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2010-09-23
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Medicare Program; Revisions to Payment Policies Under the Physician Fee Schedule for Calendar Year 2005
Part III
Rules and Regulations
D09002ee1bde504fe
D09002ee1bde51038
United States
Department of Health and Human Services
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United States Government Agency or Subagency
United States
Centers for Medicare & Medicaid Services
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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
Code of Federal Regulations
Title 42 Part 403
42 CFR Part 403
Code of Federal Regulations
Title 42 Part 405
42 CFR Part 405
Code of Federal Regulations
Title 42 Part 410
42 CFR Part 410
Code of Federal Regulations
Title 42 Part 411
42 CFR Part 411
Code of Federal Regulations
Title 42 Part 414
42 CFR Part 414
Code of Federal Regulations
Title 42 Part 418
42 CFR Part 418
Code of Federal Regulations
Title 42 Part 424
42 CFR Part 424
Code of Federal Regulations
Title 42 Part 484
42 CFR Part 484
Code of Federal Regulations
Title 42 Part 486
42 CFR Part 486
Regulation Identification Number 0938-AM90
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/
Federal Register
Vol. 69, no. 219
Office of the Federal Register, National Archives and Records Administration
2004-11-15
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1536 p.
Table of Contents:
AE 2.7:
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AE 2.106:
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https://www.govinfo.gov/app/details/FR-2004-11-15
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