ENT>14.69</ENT>
                            <ENT>1.04</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">30410</ENT>
                            <ENT/>
                            <ENT>R</ENT>
                            <ENT>Reconstruction of nose</ENT>
                            <ENT>13.72</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>15.32</ENT>
                            <ENT>16.84</ENT>
                            <ENT>1.42</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">30420</ENT>
                            <ENT/>
                            <ENT>R</ENT>
                            <ENT>Reconstruction of nose</ENT>
                            <ENT>16.62</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>15.82</ENT>
                            <ENT>16.86</ENT>
                            <ENT>1.46</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">30430</ENT>
                            <ENT/>
                            <ENT>R</ENT>
                            <ENT>Revision of nose</ENT>
                            <ENT>7.96</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>13.24</ENT>
                            <ENT>14.62</ENT>
                            <ENT>0.77</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <PRTPAGE P="66440"/>
                            <ENT I="01">30435</ENT>
                            <ENT/>
                            <ENT>R</ENT>
                            <ENT>Revision of nose</ENT>
                            <ENT>12.45</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>15.42</ENT>
                            <ENT>17.38</ENT>
                            <ENT>1.22</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">30450</ENT>
                            <ENT/>
                            <ENT>R</ENT>
                            <ENT>Revision of nose</ENT>
                            <ENT>19.38</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>16.88</ENT>
                            <ENT>19.38</ENT>
                            <ENT>1.97</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">30460</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Revision of nose</ENT>
                            <ENT>10.24</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>7.48</ENT>
                            <ENT>8.71</ENT>
                            <ENT>1.03</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">30462</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Revision of nose</ENT>
                            <ENT>20.12</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>14.64</ENT>
                            <ENT>17.44</ENT>
                            <ENT>2.54</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">30465</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Repair nasal stenosis</ENT>
                            <ENT>12.20</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>11.07</ENT>
                            <ENT>11.52</ENT>
                            <ENT>1.06</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">30520</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Repair of nasal septum</ENT>
                            <ENT>6.85</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>8.04</ENT>
                            <ENT>7.35</ENT>
                            <ENT>0.46</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">30540</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Repair nasal defect</ENT>
                            <ENT>7.81</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>8.54</ENT>
                            <ENT>8.91</ENT>
                            <ENT>0.67</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">30545</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Repair nasal defect</ENT>
                            <ENT>11.50</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>11.08</ENT>
                            <ENT>11.48</ENT>
                            <ENT>1.71</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">30560</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Release of nasal adhesions</ENT>
                            <ENT>1.28</ENT>
                            <ENT>5.28</ENT>
                            <ENT>5.02</ENT>
                            <ENT>2.02</ENT>
                            <ENT>2.08</ENT>
                            <ENT>0.10</ENT>
                            <ENT>010</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">30580</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Repair upper jaw fistula</ENT>
                            <ENT>6.76</ENT>
                            <ENT>8.13</ENT>
                            <ENT>7.95</ENT>
                            <ENT>4.69</ENT>
                            <ENT>5.24</ENT>
                            <ENT>0.89</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">30600</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Repair mouth/nose fistula</ENT>
                            <ENT>6.07</ENT>
                            <ENT>7.67</ENT>
                            <ENT>7.59</ENT>
                            <ENT>4.18</ENT>
                            <ENT>4.60</ENT>
                            <ENT>0.70</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">30620</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Intranasal reconstruction</ENT>
                            <ENT>6.04</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>8.66</ENT>
                            <ENT>8.75</ENT>
                            <ENT>0.57</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">30630</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Repair nasal septum defect</ENT>
                            <ENT>7.18</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>7.73</ENT>
                            <ENT>7.83</ENT>
                            <ENT>0.61</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">30801</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Ablate inf turbinate, superf</ENT>
                            <ENT>1.11</ENT>
                            <ENT>4.30</ENT>
                            <ENT>4.21</ENT>
                            <ENT>2.12</ENT>
                            <ENT>2.02</ENT>
                            <ENT>0.09</ENT>
                            <ENT>010</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">30802</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Cauterization, inner nose</ENT>
                            <ENT>2.05</ENT>
                            <ENT>4.97</ENT>
                            <ENT>4.79</ENT>
                            <ENT>2.51</ENT>
                            <ENT>2.44</ENT>
                            <ENT>0.16</ENT>
                            <ENT>010</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">30901</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Control of nosebleed</ENT>
                            <ENT>1.21</ENT>
                            <ENT>1.27</ENT>
                            <ENT>1.31</ENT>
                            <ENT>0.30</ENT>
                            <ENT>0.31</ENT>
                            <ENT>0.11</ENT>
                            <ENT>000</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">30903</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Control of nosebleed</ENT>
                            <ENT>1.54</ENT>
                            <ENT>3.27</ENT>
                            <ENT>2.99</ENT>
                            <ENT>0.43</ENT>
                            <ENT>0.46</ENT>
                            <ENT>0.13</ENT>
                            <ENT>000</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">30905</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Control of nosebleed</ENT>
                            <ENT>1.97</ENT>
                            <ENT>3.93</ENT>
                            <ENT>3.72</ENT>
                            <ENT>0.51</ENT>
                            <ENT>0.63</ENT>
                            <ENT>0.17</ENT>
                            <ENT>000</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">30906</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Repeat control of nosebleed</ENT>
                            <ENT>2.45</ENT>
                            <ENT>4.28</ENT>
                            <ENT>4.08</ENT>
                            <ENT>0.76</ENT>
                            <ENT>0.98</ENT>
                            <ENT>0.20</ENT>
                            <ENT>000</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">30915</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Ligation, nasal sinus artery</ENT>
                            <ENT>7.36</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>6.46</ENT>
                            <ENT>6.57</ENT>
                            <ENT>0.58</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">30920</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Ligation, upper jaw artery</ENT>
                            <ENT>11.03</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>8.96</ENT>
                            <ENT>8.96</ENT>
                            <ENT>0.80</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">30930</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Ther fx, nasal inf turbinate</ENT>
                            <ENT>1.28</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>1.64</ENT>
                            <ENT>1.63</ENT>
                            <ENT>0.12</ENT>
                            <ENT>010</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">30999</ENT>
                            <ENT/>
                            <ENT>C</ENT>
                            <ENT>Nasal surgery procedure</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>YYY</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">31000</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Irrigation, maxillary sinus</ENT>
                            <ENT>1.17</ENT>
                            <ENT>3.22</ENT>
                            <ENT>3.03</ENT>
                            <ENT>1.34</ENT>
                            <ENT>1.37</ENT>
                            <ENT>0.09</ENT>
                            <ENT>010</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">31002</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Irrigation, sphenoid sinus</ENT>
                            <ENT>1.93</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>2.69</ENT>
                            <ENT>2.96</ENT>
                            <ENT>0.15</ENT>
                            <ENT>010</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">31020</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Exploration, maxillary sinus</ENT>
                            <ENT>2.99</ENT>
                            <ENT>8.60</ENT>
                            <ENT>8.56</ENT>
                            <ENT>5.54</ENT>
                            <ENT>5.36</ENT>
                            <ENT>0.29</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">31030</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Exploration, maxillary sinus</ENT>
                            <ENT>5.95</ENT>
                            <ENT>10.40</ENT>
                            <ENT>10.94</ENT>
                            <ENT>6.44</ENT>
                            <ENT>6.55</ENT>
                            <ENT>0.60</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">31032</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Explore sinus, remove polyps</ENT>
                            <ENT>6.61</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>7.00</ENT>
                            <ENT>7.11</ENT>
                            <ENT>0.59</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">31040</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Exploration behind upper jaw</ENT>
                            <ENT>9.66</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>7.37</ENT>
                            <ENT>8.59</ENT>
                            <ENT>0.87</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">31050</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Exploration, sphenoid sinus</ENT>
                            <ENT>5.31</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>6.50</ENT>
                            <ENT>6.43</ENT>
                            <ENT>0.49</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">31051</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Sphenoid sinus surgery</ENT>
                            <ENT>7.16</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>8.36</ENT>
                            <ENT>8.30</ENT>
                            <ENT>0.62</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">31070</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Exploration of frontal sinus</ENT>
                            <ENT>4.32</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>6.18</ENT>
                            <ENT>6.06</ENT>
                            <ENT>0.38</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">31075</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Exploration of frontal sinus</ENT>
                            <ENT>9.40</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>9.32</ENT>
                            <ENT>9.52</ENT>
                            <ENT>0.75</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">31080</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Removal of frontal sinus</ENT>
                            <ENT>12.54</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>10.61</ENT>
                            <ENT>12.07</ENT>
                            <ENT>1.23</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">31081</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Removal of frontal sinus</ENT>
                            <ENT>13.99</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>15.36</ENT>
                            <ENT>14.67</ENT>
                            <ENT>2.47</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">31084</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Removal of frontal sinus</ENT>
                            <ENT>14.75</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>12.87</ENT>
                            <ENT>13.18</ENT>
                            <ENT>1.19</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">31085</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Removal of frontal sinus</ENT>
                            <ENT>15.44</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>14.42</ENT>
                            <ENT>14.19</ENT>
                            <ENT>1.73</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">31086</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Removal of frontal sinus</ENT>
                            <ENT>14.16</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>12.77</ENT>
                            <ENT>13.02</ENT>
                            <ENT>1.07</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">31087</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Removal of frontal sinus</ENT>
                            <ENT>14.39</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>11.64</ENT>
                            <ENT>12.08</ENT>
                            <ENT>1.44</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">31090</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Exploration of sinuses</ENT>
                            <ENT>10.88</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>13.40</ENT>
                            <ENT>12.97</ENT>
                            <ENT>0.94</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">31200</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Removal of ethmoid sinus</ENT>
                            <ENT>5.03</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>7.43</ENT>
                            <ENT>8.32</ENT>
                            <ENT>0.29</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">31201</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Removal of ethmoid sinus</ENT>
                            <ENT>8.49</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>8.99</ENT>
                            <ENT>9.08</ENT>
                            <ENT>0.82</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">31205</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Removal of ethmoid sinus</ENT>
                            <ENT>10.47</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>9.51</ENT>
                            <ENT>10.69</ENT>
                            <ENT>0.67</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">31225</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Removal of upper jaw</ENT>
                            <ENT>26.44</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>17.88</ENT>
                            <ENT>17.85</ENT>
                            <ENT>1.59</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">31230</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Removal of upper jaw</ENT>
                            <ENT>30.56</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>19.48</ENT>
                            <ENT>19.41</ENT>
                            <ENT>1.78</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">31231</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Nasal endoscopy, dx</ENT>
                            <ENT>1.10</ENT>
                            <ENT>3.59</ENT>
                            <ENT>3.49</ENT>
                            <ENT>0.77</ENT>
                            <ENT>0.82</ENT>
                            <ENT>0.09</ENT>
                            <ENT>000</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">31233</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Nasal/sinus endoscopy, dx</ENT>
                            <ENT>2.18</ENT>
                            <ENT>4.26</ENT>
                            <ENT>4.28</ENT>
                            <ENT>1.12</ENT>
                            <ENT>1.30</ENT>
                            <ENT>0.20</ENT>
                            <ENT>000</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">31235</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Nasal/sinus endoscopy, dx</ENT>
                            <ENT>2.64</ENT>
                            <ENT>4.64</ENT>
                            <ENT>4.77</ENT>
                            <ENT>1.26</ENT>
                            <ENT>1.49</ENT>
                            <ENT>0.26</ENT>
                            <ENT>000</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">31237</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Nasal/sinus endoscopy, surg</ENT>
                            <ENT>2.98</ENT>
                            <ENT>4.90</ENT>
                            <ENT>5.05</ENT>
                            <ENT>1.39</ENT>
                            <ENT>1.63</ENT>
                            <ENT>0.28</ENT>
                            <ENT>000</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">31238</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Nasal/sinus endoscopy, surg</ENT>
                            <ENT>3.26</ENT>
                            <ENT>4.82</ENT>
                            <ENT>5.03</ENT>
                            <ENT>1.48</ENT>
                            <ENT>1.79</ENT>
                            <ENT>0.27</ENT>
                            <ENT>000</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">31239</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Nasal/sinus endoscopy, surg</ENT>
                            <ENT>9.23</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>6.42</ENT>
                            <ENT>7.21</ENT>
                            <ENT>0.62</ENT>
                            <ENT>010</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">31240</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Nasal/sinus endoscopy, surg</ENT>
                            <ENT>2.61</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>1.27</ENT>
                            <ENT>1.50</ENT>
                            <ENT>0.24</ENT>
                            <ENT>000</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">31254</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Revision of ethmoid sinus</ENT>
                            <ENT>4.64</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>1.93</ENT>
                            <ENT>2.39</ENT>
                            <ENT>0.45</ENT>
                            <ENT>000</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">31255</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Removal of ethmoid sinus</ENT>
                            <ENT>6.95</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>2.69</ENT>
                            <ENT>3.40</ENT>
                            <ENT>0.73</ENT>
                            <ENT>000</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">31256</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Exploration maxillary sinus</ENT>
                            <ENT>3.29</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>1.49</ENT>
                            <ENT>1.80</ENT>
                            <ENT>0.33</ENT>
                            <ENT>000</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">31267</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Endoscopy, maxillary sinus</ENT>
                            <ENT>5.45</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>2.20</ENT>
                            <ENT>2.74</ENT>
                            <ENT>0.55</ENT>
                            <ENT>000</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">31276</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Sinus endoscopy, surgical</ENT>
                            <ENT>8.84</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>3.31</ENT>
                            <ENT>4.21</ENT>
                            <ENT>0.92</ENT>
                            <ENT>000</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">31287</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Nasal/sinus endoscopy, surg</ENT>
                            <ENT>3.91</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>1.69</ENT>
                            <ENT>2.07</ENT>
                            <ENT>0.39</ENT>
                            <ENT>000</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">31288</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Nasal/sinus endoscopy, surg</ENT>
                            <ENT>4.57</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>1.91</ENT>
                            <ENT>2.36</ENT>
                            <ENT>0.46</ENT>
                            <ENT>000</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">31290</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Nasal/sinus endoscopy, surg</ENT>
                            <ENT>18.50</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>9.04</ENT>
                            <ENT>10.54</ENT>
                            <ENT>1.40</ENT>
                            <ENT>010</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">31291</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Nasal/sinus endoscopy, surg</ENT>
                            <ENT>19.45</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>9.53</ENT>
                            <ENT>11.00</ENT>
                            <ENT>1.69</ENT>
                            <ENT>010</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">31292</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Nasal/sinus endoscopy, surg</ENT>
                            <ENT>15.79</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>8.05</ENT>
                            <ENT>9.33</ENT>
                            <ENT>1.21</ENT>
                            <ENT>010</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">31293</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Nasal/sinus endoscopy, surg</ENT>
                            <ENT>17.36</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>8.68</ENT>
                            <ENT>10.02</ENT>
                            <ENT>1.28</ENT>
                            <ENT>010</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">31294</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Nasal/sinus endoscopy, surg</ENT>
                            <ENT>20.20</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>9.66</ENT>
                            <ENT>11.26</ENT>
                            <ENT>1.53</ENT>
                            <ENT>010</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">31299</ENT>
                            <ENT/>
                            <ENT>C</ENT>
                            <ENT>Sinus surgery procedure</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>YYY</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">31300</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Removal of larynx lesion</ENT>
                            <ENT>15.71</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>14.57</ENT>
                            <ENT>14.77</ENT>
                            <ENT>1.17</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">31320</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Diagnostic incision, larynx</ENT>
                            <ENT>5.62</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>10.14</ENT>
                            <ENT>10.22</ENT>
                            <ENT>0.46</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">31360</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Removal of larynx</ENT>
                            <ENT>29.57</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>20.06</ENT>
                            <ENT>18.39</ENT>
                            <ENT>1.38</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">31365</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Removal of larynx</ENT>
                            <ENT>38.47</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>22.97</ENT>
                            <ENT>21.66</ENT>
                            <ENT>1.98</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">31367</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Partial removal of larynx</ENT>
                            <ENT>30.23</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>22.50</ENT>
                            <ENT>22.19</ENT>
                            <ENT>1.79</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">31368</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Partial removal of larynx</ENT>
                            <ENT>33.85</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>24.58</ENT>
                            <ENT>25.03</ENT>
                            <ENT>2.21</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">31370</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Partial removal of larynx</ENT>
                            <ENT>27.23</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>22.13</ENT>
                            <ENT>22.19</ENT>
                            <ENT>1.75</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <PRTPAGE P="66441"/>
                            <ENT I="01">31375</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Partial removal of larynx</ENT>
                            <ENT>25.73</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>21.14</ENT>
                            <ENT>20.75</ENT>
                            <ENT>1.63</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">31380</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Partial removal of larynx</ENT>
                            <ENT>25.23</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>20.78</ENT>
                            <ENT>20.69</ENT>
                            <ENT>1.71</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">31382</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Partial removal of larynx</ENT>
                            <ENT>28.23</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>22.68</ENT>
                            <ENT>22.14</ENT>
                            <ENT>1.68</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">31390</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Removal of larynx &amp; pharynx</ENT>
                            <ENT>42.17</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>25.96</ENT>
                            <ENT>25.16</ENT>
                            <ENT>2.24</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">31395</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Reconstruct larynx &amp; pharynx</ENT>
                            <ENT>43.46</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>28.50</ENT>
                            <ENT>28.39</ENT>
                            <ENT>2.49</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">31400</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Revision of larynx</ENT>
                            <ENT>11.48</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>12.49</ENT>
                            <ENT>13.12</ENT>
                            <ENT>0.83</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">31420</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Removal of epiglottis</ENT>
                            <ENT>11.32</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>8.58</ENT>
                            <ENT>9.06</ENT>
                            <ENT>0.83</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">31500</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Insert emergency airway</ENT>
                            <ENT>2.33</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>0.42</ENT>
                            <ENT>0.48</ENT>
                            <ENT>0.17</ENT>
                            <ENT>000</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">31502</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Change of windpipe airway</ENT>
                            <ENT>0.65</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>0.21</ENT>
                            <ENT>0.25</ENT>
                            <ENT>0.05</ENT>
                            <ENT>000</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">31505</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Diagnostic laryngoscopy</ENT>
                            <ENT>0.61</ENT>
                            <ENT>1.42</ENT>
                            <ENT>1.43</ENT>
                            <ENT>0.59</ENT>
                            <ENT>0.60</ENT>
                            <ENT>0.05</ENT>
                            <ENT>000</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">31510</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Laryngoscopy with biopsy</ENT>
                            <ENT>1.92</ENT>
                            <ENT>3.22</ENT>
                            <ENT>3.26</ENT>
                            <ENT>1.00</ENT>
                            <ENT>1.12</ENT>
                            <ENT>0.16</ENT>
                            <ENT>000</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">31511</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Remove foreign body, larynx</ENT>
                            <ENT>2.16</ENT>
                            <ENT>2.94</ENT>
                            <ENT>3.03</ENT>
                            <ENT>1.03</ENT>
                            <ENT>1.04</ENT>
                            <ENT>0.19</ENT>
                            <ENT>000</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">31512</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Removal of larynx lesion</ENT>
                            <ENT>2.07</ENT>
                            <ENT>2.97</ENT>
                            <ENT>3.08</ENT>
                            <ENT>1.06</ENT>
                            <ENT>1.21</ENT>
                            <ENT>0.18</ENT>
                            <ENT>000</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">31513</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Injection into vocal cord</ENT>
                            <ENT>2.10</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>1.08</ENT>
                            <ENT>1.27</ENT>
                            <ENT>0.17</ENT>
                            <ENT>000</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">31515</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Laryngoscopy for aspiration</ENT>
                            <ENT>1.80</ENT>
                            <ENT>3.19</ENT>
                            <ENT>3.37</ENT>
                            <ENT>0.88</ENT>
                            <ENT>0.97</ENT>
                            <ENT>0.14</ENT>
                            <ENT>000</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">31520</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Dx laryngoscopy, newborn</ENT>
                            <ENT>2.56</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>1.21</ENT>
                            <ENT>1.38</ENT>
                            <ENT>0.20</ENT>
                            <ENT>000</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">31525</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Dx laryngoscopy excl nb</ENT>
                            <ENT>2.63</ENT>
                            <ENT>3.45</ENT>
                            <ENT>3.54</ENT>
                            <ENT>1.23</ENT>
                            <ENT>1.44</ENT>
                            <ENT>0.21</ENT>
                            <ENT>000</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">31526</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Dx laryngoscopy w/oper scope</ENT>
                            <ENT>2.57</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>1.25</ENT>
                            <ENT>1.48</ENT>
                            <ENT>0.21</ENT>
                            <ENT>000</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">31527</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Laryngoscopy for treatment</ENT>
                            <ENT>3.27</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>1.40</ENT>
                            <ENT>1.63</ENT>
                            <ENT>0.26</ENT>
                            <ENT>000</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">31528</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Laryngoscopy and dilation</ENT>
                            <ENT>2.37</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>1.09</ENT>
                            <ENT>1.27</ENT>
                            <ENT>0.19</ENT>
                            <ENT>000</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">31529</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Laryngoscopy and dilation</ENT>
                            <ENT>2.68</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>1.25</ENT>
                            <ENT>1.48</ENT>
                            <ENT>0.22</ENT>
                            <ENT>000</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">31530</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Laryngoscopy w/fb removal</ENT>
                            <ENT>3.38</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>1.45</ENT>
                            <ENT>1.70</ENT>
                            <ENT>0.29</ENT>
                            <ENT>000</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">31531</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Laryngoscopy w/fb &amp; op scope</ENT>
                            <ENT>3.58</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>1.58</ENT>
                            <ENT>1.93</ENT>
                            <ENT>0.29</ENT>
                            <ENT>000</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">31535</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Laryngoscopy w/biopsy</ENT>
                            <ENT>3.16</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>1.44</ENT>
                            <ENT>1.72</ENT>
                            <ENT>0.26</ENT>
                            <ENT>000</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">31536</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Laryngoscopy w/bx &amp; op scope</ENT>
                            <ENT>3.55</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>1.57</ENT>
                            <ENT>1.91</ENT>
                            <ENT>0.29</ENT>
                            <ENT>000</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">31540</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Laryngoscopy w/exc of tumor</ENT>
                            <ENT>4.12</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>1.76</ENT>
                            <ENT>2.15</ENT>
                            <ENT>0.33</ENT>
                            <ENT>000</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">31541</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Larynscop w/tumr exc + scope</ENT>
                            <ENT>4.52</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>1.89</ENT>
                            <ENT>2.34</ENT>
                            <ENT>0.37</ENT>
                            <ENT>000</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">31545</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Remove vc lesion w/scope</ENT>
                            <ENT>6.30</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>2.51</ENT>
                            <ENT>2.99</ENT>
                            <ENT>0.37</ENT>
                            <ENT>000</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">31546</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Remove vc lesion scope/graft</ENT>
                            <ENT>9.73</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>3.43</ENT>
                            <ENT>4.20</ENT>
                            <ENT>0.78</ENT>
                            <ENT>000</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">31560</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Laryngoscop w/arytenoidectom</ENT>
                            <ENT>5.45</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>2.15</ENT>
                            <ENT>2.65</ENT>
                            <ENT>0.43</ENT>
                            <ENT>000</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">31561</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Larynscop, remve cart + scop</ENT>
                            <ENT>5.99</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>2.32</ENT>
                            <ENT>2.84</ENT>
                            <ENT>0.49</ENT>
                            <ENT>000</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">31570</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Laryngoscope w/vc inj</ENT>
                            <ENT>3.86</ENT>
                            <ENT>4.26</ENT>
                            <ENT>4.96</ENT>
                            <ENT>1.64</ENT>
                            <ENT>2.01</ENT>
                            <ENT>0.31</ENT>
                            <ENT>000</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">31571</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Laryngoscop w/vc inj + scope</ENT>
                            <ENT>4.26</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>1.81</ENT>
                            <ENT>2.20</ENT>
                            <ENT>0.35</ENT>
                            <ENT>000</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">31575</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Diagnostic laryngoscopy</ENT>
                            <ENT>1.10</ENT>
                            <ENT>1.69</ENT>
                            <ENT>1.80</ENT>
                            <ENT>0.76</ENT>
                            <ENT>0.82</ENT>
                            <ENT>0.09</ENT>
                            <ENT>000</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">31576</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Laryngoscopy with biopsy</ENT>
                            <ENT>1.97</ENT>
                            <ENT>3.52</ENT>
                            <ENT>3.59</ENT>
                            <ENT>1.04</ENT>
                            <ENT>1.16</ENT>
                            <ENT>0.14</ENT>
                            <ENT>000</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">31577</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Remove foreign body, larynx</ENT>
                            <ENT>2.47</ENT>
                            <ENT>3.37</ENT>
                            <ENT>3.56</ENT>
                            <ENT>1.17</ENT>
                            <ENT>1.35</ENT>
                            <ENT>0.21</ENT>
                            <ENT>000</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">31578</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Removal of larynx lesion</ENT>
                            <ENT>2.84</ENT>
                            <ENT>3.99</ENT>
                            <ENT>4.13</ENT>
                            <ENT>1.34</ENT>
                            <ENT>1.43</ENT>
                            <ENT>0.23</ENT>
                            <ENT>000</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">31579</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Diagnostic laryngoscopy</ENT>
                            <ENT>2.26</ENT>
                            <ENT>2.86</ENT>
                            <ENT>3.32</ENT>
                            <ENT>1.15</ENT>
                            <ENT>1.31</ENT>
                            <ENT>0.18</ENT>
                            <ENT>000</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">31580</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Revision of larynx</ENT>
                            <ENT>14.46</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>13.82</ENT>
                            <ENT>14.86</ENT>
                            <ENT>1.00</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">31582</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Revision of larynx</ENT>
                            <ENT>22.87</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>22.55</ENT>
                            <ENT>24.16</ENT>
                            <ENT>1.76</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">31584</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Treat larynx fracture</ENT>
                            <ENT>20.35</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>15.26</ENT>
                            <ENT>16.70</ENT>
                            <ENT>1.72</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">31587</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Revision of larynx</ENT>
                            <ENT>15.12</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>8.63</ENT>
                            <ENT>8.95</ENT>
                            <ENT>0.97</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">31588</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Revision of larynx</ENT>
                            <ENT>14.62</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>12.50</ENT>
                            <ENT>13.05</ENT>
                            <ENT>1.06</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">31590</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Reinnervate larynx</ENT>
                            <ENT>7.63</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>12.78</ENT>
                            <ENT>14.15</ENT>
                            <ENT>0.84</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">31595</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Larynx nerve surgery</ENT>
                            <ENT>8.75</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>9.64</ENT>
                            <ENT>10.09</ENT>
                            <ENT>0.68</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">31599</ENT>
                            <ENT/>
                            <ENT>C</ENT>
                            <ENT>Larynx surgery procedure</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>YYY</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">31600</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Incision of windpipe</ENT>
                            <ENT>7.17</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>2.28</ENT>
                            <ENT>2.73</ENT>
                            <ENT>0.80</ENT>
                            <ENT>000</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">31601</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Incision of windpipe</ENT>
                            <ENT>4.44</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>1.74</ENT>
                            <ENT>2.07</ENT>
                            <ENT>0.40</ENT>
                            <ENT>000</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">31603</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Incision of windpipe</ENT>
                            <ENT>4.14</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>1.19</ENT>
                            <ENT>1.45</ENT>
                            <ENT>0.44</ENT>
                            <ENT>000</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">31605</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Incision of windpipe</ENT>
                            <ENT>3.57</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>0.82</ENT>
                            <ENT>1.00</ENT>
                            <ENT>0.40</ENT>
                            <ENT>000</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">31610</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Incision of windpipe</ENT>
                            <ENT>9.29</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>7.72</ENT>
                            <ENT>7.99</ENT>
                            <ENT>0.79</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">31611</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Surgery/speech prosthesis</ENT>
                            <ENT>5.92</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>7.07</ENT>
                            <ENT>7.06</ENT>
                            <ENT>0.46</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">31612</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Puncture/clear windpipe</ENT>
                            <ENT>0.91</ENT>
                            <ENT>1.09</ENT>
                            <ENT>1.09</ENT>
                            <ENT>0.26</ENT>
                            <ENT>0.30</ENT>
                            <ENT>0.08</ENT>
                            <ENT>000</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">31613</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Repair windpipe opening</ENT>
                            <ENT>4.63</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>6.13</ENT>
                            <ENT>6.06</ENT>
                            <ENT>0.42</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">31614</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Repair windpipe opening</ENT>
                            <ENT>8.47</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>9.57</ENT>
                            <ENT>9.14</ENT>
                            <ENT>0.58</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">31615</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Visualization of windpipe</ENT>
                            <ENT>2.09</ENT>
                            <ENT>2.37</ENT>
                            <ENT>2.48</ENT>
                            <ENT>1.04</ENT>
                            <ENT>1.12</ENT>
                            <ENT>0.16</ENT>
                            <ENT>000</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">31620</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Endobronchial us add-on</ENT>
                            <ENT>1.40</ENT>
                            <ENT>6.01</ENT>
                            <ENT>5.83</ENT>
                            <ENT>0.33</ENT>
                            <ENT>0.44</ENT>
                            <ENT>0.11</ENT>
                            <ENT>ZZZ</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">31622</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Dx bronchoscope/wash</ENT>
                            <ENT>2.78</ENT>
                            <ENT>5.23</ENT>
                            <ENT>5.44</ENT>
                            <ENT>0.90</ENT>
                            <ENT>0.98</ENT>
                            <ENT>0.18</ENT>
                            <ENT>000</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">31623</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Dx bronchoscope/brush</ENT>
                            <ENT>2.88</ENT>
                            <ENT>5.97</ENT>
                            <ENT>6.20</ENT>
                            <ENT>0.89</ENT>
                            <ENT>0.97</ENT>
                            <ENT>0.13</ENT>
                            <ENT>000</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">31624</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Dx bronchoscope/lavage</ENT>
                            <ENT>2.88</ENT>
                            <ENT>5.33</ENT>
                            <ENT>5.55</ENT>
                            <ENT>0.89</ENT>
                            <ENT>0.97</ENT>
                            <ENT>0.13</ENT>
                            <ENT>000</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">31625</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Bronchoscopy w/biopsy(s)</ENT>
                            <ENT>3.36</ENT>
                            <ENT>5.48</ENT>
                            <ENT>5.64</ENT>
                            <ENT>1.01</ENT>
                            <ENT>1.11</ENT>
                            <ENT>0.18</ENT>
                            <ENT>000</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">31628</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Bronchoscopy/lung bx, each</ENT>
                            <ENT>3.80</ENT>
                            <ENT>6.95</ENT>
                            <ENT>6.98</ENT>
                            <ENT>1.10</ENT>
                            <ENT>1.20</ENT>
                            <ENT>0.18</ENT>
                            <ENT>000</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">31629</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Bronchoscopy/needle bx, each</ENT>
                            <ENT>4.09</ENT>
                            <ENT>12.00</ENT>
                            <ENT>13.12</ENT>
                            <ENT>1.17</ENT>
                            <ENT>1.28</ENT>
                            <ENT>0.16</ENT>
                            <ENT>000</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">31630</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Bronchoscopy dilate/fx repr</ENT>
                            <ENT>3.81</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>1.27</ENT>
                            <ENT>1.49</ENT>
                            <ENT>0.32</ENT>
                            <ENT>000</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">31631</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Bronchoscopy, dilate w/stent</ENT>
                            <ENT>4.36</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>1.42</ENT>
                            <ENT>1.59</ENT>
                            <ENT>0.34</ENT>
                            <ENT>000</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">31632</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Bronchoscopy/lung bx, add'l</ENT>
                            <ENT>1.03</ENT>
                            <ENT>0.85</ENT>
                            <ENT>0.83</ENT>
                            <ENT>0.24</ENT>
                            <ENT>0.27</ENT>
                            <ENT>0.18</ENT>
                            <ENT>ZZZ</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">31633</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Bronchoscopy/needle bx add'l</ENT>
                            <ENT>1.32</ENT>
                            <ENT>0.99</ENT>
                            <ENT>0.95</ENT>
                            <ENT>0.31</ENT>
                            <ENT>0.35</ENT>
                            <ENT>0.16</ENT>
                            <ENT>ZZZ</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">31635</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Bronchoscopy w/fb removal</ENT>
                            <ENT>3.67</ENT>
                            <ENT>5.19</ENT>
                            <ENT>5.65</ENT>
                            <ENT>1.13</ENT>
                            <ENT>1.28</ENT>
                            <ENT>0.24</ENT>
                            <ENT>000</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">31636</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Bronchoscopy, bronch stents</ENT>
                            <ENT>4.30</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>1.34</ENT>
                            <ENT>1.55</ENT>
                            <ENT>0.31</ENT>
                            <ENT>000</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">31637</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Bronchoscopy, stent add-on</ENT>
                            <ENT>1.58</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>0.41</ENT>
                            <ENT>0.48</ENT>
                            <ENT>0.13</ENT>
                            <ENT>ZZZ</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">31638</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Bronchoscopy, revise stent</ENT>
                            <ENT>4.88</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>1.54</ENT>
                            <ENT>1.76</ENT>
                            <ENT>0.22</ENT>
                            <ENT>000</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">31640</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Bronchoscopy w/tumor excise</ENT>
                            <ENT>4.93</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>1.53</ENT>
                            <ENT>1.80</ENT>
                            <ENT>0.46</ENT>
                            <ENT>000</ENT>
                        </ROW>
                        <ROW>
                            <PRTPAGE P="66442"/>
                            <ENT I="01">31641</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Bronchoscopy, treat blockage</ENT>
                            <ENT>5.02</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>1.49</ENT>
                            <ENT>1.68</ENT>
                            <ENT>0.35</ENT>
                            <ENT>000</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">31643</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Diag bronchoscope/catheter</ENT>
                            <ENT>3.49</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>1.04</ENT>
                            <ENT>1.13</ENT>
                            <ENT>0.20</ENT>
                            <ENT>000</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">31645</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Bronchoscopy, clear airways</ENT>
                            <ENT>3.16</ENT>
                            <ENT>4.72</ENT>
                            <ENT>4.93</ENT>
                            <ENT>0.96</ENT>
                            <ENT>1.04</ENT>
                            <ENT>0.16</ENT>
                            <ENT>000</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">31646</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Bronchoscopy, reclear airway</ENT>
                            <ENT>2.72</ENT>
                            <ENT>4.41</ENT>
                            <ENT>4.63</ENT>
                            <ENT>0.85</ENT>
                            <ENT>0.92</ENT>
                            <ENT>0.14</ENT>
                            <ENT>000</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">31656</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Bronchoscopy, inj for x-ray</ENT>
                            <ENT>2.17</ENT>
                            <ENT>5.68</ENT>
                            <ENT>6.48</ENT>
                            <ENT>0.68</ENT>
                            <ENT>0.76</ENT>
                            <ENT>0.15</ENT>
                            <ENT>000</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">31715</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Injection for bronchus x-ray</ENT>
                            <ENT>1.11</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>0.25</ENT>
                            <ENT>0.29</ENT>
                            <ENT>0.07</ENT>
                            <ENT>000</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">31717</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Bronchial brush biopsy</ENT>
                            <ENT>2.12</ENT>
                            <ENT>5.84</ENT>
                            <ENT>7.04</ENT>
                            <ENT>0.72</ENT>
                            <ENT>0.75</ENT>
                            <ENT>0.14</ENT>
                            <ENT>000</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">31720</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Clearance of airways</ENT>
                            <ENT>1.06</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>0.27</ENT>
                            <ENT>0.30</ENT>
                            <ENT>0.07</ENT>
                            <ENT>000</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">31725</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Clearance of airways</ENT>
                            <ENT>1.96</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>0.41</ENT>
                            <ENT>0.49</ENT>
                            <ENT>0.14</ENT>
                            <ENT>000</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">31730</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Intro, windpipe wire/tube</ENT>
                            <ENT>2.85</ENT>
                            <ENT>25.71</ENT>
                            <ENT>13.95</ENT>
                            <ENT>0.74</ENT>
                            <ENT>0.87</ENT>
                            <ENT>0.21</ENT>
                            <ENT>000</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">31750</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Repair of windpipe</ENT>
                            <ENT>15.19</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>17.44</ENT>
                            <ENT>17.49</ENT>
                            <ENT>1.05</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">31755</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Repair of windpipe</ENT>
                            <ENT>17.19</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>23.97</ENT>
                            <ENT>24.24</ENT>
                            <ENT>1.29</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">31760</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Repair of windpipe</ENT>
                            <ENT>23.36</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>9.77</ENT>
                            <ENT>10.24</ENT>
                            <ENT>2.95</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">31766</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Reconstruction of windpipe</ENT>
                            <ENT>31.58</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>11.68</ENT>
                            <ENT>12.66</ENT>
                            <ENT>4.53</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">31770</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Repair/graft of bronchus</ENT>
                            <ENT>23.48</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>8.53</ENT>
                            <ENT>9.38</ENT>
                            <ENT>2.84</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">31775</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Reconstruct bronchus</ENT>
                            <ENT>24.51</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>9.50</ENT>
                            <ENT>10.64</ENT>
                            <ENT>3.02</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">31780</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Reconstruct windpipe</ENT>
                            <ENT>19.70</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>8.79</ENT>
                            <ENT>9.92</ENT>
                            <ENT>1.65</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">31781</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Reconstruct windpipe</ENT>
                            <ENT>24.77</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>9.66</ENT>
                            <ENT>10.89</ENT>
                            <ENT>2.25</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">31785</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Remove windpipe lesion</ENT>
                            <ENT>18.29</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>7.67</ENT>
                            <ENT>8.92</ENT>
                            <ENT>1.59</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">31786</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Remove windpipe lesion</ENT>
                            <ENT>25.34</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>9.61</ENT>
                            <ENT>11.35</ENT>
                            <ENT>3.30</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">31800</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Repair of windpipe injury</ENT>
                            <ENT>8.10</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>8.67</ENT>
                            <ENT>8.95</ENT>
                            <ENT>0.79</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">31805</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Repair of windpipe injury</ENT>
                            <ENT>13.34</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>6.21</ENT>
                            <ENT>6.71</ENT>
                            <ENT>1.83</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">31820</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Closure of windpipe lesion</ENT>
                            <ENT>4.58</ENT>
                            <ENT>5.85</ENT>
                            <ENT>5.76</ENT>
                            <ENT>3.26</ENT>
                            <ENT>3.45</ENT>
                            <ENT>0.38</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">31825</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Repair of windpipe defect</ENT>
                            <ENT>6.98</ENT>
                            <ENT>7.44</ENT>
                            <ENT>7.55</ENT>
                            <ENT>4.47</ENT>
                            <ENT>4.92</ENT>
                            <ENT>0.53</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">31830</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Revise windpipe scar</ENT>
                            <ENT>4.54</ENT>
                            <ENT>5.93</ENT>
                            <ENT>5.84</ENT>
                            <ENT>3.56</ENT>
                            <ENT>3.77</ENT>
                            <ENT>0.44</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">31899</ENT>
                            <ENT/>
                            <ENT>C</ENT>
                            <ENT>Airways surgical procedure</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>YYY</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">32035</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Exploration of chest</ENT>
                            <ENT>11.20</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>6.08</ENT>
                            <ENT>5.96</ENT>
                            <ENT>1.26</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">32036</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Exploration of chest</ENT>
                            <ENT>12.21</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>6.29</ENT>
                            <ENT>6.36</ENT>
                            <ENT>1.43</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">32095</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Biopsy through chest wall</ENT>
                            <ENT>10.06</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>5.10</ENT>
                            <ENT>5.23</ENT>
                            <ENT>1.22</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">32100</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Exploration/biopsy of chest</ENT>
                            <ENT>16.08</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>7.00</ENT>
                            <ENT>7.41</ENT>
                            <ENT>2.24</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">32110</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Explore/repair chest</ENT>
                            <ENT>25.15</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>9.87</ENT>
                            <ENT>10.29</ENT>
                            <ENT>3.22</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">32120</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Re-exploration of chest</ENT>
                            <ENT>14.27</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>6.78</ENT>
                            <ENT>6.92</ENT>
                            <ENT>1.63</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">32124</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Explore chest free adhesions</ENT>
                            <ENT>15.33</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>6.95</ENT>
                            <ENT>7.08</ENT>
                            <ENT>1.90</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">32140</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Removal of lung lesion(s)</ENT>
                            <ENT>16.54</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>7.39</ENT>
                            <ENT>7.53</ENT>
                            <ENT>1.97</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">32141</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Remove/treat lung lesions</ENT>
                            <ENT>27.10</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>10.17</ENT>
                            <ENT>8.86</ENT>
                            <ENT>2.01</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">32150</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Removal of lung lesion(s)</ENT>
                            <ENT>16.70</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>7.50</ENT>
                            <ENT>7.55</ENT>
                            <ENT>2.01</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">32151</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Remove lung foreign body</ENT>
                            <ENT>16.82</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>7.91</ENT>
                            <ENT>7.95</ENT>
                            <ENT>2.04</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">32160</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Open chest heart massage</ENT>
                            <ENT>13.02</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>5.84</ENT>
                            <ENT>5.55</ENT>
                            <ENT>1.31</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">32200</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Drain, open, lung lesion</ENT>
                            <ENT>18.48</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>8.76</ENT>
                            <ENT>8.68</ENT>
                            <ENT>2.14</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">32201</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Drain, percut, lung lesion</ENT>
                            <ENT>3.99</ENT>
                            <ENT>19.84</ENT>
                            <ENT>20.27</ENT>
                            <ENT>1.42</ENT>
                            <ENT>1.36</ENT>
                            <ENT>0.24</ENT>
                            <ENT>000</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">32215</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Treat chest lining</ENT>
                            <ENT>12.93</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>6.23</ENT>
                            <ENT>6.56</ENT>
                            <ENT>1.69</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">32220</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Release of lung</ENT>
                            <ENT>26.41</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>11.90</ENT>
                            <ENT>12.42</ENT>
                            <ENT>3.57</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">32225</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Partial release of lung</ENT>
                            <ENT>16.63</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>7.45</ENT>
                            <ENT>7.55</ENT>
                            <ENT>2.07</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">32310</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Removal of chest lining</ENT>
                            <ENT>15.16</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>6.92</ENT>
                            <ENT>7.15</ENT>
                            <ENT>2.00</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">32320</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Free/remove chest lining</ENT>
                            <ENT>27.04</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>11.44</ENT>
                            <ENT>11.79</ENT>
                            <ENT>3.52</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">32400</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Needle biopsy chest lining</ENT>
                            <ENT>1.76</ENT>
                            <ENT>2.15</ENT>
                            <ENT>2.14</ENT>
                            <ENT>0.57</ENT>
                            <ENT>0.56</ENT>
                            <ENT>0.10</ENT>
                            <ENT>000</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">32402</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Open biopsy chest lining</ENT>
                            <ENT>8.89</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>4.68</ENT>
                            <ENT>4.89</ENT>
                            <ENT>1.07</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">32405</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Biopsy, lung or mediastinum</ENT>
                            <ENT>1.93</ENT>
                            <ENT>0.69</ENT>
                            <ENT>0.68</ENT>
                            <ENT>0.69</ENT>
                            <ENT>0.66</ENT>
                            <ENT>0.11</ENT>
                            <ENT>000</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">32420</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Puncture/clear lung</ENT>
                            <ENT>2.18</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>0.71</ENT>
                            <ENT>0.69</ENT>
                            <ENT>0.12</ENT>
                            <ENT>000</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">32421</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Thoracentesis for aspiration</ENT>
                            <ENT>1.54</ENT>
                            <ENT>2.40</ENT>
                            <ENT>2.73</ENT>
                            <ENT>0.47</ENT>
                            <ENT>0.47</ENT>
                            <ENT>0.08</ENT>
                            <ENT>000</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">32422</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Thoracentesis w/tube insert</ENT>
                            <ENT>2.19</ENT>
                            <ENT>2.87</ENT>
                            <ENT>3.04</ENT>
                            <ENT>1.03</ENT>
                            <ENT>1.04</ENT>
                            <ENT>0.12</ENT>
                            <ENT>000</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">32440</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Removal of lung</ENT>
                            <ENT>27.17</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>10.91</ENT>
                            <ENT>11.90</ENT>
                            <ENT>3.69</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">32442</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Sleeve pneumonectomy</ENT>
                            <ENT>56.37</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>18.71</ENT>
                            <ENT>16.73</ENT>
                            <ENT>3.85</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">32445</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Removal of lung</ENT>
                            <ENT>63.60</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>22.77</ENT>
                            <ENT>18.41</ENT>
                            <ENT>3.72</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">32480</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Partial removal of lung</ENT>
                            <ENT>25.71</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>10.18</ENT>
                            <ENT>11.12</ENT>
                            <ENT>3.50</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">32482</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Bilobectomy</ENT>
                            <ENT>27.28</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>11.08</ENT>
                            <ENT>11.99</ENT>
                            <ENT>3.67</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">32484</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Segmentectomy</ENT>
                            <ENT>25.30</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>9.56</ENT>
                            <ENT>10.47</ENT>
                            <ENT>3.04</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">32486</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Sleeve lobectomy</ENT>
                            <ENT>42.80</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>14.60</ENT>
                            <ENT>13.92</ENT>
                            <ENT>3.52</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">32488</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Completion pneumonectomy</ENT>
                            <ENT>42.83</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>15.56</ENT>
                            <ENT>14.67</ENT>
                            <ENT>3.81</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">32491</ENT>
                            <ENT/>
                            <ENT>R</ENT>
                            <ENT>Lung volume reduction</ENT>
                            <ENT>25.09</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>10.42</ENT>
                            <ENT>11.52</ENT>
                            <ENT>2.99</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">32500</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Partial removal of lung</ENT>
                            <ENT>24.48</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>10.26</ENT>
                            <ENT>11.30</ENT>
                            <ENT>3.26</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">32501</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Repair bronchus add-on</ENT>
                            <ENT>4.68</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>1.33</ENT>
                            <ENT>1.43</ENT>
                            <ENT>0.65</ENT>
                            <ENT>ZZZ</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">32503</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Resect apical lung tumor</ENT>
                            <ENT>31.61</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>12.08</ENT>
                            <ENT>13.57</ENT>
                            <ENT>4.38</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">32504</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Resect apical lung tum/chest</ENT>
                            <ENT>36.41</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>13.46</ENT>
                            <ENT>15.06</ENT>
                            <ENT>5.09</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">32540</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Removal of lung lesion</ENT>
                            <ENT>30.22</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>11.48</ENT>
                            <ENT>10.55</ENT>
                            <ENT>2.08</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">32550</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Insert pleural cath</ENT>
                            <ENT>4.17</ENT>
                            <ENT>14.95</ENT>
                            <ENT>17.45</ENT>
                            <ENT>1.51</ENT>
                            <ENT>1.58</ENT>
                            <ENT>0.42</ENT>
                            <ENT>000</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">32551</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Insertion of chest tube</ENT>
                            <ENT>3.29</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>0.97</ENT>
                            <ENT>1.16</ENT>
                            <ENT>0.43</ENT>
                            <ENT>000</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">32560</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Treat lung lining chemically</ENT>
                            <ENT>2.19</ENT>
                            <ENT>5.05</ENT>
                            <ENT>5.75</ENT>
                            <ENT>0.58</ENT>
                            <ENT>0.64</ENT>
                            <ENT>0.23</ENT>
                            <ENT>000</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">32601</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Thoracoscopy, diagnostic</ENT>
                            <ENT>5.45</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>2.06</ENT>
                            <ENT>2.21</ENT>
                            <ENT>0.80</ENT>
                            <ENT>000</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">32602</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Thoracoscopy, diagnostic</ENT>
                            <ENT>5.95</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>2.22</ENT>
                            <ENT>2.37</ENT>
                            <ENT>0.87</ENT>
                            <ENT>000</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">32603</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Thoracoscopy, diagnostic</ENT>
                            <ENT>7.80</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>2.74</ENT>
                            <ENT>2.88</ENT>
                            <ENT>1.14</ENT>
                            <ENT>000</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">32604</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Thoracoscopy, diagnostic</ENT>
                            <ENT>8.77</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>3.05</ENT>
                            <ENT>3.25</ENT>
                            <ENT>1.25</ENT>
                            <ENT>000</ENT>
                        </ROW>
                        <ROW>
                            <PRTPAGE P="66443"/>
                            <ENT I="01">32605</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Thoracoscopy, diagnostic</ENT>
                            <ENT>6.92</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>2.57</ENT>
                            <ENT>2.74</ENT>
                            <ENT>1.00</ENT>
                            <ENT>000</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">32606</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Thoracoscopy, diagnostic</ENT>
                            <ENT>8.39</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>2.97</ENT>
                            <ENT>3.15</ENT>
                            <ENT>1.22</ENT>
                            <ENT>000</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">32650</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Thoracoscopy, surgical</ENT>
                            <ENT>10.77</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>5.24</ENT>
                            <ENT>6.00</ENT>
                            <ENT>1.58</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">32651</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Thoracoscopy, surgical</ENT>
                            <ENT>18.70</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>7.69</ENT>
                            <ENT>7.46</ENT>
                            <ENT>1.87</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">32652</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Thoracoscopy, surgical</ENT>
                            <ENT>29.00</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>11.13</ENT>
                            <ENT>10.63</ENT>
                            <ENT>2.73</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">32653</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Thoracoscopy, surgical</ENT>
                            <ENT>18.09</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>7.45</ENT>
                            <ENT>7.21</ENT>
                            <ENT>1.89</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">32654</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Thoracoscopy, surgical</ENT>
                            <ENT>20.44</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>7.95</ENT>
                            <ENT>7.74</ENT>
                            <ENT>1.63</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">32655</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Thoracoscopy, surgical</ENT>
                            <ENT>16.09</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>6.88</ENT>
                            <ENT>7.06</ENT>
                            <ENT>1.90</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">32656</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Thoracoscopy, surgical</ENT>
                            <ENT>13.18</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>5.95</ENT>
                            <ENT>6.94</ENT>
                            <ENT>1.90</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">32657</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Thoracoscopy, surgical</ENT>
                            <ENT>12.85</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>5.97</ENT>
                            <ENT>6.82</ENT>
                            <ENT>2.00</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">32658</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Thoracoscopy, surgical</ENT>
                            <ENT>11.65</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>5.50</ENT>
                            <ENT>6.42</ENT>
                            <ENT>1.70</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">32659</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Thoracoscopy, surgical</ENT>
                            <ENT>11.86</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>5.79</ENT>
                            <ENT>6.62</ENT>
                            <ENT>1.62</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">32660</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Thoracoscopy, surgical</ENT>
                            <ENT>17.69</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>7.58</ENT>
                            <ENT>8.53</ENT>
                            <ENT>2.09</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">32661</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Thoracoscopy, surgical</ENT>
                            <ENT>13.27</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>6.05</ENT>
                            <ENT>6.91</ENT>
                            <ENT>1.93</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">32662</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Thoracoscopy, surgical</ENT>
                            <ENT>14.91</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>6.63</ENT>
                            <ENT>7.73</ENT>
                            <ENT>2.18</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">32663</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Thoracoscopy, surgical</ENT>
                            <ENT>24.56</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>9.39</ENT>
                            <ENT>10.07</ENT>
                            <ENT>2.73</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">32664</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Thoracoscopy, surgical</ENT>
                            <ENT>14.22</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>5.61</ENT>
                            <ENT>6.62</ENT>
                            <ENT>2.33</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">32665</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Thoracoscopy, surgical</ENT>
                            <ENT>21.45</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>8.56</ENT>
                            <ENT>8.34</ENT>
                            <ENT>2.16</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">32800</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Repair lung hernia</ENT>
                            <ENT>15.59</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>6.92</ENT>
                            <ENT>7.16</ENT>
                            <ENT>1.99</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">32810</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Close chest after drainage</ENT>
                            <ENT>14.83</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>6.97</ENT>
                            <ENT>7.24</ENT>
                            <ENT>1.94</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">32815</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Close bronchial fistula</ENT>
                            <ENT>49.79</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>18.57</ENT>
                            <ENT>14.77</ENT>
                            <ENT>3.28</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">32820</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Reconstruct injured chest</ENT>
                            <ENT>22.33</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>10.56</ENT>
                            <ENT>11.36</ENT>
                            <ENT>2.53</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">32850</ENT>
                            <ENT/>
                            <ENT>X</ENT>
                            <ENT>Donor pneumonectomy</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>XXX</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">32851</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Lung transplant, single</ENT>
                            <ENT>40.94</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>20.17</ENT>
                            <ENT>23.91</ENT>
                            <ENT>5.58</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">32852</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Lung transplant with bypass</ENT>
                            <ENT>44.65</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>22.56</ENT>
                            <ENT>27.85</ENT>
                            <ENT>6.02</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">32853</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Lung transplant, double</ENT>
                            <ENT>50.11</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>22.77</ENT>
                            <ENT>27.25</ENT>
                            <ENT>7.07</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">32854</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Lung transplant with bypass</ENT>
                            <ENT>53.88</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>25.76</ENT>
                            <ENT>30.24</ENT>
                            <ENT>7.22</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">32855</ENT>
                            <ENT/>
                            <ENT>C</ENT>
                            <ENT>Prepare donor lung, single</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>XXX</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">32856</ENT>
                            <ENT/>
                            <ENT>C</ENT>
                            <ENT>Prepare donor lung, double</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>XXX</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">32900</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Removal of rib(s)</ENT>
                            <ENT>23.69</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>9.56</ENT>
                            <ENT>9.72</ENT>
                            <ENT>2.94</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">32905</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Revise &amp; repair chest wall</ENT>
                            <ENT>23.17</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>9.52</ENT>
                            <ENT>9.82</ENT>
                            <ENT>3.16</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">32906</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Revise &amp; repair chest wall</ENT>
                            <ENT>29.18</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>11.03</ENT>
                            <ENT>11.54</ENT>
                            <ENT>3.98</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">32940</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Revision of lung</ENT>
                            <ENT>21.22</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>8.48</ENT>
                            <ENT>8.98</ENT>
                            <ENT>2.89</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">32960</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Therapeutic pneumothorax</ENT>
                            <ENT>1.84</ENT>
                            <ENT>1.61</ENT>
                            <ENT>1.67</ENT>
                            <ENT>0.68</ENT>
                            <ENT>0.62</ENT>
                            <ENT>0.16</ENT>
                            <ENT>000</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">32997</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Total lung lavage</ENT>
                            <ENT>7.31</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>1.83</ENT>
                            <ENT>1.87</ENT>
                            <ENT>0.55</ENT>
                            <ENT>000</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">32998</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Perq rf ablate tx, pul tumor</ENT>
                            <ENT>5.68</ENT>
                            <ENT>70.18</ENT>
                            <ENT>70.18</ENT>
                            <ENT>1.98</ENT>
                            <ENT>1.98</ENT>
                            <ENT>0.36</ENT>
                            <ENT>000</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">32999</ENT>
                            <ENT/>
                            <ENT>C</ENT>
                            <ENT>Chest surgery procedure</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>YYY</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">33010</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Drainage of heart sac</ENT>
                            <ENT>2.24</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>1.04</ENT>
                            <ENT>0.91</ENT>
                            <ENT>0.14</ENT>
                            <ENT>000</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">33011</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Repeat drainage of heart sac</ENT>
                            <ENT>2.24</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>1.12</ENT>
                            <ENT>0.97</ENT>
                            <ENT>0.15</ENT>
                            <ENT>000</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">33015</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Incision of heart sac</ENT>
                            <ENT>8.44</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>5.15</ENT>
                            <ENT>5.05</ENT>
                            <ENT>0.65</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">33020</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Incision of heart sac</ENT>
                            <ENT>14.87</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>6.37</ENT>
                            <ENT>6.57</ENT>
                            <ENT>1.80</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">33025</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Incision of heart sac</ENT>
                            <ENT>13.65</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>5.84</ENT>
                            <ENT>6.09</ENT>
                            <ENT>1.81</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">33030</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Partial removal of heart sac</ENT>
                            <ENT>22.27</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>9.11</ENT>
                            <ENT>9.31</ENT>
                            <ENT>2.84</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">33031</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Partial removal of heart sac</ENT>
                            <ENT>25.30</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>9.57</ENT>
                            <ENT>9.80</ENT>
                            <ENT>3.14</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">33050</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Removal of heart sac lesion</ENT>
                            <ENT>16.85</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>7.36</ENT>
                            <ENT>7.60</ENT>
                            <ENT>2.15</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">33120</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Removal of heart lesion</ENT>
                            <ENT>27.33</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>10.55</ENT>
                            <ENT>11.06</ENT>
                            <ENT>3.70</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">33130</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Removal of heart lesion</ENT>
                            <ENT>24.05</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>9.36</ENT>
                            <ENT>9.73</ENT>
                            <ENT>3.01</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">33140</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Heart revascularize (tmr)</ENT>
                            <ENT>28.26</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>10.29</ENT>
                            <ENT>10.58</ENT>
                            <ENT>2.86</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">33141</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Heart tmr w/other procedure</ENT>
                            <ENT>2.54</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>0.78</ENT>
                            <ENT>1.18</ENT>
                            <ENT>0.69</ENT>
                            <ENT>ZZZ</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">33202</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Insert epicard eltrd, open</ENT>
                            <ENT>13.15</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>6.07</ENT>
                            <ENT>6.07</ENT>
                            <ENT>1.71</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">33203</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Insert epicard eltrd, endo</ENT>
                            <ENT>13.92</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>6.13</ENT>
                            <ENT>6.13</ENT>
                            <ENT>1.39</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">33206</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Insertion of heart pacemaker</ENT>
                            <ENT>7.31</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>5.12</ENT>
                            <ENT>4.79</ENT>
                            <ENT>0.52</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">33207</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Insertion of heart pacemaker</ENT>
                            <ENT>8.00</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>5.22</ENT>
                            <ENT>4.94</ENT>
                            <ENT>0.59</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">33208</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Insertion of heart pacemaker</ENT>
                            <ENT>8.72</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>5.65</ENT>
                            <ENT>5.21</ENT>
                            <ENT>0.56</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">33210</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Insertion of heart electrode</ENT>
                            <ENT>3.30</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>1.66</ENT>
                            <ENT>1.45</ENT>
                            <ENT>0.18</ENT>
                            <ENT>000</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">33211</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Insertion of heart electrode</ENT>
                            <ENT>3.39</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>1.59</ENT>
                            <ENT>1.45</ENT>
                            <ENT>0.21</ENT>
                            <ENT>000</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">33212</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Insertion of pulse generator</ENT>
                            <ENT>5.51</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>3.70</ENT>
                            <ENT>3.53</ENT>
                            <ENT>0.43</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">33213</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Insertion of pulse generator</ENT>
                            <ENT>6.36</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>4.21</ENT>
                            <ENT>3.96</ENT>
                            <ENT>0.45</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">33214</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Upgrade of pacemaker system</ENT>
                            <ENT>7.78</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>5.36</ENT>
                            <ENT>5.12</ENT>
                            <ENT>0.58</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">33215</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Reposition pacing-defib lead</ENT>
                            <ENT>4.89</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>3.48</ENT>
                            <ENT>3.33</ENT>
                            <ENT>0.37</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">33216</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Insert lead pace-defib, one</ENT>
                            <ENT>5.81</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>4.54</ENT>
                            <ENT>4.37</ENT>
                            <ENT>0.36</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">33217</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Insert lead pace-defib, dual</ENT>
                            <ENT>5.78</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>4.43</ENT>
                            <ENT>4.33</ENT>
                            <ENT>0.39</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">33218</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Repair lead pace-defib, one</ENT>
                            <ENT>5.97</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>4.82</ENT>
                            <ENT>4.56</ENT>
                            <ENT>0.37</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">33220</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Repair lead pace-defib, dual</ENT>
                            <ENT>6.05</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>4.78</ENT>
                            <ENT>4.52</ENT>
                            <ENT>0.37</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">33222</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Revise pocket, pacemaker</ENT>
                            <ENT>5.01</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>4.30</ENT>
                            <ENT>4.29</ENT>
                            <ENT>0.42</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">33223</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Revise pocket, pacing-defib</ENT>
                            <ENT>6.49</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>4.87</ENT>
                            <ENT>4.73</ENT>
                            <ENT>0.45</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">33224</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Insert pacing lead &amp; connect</ENT>
                            <ENT>9.04</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>4.90</ENT>
                            <ENT>4.45</ENT>
                            <ENT>0.54</ENT>
                            <ENT>000</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">33225</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>L ventric pacing lead add-on</ENT>
                            <ENT>8.33</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>4.35</ENT>
                            <ENT>3.80</ENT>
                            <ENT>0.45</ENT>
                            <ENT>ZZZ</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">33226</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Reposition l ventric lead</ENT>
                            <ENT>8.68</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>4.73</ENT>
                            <ENT>4.28</ENT>
                            <ENT>0.59</ENT>
                            <ENT>000</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">33233</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Removal of pacemaker system</ENT>
                            <ENT>3.33</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>3.26</ENT>
                            <ENT>3.27</ENT>
                            <ENT>0.22</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">33234</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Removal of pacemaker system</ENT>
                            <ENT>7.85</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>5.48</ENT>
                            <ENT>5.19</ENT>
                            <ENT>0.56</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">33235</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Removal pacemaker electrode</ENT>
                            <ENT>9.93</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>7.23</ENT>
                            <ENT>7.02</ENT>
                            <ENT>0.73</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <PRTPAGE P="66444"/>
                            <ENT I="01">33236</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Remove electrode/thoracotomy</ENT>
                            <ENT>12.64</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>6.37</ENT>
                            <ENT>6.90</ENT>
                            <ENT>1.69</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">33237</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Remove electrode/thoracotomy</ENT>
                            <ENT>13.75</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>8.01</ENT>
                            <ENT>7.89</ENT>
                            <ENT>1.59</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">33238</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Remove electrode/thoracotomy</ENT>
                            <ENT>15.28</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>8.04</ENT>
                            <ENT>8.12</ENT>
                            <ENT>2.03</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">33240</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Insert pulse generator</ENT>
                            <ENT>7.61</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>5.25</ENT>
                            <ENT>4.91</ENT>
                            <ENT>0.41</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">33241</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Remove pulse generator</ENT>
                            <ENT>3.26</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>3.00</ENT>
                            <ENT>2.98</ENT>
                            <ENT>0.18</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">33243</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Remove eltrd/thoracotomy</ENT>
                            <ENT>23.42</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>10.93</ENT>
                            <ENT>11.19</ENT>
                            <ENT>2.10</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">33244</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Remove eltrd, transven</ENT>
                            <ENT>13.84</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>9.43</ENT>
                            <ENT>9.16</ENT>
                            <ENT>0.99</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">33249</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Eltrd/insert pace-defib</ENT>
                            <ENT>15.02</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>10.15</ENT>
                            <ENT>9.25</ENT>
                            <ENT>0.77</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">33250</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Ablate heart dysrhythm focus</ENT>
                            <ENT>25.78</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>10.88</ENT>
                            <ENT>10.94</ENT>
                            <ENT>3.19</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">33251</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Ablate heart dysrhythm focus</ENT>
                            <ENT>28.80</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>10.95</ENT>
                            <ENT>11.30</ENT>
                            <ENT>3.60</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">33254</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Ablate atria, lmtd</ENT>
                            <ENT>23.58</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>9.76</ENT>
                            <ENT>9.76</ENT>
                            <ENT>3.35</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">33255</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Ablate atria w/o bypass, ext</ENT>
                            <ENT>28.91</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>11.36</ENT>
                            <ENT>11.36</ENT>
                            <ENT>3.94</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">33256</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Ablate atria w/bypass, exten</ENT>
                            <ENT>34.77</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>13.11</ENT>
                            <ENT>13.11</ENT>
                            <ENT>4.95</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">33257</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Ablate atria, lmtd, add-on</ENT>
                            <ENT>9.63</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>5.46</ENT>
                            <ENT>5.46</ENT>
                            <ENT>0.89</ENT>
                            <ENT>ZZZ</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">33258</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Ablate atria, x10sv, add-on</ENT>
                            <ENT>11.00</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>5.98</ENT>
                            <ENT>5.98</ENT>
                            <ENT>1.09</ENT>
                            <ENT>ZZZ</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">33259</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Ablate atria w/bypass add-on</ENT>
                            <ENT>14.14</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>7.79</ENT>
                            <ENT>7.79</ENT>
                            <ENT>1.78</ENT>
                            <ENT>ZZZ</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">33261</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Ablate heart dysrhythm focus</ENT>
                            <ENT>28.80</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>11.68</ENT>
                            <ENT>11.72</ENT>
                            <ENT>3.46</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">33265</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Ablate atria,  lmtd,  endo</ENT>
                            <ENT>23.58</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>9.76</ENT>
                            <ENT>9.76</ENT>
                            <ENT>3.35</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">33266</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Ablate atria, x10sv, endo</ENT>
                            <ENT>32.91</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>12.55</ENT>
                            <ENT>12.55</ENT>
                            <ENT>4.80</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">33282</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Implant pat-active ht record</ENT>
                            <ENT>4.70</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>4.23</ENT>
                            <ENT>4.12</ENT>
                            <ENT>0.23</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">33284</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Remove pat-active ht record</ENT>
                            <ENT>3.04</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>3.37</ENT>
                            <ENT>3.45</ENT>
                            <ENT>0.14</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">33300</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Repair of heart wound</ENT>
                            <ENT>44.89</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>15.05</ENT>
                            <ENT>12.14</ENT>
                            <ENT>2.66</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">33305</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Repair of heart wound</ENT>
                            <ENT>76.85</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>25.11</ENT>
                            <ENT>17.85</ENT>
                            <ENT>3.13</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">33310</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Exploratory heart surgery</ENT>
                            <ENT>20.22</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>8.35</ENT>
                            <ENT>8.96</ENT>
                            <ENT>2.59</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">33315</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Exploratory heart surgery</ENT>
                            <ENT>26.05</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>10.34</ENT>
                            <ENT>10.61</ENT>
                            <ENT>3.28</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">33320</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Repair major blood vessel(s)</ENT>
                            <ENT>18.46</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>8.00</ENT>
                            <ENT>8.11</ENT>
                            <ENT>2.08</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">33321</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Repair major vessel</ENT>
                            <ENT>20.71</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>8.37</ENT>
                            <ENT>9.07</ENT>
                            <ENT>2.91</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">33322</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Repair major blood vessel(s)</ENT>
                            <ENT>24.30</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>9.54</ENT>
                            <ENT>9.95</ENT>
                            <ENT>2.86</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">33330</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Insert major vessel graft</ENT>
                            <ENT>25.17</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>9.49</ENT>
                            <ENT>9.87</ENT>
                            <ENT>2.82</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">33332</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Insert major vessel graft</ENT>
                            <ENT>24.46</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>9.45</ENT>
                            <ENT>9.98</ENT>
                            <ENT>3.03</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">33335</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Insert major vessel graft</ENT>
                            <ENT>33.79</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>12.48</ENT>
                            <ENT>12.90</ENT>
                            <ENT>4.28</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">33400</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Repair of aortic valve</ENT>
                            <ENT>41.37</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>14.56</ENT>
                            <ENT>15.11</ENT>
                            <ENT>4.11</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">33401</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Valvuloplasty, open</ENT>
                            <ENT>24.41</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>10.27</ENT>
                            <ENT>11.88</ENT>
                            <ENT>3.57</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">33403</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Valvuloplasty, w/cp bypass</ENT>
                            <ENT>25.39</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>12.52</ENT>
                            <ENT>13.41</ENT>
                            <ENT>3.55</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">33404</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Prepare heart-aorta conduit</ENT>
                            <ENT>31.25</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>12.00</ENT>
                            <ENT>13.27</ENT>
                            <ENT>4.33</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">33405</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Replacement of aortic valve</ENT>
                            <ENT>41.19</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>15.10</ENT>
                            <ENT>16.69</ENT>
                            <ENT>5.33</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">33406</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Replacement of aortic valve</ENT>
                            <ENT>52.55</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>18.36</ENT>
                            <ENT>18.74</ENT>
                            <ENT>5.45</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">33410</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Replacement of aortic valve</ENT>
                            <ENT>46.28</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>16.51</ENT>
                            <ENT>16.54</ENT>
                            <ENT>4.69</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">33411</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Replacement of aortic valve</ENT>
                            <ENT>61.94</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>21.08</ENT>
                            <ENT>19.90</ENT>
                            <ENT>5.48</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">33412</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Replacement of aortic valve</ENT>
                            <ENT>43.77</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>16.20</ENT>
                            <ENT>18.30</ENT>
                            <ENT>6.39</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">33413</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Replacement of aortic valve</ENT>
                            <ENT>59.74</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>23.52</ENT>
                            <ENT>22.16</ENT>
                            <ENT>6.53</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">33414</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Repair of aortic valve</ENT>
                            <ENT>39.29</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>14.27</ENT>
                            <ENT>14.20</ENT>
                            <ENT>4.57</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">33415</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Revision, subvalvular tissue</ENT>
                            <ENT>37.19</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>13.14</ENT>
                            <ENT>12.57</ENT>
                            <ENT>4.14</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">33416</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Revise ventricle muscle</ENT>
                            <ENT>36.43</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>13.23</ENT>
                            <ENT>13.36</ENT>
                            <ENT>4.57</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">33417</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Repair of aortic valve</ENT>
                            <ENT>29.17</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>11.69</ENT>
                            <ENT>12.65</ENT>
                            <ENT>4.10</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">33420</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Revision of mitral valve</ENT>
                            <ENT>25.67</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>9.49</ENT>
                            <ENT>9.52</ENT>
                            <ENT>1.82</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">33422</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Revision of mitral valve</ENT>
                            <ENT>29.61</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>11.35</ENT>
                            <ENT>12.50</ENT>
                            <ENT>3.94</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">33425</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Repair of mitral valve</ENT>
                            <ENT>49.83</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>17.59</ENT>
                            <ENT>15.32</ENT>
                            <ENT>4.07</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">33426</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Repair of mitral valve</ENT>
                            <ENT>43.15</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>15.74</ENT>
                            <ENT>16.43</ENT>
                            <ENT>5.03</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">33427</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Repair of mitral valve</ENT>
                            <ENT>44.70</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>15.69</ENT>
                            <ENT>17.52</ENT>
                            <ENT>6.09</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">33430</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Replacement of mitral valve</ENT>
                            <ENT>50.75</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>18.55</ENT>
                            <ENT>17.91</ENT>
                            <ENT>5.10</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">33460</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Revision of tricuspid valve</ENT>
                            <ENT>44.62</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>14.70</ENT>
                            <ENT>13.00</ENT>
                            <ENT>3.45</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">33463</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Valvuloplasty, tricuspid</ENT>
                            <ENT>56.95</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>19.71</ENT>
                            <ENT>16.31</ENT>
                            <ENT>3.87</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">33463</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Valvuloplasty, tricuspid</ENT>
                            <ENT>56.95</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>19.71</ENT>
                            <ENT>16.31</ENT>
                            <ENT>3.87</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">33464</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Valvuloplasty, tricuspid</ENT>
                            <ENT>44.49</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>15.83</ENT>
                            <ENT>14.67</ENT>
                            <ENT>4.15</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">33465</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Replace tricuspid valve</ENT>
                            <ENT>50.59</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>17.63</ENT>
                            <ENT>15.29</ENT>
                            <ENT>4.39</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">33468</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Revision of tricuspid valve</ENT>
                            <ENT>32.82</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>15.23</ENT>
                            <ENT>14.44</ENT>
                            <ENT>4.07</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">33470</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Revision of pulmonary valve</ENT>
                            <ENT>21.32</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>7.92</ENT>
                            <ENT>9.30</ENT>
                            <ENT>1.03</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">33471</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Valvotomy, pulmonary valve</ENT>
                            <ENT>22.83</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>11.58</ENT>
                            <ENT>10.67</ENT>
                            <ENT>3.39</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">33472</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Revision of pulmonary valve</ENT>
                            <ENT>22.90</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>8.78</ENT>
                            <ENT>10.31</ENT>
                            <ENT>3.55</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">33474</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Revision of pulmonary valve</ENT>
                            <ENT>39.27</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>12.93</ENT>
                            <ENT>11.90</ENT>
                            <ENT>3.22</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">33475</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Replacement, pulmonary valve</ENT>
                            <ENT>42.27</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>15.05</ENT>
                            <ENT>15.21</ENT>
                            <ENT>4.93</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">33476</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Revision of heart chamber</ENT>
                            <ENT>26.41</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>10.36</ENT>
                            <ENT>11.15</ENT>
                            <ENT>2.42</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">33478</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Revision of heart chamber</ENT>
                            <ENT>27.38</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>11.01</ENT>
                            <ENT>12.03</ENT>
                            <ENT>3.89</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">33496</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Repair, prosth valve clot</ENT>
                            <ENT>29.71</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>11.08</ENT>
                            <ENT>11.91</ENT>
                            <ENT>4.13</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">33500</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Repair heart vessel fistula</ENT>
                            <ENT>27.82</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>11.02</ENT>
                            <ENT>11.24</ENT>
                            <ENT>3.87</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">33501</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Repair heart vessel fistula</ENT>
                            <ENT>19.43</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>7.99</ENT>
                            <ENT>8.13</ENT>
                            <ENT>1.91</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">33502</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Coronary artery correction</ENT>
                            <ENT>21.69</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>9.33</ENT>
                            <ENT>10.19</ENT>
                            <ENT>3.00</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">33503</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Coronary artery graft</ENT>
                            <ENT>22.29</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>12.31</ENT>
                            <ENT>11.02</ENT>
                            <ENT>1.78</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">33504</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Coronary artery graft</ENT>
                            <ENT>25.30</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>10.58</ENT>
                            <ENT>11.19</ENT>
                            <ENT>3.36</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">33505</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Repair artery w/tunnel</ENT>
                            <ENT>38.35</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>15.12</ENT>
                            <ENT>14.01</ENT>
                            <ENT>2.19</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">33506</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Repair artery, translocation</ENT>
                            <ENT>37.80</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>12.69</ENT>
                            <ENT>13.62</ENT>
                            <ENT>4.66</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <PRTPAGE P="66445"/>
                            <ENT I="01">33507</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Repair art, intramural</ENT>
                            <ENT>31.35</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>11.08</ENT>
                            <ENT>12.36</ENT>
                            <ENT>4.06</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">33508</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Endoscopic vein harvest</ENT>
                            <ENT>0.31</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>0.09</ENT>
                            <ENT>0.10</ENT>
                            <ENT>0.04</ENT>
                            <ENT>ZZZ</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">33510</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>CABG, vein, single</ENT>
                            <ENT>34.87</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>12.90</ENT>
                            <ENT>14.61</ENT>
                            <ENT>4.41</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">33511</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>CABG, vein, two</ENT>
                            <ENT>38.34</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>14.15</ENT>
                            <ENT>15.60</ENT>
                            <ENT>4.56</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">33512</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>CABG, vein, three</ENT>
                            <ENT>43.87</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>15.93</ENT>
                            <ENT>16.76</ENT>
                            <ENT>4.67</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">33513</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>CABG, vein, four</ENT>
                            <ENT>45.26</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>16.36</ENT>
                            <ENT>17.07</ENT>
                            <ENT>4.88</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">33514</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>CABG, vein, five</ENT>
                            <ENT>47.97</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>17.33</ENT>
                            <ENT>17.69</ENT>
                            <ENT>4.77</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">33516</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Cabg, vein, six or more</ENT>
                            <ENT>49.65</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>17.95</ENT>
                            <ENT>18.37</ENT>
                            <ENT>5.13</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">33517</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>CABG, artery-vein, single</ENT>
                            <ENT>3.61</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>1.08</ENT>
                            <ENT>0.96</ENT>
                            <ENT>0.39</ENT>
                            <ENT>ZZZ</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">33518</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>CABG, artery-vein, two</ENT>
                            <ENT>7.93</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>2.36</ENT>
                            <ENT>1.97</ENT>
                            <ENT>0.73</ENT>
                            <ENT>ZZZ</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">33519</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>CABG, artery-vein, three</ENT>
                            <ENT>10.49</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>3.14</ENT>
                            <ENT>2.73</ENT>
                            <ENT>1.04</ENT>
                            <ENT>ZZZ</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">33521</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>CABG, artery-vein, four</ENT>
                            <ENT>12.59</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>3.77</ENT>
                            <ENT>3.42</ENT>
                            <ENT>1.37</ENT>
                            <ENT>ZZZ</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">33522</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>CABG, artery-vein, five</ENT>
                            <ENT>14.14</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>4.23</ENT>
                            <ENT>4.02</ENT>
                            <ENT>1.78</ENT>
                            <ENT>ZZZ</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">33523</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Cabg, art-vein, six or more</ENT>
                            <ENT>16.08</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>4.78</ENT>
                            <ENT>4.65</ENT>
                            <ENT>2.13</ENT>
                            <ENT>ZZZ</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">33530</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Coronary artery, bypass/reop</ENT>
                            <ENT>10.13</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>2.95</ENT>
                            <ENT>2.43</ENT>
                            <ENT>0.88</ENT>
                            <ENT>ZZZ</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">33533</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>CABG, arterial, single</ENT>
                            <ENT>33.64</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>12.55</ENT>
                            <ENT>14.50</ENT>
                            <ENT>4.56</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">33534</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>CABG, arterial, two</ENT>
                            <ENT>39.77</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>14.73</ENT>
                            <ENT>16.22</ENT>
                            <ENT>4.70</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">33535</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>CABG, arterial, three</ENT>
                            <ENT>44.64</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>16.29</ENT>
                            <ENT>17.20</ENT>
                            <ENT>5.03</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">33536</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Cabg, arterial, four or more</ENT>
                            <ENT>48.32</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>17.31</ENT>
                            <ENT>17.80</ENT>
                            <ENT>5.44</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">33542</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Removal of heart lesion</ENT>
                            <ENT>48.08</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>16.88</ENT>
                            <ENT>14.93</ENT>
                            <ENT>4.38</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">33545</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Repair of heart damage</ENT>
                            <ENT>56.93</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>20.13</ENT>
                            <ENT>17.87</ENT>
                            <ENT>5.21</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">33548</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Restore/remodel, ventricle</ENT>
                            <ENT>53.96</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>19.32</ENT>
                            <ENT>19.30</ENT>
                            <ENT>5.53</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">33572</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Open coronary endarterectomy</ENT>
                            <ENT>4.44</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>1.31</ENT>
                            <ENT>1.38</ENT>
                            <ENT>0.65</ENT>
                            <ENT>ZZZ</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">33600</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Closure of valve</ENT>
                            <ENT>30.15</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>12.14</ENT>
                            <ENT>12.32</ENT>
                            <ENT>4.42</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">33602</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Closure of valve</ENT>
                            <ENT>29.18</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>11.16</ENT>
                            <ENT>11.80</ENT>
                            <ENT>3.82</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">33606</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Anastomosis/artery-aorta</ENT>
                            <ENT>31.37</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>11.90</ENT>
                            <ENT>12.78</ENT>
                            <ENT>4.41</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">33608</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Repair anomaly w/conduit</ENT>
                            <ENT>31.72</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>12.85</ENT>
                            <ENT>13.47</ENT>
                            <ENT>4.74</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">33610</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Repair by enlargement</ENT>
                            <ENT>31.24</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>13.54</ENT>
                            <ENT>13.57</ENT>
                            <ENT>4.56</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">33611</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Repair double ventricle</ENT>
                            <ENT>35.49</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>12.36</ENT>
                            <ENT>13.24</ENT>
                            <ENT>4.37</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">33612</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Repair double ventricle</ENT>
                            <ENT>36.49</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>14.30</ENT>
                            <ENT>14.72</ENT>
                            <ENT>5.30</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">33615</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Repair, modified fontan</ENT>
                            <ENT>35.76</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>13.78</ENT>
                            <ENT>13.46</ENT>
                            <ENT>4.32</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">33617</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Repair single ventricle</ENT>
                            <ENT>38.96</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>13.94</ENT>
                            <ENT>14.96</ENT>
                            <ENT>5.66</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">33619</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Repair single ventricle</ENT>
                            <ENT>48.60</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>17.97</ENT>
                            <ENT>19.38</ENT>
                            <ENT>6.46</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">33641</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Repair heart septum defect</ENT>
                            <ENT>29.50</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>10.88</ENT>
                            <ENT>10.22</ENT>
                            <ENT>3.23</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">33645</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Revision of heart veins</ENT>
                            <ENT>27.98</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>10.66</ENT>
                            <ENT>11.21</ENT>
                            <ENT>3.79</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">33647</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Repair heart septum defects</ENT>
                            <ENT>29.37</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>12.70</ENT>
                            <ENT>13.23</ENT>
                            <ENT>3.32</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">33660</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Repair of heart defects</ENT>
                            <ENT>31.75</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>11.82</ENT>
                            <ENT>12.65</ENT>
                            <ENT>4.49</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">33665</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Repair of heart defects</ENT>
                            <ENT>34.77</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>12.16</ENT>
                            <ENT>12.99</ENT>
                            <ENT>4.00</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">33670</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Repair of heart chambers</ENT>
                            <ENT>36.58</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>15.62</ENT>
                            <ENT>14.39</ENT>
                            <ENT>4.65</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">33675</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Close mult vsd</ENT>
                            <ENT>35.87</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>15.74</ENT>
                            <ENT>15.74</ENT>
                            <ENT>4.95</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">33676</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Close mult vsd w/resection</ENT>
                            <ENT>36.87</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>16.04</ENT>
                            <ENT>16.04</ENT>
                            <ENT>5.44</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">33677</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Cl mult vsd w/rem pul band</ENT>
                            <ENT>38.37</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>16.61</ENT>
                            <ENT>16.61</ENT>
                            <ENT>5.68</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">33681</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Repair heart septum defect</ENT>
                            <ENT>32.16</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>12.87</ENT>
                            <ENT>13.77</ENT>
                            <ENT>4.45</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">33684</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Repair heart septum defect</ENT>
                            <ENT>34.29</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>13.28</ENT>
                            <ENT>13.45</ENT>
                            <ENT>3.39</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">33688</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Repair heart septum defect</ENT>
                            <ENT>34.67</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>11.61</ENT>
                            <ENT>11.04</ENT>
                            <ENT>4.73</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">33690</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Reinforce pulmonary artery</ENT>
                            <ENT>20.20</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>8.63</ENT>
                            <ENT>9.39</ENT>
                            <ENT>1.97</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">33692</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Repair of heart defects</ENT>
                            <ENT>31.38</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>19.57</ENT>
                            <ENT>16.74</ENT>
                            <ENT>4.58</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">33694</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Repair of heart defects</ENT>
                            <ENT>35.49</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>10.04</ENT>
                            <ENT>12.12</ENT>
                            <ENT>5.28</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">33697</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Repair of heart defects</ENT>
                            <ENT>37.49</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>16.93</ENT>
                            <ENT>15.90</ENT>
                            <ENT>4.09</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">33702</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Repair of heart defects</ENT>
                            <ENT>27.11</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>10.52</ENT>
                            <ENT>11.54</ENT>
                            <ENT>3.68</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">33710</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Repair of heart defects</ENT>
                            <ENT>30.28</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>11.25</ENT>
                            <ENT>12.60</ENT>
                            <ENT>4.43</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">33720</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Repair of heart defect</ENT>
                            <ENT>27.13</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>10.68</ENT>
                            <ENT>11.48</ENT>
                            <ENT>3.84</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">33722</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Repair of heart defect</ENT>
                            <ENT>29.05</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>10.60</ENT>
                            <ENT>12.22</ENT>
                            <ENT>1.30</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">33724</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Repair venous anomaly</ENT>
                            <ENT>27.55</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>10.37</ENT>
                            <ENT>10.37</ENT>
                            <ENT>4.00</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">33726</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Repair pul venous stenosis</ENT>
                            <ENT>37.04</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>13.21</ENT>
                            <ENT>13.21</ENT>
                            <ENT>5.03</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">33730</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Repair heart-vein defect(s)</ENT>
                            <ENT>36.01</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>12.85</ENT>
                            <ENT>13.48</ENT>
                            <ENT>5.03</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">33732</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Repair heart-vein defect</ENT>
                            <ENT>28.80</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>12.65</ENT>
                            <ENT>13.01</ENT>
                            <ENT>3.68</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">33735</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Revision of heart chamber</ENT>
                            <ENT>22.04</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>11.03</ENT>
                            <ENT>9.99</ENT>
                            <ENT>1.92</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">33736</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Revision of heart chamber</ENT>
                            <ENT>24.16</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>12.06</ENT>
                            <ENT>11.95</ENT>
                            <ENT>3.09</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">33737</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Revision of heart chamber</ENT>
                            <ENT>22.34</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>9.12</ENT>
                            <ENT>10.02</ENT>
                            <ENT>3.25</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">33750</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Major vessel shunt</ENT>
                            <ENT>22.06</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>9.42</ENT>
                            <ENT>9.81</ENT>
                            <ENT>1.16</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">33755</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Major vessel shunt</ENT>
                            <ENT>22.44</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>7.79</ENT>
                            <ENT>8.29</ENT>
                            <ENT>3.26</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">33762</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Major vessel shunt</ENT>
                            <ENT>22.44</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>8.68</ENT>
                            <ENT>9.41</ENT>
                            <ENT>3.14</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">33764</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Major vessel shunt &amp; graft</ENT>
                            <ENT>22.44</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>8.94</ENT>
                            <ENT>9.58</ENT>
                            <ENT>3.01</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">33766</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Major vessel shunt</ENT>
                            <ENT>23.41</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>8.47</ENT>
                            <ENT>10.06</ENT>
                            <ENT>3.70</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">33767</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Major vessel shunt</ENT>
                            <ENT>25.14</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>8.50</ENT>
                            <ENT>10.11</ENT>
                            <ENT>3.82</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">33768</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Cavopulmonary shunting</ENT>
                            <ENT>8.00</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>1.84</ENT>
                            <ENT>2.25</ENT>
                            <ENT>1.19</ENT>
                            <ENT>ZZZ</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">33770</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Repair great vessels defect</ENT>
                            <ENT>39.02</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>11.91</ENT>
                            <ENT>13.29</ENT>
                            <ENT>5.74</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">33771</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Repair great vessels defect</ENT>
                            <ENT>40.58</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>13.07</ENT>
                            <ENT>12.73</ENT>
                            <ENT>5.68</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">33774</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Repair great vessels defect</ENT>
                            <ENT>31.54</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>12.19</ENT>
                            <ENT>13.42</ENT>
                            <ENT>4.81</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">33775</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Repair great vessels defect</ENT>
                            <ENT>32.83</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>10.09</ENT>
                            <ENT>12.54</ENT>
                            <ENT>4.99</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">33776</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Repair great vessels defect</ENT>
                            <ENT>34.53</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>10.24</ENT>
                            <ENT>13.02</ENT>
                            <ENT>5.09</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <PRTPAGE P="66446"/>
                            <ENT I="01">33777</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Repair great vessels defect</ENT>
                            <ENT>33.95</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>9.91</ENT>
                            <ENT>12.76</ENT>
                            <ENT>5.49</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">33778</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Repair great vessels defect</ENT>
                            <ENT>42.62</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>14.91</ENT>
                            <ENT>15.90</ENT>
                            <ENT>6.20</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">33779</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Repair great vessels defect</ENT>
                            <ENT>43.15</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>12.44</ENT>
                            <ENT>13.90</ENT>
                            <ENT>2.92</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">33780</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Repair great vessels defect</ENT>
                            <ENT>43.85</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>13.13</ENT>
                            <ENT>16.10</ENT>
                            <ENT>3.68</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">33781</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Repair great vessels defect</ENT>
                            <ENT>43.16</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>11.11</ENT>
                            <ENT>12.22</ENT>
                            <ENT>5.97</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">33786</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Repair arterial trunk</ENT>
                            <ENT>41.74</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>14.09</ENT>
                            <ENT>15.40</ENT>
                            <ENT>5.71</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">33788</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Revision of pulmonary artery</ENT>
                            <ENT>27.26</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>8.24</ENT>
                            <ENT>10.09</ENT>
                            <ENT>4.03</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">33800</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Aortic suspension</ENT>
                            <ENT>17.23</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>6.82</ENT>
                            <ENT>7.46</ENT>
                            <ENT>2.46</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">33802</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Repair vessel defect</ENT>
                            <ENT>18.24</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>7.94</ENT>
                            <ENT>8.58</ENT>
                            <ENT>2.27</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">33803</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Repair vessel defect</ENT>
                            <ENT>20.18</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>6.38</ENT>
                            <ENT>8.07</ENT>
                            <ENT>3.20</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">33813</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Repair septal defect</ENT>
                            <ENT>21.23</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>8.80</ENT>
                            <ENT>9.85</ENT>
                            <ENT>3.13</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">33814</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Repair septal defect</ENT>
                            <ENT>26.41</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>10.39</ENT>
                            <ENT>11.52</ENT>
                            <ENT>3.85</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">33820</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Revise major vessel</ENT>
                            <ENT>16.61</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>6.95</ENT>
                            <ENT>7.65</ENT>
                            <ENT>2.35</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">33822</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Revise major vessel</ENT>
                            <ENT>17.63</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>5.93</ENT>
                            <ENT>7.44</ENT>
                            <ENT>2.68</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">33824</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Revise major vessel</ENT>
                            <ENT>20.10</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>8.45</ENT>
                            <ENT>9.21</ENT>
                            <ENT>2.89</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">33840</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Remove aorta constriction</ENT>
                            <ENT>21.21</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>9.33</ENT>
                            <ENT>9.81</ENT>
                            <ENT>2.16</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">33845</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Remove aorta constriction</ENT>
                            <ENT>22.77</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>9.37</ENT>
                            <ENT>10.36</ENT>
                            <ENT>3.22</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">33851</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Remove aorta constriction</ENT>
                            <ENT>21.85</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>8.87</ENT>
                            <ENT>9.77</ENT>
                            <ENT>3.18</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">33852</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Repair septal defect</ENT>
                            <ENT>24.28</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>14.75</ENT>
                            <ENT>13.05</ENT>
                            <ENT>2.16</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">33853</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Repair septal defect</ENT>
                            <ENT>32.35</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>12.24</ENT>
                            <ENT>13.53</ENT>
                            <ENT>4.48</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">33860</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Ascending aortic graft</ENT>
                            <ENT>59.33</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>20.20</ENT>
                            <ENT>18.32</ENT>
                            <ENT>5.76</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">33861</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Ascending aortic graft</ENT>
                            <ENT>43.94</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>15.69</ENT>
                            <ENT>16.69</ENT>
                            <ENT>6.37</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">33863</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Ascending aortic graft</ENT>
                            <ENT>58.71</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>19.58</ENT>
                            <ENT>19.13</ENT>
                            <ENT>6.59</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">33864</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Ascending aortic graft</ENT>
                            <ENT>60.00</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>20.09</ENT>
                            <ENT>20.09</ENT>
                            <ENT>6.73</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">33870</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Transverse aortic arch graft</ENT>
                            <ENT>45.93</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>16.27</ENT>
                            <ENT>17.32</ENT>
                            <ENT>6.62</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">33875</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Thoracic aortic graft</ENT>
                            <ENT>35.68</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>12.90</ENT>
                            <ENT>13.49</ENT>
                            <ENT>4.89</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">33877</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Thoracoabdominal graft</ENT>
                            <ENT>68.85</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>21.00</ENT>
                            <ENT>18.65</ENT>
                            <ENT>5.94</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">33880</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Endovasc taa repr incl subcl</ENT>
                            <ENT>34.48</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>10.91</ENT>
                            <ENT>12.19</ENT>
                            <ENT>2.75</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">33881</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Endovasc taa repr w/o subcl</ENT>
                            <ENT>29.48</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>9.66</ENT>
                            <ENT>10.80</ENT>
                            <ENT>2.33</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">33883</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Insert endovasc prosth, taa</ENT>
                            <ENT>20.99</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>7.23</ENT>
                            <ENT>8.20</ENT>
                            <ENT>2.11</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">33884</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Endovasc prosth, taa, add-on</ENT>
                            <ENT>8.20</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>2.08</ENT>
                            <ENT>2.33</ENT>
                            <ENT>0.86</ENT>
                            <ENT>ZZZ</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">33886</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Endovasc prosth, delayed</ENT>
                            <ENT>17.99</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>6.33</ENT>
                            <ENT>7.28</ENT>
                            <ENT>1.80</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">33889</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Artery transpose/endovas taa</ENT>
                            <ENT>15.92</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>3.98</ENT>
                            <ENT>4.58</ENT>
                            <ENT>2.18</ENT>
                            <ENT>000</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">33891</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Car-car bp grft/endovas taa</ENT>
                            <ENT>20.00</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>5.81</ENT>
                            <ENT>6.38</ENT>
                            <ENT>2.73</ENT>
                            <ENT>000</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">33910</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Remove lung artery emboli</ENT>
                            <ENT>29.59</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>11.34</ENT>
                            <ENT>11.38</ENT>
                            <ENT>3.70</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">33915</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Remove lung artery emboli</ENT>
                            <ENT>24.83</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>9.11</ENT>
                            <ENT>9.37</ENT>
                            <ENT>1.44</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">33916</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Surgery of great vessel</ENT>
                            <ENT>28.30</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>10.82</ENT>
                            <ENT>11.07</ENT>
                            <ENT>3.67</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">33917</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Repair pulmonary artery</ENT>
                            <ENT>25.14</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>10.02</ENT>
                            <ENT>11.10</ENT>
                            <ENT>3.70</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">33920</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Repair pulmonary atresia</ENT>
                            <ENT>32.58</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>9.46</ENT>
                            <ENT>11.64</ENT>
                            <ENT>4.38</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">33922</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Transect pulmonary artery</ENT>
                            <ENT>24.09</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>10.24</ENT>
                            <ENT>10.57</ENT>
                            <ENT>3.10</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">33924</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Remove pulmonary shunt</ENT>
                            <ENT>5.49</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>1.59</ENT>
                            <ENT>1.72</ENT>
                            <ENT>0.82</ENT>
                            <ENT>ZZZ</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">33925</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Rpr pul art unifocal w/o cpb</ENT>
                            <ENT>31.25</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>16.42</ENT>
                            <ENT>15.54</ENT>
                            <ENT>4.61</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">33926</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Repr pul art, unifocal w/cpb</ENT>
                            <ENT>44.68</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>14.79</ENT>
                            <ENT>16.23</ENT>
                            <ENT>6.22</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">33930</ENT>
                            <ENT/>
                            <ENT>X</ENT>
                            <ENT>Removal of donor heart/lung</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>XXX</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">33933</ENT>
                            <ENT/>
                            <ENT>C</ENT>
                            <ENT>Prepare donor heart/lung</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>XXX</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">33935</ENT>
                            <ENT/>
                            <ENT>R</ENT>
                            <ENT>Transplantation, heart/lung</ENT>
                            <ENT>61.68</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>22.94</ENT>
                            <ENT>25.84</ENT>
                            <ENT>9.06</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">33940</ENT>
                            <ENT/>
                            <ENT>X</ENT>
                            <ENT>Removal of donor heart</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>XXX</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">33944</ENT>
                            <ENT/>
                            <ENT>C</ENT>
                            <ENT>Prepare donor heart</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>XXX</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">33945</ENT>
                            <ENT/>
                            <ENT>R</ENT>
                            <ENT>Transplantation of heart</ENT>
                            <ENT>89.08</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>30.37</ENT>
                            <ENT>25.87</ENT>
                            <ENT>6.26</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">33960</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>External circulation assist</ENT>
                            <ENT>19.33</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>5.25</ENT>
                            <ENT>5.08</ENT>
                            <ENT>2.67</ENT>
                            <ENT>000</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">33961</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>External circulation assist</ENT>
                            <ENT>10.91</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>2.98</ENT>
                            <ENT>3.30</ENT>
                            <ENT>0.88</ENT>
                            <ENT>ZZZ</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">33967</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Insert ia percut device</ENT>
                            <ENT>4.84</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>2.40</ENT>
                            <ENT>2.12</ENT>
                            <ENT>0.35</ENT>
                            <ENT>000</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">33968</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Remove aortic assist device</ENT>
                            <ENT>0.64</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>0.26</ENT>
                            <ENT>0.24</ENT>
                            <ENT>0.07</ENT>
                            <ENT>000</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">33970</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Aortic circulation assist</ENT>
                            <ENT>6.74</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>2.53</ENT>
                            <ENT>2.41</ENT>
                            <ENT>0.82</ENT>
                            <ENT>000</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">33971</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Aortic circulation assist</ENT>
                            <ENT>11.91</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>6.00</ENT>
                            <ENT>6.00</ENT>
                            <ENT>1.25</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">33973</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Insert balloon device</ENT>
                            <ENT>9.75</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>3.94</ENT>
                            <ENT>3.62</ENT>
                            <ENT>1.26</ENT>
                            <ENT>000</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">33974</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Remove intra-aortic balloon</ENT>
                            <ENT>14.93</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>7.73</ENT>
                            <ENT>7.80</ENT>
                            <ENT>1.74</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">33975</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Implant ventricular device</ENT>
                            <ENT>20.97</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>6.29</ENT>
                            <ENT>6.29</ENT>
                            <ENT>3.07</ENT>
                            <ENT>XXX</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">33976</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Implant ventricular device</ENT>
                            <ENT>22.97</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>7.66</ENT>
                            <ENT>7.60</ENT>
                            <ENT>3.26</ENT>
                            <ENT>XXX</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">33977</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Remove ventricular device</ENT>
                            <ENT>20.07</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>9.41</ENT>
                            <ENT>10.23</ENT>
                            <ENT>2.81</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">33978</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Remove ventricular device</ENT>
                            <ENT>22.51</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>10.42</ENT>
                            <ENT>11.08</ENT>
                            <ENT>3.31</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">33979</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Insert intracorporeal device</ENT>
                            <ENT>45.93</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>13.28</ENT>
                            <ENT>14.09</ENT>
                            <ENT>6.97</ENT>
                            <ENT>XXX</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">33980</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Remove intracorporeal device</ENT>
                            <ENT>64.86</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>23.06</ENT>
                            <ENT>24.14</ENT>
                            <ENT>8.59</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">33999</ENT>
                            <ENT/>
                            <ENT>C</ENT>
                            <ENT>Cardiac surgery procedure</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>YYY</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">34001</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Removal of artery clot</ENT>
                            <ENT>17.78</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>6.36</ENT>
                            <ENT>6.53</ENT>
                            <ENT>1.85</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">34051</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Removal of artery clot</ENT>
                            <ENT>16.91</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>7.43</ENT>
                            <ENT>7.60</ENT>
                            <ENT>2.21</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">34101</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Removal of artery clot</ENT>
                            <ENT>10.85</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>4.30</ENT>
                            <ENT>4.82</ENT>
                            <ENT>1.41</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">34111</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Removal of arm artery clot</ENT>
                            <ENT>10.85</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>4.28</ENT>
                            <ENT>4.82</ENT>
                            <ENT>1.40</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">34151</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Removal of artery clot</ENT>
                            <ENT>26.41</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>8.65</ENT>
                            <ENT>9.52</ENT>
                            <ENT>3.56</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">34201</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Removal of artery clot</ENT>
                            <ENT>19.38</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>6.54</ENT>
                            <ENT>5.98</ENT>
                            <ENT>1.45</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">34203</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Removal of leg artery clot</ENT>
                            <ENT>17.73</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>6.38</ENT>
                            <ENT>7.21</ENT>
                            <ENT>2.36</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">34401</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Removal of vein clot</ENT>
                            <ENT>26.41</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>9.26</ENT>
                            <ENT>9.96</ENT>
                            <ENT>3.10</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <PRTPAGE P="66447"/>
                            <ENT I="01">34421</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Removal of vein clot</ENT>
                            <ENT>13.29</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>5.19</ENT>
                            <ENT>5.74</ENT>
                            <ENT>1.55</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">34451</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Removal of vein clot</ENT>
                            <ENT>28.41</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>9.38</ENT>
                            <ENT>10.40</ENT>
                            <ENT>3.84</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">34471</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Removal of vein clot</ENT>
                            <ENT>21.00</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>7.86</ENT>
                            <ENT>6.58</ENT>
                            <ENT>1.18</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">34490</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Removal of vein clot</ENT>
                            <ENT>10.83</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>4.34</ENT>
                            <ENT>4.88</ENT>
                            <ENT>1.41</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">34501</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Repair valve, femoral vein</ENT>
                            <ENT>16.74</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>6.42</ENT>
                            <ENT>7.45</ENT>
                            <ENT>2.35</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">34502</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Reconstruct vena cava</ENT>
                            <ENT>27.86</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>10.47</ENT>
                            <ENT>11.38</ENT>
                            <ENT>3.63</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">34510</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Transposition of vein valve</ENT>
                            <ENT>19.80</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>7.52</ENT>
                            <ENT>8.46</ENT>
                            <ENT>2.33</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">34520</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Cross-over vein graft</ENT>
                            <ENT>19.05</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>7.01</ENT>
                            <ENT>7.73</ENT>
                            <ENT>2.29</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">34530</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Leg vein fusion</ENT>
                            <ENT>17.77</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>6.76</ENT>
                            <ENT>7.68</ENT>
                            <ENT>1.74</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">34800</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Endovas aaa repr w/sm tube</ENT>
                            <ENT>21.46</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>7.25</ENT>
                            <ENT>8.20</ENT>
                            <ENT>2.46</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">34802</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Endovas aaa repr w/2-p part</ENT>
                            <ENT>23.71</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>8.17</ENT>
                            <ENT>8.97</ENT>
                            <ENT>2.33</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">34803</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Endovas aaa repr w/3-p part</ENT>
                            <ENT>24.74</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>8.01</ENT>
                            <ENT>9.11</ENT>
                            <ENT>2.01</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">34804</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Endovas aaa repr w/1-p part</ENT>
                            <ENT>23.71</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>8.06</ENT>
                            <ENT>8.93</ENT>
                            <ENT>2.30</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">34805</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Endovas aaa repr w/long tube</ENT>
                            <ENT>22.59</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>7.26</ENT>
                            <ENT>8.45</ENT>
                            <ENT>2.01</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">34806</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Aneurysm press sensor add-on</ENT>
                            <ENT>2.06</ENT>
                            <ENT>0.51</ENT>
                            <ENT>0.51</ENT>
                            <ENT>0.51</ENT>
                            <ENT>0.51</ENT>
                            <ENT>0.30</ENT>
                            <ENT>ZZZ</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">34808</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Endovas iliac a device addon</ENT>
                            <ENT>4.12</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>1.05</ENT>
                            <ENT>1.21</ENT>
                            <ENT>0.59</ENT>
                            <ENT>ZZZ</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">34812</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Xpose for endoprosth, femorl</ENT>
                            <ENT>6.74</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>1.66</ENT>
                            <ENT>1.95</ENT>
                            <ENT>1.18</ENT>
                            <ENT>000</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">34813</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Femoral endovas graft add-on</ENT>
                            <ENT>4.79</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>1.16</ENT>
                            <ENT>1.36</ENT>
                            <ENT>0.67</ENT>
                            <ENT>ZZZ</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">34820</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Xpose for endoprosth, iliac</ENT>
                            <ENT>9.74</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>2.45</ENT>
                            <ENT>2.84</ENT>
                            <ENT>1.50</ENT>
                            <ENT>000</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">34825</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Endovasc extend prosth, init</ENT>
                            <ENT>12.72</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>5.14</ENT>
                            <ENT>5.64</ENT>
                            <ENT>1.28</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">34826</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Endovasc exten prosth, add'l</ENT>
                            <ENT>4.12</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>1.14</ENT>
                            <ENT>1.25</ENT>
                            <ENT>0.44</ENT>
                            <ENT>ZZZ</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">34830</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Open aortic tube prosth repr</ENT>
                            <ENT>35.10</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>10.33</ENT>
                            <ENT>12.01</ENT>
                            <ENT>4.55</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">34831</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Open aortoiliac prosth repr</ENT>
                            <ENT>37.85</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>11.27</ENT>
                            <ENT>11.49</ENT>
                            <ENT>4.89</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">34832</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Open aortofemor prosth repr</ENT>
                            <ENT>37.85</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>11.80</ENT>
                            <ENT>13.21</ENT>
                            <ENT>4.85</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">34833</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Xpose for endoprosth, iliac</ENT>
                            <ENT>11.98</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>3.29</ENT>
                            <ENT>3.86</ENT>
                            <ENT>1.70</ENT>
                            <ENT>000</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">34834</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Xpose, endoprosth, brachial</ENT>
                            <ENT>5.34</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>1.57</ENT>
                            <ENT>1.88</ENT>
                            <ENT>0.76</ENT>
                            <ENT>000</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">34900</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Endovasc iliac repr w/graft</ENT>
                            <ENT>16.77</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>6.05</ENT>
                            <ENT>6.81</ENT>
                            <ENT>2.00</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">35001</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Repair defect of artery</ENT>
                            <ENT>20.70</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>7.70</ENT>
                            <ENT>8.62</ENT>
                            <ENT>2.81</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">35002</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Repair artery rupture, neck</ENT>
                            <ENT>22.12</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>7.51</ENT>
                            <ENT>8.60</ENT>
                            <ENT>3.00</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">35005</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Repair defect of artery</ENT>
                            <ENT>19.18</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>8.52</ENT>
                            <ENT>8.68</ENT>
                            <ENT>1.77</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">35011</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Repair defect of artery</ENT>
                            <ENT>18.50</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>6.29</ENT>
                            <ENT>7.13</ENT>
                            <ENT>2.55</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">35013</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Repair artery rupture, arm</ENT>
                            <ENT>23.10</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>7.76</ENT>
                            <ENT>8.71</ENT>
                            <ENT>3.10</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">35021</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Repair defect of artery</ENT>
                            <ENT>22.09</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>8.46</ENT>
                            <ENT>8.93</ENT>
                            <ENT>2.87</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">35022</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Repair artery rupture, chest</ENT>
                            <ENT>25.62</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>10.57</ENT>
                            <ENT>10.21</ENT>
                            <ENT>3.17</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">35045</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Repair defect of arm artery</ENT>
                            <ENT>17.94</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>6.27</ENT>
                            <ENT>6.88</ENT>
                            <ENT>2.45</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">35081</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Repair defect of artery</ENT>
                            <ENT>33.37</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>10.70</ENT>
                            <ENT>11.08</ENT>
                            <ENT>4.01</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">35082</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Repair artery rupture, aorta</ENT>
                            <ENT>41.93</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>12.76</ENT>
                            <ENT>14.02</ENT>
                            <ENT>5.44</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">35091</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Repair defect of artery</ENT>
                            <ENT>35.35</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>9.99</ENT>
                            <ENT>11.77</ENT>
                            <ENT>5.14</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">35092</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Repair artery rupture, aorta</ENT>
                            <ENT>50.81</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>14.50</ENT>
                            <ENT>16.06</ENT>
                            <ENT>6.40</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">35102</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Repair defect of artery</ENT>
                            <ENT>36.37</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>11.28</ENT>
                            <ENT>11.82</ENT>
                            <ENT>4.48</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">35103</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Repair artery rupture, groin</ENT>
                            <ENT>43.49</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>12.63</ENT>
                            <ENT>14.23</ENT>
                            <ENT>5.76</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">35111</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Repair defect of artery</ENT>
                            <ENT>26.17</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>8.50</ENT>
                            <ENT>9.48</ENT>
                            <ENT>3.47</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">35112</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Repair artery rupture,spleen</ENT>
                            <ENT>32.44</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>10.07</ENT>
                            <ENT>11.01</ENT>
                            <ENT>4.08</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">35121</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Repair defect of artery</ENT>
                            <ENT>31.41</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>9.96</ENT>
                            <ENT>11.16</ENT>
                            <ENT>4.30</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">35122</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Repair artery rupture, belly</ENT>
                            <ENT>37.76</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>11.51</ENT>
                            <ENT>12.65</ENT>
                            <ENT>4.75</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">35131</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Repair defect of artery</ENT>
                            <ENT>26.29</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>8.63</ENT>
                            <ENT>9.68</ENT>
                            <ENT>3.80</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">35132</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Repair artery rupture, groin</ENT>
                            <ENT>32.44</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>10.28</ENT>
                            <ENT>11.32</ENT>
                            <ENT>4.30</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">35141</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Repair defect of artery</ENT>
                            <ENT>20.83</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>6.93</ENT>
                            <ENT>7.92</ENT>
                            <ENT>2.90</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">35142</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Repair artery rupture, thigh</ENT>
                            <ENT>25.03</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>8.24</ENT>
                            <ENT>9.30</ENT>
                            <ENT>3.36</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">35151</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Repair defect of artery</ENT>
                            <ENT>23.61</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>7.64</ENT>
                            <ENT>8.81</ENT>
                            <ENT>3.24</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">35152</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Repair artery rupture, knee</ENT>
                            <ENT>27.53</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>9.11</ENT>
                            <ENT>10.24</ENT>
                            <ENT>3.61</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">35180</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Repair blood vessel lesion</ENT>
                            <ENT>15.01</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>6.25</ENT>
                            <ENT>6.60</ENT>
                            <ENT>1.00</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">35182</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Repair blood vessel lesion</ENT>
                            <ENT>31.58</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>10.82</ENT>
                            <ENT>11.81</ENT>
                            <ENT>4.36</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">35184</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Repair blood vessel lesion</ENT>
                            <ENT>18.72</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>6.50</ENT>
                            <ENT>7.39</ENT>
                            <ENT>2.53</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">35188</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Repair blood vessel lesion</ENT>
                            <ENT>15.05</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>6.28</ENT>
                            <ENT>6.95</ENT>
                            <ENT>2.16</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">35189</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Repair blood vessel lesion</ENT>
                            <ENT>29.85</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>10.67</ENT>
                            <ENT>11.30</ENT>
                            <ENT>4.01</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">35190</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Repair blood vessel lesion</ENT>
                            <ENT>13.33</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>5.23</ENT>
                            <ENT>5.85</ENT>
                            <ENT>1.80</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">35201</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Repair blood vessel lesion</ENT>
                            <ENT>16.84</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>6.31</ENT>
                            <ENT>7.15</ENT>
                            <ENT>2.34</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">35206</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Repair blood vessel lesion</ENT>
                            <ENT>13.76</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>5.30</ENT>
                            <ENT>5.92</ENT>
                            <ENT>1.87</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">35207</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Repair blood vessel lesion</ENT>
                            <ENT>10.85</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>6.63</ENT>
                            <ENT>6.99</ENT>
                            <ENT>1.48</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">35211</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Repair blood vessel lesion</ENT>
                            <ENT>24.50</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>9.70</ENT>
                            <ENT>10.15</ENT>
                            <ENT>3.20</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">35216</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Repair blood vessel lesion</ENT>
                            <ENT>36.47</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>13.56</ENT>
                            <ENT>11.26</ENT>
                            <ENT>2.65</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">35221</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Repair blood vessel lesion</ENT>
                            <ENT>26.54</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>8.33</ENT>
                            <ENT>9.13</ENT>
                            <ENT>3.37</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">35226</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Repair blood vessel lesion</ENT>
                            <ENT>15.22</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>5.79</ENT>
                            <ENT>6.61</ENT>
                            <ENT>2.02</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">35231</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Repair blood vessel lesion</ENT>
                            <ENT>21.08</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>7.72</ENT>
                            <ENT>8.74</ENT>
                            <ENT>2.89</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">35236</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Repair blood vessel lesion</ENT>
                            <ENT>17.94</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>6.29</ENT>
                            <ENT>7.08</ENT>
                            <ENT>2.43</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">35241</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Repair blood vessel lesion</ENT>
                            <ENT>25.50</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>10.02</ENT>
                            <ENT>10.56</ENT>
                            <ENT>3.53</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">35246</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Repair blood vessel lesion</ENT>
                            <ENT>28.15</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>10.10</ENT>
                            <ENT>10.76</ENT>
                            <ENT>3.86</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">35251</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Repair blood vessel lesion</ENT>
                            <ENT>31.83</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>9.45</ENT>
                            <ENT>10.61</ENT>
                            <ENT>4.13</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">35256</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Repair blood vessel lesion</ENT>
                            <ENT>18.98</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>6.37</ENT>
                            <ENT>7.35</ENT>
                            <ENT>2.63</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">35261</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Repair blood vessel lesion</ENT>
                            <ENT>18.88</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>6.97</ENT>
                            <ENT>7.49</ENT>
                            <ENT>2.61</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">35266</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Repair blood vessel lesion</ENT>
                            <ENT>15.75</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>5.47</ENT>
                            <ENT>6.23</ENT>
                            <ENT>2.10</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <PRTPAGE P="66448"/>
                            <ENT I="01">35271</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Repair blood vessel lesion</ENT>
                            <ENT>24.50</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>9.68</ENT>
                            <ENT>10.09</ENT>
                            <ENT>3.16</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">35276</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Repair blood vessel lesion</ENT>
                            <ENT>25.72</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>9.78</ENT>
                            <ENT>10.48</ENT>
                            <ENT>3.49</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">35281</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Repair blood vessel lesion</ENT>
                            <ENT>29.93</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>9.28</ENT>
                            <ENT>10.48</ENT>
                            <ENT>3.97</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">35286</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Repair blood vessel lesion</ENT>
                            <ENT>17.06</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>6.31</ENT>
                            <ENT>7.17</ENT>
                            <ENT>2.35</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">35301</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Rechanneling of artery</ENT>
                            <ENT>19.53</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>6.68</ENT>
                            <ENT>7.55</ENT>
                            <ENT>2.68</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">35302</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Rechanneling of artery</ENT>
                            <ENT>21.27</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>6.90</ENT>
                            <ENT>6.90</ENT>
                            <ENT>2.98</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">35303</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Rechanneling of artery</ENT>
                            <ENT>23.52</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>7.45</ENT>
                            <ENT>7.45</ENT>
                            <ENT>3.26</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">35304</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Rechanneling of artery</ENT>
                            <ENT>24.52</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>7.70</ENT>
                            <ENT>7.70</ENT>
                            <ENT>3.41</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">35305</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Rechanneling of artery</ENT>
                            <ENT>23.52</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>7.45</ENT>
                            <ENT>7.45</ENT>
                            <ENT>3.26</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">35306</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Rechanneling of artery</ENT>
                            <ENT>9.25</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>2.28</ENT>
                            <ENT>2.28</ENT>
                            <ENT>1.34</ENT>
                            <ENT>ZZZ</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">35311</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Rechanneling of artery</ENT>
                            <ENT>28.52</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>9.63</ENT>
                            <ENT>10.68</ENT>
                            <ENT>3.42</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">35321</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Rechanneling of artery</ENT>
                            <ENT>16.51</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>5.77</ENT>
                            <ENT>6.57</ENT>
                            <ENT>2.25</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">35331</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Rechanneling of artery</ENT>
                            <ENT>27.61</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>8.81</ENT>
                            <ENT>10.01</ENT>
                            <ENT>3.83</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">35341</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Rechanneling of artery</ENT>
                            <ENT>26.10</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>8.24</ENT>
                            <ENT>9.55</ENT>
                            <ENT>3.78</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">35351</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Rechanneling of artery</ENT>
                            <ENT>24.53</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>7.64</ENT>
                            <ENT>8.61</ENT>
                            <ENT>3.35</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">35355</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Rechanneling of artery</ENT>
                            <ENT>19.78</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>6.35</ENT>
                            <ENT>7.21</ENT>
                            <ENT>2.67</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">35361</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Rechanneling of artery</ENT>
                            <ENT>30.11</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>9.59</ENT>
                            <ENT>10.64</ENT>
                            <ENT>4.15</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">35363</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Rechanneling of artery</ENT>
                            <ENT>32.22</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>10.43</ENT>
                            <ENT>11.50</ENT>
                            <ENT>4.33</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">35371</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Rechanneling of artery</ENT>
                            <ENT>15.23</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>5.33</ENT>
                            <ENT>6.14</ENT>
                            <ENT>2.14</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">35372</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Rechanneling of artery</ENT>
                            <ENT>18.50</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>6.12</ENT>
                            <ENT>7.08</ENT>
                            <ENT>2.63</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">35390</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Reoperation, carotid add-on</ENT>
                            <ENT>3.19</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>0.82</ENT>
                            <ENT>0.94</ENT>
                            <ENT>0.46</ENT>
                            <ENT>ZZZ</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">35400</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Angioscopy</ENT>
                            <ENT>3.00</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>0.72</ENT>
                            <ENT>0.91</ENT>
                            <ENT>0.43</ENT>
                            <ENT>ZZZ</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">35450</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Repair arterial blockage</ENT>
                            <ENT>10.05</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>2.97</ENT>
                            <ENT>3.26</ENT>
                            <ENT>1.25</ENT>
                            <ENT>000</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">35452</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Repair arterial blockage</ENT>
                            <ENT>6.90</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>2.06</ENT>
                            <ENT>2.33</ENT>
                            <ENT>0.94</ENT>
                            <ENT>000</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">35454</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Repair arterial blockage</ENT>
                            <ENT>6.03</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>1.76</ENT>
                            <ENT>2.04</ENT>
                            <ENT>0.87</ENT>
                            <ENT>000</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">35456</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Repair arterial blockage</ENT>
                            <ENT>7.34</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>2.12</ENT>
                            <ENT>2.44</ENT>
                            <ENT>1.04</ENT>
                            <ENT>000</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">35458</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Repair arterial blockage</ENT>
                            <ENT>9.48</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>2.80</ENT>
                            <ENT>3.13</ENT>
                            <ENT>1.26</ENT>
                            <ENT>000</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">35459</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Repair arterial blockage</ENT>
                            <ENT>8.62</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>2.65</ENT>
                            <ENT>2.91</ENT>
                            <ENT>1.21</ENT>
                            <ENT>000</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">35460</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Repair venous blockage</ENT>
                            <ENT>6.03</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>1.74</ENT>
                            <ENT>2.01</ENT>
                            <ENT>0.83</ENT>
                            <ENT>000</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">35470</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Repair arterial blockage</ENT>
                            <ENT>8.62</ENT>
                            <ENT>61.12</ENT>
                            <ENT>74.97</ENT>
                            <ENT>3.44</ENT>
                            <ENT>3.39</ENT>
                            <ENT>0.69</ENT>
                            <ENT>000</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">35471</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Repair arterial blockage</ENT>
                            <ENT>10.05</ENT>
                            <ENT>65.97</ENT>
                            <ENT>83.09</ENT>
                            <ENT>4.68</ENT>
                            <ENT>4.31</ENT>
                            <ENT>0.67</ENT>
                            <ENT>000</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">35472</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Repair arterial blockage</ENT>
                            <ENT>6.90</ENT>
                            <ENT>47.48</ENT>
                            <ENT>55.90</ENT>
                            <ENT>2.81</ENT>
                            <ENT>2.78</ENT>
                            <ENT>0.58</ENT>
                            <ENT>000</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">35473</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Repair arterial blockage</ENT>
                            <ENT>6.03</ENT>
                            <ENT>46.50</ENT>
                            <ENT>53.15</ENT>
                            <ENT>2.49</ENT>
                            <ENT>2.46</ENT>
                            <ENT>0.51</ENT>
                            <ENT>000</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">35474</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Repair arterial blockage</ENT>
                            <ENT>7.35</ENT>
                            <ENT>60.37</ENT>
                            <ENT>74.03</ENT>
                            <ENT>2.98</ENT>
                            <ENT>2.93</ENT>
                            <ENT>0.57</ENT>
                            <ENT>000</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">35475</ENT>
                            <ENT/>
                            <ENT>R</ENT>
                            <ENT>Repair arterial blockage</ENT>
                            <ENT>9.48</ENT>
                            <ENT>48.63</ENT>
                            <ENT>52.35</ENT>
                            <ENT>3.38</ENT>
                            <ENT>3.47</ENT>
                            <ENT>0.62</ENT>
                            <ENT>000</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">35476</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Repair venous blockage</ENT>
                            <ENT>6.03</ENT>
                            <ENT>37.11</ENT>
                            <ENT>40.91</ENT>
                            <ENT>2.23</ENT>
                            <ENT>2.29</ENT>
                            <ENT>0.34</ENT>
                            <ENT>000</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">35480</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Atherectomy, open</ENT>
                            <ENT>11.06</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>4.04</ENT>
                            <ENT>4.04</ENT>
                            <ENT>1.28</ENT>
                            <ENT>000</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">35481</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Atherectomy, open</ENT>
                            <ENT>7.60</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>2.57</ENT>
                            <ENT>2.72</ENT>
                            <ENT>1.13</ENT>
                            <ENT>000</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">35482</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Atherectomy, open</ENT>
                            <ENT>6.64</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>2.01</ENT>
                            <ENT>2.28</ENT>
                            <ENT>0.89</ENT>
                            <ENT>000</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">35483</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Atherectomy, open</ENT>
                            <ENT>8.09</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>2.56</ENT>
                            <ENT>2.79</ENT>
                            <ENT>1.15</ENT>
                            <ENT>000</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">35484</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Atherectomy, open</ENT>
                            <ENT>10.42</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>2.90</ENT>
                            <ENT>3.33</ENT>
                            <ENT>1.27</ENT>
                            <ENT>000</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">35485</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Atherectomy, open</ENT>
                            <ENT>9.48</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>2.87</ENT>
                            <ENT>3.20</ENT>
                            <ENT>1.35</ENT>
                            <ENT>000</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">35490</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Atherectomy, percutaneous</ENT>
                            <ENT>11.06</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>5.17</ENT>
                            <ENT>4.93</ENT>
                            <ENT>0.71</ENT>
                            <ENT>000</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">35491</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Atherectomy, percutaneous</ENT>
                            <ENT>7.60</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>3.85</ENT>
                            <ENT>3.57</ENT>
                            <ENT>0.74</ENT>
                            <ENT>000</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">35492</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Atherectomy, percutaneous</ENT>
                            <ENT>6.64</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>3.48</ENT>
                            <ENT>3.34</ENT>
                            <ENT>0.43</ENT>
                            <ENT>000</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">35493</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Atherectomy, percutaneous</ENT>
                            <ENT>8.09</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>3.96</ENT>
                            <ENT>3.88</ENT>
                            <ENT>0.56</ENT>
                            <ENT>000</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">35494</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Atherectomy, percutaneous</ENT>
                            <ENT>10.42</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>5.15</ENT>
                            <ENT>4.80</ENT>
                            <ENT>0.59</ENT>
                            <ENT>000</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">35495</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Atherectomy, percutaneous</ENT>
                            <ENT>9.48</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>4.45</ENT>
                            <ENT>4.42</ENT>
                            <ENT>0.69</ENT>
                            <ENT>000</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">35500</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Harvest vein for bypass</ENT>
                            <ENT>6.44</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>1.59</ENT>
                            <ENT>1.81</ENT>
                            <ENT>0.93</ENT>
                            <ENT>ZZZ</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">35501</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Artery bypass graft</ENT>
                            <ENT>28.99</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>11.06</ENT>
                            <ENT>9.75</ENT>
                            <ENT>4.10</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">35506</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Artery bypass graft</ENT>
                            <ENT>25.23</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>8.31</ENT>
                            <ENT>8.88</ENT>
                            <ENT>2.87</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">35508</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Artery bypass graft</ENT>
                            <ENT>25.99</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>8.76</ENT>
                            <ENT>9.10</ENT>
                            <ENT>2.78</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">35509</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Artery bypass graft</ENT>
                            <ENT>27.99</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>10.77</ENT>
                            <ENT>9.77</ENT>
                            <ENT>3.92</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">35510</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Artery bypass graft</ENT>
                            <ENT>24.29</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>7.69</ENT>
                            <ENT>8.93</ENT>
                            <ENT>2.12</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">35511</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Artery bypass graft</ENT>
                            <ENT>22.12</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>7.65</ENT>
                            <ENT>8.50</ENT>
                            <ENT>2.91</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">35512</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Artery bypass graft</ENT>
                            <ENT>23.79</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>7.47</ENT>
                            <ENT>8.73</ENT>
                            <ENT>2.12</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">35515</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Artery bypass graft</ENT>
                            <ENT>25.99</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>9.08</ENT>
                            <ENT>9.18</ENT>
                            <ENT>2.78</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">35516</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Artery bypass graft</ENT>
                            <ENT>24.11</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>7.45</ENT>
                            <ENT>7.12</ENT>
                            <ENT>2.34</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">35518</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Artery bypass graft</ENT>
                            <ENT>22.57</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>7.32</ENT>
                            <ENT>8.14</ENT>
                            <ENT>3.03</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">35521</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Artery bypass graft</ENT>
                            <ENT>24.00</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>7.94</ENT>
                            <ENT>8.88</ENT>
                            <ENT>3.13</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">35522</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Artery bypass graft</ENT>
                            <ENT>23.05</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>7.39</ENT>
                            <ENT>8.57</ENT>
                            <ENT>2.12</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">35523</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Artery bypass graft</ENT>
                            <ENT>24.00</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>9.20</ENT>
                            <ENT>9.20</ENT>
                            <ENT>2.14</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">35525</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Artery bypass graft</ENT>
                            <ENT>21.59</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>7.03</ENT>
                            <ENT>8.20</ENT>
                            <ENT>2.12</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">35526</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Artery bypass graft</ENT>
                            <ENT>31.47</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>14.03</ENT>
                            <ENT>13.26</ENT>
                            <ENT>3.63</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">35531</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Artery bypass graft</ENT>
                            <ENT>38.98</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>11.46</ENT>
                            <ENT>12.96</ENT>
                            <ENT>5.18</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">35533</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Artery bypass graft</ENT>
                            <ENT>29.79</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>9.49</ENT>
                            <ENT>10.60</ENT>
                            <ENT>3.85</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">35536</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Artery bypass graft</ENT>
                            <ENT>33.60</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>9.50</ENT>
                            <ENT>11.22</ENT>
                            <ENT>4.62</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">35537</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Artery bypass graft</ENT>
                            <ENT>41.75</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>13.08</ENT>
                            <ENT>13.08</ENT>
                            <ENT>5.72</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">35538</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Artery bypass graft</ENT>
                            <ENT>46.82</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>14.43</ENT>
                            <ENT>14.43</ENT>
                            <ENT>6.39</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">35539</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Artery bypass graft</ENT>
                            <ENT>43.98</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>13.46</ENT>
                            <ENT>13.46</ENT>
                            <ENT>6.02</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">35540</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Artery bypass graft</ENT>
                            <ENT>49.20</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>14.80</ENT>
                            <ENT>14.80</ENT>
                            <ENT>6.76</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">35548</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Artery bypass graft</ENT>
                            <ENT>22.57</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>7.73</ENT>
                            <ENT>8.57</ENT>
                            <ENT>2.98</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <PRTPAGE P="66449"/>
                            <ENT I="01">35549</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Artery bypass graft</ENT>
                            <ENT>24.34</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>8.73</ENT>
                            <ENT>9.55</ENT>
                            <ENT>3.30</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">35551</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Artery bypass graft</ENT>
                            <ENT>27.72</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>9.37</ENT>
                            <ENT>10.42</ENT>
                            <ENT>3.75</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">35556</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Artery bypass graft</ENT>
                            <ENT>26.62</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>8.63</ENT>
                            <ENT>9.17</ENT>
                            <ENT>3.10</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">35558</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Artery bypass graft</ENT>
                            <ENT>23.00</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>7.86</ENT>
                            <ENT>8.70</ENT>
                            <ENT>3.00</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">35560</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Artery bypass graft</ENT>
                            <ENT>33.90</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>10.61</ENT>
                            <ENT>11.96</ENT>
                            <ENT>4.75</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">35563</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Artery bypass graft</ENT>
                            <ENT>25.99</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>8.87</ENT>
                            <ENT>9.69</ENT>
                            <ENT>3.52</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">35565</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Artery bypass graft</ENT>
                            <ENT>25.00</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>8.16</ENT>
                            <ENT>9.14</ENT>
                            <ENT>3.30</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">35566</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Artery bypass graft</ENT>
                            <ENT>32.22</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>9.84</ENT>
                            <ENT>10.61</ENT>
                            <ENT>3.83</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">35571</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Artery bypass graft</ENT>
                            <ENT>25.39</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>8.08</ENT>
                            <ENT>9.46</ENT>
                            <ENT>3.43</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">35572</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Harvest femoropopliteal vein</ENT>
                            <ENT>6.81</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>1.92</ENT>
                            <ENT>2.08</ENT>
                            <ENT>0.99</ENT>
                            <ENT>ZZZ</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">35583</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Vein bypass graft</ENT>
                            <ENT>27.62</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>8.63</ENT>
                            <ENT>9.39</ENT>
                            <ENT>3.17</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">35585</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Vein bypass graft</ENT>
                            <ENT>32.22</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>10.10</ENT>
                            <ENT>11.15</ENT>
                            <ENT>4.02</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">35587</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Vein bypass graft</ENT>
                            <ENT>26.08</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>8.50</ENT>
                            <ENT>9.97</ENT>
                            <ENT>3.52</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">35600</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Harvest art for cabg add-on</ENT>
                            <ENT>4.94</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>1.52</ENT>
                            <ENT>1.57</ENT>
                            <ENT>0.73</ENT>
                            <ENT>ZZZ</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">35601</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Artery bypass graft</ENT>
                            <ENT>26.99</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>10.42</ENT>
                            <ENT>9.52</ENT>
                            <ENT>3.72</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">35606</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Artery bypass graft</ENT>
                            <ENT>22.36</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>7.30</ENT>
                            <ENT>8.15</ENT>
                            <ENT>2.70</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">35612</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Artery bypass graft</ENT>
                            <ENT>16.71</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>6.31</ENT>
                            <ENT>7.09</ENT>
                            <ENT>2.09</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">35616</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Artery bypass graft</ENT>
                            <ENT>21.74</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>7.12</ENT>
                            <ENT>7.61</ENT>
                            <ENT>2.20</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">35621</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Artery bypass graft</ENT>
                            <ENT>20.95</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>6.77</ENT>
                            <ENT>7.72</ENT>
                            <ENT>2.92</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">35623</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Bypass graft, not vein</ENT>
                            <ENT>25.79</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>8.43</ENT>
                            <ENT>9.46</ENT>
                            <ENT>3.46</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">35626</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Artery bypass graft</ENT>
                            <ENT>29.06</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>10.27</ENT>
                            <ENT>11.12</ENT>
                            <ENT>4.08</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">35631</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Artery bypass graft</ENT>
                            <ENT>35.90</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>10.55</ENT>
                            <ENT>12.18</ENT>
                            <ENT>4.96</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">35636</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Artery bypass graft</ENT>
                            <ENT>31.62</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>9.71</ENT>
                            <ENT>11.00</ENT>
                            <ENT>4.10</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">35637</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Artery bypass graft</ENT>
                            <ENT>32.92</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>10.64</ENT>
                            <ENT>10.64</ENT>
                            <ENT>4.44</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">35638</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Artery bypass graft</ENT>
                            <ENT>33.47</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>10.78</ENT>
                            <ENT>10.78</ENT>
                            <ENT>4.52</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">35642</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Artery bypass graft</ENT>
                            <ENT>18.85</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>6.21</ENT>
                            <ENT>7.45</ENT>
                            <ENT>2.28</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">35645</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Artery bypass graft</ENT>
                            <ENT>18.34</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>7.97</ENT>
                            <ENT>8.12</ENT>
                            <ENT>2.50</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">35646</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Artery bypass graft</ENT>
                            <ENT>32.84</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>10.44</ENT>
                            <ENT>11.77</ENT>
                            <ENT>4.44</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">35647</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Artery bypass graft</ENT>
                            <ENT>29.62</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>9.65</ENT>
                            <ENT>10.70</ENT>
                            <ENT>3.99</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">35650</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Artery bypass graft</ENT>
                            <ENT>20.08</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>6.92</ENT>
                            <ENT>7.64</ENT>
                            <ENT>2.72</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">35651</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Artery bypass graft</ENT>
                            <ENT>25.97</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>8.70</ENT>
                            <ENT>9.71</ENT>
                            <ENT>3.36</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">35654</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Artery bypass graft</ENT>
                            <ENT>26.17</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>8.35</ENT>
                            <ENT>9.50</ENT>
                            <ENT>3.53</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">35656</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Artery bypass graft</ENT>
                            <ENT>20.39</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>6.83</ENT>
                            <ENT>7.71</ENT>
                            <ENT>2.80</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">35661</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Artery bypass graft</ENT>
                            <ENT>20.22</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>7.04</ENT>
                            <ENT>7.98</ENT>
                            <ENT>2.72</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">35663</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Artery bypass graft</ENT>
                            <ENT>23.80</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>7.89</ENT>
                            <ENT>8.93</ENT>
                            <ENT>3.11</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">35665</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Artery bypass graft</ENT>
                            <ENT>22.22</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>7.35</ENT>
                            <ENT>8.40</ENT>
                            <ENT>3.01</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">35666</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Artery bypass graft</ENT>
                            <ENT>23.53</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>8.50</ENT>
                            <ENT>9.56</ENT>
                            <ENT>3.16</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">35671</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Artery bypass graft</ENT>
                            <ENT>20.64</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>7.62</ENT>
                            <ENT>8.49</ENT>
                            <ENT>2.78</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">35681</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Composite bypass graft</ENT>
                            <ENT>1.60</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>0.40</ENT>
                            <ENT>0.47</ENT>
                            <ENT>0.23</ENT>
                            <ENT>ZZZ</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">35682</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Composite bypass graft</ENT>
                            <ENT>7.19</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>1.69</ENT>
                            <ENT>2.04</ENT>
                            <ENT>1.03</ENT>
                            <ENT>ZZZ</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">35683</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Composite bypass graft</ENT>
                            <ENT>8.49</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>1.96</ENT>
                            <ENT>2.39</ENT>
                            <ENT>1.20</ENT>
                            <ENT>ZZZ</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">35685</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Bypass graft patency/patch</ENT>
                            <ENT>4.04</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>0.96</ENT>
                            <ENT>1.15</ENT>
                            <ENT>0.58</ENT>
                            <ENT>ZZZ</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">35686</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Bypass graft/av fist patency</ENT>
                            <ENT>3.34</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>0.85</ENT>
                            <ENT>0.99</ENT>
                            <ENT>0.47</ENT>
                            <ENT>ZZZ</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">35691</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Arterial transposition</ENT>
                            <ENT>18.32</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>5.94</ENT>
                            <ENT>7.17</ENT>
                            <ENT>2.59</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">35693</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Arterial transposition</ENT>
                            <ENT>15.64</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>6.11</ENT>
                            <ENT>6.91</ENT>
                            <ENT>2.22</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">35694</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Arterial transposition</ENT>
                            <ENT>19.19</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>6.31</ENT>
                            <ENT>7.45</ENT>
                            <ENT>2.70</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">35695</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Arterial transposition</ENT>
                            <ENT>19.97</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>6.70</ENT>
                            <ENT>7.62</ENT>
                            <ENT>2.74</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">35697</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Reimplant artery each</ENT>
                            <ENT>3.00</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>0.74</ENT>
                            <ENT>0.88</ENT>
                            <ENT>0.41</ENT>
                            <ENT>ZZZ</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">35700</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Reoperation, bypass graft</ENT>
                            <ENT>3.08</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>0.76</ENT>
                            <ENT>0.89</ENT>
                            <ENT>0.44</ENT>
                            <ENT>ZZZ</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">35701</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Exploration, carotid artery</ENT>
                            <ENT>9.11</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>4.31</ENT>
                            <ENT>4.73</ENT>
                            <ENT>1.12</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">35721</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Exploration, femoral artery</ENT>
                            <ENT>7.66</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>3.83</ENT>
                            <ENT>4.13</ENT>
                            <ENT>1.03</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">35741</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Exploration popliteal artery</ENT>
                            <ENT>8.61</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>3.86</ENT>
                            <ENT>4.26</ENT>
                            <ENT>1.12</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">35761</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Exploration of artery/vein</ENT>
                            <ENT>5.84</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>3.43</ENT>
                            <ENT>3.72</ENT>
                            <ENT>0.75</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">35800</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Explore neck vessels</ENT>
                            <ENT>7.99</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>3.95</ENT>
                            <ENT>4.30</ENT>
                            <ENT>0.95</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">35820</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Explore chest vessels</ENT>
                            <ENT>36.81</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>12.90</ENT>
                            <ENT>10.05</ENT>
                            <ENT>1.95</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">35840</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Explore abdominal vessels</ENT>
                            <ENT>10.87</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>4.81</ENT>
                            <ENT>5.04</ENT>
                            <ENT>1.34</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">35860</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Explore limb vessels</ENT>
                            <ENT>6.72</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>3.38</ENT>
                            <ENT>3.70</ENT>
                            <ENT>0.78</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">35870</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Repair vessel graft defect</ENT>
                            <ENT>24.39</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>7.91</ENT>
                            <ENT>8.84</ENT>
                            <ENT>3.01</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">35875</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Removal of clot in graft</ENT>
                            <ENT>10.64</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>4.28</ENT>
                            <ENT>4.73</ENT>
                            <ENT>1.41</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">35876</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Removal of clot in graft</ENT>
                            <ENT>17.74</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>5.94</ENT>
                            <ENT>6.72</ENT>
                            <ENT>2.40</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">35879</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Revise graft w/vein</ENT>
                            <ENT>17.28</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>5.97</ENT>
                            <ENT>6.83</ENT>
                            <ENT>2.28</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">35881</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Revise graft w/vein</ENT>
                            <ENT>19.22</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>6.46</ENT>
                            <ENT>7.56</ENT>
                            <ENT>2.56</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">35883</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Revise graft w/nonauto graft</ENT>
                            <ENT>23.07</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>8.49</ENT>
                            <ENT>8.49</ENT>
                            <ENT>3.19</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">35884</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Revise graft w/vein</ENT>
                            <ENT>24.57</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>8.93</ENT>
                            <ENT>8.93</ENT>
                            <ENT>3.41</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">35901</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Excision, graft, neck</ENT>
                            <ENT>8.26</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>4.24</ENT>
                            <ENT>4.77</ENT>
                            <ENT>1.15</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">35903</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Excision, graft, extremity</ENT>
                            <ENT>9.44</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>4.60</ENT>
                            <ENT>5.37</ENT>
                            <ENT>1.30</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">35905</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Excision, graft, thorax</ENT>
                            <ENT>33.39</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>10.65</ENT>
                            <ENT>11.91</ENT>
                            <ENT>4.44</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">35907</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Excision, graft, abdomen</ENT>
                            <ENT>37.14</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>10.87</ENT>
                            <ENT>12.51</ENT>
                            <ENT>4.92</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">36000</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Place needle in vein</ENT>
                            <ENT>0.18</ENT>
                            <ENT>0.46</ENT>
                            <ENT>0.51</ENT>
                            <ENT>0.06</ENT>
                            <ENT>0.06</ENT>
                            <ENT>0.01</ENT>
                            <ENT>XXX</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">36002</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Pseudoaneurysm injection trt</ENT>
                            <ENT>1.96</ENT>
                            <ENT>2.24</ENT>
                            <ENT>2.55</ENT>
                            <ENT>0.85</ENT>
                            <ENT>0.91</ENT>
                            <ENT>0.17</ENT>
                            <ENT>000</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">36005</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Injection ext venography</ENT>
                            <ENT>0.95</ENT>
                            <ENT>8.46</ENT>
                            <ENT>8.05</ENT>
                            <ENT>0.39</ENT>
                            <ENT>0.35</ENT>
                            <ENT>0.05</ENT>
                            <ENT>000</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">36010</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Place catheter in vein</ENT>
                            <ENT>2.43</ENT>
                            <ENT>11.09</ENT>
                            <ENT>15.19</ENT>
                            <ENT>0.78</ENT>
                            <ENT>0.79</ENT>
                            <ENT>0.20</ENT>
                            <ENT>XXX</ENT>
                        </ROW>
                        <ROW>
                            <PRTPAGE P="66450"/>
                            <ENT I="01">36011</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Place catheter in vein</ENT>
                            <ENT>3.14</ENT>
                            <ENT>19.61</ENT>
                            <ENT>23.71</ENT>
                            <ENT>1.01</ENT>
                            <ENT>1.03</ENT>
                            <ENT>0.27</ENT>
                            <ENT>XXX</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">36012</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Place catheter in vein</ENT>
                            <ENT>3.51</ENT>
                            <ENT>20.23</ENT>
                            <ENT>19.58</ENT>
                            <ENT>1.28</ENT>
                            <ENT>1.23</ENT>
                            <ENT>0.23</ENT>
                            <ENT>XXX</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">36013</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Place catheter in artery</ENT>
                            <ENT>2.52</ENT>
                            <ENT>18.76</ENT>
                            <ENT>20.06</ENT>
                            <ENT>0.93</ENT>
                            <ENT>0.81</ENT>
                            <ENT>0.25</ENT>
                            <ENT>XXX</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">36014</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Place catheter in artery</ENT>
                            <ENT>3.02</ENT>
                            <ENT>18.94</ENT>
                            <ENT>19.52</ENT>
                            <ENT>1.11</ENT>
                            <ENT>1.07</ENT>
                            <ENT>0.19</ENT>
                            <ENT>XXX</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">36015</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Place catheter in artery</ENT>
                            <ENT>3.51</ENT>
                            <ENT>18.54</ENT>
                            <ENT>21.09</ENT>
                            <ENT>1.05</ENT>
                            <ENT>1.12</ENT>
                            <ENT>0.21</ENT>
                            <ENT>XXX</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">36100</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Establish access to artery</ENT>
                            <ENT>3.02</ENT>
                            <ENT>11.23</ENT>
                            <ENT>11.65</ENT>
                            <ENT>1.21</ENT>
                            <ENT>1.16</ENT>
                            <ENT>0.26</ENT>
                            <ENT>XXX</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">36120</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Establish access to artery</ENT>
                            <ENT>2.01</ENT>
                            <ENT>9.20</ENT>
                            <ENT>9.95</ENT>
                            <ENT>0.59</ENT>
                            <ENT>0.62</ENT>
                            <ENT>0.14</ENT>
                            <ENT>XXX</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">36140</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Establish access to artery</ENT>
                            <ENT>2.01</ENT>
                            <ENT>10.47</ENT>
                            <ENT>11.62</ENT>
                            <ENT>0.71</ENT>
                            <ENT>0.67</ENT>
                            <ENT>0.16</ENT>
                            <ENT>XXX</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">36145</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Artery to vein shunt</ENT>
                            <ENT>2.01</ENT>
                            <ENT>10.28</ENT>
                            <ENT>11.41</ENT>
                            <ENT>0.66</ENT>
                            <ENT>0.66</ENT>
                            <ENT>0.11</ENT>
                            <ENT>XXX</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">36160</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Establish access to aorta</ENT>
                            <ENT>2.52</ENT>
                            <ENT>11.54</ENT>
                            <ENT>12.51</ENT>
                            <ENT>1.05</ENT>
                            <ENT>0.94</ENT>
                            <ENT>0.26</ENT>
                            <ENT>XXX</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">36200</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Place catheter in aorta</ENT>
                            <ENT>3.02</ENT>
                            <ENT>13.65</ENT>
                            <ENT>15.08</ENT>
                            <ENT>1.02</ENT>
                            <ENT>1.01</ENT>
                            <ENT>0.24</ENT>
                            <ENT>XXX</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">36215</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Place catheter in artery</ENT>
                            <ENT>4.67</ENT>
                            <ENT>25.94</ENT>
                            <ENT>26.48</ENT>
                            <ENT>1.89</ENT>
                            <ENT>1.75</ENT>
                            <ENT>0.27</ENT>
                            <ENT>XXX</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">36216</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Place catheter in artery</ENT>
                            <ENT>5.27</ENT>
                            <ENT>28.03</ENT>
                            <ENT>28.54</ENT>
                            <ENT>2.09</ENT>
                            <ENT>1.94</ENT>
                            <ENT>0.31</ENT>
                            <ENT>XXX</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">36217</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Place catheter in artery</ENT>
                            <ENT>6.29</ENT>
                            <ENT>45.85</ENT>
                            <ENT>50.63</ENT>
                            <ENT>2.43</ENT>
                            <ENT>2.30</ENT>
                            <ENT>0.44</ENT>
                            <ENT>XXX</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">36218</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Place catheter in artery</ENT>
                            <ENT>1.01</ENT>
                            <ENT>3.76</ENT>
                            <ENT>4.42</ENT>
                            <ENT>0.39</ENT>
                            <ENT>0.36</ENT>
                            <ENT>0.07</ENT>
                            <ENT>ZZZ</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">36245</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Place catheter in artery</ENT>
                            <ENT>4.67</ENT>
                            <ENT>28.77</ENT>
                            <ENT>30.42</ENT>
                            <ENT>2.11</ENT>
                            <ENT>1.89</ENT>
                            <ENT>0.31</ENT>
                            <ENT>XXX</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">36246</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Place catheter in artery</ENT>
                            <ENT>5.27</ENT>
                            <ENT>27.41</ENT>
                            <ENT>28.68</ENT>
                            <ENT>1.99</ENT>
                            <ENT>1.91</ENT>
                            <ENT>0.38</ENT>
                            <ENT>XXX</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">36247</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Place catheter in artery</ENT>
                            <ENT>6.29</ENT>
                            <ENT>45.15</ENT>
                            <ENT>47.31</ENT>
                            <ENT>2.36</ENT>
                            <ENT>2.25</ENT>
                            <ENT>0.47</ENT>
                            <ENT>XXX</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">36248</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Place catheter in artery</ENT>
                            <ENT>1.01</ENT>
                            <ENT>3.17</ENT>
                            <ENT>3.61</ENT>
                            <ENT>0.38</ENT>
                            <ENT>0.36</ENT>
                            <ENT>0.07</ENT>
                            <ENT>ZZZ</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">36260</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Insertion of infusion pump</ENT>
                            <ENT>9.82</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>4.64</ENT>
                            <ENT>4.76</ENT>
                            <ENT>1.29</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">36261</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Revision of infusion pump</ENT>
                            <ENT>5.55</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>3.06</ENT>
                            <ENT>3.36</ENT>
                            <ENT>0.70</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">36262</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Removal of infusion pump</ENT>
                            <ENT>4.05</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>2.71</ENT>
                            <ENT>2.73</ENT>
                            <ENT>0.54</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">36299</ENT>
                            <ENT/>
                            <ENT>C</ENT>
                            <ENT>Vessel injection procedure</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>YYY</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">36400</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Bl draw &lt; 3 yrs fem/jugular</ENT>
                            <ENT>0.38</ENT>
                            <ENT>0.28</ENT>
                            <ENT>0.28</ENT>
                            <ENT>0.09</ENT>
                            <ENT>0.09</ENT>
                            <ENT>0.03</ENT>
                            <ENT>XXX</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">36405</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Bl draw &lt; 3 yrs scalp vein</ENT>
                            <ENT>0.31</ENT>
                            <ENT>0.27</ENT>
                            <ENT>0.27</ENT>
                            <ENT>0.08</ENT>
                            <ENT>0.08</ENT>
                            <ENT>0.03</ENT>
                            <ENT>XXX</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">36406</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Bl draw &lt; 3 yrs other vein</ENT>
                            <ENT>0.18</ENT>
                            <ENT>0.25</ENT>
                            <ENT>0.26</ENT>
                            <ENT>0.04</ENT>
                            <ENT>0.05</ENT>
                            <ENT>0.01</ENT>
                            <ENT>XXX</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">36410</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Non-routine bl draw &gt; 3 yrs</ENT>
                            <ENT>0.18</ENT>
                            <ENT>0.32</ENT>
                            <ENT>0.30</ENT>
                            <ENT>0.05</ENT>
                            <ENT>0.05</ENT>
                            <ENT>0.01</ENT>
                            <ENT>XXX</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">36415</ENT>
                            <ENT/>
                            <ENT>X</ENT>
                            <ENT>Routine venipuncture</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>XXX</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">36416</ENT>
                            <ENT/>
                            <ENT>B</ENT>
                            <ENT>Capillary blood draw</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>XXX</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">36420</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Vein access cutdown &lt; 1 yr</ENT>
                            <ENT>1.01</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>0.21</ENT>
                            <ENT>0.24</ENT>
                            <ENT>0.07</ENT>
                            <ENT>XXX</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">36425</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Vein access cutdown &gt; 1 yr</ENT>
                            <ENT>0.76</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>0.21</ENT>
                            <ENT>0.21</ENT>
                            <ENT>0.06</ENT>
                            <ENT>XXX</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">36430</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Blood transfusion service</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.93</ENT>
                            <ENT>0.97</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>0.06</ENT>
                            <ENT>XXX</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">36440</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Bl push transfuse, 2 yr or &lt;</ENT>
                            <ENT>1.03</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>0.25</ENT>
                            <ENT>0.27</ENT>
                            <ENT>0.10</ENT>
                            <ENT>XXX</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">36450</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Bl exchange/transfuse, nb</ENT>
                            <ENT>2.23</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>0.77</ENT>
                            <ENT>0.74</ENT>
                            <ENT>0.21</ENT>
                            <ENT>XXX</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">36455</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Bl exchange/transfuse non-nb</ENT>
                            <ENT>2.43</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>0.66</ENT>
                            <ENT>0.84</ENT>
                            <ENT>0.15</ENT>
                            <ENT>XXX</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">36460</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Transfusion service, fetal</ENT>
                            <ENT>6.58</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>1.81</ENT>
                            <ENT>2.03</ENT>
                            <ENT>0.79</ENT>
                            <ENT>XXX</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">36468</ENT>
                            <ENT/>
                            <ENT>R</ENT>
                            <ENT>Injection(s), spider veins</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>000</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">36469</ENT>
                            <ENT/>
                            <ENT>R</ENT>
                            <ENT>Injection(s), spider veins</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>000</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">36470</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Injection therapy of vein</ENT>
                            <ENT>1.09</ENT>
                            <ENT>2.41</ENT>
                            <ENT>2.54</ENT>
                            <ENT>0.64</ENT>
                            <ENT>0.68</ENT>
                            <ENT>0.12</ENT>
                            <ENT>010</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">36471</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Injection therapy of veins</ENT>
                            <ENT>1.60</ENT>
                            <ENT>2.56</ENT>
                            <ENT>2.82</ENT>
                            <ENT>0.79</ENT>
                            <ENT>0.87</ENT>
                            <ENT>0.19</ENT>
                            <ENT>010</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">36475</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Endovenous rf, 1st vein</ENT>
                            <ENT>6.72</ENT>
                            <ENT>35.74</ENT>
                            <ENT>43.55</ENT>
                            <ENT>1.88</ENT>
                            <ENT>2.20</ENT>
                            <ENT>0.37</ENT>
                            <ENT>000</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">36476</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Endovenous rf, vein add-on</ENT>
                            <ENT>3.38</ENT>
                            <ENT>6.14</ENT>
                            <ENT>7.00</ENT>
                            <ENT>0.83</ENT>
                            <ENT>0.98</ENT>
                            <ENT>0.18</ENT>
                            <ENT>ZZZ</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">36478</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Endovenous laser, 1st vein</ENT>
                            <ENT>6.72</ENT>
                            <ENT>26.95</ENT>
                            <ENT>36.85</ENT>
                            <ENT>2.04</ENT>
                            <ENT>2.29</ENT>
                            <ENT>0.37</ENT>
                            <ENT>000</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">36479</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Endovenous laser vein addon</ENT>
                            <ENT>3.38</ENT>
                            <ENT>6.35</ENT>
                            <ENT>7.17</ENT>
                            <ENT>0.95</ENT>
                            <ENT>1.04</ENT>
                            <ENT>0.18</ENT>
                            <ENT>ZZZ</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">36481</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Insertion of catheter, vein</ENT>
                            <ENT>6.98</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>2.35</ENT>
                            <ENT>2.47</ENT>
                            <ENT>0.55</ENT>
                            <ENT>000</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">36500</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Insertion of catheter, vein</ENT>
                            <ENT>3.51</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>1.25</ENT>
                            <ENT>1.31</ENT>
                            <ENT>0.20</ENT>
                            <ENT>000</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">36510</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Insertion of catheter, vein</ENT>
                            <ENT>1.09</ENT>
                            <ENT>1.08</ENT>
                            <ENT>2.48</ENT>
                            <ENT>0.30</ENT>
                            <ENT>0.45</ENT>
                            <ENT>0.10</ENT>
                            <ENT>000</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">36511</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Apheresis wbc</ENT>
                            <ENT>1.74</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>0.57</ENT>
                            <ENT>0.65</ENT>
                            <ENT>0.08</ENT>
                            <ENT>000</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">36512</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Apheresis rbc</ENT>
                            <ENT>1.74</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>0.60</ENT>
                            <ENT>0.67</ENT>
                            <ENT>0.08</ENT>
                            <ENT>000</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">36513</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Apheresis platelets</ENT>
                            <ENT>1.74</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>0.55</ENT>
                            <ENT>0.64</ENT>
                            <ENT>0.17</ENT>
                            <ENT>000</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">36514</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Apheresis plasma</ENT>
                            <ENT>1.74</ENT>
                            <ENT>10.49</ENT>
                            <ENT>13.73</ENT>
                            <ENT>0.53</ENT>
                            <ENT>0.62</ENT>
                            <ENT>0.08</ENT>
                            <ENT>000</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">36515</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Apheresis, adsorp/reinfuse</ENT>
                            <ENT>1.74</ENT>
                            <ENT>45.46</ENT>
                            <ENT>55.86</ENT>
                            <ENT>0.48</ENT>
                            <ENT>0.57</ENT>
                            <ENT>0.08</ENT>
                            <ENT>000</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">36516</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Apheresis, selective</ENT>
                            <ENT>1.22</ENT>
                            <ENT>49.53</ENT>
                            <ENT>66.77</ENT>
                            <ENT>0.39</ENT>
                            <ENT>0.43</ENT>
                            <ENT>0.08</ENT>
                            <ENT>000</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">36522</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Photopheresis</ENT>
                            <ENT>1.67</ENT>
                            <ENT>37.40</ENT>
                            <ENT>34.87</ENT>
                            <ENT>0.94</ENT>
                            <ENT>0.95</ENT>
                            <ENT>0.13</ENT>
                            <ENT>000</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">36555</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Insert non-tunnel cv cath</ENT>
                            <ENT>2.68</ENT>
                            <ENT>3.81</ENT>
                            <ENT>4.78</ENT>
                            <ENT>0.59</ENT>
                            <ENT>0.69</ENT>
                            <ENT>0.11</ENT>
                            <ENT>000</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">36556</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Insert non-tunnel cv cath</ENT>
                            <ENT>2.50</ENT>
                            <ENT>2.85</ENT>
                            <ENT>4.24</ENT>
                            <ENT>0.55</ENT>
                            <ENT>0.65</ENT>
                            <ENT>0.19</ENT>
                            <ENT>000</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">36557</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Insert tunneled cv cath</ENT>
                            <ENT>5.11</ENT>
                            <ENT>15.09</ENT>
                            <ENT>18.11</ENT>
                            <ENT>2.29</ENT>
                            <ENT>2.47</ENT>
                            <ENT>0.57</ENT>
                            <ENT>010</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">36558</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Insert tunneled cv cath</ENT>
                            <ENT>4.81</ENT>
                            <ENT>14.84</ENT>
                            <ENT>17.93</ENT>
                            <ENT>2.35</ENT>
                            <ENT>2.45</ENT>
                            <ENT>0.57</ENT>
                            <ENT>010</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">36560</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Insert tunneled cv cath</ENT>
                            <ENT>6.26</ENT>
                            <ENT>21.31</ENT>
                            <ENT>25.48</ENT>
                            <ENT>2.72</ENT>
                            <ENT>2.87</ENT>
                            <ENT>0.57</ENT>
                            <ENT>010</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">36561</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Insert tunneled cv cath</ENT>
                            <ENT>6.01</ENT>
                            <ENT>22.24</ENT>
                            <ENT>25.90</ENT>
                            <ENT>2.64</ENT>
                            <ENT>2.79</ENT>
                            <ENT>0.57</ENT>
                            <ENT>010</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">36563</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Insert tunneled cv cath</ENT>
                            <ENT>6.21</ENT>
                            <ENT>23.09</ENT>
                            <ENT>24.91</ENT>
                            <ENT>2.60</ENT>
                            <ENT>2.79</ENT>
                            <ENT>0.84</ENT>
                            <ENT>010</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">36565</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Insert tunneled cv cath</ENT>
                            <ENT>6.01</ENT>
                            <ENT>17.51</ENT>
                            <ENT>21.10</ENT>
                            <ENT>2.47</ENT>
                            <ENT>2.71</ENT>
                            <ENT>0.57</ENT>
                            <ENT>010</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">36566</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Insert tunneled cv cath</ENT>
                            <ENT>6.51</ENT>
                            <ENT>111.82</ENT>
                            <ENT>68.65</ENT>
                            <ENT>2.60</ENT>
                            <ENT>2.85</ENT>
                            <ENT>0.57</ENT>
                            <ENT>010</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">36568</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Insert picc cath</ENT>
                            <ENT>1.92</ENT>
                            <ENT>5.87</ENT>
                            <ENT>6.70</ENT>
                            <ENT>0.59</ENT>
                            <ENT>0.59</ENT>
                            <ENT>0.11</ENT>
                            <ENT>000</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">36569</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Insert picc cath</ENT>
                            <ENT>1.82</ENT>
                            <ENT>4.47</ENT>
                            <ENT>5.90</ENT>
                            <ENT>0.67</ENT>
                            <ENT>0.62</ENT>
                            <ENT>0.19</ENT>
                            <ENT>000</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">36570</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Insert picvad cath</ENT>
                            <ENT>5.33</ENT>
                            <ENT>21.23</ENT>
                            <ENT>27.19</ENT>
                            <ENT>2.10</ENT>
                            <ENT>2.41</ENT>
                            <ENT>0.57</ENT>
                            <ENT>010</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">36571</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Insert picvad cath</ENT>
                            <ENT>5.31</ENT>
                            <ENT>24.50</ENT>
                            <ENT>28.86</ENT>
                            <ENT>2.44</ENT>
                            <ENT>2.58</ENT>
                            <ENT>0.57</ENT>
                            <ENT>010</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">36575</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Repair tunneled cv cath</ENT>
                            <ENT>0.67</ENT>
                            <ENT>3.30</ENT>
                            <ENT>3.67</ENT>
                            <ENT>0.23</ENT>
                            <ENT>0.25</ENT>
                            <ENT>0.20</ENT>
                            <ENT>000</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">36576</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Repair tunneled cv cath</ENT>
                            <ENT>3.21</ENT>
                            <ENT>5.90</ENT>
                            <ENT>6.42</ENT>
                            <ENT>1.56</ENT>
                            <ENT>1.70</ENT>
                            <ENT>0.19</ENT>
                            <ENT>010</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">36578</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Replace tunneled cv cath</ENT>
                            <ENT>3.51</ENT>
                            <ENT>9.16</ENT>
                            <ENT>10.14</ENT>
                            <ENT>2.00</ENT>
                            <ENT>2.15</ENT>
                            <ENT>0.19</ENT>
                            <ENT>010</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">36580</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Replace cvad cath</ENT>
                            <ENT>1.31</ENT>
                            <ENT>3.96</ENT>
                            <ENT>5.45</ENT>
                            <ENT>0.43</ENT>
                            <ENT>0.42</ENT>
                            <ENT>0.19</ENT>
                            <ENT>000</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">36581</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Replace tunneled cv cath</ENT>
                            <ENT>3.45</ENT>
                            <ENT>15.49</ENT>
                            <ENT>17.49</ENT>
                            <ENT>1.73</ENT>
                            <ENT>1.83</ENT>
                            <ENT>0.19</ENT>
                            <ENT>010</ENT>
                        </ROW>
                        <ROW>
                            <PRTPAGE P="66451"/>
                            <ENT I="01">36582</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Replace tunneled cv cath</ENT>
                            <ENT>5.21</ENT>
                            <ENT>21.53</ENT>
                            <ENT>23.76</ENT>
                            <ENT>2.45</ENT>
                            <ENT>2.66</ENT>
                            <ENT>0.19</ENT>
                            <ENT>010</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">36583</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Replace tunneled cv cath</ENT>
                            <ENT>5.26</ENT>
                            <ENT>21.57</ENT>
                            <ENT>23.80</ENT>
                            <ENT>2.48</ENT>
                            <ENT>2.68</ENT>
                            <ENT>0.19</ENT>
                            <ENT>010</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">36584</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Replace picc cath</ENT>
                            <ENT>1.20</ENT>
                            <ENT>3.96</ENT>
                            <ENT>5.47</ENT>
                            <ENT>0.61</ENT>
                            <ENT>0.58</ENT>
                            <ENT>0.19</ENT>
                            <ENT>000</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">36585</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Replace picvad cath</ENT>
                            <ENT>4.81</ENT>
                            <ENT>22.54</ENT>
                            <ENT>25.17</ENT>
                            <ENT>2.42</ENT>
                            <ENT>2.58</ENT>
                            <ENT>0.19</ENT>
                            <ENT>010</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">36589</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Removal tunneled cv cath</ENT>
                            <ENT>2.27</ENT>
                            <ENT>1.86</ENT>
                            <ENT>2.05</ENT>
                            <ENT>1.23</ENT>
                            <ENT>1.31</ENT>
                            <ENT>0.24</ENT>
                            <ENT>010</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">36590</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Removal tunneled cv cath</ENT>
                            <ENT>3.32</ENT>
                            <ENT>3.62</ENT>
                            <ENT>3.49</ENT>
                            <ENT>1.59</ENT>
                            <ENT>1.65</ENT>
                            <ENT>0.44</ENT>
                            <ENT>010</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">36591</ENT>
                            <ENT/>
                            <ENT>T</ENT>
                            <ENT>Draw blood off venous device</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.54</ENT>
                            <ENT>0.54</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>0.01</ENT>
                            <ENT>XXX</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">36592</ENT>
                            <ENT/>
                            <ENT>T</ENT>
                            <ENT>Collect blood from picc</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.67</ENT>
                            <ENT>0.67</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>0.01</ENT>
                            <ENT>XXX</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">36593</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Declot vascular device</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.82</ENT>
                            <ENT>0.60</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>0.37</ENT>
                            <ENT>XXX</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">36595</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Mech remov tunneled cv cath</ENT>
                            <ENT>3.59</ENT>
                            <ENT>10.83</ENT>
                            <ENT>14.04</ENT>
                            <ENT>1.38</ENT>
                            <ENT>1.41</ENT>
                            <ENT>0.21</ENT>
                            <ENT>000</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">36596</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Mech remov tunneled cv cath</ENT>
                            <ENT>0.75</ENT>
                            <ENT>2.57</ENT>
                            <ENT>3.13</ENT>
                            <ENT>0.43</ENT>
                            <ENT>0.47</ENT>
                            <ENT>0.05</ENT>
                            <ENT>000</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">36597</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Reposition venous catheter</ENT>
                            <ENT>1.21</ENT>
                            <ENT>2.04</ENT>
                            <ENT>2.22</ENT>
                            <ENT>0.46</ENT>
                            <ENT>0.45</ENT>
                            <ENT>0.07</ENT>
                            <ENT>000</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">36598</ENT>
                            <ENT/>
                            <ENT>T</ENT>
                            <ENT>Inj w/fluor, eval cv device</ENT>
                            <ENT>0.74</ENT>
                            <ENT>2.22</ENT>
                            <ENT>2.43</ENT>
                            <ENT>0.27</ENT>
                            <ENT>1.45</ENT>
                            <ENT>0.05</ENT>
                            <ENT>000</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">36600</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Withdrawal of arterial blood</ENT>
                            <ENT>0.32</ENT>
                            <ENT>0.50</ENT>
                            <ENT>0.49</ENT>
                            <ENT>0.07</ENT>
                            <ENT>0.08</ENT>
                            <ENT>0.02</ENT>
                            <ENT>XXX</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">36620</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Insertion catheter, artery</ENT>
                            <ENT>1.15</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>0.15</ENT>
                            <ENT>0.19</ENT>
                            <ENT>0.07</ENT>
                            <ENT>000</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">36625</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Insertion catheter, artery</ENT>
                            <ENT>2.11</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>0.50</ENT>
                            <ENT>0.52</ENT>
                            <ENT>0.26</ENT>
                            <ENT>000</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">36640</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Insertion catheter, artery</ENT>
                            <ENT>2.10</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>0.91</ENT>
                            <ENT>0.97</ENT>
                            <ENT>0.21</ENT>
                            <ENT>000</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">36660</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Insertion catheter, artery</ENT>
                            <ENT>1.40</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>0.41</ENT>
                            <ENT>0.42</ENT>
                            <ENT>0.14</ENT>
                            <ENT>000</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">36680</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Insert needle, bone cavity</ENT>
                            <ENT>1.20</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>0.28</ENT>
                            <ENT>0.38</ENT>
                            <ENT>0.11</ENT>
                            <ENT>000</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">36800</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Insertion of cannula</ENT>
                            <ENT>2.43</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>1.53</ENT>
                            <ENT>1.67</ENT>
                            <ENT>0.25</ENT>
                            <ENT>000</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">36810</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Insertion of cannula</ENT>
                            <ENT>3.96</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>1.32</ENT>
                            <ENT>1.50</ENT>
                            <ENT>0.45</ENT>
                            <ENT>000</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">36815</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Insertion of cannula</ENT>
                            <ENT>2.62</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>1.04</ENT>
                            <ENT>1.10</ENT>
                            <ENT>0.35</ENT>
                            <ENT>000</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">36818</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Av fuse, uppr arm, cephalic</ENT>
                            <ENT>11.81</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>4.49</ENT>
                            <ENT>5.26</ENT>
                            <ENT>1.90</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">36819</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Av fuse, uppr arm, basilic</ENT>
                            <ENT>14.39</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>5.11</ENT>
                            <ENT>5.74</ENT>
                            <ENT>1.96</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">36820</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Av fusion/forearm vein</ENT>
                            <ENT>14.39</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>5.24</ENT>
                            <ENT>5.81</ENT>
                            <ENT>1.95</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">36821</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Av fusion direct any site</ENT>
                            <ENT>9.15</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>3.94</ENT>
                            <ENT>4.29</ENT>
                            <ENT>1.23</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">36822</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Insertion of cannula(s)</ENT>
                            <ENT>5.51</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>3.74</ENT>
                            <ENT>4.06</ENT>
                            <ENT>0.79</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">36823</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Insertion of cannula(s)</ENT>
                            <ENT>22.82</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>8.63</ENT>
                            <ENT>9.00</ENT>
                            <ENT>2.89</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">36825</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Artery-vein autograft</ENT>
                            <ENT>10.00</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>4.22</ENT>
                            <ENT>4.63</ENT>
                            <ENT>1.35</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">36830</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Artery-vein nonautograft</ENT>
                            <ENT>12.00</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>4.13</ENT>
                            <ENT>4.68</ENT>
                            <ENT>1.66</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">36831</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Open thrombect av fistula</ENT>
                            <ENT>8.01</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>3.18</ENT>
                            <ENT>3.56</ENT>
                            <ENT>1.09</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">36832</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Av fistula revision, open</ENT>
                            <ENT>10.50</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>3.74</ENT>
                            <ENT>4.23</ENT>
                            <ENT>1.44</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">36833</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Av fistula revision</ENT>
                            <ENT>11.95</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>4.12</ENT>
                            <ENT>4.66</ENT>
                            <ENT>1.65</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">36834</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Repair A-V aneurysm</ENT>
                            <ENT>11.11</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>4.21</ENT>
                            <ENT>4.50</ENT>
                            <ENT>1.37</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">36835</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Artery to vein shunt</ENT>
                            <ENT>7.43</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>3.74</ENT>
                            <ENT>4.03</ENT>
                            <ENT>0.98</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">36838</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Dist revas ligation, hemo</ENT>
                            <ENT>21.59</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>7.04</ENT>
                            <ENT>8.21</ENT>
                            <ENT>3.02</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">36860</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>External cannula declotting</ENT>
                            <ENT>2.01</ENT>
                            <ENT>3.36</ENT>
                            <ENT>2.57</ENT>
                            <ENT>0.63</ENT>
                            <ENT>0.65</ENT>
                            <ENT>0.11</ENT>
                            <ENT>000</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">36861</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Cannula declotting</ENT>
                            <ENT>2.52</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>1.22</ENT>
                            <ENT>1.35</ENT>
                            <ENT>0.27</ENT>
                            <ENT>000</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">36870</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Percut thrombect av fistula</ENT>
                            <ENT>5.17</ENT>
                            <ENT>40.78</ENT>
                            <ENT>46.89</ENT>
                            <ENT>2.76</ENT>
                            <ENT>2.95</ENT>
                            <ENT>0.29</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">37140</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Revision of circulation</ENT>
                            <ENT>25.12</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>8.92</ENT>
                            <ENT>9.70</ENT>
                            <ENT>2.02</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">37145</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Revision of circulation</ENT>
                            <ENT>26.13</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>10.45</ENT>
                            <ENT>10.65</ENT>
                            <ENT>3.26</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">37160</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Revision of circulation</ENT>
                            <ENT>23.13</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>7.92</ENT>
                            <ENT>8.59</ENT>
                            <ENT>2.82</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">37180</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Revision of circulation</ENT>
                            <ENT>26.13</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>9.27</ENT>
                            <ENT>9.78</ENT>
                            <ENT>3.35</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">37181</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Splice spleen/kidney veins</ENT>
                            <ENT>28.26</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>8.83</ENT>
                            <ENT>9.91</ENT>
                            <ENT>3.41</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">37182</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Insert hepatic shunt (tips)</ENT>
                            <ENT>16.97</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>6.33</ENT>
                            <ENT>6.19</ENT>
                            <ENT>1.00</ENT>
                            <ENT>000</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">37183</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Remove hepatic shunt (tips)</ENT>
                            <ENT>7.99</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>3.09</ENT>
                            <ENT>3.05</ENT>
                            <ENT>0.47</ENT>
                            <ENT>000</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">37184</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Prim art mech thrombectomy</ENT>
                            <ENT>8.66</ENT>
                            <ENT>49.91</ENT>
                            <ENT>60.78</ENT>
                            <ENT>3.23</ENT>
                            <ENT>3.29</ENT>
                            <ENT>0.55</ENT>
                            <ENT>000</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">37185</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Prim art m-thrombect add-on</ENT>
                            <ENT>3.28</ENT>
                            <ENT>16.38</ENT>
                            <ENT>19.62</ENT>
                            <ENT>1.12</ENT>
                            <ENT>1.11</ENT>
                            <ENT>0.21</ENT>
                            <ENT>ZZZ</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">37186</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Sec art m-thrombect add-on</ENT>
                            <ENT>4.92</ENT>
                            <ENT>34.90</ENT>
                            <ENT>42.13</ENT>
                            <ENT>1.79</ENT>
                            <ENT>1.72</ENT>
                            <ENT>0.32</ENT>
                            <ENT>ZZZ</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">37187</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Venous mech thrombectomy</ENT>
                            <ENT>8.03</ENT>
                            <ENT>48.21</ENT>
                            <ENT>59.18</ENT>
                            <ENT>2.99</ENT>
                            <ENT>3.06</ENT>
                            <ENT>0.51</ENT>
                            <ENT>000</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">37188</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Venous m-thrombectomy add-on</ENT>
                            <ENT>5.71</ENT>
                            <ENT>42.22</ENT>
                            <ENT>52.08</ENT>
                            <ENT>2.18</ENT>
                            <ENT>2.27</ENT>
                            <ENT>0.37</ENT>
                            <ENT>000</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">37195</ENT>
                            <ENT/>
                            <ENT>C</ENT>
                            <ENT>Thrombolytic therapy, stroke</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>XXX</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">37200</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Transcatheter biopsy</ENT>
                            <ENT>4.55</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>1.65</ENT>
                            <ENT>1.57</ENT>
                            <ENT>0.27</ENT>
                            <ENT>000</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">37201</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Transcatheter therapy infuse</ENT>
                            <ENT>4.99</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>2.33</ENT>
                            <ENT>2.44</ENT>
                            <ENT>0.33</ENT>
                            <ENT>000</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">37202</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Transcatheter therapy infuse</ENT>
                            <ENT>5.67</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>3.34</ENT>
                            <ENT>3.18</ENT>
                            <ENT>0.43</ENT>
                            <ENT>000</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">37203</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Transcatheter retrieval</ENT>
                            <ENT>5.02</ENT>
                            <ENT>30.10</ENT>
                            <ENT>31.48</ENT>
                            <ENT>2.07</ENT>
                            <ENT>2.05</ENT>
                            <ENT>0.29</ENT>
                            <ENT>000</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">37204</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Transcatheter occlusion</ENT>
                            <ENT>18.11</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>6.23</ENT>
                            <ENT>6.07</ENT>
                            <ENT>1.48</ENT>
                            <ENT>000</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">37205</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Transcath iv stent, percut</ENT>
                            <ENT>8.27</ENT>
                            <ENT>108.64</ENT>
                            <ENT>56.20</ENT>
                            <ENT>3.25</ENT>
                            <ENT>3.50</ENT>
                            <ENT>0.60</ENT>
                            <ENT>000</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">37206</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Transcath iv stent/perc addl</ENT>
                            <ENT>4.12</ENT>
                            <ENT>66.45</ENT>
                            <ENT>33.94</ENT>
                            <ENT>1.58</ENT>
                            <ENT>1.50</ENT>
                            <ENT>0.31</ENT>
                            <ENT>ZZZ</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">37207</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Transcath iv stent, open</ENT>
                            <ENT>8.27</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>2.37</ENT>
                            <ENT>2.77</ENT>
                            <ENT>1.17</ENT>
                            <ENT>000</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">37208</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Transcath iv stent/open addl</ENT>
                            <ENT>4.12</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>1.01</ENT>
                            <ENT>1.19</ENT>
                            <ENT>0.59</ENT>
                            <ENT>ZZZ</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">37209</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Change iv cath at thromb tx</ENT>
                            <ENT>2.27</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>0.77</ENT>
                            <ENT>0.75</ENT>
                            <ENT>0.15</ENT>
                            <ENT>000</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">37210</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Embolization uterine fibroid</ENT>
                            <ENT>10.60</ENT>
                            <ENT>83.21</ENT>
                            <ENT>83.21</ENT>
                            <ENT>3.68</ENT>
                            <ENT>3.68</ENT>
                            <ENT>0.60</ENT>
                            <ENT>000</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">37215</ENT>
                            <ENT/>
                            <ENT>R</ENT>
                            <ENT>Transcath stent, cca w/eps</ENT>
                            <ENT>19.58</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>9.93</ENT>
                            <ENT>9.51</ENT>
                            <ENT>1.09</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">37216</ENT>
                            <ENT/>
                            <ENT>N</ENT>
                            <ENT>Transcath stent, cca w/o eps</ENT>
                            <ENT>18.85</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>5.75</ENT>
                            <ENT>7.28</ENT>
                            <ENT>1.04</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">37250</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Iv us first vessel add-on</ENT>
                            <ENT>2.10</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>0.77</ENT>
                            <ENT>0.76</ENT>
                            <ENT>0.21</ENT>
                            <ENT>ZZZ</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">37251</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Iv us each add vessel add-on</ENT>
                            <ENT>1.60</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>0.50</ENT>
                            <ENT>0.52</ENT>
                            <ENT>0.19</ENT>
                            <ENT>ZZZ</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">37500</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Endoscopy ligate perf veins</ENT>
                            <ENT>11.54</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>5.35</ENT>
                            <ENT>6.10</ENT>
                            <ENT>1.54</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">37501</ENT>
                            <ENT/>
                            <ENT>C</ENT>
                            <ENT>Vascular endoscopy procedure</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>YYY</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">37565</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Ligation of neck vein</ENT>
                            <ENT>11.97</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>5.13</ENT>
                            <ENT>5.38</ENT>
                            <ENT>1.33</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">37600</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Ligation of neck artery</ENT>
                            <ENT>12.34</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>4.91</ENT>
                            <ENT>5.77</ENT>
                            <ENT>1.41</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">37605</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Ligation of neck artery</ENT>
                            <ENT>14.20</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>5.44</ENT>
                            <ENT>6.17</ENT>
                            <ENT>1.99</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <PRTPAGE P="66452"/>
                            <ENT I="01">37606</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Ligation of neck artery</ENT>
                            <ENT>8.72</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>4.86</ENT>
                            <ENT>4.71</ENT>
                            <ENT>1.23</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">37607</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Ligation of a-v fistula</ENT>
                            <ENT>6.19</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>3.02</ENT>
                            <ENT>3.29</ENT>
                            <ENT>0.85</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">37609</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Temporal artery procedure</ENT>
                            <ENT>3.02</ENT>
                            <ENT>4.19</ENT>
                            <ENT>4.34</ENT>
                            <ENT>1.82</ENT>
                            <ENT>1.89</ENT>
                            <ENT>0.36</ENT>
                            <ENT>010</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">37615</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Ligation of neck artery</ENT>
                            <ENT>7.72</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>4.09</ENT>
                            <ENT>4.10</ENT>
                            <ENT>0.68</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">37616</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Ligation of chest artery</ENT>
                            <ENT>18.89</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>7.92</ENT>
                            <ENT>8.00</ENT>
                            <ENT>2.33</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">37617</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Ligation of abdomen artery</ENT>
                            <ENT>23.71</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>7.88</ENT>
                            <ENT>8.52</ENT>
                            <ENT>2.98</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">37618</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Ligation of extremity artery</ENT>
                            <ENT>5.95</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>3.36</ENT>
                            <ENT>3.48</ENT>
                            <ENT>0.67</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">37620</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Revision of major vein</ENT>
                            <ENT>11.49</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>5.45</ENT>
                            <ENT>5.58</ENT>
                            <ENT>0.91</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">37650</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Revision of major vein</ENT>
                            <ENT>8.41</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>4.23</ENT>
                            <ENT>4.45</ENT>
                            <ENT>1.01</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">37660</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Revision of major vein</ENT>
                            <ENT>22.20</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>7.58</ENT>
                            <ENT>8.32</ENT>
                            <ENT>2.49</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">37700</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Revise leg vein</ENT>
                            <ENT>3.76</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>2.38</ENT>
                            <ENT>2.59</ENT>
                            <ENT>0.53</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">37718</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Ligate/strip short leg vein</ENT>
                            <ENT>7.05</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>3.47</ENT>
                            <ENT>3.76</ENT>
                            <ENT>0.14</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">37722</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Ligate/strip long leg vein</ENT>
                            <ENT>8.08</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>3.68</ENT>
                            <ENT>4.04</ENT>
                            <ENT>0.86</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">37735</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Removal of leg veins/lesion</ENT>
                            <ENT>10.81</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>4.68</ENT>
                            <ENT>5.09</ENT>
                            <ENT>1.48</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">37760</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Ligation, leg veins, open</ENT>
                            <ENT>10.69</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>4.48</ENT>
                            <ENT>4.91</ENT>
                            <ENT>1.44</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">37765</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Phleb veins extrem 10-20</ENT>
                            <ENT>7.63</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>3.57</ENT>
                            <ENT>4.09</ENT>
                            <ENT>0.48</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">37766</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Phleb veins extrem 20+</ENT>
                            <ENT>9.58</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>4.13</ENT>
                            <ENT>4.72</ENT>
                            <ENT>0.48</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">37780</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Revision of leg vein</ENT>
                            <ENT>3.87</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>2.39</ENT>
                            <ENT>2.62</ENT>
                            <ENT>0.53</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">37785</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Ligate/divide/excise vein</ENT>
                            <ENT>3.87</ENT>
                            <ENT>4.91</ENT>
                            <ENT>5.05</ENT>
                            <ENT>2.57</ENT>
                            <ENT>2.65</ENT>
                            <ENT>0.54</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">37788</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Revascularization, penis</ENT>
                            <ENT>23.21</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>12.03</ENT>
                            <ENT>10.56</ENT>
                            <ENT>2.26</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">37790</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Penile venous occlusion</ENT>
                            <ENT>8.37</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>5.15</ENT>
                            <ENT>4.76</ENT>
                            <ENT>0.59</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">37799</ENT>
                            <ENT/>
                            <ENT>C</ENT>
                            <ENT>Vascular surgery procedure</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>YYY</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">38100</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Removal of spleen, total</ENT>
                            <ENT>19.47</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>6.84</ENT>
                            <ENT>6.50</ENT>
                            <ENT>1.92</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">38101</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Removal of spleen, partial</ENT>
                            <ENT>19.47</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>6.91</ENT>
                            <ENT>6.71</ENT>
                            <ENT>2.05</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">38102</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Removal of spleen, total</ENT>
                            <ENT>4.79</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>1.23</ENT>
                            <ENT>1.43</ENT>
                            <ENT>0.63</ENT>
                            <ENT>ZZZ</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">38115</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Repair of ruptured spleen</ENT>
                            <ENT>21.80</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>7.43</ENT>
                            <ENT>7.04</ENT>
                            <ENT>2.09</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">38120</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Laparoscopy, splenectomy</ENT>
                            <ENT>16.97</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>6.92</ENT>
                            <ENT>7.15</ENT>
                            <ENT>2.25</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">38129</ENT>
                            <ENT/>
                            <ENT>C</ENT>
                            <ENT>Laparoscope proc, spleen</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>YYY</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">38200</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Injection for spleen x-ray</ENT>
                            <ENT>2.64</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>1.09</ENT>
                            <ENT>0.99</ENT>
                            <ENT>0.14</ENT>
                            <ENT>000</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">38204</ENT>
                            <ENT/>
                            <ENT>B</ENT>
                            <ENT>Bl donor search management</ENT>
                            <ENT>2.00</ENT>
                            <ENT>0.46</ENT>
                            <ENT>0.46</ENT>
                            <ENT>0.46</ENT>
                            <ENT>0.46</ENT>
                            <ENT>0.06</ENT>
                            <ENT>XXX</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">38205</ENT>
                            <ENT/>
                            <ENT>R</ENT>
                            <ENT>Harvest allogenic stem cells</ENT>
                            <ENT>1.50</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>0.53</ENT>
                            <ENT>0.60</ENT>
                            <ENT>0.07</ENT>
                            <ENT>000</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">38206</ENT>
                            <ENT/>
                            <ENT>R</ENT>
                            <ENT>Harvest auto stem cells</ENT>
                            <ENT>1.50</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>0.55</ENT>
                            <ENT>0.61</ENT>
                            <ENT>0.07</ENT>
                            <ENT>000</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">38207</ENT>
                            <ENT/>
                            <ENT>I</ENT>
                            <ENT>Cryopreserve stem cells</ENT>
                            <ENT>0.89</ENT>
                            <ENT>0.40</ENT>
                            <ENT>0.40</ENT>
                            <ENT>0.40</ENT>
                            <ENT>0.40</ENT>
                            <ENT>0.01</ENT>
                            <ENT>XXX</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">38208</ENT>
                            <ENT/>
                            <ENT>I</ENT>
                            <ENT>Thaw preserved stem cells</ENT>
                            <ENT>0.56</ENT>
                            <ENT>0.25</ENT>
                            <ENT>0.25</ENT>
                            <ENT>0.25</ENT>
                            <ENT>0.25</ENT>
                            <ENT>0.02</ENT>
                            <ENT>XXX</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">38209</ENT>
                            <ENT/>
                            <ENT>I</ENT>
                            <ENT>Wash harvest stem cells</ENT>
                            <ENT>0.24</ENT>
                            <ENT>0.11</ENT>
                            <ENT>0.11</ENT>
                            <ENT>0.11</ENT>
                            <ENT>0.11</ENT>
                            <ENT>0.01</ENT>
                            <ENT>XXX</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">38210</ENT>
                            <ENT/>
                            <ENT>I</ENT>
                            <ENT>T-cell depletion of harvest</ENT>
                            <ENT>1.57</ENT>
                            <ENT>0.71</ENT>
                            <ENT>0.71</ENT>
                            <ENT>0.71</ENT>
                            <ENT>0.71</ENT>
                            <ENT>0.03</ENT>
                            <ENT>XXX</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">38211</ENT>
                            <ENT/>
                            <ENT>I</ENT>
                            <ENT>Tumor cell deplete of harvst</ENT>
                            <ENT>1.42</ENT>
                            <ENT>0.64</ENT>
                            <ENT>0.64</ENT>
                            <ENT>0.64</ENT>
                            <ENT>0.64</ENT>
                            <ENT>0.02</ENT>
                            <ENT>XXX</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">38212</ENT>
                            <ENT/>
                            <ENT>I</ENT>
                            <ENT>Rbc depletion of harvest</ENT>
                            <ENT>0.94</ENT>
                            <ENT>0.42</ENT>
                            <ENT>0.42</ENT>
                            <ENT>0.42</ENT>
                            <ENT>0.42</ENT>
                            <ENT>0.02</ENT>
                            <ENT>XXX</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">38213</ENT>
                            <ENT/>
                            <ENT>I</ENT>
                            <ENT>Platelet deplete of harvest</ENT>
                            <ENT>0.24</ENT>
                            <ENT>0.11</ENT>
                            <ENT>0.11</ENT>
                            <ENT>0.11</ENT>
                            <ENT>0.11</ENT>
                            <ENT>0.01</ENT>
                            <ENT>XXX</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">38214</ENT>
                            <ENT/>
                            <ENT>I</ENT>
                            <ENT>Volume deplete of harvest</ENT>
                            <ENT>0.81</ENT>
                            <ENT>0.36</ENT>
                            <ENT>0.36</ENT>
                            <ENT>0.36</ENT>
                            <ENT>0.36</ENT>
                            <ENT>0.01</ENT>
                            <ENT>XXX</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">38215</ENT>
                            <ENT/>
                            <ENT>I</ENT>
                            <ENT>Harvest stem cell concentrte</ENT>
                            <ENT>0.94</ENT>
                            <ENT>0.42</ENT>
                            <ENT>0.42</ENT>
                            <ENT>0.42</ENT>
                            <ENT>0.42</ENT>
                            <ENT>0.02</ENT>
                            <ENT>XXX</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">38220</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Bone marrow aspiration</ENT>
                            <ENT>1.08</ENT>
                            <ENT>2.67</ENT>
                            <ENT>3.20</ENT>
                            <ENT>0.45</ENT>
                            <ENT>0.48</ENT>
                            <ENT>0.05</ENT>
                            <ENT>XXX</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">38221</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Bone marrow biopsy</ENT>
                            <ENT>1.37</ENT>
                            <ENT>2.78</ENT>
                            <ENT>3.36</ENT>
                            <ENT>0.57</ENT>
                            <ENT>0.61</ENT>
                            <ENT>0.07</ENT>
                            <ENT>XXX</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">38230</ENT>
                            <ENT/>
                            <ENT>R</ENT>
                            <ENT>Bone marrow collection</ENT>
                            <ENT>4.80</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>3.13</ENT>
                            <ENT>3.17</ENT>
                            <ENT>0.48</ENT>
                            <ENT>010</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">38240</ENT>
                            <ENT/>
                            <ENT>R</ENT>
                            <ENT>Bone marrow/stem transplant</ENT>
                            <ENT>2.24</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>0.93</ENT>
                            <ENT>0.98</ENT>
                            <ENT>0.11</ENT>
                            <ENT>XXX</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">38241</ENT>
                            <ENT/>
                            <ENT>R</ENT>
                            <ENT>Bone marrow/stem transplant</ENT>
                            <ENT>2.24</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>0.94</ENT>
                            <ENT>0.99</ENT>
                            <ENT>0.11</ENT>
                            <ENT>XXX</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">38242</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Lymphocyte infuse transplant</ENT>
                            <ENT>1.71</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>0.67</ENT>
                            <ENT>0.72</ENT>
                            <ENT>0.08</ENT>
                            <ENT>000</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">38300</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Drainage, lymph node lesion</ENT>
                            <ENT>2.28</ENT>
                            <ENT>4.22</ENT>
                            <ENT>4.26</ENT>
                            <ENT>2.03</ENT>
                            <ENT>2.04</ENT>
                            <ENT>0.25</ENT>
                            <ENT>010</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">38305</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Drainage, lymph node lesion</ENT>
                            <ENT>6.55</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>4.20</ENT>
                            <ENT>4.32</ENT>
                            <ENT>0.88</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">38308</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Incision of lymph channels</ENT>
                            <ENT>6.73</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>3.54</ENT>
                            <ENT>3.64</ENT>
                            <ENT>0.85</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">38380</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Thoracic duct procedure</ENT>
                            <ENT>8.34</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>5.05</ENT>
                            <ENT>5.37</ENT>
                            <ENT>0.74</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">38381</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Thoracic duct procedure</ENT>
                            <ENT>13.32</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>6.07</ENT>
                            <ENT>6.47</ENT>
                            <ENT>1.85</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">38382</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Thoracic duct procedure</ENT>
                            <ENT>10.51</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>5.43</ENT>
                            <ENT>5.59</ENT>
                            <ENT>1.37</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">38500</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Biopsy/removal, lymph nodes</ENT>
                            <ENT>3.76</ENT>
                            <ENT>3.75</ENT>
                            <ENT>3.72</ENT>
                            <ENT>2.02</ENT>
                            <ENT>2.05</ENT>
                            <ENT>0.49</ENT>
                            <ENT>010</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">38505</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Needle biopsy, lymph nodes</ENT>
                            <ENT>1.14</ENT>
                            <ENT>2.11</ENT>
                            <ENT>2.08</ENT>
                            <ENT>0.73</ENT>
                            <ENT>0.76</ENT>
                            <ENT>0.09</ENT>
                            <ENT>000</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">38510</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Biopsy/removal, lymph nodes</ENT>
                            <ENT>6.69</ENT>
                            <ENT>5.38</ENT>
                            <ENT>5.46</ENT>
                            <ENT>3.08</ENT>
                            <ENT>3.28</ENT>
                            <ENT>0.72</ENT>
                            <ENT>010</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">38520</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Biopsy/removal, lymph nodes</ENT>
                            <ENT>6.95</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>3.75</ENT>
                            <ENT>3.90</ENT>
                            <ENT>0.84</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">38525</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Biopsy/removal, lymph nodes</ENT>
                            <ENT>6.35</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>3.47</ENT>
                            <ENT>3.38</ENT>
                            <ENT>0.80</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">38530</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Biopsy/removal, lymph nodes</ENT>
                            <ENT>8.26</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>4.12</ENT>
                            <ENT>4.25</ENT>
                            <ENT>1.12</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">38542</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Explore deep node(s), neck</ENT>
                            <ENT>6.08</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>3.96</ENT>
                            <ENT>4.22</ENT>
                            <ENT>0.60</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">38550</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Removal, neck/armpit lesion</ENT>
                            <ENT>6.99</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>4.28</ENT>
                            <ENT>4.09</ENT>
                            <ENT>0.88</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">38555</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Removal, neck/armpit lesion</ENT>
                            <ENT>15.42</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>7.45</ENT>
                            <ENT>7.98</ENT>
                            <ENT>1.76</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">38562</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Removal, pelvic lymph nodes</ENT>
                            <ENT>10.92</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>5.76</ENT>
                            <ENT>5.76</ENT>
                            <ENT>1.20</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">38564</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Removal, abdomen lymph nodes</ENT>
                            <ENT>11.29</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>5.20</ENT>
                            <ENT>5.22</ENT>
                            <ENT>1.32</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">38570</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Laparoscopy, lymph node biop</ENT>
                            <ENT>9.28</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>4.03</ENT>
                            <ENT>4.00</ENT>
                            <ENT>1.13</ENT>
                            <ENT>010</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">38571</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Laparoscopy, lymphadenectomy</ENT>
                            <ENT>14.70</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>6.79</ENT>
                            <ENT>6.22</ENT>
                            <ENT>1.15</ENT>
                            <ENT>010</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">38572</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Laparoscopy, lymphadenectomy</ENT>
                            <ENT>16.86</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>5.93</ENT>
                            <ENT>6.50</ENT>
                            <ENT>1.91</ENT>
                            <ENT>010</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">38589</ENT>
                            <ENT/>
                            <ENT>C</ENT>
                            <ENT>Laparoscope proc, lymphatic</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>YYY</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">38700</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Removal of lymph nodes, neck</ENT>
                            <ENT>12.68</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>6.51</ENT>
                            <ENT>6.37</ENT>
                            <ENT>0.72</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">38720</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Removal of lymph nodes, neck</ENT>
                            <ENT>21.72</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>10.16</ENT>
                            <ENT>9.76</ENT>
                            <ENT>1.20</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">38724</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Removal of lymph nodes, neck</ENT>
                            <ENT>23.72</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>10.92</ENT>
                            <ENT>10.37</ENT>
                            <ENT>1.28</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">38740</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Remove armpit lymph nodes</ENT>
                            <ENT>10.57</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>5.00</ENT>
                            <ENT>4.96</ENT>
                            <ENT>1.32</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <PRTPAGE P="66453"/>
                            <ENT I="01">38745</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Remove armpit lymph nodes</ENT>
                            <ENT>13.71</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>6.04</ENT>
                            <ENT>6.06</ENT>
                            <ENT>1.74</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">38746</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Remove thoracic lymph nodes</ENT>
                            <ENT>4.88</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>1.42</ENT>
                            <ENT>1.51</ENT>
                            <ENT>0.72</ENT>
                            <ENT>ZZZ</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">38747</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Remove abdominal lymph nodes</ENT>
                            <ENT>4.88</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>1.26</ENT>
                            <ENT>1.46</ENT>
                            <ENT>0.64</ENT>
                            <ENT>ZZZ</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">38760</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Remove groin lymph nodes</ENT>
                            <ENT>13.49</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>5.91</ENT>
                            <ENT>6.02</ENT>
                            <ENT>1.72</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">38765</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Remove groin lymph nodes</ENT>
                            <ENT>21.78</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>8.34</ENT>
                            <ENT>8.57</ENT>
                            <ENT>2.48</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">38770</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Remove pelvis lymph nodes</ENT>
                            <ENT>13.98</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>6.71</ENT>
                            <ENT>6.22</ENT>
                            <ENT>1.40</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">38780</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Remove abdomen lymph nodes</ENT>
                            <ENT>17.56</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>7.98</ENT>
                            <ENT>8.08</ENT>
                            <ENT>1.89</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">38790</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Inject for lymphatic x-ray</ENT>
                            <ENT>1.29</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>0.75</ENT>
                            <ENT>0.75</ENT>
                            <ENT>0.13</ENT>
                            <ENT>000</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">38792</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Identify sentinel node</ENT>
                            <ENT>0.52</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>0.49</ENT>
                            <ENT>0.46</ENT>
                            <ENT>0.06</ENT>
                            <ENT>000</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">38794</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Access thoracic lymph duct</ENT>
                            <ENT>4.51</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>3.17</ENT>
                            <ENT>3.31</ENT>
                            <ENT>0.32</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">38999</ENT>
                            <ENT/>
                            <ENT>C</ENT>
                            <ENT>Blood/lymph system procedure</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>YYY</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">39000</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Exploration of chest</ENT>
                            <ENT>7.49</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>4.27</ENT>
                            <ENT>4.46</ENT>
                            <ENT>0.89</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">39010</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Exploration of chest</ENT>
                            <ENT>13.11</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>6.33</ENT>
                            <ENT>6.93</ENT>
                            <ENT>1.76</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">39200</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Removal chest lesion</ENT>
                            <ENT>15.04</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>6.19</ENT>
                            <ENT>6.86</ENT>
                            <ENT>2.03</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">39220</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Removal chest lesion</ENT>
                            <ENT>19.47</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>7.99</ENT>
                            <ENT>8.67</ENT>
                            <ENT>2.46</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">39400</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Visualization of chest</ENT>
                            <ENT>8.00</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>4.15</ENT>
                            <ENT>4.50</ENT>
                            <ENT>0.82</ENT>
                            <ENT>010</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">39499</ENT>
                            <ENT/>
                            <ENT>C</ENT>
                            <ENT>Chest procedure</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>YYY</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">39501</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Repair diaphragm laceration</ENT>
                            <ENT>13.89</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>5.81</ENT>
                            <ENT>6.13</ENT>
                            <ENT>1.78</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">39502</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Repair paraesophageal hernia</ENT>
                            <ENT>17.09</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>6.58</ENT>
                            <ENT>6.86</ENT>
                            <ENT>2.17</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">39503</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Repair of diaphragm hernia</ENT>
                            <ENT>108.67</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>27.38</ENT>
                            <ENT>30.37</ENT>
                            <ENT>10.98</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">39520</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Repair of diaphragm hernia</ENT>
                            <ENT>16.63</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>6.79</ENT>
                            <ENT>7.41</ENT>
                            <ENT>2.24</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">39530</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Repair of diaphragm hernia</ENT>
                            <ENT>16.22</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>6.23</ENT>
                            <ENT>6.68</ENT>
                            <ENT>2.11</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">39531</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Repair of diaphragm hernia</ENT>
                            <ENT>17.23</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>6.58</ENT>
                            <ENT>6.98</ENT>
                            <ENT>2.22</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">39540</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Repair of diaphragm hernia</ENT>
                            <ENT>14.51</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>5.70</ENT>
                            <ENT>5.96</ENT>
                            <ENT>1.80</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">39541</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Repair of diaphragm hernia</ENT>
                            <ENT>15.67</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>6.06</ENT>
                            <ENT>6.32</ENT>
                            <ENT>1.93</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">39545</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Revision of diaphragm</ENT>
                            <ENT>14.58</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>6.92</ENT>
                            <ENT>7.23</ENT>
                            <ENT>1.84</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">39560</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Resect diaphragm, simple</ENT>
                            <ENT>12.97</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>5.52</ENT>
                            <ENT>5.90</ENT>
                            <ENT>1.59</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">39561</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Resect diaphragm, complex</ENT>
                            <ENT>19.75</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>9.31</ENT>
                            <ENT>9.32</ENT>
                            <ENT>2.45</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">39599</ENT>
                            <ENT/>
                            <ENT>C</ENT>
                            <ENT>Diaphragm surgery procedure</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>YYY</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">40490</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Biopsy of lip</ENT>
                            <ENT>1.22</ENT>
                            <ENT>2.08</ENT>
                            <ENT>1.85</ENT>
                            <ENT>0.57</ENT>
                            <ENT>0.59</ENT>
                            <ENT>0.05</ENT>
                            <ENT>000</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">40500</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Partial excision of lip</ENT>
                            <ENT>4.35</ENT>
                            <ENT>7.90</ENT>
                            <ENT>7.40</ENT>
                            <ENT>4.36</ENT>
                            <ENT>4.34</ENT>
                            <ENT>0.38</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">40510</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Partial excision of lip</ENT>
                            <ENT>4.74</ENT>
                            <ENT>6.73</ENT>
                            <ENT>6.67</ENT>
                            <ENT>3.62</ENT>
                            <ENT>3.81</ENT>
                            <ENT>0.49</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">40520</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Partial excision of lip</ENT>
                            <ENT>4.71</ENT>
                            <ENT>6.99</ENT>
                            <ENT>7.26</ENT>
                            <ENT>3.81</ENT>
                            <ENT>3.96</ENT>
                            <ENT>0.52</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">40525</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Reconstruct lip with flap</ENT>
                            <ENT>7.61</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>5.33</ENT>
                            <ENT>5.81</ENT>
                            <ENT>0.85</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">40527</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Reconstruct lip with flap</ENT>
                            <ENT>9.20</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>6.13</ENT>
                            <ENT>6.74</ENT>
                            <ENT>0.97</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">40530</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Partial removal of lip</ENT>
                            <ENT>5.45</ENT>
                            <ENT>7.58</ENT>
                            <ENT>7.69</ENT>
                            <ENT>4.26</ENT>
                            <ENT>4.42</ENT>
                            <ENT>0.55</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">40650</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Repair lip</ENT>
                            <ENT>3.69</ENT>
                            <ENT>5.98</ENT>
                            <ENT>6.38</ENT>
                            <ENT>3.16</ENT>
                            <ENT>3.23</ENT>
                            <ENT>0.38</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">40652</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Repair lip</ENT>
                            <ENT>4.32</ENT>
                            <ENT>7.25</ENT>
                            <ENT>7.49</ENT>
                            <ENT>4.11</ENT>
                            <ENT>4.18</ENT>
                            <ENT>0.52</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">40654</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Repair lip</ENT>
                            <ENT>5.37</ENT>
                            <ENT>8.08</ENT>
                            <ENT>8.34</ENT>
                            <ENT>4.68</ENT>
                            <ENT>4.80</ENT>
                            <ENT>0.60</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">40700</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Repair cleft lip/nasal</ENT>
                            <ENT>13.97</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>8.65</ENT>
                            <ENT>8.86</ENT>
                            <ENT>0.95</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">40701</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Repair cleft lip/nasal</ENT>
                            <ENT>17.03</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>7.81</ENT>
                            <ENT>9.56</ENT>
                            <ENT>1.65</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">40702</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Repair cleft lip/nasal</ENT>
                            <ENT>14.09</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>5.81</ENT>
                            <ENT>7.03</ENT>
                            <ENT>1.23</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">40720</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Repair cleft lip/nasal</ENT>
                            <ENT>14.54</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>9.52</ENT>
                            <ENT>9.70</ENT>
                            <ENT>1.80</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">40761</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Repair cleft lip/nasal</ENT>
                            <ENT>15.69</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>9.28</ENT>
                            <ENT>9.77</ENT>
                            <ENT>1.94</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">40799</ENT>
                            <ENT/>
                            <ENT>C</ENT>
                            <ENT>Lip surgery procedure</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>YYY</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">40800</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Drainage of mouth lesion</ENT>
                            <ENT>1.19</ENT>
                            <ENT>3.84</ENT>
                            <ENT>3.40</ENT>
                            <ENT>1.88</ENT>
                            <ENT>1.83</ENT>
                            <ENT>0.13</ENT>
                            <ENT>010</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">40801</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Drainage of mouth lesion</ENT>
                            <ENT>2.57</ENT>
                            <ENT>4.88</ENT>
                            <ENT>4.45</ENT>
                            <ENT>2.58</ENT>
                            <ENT>2.66</ENT>
                            <ENT>0.31</ENT>
                            <ENT>010</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">40804</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Removal, foreign body, mouth</ENT>
                            <ENT>1.26</ENT>
                            <ENT>3.78</ENT>
                            <ENT>3.59</ENT>
                            <ENT>1.83</ENT>
                            <ENT>1.84</ENT>
                            <ENT>0.11</ENT>
                            <ENT>010</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">40805</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Removal, foreign body, mouth</ENT>
                            <ENT>2.73</ENT>
                            <ENT>5.13</ENT>
                            <ENT>4.80</ENT>
                            <ENT>2.65</ENT>
                            <ENT>2.73</ENT>
                            <ENT>0.32</ENT>
                            <ENT>010</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">40806</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Incision of lip fold</ENT>
                            <ENT>0.31</ENT>
                            <ENT>2.43</ENT>
                            <ENT>2.13</ENT>
                            <ENT>0.51</ENT>
                            <ENT>0.50</ENT>
                            <ENT>0.04</ENT>
                            <ENT>000</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">40808</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Biopsy of mouth lesion</ENT>
                            <ENT>0.98</ENT>
                            <ENT>3.60</ENT>
                            <ENT>3.13</ENT>
                            <ENT>1.62</ENT>
                            <ENT>1.55</ENT>
                            <ENT>0.10</ENT>
                            <ENT>010</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">40810</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Excision of mouth lesion</ENT>
                            <ENT>1.33</ENT>
                            <ENT>3.68</ENT>
                            <ENT>3.28</ENT>
                            <ENT>1.72</ENT>
                            <ENT>1.69</ENT>
                            <ENT>0.13</ENT>
                            <ENT>010</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">40812</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Excise/repair mouth lesion</ENT>
                            <ENT>2.33</ENT>
                            <ENT>4.54</ENT>
                            <ENT>4.13</ENT>
                            <ENT>2.28</ENT>
                            <ENT>2.34</ENT>
                            <ENT>0.28</ENT>
                            <ENT>010</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">40814</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Excise/repair mouth lesion</ENT>
                            <ENT>3.45</ENT>
                            <ENT>5.69</ENT>
                            <ENT>5.31</ENT>
                            <ENT>3.69</ENT>
                            <ENT>3.79</ENT>
                            <ENT>0.41</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">40816</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Excision of mouth lesion</ENT>
                            <ENT>3.70</ENT>
                            <ENT>5.90</ENT>
                            <ENT>5.53</ENT>
                            <ENT>3.77</ENT>
                            <ENT>3.88</ENT>
                            <ENT>0.40</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">40818</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Excise oral mucosa for graft</ENT>
                            <ENT>2.72</ENT>
                            <ENT>5.82</ENT>
                            <ENT>5.49</ENT>
                            <ENT>3.74</ENT>
                            <ENT>3.85</ENT>
                            <ENT>0.21</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">40819</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Excise lip or cheek fold</ENT>
                            <ENT>2.45</ENT>
                            <ENT>4.93</ENT>
                            <ENT>4.50</ENT>
                            <ENT>3.10</ENT>
                            <ENT>3.10</ENT>
                            <ENT>0.29</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">40820</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Treatment of mouth lesion</ENT>
                            <ENT>1.30</ENT>
                            <ENT>5.30</ENT>
                            <ENT>4.61</ENT>
                            <ENT>2.94</ENT>
                            <ENT>2.69</ENT>
                            <ENT>0.11</ENT>
                            <ENT>010</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">40830</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Repair mouth laceration</ENT>
                            <ENT>1.78</ENT>
                            <ENT>4.04</ENT>
                            <ENT>3.88</ENT>
                            <ENT>2.00</ENT>
                            <ENT>2.05</ENT>
                            <ENT>0.19</ENT>
                            <ENT>010</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">40831</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Repair mouth laceration</ENT>
                            <ENT>2.50</ENT>
                            <ENT>5.24</ENT>
                            <ENT>4.94</ENT>
                            <ENT>2.70</ENT>
                            <ENT>2.87</ENT>
                            <ENT>0.30</ENT>
                            <ENT>010</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">40840</ENT>
                            <ENT/>
                            <ENT>R</ENT>
                            <ENT>Reconstruction of mouth</ENT>
                            <ENT>9.03</ENT>
                            <ENT>10.01</ENT>
                            <ENT>9.90</ENT>
                            <ENT>5.58</ENT>
                            <ENT>6.27</ENT>
                            <ENT>1.08</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">40842</ENT>
                            <ENT/>
                            <ENT>R</ENT>
                            <ENT>Reconstruction of mouth</ENT>
                            <ENT>9.03</ENT>
                            <ENT>10.20</ENT>
                            <ENT>10.13</ENT>
                            <ENT>5.72</ENT>
                            <ENT>6.25</ENT>
                            <ENT>1.08</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">40843</ENT>
                            <ENT/>
                            <ENT>R</ENT>
                            <ENT>Reconstruction of mouth</ENT>
                            <ENT>12.62</ENT>
                            <ENT>11.33</ENT>
                            <ENT>11.63</ENT>
                            <ENT>5.74</ENT>
                            <ENT>6.77</ENT>
                            <ENT>1.39</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">40844</ENT>
                            <ENT/>
                            <ENT>R</ENT>
                            <ENT>Reconstruction of mouth</ENT>
                            <ENT>16.57</ENT>
                            <ENT>15.21</ENT>
                            <ENT>15.48</ENT>
                            <ENT>9.11</ENT>
                            <ENT>10.33</ENT>
                            <ENT>2.00</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">40845</ENT>
                            <ENT/>
                            <ENT>R</ENT>
                            <ENT>Reconstruction of mouth</ENT>
                            <ENT>19.13</ENT>
                            <ENT>16.02</ENT>
                            <ENT>16.54</ENT>
                            <ENT>10.21</ENT>
                            <ENT>11.71</ENT>
                            <ENT>2.01</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">40899</ENT>
                            <ENT/>
                            <ENT>C</ENT>
                            <ENT>Mouth surgery procedure</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>YYY</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">41000</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Drainage of mouth lesion</ENT>
                            <ENT>1.32</ENT>
                            <ENT>2.55</ENT>
                            <ENT>2.43</ENT>
                            <ENT>1.33</ENT>
                            <ENT>1.37</ENT>
                            <ENT>0.12</ENT>
                            <ENT>010</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">41005</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Drainage of mouth lesion</ENT>
                            <ENT>1.28</ENT>
                            <ENT>4.32</ENT>
                            <ENT>3.83</ENT>
                            <ENT>1.77</ENT>
                            <ENT>1.74</ENT>
                            <ENT>0.12</ENT>
                            <ENT>010</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">41006</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Drainage of mouth lesion</ENT>
                            <ENT>3.28</ENT>
                            <ENT>5.43</ENT>
                            <ENT>5.11</ENT>
                            <ENT>2.82</ENT>
                            <ENT>2.99</ENT>
                            <ENT>0.35</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">41007</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Drainage of mouth lesion</ENT>
                            <ENT>3.14</ENT>
                            <ENT>5.34</ENT>
                            <ENT>5.24</ENT>
                            <ENT>2.72</ENT>
                            <ENT>2.87</ENT>
                            <ENT>0.31</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">41008</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Drainage of mouth lesion</ENT>
                            <ENT>3.40</ENT>
                            <ENT>5.51</ENT>
                            <ENT>5.09</ENT>
                            <ENT>2.84</ENT>
                            <ENT>3.02</ENT>
                            <ENT>0.42</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">41009</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Drainage of mouth lesion</ENT>
                            <ENT>3.63</ENT>
                            <ENT>5.83</ENT>
                            <ENT>5.40</ENT>
                            <ENT>3.14</ENT>
                            <ENT>3.35</ENT>
                            <ENT>0.47</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <PRTPAGE P="66454"/>
                            <ENT I="01">41010</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Incision of tongue fold</ENT>
                            <ENT>1.08</ENT>
                            <ENT>3.90</ENT>
                            <ENT>3.66</ENT>
                            <ENT>1.56</ENT>
                            <ENT>1.58</ENT>
                            <ENT>0.07</ENT>
                            <ENT>010</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">41015</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Drainage of mouth lesion</ENT>
                            <ENT>4.00</ENT>
                            <ENT>6.29</ENT>
                            <ENT>5.84</ENT>
                            <ENT>3.98</ENT>
                            <ENT>4.06</ENT>
                            <ENT>0.46</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">41016</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Drainage of mouth lesion</ENT>
                            <ENT>4.11</ENT>
                            <ENT>6.22</ENT>
                            <ENT>5.92</ENT>
                            <ENT>4.07</ENT>
                            <ENT>4.14</ENT>
                            <ENT>0.53</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">41017</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Drainage of mouth lesion</ENT>
                            <ENT>4.11</ENT>
                            <ENT>6.37</ENT>
                            <ENT>6.00</ENT>
                            <ENT>4.12</ENT>
                            <ENT>4.21</ENT>
                            <ENT>0.53</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">41018</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Drainage of mouth lesion</ENT>
                            <ENT>5.14</ENT>
                            <ENT>6.75</ENT>
                            <ENT>6.44</ENT>
                            <ENT>4.48</ENT>
                            <ENT>4.52</ENT>
                            <ENT>0.68</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">41019</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Place needles h&amp;n for rt</ENT>
                            <ENT>8.84</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>3.28</ENT>
                            <ENT>3.28</ENT>
                            <ENT>0.59</ENT>
                            <ENT>000</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">41100</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Biopsy of tongue</ENT>
                            <ENT>1.39</ENT>
                            <ENT>2.68</ENT>
                            <ENT>2.55</ENT>
                            <ENT>1.17</ENT>
                            <ENT>1.29</ENT>
                            <ENT>0.15</ENT>
                            <ENT>010</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">41105</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Biopsy of tongue</ENT>
                            <ENT>1.44</ENT>
                            <ENT>2.67</ENT>
                            <ENT>2.49</ENT>
                            <ENT>1.20</ENT>
                            <ENT>1.26</ENT>
                            <ENT>0.13</ENT>
                            <ENT>010</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">41108</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Biopsy of floor of mouth</ENT>
                            <ENT>1.07</ENT>
                            <ENT>2.52</ENT>
                            <ENT>2.30</ENT>
                            <ENT>1.08</ENT>
                            <ENT>1.10</ENT>
                            <ENT>0.10</ENT>
                            <ENT>010</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">41110</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Excision of tongue lesion</ENT>
                            <ENT>1.53</ENT>
                            <ENT>3.65</ENT>
                            <ENT>3.32</ENT>
                            <ENT>1.64</ENT>
                            <ENT>1.64</ENT>
                            <ENT>0.13</ENT>
                            <ENT>010</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">41112</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Excision of tongue lesion</ENT>
                            <ENT>2.77</ENT>
                            <ENT>5.26</ENT>
                            <ENT>4.86</ENT>
                            <ENT>3.24</ENT>
                            <ENT>3.23</ENT>
                            <ENT>0.28</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">41113</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Excision of tongue lesion</ENT>
                            <ENT>3.23</ENT>
                            <ENT>5.51</ENT>
                            <ENT>5.12</ENT>
                            <ENT>3.39</ENT>
                            <ENT>3.43</ENT>
                            <ENT>0.34</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">41114</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Excision of tongue lesion</ENT>
                            <ENT>8.71</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>6.30</ENT>
                            <ENT>6.74</ENT>
                            <ENT>0.83</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">41115</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Excision of tongue fold</ENT>
                            <ENT>1.76</ENT>
                            <ENT>4.18</ENT>
                            <ENT>3.74</ENT>
                            <ENT>1.72</ENT>
                            <ENT>1.79</ENT>
                            <ENT>0.18</ENT>
                            <ENT>010</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">41116</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Excision of mouth lesion</ENT>
                            <ENT>2.47</ENT>
                            <ENT>5.56</ENT>
                            <ENT>4.95</ENT>
                            <ENT>2.80</ENT>
                            <ENT>2.80</ENT>
                            <ENT>0.23</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">41120</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Partial removal of tongue</ENT>
                            <ENT>10.91</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>14.32</ENT>
                            <ENT>14.81</ENT>
                            <ENT>0.79</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">41130</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Partial removal of tongue</ENT>
                            <ENT>15.51</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>15.88</ENT>
                            <ENT>16.03</ENT>
                            <ENT>0.93</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">41135</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Tongue and neck surgery</ENT>
                            <ENT>29.83</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>21.84</ENT>
                            <ENT>22.53</ENT>
                            <ENT>1.89</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">41140</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Removal of tongue</ENT>
                            <ENT>28.81</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>23.56</ENT>
                            <ENT>25.11</ENT>
                            <ENT>2.27</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">41145</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Tongue removal, neck surgery</ENT>
                            <ENT>37.59</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>28.79</ENT>
                            <ENT>29.66</ENT>
                            <ENT>2.55</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">41150</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Tongue, mouth, jaw surgery</ENT>
                            <ENT>29.52</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>23.02</ENT>
                            <ENT>23.86</ENT>
                            <ENT>1.95</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">41153</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Tongue, mouth, neck surgery</ENT>
                            <ENT>33.28</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>23.92</ENT>
                            <ENT>24.46</ENT>
                            <ENT>2.01</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">41155</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Tongue, jaw, &amp; neck surgery</ENT>
                            <ENT>43.96</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>27.59</ENT>
                            <ENT>27.19</ENT>
                            <ENT>2.34</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">41250</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Repair tongue laceration</ENT>
                            <ENT>1.93</ENT>
                            <ENT>3.86</ENT>
                            <ENT>3.30</ENT>
                            <ENT>1.61</ENT>
                            <ENT>1.39</ENT>
                            <ENT>0.18</ENT>
                            <ENT>010</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">41251</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Repair tongue laceration</ENT>
                            <ENT>2.29</ENT>
                            <ENT>3.48</ENT>
                            <ENT>3.38</ENT>
                            <ENT>1.78</ENT>
                            <ENT>1.66</ENT>
                            <ENT>0.22</ENT>
                            <ENT>010</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">41252</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Repair tongue laceration</ENT>
                            <ENT>2.99</ENT>
                            <ENT>4.59</ENT>
                            <ENT>4.24</ENT>
                            <ENT>2.12</ENT>
                            <ENT>2.19</ENT>
                            <ENT>0.29</ENT>
                            <ENT>010</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">41500</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Fixation of tongue</ENT>
                            <ENT>3.74</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>7.52</ENT>
                            <ENT>7.48</ENT>
                            <ENT>0.30</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">41510</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Tongue to lip surgery</ENT>
                            <ENT>3.45</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>6.47</ENT>
                            <ENT>7.20</ENT>
                            <ENT>0.20</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">41520</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Reconstruction, tongue fold</ENT>
                            <ENT>2.77</ENT>
                            <ENT>5.80</ENT>
                            <ENT>5.21</ENT>
                            <ENT>3.26</ENT>
                            <ENT>3.44</ENT>
                            <ENT>0.27</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">41599</ENT>
                            <ENT/>
                            <ENT>C</ENT>
                            <ENT>Tongue and mouth surgery</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>YYY</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">41800</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Drainage of gum lesion</ENT>
                            <ENT>1.21</ENT>
                            <ENT>4.80</ENT>
                            <ENT>3.69</ENT>
                            <ENT>2.12</ENT>
                            <ENT>1.70</ENT>
                            <ENT>0.12</ENT>
                            <ENT>010</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">41805</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Removal foreign body, gum</ENT>
                            <ENT>1.28</ENT>
                            <ENT>4.64</ENT>
                            <ENT>3.65</ENT>
                            <ENT>2.70</ENT>
                            <ENT>2.46</ENT>
                            <ENT>0.13</ENT>
                            <ENT>010</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">41806</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Removal foreign body,jawbone</ENT>
                            <ENT>2.73</ENT>
                            <ENT>5.82</ENT>
                            <ENT>4.70</ENT>
                            <ENT>3.34</ENT>
                            <ENT>3.19</ENT>
                            <ENT>0.37</ENT>
                            <ENT>010</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">41820</ENT>
                            <ENT/>
                            <ENT>R</ENT>
                            <ENT>Excision, gum, each quadrant</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>000</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">41821</ENT>
                            <ENT/>
                            <ENT>R</ENT>
                            <ENT>Excision of gum flap</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>000</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">41822</ENT>
                            <ENT/>
                            <ENT>R</ENT>
                            <ENT>Excision of gum lesion</ENT>
                            <ENT>2.35</ENT>
                            <ENT>4.80</ENT>
                            <ENT>4.34</ENT>
                            <ENT>1.85</ENT>
                            <ENT>1.86</ENT>
                            <ENT>0.31</ENT>
                            <ENT>010</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">41823</ENT>
                            <ENT/>
                            <ENT>R</ENT>
                            <ENT>Excision of gum lesion</ENT>
                            <ENT>3.63</ENT>
                            <ENT>6.45</ENT>
                            <ENT>6.01</ENT>
                            <ENT>3.73</ENT>
                            <ENT>3.87</ENT>
                            <ENT>0.47</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">41825</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Excision of gum lesion</ENT>
                            <ENT>1.35</ENT>
                            <ENT>3.69</ENT>
                            <ENT>3.37</ENT>
                            <ENT>1.46</ENT>
                            <ENT>1.85</ENT>
                            <ENT>0.15</ENT>
                            <ENT>010</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">41826</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Excision of gum lesion</ENT>
                            <ENT>2.35</ENT>
                            <ENT>5.09</ENT>
                            <ENT>3.76</ENT>
                            <ENT>2.57</ENT>
                            <ENT>2.34</ENT>
                            <ENT>0.30</ENT>
                            <ENT>010</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">41827</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Excision of gum lesion</ENT>
                            <ENT>3.72</ENT>
                            <ENT>6.64</ENT>
                            <ENT>6.08</ENT>
                            <ENT>3.38</ENT>
                            <ENT>3.52</ENT>
                            <ENT>0.35</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">41828</ENT>
                            <ENT/>
                            <ENT>R</ENT>
                            <ENT>Excision of gum lesion</ENT>
                            <ENT>3.11</ENT>
                            <ENT>4.09</ENT>
                            <ENT>3.94</ENT>
                            <ENT>1.64</ENT>
                            <ENT>2.30</ENT>
                            <ENT>0.44</ENT>
                            <ENT>010</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">41830</ENT>
                            <ENT/>
                            <ENT>R</ENT>
                            <ENT>Removal of gum tissue</ENT>
                            <ENT>3.38</ENT>
                            <ENT>5.98</ENT>
                            <ENT>5.47</ENT>
                            <ENT>3.11</ENT>
                            <ENT>3.37</ENT>
                            <ENT>0.44</ENT>
                            <ENT>010</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">41850</ENT>
                            <ENT/>
                            <ENT>R</ENT>
                            <ENT>Treatment of gum lesion</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>000</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">41870</ENT>
                            <ENT/>
                            <ENT>R</ENT>
                            <ENT>Gum graft</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>000</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">41872</ENT>
                            <ENT/>
                            <ENT>R</ENT>
                            <ENT>Repair gum</ENT>
                            <ENT>2.90</ENT>
                            <ENT>6.04</ENT>
                            <ENT>5.53</ENT>
                            <ENT>3.30</ENT>
                            <ENT>3.38</ENT>
                            <ENT>0.30</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">41874</ENT>
                            <ENT/>
                            <ENT>R</ENT>
                            <ENT>Repair tooth socket</ENT>
                            <ENT>3.13</ENT>
                            <ENT>5.66</ENT>
                            <ENT>5.25</ENT>
                            <ENT>2.72</ENT>
                            <ENT>2.94</ENT>
                            <ENT>0.45</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">41899</ENT>
                            <ENT/>
                            <ENT>C</ENT>
                            <ENT>Dental surgery procedure</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>0.00</ENT>
                            <ENT>YYY</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">42000</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Drainage mouth roof lesion</ENT>
                            <ENT>1.25</ENT>
                            <ENT>2.48</ENT>
                            <ENT>2.52</ENT>
                            <ENT>1.20</ENT>
                            <ENT>1.22</ENT>
                            <ENT>0.12</ENT>
                            <ENT>010</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">42100</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Biopsy roof of mouth</ENT>
                            <ENT>1.33</ENT>
                            <ENT>2.27</ENT>
                            <ENT>2.18</ENT>
                            <ENT>1.26</ENT>
                            <ENT>1.31</ENT>
                            <ENT>0.13</ENT>
                            <ENT>010</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">42104</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Excision lesion, mouth roof</ENT>
                            <ENT>1.66</ENT>
                            <ENT>3.57</ENT>
                            <ENT>3.06</ENT>
                            <ENT>1.67</ENT>
                            <ENT>1.60</ENT>
                            <ENT>0.16</ENT>
                            <ENT>010</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">42106</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Excision lesion, mouth roof</ENT>
                            <ENT>2.12</ENT>
                            <ENT>4.45</ENT>
                            <ENT>3.83</ENT>
                            <ENT>2.07</ENT>
                            <ENT>2.25</ENT>
                            <ENT>0.25</ENT>
                            <ENT>010</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">42107</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Excision lesion, mouth roof</ENT>
                            <ENT>4.48</ENT>
                            <ENT>6.53</ENT>
                            <ENT>6.12</ENT>
                            <ENT>3.69</ENT>
                            <ENT>3.82</ENT>
                            <ENT>0.44</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">42120</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Remove palate/lesion</ENT>
                            <ENT>11.70</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>12.28</ENT>
                            <ENT>12.02</ENT>
                            <ENT>0.52</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">42140</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Excision of uvula</ENT>
                            <ENT>1.65</ENT>
                            <ENT>4.58</ENT>
                            <ENT>4.15</ENT>
                            <ENT>2.11</ENT>
                            <ENT>2.10</ENT>
                            <ENT>0.13</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">42145</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Repair palate, pharynx/uvula</ENT>
                            <ENT>9.63</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>7.48</ENT>
                            <ENT>7.48</ENT>
                            <ENT>0.65</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">42160</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Treatment mouth roof lesion</ENT>
                            <ENT>1.82</ENT>
                            <ENT>3.77</ENT>
                            <ENT>4.01</ENT>
                            <ENT>1.69</ENT>
                            <ENT>1.99</ENT>
                            <ENT>0.17</ENT>
                            <ENT>010</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">42180</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Repair palate</ENT>
                            <ENT>2.52</ENT>
                            <ENT>3.37</ENT>
                            <ENT>3.22</ENT>
                            <ENT>1.86</ENT>
                            <ENT>1.98</ENT>
                            <ENT>0.21</ENT>
                            <ENT>010</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">42182</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Repair palate</ENT>
                            <ENT>3.84</ENT>
                            <ENT>3.99</ENT>
                            <ENT>3.93</ENT>
                            <ENT>2.39</ENT>
                            <ENT>2.71</ENT>
                            <ENT>0.40</ENT>
                            <ENT>010</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">42200</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Reconstruct cleft palate</ENT>
                            <ENT>12.41</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>8.62</ENT>
                            <ENT>9.41</ENT>
                            <ENT>1.27</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">42205</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Reconstruct cleft palate</ENT>
                            <ENT>13.57</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>7.36</ENT>
                            <ENT>8.71</ENT>
                            <ENT>1.58</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">42210</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Reconstruct cleft palate</ENT>
                            <ENT>14.91</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>10.24</ENT>
                            <ENT>10.84</ENT>
                            <ENT>2.17</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">42215</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Reconstruct cleft palate</ENT>
                            <ENT>8.88</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>7.41</ENT>
                            <ENT>8.24</ENT>
                            <ENT>1.31</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                            <ENT I="01">42220</ENT>
                            <ENT/>
                            <ENT>A</ENT>
                            <ENT>Reconstruct cleft palate</ENT>
                            <ENT>7.07</ENT>
                            <ENT>NA</ENT>
                            <ENT>NA</ENT>
                            <ENT>7.21</ENT>
                            <ENT>6.99</ENT>
                            <ENT>0.73</ENT>
                            <ENT>090</ENT>
                        </ROW>
                        <ROW>
                     