United States Government Publishing Office publisher pbl distributor dst United States National Archives and Records Administration Office of the Federal Register author aut Government Organization text government publication eng FR Regulatory Information 2004_register executive 2010-09-23 article Part III Rules and Regulations D09002ee1c81278fd D09002ee1c81279c8 United States Department of Health and Human Services originator org United States Government Agency or Subagency United States Centers for Medicare & Medicaid Services originator org United States Government Agency or Subagency This final rule refines the resource-based practice expense relative value units (RVUs) and makes other changes to Medicare Part B payment policy. These policy changes concern: supplemental survey data for practice expense; updated geographic practice cost indices for physician work and practice expense; updated malpractice RVUs; revised requirements for supervision of therapy assistants; revised payment rules for low osmolar contrast media; changes to payment policies for physicians and practitioners managing dialysis patients; clarification of care plan oversight requirements; revised requirements for supervision of diagnostic psychological testing services; clarifications to the policies affecting therapy services; revised requirements for assignment of Medicare claims; addition to the list of telehealth services; and, several coding issues. 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 also addresses the following provisions of the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (Pub. L. 108-17) (MMA): coverage of an initial preventive physical examination; coverage of cardiovascular (CV) screening blood tests; coverage of diabetes screening tests; incentive payment improvements for physicians in shortage areas; payment for covered outpatient drugs and biologicals; payment for renal dialysis services; coverage of routine costs associated with certain clinical trials of category A devices as defined by the Food and Drug Administration; hospice consultation service; indexing the Part B deductible to inflation; extension of coverage of intravenous immune globulin (IVIG) for the treatment in the home of primary immune deficiency diseases; revisions to reassignment provisions; and, payment for diagnostic mammograms, physicians' services associated with drug administration services and coverage of religious nonmedical health care institution items and services to the beneficiary's home. In addition, this rule updates the codes subject to the physician self-referral prohibition, discusses payment for set-up of portable x- ray equipment, discusses the third five-year refinement of work RVUs, and solicits comments on potentially misvalued work RVUs. We are also finalizing the calendar year (CY) 2004 interim RVUs and are issuing interim RVUs for new and revised procedure codes for CY 2005. As required by the statute, we are announcing that the physician fee schedule update for CY 2005 is 1.5 percent, the initial estimate for the sustainable growth rate for CY 2005 is 4.3, and the conversion factor for CY 2005 is $37.8975. 69 FR 66236 https://www.govinfo.gov/app/details/FR-2004-11-15/04-24758 04-24758 fr15no04-18 RIN 0938-AM90 4120-01-P CMS-1429-FC https://www.govinfo.gov/app/details/FR-2004-11-15/04-24758 https://www.govinfo.gov/content/pkg/FR-2004-11-15/html/04-24758.htm https://www.govinfo.gov/content/pkg/FR-2004-11-15/pdf/04-24758.pdf Grant Programs-Health Health Insurance Hospitals Intergovernmental Relations Medicare Reporting and Recordkeeping Requirements Administrative Practice and Procedure Health Facilities Health Professions Kidney Diseases Medical Devices Rural Areas X-Rays Laboratories Hospice Care Emergency Medical Services 680 p. 66236 66915 69 FR 66236 Title 42 Part 403 42 CFR Part 403 Title 42 Part 405 42 CFR Part 405 Title 42 Part 410 42 CFR Part 410 Title 42 Part 411 42 CFR Part 411 Title 42 Part 414 42 CFR Part 414 Title 42 Part 418 42 CFR Part 418 Title 42 Part 424 42 CFR Part 424 Title 42 Part 484 42 CFR Part 484 Title 42 Part 486 42 CFR Part 486 RIN 0938-AM90 Medicare Program; Revisions to Payment Policies Under the Physician Fee Schedule for Calendar Year 2005; Federal Register Vol. 69, Issue RULE 04-24758 III DEPARTMENT OF HEALTH AND HUMAN SERVICES Centers for Medicare & Medicaid Services 2005-01-01 CMS-1429-FC 4120-01-P 04-24758 Final rule with comment period.

This final rule refines the resource-based practice expense relative value units (RVUs) and makes other changes to Medicare Part B payment policy. These policy changes concern: supplemental survey data for practice expense; updated geographic practice cost indices for physician work and practice expense; updated malpractice RVUs; revised requirements for supervision of therapy assistants; revised payment rules for low osmolar contrast media; changes to payment policies for physicians and practitioners managing dialysis patients; clarification of care plan oversight requirements; revised requirements for supervision of diagnostic psychological testing services; clarifications to the policies affecting therapy services; revised requirements for assignment of Medicare claims; addition to the list of telehealth services; and, several coding issues. 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 also addresses the following provisions of the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (Pub. L. 108-17) (MMA): coverage of an initial preventive physical examination; coverage of cardiovascular (CV) screening blood tests; coverage of diabetes screening tests; incentive payment improvements for physicians in shortage areas; payment for covered outpatient drugs and biologicals; payment for renal dialysis services; coverage of routine costs associated with certain clinical trials of category A devices as defined by the Food and Drug Administration; hospice consultation service; indexing the Part B deductible to inflation; extension of coverage of intravenous immune globulin (IVIG) for the treatment in the home of primary immune deficiency diseases; revisions to reassignment provisions; and, payment for diagnostic mammograms, physicians' services associated with drug administration services and coverage of religious nonmedical health care institution items and services to the beneficiary's home. In addition, this rule updates the codes subject to the physician self-referral prohibition, discusses payment for set-up of portable x- ray equipment, discusses the third five-year refinement of work RVUs, and solicits comments on potentially misvalued work RVUs. We are also finalizing the calendar year (CY) 2004 interim RVUs and are issuing interim RVUs for new and revised procedure codes for CY 2005. As required by the statute, we are announcing that the physician fee schedule update for CY 2005 is 1.5 percent, the initial estimate for the sustainable growth rate for CY 2005 is 4.3, and the conversion factor for CY 2005 is $37.8975.

Effective Date: These regulations are effective on January 1, 2005. Pam West (410) 786-2302 (for issues related to Practice Expense, Respiratory Therapy Coding, and Therapy Supervision). Grant Programs-Health Health Insurance Hospitals Intergovernmental Relations Medicare Reporting and Recordkeeping Requirements Administrative Practice and Procedure Health Facilities Health Professions Kidney Diseases Medical Devices Rural Areas X-Rays Laboratories Hospice Care Emergency Medical Services Medicare: Physician fee schedule (2005 CY); payment policies and relative value units adjustment, Martin@omb.eop.gov cms.gov http://bphc.hrsa.gov/opa/howto.htm http://cms.hhs.gov/medlearn/refphys.asp http://www.access.gpo.gov/nara/index.html http://www.cms.hhs.gov http://www.cms.hhs.gov/ http://www.cms.hhs.gov/coverage/8a.asp http://www.cms.hhs.gov/manuals/ http://www.cms.hhs.gov/manuals/104_claims/clm104c05.pdf http://www.cms.hhs.gov/medicarereform/ccip/ http://www.cms.hhs.gov/medlearn/matters/mmarticles/2005/SE0449.pd http://www.cms.hhs.gov/medlearn/therapy http://www.cms.hhs.gov/physicians/pfs http://www.cms.hhs.gov/physicians/telehealth http://www.cms.hhs.gov/providers/bonuspayment http://www.cms.hhs.gov/providers/drugs/asp.asp http://www.cms.hhs.gov/providers/pufdownload/rvudown.asp http://www.cms.hhs.gov/regulations/ecomments http://www.sph.umich.edu/kecc medicare.gov www.cms.hhs.gov/physicians/ Vol. 69, no. 219 Office of the Federal Register, National Archives and Records Administration 2004-11-15 continuing daily deposited born digital 1536 p. Table of Contents: AE 2.7: GS 4.107: AE 2.106: KF70.A2 https://www.govinfo.gov/app/details/FR-2004-11-15 P0b002ee180976b59 0097-6326 0042-1219 0364-1406 769-004-00000-9 000582072 f:fr15no04 https://www.govinfo.gov/app/details/FR-2004-11-15 https://www.govinfo.gov/content/pkg/FR-2004-11-15/pdf/FR-2004-11-15.pdf https://www.govinfo.gov/content/pkg/FR-2004-11-15/xml/FR-2004-11-15.xml fdlp 65515 67039 DGPO 2010-09-23 2024-06-06 FR-2004-11-15 machine generated eng FR FR-2004-11-15 69 219