Rule: Medicare: Physician Fee Schedule (CY 2007) Payment Policies and Relative Value Units

Friday,
December 1, 2006
Book 2 of 2 Books
Pages 69623–70274
Part II
Department of
Health and Human
Services
Centers for Medicare & Medicaid Services
42 CFR Parts 405, 410, et al.

Medicare Program; Revisions to Payment
Policies, etc.; Final Rule
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69624 Federal Register / Vol. 71, No. 231 / Friday, December 1, 2006 / Rules and Regulations
DEPARTMENT OF HEALTH AND fee schedule for ambulance services and persons without Federal Government
HUMAN SERVICES the ambulance inflation factor update identification, commenters are
for CY 2007. encouraged to leave their comments in
Centers for Medicare & Medicaid As required by the statute, we are the CMS drop slots located in the main
Services announcing that the physician fee lobby of the building. A stamp-in clock
schedule update for CY 2007 is ¥5.0 is available for persons wishing to retain
42 CFR Parts 405, 410, 411, 414, 415, percent, the initial estimate for the a proof of filing by stamping in and
and 424 sustainable growth rate for CY 2007 is retaining an extra copy of the comments
[CMS–1321–FC and CMS–1317–F]
2.0 percent and the CF for CY 2007 is being filed.)
$35.9848. Comments mailed to the addresses
RINs 0938–AO24 and 0938–AO11 DATES: Effective Date: These regulations indicated as appropriate for hand or
are effective on January 1, 2007. courier delivery may be delayed and
Medicare Program; Revisions to Comment Date: Comments will be
Payment Policies, Five-Year Review of received after the comment period.
considered if we receive them at one of Submission of comments on
Work Relative Value Units, Changes to the addresses provided below, no later
the Practice Expense Methodology paperwork requirements. You may
than 5 p.m. on January 2, 2007. submit comments on this document’s
Under the Physician Fee Schedule, and
ADDRESSES: In commenting, please refer paperwork requirements by mailing
Other Changes to Payment Under Part
to file code CMS–1321–FC. Because of your comments to the addresses
B; Revisions to the Payment Policies
staff and resource limitations, we cannot provided at the end of the ‘‘Collection
of Ambulance Services Under the Fee
accept comments by facsimile (FAX) of Information Requirements’’ section in
Schedule for Ambulance Services; and
transmission. this document.
Ambulance Inflation Factor Update for You may submit comments in one of
CY 2007 For information on viewing public
three ways (no duplicates, please): comments, see the beginning of the
AGENCY: Centers for Medicare & 1. Electronically. You may submit SUPPLEMENTARY INFORMATION section.
Medicaid Services (CMS), HHS. electronic comments on specific issues
in this regulation to http:// FOR FURTHER INFORMATION CONTACT: Pam
ACTION: Final rule with comment period.
www.cms.hhs.gov/eRulemaking. Click West, (410) 786–2302 (for issues related
SUMMARY: This final rule with comment on the link ‘‘Submit electronic to practice expense).
period addresses certain provisions of comments on CMS regulations with an Stephanie Monroe, (410) 786–6864
the Deficit Reduction Act of 2005, as open comment period.’’ (Attachments (for issues related to the geographic
well as making other changes to should be in Microsoft Word, practice cost index).
Medicare Part B payment policy. These WordPerfect, or Excel; however, we Craig Dobyski, (410) 786–4584 (for
changes are intended to ensure that our prefer Microsoft Word.) issues related to list of telehealth
payment systems are updated to reflect 2. By mail. You may mail written services).
changes in medical practice and the comments (one original and two copies) Roberta Epps, (410) 786–4503 (for
relative value of services. This final rule to the following address ONLY: Centers issues related to diagnostic imaging
with comment period also discusses for Medicare & Medicaid Services, services).
geographic practice cost indices (GPCI) Department of Health and Human Bill Larson, (410) 786–4639 (for issues
changes; requests for additions to the Services, Attention: CMS–1321–FC, P.O. related to coverage of bone mass
list of telehealth services; payment for Box 8014, Baltimore, MD 21244–8014. measurement and addition of
covered outpatient drugs and Please allow sufficient time for mailed ultrasound screening for abdominal
biologicals; payment for renal dialysis comments to be received before the aortic aneurysm to the ‘‘Welcome to
services; policies related to private close of the comment period. Medicare’’ benefit).
contracts and opt-out; policies related to 3. By express or overnight mail. You Dorothy Shannon, (410) 786–3396 (for
bone mass measurement (BMM) may send written comments (one issues related to the outpatient therapy
services, independent diagnostic testing original and two copies) to the following cap).
facilities (IDTFs), the physician self- address only: Centers for Medicare & Catherine Jansto, (410) 786–7762 (for
referral prohibition; laboratory billing Medicaid Services, Department of issues related to payment for covered
for the technical component (TC) of Health and Human Services, Attention: outpatient drugs and biologicals).
physician pathology services; the CMS–1321–FC, Mail Stop C4–26–05, Henry Richter, (410) 786–4562 (for
clinical laboratory fee schedule; 7500 Security Boulevard, Baltimore, MD issues related to payments for end-stage
certification of advanced practice 21244–1850. renal disease facilities).
nurses; health information technology, 4. By hand or courier. If you prefer,
you may deliver (by hand or courier) Fred Grabau, (410) 786–0206 (for
the health care information
your written comments (one original issues related to private contracts and
transparency initiative; updates the list
and two copies) before the close of the opt-out provision).
of certain services subject to the
physician self-referral prohibitions, comment period to one of the following David Walczak, (410) 786–4475 (for
finalizes ASP reporting requirements, addresses. If you intend to deliver your issues related to reassignment
and codifies Medicare’s longstanding comments to the Baltimore address, provisions).
policy that payment of bad debts please call telephone number (410) 786– August Nemec, (410) 786–0612 (for
associated with services paid under a 7197 in advance to schedule your issues related to independent diagnostic
fee schedule/charge-based system are arrival with one of our staff members. testing facilities).
not allowable. Room 445–G, Hubert H. Humphrey Anita Greenberg, (410) 786–4601 (for
We are also finalizing the calendar Building, 200 Independence Avenue, issues related to the clinical laboratory
year (CY) 2006 interim RVUs and are SW., Washington, DC 20201; or 7500 fee schedule).
issuing interim RVUs for new and Security Boulevard, Baltimore, MD James Menas, (410) 786–4507 (for
revised procedure codes for CY 2007. 21244–1850. issues related to payment for physician
In addition, this rule includes (Because access to the interior of the pathology services).
revisions to payment policies under the HHH Building is not readily available to Anne Tayloe, (410) 786–4546; or
Federal Register / Vol. 71, No. 231 / Friday, December 1, 2006 / Rules and Regulations 69625
Glenn McGuirk, (410) 786–5723 (for Regulations. Information on the 5. Payment for Drugs Furnished During CY
issues related to the ambulance fee regulation’s impact appears throughout 2006 and Subsequent Years in
schedule. the preamble and is not exclusively in Connection With the Furnishing of Renal
Dialysis Services if Separately Billed by
Diane Milstead, (410) 786–3355 or section VI.
Renal Dialysis Facilities
Gaysha Brooks, (410) 786–9649 (for all 6. Other Issues
other issues). Table of Contents
G. Revisions Related to Payment for Renal
SUPPLEMENTARY INFORMATION: I. Background Dialysis Services Furnished by End Stage
Submitting Comments: We welcome A. Development of the Relative Value Renal Disease (ESRD) Facilities
comments from the public on the System 1. Growth Update to the Drug Add-on
B. Components of the Fee Schedule Adjustment to the Composite Rate
following issues: interim Relative Value Payment Amounts 2. Update to the Geographic Adjustments
Units (RVUs) for selected procedure C. Most Recent Changes to the Fee to the Composite Rates
codes identified in Addendum C and Schedule H. Private Contracts and Opt-Out
the physician self-referral designated II. Provisions of the Final Rule Provision—Practitioner Definition
health services (DHS) listed in Tables 18 A. Resource-Based Practice Expense I. Changes to Reassignment and Physician
and 19. You can assist us by referencing Relative Value Units Self-Referral Rules Relating to Diagnostic
the file code CMS–1321–FC and the 1. Current Methodology Tests
specific ‘‘issue identifier’’ that precedes 2. Proposals for Revising the PE J. Supplier Access to Claims Billed on
the section on which you choose to Methodology Reassignment
3. Specific Changes to the Indirect PE K. Coverage of Bone Mass Measurement
comment. Methodology for Calendar Year 2007 1. Provisions of the June 24, 1998 IFC
Inspection of Public Comments: All 4. Additional PE Issues for CY 2007 2. Additional Scientific Evidence
comments received before the close of a. RUC Recommendations for Direct PE 3. Changes to the June 24, 1998 IFC
the comment period are available for Inputs and Other PE Input Issues 4. Analysis of and Response to Comments
viewing by the public, including any b. Payment for Splint and Cast Supplies on the June 24, 1998 IFC and the CY
personally identifiable or confidential c. Medical Nutrition Therapy Services 2007 PFS Proposed Rule
business information that is included in d. Surgical Pathology Codes L. Independent Diagnostic Testing Facility
a comment. We post all comments e. PE Issues from Rulemaking for CY 2006 (IDTF) Issues
received before the close of the f. Other PE Issues for CY 2007 1. IDTF Changes
g. Specific PE Concerns Raised by 2. Performance Standards for IDTFs
comment period on the following Web Commenters 3. Supervision
site as soon as possible after they have h. Concerns About Decreases in PE RVUs 4. Place of Service
been received: http://www.cms.hhs.gov/ i. Equipment Utilization and Interest Rate 5. Analysis of and Response to Public
eRulemaking. Click on the link Assumptions Comments
‘‘Electronic Comments on CMS j. Further Review of PE Direct Inputs 6. Provisions of the Final Rule
Regulations’’ on that Web site to view k. Supply and Equipment Items Needing M. Independent Laboratory Billing for the
public comments. Specialty Input TC of Physician Pathology Services to
Comments received timely will also B. Geographic Practice Cost Indices (GPCIs) Hospital Patients
be available for public inspection as C. Medicare Telehealth Services N. Public Consultation for Medicare
D. Miscellaneous Coding Issues Payment for New Outpatient Clinical
they are received, generally beginning 1. Global Period for Remote Afterloading Diagnostic Laboratory Tests
approximately 3 weeks after publication High Intensity Brachytherapy Procedures 1. Medicare, Medicaid, and SCHIP Benefits
of a document, at the headquarters of 2. Assignment of RVUS for Proton Beam Improvement Protection Act of 2000
the Centers for Medicare & Medicaid Treatment Delivery Services (BIPA)
Services, 7500 Security Boulevard, E. Deficit Reduction Act (DRA) 2. Medicare Prescription Drug,
Baltimore, Maryland 21244, Monday 1. Section 5102—Adjustments for Improvement, and Modernization Act of
through Friday of each week from 8:30 Payments to Imaging Services 2003 (MMA)
a.m. to 4 p.m. To schedule an a. Payment for Multiple Imaging 3. Other Laboratory Issues
appointment to view public comments, Procedures for 2007 a. Quality
b. Reduction in TC for Imaging Services b. Blood Glucose Monitoring in SNFs
phone 1–800–743–3951. Under the PFS to OPD Payment Amount c. Other Lab Issues—Clinical Diagnostic
This Federal Register document is c. Interaction of the Multiple Imaging Laboratory Date of Service (DOS) for
also available from the Federal Register Payment Reduction and the OPPS Cap Stored Specimens
online database through Government 2. Section 5107—Revisions to Payments for O. Criteria for National Certifying Bodies
Printing Office Access, a service of the Therapy Services that Certify Advanced Practice Nurses
U.S. Government Printing Office. The 3. Section 5112—Addition of Ultrasound P. Chiropractic Services Demonstration
Web site address is: http:// Screening for Abdominal Aortic Q. Promoting Effective Use of Health
www.access.gpo.gov/nara/index.html. Aneurysm (AAA) Information Technology (HIT)
Information on the physician fee a. Coverage R. Health Care Information Transparency
b. Payment Initiative
schedule can also be found on the CMS 4. Section 5113—Non-Application of the S. Bad Debt Payment for Services
homepage. You can access this data by Part B Deductible for Colorectal Cancer Associated with Reasonable Charge/Fee
using the following directions: Screening Tests Schedules
1. Go to the following Web site: http:// 5. Section 5114—Addition of Diabetes III. Revisions to the Payment Policies of
www.cms.hhs.gov/PhysicianFeeSched/. Outpatient Self-Management Training Ambulance Services Under the Fee
2. Select ‘‘PFS Federal Regulation Services (DSMT) and Medical Nutrition Schedule for Ambulance Services and
Notices.’’ Therapy (MNT) for the FQHC Program the Ambulance Inflation Factor Update
To assist readers in referencing F. Payment for Covered Outpatient Drugs for CY 2007
sections contained in this preamble, we and Biologicals (ASP Issues) A. History of Medicare Ambulance
1. ASP Issues Services

are providing the following table of 2. Intravenous Immune Globulin (IVIG) B. Provisions of the Final Regulation
contents. Some of the issues discussed 3. Clotting Factor Furnishing Fee C. Analysis of and Responses to Public
in this preamble affect the payment 4. Widely Available Market Prices (WAMP) Comments
policies, but do not require changes to and Average Manufacturer Price (AMP) D. Ambulance Inflation Factor (AIF) for
the regulations in the Code of Federal Threshold 2007
IV. Five-Year Refinement of Relative Value B. The Percentage Change in the Medicare Addendum B—2007 Relative Value Units
Units Under the Physician Fee Schedule: Economic Index (MEI) and Related Information Used in
Responses to Public Comments on the C. The Update Adjustment Factor (UAF) Determining Medicare Payments for
Five-Year Review of Work Relative Value VIII. Allowed Expenditures for Physicians’ 2006.
Units Services and the Sustainable Growth Addendum C—Codes with Interim RVUs
A. Scope of Five-Year Review Rate Addendum D—2007 Geographic Practice
B. Review of Comments (Includes Table A. Medicare Sustainable Growth Rate Cost Indices by Medicare Carrier and
entitled ‘‘Work RVU Revisions in B. Physicians’ Services Locality
Response to the June 29, 2006 proposed C. Preliminary Estimate of the SGR for Addendum E—GAF Addenda
notice’’) 2007 Addendum F—Addendum F: CPT/HCPCS
C. Discussion of Comments by Clinical D. Revised Sustainable Growth Rate for Imaging Codes Defined by DRA 5102(b)
Area 2006 Addendum G—CY 2007 Wage Index For
1. Dermatology and Plastic Surgery E. Final Sustainable Growth Rate for 2005 Urban Areas Based On CBSA Labor
2. Orthopedic Surgery F. Calculation of 2007, 2006, and 2005 Market Areas
3. Gynecology, Urology, Pain Medicine, Sustainable Growth Rates
Addendum H—CY 2007 ESRD Wage Index
and Neurosurgery IX. Anesthesia and Physician Fee Schedule
for Rural Areas Based on CBSA Labor
4. Radiology, Pathology, and Other Conversion Factors for CY 2007
Market Areas
Miscellaneous Services A. Physician Fee Schedule Conversion
Factor Addendum I—RUCA Rurality Level by State
5. Evaluation and Management Services and Zip Code
6. Cardiothoracic Surgery B. Anesthesia Fee Schedule Conversion
Factor Addendum J—Updated List of CPT/HCPCS
7. General, Colorectal and Vascular Surgery Codes Used to Describe Certain
8. Otolaryngology and Ophthalmology X. Telehealth Originating Site Facility Fee
Payment Amount Update Designated Health Services Under the
9. HCPAC codes
XI. Provisions of the Final Rule Physician Self-Referral Provision
D. Other Issues Under the 5-Year Review
XII. Waiver of Proposed Rulemaking and In addition, because of the many
1. Anesthesia Services
Delay in Effective Date organizations and terms to which we refer by
2. Discussion of Post-Operative Visits
XIII. Collection of Information acronym in this final rule with comment
included in the Global Surgical Packages
Requirements period, we are listing these acronyms and
3. Budget Neutrality
XIV. Response to Comments their corresponding terms in alphabetical
4. Review Process
XV. Regulatory Impact Analysis order below:
V. Refinement of Relative Value Units for
Calendar Year 2007 and Response to A. RVU Impacts AAA Abdominal aortic aneurysm
1. Resource-Based Work and PE RVUs AAD American Academy of Dermatology
Public Comments on Interim Relative
2. Section 5102 of the DRA Adjustments AAFP American Academy of Family
Value Units for 2006
for Payments for Imaging Services Physicians
A. Summary of Issues Discussed Related to
3. Combined Impacts AANS American Association of
the Adjustment of Relative Value Units
B. Geographic Practice Cost Indices (GPCI) Neurological Surgeons
B. Process for Establishing Work Relative
Payment Localities AAO American Academy of
Value Units for the 2006 Physician Fee C. Global Period for Remote Afterloading
Schedule Ophthalmology
High Intensity Brachytherapy Procedures AAOS American Academy of Orthopaedic
C. Work Relative Value Unit Refinements D. DRA 5112: Addition of Ultrasound
of Interim Relative Value Units Surgeons
Screening for Abdominal Aortic
1. Methodology (Includes table entitled AATS American Association for Thoracic
Aneurysm to ‘‘Welcome to Medicare’’
‘‘2006 Interim Work Relative Value Units Surgery
Benefit
for Codes Reviewed Under the ACC American College of Cardiology
E. DRA 5113: Colorectal Screening
Refinement Panel Process’’) ACG American College of Gastroenterology
Exemption from Part B Deductible
2. Interim 2006 Codes F. Section 5114: Addition of Diabetes ACHPN Advanced Certified Hospice and
D. Establishment of Interim Work Relative Outpatient Self-management Training Palliative Nurse
Value Units for New and Revised Services (DSMT) and Medical Nutrition ACOG American College of Obstetrics and
Physician’s Current Procedural Therapy (MNT) for the FQHC Program Gynecology
Terminology (CPT) Codes and New G. Payment for Covered Outpatient Drugs ACR American College of Radiology
Healthcare Common Procedure Coding and Biologicals (ASP Issues) ACS American College of Surgeons
System Codes (HCPCS) for 2007 H. Provisions Related to Payment for Renal ADA American Dietetic Association
(Includes Table titled ‘‘American Dialysis Services Furnished by End State AFROC Association of Freestanding
Medical Association Specialty Relative Renal Disease (ESRD) Facilities Radiation Oncology Centers
Value Update Committee and Health I. Private Contracts and Opt-out Provision AGA American Gastroenterological
Care Professionals Advisory Committee J. Supplier Access to Claims Billed on Association
Recommendations and CMS’ Decisions Reassignment AMA American Medical Association
for New and Revised 2007 CPT Codes’’) K. Coverage of Bone Mass Measurement AMP Average manufacturer price
E. Discussion of Codes for Which There L. IDTF Changes APC Ambulatory payment classification
Were No RUC Recommendations or for M. Independent Lab Billing for TC ASA American Society of Anesthesiologists
Which the RUC Recommendations Were Component of Physician Pathology ASC Ambulatory surgical center
Not Accepted Services for Hospital Patients ASCRS American Society of Colon and
F. Additional Pricing Issue N. Public Consultation for Medicare Rectal Surgeons
G. Establishment of Interim PE RVUs for Payment for New Outpatient Clinical ASGE American Society of Gastrointestinal
New and Revised Physician’s Current Diagnostic Laboratory Tests Endoscopy
Procedural Terminology (CPT) Codes O. Bad Debt Payment for Services ASP Average sales price
and New Healthcare Common Procedure Associated with Reasonable Charge/Fee ASSH American Society for Surgery of the
Coding System (HCPCS) Codes for 2007 Schedules Hand
VI. Physician Self-Referral Prohibition: P. Revisions to Payment Policies under the ASTRO American Society for Therapeutic
Annual Update to the List of CPT/ Ambulance Fee Schedule and the Radiology and Oncology
HCPCS Codes Ambulance Inflation Factor Update for AUA American Urological Association
A. General CY 2007 BBA Balanced Budget Act of 1997 (Pub. L.

B. Nuclear Medicine Q. Alternatives Considered 105–33)
C. Annual Update to the Code List R. Impact on Beneficiaries BBRA [Medicare, Medicaid and State Child
VII. Physician Fee Schedule Update for CY S. Accounting Statement Health Insurance Program] Balanced
2007 Addendum A—Explanation and Use of Budget Refinement Act of 1999 (Pub. L.
A. Physician Fee Schedule Update Addendum B. 106–113)
BIPA Medicare, Medicaid, and SCHIP JCAAI Joint Council of Allergy, Asthma, TA Technology Assessment
Benefits Improvement Protection Act of and Immunology TC Technical Component
2000 LCD Local coverage determination UAF Update adjustment factor
BLS Bureau of Labor Statistics LOCM Low osmolar contrast media UPIN Unique Physician Identification
BMD Bone mineral density LOINC Logical Observation Identifiers Number
BMM Bone mass measurement Names and Codes USPSTF United States Preventive Services
BN Budget neutrality MA Medicare Advantage Task Force
BNF Budget neutrality factor MCP Monthly capitation payment VA [Department of] Veteran Affairs
BP Best price MedPAC Medicare Payment Advisory WAC Wholesale acquisition cost
CAD Computer-aided detection Commission WAMP Widely available market price
CAH Critical access hospital MEI Medicare Economic Index WHO World Health Organization
CAP Competitive acquisition program MLN Medicare Learning Network
CBSA Core-Based Statistical Area MMA Medicare Prescription Drug, I. Background
CCI Correct Coding Initiative Improvement, and Modernization Act of Since January 1, 1992, Medicare has
CEO Chief executive officer 2003 (Pub. L. 108–173)
CF Conversion factor MNT Medical nutrition therapy
paid for physicians’ services under
CFO Chief financial officer MRA Magnetic resonance angiography section 1848 of the Social Security Act
CFR Code of Federal Regulations MRI Magnetic resonance imaging (the Act), ‘‘Payment for Physicians’
CMP Competitive medical plan MSA Metropolitan statistical area Services.’’ The Act requires that
CMS Centers for Medicare & Medicaid MSVP Multi-specialty visit package payments under the physician fee
Services NCD National coverage determination schedule (PFS) be based on national
CNS Clinical nurse specialist NCQDIS National Coalition of Quality uniform relative value units (RVUs)
CPI Consumer Price Index Diagnostic Imaging Services based on the resources used in
CPT (Physicians’) Current Procedural NDC National drug code furnishing a service. Section 1848(c) of
Terminology (4th Edition, 2002, NEMA National Electrical Manufacturers
copyrighted by the American Medical Association
the Act requires that national RVUs be
Association) NHE National health expenditures established for physician work, practice
CT Computed tomography NOP National Osteoporosis Foundation expense (PE), and malpractice expense.
CTA Computed tomographic angiography NP Nurse practitioner Before the establishment of the
CY Calendar year NPP Nonphysician practitioners resource-based relative value system,
DHS Designated health services NPWP Nonphysician Work Pool Medicare payment for physicians’
DME Durable medical equipment NSQIP National Surgical Quality services was based on reasonable
DMEPOS Durable medical equipment, Improvement Program charges.
prosthetics, orthotics, and supplies OBRA Omnibus Budget Reconciliation Act
DRA Deficit Reduction Act OIG Office of Inspector General A. Development of the Relative Value
DSMT Diabetes outpatient self-management OMB Office of Management and Budget System
training services OPD Outpatient Department
DXA Dual energy x-ray absorptiometry OPPS Outpatient prospective payment 1. Work RVUs
E/M Evaluation and management system The concepts and methodology
EPO Erythopoeitin OSCAR Online Survey and Certification underlying the PFS were enacted as part
ESRD End stage renal disease and Reporting
FAX Facsimile PA Physician assistant
of the Omnibus Budget Reconciliation
FDA Food and Drug Administration (HHS) PBM Pharmacy benefit managers Act (OBRA) of 1989 (Pub. L. 101–239),
FQHC Federally qualified health center PC Professional component and OBRA 1990 (Pub. L. 101–508). The
FR Federal Register PE Practice Expense final rule, published November 25, 1991
GAF Geographic adjustment factor PE/HR Practice expense per hour (56 FR 59502), set forth the fee schedule
GAO Government Accountability Office PEAC Practice Expense Advisory for payment for physicians’ services
GDP Gross domestic product Committee beginning January 1, 1992. Initially,
GPO Group purchasing organization PERC Practice Expense Review Committee only the physician work RVUs were
GPCI Geographic practice cost index PET Positron emission tomography resource-based, and the PE and
HCPAC Health Care Professional Advisory PFS Physician Fee Schedule
Committee PLI Professional liability insurance
malpractice RVUs were based on
HCPCS Healthcare Common Procedure PPI Producer price index average allowable charges.
Coding System PPO Preferred provider organization The physician work RVUs established
HCRIS Healthcare Cost Report Information PPS Prospective payment system for the implementation of the fee
System PRA Paperwork Reduction Act schedule in January 1992 were
HSA Health Savings Account PRM Provider Reimbursement Manual developed with extensive input from
HHA Home health agency PT Physical therapy the physician community. A research
HHS [Department of] Health and Human QCT Quantitative computerized team at the Harvard School of Public
Services tomography Health developed the original physician
HIT Health information technology RFA Regulatory Flexibility Act
HMO Health maintenance organization RHC Rural health clinic
work RVUs for most codes in a
HOCM High osmolar contrast media RIA Regulatory impact analysis cooperative agreement with the
HPSA Health Professional Shortage Area RN Registered nurse Department of Health and Human
HRSA Health Resources Services RUC [AMA’s Specialty Society] Relative Services (HHS). In constructing the
Administration (HHS) (Value) Update Committee code-specific vignettes for the original
HUD [Department of] Housing and Urban RVU Relative value unit physician work RVUs, Harvard worked
Development SGR Sustainable growth rate with panels of experts, both inside and
ICF Intermediate care facilities SMS [AMA’s] Socioeconomic Monitoring outside the Federal government, and
IDTF Independent diagnostic testing facility System obtained input from numerous
IFC Interim final rule with comment period SNF Skilled nursing facility
IPPE Initial preventive physical SNM Society for Nuclear Medicine
physician specialty groups.
examination SPA Single photon absorptiometry Section 1848(b)(2)(A) of the Act
IPPS Inpatient prospective payment system STS Society of Thoracic Surgeons specifies that the RVUs for radiology
IVIG Intravenous immune globulin SVS Society for Vascular Surgery services are based on relative value
IWPUT Intra-service work per unit of time SXA Single energy x-ray absorptiometry scale we adopted under section
1834(b)(1)(A) of the Act, (the American specific information on hours worked third 5-year review is being finalized in
College of Radiology (ACR) relative and PEs. this rule for CY 2007.
value scale), which we integrated into Separate PE RVUs are established for In 1999, the AMA’s RUC established
the overall PFS. Section 1848(b)(2)(B) of procedures that can be performed in the Practice Expense Advisory
the Act specifies that the RVUs for both a nonfacility setting, such as a Committee (PEAC) for the purpose of
anesthesia services are based on RVUs physician’s office, and a facility setting, refining the direct PE inputs. Through
from a uniform relative value guide. We such as a hospital outpatient March 2004, the PEAC provided
established a separate conversion factor department (OPD). The difference recommendations to CMS for over 7,600
(CF) for anesthesia services, and we between the facility and nonfacility codes (all but a few hundred of the
continue to utilize time units as a factor RVUs reflects the fact that a facility codes currently listed in the AMA’s
in determining payment for these receives separate payment from Current Procedural Terminology (CPT)
services. As a result, there is a separate Medicare for its costs of providing the codes).
payment methodology for anesthesia service, apart from payment under the In the November 15, 2004, PFS final
services. PFS. The nonfacility RVUs reflect all of rule (69 FR 66236) (hereinafter referred
We establish physician work RVUs for the direct and indirect PEs of providing to as the CY 2005 PFS final rule), we
new and revised codes based on a particular service. implemented the first 5-year review of
recommendations received from the Section 212 of the Balanced Budget the malpractice RVUs (69 FR 66263).
American Medical Association’s (AMA) Refinement Act of 1999 (BBRA) (Pub. L. 5. Adjustments to RVUS Are Budget
Specialty Society Relative Value Update 106–113) directed the Secretary of Neutral
Committee (RUC). Health and Human Services (the
Secretary) to establish a process under Section 1848(c)(2)(B)(ii)(II) of the Act
2. Practice Expense Relative Value Units provides that adjustments in RVUs for a
(PE RVUs) which we accept and use, to the
maximum extent practicable and year may not cause total PFS payments
Section 121 of the Social Security Act consistent with sound data practices, to differ by more than $20 million from
Amendments of 1994 (Pub. L. 103–432), data collected or developed by entities what they would have been if the
enacted on October 31, 1994, amended and organizations to supplement the adjustments were not made. In
section 1848(c)(2)(C)(ii) of the Act and data we normally collect in determining accordance with section
required us to develop resource-based the PE component. On May 3, 2000, we 1848(c)(2)(B)(ii)(II) of the Act, if
PE RVUs for each physician’s service published the interim final rule (65 FR adjustments to RVUs cause
beginning in 1998. We were to consider 25664) that set forth the criteria for the expenditures to change by more than
general categories of expenses (such as submission of these supplemental PE $20 million, we make adjustments to
office rent and wages of personnel, but survey data. The criteria were modified ensure that expenditures do not increase
excluding malpractice expenses) in response to comments received, and or decrease by more than $20 million.
comprising PEs. published in the Federal Register (65 B. Components of the Fee Schedule
Section 4505(a) of the Balanced FR 65376) as part of a November 1, 2000 Payment Amounts
Budget Act of 1997 (BBA) (Pub. L. 105– final rule. The PFS final rules published
33), amended section 1848(c)(2)(C)(ii) of in 2001 and 2003, respectively, (66 FR To calculate the payment for every
the Act to delay implementation of the 55246 and 68 FR 63196) extended the physician service, the components of
resource-based PE RVU system until period during which we would accept the fee schedule (physician work, PE,
January 1, 1999. In addition, section these supplemental data. and malpractice RVUs) are adjusted by
4505(b) of the BBA provided for a 4-year a geographic practice cost index (GPCI).
transition period from charge-based PE 3. Resource-Based Malpractice RVUs The GPCIs reflect the relative costs of
RVUs to resource-based RVUs. Section 4505(f) of the BBA amended physician work, PEs, and malpractice
We established the resource-based PE section 1848(c) of the Act to require us insurance in an area compared to the
RVUs for each physician’s service in a to implement resource-based national average costs for each
final rule, published November 2, 1998 malpractice RVUs for services furnished component.
(63 FR 58814), effective for services on or after 2000. The resource-based Payments are converted to dollar
furnished in 1999. Based on the malpractice RVUs were implemented in amounts through the application of a
requirement to transition to a resource- the PFS final rule published November CF, which is calculated by the Office of
based system for PE over a 4-year 2, 1999 (64 FR 59380) (hereinafter the Actuary and is updated annually for
period, resource-based PE RVUs did not referred to as the CY 2000 PFS final inflation.
become fully effective until 2002. rule). The malpractice RVUs were based The general formula for calculating
This resource-based system was based on malpractice insurance premium data the Medicare fee schedule amount for a
on two significant sources of actual PE collected from commercial and given service and fee schedule area can
data: The Clinical Practice Expert Panel physician-owned insurers from all the be expressed as:
(CPEP) data and the AMA’s States, the District of Columbia, and Payment = [(RVU work × GPCI work) +
Socioeconomic Monitoring System Puerto Rico. (RVU PE × GPCI PE) + (RVU
(SMS) data. The CPEP data were malpractice × GPCI malpractice)] ×
4. Refinements to the RVUs CF.
collected from panels of physicians,
practice administrators, and Section 1848(c)(2)(B)(i) of the Act However, as discussed in section IV.D
nonphysicians (for example, registered requires that we review all RVUs no less of this final rule with comment period,
nurses) nominated by physician often than every 5 years. The first 5-year due to the need to meet the budget
specialty societies and other groups. review of the physician work RVUs neutrality (BN) provisions of
The CPEP panels identified the direct went into effect in 1997, published on 1848(c)(2)(B)(ii), we are applying a BN
inputs required for each physician’s November 22, 1996 (61 FR 59489). The adjustor to the work RVUs in order to
service in both the office setting and second 5-year review of work RVUs calculate payment for a service.
out-of-office setting. The AMA’s SMS went into effect in 2002, published on Therefore, payment for services will
data provided aggregate specialty- November 1, 2001 (66 FR 55246). The now be calculated as follows:
Payment = [(RVU work × BN adjustor × notice, we proposed revisions to work required that the new payment
GPCI work) + (RVU PE × GPCI PE) RVUs affecting payment for physicians’ methodology be phased-in over 4 years,
+ (RVU malpractice × GPCI services. The revisions reflect changes effective for services furnished in CY
malpractice)] × CF.) in medical practice, coding changes, 1999, and fully effective in CY 2002.
and new data on relative value The first step toward implementation of
C. Most Recent Changes to the Fee components that affect the relative the statute was to adjust the PE values
Schedule amount of physician work required to for certain services for CY 1998. Section
The final rule with comment period perform each service, as required by the 4505(d) of the BBA required that, in
that appeared in the Federal Register on statute. We also proposed revisions to developing the resource-based PE RVUs,
November 21, 2005 (70 FR 70116) our methodology for calculating PE the Secretary must:
(hereinafter referred to as the CY 2006 RVUs, including changes based on • Use, to the maximum extent
PFS final rule with comment period) supplemental survey data for PE. This possible, generally accepted cost
addressed Medicare Part B payment revised methodology would be used to accounting principles that recognize all
policy including the PFS that is establish payment for services beginning staff, equipment, supplies, and
applicable for CY 2006; and finalized January 1, 2007. expenses, not solely those that can be
certain provisions of the interim final In this final rule with comment linked to specific procedures.
rule to implement the Competitive period, we are responding to the • Develop a refinement method to be
Acquisition Program (CAP) for Part B comments received on that notice. To used during the transition.
Drugs. the extent that comments received were • Consider, in the course of notice
It also revised Medicare Part B outside the scope of the proposed and comment rulemaking, impact
payment and related policies regarding: notice, they are not addressed in this projections that compare new proposed
physician work, PE and malpractice rule. payment amounts to data on actual
RVUs; Medicare telehealth services; Work RVU revisions will be fully physician PE.
multiple diagnostic imaging procedures; implemented for services furnished to Beginning in CY 1999, we began the
covered outpatient drugs and Medicare beneficiaries on or after 4-year transition to resource-based PE
biologicals; supplemental payments to January 1, 2007. The changes in PE RVUs. In CY 2002, the resource-based
Federally Qualified Health Centers methodology will be phased-in over a 4- PE RVUs were fully transitioned.
(FQHCs); renal dialysis services; year period; although, as we gain
coverage for glaucoma screening experience with the new methodology, 1. Current Methodology
services; National Coverage we will reexamine this policy beginning The following sections discuss the
Determination (NCD) timeframes; and next year and propose necessary current PE methodology.
physician referrals for nuclear medicine revisions through future rulemaking.
services and supplies to health care a. Data Sources
entities with which physicians have II. Provisions of the Proposed Rule
There are two primary data sources
financial relationships. A. Resource-Based Practice Expense used to calculate PE. The AMA’s
In addition, the rule finalized the (PE) Relative Value Units (RVUs) Socioeconomic Monitoring System
interim RVUs for CY 2005 and issued
interim RVUs for new and revised Practice expense (PE) is the portion of (SMS) survey data are used to develop
procedure codes for CY 2006. The rule the resources used in furnishing the the PE per hour (PE/HR) for each
also updated the codes subject to the service that reflects the general specialty. The second source of data
physician self-referral prohibition and categories of physician and practitioner used to calculate PE was originally
discussed payment policies relating to expenses, such as office rent and developed by the Clinical Practice
teaching anesthesia services, therapy personnel wages but excluding Expert Panels (CPEP). The CPEP data
caps, private contracts and opt-out, and malpractice expenses, as specified in include the supplies, equipment and
chiropractic and oncology section 1848(c)(1)(B) of the Act. staff times specific to each procedure.
demonstrations. Section 121 of the Social Security The AMA developed the SMS survey
In accordance with section Amendments of 1994 (Pub. L. 103–432), in 1981 and discontinued it in 1999.
1848(d)(1)(E)(i) of the Act, we also enacted on October 31, 1994, required Beginning in 2002, we incorporated the
announced that the PFS update for CY CMS to develop a methodology for a 1999 SMS survey data into our
2006 would be ¥4.4 percent; the initial resource-based system for determining calculation of the PE RVUs, using a 5-
estimate for the sustainable growth rate PE RVUs for each physician’s service. year average of SMS survey data. (See
for CY 2006 would be 1.7 percent; and Until that time, PEs were based on Revisions to Payment Policies and Five-
the CF for CY 2006 would be $36.1770. historical allowed charges. This Year Review of and Adjustments to the
However, subsequent to publication of legislation stated that the revised PE Relative Value Units Under the
the CY 2006 PFS final rule with methodology must consider the staff, Physician Fee Schedule for CY 2002
comment period, section 5104 of the equipment, and supplies used in the final rule, published November 1, 2001
Deficit Reduction Act (DRA) of 2005 provision of various medical and (66 FR 55246) (hereinafter referred to as
(Pub. L. 109–171, February 8, 2006), was surgical services in various settings CY 2002 PFS final rule).) The SMS PE
enacted which amended section 1848(d) beginning in 1998. The Secretary has survey data are adjusted to a common
of the statute. As a result of this interpreted this to mean that Medicare year, 1995. The SMS data provide the
statutory change we maintained the CY payments for each service would be following six categories of PE costs:
2005 CF of $37.8975 for CY 2006. based on the relative PE resources • Clinical payroll expenses, which
We also note that the Five-Year typically involved with furnishing the are payroll expenses (including fringe
Review of Work Relative Value Units service. benefits) for nonphysician personnel.
Under the Physician Fee Schedule and The initial implementation of • Administrative payroll expenses,
Proposed Changes to the Practice resource-based PE RVUs was delayed which are payroll expenses (including
Expense Methodology proposed notice from January 1, 1998, until January 1, fringe benefits) for nonphysician
appeared in the Federal Register on 1999, by section 4505(a) of the BBA. In personnel involved in administrative,
June 29, 2006 (71 FR 37170). In that addition, section 4505(b) of the BBA secretarial or clerical activities.
• Office expenses, which include for over 7,600 codes which we have 2. Proposals for Revising the PE
expenses for rent, mortgage interest, reviewed and accepted. As a result, the Methodology
depreciation on medical buildings, current PE inputs differ markedly from We have three major goals for our
utilities and telephones. those originally recommended by the resource-based PE methodology:
• Medical material and supply CPEPs. The PEAC has now been • To ensure that the PE portion of
expenses, which include expenses for replaced by the Practice Expense PFS payments reflect, to the greatest
drugs, x-ray films, and disposable Review Committee (PERC), which acts extent possible, the relative resources
medical products. to assist the RUC in recommending PE
• Medical equipment expenses, required for each of the services on the
inputs. PFS. This could only be accomplished
which include expenses depreciation,
leases, and rent of medical equipment b. Allocation of PE to Services by using the best available data to
used in the diagnosis or treatment of To establish PE RVUs for specific calculate the PE RVUs.
patients. services, it is necessary to establish the • To develop a payment system for
• All other expenses, which include direct and indirect PE associated with PE that is understandable and at least
expenses for legal services, accounting, each service. Our current approach somewhat intuitive, so that specialties
office management, professional allocates aggregate specialty practice could better predict the impacts of
association memberships, and any costs to specific procedures and, thus, is changes in the PE data.
professional expenses not previously often referred to as a ‘‘top-down’’ • To stabilize the PE portion of PFS
mentioned in this section. approach. The specialty PEs are derived payments so that changes in PE RVUs
In accordance with section 212 of the from the AMA’s SMS survey and do not produce large fluctuations in the
BBRA, we established a process to supplementary survey data. The PEs for payment for given procedures from
supplement the SMS data for a specialty a given specialty are allocated to the year-to-year.
with data collected by entities and services furnished by that specialty on In the CY 2006 PFS proposed rule (70
organizations other than the AMA (that the basis of the direct input data and FR 45764), we proposed the following
is, the specialty itself). (See the Criteria work RVUs assigned to each CPT code. changes to the PE methodology that we
for Submitting Supplemental Practice The specific process is outlined in the believed would help in achieving these
Expense Survey Data interim final rule June 29, 2006 proposed notice (71 FR three major goals:
with comment period, (May 3, 2000, 65 37242). • Using the PE/HR data from seven
FR 25664).) Originally, the deadline to specialty-specific supplementary
submit supplementary survey data was c. Other Methodological Issues: surveys.
through August 1, 2001. In the CY 2002 Nonphysician Work Pool (NPWP) • Calculating the direct PE using a
PFS final rule (66 FR 55246), the As an interim measure, until we could bottom-up methodology.
deadline was extended through August further analyze the effect of the top- • Eliminating the NPWP.
1, 2003. To ensure maximum down methodology on the Medicare We also proposed an indirect PE
opportunity for specialties to submit payment for services with no physician methodology that was to assign to each
supplementary survey data, we work (including the technical service the higher of the current indirect
extended the deadline to submit surveys components (TCs) of radiation oncology, PE RVUs or the indirect PE RVUs
until March 1, 2005 in the Revisions to radiology and other diagnostic tests), we calculated using the supplementary
Payment Policies Under the Physician created a separate PE pool for these survey data.
Fee Schedule for CY 2004 final rule, services. However, any specialty society In the CY 2006 PFS final rule with
(November 7, 2003; 68 FR 63196) could request that its services be comment period (70 FR 70116), we
(hereinafter referred to as CY 2004 PFS removed from the nonphysician work withdrew these proposals primarily
final rule). pool (NPWP). The specific steps for the because a programming error for the
The CPEPs consisted of panels of NPWP calculation are detailed in the indirect PE RVU calculation had led to
physicians, practice administrators, and June 29, 2006 proposed notice (71 FR the publication of inaccurate proposed
nonphysicians (registered nurses (RNs), 37243). PE RVUs. On February 15, 2006, we
for example) who were nominated by sponsored a PE Town Hall Meeting and
d. Facility/Non-facility Costs invited the public, including all
physician specialty societies and other
groups. There were 15 CPEPs consisting Procedures that can be furnished in a specialty representatives to attend. At
of 180 members from more than 61 physician’s office, as well as in a this meeting, we supplied a detailed
specialties and subspecialties. hospital, have two PE RVUs: facility and description of the bottom-up approach
Approximately 50 percent of the non-facility. The non-facility setting to the calculation of resource-based PE
panelists were physicians. includes physicians’ offices, patients’ RVUs. Three examples were examined
The CPEPs identified specific inputs homes, freestanding imaging centers, in detail that illustrated the impact of
involved in each physician’s service and independent pathology labs. the various assumptions that could be
provided in an office or facility setting. Facility settings include hospitals, used under a bottom-up approach. We
The inputs identified were the quantity ambulatory surgical centers (ASCs), and specifically requested input from all
and type of nonphysician labor, medical skilled nursing facilities (SNFs). The interested parties on possible changes to
supplies, and medical equipment. methodology for calculating the PE RVU our PE methodology, including the
In 1999, the AMA’s RUC established is the same for both facility and non- move to a bottom-up approach and the
the Practice Expense Advisory facility RVUs, but is applied various methods of calculating indirect
Committee (PEAC). From 1999 to March independently to yield two separate PE PE.
2004, the PEAC, a multi-specialty RVUs. Because the PEs for services We reviewed the approximately 35
committee, reviewed the original CPEP provided in a facility setting are comments that we received in response
inputs and provided us with generally included in the payment to to our solicitation. Many of the
recommendations for refining these the facility (rather than the payment to comments were combined efforts from
direct PE inputs for existing CPT codes. the physician under the fee schedule), related specialty organizations.
Through its last meeting in March 2004, the PE RVUs are generally lower for Additionally, the AMA RUC also
the PEAC provided recommendations services provided in the facility setting. supplied a letter that captured the
comments of nearly 30 specialty many commenters suggested a rate of commenters in the CY 2006 PFS
organizations. The following is a approximately prime plus 2 percent. proposed rule, will lead to greater
summary of the comments received as a • Proxy Work RVUs for No Physician stability and accuracy in the PE portion
result of the February 15, 2006 PE Town Work Services: Commenters were of our payment system. Currently, under
Hall meeting. divided on the assignment of a proxy the top-down methodology, the need to
• Delaying Implementation of work RVU to services that contain no scale the CPEP costs to equal the SMS
Changes to the Current PE Methodology: physician work. Some commenters costs has meant that any changes in the
There were mixed opinions from believed that no physician work direct PE inputs for one service often
commenters on whether we should services are unfairly penalized under leads to unexpected results for other
proceed with a proposal to use a any bottom-up approach, while other services where the inputs have not been
bottom-up approach. Some commenters comments stated that the inclusion of a altered. In addition, the current PE
emphasized that the CPEP data has been proxy work RVU would double count RVUs for a procedure do not necessarily
refined and is now the best available the clinical labor associated with the no change proportionately with changes in
source of data, and asserted that it physician work services. the direct inputs, creating possible
should be used for the calculation of After considering these comments, we anomalous values. We believe that our
resource-based PE RVUs. Other made the following proposals for direct proposed bottom-up methodology
comments suggested a delay in changing PEs in the June 29, 2006 proposed would resolve these issues, so that
to a bottom-up approach because of the notice (71 FR 37245). changes in the PE RVUs would be more
other issues that are affecting PFS a. Use a Bottom-up Method to Calculate intuitive and would result in fewer
payments this year (such as, the effect the Direct PEs surprises.
of imaging payment provisions in the We believe that we have consistently b. Use the PE/HR Data from the 7
DRA, the impact of the negative update, made a good faith effort to ensure Surveys We Have Previously Accepted
and the uncertainty regarding the fairness in our PE RVU-setting system and, in addition, Use the PE/HR Data
impact of the 5-Year Review of work by using the best data available at any from the Survey Submitted by the
RVUs). one time. The reason we did not adopt National Coalition of Quality Diagnostic
• Transition to a Bottom-Up the bottom-up methodology originally Imaging Services (NCQDIS)
Approach: The majority of commenters proposed in 1997 and instead adopted
requested a minimum 1-year transition the top-down methodology finalized in As explained in the CY 2005 PFS final
to a maximum 3-year transition period 1998 was because we recognized the rule with comment period (69 FR
to fully implement any change to a concerns among the physician 66242), we received surveys from the
bottom-up approach. All of the community that the resource input data American College of Cardiology (ACC),
commenters supported a transition developed in 1995 by the CPEP were the American College of Radiology
period whether or not they supported less reliable than the aggregate specialty (ACR), and the American Society for
the implementation of a bottom-up cost data derived from the SMS process. Therapeutic Radiology and Oncology
approach. However, the situation has now (ASTRO) by March 1, 2004. The data
• Use of Supplemental Survey Data: changed. The PEAC/PERC/RUC has submitted by the ACC and the ACR met
Many commenters stated that, completed the refinement of the original our criteria. However, as requested by
irrespective of what we proposed for CY CPEP data and we believe that the the ACC and the ACR, we deferred
2007, the supplemental survey data that refined PE inputs now, in general, using their data until issues related to
has already been accepted should be accurately capture the relative direct the NPWP could be addressed. (The
used. Other commenters believed that costs of PFS services. Conversely, survey data from ASTRO did not meet
the supplemental survey data grossly although we have now accepted the precision criteria established for
overstated PEs and should not be supplementary survey data from 13 supplemental surveys; therefore, we did
utilized in the development of resource- specialties, we have not received not accept or use it in the calculation of
based PE RVUs. updated aggregate cost data from most PE RVUs for 2005.)
• Multi-Specialty PE Survey: The specialties. Thus, we believe that, in the In March 2005, we also received
majority of commenters supported the aggregate, the refined direct input data surveys from the Association of
construction and use of a multi- represent more reliably the relative Freestanding Radiation Oncology
specialty survey to collect PE data. direct cost PE inputs for physicians’ Centers (AFROC), the American
Commenters believed that the services. Urological Association (AUA), the
supplemental survey data is inflated Therefore, instead of using the top- American Academy of Dermatology
and that the SMS survey data are down approach to calculate the direct (AAD), the Joint Council of Allergy,
outdated. PE RVUs, where the aggregate CPEP/ Asthma, and Immunology (JCAAI), the
• Review Equipment Utilization RUC costs for each specialty are scaled NCQDIS, and a joint survey from the
Assumptions and Interest Rates: Many to match the aggregate SMS costs, we American Gastroenterological
commenters supported the review and proposed to adopt a bottom-up method Association (AGA), the American
revision of both the current utilization of determining the relative direct costs Society of Gastrointestinal Endoscopy
assumptions and the interest rates for each service. Under this method, the (ASGE) and the American College of
associated with high cost equipment. direct costs would be determined by Gastroenterology (ACG).
Commenters had mixed reactions as to adding the costs of the resources (that is, All the surveys, with the exception of
whether the utilization rates should be the clinical staff, equipment and the survey from NCQDIS, met our
higher or lower, and some suggested supplies) typically required to provide criteria. Therefore, we proposed in the
that we review the possibility of the service. The costs of the resources, CY 2006 PFS proposed rule (70 FR
equipment-specific utilization in turn, would be calculated from the 45775) to use the survey data from all
assumptions for the future. Most refined direct PE inputs in our PE the surveys meeting our criteria in the
commenters believed that the current 11 database. calculation of PE RVUs for 2006; but, as
percent interest rate is significantly We believe that this proposed change, discussed in the CY 2006 PFS final rule
higher then the actual interest rates and which was welcomed by most with comment period (70 FR 70116) and
above in this section, this proposal was L. 108–173) added section 1848(c)(2)(I) The major specialties comprising the
not finalized. of the Act to require CMS to use survey NPWP (radiology, radiation oncology
We contracted with the Lewin Group data submitted by a specialty group and cardiology) have now submitted
(Lewin) to evaluate whether the where at least 40 percent of the supplemental survey data that we have
supplemental survey data that were specialty’s payments for Part B services accepted and proposed to use in their
submitted met our criteria and to make are attributable to the administration of PE calculations. (See the discussion on
recommendations to us regarding their drugs in 2002 to adjust PE RVUs for supplementary surveys above in this
suitability for use in calculating PE drug administration services. The section.) Now that we have
RVUs. As described in the CY 2006 PFS statute applies to surveys that include representative aggregate PE data for
proposed rule (70 FR 45775), Lewin expenses for the administration of drugs these specialties, and with the
recommended blending the radiation and biologicals, and were received by completion of the refinement of the
oncology data from the AFROC survey March 1, 2005 for determining the CY direct cost inputs, the continued
data with the ASTRO survey data 2006 PE RVUs. Section 303(a)(1)(A)(ii) necessity and equity of treating these
submitted in 2004 to calculate the PE/ of the MMA also added section technical services outside the PE
HR. According to Lewin, the goal of the 1848(c)(2)(B)(iv)(II) of the Act to provide methodology applied to other services is
AFROC survey was to represent the an exemption from budget neutrality questionable.
population of freestanding radiation (BN) in 2005 and 2006 for any Therefore, we proposed to eliminate
oncology centers only. To develop an additional expenditures resulting from the NPWP and to calculate the PE RVUs
overall average for the radiation the use of these surveys. In the Changes for the services currently in the work
oncology PE pool, Lewin recommended to Medicare Payment for Drugs and pool by the same methodology used for
we use the AFROC survey for all other services. This would also allow
Physician Fee Schedule Payments for
freestanding radiation oncology centers, the use of the refined CPEP/RUC data to
CY 2004 interim final rule published
and the hospital-based subset of last price the direct costs of individual
January 7, 2004 (69 FR 1084), we stated
year’s ASTRO survey. We agreed that services, rather than utilizing the pre-
that the specialties of urology,
this blending of the AFROC and ASTRO 1998 charge-based PE RVUs. In
data was a reasonable way to calculate gynecology, and rheumatology meet this addition, the revised methodology
an average PE/HR that fully reflects the criteria. As described in the CY 2006 would lead to greater stability for the PE
practice of radiation oncology in all PFS final rule with comment period (70 RVUs for these services and would lead
settings. Blending the survey data FR 70116), we accepted for the purposes to more intuitive results than have
overcame the initial problem that the of calculating the 2006 PE RVUs for occurred with the NPWP methodology.
ASTRO data do not meet the precision drug administration services the new
survey data from the AUA and d. Modify the Current Indirect PE RVUs
criteria as discussed in the CY 2005 PFS
exempted from the BN adjustment any Methodology
final rule (69 FR 66242). In addition, as
discussed in the CY 2006 PFS proposed impacts of accepting these data for As described previously, the SMS and
rule (70 FR 45776), blending of the data purposes of calculating PE RVUs for supplementary survey data are the
allowed for a broader base of radiation drug administration services. source for the specialty-specific
oncology providers to be represented. (Note: Rheumatology and gynecology did aggregate indirect costs used in our PE
Also, as discussed in the CY 2006 PFS not submit supplemental survey data.) calculations. We then allocate the
proposed rule (70 FR 45764), Lewin indirect costs to particular codes on the
indicated that the survey data submitted c. Eliminate the NPWP and Calculate basis of the direct costs allocated to a
by the NCQDIS on independent the PE RVUs for all Services Using the code and the work RVUs. In the CY
diagnostic testing facilities (IDTFs) did Same Methodology 2006 PFS proposed rule (70 FR 45764),
not meet our precision criterion. we stated that we had no information
However, upon further analysis, Lewin Primarily because of the lack of that would indicate that the current
agreed with NCQDIS’ determination that representative SMS data or accurate indirect PE methodology is inaccurate.
the inclusion of one inaccurate record direct cost inputs for specialties such as At that time, we also were not aware of
skewed the findings outside the radiology and radiation oncology, the any alternative approaches or data
acceptable precision range. Lewin adoption of the top-down approach sources that we could use to calculate
recalculated the precision level at 8.1 necessitated the creation of the NPWP. more appropriately the indirect PE,
percent of the mean PE/HR (weighted by This separate work pool was created to other than the new supplementary
the number of physicians in the allocate PE RVUs for TC codes and survey data, which we proposed to
practice). Lewin indicated that the level codes that are not furnished by incorporate into our PE calculations.
of precision for the total PE/HR satisfies physicians and, thus, have no work Therefore, in the CY 2006 PFS proposed
the level of precision requirement, and RVUs. In the CY 2000 Physician Fee rule, we proposed to use the current
recommended acceptance of the survey. Schedule; Payment Policies and indirect PEs in our calculation,
We proposed to use the PE/HR data Relative Value Unit Adjustment final incorporating the new survey data into
from all of these surveys, including the rule, we indicated that ‘‘the purpose of the codes furnished by the specialties
NCQDIS survey, in the calculation of this pool was only to protect the (TC) submitting the surveys (71 FR 45764).
the PE RVUs for 2007. For radiation services from the substantial decreases’’ We also indicated in that same proposed
oncology, we proposed to use the new caused by inaccurate CPEP data and the rule that we would welcome any
PE/HR derived from combining the lack of physician work RVU in the suggestions that would assist us in
AFROC and ASTRO survey data, as allocation of the indirect costs (64 FR further refinement of this indirect PE
recommended by Lewin. The proposed 59406). Unfortunately, the services methodology. For example, we were
figures for PE per physician hour were priced by the NPWP methodology have considering whether we should
listed in Table 52 in the June 29, 2006 proven to be especially vulnerable to continue to accept supplementary
proposed notice (71 FR 37246). any change in the work pool’s survey data or whether it would be
Section 303(a)(1)(B) of the Medicare composition. This has led to significant preferable and feasible to have an SMS-
Prescription Drug, Improvement, and fluctuations from year-to-year in the PE type survey of only indirect costs for all
Modernization Act of 2003 (MMA) (Pub. RVUs calculated for these services. specialties, or whether a more formula-
based methodology independent of the create an index. This index would stability of the PE RVUs. We believe it
SMS should be adopted, perhaps using reflect the relationship between each is now appropriate to use updated
the specialty-specific indirect-to-total specialty’s indirect scaling factor and utilization data in the calculation of the
cost percentage as a basis of the the overall indirect scaling factor for the indirect PEs. We believe the other
calculation. For a prior discussion of entire PFS. For example, if a specialty proposed changes in the PE
many of the issues associated with had an indirect practice cost index of methodology would help obtain the
allocating indirect costs, please refer to 2.00, this specialty would have an year-to-year stability we were
the CY 2000 Physician Fee Schedule; indirect scaling factor that was twice the attempting to achieve by continuing to
Payment Policies and Relative Value overall average indirect scaling factor. If use the older utilization data.
Unit Adjustment proposed rule (63 FR a specialty had an indirect practice cost Additionally, the use of more current
30823). index of 0.50, this specialty would have utilization data would reflect the more
an indirect scaling factor that was half current practice patterns. We proposed
3. Specific Changes to the Indirect PE
the overall average indirect scaling to use the 2005 utilization data in the
Methodology for CY 2007
factor. The calculation and application calculation of the 2007 indirect PE
a. Summary of the PE Proposals From of the indirect practice cost index is RVUs. We also sought comments on
the June 29, 2006 Proposed Notice described in more detail below in this whether the utilization data should be
As a result of collaboration with the section. updated yearly, which would increase
PFS community and public comments the accuracy of the PE calculations, or
(3) Use of the Clinical Labor Costs in the
on this issue, in the June 29, 2006 less often, which would increase the
Indirect Allocation for a Service When
proposed notice, we proposed the stability of the PE RVUs.
the Clinical Labor Costs are Greater than
following modifications to the indirect the Physician Work RVU (5) Elimination of the Special
PE methodology. Methodologies for Services with
We have received numerous
(1) Indirect Percentage Factor: Use of the comments that services with little or no Technical Components (TCs) and
Specialty-Specific Percentage that physician work RVUs are disadvantaged Professional Components (PCs)
Indirect PEs Represent of Total PEs under our current indirect allocation Under the PFS, when services have
Based on the Survey Data methodology based on the direct costs TC, PC, and global components that can
We currently allocate indirect and the work RVUs. In response to these be billed separately, the payment for the
expenses on the sum of the direct comments, when the clinical labor global component equals the sum of the
expenses and the work RVUs (converted portion of the direct PE RVU is greater payment for the TC and PCs. Under the
to dollars by multiplying by the CF). We than the physician work RVU for a current PE methodology, the different
proposed to allocate indirect expenses particular service, we proposed to mix of specialties that furnish the
by applying a specialty-specific indirect allocate on the direct costs and the global, TC and PCs can cause the PE
percentage factor to the direct expenses clinical labor costs. For example, if a RVUs, otherwise created by the
to recognize the varying proportion that service has no physician work, if the methodology, to fail to add together
indirect costs represent of total costs by direct PE RVU is 1.10 and if the clinical properly; that is, the global component
specialty. This will have the effect of labor portion of the direct PE RVU is does not equal the sum of the PC and
relatively increasing the indirect 0.65 RVUs, we would use the 1.10 direct TCs. The global component might
expense allocation for services that are PE RVUs and the 0.65 clinical labor exceed the sum of the TC and PCs or it
on average furnished by specialties with portion of the direct PE RVUs for the might be less than the sum of the TC
higher indirect PE percentages, and indirect PE allocation for that service. and PCs. We ensure that the TC and PCs
relatively decreasing the indirect As another example, if the physician add to the global component in one of
expense allocation for services that are work RVUs for a service are 0.25, if the two ways. For services in the NPWP, we
furnished by specialties with lower direct PE RVU is 1.10 and if the clinical set the PE RVUs for the global
indirect PE percentages. For a given labor portion of the direct PE RVU is component equal to the sum of the PC
service, the specific indirect percentage 0.65 RVUs, we would use the 1.10 direct PE RVU and the TC PE RVU. For
factor to apply to the direct costs for the PE RVUs and the 0.65 clinical labor services outside the NPWP, we set the
purpose of the indirect allocation will RVUs for the indirect allocation for that PE RVUs for the TC equal to the
be calculated as the weighted average of service. We would not use the 0.25 difference between the global PE RVUs
the ratio of the indirect to direct costs physician work RVUs for the indirect PE and the PC RVUs.
(based on the survey data) for the allocation since the 0.65 clinical labor With our proposed change to a
specialties that furnish the service. For RVUs are greater than the 0.25 bottom-up methodology for the direct
example, if a service is furnished by a physician work RVUs. PEs, there will be no weighted averaging
single specialty with indirect PEs that of the direct cost inputs necessary to
(4) Use of 2005 Utilization Data in the create the direct PE RVUs and,
were 75 percent of total PEs, the indirect Indirect PE RVU Calculation
percentage factor to apply to the direct therefore, the direct PE RVUs for the PC
costs for the purposes of the indirect Under the current PE methodology, and TCs would sum to the global
allocation would be (0.75/0.25) = 3.0. we predominately use the 1997–2000 component. Under the current
utilization data in the calculation of the methodology, as a result of the process
(2) Continued Use of the Specialty- indirect PE RVUs when the service used to ensure the PC and TCs sum to
Specific Indirect Scaling Factors existed during 1997–2000 or the first the global, RVUs for a service with a
As described earlier in this section, year of utilization data if the service did global component can be either more or
we incorporate the indirect PE/HR not exist during that time period. We less than the RVUs that would have
surveys into the methodology through used those years of utilization data been calculated for the service if the PC
the use of specialty-specific indirect primarily to increase the year-to-year and TCs did not have to sum to the
scaling factors. We would continue to stability of the PE RVUs. With the global.
use the specialty-specific indirect changes we proposed to PE RVUs, in Given the proposed change to bottom-
scaling factors; however, to apply them particular the elimination of the NPWP, up methodology and the elimination of
in a simpler manner we proposed to we will increase the year-to-year the NPWP, we believe it is
inappropriate to have codes for which product of the number of minutes each There are two situations where this
the global, and the TC and PCs are piece of equipment is used in the formula is modified:
assigned RVUs that are either less than service and the equipment cost per • If the service is a global service (that
or greater than the methodology would minute. The equipment cost per minute is, a service with global, professional
otherwise produce, and thus, are paid at is calculated as described at the end of and technical components), then the
a rate that is either less than or greater this section. indirect allocator is:
than the methodology would otherwise Apply a BN adjustment to the direct indirect percentage * (direct PERVU/
specify. (See section II.A.1. of this final inputs. direct percentage) + clinical PE
rule with comment period for the Step 2: Calculate the current aggregate RVU + work RVU.
discussion of the current methodology.) pool of direct PE costs. To do this, • If the clinical labor PE RVU exceeds
Therefore, we proposed that in the multiply the current aggregate pool of the work RVU (and the service is not a
calculation of the indirect percentage total direct and indirect PE costs (that is, global service), then the indirect
factor described earlier in section the current aggregate PE RVUs allocator is:
II.A.3.a.(1), we would use a weighted multiplied by the CF) by the average
direct PE percentage from the SMS and indirect percentage * (direct PERVU/
average of the ratio of indirect to direct
supplementary specialty survey data. direct percentage) + clinical PE
costs across all the specialties that
Step 3: Calculate the aggregate pool of RVU.
furnish the global components, TCs, and
PCs; that is, we would apply the same direct costs. To do this, for all PFS (Note that for global services the indirect
weighted average indirect percentage services, sum the product of the direct allocator is based on both the work RVU and
factor to allocate indirect expenses to costs for each service from Step 1 and the clinical labor PE RVU. We do this to
the utilization data for that service. recognize that, for the professional service,
the global components, PC, and TCs for indirect PEs will be allocated using the work
a service. We also proposed to utilize a Step 4: Using the results of Step 2 and
RVUs, and for the TC service, indirect PEs
similar weighted averaging approach Step 3 calculate a direct PE BN will be allocated using the direct PE RVU and
across all the specialties that furnish the adjustment so that the proposed the clinical labor PE RVU. This also allows
components when calculating the aggregate direct cost pool does not the global component RVUs to equal the sum
indirect PE scaling factor. Because the exceed the current aggregate direct cost of the PC and TC RVUs.)
direct PE RVUs for the TC and PCs sum pool and apply it to the direct costs
For presentation purposes in the
to the global under the bottom-up from Step 1 for each service.
Step 5: Convert the results of Step 4 examples in the Table 1, the formulas
methodology, and we proposed to were divided into two parts for each
calculate the indirect percentage factor to an RVU scale for each service. To do
this, divide the results of Step 4 by the service. The first part does not vary by
and the indirect scaling factor so that service and is
they do not vary between the TCs, PCs, Medicare PFS CF.
the indirect percentage * (direct PE
and global components, our proposed (iii) Create the Indirect PE RVUs RVU/direct percentage).
methodology would create TCs and PCs
Create indirect allocators. The second part is either the work
that sum to the global, and no other Step 6: Based on the SMS and
special methodology would need to be RVU, clinical PE RVU, or both
supplementary specialty survey data, depending on whether the service is a
employed. calculate direct and indirect PE global service and whether the clinical
(a) PE RVU Methodology percentages for each physician PE RVU exceeds the work RVU (as
The following is a description of the specialty. described earlier in this step.)
proposed PE RVU methodology. Step 7: Calculate direct and indirect Apply a BN adjustment to the indirect
PE percentages at the service level by allocators.
(i) Setup File taking a weighted average of the results Step 9: Calculate the current aggregate
First, we create a setup file for the PE of Step 6 for the specialties that furnish pool of indirect PE RVUs by multiplying
methodology. The setup file contains the service. Note that for services with the current aggregate pool of PE RVUs
the direct cost inputs, the utilization for TC and PCs we are calculating the direct by the average indirect PE percentage
each procedure code at the specialty and indirect percentages across the from the physician specialty survey
and facility/nonfacility place of service global components, PCs and TCs. That data. This is similar to the Step 2
level, and the specialty-specific survey is, the direct and indirect percentages calculation for the direct PE RVUs.
PE per physician hour data. for a given service (for example, Step 10: Calculate an aggregate pool of
echocardiogram) do not vary by the PC, proposed indirect PE RVUs for all PFS
(ii) Calculate the Direct Cost PE RVUs TC and global components. services by adding the product of the
Sum the costs of each direct input. Step 8: Calculate the service level indirect PE allocators for a service from
Step 1: Sum the direct costs of the allocators for the indirect PEs based on Step 8 and the utilization data for that
inputs for each service. The direct costs the percentages calculated in Step 7. service. This is similar to the Step 3
consist of the costs of the direct inputs The indirect PEs are allocated based on calculation for the direct PE RVUs.
for clinical labor, medical supplies, and the three components: The direct PE Step 11: Using the results of Step 9
medical equipment. The clinical labor RVU, the clinical PE RVU and the work and Step 10, calculate an indirect PE
cost is the sum of the cost of all the staff RVU. (Note that the work RVU used in adjustment so that the aggregate indirect
types associated with the service; it is the calculation included the separate allocation does not exceed the available
the product of the time for each staff work BN adjustment from the 5-Year aggregate indirect PE RVUs and apply it
type and the wage rate for that staff Review of the work RVUs discussed in to indirect allocators calculated in Step
type. The medical supplies cost is the the June 29, 2006 proposed notice. In 8. This is similar to the Step 4
sum of the supplies associated with the this final rule, unadjusted work RVUs calculation for the direct PE RVUs.
service; it is the product of the quantity are used.) Calculate the Indirect Practice Cost
of each supply and the cost of the For most services the indirect Index.
supply. The medical equipment cost is allocator is: Step 12: Using the results of Step 11,
the sum of the cost of the equipment indirect percentage * (direct PE RVU/ calculate aggregate pools of specialty-
associated with the service; it is the direct percentage) + work RVU. specific adjusted indirect PE allocators
for all PFS services for a specialty by (iv) Calculate the Final PE RVUs. TC and 26 modifier: Flag the services
adding the product of the adjusted Step 18: Add the direct PE RVUs from that are PC and TC services, but do not
indirect PE allocator for each service Step 6 to the indirect PE RVUs from use TC and 26 modifiers (for example,
and the utilization data for that service. Step 17. electrocardiograms). This flag associates
Step 13: Using the specialty-specific Step 19: Calculate and apply the final the PC and TC with the associated
indirect PE/HR data, calculate specialty- PE BN adjustment by comparing the global code for use in creating the
specific aggregate pools of indirect PE results of Step 18 to the current pool of indirect PE RVU. For example, the
for all PFS services for that specialty by PE RVUs. This final BN adjustment is professional service code 93010 is
primarily required because certain associated with the global code 93000.
adding the product of the indirect PE/
specialties are excluded from the PE • Payment modifiers: Payment
HR for the specialty, the physician time
RVU calculation for rate-setting modifiers are accounted for in the
for the service, and the specialty’s
purposes, but all specialties are creation of the file. For example,
utilization for the service.
included for purposes of calculating the services billed with the assistant at
Step 14: Using the results of Step 12 surgery modifier are paid 16 percent of
final BN adjustment. (See ‘‘Specialties
and Step 13, calculate the specialty- the PFS amount for that service;
excluded from rate-setting calculation’’
specific indirect PE scaling factors as therefore, the utilization file is modified
below in this section.)
under the current methodology. to only account for 16 percent of any
Step 15: Using the results of Step 14, (v) Setup File Information service that contains the assistant at
calculate an indirect practice cost index • Specialties excluded from rate- surgery modifier.
at the specialty level by dividing each setting calculation: For the purposes of • Work RVUs from the 5-Year
specialty-specific indirect scaling factor calculating the PE RVUs, we exclude Review: The setup file contains the
by the average indirect scaling factor for certain specialties such as midlevel proposed work RVUs from the 5-Year
the entire PFS. practitioners paid at a percentage of the Review published in the June 29, 2006
PFS, audiology, and low volume proposed notice (71 FR 37174).
Step 16: Calculate the indirect
practice cost index at the service level specialties from the calculation. This is (vi) Equipment Cost Per Minute =
to ensure the capture of all indirect the same approach used under the
current methodology. These specialties The equipment cost per minute is
costs. Calculate a weighted average of calculated as:
the practice cost index values for the are included for the purposes of
calculating the BN adjustment. (1/(minutes per year * usage)) * price *
specialties that furnish the service. Note ((interest rate/(1¥(1/((1 + interest rate) *
• Crosswalk certain low volume
that for services with TC and PCs, we life of equipment)))) + maintenance)
physician specialties: Crosswalk the
calculate the indirect practice cost index Where:
utilization of certain specialties with
across the global components, PCs and minutes per year = maximum minutes per
relatively low PFS utilization to the
TCs. Under this method, the indirect year if usage were continuous (that is,
associated specialties. This is the same
practice cost index for a given service usage = 1); 150,000 minutes.
approach used under the current usage = equipment utilization assumption;
(for example, echocardiogram) does not methodology.
vary by the PC, TC and global 0.5.
• Physical therapy utilization: price = price of the particular piece of
components. Crosswalk physical therapy utilization equipment.
Step 17: Apply the service level to the specialty of physical therapy. interest rate = 0.11.
indirect practice cost index calculated This is the same approach used under life of equipment = useful life of the
in Step 16 to the service level adjusted the current methodology. particular piece of equipment.
indirect allocators calculated in Step 11 • Identify professional and technical maintenance = factor for maintenance; 0.05.
to get the indirect PE RVU. services not identified under the usual BILLING CODE 4120–01–P
ER01DE06.002</GPH>
BILLING CODE 4120–01–C

ER01DE06.003</GPH>
(b) Transition the Resulting Revised PE b. Comments and Responses From the indicated that it was inequitable to
RVUs Over a 4-Year Period June 29, 2006 Proposed Notice accept more recent data from only a few
The following is a summary of the specialties. Another commenter did not
As explained in the June 29, 2006 agree that individual specialty groups
proposed notice, we had concerns that, comments we received on the June 29,
2006 proposed notice (71 FR 37170). should be allowed to provide survey
when combined with a negative update data. Conversely, several commenters
factor for CY 2007 and the changes to (1) Bottom-Up Methodology strongly supported our acceptance and
the work RVUs under the 5-Year use of the supplementary survey data.
Review, the shifts in some of the PE Comment: The majority of
commenters expressed support for the Response: The BBRA requires us to
RVUs resulting from the immediate establish a process for specialty groups
implementation of our proposals could proposed bottom-up approach to
calculating resource-based PE RVUs. to submit supplemental survey data.
potentially cause some disruption for The statute mandated that we establish
medical practices (71 FR 37252). Many of these commenters stated that
the bottom-up approach, which bases criteria for surveys, but required that we
Therefore, we proposed to transition the accept such data for only two years.
PE changes over a 4-year period. This the direct portion of the PE RVUs on the
actual direct cost inputs, produces more However, to give all specialty groups an
would also give ample opportunity for opportunity to submit data, we twice
us, as well as the medical specialties accurate, intuitive, and stable PE RVUs.
A few commenters expressed concern extended the period for submitting data.
and the RUC, to identify any anomalies Therefore, we accepted data over a 6-
in the PE data, to make any further about the proposed bottom-up
approach. These commenters were not year period, instead of the 2-year period
appropriate revisions, and to collect mandated by the Congress. In addition,
additional data as needed prior to the critical of the merits of the proposed
bottom-up methodology itself, but were our contractor, Lewin, was available to
full implementation of the PE changes. provide assistance to any group
instead critical of the data sources used
During the transition period, the PE interested in submitting a survey by
in the calculation of resource-based PE
RVUs would be calculated on the basis helping to ensure that the proper
RVUs. The commenters suggested that
of a blend of RVUs calculated using our protocols were met in order to maximize
the proposal should be delayed until the
methodology described above in this the survey’s chance of meeting our
direct cost data, aggregate specialty cost
section (weighted by 25 percent during survey criteria.
data, and indirect specialty cost data
CY 2007, 50 percent during CY 2008, 75 We recognize the limitations of the
derived from the aggregate specialty cost
percent during CY 2009, and 100 supplemental survey process. However,
data could be verified.
percent thereinafter), and the current CY we were obligated by statute to establish
Response: We are appreciative of the
2006 PE RVUs for each existing code. PE and use such a process, all specialty
support for the proposed bottom-up
RVUs for codes that are new during this groups had an equal opportunity to
approach to calculating resource-based
period would be calculated using only submit data, and groups that conducted
PE. We also appreciate the comments
the methodology, and paid at the fully surveys did so at great expense. If the
that expressed concern about our data
transitioned rate. submitted survey data met the criteria
sources, since we also believe that it is
We also believe the methodology is important that we use the best available we established by notice and comment
less confusing and more intuitive than data to develop the PE RVUs. As rulemaking, we were obligated to accept
the current approach. First, the NPWP discussed in greater detail in subsequent and use the supplemental survey data to
would be eliminated and all services responses, we do believe that the data the maximum extent practicable and
would be priced using one sources used to calculate the proposed consistent with sound data practices.
methodology, eliminating the PE RVUs are the best available at this Additionally, we previously accepted
complicated calculations needed to time. This is particularly true of the most of the surveys we proposed to use
price NPWP services. Second, any direct cost input data that forms the in the CY 2007 PFS proposed rule in
revisions made to the direct inputs for basis of the bottom-up methodology, either the CY 2005 or the CY 2006 PFS
one or more services would now have and that has been thoroughly analyzed final rules with comment. Although we
predictable results. Changes in the and discussed by the RUC, PEAC, delayed the use of these surveys for
direct practice inputs for a service HCPAC and the PERC and then has been various reasons, as explained fully in
would proportionately change the PE reviewed by us. Therefore, we will the CY 2005 and CY 2006 rules, there
RVUs for that service without implement the bottom-up methodology is no reason to continue to delay
significantly affecting the PE RVUs for as proposed. implementation of these surveys.
unrelated services (except, of course, to We note that we support the AMA’s
the extent that a BN adjustment is (2) Supplemental Survey Data efforts to field a multi-specialty survey.
required to be applied by the statute). Comment: Several commenters However, the earliest this data would be
The methodology will also create a expressed concern about the significant available to incorporate into the PFS
system that would be significantly more increase in PE values for specialty would be for CY 2009. We will consider
stable from year-to-year than the current groups that submitted supplemental any such data as soon as it becomes
approach. Specialties should no longer survey data. They stated their belief that available.
experience the wide fluctuations in the data has created serious inequities Comment: The majority of
payment for a given service due to an in the relativity of PE RVUs across the commenters expressed support for the
aberrant direct cost scaling factor. Direct PFS. The commenters recommended design and use of a multi-specialty
PEs should only change for a service if that the supplemental survey data not practice cost survey. Several
the service is further refined or when be used; but, rather, that we wait until commenters further recommended that
prices are updated, while indirect PEs a new multi-specialty survey can be any multi-specialty practice cost survey
should change only when there are completed before using this revised adhere to the same standards as the
changes in the mix of specialties data. One commenter questioned the supplemental surveys accepted by CMS.
furnishing the service or if any future validity of supplemental survey data, Two commenters were concerned that a
new survey data for indirect costs are noting that the response rates were multi-specialty practice costs survey
utilized. fairly low. The commenter also would not capture the practice costs
associated with specialties whose Supplemental Practice Expense Data claims data file for 2003, a radiation
practices focus on technical services. Submitted for 2004.’’ As described in oncologist was deemed to be hospital-
Response: We support the design of this report, independent laboratory based if 50 percent or more of his
an AMA-sponsored multi-specialty organizations were surveyed at the claims, based on the Unique Physician
survey and we understand that over 40 practice level because most independent Identification Number (UPIN), were for
physician and nonphysician specialties labs are owned by an organization, not services furnished at a hospital-based
have agreed to participate. The AMA physicians; this is also the case with radiation oncology center. The rationale
has designed this survey tool and the many free-standing radiology practices. for weighting the PE/HR by Medicare
process has been open for comment to Lewin applied a comparable claims was discussed by Lewin in its
all interested parties. We have also methodology to the radiology practice ‘‘2005 Recommendations to CMS’’
offered comments on the survey design level supplemental survey data for its regarding the American Society for
to ensure that both the appropriate May 26, 2004 recommendation to CMS. Therapeutic Radiation and Oncology
practice cost data is collected and the The radiology supplemental survey (ASTRO) supplemental survey data.
highest standards are met in the reported that less than 10 percent of In its comments, AFROC offered two
collection of this data. radiologists in the practice were part- alternative calculations. The first
Comment: A few commenters time doctors. The average of the practice proposed to recount the Medicare
recommended that we commit to hours for the 2,250 full-time doctors was claims after removing TC only claims.
including the costs associated with 38.9 hours and for the 237 part-time This method results in a reweighting of
uncompensated care in the PE RVUs. doctors 22.2 hours. Using the hospital-based versus freestanding
One commenter suggested that the costs supplemental survey data results in less radiation oncologists of 64 percent
of uncompensated care should be than a 5 percent increase in the total hospital based and 36 percent
included in the AMA-sponsored multi- practice hours over the number of hours freestanding. The second method used
specialty practice cost survey. derived from using the SMS time-weighting to determine the mix of
Response: Many specialties must deal methodology. hospital based versus freestanding
with the issue of uncompensated care, We have determined that the original practitioners. AFROC used physician
though we believe that the number of Lewin calculation is consistent with time data for FY 2004 by radiation
patient care hours spent on historical practice hour calculations oncology CPT code and removed the
uncompensated care is significantly used in the SMS, and with subsequent TCs, resulting in a reweighting of
higher for emergency medicine. We recommendations submitted by Lewin hospital-based versus freestanding
currently make an adjustment to the to CMS. proportion of physician time of 62
patient care hours for emergency Comment: Lewin recommended percent to 38 percent, yielding a
medicine to account for the hours of accepting supplemental survey data combined average PE/HR of $213.07.
uncompensated care included in the from ASTRO and AFROC by blending Lewin reviewed AFROC’s analysis
SMS survey because the calculated PE/ the data in the proportion of 75 percent and believes that AFROC presented two
hour should only reflect reimbursable hospital-based radiation oncology and reasonable alternatives to weighting
hours. We agree that it would be 25 percent freestanding radiation hospital-based and freestanding
beneficial if the AMA-sponsored multi- oncology, resulting in a PE/HR of radiation oncologists, with both
specialty survey includes a question on $161.08. AFROC engaged the services of methods resulting in essentially the
this issue. an independent claims analyst who same answer. However, Lewin has
Comment: ACR expressed concern found that a 62/38 proportion is more determined that the time-weighting
that we did not fully utilize its appropriate, resulting in a PE/HR of method is more consistent with the SMS
supplementary survey data by excluding $213. AFROC supplied this information and Lewin analysis of practice hours per
data on part-time physicians. as part of its comments on the proposed physician. Lewin conducted the
Response: The precedent for applying notice. physician time-weighting analysis using
average full-time practice hours to all Response: Lewin calculated a PE/HR our time and utilization data for FY
doctors in the practice when analyzing for radiation oncology of $161.08, which 2005, resulting in a hospital-based to
practice hours was set by the AMA’s is the weighted average based on the freestanding weight of 63 percent to 37
Socioeconomic Monitoring System percentage of Medicare claims for percent, respectively. The combined
(SMS) and was also discussed in the hospital-based (75 percent) versus average using this weighting results in
September 23, 2003 Lewin report, freestanding (25 percent) radiation a PE/HR for radiation oncologist of
‘‘Recommendations Regarding oncologists. In our standard outpatient $209.19, as shown in Table 2.
TABLE 2
ASTRO survey AFROC survey Combined average
ASTRO’s ASTRO’s
hospital-based hospital-based
Hospital-based Freestanding Weighted Freestanding and AFROC’s and AFROC’s
physicians practices average practices freestanding freestanding
(by share of (by share of
Medicare claims) physician time)
Number in Sample 67 23
Percent of Medi-
care Claims ....... 75.2% 24.8% 24.8%

Percent of Physi-
cian Time (Facil-
ity vs. Non-Facil-
ity) ...................... 63.0% 37.0% 37.0%
TABLE 2—Continued
ASTRO survey AFROC survey Combined average
ASTRO’s ASTRO’s
hospital-based hospital-based
Hospital-based Freestanding Weighted Freestanding and AFROC’s and AFROC’s
physicians practices average practices freestanding freestanding
(by share of (by share of
Medicare claims) physician time)
Direct PE per hour:

Clinical Payroll $9.93 $104.80 $33.46 $153.24 $45.47 $62.98
Medical Equip-
ment ........... 3.64 80.92 22.81 91.04 25.32 35.99
Medical Sup-
plies ............ 1.56 31.56 9.00 13.11 4.42 5.84
Indirect PE per
hour:
Office Expense 19.31 69.40 31.73 87.88 36.32 44.69
Clerical Payroll 12.04 39.42 18.83 59.56 23.82 29.63
Other Expense 16.92 20.17 17.73 52.43 25.73 30.06
Total PE
per hour 63.40 346.27 133.55 457.26 161.08 209.19
Lewin agrees with AFROC that Response: As discussed in section in addition to the intensity of the
weighting by hours of patient care is III.D.3. of this final rule with comment physician work involved, services with
most consistent with our underlying period , the BN adjustment necessitated low or no work RVUs could be valued
methodology for calculating physician by the 5-Year Review of work RVUs will inappropriately unless we use a proxy
practice hours. Lewin has recommended be accomplished through the use of a for the work RVUs in allocating indirect
that the time-weighting methodology for separate, BN adjustor applied to the PE to them. To bring these services onto
determining the percentage of hospital- work RVUs. However, as recommended the same scale as services that do
based to freestanding radiation by the commenters, we will not use the contain physician work, we believe it is
oncologist PE be adopted, which would budget-neutralized work RVUs to appropriate to utilize clinical labor costs
result in a PE/HR of $213/HR based on calculate indirect PE. as a proxy for physician work in the
2004 data or $209/HR based on 2005 Comment: Many commenters indirect allocation. We agree with the
data. We accept Lewin’s disagreed with the use of the physician majority of commenters and will
recommendation and will implement a work RVUs in allocating indirect PE. finalize our proposal to use clinical
PE/HR of $209 for radiation oncology. Some commenters further contended labor costs in allocating indirect PE
that the intensity portion of physician where the physician work RVU is zero
(3) Nonphysician Workpool work has no correlation to indirect PEs. or less than the clinical labor RVU.
Comment: With the exception of those A few commenters contended that Comment: Several commenters
comments that requested that we delay physician time would be a more recommended that the methodology be
the entire revision to the PE appropriate allocation tool than modified to include clinical labor time
methodology, the majority of physician work RVUs. in the calculation of specialty-specific
commenters expressed support for the Response: There is no perfect method aggregate indirect PE pools.
elimination of the NPWP. of allocating indirect expenses down to Response: We do not agree with the
individual services. We believe the commenters because the PE/HR for each
Response: The development of the work RVUs are the most constant of the specialty is calculated using physician
NPWP was necessitated by our lack of available allocation tools, and this time as the denominator; clinical staff
accurate aggregate cost data for characteristic coincides best with our time is not included in that calculation.
specialties such as radiology and goal of stability for the PE RVUs. In this It would be inconsistent to then use
radiation oncology necessitated the final rule with comment, we will clinical labor time in the creation of the
development of the NPWP. The major continue to use the work RVUs as one specialty-specific indirect PE pools.
specialties comprising the NPWP have of the indirect PE allocators. Comment: Many commenters
now submitted supplemental survey Comment: Many commenters recommend the use of unscaled direct
data that we have accepted. Now that supported the proposal to use clinical inputs in the allocation of the indirect
we have reliable aggregate PE data for labor costs as an indirect allocator when PE.
these specialties, as well as and refined either the clinical labor RVU exceeds Response: It would be inconsistent to
direct input data at the code level, we the work RVU or when the service does base the direct PE RVUs on budget
will finalize our proposal to eliminate not contain physician work. Two neutral scaled direct inputs, and then
the NPWP. commenters disagreed with the use of use unscaled direct inputs that are not
(4) Indirect PE RVUs Methodology clinical labor costs in allocating indirect budget neutral in creation of the indirect
PE and stated that this is a ‘‘fudge PE RVUs. We also disagree with the
Comment: Many commenters factor’’ that inappropriately allocates commenters’ suggestion that we should
recommended that we not use the costs to services with very low or no use unscaled inputs for the direct PE
budget-neutralized work RVUs in the physician work. RVUs. Direct costs represent, on
indirect PE allocation, but rather use the Response: Because work RVUs reflect average, approximately one-third of PEs
unadjusted work RVUs. the time required to perform the service based on the SMS survey data.
Therefore, we believe it is appropriate to example, if the majority of services more appropriately viewed as scaling
scale the direct inputs so that furnished were for the PC of a factors. The purpose of the separate
approximately one-third of the aggregate procedure, we believe the commenter is direct and indirect adjustments is to
PE RVUs are for direct PEs. suggesting that it would then be scale the pool of direct input RVUs and
Comment: Several commenters necessary for the PC to have a higher PE the pool of indirect RVUs to the direct
contended that the approach of basing RVU then the TC). Therefore, we will and indirect RVUs that are available, as
PE calculations on the weighted average retain our current methodology for the determined by the total direct and
of all specialties performing a service is allocation of indirect PE for services indirect dollars from the SMS and
flawed and should be replaced with an with TC and PCs, but we welcome supplemental surveys. For this reason,
approach that bases the specialty- further clarification regarding this the adjustments should be viewed as
weighted factors upon specialties that suggestion. direct and indirect scaling factors, as
represent 95 percent of the utilization opposed to BN adjustments. If we only
for a CPT code and modifier. A (5) Transition Period
applied one BN/scaling factor to the
commenter stated that utilizing the Comment: The majority of final PE RVUs, there would not be the
service counts associated with lower commenters expressed support for the appropriate balance between the direct
cost specialties, such as optometry, that proposal to transition the PE and indirect PE RVUs and services with
would perform only the postoperative methodology changes over a 4-year more direct RVUs would be paying for
portion of a service, as opposed to the period. One commenter recommended those services with less direct RVUs,
full service, inappropriately deflates the that if the work RVU changes associated since the indirect scaler is greater then
total PEs of a service when the practice with the 5-Year Review are not the direct scaler.
costs of these specialties are weight transitioned, then the PE RVUs should Since the direct and indirect RVU
averaged. also not be transitioned. pools are scaled and made ‘‘budget
Response: With regards to the general Response: We are concerned that, neutral’’ in these initial steps, the final
question of including all specialties when combined with the negative BN adjustment is very small. The only
performing a service in the weight- update adjustment factor (UAF) for CY reason the final adjustment is needed is
averaging of the practice costs of the 2007 and the impact of changes to the because the RVUs associated with
service, this is an issue that has been work RVUs under the 5-Year Review, specialties that are not used in the rate
raised since we first proposed a the shifts associated with the PE setting process need to be incorporated
resource-based PE methodology. We methodology changes could potentially back into the system. This introduction
still believe, as we have previously cause some disruption for medical of additional RVUs causes a very small
stated, that the inclusion of specialties practices. For this reason, we will adjustment in the final step. For these
that perform a very small proportion of finalize the proposed 4-year transition reasons, we will finalize the proposal to
a service has no discernible impact on to the PE methodology. utilize three separate adjustments in the
the PE calculation. Comment: One comment supported calculation of resource-based PE RVUs.
We agree that it would be the use of supplemental survey data, but Comment: Several commenters
inappropriate to assign full service requested that this supplemental survey applauded our proposals relating to the
counts to a specialty that only performs data be implemented with no transition, PE methodology for being more intuitive
the postoperative work of a given since this data was originally accepted and transparent, but requested that we
surgical procedure. For this reason, we 1–2 years ago. go one step further toward pure
have always adjusted the per specialty Response: The supplemental survey transparency by publishing the PE/HR
utilization for a service using the data is not independently transitioned figures and the specialty indirect
appropriate payment modifier (modifier in the proposed PE methodology. practice cost indices.
-55) before the service is used to weight Rather, the RVUs resulting from all the Response: We appreciate the support
the practice costs of the various changes to the methodology, which are for the intuitive and transparent nature
specialties performing a given service. to some degree interdependent, would of the revised methodology. Following
For example, if a specialty performs be transitioned over 4 years. It would be our original intention of making this
100,000 postoperative-only services for very difficult to isolate one aspect of our methodology resource-based, intuitive,
a specific procedure (that is, uses proposed methodology and exempt it and transparent, we will publish both
modifier -55), those services would be from the transition. In addition, we are the PE/HR figures and the indirect
counted based upon the code-specific concerned that such an approach could practice cost indices on the homepage of
postoperative percentage multiplied by lead to inequities whereby, for a given the CMS Web site.
the 100,000 services. If the specialty, a PE methodology change that Comment: A few commenters
postoperative percentage was 10 has a positive impact would be requested that either their services be
percent, the specialty performing transitioned over 4 years, while a ‘‘frozen’’ at the current 2006 PE RVUs or
100,000 postoperative-only services will change with a negative impact would that a floor be placed on the percent
be weighted with only 10,000 services. not. For these reasons, we will finalize reduction associated with any given
Therefore, we do not believe that any the 4-year transition as proposed. service due to the revised methodology.
further adjustments are needed. Response: We do not believe it would
Comment: One commenter (6) Other Comments on the PE be equitable to maintain current values
recommended that the indirect PE Methodology for certain codes or to place a floor on
allocation be distributed from the global Comment: Several commenters the percentage reduction associated
services to the professional and requested that one budget neutrality with a given service in a resource-based
technical services based upon the share factor (BNF) be applied for PE as system. However, in order to minimize
of billings for each service. opposed to applying a direct adjuster, any potential disruptive effects that
Response: Although we are unsure of an indirect adjuster, and a final BN could be caused by sudden shifts in
what, exactly, the commenter is adjustment. RVUs, we will be finalizing our
suggesting, it is not clear to us how this Response: The separate adjusters for proposal to transition to the bottom-up
recommendation could result in an the direct and indirect pools of RVUs methodology over a 4-year period. This
appropriate resource-based PE RVU (for are not pure BN adjustments but are transition period will allow interested
parties an opportunity to review the Comment: Several commenters catheterization services be based solely
data elements associated with their supported the use of revised 2005 upon the PE data for cardiology.
services. For these reasons, we will not utilization data. A few commenters Response: We agree with these
institute a floor on the reduction in PE expressed concerns that the use of this comments. We currently do not have
RVUs for a service, nor will we freeze revised single year data might cause direct cost input data for the nonfacility
any services at their CY 2006 PE RVUs. problems with the stability of the PE setting for these services. Until we are
Comment: Several commenters have RVUs and requested that we delay using able to obtain such data, we will carrier-
requested that, for purposes of this data until the impact on the price the cardiac catheterization codes.
calculating resource-based PE RVUs, stability of PE RVUs can be determined. We urge interested parties to continue to
certain services should be assigned to Response: We will finalize our work with the RUC to develop direct
specialties with higher PEs then those proposal to incorporate the most current cost inputs for these services in the
that are reported in the Medicare claims Medicare utilization data into the future.
data. calculation of resource-based PE RVUs. Comment: One commenter
Response: Unless there is evidence We have always attempted to use the recommended that we reinstate the
that the Medicare claims data is most current data available in rate- clinical labor costs associated with
incorrect, or that there is something setting. Although we understand the physicians bringing their own staff to
unique about the services in question, concerns conveyed by the few the hospital and contended that not
we do not believe it would be comments that requested a delay in the counting these costs is in violation of
appropriate to override our existing use of the 2005 utilization data, we do the statute.
Response: We have indicated that we
utilization data. The Medicare claims not believe that the use of this data will
will not pay for clinical staff brought by
data identifies what specialties are destabilize the PE RVUs to the extent
physicians to the hospital for the
furnishing what services and this is an that a delay would be warranted.
following reasons: (1) These costs are
essential component in the development Comment: Some commenters
already paid to the hospital and would
of our resource-based system. If contended that we are in violation of the thus be a double payment; (2) we
interested specialties contend that MMA when reducing the PE RVUs of already pay for physician extender staff
persons within their specialty are drug administration services by through the physician work RVUs; and
reporting their specialty designation adopting a new methodology. The (3) we pay physician assistants (PAs)
incorrectly, we urge those specialties to commenters stated that, because the directly when they serve as assistants at
work with their respective organizations oncology supplemental survey is not surgery. In response to this decision, the
to educate their membership about the being used for the same purpose as it thoracic surgeons contended that
importance of correct reporting of their was when MMA directed us to use the hospitals are no longer providing the
specialty designation when billing survey, all drug administration services staff to furnish adequate care. We asked
Medicare. must be exempt from any impact the Office of Inspector General (OIG) to
Comment: Several commenters associated with the revised PE conduct an independent assessment of
contended that the independent methodology. the staffing arrangements between
diagnostic testing facility (IDTF) survey Response: We disagree with this hospitals and thoracic surgeons. In
data does not reflect the costs of cardiac comment. Although the MMA was response to our request, in an April
event monitoring services, because enacted prior to these changes in our PE 2002 report, the OIG clearly supported
issues such as hours of operation, methodology, the MMA did not our position to exclude the costs of
intense staffing needs and equipment prescribe the use of any particular clinical staff brought to the hospital
usage are not taken into account. resource-based PE RVU methodology or from the PE calculations. For these
Response: We agree with the constrain our rulemaking authority. The reasons we will continue to exclude the
commenters that cardiac event MMA directed us to use the oncology clinical labor costs associated with
monitoring services are unique and are survey data in determining PE RVUs. physicians bringing their own staff to
not appropriately represented by the We have, in fact, used the survey data the hospital from the calculation of
IDTF survey data. For this reason, we (in exactly the way the Congress resource-based PE RVUs.
will use the PE data associated with envisioned when it passed MMA) to Comment: One commenter
cardiology to value these services. establish PE RVUs for services furnished recommended that the practice costs
Additionally, as discussed in more during CYs 2004, 2005 and 2006. In associated with the handling of
detail in the section on direct cost addition, under the revised PE pharmaceuticals should be incorporated
inputs (section II.A.4.f. of this final rule methodology, we are utilizing the into the cost categories associated with
with comment period), we are revising survey data in the calculation of the the calculation of resource-based PE
the direct inputs for these services to indirect PE RVUs. Thus, we do not RVUs.
reflect that the PEs are not limited to believe that the use of the survey data Response: The commenter did not
direct patient encounters. within our revised methodology violates offer any recommended inputs or
Comment: Some commenters the provisions of MMA. strategies on how to incorporate these
recommended that we review the Comment: Several commenters costs into the methodology. For this
crosswalk used for both interventional contended that the proposed indirect reason we will not incorporate any
pain management and pain medicine in practice costs may not be appropriate additional costs related to the handling
the CY 2007 PFS proposed rule. The for cardiology practices that operate of pharmaceuticals into the
commenters suggested that the free-standing cardiac catheterization methodology at this time.
appropriate crosswalk for these labs. The commenters further stated that Comment: One commenter
specialties is the ‘‘all physician’’ PE/HR. the nonfacility technical billings for recommended that administrative staff
Response: We agree with this cardiac catheterization are dominated time should be counted as a direct cost.
comment and will crosswalk both by IDTFs, but the IDTF supplemental Response: Administrative staff time
interventional pain management and survey data was primarily based on was included in the original CPEP data
pain medicine to the ‘‘all physician’’ imaging centers. The commenters as direct PE. However, because of the
PE/HR. recommended that the cardiac difficulty in accurately assigning the
administrative time to individual by the RUC and proposed to adopt all supplies needed to perform each
procedures, we then converted this of them. We have worked with the AMA procedure.
expense to an indirect cost. We agree staff to correct any typographical errors Because the application of the 90-day
that, in principle, it could be helpful to and to ensure that previously PEAC- global standard supplies and equipment
treat as many of the practice costs as accepted standards are incorporated in would result in the deletion of some
possible as direct, rather than indirect the recommendations. original CPEP inputs, we requested that
PE, and we would be willing to consider The complete PERC recommendations all the medical specialties examine the
such recommendations if the PERC or and the revised PE database can be direct PE inputs on our Web site and
RUC would agree to undertake the task found on our Web site. (See the inform us if there are additional items
of assigning administrative staff times to SUPPLEMENTARY INFORMATION section of from the original CPEP data that are a
each code. this final rule with comment period for necessary part of the postoperative care
Comment: One commenter directions on accessing our Web site.) and if the PERC-recommended PE
recommended that special resource Comment: We received comments inputs were listed correctly.
considerations for screening services from many of the specialty societies Comment: Several commenters
should be factored into the calculation thanking us for our acceptance of the expressed concern regarding the
of the PE RVUs. accuracy of our PE database for the
PERC recommendations.
Response: We have attempted to specialty-specific PERC
Response: We thank the specialty
account for all resource cost in the recommendations and the application of
societies for their positive remarks and
calculation of the PE RVUS for all the standard supplies and equipment
services. Unfortunately, the commenter we look forward to our continuing that we proposed to include in the 90-
did not supply any documentation relationship with the PERC and the day global codes. One commenter
regarding additional resources that the societies. representing urologists noted that
commenter believes should be included (ii) Standard Supplies and Equipment several supply items approved by the
for screening services. Therefore, we for 90-Day Global Codes PERC were missing in the PE database
will not add additional resources as and provided us with specific supply
requested at this time. In our proposed rule of August 22, inputs for CPT codes 57310, 57311,
Comment: Many specialty societies 2006, we proposed to revise the CPEP 57320, and 57330. Another commenter
expressed concern that the Medicare supply and equipment inputs for those representing prosthetic urologists
database currently does not permit the 90-day global procedures for which the recommended that the standard
collection of nurse practitioner (NP) RUC had only refined the clinical labor supplies used for infection control or
specialty-specific data. The commenters direct PE inputs. We proposed to apply patient comfort be included for each
contended that this limitation unfairly the standard supply and equipment postoperative visit, such as gloves for
excludes NPs from participating in inputs for the facility setting for 90-day the physician and clinical staff, table
certain demonstration projects and other global services to these remaining paper, patient drapes and gowns, and
programs. The commenters also state unrefined 90-day global procedure also questioned the accuracy of the
that they are ready to work with us on codes. As recommended by the PERC at number of ‘‘multi-specialty visit
this and any related issues. its April 2006 meeting, for supplies, we package’’ (MSVP) associated with their
Response: It is not clear from the proposed to include one minimum services. They believe that their services
comment exactly what specialty-specific supply visit package for each entail more postoperative visits than the
data is at issue. However, we would postoperative visit assigned to each current number of MSVPs reflected in
certainly be willing to work with the code and a postsurgical incision care kit the PE database. A society representing
commenters to address their concerns. (suture, staple, or both) where gynecologic oncologists also
appropriate, along with additional items recommended that the standard
4. Additional PE Issues for CY 2007 reviewed and recommended by the supplies for their procedures should be
a. RUC Recommendations for Direct PE PERC for certain procedures. For modified to include additional supplies
Inputs and Other PE Input Issues equipment, we proposed to include an that are associated with their
In the CY 2007 PFS proposed rule (71 exam table and light as the standard procedures, such as a pelvic exam kit
FR 48982), we proposed the following equipment, as well as other equipment and a patient drape. Lastly, a medical
concerning direct PE inputs. items recommended by the PERC that society representing ophthalmologists
were identified by the specialty urged us to incorporate the PERC-
(i) RUC PE Recommendations societies as necessary during the recommended supply and equipment
The AMA’s Relative Value Update postoperative visit period. However, direct inputs for the 90-day global
Committee (RUC) established a new there are several issues on which we ophthalmologic codes.
subcommittee, the Practice Expense requested input from the PERC or the Response: We thank the urology
Review Committee (PERC), to assist the specialty before we finalized the specialty for reviewing the PE database
RUC in recommending direct PE inputs recommended standards. For example, and providing us with the specific
(clinical staff, supplies, and equipment) for many of the 90-day codes in supply items missing from their four
for new and existing CPT codes. The question, the current supply input data CPT codes. These PERC-approved
RUC reviews and gives final approval contain supplies in far larger quantities supplies have been added as requested.
for all PERC recommendations. than are contained in either the visit We have addressed the prosthetic
The PERC reviewed the PE inputs for package or incision care kit. For other urologists’ concerns regarding the
over 2000 existing codes, some of which codes, the current data include items inclusion of supplies for infection
were unresolved PE issues from the CY that are not contained in the package or control and patient comfort by ensuring
2006 PFS final rule with comment kit. In other cases, the PERC that one MSVP was included in the PE
period, at their meetings held in recommendations contain additional database for each postoperative visit for
September 2005, February 2006 and items in quantities that appear these services. The MSVP contains,
April 2006. excessive. We plan to work with all the among other things, 2 pairs of gloves,
We reviewed the PERC concerned specialties to ensure that the table paper, and a patient gown. We also
recommendations that were forwarded finalized inputs do represent the typical note that the inclusion of a patient
drape is a standard for the codes 1861(s)(2)(A) of the Act. This proposal • Cast sole.
identified by the specialty for was not finalized; however, in our CY • Elastoplast roll.
gynecology and obstetrics. To the extent 2006 final rule with comment period (70 • Fiberglass splint.
that prosthetic urologists believe a FR 70116) we asked the medical • Ace wrap.
patient drape is needed in their 90-day specialties and the PERC to determine • Kerlix.
global codes, we encourage them to the typical supplies for splints and casts • Webril.
work through the RUC process to correct necessary for each of the fracture • Malleable arch bars and elastics.
possible discrepancies. In regard to the management codes and the cast/ The splint and cast supplies will not
request for additional MSVPs for each strapping application codes because we be included in the PEs for the following
procedure performed by the urologic wanted to make certain that the supply CPT codes:
prosthetists, we believe the commenter inputs were correct before we proceeded • 24500 through 24685.
is mistaken, as there is one MSVP for • 25500 through 25695.
with rulemaking for the CY 2007 PFS.
each of the RUC-recommended • 26600 through 26785.
At its February 2006 meeting, the PERC • 27500 through 27566.
postoperative visits entered in the PE reviewed and approved the supply • 27750 through 27848.
database. With respect to the comments inputs submitted by the American • 28400 through 28675.
about the absence of specific supplies in Academy of Orthopaedic Surgeons • 29000 through 29750.
gynecologic oncology procedures, we (AAOS) for each CPT code for fracture We specifically requested input, from
would note that the 90-day CPT codes management and cast/strapping medical specialties and contractors on
identified by the specialty for application and these were forwarded to our proposal.
gynecology and obstetrics all contain us as PERC recommendations. During Comment: Commenters offered their
these specific items as part of the this interim period we also reassessed appreciation and support of our
standard packages, as approved by the the options for payment of materials for proposal to pay for medically necessary
RUC and accepted by CMS. We would splints and casts. splint and cast supplies using HCPCS
again suggest that the commenter work We believe that the majority of the Q-codes for both statutory benefits, that
through the RUC process to assure that splint and cast supplies that are is, sections 1861(s)(5) and 1861(s)(2)(A)
the necessary inputs are included in currently paid through the Q-codes are of the Act. However, one commenter
these services. In response to the request furnished in relationship to cast/ requested that we clarify ‘‘whether this
from the society representing strapping procedures for the separation applied to the rehabilitation
ophthalmologists to implement the management of fractures and non-physician service codes.’’ In
PERC-recommended supply and dislocations. However, we did not addition, a few commenters noted that
equipment changes for ophthalmology intend for the medically necessary the supplies for the Unna-boot have
services, we have already incorporated splint and cast supplies used for other
these changes into the PE database and been excluded from payment under the
reasons (for example, serial casting, Q-codes, because they are assigned
they are reflected in the PE RVUs. wound care, or protection) not to be
However, we would note that further HCPCS A-codes, and asked that we
paid. Because it may be difficult for the clarify if the Unna-boot supplies will
equipment adjustments were not made contractors to identify the purpose for
for the ophthalmology CPT codes, as the now be included in the Q-codes. One
the cast/strapping application procedure commenter suggested that we omit the
PERC recommendations did not include on a claim form, we believe that
any changes to the current equipment or cast shoe from the list of supplies that
contractors may have been paying for are covered under either benefit.
ophthalmology lane assignments. the splint and cast supply Q-codes Another commenter asked us to
b. Payment for Splint and Cast Supplies when the service is performed for other temporarily include the A-HCPCS
purposes than treatment of fractures and codes, A–6441 though A–6457, as
In the CY 2000 and CY 2001 PFS final
dislocations. billable HCPCS codes in conjunction
rules (64 FR 59380 and 65 FR 65376, Since these splint and cast supplies
respectively), we removed splint and with the strapping and casting CPT
can be covered under both sections procedures codes.
cast supplies from the PE database for
1861(s)(5) and 1861(s)(2)(A) of the Act, Response: We will proceed with our
the CPT codes for fracture management
we proposed to include payment for proposal to pay for the splint and cast
and cast/strapping application
both statutory benefits using the supplies using the existing HCPCS Q-
procedures. Because splint and cast
separate HCPCS Q-codes. This would codes for all medically necessary splints
supplies could be separately billed
allow for payment for these medically and casts, as appropriate. While we
using Healthcare Common Procedure
necessary supplies whether based on appreciate the comments received, we
Coding System (HCPCS) codes (Q4001
sections 1861(s)(5) or 1861(s)(2)(A) of have questions about and do not
through Q4051) that were established
the Act, while ensuring that no understand the request concerning
for payment of these supplies under
duplicate payments are made. whether this applied to the
section 1861(s)(5) of the Act, we did not
want to make duplicate payment under Physicians will continue to bill the ‘‘rehabilitation nonphysician service
the PFS for these items. HCPCS Q-codes, in addition to the cast/ codes.’’ We apologize that our listing of
In the CY 2006 PFS proposed rule (70 strapping application procedure codes, the applicable CPT code ranges in the
FR 45764), we proposed to reinstate to be paid for these materials. proposal caused confusion about
payment for all splints and cast supplies The following supplies will continue whether the Unna-boot supplies that
through the PE component of the PFS to be paid separately using the HCPCS currently are identified with HCPCS A-
because we believed we may have Q-codes and would not be included in codes would change and be paid using
unintentionally prohibited the PE database: the Q-codes. For clarification purposes,
• Fiberglass roll.
remuneration for these supplies when • Cast padding. we would like to note that our proposal
they are not used for reduction of a • Cast shoe. does not change the existing Q-code
fracture or dislocation (covered under • Stockingnet/stockinette. descriptors or their pairing with certain
section 1861(s)(5) of the Act), but rather • Plaster bandage. CPT codes for payment purposes. For
are provided (and covered) as ‘‘incident • Denver splint. CPT code 29580, (Strapping; Unna boot)
to’’ a physician’s service under section • Dome paste bandage. physicians and other qualified providers
will continue to use the A-codes conversion of work to clinical labor time and other commenters compared these
designed for the Unna-boot supplies. for MNTs as part of the PE component. services to CPT codes 99213 (mid-level
We appreciate the comments from the At that time we received several E/M service) and 90804 (individual
commenter asking us to remove the cast comments, including one from the psychotherapy service). These
shoe from the PE database since shoes American Dietetic Association (ADA), commenters also requested that the total
are statutorily noncovered items, except urging us to adopt the work values work RVUs for 97802, 97803, and G0270
for certain diabetic shoes and those that recommended by the HCPAC. be equal and the total work RVUs for
are attached to braces. The cast shoe More recently, the ADA has requested CPT code 97804 and HCPCS code
was erroneously identified as a supply us to reconsider our decision not to G0271 also be equal. In addition, the
item separately paid using the Q-codes accept the HCPAC recommended work ADA provided specific supplies and
in the listing in our proposed rule. We RVUs. The ADA contends that the equipment to be added to the PE
now realize that the listing in the payment rate established by section database in order to facilitate correct PE
proposed rule, in reality, merely 105(c) of BIPA, 85 percent of the PFS calculations for these codes.
identifies the supply inputs to be amount that would be paid for the same Response: We appreciate that the
removed from the PE database rather service if furnished by a physician, is commenters acknowledge and support
than those that are separately billable. based on the premise that work values our decision to establish work RVUs for
We agree with the commenter, and will are inherent to these MNT services. The the 5 MNT services. However, we do not
remove the cast shoe item from our PE ADA believes that without work RVUs, believe it would be appropriate to
database (27 codes). While we the payment for these services does not accommodate the request to increase
appreciate a commenter’s request to reflect 85 percent of what a physician these work RVUs. We believe that the
include certain A-codes as separately would be paid for performing the same HCPAC work recommendations best
billable under our proposal, these items service. Because these MNT codes were represent the MNT services and
were never included in the PE database created specifically for MNT encourage the ADA to utilize the
and it would not be appropriate to professionals, the ADA compared the established RUC or HCPAC processes to
include them in the existing Q-codes. work associated with their services to further assess valuation of their services.
physician E/M services of CPT codes For this reason, we will maintain the
c. Medical Nutrition Therapy Services 99203 and 99213, which have respective proposed work values for all MNT CPT/
In 2000, the Health Care Professional work RVUs of 1.34 and 0.67. HCPCS codes. However, we have added
Advisory Committee (HCPAC) After reviewing the issues and the supplies and equipment to the PE
recommended that we assign work relevant arguments raised by the ADA, database as requested.
RVUs to three new medical nutrition we are persuaded that it would be
therapy (MNT) CPT codes: 97802, d. Surgical Pathology Codes
appropriate to include work RVUs for
Medical nutrition therapy; initial the MNT services. Consequently, we The College of American Pathologists
assessment and intervention, proposed to establish work RVUs for commented on the equipment times
individual, face-to-face with the patient, each code at the level previously assigned to CPT codes 88304 and 88305
each 15 minutes at 0.45 RVUs; 97803, recommended by the HCPAC, as in the basic surgical pathology family of
Medical nutrition therapy; re- follows: codes. While all six codes in this family
assessment and intervention, • CPT code 97802 = 0.45 RVUs. have been refined by the PEAC, this
individual, face-to-face with the patient, • CPT code 97803 = 0.37 RVUs. refinement occurred at four separate
each 15 minutes at 0.37 RVUs; and • CPT code 97804 = 0.25 RVUs. PEAC meetings. CPT codes 88304 and
97804, Medical nutrition therapy; group Because we proposed to add the work 88305 were refined at the first PEAC
(two or more individuals), each 30 RVUs to these services, the MNT meeting in April 1999 before time
minutes at 0.25 RVUs. However, during clinical labor time in the direct input standards were established for the
rulemaking for the CY 2001 PFS final database will be removed. Additionally, equipment at subsequent PEAC
rule, we indicated that MNT was not two HCPCS codes, G0270, MNT subs tx meetings when the other four CPT codes
covered because there was no statutory for change dx and G0271, Group MNT 88300, 88302, 88307, and 88309 were
benefit category that would allow 2 or more 30 mins were created to track reviewed. Using our proposed bottom-
medical nutritionists to bill these MNT services following the second up PE methodology to value these
services. We also did not accept the referral in the same year and these codes, the lack of the equipment time
HCPAC recommendations for work HCPCS codes correspond to CPT codes standards for CPT codes 88304 and
RVUs for these MNT services because 97803 and 97804, respectively. 88305 create a rank-order anomaly in
the codes were designed for use only by Therefore, we also proposed to add the this family. Consequently, the College of
nonphysicians. The following year, same work RVUs to these HCPCS codes American Pathologists, after reviewing
section 105(c) of the Medicare, and to delete the MNT clinical labor and applying current standards for the
Medicaid, and State Child Health inputs from the PE database upon equipment times, submitted suggested
Insurance Program Benefits adoption of this policy. We encouraged revised equipment times to us. We
Improvement Protection Act of 2000 specialty societies and other proposed to accept these times and the
(BIPA) (Pub. L. 106–554) provided for professional groups to comment on this times will be reflected in the PE
the coverage of MNT services when proposal. database on our Web site (See the
furnished by registered dietitians or Comment: We received comments SUPPLEMENTARY INFORMATION section of
nutritional professionals at 85 percent of from the ADA, several MNT providers, this final rule with comment period for
the amount that a physician would be one drug company, the National Kidney directions on accessing our Web site.)
paid for the same services. As a result, Foundation and one Congressional Comment: The College of American
we established values for these MNT member all supporting our decision to Pathologists expressed appreciation for
services for the CY 2002 PFS. In keeping establish work RVUs for the MNT these revisions to the equipment time to
with our earlier decision, we did not services. Further, several commenters the surgical pathology CPT codes.
assign the HCPAC-recommended work joined the ADA in requesting an Response: We appreciate the College
values. However, the associated work increase in the proposed work RVUs. In of American Pathologists’s review of the
value for each code was utilized in the justification of their request, the ADA PE direct inputs, which led to our
proposal. We are finalizing our proposal • FAC loader. ACR as presented in Table 15 of the CY
for these changes in the equipment We proposed to add a computer and 2006 PFS proposed rule.
times in the PE database. printer to the equipment for CPT code • Equipment pricing on the
88185 (70 FR 70138). ultrasound color doppler transducers
e. PE Issues from Rulemaking for CY and vaginal probe received from the
2006 (iv) Low Osmolar Contrast Media
American College of Obstetrics and
In the CY 2006 PFS final rule with (LOCM) and High Osmolar Contrast
Gynecology (ACOG).
comment period (70 FR 70116), we Media (HOCM) • Equipment pricing for CPT code
explained that we were not Because separate payment is available 36522, extracorporeal photopheresis.
implementing the PERC or other for both types of contrast media, we • Pricing of the EMG botox machine
proposed PE changes for CY 2006 due proposed to delete LOCM and HOCM used in CPT code 92265 as presented by
to issues with the PE methodology. In from the PE database in this final rule the American Academy of
the CY 2007 PFS proposed rule, we with comment period (70 FR 70138). Ophthalmology (AAO).
proposed that the PERC and other PE Comment: Several specialty
(vii) Supply Item for In Situ
changes originally proposed for CY 2006 organizations expressed their
Hybridization Codes (CPT Codes 88365,
would be implemented and effective appreciation for implementing the
88367, and 88368)
with the CY 2007 PFS (71 FR 48987). recommendations for the PE changes in
The following subsections, (i) through section (i) of this section to CPT codes We proposed to implement the
(x), summarize the PE proposals from 36522, 78350, 76975 and 15852; in Society for Clinical Pathologists’ request
the CY 2006 PFS final rule with section (ii) of this section for changing to change the probe quantity to 1.5 for
comment period. the amount and test substance inputs in CPT code 88367, In situ hybridization,
(i) PE Recommendations on CPEP CPT 95015; in section (iii) of this auto, which is equal to the quantity in
Inputs for CY 2006 section for implementing the PE the other two codes in the family.
We proposed to use a clinical labor changes to the flow cytometry CPT (viii) Supply Item for Percutaneous
time of 167 minutes for the service codes 88184 and 88185; and in section Vertebroplasty Procedures (CPT codes
period for CPT code 36522, (iv) of this section for removing the 22520 and 22525)
Extracorporeal Photopheresis; maintain LOCM and HOCM from the PE database
the nonfacility setting PE RVUs for CPT because they are separately reimbursed. Based on documentation provided by
code 78350, single photon bone Response: We will implement these the Society for Interventional Radiology,
densitometry; and remove the PE inputs changes for CY 2007. we proposed to implement a new price
for the nonfacility setting for CPT codes of $696.00 for the vertebroplasty kit, to
(v) Imaging Rooms replace a temporary price of $660.50
76975, GI endoscopic ultrasound, and
15852, Dressing change not for burn. (70 We proposed to implement the that was a placeholder price from the
FR 70136 through 70137) updates for the contents and prices of 5 CY 2006 PFS final rule with comment
‘‘rooms’’ used in imaging procedures period (70 FR 70139).
(ii) Supply Items for CPT Code 95015 including—
(Which is Used for Intradermal Allergy (ix) Clinical Labor for G-Codes Related
• Basic radiology room; to Home Health and Hospice Physician
Tests with Drugs, Biologicals, or • Radiographic-fluoroscopic room;
Venoms) Supervision, Certification and
• Mammography room;
Recertification
We proposed to implement the allergy • Computed tomography (CT) room;
and immunology specialty’s and We proposed to apply the refinements
recommendation to change the test • Magnetic resonance imaging (MRI) made to the PE inputs to CPT codes
substance in CPT code 95015 to venom, room (70 FR 70139). 99375 and 99378 for home health and
at $10.70 (from single antigen, at $5.18) Comment: Two commenters hospice supervision to four G-codes that
and the quantity to 0.3 ml (from 0.1 ml) questioned why the contents and prices are related to home health and hospice
(70 FR 70138). for ultrasound ‘‘rooms’’ were not being physician supervision, certification and
updated in CY 2007 proposed rule. recertification, G0179, GO180, GO181,
(iii) Flow Cytometry Services Response: The imaging rooms and GO182. These G-codes are
Based on information from the society proposals that appeared in this year’s incorrectly valued for clinical labor.
representing independent laboratories, proposed rule were deferred from the These G-codes are crosswalked from
we proposed to implement the previous year. These imaging rooms all CPT codes 99375 and 99378, which
following direct PE inputs: contained equipment without updated underwent PEAC refinement in January
• Clinical Labor: We proposed to pricing information. The two ultrasound 2003 for the CY 2004 PFS. However, at
change the staff type in the service rooms, general and vascular, were that time we inadvertently did not apply
(intra) period in both CPT codes 88184 valued during the repricing of the the new refinements to these specific G-
and 88185 to cytotechnologist, at $0.45 equipment for the PE database that codes (70 FR 70139 through 70140).
per minute (currently lab technician, at occurred during rulemaking for CY
(x) Programmers for Implantable
$0.33 per minute). 2005.
Neurostimulators and Intrathecal Drug
• Supplies: We proposed to change (vi) Equipment Pricing for Select Infusion Pumps
the antibody cost for both CPT codes Services and Procedures
88184 and 88185 to $8.50 (from $3.544). Although we had initially proposed in
• Equipment: We proposed to add the We proposed to accept the following the CY 2006 PFS proposed rule to
following equipment to CPT code equipment pricing information provided remove two programmers from the PE
88184: by various specialty societies for select database (EQ208 for medication pump
• Computer. services and procedures as discussed in from two codes (CPT codes 62367 and
• Printer. the CY 2006 PFS final rule with 62368) and EQ209 for the
• Slide strainer. comment period (70 FR 70139). neurostimulator from 8 codes (CPT
• Biohazard hood. • Equipment pricing for certain codes 95970 through 97979)), based on
• Wash assistant. radiology services received from the comments received as discussed in the
CY 2006 PFS final rule with comment (iii) Cardiac Monitoring Services commenters suggested that CPT code
period (70 FR 70140), we determined We requested more specific PE 92326 (remote, real-time, wireless
that we will retain these programmers in information on remote cardiac event cardiac monitoring) be added to the
the database. In addition, we added monitoring services in the CY 2007 PFS above list of services:
‘‘with printer’’ to the description of proposed rule as a result of a comment Response: We appreciate that the
EQ208, based on comments received. and response discussion in last year’s provider group conducted such a
We proposed to implement these final rule related to these services and detailed survey to capture the costs of
decisions for CY 2007. an inappropriate fit with the direct PE these services. We have reviewed the
Comment: Commenters expressed model used for typical physicians’ direct inputs that were forwarded by the
appreciation for the implementation of services. These services are commenter and have accepted many of
these changes that had been deferred overwhelmingly performed by their recommendations, some with
from the previous year. specialized IDTFs that are paid under modifications, for all these codes. For
Response: We will implement the PE the PFS, but frequently maintain more example, we used the ‘‘discounted’’
changes noted in sections (vi) through extensive operating hours than the purchase prices for the equipment
(x) of this section for CY 2007. typical physician office due to the which is our standard policy rather than
f. Other PE Issues for CY 2007 characteristics of cardiac monitoring the additional list prices that were also
services. Specifically, we requested data included. The specific direct inputs for
(i) Clarification With Respect to Non- the following CPT/HCPCS codes: 93012,
to indicate the typical number and type
Facility PE RVUs 93271, 93270, 93733, 93736, 93232,
of transmissions or other encounters per
In the CY 2006 PFS final rule with day between the beneficiary and the 93226, 93231, 93225, G0248 and G0249
comment period (70 FR 70335), we IDTF for each of the remote monitoring are included in the PE database that is
provided a clarification in Addendum A services. We also requested the number posted with this rule on the CMS Web
concerning use of ‘‘NA’’ in the PE RVU and type of clinical staff, as well as the site. We will consider these inputs
columns for Addendum B. Commenters corresponding times, that are necessary interim, for CY 2007, and will continue
requested that further clarification be to ensure that appropriate services are to work with the provider group to
made concerning the payment amount available for each patient. Additionally, appropriately value these services. For
for procedures performed in the non- we requested assistance in identifying the request to include CPT code 93236
facility setting if there is an ‘‘NA’’ in the any other direct PE inputs for typical in this list of codes, we would note that
non-facility PE RVU column. In the CY supplies and equipment relating to this procedure is not valued in the
2007 PFS proposed rule, we clarified these services, and any data that would nonfacility setting and has no direct
that our policy is that the service will reflect indirect PE, such as overhead inputs. CPT code 93236 is discussed in
be paid at the facility PE RVU rate if the and non-clinical payroll expenses. the following comment and response.
Medicare carrier pays for the service in Because we believe that the following g. Specific PE Concerns Raised by
the non-facility setting. In the CY 2007 codes, predominately performed by Commenters
PFS proposed rule (71 FR 48982), we specialized IDTFs, represent atypical PE
proposed revisions to Addendum A to scenarios, we requested PE information (i) Wireless Cardiac Monitoring
include this clarification. for these services:
Comment: Commenters expressed • Cardiac event monitoring (CPT Comment: One commenter expressed
appreciation for this clarification. codes 93271, 93012 and 93270). concern about the impact of the PE
Response: We have modified • Pacemaker monitoring (CPT codes methodology proposal and stated that
Addendum A to include this 93733 and 93736). there is not a CPT code that accurately
clarification. • Holter monitoring (CPT codes represents ‘‘remote, real-time cardiac
93232, 93226, 93231 and 93225). monitoring through wireless
(ii) Supply for CPT Code 50384, • INR monitoring (HCPCS codes communications and computerized
Removal (Via Snare/Capture) of G0248 and G0249). arrhythmia detection technology’’
Internally Dwelling Ureteral Stent Via Comment: Several commenters voiced service. The commenter requested that a
Percutaneous Approach, Including concern about the dramatic decrease in HCPCS code be created specifically for
Radiological Supervision and the PE RVUs for these services and most this service and provided direct input
Interpretation agreed that the remote cardiac recommendations that could be used to
Upon review of the RUC- monitoring services do not fit the PE price this new code. In the event that we
recommended direct PE inputs for CPT model for physicians’ services and could not create a HCPCS code, the
code 50384, a new procedure for the believed that the information that we commenter requested that the direct
2006 CPT codes, we identified the requested could be useful to value these inputs be applied to the CPT code 93236
inappropriate inclusion of a ureteral technical services. One commenter which is currently being used to bill for
stent that we proposed to delete for CY submitted the requested information this service.
2007. We believe that the addition of the after conducting a survey of 7 large Response: We are reluctant to create
ureteral stent, valued by the specialty at IDTFs specializing in these remote a HCPCS code at this time because the
$162, to CPT code 50384, which is the cardiac monitoring services. For each of commenter has not demonstrated a
procedure for the removal of a stent, the 11 CPT/HCPCS codes referenced compelling need for a distinct code for
was an inadvertent error by the above in this section, the commenter this service. Because this code is
specialty during the April 2005 RUC provided recommendations for the currently not valued in the nonfacility
meeting. direct PE inputs, including the type of setting, we proposed to carrier price this
Comment: The commenters agreed clinical labor and the related minutes service for CY 2007. We suggest that if
with the deletion of the ureteral stent for their service, the needed disposable the commenter believes a distinct code
from this service. supplies and the equipment costs, the is necessary to describe this service, the
Response: This stent will be removed number of minutes in use, and the provider should work with the specialty
from CPT code 50384 in the PE respective life of each piece of and contact the CPT Editorial Panel to
database. equipment. In addition, two pursue this matter. We will maintain
our proposal to carrier price this service time we established the clinical labor service period and 6 minutes assigned
for CY 2007. rates for CY 2002. to the postservice period. Also, the
Response: We used data from the supply item the commenters reported as
(ii) Endovenous Ablation Services, CPT Bureau of Labor Statistics (BLS) to missing is included in the PE database.
Codes 36475, 36476, 36478, and 36479 establish the base wage rate for
Comment: We received numerous audiologists when we repriced the (vii) Supply Inputs for CPT 31730
comments with concerns about the clinical staff wage rates for CY 2002. We Comment: Prior to the publication of
decrease in PE RVUs proposed for CY also applied a 33.6 percent fringe the CY 2007 PFS proposed rule, we
2007. In addition, a few commenters benefit factor to all wage rates, received documentation from the
noted a disparity between the cost of including the wage rate for audiology. association representing pulmonary
supplies for the RF and the laser Therefore, we will maintain the wage physicians that specified the contents of
ablation procedures, CPT codes 36475 rate for audiologists until the time that the fast track supply tray for CPT code
and 36478, respectively. One all clinical labor wages are updated in 31730. The specialty was complying
commenter supplied documentation to future rulemaking. with our request for information on
support that the price of the supply items needing specialty input in
(v) Medical Physicists Wage Rate
endovascular laser kit, at $677, in the PE last year’s final rule.
database is not typical. This commenter Comment: Several commenters Response: We thank the specialty
presented a range of prices from $275 to recommended that we accept the 2005 group for its submission of the fast track
$315 as typical. The commenter also survey data on hourly wages, inflated to supply tray contents and note that we
demonstrated that 3 other supplies 2006, that was presented by the accepted this documentation and the
listed for CPT code 36478 were association representing medical $750 price in our proposed rule.
duplicated as they are part of the kit. physicists. They contend that we However, we regret that we did not
Another commenter noted a price of inappropriately used the wage rate for remove the duplicated supply items
$360 for the laser kit. health physicists, instead of medical from the PE database at that time. The
Response: We reviewed the supplies physicists, when we updated the following supplies will be removed
in the laser kit and the other supplies clinical labor wage rates for CY 2002. from the inputs for CPT 31730 because
for this endovenous service and believe Response: In the PFS final rule for CY they are already contained in the fast
that the hydrophilic guide wire, the 2002, we finalized our proposal to price track tray: alcohol pads, 6 cc syringe
vascular sheath and the vessel dilator the physicist staff type on the average with needle, 27G needle and 4x4 gauze
are duplicated. These items were salary data for all certified health pads. The PE RVUs that appear in this
removed from the database for CPT code physicists from the 1999 survey rule reflect the removal of these supply
36478. In addition, based on the conducted by the American Academy of items.
information and documentation Health Physics and the American Board
of Health Physics. At the time we were (viii) Supply Costs for CPT Code 58565
supplied, we used the $360 laser kit to
average with the existing price of $677 revising the wage rates, this was the best Comment: One commenter noted that
to obtain the new price of $519. We information available. Further, the the cost of the kit used for hysteroscopic
have also made this change to the PE source of the majority of wage rates in tubal implant for sterilization (supply
database. While we realize that the PE the CY 2002 PFS final rule was the BLS. code SA076) has increased in price from
RVUs were negatively impacted by the In the case of medical physicists, we $980 to $1245. The specialty society
change in the PE methodology, it is also were unable to obtain salary data from representing gynecology and obstetrics
important to ensure that the direct BLS. We agree with the commenters that services did not supply supporting
inputs accurately reflect the typical this revised 2005 salary data is more documentation.
resources used to provide each service. appropriate than our current salary data. Response: We appreciate that this
We will utilize this revised data, commenter has reviewed the direct
(iii) Development of Nonfacility PE for deflated to 2002, to keep all salary data inputs for accuracy. However, lacking
Arthroscopic Procedures on the same scale. As a result of this any documentation to substantiate this
Comment: We received comments information, we will change the wage request for a higher price, we will
requesting that we establish direct PE rate per minute for the two following maintain the $980 price for the kit in the
inputs for five arthroscopy codes for the clinical staff types: (a) Medical PE database for CY 2007. We will add
nonfacility setting, including CPT codes physicists from $1.21 to $1.523; and (b) this supply to the table requiring
29870, 29805, 29830, 29840 and 29900. medical dosimetrists/medical physicists specialty input and will review any
Response: The RUC discussed this from $0.92 to $1.075. documentation provided by the
request at its October 2006 meeting and specialty as part of a future rulemaking.
determined that the procedures are not (vi) Home Visit E/M Services
Comment: We received a comment (ix) Bone Density Testing Services
safe to perform in the physician’s office.
We support the RUC’s decision not to that stated that the home care clinical Comment: Many commenters
value these arthroscopy procedures in labor times are incorrectly reported in requested that we review the costs
the nonfacility setting and will continue our PE database with each lacking 6 related to bone density testing (DXA)
to use the ‘‘NA’’ indicator in the PE minutes in the pre-service period. In services, particularly related to CPT
RVU column for the nonfacility setting addition, the commenter stated that a codes 76075 and 76076 used for
in Addendum B. supply item, specula tips, is missing in detection and quantification of
one service. Another commenter voiced osteoporosis. These commenters state
(iv) Audiologist Wage Rate support for the efforts of the home care that the current direct inputs in the PE
Comment: One commenter requested physician group. database identify the low cost pencil
that we add 25 percent to the Response: We have verified that our beam technology ($41,000) as the
professional audiologists wage rate per PE database is correct. For the CPT equipment utilized in performing these
minute which is now $0.52. The codes 99341, 99342, and 99343, there is DXA services in place of the higher cost
commenter contended that the fringe a total 12 minutes labor for each code, fan beam technology ($85,000).
benefits factor was not applied at the with 6 minutes assigned to the pre- Commenters contended that the
majority of densitometers sold are of the performing this procedure in the office. above concerns were echoed in
higher cost fan beam variety. Another For CY 2007, we have maintained the comments from a society representing
commenter noted that the DXA services current clinical labor assignment in the NPs and a society concerned with
using the fan beam technology should PE database. research on women’s health.
also contain ‘‘phantom’’ equipment to We also received several comments
h. Concerns About Decreases in PE regarding a related service, CPT code
be used to perform the daily quality
RVUs for Women’s Health and Other 19296, Placement of a radiotherapy
check on this equipment.
Response: We have changed the PE Services afterloading balloon catheter into the
database to reflect the fan beam DXA Many commenters raised concerns breast for interstitial radioelement
technology for CPT codes 76075 and regarding payment for services that application. Commenters expressed
76076. In addition, we have added, on affect women’s health: concern regarding the proposed
an interim basis, the ‘‘solid water Comment: We received many decrease in payment for this service and
calibration check phantom’’ to the comments regarding the proposed predicted that this decrease from 129.74
equipment file in the PE database for the decrease in PE RVUs for either specific RVUs in 2006 to 89.31 RVUs in 2010
family of codes using the fan beam services or for given specialties. Many would cause the service not to be
technology for 15 minutes each, based commenters raised concerns regarding offered in a physician’s office to
on the survey information presented by payment for services that affect Medicare patients.
one commenter noting that these DXA women’s health. We received comments that expressed
services are performed, on average, Commenters opposed the proposed concern regarding the proposed
twice daily. We ask the medical decrease in payment for the axial bone decrease in payments for a number of
specialty to provide us with the correct density testing (DXA) service, CPT code other services. These include: The
information on the specific ‘‘phantom’’ 76075, which is used for detection and surgical hysteroscopy service, CPT code
used for the fan beam DXA technology, quantification of osteoporosis, and CPT 58565; the chemodenervation
including pricing verification. While code 76077, which is used for vertebral procedures, CPT codes 64612, 64613
reviewing the PE database for these fracture assessment. The commenters and 64614; the EMG-guided Botox
services, we discovered a rank order raised the concern that the proposed therapy, CPT 92265; and endovenous
anomaly between CPT code 76075 and decrease in payment for these services ablation procedures, CPT codes 36475,
76076 that apparently is due to a change would severely restrict patient access to 36476, 36478 and 36479.
in the clinical labor from the April 2006 bone density testing, thereby We also received comments regarding
PERC meeting where CPT code 76075 undermining our effort to effectively the effect on certain specialties of our
was used as a reference code. We have screen Medicare beneficiaries for proposed payments. One commenter
added back the 5 minutes of labor time osteoporosis and vertebral fractures. stated that the proposed cuts could
in the PE database to CPT code 76075 These commenters identified what they diminish Medicare patients’ access to
to correct this rank order anomaly. believed to be flaws in the direct input cardiac care. Many commenters
data and with the utilization rate requested that we reconsider the cuts for
(x) PE Missing for CPT Code 28890 applied to the DXA machine. The interventional radiology, and others
Comment: One commenter stated that commenters also requested that we keep requested that we reverse any decrease
the non-facility inputs for CPT code the payment for these services at the for anesthesiology. Another commenter
28890, Extracorporeal shock wave, high current level. expressed concern regarding the
energy, performed by a physician, We received several comments that decreases for this specialty. Commenters
requiring anesthesia other than local, expressed concern about the decrease in opposed the changes to the RVUs that
including ultrasound guidance, payment for computer-aided detection would cause a total 14 percent decrease
involving the plantar fascia, lacked (CAD) services, CPT codes 76082 and in payment for clinical social workers.
enough clinical staff to assist the 76083, both add-on procedures that are In addition, other commenters
physician with applying the regional billed in combination with an expressed concern regarding our
(anesthetic) block and that the appropriate mammography service. The proposed payments for gastroenterology,
ultrasound equipment was not included commenters stressed that CAD systems neonatology, pain management,
in the PE database for this ‘‘shock- for mammography are diagnostic tools radiosurgery and phlebology.
wave’’ service. that can increase breast cancer detection Response: We understand the concern
Response: In the CY 2006 PFS final rates, especially in the early stages. One expressed by all of these commenters.
rule with comment, we assigned commenter contended that the decrease However, payments made for services
nonfacility PE inputs for CPT code in payment for this service could on the PFS can only reflect, in a budget
28890, because we believed these cripple the ability of physicians to offer neutral manner, the relative resources
services were being performed in the this highest quality screening service to required to perform each service. With
office. (This assignment of PE for CPT the broadest patient population. the exception of the requested changes
28890 is discussed in a subsequent Several commenters expressed to the equipment direct inputs for the
section of this rule.) Since the ‘‘shock- concern about the proposed RVUs for DXA service, the commenters have not
wave’’ machine was the only equipment the various radiation therapy codes provided specific information regarding
listed in the PE database, we added the involved in breast brachytherapy, as the relative resources required for the
ultrasound equipment for 36 minutes, to well as brachytherapy for ovarian and services in question that would support
the PE database, but we question cervical cancer. A society representing the requested changes in payment. We
whether additional staff is needed to brachytherapy stated that the proposed also do not believe it would be equitable
assist the physician during the reductions may force providers to resort to keep the payment for any specific
procedure since one nurse ‘‘blend’’ (RN/ to other less beneficial cancer service at the current rate when there
LPN/MTA) staff type is currently treatments. One commenter contended are many other services that will see
assigned for this procedure. We would that the proposals could deny a greater decreases in payment. We would note
entertain future discussions on this number of African American women that one of the main reasons for the
issue with interested parties, including access to an important, patient friendly proposed 4-year transition of our new
the specialty organization involved in and proven breast cancer treatment. The PE methodology was to give specialties
and practitioners the opportunity to in use 50 percent of the time when the timeline, recurring at least every 5 years,
work with us to determine whether any utilization is actually higher, our price for the comprehensive review of the PE
changes in our payment calculation for per minute would be too high. The RUC database direct inputs. Both MedPAC
such services is warranted and we are recommended we use a rate higher than and the RUC made suggestions that the
open to further discussion on this issue. 50 percent and permit individual new, higher-priced supplies and
We also applaud the commenters who specialty societies to present support for equipment may need to be updated
have stressed the importance of lower rates for specific equipment more frequently because their prices
women’s health issues. We certainly items. While the overall comments may decrease over time as other
share their commitment to ensuring that contained a broad array of suggested companies manufacture them.
those services that meet the health care revisions to the utilization rate, a few Response: We appreciate the
needs of women remain accessible to specialty organizations believed that the commenters’ remarks regarding the
our beneficiaries. In addition, we utilization rate should be lower than 50 establishment of a regular update
appreciate the important role that all of percent. Several comments, specific to process for the direct inputs utilized in
the preventive screening services play equipment for bone density testing the calculation of resource-based PE
in helping to maintain the health of (DXA), believe the utilization rate to be RVUs. We plan to examine this issue
these beneficiaries. In response to closer to 20 percent for these services with both the RUC and interested
comments, we have revised our performed in primary care physicians’ specialty organizations, as well as with
equipment database to reflect the correct offices and requested that we review the medical community to determine
DXA equipment. It should also be noted this utilization to more appropriately
that, although payment for the CAD the most useful approach to updating
measure the actual utilization of this our direct PE inputs. Additionally, we
service itself is decreasing, payment for equipment. MedPAC suggested that we
most mammography services is encourage interested parties to continue
begin our updating process by looking at working with the RUC to develop direct
increasing, which could potentially the higher-priced equipment, and noted
offset any reductions to the providers of inputs for those services absent inputs
a study it conducted of imaging and to correct any errors contained in
CAD. However, we will request that the providers in six markets that indicated
RUC review again the PE inputs for the our direct input database.
70 percent and 90 percent utilization
DXA and CAD services to ensure that rates for CT and MRI, respectively. A k. Supply and Equipment Items Needing
the direct inputs associated with these few commenters noted that they would Specialty Input
services are accurately reflected in our like for us to assign code-specific
PE database. We have identified certain supply and
equipment utilization rates, although
equipment items for which we were
i. Equipment Utilization and Interest they did not forward possible avenues
unable to verify the pricing information
Rate Assumptions for us to follow in making the
in Table 3: Supply Items Needing
Comment: Many specialty societies, determinations of these assignments.
Specialty Input for Pricing and Table 4:
MedPAC, and the RUC all offered Response: We agree with commenters Equipment Items Needing Specialty
comments about the 11 percent interest that the proposed interest rate of 11 Input for Pricing. In our CY 2007 PFS
rate and the 50 percent utilization rate percent and the proposed 50 percent proposed rule, we listed both supply
used to calculate the price per minute utilization rate should be examined for and equipment items for which pricing
for each piece of equipment. MedPAC accuracy. We are committed to working documentation was needed from the
stressed the importance of obtaining a with all interested parties to define the medical specialty societies and, for
reliable source for updating the yearly most accurate utilization and interest many of these items, we received
interest rate that physicians would pay rate information for equipment used in sufficient documentation in the form of
when borrowing money to buy the performance of physicians’ services. catalog listings, vendor Web sites,
equipment. They believe that we should We do not believe that we have invoices, and manufacturer quotes. We
select the Federal Reserve Board sufficient empirical evidence to justify a have accepted the documented prices
because of the frequent updating, issued change in this final rule, but we will for many of these items and these prices
quarterly. MedPAC notes that interest continue to work with the physician are reflected in the PE RVUs in
rates, of more than one year, ranged community to examine, and potentially Addendum B of this final rule with
from 5.3 percent to 6.0 percent over the revise, these estimates in future comment period. For the items listed in
past 5 years. Other commenters rulemaking. We have used the 11 Tables 3 and 4, we are requesting that
suggested that we adopt the prime percent interest rate and the 50 percent commenters provide pricing
interest rate plus 2 percent, while the utilization rate to determine the information on items in these tables
RUC and several specialty societies valuation for equipment reflected in the along with acceptable documentation,
noted that we should select a PE RVUs in Addendum B. as noted in the footnote to each table, to
competitive market rate. One j. Further Review of PE Direct Inputs support recommended prices.
commenter suggested using caution in
our selection process and requested that Comment: Several commenters, In Tables 5 and 6, we have listed new
the interest rate be examined before including the RUC and MedPAC, supplies and equipment from the new
future changes are made. recommended that we establish an CPT codes for CY 2007 that are
For updating the current 50 percent update process to ensure that the direct discussed elsewhere in this final rule
utilization rate, many commenters, PE inputs—wage rates of clinical staff, with comment period. These items have
including the MedPAC and the RUC, purchase price of supplies, and been added to the PE database and,
suggested that this rate should be purchase price of equipment—are where priced, are reflected in the PE
higher. These comments stressed that by updated for completeness and accuracy. RVUs in Addendum B.
using the assumption that equipment is MedPAC requested that we establish a BILLING CODE 4120–01–P
ER01DE06.004</GPH>
ER01DE06.005</GPH>

ER01DE06.006</GPH>
TABLE 5.—PRACTICE EXPENSE SUPPLY ITEM ADDITIONS FOR CY 2007

*CPT
Equip code(s) as-
Supply description Unit Unit price Supply category
code sociated
with item
NA .......... Agent, embolic 1 .................................................... Vial ......... ...................... 37210 Accessory, Procedure.
NA .......... Bolster covers, disposable .................................... Item ........ 0.06 96904 Gown, drape.
NA .......... Filter, mouthpiece .................................................. Unit ........ 4.6 95012 Infection control.
NA .......... Gas, argon ............................................................. Cu ft ....... 0.25 19105 Accessory, Procedure.
NA .......... Kit, capsule, ESO, endoscopy w-application ........ Kit ........... 450 91111 Kit, Pack, Tray.
NA .......... Kit, gold markers, fiducial, 3 per kit ...................... Kit ........... 119 55876 Kit, Pack, Tray.
NA .......... Probe, cryoablation, (Viscia ICE 30 or 40) ........... Item ........ 1589 19105 Accessory, Procedure.
*CPT codes and descriptions only are copyright 2007 American Medical Association. All Rights Reserved. Applicable FARS/DFARS77373y.
1. Price verification needed. Item(s) added to table of equipment requiring specialty input.
TABLE 6.—PRACTICE EXPENSE EQUIPMENT ITEM ADDITIONS FOR CY 2007

*CPT
Equip code(s) as-
Equipment description Life Unit price Equipment category
code sociated
with item
.
NA ........... AV projection system (integrated headphone, 5 3800 70554 IMAGING EQUIP.
video goggles, transducer, control unit w-re-
mote-Cinema Vision).
NA ........... camera mount-floor 2 ........................................... 15 1 2300 96904 OTHER EQUIPMENT.
NA ........... cross slide attachment 2 ...................................... 10 1 500 96904 OTHER EQUIPMENT .
NA ........... cryoablation system, fibroadenoma ..................... 3 24950 19105 OTHER EQUIPMENT.
NA ........... dermal imaging software 2 ................................... 5 1 4500 96904 OTHER EQUIPMENT.
NA ........... dermoscopy attachments 2 .................................. 5 1 650 96904 OTHER EQUIPMENT.
NA ........... Gammaknife ........................................................ 7 3870000 77371 IMAGING EQUIP.
NA ........... generator, spine, IDET, w-extension ................... 5 28299 22526 OTHER EQUIPMENT.
22527
NA ........... genetic counseling, pedigree, software 2 ............. 5 .................... 96040 DOCUMENTATION.
NA ........... image-acquisition software and hardware 3 108807 70554 IMAGING EQUIP.
(Brainwave RealTime, PA, Hardware).
NA ........... lens, macro, 35–70 mm 2 .................................... 5 .................... 96904 OTHER EQUIPMENT.
NA ........... monitoring system, nitric oxide w-computer 5 39200 95012 OTHER EQUIPMENT.
(Acerine, NIOX).
NA ........... radioactive source 3 ............................................. .................... .................... 77371 IMAGING EQUIP.
NA ........... speakers, sound field (brainstem implant) .......... 5 1775 92640 OTHER EQUIPMENT.
NA ........... SRS system, Lincac ............................................ 7 4350000 77372 IMAGING EQUIP.
NA ........... SRS system, SBRT, six-systems, average ......... 7 4000000 77373 IMAGING EQUIP.
NA ........... strobe, 400 watts (Studio)(2) 2 ............................. 10 1 1500 96904 OTHER EQUIPMENT.
*CPT codes and descriptions only are copyright 2007 American Medical Association. All Rights Reserved. Applicable FARS/DFARS77373y.
1. Prices interim for CY 2007—Acceptable documentation required for price verification.
2. Price verification needed. Item(s) added to table of equipment requiring specialty input.
3. Discussion with CMS necessary to establish appropriate value.
B. Geographic Practice Cost Indices years and allows us to make after January 1, 2004 and before January
(GPCIs) adjustments based on our review. This 1, 2007. Beginning on January 1, 2007,
section of the Act also requires us to the 1.00 floor will be removed and the
Section 1848(e)(1)(A) of the Act phase-in the adjustment over 2 years, work GPCI will revert to the fully
requires us to develop separate GPCIs to implementing only one-half of any implemented value. The values for the
measure resource cost differences adjustment in the first year if more than work GPCI and subsequent changes to
among localities compared to the 1 year has elapsed since the last GPCI the geographic adjustment factor (GAF)
national average for each of the three fee revision. CMS is currently working with published in the CY 2007 PFS proposed
schedule components. While requiring Acumen, LLC to review and revise the rule reflect the removal of the 1.0 floor.
that the PE and malpractice GPCIs GPCIs in accordance with the For many payment localities, this
reflect the full relative cost differences, requirement that GPCIs be revised at change had no impact on the GAF;
section 1848(e)(1)(A)(iii) of the Act least every 3 years. We expect to however, the GAFs for a number of
requires that the physician work GPCIs implement any revisions based on our payment localities were reduced due to
reflect only one-quarter of the relative review in January 2008. this change. The impact of this change
cost differences compared to the In addition, section 412 of the MMA on the GAFs for those payment
national average. amended section 1848(e)(1) of the Act to localities was shown in Table 3 of the
Section 1848(e)(1)(C) of the Act establish a floor of 1.0 for the work GPCI CY 2007 PFS proposed rule (71 FR
requires us, in consultation with for any locality where the GPCI would 48993).
appropriate physician representatives, otherwise fall below 1.0 for purposes of In the CY 2007 PFS proposed rule, we
to review the GPCIs at least every 3 payment for services furnished on or also published the proposed GPCIs for
2007 in Addendum D and the proposed cost counties from a locality will result to work with both groups to study our
GAFs for 2007 in Addendum E (71 FR in lower GPCIs for the remaining current methodology and develop
49246 through 49249). The GPCIs counties. Therefore, because of this alternative options.
shown in Addendum D represent the redistributive impact, we have We received the following comments
fully implemented value and reflect refrained, in the past, from making in response to our GPCI proposals.
2007 BN scaling coefficients provided changes to payment localities unless the
by our Office of the Actuary. State medical association provides Comment: During the comment
In the CY 2005 PFS proposed rule, we evidence that any proposed change has period, commenters advised us of two
discussed issues relating to changes to statewide support. errors in Table 3 (there were two entries
the GPCI payment localities (69 FR We requested suggestions on for Kansas and there was a mistake in
47504). In that proposed rule, we noted alternative ways that we could the equation for calculating the GAF).
that we look for the support of a State administratively reconfigure payment We were also advised of typographical
medical society as the impetus for localities that could be developed and errors in Addendum D.
changes to existing payment localities. proposed in future rulemaking. In Response: We appreciate that these
Because the GPCIs for each locality are addition, MEDPAC and the General were brought to our attention. Table 7
calculated using the average of the Accounting Office (GAO) have both contains the corrected information and
county-specific data from all of the expressed interest in studying the we have corrected Addendum D in this
counties in the locality, removing high physician payment localities. We intend final rule.
TABLE 7.—PAYMENT LOCALITIES WITH NEGATIVE PERCENT CHANGE IN GAF 1 BETWEEN 2006 AND 2007 DUE TO
REMOVAL OF THE 1.000 WORK FLOOR
2006 2007 Percent
Locality name GAF GAF change
Fort Worth, TX ......................................................................................................................................... 0.998 0.996 ¥0.17

Rest of Michigan ...................................................................................................................................... 0.986 0.984 ¥0.20
Rest of New York .................................................................................................................................... 0.952 0.950 ¥0.21
Rest of Maryland ..................................................................................................................................... 0.982 0.978 ¥0.36
Metropolitan St. Louis, MO ...................................................................................................................... 0.978 0.974 ¥0.41
Rest of Pennsylvania ............................................................................................................................... 0.950 0.946 ¥0.44
Ohio ......................................................................................................................................................... 0.970 0.966 ¥0.44
Austin, TX ................................................................................................................................................ 1.020 1.015 ¥0.47
New Hampshire ....................................................................................................................................... 1.010 1.005 ¥0.50
Minnesota ................................................................................................................................................ 0.980 0.975 ¥0.53
Galveston, TX .......................................................................................................................................... 0.991 0.986 ¥0.54
Metropolitan Kansas City, MO ................................................................................................................. 0.987 0.981 ¥0.56
Fort Lauderdale, FL ................................................................................................................................. 1.022 1.016 ¥0.59
Arizona ..................................................................................................................................................... 0.999 0.993 ¥0.65
Wisconsin ................................................................................................................................................. 0.956 0.950 ¥0.65
Colorado .................................................................................................................................................. 0.998 0.991 ¥0.67
East St. Louis, IL ..................................................................................................................................... 1.003 0.996 ¥0.68
New Orleans, LA ..................................................................................................................................... 0.984 0.977 ¥0.73
Rest of Washington ................................................................................................................................. 0.984 0.976 ¥0.77
Indiana ..................................................................................................................................................... 0.937 0.930 ¥0.79
Beaumont, TX .......................................................................................................................................... 0.951 0.942 ¥0.96
Alabama ................................................................................................................................................... 0.923 0.914 ¥0.99
Virginia ..................................................................................................................................................... 0.958 0.948 ¥1.06
Southern Maine ....................................................................................................................................... 0.992 0.981 ¥1.09
Rest of Georgia ....................................................................................................................................... 0.943 0.932 ¥1.14
Tennessee ............................................................................................................................................... 0.933 0.921 ¥1.27
Utah ......................................................................................................................................................... 0.960 0.948 ¥1.30
South Carolina ......................................................................................................................................... 0.930 0.917 ¥1.41
Rest of Illinois .......................................................................................................................................... 0.952 0.938 ¥1.43
Rest of Florida ......................................................................................................................................... 0.982 0.968 ¥1.45
West Virginia ............................................................................................................................................ 0.942 0.928 ¥1.47
North Carolina .......................................................................................................................................... 0.951 0.936 ¥1.55
New Mexico ............................................................................................................................................. 0.947 0.932 ¥1.57
Rest of Louisiana ..................................................................................................................................... 0.936 0.919 ¥1.78
Kentucky .................................................................................................................................................. 0.932 0.915 ¥1.80
Kansas* .................................................................................................................................................... 0.936 0.919 ¥1.81
Rest of Oregon ........................................................................................................................................ 0.946 0.929 ¥1.81
Vermont ................................................................................................................................................... 0.968 0.950 ¥1.82
Virgin Islands ........................................................................................................................................... 1.007 0.989 ¥1.83
Rest of Texas .......................................................................................................................................... 0.947 0.929 ¥1.87
Idaho ........................................................................................................................................................ 0.922 0.904 ¥1.91
Iowa ......................................................................................................................................................... 0.927 0.909 ¥1.97
Rest of Maine .......................................................................................................................................... 0.936 0.916 ¥2.14
Oklahoma ................................................................................................................................................. 0.913 0.893 ¥2.14

Mississippi ................................................................................................................................................ 0.919 0.898 ¥2.31
Arkansas .................................................................................................................................................. 0.905 0.884 ¥2.34
Puerto Rico .............................................................................................................................................. 0.905 0.883 ¥2.44
Nebraska .................................................................................................................................................. 0.925 0.902 ¥2.44
Wyoming .................................................................................................................................................. 0.934 0.910 ¥2.55
TABLE 7.—PAYMENT LOCALITIES WITH NEGATIVE PERCENT CHANGE IN GAF 1 BETWEEN 2006 AND 2007 DUE TO
REMOVAL OF THE 1.000 WORK FLOOR—Continued
2006 2007 Percent
Locality name GAF GAF change
Montana ................................................................................................................................................... 0.928 0.902 ¥2.83

Rest of Missouri* ..................................................................................................................................... 0.910 0.883 ¥2.97
North Dakota ............................................................................................................................................ 0.924 0.895 ¥3.16
South Dakota ........................................................................................................................................... 0.922 0.891 ¥3.35
1 Calculation for the GAF: (0.52466*work gpci) + (0.03865*mp gpci) + (0.43669*pe gpci)
Comment: We received several Response: The commenters are adding services to or deleting services
comments indicating that the GPCIs for suggesting a change in methodology for from the list of telehealth services on an
Puerto Rico are inadequate because they calculating the malpractice RVUs. We annual basis.
do not take into consideration the did not make any proposals relating to In the December 31, 2002 Federal
higher costs of living in Puerto Rico. this methodology; therefore, comments Register (67 FR 79988), we established
Commenters are concerned that relating to malpractice RVU policy are a process for adding services to or
physicians in Puerto Rico will relocate outside the scope of this rule. We deleting services from the list of
to areas with higher GPCIs. Their appreciate the commenters’ suggestions, Medicare telehealth services. This
comments focused on suggested and if we were to propose changes to process provides the public an ongoing
revisions to the data used in calculating malpractice RVU policy, we would opportunity to submit requests for
the GPCIs for Puerto Rico with the consider the commenters’ suggestions in adding services. We assign any request
intent of raising the GPCI for Puerto future rulemaking. to make additions to the list of Medicare
Rico. Comment: Commenters indicated that telehealth services to one of the
Response: We want to ensure that they were troubled about the data used following categories:
beneficiaries have access to high quality in developing the GPCIs. Specifically, • Category #1: Services that are
care in all parts of the United States; the proxy categories used in the wage similar to office and other outpatient
however, we do not use relative costs of determination and the real estate data visits, consultation, and office
living in the calculation of the GPCIs as used in the rent portion of the PE GPCI psychiatry services. In reviewing these
the commenters are requesting. Relative are of the greatest concern. They stated requests, we look for similarities
costs of living among payment localities that our data do not reflect true costs between the proposed and existing
are already accounted for within other and, therefore, put many practitioners in telehealth services for the roles of, and
measures of relative resource cost that rural areas at a disadvantage and create interactions among, the beneficiary, the
we use in calculating GPCIs, and we do inequities between payment localities. physician (or other practitioner) at the
not believe it would be appropriate to Response: We have previously
distant site and, if necessary, the
use different measures of resource cost addressed the issue of rental data in the
telepresenter. We also look for
for some localities than are used for CY 2005 PFS final rule (69 FR 66261).
similarities in the telecommunications
others. We stated that the Department of
system used to deliver the proposed
Comment: We received numerous Housing and Urban Development (HUD)
service, for example, the use of
comments reflecting concerns about the rental data may be the subject of
interactive audio and video equipment.
negative impact on physician payments concern, but we believe it remains the
resulting from removal of the MMA- best data source to fulfill our • Category #2: Services that are not
mandated floor of 1.0 on the physician requirements that the data be available similar to the current list of telehealth
work GPCI. Comments also stated that for all areas, be updated annually, and services. Our review of these requests
GPCIs should not be applied to retain consistency area-to-area and year- includes an assessment of whether the
physician work as a general policy. to-year. In that same rule, we discussed use of a telecommunications system to
Response: The 1.000 floor is being our belief that the wage proxies we use deliver the service produces similar
removed for services furnished after are the best tools available for the diagnostic findings or therapeutic
December 31, 2006, because the MMA development of the GPCIs. However, we interventions as compared with the
provision established the floor only for will consider the possibility of using face-to-face ‘‘hands on’’ delivery of the
services furnished on or after January 1, different wage proxies or wage data same service. Requestors should submit
2004, and before January 1, 2007. We do sources for some future update of the evidence showing that the use of a
not have the legal authority to extend GPCIs. telecommunications system does not
application of the floor beyond the affect the diagnosis or treatment plan as
statutory timeframe. In addition, C. Medicare Telehealth Services compared to a face-to-face delivery of
application of GPCIs to the work RVUs As discussed in the CY 2007 PFS the requested service.
is required by the statute. proposed rule (71 FR 48994), section Since establishing the process, we
Comment: We received numerous 1834(m)(4)(F) of the Act defines have added the following to the list of
comments requesting that we telehealth services as professional Medicare telehealth services:
administratively change the relative consultations, office visits, and office Psychiatric diagnostic interview
values for codes that have a TC and a psychiatry services (identified as of July examination; ESRD services with two to
PC. The focus of the comments was that 1, 2000 by CPT codes 99241 through three visits per month and four or more
for many codes the TC has a higher 99275, 99201 through 99215, 90804 visits per month (although we require at
malpractice relative value than the PC. through 90809, and 90862) and any least one visit a month by a physician,
A suggestion was made that we additional service specified by the CNS, NP, or PA to examine the vascular
administratively change the TC RVU to Secretary. In addition, the statute access site); and individual medical
equal the PC RVU. requires us to establish a process for nutritional therapy.
Requests to add services to the list of We received the following comments Response: We appreciate the
Medicare telehealth services must be on the Medicare telehealth services. comment on the use of SNFs as
submitted and received no later than Comment: Some commenters stated telehealth originating sites. As
December 31 of each CY to be that the process for adding services to discussed earlier in this section, the
considered for the next proposed rule. the list of Medicare telehealth services Report to Congress that could permit an
For example, requests submitted before does not require an originating site to be SNF to serve as an originating site is
the end of CY 2005 are considered for approved prior to the approval of a currently under review within HHS. We
the CY 2007 proposed rule. For more service for telehealth (and mentioned expect to address this issue in future
information on submitting a request for that we previously approved ESRD- rulemaking after the Report to Congress
an addition to the list of Medicare related visits furnished under the is issued.
telehealth services, visit our Web site at monthly capitation payment (MCP) for Comment: Two commenters requested
http://www.cms.hhs.gov/telehealth. telehealth without the approval of a clarification on whether the public
We received the following requests for dialysis center as an originating site). would need to resubmit a request to
additional approved services in CY The commenters believe that approving approve nursing facility care for
2005: Nursing facility care; speech nursing facility services for telehealth is telehealth if it is determined that SNFs
language pathology; audiology; and mutually exclusive from the Report to could be added as an originating site.
physical therapy services. Congress on permitting a SNF to be a Response: After the Report to
After reviewing the public requests, Medicare telehealth originating site and Congress is issued regarding SNFs as a
we explained that section that the findings of the report are not telehealth originating site, we will
1834(m)(4)(C)(ii) of the Act defines a necessary to approve services for address the requests to approve nursing
telehealth originating site as a telehealth. Moreover, the commenters facility care for telehealth and discuss
requested that we approve nursing our review through future rulemaking. It
physician’s or practitioner’s office; or a
facility care for telehealth (initial would not be necessary to resubmit a
hospital, critical access hospital (CAH),
nursing facility care, subsequent nursing request to approve nursing facility care
rural health clinic, or Federally
for telehealth.
qualified health center (FQHC). SNFs facility care, nursing facility discharge
Comment: Commenters stated that we
are not defined in the statute as services and other nursing facility
added medical nutritional therapy
originating sites. The authority to allow services) prior to the completion of the (MNT) to the list of telehealth services
SNFs to serve as telehealth originating Report to Congress on permitting a SNF in the CY 2006 PFS rule without
sites is dependent upon HHS submitting to be an originating site. nutrition professionals being authorized
the Report to Congress on permitting a Response: As previously discussed in to furnish telehealth services. The
SNF to be an originating site (as this section, the MMA specifically commenters note that physical
required by the section 418 of the MMA) requires an evaluation of SNFs as therapists, audiologists, and speech
and the Secretary concluding in the potential originating sites for the language pathologists currently cannot
Report that it is advisable to include a furnishing of telehealth services, and a furnish Medicare telehealth services and
SNF as a Medicare telehealth originating Report to Congress on such evaluation. requested an explanation as to why we
site and that mechanisms could be The law provides the authority to add cannot also consider approving
established to ensure that use of a SNFs as an originating site if the audiology, speech language pathology,
telecommunications system does not Secretary concludes in the report that it and physical therapy services for
serve as a substitute for the required in- is advisable to do so, and that telehealth.
person physician or practitioner visits to mechanisms could be established to Response: The statute permits a
SNF residents. ensure that the use of telehealth does physician, as defined by section 1861(r)
As discussed in the CY 2007 PFS not substitute for the required in-person of the Act or a practitioner as described
proposed rule, given that SNFs are not physician or practitioner visits to SNF in section 1842(b)(18)(C) of the Act (that
defined in the statute as a telehealth residents (which could have significant is, CNS, NP, PA, nurse midwife, clinical
originating site and HHS is currently implications for the type of services we psychologist, clinical social worker,
reviewing the Report to Congress, it would approve for telehealth). As such, registered dietitian or other nutrition
would not be appropriate to approve we believe that a decision to add (or not professional), to furnish Medicare
nursing facility care for telehealth at this add) nursing facility care to the list of telehealth services. Registered dietitians
time. Medicare telehealth services is related or nutrition professionals are included
In addition, we explained that the to the conclusions reached in the Report in the statutory definition of practitioner
statute permits only a physician, as to Congress on permitting a SNF to under section 1842(c)(18)(C)(vi), and
defined by section 1861(r) of the Act or serve as an originating site. Given that thus, are permitted under the statute to
a practitioner as described in section the conclusions of the Report to furnish telehealth services (and are the
1842(b)(18)(C) of the Act (CNS, NP, PA, Congress are not final, we do not believe only practitioners permitted by the
nurse midwife, clinical psychologist, that it would be appropriate to consider statute to furnish MNT). As such, when
clinical social worker, registered the request to add nursing facility care approving individual MNT for
dietitian or other nutrition professional), to the list of Medicare telehealth telehealth, registered dietitians and
to furnish Medicare telehealth services. services at this time. We intend to nutrition professionals as defined in
Since speech language pathologists, review and consider the § 410.134 were added to the list of
audiologists and physical therapists are recommendations of the Report to practitioners that may furnish and
not permitted under the statute to Congress once it is issued and would receive payment for a telehealth service
provide and receive payment for address the request to approve nursing in the CY 2006 PFS final rule with
Medicare telehealth services at the facility care for telehealth in future comment period (70 FR 70160).
distant site, we could not fully consider rulemaking. In contrast, speech language
the request to add speech therapy, Comment: One commenter expressed pathologists, audiologists and physical
audiology services and physical therapy support for expanding telehealth therapists are not permitted under the
to the list of Medicare telehealth services and for allowing SNFs to serve statute to provide and receive payment
services (71 FR 48994). as a telehealth originating site. for Medicare telehealth services at the
distant site. Therefore, we do not • CPT code 77782 = 2.04 payment each time the services are
believe it would be appropriate to • CPT code 77783 = 3.27 provided and allow payment to be based
consider adding audiology, speech • CPT code 77784 = 5.15 on the actual service(s) provided.
language pathology, and physical We proposed to delete the registered Because of the change in the global
therapy services for telehealth. nurse (RN) time in the postservice period a request will be made to the
Comment: Two commenters requested period, as well as the patient gowns for RUC for a revaluation of the work RVUs
that we provide clarification on when the postservice visit. We also noted that, and the PE inputs for these services. On
the telehealth Report to Congress, as to the extent that these services are an interim basis the work RVUs and the
required by section 223(d) of the BIPA, performed as staged procedures, PE inputs will be revised as delineated
would be completed and submitted to providers may make use of applicable in the proposed rule. In addition, the
Congress. Another commenter urged us modifiers. RN time in the postservice period, as
to expedite the completion of the We received the following comments well as the patient gowns for the
telehealth report (as required by the on these coding issues. postservice visit will be deleted from
BIPA). Comment: Many commenters the PE database as proposed.
Response: The Report to Congress on concurred with our proposal. However, Separate payment will be made for
additional sites and settings, some commenters wanted either a medically necessary post-therapy visits
practitioners, and geographic areas that reconsideration of the proposed work based on the documented level of E/M
may be appropriate for Medicare RVU reduction, or if needed, a service for the post procedure
telehealth payment, as required by reduction in the CF. One commenter encounter(s).
section 223(d) of the BIPA, is under agreed with the global period revision We also note that appropriate
development. We will work to expedite but recommended establishment of a modifiers are to be used when these
the completion of this report. threshold for brachytherapy codes at a services are performed as staged
maximum of 10 percent per year. procedures.
D. Miscellaneous Coding Issues Another commenter concurred with the
The following sections address change in the global period; however, 2. Assignment of RVUs for Proton Beam
the commenter recommended no change Treatment Delivery Services
specific coding issues related to
payment for services under the PFS. in the work RVUs or a reduction to the As discussed in the CY 2006 PFS
1992 levels, and prior to any work RVU proposed rule, we have received a
1. Global Period for Remote request to assign PE inputs for the non-
changes it was recommended that such
Afterloading High Intensity facility setting to Proton Beam treatment
changes be reviewed by the RUC. In
Brachytherapy Procedures delivery services represented by CPT
addition, the RUC, in its comments,
CPT code 77783, Remote afterloading agreed to include a review of the codes 77520 through 77525. These
high intensity brachytherapy; 9–12 brachytherapy codes on its April 2007 services are currently carrier-priced;
source positions or catheters, resides in meeting agenda and several commenters therefore, payment in the facility or
a family of codes with varying numbers expressed an interest in working with non-facility setting is established by
of source positions. All of the codes in the RUC on the work RVUs and PE each carrier. To the extent that
the family, CPT codes 77781 through inputs. physicians and suppliers wish to have
77784, are currently designated as 90- Response: We believe that the national RVUs assigned for these
day global services. CPT codes 77781 commenters misunderstood the intent of services, we encourage them to use the
through 77784 are used to treat many the proposed work RVU reductions. established process at the AMA–RUC.
clinical conditions, but primarily They are designed to allow the billing Comment: We received several
patients with prostate cancer, breast of the brachytherapy physician service comments in response to this
cancer and sarcoma. Patients with any codes on a more frequent basis than is discussion. Two commenters stated that
of these conditions usually receive currently permitted, and are reflective of due to the relatively limited availability
several treatments (2 through 10) over a the present course of treatment of these services in freestanding
2 to 10-day period of time. Due to the regimens. The current codes have a 90- environments given the small number of
increasing variability in treatment day global period and are to be billed proton therapy centers at this point in
regimens, it is difficult to assign RVUs only once for the entirety of physician time, these services should remain
for a ‘‘typical’’ patient based on a global services provided during the specified carrier priced. However, one commenter
period of 90 days. time period. indicated that allowances established by
Therefore, we proposed that this Comment: Some commenters carriers do not appear to account for
family of codes (CPT codes 77781, expressed concern that the PE inputs for capital and operating costs. This
77782, 77783 and 77784) be assigned a the brachytherapy codes should not be commenter referenced payment
global period of ‘‘XXX’’, which will reduced to reflect the removal of a post- amounts proposed for hospital OPDs
permit separate payment each time the operative visit because there is no visit. under the Outpatient Prospective
services are provided and allow Response: A post-operative visit is Payment System (OPPS), and urged us
payment to be based on the actual included within the current PE inputs to provide guidance to carriers in
service(s) provided. We will request that for the current 90-day global period establishing appropriate payment for
the RUC revalue the work RVUs and the brachytherapy codes. The change to a these services under the PFS.
PE inputs for these services if a change global period of ‘‘XXX’’ necessitates the Other commenters suggested that
in the global period is finalized. removal of this visit from the PE inputs RVUs should be established for these
However we proposed, on an interim because the codes could be billed services. Many of these commenters
basis, to revise the work RVUs and PE several times during a course of expressed agreement with the payment
inputs to reflect the removal of the treatment, and each occurrence would rate for these services under OPPS.
postoperative visit, CPT code 99212 that not include a post-operative visit. These commenters were concerned that
is currently assigned to these services. The brachytherapy family of codes since each State has its own CMS-
The interim work RVUs for these (CPT codes 77781, 77782, 77783 and contracted carrier, variations exist in
services are as follows: 77784) will be assigned a global period proton therapy coverage and
• CPT code 77781 = 1.21 of ‘‘XXX’’, which will permit separate reimbursement under the PFS. These
commenters requested that we provide TC of selected diagnostic imaging policy as it applies to common
payment rates for carriers to use when procedures belonging to one of eleven combinations of imaging services, we
these services are furnished in imaging families when the procedures believe it would be prudent to maintain
freestanding centers so that payments are performed on contiguous body areas the multiple imaging payment reduction
are consistent with payment rates under by 50 percent for CY 2006. However, in at its current 25 percent level while we
OPPS. the final rule with comment period, we continue to examine the appropriate
We also received comments from the stated that we would phase-in the 50 payment levels. Therefore, we proposed
AMA–RUC and ASTRO regarding this percent reduction over 2 years to continue the multiple imaging
discussion. The RUC reiterated the beginning with a 25 percent reduction payment reduction for CY 2007 at the 25
process that is used to develop RVUs in 2006. We also sought additional data percent level. We would proceed
and ASTRO indicated it would be and comments on the appropriateness of through future rulemaking in the event
willing to participate in the 50 percent as the final level of we determine that revisions to the
development of RVUs for these services. reduction. The reduction applies to the policy are warranted.
Response: As discussed in the CY TC and the technical portion of the
b. Reduction in TC for Imaging Services
2006 PFS proposed rule, at the present global service, but does not apply to the
Under the PFS to OPD Payment Amount
time payment for these services is PC of the service. Currently, we make
established at the carrier level. The full payment for the highest priced Section 5102(b)(1) of the DRA
carriers have discretion to establish procedure and reduce payment for each amended section 1848 of the Act and
payment using available information additional procedure by 25 percent, requires that, for imaging services, if—
about these services. Should providers when more than one procedure from the ‘‘(i) The technical component
wish to have RVUs established for these same imaging family is performed (including the technical component
services, we would request that they use during the same session on the same portion of a global fee) of the service
the AMA–RUC process that has been day. established for a year under the fee
established for recommending RVUs As described in the CY 2006 PFS final schedule * * * without application of
and direct PE inputs used to compute rule with comment period, at the time, the geographic adjustment factor * * *,
national RVUs for PFS services to CMS. the statute required us to make changes exceeds
such as this in a budget neutral manner, (ii) The Medicare OPD fee schedule
E. Deficit Reduction Act (DRA) meaning that the estimated savings amount established under the
The Deficit Reduction Act of 2005 generated by the application of the prospective payment system for hospital
(DRA) (Pub. L. 109–171), was enacted multiple imaging procedure payment outpatient department services * * *
February 8, 2006 and included reduction were used to increase for such service for such year,
provisions that affect the Medicare payment for other physician fee determined without regard to
program. The following section schedule services. We increased the CY geographic adjustment * * *, the
addresses the specific DRA provisions 2006 PE RVUs by 0.3 percent to offset Secretary shall substitute the amount
that were addressed in the CY 2007 PFS the estimated savings generated by the described in clause (ii), adjusted by the
proposed rule (71 FR 48996). multiple imaging payment reduction geographic adjustment factor [under the
policy. PFS] * * *, for the fee schedule amount
1. Section 5102—Adjustments for Subsequent to the publication of the for such technical component for such
Payments to Imaging Services CY 2006 PFS final rule with comment year.’’
Section 5102 of the DRA includes two period, section 5102(a) of the DRA As required by the statute, for imaging
provisions that affect payments of (Multiple Procedure Payment Reduction services (described below in this
imaging services under the Medicare for Imaging Exempted From Budget section) furnished on or after January 1,
PFS. The first provision addresses Neutrality), required that ‘‘effective for 2007, we will cap the TC of the PFS
payment for certain multiple imaging fee schedules established beginning payment amount for the year (prior to
procedures for CY 2007 and application with 2007, reduced expenditures geographic adjustment) by the CY 2007
of BN while the second provision attributable to the multiple procedure OPPS payment amount (prior to
addresses limiting the payment amount payment reduction for imaging under geographic adjustment). We will then
under PFS to the OPD payment amount the CY 2006 PFS final rule with apply the PFS geographic adjustment to
for the TC of certain imaging services. comment period (42 CFR 405, et al.) the capped payment amount.
insofar as it relates to the PFSs for 2006 Section 5102(b)(2) of the DRA
a. Payment for Multiple Imaging and 2007’’ are exempted from the BN exempts the estimated savings from this
Procedures for 2007 provision. As a result, we proposed to provision from the PFS BN requirement.
In general, Medicare prices diagnostic remove the 0.3 percent increase to the Section 5102(b)(1) of the DRA defines
imaging procedures in the following CY 2006 PE RVUs from the CY 2007 PE imaging services as ‘‘* * * imaging and
three ways: RVUs in accordance with the statute. computer-assisted imaging services,
• The PC represents the physician’s In addition, in response to our request including X-ray, ultrasound (including
interpretation (PC-only services are for data on the appropriateness of the 50 echocardiography), nuclear medicine
billed with the 26 modifier). percent reduction in the CY 2006 PFS (including positron emission
• The TC represents PE and includes final rule with comment period (70 FR tomography), MRI, CT, and fluoroscopy,
clinical staff, supplies, and equipment 70261), the ACR provided information but excluding diagnostic and screening
(TC-only services are billed with the TC for 25 code combinations supporting a mammography.’’
modifier). reduction of between 21 and 44 percent. To apply section 5102(b) of the DRA,
• The global service represents both Given the expected interaction between we needed to determine the CPT and
PC and TC. the multiple procedure imaging policy alpha-numeric HCPCS codes that fall
As discussed in the CY 2006 PFS final and the further imaging payment within the scope of ‘‘imaging services’’
rule with comment period (70 FR reductions mandated by section 5102(b) defined by the DRA provision. In
70261), in the CY 2006 PFS proposed of the DRA, along with the new general, we believe that imaging
rule (70 FR 45764 through 46064), we information we have received from the services provide visual information
had proposed to reduce payment for the ACR on the multiple imaging procedure regarding areas of the body that are not
normally visible, thereby assisting in the as a TC cap. We excluded any service services are within the statutory
diagnosis or treatment of illness or where the CPT code describes a definition of imaging services and are
injury. We began by considering the procedure for which fluoroscopy, also within the statutory definition of
CPT 7XXXX series codes for radiology ultrasound, or another imaging modality PFS services (that is, carrier-priced TCs
services and then adding in other CPT is either included in the code whether of PET scans).
codes and alpha-numeric HCPCS codes or not it is used or is employed A list of proposed codes that identify
that describe imaging services. We then peripherally in the performance of the imaging services defined by the DRA
excluded nuclear medicine services that main procedure, for example, CPT code OPPS cap provision was found in
were either non-imaging diagnostic or 31622 for bronchoscopy with or without
Addendum F of the proposed rule.
treatment services. We also excluded all fluoroscopic guidance and CPT code
codes for unlisted procedures, since we 43242 for upper gastrointestinal To the extent changes are made to
would not know in advance of any endoscopy with transendoscopic codes for services already on the list, we
specific clinical scenario whether or not ultrasound-guided intramural or proposed to update the list through
the unlisted procedure was an imaging transmural fine needle aspiration/ program instructions to our contractors.
service. We excluded all mammography biopsy(s). In these cases, we are unable To the extent that the same imaging
services, consistent with the statute. We to clearly distinguish imaging from non- service is coded differently under the
excluded radiation oncology services imaging services because, for example, a PFS and the OPPS, we proposed to
that were not imaging or computer- specific procedure may or may not crosswalk the code under the PFS to the
assisted imaging services. We also utilize an imaging modality, or the use appropriate code under the OPPS that
excluded all HCPCS codes for imaging of an imaging technology cannot be could be reported for the same service
services that are not separately paid segregated from the performance of the provided in the hospital outpatient
under the OPPS since there would be no main procedure. Note that we included setting. These crosswalks are listed in
corresponding OPPS payment to serve carrier priced services since these Table 8.
TABLE 8.—CROSSWALKS
MFS Code Descriptor OPPS Code Desc
74185 .......... Mri angio, abdom w or w/o dye ...................................... C8900 .......... MRA w/cont, abd.
76093 * ........ Magnetic image, breast .................................................. C8905 .......... MRI w/o fol w/cont, brst, un.
76094 * ........ Magnetic image, both breasts ........................................ C8908 ......... MRI w/o fol w/cont, breast.
71555 .......... Mri angio chest w or w/o dye ......................................... C8909 .......... MRA w/cont, chest.
73725 .......... Mr ang lwr ext w or w/o dye ........................................... C8912 .......... MRA w/cont, lwr ext.
72198 .......... Mr angio pelvis w/o & w/dye .......................................... C8918 .......... MRA w/cont, pelvis.
* Note: These codes have been renumbered for CY 2007. New code number is reflected in Addendum F.
c. Interaction of the Multiple Imaging imaging reduction and the OPPS cap, apply the OPPS cap to the reduced
Payment Reduction and the OPPS Cap we proposed to first apply the multiple amount as illustrated in Table 9.
For CY 2007 imaging services imaging payment reduction and then
potentially subject to both the multiple
TABLE 9
25% Multiple
Pre-OPPS cap OPPS cap Final MPFS
HCPCS imaging
MPFS rate rate payment
reduction
7XXX1 .............................................................................................................. $341.89 $256.42 $316.55 $256.42

7XXX2 .............................................................................................................. 552.86 414.65 391.83 391.83
We considered first applying the that OPPS rate was never intended to OPPS. Another commenter noted that
OPPS cap and then applying the reflect the cost of providing individual we need to recognize that the delivery
multiple procedure reduction. However, physicians’ services. They indicated of care has shifted from the hospital to
as indicated in the CY 2006 OPPS final that it is methodologically unjustifiable, physicians’ offices; that there is an
rule, we received public comments and that it undermines the resource- increased complexity of care; and the
suggesting that the OPPS payment rates based system. need to practice defensive medicine due
may implicitly include at least some One commenter noted that physician to the threat of malpractice lawsuits.
multiple imaging discount. While we costs are determined on a per procedure One commenter noted that hospital and
continue to examine this issue, we IDTF payments should not be the same.
basis, whereas hospital costs are not
believe the most appropriate policy is to determined on a per procedure basis Various commenters indicated that
apply the multiple imaging payment because expensive capital equipment is the cap will have a devastating impact
reduction prior to the application of the allocated over other procedures within and threatens the future viability of
OPPS cap. a revenue center. Given this outpatient imaging. Commenters

methodological difference, the predicted that the consequences will
i. OPPS Cap include:
commenter indicated that it is not
Comment: Many commenters surprising that the cost of a procedure • Reduced patient access to
criticized the OPPS cap, maintaining under the PFS is greater than under diagnostic technologies capable of
preventing the onset of more serious purpose of the DRA provision: ‘‘Medical Because these codes meet the statutory
conditions, requiring more complex and imaging uses noninvasive techniques to definition of procedures subject to the
expensive treatment later. view all parts of the body and thereby OPPS cap, we will retain these codes on
• Shifting of procedures back to diagnose an array of medical conditions. the list of procedures subject to the cap,
hospitals. These techniques include the use of but payments for the procedures will
• Increased volume to offset the ionizing radiation (X-rays and CT not be affected by the cap.
affects of the payment cuts. scans), MRI, ultrasound and scans Comment: One commenter noted that
• Conversion of IDTFs ownership and obtained after the injection of radio the Ambulatory Payment Classification
legal structure to allow billing under nucleotides (such as bone scans and (APC) groups are intended to set an
OPPS, negating any savings from the PET).’’ average payment, where some lower
cap. Response: The DRA defines imaging cost procedures are paid at a higher
A few commenters requested a delay service subject to the OPPS cap as average rate, and some higher cost
in implementing the cap and requested ‘‘imaging and computer-assisted procedures are paid at a lower average
that we consider co-sponsoring imaging services, including x-ray, rate. In crosswalking from the PFS to the
H.R.5704 that calls for a 2-year ultrasound (including OPPS payment, the commenter noted
moratorium on imaging cuts. echocardiography), nuclear medicine, that it would be more equitable to
Response: We acknowledge the (including positron emission crosswalk to the median cost by CPT
commenters concerns and appreciate tomography [PET], magnetic resonance code, rather than using the median cost
their comments. However, we are imaging [MRI], computed tomography per the APC grouping payment.
obligated to implement the statutory [CT], and fluoroscopy, but excluding One commenter requested exclusion
provision. We will continue to work diagnostic and screening of codes bundled under OPPS having no
with the Congress and specialty mammography.’’ The DRA does not additional APC payment, but having a
societies to ensure equitable payments distinguish between diagnostic and TC amount under PFS. The commenter
and proper access to care. therapeutic imaging. We have no noted that the list of bundled services
Comment: Several commenters authority to modify the statutory under the APC payments will vary from
requested that the following procedure definition of imaging services. year-to-year and it is inappropriate to
codes be excluded from the OPPS cap: Therefore, we cannot exclude certain not make a payment under PFS as there
• Non-invasive vascular diagnostic non-invasive diagnostic study is no packaging of the service into
study codes (CPT codes 93875–93990 procedures, imaging guidance another procedure. Another commenter
and G0365) because they either contain procedures, nuclear medicine noted that drugs and
no imaging or are predominately non- procedures, and radiation oncology radiopharmaceuticals are bundled into
imaging in nature. Particularly noted imaging procedures. However, in our some OPPS procedures. They indicated
were transcranial Doppler procedures review of the codes in response to that these should be unbundled to
and duplex scans. comments, we determined that there are achieve more parity in the payment
• Imaging guidance procedures that certain non-invasive vascular diagnostic systems.
are integral to the performance of study codes that do not involve the Response: The DRA is specific in its
interventional treatment or diagnostic generation of an image, (that is, codes requirements to compare the TC of a
procedures. CPT codes cited were: 93875, 93922, 93923, 93924 and 93965.) service for a year to the Medicare OPD
75894, 75896, 75901–75945, 75952, Therefore, we are removing these codes fee schedule amount. Therefore, we will
75954, 75962, 75966, 75970, 75989– from the list of codes subject to the crosswalk the TC to the corresponding
75996, 76940–76948 and 76965. OPPS cap. OPD fee schedule service and use that
• Nuclear medicine codes 78020, Additionally, we note that imaging rate as a cap. For the same reason, we
78135, 78140, 78190, and 78282, based guidance procedures that are separately must use the OPD payment amount
on the fact that other nuclear medicine billed, are appropriately included on the even if there are drugs or
codes, such as radioisotope lab codes list of codes subject to the cap. radiopharmaceuticals bundled into a
were excluded. However, codes 75952, 75954, and particular OPD payment amount.
• Codes performed in conjunction 75993–75996 were inadvertently In regard to the concern that bundled
with radiation therapy (CPT codes included on the list. These codes do not services vary year to year, we intend to
76370, 76950, 76965, 77417, and 77421) have a TC and we are removing them review the relevant OPD and PFS codes
because they are never performed for from the list. to determine the appropriate crosswalk
diagnostic purposes. The commenters Regarding carrier-priced services, all for a given year. We recognize that there
were pleased that we excluded radiation physicians’ services (as defined by the will be changes and we believe our
oncology codes. statute under section 1848(j)(3) of the process will help to ensure that TC
• Positron Emission Tomography Act) are paid under the PFS, regardless codes are being crosswalked to the most
(PET), PET/ CT, and CT/Computed of how they are priced. Carrier-priced appropriate OPD codes.
Tomographic Angiography (CTA) and services are services for which an
Category III codes used to report alternative methodology is used to ii. Multiple Procedure Payment
emerging technologies because they are arrive at TC payment under the PFS, Reduction
carrier-priced codes and, therefore, not and, therefore, they are subject to the Comment: Many commenters
paid under the PFS. DRA provision. The same is true of expressed appreciation for our decision
• Codes for imaging service that are Category III codes to the extent that they to apply the multiple procedure
not separately paid under OPPS since are carrier-priced (and to the extent they payment reduction prior to application
there is no corresponding OPPS are not carrier-priced, there is no basis of the OPPS cap, and for maintaining
payment to serve as a TC cap. Codes to exempt these codes from application the reduction at 25 percent. However,
cited were cardiac catheterization codes of the cap). the commenters also indicated that the
93555 and 93556 and code 0152T. Regarding codes that are not multiple procedure payment reduction
Additionally, several commenters separately paid under the OPPS, we is duplicative, inappropriate and
proposed the following definition of agree that there is no corresponding excessive in light of the OPPS cap, and
medical imaging procedures for the OPPS payment to serve as a TC cap. requested its elimination. Other
commenters requested continued 2. Section 5107—Revisions to Payments exceptions process will not apply to
evaluation, indicating a 25 percent for Therapy Services therapy services after December 31,
reduction is greater than what is Section 1833(g) of the Act applies an 2006, but the therapy caps will remain
justified by any efficiencies achieved in, annual per beneficiary combined cap inapplicable to therapy services
performing multiple procedures. One beginning January 1, 1999 on outpatient provided in the outpatient hospital
commenter noted we had previously physical therapy and speech-language setting as provided under section
stated that our multiple procedure pathology services and a similar 1833(g) of the Act.
analysis does not disprove earlier Comment: We received six comments
separate cap on outpatient occupational
assertions by physician and industry about therapy caps. All indicated that
therapy services. These caps apply to
representatives that some portion of the cap exception process was working
expenses incurred for the respective
multiple procedure efficiencies may be well to assure provision of needed
therapy services under Medicare Part B, therapy services. Some commenters
already reflected in OPPS payment with the exception of outpatient
rates. Conversely, MedPAC indicated acknowledged that we do not have the
hospital services. The caps were in authority to extend therapy cap
that it is unclear why the DRA OPPS effect from January 1, 1999 through
cap justifies maintaining the 25 percent exceptions, but they requested that we
December 31, 1999, from September 1, be aggressive in urging the Congress to
reduction since the DRA policy applies 2003 through December 7, 2003, and
only to those services where the TC intervene to extend the exceptions or
beginning January 1, 2006. In 2000 remove the caps.
exceeds the OPPS rate. In addition, through 2002, and from December 8, Several commenters urged us to place
MedPAC requested more information on 2003 through December 31, 2005, the a high priority in resources and funding
the ACR data cited in the CY 2007 PFS Congress placed moratoria on on continuing to conduct research that
proposed rule (71 FR 48996). implementation of the caps. Section could be used to identify alternatives to
Response: When we proposed the 1833(g)(2) of the Act provides that, for the cap that would ensure that patients
multiple procedure payment reduction 1999 through 2001, the caps were receive medically necessary therapy
last year, as recommended by MedPAC, $1500, and for years after 2001, the caps services. Some commenters cited the
our data supported a 50 percent are equal to the preceding year’s cap Medicare Payment Advisory
payment reduction. However, we agreed increased by the percentage increase in Commission (MedPAC)
to phase-in the reduction over two years the Medicare Economic Index (MEI) recommendations of June 2006
to allow for a transition of the changes (except that if an increase for a year is regarding continued research into
in payment for these services not a multiple of $10, it is rounded to measuring patient condition and
attributable to the reduction policy and the nearest multiple of $10). treatment outcomes as a basis for
to provide further opportunity for As discussed in the CY 2006 PFS reforming the payment system.
public comment. Subsequently, the proposed rule, we implemented the Commenters also mentioned the
Congress passed the DRA provision separate statutory limits of $1740 for Government Accountability Office
capping imaging procedures at the outpatient physical therapy and speech- publication issued in November 2005
OPPS payment rate. In view of the DRA language pathology services and $1740 (GAO–06–59) recommending that DHHS
provision, and additional data received for occupational therapy on January 1, ‘‘expedite development of a process for
from ACR, we determined that it is more 2006. The DRA was enacted on ensuring that these services were
appropriate to retain the multiple February 8, 2006. Section 5107(a) of the considered in its efforts to standardize
procedure payment reduction at 25 DRA required the Secretary to develop existing patient assessment
percent, rather than to increase it to 50 an exceptions process for the therapy instruments.’’ Specifically, the one
percent as previously proposed. We caps effective January 1, 2006. The commenter, while recognizing
share the concerns of the providers of exceptions process applies only to important priorities in allocating limited
imaging services that excessive expenses incurred in 2006. Details of funds, strongly urged us to conduct
reductions could be harmful to both the exceptions process were published research and pilot studies leading to
physicians and patients. Therefore, we in a manual change on February 13, alternatives to therapy caps that ensure
believe it is more appropriate to 2006 (CR 4364). The change request the needs of patients are met through
maintain the 25 percent reduction level consists of three transmittals with high quality care. Another commenter
while we continue to examine this current numbers of— agreed and also noted strong support for
• Transmittal 855, CR 4364, Pub. L. development of a condition-based
issue.
100–04; payment as a viable alternative to caps.
The list of codes that identify imaging • Transmittal 47, CR 4365, Pub. L. We received no negative comments
services defined by the DRA OPPS cap 100–02; and concerning the exception process or our
provision can be found in Addendum F • Transmittal 140, CR 4364, Pub. L. efforts to develop alternative payment
to this final rule with comment period. 100–08. systems based on the patient’s need for
Note that the list in the proposed rule The transmittals are available on the services.
was affected by the renumbering of CPT CMS Web site at http:// Response: As commenters noted, we
codes that is effective January 1, 2007. www.cms.hhs.gov/Transmittals/. do not have the authority to extend the
Addendum F in this final rule with In accordance with the statute, the exceptions process beyond the
comment period reflects the therapy caps will remain in effect, but December 31, 2006, statutory expiration
renumbering of CPT codes that is without the exceptions process, for date. We will continue, to the extent
effective January 1, 2007, and also expenses incurred beginning on January that resources allow, pursuing a
reflects the removal of certain codes in 1, 2007. The dollar amount of each payment policy that encourages
response to comments, as discussed therapy cap in CY 2007 will be $1780 provision of high quality, covered
previously in this section. Payment for (which is the CY 2006 rate ($1740) services to all beneficiaries who need
an individual service on this list will increased by the percentage increase in them.
only be capped if the PFS TC payment the MEI), rounded to the nearest Section 5107(b) of the DRA requires
amount exceeds the OPPS payment multiple of $10. As noted previously in the Secretary to implement edits for
amount. this section, under the statute, the clinically illogical combinations of
procedure codes and other edits to limit As provided in the DRA, this new the term ‘‘eligible beneficiary’’ for
inappropriate payment for therapy coverage allows payment for a one-time coverage of ultrasound screening
services by July 1, 2006. As explained only screening examination. We examinations for AAA to mean an
in the CY 2006 PFS proposed rule, in proposed new § 410.19(b) to provide for individual who—
January 2006, we implemented Correct the coverage of the screening • Has received a referral for an
Coding Initiative (CCI) edits for the examinations for AAAs as specified in ultrasound screening as a result of an
therapy providers that bill the fiscal section 5112 of the DRA. We also IPPE (as defined in section 1861(ww)(1)
intermediaries, thus, addressing the proposed to add new § 410.19(c) of the Act);
section 5107 of the DRA requirement for (Limitation on coverage of ultrasound • Has not been previously furnished
edits for clinically illogical screening for abdominal aortic such a covered ultrasound screening
combinations of procedure codes. aneurysms.) to provide the limitation on examination under the Medicare
Adoption of these code edits ensures coverage for an individual who is not an program; and
that these providers of outpatient Part B eligible beneficiary as defined in new • Is included in at least one of the
therapy services, including SNFs, § 410.19(a). following risk categories:
comprehensive outpatient rehabilitation We proposed the definitions set forth + Has a family history of an AAA.
in new § 410.19(a) to implement the + Is a man age 65 to 75 years who
facilities, certain outpatient physical
statutory provisions and to help the smoked at least 100 cigarettes in his
therapy and speech-language therapy
reader in understanding the provisions lifetime.
providers (rehabilitation agencies) and + Is an individual who manifests
home health agencies (HHAs) (where of this regulation. The definitions
other risk factors that are described in
beneficiary is not under a Part A plan include the following terms:
a benefit category recommended by the
of care) meet the same CCI edit • Eligible beneficiary.
• Ultrasound screening for abdominal USPSTF regarding an AAA that has
requirements as those that have been in been determined by the Secretary
place for physicians, private practice aortic aneurysms.
Specifically, section 5112(a)(1) of the through the NCD process.
therapists, and OPPS hospitals. We also To facilitate our consideration of
noted that we are considering the DRA amended section 1861 of the Act
to provide that coverage of ultrasound possible expansions of coverage in the
implementation of other edits in the future for identifying other risk factors
future to further address concerns about screening for AAAs will be available for
an individual: (1) Who receives a in a benefit category recommended for
inappropriate payment for therapy screening for the early detection of
services. referral for such as ultrasound screening
as a result of an initial preventive AAAs by the USPSTF, and alternative
Comment: MedPAC indicated that the physical examination (IPPE) (as defined screening technologies to ultrasound
CCI code-pair edits we have in section 1861(ww)(1) of the Act); (2) screening for AAAs of commensurate
implemented are a good start in who has not been previously furnished accuracy and cost, we proposed to add
controlling inappropriate billing, but such as ultrasound screening under this language to our regulations that would
encouraged further work and title; and (3) who has a family history allow us to make determinations
consultation with experts to develop of AAA or manifests risk factors through the NCD process. The NCD
other clinically appropriate edits for included in a beneficiary category process would allow the Secretary to
therapy services. recommended for screening by the expand coverage more quickly following
Response: We appreciate the United States Preventive Services Task an assessment of those subjects than is
MedPAC’s remarks and will consider its Force (USPSTF) regarding AAAs. possible under the standard rulemaking
suggestions in the implementation of Section 5112(a)(2) of the DRA also process. We intend to use the NCD
future edits. adds a definition of the term process, which includes an opportunity
‘‘ultrasound screening for an Abdominal for public comments, for evaluating the
3. Section 5112—Addition of medical and scientific issues relating to
Ultrasound Screening for Abdominal Aortic Aneurysm’’ to mean, ‘‘(1) a
procedure using sound waves (or other the coverage of alternative screening
Aortic Aneurysm (AAA) technologies and the identification of
procedures using alternative
a. Coverage technologies, of commensurate accuracy other risk factors for AAAs
and cost, that the Secretary may specify) recommended by the USPSTF that may
Section 5112 of the DRA amended be brought to our attention in the future.
section 1861 of the Act to provide for provided for the early detection of
abdominal aortic aneurysm; and (2) Use of an NCD to establish a change in
coverage under Part B of ultrasound the scope of benefits is authorized by
screening for AAAs, effective for includes a physician’s interpretation of
the results of the procedure.’’ section 1871(a)(2) of the Act. An
services furnished on or after January 1, aggrieved party can challenge an NCD
Based on this provision, we reviewed
2007, subject to certain eligibility and under the procedures established by
the 2005 USPSTF recommendations and
other limitations. This screening test section 1869(f) of the Act. We proposed
related material on ultrasound screening
will be available even if the qualifying to add these coverage provisions in new
for AAAs which includes—
patient does not present signs or
• A recommendation for a one-time § 410.19 (a)(1)(i) and
symptoms of disease or illness. § 410.19(a)(2)(iii)(C).
ultrasound screening for men aged 65 to
To conform the regulations to the 75 who have smoked at least 100 Section 5112(b) of DRA also amended
statutory requirements of section 5112 cigarettes in their lifetime; section 1861(ww)(2) of the Act (the IPPE
of the DRA, we proposed to include an • No recommendation for, or against, benefit) by adding the new ultrasound
exception in § 411.15(a)(1) to permit ultrasound screening for AAAs for men screening benefit to the list of
coverage for ultrasound screening for who have not smoked at least 100 preventive services for which
AAAs that meet the conditions for cigarettes in their lifetime; and physicians and other qualified
coverage that we proposed to specify • A recommendation against routine nonphysician practitioners (NPPs) must
under new § 410.19(b) (Conditions for screening for AAAs in women. provide ‘‘education, counseling and
coverage of an ultrasound screening for Based on the statutory language and referral’’ to new beneficiaries who take
abdominal aortic aneurysms). We also the USPSTF recommendations outlined advantage of the IPPE benefit within the
proposed to add a new § 411.15(k)(12). in this section, we proposed to define first 6 months after the effective date of
their first Part B coverage period. screenings for AAAs because of the IPPE utilization of the new AAA screening
Therefore, we also proposed to amend referral requirement for the exam. benefit over the next couple of years to
§ 410.16(a)(7) of the regulations so that Response: The commenters are correct determine if beneficiary access to this
it reflects the additional responsibilities that the IPPE referral requirement for service is a concern that requires our
that physicians and qualified NPPs will coverage of the ultrasound screening for efforts to ensure appropriate beneficiary
have under the IPPE benefit for the new AAAs will preclude many older awareness and utilization of the benefit.
ultrasound screening benefit. beneficiaries from qualifying for Response: We agree that we should
We received 14 comments that coverage of the exam, but that monitor use of this benefit to ensure that
generally supported the proposal to requirement is specified in section 5112 there is appropriate beneficiary
implement section 5112 of the DRA that of the DRA. It would require a change awareness and use of the service.
provides for Medicare coverage of in the statute to permit us to expand the Comment: A commenter urged us to
ultrasound screening for AAAs. Several scope of the benefit to older implement a targeted campaign to
commenters had suggestions for revising beneficiaries who do not satisfy this educate beneficiaries and physicians
certain specific coverage provisions of requirement. about the new screening benefit and to
the proposal. Comment: Several commenters encourage their use of it.
Comment: Several commenters suggested that we should implement Response: We will release the
addressed the issue of the need for safeguards against providers billing for appropriate manual and transmittal
certification of qualification duplicative testing for the AAA
instructions and other information,
requirements for the Medicare providers screening and an abdominal or
including a ‘‘Medicare Learning
or suppliers who furnish beneficiaries retroperitoneal ultrasound exam (with a
Network (MLN) Matters’’ provider
with the new ultrasound screening for diagnosis such as abdominal pain) later
education article, an updated new
the same or the next day.
AAAs. A commenter referenced the ‘‘Medicare Preventive Services Guide,’’
Response: We agree that the potential
USPSTF recommendations that state, and other information. We would
for duplicative billing for the screening
‘‘There is good evidence that abdominal and the diagnostic ultrasound test of the encourage the medical community to
ultrasonography, performed in a setting same type does exist. Therefore, we will contribute to this effort by distributing
with adequate quality assurance (that is, work with our contractors to implement their own communications, bulletins, or
in an accredited facility with the necessary safeguards to insure that other publications to physicians,
credentialed technologists), is an this type of billing does not occur. qualified NPPs, and beneficiaries.
accurate screening test for AAA.’’ The Comment: Several commenters are Except for the additional language
commenter noted that the proposed rule concerned that the proposed rule does added at § 410.19(b) relating to the
did not mention the qualifications of the not provide any guidance on the ability of a provider or supplier to
people performing the screening and meaning of the statutory IPPE referral furnish ultrasound diagnostic services,
strongly recommended that quality requirement for coverage of the AAA we are finalizing this section as
standards be applied to any laboratories screening service. The commenter proposed to provide for coverage of the
performing this testing. suggests that the term ‘‘referral’’ should AAA screening service for beneficiaries
Response: Section 5112 of the DRA be interpreted to include a practitioner’s under the statute, subject to the
provides for coverage of a one-time ‘‘direction to receive care from a statutory eligibility and other
ultrasound screening for AAAs for qualified provider’’ that may be limitations.
beneficiaries, subject to certain provided orally or in written form b. Payment
eligibility and other limitations. during or after the eligible beneficiary
However, section 5112 does not receives his or her IPPE service. Beginning January 1, 2007, we
expressly address the subject of quality Response: Section 410.16(a)(7) (as proposed to pay for ultrasound
standards for the providers or suppliers modified in this final rule) provides that screening for AAAs through the use of
of these services and, therefore, in the each eligible beneficiary who takes a new HCPCS code G0389, Ultrasound,
absence of a clearly demonstrated need advantage of that benefit is entitled B-scan and/or real time with image
for quality or qualification standards (among other things) to education, documentation; for abdominal aortic
that are specifically targeted to counseling, and referral, including a aneurysm (AAA) screening. We
ultrasound screenings for AAAs, we do brief written plan such as a checklist proposed that payment for this service
not believe it is appropriate to establish provided to the beneficiary for obtaining be made at the same level as CPT code
at this time such detailed standards for appropriate screening and other 76775, Ultrasound, retroperitoneal (eg,
these services. We believe that any preventive services that are covered as renal, aorta, nodes), B-scan and/or real
Medicare provider or supplier that is separate Medicare benefits, such as the time with image documentation;
authorized to provide covered ultrasound screening for AAAs. Based limited. CPT code 76775 is used to bill
diagnostic ultrasound services is on this referral provision for the IPPE for the service when it is provided as a
qualified to provide covered ultrasound benefit, we believe there is considerable diagnostic test, and we believe the
screening services for AAAs. The flexibility that is allowed the IPPE service associated with the HCPCS
ultrasound test is conducted in a similar provider in making referrals to qualified codereflects equivalent resources and
manner whether the test is for a Medicare providers of screening and work intensity to those contained in
screening or diagnostic purpose. We are other preventive services, such as the CPT code 76775.
adding language at § 410.19(b) to reflect AAA screening service. However, at a In addition, since the DRA provides
this condition. minimum, we believe § 410.16(a)(7)of that the Medicare Part B deductible will
Comment: Two commenters the IPPE regulation requires that the not apply for ultrasound screening for
expressed concern that many referral include a brief written plan AAA (as defined in section 1861(bbb) of
beneficiaries who became entitled to provided the beneficiary for obtaining, if the Act), we proposed to revise
Medicare Part B coverage for the first appropriate, the AAA screening service § 410.160 to include an exception from
time before the IPPE benefit became from a qualified Medicare provider. the Medicare Part B deductible for the
effective (January 2005) will not be able Comment: Several commenters ultrasound screening for AAA as
to qualify for coverage of the ultrasound recommended that we monitor the described in § 410.19 (Conditions for
coverage of an ultrasound screening for instances the test or procedure is no • We are incorporating paragraph
abdominal aortic aneurysms). longer classified as a ‘‘screening test.’’ (a)(2) into (a)(1), and redesignating and
Comment: Commenters were in Thus, the deductible would not be revising current paragraph (a)(3) as new
agreement with the proposed payment waived in such situations. paragraph (b). We also clarify that it is
amount for this service. After reviewing the public comments, generally permissible for both FQHCs
Response: We will adopt the proposed we are finalizing § 410.160 as proposed. and RHCs to furnish, when necessary,
values for this new HCPCS code (that is, most types of medical and other health
make it equivalent to CPT code 76775). 5. Section 5114—Addition of Diabetes visits on the same day to the same
This service will be identified by the Outpatient Self-Management Training patient. We also amend this paragraph
following code number and descriptor Services (DSMT) and Medical Nutrition to permit a separate additional FQHC
G0389, Ultrasound, B-scan and/or real Therapy (MNT) for the FQHC Program visit for DSMT and MNT services
time with image documentation; for Section 5114 of the DRA amended (which may occur on the same date of
abdominal aortic aneurysm (AAA) section 1861(aa)(3) the Act to add DSMT service when the beneficiary receives
screening. and MNT services to the list of Medicare care from their FQHC physician or NPP)
We will also finalize the proposed covered and reimbursed services under when reasonable and necessary,
revisions to § 410.160 to include an the Medicare FQHC benefit, effective for consistent with the Congressional
exception from the Medicare Part B services provided on or after January 1, mandate under section 5114 of the DRA
deductible for the ultrasound screening 2006. Although this statutory change to provide coverage and adequate access
for AAA as described in § 410.19. has already been implemented in to these services in the FQHC setting.
4. Section 5113—Non-Application of administrative instructions, we • Finally, we are redesignating and
the Part B Deductible for Colorectal proposed to conform the regulations to revising current paragraph (a)(4) as new
Cancer Screening Tests the new statutory requirement. paragraph (c).
Current Medicare policy requires that, FQHCs certified as DSMT and MNT
providers have been allowed to bundle F. Payment for Covered Outpatient
with limited exceptions, incurred Drugs and Biologicals (ASP Issues)
expenses for covered part B services are the cost of those services into their
subject to, and count toward meeting FQHC payment rates. But before the Medicare Part B covers a limited
the Part B annual deductible. Section enactment of the DRA, the provision of number of prescription drugs and
5113 of the DRA amended section these services would not generate a biologicals. For the purposes of this
1833(b) of the Act to provide for an separate FQHC visit payment. Effective final rule with comment period, the
exception to the application of the Part for services furnished on or after term ‘‘drugs’’ will hereinafter refer to
B deductible for colorectal cancer January 1, 2006, FQHCs that are both drugs and biologicals. Medicare
screening tests. Beginning January 1, certified providers of DSMT and MNT Part B covered drugs not paid on a cost
2007, colorectal cancer screening services can receive per visit payments or prospective payment basis generally
services, as described in section for covered services furnished by fall into the following three categories:
1861(pp)(1) of the Act, are no longer registered dietitians or nutrition • Drugs furnished incident to a
subject to the Part B deductible. The professionals. That is, if all relevant physician’s service.
program requirements are met, these
conditions for and limitations on • Durable medical equipment (DME)
coverage for colorectal cancer screening services are included under the
drugs.
tests under Medicare Part B are Medicare FQHC benefit as billable
visits. • Drugs specifically covered by
described in § 410.37. statute (for example, certain
To conform our regulations to this In public response to the proposed
rule, we received a small number of immunosuppressive drugs).
statutory change, we proposed to revise
comments expressing support for our Beginning in CY 2005, the vast
§ 410.160 to include an exception from
proposal. Therefore, we will finalize the majority of Medicare Part B drugs not
the Part B annual deductible for the
changes as proposed. paid on a cost or prospective payment
colorectal cancer screening services
To conform the regulations, we are basis are paid under the average sales
described in § 410.37.
Comment: Commenters were amending § 405.2446(b) to expand the price (ASP) methodology. The ASP
supportive of this conforming change. scope of FQHC services to include methodology is based on data submitted
However, it was pointed out that we had certified providers of DSMT and MNT to us quarterly by manufacturers. In
failed to address the situation where a services by adding a new paragraph addition to the payment for the drug,
colorectal cancer screening service (b)(10). We are also revising § 405.2463 Medicare currently pays a furnishing fee
actually results in a beneficiary having by— for blood clotting factors, a dispensing
a biopsy or a growth removed, requiring • Revising paragraph (a) to expand fee for inhalation drugs, and a supplying
the service to be coded as a diagnostic the definition of an FQHC visit to fee to pharmacies for certain Part B
procedure. Clarification was requested include certified providers of DSMT and drugs.
as to whether in such situations, the MNT services under new paragraph In January 2006, the drug coverage
deductible would still be waived. (a)(1)(ii)(B). We are also revising the available to Medicare beneficiaries
Response: Section 1834(d)(3)(D) of the definition of an rural health clinic expanded with the implementation of
Act states ‘‘if during the course of such (RHC) visit in new paragraph (a)(1)(i) to the Medicare Part D benefit. The
screening colonoscopy, a lesion or include a face-to-face encounter Medicare Part D benefit does not change
growth is detected which results in a between a patient and a clinical Medicare Part B drug coverage.
biopsy or removal of the lesion or psychologist or clinical social worker to This section of the preamble discusses
growth, payment under this part shall conform to statutory language at section changes and issues related to the
not be made for the screening 1861(aa)(1)(B) of the Act. We also determination of the payment amounts
colonoscopy but shall be made for the proposed to redesignate and revise for covered Part B drugs and furnishing
procedure classified as a colonoscopy paragraphs (b) and (c) as new blood clotting factor. This section also
with such biopsy or removal.’’ Based on paragraphs (a)(2) and (a)(3), discusses changes to how manufacturers
this statutory language, in such respectively. calculate and report ASP data to us.
1. ASP Issues final rule. We also stated that because • Requests for billing codes for
Section 303(c) of the MMA amended the comments received during the specific products;
title XVIII of the Act by adding new comment period in response to the • Whether alternative payment
section 1847A. This new section revised April 6, 2004 IFC were made during the methodologies or exceptions to the ASP-
the payment methodology for the vast initial months of manufacturers’ based payment should be considered;
majority of drugs and biologicals not experience with calculating and • Billing and claims processing and
paid on a cost or prospective payment reporting ASPs and prior to publication adjudication issues;
of payment amounts based on the ASP • Variation in local coverage policies:
basis furnished on or after January 1,
methodology, we believed there was • Whether Part B policies apply to
2005. The ASP reporting requirements
good reason to give the public an Medicaid and/or Part D;
are set forth in section 1927(b) of the • Issues related to Competitive
Act. Manufacturers must submit ASP opportunity to provide additional
comments. Therefore, we sought Acquisition of Outpatient Drugs and
data for each 11-digit NDC to us Biologicals Under Part B (CAP); and
quarterly. The manufacturers’ comments on the ASP reporting
provisions in the April 6, 2004 IFC, as • Issues pertaining to the content and
submissions are due to CMS no later format of the quarterly Part B drug
than 30 days after the last day of each well as several topics specifically
discussed in the CY 2007 PFS proposed pricing files.
calendar quarter. The methodology for
developing Medicare drug payment rule. These topics included: Fees not b. Fees Not Considered Price
allowances based on the manufacturers’ considered price concessions, excluded Concessions
submitted ASP data is described in the sales known on a lagged basis, nominal
Section 1847A(c)(5)(A) of the Act
regulations in part 414, subpart K. We sales, and other price concession issues.
states that the ASP is to be calculated by
update the Part B drug payment In this final rule with comment period,
the manufacturer on a quarterly basis.
amounts quarterly based on the data we we are responding to comments
As a part of that calculation,
receive. received on the April 6, 2004 IFC and
manufacturers must take into account
On April 6, 2004, we published the the CY 2007 PFS proposed rule and
price concessions such as—
Manufacturer’s Submission of Average revising provisions related to the
• Volume discounts;
Sales Price Data for Medicare Part B estimation methodology for price • Prompt pay discounts;
Drugs and Biologicals (ASP) interim concessions known on a lagged basis, • Cash discounts;
final rule with comment period (IFC) which were finalized in the September • Free goods that are contingent on
(69 FR 17935) to implement the ASP 16, 2004 final rule. Except as otherwise any purchase requirement;
calculation and reporting requirements. specified in this final rule with • Chargebacks; and
Manufacturers were required to submit comment, we are finalizing the • Rebates (other than rebates under
their initial quarterly ASP data to us provisions of part 414, subpart J as the Medicaid drug rebate programs).
shortly thereafter, by April 30, 2004. We presented in the April 6, 2004 IFC. If the data on these price concessions
received comments on the April 6, 2004 a. Comments Not Related to ASP are lagged, then the manufacturer is
IFC from drug manufacturers, Reporting required to estimate costs attributable to
pharmacies, physicians, national these price concessions using the
associations of the pharmaceutical As stated in the CY 2007 PFS required ratio methodology as specified
industry, national associations of proposed rule, we received numerous in § 414.804(a)(3). This methodology
physicians, and consultants. These comments on the use and potential was finalized in the September 16, 2004
comments addressed a variety of aspects impacts of the ASP payment final rule based on comments submitted
of calculating and reporting ASPs. On methodology. The April 6, 2004 IFC in response to the April 6, 2004 IFC. In
September 16, 2004, we published the implemented provisions of the MMA the CY 2007 PFS proposed rule, we
Manufacturer’s Submission of Average related to how manufacturers calculate proposed modifications to the
Sales Price Data for Medicare Part B ASP and report their ASP data. Thus, requirements for estimating lagged price
Drugs and Biologicals (ASP) final rule comments about the appropriateness concessions specified § 414.804(a)(3) to
(69 FR 55763) addressing only the and use of 106 percent of the ASP as a conform with other proposals put forth
comments pertaining to the basis for Medicare Part B drug payment in the proposed rule. Comments
methodology for estimating lagged price rates are outside the scope of the final received in response to the proposed
concessions. We have also addressed ASP reporting rule. Implementation of rule related to potential impacts on the
ASP calculation and reporting the ASP payment methodology as the estimation of lagged price concessions
requirements in other proposed and basis for establishing payment amounts are discussed in the appropriate
final rules and information collection for the vast majority of Part B drugs was subsections in this section.
notices, including rulemaking to discussed in notice and comment In response to the April 6, 2004 IFC,
implement the Competitive Acquisition rulemaking in the CY 2005 PFS commenters representing drug
Program for Part B Drugs and proposed and final rules (69 FR 47520 manufacturers, national associations of
Biologicals (CAP) (70 FR 39069, 70 FR and 69 FR 66299). Comments about the wholesalers and distributors, and
45842, 70 FR 70215, 70 FR 70477, and ASP payment methodology that address physicians and other health care
71 FR 48130). In addition, we have issues other than how manufacturers providers requested clarification and
posted official agency guidance, calculate and report their ASPs are detailed guidance on the treatment of
including responses to frequently asked outside the scope of this rulemaking. administrative fees, service fees and fees
questions, on our Web site to implement Other topics for which we received paid to pharmacy benefit managers
the ASP provisions in accordance with comments that are not within the scope (PBMs) in the ASP calculation. We
section 1847A(c)(5)(C) of the Act. of this rulemaking and are not otherwise posted guidance on our Web site
In the CY 2007 PFS proposed rule, we addressed are as follows: (http://questions.cms.hhs.gov/cgi-bin/

stated that we intended to finalize the • How the ASP-based payment rates cmshhs.cfg) to clarify that in the
April 6, 2004 IFC in the near future and are calculated; absence of specific guidance in the Act
that we may publish the final rule as • How NDCs are assigned to billing or Federal regulations, the manufacturer
part of this rulemaking, or as a separate codes; may make reasonable assumptions in its
calculations of ASP, consistent with the provide detailed information about fide services; while a few commenters
general requirements and intent of the whether and how one would determine requested that certain services such as
Act, Federal regulations, and its the extent to which these activities are ‘‘pick, pack and ship,’’ chargeback
customary business practices. These bona fide services actually performed on administration, data services, and
assumptions should be submitted along behalf of the manufacturer. To better patient care programs be specifically
with the ASP data. In December 2004, understand the scope of appropriate included in a list of bona fide services.
we posted further guidance on our Web bona fide services and how they may A few commenters stated that such a
site addressing service fees and vary across categories of drugs, we list, even if the list were illustrative,
administrative fees paid to buyers sought comment on the specific types of would be helpful in standardizing the
(http://questions.cms.hhs.gov/cgi-bin/ services entities performed on behalf of treatment of service fees across
cmshhs.cfg). the manufacturer and the necessity of manufacturers’ ASP calculations. Other
On July 6, 2005, we restated our those services in the efficient commenters cautioned that establishing
guidance on service fees in the preamble distribution of drugs. We also stated that a list of bona fide services would require
of the Competitive Acquisition of we were considering providing further ongoing refinement in order for
Outpatient Drugs and Biologicals Under guidance on the types of services that manufacturers to accurately calculate
Part B (CAP) interim final rule with may qualify as bona fide services for ASPs as service fee arrangements
comment (70 FR 39069). Subsequently, purposes of the ASP calculation. We evolved.
we received requests for clarification on also indicated that we were considering Several commenters recommended
how fees paid to entities such as group providing further guidance on or that we adopt a more general standard
purchasing organizations (GPOs) or revising the approach or methodology for evaluating whether an arrangement
PBMs must be treated for purposes of manufacturers must use to determine represents a bona fide service fee
the ASP calculation. the fair market value of bona fide arrangement. However, very few
Therefore, we proposed to further services performed on their behalf and suggestions for modifying the wording
clarify in the final ASP reporting rule whether the service fee paid was passed of the proposed definition of bona fide
that, beginning with the ASP reporting on in whole or in part, as well as service fee were offered. One
for sales during the first quarter of CY activities that should not be considered commenter recommended changing
2007, bona fide service fees that are paid bona fide services performed on behalf ‘‘itemized’’ to ‘‘supply chain’’ to address
by a manufacturer to an entity, whether of manufacturers, and bona fide services concerns regarding how fair market
or not the entity takes title to the drug, that may be appropriate for all or value may be determined, and several
are not considered price concessions specific types of products or commenters recommended that we
under § 414.804(a)(2) insofar as, and to circumstances. We also sought delete the requirement that the fees not
the extent that, they satisfy the comments on the costs and relative be passed on; these comments are
definition of a bona fide service fee that discussed in more detail below in this
costs of services performed on behalf of
we proposed at § 414.802. In § 414.802, section.
manufacturers. Specifically related to
we proposed to define bona fide service In discussing how a more general
the determination of whether or not a
fees as fees paid by a manufacturer to an standard might be applied, several
fee represents fair market value for ASP
entity that represent fair market value commenters suggested allowing the
purposes, we solicited comments on the
for a bona fide, itemized service actually marketplace to decide the appropriate
potential appropriateness of fees tied to
performed on behalf of the manufacturer scope of services and fair market value.
performance of a service, fixed fee,
that the manufacturer would otherwise These commenters stated that this
revenue generated by product sales, or
perform (or contract for) in the absence approach would result in a satisfactory
other basis. In addition, we requested
of the service arrangement, and that are means of determining fees that are not
not passed on, in whole or in part, to a comments on the appropriate methods price concessions (that is, are bona fide
client or customer of an entity, whether for determining whether a fee is passed and not passed on) by virtue of the
or not the entity takes title to the drug. on in whole or in part and on how competitiveness of the market for drug
We further proposed that our current Medicare’s guidance on the treatment of distribution service. Under this
guidance, which provides that bona fide service fees for ASP calculation approach, any service and price agreed
service fees means expenses that would purposes may differ with the treatment to in an arm’s-length contract with the
have generally been paid for by the of service fees for financial accounting manufacturer would be sufficient for
manufacturer at the same rate had these or other purposes, and any implications determining that the services were bona
services been performed by other that this may have for manufacturers. fide and at fair market value for ASP
entities, would remain in effect unless Comment: We received numerous purposes.
we adopted an alternative approach. comments on the topic of service fees. Other commenters, who support a
Further, we proposed to clarify in the Among the commenters there was general standard, suggest that so long as
final ASP reporting rule that fees, general agreement with our clarification a service is ‘‘reasonably necessary’’ or
including service fees, administrative that the treatment of bona fide service ‘‘necessary and useful’’ in meeting a
fees and other fees, paid to GPOs or fees in the ASP calculation should not manufacturer’s business needs, it
PBMs are not considered price be conditioned on whether or not the should be considered to be both bona
concessions under § 414.804(a)(2) entity takes title to the drug. However, fide and a service performed on behalf
insofar as, and to the extent that, they many commenters objected to a of the manufacturer. These commenters
satisfy the definition of a bona fide definition of bona fide service fee that emphasize that the purpose of the
service fee that we proposed at would limit in any way the services or service should determine whether it was
§ 414.802. amount of fee that a manufacturer performed on behalf of the
In the CY 2007 PFS proposed rule, we would establish in a contract with any manufacturer. As a result, in the
discussed comments to the April 6, partner in the distribution of drugs or opinion of these commenters, all
2004 IFC that provided some insight that otherwise would limit flexibility activities related to distributing drugs
into the types of activities that are and evolution in the industry. Many of are services a manufacturer would
performed in the distribution of drugs. the commenters on this issue were either have to perform or contract for if
We noted that these comments did not opposed to establishing a list of bona it did not have the capacity to perform
the activity or chose not to perform the several commenters stated that for a excluded from the calculation of ASP or
activity. variety of reasons, manufacturers may to eliminate the ‘‘not passed on’’ or
Some of the comments in support of not know or be able to accurately certify ‘‘itemized’’ requirements.) However, we
a general standard pointed to the that a fee is not passed on in whole or found many of the comments
personal services safe harbor from anti- in part. These commenters identified informative with respect to how our
kickback penalties as specified in 42 anti-trust constraints as one such definition of a bona fide service fee is
CFR 1001.952(d)(7) as a potential reason. met and we discuss below in this
benchmark for purposes of identifying Commenters asked that: (1) We clarify section how these comments have been
services and fees that would be that services that can only be performed incorporated into our guidance. In
excluded from the ASP calculation. by the party that takes possession of the codifying the definition of bona fide
Other commenters recommended that drug from the manufacturer may be service fees, we seek to clarify a
any reasonable method of determining considered to be bona fide services; and framework for differentiating between
fair market value should be acceptable. (2) we remove the limitation in our those price concessions that must be
However, several commenters requested current guidance that bona fide service included in the calculation of ASP and
that we specify the acceptable methods fees must be at the same rate had these bona fide service fees,which are not
for determining fair market value. A services been performed by other included in the calculation of ASP.
small number of commenters requested entities. Beginning with the effective date of this
that we specifically address whether the We did not receive comments on final rule with comment, the definition
income method, market method or cost services that should not be considered of bona fide service fees will apply to
method could be used to estimate the bona fide services, or on the costs or the ASP reporting for sales during the
range for fair market value of the bona relative costs of services performed on first calendar quarter of 2007.
fide service fee arrangement for ASP behalf of manufacturers. Additional guidance is discussed below.
purposes. These commenters did not Response: After consideration of the
provide details on the applicability of comments received, we are finalizing (1) Bona fide, Itemized, Actually
these three methods for estimating fair our proposed definition of bona fide Performed on Behalf of the
market value for commonly performed service fees at § 414.802 which specifies Manufacturer and ‘‘Otherwise
drug distribution services. Many that in order for a fee to be determined Performed’’
commenters stated that, regardless of not to be a price concession, and thus The first and second elements of the
the method used to determine fair to be excluded from the calculation of definition of bona fide service fees relate
market value, manufacturers should be the ASP, the following conditions must to the scope of bona fide services for
permitted to calculate fair market value be met: which a fee paid does not represent a
across a set of services (in lieu of • The fee paid must be for a bona price concession for ASP purposes. To
determining fair market value for each fide, itemized service that is actually be considered a bona fide service fee,
itemized service specified in an performed on behalf of the the fee must be for services that are:
arrangement), and that it would be manufacturer; Bona fide, itemized, actually performed
impossible to calculate fair market value • The manufacturer would otherwise on behalf of the manufacturer, and those
adequately for certain low-volume or perform or contract for the service in the the manufacturer would otherwise
value-added services or certain services absence of the service arrangement; perform or contract for in the absence of
that can only be performed by the • The fee represents fair market the service arrangement. Some
purchaser (for example, in the case of value; and commenters requested further guidance
wholesalers, compiling, and sharing • The fee is not passed on in whole on these elements. We were persuaded
retail customer data). Some commenters or in part to a client or customer of any by comments that referenced the
noted that service fee contracts may be entity. necessity or usefulness of services.
broadly constructed for a set of services We believe that if a fee satisfies the Therefore, we interpret these elements
across a number of drugs without definition of bona fide services fees it of the definition to encompass any
itemizing each service or activity. To can be excluded from the calculation of reasonably necessary or useful services
reflect market practices and trends, as the ASP. We believe the specificity and of value to the manufacturer that are
noted above in this section, one scope of this definition provides an associated with the efficient distribution
commenter recommended that we revise appropriate safeguard against the of drugs. In response to commenters’
the proposed definition of bona fide potential risk for inappropriately higher concerns, we are clarifying that services
service fees to remove the word ASPs, while adopting a more general ‘‘on behalf of’’ the manufacturer include
‘‘itemized’’ and, in its place, insert standard, a more limited definition or both those the manufacturer has the
‘‘supply chain.’’ relying solely on market forces, as some capacity to perform, and those that can
Several commenters supported our commenters suggested, would not. This only be performed by another entity.
proposed definition of bona fide service is because, taken together, this four Although some commenters provided
fees in general, while also suggesting elements describe those situations in us with general information on what
that we refine or eliminate the ‘‘not which we believe a fee paid is they would view to be bona fide
passed on’’ requirement because it is not compensation for services rather than a services, to avoid inadverently limiting
needed if the services included in an price concession for drugs. We disagree the scope of what could constitute a
arrangement are bona fide and the fee with the comments that recommended bona fide service, we will not establish
represents fair market value. A number alternative standards because a a list of ‘‘bona fide services’’ at this
of commenters offered that including definition with greater breadth or less time.
‘‘itemized’’ in the definition was specificity or both would not as clearly
unnecessary for the same reason. While distinguish bona fide services fees from (2) Fair Market Value
a few commenters stated that specific price concessions and could result in The third element of the definition of
requirements not to pass on fees and inappropriately high ASPs and bona fide service fees specifies that the
terms requiring disclosure of any fees insconsistent treatment of services fees fees must represent fair market value. In
passed on could be written in the bona (for example, if we were to permit a fee response to comments, we are refining
fide service fee contracts. In contrast, for any services at any price to be our current guidance to address
concerns that it may not permit the definition of ‘‘bona fide service fee’’ arrangements to be excluded from the
exclusion from ASP of fees for services is passed on. Although we decided to ASP calculation without having to meet
that can only be performed by the entity retain the ‘‘not passed on’’ requirement our definition of bona fide service fees.
to which the fee is paid. Therefore, our in the definition of bona fide service Other commenters expressed concern
guidance is that bona fide service fees fees because of its importance in that considering GPO and PBM fees to
means expenses that generally would distinguishing bona fide service fees be price concessions could artificially
have been paid for by the manufacturer from price concessions, we believe it is deflate ASP such that it would not
at the same rate had these services been appropriate to seek to balance our goal accurately reflect the costs incurred by
performed by other or similarly situated of ensuring appropriate Medicare physicians and other providers. Another
entities. payments are made with the level of commenter suggested that we provide
In addition, we tend to agree with the burden a manufacturer would have to additional guidance on payments to
commenters that, in certain undertake to validate that a fee was not managed care organizations.
circumstances, it may be appropriate to passed on. Therefore, with respect to Response: We note that we did not
calculate fair market value for a set of certifying to the accuracy of their ASP make a specific proposal with respect to
itemized bona fide services, rather than calculations when it is unknown to the how PBM and GPO fees must be treated
fair market value for each individual manufacturer whether the fee paid was for ASP purposes other than to say that
itemized service, when the nature of the passed on in whole or in part to a client to the extent that such fees meet the
itemized services warrants such or customer of any entity, we are definition of ‘‘bona fide service fee,’’
treatment. We also tend to agree that the clarifying, in this preamble, how they are excluded from the calculation
appropriate method or methods for manufacturers may address this of ASP. We are continuing to develop
determining whether a fee represents concern. If a manufacturer has our understanding of the variety of
fair market value may depend upon the determined that a fee paid meets the agreements made with entities such as
specifics of the contracting terms, such other elements of the definition of PBMs and GPOs and the possible effects
as the activities the entity will perform ‘‘bona fide service fee,’’ then the of these arrangements on the calculation
and the agreed-upon mechanism for manufacturer may presume, in the of ASP and provider acquisition costs.
establishing the payment (for example, absence of any evidence or notice to the For this reason, at this time we believe
percentage of goods purchased). We contrary, that the fee paid is not passed it is premature for us to provide specific
believe manufacturers are well- on to a client or customer of any entity. guidance with respect to treatment of
equipped to determine the most Comment: Several commenters fees paid by manufacturers to PBMs and
appropriate, industry-accepted method indicated that some of the fees that they GPOs in the ASP calculation (other than
for determining fair market value of believe would meet our definition of to specify, as we proposed, that PBM
drug distribution services for which bona fide services fees for ASP purposes and GPO fees that meet the definition of
they contract. Therefore, we are not would be treated as a reduction to ‘‘bona fide service fees’’ are excluded
mandating the specific method revenues for financial accounting from the calculation of ASP). Instead,
manufacturers must use to determine purposes. Commenters asked us to we will continue to consider the
whether a fee represents fair market clarify that the treatment of service fees comments received and to study the
value for purposes of excluding bona for ASP purposes and financial matter further. In addition, we may take
fide service fees from the calculation of accounting purposes may be different, into consideration how fees paid to
ASP. and that if a fee meets our definition of these entities are addressed in the
a bona fide service fee it can be context of the Medicaid drug rebate
(3) ‘‘Not Passed On’’
excluded from the ASP regardless of its program. We also note that the MedPAC
We appreciate the commenter views treatment for financial accounting commented that in the upcoming year it
on the fourth element of the definition purposes. would be continuing to examine the
of bona fide service fees, which Response: Fees that meet our issue of the average prices physicians
specifies that the bona fide service fee definition of bona fide service fees are pay and the effect of price concessions
must not be passed on, in whole or in not considered price concessions for that might not be passed on to
part, to a client or customer of an entity. purposes of the ASP calculation, physicians.
At this time, we understand that there regardless of how they are treated for In the absence of specific guidance,
may be significant barriers that limit a financial accounting purposes. the manufacturer may make reasonable
manufacturer’s ability to determine Comment: Many commenters asserted assumptions in its calculations of ASP,
whether a fee that otherwise meets the that all fees and other payments to GPOs consistent with the general
definition of ‘‘bona fide service fee’’ and PBMs should be excluded from ASP requirements and the intent of the Act,
described in this rule is passed on, in because the statute requires only that Federal regulations, and its customary
whole or in part, to a client or customer sales to purchasers be included in ASP, business practices. These assumptions
of any entity. Nevertheless, we believe and, they argue, GPOs and PBMs are not should be submitted along with the ASP
that it is essential to retain the ‘‘not purchasers, do not take title to and data.
passed on’’ element in the definition of possession of products, and the fees Recognizing that the treatment of fees
bona fide service fees. The ‘‘not passed paid to GPOs and PBMs are not passed to PBMs and GPOs in the ASP
on’’ element is, in our view, a key factor on to physicians (or other providers) in calculation may have implications for
in distinguishing a price concession a manner that can be attributable to a the integrity of the ASP payment
from a bona fide service fee because, if particular purchase or drug. methodology, we will be paying close
a fee that is passed on is excluded from Commenters asked that, if we consider attention to this issue and may provide
the ASP calculation, then there is a fees paid to GPOs and PBMs to be price more specific guidance in the future
greater risk of the ASP being concessions (except to the extent that through rulemaking or through program
inappropriately higher. the fees are bona fide service fees for instruction or other guidance (consistent
However, we recognize that, in some purposes of the ASP calculation), we with our authority under section
instances, manufacturers may have no allow fees paid to the GPOs and PBMs 1847A(c)(5)(C) of the Act).
effective way of knowing whether a fee under arrangements that meet the anti- Comment: Many commenters noted
paid that meets the other elements of kickback safe harbor for purchasing that the Congress excluded wholesaler
prompt pay discounts from the NDC has been sold for NDCs with less Comment: We received comments
calculation of average manufacturer than 12 months of sales, except for that were supportive of our approach.
price (AMP) under the DRA. redesignated NDCs as described in However, some commenters stated that
Commenters asserted that we have the section II.F.1.e.). The manufacturer then the proposed methodology would be
authority to extend this provision to calculates a percentage using this overly complex and inappropriate for
ASP reporting and thus could exclude summed amount as the numerator and certain types of exempted sales known
wholesaler prompt pay discounts from the sales (the number of units after non- on a lagged basis. Several commenters
ASP reporting. lagged exempted sales have been stated that the proposed methodology
Response: We do not agree that subtracted from total sales) for the same would be helpful and useful for
extending the DRA provision to ASP period (12 months or less, if applicable) accurately excluding from the ASP
reporting would be consistent with as the denominator. The result would be calculation sales excluded based on the
Congressional intent. Section a rolling average percentage estimate for type of entity to which the sale is made
1847A(c)(3) does not specify a carve-out lagged exempted sales that is applied to and known on a lagged basis (for
for prompt pay discounts extended to the sales (the number of units after non- example, sales relating to subclauses (I),
wholesalers. Therefore, along with all lagged exempted sales have been (II), and (IV) of section 1927(c)(1)(C)(i)
other prompt pay discounts, prompt subtracted from total sales) for the of the Act). However, most of these
payment discounts extended to quarter being reported. The product that commenters cautioned that use of the
wholesalers must be included in the results from multiplying the rolling proposed methodology to estimate and
calculation of ASP. average percentage estimate of lagged exclude from the ASP calculation sales
c. Estimation Methodology for Lagged exempted sales and sales (the number of which are excluded on the basis of
Exempted Sales units after non-lagged exempted sales rebates paid to State pharmacy
have been subtracted from total sales) assistance programs and Part D plans or
Section 1847A(c)(2) of the Act
would determine the number of lagged qualified retiree prescription drug plans
requires manufacturers to exclude from
exempted sales (in units) to be excluded (for example, prices under clauses (III)
the calculation of ASP those sales that
from the denominator of the ASP and (VI) of section 1927(c)(1)(C)(i) of the
are exempt from inclusion in the
calculation. Manufacturers would be Act) and known on a lagged basis would
determination of Medicaid best price
required to make a corresponding be: (1) Inadequate to fully and
(BP). In the comments on the April 6,
adjustment to the numerator of the ASP accurately account and adjust for other
2004 IFC, commenters requested more
calculation to ensure that the total in price concessions applicable to these
guidance on the method manufacturers
dollars for the reporting quarter does not sales; and (2) may lead to an
should use to exclude exempted sales
include revenue related to lagged, inappropriately low ASP if a
that are known on a lagged basis.
Manufacturers identify exempted sales exempted sales excluded from the manufacturer is unable to identify and
based on direct sales and through denominator using the proposed remove all price concessions associated
chargeback and rebate data that may not estimation methodology. Further, with an exempted sale. Some
be sufficiently available at the time the manufacturers would be required to commenters supported an alternative,
ASP is calculated. In the absence of remove the dollar value of lagged two-pronged approach. Lagged sales
specific guidance on how to account for exempted sales from their estimates of excluded based on the type of entity to
lagged exempted sales (that is, lagged price concessions by subtracting which the sale is made would be
exempted sales identified through the dollar value of estimated lagged removed from the ASP using the
chargeback or rebate processes), exempted sales from the denominator as proposed methodology if the
manufacturers have relied upon specified in § 414.804(a)(3)(i). manufacturer determined that a 12-
assumptions in accordance with their Our proposed methodology for month rolling average estimation
customary business practices to develop excluding lagged, exempted sales is methodology was necessary to
their approach for excluding these sales similar to the methodology accurately exclude these lagged
from the ASP calculation. In our work manufacturers are required to use to exempted sales from the ASP
with manufacturers that submit ASP estimate price concessions known on a calculation. On the other hand, the
data, we understand that some lagged basis, and was recommended by manufacturer would either not make
manufacturers have used a ratio manufacturers. We believe requiring any adjustment for or use reasonable
methodology for estimating exempted similar methods to estimate both lagged assumptions to determine the best
sales known on a lagged basis that is exempted sales and lagged price method for excluding any prices under
similar to the ratio methodology concessions would be reasonable and a State pharmaceutical assistance
manufacturers must use to estimate reduces potential errors in the program, and any prices charged which
price concessions known on a lagged manufacturers’ ASP calculations, while are negotiated by a prescription drug
basis. ensuring that exempted sales are plan under Part D of title XVIII, by an
To establish a uniform approach, we appropriately removed from the ASP MA–PD plan under Part C of title XVIII
proposed to require, in the final ASP calculation. In addition, using an or by a qualified retiree prescription
reporting rule, that all manufacturers estimation methodology to remove drug plan as defined in section 1860D–
use a 12-month (or less, if applicable) lagged exempted sales would reduce the 22(a)(2) of the Act. Several commenters
rolling average ratio methodology to likelihood of quarter-to-quarter suggested we adopt an approach that
estimate exempted sales known on a variations in the ASP. would permit manufacturers not to
lagged basis (through chargebacks or We sought comments on the proposed exclude certain exempted sales because:
rebates) to more accurately exclude methodology for excluding exempted (1) Current information sources may not
these sales from the ASP calculation. sales known on a lagged basis from the distinguish all exempted sales; (2)
Specifically, for exempted sales known ASP calculation and estimate of lagged certain sales may satisfy more than one
on a lagged basis, the manufacturer price concessions. We also solicited of the exemptions from the
would sum the lagged exempted sales suggestions on appropriate alternative determination of BP so there would be
for the most recent 12-month period methodologies that may be less a potential for over counting excluded
available (or the number of months the complex. sales (for example, a sale to a 340B
hospital that is also reimbursed by methodology to more accurately Effective January 1, 2007, the DRA
Medicare Part D); and (3) in some estimate and exclude these sales from revises the AMP calculation (to omit
instances the manufacturer may be the ASP calculation. Our proposal was customary prompt pay discounts
unable to fully identify and adjust for based on comments we received in extended to wholesalers), adds a
the price concessions granted along the response to the April 6, 2004 IFC and monthly AMP reporting requirement,
distribution chain associated with subsequent feedback from a few and establishes limitations on nominal
certain exempted sales (for example, the manufacturers. The comments received sales (only sales to certain entities may
portion of volume discounts granted to in response to the proposed rule reflect qualify as nominal sales). Section
distributors and pharmacies that were a broader set of manufacturers’ 1927(c)(1)(D) of the Act limits the
based on excluded sales). In addition, a perspectives. Some commenters nominal sales exclusion to sales at a
few commenters noted that we did not indicated that for certain types of nominal price made to the following
specify a standard method for making exempted sales the proposed entities:
the necessary corresponding adjustment methodology for excluding lagged • Covered entities as described in
to the numerator of the ASP calculation exempted sales from the ASP section 340B(a)(4) of the Public Health
to ensure that the total in dollars for the calculation might lead to inaccuracies in Services Act.
reporting quarter does not include the ASP calculation in their particular • Intermediate care facilities for the
revenue related to lagged, exempted circumstances. At the same time, a mentally retarded (ICFs/MR).
sales excluded from the denominator number of commenters supported the • State-owned or operated nursing
using the proposed estimation proposed methodology. We recognize facilities.
methodology. These commenters • Any other facility or entity that the
these commenters’ concerns regarding
suggested that the excluded sales be Secretary determines is a safety net
the difficulties in tracking both the
valued at the manufacturer’s wholesale provider to which sales of such drugs at
exempted sale and its associated price
acquisition cost (less customary prompt a nominal price would be appropriate
concessions. Given the range of
pay discounts) for purposes of making based on the factors described in section
comments, we do not believe it is not
the necessary adjustment. 1927(c)(1)(D)(ii) of the Act.
advisable to mandate the use of the In light of the DRA changes affecting
A few manufacturers supported our methodology, which we proposed at
proposal for calculating excluded sales which sales may be considered sales at
§ 414.804(a)(4)(iii), for excluding lagged a nominal price or merely nominal in
known on a lagged basis; however, one exempted sales. We recognize the
manufacturer requested that we amount, for purposes of section
proposed ratio methodology may not be 1927(c)(1)(C)(ii)(III), the CY 2007 PFS
consider requiring use of a revenue- the most accurate method for
based ratio instead of or as an proposed rule sought to clarify the
identifying and excluding certain types method manufacturers must follow in
alternative to the proposed units-based of exempted sales known on a lagged
ratio. This commenter recommended 2007 to identify such sales for ASP
basis. However we also believe that our reporting purposes and to exclude sales
that manufacturers be given a choice proposed ratio methodology may be
between a revenue-based or a units- at a nominal price from the calculation
appropriate for identifying and of ASP. For 2007 and beyond, we
based method to fit their data systems. excluding lagged exempted sales in
Another manufacturer noted that a proposed to continue to rely on the
some instances. For this reason, we are Medicaid threshold (less than 10
revenue-based ratio would result in not including the methodology in our
unintended results if the price of the percent of AMP) to determine whether
regulations, but are allowing the a sale is at a nominal price and to apply
drug changed during the 12-month
manufacturers to use the methodology the limitations in section 1927(c)(1)(D)
period used to establish the estimation
where applicable. We did not receive of the Act for determining the types of
ratio; therefore, a ratio methodology
specific comments on our proposed sales that can be considered to be sales
based on units such as the one we
modifications to § 414.804(a)(1) and (3) at a nominal price for purposes of the
proposed should be required.
Response: Section 1847A(c)(2) of the clarifying further that exempted sales ASP calculation. We made this proposal
Act requires that manufacturers exclude are excluded from the ASP calculation. for several reasons.
certain sales from their ASP We are finalizing those clarifications as As we indicated in the CY 2007 PFS
calculations. The statute does not make proposed. proposed rule, we believe this approach
the exclusion of these sales from the d. Nominal Sales helps maintain continuity in the ASP
ASP calculation optional. Therefore, we calculation and minimizes
do not have the discretion to permit Section 1847A(c)(2)(B) of the Act manufacturers’ reporting burden, as
manufacturers not to exclude sales from requires manufacturers to exclude from Medicare continues to follow the
ASP that are exempt from the the ASP calculation sales that are Medicaid approach for identifying sales
determination of BP. Manufacturers merely nominal in amount, as applied at a nominal price and manufacturers
must comply with the requirements in for purposes of section can use a single method for identifying
§ 414.804(a)(4)(i). In this final rule with 1927(c)(1)(C)(ii)(III) of the Act, except as nominal sales for both ASP and AMP
comment period we are revising the Secretary may otherwise provide. In purposes.
§ 414.804(a)(4)(i) by adding a reference the preamble to the April 6, 2004 IFC, In addition, we believe the DRA
to nominal prices, as well as sales we stated that, for ASP purposes, sales modifications to section 1927 of the Act
exempt from inclusion in the to an entity that are nominal in amount will have minimal effect on reported
determination of BP. We believe that are defined in the Medicaid drug rebate ASPs. We expect that the exclusion of
this revision conforms the regulatory agreement (see sample agreement at customary prompt pay discounts
text to the language of the statute. http://www.cms.hhs.gov/ extended to wholesalers from AMP
To establish a uniform approach for MedicaidDrugRebateProgram/ would lead to a modest increase in
excluding exempted sales known on a downloads/rebateagreement.pdf). That AMP, and as a result a modest increase
lagged basis, we proposed to amend is, for ASP purposes, a sale at a nominal in the nominal price threshold for
§ 414.804(a)(4) to require that all price is a sale at a price less than 10 purposes of ASP reporting. At the same
manufacturers use a 12-month (or less, percent of the AMP in the same quarter time, we anticipate that the limitation
if applicable) rolling average ratio for which the AMP is computed. on the types of entities to which the
nominal sales exclusion may apply, as safety net providers that would qualify e. Other Price Concession Issues
specified in section 1927(c)(1)(D) of the for the nominal sales exclusion. In our ongoing work with
Act, will result in a modest reduction in Response: The issue of whether the manufacturers that submit ASP data,
the number of sales that qualify for the Secretary should designate additional some manufacturers have posed
nominal sales exclusion for purposes of types of entities that would qualify as questions or raised concerns about how
ASP reporting because we believe that safety net providers for purposes of the estimate of lagged price concessions
the entities outlined in section section 1927(c)(1)(D) of the Act is is done prior to having 12 months of
1927(c)(1)(D) of the Act generally outside of the scope of this rulemaking. data for a NDC and, when a product is
represent the types of entities to which Comment: We received a comment redesignated with a new NDC, whether
manufacturers sell at a nominal price. suggesting that because of the short price concessions from the prior NDC
Consequently, we expect these two timeframe for performing the ASP must be included in calculating the ASP
countervailing changes would have a calculation, manufacturers should be for the new NDC. Manufacturers and
minimal overall impact on nominal allowed to identify sales at a nominal other stakeholders have also asked us
sales that would be excluded from the price for ASP purposes using the AMP about how Medicare’s ASP guidance
ASP calculation. For these reasons, we for the previous quarter provided that concerning price concessions is to be
proposed to continue to rely on the the manufacturer does this consistently
application of section applied when drugs are sold under
across all of its products. bundling arrangements.
1927(c)(1)(C)(ii)(III) of the Act (as Response: We are concerned that the
limited by section 1927(c)(1)(D) of the In response, we proposed
commenter’s suggestion that we allow clarifications and solicited comment on
Act) for identifying sales to an entity at use of last quarter’s AMP to identify
a nominal price for purposes of these issues.
sales at a nominal price in the current
excluding such sales from the quarter could have an adverse impact on (1) Price Concessions for NDCs With
manufacturer’s calculation of the ASP. the accuracy of the ASP calculation. It Less Than 12 Months of Sales
We solicited comments on our is possible for the AMP to change
proposal to continue use of the AMP as To address situations when a NDC
substantially from one quarter to the with price concessions known on a
the basis for identifying the threshold next (for example, when generic
for sales at a nominal price for purposes lagged basis has not been sold for a full
products first become available). In such 12 months, we proposed to revise
of the exclusion from the ASP situations, using the current quarter’s
calculation and on whether an § 414.804(a)(3) to specify that the period
AMP, as opposed to last quarter’s AMP, used to estimate lagged price
alternative threshold is necessary or would generally result in a more
desirable to ensure the accuracy of the concessions is the total number of
accurate identification of sales at a months the NDC has been sold. We
ASP payment methodology.
nominal price. Consequently, we are proposed to require that manufacturers
Specifically, we sought comments on
continuing to require that for ASP use less than 12 months of data in the
whether sales at less than 10 percent of
calculation purposes nominal sales in a estimation methodology for lagged price
the ASP (instead of the AMP) should be
reporting quarter be identified based on concessions for NDCs with less than 12
used as the threshold for determining
the AMP for the same quarter. months of sales (except when the
whether a sale to an entity identified in
section 1927(c)(1)(D) of the Act is at a In the CY 2007 PFS proposed rule, we manufacturer has redesignated the
nominal price. We also sought also responded to requests for product’s NDC, as discussed in this
comments on our belief that the new clarification on a technical aspect section). We also clarified in the
limitations in section 1927(c)(1)(D) of related to the identification of nominal preamble of the proposed rule that
the Act, if applied for ASP purposes, sales. Specifically, some manufacturers manufacturers may include the current
will have minimal impact on reported have asked whether sales at a nominal ASP reporting quarter in the most recent
ASPs. price are identified by performing a 12-month period (or less for NDCs with
Comment: We received comments series of calculations once or whether less than 12 months of sales) so long as
supporting our proposals to continue to the manufacturer repeats the series of the manufacturer follows this approach
rely on the application of section calculations until no remaining ASP in calculating the ASP for all of its
1927(c)(1)(C)(ii)(III) of the Act, as eligible sales are below the nominal reported NDCs.
modified by section 1927(c)(1)(D) of the threshold. Manufacturers must identify Comment: We received a number of
Act, to identify and exclude sales at a sales at a nominal price by performing comments supporting our proposal.
nominal price from the ASP calculation. the following steps once— Response: We are finalizing our
These commenters agreed that using the • The manufacturer calculates the proposal. We will require that
same standard for Medicare and AMP for the reporting quarter to manufacturers use less than 12 months
Medicaid purposes would reduce identify the dollar amount that of data in the estimation methodology
reporting burden. represents 10 percent of the AMP for for lagged price concessions for NDCs
Response: We appreciate the that reporting period. with less than 12 months of sales
comments in support of our proposal. • The manufacturer then identifies (except when the manufacturer has
We are adopting our proposal to sales at prices below this amount and redesignated the product’s NDC, as
continue to rely on the Medicaid excludes these sales from the ASP discussed in this section).
threshold (less than 10 percent of AMP) calculation.
• Beginning in 2007, only those sales (2) Redesignated NDCs
to determine whether a sale is at a
nominal price, and to apply the that meet the criteria discussed From time to time, a manufacturer
limitations in section 1927(c)(1)(D) of previously and are to an entity may change the NDC assigned to a
the Act for purposes of identifying sales identified in section 1927(c)(1)(D) of the specific product and package size while
at a nominal price in determining the Act shall be excluded from the continuing or offering price concessions
ASP. calculation of ASP. that span across sales of the product
Comment: We received a few We received no comments concerning under its prior and redesignated NDCs.
comments suggesting that the Secretary this clarification; therefore we are For example, an NDC may be changed
provide a list of additional types of finalizing the clarification as proposed. to reflect a change in the labeler code
while lagged price concessions in place instances when a manufacturer (3) Bundled Price Concessions
under the prior NDC remain in effect redesignates an NDC meaning the The statute requires that the ASP
and carry over to the redesignated NDC. manufacturer establishes a new NDC as include volume discounts, prompt pay
Another example would be a a replacement for a prior NDC for the discounts, cash discounts, free goods
manufacturer that modifies its package same product and package size. After that are contingent on any purchase
design or other non-drug feature of the reviewing the comments, we are requirement, chargebacks, and rebates
NDC and assigns a new NDC to reflect finalizing our proposal. When a (other than rebates under section 1927
the revised packaging. manufacturer redesignates an NDC of the Act). Thus far, we have not
We proposed to clarify in the final (except when a product is repackaged or provided specific guidance in the ASP
ASP reporting rule that, when an NDC relabeled by a different manufacturer or context on the issue of how to allocate
is changed (except when a product is relabeler or is privately labeled) for a price concessions across drugs that are
repackaged or relabeled by a different specific drug product and package size sold under bundling arrangements. In
manufacturer or relabeler or is privately and lagged price concessions offered for the absence of specific guidance, the
labeled) and lagged price concessions
the prior NDC remain in effect, the manufacturer may make reasonable
offered for the prior NDC remain in
manufacturer must use 12 months (or assumptions in its calculations of ASP,
effect, the manufacturer must use 12
the total number of months of sales of consistent with the general
months (or the total number of months
of sales of the prior and redesignated the prior and redesignated NDCs if the requirements and the intent of the Act,
NDCs if the total number of months of total number of months of sales is less Federal regulations, and its customary
sales is less than 12 months) of sales than 12 months) of sales and price business practices. Manufacturers
and price concession data from the prior concession data from the prior and should include these assumptions in
and redesignated NDCs to estimate redesignated NDCs to estimate lagged their ASP submissions.
lagged price concessions applicable to price concessions applicable to the As we indicated in the CY 2007 PFS
the redesignated NDC. In establishing redesignated NDC. Several commenters proposed rule, we expect manufacturers
this methodology, we are relying on our recommended that we clarify that this of drugs reimbursed by Medicare Part B
authority under section 1847A(c)(5)(A) policy would never apply to a change in to comply with all applicable laws,
of the Act. the product code for an NDC. We regulations, and legal decisions
We sought comments on our proposed disagree and believe the policy could including, but not limited to the Stark
refinements to the estimation of lagged apply to a change in the product code law, other relevant anti-kickback laws,
price concessions for NDCs with less depending on the circumstances. When antitrust laws, and laws governing fair
than 12 months of sales and when a an NDC is redesignated as a replacement trade practices (71 FR 49003). Our
manufacturer redesignates the NDC for a prior NDC for a specific drug discussion of this issue in the proposed
assigned to a product. We also solicited product and package size and lagged rule or in this final rule with comment
suggestions for potentially clarifying price concessions for the prior NDC period should not be construed as an
these policies further. remain in effect, we believe the policy endorsement or authorization of any
Comment: We received a number of described previously should apply pricing practices that contravene any
comments supporting our proposal. In regardless of which segment of the NDC laws, legal decisions, or regulations.
addition, some commenters asked for code is changed. In the CY 2007 PFS proposed rule, we
more guidance concerning what indicated that we would like to better
Several commenters asked for understand how bundling affects sales
circumstances the policy regarding
guidance concerning how to handle of Part B drugs and the ASP calculation,
redesignated NDCs would or would not
situations where the redesignated NDC and any concerns stakeholders may
apply to. In particular, some
commenters suggested the policy should and prior NDC are for a time sold have on this issue (71 FR 49003).
not apply when there is a change in the concurrently. If the redesignated NDC is Furthermore, we indicated that we are
9-digit NDC (that is, a change in the a replacement for the prior NDC and if considering providing guidance,
product code). We also received the two NDCs are sold for only a limited through rulemaking or through program
comments asking for clarification on time concurrently, then we agree with instruction or other guidance (consistent
how manufacturers should combine commenters’ suggestion that lagged with our authority under section
price concessions in situations where price concessions that are based on sales 1847A(c)(5)(C) of the Act) on the
the NDC is redesignated and both of the prior NDC and redesignated NDC methodology manufacturers must use
products are sold for a time should be combined to calculate a single for apportioning price concessions
concurrently. Some commenters asked lagged price concessions ratio (for the across Part B drugs sold under bundling
whether the lagged price concessions for applicable price concessions) that arrangements for purposes of the
the prior and redesignated NDCs should would be applied to the ASP calculation calculation of ASP. We also noted that
be combined to create a single lagged for the prior NDC and for the in considering this issue our goal is to
price concession ratio to be used to redesignated NDC. In this situation, the ensure that the ASP is an accurate
estimate lagged price concessions for manufacturer should combine the reflection of market prices for Part B
the prior and redesignated NDC, and if lagged price concession data that are drugs and that the treatment of bundled
so, how long this practice should occur. based on sales of the prior NDC and price concessions in the ASP
In addition, some commenters noted redesignated NDC as described calculation does not create
that the Food and Drug Administration previously until the last lot sold of the inappropriate financial incentives.
(FDA) has issued a proposed rule prior NDC expires. Finally, we agree In the CY 2007 PFS proposed rule, we
concerning the assignment of NDC that the FDA’s proposed regulations solicited comments on a number of
codes, and that the issue of redesignated concerning the assignment of NDC issues related to bundled price
NDCs and the ASP calculation may codes, once they are finalized, may have concessions, including how frequently
need to be revisited when the FDA implications for our policy concerning Part B drugs are sold under bundling
finalizes its regulation. redesignated NDCs, and we may revisit arrangements, the different structures of
Response: In making our proposal, we this issue in the future, if we believe it bundling arrangements that may exist
intended our proposal to apply in is warranted. (for example, the number of products
included in a bundling arrangement; of AMP and BP. The current Medicaid price concessions in the ASP
whether the price concessions are National Drug Rebate Agreement states calculation, and that any bundled price
contingent on the purchase of only one that ‘‘for Bundled Sales, the allocation concessions that meet a safe harbor to
product, the purchase of multiple of the discount is made proportionately the OIG anti-kickback statute should be
products, or the inclusion of one or to the dollar value of the units of each handled like nonbundled price
more products on a formulary; and the drug sold under the bundled concessions for ASP calculation
timing of the price concessions), and the arrangement.’’ purposes.
extent to which sales of Part B drugs are Another commenter suggested that we We also received some comments
bundled with sales of non-Part B drugs adopt the current Medicaid rebate expressing satisfaction with current
or non-drug products. We also sought program methodology for apportioning contracts with drug manufacturers, and
comments on what effect bundling bundled price concessions described raising concerns that the establishment
arrangements may have on the ASP above, but create an exception for of guidelines concerning the treatment
calculation, on beneficiary access to dominant drugs without significant of bundled price concessions in the ASP
high quality, appropriate care (including clinical alternatives. This commenter calculation may require them to
access to drugs that may not have stated that drug manufacturers do not renegotiate those contracts. In addition,
clinical alternatives), and on costs to the have an incentive to provide discounts we received some comments expressing
Medicare program and beneficiaries. In on dominant drugs that do not have concern about the affect of bundling
addition, we solicited comments on significant clinical alternatives. As a arrangements on physician and health
whether additional guidance on result, the commenter believes that in care provider’s choice of products.
apportioning bundled price concessions situations where a ‘‘dominant’’ drug is A number of commenters also raised
for purposes of the calculation of ASP bundled with non-dominant drugs, the issue of Part B drugs being bundled
is needed and potential methodologies none of the bundled price concessions with non-Part B drugs or other products.
that Medicare could consider requiring. should be apportioned to the Some stated that when Part B drugs are
Furthermore, we solicited comments on ‘‘dominant’’ drug. Furthermore, the bundled with other products, the
how variation in the structure of commenter stated that if the Medicaid bundled price concessions should not
bundling arrangements may affect the methodology were employed without an be apportioned from other products to
impact of potential apportionment exception for dominant drugs, there Part B drugs, citing concerns that the
methodologies on the ASP calculation. would be the potential to lower the ASP Part B drug payment rates would be
Comment: Some commenters for a dominant drug in a bundle while inappropriately low. However, another
recommended that we provide guidance increasing the ASP for the other, non- commenter believes that bundled price
on the treatment of bundled price dominant drugs in that bundle. The concessions should be allocated from
concessions in the ASP calculation. A commenter believes such a policy non-Part B drug products to Part B
number of these commenters stated that would result in an unfair competitive drugs, stating that it otherwise results in
having specific guidance on this issue advantage and would impose additional government overpayments. A number of
would promote consistency in ASP costs on the public health system and other commenters offered suggestions
reporting across manufacturers. In the Medicare program. The commenter on how a bundle should be defined,
addition, many commenters believed stated that determining whether a with several commenters suggesting that
that we should issue another proposed bundling arrangement contained a discounts contingent on the placement
rule with a specific proposal and offer dominant drug would be relatively easy of one or more products on a formulary
an opportunity for public comment for manufacturers, and suggested a should not constitute a bundle. We also
before finalizing any policy. Many of number of criteria such as a drug’s received comments recommending that
these commenters were also concerned indication and risk profile, whether it is for the purposes of the ASP calculation
about how the treatment of bundled a single source product, its patent- we only consider bundling
price concessions in the ASP protected status, the drug’s market arrangements to exist in situations
calculation would affect providers who share, the relative magnitude of where several different products are
do not purchase the drug as part of a incentives provided on the drug both sold for a single price, and the
bundling arrangement. before and after it is inclusion in the individual products do not have
Some commenters did not take a bundle, the effect of the introduction of separately identifiable prices.
position on whether specific guidance the drug into the bundle on the sales Finally, we note that the MedPAC
was needed on the treatment of bundled volume of other products in the bundle, commented that it would be examining
price concessions in the ASP and Medicare expenditures on the drug the issue of bundled price concessions
calculation, citing both the general relative to potential alternatives. and the ASP in the upcoming year.
desirability of having guidance on In contrast, another commenter urged Response: In considering the issue of
various ASP reporting issues and us not to adopt a methodology where bundled price concessions, our goal is
concerns that a specific methodology price concessions offered on drugs sold to ensure the accuracy of the ASP
with regard to bundled price under bundling arrangements are calculation and to prevent the treatment
concessions and ASP might be allocated across those drugs based on of bundled price concessions in the ASP
inflexible and hinder beneficial specified criteria. The commenter stated calculation from creating inappropriate
arrangements. that the ASP is intended to reflect the financial incentives. A number of
While most commenters did not offer prices available in the market for each comments suggested, that potential
a specific suggestion on a potential product, and they believe reallocating bundling arrangements may be complex
methodology for the treatment of discounts across drugs is unnecessary and vary widely in terms of the
bundled price concessions in the ASP and could result in inaccurate ASPs, structure and types of performance
calculation, a few commenters did. One impaired beneficiary access, and requirements upon which a bundled
commenter suggested that Medicare inappropriate financial incentives. discount may be conditioned, the
adopt for ASP purposes the Another commenter stated that magnitude of price concessions, and the
apportionment methodology that the manufacturers should be allowed to characteristics of the drugs or other
Medicaid rebate program requires make reasonable assumptions products included in the bundle (for
manufacturers to use in the calculation concerning the treatment of bundled example, whether the bundle includes
Part B drugs only or other products, the Recognizing that the treatment of contractor jurisdictions. However, the
market position of products in the bundled price concessions in the ASP following resources may be helpful and
bundle, the relative sales volume of calculation has implications for the can be retrieved at http://
products in the bundle, and how integrity of the ASP payment www.cms.hhs.gov/
commonly a particular product is sold methodology, we will be paying close McrPartBDrugAvgSalesPrice/
under a bundling arrangement). Given attention to this issue and may provide 02_aspfiles.asp#TopOfPage.
the potentially wide range of bundling more specific guidance in the future The NDC to HCPCS crosswalk is
arrangements that might exist, based on through rulemaking or through program posted quarterly on our Web site and
the information we currently have about instruction or other guidance (consistent lists a majority of billing codes used by
such arrangements, we are not in a with our authority under section providers to submit claims for drugs.
position to determine, at this time, 1847(c)(5)(C) of the Act) if we determine We welcome ongoing feedback on the
whether there is a universal approach it is warranted. Furthermore, as we accuracy of the crosswalk. We also
for treating bundled price concessions continue to monitor this issue, we want publish a list of many of the frequently
in the ASP calculation that would to be sure we are aware of concerns administered drugs that are billed using
address all potential structures of from all stakeholders, and thus we the not otherwise classified billing
bundling arrangements in a manner that encourage the public to relay additional codes.
would achieve our goal of ensuring the information or concerns to us on this Comment: Several commenters
accuracy of the ASP payment issue as they may arise. In addition, we suggested that we develop a formal
methodology and preventing note that MedPAC has indicated it will process for requesting a determination
inappropriate financial incentives. be studying this issue in the upcoming of whether for a particular NDC the ASP
Furthermore, we note that we year, and we look forward to its work reporting requirements apply. These
received a comment suggesting that in this area. commenters contend such a process is
Medicare adopt a special policy Finally, we emphasize that we expect necessary particularly for drugs that
concerning the treatment of bundled manufacturers of drugs reimbursed by may be typically self-administered, may
price concessions in the ASP Medicare Part B to comply with all be used for prevention or cosmetic
calculation for bundling arrangements applicable laws, regulations, and legal purposes, are available in potentially
that include dominant drugs without decisions including, but not limited to noncovered forms, and new drugs for
significant clinical alternatives. We do the Stark law, other relevant anti- which LCDs have not yet been made.
kickback laws, antitrust laws, and laws
not believe it would be feasible for the Response: Medicare Part B drug
governing fair trade practices. Our
Medicare program to establish a coverage under title XVIII is generally
discussion of this issue should not be
definition of a dominant drug without limited to certain drugs within specific
construed as an endorsement or
significant clinical alternatives that benefit categories as described at the
authorization of any pricing practices
would be precise enough to clearly beginning of this section. For the most
that contravene any laws, legal
delineate when a product was or was part, we believe manufacturers have
decisions, or regulations.
not dominant, especially given the identified the drugs for which they have
potential for great variation in the f. Other ASP Reporting Issues an ASP reporting obligation. Medicare
structure of bundling arrangements and Comment: Several commenters stated has established processes for issuing
the characteristics of drugs included in that it can be difficult for manufacturers national, as well as local, coverage
those arrangements. to determine which drugs are subject to determinations for Part B drugs and
Since we do not yet fully understand the ASP reporting requirements, other services. Therefore, we are not
the variety of bundling arrangements considering that section persuaded by the commenters that an
that exist in the marketplace and how 1927(b)(3)(A)(iii) of the statute states entirely separate process is necessary for
they are likely to evolve over time, we that ASP data must be reported for assisting manufacturers in determining
believe it is important to be cautious in drugs that are described in whether a drug qualifies for coverage
establishing a specific methodology that subparagraph (C), (D), (E), or (G) of under Part B as a means of determining
all manufacturers must follow for ASP section 1842(o)(1), or 1881(b)(13)(A)(ii) whether it is subject to the ASP
purposes. Consequently, we are not of the Act. reporting requirements. We encourage
establishing a specific methodology that Response: In general, these manufacturers to contact us directly to
manufacturers must use for the subparagraphs refer to broad categories discuss the specifics of their ASP
treatment of bundled price concessions of drugs covered by Medicare Part B reporting concerns.
for purposes of the ASP calculation at such as drugs that are administered Comment: One commenter asked us
this time. In the absence of specific incident to a physician’s service in to clarify whether manufacturers have to
guidance, the manufacturer may make physician offices; certain include in their calculation of the ASP
reasonable assumptions in its immunosuppressive, oral anticancer, for a given NDC sales of that NDC that
calculations of ASP, consistent with the and oral anti-emetic drugs supplied by are used for purposes not covered by
general requirements and the intent of pharmacies; infusion drugs furnished Medicare Part B. The commenter also
the Act, Federal regulations, and its through an item of DME; intravenous wanted to know if NDCs that are labeled
customary business practices. Our immune globulin (IVIG), inhalation for Medicare noncovered indications are
intent in not being prescriptive in this drugs furnished through an item of subject to the ASP reporting provisions.
area at this time is to allow DME, and separately payable drugs Response: With respect to whether a
manufacturers the flexibility to adopt a furnished by ESRD providers. Because manufacturer may exclude sales for
methodology with regard to the Medicare Part B drugs are subject to noncovered uses from its calculation of
treatment of bundled price concessions local coverage determinations (LCDs) by the ASP for an NDC and whether NDCs
in the ASP calculation that, based on the local claims processing contractors that are labeled for cosmetic or other
their particular circumstances, will best and the scope of Part B drug coverage typically noncovered use (for example,
ensure the accuracy of the ASP varies among contractors, we do not contraception) are exempt from the ASP
calculation and not create inappropriate maintain a list of all drugs covered reporting requirements, we believe the
financial incentives. under Part B at any given time in all statute provides no such exclusion.
Comment: Another commenter not changed. Some commenters stated purposes to have the same meaning as
suggested that we clarify whether that the title-holding manufacturer under the Medicaid Rebate Agreement.
manufacturers are required to report should determine which entity has the Therefore, wholesalers that relabel or
ASP data for infusion drugs ASP reporting obligation. In addition, a repackage NDCs and pharmacies must
administered via DME and for a drug commenter requested that report ASP data to the extent that they
that is usually self-administered and not manufacturers not be required to certify qualify as manufacturers for Medicaid
covered by Medicare Part B (even if ASP data that they did not have access drug rebate purposes.
Medicare utilization data suggests that to or did not generate. One commenter Comment: A few commenters
there are small levels of utilization suggested that a manufacturer’s ASP requested that we formalize our
which a manufacturer believes are reporting obligation would cease upon guidance on whether sales in the United
contractor mistakes). the transfer of the product to another States include sales to purchasers in the
Response: Section 1927(b)(3)(A)(iii) of manufacturer with control over its territories.
the Act specifies the drugs for which pricing. Response: We are not addressing this
manufacturers have to report ASP data, Response: For ASP purposes, the issue in the regulations text.
and it includes infusion drugs furnished definition of manufacturer has the same Comment: A few commenters
through an item of DME (by reference to definition set forth in section 1927(k)(5) requested that we incorporate into the
section 1842(o)(1)(D) of the Act). of the Act, which is the definition regulation our current guidance on the
Manufacturers must report ASP data for included in the Medicaid drug rebate treatment of returned units.
these drugs quarterly. statute. We believe that likewise the Response: We issued guidance on our
With respect to drugs that a ASP reporting obligation should follow Web site in September 2004 instructing
manufacturer believes are noncovered the process established under the manufacturers not to make adjustments
by Medicare despite a local claims Medicaid drug rebate program, and we to the ASP calculation to account for
processing contractor’s payments for the see no reason to establish separate returns. We stated in that guidance
drug, we are aware of one such situation guidance at this time. Further, we beginning with the data submission for
and have been working closely with the believe that manufacturers have means sales during the third quarter of 2004
manufacturer to resolve the matter. We of dealing with these issues within their and thereafter, manufacturers should
encourage manufacturers to contact us business arrangements. not subtract the value of the returns
directly so that we can consider these Comment: One commenter from the numerator of the ASP
issues on a case-by-case basis. recommended that we provide guidance calculation and should not subtract the
Comment: One manufacturer that sales between wholly-owned number of units returned from the
expressed concern that submitting ASP subsidiaries of a common parent denominator. In other words, the value
data for a noncovered drug may be company would not constitute a sale for of returns should not be included in the
viewed as a claim for coverage. ASP reporting and calculation purposes. numerator and the number of returned
Response: We do not believe that Response: We will consider the issue units should not be included in the
reporting ASP data for a drug, in the and any broader implications it may denominator when calculating the ASP
absence of other actions, would be a have for the ASP calculation, and may for a reporting quarter. This continues
claim of coverage for the drug. issue additional guidance if we be our guidance as we study the issue
Comment: A few commenters determine it is appropriate. further, but we have decided not to
requested clarification regarding when a Comment: Some manufacturers place this guidance into the regulation
manufacturer’s reporting obligation for supported maintaining the same text at this time.
an NDC ends. One commenter noted definition of manufacturer for ASP Comment: Some of the commenters
that ASP will not be a positive number purposes and for Medicaid AMP and BP noted that, at this time, manufacturers’
unless there is product sold in a quarter, purposes. Several commenters reasonable assumptions continue to be
and suggest there is no need to report requested that we formally state that an important principle in ensuring that
the ASP after the last lot is sold. wholesalers and distributors do not the calculation of ASP is appropriate.
Response: In the March 3, 2006 have to report ASP data. A retail Several commenters suggested we
Federal Register (71 FR 10975), we pharmacy chain requested that retail include in the final rule guidance we
clarified that manufacturers would no pharmacies be excluded from the have previously provided through Q&A
longer report ASP data for an NDC definition of manufacturer in so far as that in the absence of guidance
beginning the reporting period after they they repackage drugs for purposes of manufacturers may make reasonable
report the ASP data for the quarter dispensing drugs to customers under assumptions and should provide those
during which the expiration date of the state law. Similarly, a mail order assumptions in their ASP submission.
last lot sold occurs. We are aware that pharmacy requested that we clarify that Response: We agree with these
a manufacturer’s ASP will not be a mail order pharmacies are not commenters; manufacturers’ reasonable
positive value unless a reportable sale considered manufacturers. One assumptions remain an important aspect
occurs in the reporting period. However, commenter suggested that only the of ASP reporting. The complexities of
for single source drugs, manufacturers holders of the product’s New Drug each calculation can differ across
not only have a requirement to report Approval, Abbreviated New Drug manufacturers. Therefore, it is essential
ASP but also wholesale acquisition cost Approval, or Biologic License that each manufacturer examine the
(WAC). Application should be considered facts and complexities of its business
Comment: Several commenters manufacturers or repackagers for the practices and products to determine
requested that we clarify whether the purposes of reporting ASP. how it will comply with the ASP
manufacturer that holds title to the NDC Response: Under section 1847A of the reporting requirements. We posted a
is always responsible for reporting the Act, entities that fall under the frequently asked question on our Web
ASP data, and whether certain definition of manufacturers in section site to inform manufacturers of the
exceptions are permissible such as 1927(k)(5) of the Act must report ASP importance of reasonable assumptions.
when manufacturers establish licensing data. This definition is separate from the In that guidance we state, ‘‘In the
agreements or a manufacturer divests a FDA process for drug applications. We absence of specific guidance in the Act
product but the NDC’s labeler code is interpret manufacturer for ASP or Federal regulations, the manufacturer
may make reasonable assumptions in its to require that each ASP report be Comment: One commenter asked that
calculations of ASP, consistent with the certified by the manufacturer at this we clarify that the number units to be
general requirements and the intent of time. With the ASP data being the basis reported are the number of units sold
the Act, Federal regulations, and its of Medicare payment rates for the vast excluding exempted sales.
customary business practices. These majority of Part B covered drugs and Response: The commenter is correct.
assumptions should be submitted along biologicals, we believe that certification Effective with the publication of the FY
with the ASP data and the signed requirement is an important program 2007 IPPS final rule (August 18, 2006,
certification form.’’ safeguard. We acknowledge the 71 FR 47870), we revised the definition
Comment: Some commenters wanted operational constraints some of unit in § 414.802. ‘‘Unit’’ means the
to know whether data on nominal sales manufacturers may experience in product represented by the 11-digit
must be reported at this time as required obtaining certain senior executive level NDC. During the first 3 years of the CAP
under section 1927(b)(3)(A)(iii)(III) of signatures to coincide with the quarterly (as defined in § 414.902), the method of
the Act. ASP reporting deadlines, although our counting units excludes units of CAP
Response: We currently consider the experience is that nearly all drugs (as defined in § 414.902) for use
requirements of section manufacturers are able to do so without under the CAP (as defined in § 414.902).
1927(b)(3)(A)(iii)(III) of the Act for the causing a delay in reporting their ASP The CAP is the Competitive Acquisition
reporting of nominal prices for purposes data timely. for Outpatient Part B Drug and
of ASP to be met when the manufacturer Comment: Several commenters noted Biologicals which began in July 2006.
reports its ASPs, to the extent that the that the Medicaid AMP and BP can be Units of drugs sold to an approved CAP
ASPs accurately account for nominal restated within the specified time vendor for use under the CAP are
prices that are excluded from the ASP period. These commenters requested excluded from the ASP calculation.
calculation. Thus, we are not currently that we establish procedures to identify Manufacturers must report the number
requiring this information to be potentially errant ASP data and to allow of units sold after adjusting for
separately reported from the ASP. As we for corrections of ASP data. exempted sales, including exempted
gain more experience with the ASP Response: If a manufacturer has good sales known on a lagged basis.
system, we may require this information cause for resubmitting its quarterly ASP Comment: In response to the April 6,
to be separately reported in the future. data, it may do so following the 2006 IFC, a commenter stated that some
We note that our interpretation of the submission instructions available at manufacturers submit AMP and then
reporting requirement for nominal http://questions.cms.hhs.gov/cgi-bin/ restate it in subsequent periods to take
prices for purposes of ASP has no effect cmshhs.cfg. Resubmission of ASP data into account rebates. The commenter
on any Medicaid reporting requirement. does not constitute a release from requested that we provide assurance
Comment: Several commenters stated liability for failure to submit timely and that they will not be liable for
that the statute does not require accurate ASP data. misrepresentation of nominal sales, if
certification of the ASP by the Comment: Several manufacturers the manufacturer bases its nominal sales
manufacturer’s chief financial officer suggested that the reasonable on AMP for the reporting quarter and
(CFO), chief executive officer (CEO) or assumptions submitted along with the then the manufacturer modifies AMP
individual who has delegated authority ASP data be afforded the same subsequently to take into account
to sign for and reports directly to either confidential protections as specified for rebates.
the CFO or CEO. A large international the ASP data. Response: Nominal sales for ASP
manufacturer commented that it was Response: We provided guidance on purposes are calculated based on the
impractical to have ASP reports our Web site addressing this issue. That AMP for the reporting quarter. We have
certified by international executives. guidance states, ‘‘As indicated in not provided guidance on how a
Another manufacturer commented that section 1927(b)(3)(D) of the Act, as manufacturer should handle
its organizational structure did not have amended by MMA section 303(i)(4)(D), identification of nominal sales if current
executives matching the specified titles, information disclosed by the reporting quarter AMP is subsequently
and therefore, it was impossible to manufacturer in connection with the restated for Medicaid purposes. We did
comply with this requirement. Further, requirement for ASP data submission is not receive comments on this issue in
many commenters stated that it was confidential and, not withstanding other response to our request in the proposed
inappropriate to require certification of laws, shall not be disclosed by the rule regarding the method
the ASP data until sufficient guidance Secretary (or contractor therewith) in a manufacturers must use to identify
on how to calculate the ASP has been form which discloses the identity of a nominal sales. We believe that
established. A few commenters specific manufacturer or wholesaler, maunfacturers may have considered this
suggested that the certification language prices charged for drugs by such issue in making their comments in
should be revised to acknowledge that manufacturer or wholesaler, except as support of continued use of the AMP as
reasonable assumptions had been made necessary by the Secretary to carry out the basis for determining nominal sales
and to reflect the limited ability of the provisions of section 1847A or excluded from the calculation of ASP.
manufacturers to accurately estimate 1847B of the Act, and to permit the OIG, We will continue to work with
lagged price concessions and determine the Comptroller General, and the manufacturers to determine if further
whether fees were passed on in whole Director of the Congressional Budget guidance on this issue is warranted.
or in part. Another commenter stated Office to review the information With regard to the comment concerning
that the penalties for failing to report provided. http://questions.cms.hhs.gov/ liability, if the Secretary determines that
accurate ASP data are a sufficient cgi-bin/cmshhs.cfg. As is good practice a manufacturer has made a
deterrent to abuse, and the certification with any sensitive material, misrepresentation in the reporting of its
is unnecessary and should be manufacturers should clearly mark their ASP for a drug, the Secretary may apply
eliminated. reported ASP data, if applicable, to a civil money penalty as specified in

Response: Because of the indicate that the information contained section 1847A(d)(4) of the Act.
consequences for failing to submit therein is confidential, proprietary, or Comment: One commenter suggests
accurate and timely ASP data, we contains trade secrets, for example, as we explore methods of receiving ASP
continue to believe there is good reason appropriate. data by e-mail. This commenter also
recommends we include information in Response: If the Secretary determines level rather than at the 11-digit NDC
the final rule on where and how to that manufacturer has made a level.
submit ASP data. misrepresentation in the reporting of its In response to the commenter’s
Response: At this time, we do not ASP for a drug, the Secretary may apply request for clarification on a technical
permit electronic mail submission of a civil money penalty in section aspect of the methodology described
ASP data because the confidentiality of 1847A(d)(4) of the Act. above in a situation involving bundled
the ASP data would not be assured. Comment: One commenter suggested price concessions, we are clarifying in
However, we continue to explore that we consider requiring this final rule with comment that this
opportunities for enhancing the manufacturers to report ASP data policy was not intended to be guidance
efficiency of the ASP submission monthly. on the treatment of bundled price
process. Procedural information on how Response: Section 1927(b)(3) of the concessions (for example, when price
and where to submit ASP data is Act sets forth the quarterly reporting concessions on one drug are contingent
provided in a Q&A on our Web site. We requirement. We believe changes to the on the purchase of one or more other
believe it is best to provide information frequency of ASP reporting would drugs) in the ASP calculation. As
on the logistics of how and where to require a statutory change. discussed in more detail elsewhere in
submit the ASP data through our Web Comment: One commenter noted that this preamble, we have not provided
site, which can be updated more quickly for Medicaid BP determinations specific guidance on the methodology
than a regulation. manufacturers may not exempt prices manufacturers should use for the
Comment: We received comments given to State pharmacy assistance treatment of bundled price concessions
recommending we provide guidance in programs that we have not identified as in the ASP calculation. In terms of the
the final regulation on requirements a State Pharmaceutical Assistance commenter’s request for additional
related to the reporting of WAC and Program excluded from the Medicaid BP clarification on other technical aspects
urged Addendum A to be revised to and may not exclude Medicaid of the calculation described above, we
include this information. supplemental rebates that are not under believe the level of detail prescribed on
Response: In the CY 2006 PFS final an approved supplemental rebate the technical aspects of the calculation
rule, we clarified that manufacturers agreement. This commenter asked is sufficient, given the variation in price
must report WAC for all single source whether the same rule applies to concession offerings across
drugs (including new drugs) each excluding exempt sales from the ASP manufacturers.
reporting period in addition to reporting calculation. After consideration of the public
ASP. Manufacturers must report the Response: To be excluded from the comments, we are finalizing subpart J
WAC in effect on the last day of the ASP calculation, the Medicaid (§§ 414.800 through 414.806) by—(1)
reporting period. Effective July 2006, we supplemental rebates must be under an revising § 414.802 and § 414.804 as
revised the reporting template, approved supplemental rebate specified in this section of the preamble
Addendum A, to include a specific agreement authorized by us through a to this final rule with comment; and (2)
column for reporting WAC. Addendum Medicaid State plan, and the State incorporating the provisions of
A can be found on our Web site at— pharmacy assistance programs must be § 414.800 and § 414.806 as specified in
http://www.cms.hhs.gov/ identified by us as State Pharmaceutical the April 6, 2004 IFC without change.
McrPartBDrugAvgSalesPrice/. Assistance Program excluded from the
Comment: We received comments Medicaid BP. 2. Intravenous Immune Globulin (IVIG)
suggesting that we publicize the NDC– Comment: We received a comment in Comment: We received several
HCPCS crosswalk and have a process for response to the April 6, 2004 IFC, asking comments urging the continuation of
informing manufacturers of where us to provide more clarification on a the 1-year temporary preadministration-
changes have occurred, and a process methodology that we indicated related services fee for IVIG that we
for soliciting and responding to input on manufacturers should use in situations established for 2006. Commenters stated
the crosswalk. Also, they suggest where a manufacturer is unable to that there continue to be concerns with
establishing procedures so associate price concessions with IVIG access and availability and that
manufacturers can determine whether individual 11-digit NDCs. The eliminating the fee will have an adverse
we are defining package codes correctly. commenter requested information on impact on beneficiary access to care.
Response: Every quarter, we publish several technical aspects of the formula, Furthermore, some indicated that we
on the CMS Web site a crosswalk of including one scenario involving did not provide any rationale in the
NDCs to HCPCS codes. Included in the bundled price concessions. proposed rule for why the fee was no
crosswalk is information on the package Response: In the April 6, 2004 IFC longer needed.
size and package quantity that we with comment, we indicated that if a A number of commenters expressed
believe is reflected by each NDC. The manufacturer is unable to associate concerns about the adequacy of
crosswalk file provides an e-mail price concessions to the individual NDC Medicare’s drug and drug
address (sec303aspdata@cms.hhs.gov) level, the manufacturer should associate administration payment rates for IVIG,
to which individuals can send those price concessions within the and made some suggestions for changes
comments. Furthermore, as of July 2006, group of NDCs for which it can associate to these payment rates that they have
manufacturers are now required to the price concessions based on the previously expressed to us. For
report with their ASP submission percentage of sales (in dollars) for the example, some urged us to take actions
specific information on the package size group of NDCs that is attributable to such as establishing separate HCPCS
of each NDC as specified in more detail each individual NDC. This guidance codes for each IVIG product, increasing
in the Appendix A data elements guide was issued in the early stages of ASP payment for IVIG administration in
on our Web site. implementation, and was intended to physicians’ offices, and instituting a
Comment: We received comments address situations where manufacturers payment adjustment to the ASP-based
requesting clarification of how and are unable to associate price payment rates for IVIG.
when civil monetary penalties would concessions to the 11-digit NDC level One commenter provided information
apply in certain situations where ASP such as when a manufacturer reporting from a survey conducted of 800 patients
was misreported. maintains data on rebates at the drug with primary immune deficiency
syndrome. The commenter stated that rulemaking if we determine it is no We believe that continuation of this
since the beginning of 2005, Medicare longer warranted. Consequently, in temporary separate payment provided
patients receiving IVIG have been more 2007, we will temporarily allow a through G0332 in CY 2007 for the
likely than patients with other types of separate payment for each day of IVIG physician office and hospital outpatient
insurance to report a shift in site of care, administration to physicians and resources associated with additional
increased intervals between infusions, hospital OPDs that administer IVIG to IVIG preadministration-related services
reduced IVIG dosages, and adverse Medicare beneficiaries. This payment is will help facilitate beneficiary access to
health effects, and they believe that this for the extra resources expended on care in this current period where there
is the result of Medicare reimbursement locating and obtaining appropriate IVIG may be continuing market fluctuations
issues. products and on scheduling patients’ for IVIG products. At the same time, we
Response: We recognize the infusions during this time when there will continue to work with the IVIG
importance of IVIG to patients who need may continue to be transient disruptions community, manufacturers, providers,
it and we are concerned about reports of in the marketplace. In 2007, the and other stakeholders, and will be
problems with IVIG access and preadministration-related service monitoring IVIG market developments
availability. Since 2005, we have taken payment will continue to be billed and access to care closely.
several specific actions that are within under the same HCPCS code as 2006: Commenters made several suggestions
our statutory authority in response to G0332, preadministration-related for changes to Medicare IVIG-related
the IVIG concerns that have been raised, services for intravenous infusion of payments. Regarding comments
including creating separate billing codes immunoglobulin, per infusion encounter requesting the establishment of brand-
for lyophilized and non–lyophilized (This service is to be billed in specific HCPCS codes for IVIG products,
IVIG in April 2005, having discussions conjunction with administration of while HCPCS coding is outside the
with manufacturers about their ASP immunoglobulin). This payment will on scope of this rulemaking, we note that
data to confirm that their ASPs have average be about $71 per day of IVIG HCPCS coding procedures do not
been developed in accordance with administration in physicians’ offices. provide for brand-specific coding. For
applicable guidance, and for 2006 The payment for preadministration- further discussion of HCPCS coding
establishing a temporary additional related services is in addition to the procedures, see http://
payment for IVIG preadministration– separate payments Medicare makes for www.cms.hhs.gov/medicare/hcpcs/
related services to compensate the IVIG product itself and its codpayproc.asp.
physicians and hospital OPDs for extra administration. Commenters also expressed concern
resources expended on locating and regarding Medicare ASP+6 percent
obtaining appropriate IVIG products and We note that for 2007 we reviewed payment rates for IVIG, suggesting we
on scheduling patients infusions during and revised the resource based relative make an adjustment to the payment rate.
a period where there may be temporary value units crosswalk for G0332. We Section 1847(o)(1)(E) of the Act
market instability. In addition, we continue to believe the administrative specifies that the payment amount for
continue to work with manufacturers, resources associated with IVIG IVIG furnished in physicians’ offices
patient groups, and stakeholders to preadministration-related services are and the home will be the amount
understand the present situation and to similar to the clinical staff resources provided under section 1847A of the
assess potential actions that could help associated with ESRD management Act. With limited exceptions not
ensure an adequate supply of IVIG and services, where both types of services applicable here, section 1847A of the
patients receiving appropriate, high are typically conducted over the course Act specifies that the payment amount
quality care. of a month, without requiring face-to- is 106 percent of a drug’s ASP. We do
Furthermore, there are currently two face visits with clinical staff for this not have the discretion to adjust the
studies underway in HHS concerning ongoing preparation for treatment of payment rate upward by adjusting the
IVIG. The HHS Assistant Secretary for these patients. Considering the expected percentage that is added on to the ASP
Planning and Evaluation has staff resources required to prepare for to arrive at the payment rate. While
commissioned a study to better IVIG infusions for patients who require some commenters suggested we use
understand the market for IVIG and them, we believe those resources are inherent reasonableness authority to
evaluate the demand, supply, and greater than the lowest level ESRD- increase the IVIG payment rate, we do
access to IVIG. The HHS OIG is also related service described by HCPCS not believe that we have the data to
conducting a study on availability and code G0319, End stage renal disease support a determination concerning
pricing of IVIG. We anticipate that these (ESRD) related services during the inherent reasonableness. Finally, we
studies will provide more information course of treatment, for patients 20 received several comments requesting
on IVIG supply, demand, and pricing. years of age and over; with one face-to- that we classify IVIG therapy as a
With several studies on IVIG not yet face physician visit per month, but we biological response modifier. We note
completed and with comments from do not believe they are as great as those that the term ‘‘biological response
stakeholders suggesting that some required by the mid-level ESRD-related modifier’’ is used in the text preceding
beneficiaries are experiencing IVIG code G0318, End stage renal disease CY 2006 CPT codes, and as such, we
access issues such as delayed treatments (ESRD) related services during the refer commenters to the AMA CPT
and site of service shifts, we believe it course of treatment, for patients 20 Editorial Panel, as they are the creators
is appropriate to continue the temporary years of age and over; with 2 or 3 face- and maintainers of CPT codes and CPT
IVIG preadministration-related services to-face physician visits per month. code instructions.
payment into CY 2007 to help ensure Therefore, for 2007, we have
continued patient access to IVIG. We crosswalked G0332 to a 50 percent 3. Clotting Factor Furnishing Fee
will continue to review IVIG access blend of the 2007 transitional PE RVUs Section 303(e)(1) of the MMA added
during CY 2007 as additional for G0318 and G0319. As we did for section 1842(o)(5) of the Act which
information becomes available, and we 2006, we have not allocated physician requires the Secretary, beginning in CY
will discontinue this temporary work RVUs to G0332 since we do not 2005, to pay a furnishing fee, in an
preadministration-related service believe there is physician work amount the Secretary determines to be
payment during CY 2007 through associated with G0332. appropriate, to hemophilia treatment
centers and homecare companies for the For CY 2007, we proposed to specify 5. Payment for Drugs Furnished During
items and services associated with the an applicable threshold percentage of 5 CY 2006 and Subsequent Years in
furnishing of blood clotting factor. percent for the WAMP and the AMP. At Connection With the Furnishing of
Section 1842(o)(5)(C) of the Act present, the OIG is continuing its Renal Dialysis Services if Separately
specifies that the furnishing fee for comparison of both the WAMP and the Billed by Renal Dialysis Facilities
clotting factor for years after CY 2006 AMP. Currently, we do not have data In the CY 2006 PFS final rule (70 FR
and subsequent years will be equal to that suggests that another level is more 70116), we stated that payment for a
the fee for the previous year increased appropriate. Therefore, we believe that drug furnished during CY 2006 in
by the percentage increase in the continuing the 5 percent applicable connection with renal dialysis services
consumer price index (CPI) for medical threshold percentage for both the and separately billed by freestanding
care for the 12-month period ending WAMP and AMP is appropriate. renal dialysis facilities and hospital-
with June of the previous year. based facilities would be based on
The 2006 furnishing fee for clotting We received numerous comments
regarding our decision to maintain the section 1847A of the Act. For CY 2007,
factor is $0.146. The percent increase in we clarified that the policy would
the CPI for medical care for the 12- WAMP and AMP threshold at 5 percent,
extend for CY 2006 and subsequent
month period ending with June 2006 is as well as our request for comments
years until otherwise specified. We
4.1 percent. Consequently, the regarding operational issues
received comments regarding our policy
furnishing fee will be $0.152 per unit surrounding implementation of the 5 clarification of the policy, as well as our
clotting factor for CY 2007. While the percent threshold. intention to extend the policy beyond
furnishing fee payment rate is Comment: Several comments CY 2006 until otherwise specified.
calculated at 3 digits, the actual amount supported our decision to continue Comment: Several commenters
paid to providers and suppliers is using 5 percent as the threshold and supported our decision to clarify that
rounded to 2 digits. commended us for requesting comments the payment policy for separately-billed
4. Widely Available Market Prices on the important operational issues ESRD drugs applied to CY 2006 and
(WAMP) and Average Manufacturer associated with price comparisons. subsequent years until otherwise
Price (AMP) Threshold Other commenters acknowledged that specified. These commenters viewed the
that there are many operational issues current payment policy as the best
Section 1847A(d)(1) of the Act states option available under the statute, citing
that ‘‘the Inspector General of HHS shall involved with implementation of the 5
percent threshold and advised us to consistency with the methodology used
conduct studies, which may include to pay for other Part B drugs.
surveys to determine the widely proceed cautiously before adjusting
Commenters indicated that the current
available market prices (WAMP) of payment amounts. These commenters
methodology was more accurate and
drugs and biologicals to which this stated that the AMP and the ASP use
easier to administer than attempting to
section applies, as the Inspector different methodologies when
update a prior year’s acquisition cost
General, in consultation with the accounting for price concessions and data. Other commenters, while
Secretary, determines to be such differences could result in varied applauding our decision to clarify the
appropriate.’’ Section 1847A(d)(2) of the ASP and AMP values. They also policy, explicitly encouraged us to be
Act states that, ‘‘based upon such indicated that we have never issued a more direct and expressly state that the
studies and other data for drugs and final rule describing how the AMP is payment for drugs furnished in
biologicals, the Inspector General shall calculated. The commenters indicated connection with renal dialysis services
compare the ASP under this section for that such differences must be accounted and separately billed by freestanding
drugs and biologicals with— for prior to substituting the WAMP or renal dialysis facilities and hospital-
• The WAMP for these drugs and the AMP for the ASP. Commenters also based facilities will be based on ASP+6
biologicals (if any); and encouraged us to provide stakeholders percent. They indicated that stating that
• The AMP (as determined under with an opportunity to comment payment would be based on ASP+6
section 1927(k)(1) of the Act) for such through rulemaking prior to proceeding percent rather than stating that payment
drugs and biologicals.’’ with the substitutions of payment will be based on section 1847A of the
Section 1847A(d)(3)(A) of the Act allowances. Commenters were Act would avoid confusion, provide
states that, ‘‘the Secretary may disregard particularly interested in the clarity for the provider community, and
the ASP for a drug or biological that methodology utilized by the OIG in ensure consistency with current
exceeds the WAMP or the AMP for such conducting its surveys. regulatory language.
drug or biological by the applicable Response: We appreciate the
threshold percentage (as defined in Response: We understand that there commenters who acknowledge that the
paragraph 1847A(d)(3)(B)).’’ The are complicated operational issues current payment methodology is the
applicable threshold is specified as 5 associated with potential payment rate most appropriate option available. We
percent for CY 2005. For CY 2006 and substitutions. Therefore we will proceed also thank the commenters who noted
subsequent years, section cautiously and provide stakeholders, the discrepancy between the preamble
1847A(d)(3)(B) of the Act establishes particularly manufacturers of drugs language and regulatory text. We
that the applicable threshold is the impacted by potential price acknowledge that we inadvertently
percentage applied thereafter, subject to substitutions, with adequate notice of made reference to ASP+6 percent in our
such adjustment as the Secretary may our intentions regarding such, including regulatory text instead of referring to
specify for the WAMP or the AMP, or the opportunity to provide input with section 1847A of the Act. In accordance
both. In CY 2006, we specified an regard to the processes for substituting with section 1881(b)(13)(A)(iii),
applicable threshold percentage of 5 the WAMP or the AMP for the ASP. As payment for drugs furnished in 2006
percent for both the WAMP and AMP. required by statute, we are finalizing our and subsequent years will be based on
We based this decision on the limited proposal to establish the WAMP and the acquisition costs or the amount
data available to support a change in the AMP threshold at 5 percent for CY 2007. determined under section 1847A of the
current threshold percentage. Act, as the Secretary may specify. The
amount determined under section Act, and oral anti-emetic drugs used as • An update to the wage index
1847A of the Act, except in limited part of an anticancer chemotherapeutic adjustments to reflect the latest hospital
circumstances, is ASP+6 percent. regimen described in section wage data, including a BN adjustment to
Therefore, we are revising the regulatory 1861(s)(2)(T) of the Act. For 2006, we the wage index for CY 2007.
text to state that payment for a drug pay a supplying fee of $24 per We received a total of 10 comments
furnished during CY 2006 and prescription for the first prescription in from the ESRD community that
subsequent years, until otherwise a 30-day period, and $16 per represented major organizations and
specified, in connection with renal prescription for all subsequent concerned individuals. The comments
dialysis services and separately billed prescriptions in a 30-day period. and responses are summarized in the
by freestanding renal dialysis facilities Medicare also pays a special supplying following sections.
and hospital-based facilities is based on fee rate of $50 for the first Comment: Several comments focused
section 1847A of the Act. immunosuppressive prescription after a on the need to specify that payment for
Comment: MedPAC expressed Medicare covered transplant. Since we separately billable ESRD drugs in CY
concern that there is no recent evidence did not propose a change to these rates 2007 will continue at ASP +6 percent.
that ASP+6 percent reflects the variation for 2007, they will continue to be in The comments cross referenced a
in the acquisition of costs of physicians effect in 2007. section in the CY 2007 PFS proposed
and dialysis providers and thus, the Comment: We received a comment rule (71 FR 49004) that discussed
current payment rate should not be set asking that we clarify how infusion proposals for establishing the ASP rate
indefinitely. They also recommended drugs administered through DME will for WAMPs and AMP. This proposal
that in the future we periodically collect be paid in 2007, in light of the preceded the section outlining the
acquisition cost data from providers to competitive bidding program that is proposed payment changes for ESRD
gauge the appropriate percentage of ASP authorized to be phased-in beginning in facilities, and thus led to some
for the payment amount, acknowledging 2007. confusion regarding the use of the ASP-
that an analysis of this data could lead based payment methodology for
Response: Beginning in 2004, infusion
to a different percentage amount for the separately billable ESRD drug payments
drugs furnished through an item of DME
payment rate. in CY 2007.
covered under section 1861(n) of the Response: As noted in section II.E.5.,
Response: We acknowledge
Act are paid at 95 percent of the AWP entitled, ‘‘Payment for Drugs Furnished
MedPAC’s recommendations. We will
in effect as of October 1, 2003. These during CY 2006 and Subsequent Years
continue to monitor the payment
payment rates continue until such time in Connection with the Furnishing of
methodology in relation to the
as the Secretary establishes a Renal Dialysis Services if Separately
acquisition costs of physician and
competitive acquisition program for Billed by Renal Dialysis Facilities,’’ we
dialysis providers for future analysis.
these drugs in specific competitive proposed no policy changes to the
6. Other Issues acquisition areas, in which case the approach that we currently use to pay
Comment: We have received several payment rates in the competitive for separately billed ESRD drugs.
comments requesting the creation or acquisition areas will be determined Therefore, for CY 2007, payment for
revision of billing codes for certain drug under the CAP. Beginning in 2007, the separately billable drugs furnished by
products. Secretary has the authority, under ESRD facilities will continue at ASP+6
Response: Requests for the creation of section 1847 of the Act, to phase-in percent in accordance with section
new or revised billing codes for drug implementation of the competitive 1847A of the Act.
products is outside the scope of this acquisition program, which will be the Comment: We received a comment
rulemaking. There is a separate, well- subject of separate rulemaking. recommending that we implement the
established, process for the public to G. Revisions Related to Payment for MedPAC’s recommendation that the
make requests for new or revised billing Renal Dialysis Services Furnished by composite rate be equalized between
codes for drug products through the End Stage Renal Disease (ESRD) hospital-based and independent dialysis
HCPCS panel. More information on the Facilities facilities. The commenter stated that,
HCPCS coding process can be obtained notwithstanding the language under
at the following Web site: http:// In the CY 2007 PFS proposed rule (71 1881(b)(7) of the Act, we had the
www.cms.hhs.gov/MedHCPCSGenInfo/. FR 48982), we outlined the proposed statutory authority to administratively
Comment: We received a few updates to the case-mix adjusted revise the current hospital-based/
comments recommending that Medicare composite rate payment system independent facility rate structure to
increase the pharmacy supplying fee it established under section 1881(b)(12) of provide the same rate to both facility
pays for immunosuppressive, oral anti- the Act, added by section 623 of the types.
cancer, and oral-antiemetic drugs for MMA. These included updates to the Response: While section 1881(b)(7) of
2007. We also received a comment drug add-on component of the the Act provided some discretion in
suggesting that we have a process in composite rate system, as well as the establishing the initial composite
place to increase the supplying fee over wage index values used to adjust the payment rates, it did specify the need to
time so that it remains adequate. In labor component of the composite differentiate between hospital-based and
addition, we received a comment asking payment rate. other renal dialysis facilities. Therefore,
that we make clear in the final rule that Specifically, we proposed the based on our analysis of cost
we will continue to reimburse the following provisions which are differences, we established separate
supplying fee in 2007 at the 2006 rates. described in more detail below in this composite rates for hospital-based
Response: We pay a supplying fee for section. facilities and independent facilities.
Medicare Part B drugs and biologicals • A method to annually calculate the Section 1881(b)(12) of the Act, added by
eligible for a supplying fee are growth update to the drug add-on section 623(d) of MMA, established a
immunosuppressive drugs described in adjustment required by section new basic case-mix adjusted payment
section 1861(s)(2)(J) of the Act, oral 1881(b)(12) of the Act, as well as an system. The statute instructed us to use,
anticancer chemotherapeutic drugs estimated growth update adjustment to as one of the elements of the new
described in section 1861(s)(2)(Q) of the the add-on amount for CY 2007. system, the services comprising the
composite rate established under payment system that was subsequently In addition, we indicated that we
section 1881(b)(7) of the Act. We believe enacted by the DRA, effective January 1, would reconsider our methodology for
that the statute requires that we carry 2006. Since we compute the drug add- updating the drug add-on component of
forward the composite rate structure on adjustment as a percentage of the the payment system when we have
established in accordance with section weighted average base composite rate, sufficient historical data reflecting the
1881(b)(7) of the Act prior to enactment the drug add-on percentage was revised drug payment methodology
of MMA. The statute directed us to decreased to account for the higher using ASP pricing.
substitute, in place of a payment system composite payment rate resulting in a Comment: Commenters were
based solely on the composite rate 14.5 percent add-on adjustment for CY generally favorable toward using a
established under section 1881(b)(7) of 2006. This adjustment was necessary to standard index to update the drug add-
the Act, a payment system comprised of ensure that the total drug add-on dollars on adjustment, but were concerned
the original composite rate, remained constant. about the calculation of the utilization
incorporating the services included factor. They suggested that we use our
a. Estimating Growth in Expenditures National Health Expenditures (NHE)
under that composite rate, plus a drug
for Drugs and Biologicals for CY 2007 projection that uses only the Medicare
add-on component. Moreover, the 1.6
percent update established under In developing the growth update to Part B component of the projection to
section 623(a) of MMA clearly the drug add-on for CY 2006, we estimate prescription drug expenditures.
contemplated that the update would be conducted a trend analysis of prior Response: We do not believe that the
applied to ‘‘such composite rate years’ ESRD drug expenditure data Part B drug projections included in the
payment amounts * * *’’ in effect in (2001 through 2004). All 4 years of data NHE projections would be the best
the prior year. Therefore, in accordance used for the trend analysis reflected proxy for the growth in ESRD drug
with section 1881(b)(12) of the Act, we expenditures associated with payment expenditures. The NHE projections are
will continue to maintain the separate for separately billed drugs and based on the economic, demographic
composite rates for hospital-based and biologicals under the AWP and Medicare spending projections
freestanding facilities that were methodology. Therefore, we could contained in the Medicare Trustees
established under section 1881(b)(7) of develop growth estimates for CY 2006 Report, as opposed to an independent
the Act. using comparable historical expenditure forecast of economic assumptions, such
data. To extend the trend analysis for as the Global Insights projections of the
1. Growth Update to the Drug Add-On CY 2007, we would need to include PPI for prescription drugs that are used
Adjustment to the Composite Rates drug expenditure data from CY 2005. in our Medicare market basket forecasts
Section 623(d) of the MMA added However, in CY 2005, section to update many of our payment systems.
section 1881(b)(12)(B)(ii) of the Act 1881(b)(13)(A)(ii) of the Act required The NHE projection modeling approach
which required the establishment of an that we use a different drug payment is at an aggregate level. It does not
add-on to the composite rate to account methodology, based on average capture the nuances of both labor and
for changes in the drug payment acquisition costs, rather than the AWP economic markets as accurately as does
methodology stemming from enactment methodology used in prior years. the specific PPI forecast from Global
of the MMA. Section 1881(b)(12)(C) of Therefore, ESRD drug expenditure data Insights, Inc. We believe that using the
the Act provides that the drug add-on for CY 2005 are not comparable to PPI is a more accurate predictor of ESRD
must reflect the difference in aggregate expenditure data for CY 2001 through drug pricing growth. In addition, we
payments between the revised drug CY 2004 for trend analysis purposes. believe that estimating utilization from
payment methodology for separately This data issue will extend to reported ESRD claims data, as discussed
billable ESRD drugs (acquisition costs in subsequent years’ data as well since we below in this section, is superior to
CY 2005; ASP+6 percent in CY 2006) are now paying for separately billable using NHE’s Part B projections.
and the AWP payment methodology in drugs using ASP+6 percent. Because we
effect in CY 2004. do not have comparable data on which b. Estimating Growth in Per Patient
In addition, section 1881(b)(12)(F) of to base continuing trend analysis, we Drug Utilization
the Act requires that, beginning in CY decided to re-evaluate our methodology To isolate and project the growth in
2006, we establish an annual update to for updating the drug add-on per patient utilization of ESRD drugs for
the drug add-on to reflect the estimated adjustment. CY 2007, we needed to remove the
growth in expenditures for separately Section 1881(b)(12)(F) of the Act enrollment and price growth
billable drugs and biologicals furnished specifies that the drug update must components from the latest historical
by ESRD facilities. This growth update reflect ‘‘the estimated growth in drug expenditure data and consider the
applies only to the drug add-on portion expenditures for drugs and biologicals residual utilization growth. We
of the case-mix adjusted payment that are separately billable * * *’’ By proposed to use total drug expenditure
system. referring to ‘‘expenditures’’, we believe data from CYs 2004 and 2005 to
The CY 2006 drug add-on adjustment the statute contemplates that the update estimate per patient utilization growth
to the composite rate is 14.5 percent. would account for both increases in for CY 2007.
The drug add-on adjustment for CY drug prices, as well as increases in We first estimated total drug
2006 incorporates an inflation utilization of those drugs. expenditures. For the CY 2007 PFS
adjustment of 1.4 percent. This In order to meet this requirement, we proposed rule (71 FR 49007), we used
computation is explained in detail in proposed an update methodology that the final CY 2004 ESRD facility claims
the CY 2006 PFS final rule with uses the producer price index (PPI) for data and the latest available CY 2005
comment period (70 FR 70162). We note prescription drugs as a proxy measure of ESRD facility claims data, updated
that the drug add-on adjustment of 14.7 drug pricing growth, in conjunction through December 31, 2005. That is, for
percent that was published in the CY with an estimate of per patient growth CY 2005 we used claims that were
2006 PFS final rule with comment in drug utilization. We proposed to received, processed, paid, and passed to
period did not account for the 1.6 estimate growth in per patient the National Claims History File as of
percent update to the composite rate utilization of drugs by using historical December 31, 2005. For this final rule
portion of the basic case-mix adjusted data from 2004 and 2005. with comment period, we are using
more updated CY 2005 claims with The result was a proposed utilization the Part B enrollment growth included
dates of service for the same time factor equal to 1.00 ((0.91/1.03)/0.88) = in the 2006 Trustees Report.
period. This updated CY 2005 data file 1.0). Response: The 3 percent enrollment
includes claims that were received, We observed no growth in per patient growth projection represents the
processed, paid, and passed to the utilization of drugs between 2004 and estimated growth factor specific to
National Claims History File as of June 2005. Therefore, we projected no growth dialysis patients between CY 2004 and
30, 2006. in per patient utilization for CY 2007. CY 2005.
For the proposed rule, we adjusted Comment: On commenter suggested Comment: One comment expressed
the December 2005 file to reflect our that we should use the drug expenditure concern that we were basing payment
estimate of what the total drug weights we developed in computing the policy on the assumption that the new
expenditures would be using the final drug add-on adjustment related to ASP EPO monitoring policy would decrease
June 30, 2006 bill file for CY 2005. The pricing for 2006, rather than the weights utilization of drugs.
net adjustment we applied to the CY developed by the OIG with respect to Response: The determination of the
2005 claims data was an increase of 13 acquisition costs for 2005. This would CY 2007 update was not based on an
percent to the December 2005 have resulted in an overall price assumption that the new EPO
expenditure data. For this final rule, we reduction of 13.2 percent rather than the monitoring policy would decrease
are using the CY 2005 claims file as of utilization. The discussion of the EPO
overall reduction of 12 percent we used
June 30, 2006, which represents the monitoring policy was only intended to
in our calculation.
final claims file for that year. Next, we illustrate the need to use the latest data
Response: We believe it would be
removed the enrollment and price available to determine utilization,
more appropriate to use the published
growth components from total estimated especially since new policies such as
OIG weights as they represent the
drug expenditures for CYs 2004 and the EPO monitoring could affect
weights that were used to develop the
2005. utilization growth in the future. The
2005 drug add-on adjustment. If we potential effect of the monitoring policy
To calculate the per patient utilization
were to use updated weights, it would was not incorporated into the
growth, we removed the enrollment
be more appropriate to use actual 2005 computation of the CY 2007 adjustment
component by using the growth in
weights. Preliminary analysis suggests factor.
enrollment data between 2004 and 2005.
that if we were to develop weights based
This was approximately 3 percent. To i. Applying the Growth Update to the
on the most recent 2005 expenditure
remove the price effect, we used a two-
data, the resulting price reduction factor Drug Add-On Adjustment
step process. For the proposed rule, we
would be well under 13.2 percent. For CY 2006, we estimated the growth
first calculated a weighted average
between erythopoeitin (EPO) and non- However, as discussed above in this update by trending drug expenditures
EPO price growth factors to account for section, we believe the price reduction forward based on four years of AWP
the growth in pre-MMA pricing between calculation should be consistent with payment data (CY 2001 through CY
2004 and 2005. Since EPO was priced the calculation used to develop the 2005 2004). We then applied the estimated
at $10 per thousand units prior to the drug add-on adjustment. Therefore, for growth update percentage to the total
implementation of the MMA, there was this final rule with comment we are amount of drug add-on dollars
no growth for EPO between 2004 and using the same 12 percent price established for CY 2005 to come up with
2005. For the non-EPO drugs, we used reduction factor calculated in the a dollar amount for the CY 2006 growth
the PPI as a proxy for the growth proposed rule. update. In addition, we projected the
between the 2 years to maintain Comment: One commenter indicated growth in dialysis treatments for CY
consistency with the established that their analysis resulted in a slightly 2006 based on the projected growth in
methodology for calculating the drug different value for the reduction in total ESRD enrollment. We divided the
add-on adjustment for CY 2005 which drug expenditures than we calculated projected total dialysis treatments for
used the PPI to estimate the price between 2004 and 2005. Rather than the CY 2006 into the projected dollar
growth in separately billable drugs (69 9 percent reduction we calculated for amount of the CY 2006 growth to
FR 66321). For the proposed rule, we the proposed rule, this commenter develop the per treatment growth
next incorporated the estimated computed a 9.198 percent reduction update amount. This growth update
negative 13 percent weighted price using the 2004 5 percent sample file amount, combined with the CY 2005 per
difference between 2005 AWP and 2005 compared to the 2005 ESRD file. treatment drug add-on amount, resulted
AAP pricing as was published in the CY Response: Although the 2004 5 in an average drug add-on amount per
2005 PFS final rule with comment percent file may have contained a treatment of $18.88 (or a 14.5 percent
period (69 FR 66319 through 66334). significant number of ESRD claims, our adjustment to the composite rate) for CY
This two-step process accounts for the analysis uses 100 percent of the 2004 2006.
price effect from 2004 to 2005, that is, ESRD facility claims. As such, we Beginning in CY 2007, we proposed to
an overall 12 percent reduction in price believe the results calculated by the annually update the per treatment drug
between 2004 and 2005. commenter are consistent with our add-on amount of $18.88 established in
For the proposed rule, following the results, but that slight differences would CY 2006 and convert the update to an
removal of the enrollment and price be expected when an incomplete file is adjustment factor as stipulated in
effects from the expenditure data, we used. For the final rule, using the latest, section 1881(b)(12)(F) of the Act. By
expected the residual growth to reflect complete ESRD claims file for CY 2005 proposing to apply the update to the CY
the per patient utilization growth. To (June 30, 2006), we computed a 9.5 2006 per treatment add-on amount, the
remove the enrollment and price effects, percent reduction in total ESRD facility need to estimate growth in dialysis
we divided the product of the drug expenditures between CY 2004 and treatments is eliminated for CY 2007
enrollment growth of 3 percent (1.03) CY 2005. and future years.

and the price reduction of 12 percent Comment: We received one comment We received no comments on this
(1.00 ¥ 0.12 = 0.88) into the total drug that the source of the 3 percent proposed change and are therefore
expenditure decrease between 2004 and enrollment growth we projected for CY adopting this provision in this final
2005 of 9 percent (1.00 ¥ 0.09 = 0.91). 2007 was unclear, and did not match rule.
ii. Update to the Drug Add-On adjustment would no longer be 2004 and 2005 of 9.5 percent
Adjustment necessary. (1.0¥0.095 = 0.0905). The result is a
Response: We have not accepted this utilization factor equal to 1.0 ((0.905/
In the proposed rule, we estimated no
recommendation. While we appreciate 1.03)/0.88) = 1.0).
growth in per patient utilization of
the concern related to accuracy of an Using the projected growth of the CY
ESRD drugs for CY 2007. Using the
update based on proxy measures for 2007 PPI for prescription drugs of 4.03
projected growth of the CY 2007 PPI for
price and the proposed utilization percent, we projected that the combined
prescription drugs of 4.9 percent, we
computations, the very nature of growth in per patient utilization and
projected that the combined growth in
estimating future expenditures under a pricing for CY 2007 would result in an
per patient utilization and pricing for
prospective payment system requires update equal to the PPI growth or 4.03
CY 2007 would result in an update
that those estimates are based on the percent (1.0 × 1.0403 = 1.0403). This
equal to the PPI growth or 4.9 percent
best historical data available. As such, update factor was applied to the CY
(1.0 × 1.049 = 1.049). This proposed we believe we have met our obligation 2006 average per treatment drug add-on
update factor was applied to the CY under the statue in estimating the amount of $18.88 (reflecting a 14.5
2006 average per treatment drug add-on growth in ESRD drug expenditures for percent adjustment in CY 2006),
amount of $18.88 (reflecting a 14.5 CY 2007. Moreover forecast error resulting in a weighted average increase
percent adjustment in CY 2006), adjustments are rarely made in any of to the composite rate of $0.76 for CY
resulting in a proposed weighted CMS’ prospective payment systems. 2007 or a 0.5 percent increase in the CY
average increase to the composite rate of We also note that even after ASP 2006 drug add-on percentage. Thus, the
$0.93 for CY 2007 or a 0.6 percent expenditure data become available for total drug add-on adjustment to the
increase in the CY 2006 drug add-on purposes of using trend analysis to composite rate for CY 2007, including
percentage. Thus, the total proposed estimate future expenditures, those the growth update, is 15.1 percent
drug add-on adjustment to the estimates may not be the same as actual (1.145 × 1.005 = 1.151).
composite rate for CY 2007, including expenditures. That could also be the
the growth update, was 15.2 percent case for the 2006 update currently in c. OIG Report on New Drug Codes
(1.145 × 1.006 = 1.152). effect. While the commenters are not Section 623(c)(1) of the MMA
In addition, we proposed to continue suggesting that we revisit the 2006 mandated that the OIG conduct two
to use this method to estimate the update, we believe that once we set the studies to determine the difference
growth update to the drug add-on policy of adjusting any year’s estimated between the Medicare payment amount
component of the case-mix adjusted update, we would need to do so for all for separately billable ESRD drugs and
payment system until we have at least years, not just those covered by the the facilities’ acquisition costs for these
3 years worth of ASP-based historical proposed interim update methodology. drugs, as well as estimating the growth
drug expenditure data that could be Comment: One commenter wanted an rate of expenditures for these drugs. The
used to conduct a trend analysis to update on the steps we were taking to initial study, ‘‘Medicare Reimbursement
estimate the growth in drug obtain drug utilization data from for Existing End Stage Renal Disease
expenditures. Given the time lag in the hospital-based ESRD facilities for Drugs’’ (OEI–03–04–00120), was
availability of ASP drug expenditure purposes of refining the drug add-on completed in May 2004, and reported
data, we expect that the earliest we adjustment related to those providers. In on existing ESRD drugs. This report was
could consider using trend analysis to last year’s final rule we indicated that used to set the CY 2005 payment rates
update the drug add-on adjustment we would pursue options for obtaining for ESRD drugs billed by independent
would be 2010. We proposed to that data (70 FR 70163). dialysis facilities (69 FR 66322). The
reevaluate our methodology for Response: We have determined that a second study (‘‘Medicare
estimating the growth update at that separate data collection of historical Reimbursement for New ESRD Drugs’’
time. drug dosing data for hospital based (OEI–03–06–00200)) focused on new
Comment: We received comments facilities would be both burdensome drugs. New drugs for the purpose of this
requesting clarification concerning the and costly. Therefore, we decided not to study were defined as an ESRD drug
PPI projections we use in calculating the pursue that avenue for estimating the that did not have a billing code prior to
growth update to the drug add-on drug add-on amount related to those January 1, 2004.
adjustment. facilities. However, once we have 2006 One drug, darbepoetin alfa (Aranesp)
Response: We use the PPI for ASP data, we will evaluate the accounted for the majority of all
prescription drugs developed by Global difference in payments to hospital-based payments for new drugs. Therefore, this
Insight for the fourth quarter of 2007, ESRD facilities under cost was the only new ESRD drug studied.
which represents a four quarter average reimbursement compared to ASP-based The OIG report found that use of this
percent change projection between 2006 payments to determine if our drug add- drug was limited to a small number of
and 2007. For the final rule we are using on estimate was reasonable. facilities (only 157 facilities reported
the latest projection for 2007 which is using this drug with concentrated use in
4.03 percent. iii. Final Growth Update to the Drug approximately 55 of these facilities).
Comment: A number of comments Add-On Adjustment for 2007 Because of the recent changes we made
recommended that a mechanism be Similar to the proposed rule, we to the drug payment methodology and
established to provide for forecasting estimated no growth in per patient the lack of comparable historical data,
error adjustment of prior estimates. This utilization of ESRD drugs for CY 2007. the OIG report made no estimate of an
adjustment would be applied only for We removed the enrollment and price expenditure growth rate for this drug.
the years covered by the proposed effects from the expenditure data to Darbepoetin alfa (Aranesp) is
interim methodology for updating the determine the per patient utilization currently paid as a separately billable
drug add-on adjustment. The comments growth. To do this, we divided the drug at ASP+6 percent. Because of the
suggest that once stable expenditure product of the enrollment growth of 3 recent (CY 2006) implementation of the
data is available to use historical trend percent (1.03) and the price reduction of ASP+6 percent drug payment
analysis for updating the drug add-on 12 percent (1.00¥0.12 = 0.88) into the methodology, the small number of
adjustment, the forecast error total drug expenditure decrease between facilities using this drug for ESRD
patients, and the lack of historical data index values based on FY 2003 hospital rural Massachusetts. For CY 2007, we
for trending purposes, we have no data data see the FY 2007 IPPS final rule proposed to continue to use this value
to indicate that any difference in entitled, ‘‘Changes to the Hospital and requested public input on an
payment methods for Aranesp (between Inpatient Prospective Payment Systems alternative methodology.
CY 2004 and CY 2006) would affect our and Fiscal Year 2007 Rates,’’ (71 FR Since there may be additional rural
calculation of the drug add-on or of the 48016). Section F of the preamble to that areas in the future similarly impacted by
growth update. Moreover, since Aranesp final rule describes the cost report a lack of hospital wage data on which
was approved in 2001 for use in ESRD schedules, line items, data elements, to derive a hospital wage index, we
patients, we believe that expenditures adjustments, and wage index stated that we were considering
for Aranesp were reflected in the computations. The wage index data alternative methodologies for imputing
historical data used to establish the CY affecting ESRD composite rates for each a rural wage index for areas in States
2005 drug add-on under a generic drug urban and rural locale may also be where no hospital wage data are
code. Therefore, we proposed to make accessed on the CMS Web site at: available. We also described an
no additional changes to the drug add- http://www.cms.hhs.gov/ alternative methodology whereby we
on adjustment for CY 2007. We received AcuteInpatientPPS/WIFN/list.asp. The would impute a rural wage index value
no comments on this issue. wage data are located in the section by using a simple average CBSA-based
entitled, ‘‘FY 2007 Final Rule rural wage index value at the Census
2. Update to the Geographic Division level. For CY 2007, hospital
Occupational Mix Adjusted and
Adjustments to the Composite Rates wage data are not available to compute
Unadjusted Average Hourly Wage and
Section 1881(b)(12)(D) of the Act, Pre-Reclassified Wage Index by CBSA’’. a rural wage index for ESRD facilities in
added by section 623(d) of the MMA, Comment: One commenter criticized rural Massachusetts, and this proposed
gave the Secretary the authority to our use of hospital wage and alternative methodology could be
revise the wage indexes previously employment data to develop the ESRD applied in this case. Massachusetts is
applied to the ESRD composite rates. wage index. The commenter maintained located in Census Division I (New
The wage indexes are calculated for that the use of hospital data presumed England).
each urban and rural area. The purpose that wage levels in hospitals and Under this proposed alternative
of the wage index is to adjust the freestanding ESRD facilities are similar, methodology, the States in Census
composite rates for differing wage levels a conclusion which has not been Division I for which rural wage index
covering the areas in which ESRD substantiated. The commenter urged us values are available would be used; this
facilities are located. to locate an alternative data source that would result in a simple average
reflects information directly tied to proposed rural wage index value of
a. Updates to the CBSA Definitions 1.0227 (1.0770 after applying BNF).
ESRD facilities.
In the CY 2007 proposed rule (71 FR Response: Although the mix of Rural Puerto Rico is similar to rural
49008), we published revised CBSA- occupations in hospitals is broader and Massachusetts in that there are ESRD
based geographic areas which reflected more diverse, ESRD facilities compete facilities where there are no acute care
all of the changes announced by OMB with hospitals for labor. While the use hospitals and, therefore, no hospital
in Bulletins 05–02 and 06–01 issued of wage and employment data from data. However, the situation for
February 22, 2005 and December 5, freestanding ESRD facility cost reports facilities in rural Puerto Rico is different
2005, respectively. Those bulletins would result in the development of a in that the floor would be applied to
changed the titles of several of the wage index which reflected ESRD wage rural Puerto Rico ESRD facilities. All
MSAs and Metropolitan Divisions used levels among independent facilities, the areas in Puerto Rico that have an index
in connection with the urban wage administrative burden posed by the are eligible for the floor because they
index. need for the Medicare fiscal have wage-index values that are less
intermediaries to engage in a separate than 0.8000. For CY 2007, we proposed
b. Updated Wage Index Values to apply the floor to rural Puerto Rico.
data collection to compile, edit, and
In the CY 2006 PFS final rule with validate ESRD wage and employment The third situation involves an urban
comment period, we stated that we data would be considerable. Given the area in Hinesville, GA (CBSA 25980).
intended to update the wage index similarity of the labor market for For CY 2006, we used a wage index
values annually (70 FR 70167). Current professional, technical, and nursing staff value based on the average of the wage
ESRD wage index values for CY 2006 between hospitals and ESRD facilities, index values in all of the other urban
were developed from FY 2002 wage and we believe our use of hospital wage and areas within the same State to serve as
employment data obtained from the employment data obtained from the a reasonable proxy for the urban areas
Medicare hospital cost reports. The Medicare cost reports to develop the without hospital wage index data.
values are calculated without regard to ESRD wage index is appropriate. Specifically, we used the average wage
geographic reclassifications authorized index value for all urban areas within
under sections 1886(d)(8) and (d)(10) of (i) Wage Index Values for Areas With No the State of Georgia as the urban wage
the Act and utilize pre-floor hospital Hospital Data index for purposes of calculating the
data that is unadjusted for occupational In CY 2006, while adopting the CBSA value for Hinesville for CY 2006. For CY
mix. designations, we identified a small 2007, we proposed to continue using
The methodology for calculating the number of ESRD facilities in both urban this method for Hinesville, GA (CBSA
CY 2006 wage index values was and rural geographic areas where there 25980).
described in the CY 2006 PFS final rule is no hospital wage data on which to We solicited comments on
with comment period (70 FR 70168). We base the calculations of the CY 2006 maintaining our current policy for
proposed to use the same methodology ESRD wage index values. establishing wage index values for rural
for CY 2007, with the exception that FY The first situation was rural and urban areas without hospitals or
2003 hospital data will be used to Massachusetts. Because there were no adopting an alternative approach. We
develop the CY 2007 ESRD wage index reasonable proxies for rural data within also indicated that we would continue
values. For a detailed description of the Massachusetts, we used the prior year’s to evaluate existing hospital wage data
development of the CY 2007 ESRD wage acute care hospital wage index value for and, possibly, wage data from other
sources, such as the Bureau of Labor • For rural Puerto Rico, we will apply a 50/50 blend between an ESRD
Statistics, to determine if other the CY 2007 ESRD wage index floor. facility’s MSA-based composite rate,
methodologies of imputing a wage index • For Hinesville, GA (CBSA 25980), and its CY 2007 CBSA-based rate
value where hospital wage data are not we will use the average wage index reflecting its revised wage index values.
available may be feasible. value for all urban areas within the State
For CY 2007, we are reducing the
We received no comments on of Georgia as the urban wage index for
maintaining our current policy for wage index floor to 0.80. As we stated
purposes of calculating the value for
establishing wage index values for rural Hinesville for CY 2007. in the CY 2006 PFS final rule with
and urban areas without hospitals, or an comment period, we intend to reassess
(ii) Second Year of the Transition the continuing need for a wage index
alternative approach for developing
wage index values for rural areas For each transition year, the share of floor in CY 2008 and CY 2009 (70 FR
without hospitals for CY 2007 and the blended wage-adjusted base 70169 through 70170). The wage index
subsequent years. Therefore, for CY payment rate that is derived from the floors, caps, and blended shares of the
2007, we will maintain our current MSA-based and CBSA-based wage composite rates applicable to all ESRD
policies for establishing wage index index values is shown in Table 10. In facilities during CYs 2007 through 2009
values for rural and urban areas: the CY 2007 PFS proposed rule, we are shown in Table 10. They are
• For rural Massachusetts, we will proposed no changes to the transition. identical to the values shown in Table
continue to use the prior year’s acute CY 2007 is the second year of the 4-year 20 of the CY 2006 PFS final rule with
care hospital wage index value for rural transition period. Consistent with the comment period (70 FR 70170) for the
Massachusetts. transition blends, we are implementing applicable years.
TABLE 10.—WAGE INDEX TRANSITION BLEND

Old MSA New CBSA
CY payment Floor Ceiling (percent) (percent)
2007 .................................................. 0.80* ................................................. None ................................................. 50 50

2008 .................................................. Reassess .......................................... None ................................................. 25 75
2009 .................................................. Reassess .......................................... None ................................................. 0 100
*Each wage index floor is multiplied by a BN adjustment factor. For CY 2007 the BN adjustment is 1.052818 resulting in an actual wage index
floor of 0.8423.
The following is an example of how for CY 2007 does not change in CYs ability of dialysis facilities to recruit and
the wage-adjusted composite rates 2008 and 2009. In actuality, the wage- retain qualified personnel.
would be blended during CY 2007 and adjusted composite rate would change Response: We believe that the ESRD
the 2 subsequent transition years. because of annual revisions to the wage wage index should not be artificially
Example: An ESRD facility has a index. However, the example serves constrained by the application of floors
wage-adjusted composite rate (without only to demonstrate the effect on the and ceilings. We eliminated the cap of
regard to any case-mix adjustments) of composite rate of the CBSA-based wage 1.30 because of the effect it had on
$135.00 per treatment in CY 2006. Using index values which will be phased-in restricting payments in high wage areas.
CBSA-based geographic area during the remaining 3 years of the While we would like to eliminate the
designations, the facility’s CY 2007 transition period. floor as well, we recognized that its
wage-adjusted composite rate, reflecting Comment: One commenter immediate elimination could
its wage index value as shown in representing a number of dialysis substantially reduce composite
Addendum H, would be $145.00. facilities in Puerto Rico disagreed with payments in locales where prevailing
During the remaining 3 years of the 4- our proposal to reduce the wage index labor costs are lower. Accordingly, in
year transition period to the new CBSA- floor to 0.80, pointing out that wage CY 2006 we implemented a reduction in
based wage index values, this facility’s index values have not been realistically the wage index floor to 0.85, and
blended rate through CY 2009 would be updated in quite some time. The proposed a further reduction to 0.80 in
calculated as follows: commenter was concerned with further CY 2007. We plan to reassess the
CY 2007 = (0.50 $135.00) + (0.50 × reductions in composite payments and continuing application of the wage
$145.00) = $140.00 recommended that the reduction in the index floor in connection with the CY
CY 2008 = (0.25 × $135.00) + (0.75 × wage index floor for CY 2007 be 2008 and CY 2009 updates to the
$145.00) = $142.50 suspended. Another commenter also composite payment rates.
CY 2009 = (0.00 × $135.00) + (1.00 × recommended that the impact of any The actual wage index values for
$145.00) = $145.00 further planned proposed reductions in urban locales in Puerto Rico, without
We note that this hypothetical the wage index floor be thoroughly application of any floor and prior to the
example assumes that the calculated considered before implementation application of the CY 2007 the BN
wage-adjusted composite rate of $145.00 because of potential impact on the adjustment, are shown in Table 11.
TABLE 11.—WAGE INDEX VALUES FOR URBAN LOCALES IN PUERTO RICO

CBSA code Urban area Wage index
10380 ................ Aguadilla-Isabela-San Sebastian ......................................................................................................................... 0.3922

21940 ................ Fajardo .................................................................................................................................................................. 0.4044
25020 ................ Guayama .............................................................................................................................................................. 0.3241
32420 ................ Mayaguez ............................................................................................................................................................. 0.3857
38660 ................ Ponce .................................................................................................................................................................... 0.4851
TABLE 11.—WAGE INDEX VALUES FOR URBAN LOCALES IN PUERTO RICO—Continued

CBSA code Urban area Wage index
41900 ................ San German-Cabo Rojo ....................................................................................................................................... 0.4893

41980 ................ San Juan-Caguas-Guaynabo ............................................................................................................................... 0.4397
49500 ................ Yauco .................................................................................................................................................................... 0.3861
The proposed CY 2007 wage index adjustments described earlier in this 2005. For more information on this file,
floor of 0.80 is substantially higher than section. Because the ESRD wage index see the following link: http://
each of the above wage index values. is only applied to the labor-related www.cms.hhs.gov/IdentifiableDataFiles/
After application of the BN adjustment portion of the composite rate, we 05.asp#TopOfPage.
to the wage index floor of 0.80, each computed the proposed BNF adjustment After the publication of this final rule
area in Puerto Rico has a wage index of based on that proportion (53.711 with comment period, we intend to
0.8423 reflected in its composite rate. percent). make available the updated version of
Therefore, we believe that the CY 2007 To compute the proposed CY 2007 the CY 2005 outpatient claims (paid and
wage index floor of 0.80 compared to wage index BNF, we used the proposed processed as of June 30, 2006) that were
actual wage levels will not adversely wage index values, 2005 outpatient used to compute the BNF.
affect access to care for dialysis patients claims (paid and processed as of To compute the final CY 2007 ESRD
in Puerto Rico. December 31, 2005), and geographic wage index BNF, we used FY 2003 pre-
With respect to the commenter’s location information for each facility. floor, pre-reclassified, non-occupational
concern that the wage index values have Using treatment counts from the 2005 mix-adjusted hospital wage data to
not been updated in quite some time, claims and facility-specific CY 2006 compute the wage index values, 2005
we point out that the CY 2007 wage composite rates, we computed the outpatient claims (paid and processed
index values were developed from the estimated total dollar amount each as of June 30, 2006), and geographic
latest available FY 2003 hospital wage ESRD provider would have received in location information for each ESRD
and employment data obtained from the CY 2006 (the first year of the 4-year facility which may be found through
Medicare cost reports. While we will transition). The total of these payments Dialysis Facility Compare. The FY 2003
not suspend application of the proposed became the target amount of hospital wage index data for each urban
0.80 wage index floor in CY 2007, we expenditures for all ESRD facilities for and rural locale by CBSA may also be
intend to carefully assess the potential CY 2007. Next, we computed the accessed on the CMS Web site at:
impact of any further proposed estimated dollar amount that would http://www.cms.hhs.gov/
reductions in the wage index floor for have been paid to the same ESRD AcuteInpatientPPS/WIFN/list.asp. The
CY 2008 and following years. facilities using the ESRD wage index for wage index data are located in the
CY 2007 (the second year of the 4-year section entitled, ‘‘FY 2007 Final Rule
c. Budget Neutrality (BN) Adjustment
transition). The total of these payments Occupational Mix Adjusted and
Section 1881 (b)(12)(E)(i) of the Act, became the second year new amount of Unadjusted Average Hourly Wage and
as added by section 623(d) of the MMA, wage-adjusted composite rate Pre-Reclassified Wage Indexes by
requires that any revisions to the ESRD expenditures for all ESRD facilities. CBSA’’.
composite rate payment system as a After comparing these dollar amounts Dialysis Facility Compare can be
result of the MMA provision (including (target amount divided by second year found by going to the following CMS
the geographic adjustment) be made in new amount), we calculated an Web site: http://www.cms.hhs.gov/
a budget neutral manner. This means adjustment factor that, when multiplied DialysisFacilityCompare/.
that aggregate payments to ESRD by the applicable CY 2007 ESRD wage Using treatment counts from the latest
facilities in CY 2007 should be the same index, would result in aggregate 2005 claims file and facility-specific CY
as aggregate payments that would have payments within the target amount of 2006 composite rates, we computed the
been made if we had not made any composite rate expenditures. The estimated total dollar amount each
changes to the geographic adjusters. We proposed BN adjustment factor for the ESRD provider would have received in
note that the BN adjustment discussed CY 2007 wage index was 1.053069. CY 2006 (the first year of the 4-year
in this final rule only addresses the To ensure BN we also must apply the transition). The total of these payments
impact of changes in the geographic BNF to the wage index floor of 0.8000 became the target amount of
adjustments. A separate BN adjustment which resulted in a proposed adjusted expenditures for all ESRD facilities for
was developed for the case-mix wage index floor of 0.8425 for CY 2007. CY 2007. Next, we computed the
adjustments, currently in effect. Since Comment: We received comments estimated dollar amount that would
we did not propose any changes to the asking that we clarify the calculation of have been paid to the same ESRD
case-mix measures for CY 2007, the the wage index BNF so that commenters facilities using the ESRD wage index for
current case-mix BN will remain in could understand that the BNF is being CY 2007 (the second year of the 4-year
effect for CY 2007. For CY 2007, we calculated correctly. One commenter transition). The total of these payments
again proposed to apply a BNF directly asked that we provide both the data and became the second year new amount of
to the ESRD wage index values, as we the methodology so that they could wage-adjusted composite rate
did in CY 2006. As we explained in the assess the accuracy of our computations. expenditures for all ESRD facilities.
CY 2006 PFS final rule with comment Response: During the comment period After comparing these dollar amounts
period (70 FR 70170 through 70171), we on the CY 2007 PFS proposed rule, we (target amount divided by second year
believe this is the simplest approach made available an ESRD Composite new amount), we calculated an
because it allows us to maintain our Payment System File. This file adjustment factor that, when multiplied
base composite rates during the contained select claim level data from by the applicable FY 2007 wage index
transition from the current wage the 2005 ESRD facility outpatient value, will result in aggregate payments
adjustments to the revised wage claims, updated through December 31, to ESRD facilities that will remain
within the target amount of composite where a reassignment has occurred we amended § 424.80(d) to provide that
rate expenditures. When making this under a contractual arrangement. We a supplier, who reassigns his or her
calculation, the ESRD wage index floor also stated that we were concerned right to bill Medicare to an entity with
value of 0.8000 is used whenever about the existence of certain which he or she is employed as an
appropriate. arrangements that are not within the independent contractor, has the right to
The final BN adjustment factor for the intended purpose of our physician self- access the entity’s billing information
CY 2007 wage index is 1.052818. referral rules, which allow physician concerning the services the supplier is
To ensure BN we also must apply the group practices to bill for services alleged to have performed and for which
BNF to all index values, including the furnished by a contractor physician in a the entity billed Medicare. We extended
wage index floor of 0.8000, which ‘‘centralized building’’ as defined at such a right in order to give added
results in an adjusted wage index floor § 411.351. We are concerned that assurance that the services for which
of 0.8423 for CY 2007. allowing physician group practices or such an entity billed Medicare were in
other suppliers to purchase or otherwise fact performed and were performed as
d. ESRD Wage Index Tables
contract for the provision of diagnostic billed. In the CY 2007 PFS proposed
Addenda F and G show the CY 2007 tests and then to realize a profit when rule, we stated that we believe that
ESRD wage index, including the BNF billing Medicare may lead to patient and employees, in addition to independent
adjustment, for urban areas (Addendum program abuse in the form of over contractors, should have access to
F) and rural areas (Addendum G). utilization of services and result in records on billings for services
H. Private Contracts and Opt-Out higher costs to the Medicare program. furnished by them (71 FR 49057 through
Provision—Practitioner Definition We proposed to amend our 49058). We proposed changing the title
reassignment regulations to clarify how of § 424.80(d) and amending
Section 4507 of the BBA amended the purchased test and purchased § 424.80(d)(2) of our regulations to state
section 1802 of the Act to permit certain interpretation rules apply in the case of that the individual supplier who
physicians and practitioners to opt-out a reassignment made under the reassigns his or her right to bill and
of Medicare if certain conditions were contractual arrangement exception set receive Medicare payment to an entity
met, and to provide through private forth at § 424.80(d)(2). In addition, we has unrestricted access to claims
contracts services that would otherwise proposed to change the definition of information submitted by that entity for
be covered by Medicare. Before ‘‘centralized building’’ at § 411.351 of services furnished by the individual
enactment of the BIPA (Pub. L. 106– the physician self-referral regulations to supplier, irrespective of whether the
554), section 1802(b)(5)(C) of the Act, place certain restrictions on what types supplier is an employee or an
which refers to the definition of of space ownership or leasing independent contractor of the entity
‘‘practitioner’’ at section 1842(b)(18)(C) arrangements will qualify for purposes receiving payment. Under our proposal,
of the Act, did not include registered of the physician self-referral in-office if an entity receiving the reassigned
dietitians or nutrition professionals ancillary services exception and benefits were to refuse to provide the
among the practitioners who may physician services exception. We billing information to the employee
choose to opt-out of Medicare. Section received numerous comments on our supplier requesting the information, the
105(d) of the BIPA amended the proposals. Instead of issuing final entity’s right to receive reassigned
definition of practitioner located at regulations at this time, we are studying benefits could be revoked under
section 1842(b)(18)(c) of the Act to the issues further and plan to issue final § 424.82(c)(3) (which is currently the
include registered dietitians or nutrition regulations in the near future. We case with respect to an entity’s refusal
professionals. Because section remain committed to addressing to provide billing information to an
1802(b)(5)(C) of the Act references revenue-driven arrangements that may independent contractor supplier).
section 1842(b)(18)(c) of the Act in order be facilitating over utilization of We are adopting the proposal without
to define the term practitioner for diagnostic services, but do not wish to modification.
purposes of opting out of Medicare, unduly impact legitimate group practice Comment: Two commenters who
current law permits registered dietitians arrangements that enable Medicare support the proposal stated they are
or nutrition professionals to opt-out of beneficiaries to have the convenience of unsure how having unrestricted access
Medicare. Because the definition of receiving medical services at one to submitted claims data will
practitioner located at § 405.400 does location. correspond to improved program
not include registered dietitians or integrity. They believe that a more
J. Supplier Access to Claims Billed on practical approach to ensure Medicare
nutrition professionals, we proposed to
Reassignment program integrity would be to
amend that section so that it is
consistent with section 1802(b)(5)(C) of Section 1842(b)(6) of the Act generally incorporate physician involvement in
the Act. provides that Medicare may pay Part B compliance programs that are structured
Commenters were very supportive of benefits only to the physician or other to address risk areas particular to their
our proposals. Therefore, we are supplier who performed the service, or operations. These commenters are also
finalizing the changes to § 405.400 as to the beneficiary. This provision, concerned that providing unrestricted
proposed. known as the prohibition on access to submitted claims data is not a
reassignment, contains several clear requirement for a billing entity to
I. Changes to Reassignment and exceptions. Section 952 of the MMA meet.
Physician Self-Referral Rules Relating to amended section 1842(b)(6)(A)(ii) of the Response: We believe that by allowing
Diagnostic Tests Act to allow a physician or other person a physician or other supplier access to
In the CY 2007 PFS proposed rule, we who was in a contractual arrangement billing information concerning services
stated that recent changes to our rules rather than in an employee-employer allegedly performed by that physician or
on reassignment of the right to receive relationship to reassign his or her right other supplier, we gain more assurance
Medicare payment may have led to to bill and receive payment, irrespective that entities that are billing on
some confusion as to whether the anti- of whether the services were performed reassignment are billing for services
markup and purchased interpretation on the premises of the entity. In actually performed and are otherwise
requirements apply to certain situations implementing section 952 of the MMA, billing accurately for such services.
With respect to the commenters’ but rather on our general rulemaking these measurements. This section
suggestion that physician involvement authority found at sections 1102(a) and summarizes the provisions discussed in
in compliance programs offers a more 1871(a) of the Act. We also believe for the June 24, 1998 IFC.
practical approach to ensure Medicare the reasons stated in the proposed rule
a. Coverage Conditions and Frequency
program integrity, we believe that that the same program integrity
Standards
physicians should be engaged already in concerns with respect to contractor
compliance programs, and that such access to billing records also apply to We established conditions for
involvement should include the employee access to billing records. And, coverage and frequency standards for
physician regularly requesting access to we reiterate that we are aware of medically necessary BMMs for five
billing records for services that he or she allegations of employee suppliers being categories of Medicare beneficiaries in
allegedly performed and that are being denied access to their billing records. § 410.31.
billed to Medicare, through a Moreover, we do not believe it is In § 410.31(a), we defined ‘‘bone mass
reassignment, by the entity that employs sufficient to leave it to physicians and measurement’’ based on the statutory
the physician as an independent other suppliers to negotiate access to definition in section 4106 of the BBA.
contractor or employee. We disagree billing records as a condition of their In accordance with the ‘‘reasonable and
that our proposal would pose an unclear employment, as the parties may have necessary’’ provisions of section
requirement for entities to meet. An unequal bargaining power. 1862(a)(1)(A) of the Act, we established
entity that bills Medicare for services Comment: A commenter stated that if the conditions for coverage of BMMs in
that were allegedly performed by a the supplier has claims liability, he or § 410.31(b) of the regulations. Consistent
physician or other supplier in the she should have access to the billing with § 410.32 (Diagnostic x-ray tests,
entity’s employ may not unreasonably records, but that if the supplier does not diagnostic laboratory tests, and
refuse to provide access (or have claims liability he or she should diagnostic tests: Conditions), we
unreasonably delay in providing access) not have access to the billing records. provided that coverage be available for
to the physician or other supplier with Response: Irrespective of whether the the BMM only if it is ordered by the
respect to the relevant billing supplier has claims liability, we have an physician or a qualified NPP (as defined
information. We do not believe it is interest in knowing whether we are in § 410.32(a)) treating the beneficiary
practical or necessary to attempt to paying correctly for services that were following an evaluation of the
define by regulation just how soon after furnished or furnished as billed. beneficiary’s need for the test, including
a request an entity has to provide Therefore, we wish to provide a right of a determination as to the medically
access, or whether, in a given case, an access to billing information to all appropriate procedure to be used for the
entity would be justified in refusing to suppliers who are furnishing services beneficiary. We believed that BMMs
provide access if the physician or and reassigning payment to their were not demonstrably reasonable and
supplier has already gained access to employers, and we encourage them to necessary unless (among other things)
the records. Rather, we believe that avail themselves of this right in order to they are ordered by the physician
entities should be guided by common ensure that we are paying properly. treating the beneficiary following a
sense and when in doubt may wish to K. Coverage of Bone Mass Measurement careful evaluation of the beneficiary’s
err on the side of providing access, medical need, and they are employed to
because an entity that unreasonably In an IFC entitled ‘‘Medicare Coverage
of and Payment for Bone Mass manage the beneficiary’s care.
refuses to provide billing information or
Measurements’’ published in the To ensure that the BMM is performed
does not provide it in a timely manner
Federal Register on June 24, 1998 (63 as accurately and consistently in
may have its right to receive reassigned
FR 34320), we implemented section accordance with appropriate quality
benefits revoked under § 424.82(c)(3).
Comment: We received one comment 4106 of the BBA by establishing a new assurance guidelines as possible, we
opposing the proposal. According to section, § 410.31, Bone Mass required that it be performed under the
this commenter, in section 952 of the Measurement: Conditions for Coverage appropriate supervision of a physician
MMA, the Congress authorized us to and Frequency Standards. Section 4106 as defined in § 410.32(b)(3). To ensure
make changes to the reassignment rules of the BBA statutorily defined BMM and that the BMM is medically appropriate
with respect to contractor arrangements individuals that are qualified to receive for the five categories specified in the
only. The Congress evidenced no intent a BMM. The June 24, 1998 IFC, under law, we provided that it be reasonable
to change the reassignment rules with the ‘‘reasonable and necessary’’ and necessary for diagnosing, treating,
respect to employees, and nor is there provisions of section 1862(a)(1)(A) of or monitoring the condition of the
any evidence of which the commenter is the Act, also established conditions for beneficiary who meets the coverage
aware that right of access by employee coverage of the tests that must be requirements specified in § 410.31(d).
suppliers is a current program integrity ordered by physicians or NPPs. Lastly, Furthermore, in § 410.31(c), we set
issue. The commenter also believes that as directed by section 4106 of the BBA, forth limitations on the frequency for
access to billing information is a matter we established frequency standards covering a BMM. Generally, we cover a
that should be left to the terms of a governing the time period when BMM for a beneficiary if at least 23
provider’s employment contract. qualified individuals would be eligible months have passed since the month the
Response: For the reasons stated in to receive covered BMMs. last BMM was performed. However, we
the CY 2007 PFS proposed rule (71 FR allow for coverage of follow-up BMMs
49057), we believe we are permitted, but 1. Provisions of the June 24, 1998 IFC performed more frequently than once
not required, to make payment under The June 24, 1998 IFC implemented every 23 months when medically
the reassignment provisions. Moreover, section 4106 of the BBA by establishing necessary. We listed the following
we are under a statutory command, conditions for coverage and frequency examples of situations where more
through section 1833(e) of the Act, to standards for BMMs to ensure that they frequent BMMs procedures may be
not make payment unless we are are paid for uniformly throughout the medically necessary to include:
satisfied that payment is correct. Our Medicare program and that they are • Monitoring beneficiaries on long-
rulemaking authority for our proposal is reasonable and necessary for Medicare term glucocorticoid (steroid) therapy of
not based on section 952 of the MMA, beneficiaries who are eligible to receive more than 3 months.
• Allowing for a confirmatory that the section does not apply to WHO [World Health Organization]
baseline BMM (either central or payment for BMMs. recommendations and other guidelines
peripheral) to permit monitoring of for using BMD and interpreting BMD
e. Conforming Changes
beneficiaries in the future if the initial results for diagnosis are based on DXA
test was performed with a technique In the June 24, 1998 IFC, to allow for measurements of the hip or spine.’’ The
that is different from the proposed appropriate placement in the CFR of the report further states, ‘‘Incorporating
monitoring method. BMM coverage requirements, we these techniques for bone assessment
redesignated § 410.31 (Prescription into future clinical trials and
b. Beneficiaries Who May Be Covered drugs used in immunosuppressive observational studies will help in better
In § 410.31(d), we amended our therapy) as § 410.30. understanding their appropriate use as a
regulations to conform to the statutory 2. Additional Scientific Evidence means of predicting the risk of bone
requirement that the following disease and fracture.’’
categories of beneficiaries may receive In 2004, the Surgeon General issued a
report, Bone Health and Osteoporosis 3. Changes to the June 24, 1998 IFC
Medicare coverage for a medically
necessary BMM: (U.S. Department of Health and Human We received 18 public comments on
• A woman who has been determined Services, Bone Health and Osteoporosis: the June 24, 1998 IFC. The majority of
by the physician or a qualified NPP A Report of the Surgeon General. the comments had specific
treating her to be estrogen-deficient and Rockville, MD: U.S. Department of recommendations for changes to the
at clinical risk for osteoporosis, based Health and Human Services, Office of IFC. Based on the comments received on
on her medical history and other the Surgeon General, 2004). This report the IFC, the Surgeon General’s report,
findings. provides scientific evidence related to and other evidence, we proposed
• An individual with vertebral the prevention, assessment, diagnosis, changes to § 410.31. We solicited
abnormalities as demonstrated by an x- and treatment of bone disease. The comments on these proposals.
ray to be indicative of osteoporosis, report states that identification of those
at risk of bone disease and fracture is 4. Analysis of and Response to
osteopenia, or vertebral fracture. Comments on the June 24, 1998 IFC and
• An individual receiving (or important so that appropriate
interventions can be implemented. the CY 2007 PFS Proposed Rule
expecting to receive) glucocorticoid
(steroid) therapy equivalent to 7.5 mg of However, as the report states, In this final rule, we are responding
prednisone, or greater, per day, for more ‘‘Assessing the risk of bone disease and to the public comments that we received
than 3 months. fracture remains a challenge. Not all of on our proposed revisions to § 410.31.
• An individual with primary the risk factors have been identified, In addition, as we stated in CY 2007
hyperparathyroidism. and the relative importance of those that proposed rule, we are responding to the
• An individual being monitored to are known remains unclear.’’ public comments received on the June
assess the response to or efficacy of an As bone strength is not measured 24, 1998 IFC. We received
FDA-approved osteoporosis drug directly, bone mineral density (BMD) approximately 35 timely public
therapy. remains the single best predictor of comments on our proposed revisions to
fracture risk, with the most widely the regulations regarding coverage for
c. Waiver of Liability accepted method for measuring BMD bone mass measurements (§ 410.31).
Section 410.31(e) provides that being the dual energy x-ray Most commenters supported the
Medicare payment would be denied for absorptiometry (DXA) for a bone density proposed coverage revisions and noted
a BMM in accordance with section study at the axial skeleton (for example, their specific concerns and provided
1862(a)(1)(A) of the Act if the regulatory hips and spine). As there are many suggested revisions to several of the
standards are not satisfied. Existing sources of variability in the coverage provisions. However, most of
regulations concerning limitation on measurement of BMD, a quality control the commenters expressed significant
liability are set forth in § 411.400 system related to both the methodology concerns regarding proposed payment
through § 411.406 and are applicable to and reporting of test results is important reductions for these tests that would
denial of BMMs under § 410.31. to ensure the validity of DXA analysis. result from initiatives described in other
In addition to DXA of the axial sections of the proposed rule relative to
d. Payments for BMMs skeleton, bone mass can also be PE and other payment calculations.
Medicare payments for covered measured using other techniques. These Comments and our responses regarding
BMMs are paid for under the PFS (42 other techniques include DXA bone the proposed payment reductions are
CFR part 414) as required by statute. In density study for the appendicular detailed in section II.A.4. of the
the June 24, 1998 IFC, we revised the skeleton (for example, radius, wrist, preamble to this final rule. The
definition of ‘‘physician services’’ in heel); quantitative computerized following is a summary of our proposals
§ 414.2 to include bone mass tomography (QCT), BMD study for the and the comments received and our
measurements. When BMM procedures axial skeleton or appendicular skeleton; responses on the coverage for bone mass
are furnished to hospital inpatients and radiographic absorptiometry measurement:
outpatients, the TCs of these procedures (photodensitometry, radiogrammetry);
are payable under existing payment single-photon absorptiometry (SPA); a. ‘‘BMM’’ Definition (§ 410.31(a))
methods for hospital services. These single energy x-ray absorptiometry At § 410.31(a)(2), we proposed to
methods include payments under the (SXA) for the appendicular skeleton; revise the definition of ‘‘bone mass
prospective payment system, on a and ultrasound BMD study for the measurement’’ to remove coverage for
reasonable cost basis, or under a special appendicular skeleton. For these the use of SPA, which uses isotope
provision for determining payment rates techniques (except for SPA which was sources to measure BMD. Many medical
for hospital outpatient radiology not discussed), the 2004 Surgeon experts indicate that SPA has largely
services. General report states, ‘‘While these been replaced by the newer techniques
In the June 24, 1998 IFC, we revised methods do assess bone density and of DXA, which are believed to be
§ 414.50(a), regarding physician billing may provide an indication of fracture superior in accuracy and precision.
for purchased diagnostic tests, to clarify risk, it is important to note that the Medicare claims data in recent years
continue to show a steady decline in the that the heel DXA is a superior diagnosis can be accomplished by
use of the SPA procedure by the approach for the initial osteoporosis various techniques, though the
beneficiary population. Further, there is screening because of its—(1) strong appropriate use of these technologies in
a lack of evidence to support continued correlation to fracture probability; (2) the prediction of bone disease and the
use of SPA, an older procedure where the reactive nature of the heel to bone risk of fracture has yet to be clearly
the metrics have not been correlated mass changes; (3) patient preference for defined. Therefore, we are not revising
with fracture rate. a less threatening exam; (4) the our proposal based on this comment.
We proposed to revise the definition elimination of radiation exposure to the
of a ‘‘bone mass measurement’’ to read, b. Conditions for Coverage (§ 410.31(b))
abdomen that results from a central
‘‘Is performed with either a bone bone mass measurement; and (5) the In § 410.31(b), we proposed to revise
densitometer (other than a single- ability of the peripheral heel DXA to the conditions for coverage for BMMs by
photon or dual-photon absorptiometry) deliver a service at a lower cost than requiring that for a medically necessary
or with a bone sonometer system that most other BMM technologies. BMM to be covered for an individual
has been cleared for marketing for this Response: Based on our review of the being monitored to assess the response
use by the FDA under 21 CFR part 807, available medical literature, we have to or efficacy of an FDA-approved
or approved for marketing by the FDA determined that there is insufficient osteoporosis drug therapy
for this use under 21 CFR part 814.’’ evidence to conclude that peripheral (§ 410.31(d)(5)) the individual would be
Comment: We requested comments on DXA at the heel is a superior method of required to meet the present conditions
our proposal to noncover SPA, BMD measurement when compared to for coverage under § 410.31(b), and the
including any evidence of benefit for other peripheral sites. Thus, we are not monitoring would have to be performed
this technique, particularly in making any changes to our proposal by the use of an DXA system (axial
comparison with other alternatives. based on this comment. system).
Most of the commenters supported the Comment: A commenter expressed We recognized that in the June 24,
position that SPA has largely been concern about our statement in the 1998 IFC, we allowed the physician or
replaced by the newer, more accurate, June 24, 1998 IFC indicating that QCT qualified NPP treating the beneficiary
and precise techniques such as SEXA can measure bone density at the spine more flexibility in ordering those
and DXA, and we should not continue and hip. The commenter indicated that diagnostic measurements, but we
to cover them. However, a commenter only central (axial) DXA can measure proposed to limit that flexibility for the
from the June 24, 1998 IFC suggested BMD at the spine or hip and QCT is type of BMM that is used for monitoring
that while use of SPA devices (at the limited to the spine or the wrist. The individuals receiving osteoporosis drug
wrist) is declining as newer and faster commenter also stated that spine QCT therapy and other purposes (as
equipment is becoming available, we exposes the patient to a significantly discussed later in this section) because
should continue to cover their use higher dose of radiation and that the of new evidence and other information
indefinitely based on the view that their technique is significantly less precise received since publication of the June
accuracy and precision are close to that than central DXA or peripheral DXA or 24, 1998 IFC that supports the need for
of x-ray based techniques at the wrist ultrasound. The commenter requiring the use of the DXA
and heel and that their radiation recommended that we drop coverage of measurement (axial skeleton) in those
exposure is low. this technique once there is sufficient circumstances. In addition to the 2004
Response: We agree with the more geographic overlap between QCT and Surgeon General’s Report that
recent comments concerning SPA and the alternative techniques, which are recognized the superiority of the DXA
note that we proposed to noncover SPA believed to be less costly, safer, and a (axial skeleton) for measuring bone mass
tests beginning in CY 2007. In response more precise means of measuring bone over time, the International Society for
to the June 24, 1998 IFC comment mass than the QCT technique. Clinical Densitometry currently
regarding continuing coverage Response: On the basis of our review recommends that if an individual has a
indefinitely, we note that Medicare of the existing medical literature, we low bone mass using a peripheral
claims data in recent years continue to have determined that QCT can provide measurement (appendicular skeleton)
show a steady decline in the use of the both central (spine and hip) and he or she should have a DXA (axial
SPA procedure by the beneficiary peripheral BMD measurements but does skeleton) performed for monitoring or
population as the more accurate and expose the patient to significantly confirmatory diagnostic purposes.
precise procedures have become much higher doses of radiation. Though the Therefore, we also proposed to revise
more widely available. We agree that appropriate use of QCT has yet to be § 410.31(b) by adding a requirement that
there is a lack of evidence to support defined, it may be used as an alternative in the case of any individual who
continued use of the older SPA to spine and hip DXA measurements as qualifies for a BMM as provided for in
procedure where the metrics have not a method for measuring BMD (Surgeon § 410.31(d) and who receives a
been correlated with fracture risk. General’s Report, 2004). Therefore, we confirmatory baseline BMM to permit
Therefore, we are revising the definition are not making any changes to our monitoring in the future, Medicare may
of ‘‘bone mass measurement’’ in proposal as a result of this comment. cover a medically necessary BMM for
§ 410.31(a) to remove coverage for the Comment: Another commenter from that individual, if the present conditions
use of SPA. As a result, the status the June 24, 1998 IFC stated that there for coverage under § 410.31(b) are met,
indicator for CPT code 78350 will is insufficient evidence to support the and the BMM is performed by a DXA
change from active (A) to noncovered clinical utility of BMD measurements of system (axial skeleton) (if the initial
(N) effective January 1, 2007. an individual’s finger, tibia, or patella, measurement was not performed by this
Comment: A June 24, 1998 IFC which are performed by the use of either system).
commenter expressed the view that a peripheral x-ray or an ultrasound As indicated previously in this
available research and their experience device, and suggested that measurement section, the most widely accepted
had demonstrated that the use of of those peripheral sites not be covered method for measuring BMD is the use of
peripheral DXA at the heel is superior under Medicare. DXA (Surgeons General’s Report 2004)
to any other BMD test taken at any other Response: Measurement of peripheral at axial skeletal sites. DXA (axial
peripheral site. The commenter believes bone density for screening and initial skeleton) measures BMD at the hip and
spine (sites likely to fracture in patients more likely than peripheral sites to though monitoring by densitometry has
who have osteoporosis). DXA is precise, show an increase in BMD over time. For not been demonstrated to be effective in
safe, and low in radiation exposure, and these reasons, we believe that the use of improving compliance (NIH Consensus
permits more accurate and reliable DXA at central sites is the best method Panel, 2001). Importantly, BMD changes
monitoring of individuals over time. for measuring BMD for both monitoring are not correlated with the fracture risk
DXA of the femoral neck is the best patients receiving FDA-approved reduction resulting from antiresorptive
validated test to predict hip fracture and osteoporosis drug therapy, and treatment (Roux, Garnero 2005).
is comparable to forearm measurements confirming BMD measurements Therefore, while the efficacy of
for predicting fractures at other sites performed on peripheral devices for antiresorptive treatments has been
(Evidence Report/Technology patients who may be monitored in the verified in large trial powered to show
Assessment No 28, Agency for future. In view of the comments reductions in fracture risk, it does not
Healthcare Research and Quality received and our review of the medical appear that fracture risk can be
(AHRQ), January 2001). literature, and other information, we are measured in individual patients being
Comment: Several June 24, 1998 IFC adopting our revision of § 410.31(b) treated for osteoporosis. We are not
commenters expressed concern without change. making any changes to the final rule
regarding the following statement from Comment: While most of the based on this comment.
the June 24, 1998 IFC that ‘‘there is a commenters supported our proposal to
consensus that measurements of the limit coverage of monitoring patients c. Bone Mass Measurement: Standards
central skeletal sites is the preferred receiving osteoporosis drug therapy and on Frequency of Coverage (§ 410.31(c))
method of assessment’’ as compared for performing confirmatory baseline To conform the examples of a BMM
with measurements of peripheral tests to the DXA of the central (axial) exception to the standards on frequency
skeletal sites. These commenters stated skeleton, several commenters urged us of coverage in § 410.31(c)(2) to the
that peripheral devices provide not to preclude coverage of QCT of the regulation change we proposed in
basically the same measurement central (axial) skeleton for these § 410.31(b)(3), we proposed to revise the
benefits as central devices and have the purposes for individuals who have had confirmatory baseline test example in
added advantages of being easier to use, an initial screening with a peripheral § 410.31(c)(2)(ii) to read, ‘‘Allowing for
allowing greater patient accessibility, test. These commenters stated that the a confirmatory baseline measurement to
and reducing patient radiation QCT technology has been relied upon permit monitoring of beneficiaries in the
exposure. However, the majority of the for some time now by certain hospitals future if the requirements of paragraph
commenters on both the IFC and the and imaging centers, and it would be (b)(3) of this section are met.’’
proposed rule, strongly supported the unfair to them and their patients to Comment: A number of commenters
aforementioned statement from the IFC preclude coverage for their tests in the offered recommendations on the
and expressed specific concern that the final rule. exceptions in paragraph (c)(2) to the
IFC allowed for coverage of peripheral Response: We agree with the general rule in paragraph (c)(1) that
BMMs that have not been demonstrated commenters who supported our provided that ‘‘Except as allowed under
to be useful in monitoring patients who proposal to limit coverage of monitoring paragraph (c) (2) of this section,
are receiving osteoporosis drug patients receiving osteoporosis drug Medicare may cover a bone mass
therapies. These commenters agreed therapy, for performing confirmatory measurement (BMM) for a beneficiary if
that only central devices (especially the baseline test to the DXA of the central at least 23 months have passed since the
DXA device) were useful in monitoring (axial) skeleton, and to not allow month the last BMM was performed.’’
patients receiving pharmacologic coverage of the QCT for these purposes. The exceptions specified were— (1)
therapy and they specifically (Surgeon General’s Report, 2004). The monitoring beneficiaries on long-term
recommended that peripheral tests be radiation exposure is significantly glucocorticoid (steroid) therapy of more
limited to screening for osteoporosis, higher, for example, with the use of the than 3 months; and (2) allowing for a
and not be used for monitoring patients lumbar spine QCT than is the case with confirmatory baseline BMM to permit
receiving FDA-approved osteoporosis the use of the DXA at central skeletal monitoring of beneficiaries in the future.
drug therapy. sites (Surgeon General’s Report, 2004). These commenters indicated that in
Response: As we indicated in the Therefore, we are not making any addition to the exceptions specified in
proposed rule, we agree that the most change to our proposal based on these paragraph (c)(2), there were certain
widely accepted method for measuring comments. individuals who were at higher risk of
BMD is the use of dual x-ray Comment: A commenter supported bone loss due to a disease, drug therapy,
absorptiometry (DXA) (Surgeon our proposal to change the conditions of or other reasons who should be
General’s report 2004) at central skeletal coverage and standards on frequency of measured more frequently than once
sites. DXA measures BMD at the hip and bone mass measurements to encourage every 2 years. Most of these commenters
spine (sites likely to fracture in patients the use of DXA of the axial skeleton for recommended that these individuals
who have osteoporosis), is precise, safe, confirmatory baseline tests and for should have a follow-up measurement
and low in radiation exposure, and monitoring a patient’s response to at least once every 12 or every 12 to 18
permits monitoring over time. DXA of therapy, but cautioned that the medical months. Another commenter asked us to
the femoral neck is the best validated literature does not support the use of make an exception under paragraph (c)
test to predict hip fracture and is DXA or other BMMs to assess efficacy (2) for individuals with
comparable to forearm measurements of osteoporosis therapies. The hyperparathyroidism who due to their
for predicting fracture at other sites commenter recommended that CMS diagnosis require both a DXA of the
(AHRQ report 2001). The World Health clarify that BMM is not appropriate for axial and the appendicular skeleton
Organization (WHO) classification of monitoring the efficacy of osteoporosis upon initial testing.
BMD for the diagnosis of osteoporosis is therapies in preventing bone fractures. Response: In establishing the
based primarily on reference data Response: We recognize that the goals frequency of coverage general rule in
obtained by DXA of the axial skeleton. of monitoring patients are to increase § 410.31(c)(1) of the IFC, we relied upon
When monitoring the effectiveness of adherence to treatment regimens and the guidance of the American
therapy, these central skeletal sites are determine treatment response even Association of Clinical
Endocrinologists, the ACR, and the osteoporosis, as well as for other commenters on the proposed rule, we
National Osteoporosis Foundation, medical circumstances where it might are adopting this revision as final
which appeared to be generally in be appropriate to cover more than one without change.
agreement for the need to follow certain BMM every 2 years, the treating
d. Bone Mass Measurement:
clinical guidelines for performing provider currently has considerable
Beneficiaries Who May Be Covered
follow-up BMMs to the initial BMM that flexibility in accordance with our
(§ 410.31(d))
is performed. Based on that information, regulations to determine the frequency
we specified in the June 24, 1998 IFC a of testing in any particular case, subject The Congress has recognized that
general frequency of coverage interval of to the review of the local Medicare individuals receiving long-term
one follow-up examination every 2 contractor. However, in the absence of glucocorticoid steroid therapy are
years, identifying examples of situations sufficient evidence in the medical qualified individuals for purposes of
where more frequent BMMs may be literature to support any specific section 1861(rr)(1) of the Act. Therapy
covered when medically necessary. We frequency interval for individuals to prevent bone loss in most patients
have decided to basically retain that receiving steroid therapy, we are not beginning long-term therapy has been
general frequency of coverage standard establishing any specific frequency recommended at a prednisone
and continue to allow Medicare interval for coverage of these equivalent of greater than 5 mg/day for
contractors to cover additional individuals in this regulatory example at least 3 months (McIlwain, 2003).
exceptions to the specified exception of possible exceptions to the general Based on our review of the current
examples based on medical necessity, standard in section § 410.31(c) of the evidence, we proposed to reduce the
even though there is a lack of evidence final rule. Rather, we are leaving this to dosage equivalent in § 410.31(d)(3) from
that adjusting therapy based on serial our local Medicare contractors, based on an average of 7.5 mg/day of prednisone
densitometry at any level improves the best evidence that is available to for at least 3 months to an average of 5.0
outcomes (AHRQ Report 2001). Follow- them and their medical consultants. mg/day of prednisone for the same
up testing should be done when the Comment: A June 24, 1998 IFC period.
expected change in BMD is at least commenter expressed concern regarding Comment: A number of commenters
equal to or exceeds the least significant our policy in § 410.31(c)(2)(ii) that expressed concern that certain
change, which is the smallest change in allows coverage of a confirmatory categories of individuals that warranted
BMD that is beyond the range of error, baseline BMM (either central or inclusion under the BMM benefit were
as changes in BMD are usually small in peripheral) to permit monitoring of not covered and they recommended that
proportion to the error inherent in the beneficiaries in the future if the initial the IFC be revised to include them in
test itself (Baim, Wilson et al., 2005). test was performed with a technique the final rule. However, a commenter
Each DXA facility should determine its that is different from the proposed noted that the Medicare law needed to
precision error and then calculate the monitoring method. That is, a qualified be amended so that the legal definition
least significant change (Baim, Wilson et individual may be tested initially with of ‘‘qualified’’ individuals for BMM
al., 2005). Regarding the comment on DXA at the hip and spine and then have coverage keeps pace with additional
individuals with hyperparathyroidism, a confirmatory test with a peripheral current scientific and clinical evidence
we recognize that the mechanics of bone device on which the patient is to be on who is at risk for osteoporosis.
loss may be different for these patients monitored every 2 years. The Overall, more than 27 additional
than they are for estrogen-deficient post- commenter suggested that this policy be categories of ‘‘qualified’’ individuals
menopausal women, resulting in revised to preclude coverage of the were recommended for coverage of bone
fracture risks that may be different and confirmatory test by the use of a mass measurements under the benefit.
more difficult to determine (Miller, peripheral device because its precision These included patients diagnosed with
Bilezikian, 2002). Thus, it may be is significantly poorer than the male hypogonadism, Parkinson’s
medically necessary for a treating stationary table DXA. The commenter disease, multiple sclerosis, myasthenia
provider to perform both a DXA of the believes that peripheral devices are best gravis, Gaucher’s disease, mastocytosis,
axial and the appendicular skeleton in suited for screening and initial malabsorption syndromes, history of
the initial screening of patients with this diagnosis and not for monitoring a bulimia, chronic lung disease, renal
diagnosis. However, we believe the patient’s response to drug therapy. disease, diabetes mellitus, rheumatoid
evidence is insufficient to establish a Response: We agree that confirmatory arthritis, secondary
national policy exception to the 2-year testing with a peripheral device should hyperparathyroidism and nonvertebral
frequency standard for these individuals be precluded from coverage. As stated fractures, tobacco dependence, as well
as specified in § 410.31(c). Nonetheless, in the Surgeon General’s report, as well as patients on heparin therapy,
we have decided to allow the treating as recommendations by the anticonvulsant therapy, methotrexate
provider to determine what is medically International Society of Clinical therapy, thyroid replacement therapy,
necessary in any particular case, subject Densitometry (Journal of Clinical and antiepileptic drug therapy, etc.
to the review of the local Medicare Densitomery 2004; 7:1–5), central Response: We have carefully reviewed
contractor. skeletal sites are most appropriate for the above additional categories of
Comment: A June 24, 1998 IFC monitoring the effectiveness of therapy, individuals who have been
commenter questioned whether we as they are more likely than peripheral recommended for Medicare coverage
would cover bone mass measurements sites to show an increase in BMD in under the final rule, and have
for individuals on steroid therapy every response to treatment. Therefore, we concluded that they do not qualify for
6 months after the initial treatment, as included a provision in the proposed coverage under the specific statutory
well as a baseline exam at the start of rule revising § 410.31(c)(2)(ii) to language mentioned above. Section
therapy as was suggested in the preclude coverage of a confirmatory test 1861(rr) of the Act provides that the
reference to the recommendations of that is performed with the use of a term ‘‘qualified individual’’ for
others in the June 24, 1998 IFC (63 FR peripheral device and to limit such purposes of this benefit means ‘‘an
34234). coverage to a central (axial) DXA. For individual who is (in accordance with
Response: For those individuals on the reasons described above, as well as regulations prescribed by the
steroid therapy who are at high risk for the general support of the public Secretary)—(A) an estrogen-deficient
woman at clinical risk for osteoporosis; disease, is not FDA-approved for Response: We agree that the minimum
(B) an individual with vertebral osteoporosis treatment but, its safety 7.5 mg of prednisone dose provision
abnormalities; (C) an individual and efficacy in reducing or reversing needs to be lowered and that use of an
receiving long-term glucocorticoid steroid-induced osteoarthritis is average dose measurement in specifying
steroid therapy; (D) an individual with supported by a large body medical this standard is appropriate. Patients
primary hyperparathyroidism; or (E) an literature. with glucocorticoid-induced
individual being monitored to assess the Response: We recognize that not all osteoporosis appear to be at high risk for
responsive to or efficacy of an approved Medicare beneficiaries who are treated fractures. Researchers have reported that
osteoporosis drug therapy.’’ Therefore, for osteoporosis are prescribed FDA- reductions in bone mass have been seen
we believe a change in the Medicare approved osteoporosis drug therapy. as early as 3 months after starting
statute would be required in order for us However, in implementing the statutory therapy (McIlwain, 2003). Therapy to
to cover these additional categories of mandate in section 1861(rr)(2) of the Act prevent bone loss in most patients
individuals under the BMM benefit. to include as a ‘‘qualified individual’’ beginning long-term therapy has been
Comment: Most of the commenters for Medicare-covered bone mass recommended at a prednisone
supported our broad interpretation of measurements ‘‘an individual being equivalent of ≥5 mg/day for at least 3
the statutory category of ‘‘An estrogen- monitored to assess the response to, or months (McIlwain, 2003). Based on the
deficient woman and at clinical risk for efficacy of an approved osteoporosis comments that we have received and
osteoporosis’’ that was specified in the drug therapy,’’ we do not believe it is our review of the current evidence, we
interim final regulation provision appropriate for us to extend such are adopting our proposal to revise
§ 410.31(d)(1). A June 24, 1998 IFC coverage to beneficiaries who are § 410.31(d)(3) to reduce the minimum
commenter noted that because the risk receiving non-FDA approved dosage requirement from 7.5 mg to an
factors associated with osteoporosis are osteoporosis drug therapies. Thus, we average of 5.0 mg/day of prednisone for
so numerous and complex, it is are not adopting the changes at least 3 months.
appropriate to allow a woman’s treating recommended by the commenters. Comment: Several IFC commenters
physician or other treating practitioner expressed concern that Medicare
Comment: A number of commenters
to determine whether she is estrogen- beneficiaries at risk for osteoporosis due
addressed our proposal to revise
deficient or a clinical risk of to their use of antiepileptic drugs are
§ 410.31(d)(3) which stated that one of
osteoporosis. However, several June 24, not eligible for an initial bone mass
the categories of beneficiaries who was
1998 IFC commenters were concerned screening because they are not included
about how the definition would be entitled to receive Medicare coverage for in any of the five categories of patients
implemented by Medicare contractors. a medically necessary BMM was ‘‘An defined as ‘‘qualified individuals.’’ The
A commenter expressed concern that individual receiving (or expecting to commenter indicates that if it is not
because there is not an existing ICD–9– receive) glucocorticoid (steroid) therapy possible to change this under current
CM diagnosis code to describe the equivalent to 7.5 mg of prednisone, or law is it possible for us to confirm that
condition of estrogen-deficient, this greater, per day for more than 3 follow-up monitoring tests would be
could result in the need for practitioners months.’’ The majority of these covered every 2 years for a patient on
to use several other ICD–9–CM codes commenters suggested that the anti-epileptic drugs who shows signs of
that describe conditions likely to result minimum requirement of 7.5 mg of osteoporosis and who is then placed on
from estrogen deficient, and in prednisone, or greater, per day osteoporosis FDA-approved drug
variations in Medicare coverage from provision was too strict, and that a dose therapy.
carrier to carrier. requirement of 5.0 mg per day was more Response: We agree that patients on
Response: We allowed the treating appropriate. However, several antiepileptic drugs may be at increased
physician or other treating practitioner commenters stated that even lower risk for fractures. Still, the current law
the discretion and flexibility to dosage amounts than 5.0 mg have been does not generally address this group of
determine whether a female beneficiary shown to cause significant bone loss patients as ‘‘qualified’’ individuals
is estrogen-deficient and at clinical risk over prolonged periods of time, usually under section 1861(rr) of the Act.
for osteoporosis. Creating a code because of comorbidities such as Monitoring of individuals on anti-
specifically for reimbursement when the rheumatoid arthritis. A commenter epileptic drugs who may also be FDA-
condition is described by other codes is recommended that this beneficiary approved drug therapy for osteoporosis,
not required. Therefore, we are not category be expanded to allow coverage of course, may be covered as provided
making any changes to our proposals for any patient taking steroids for longer under the BMM benefit.
based on these comments. than 3 months regardless of the dose
Comment: Several IFC commenters that is taken by the patient. Another e. Use of the NCD Process (§ 410.31(f))
indicated that the beneficiary category commenter was also concerned about To facilitate future consideration of
in § 410.31(d)(5) of ‘‘An individual the 7.5 mg of prednisone, or greater, per coverage of additional BMM systems for
being monitored to assess the response day provision, but suggested a minor purposes of proposed paragraphs
to or efficacy of an FDA-approved change that would allow an individual § 410.31(b)(2) and (b)(3), which will
osteoporosis drug therapy’’ is too receiving (or expecting to receive) limit coverage of BMMs for monitoring
limited and should be expanded to glucocorticoid (steroid) therapy individuals receiving osteoporosis drug
include coverage of individuals equivalent to an average of 7.5 mg of therapy and for performing confirmatory
receiving other treatments, including prednisone, or greater, per day for more baseline measurements, we proposed to
certain medications that do not have than 3 months to be covered under the identify additional BMM systems for
FDA approval for osteoporosis benefit. This commenter stated that use those purposes through the NCD
treatment, and certain rehabilitation of the average measurement is more in process. By using the NCD process, we
treatments such as therapy-weight line with the realities of modern could conduct a timely assessment of
lifting and similar interventions. A medicine and would clarify that those FDA-approved BMMs. Use of an NCD to
commenter noted, for example, that individuals who are receiving the same add coverage of effective BMM systems
didronel, which has been approved by dosage at different intervals (every other for these purposes is authorized by the
the FDA for the treatment of Paget’s day) are eligible for coverage. reasonable and necessary provision of
sections 1862(a)(1)(A) and 1871(a)(2) of of a device or technique that meets our or other providers in documenting
the Act. definition of a BMM as defined in Medicare claims for bone mass
Comment: One commenter requests § 410.31(a), we believe it would be measurements. However, our original
that we give Medicare carriers appropriate to consider evaluating any intent was that local Medicare
discretion to cover new and advanced formal request for an NCD for such a contractors were to be responsible for
technologies that become available to device or technique, if it were submitted developing those appropriate specific
screen for risk of fracture rather than to us for evaluation. diagnostic coding guidelines for the
requiring that such technologies be physicians and other providers in their
evaluated through the NCD as specified f. Other Issues
respective localities and for
in the proposed rule. The commenter Comment: A commenter questioned communicating those guidelines to
stated that the NCD process can be long why there was no discussion in the IFC them and to the general medical
and cumbersome, and that requiring about the importance of ethnicity as a community, and they have been doing
that new technologies be added through risk factor for low bone mass and that successfully since 1998. We expect
this process could prevent beneficiaries osteoporosis. The commenter suggests our contractors will continue to do this
from having access to these new and that ethnicity is one of the most as necessary in the future.
better technologies for some length of important risk factors for low bone mass
Comment: A commenter suggests the
time. and osteoporosis.
Response: We agree that ethnicity as need for a unique CPT code or modifier
Response: The IFC implemented
well as many other risk factors may to help distinguish a ‘‘confirmatory
section 4106 of the BBA by establishing
result in certain individuals being baseline bone mass measurement’’ from
conditions for coverage and frequency
considered to be more likely to develop a BMM that may be in violation of the
standards for BMMs to ensure that
osteoporosis than other individuals. For frequency of coverage standard of one
(among other things) they are paid for
uniformly throughout the Medicare example, the National Osteoporosis follow-up monitoring test every 2 years.
program. To ensure that important new Foundation (NOF) and other medical Response: We do not believe there is
and advanced BMM technologies as professional organizations have reported a need to establish a unique CPT code
defined under the statute and that Caucasians and Asians appear to be or modifier to distinguish a
regulations are paid for uniformly under more at risk for developing osteoporosis ‘‘confirmatory baseline bone mass
the program, we believe they should be than other ethnic groups. However, the measurement’’ for a BMM that may be
identified and evaluated through the NOF has also indicated that significant in violation of the frequency of coverage
NCD process. By relying on the NCD risk has been reported in people of all standard of one follow-up monitoring
process for this purpose, we believe we ethnic backgrounds, including African- test every 2 years because local
will able to conduct a timely assessment Americans and Hispanic-Americans. Medicare contractors rely on the use of
of FDA-approved BMMs for possible The reason that this subject was not frequency screens (or edits) in
uniform coverage under the program discussed in the IFC was that ethnicity determining whether follow-up tests are
that is not possible if we left this to local was not specifically identified in the medically necessary for individual
contractor discretion. In most BMM Amendment that was enacted in patients. These frequency screens (or
circumstances, the NCD process is 1997 as a risk factor or medical edits) do not require the use of a unique
required to be completed within 9 to 12 indication that warranted Medicare CPT code or modifier by providers in
months of the time that we accept a coverage of bone mass measurements. billing for these follow-up tests in order
formal request for an NCD on a Therefore, a careful examination of this for local contractors to be effective in
particular procedure. subject is beyond the scope of this final making their medical necessity
Comment: Several commenters noted rule. However, we expect that in determinations.
that the WHO is currently in the process completing an evaluation of the In view of the comments and our
of developing a standardized beneficiary’s need for the bone mass review of the medical literature, and
methodology for determining fracture measurement, as provided in other information, we are adopting our
risk. A commenter indicated that § 410.31(b)(1), the physician or other proposed revisions to § 410.31 as final
although DXA is one important tool for qualified practitioner (as these terms are without change.
measuring fracture risk, there are other defined in the regulation) will take
clinical risk factors that are also ethnicity and other significant risk L. Independent Diagnostic Testing
important to evaluation, specifically to factors into account in ordering Facility (IDTF) Issues
determine which patients are likely to medically necessary tests for individual 1. IDTF Changes
best respond to treatment. The patients to the extent that it is possible
commenters suggested that employing to do so under the statutory beneficiary During the course of a national review
the new risk assessment methodology categories specified in § 410.31(d). in 2003–2004, the OIG found a potential
may lead to better patient outcomes by Comment: Several commenters $71 million in improper payments made
helping providers better identify those indicated that the IFC offered to IDTFs (Review of Claims Billed by
patients who should be on therapy and insufficient guidance on how to Independent Diagnostic Testing
they ask CMS to recognize this new document the medical necessity of bone Facilities for Services Provided to
assessment methodology for coverage mass measurements performed on Medicare Beneficiaries During Calendar
under Medicare Part B when WHO ‘‘qualified individuals’’ (§ 410.31(d)) by Year 2001 (A–03–03–00002)). The OIG
completes its work on it. the use of ICD–9–CM diagnosis codes. found that erroneous payments were
Response: We do not know enough The commenter suggested that we made as the result of poor or missing
about the parameters of the develop national guidelines that would documentation or lack of medical
standardized methodology for help providers in documenting the necessity. Moreover, in recent years, we
determining fracture risk that the WHO medical necessity of bone mass have determined with the help of our
is developing to respond very measurements. contractors that a number of IDTFs in
specifically to this comment. However, Response: The IFC did not provide California and other States are
if this standardized methodology for guidance on the ICD–9–CM diagnosis perpetrating schemes to defraud the
measuring fracture risk relies on the use codes that could be used by physicians Medicare program.
Since 2000, the number of IDTFs in Medicare billings, whichever amount is the Medicare enrollment application
California has increased by 40 percent, greater, that covers both the place of within 30 calendar days;
which is a far greater percentage business and all customers and • Maintain a physical facility on an
increase than the Medicare population employees of the IDTF. appropriate site. For the purposes of this
in that State. The number of IDTFs Furthermore, we proposed in the new standard, a post office box or
billing Medicare in California alone performance standard number 7 that an commercial mailbox is not considered a
increased more than 400 percent from IDTF agrees not to directly solicit physical facility. The physical facility
2000 to 2005. The increased use of IDTF patients. This provision does not must contain space for equipment
services has not lowered the use of preclude the IDTF from public appropriate to the services designated
diagnostic testing within other settings. advertisement or marketing its services on the enrollment application, facilities
The increased rates of utilization within to physicians and other suppliers, for hand washing, adequate patient
IDTFs are likely to be unrealistic due to however it does prohibit recruitment of privacy accommodations, and the
an increase in the need for diagnostic beneficiaries through direct solicitation. storage of both business records and
testing within California’s Medicare Additionally, the IDTF will be current medical records;
population. Also, these IDTFs are required to grant us, or our designated • Have all applicable testing
growing at a rate faster than we can fee-for-service contractors, including equipment available at the physical site,
survey these facilities. The actual our agents, to have access to the IDTF excluding portable equipment. A catalog
growth of IDTFs is not a problem. physical location, all equipment, and of portable equipment, including
However, the results of the OIG audit beneficiary medical records during equipment serial numbers, must be
make it clear that we need to closely normal business hours. For portable maintained at the physical site. In
monitor IDTFs and establish standards equipment, an IDTF will be required to addition, portable equipment must be
to ensure quality care for Medicare maintain a catalog of portable made available for inspection within 2
beneficiaries. To address the erroneous equipment and be able to produce the business days of our inspection request.
payments identified by the OIG, we cataloged equipment within 2 business The IDTF will be required to maintain
proposed to establish IDTF performance days. If the IDTF denies this access, the a current inventory of the equipment
standards similar to those in § 424.57 IDTF’s Medicare enrollment will be (including serial/registration numbers),
which we adopted for Durable Medical immediately revoked. provide this information to the
Equipment, Prosthetics, Orthotics, and To ensure that equipment used by an designated fee-for-service contractor and
Supplies (DMEPOS) Suppliers in the IDTF is maintained and operates notify the contractor of any changes in
Additional Supplier Standards final rule properly, we sought public comments equipment;
published in the October 11, 2000 regarding IDTF supplier standard • Maintain a primary business phone
Federal Register (65 FR 60366). number 11, which requires that an IDTF under the name of the business. The
In the CY 2007 PFS proposed rule, we must have its testing equipment business phone must be located at the
proposed that each IDTF be required to calibrated per equipment instructions or designated site of the business. The
be in compliance with the proposed in compliance with applicable industry telephone number or toll free numbers
fourteen suppler standards discussed in standards. Specifically, we sought must be available in a local directory
section II.L.2. of this final rule with public comments regarding the and through directory assistance;
comment period to obtain or retain organizations or entities that may • Have a comprehensive liability
enrollment in the Medicare program (71 currently establish testing specifications insurance policy of at least $300,000 or
FR 49061). Accordingly, at § 410.33(h), for diagnostics equipment. Further, if 20 percent of its average annual
we proposed that if an IDTF fails to these organizations or entities do not Medicare billings, whichever amount is
meet one or more of the standards at the exist, we invited public comments on greater, that covers both the place of
time of enrollment or at the time of re- the establishment of a supplier standard business and all customers and
enrollment, then its enrollment that relies on the manufacturer’s employees of the IDTF. The insurance
application would be denied. Also, if at maintenance and calibration standards. policy must be carried by a non-relative
any time we determine that an enrolled owned company. The policy must list
IDTF no longer meets the performance 2. Performance Standards for IDTFs
the serial numbers of any and all
standards, its billing privileges would The IDTF would be required to meet equipment used by the IDTF;
be revoked. the following standards as of January 1, • Agree not to directly solicit
We believe that these performance 2007 and any newly or reenrolling IDTF patients, which includes, but is not
standards are needed to ensure that would be required to certify in its limited to, a prohibition on telephone,
minimum quality standards are met to enrollment application that it meets and computer, or in-person contacts. The
protect beneficiaries, as well as the will continue to meet the standards. At IDTF will accept only those patients
Medicare Trust Fund. These standards § 410.33, we proposed to specify that referred for diagnostic testing by an
are merely good business practices that the IDTF is required to— attending physician, who is furnishing a
will help to ensure that suppliers are • Operate its business in compliance consultation or treating a beneficiary for
providing a quality care to Medicare with all applicable Federal, State, and a specific medical problem and who
beneficiaries. Examples of the kind of local licensure and regulatory uses the results in the management of
standards are a primary business phone requirements for the health and safety of the beneficiary’s specific medical
number and address. Another example patients; problem. NPPs may order tests as set
is a posting of standards for review by • Provide complete and accurate forth in § 410.32(a)(3);
patients and the public. information on its enrollment • Answer beneficiaries’ questions and
For IDTFs, we proposed to adopt a application as stated in the respond to their complaints.
number of standards that we adopted for ‘‘Requirements for Providers and Documentation of those contacts must
DMEPOS suppliers, including supplier Suppliers to Establish and Maintain be maintained at the physical site;
standard number 6 which requires a Enrollment final rule’’ (April 21, 2006, • Openly post these standards for
supplier to maintain a comprehensive 71 FR 20754). Any change in enrollment review by patients and the public;
liability insurance policy of $300,000 or information must be reported to the • Disclose to the government, any
20 percent of its average annual designated fee-for-service contractor on person having ownership, financial or
control interest, or any other legal expressed concern about our proposal to information from the public before
interest in the supplier at the time of limit the number of IDTFs that a adopting IDTF accreditation standards.
enrollment or within 30 days of a physician can oversee. Comment: Several commenters
change; Response: While we understand the recommended establishing a grace
• Have its testing equipment concerns associated with limiting the period before carriers begin the
calibrated per equipment instructions number of IDTFs that a physician can revocation process for those IDTFs that
and in compliance with applicable oversee to three, we believe that limiting fail to meet the new performance
national standards; the number of IDTFs that a physician standards.
• Have technical staff on duty with can oversee will promote quality of care. Response: While we understand the
the appropriate credentials to perform We are defining the supervising concerns of the commenters, we do not
tests. The IDTF must produce the physician to be the person who is listed believe that it is practical to delay
applicable Federal or State licenses and/ in Attachment 2, Section E on the CMS– implementation of these standards.
or certifications of the individuals 855B enrollment application. With the publication of this final rule
performing these services; Comment: Several commenters with comment period, all IDTFs are
• Have proper medical record storage suggested that the proposed standards being notified of the new performance
and be able to retrieve medical records be revised to reflect that mobile IDTFs standards. Moreover, we believe that
upon request from CMS or its will have different needs and most IDTFs meet the performance
designated fee-for-service contractor requirements from those IDTFs which standards that we are adopting, or that
within 2 business days; and are stationary. they can do so within the time period
• Permit CMS, including its agents or Response: We appreciate this between the publication of this final
its designated fee-for-service comment and have revised our policy in rule with comment period and its
contractors, to conduct unannounced, this final rule with comment period to effective date. In addition, as we put
on-site inspections to confirm the address IDTF performance standards for this policy into operation, we will
IDTF’s compliance with these both fixed and mobile IDTFs. consider phasing-in our implementation
standards. The IDTF is required to Comment: Several commenters approach. In the event that an IDTF’s
provide access, during regular business recommended that we expand the billing privileges are revoked, the
hours, to CMS and beneficiaries, as well proposed IDTF performance standards supplier can appeal the revocation.
as maintain a visible sign posting the to all imaging services. Comment: Several commenters
normal business hours of the IDTF. Response: While we appreciate this expressed the concern that an
3. Supervision comment, we will consider this change unannounced site visit by CMS or our
in a future rulemaking document. representatives could be potentially
To ensure quality care is provided to
Comment: One commenter expressed disruptive to an IDTF’s operations.
Medicare beneficiaries, we proposed to
revise § 410.33(b)(1) to read that concern regarding our proposal that an Response: We believe that
physicians will be limited to providing IDTF maintain a physical facility on an unannounced site visits are a useful tool
supervision to ‘‘no more than three appropriate site and that IDTFs would to ensure that IDTFs are meeting their
IDTF sites.’’ be required to maintain a specified enrollment requirements and
number of square feet per facility. performance standards. We will work
4. Place of Service Response: While we understand the closely with our contractors to limit any
In addition to establishing specific commenter’s concern, it was never our disruptions during a site visit.
performance standards for IDTFs, at intent to establish a minimum square Comment: One commenter
§ 410.33(i), we proposed to define the foot requirement. We believe that the recommended that we eliminate the
‘‘point of the actual delivery of service’’ size of an IDTF can vary depending on IDTF benefit.
as the correct ‘‘Place of Service’’ for the the services performed. Accordingly, we Response: We believe that
claim form in the case of diagnostic believe that the size of a fixed-based establishing performance standards and
testing performed outside the IDTF’s IDTF should be of sufficient size to the other changes in this regulation will
physical location. For example, when an provide the services offered by the improve quality and assist us in our
IDTF performs a diagnostic test at a IDTF, such as maintaining records, and efforts to reduce fraud and abuse in the
beneficiary’s residence, we believe that performing administrative tasks. Medicare program. Accordingly, we are
it is reasonable to establish the Comment: Several commenters finalizing this proposal.
beneficiary’s residence as the ‘‘Place of recommended that physicians can be Comment: One commenter
Service.’’ Previously, there has been no proficient in analyzing test results recommended eliminating the
set procedure, so therefore, we believe without being considered a specialist in requirement to maintain a primary
that the information is gathered at the the field relating to that specific type of business phone located at the
collection point from the beneficiary, diagnostic testing. designated site for business, especially
and this is the point service. While most Response: This issue is outside of the with regards to mobile IDTFs.
diagnostic tests are performed in an scope of the provisions of the proposed Response: We believe that it is
office setting, we solicited public rule, and therefore, we are not providing essential that fixed and mobile IDTFs
comments regarding the types of a response at this time. maintain a primary business telephone
services that can be safely and Comment: In lieu of the specific number. Moreover, we believe the
appropriately used in a residential performance standards proposed, primary business telephone number for
setting. several commenters recommended that fixed-based IDTFs is located at the
we use accreditation as a method for practice location for the IDTF. For
5. Analysis of and Responses to Public improving compliance and limiting mobile IDTFs, we believe that the
Comments fraud and abuse with IDTFs. primary business telephone number is
Comment: Several commenters agreed Response: While we appreciate this the home location for the mobile
with our proposal to limit the number comment, we are not able to adopt this facility.
of IDTFs that a physician can oversee to recommendation. We believe that it is Comment: Several commenters
three. Conversely, some commenters essential that we obtain additional recommended that we clarify where
mobile IDTFs would store patient Additionally, we received comments television, radio, internet, direct
records. suggesting that we establish a flat rate mailing, billboards, or newspapers.
Response: We believe that it is such as the $300,000 proposed, having Comment: One commenter
appropriate for a mobile IDTF to store a $300,000 policy for each facility, an recommended that complaints by
patient records at their home location. increase to a $500,000 flat coverage, a beneficiaries should be documented on
Comment: In lieu of the proposed comprehensive insurance policy of $1 paper and kept at a home office
performance standards, several million, or an aggregate rate of $3 location.
commenters recommended that we million. Response: At this time, we are not
implement modality specific standards Response: In order to reduce requiring that an IDTF collect and
to address the diverse nature of the administrative burden associated with maintain a log of beneficiaries’
services provided by IDTFs. calculating comprehensive liability questions and complaints because we
Response: We are not able to adopt insurance for suppliers and to ensure did not propose this requirement in the
this recommendation because we compliance of this new standard, we CY 2007 PFS proposed rule. In a future
believe that it is essential that we obtain will establish a comprehensive liability rulemaking document, we will address
additional information from the public insurance amount of $300,000 per a formal collection process for this
before adopting modality-specific location for IDTFs. We agree with the documentation.
standards. recommendation that comprehensive Comment: Several commenters
Comment: Several commenters stated liability insurance coverage of $300,000 expressed concern regarding the storage
that our proposal for a physician to be per facility location is more appropriate, and specifications of medical records
responsible for overall operations and given that the likelihood of an incident (namely the comprehensive medical
administration of an IDTF has no basis, occurring would increase as the number records of the beneficiaries they are
and that a physician should solely play of facilities increases. We believe that currently treating or have treated), as
a clinical or technical role. the $300,000 per location represents the well as how we would be defining
Response: We believe that a reasonable level of coverage for a current medical records, largely due to
supervising physician, as identified in facility’s comprehensive liability the additional burden of HIPAA
Attachment 2 of the CMS–855B insurance and we will change requirements associated with a patient’s
Medicare enrollment application, is performance standard 6 to reflect this comprehensive medical treatments.
fundamentally responsible for the change. Response: We view current medical
proper administration of an IDTF’s
Comment: One commenter suggested records as consisting of the services
services.
that we eliminate the provision that provided by the IDTF to its current and
Comment: Several commenters
insurance policy must be carried by a prior patients. Upon request, CMS or its
questioned our interpretation for the
non-relative-owned company. contractors may request comprehensive
point-of-service for services provided
outside the IDTF, specifically at the Response: Consistent with our medical records for an IDTF.
beneficiary’s residence. DMEPOS supplier standards, we believe Comment: Several commenters
Response: The beneficiary’s location the comprehensive liability insurance expressed support for IDTF supplier
will be considered the place of service must be obtained from a verified third standard 11 which mandates the
for pure, home-based testing. Those party to ensure that the coverage exists. calibration of all IDTF testing
diagnostic tests which have another Comment: Several commenters equipment. These commenters
element outside of the testing location recommended our performance recommended that we work with the
will continue to have the IDTF as the standards address State requirements, National Electrical Manufacturers
place of service of that diagnostic and that we should develop a Federal Association (NEMA) prior to
procedure. set of standards that would not vary establishing any calibration and
Comment: Several commenters from State to State. maintenance requirements.
recommended that there is a need for a Response: While we understand this Response: We appreciate these
supervising physician within an IDTF concern, we believe that each State comments and intend to work with
and that the language in the proposed should continue to establish its own NEMA and other organizations in the
rule stating that, ‘‘a physician could licensing requirements. Further, we development of calibration and
oversee no more than three IDTFs,’’ believe that all IDTFs must maintain maintenance requirements.
could be interpreted to mean that a compliance with applicable Federal, Comment: We received a comment
physician does not have to oversee an State, and local licensure and regulatory stating that IDTFs should not be
IDTF. requirements. required to post performance standards.
Response: We concur with this Comment: Several commenters Response: We believe that posting
recommendation and believe that this expressed concern with our proposed performance standards educates
standard should be interpreted as a supplier standard 7 which states that an patients of an IDTF regarding their
physician will oversee one to no more IDTF agrees not to directly solicit rights within the IDTF setting.
than three IDTFs, not that an IDTF does patients, and these commenters Therefore, we will adopt this standard
not need a supervising physician. recommended that we remove or clarify as proposed.
Comment: We received numerous standard seven. Comment: Several commenters
comments concerning one aspect of Response: We understand the recommended that we postpone
performance standard 6. We proposed concerns of the commenters, but we are implementing the proposed IDTF
that the IDTF would have to maintain a not attempting to prohibit public performance standards in 2007 and
comprehensive liability insurance advertising. Supplier standard 7 is work with industry to develop
policy of $300,000 or 20 percent of the designed to prohibit an IDTF or its standards for the CY 2008 PFS.
IDTF’s Medicare billings, whichever representative from direct, person-to- Response: Given the widespread
amount is greater. We received person solicitation of beneficiaries by support of IDTF performance standards,
comments suggesting the removal of the means of phone, computer, or in-person. we believe it is appropriate to
20 percent condition as this would be Clearly, an IDTF can use public implement our proposed changes as
an undue burden to the IDTF. advertisement, including advertising on soon as possible. Therefore, we will
implement the IDTF standards in this from public advertisement or marketing if currently enrolled in the Medicare
final rule with comment period. of its services to beneficiaries, program.
Comment: Several commenters physicians and other suppliers, it does Accordingly, at § 410.33(h), we are
recommended that our proposed 30-day prohibit recruitment of beneficiaries stating that if an IDTF fails to meet one
timeframe for reporting changes in through direct solicitation, namely or more of the standards at the time of
enrollment data was insufficient and through person-to-person contact, enrollment, then the enrollment
that IDTFs should be allowed to whether it be in-person, by computer, or application would be denied. Also, we
continue to report changes within 90 telephone. are adopting the position that if at any
days. Since we did not include the time we determine that an enrolled
Response: Consistent with the requirement in the CY 2007 PFS IDTF no longer meets one or more of the
reporting requirements for DMEPOS proposed rule, we are revising IDTF performance standards, the IDTF’s
suppliers, and given the fraud and abuse performance standard 8 and removing billing privileges would be revoked.
concerns in this area, we believe that it the sentence concerning the As specified in § 410.33, the IDTF will
is appropriate to adopt the 30-day documentation of contacts concerning be required to meet the following
timeframe for IDTFs to report changes in beneficiaries’ questions and complaints standards as of January 1, 2007 and any
enrollment information. because we believe it would be unfair newly or reenrolling IDTF will be
and confusing to the public, and would required to certify in its enrollment
6. Provisions of the Final Rule. present an undue paperwork burden. application that it meets and will
a. Performance Standards for IDTFs We are revising supplier standard continue to meet the standards.
number 11 to state that each piece of • Operate its business in compliance
We received numerous valuable diagnostic testing equipment be
comments concerning the proposed with all applicable Federal, State, and
maintained and calibrated to its
supplier standards and have revised local licensure and regulatory
manufacturer’s standards. To ensure
them to reflect the issues brought forth requirements for the health and safety of
that equipment used by an IDTF is
during the comment period. Therefore, patients;
maintained and operates properly, we
we have amended these new standards • Provide complete and accurate
sought public comments regarding IDTF
to reflect the differences in an IDTF’s information on its enrollment
supplier standard number 11, which
setting and the services which they application as stated in the
requires that an IDTF must have its
provide. We are adopting the provisions testing equipment calibrated per ‘‘Requirements for Providers and
contained in the proposed rule as final equipment instructions or in Suppliers to Establish and Maintain
with the following changes. compliance with applicable industry Enrollment final rule’’ published in the
We are revising supplier standard standards. Specifically, we sought April 21, 2006 Federal Register (71 FR
number 3 to address concerns regarding public comments regarding the 20754). Any change in enrollment
how performance standards affect organizations or entities that may information must be reported to the
mobile IDTFs, rather than fixed location currently establish testing specifications designated fee-for-service contractor on
IDTFs. Specifically, we are adopting a for diagnostics equipment. We received the Medicare enrollment application
position that IDTF performance a number of comments supporting this within 30 calendar days;
standards apply to the home location of proposal with minor changes suggested • Maintain a physical facility on an
the mobile IDTF, not the mobile vehicle. by leaders within this industry. We are appropriate site. For the purposes of this
Accordingly, the home location of the adopting a recommendation that we use standard, a post office box or
mobile IDTF, not the mobile IDTF each manufacturer’s maintenance and commercial mailbox is not considered a
vehicle, is required to maintain patient calibration standards which they have physical facility. The physical facility,
records, a primary business phone, and determined are appropriate for the including mobile units, must contain
meet all other performance standards diagnostic testing equipment they space for equipment appropriate to the
met by fix location IDTFs. manufacture for use within these IDTFs. services designated on the enrollment
We are revising supplier standard We will continue to consult with application, facilities for hand washing,
number 6 to establish a set amount for industry leaders regarding the best adequate patient privacy
comprehensive liability insurance in the approaches to ensure that all IDTF accommodations, and the storage of
amount of $300,000 per location (an testing equipment is maintained and both business records and current
amount similar to the amount of calibrated in accordance with medical records within the office setting
insurance coverage for DMEPOS manufacturer’s specifications. of the IDTF, or IDTF home office, not
suppliers). We are adopting, for IDTFs, We are clarifying supplier standard within the actual mobile unit;
supplier standard number 6 which number 14 that fixed and mobile IDTFs • Have all applicable diagnostic
requires a supplier to maintain a are required to grant CMS, or our testing equipment available at the
comprehensive liability insurance designated fee-for-service contractors, physical site, excluding portable
policy of $300,000 for each IDTF access to the IDTF physical location, all diagnostic testing equipment. A catalog
location, which covers both the place of equipment, and beneficiary medical of portable diagnostic testing
business and all customers and records during normal business hours. equipment, including diagnostic testing
employees of the IDTF. We believe that We also adopted the position that for equipment serial numbers, must be
the second part of the proposed portable equipment, an IDTF will be maintained at the physical site. In
provision of 20 percent of its average required to maintain a catalog of addition, portable diagnostic testing
annual Medicare billings, if greater than portable equipment and be able to equipment must be made available for
the $300,000 would be a burdensome produce the cataloged equipment within inspection within 2 business days of our
task for supplier to calculate on annual 2 business days. If the IDTF denies CMS inspection request. The IDTF will be
basis and lead to compliance concerns. or our designated fee-for-service required to maintain a current inventory
We are clarifying supplier standard contractor access to its fixed located or of the diagnostic testing equipment
number 7 that an IDTF agrees not to the home location for a mobile vehicle, (including serial/registration numbers),
directly solicit patients. While this the IDTF’s Medicare enrollment will be provide this information to the
provision does not preclude an IDTF denied if initially enrolling or revoked designated fee-for-service contractor and
notify the contractor of any changes in provide access, during regular business home location of the mobile IDTF or
equipment; hours, to CMS and beneficiaries, as well portable x-ray supplier.
• Maintain a primary business phone as maintain a visible sign posting the However, when a diagnostic test
under the name of the business. The normal business hours of the IDTF. contains a home-based element (that is,
primary business phone must be located While we understand that these the beneficiary performs a portion of the
at the designated site of the business, or additional standards could lead certain testing in his or her residence) and a
within the home office of mobile IDTF IDTFs to withdraw from the Medicare facility-based element (that is, an IDTF
units. The telephone number or toll free program rather than comply with the reads or monitors the test results), the
numbers must be available in a local new standards, we believe that place of service is not clearly
directory and through directory legitimate businesses would not oppose established and the fixed location of the
assistance; these changes. Moreover, we emphasize IDTF will remain as the place of service
• Have a comprehensive liability that services provided by an IDTF are for these tests. Accordingly, diagnostic
insurance policy of at least $300,000 per also readily available to beneficiaries tests containing both home-based and
location that covers both the place of through other avenues such as facility-based elements are billed to the
business and all customers and physicians’ offices, outpatient designated Medicare contractor
employees of the IDTF. The insurance laboratories, outpatient radiology associated with the practice location of
policy must be carried by a non-relative facilities, and outpatient clinics. We the fixed IDTF.
owned company. The policy must list In a future rulemaking effort, we will
believe that the implementation of these
the serial numbers of any and all seek public input regarding the
standards would improve the quality of
diagnostic equipment used by the IDTF, appropriate place of service for
services provided to Medicare
whether the equipment is stationary, in diagnostic testing when services are
beneficiaries by IDTFs without any
a mobile unit, or at the beneficiary’s rendered in multiple parts in different
associated access concerns.
residence; locations.
• Agree not to directly solicit b. Supervision
M. Independent Laboratory Billing for
patients, which includes, but is not To ensure quality care is provided to the TC of Physician Pathology Services
limited to, a prohibition on telephone, Medicare beneficiaries, we are adopting to Hospital Patients
computer, or in-person contracts. The the position to revise § 410.33(b)(1) to
IDTF will accept only those patients The TC of physician pathology
read that physicians will be limited to services refers to the preparation of the
referred for diagnostic testing by an providing supervision to ‘‘no more than
attending physician, who is furnishing a slide involving tissue or cells that a
three (3) IDTF sites.’’ This reference to pathologist will interpret. (In contrast,
consultation or treating a beneficiary for the supervising physician applies to the
a specific medical problem and who the pathologist’s interpretation of the
individual listed as the supervising slide is the PC service. If this service is
uses the results in the management of physician in the Medicare enrollment
the beneficiary’s specific medical furnished by the hospital pathologist for
application (that is, CMS–855 B, a hospital patient, it is separately
problem. NPPs may order tests as set Attachment 2, Section E), not the
forth in § 410.32(a)(3); billable. If the independent laboratory’s
physician supervising the interpretation pathologist furnishes the PC service, it
• Answer beneficiaries’ questions and
of a diagnostic test. is usually billed with the TC service as
respond to their complaints;
• Openly post these standards for c. Place of Service a combined service.)
review by patients and the public; In the CY 2000 PFS final rule (64 FR
• Disclose to the government, any In addition to establishing specific 59380 and 59408 through 59409), we
person having ownership, financial or performance standards for IDTFs, we are stated that we would implement a
control interest, or any other legal defining the ‘‘point of the actual policy to pay only the hospital for the
interest in the supplier at the time of delivery of service’’ as the correct ‘‘Place TC of physician pathology services
enrollment or within 30 days of a of Service’’ on the claim form. In the furnished to hospital patients. Before
change; case of diagnostic testing that is that proposal, any independent
• Have its testing equipment performed completely outside of a fixed laboratory could bill the carrier under
calibrated and maintained per facility location, we believe that the the PFS for the TC of physician
equipment instructions and in point of actual delivery of service is the pathology services for hospital patients.
compliance with applicable beneficiary’s’ residence, or location As stated in the CY 2000 PFS final rule,
manufacturers suggested maintenance where the test is being administered. As this policy has contributed to the
and calibration standards; such, these services should be billed to Medicare program paying twice for the
• Have technical staff on duty with the designated Medicare contractor. For TC service, first through the inpatient
the appropriate credentials to perform example, when a diagnostic test is prospective payment rate to the hospital
tests. The IDTF must produce the performed at a beneficiary’s residence, where the patient is an inpatient and
applicable Federal or State licenses and we believe that it is reasonable to again to the independent laboratory that
certifications of the individuals establish the beneficiary’s residence as bills the carrier, instead of the hospital,
performing these services; the ‘‘Place of Service’’ and that these for the TC service.
• Have proper medical record storage services be billed to the designated Therefore, in the CY 2000 PFS final
and be able to retrieve medical records Medicare contractor where the rule at § 415.130, we provided that, for
upon request from CMS or our beneficiary resides. Previously, there services furnished on or after January 1,
designated fee-for-service contractor has been no set policy regarding 2001, the carriers would no longer pay
within 2 business days; and diagnostic testing performed by claims to the independent laboratory
• Permit CMS, including our agents beneficiary. Accordingly, mobile IDTF under the PFS for the TC of physician
or our designated fee-for-service and portable x-ray supplier services pathology services for hospital patients.
contractors, to conduct unannounced, performed in beneficiary’s residence Ordinarily, the provisions in the final
on-site inspections to confirm the would be billed to the designated PFS are implemented in the following
IDTF’s compliance with these Medicare contractor where the year. However, in this case, the change
standards. The IDTF is required to beneficiary resides, rather than the to § 415.130 was delayed one year (until
January 1, 2001), at the request of the scans. Only hospitals that have 1. Medicare, Medicaid, and SCHIP
industry, to allow independent outsourced no other diagnostic services Benefits Improvement Protection Act of
laboratories and hospitals sufficient other than physician pathology services 2000 (BIPA)
time to negotiate arrangements. may have to establish new billing Section 531(b) of BIPA mandated that
Moreover, our full implementation of systems or procedures. we establish, no later than 1 year after
§ 415.130 was further delayed through Similarly, we are not requiring the date of enactment, procedures that
CY 2006. Most recently, under section independent laboratories to establish permit public consultation for payment
732 of the MMA, we were required to new billing procedures and systems. determinations for new clinical
pay separately under Medicare Part B Independent laboratories have similar diagnostic laboratory tests under
for the TC of physician pathology billing systems in operation for clinical Medicare Part B in a manner consistent
services for services furnished during laboratory services that are provided to with the procedures established for
2005 and 2006. hospital inpatients. Also, neither
However, we continue to believe that implementing ICD–9–CM coding
individual laboratories nor any industry modifications. In the CY 2002 PFS final
hospital prospective payment amounts laboratory specialty group for
already compensate hospitals for the TC rule (66 FR 58743), we specified the
independent laboratories has procedures to implement section 531(b)
of physician pathology tests and that commented on this increased
additional payment under the PFS is of BIPA.
complexity, cost, and burden. These procedures were most recently
inappropriate. Therefore, we are Comment: One individual commented
amending § 415.130 to provide that, for used to determine the payments for new
on a draft instruction that has been sent 2006 clinical laboratory fee schedule
services furnished after December 31, to the Medicare carriers for comment.
2006, an independent laboratory may codes. First, we convened a public
The instruction implements the meeting to solicit expert input on the
not bill the carrier for the TC of payment policy for physician pathology
physician pathology services furnished nature of the new tests before rate
TC services beginning in 2007. determinations were made. We have
to a hospital inpatient or outpatient. Response: This item is not a subject
Under § 415.130(d), we will pay under held these meetings each year since
of the proposed rule and we are not 2002 to receive this expert input on the
the PFS for the TC of a physician
addressing this comment as part of this next year’s codes. Our most recent
pathology service furnished by an
rule. The draft Internet Only Manual meeting was announced in the Federal
independent laboratory for services
instructions are reviewed by carriers Register on May 27, 2005 (70 FR 30734)
provided to an inpatient or outpatient of
during their development. There is a and occurred on July 18, 2005. In that
a ‘‘covered hospital’’ (as defined in
formal review process for evaluation of meeting, we requested that presenters
§ 415.130(a)(1)) on or before December
these comments apart from the address the new test codes, each test’s
31, 2006.
We received comments from regulation process. purpose, method, cost, and a
individuals and groups. Comment: Several commenters recommendation for one of two methods
Comment: Several commenters stated identified an issue involving proposed (crosswalking or gapfilling) for
that the policy, in the CY 2000 PFS final § 415.130. The commenters expressed determining payment for the new
rule, was based on flawed assumptions concern that the effect of the proposed clinical laboratory codes. Crosswalking
and facts, and that the hospital’s regulation would not be limited to the and gapfilling are discussed in section
inpatient payment rate does not include TC of physician services. Proposed II.N.2.d of this final rule with comment
payment for this service. § 415.130 reads, ‘‘For services furnished period.
Response: We addressed specific after December 31, 2006, an Following the public meeting, we
comments regarding the establishment independent laboratory may not bill the posted a summary of the new codes and
of the inpatient prospective payment carrier for physician pathology services the payment recommendations that
system (IPPS) and the inclusion of the furnished to a hospital inpatient or were presented during the public
TC physician pathology costs in this outpatient.’’ meeting on our Web site. The summary
payment system in the final rule Response: We appreciate the issue also displayed our tentative payment
published in the CY 2000 PFS final rule that the commenters have identified determinations and indicated a
(64 FR 59408 through 59409). We through their careful reading of the comment period for interested parties to
believe that our discussion in that final proposed rule. The quoted sentence submit written comments. After
rule is still valid. omitted the reference to the ‘‘technical reviewing the comments received, we
Comment: Several commenters component’’ of physician pathology issued Medicare Transmittal 750, 2006
indicated that hospitals and services. We are revising the regulation Annual Update for Clinical Laboratory
independent laboratories will have to text accordingly as this was clearly our Fee Schedule, which provided all
set up costly and administratively intent. instructions and final rate
complex billing systems and determinations for the 2006 clinical
N. Public Consultation for Medicare
procedures. These commenters and laboratory fee schedule including the
Payment for New Outpatient Clinical
others asked us to allow hospitals and new codes and fees, on November 18,
Diagnostic Laboratory Tests
independent laboratories that have these 2005.
grandfathered arrangements to continue Section 1833(h) of the Act requires
the Secretary to establish fee schedules 2. Medicare Prescription Drug,
bill in the same manner.
Response: We are not requiring the for clinical laboratory tests under Improvement, and Modernization Act of
hospitals to establish new billing Medicare Part B. We proposed to 2003 (MMA)
procedures or systems. The billing of TC implement section 942(b) of the MMA In the CY 2007 PFS proposed rule (71
physician pathology services involves which specifies annual procedures for FR 49064), we proposed to implement
the same billing procedures and consulting the public on how to section 942(b) of the MMA which
processes that the hospital may have establish payment for new clinical requires that we establish procedures for
established for any outsourced laboratory test codes to be included in consulting the public on how to
diagnostic tests for hospital inpatients, the annual update of the clinical establish payment for new clinical
such as MRI, CT scan, and ultrasound laboratory fee schedule. laboratory test codes to be included in
the annual update of the clinical which recommendations are based) on consultation is that we codify this
laboratory fee schedule. Similar the appropriate basis for establishing process in regulations. Therefore, we
procedures were already mandated by payment amounts for the list of codes proposed to codify our current process
legislation in section 531(b) of the BIPA made available to the public on the for public consultation for new clinical
which requires payment determinations same day the list of codes is made diagnostic laboratory tests paid under
for new clinical diagnostic laboratory available; the Medicare Part B clinical laboratory
tests under Medicare Part B be made in • Convenes a meeting that includes fee schedule at new Subpart G—
a manner consistent with the representatives of CMS officials Payment for New Clinical Diagnostic
procedures established for involved in determining payment Laboratory Tests (§ 414.502 through
implementing ICD–9–CM coding amounts, to receive public comments § 414.506).
modifications. and recommendations (and data on Comment: Several comments
Specifically, the MMA requires the which the recommendations are based) supported the consultation process for
Secretary to establish by regulation not less than 30 days after publication new clinical diagnostic laboratory tests
procedures for determining the basis for of the notice in the Federal Register; paid under the Medicare Part B clinical
and amount of payment for a clinical and laboratory fee schedule. Commenters
diagnostic laboratory test that is • Considers the comments and suggested changes to the meeting and
assigned a new or substantially revised recommendations (and accompanying posting of data presented in the
HCPCS code on or after January 1, 2005. data) received at the public meeting, meeting. For example, a commenter
We refer to these tests as ‘‘new tests.’’ develops and makes available to the suggested we should require a 60-day
public (through an Internet Web site and time period from the Federal Register
a. Basis and Scope (§ 414.500) other appropriate mechanisms)— notice of the public meeting and the
We proposed to add a new subpart + A list of determinations for the date of the public meeting. Commenters
implementing provisions of section appropriate basis for establishing a also requested that we post on the
1833(h)(8) of the Act—procedures for payment amount for each code, together Internet additional detail regarding data
determining the basis for, and amount with an explanation of the reasons for and rationale used for public
of, payment for a new clinical each determination, the data on which recommendations and final payment
diagnostic laboratory test with respect to the determinations are based, and a decisions.
which a new or substantially revised request for public written comments on Response: We want to take this
HCPCS code is assigned on or after the proposed determination; and opportunity to explain the timeframes
January 1, 2005. + A list of final determinations of the for the annual update to the clinical
We received no comments on this payment amounts for tests, together laboratory fee schedule. The Medicare
subpart. Therefore, we are finalizing with the rationale for each Part B clinical laboratory fee schedule
§ 414.500 as proposed. determination, the data on which the utilizes the codes developed by the
determinations are based, and responses AMA’s Current Procedural Terminology
b. Definition (§ 414.502) to comments and suggestions from the (CPT) Editorial Panel. The CPT codes
As specified in section 942(b) of the public. are developed as the result of quarterly
MMA, we are defining the term In the CY 2007 PFS proposed rule, we meetings throughout the year and the
‘‘Substantially Revised Healthcare indicated these procedures have been codes to be included in the upcoming
Common Procedure Coding System most recently used to finalize the year’s fee schedule (effective January
Code’’ to mean a code for which there payments for new 2006 clinical 1st) are available as early as May. We
has been a substantive change to the laboratory fee schedule codes and we then list the new clinical laboratory
definition of the test or procedure to believe that our current process for tests codes on our Web site in June
which the code applies (such as a new providing for public consultation on the along with registration information for
analyte or a new methodology for establishment of payment amounts for the public meeting. We schedule the
measuring an existing analyte specific new clinical laboratory tests is date of the public meeting not fewer
test). consistent with the requirements of than 30 days after announcing the
We did not receive comments on this section 1833(h)(8)(B) of the Act. We meeting in the Federal Register. This
subpart. Therefore, we are finalizing currently make available to the public timeframe results in a July date for the
§ 414.502 as proposed. through a posting on the CMS Web site public meeting, followed by a posting of
a list of new laboratory test codes for the our tentative payment determinations
c. Procedures for Public Consultation for next calendar year. We publish a and a comment period in September.
Payment for a New Clinical Diagnostic Federal Register notice of a meeting to The updated clinical laboratory fee
Laboratory Test (§ 414.506) receive public comments and schedule is prepared in October for
For a clinical laboratory test that is recommendations and convene the release to our contractors during the
assigned a new or substantially revised meeting with appropriate CMS officials first week in November. Our contractors
code on or after January 1, 2005, section in attendance. We consider the input have many information system steps to
1833(h)(8)(B) of the Act provides that received at the public meeting and we complete during the months of
determinations of payment amounts for make available to the public on the CMS November and December so that the
new tests shall be made only after the Web site a list of the proposed updated clinical laboratory fee schedule
Secretary: determinations and seek comment. We is ready to pay claims effective January
• Makes available to the public then make available to the public our 1st of the calendar year.
(through an Internet Web site and other final determinations in the instructions With the constraints of the this
appropriate mechanisms) a list that that we provide to our claims processing process, we will strive to provide as
includes codes for which establishment contractors to implement the Medicare much time as is feasible between the
of a payment amount is being Part B clinical laboratory fee schedule announcement of the meeting and the
considered for the next calendar year; each year. meeting itself. As required under both
• Publishes a Federal Register notice The most significant change required the statute and § 414.506, the public
of a meeting to receive public comments by section 1833(h)(8)(A) of the Act with meeting will take place ‘‘not fewer’’
and recommendations (and data on respect to our procedures for public than 30 days after we publish notice of
the meeting in the Federal Register. Our clinical laboratory fee schedule. We d. Payment for a New Clinical
proposed regulatory language allows us state in the public meeting notice that Diagnostic Laboratory Test—
flexibility to provide additional time presentations should address the new Crosswalking and Gapfilling (§ 414.508)
when feasible. However, extending the test code(s) and descriptor(s), the test We proposed to add new § 414.508 to
notification period announcing the date purpose and method, costs and charges, indicate when, in establishing the
of the public meeting to 60 days from and other background information. We payment amount for a new clinical
the Federal Register notice of the public certainly encourage presenters to laboratory test, one of two payment
meeting could cause delays to the rate- include in their presentations market methods can be utilized. The first
setting process and to the timely release availability of the test and other payment method, called
of the updated clinical laboratory fee information on the new technology. ‘‘crosswalking,’’ is used if a new test is
schedule. Also, a question and answer period is determined to be comparable to an
Commenters also requested that when scheduled during the meeting to permit
we announce public recommendations existing test, multiple existing test
a robust discussion of each new test codes, or a portion of an existing test
or our determinations, we should code. As noted, when we have hosted
include data and the rationale on which code. We proposed that a new test code
the public meetings in the past, the would be assigned the related existing
the recommendation or determination is laboratory industry has sometimes
based. However, we note that local fee schedule amounts and national
submitted payment recommendations limitation amount (NLA).
recommendations from the public that are sparse of information and data
meeting have sometimes lacked the In new § 414.508, we proposed to use
supporting the payment the second method, called ‘‘gapfilling,’’
detail requested by commenters. We recommendations. Thus, we do not
have considered all payment when no comparable, existing test is
believe opportunities for information available. Currently when using this
recommendations received from the
gathering on new technology tests have method, manual instructions are
public, even those that have sometimes
been fully utilized within the public provided to each Medicare carrier to
lacked the supporting detail requested
meeting process. While we can work determine a payment amount for its
by commenters. In some cases,
companies have expressed concern with laboratories to explore other geographic area(s) for use in the first
about revealing data to laboratory payment options for new technology year, and the carrier-specific amounts
competitors during the public meeting. tests, we must implement the statutorily are used to establish an NLA for
When soliciting public input for the required public meeting process. We following years. Consistent with our
meeting, we will recommend that all encourage the laboratory industry to current process, the sources of
participants in the public consultation fully participate in this process and to information carriers examine in
process strive for transparency and try include in its public recommendations determining gapfill amounts, if
to provide as much supporting data detailed background information available, include—
information as possible to assist us and on market availability and other • Charges for the test and routine
others in evaluating the concerns that laboratories have for the discounts to charges;
recommendation. As required by the new technology test codes. • Resources required to perform the
statute, we will provide the rationale for Comment: We received a comment test;
our payment determinations. requesting that we establish a • Payment amounts determined by
Comment: Two commenters stated reconsideration process that would other payers; and
that a whole new generation of allow interested parties to request a • Charges, payment amounts, and
diagnostic tests will contribute to formal review of payment rate resources required for other tests that
treatment that is more tailored to the determinations. The commenter may be comparable or otherwise
individual so that maintaining the suggested that interested parties be relevant.
current system for setting payment will given an opportunity to request and Currently, our manual instructions
not be sufficient because the new receive a reconsideration of a CMS allow carriers to consider other sources
generation tests are more complex than decision to crosswalk or gapfill a new or of information as appropriate, including
the individual test codes currently paid revised test code, CMS crosswalk clinical studies and information
under the clinical laboratory fee determination, a contractor provided by clinicians practicing in the
schedule. Also, the commenters determination of a gapfill price, or a area, manufacturers, or other interested
indicated that some of the new CMS calculation of the NLA for a new parties. Carriers are also instructed to
generation tests may be performed by test. establish carrier specific amounts on or
only one laboratory in the country so before March 31 of the year and to
Response: We understand the revise their carrier specific amount, if
that establishing a payment amount for
concerns of the commenter, but we are necessary, on or before September 1 of
the new test becomes a de facto national
price which may be insufficient for not establishing a formal the year. In this manner, a carrier may
other laboratories in the future. reconsideration process in this final revise its carrier specific amount based
Response: We appreciate the rule. However, we are revising § 414.508 on additional information, but there is
commenters’ recognition that to provide that, if we gapfill a test, but also a specific time frame to perform
establishing payment for new determine after the first year of this revision so that we have adequate
technology testing is complex and gapfilling that carrier-specific gapfilled time to receive and use the carrier
subject to many professional amounts will not pay for the test specific amounts for the calculation of
perspectives. In this rulemaking, we are appropriately, we may crosswalk the the next year’s clinical laboratory fee
complying with the MMA mandate to test. Furthermore, we expect to solicit schedule.
codify a public consultation process for comments on a potential In light of MMA provisions, we
payment of new clinical laboratory test reconsideration process in a future proposed to prospectively eliminate
codes. The statute requires that we host rulemaking. payment of new gapfilled tests at a
a public meeting to receive After careful review of the public carrier specific amount after the first
recommendations on individual test comments, we are finalizing § 414.506 year in new § 414.508. Section
codes added to the Medicare Part B as proposed. 1833(h)(8)(A) of the Act gives the
Secretary authority to establish physicians, providers and the clinical by Medicare. Our regulations at
procedures for determining the payment laboratory community to identify ways § 410.32(a) already require that, for any
amount for laboratory tests for which to promote utilization decisions such as diagnostic test, including a clinical
new or substantially revised HCPCS using a laboratory claims attachment diagnostic laboratory test, to be
codes were established on or after standard involving the Logical considered reasonable and necessary, it
January 1, 2005. Under this authority, in Observation Identifiers Names and must be both ordered by the physician
new § 414.508(b), we proposed to pay Codes (LOINC) database as a means for and the ordering physician must use the
for a new gapfilled laboratory test under reporting test result data. This could be result in the management of the
our existing methodology for the first one possible component of a beneficiary’s specific medical problem.
year (the carrier would establish a comprehensive system of collecting Tests not ordered by the physician who
gapfill amount.) Beginning in the clinical laboratory test data. Detailed is treating the beneficiary are not
second year, the test would be paid at information on the LOINC reporting reasonable and necessary.
the national limitation amount. This system is available at the Web site at In the context of blood glucose
would result in consistent payment in http://www.loinc.org. monitoring, we most recently explained
geographic areas for a new test using the Comment: Several commenters this policy in Transmittal AB–00–108,
median of the carriers’ gapfilled endorsed our interest in working with which is available on our Web site at
amounts. the laboratory community on laboratory http://www.cms.gov/transmittals/
Comment: Commenters were quality of care initiatives. However, two downloads/ab00108.pdf. This
supportive of our proposal to set the commenters objected to LOINC interpretation of § 410.32 also is the
price for gapfilled tests at the NLA. reporting system as operationally basis for our policy in section 90.1 of
Other commenters suggested that the burdensome for laboratory information Chapter 7 of the Medicare Claims
method used by contractors to systems because it would require Processing Manual (‘‘Skilled Nursing
determine their price for gapfilled tests merging a data quality field from the Facility Part B Billing,’’ which is
should be more specific. laboratory information system to the available on our Web site at http://
Response: We appreciate the support laboratory billing system, training www.cms.hhs.gov/manuals/downloads/
for our proposal to establish the information systems staff, and sending clm104c07.pdf.)
payment rate for a gapfilled test at the reference laboratory result data to the In addition, separate authority under
NLA. However, we do not agree specific referral laboratory who prepares the section 1835(a)(2)(B) of the Act provides
changes to the gapfilling methodology claim. One of these commenters also that, in the case of certain ‘‘medical and
should be made in the final rule, stated that regulations on privacy of other health services’’ (including
without a chance to receive multi- medical information should be clinical diagnostic laboratory services),
stakeholder input on the commenter’s considered. One commenter indicated payment may be made for Part B
suggestions. We do believe that we must that the LOINC reporting system services that are furnished by a provider
engage the clinical laboratory requires narrative reporting for some of services only if a physician certifies—
community and our contractors in microbiology tests which is not in a data and recertifies where those services are
additional discussions regarding the quality field format. furnished over a period of time, with
Response: We are pleased the such frequency, and accompanied by
procedures and data used to determine
commenters supported the development such supporting material, as may be
the payment amounts for gapfilled tests.
of measures related to the quality of provided by regulation—that those
We will plan to discuss with our
clinical laboratory services. We agree services were medically necessary. In
contractors their experience establishing
that it is imperative to work with the CY 2007 PFS proposed rule (71 FR
the gapfill amounts and also to host a
physicians, providers and the clinical 49065), we proposed to use our
forum or meeting during the upcoming
laboratory community to identify authority under section 1835(a)(2)(B) of
year to listen to additional suggestions
quality measures that can efficiently be the Act to amend § 424.24 to provide
from the public. After participating in
incorporated into the laboratory billing that, for each blood glucose test
these additional information gathering
system. We understand the reporting of furnished to a resident of a SNF, the
steps, we will consider possible changes laboratory quality measures must reach physician must certify that the test is
to the regulations for the 2008 proposed compatibility with privacy rules. medically necessary. We also proposed
rule and/or additional subregulatory Furthermore, the important role of to clarify that a physician’s standing
guidance if appropriate. quality measures in the evolution of order is not sufficient to order a series
As discussed above, in response to a of blood glucose tests.
healthcare reporting will remain strong.
comment suggesting that we establish a Comment: Many commenters
While changes to information
reconsideration process, we are revising explained that it is common medical
technology may be required,
§ 414.508 to provide that we may practice in the nursing home for the
laboratories should be anticipating
crosswalk a test if we determine that physician to certify a standing order for
further interest to include a laboratory
carrier-specific gapfilled amounts will a 1-month time period for the nurse to
quality measure field in laboratory
not pay for the test appropriately. perform daily glucose monitoring
billing systems.
We are finalizing § 414.508 with the fingerstick tests throughout the month
exceptions noted above in this section. b. Blood Glucose Monitoring in SNFs and based on the results, the nursing
3. Other Laboratory Issues In the CY 2007 PFS proposed rule (71 staff dispense insulin, as needed by the
FR 49064), we included a discussion of patient. Thus, the commenters objected
a. Quality our longstanding policy on blood that the proposal will impose a burden
In the CY 2007 PFS proposed rule (71 glucose monitoring in SNFs submitted on SNFs who perform tests under these
FR 49064), we discussed that we are for payment under the Medicare Part B situations.
exploring the development of measures clinical laboratory fee schedule. We Response: This amendment to
related to the quality and efficiency of explained that section 1862(a)(1)(A) of § 424.24 establishes a certification
care, including those involving clinical the Act requires that a service be requirement that affects only services
laboratory fee schedule services. We reasonable and necessary for diagnosis that are furnished by a provider of
stated our interest to work with and treatment to be eligible for coverage services for which the provider of
services seeks payment under Medicare services for which providers bill impose an unfair burden on clinical
Part B. To the extent payment is separately under Medicare Part B. We laboratories that provide services to
available under Medicare Part A or the recognize the value of blood glucose SNFs because the independent
services are not furnished by a provider testing and strongly support this testing laboratory is not informed or
of services (as defined under section when it is medically necessary. responsible for the documentation
1861(u)of the Act), this certification However, we must also ensure that requirements in the SNF.
requirement does not apply. blood glucose testing is medically Response: Independent clinical
Payment for glucose monitoring is necessary when furnished by a provider laboratories are not providers of
encompassed under other payment of services for which the provider bills services, so our amendment to § 424.24
systems that are available to the nursing Medicare Part B. We believe that this does not affect these entities. We
homes. Medicare pays as part of the revision to § 424.24 strikes the disagree that an independent clinical
bundled payment to the facility for appropriate balance between our laboratory that is providing services to
beneficiaries in a Part A-covered stay in commitment to beneficiary access to SNF customers should not be informed
a hospital or in a SNF. It is when the blood glucose testing and our obligation or ensure the medical necessity
provider requests Medicare to separately to ensure that each test is medically documentation is sufficient.
pay for a blood glucose test under the necessary. Independent clinical laboratories must
outpatient Part B clinical laboratory fee We do not believe that our comply with § 410.32(a). Furthermore,
schedule that the service must meet the amendment to § 424.24 imposes a new independent clinical laboratories must
certification requirement under obligation. As discussed above in this be certified under the Clinical
§ 424.24(f). section, § 410.32(a) and our program Laboratory Improvement Amendments
We also note that the revisions to instructions already require that a of 1988 (CLIA) (Pub. L. 100–578). Under
§ 424.24 does not alter existing policies laboratory test must be ordered by a the standard for test requests at
issued under section 1862(a)(1)(A) of physician and the ordering physician § 493.1241, the laboratory must have a
the Act. As discussed above in this must use the result in the management written or electronic request for patient
section, under § 410.32(a), the test must of the beneficiary’s specific medical testing from an authorized person. An
be ordered by the physician who is problem. However, as discussed in the independent clinical laboratory,
treating the beneficiary and the proposed rule, we have received whether it is providing services to SNF
physician must use the results promptly inquiries regarding the application of customers or other provider types, must
in the management of the beneficiary’s § 410.32(a) in the context of blood remain informed and involved to ensure
specific medical condition. glucose testing provided by SNFs. In the laboratory service is rendered in
Comment: Some commenters raised addition, we received a specific inquiry accordance with the regulation and
concerns that coverage policies are not asking for clarification of section 90.1 of instructions applicable for receiving
consistently describing diabetes care Chapter 7 of the Medicare Claims payment under the clinical laboratory
categories, glucose monitoring Processing Manual. Furthermore, we fee schedule.
protocols, and an individual glucose test have become aware that some providers Comment: One commenter asserted
service. The commenters suggested have filed claims before Administrative that we are obligated to perform a
more specific coverage policies would Law Judges challenging our policy Regulatory Impact Analysis for our
benefit providers. regarding blood glucose testing in SNFs. proposal to clarify § 424.24 requiring the
Response: We understand the To the extent there has been physician to certify each test is
suggestion that refinements to coverage confusion regarding our policies, our medically necessary and stating that a
policies could benefit providers. The amendment to § 424.24 provides a clear physician’s standing order is not
2002 NCD for blood glucose tests rule that, for payment to be made for sufficient to order blood glucose tests
specifies coverage and frequency blood glucose tests under Medicare part for payment under the Medicare Part B
limitations for reimbursement under the B to a provider of services, a physician clinical laboratory fee schedule.
Part B. The NCD is not specific to must certify that each test is medically Another commenter stated our
nursing home common practices and necessary. We also have clarified that a amendment to § 424.24 does not
applies to all providers submitting physician’s standing order is not comport with the Paperwork Reduction
claims for payment under the clinical sufficient to order a series of blood Act of 1995 to publish a notice in the
laboratory fee schedule. During the glucose tests. Federal Register on collection of
years since the release of the NCD, Comment: One commenter alerted information.
laboratories along with other providers that some home health providers are Response: We do not believe our
who seek payment from the clinical engaging in inappropriate physician amendment to § 424.24 requires a
laboratory fee schedule have had ordering of clinical diagnostic blood regulatory impact analysis or a
opportunity to carefully review the NCD glucose tests, for payment under the Paperwork Reduction Act notice. We
and request further refinements and Part B benefit, so that the clarification believe that § 424.24(f) does not impose
examples to enhance the NCD’s to the regulation should apply not just any new obligations, but merely codifies
interrelationship with payment under to SNFs but also to home health as a condition of payment what has long
the clinical laboratory fee schedule. agencies. been required under § 410.32(a) and our
Interested parties can find more Response: We agree with the program instructions.
information on the coverage policy commenter that the regulation should After careful review of public
process on our Web site at http:// apply to providers of services who bill comments, we are finalizing § 424.24(f)
www.cms.hhs.gov/center/coverage.asp. to the Medicare Part B clinical as proposed.
With respect to the burden of this laboratory fee schedule, including home
certification requirement, we believe health agencies. We are revising c. Other Lab Issues—Proposed Clinical
that, by enacting section 1835(a)(2)(B) of § 424.24(f) to provide that the Diagnostic Laboratory Date of Service
the Act, the Congress recognized that it certification requirement applies to all (DOS) for Stored Specimens
may be appropriate for the Secretary to providers of services. In the CY 2007 PFS proposed rule (71
impose conditions of payment for Comment: One commenter disagreed FR 49064), we proposed to add new
services furnished by providers of with our proposal stating that it would § 414.510 to address concerns regarding
the date of service of a clinical rare occasion a test that otherwise meets are cultured at the laboratory and
diagnostic laboratory test that use a the conditions of the regulation may be ultimately tested. The commenters
stored (or ‘‘archived’’) specimen. In the ordered by the patient’s physician less believe the result of this type of
final rule of coverage and administrative than 14 days following the date of the laboratory test does not relate to the
policies for clinical diagnostic discharge from the hospital. The procedure performed in the hospital,
laboratory services (66 FR 58792) that commenter requested the regulation be nor would the result typically affect
we published in the November 23, 2001 revised to reflect these rare situations. treatment during the hospital stay if it
Federal Register, we adopted a policy Response: At this time, we do not were available immediately. The
under which the date of service for believe it is appropriate to create an commenters requested the regulation
clinical diagnostic laboratory services exception to the 14-day requirement. specify the date of service for these
generally is the date the specimen is We remain very concerned that only types of fresh tissue sample tests to be
collected. However, for laboratory tests tests that can legitimately be different than the date of service for
that use an archived specimen, the date distinguished from the care a fixed tissue samples to permit separate
of service is the date the specimen was beneficiary receives in the hospital be payment under Medicare Part B.
obtained from the storage. We defined subject to this provision regarding the Response: We agree with the
an ‘‘archived’’ specimen as a specimen date of service of the test, which results commenters that these tests, which are
that is stored for more than 30 calendar in separate payment for the test. We almost always used to determine post-
days before testing. The date of service believe it is more difficult to determine hospital chemotherapy care for patients
for these archived specimens is the date that a test ordered less than 14 days who also require hospital treatment for
the specimen was obtained from storage. before discharge is appropriately tumor removal or resection, appear to be
Specimens stored 30 days or less have separable from the hospital stay that unrelated to the hospital treatment in
a date of service of the date the preceded the test. We would like more cases where it would be medically
specimen was collected. In situations in information about the circumstances inappropriate to collect a test specimen
which a specimen is taken while the and tests cited by the commenters other than at the time of surgery,
patient is treated in a hospital setting, before taking any additional action in especially when the specific drugs to be
but then later used for a test after the this area. We are very concerned about tested are ordered at least 14 days
patient has been discharged from the the possibilities for unbundling care following hospital discharge, as
hospital setting, date of service of a test that appropriately should be associated discussed above for tests on stored
may affect payment because, if the date with the hospital stay in these tissue samples. We are very concerned
of service falls during an inpatient stay circumstances and will continue to about unbundling services that are
or outpatient procedure, payment for review this policy in the future to appropriately associated with hospital
the laboratory test usually is bundled ensure that our goal of appropriately treatment, and therefore, believe it is
with the hospital service. To address recognizing hospital and post-hospital critical to move cautiously in the area of
concerns raised for tests related to care is achieved. determining different dates of service
cancer recurrence and therapeutic Comment: Two commenters suggested for tests for which the specimen
interventions, we proposed to modify rewording the second condition which collection occurs during a hospital
our policy so that the date of service states the test could not reasonably have service. As a result, we are adding
would be the date the specimen is been ordered while the patient was § 414.510(b)(4), specifically for
obtained from storage, even if the hospitalized. The commenters suggested chemotherapy sensitivity tests, because
specimen is obtained less than 31 days the necessity of the test they are we understand that the results of these
from the date it was collected, without concerned with is unrelated to the tests, even if they were available
violating the unbundling rules as long procedure performed in the hospital but immediately and not several weeks
as the following conditions are met: is necessary to determine cancer following the collection of the
• The test is ordered by the patient’s recurrence and therapeutic specimen, would almost never affect the
physician at least 14 days following the interventions after the patient is treatment regimen at the hospital.
date of the patient’s discharge from the discharged from the hospital. Therefore, we see a valid distinction
hospital. Response: We agree that the second between these tests and other tests of
• The test could not reasonably have criterion could be clarified, to state that cultured specimens that give results
been ordered while the patient was it would be inappropriate to have after hospital discharge, but that are
hospitalized. collected the specimen other than directly related to not only the
• The procedure performed while the during the procedure, and have done so condition for which the patient is
beneficiary is a patient of the hospital is in this final rule. Our intent in hospitalized, but would typically be
for purposes other than collection of the establishing this criterion was to ensure used for the specific care during the
specimen needed for the test. that tests that meet the definitions in hospital stay as well, if available during
• The test is reasonable and this provision are not directly related to the hospital stay. This section will allow
medically necessary. the care provided in the hospital, and separate payment for chemotherapy
Comment: One commenter suggested we believe the modification we are sensitivity tests, as identified by the
adding a condition stating the test finalizing meets that intent more clearly Secretary in subregulatory guidance,
cannot be performed by the hospital than our original proposal. from the inpatient procedure as long as
laboratory. Comment: Three commenters certain criteria are met.
Response: We disagree that the discussed several high complexity We are finalizing § 414.510 as
regulations should limit the type of clinical laboratory tests that are proposed with the exceptions noted
laboratory performing the test on the performed on specimens collected as a above in this section.
specimen. The purpose of the regulatory part of an inpatient procedure. The tests
change is directed to date of service for determine the sensitivity of the patient’s O. Criteria for National Certifying
specimens. cancer to particular types of Bodies That Certify Advanced Practice
Comment: Two commenters chemotherapy. The specimen is Nurses
supported our proposal. However, one prepared so that the live cancer cells, Federal regulatory qualifications for
commenter expressed concern that on a collected at the time of the procedure, NPs at § 410.75 require that an
individual be certified as an NP by a for CNSs is to recognize all appropriate certifying body for advanced practice
recognized national certifying body that national certifying bodies for CNSs as nurses. We realize that the agency may
has established standards for NPs. the program does for NPs.’’ Accordingly, receive other requests in the future from
Similarly, Federal regulatory in an effort to recognize all appropriate organizations that wish to be added to
qualifications for clinical nurse national certifying bodies for CNSs and the list of recognized or approved
specialists (CNSs) at § 410.76 require NPs, we added, at that time, the national certifying bodies. In
that an individual be certified as a CNS Oncology Nurses Certification anticipation of those requests, we are
by a national certifying body that has Corporation (ONCC) and the Critical interested in developing certification
established standards for CNSs and that Care Certification Corporation (CCCC) to standards that would facilitate the
is approved by the Secretary. the list of recognized national certifying process for making these decisions.
Currently, there is not a list of bodies for advanced practice nurses. We appreciate the comments that we
recognized or approved national The National Board on Certification of received on these two issues related to
certifying bodies for NPs and CNSs in Hospice and Palliative Care Nurses the NP and CNS benefits. However, we
regulations. However, Chapter 15, (NBCHPN) has requested that we now are delaying our decision about whether
section 200 of the Benefit Policy follow the same course of action as we to include the NBCHPN under the
Manual, Pub. 100–02 contains a list of did for the ONCC and the CCCC by manual instruction listing of recognized
national certifying bodies that are adding its name to the list of recognized national certifying bodies for NPs and
recognized by Medicare as being national certifying bodies. That is, CNSs until we have had more time to
appropriate for certification of NPs. NBCHPN believes that it is an examine and investigate the comments
Although the manual provision appropriate national certifying body that we received about this issue.
regarding CNS services at Chapter 15, based on its certification experience, In regards to the issue concerning our
section 210 of the Benefit Policy Manual principles, services, and the establishment of certification criteria or
lists only the American Nurses certification exam that it administers to standards to determine whether an
Credentialing Center as an approved advanced practice nurses who organization should be listed as a
national certifying body for CNSs, we specialize in palliative care for hospice recognized national certifying body for
indicated that the list of recognized patients. NPs and CNSs (that is, advanced
certifying bodies in the manual The NBCHPN stated in information it practice nurses), we will consider the
provision for NP services would also sent to the agency that its organization information that we received in
apply for CNSs in the ‘‘Revisions to is a well-established certification body comments on this issue for future
Payment Policies Under the CY 2003 with more than a 12-year history of rulemaking, and would consider
Physician Fee Schedule and Inclusion certification and that it has been proposing specific certification
of Registered Nurses in the Personnel certifying advanced practice hospice standards that an organization must
Provision of the Critical Access Hospital and palliative nurses since 2003 in meet in order to be included under the
Emergency Services Requirement for partnership with the ANCC. Starting in manual instruction listing of recognized
Frontier Areas and Remote Locations; 2005, the NBCHPN became sole national certifying bodies for NPs and
Payment Policies final rule (December proprietor of the Advanced Certified CNSs.
31, 2002, 67 FR 79987). The national Hospice and Palliative Nurse (ACHPN)
P. Chiropractic Services Demonstration
certifying bodies that are listed under examination. Master’s level NPs and
CNSs sit for this ACHPN examination In the CY 2006 PFS final rule with
the manual instruction at section 200,
that is based on a role delineation study comment period (70 FR 70266), we
and that currently apply for both NPs
for the advanced practice level of included a discussion of the 2-year
and CNSs (collectively, advanced
hospice and palliative nursing. demonstration authorized by section
practice nurses) are as follows:
• American Academy of Nurse Additionally, the NBCHPN stated that it 651 of the MMA to evaluate the
Practitioners; has met the requirements of the feasibility and advisability of covering
• American Nurses Credentialing American Board of Nursing Specialties chiropractic services under Medicare.
Center; and is an active member of the Board of These services extend beyond the
• National Certification Corporation Specialties, as is the ANCC. The current coverage for manipulation to
for Obstetric, Gynecologic and Neonatal Executive Director of the NBCHPN care for neuromusculoskeletal
Nursing Specialties; stated that she believes that the absence conditions typical among eligible
• National Certification Board of of the NBCHPN from the current list of beneficiaries, and cover diagnostic and
Pediatric Nurse Practitioners and recognized national certifying bodies other services that a chiropractor is
Nurses; presents a barrier for advanced practice legally authorized to perform by the
• Oncology Nurses Certification nurses in the hospice palliative care State or jurisdiction in which the
Corporation; specialty because they are denied treatment is provided. The
• Critical Care Certification enrollment on the basis that they do not demonstration is being conducted in
Corporation. meet the certification qualification four sites, two rural and two urban. The
In the December 31, 2002 final rule, requirement. The Web site for the demonstration must be budget neutral
in response to a public comment, we NBCHPN can be found at http:// as the statute requires the Secretary to
stated, ‘‘it is not the agency’s intention www.nbchpn.com. ensure that the aggregate payment made
to be overly restrictive in our program We solicited public comments on under the Medicare program does not
requirements and consequently prevent whether it would be appropriate to exceed the amount which would be
qualified CNSs who specialize in areas include the NBCHPN under the list of paid in the absence of the
of medicine other than those certified by recognized and approved national demonstration.
the American Nurses Credentialing certifying bodies for NPs and CNSs Ensuring BN requires that the
Center (ANCC) from participating under under manual instructions for both NPs Secretary develop a strategy for
the CNS benefit and from rendering care and CNSs. We also solicited public recouping funds should the
to patients in need of specialized comments on criteria or standards that demonstration result in costs higher
services. Furthermore, the intent of the we could use to determine whether an than those that would occur in the
revision to the certification requirement organization is an appropriate national absence of the demonstration. As we
stated in the CY 2006 PFS final rule Q. Promoting Effective Use of Health coordination with other Federal
with comment period (70 FR 70266), we Information Technology (HIT) agencies and with the Office of the
would make adjustments in the national We recognize the potential for health National Coordinator for HIT. One of
chiropractor fee schedule to recover the information technology (HIT) to those activities is promotion of data
costs of the demonstration in excess of facilitate improvements in the quality standards for clinical information, as
the amount estimated to yield BN. We and efficiency of health care services. well as for claims and administrative
will assess BN by determining the One recent RAND study found that data.
change in costs based on a pre- and broad adoption of electronic health As noted above in this section, the
post-comparison of costs and the rate of records (EHRs) could save more than Administration supports the adoption of
change for specific diagnoses that are $81 billion annually and, at the same HIT as a normal cost of doing business.
treated by chiropractors and physicians time, improve quality of care.1 The The adoption and use of HIT may
in the demonstration sites and control largest potential savings that the study contribute to improved processes and
sites. We will not limit our analysis to identified was in the hospital setting outcomes of care, including shortened
reviewing only chiropractor claims, because of shorter hospital stays illnesses and the avoidance of adverse
because the costs of the expanded promoted by better coordinated care; drug reactions.
chiropractor services may have an Nine commenters responded to our
less nursing time spent on
impact on other Medicare costs. HIT proposals. The following is a
administrative tasks; better use of
Any needed reduction would be made summary of the comments addressing
medications in hospitals; and better
in the 2010 and 2011 physician fee the use of HIT to enhance quality of
utilization of drugs, laboratory services,
schedules as it will take approximately care, the costs associated with HIT
and radiology services in hospital
2 years to complete the claims analysis. adoption, the importance of
outpatient settings. The study also
If we determine that the adjustment for interoperability standards, and the
identified potential quality gains
BN is greater than 2 percent of spending impact of new rules related to Medicare
through enhanced patient safety,
for the chiropractor fee schedule codes fraud and abuse statutes.
decision support tools for evidence- Comment: Several commenters stated
(comprised of the 3 currently covered based medicine, and reminder that adoption of HIT could lead to
CPT codes 98940, 98941, and 98942), mechanisms for screening and improved quality, enhanced patient
we would implement the adjustment preventive care. Despite these large safety, and increased efficiency. Some
over a 2-year period. However, if the potential benefits, the study found that commenters noted that HIT can reduce
adjustment is less than 2 percent of only about 20 to 25 percent of hospitals administrative costs; however, more
spending under the chiropractor fee have adopted HIT systems. commenters focused on the potential
schedule codes, we would implement It is important to note the caveats to
financial barriers to the adoption of HIT.
the adjustment over a 1-year period. We the RAND study. The projected savings We received several comments
will include the detailed analysis of BN are across the health care sector, and addressing the high costs associated
and the proposed offset during the CY any Federal savings would be a reduced with HIT implementation. Most
2009 rulemaking process. Physical portion of the total savings. In addition, commenters stated that adoption of HIT
therapy (PT) services performed by there are significant assumptions made is not a normal cost of doing business
chiropractors under the demonstration in the RAND study. National savings are in health care. Several commenters
are subject to the PT therapy cap. These projected in some cases based on one or emphasized that any reduction in
services are included under the cap two small studies. Also, the study physician payment related to the
because chiropractors are subject to the assumes patient compliance, in the form sustainable growth rate (SGR) would
same rules as medical doctors for of participation in disease management make it difficult for physicians to invest
therapy services under the programs and following medical advice. in HIT. Some commenters noted that
demonstration. For these reasons, extreme caution incentives, such as loans, grants, and tax
Comment: One commenter indicated should be used in interpreting these credits, could aid physicians by
that it continues to oppose our results. reducing the burden of cost for
methodology for assuring BN under the In his 2004 State of the Union
implementing HIT. A few commenters
demonstration. Instead of the Address, the President announced a
stated that implementation of HIT
application of an adjustment to the plan to ensure that most Americans
should be a shared expense between
national chiropractor fee schedule, the have EHRs within 10 years.2 One part of
providers, purchasers, and payers.
commenter recommends that we make this plan involves developing voluntary Most commenters highlighted lack of
an adjustment to the totality of services standards and promoting the adoption interoperability standards as a current
payable under the Part B Trust Fund of interoperable HIT systems that use barrier to HIT implementation. Several
and that this would be consistent with these standards. The 2007 Budget states commenters noted that interoperability
the requirements in section 651(f)(A) of that ‘‘The Administration supports the standards are a critical component of
the MMA. adoption of HIT as a normal cost of any HIT system and must include a
Response: Section 651(f)(1)(B) of the doing business to ensure patients standard set of policies, procedures, and
MMA requires that ‘‘* * * the Secretary receive high quality care.’’ standards for data collection and
shall ensure that the aggregate payments Over the past several years, we have
documentation. One commenter stated
made by the Secretary under the undertaken several activities to promote
that progress has been slow in
Medicare program do not exceed the the adoption and effective use of HIT in
disseminating standards and this
amount which the Secretary would have 1 RAND News Release: Rand Study Says
discourages physician practices from
paid under the Medicare program if the Computerizing Medical Records Could Save $81 making large investments in HIT that
demonstration projects under this Billion Annually and Improve the Quality of quickly may become obsolete.
section were not implemented.’’ The Medical Care, September 14, 2005, available at: One commenter applauded new
statute does not specify a specific http://rand.org/news/press.05/09.14.html. regulatory provisions related to HIT for
2 Transforming Health Care: The President’s
methodology for ensuring BN. We Health Information Technology Plan, available at:
physician self-referral and anti-kickback
believe our intended methodology http://www.whhitehouse.gov/infocus/technology/ statutes. However, the commenter
meets the statutory requirements. economic_policy200404/chap3.html. further stated that Medicare fraud and
abuse statutes continue to hinder the physicians and others without running spends $1.9 trillion on health care, or 16
adoption of HIT because the rules are afoul of the Stark (physician self- percent of the gross domestic product
still unclear on some issues. referral) and anti-kickback statutes. We (GDP). By 2015, projections are that
We received a few comments noting believe that these rules facilitate the health care will consume 20 percent of
that specific issues related to HIT use in adoption of HIT by physicians and other GDP. As indicated in the 2006 Annual
health care, such as the protection of health care providers who might Report of the Boards of Trustees, the
patient privacy and data stewardship, otherwise have been unable or Medicare program alone consumes 3.2
still need to be resolved. unwilling to invest in the technology. percent of the GDP and by 2040 it will
Response: We thank all commenters We also believe that these regulatory consume 8.0 percent of the GDP.
for their thoughtful and valuable changes help to stimulate the adoption Part of the reason health care costs are
discussion of the issues. In the HIT of effective HIT, and that, as HIT use rising so quickly is that most consumers
section of the preamble to the proposed spreads, the benefits relative to the costs of health care, that is, patients, are
rule, we recognized the potential for of implementation may increase for all frequently not aware of the actual cost
effective HIT to facilitate improvements stakeholders. of their health care. Health insurance
in the quality and efficiency of health The majority of commenters pointed coverage shields them from the full cost
care services. We also pointed out our out that the current lack of HIT of services, and they have only limited
promotion of the adoption and effective infrastructure, including lack of information about the quality and costs
use of HIT in coordination with other interoperability standards, is a major of their care. Consequently, consumers
Federal agencies and the Office of the obstacle to adoption and effective use of do not have incentives or means to
National Coordinator for HIT. Here, we HIT. To address the lack of carefully shop for providers offering the
will discuss three areas that we are infrastructure, the Secretary has best value. Thus, providers of health
emphasizing to promote the effective undertaken a national strategy that calls care are not subject to the competitive
use of HIT, in light of the comments we for Federal agencies to collaborate with pressures that exist in other markets for
received: (1) Value-based purchasing, private stakeholders in the development offering quality services at the best
(2) the recent CMS and OIG final rules of architecture, standards, certification possible price. Reducing the rate of
regarding donation of certain HIT, and processes, and methods of governance increase in health care prices and
(3) infrastructure and interoperability to facilitate the adoption of effective avoiding health services that are of little
standards. HIT. In September 2005, the Secretary value could help to stem the growth in
We continue our work toward the selected 16 commissioners to serve on health care spending, and potentially
implementation of value-based the American Health Information reduce the number of individuals who
purchasing payment system reforms Community (AHIC), which is a federally are unable to afford health insurance.
because we believe that, among other chartered collaborative forum of private Part of the President’s health care
advantages, value-based purchasing can and public interests charged with agenda is to expand Health Savings
encourage physicians to invest in advising the Secretary on how to make Accounts (HSAs), which would provide
activities, such as effective HIT, that health information digital and consumers with greater financial
have the potential to improve quality interoperable. The goals of the incentives to compare providers in
and decrease unnecessary costs. Community include immediate access terms of price and quality, and choose
However, linking a portion of Medicare to vital medical information at the point those physicians and services that offer
payments to valid measures of quality of care, privacy protection, better data the best value.
and effective use of resources could give for research, and overall cost savings. In order to exercise those choices,
physicians more direct incentives to The work of the Community has been consumers must have accessible and
implement innovative ideas and divided among four workgroups: (1) The useful information on the price and
approaches that may result in improved EHRs Workgroup, (2) the Chronic Care quality of health care items and
value of care. We agree with the Workgroup, (3) the Consumer services. Typically, health care
commenters that noted that the use of Empowerment Workgroup, and (4) the providers do not publicly quote or
effective HIT could increase quality, Biosurveillance Workgroup, (5) the publish their prices. Moreover, list
efficiency, and patient safety. We also Confidentiality, Privacy, and Security prices, or charges, generally differ from
agree with the commenters that noted Workgroup, and (6) the Quality the actual prices negotiated and paid by
that effective use of HIT can be used to Workgroup. The AHIC Workgroups have different health plans. Thus, even if
decrease the burden of reporting to made recommendations, as their initial consumers were financially motivated
value-based purchasing programs. ‘‘breakthroughs,’’ pertaining to: An to shop for the BP, it would be very
However, we disagree with the electronic medication summary and difficult at the current time for them to
commenters that recommended direct registration history; secure messaging access usable information.
government funding of HIT. As stated in capabilities for individuals with chronic For these reasons, HHS has launched
the President’s 2007 Budget, ‘‘the disease; biosurveillance monitoring; a major health care information
Administration supports the adoption of and, through secure means, broadening transparency initiative. This effort
[HIT] as a normal cost of doing business the availability and access to current builds on steps taken by CMS to make
to ensure patients receive high quality and historical laboratory results and quality and price information available.
care.’’ interpretations. More information about For example, Medicare has provided
Commenters noted that multiple the Community is available at: http:// unprecedented information about drug
stakeholders in the health care system, www.hhs.gov/healthit/ahic.html. prices in the Medicare prescription drug
including purchasers and payers, benefit, and is now adding to these
benefit from provider adoption and use R. Health Care Information efforts in other areas. Medicare payment
of effective HIT and should share in the Transparency Initiative information for common elective
cost. CMS and OIG have recently issued The United States (U.S.) faces a procedures and other common
final rules to allow hospitals and other dilemma in health care. Although the admissions for all hospitals by county
health care providers under some rate of increase in health care spending has been posted on our Web site at
circumstances to donate electronic slowed last year, costs are still growing http://www.cms.hhs.gov/
prescribing and EHRs technology to at an unsustainable rate. The U.S. HealthCareConInit/.
On our Web site, we will be posting commenter also noted the important provider based on the knowledge of the
geographically-based Medicare payment work of the AMA Consortium for potential overall costs of care, and
information for common procedures for Performance Improvement in bringing taking into account whether the
ambulatory surgery centers, hospitals, together multiple physician medical physician is effective at helping the
OPDs, and physician offices. In specialties. patient prevent life threatening
addition, a number of tools providing Response: We agree that physician illnesses, could help the patient avoid
usable healthcare information are price and quality information must be unnecessary costs later on.
already available to Medicare credible, accessible, and meaningful to For patients with life threatening
beneficiaries. Supported by the public consumers and other stakeholders. To illnesses, cost is also at issue. However,
and private quality alliances, consumers ensure this is the case for our most insurance, including Medicare,
can access ‘‘Compare’’ Web sites transparency efforts, we rely heavily on does require cost sharing, and if
through www.medicare.gov where they physician groups and broad stakeholder information on price and quality is
can evaluate important aspects of their coalitions to help advise as to the available it may be possible for
health care options for care at a hospital, measures we are using, particularly for beneficiaries to choose high quality
nursing home, home health agency quality and in considering episodes of providers at a reduced cost, which
(HHA), and dialysis facility, as well as care. We are actively working with the would therefore minimize the patient’s
compare their costs and coverage when AMA Consortium for Performance out-of-pocket costs. We also agree that it
choosing a prescription drug plan. Improvement, the AQA, the National is important to recognize that
We are developing a new project with Quality Forum (NQF), and various beneficiary out-of-pocket costs are in
the goals of providing Medicare medical specialty groups to identify part driven by the type of coverage the
beneficiaries with more comprehensive useful quality measures. We are beneficiary has and whether the
information on quality and costs, conducting research and working beneficiary has any supplemental
including more complete measures of directly with the AQA to identify coverage. Combining information on
health outcomes, satisfaction, and potential episode of care measures. We multiple services related to the same
volume of services that matter to are building on the model we used for clinical condition into a broader episode
consumers, and more comprehensive inpatient and ambulatory surgery of care could provide a prospective
measures of costs for entire episodes of centers to provide the most accurate patient and his or her family even more
care, not just payments for particular information possible when releasing useful cost and quality information. For
services and admissions. We intend for Medicare payment data. By December example, if a patient has a serious
this Medicare project to incorporate 2006, we plan to release Medicare data, illness, he or she (or his or her family)
private health care data, Medicaid data, including the number of services, would be better able to choose a
and Medicare data to measure cost and charges and payment rates for a group physician or other health care provider
quality of care information at the of common physicians’ services by that more closely suits the patient’s
physician and hospital levels. Under locality. preferences by comparing, before
this project, quality, cost, pricing, and Comment: Many comments focused treatment: (1) The cost of treatment; (2)
patient information will be reported to on the usefulness of price information. the various types of services and
Medicare beneficiaries in a meaningful One commenter questioned the premise treatments associated with that
and transparent way. that consumers should use price particular illness; and (3) the outcome
In response to the CY 2007 PFS information in health care decisions. for patients with similar health
proposed rule (71 FR 49064), we Several other commenters noted the conditions.
received the following comments on the limitations of price information and the Comment: One commenter questioned
transparency issue. need for consumers and patients to whether releasing price information
Comment: Most commenters understand the context for it. They could increase health care costs because
supported our efforts to release quality added that providing price information the pricing information could encourage
information to create a more transparent on health care services should not be patients to delay necessary care and
health care system so that patients and placed in the same class as shopping for which presumably may result in more
consumers will be able to make more airline tickets or hotel accommodations. advanced disease. The commenter
informed decisions about their health They further questioned whether price stated that price information should not
care. Several commenters questioned plays a significant role in choosing a be released for E/M, and preventive
the usefulness of price information and physician or hospital, particularly when services.
many suggested criteria for determining a patient is facing a life threatening Response: We believe that the release
what information would be most illness. Other commenters have advised of price information will not inhibit a
credible, accessible and meaningful that the price is subject to individual patient’s use of appropriate health care
both to consumers and to providers and health plan benefit packages and could services, in particular, preventive or
other stakeholders. The commenters change depending on the course of evaluative services. It is our expectation
stated that the information must be beneficiary illness. Further, in an that the transparency of price and
valid, reliable, and sensitive to the care emergency, additional services may be quality information will encourage
being delivered in order for the required which will therefore raise the patients to obtain health care services
information to be useable. Several costs of services for beneficiaries. that are proven in quality of care and
commenters also noted the importance Response: We agree that making outcomes for patients and the provision
of relying on the AQA (a multi- health care decisions, including the of these chosen services should result in
stakeholder group identifying selection of providers, is a serious a decrease in the overall costs of health
ambulatory quality measures) and the undertaking. For this reason, it is care.
joint steering committee formed by critical that consumers, patients, and Comment: One commenter thought
AQA, the Hospital Quality Alliance their families have information which that payment information should be
(HQA), and the Quality Alliance will help them make important health broken into the work component, PE
Steering Committee, to be the forum care decisions. For those patients in the and malpractice. They further suggested
where all stakeholders come together to early stages of illness, or those who may arraying information to reflect the
identify useful measures. One need preventive care, choosing a relative costliness of different settings of
care for the same services, such as Further, we are working with the on the work of a multi-stakeholder
ambulatory surgery centers, OPDs, or Department to lessen the barriers to IT consensus process through the National
physicians’ offices. adoption by identifying and endorsing Quality Forum and the AQA. We are
Response: We agree that those standards for seamless movement of also relying on this process to identify
separate service components could be of information across settings. physician quality measures for
some interest, but we do not understand Comment: One commenter said the transparency. The PVRP can be a
how they would be of benefit to the primary driver of health care costs was building-block for future efforts to
patient or consumer when he or she is the lack of productivity increases in measure physician quality.
making health care decisions. Such health care and questioned whether Further, we are seeking to benefit the
service component break outs provide providing more information to Medicare program by applying quality
no information on out-of-pocket or consumers would have any impact on measures developed by the private
overall costs as to the specific service or the efficiency of the system. The sector to comprehensive data on
as to a broader episode of care that takes commenter stated that the reason for physicians’ services to improve the
into consideration care delivered across this lack of productivity improvement quality of Medicare services, and to
settings and time. was due to the labor intensive nature of provide Medicare beneficiaries with
We believe that providing our health care system since the United useful quality information. Specifically,
comparative information on the costs of States government did not purchase HIT under a new Medicare project that will
care in different settings when the directly for providers. begin in six areas, data from Medicare
services and patient needs are similar is Response: We agree that health care is and private purchasers are being
an interesting concept. We will consider labor intensive and that increased combined to create quality measures
suggestions as to how this type of data adoption of effective HIT has the that will be reported to Medicare
may be provided. potential to improve productivity. For beneficiaries. Information on physician
Comment: One commenter stated that these reasons, increasing adoption of performance on quality will be used for
it is inappropriate to make public effective HIT, including EHRs is one the feedback to physicians on services
efficiency information, cost and most important initiatives for this provided to Medicare beneficiaries, and
utilization ratings without administration. As we have stated
information on physician performance
commensurate quality data, and that previously in our other responses in this
will be made available to beneficiaries.
efficiency measurement should be section, we have in place a number of
restricted to areas where this type of The purpose of this important project is
initiatives aimed at lessening the
data are available, and risk adjusted. to encourage improvements in the
barriers to adoption and initiatives
Further, the commenter added that quality of Medicare services, and
supporting both hospitals and
payers should make their methodology provide information to Medicare
physicians. However, we strongly
and data sources easily available to beneficiaries that will permit them to
support the notion that market forces,
physicians. make more informed choices about how
including consumers empowered to
Response: We agree that both cost and and where they will receive their care.
make more informed health care
quality data are important for Over time, using the experience of these
decisions, are also critical for improving
consumers to make informed decisions initiatives, we will identify which
the value of the health system.
about providers and treatment options. Comment: One commenter stated that measures and what data collection
We are exploring a range of options for health plans should be required to mechanisms are best used to release
how to measure efficiency, including release their fee schedules showing total physician specific information to
risk adjustment options. We also agree charges and methods of calculating fees Medicare beneficiaries.
that it is important for physicians to for physicians and hospitals. Regarding the earlier comment about
understand how cost and quality data Response: The purpose of our G-code reporting, we chose the path of
are being measured. transparency initiative is to make it reporting quality measures on claims
Comment: One commenter questioned easier for consumers and patients to through G-codes because those claims
whether all the resources going into the make better informed health care could be built on existing data systems,
transparency efforts might be better decisions based on their own unique creating fewer burdens for physician
spent supporting physician adoption of health circumstances. We have offices and CMS. Physicians,
EHRs, patient registries, and group partnered with the Agency for predominantly, already use claims
medical visits. Healthcare Research and Quality, and supported data systems so, therefore, we
Response: Our transparency efforts we are exploring, in the context of the believe at this time it is the most
are aimed at helping consumers make AQA and the Quality Alliance Steering practical system. In the future, we hope
better informed health care decisions. Committee, a variety of options for to be able to accept, and for physicians
We have many other initiatives aimed at releasing pricing, payment and episode to be able to report, using the electronic
supporting these other important of care costs. means outlined by the commenter. We
physician tools, for example, Quality Comment: One commenter questioned ask the commenter to work with us to
Improvement Organizations (QIOs) are whether physicians could report ensure that EHRs and other information
working across the country to provide directly to us or to carriers on the systems are designed to collect the
technical assistance to physicians to clinical quality measures currently clinical data components necessary to
help these physicians redesign work reflected in the Physician Voluntary measure a broad range of quality
practices to adopt EHRs. Several Reporting Program (PVRP) initiative indicators.
significant initiatives, including the instead of through the established Comment: A commenter also
Physician Group Practice demonstration mechanism of G-codes or CPT category suggested that group practices should be
and the Medicare Health Support II codes (if available). allowed to create scores for their whole
program are identifying effective care Response: Currently, the PVRP data group and report at the aggregate level.
management strategies, including the are not reported publicly, as would be The commenter stated that group
physician adoption of EHRs, patient the case in a transparency initiative, but practices have internal mechanisms,
registries, and group medical visits as are provided confidentially to including incentive structures, for
recommended by the commenter. physicians. These measures are based improving quality that should be used.
Response: We recognize that February 10, 2006 Federal Register (71 III. Revisions to the Payment Policies of
comparing groups of physicians by price FR 6991), we issued a notice extending Ambulance Services under the Fee
and quality measures could be useful the timeline for publication of a final Schedule for Ambulance Services and
both for consumers and patients in rule associated with provisions of the the Ambulance Inflation Factor Update
regions where these groups are widely February 10, 2003 proposed rule by one for CY 2007.
available. We also appreciate the year to February 10, 2007. At this time, Under the ambulance fee schedule,
usefulness of the data for internal we are not finalizing other proposed the Medicare program pays for
quality improvement for physician provisions of the February 10, 2003 transportation services for Medicare
groups. However, for purposes of proposed rule. beneficiaries when other means of
consumer choice, it may be important to We received the following comment
transportation are contraindicated.
have physician-specific information. regarding this provision from the
Ambulance services are classified into
Even with a group, beneficiaries would February 10, 2003 proposed rule.
Comment: A commenter stated that different levels of ground (including
want to know the physician’s treatment
the clarification of policy that bad debt water) and air ambulance services based
patterns, including quality information,
reimbursement is not available for on the medically necessary treatment
to best suit the beneficiary’s needs or
services paid under a fee schedule is a provided during transport. These
preferences. We agree that information
change in policy for outpatient therapy. services include the following levels of
on both price and quality on individual
Response: During the initial stages of service:
physicians would be useful for
developing the Medicare program in • For Ground—
consumers and patients.
1966, the issue of ‘‘bad debt’’ arose but + Basic Life Support (BLS)
S. Bad Debt Payment for Services was not mentioned explicitly in the + Advanced Life Support, Level 1
Associated With Reasonable Charge/Fee statute. However, at that time, based on (ALS1)
Schedules the intent of the anti-cross-subsidization + Advanced Life Support, Level 2
Under the Medicare program, principle found in the definition of (ALS2)
payment may be made for unrecovered ‘‘reasonable cost’’ at section + Specialty Care Transport (SCT)
1861(v)(1)(A) of the Act, Medicare + Paramedic ALS Intercept (PI)
costs (bad debt) attributable to
• For Air—
uncollectible deductible and adopted the policy to pay for the
+ Fixed Wing Air Ambulance (FW)
coinsurance of Medicare beneficiaries as unrecovered costs attributable to
+ Rotary Wing Air Ambulance (RW)
specified in § 413.89 and the Provider uncollectible deductible and
Reimbursement Manual (PRM) (CMS coinsurance of Medicare beneficiaries. A. History of Medicare Ambulance
Pub. 15 Part 1, Chapter 3). Entities Accordingly, we believe that this Services
currently eligible to receive Medicare statutory prohibition on cross-
1. Statutory Coverage of Ambulance
bad debt payments, with some subsidization does not apply where
Services
limitations, include hospitals, skilled services are reimbursed on anything
nursing facilities (SNFs), CAHs, RHCs, other than the basis of ‘‘reasonable Under sections 1834(l) and 1861(s)(7)
ESRD facilities, FQHCs, community costs’’. of the Social Security Act (the Act),
mental health clinics, health The Medicare program has never Medicare Part B (Supplemental Medical
maintenance organizations (HMOs) allowed payment of bad debts for Insurance) covers and pays for
reimbursed on a cost basis, competitive services paid for on the basis of a fee ambulance services, to the extent
medical plans (CMPs), and health care schedule or reasonable charge prescribed in regulations, when the use
pre-payment plans. The bad debt policy methodology, such as but not limited to, of other methods of transportation
for ESRD facilities is set forth in services of physicians, suppliers, would be contraindicated by the
§ 413.178. certified registered nurse anesthetists, or beneficiary’s medical condition.
The current bad debt regulation at NPs. Under a fee schedule or reasonable The House Ways and Means
§ 413.89(i) excludes payment of bad charge methodology, Medicare does not Committee and Senate Finance
debts specifically for those services share proportionately in an entity’s Committee Reports that accompanied
furnished by anesthetists paid under a incurred costs but rather makes the 1965 Social Security Amendments
fee schedule. In the February 10, 2003 payment for a specific service. The suggest that the Congress intended
Federal Register, we published the payment is not related to the cost of a that—
Provider Bad Debt Payment proposed service and thus, does not embody the • The ambulance benefit cover
rule where we proposed to amend the concept of unrecovered costs due to transportation services only if other
language in the existing bad debt uncollected amounts of deductibles and means of transportation are
regulations to clarify that bad debts are coinsurance. Thus, payment of bad debt contraindicated by the beneficiary’s
not recognized or reimbursed for all applies only to services reimbursed on medical condition; and
covered services paid for under a the basis of reasonable cost or to • Only ambulance service to local
reasonable charge-based methodology or services paid under one of Medicare’s facilities be covered unless necessary
a fee schedule (68 FR 6682). As stated prospective payment systems that have services are not available locally, in
in that proposed rule, the proposed a basis in reasonable costs that do not which case, transportation to the nearest
amendment was intended to clarify our reflect Medicare payment of bad debts facility furnishing those services is
longstanding policy and is not a change during a specified provider base period. covered (H.R. Rep. No. 213, 89th Cong.,
in policy. Accordingly, when outpatient therapy 1st Sess. 37 and Rep. No. 404, 89th
In this final rule with comment services began to be paid for on a fee Cong., 1st Sess. Pt 1, 43 (1965)).
period, we are finalizing the amendment schedule methodology, payment of bad The reports indicate that
to the regulations, as proposed in the debts associated with these services was transportation may also be provided
February 10, 2003 proposed rule, to no longer available. from one hospital to another, to the
clarify that payment of bad debts for Therefore, we do not agree with the beneficiary’s home, or to an extended
covered services paid for under a commenter and we are revising care facility.
reasonable charge-based methodology or § 413.89(i) and adding new § 413.178(d) 2. Medicare Regulations for
a fee schedule is not allowable. In the as proposed. Ambulance Services
Our regulations relating to ambulance of ‘‘urban area’’ as defined by the Modification, consistent with the
services are set forth at 42 CFR part 410, Executive Office of Management and provisions of section 1834(l), to more
subpart B and 42 CFR part 414, subpart Budget (OMB). In addition, we are accurately determine rural census tracts
H. Section 410.10(i) lists ambulance removing the definition of ‘‘Goldsmith within metropolitan areas.
services as one of the covered medical modification’’ and amending our These changes will affect whether
and other health services under definition of ‘‘rural area’’ to include certain areas are recognized as rural or
Medicare Part B. Therefore, ambulance areas determined to be rural under the urban. The distinction between urban
services are subject to basic conditions most recent version of the Goldsmith and rural is important for ambulance
and limitations set forth at § 410.12 and modification. payment purposes because ambulance
to specific conditions and limitations We are withdrawing our proposal to payments are based on the point of pick-
included at § 410.40. Part 414, subpart change the language of our regulation up for the transport, and the point of
H, describes how payment is made for defining ‘‘specialty care transport pick-up for urban and rural transport is
ambulance services covered by (SCT)’’ to conform to our existing paid differently. Of particular
Medicare. payment policies. In response to public significance to the ambulance fee
The national fee schedule for comments, we are broadening and schedule, the changes would affect
ambulance services is being phased in clarifying our interpretation of the whether or not certain areas are eligible
over a 5-year transition period existing language and responding to for certain rural bonus payments under
beginning April 1, 2002 as specified in other issues associated with the the ambulance fee schedule. For
§ 414.615. As of January 1, 2006, the definition of SCT. example, the changes would affect
total payment amount for air ambulance In addition, we are discontinuing our whether or not certain areas are
providers and suppliers is based on 100 annual review of the original CF recognized as what we refer to as
percent of the national ambulance fee assumptions and of the original air ‘‘Super Rural Bonus’’ areas established
schedule. In accordance with section ambulance rates from the initial by section 414(c) of the MMA and set
414 of the Medicare Prescription Drug, implementation of the fee schedule in forth in section 1834(l)(12) of the Act.
Improvement and Modernization Act of 2002 because we have not identified any That section specifies that, for services
2003 (MMA) (Pub. L. 108–173), we significant differences from those furnished during the period July 1, 2004
added § 414.617 which specifies that for assumptions in the 4 years since the through December 31, 2009, the
ambulance services furnished during implementation of the fee schedule. We payment amount for the ground
the period July 1, 2004 through will continue to monitor payment and ambulance base rate is increased by a
December 31, 2009, the ground billing data on an ongoing basis and ‘‘percent increase’’ (Super Rural Bonus)
ambulance base rate is subject to a floor make adjustments to the CF and to air where the ambulance transport
amount, which is determined by ambulance rates as appropriate to reflect originates in a rural area (which
establishing nine fee schedules based on any significant changes in these data. includes Goldsmith areas) that we
each of the nine census divisions, and Finally, in response to public determine to be in the lowest 25th
using the same methodology as was comment, we are withdrawing our percentile of all rural populations
used to establish the national fee proposal to revise our current definition arrayed by population density.
schedule. If the regional fee schedule of ‘‘Emergency response’’ to further
specify the conditions that warrant a a. Core-Based Statistical Areas (CBSAs):
methodology for a given census division
higher payment for immediate response. Revised Office of Management and
results in an amount that is lower than
Our reasons for withdrawing our Budget (OMB) Metropolitan Area
or equal to the national ground base
proposal are explained in section III.B.4. Definitions
rate, then it is not used, and the national
fee schedule amount applies for all of this preamble. In the February 27, 2002 final rule (67
providers and suppliers in the census FR 9100), we stated that we could not
1. Adoption of New Geographic easily adopt and implement, within the
division. If the regional fee schedule Standards for the Ambulance Fee
methodology for a given census division timeframe necessary to implement the
Schedule fee schedule, a methodology for
results in an amount that is greater than
the national ground base rate, then the Historically, the Medicare ambulance recognizing geographic population
fee schedule portion of the base rate for fee schedule has used the same density disparities other than MSA/
that census division is equal to a blend geographic area designations as the nonMSA. We also stated that we would
of the national rate and the regional rate. acute care hospital IPPS and other consider alternative methodologies that
For CY 2006, this blend is 40 percent Medicare payment systems to take into may more appropriately address
regional ground base rate and 60 percent account appropriate urban and rural payment to isolated, low-volume rural
national ground base rate. As of January differences. This provides a consistent ambulance providers and suppliers at a
1, 2007, the total payment amount for and objective national definition for later date. The application of any rural
ground ambulance providers and ambulance payment purposes within adjustment is determined by the
suppliers will be based on either 100 the ambulance fee schedule and geographic location of the beneficiary at
percent of the national ambulance fee generally across Medicare payment the time he or she is placed on board the
schedule or 80 percent of the national systems. It also utilizes geographic area ambulance. We are now finalizing the
ambulance fee schedule and 20 percent designations that more realistically adoption of OMB’s revised geographic
of the regional ambulance fee schedule. reflect rural and urban populations, area designations for urban and rural
resulting in more accurate payments for areas and the most recent modification
B. Provisions of the Final Regulation ambulance services. Accordingly, we of the Goldsmith Modification to
In this rule, we are finalizing changes are adopting OMB’s CBSA-based address payment to those isolated, low-
to the fee schedule for payment of geographic area designations, which volume rural providers and suppliers.
ambulance services by adopting revised have been adopted for the IPPS, to more Prior to the 2000 decennial census,
geographic designations for urban and accurately identify urban and rural areas geographic areas were consistently
rural areas as set forth in OMB’s Core- for ambulance fee schedule payment defined by OMB as Metropolitan
Based Statistical Areas (CBSAs) purposes. We are also adopting the most Statistical Areas (MSAs) with an MSA
standard. We are adding the definition recent modification of the Goldsmith being defined as an urban area and
anything outside an MSA being defined designated either urban or rural based area’’ under the ambulance fee schedule
as a rural area. In addition, for purposes on the pick-up point of the transport. for the reasons discussed. Therefore, we
of ambulance policy, we recognized the As of June 6, 2003, the new OMB are revising § 414.605 to include a
1990 update of Goldsmith areas definitions recognized 49 new MSAs definition of urban area and to reflect
(generally, rural census tracts within and 565 new Micropolitan Areas, and OMB’s revised CBSA-based geographic
counties that covered large tracts of land extensively revised the composition of area designations in our definition of
with one predominant urban area only) many of the existing MSAs. There are rural area.
as rural areas (65 FR 55077 through 1,090 counties in MSAs under the new Comment: Some commenters
55100). In Fall 1998, OMB chartered the definitions (previously, there were 848 suggested that we should mitigate any
Metropolitan Area Standards Review counties in MSAs). Of these 1,090 financial impact of the CBSA-based
Committee to examine the Metropolitan counties, 737 are in the same MSA as geographic changes by holding
Area (MA) standards and develop they were prior to the changes, 65 are negatively-affected ambulance
recommendations for possible changes in a different MSA, and 288 were not companies harmless or by adopting a
to those standards. Three notices related previously designated to any MSA (69 phase-in of the CBSA-based geographic
to the review of the standards were FR 49027). changes.
published on the following dates in the There are 674 counties in Response: While we understand the
Federal Register, providing an Micropolitan Areas. Of these, 41 were concern of some ambulance companies
opportunity for public comment on the previously in an MSA, while 633 were about the CBSA-based geographic
recommendations of the Committee: not previously designated to an MSA. changes, we think most negative
December 21, 1998 (63 FR 70525 There are five counties that previously impacts will be mitigated when we
through 70561); October 20, 1999 (64 FR were designated to an MSA, but are no incorporate the updated Goldsmith
56627 through 56644); and August 22, longer designated to either an MSA or Modification using RUCAs, as we
2000 (65 FR 51059 through 51077). a new Micropolitan Area (Carter discuss in section III.B.1.b. of this final
In the December 27, 2000, Federal County, Kentucky; St. James Parish, rule. The RUCAs allow us to continue
Louisiana; Kane County, Utah; to recognize sub-county rural areas in
Register (65 FR 82227 through 82238),
Culpepper County, Virginia; and King CBSA-based MSAs. Further, we believe
OMB announced its new standards. In
George County, Virginia) (69 FR 49027). that accurate payments to rural areas
that notice, OMB defined a CBSA, Our adoption of CBSA-based should not be further delayed.
beginning in 2003, as ‘‘a geographic geographic area designations means that Ambulance payments will not reflect
entity associated with at least one core ambulance providers and suppliers that the population changes documented by
of 10,000 or more population, plus pick up Medicare beneficiaries in areas the CY 2000 decennial census and
adjacent territory that has a high degree that are now outside of MSAs (but had reflected in CBSA-based geographic
of social and economic integration with been within MSA areas) may experience designations until CY 2007. Finally,
the core as measured by commuting increases in payment, while those ambulance providers and suppliers who
ties.’’ CBSAs are conceptually areas that ambulance providers and suppliers that benefit from the floor amount based on
contain a recognized population pick up Medicare beneficiaries in areas Regional fee schedules will continue to
nucleus and adjacent communities that that are now within MSA areas (but had receive transition payments through CY
have a high degree of integration with been outside of MSAs) may experience 2009, mitigating the overall financial
that nucleus. The purpose of the new decreases in payment. impacts of the ambulance fee schedule.
OMB standards is to provide nationally The use of updated geographical areas Comment: Several commenters
consistent definitions for collecting, means the recognition of new urban and suggested delaying the implementation
tabulating, and publishing Federal rural boundaries based on the of the CBSA-based geographic changes
statistics for a set of geographic areas. population migration that occurred over until the findings of the GAO report on
The OMB standards designate and a 10-year period, between 1990 and costs and access as they relate to
define two categories of CBSAs: 2000. ambulance services is published. The
Metropolitan Statistical Areas (MSAs); We believe that updating the MSA final report is currently due to be
and Micropolitan Statistical Areas (65 definition to conform with OMB’s published by December 2007.
FR 82227 through 82238). According to CBSA-based geographic area Response: We contacted the GAO
OMB, MSAs are based on urbanized designations, coupled with updating the concerning this report. At this time, the
areas of 50,000 or more population and Goldsmith Modification (that is, using draft findings are not available and GAO
Micropolitan Statistical Areas (referred the current Rural Urban Commuting is not permitted to discuss the report
to in this discussion as Micropolitan Areas (RUCAs) version, as discussed in until its release. In view of the
Areas) are based on urban clusters of at section III.B.1.b of this final rule), will mitigating effects of our use of RUCAs,
least 10,000 population but less than more accurately reflect the and in light of the fact that no ‘‘super
50,000 population. Counties that do not contemporary urban and rural nature of rural bonus’’ areas are affected by the
fall within CBSAs are deemed ‘‘Outside areas across the country for ambulance CBSA-based geographic designations,
CBSAs.’’ payment purposes and cause ambulance we think that the better course of action
Under the ambulance fee schedule, fee schedule payments to become more is to finalize our adoption of CBSA-
MSAs would continue to be recognized accurate. based urban and rural designations.
as urban areas and all other areas As of October 1, 2004, the IPPS However, we will maintain contact with
outside MSAs (including Micropolitan adopted OMB’s revised metropolitan the GAO and, when their findings are
Areas, areas ‘‘Outside CBSAs’’, and area definitions to identify ‘‘urban available, we will consider whether any
areas that are determined to be rural areas’’ for payment purposes. Under the further adjustments are necessary.
under the most recent modification of IPPS, MSAs are considered urban areas
the Goldsmith Modification) would be and Micropolitan Areas and areas b. Updated Goldsmith Modification:
recognized as rural areas. As noted ‘‘Outside CBSAs’’ are considered rural Rural Urban Commuting Areas (RUCAs)
previously, these designations are areas as specified in § 412.64(b). We are The Goldsmith Modification evolved
important because under the ambulance adopting similar CBSA-based from an outreach grant program
fee schedule, Medicare transports are designations of ‘‘urban area’’ and ‘‘rural sponsored by the Office of Rural Health
Policy of the Health Resources and rural census tracts within them that will commenters who suggested that we
Services Administration (HRSA). This be recognized as rural areas through our follow HRSA’s guidelines and consider
program was created to establish an use of RUCAs. While this may not mean areas to be rural if they fall within
operational definition of rural that every commenter will be ultimately RUCA levels 4 through 10. One
populations lacking easy access to satisfied, we believe that using RUCAs commenter suggested that a rurality
health services in Large Area to identify sub-county rural areas within level of 2.0 might be a better breakpoint
Metropolitan Counties (LAMCs). Dr. urban counties will resolve many of the for EMS purposes. However, we believe
Harold F. Goldsmith and his associates commenters’ concerns. that HRSA’s guidelines accurately
created a methodology for identifying Comment: Although a number of identify rural areas for ambulance
rural census tracts located within a large commenters were supportive of our use payment purposes and are generally
metropolitan county of at least 1,225 of RUCAs, they requested that we clarify consistent with Medicare payment
square miles. Using a combination of how we intend to define rurality using policies. We will, therefore, consider
data on population density and RUCA categories. any census tract falling at or above
commuting patterns, census tracts were Response: The RUCA system is an RUCA level 4.0 to be a rural area for
identified as being so isolated by updated version of the Goldsmith purposes of payment for ambulance
distance or physical features that they Modification that uses a 10-point scale services. We are finalizing our proposal
were more rural than urban in character. of rurality. RUCA levels are assigned to to use the most recent modification of
The original Goldsmith Modification a census tract based on the association the Goldsmith Modification
was developed using data from the 1980 of a given area’s population to the incorporating RUCAs, as directed by
census. To more accurately reflect nearest urban commuting area as section 1834(l) of the Act. We will use
current demographic and geographic follows: 4.0 on the RUCA scale as the
characteristics of the nation, HRSA’s (1) Metropolitan-area core: Primary delineation between rural and urban
Office of Rural Health Policy, in flow within an urbanized area (UA). (4.0 and greater is rural and less than 4.0
partnership with the Department of (2) Metropolitan-area high is urban).
Agriculture’s Economic Research commuting: Primary flow 30% or more Comment: One commenter discussed
Service and the University of to a UA. zip code areas that ‘‘bleed’’ from one
Washington, developed an update to the (3) Metropolitan-area low commuting: type of geographic area to another, such
Goldsmith modification designated as Primary flow 5 percent to 30 percent to as from rural to urban. This commenter
Rural-Urban Commuting Area Codes a UA. was concerned that zip codes that were
(RUCAs) (69 FR 47518 through 47519). (4) Large town core: Primary flow predominantly, but not totally, located
Rather than being limited to LAMCs, within a place of 10,000 to 49,999. within a rural area would not receive
RUCAs use urbanization, population (5) Large town high commuting: rural payments for ambulance pick-ups
density, and daily commuting data to Primary flow 30 percent or more to a in those areas due to the urban
categorize every census tract in the place of 10,000 to 49,999. influence of part of the zip code area.
country. Thus, RUCAs are used to (6) Large town low commuting: Response: When we review a claim
identify rural census tracts in all Primary flow 5 percent to 30 percent to for ambulance services, we specifically
metropolitan counties. Section 1834(l) a place of 10,000 to 49,999. examine the zip code for the pick-up
of the Act requires that we use the most (7) Small town core: Primary flow point to determine whether that zip
recent modification of the Goldsmith within a place of 2,500 to 9,999. code contains both urban and rural
Modification to determine rural census (8) Small town high commuting: areas. Census tracts under RUCAs can
tracts within MSAs. Therefore, we are Primary flow 30 percent or more to a be broken down by zip code for every
removing the definition of ‘‘Goldsmith place of 2,500 to 9,999. county, which allows us to identify
modification’’ at § 414.605 and (9) Small town low commuting: rural and urban areas within a given
incorporating a reference to the most Primary flow 5 percent to 30 percent to county. Generally, we would categorize
current version of the Goldsmith a place of 2,500 to 9,999. a zip code as urban or rural, and make
modification, which are the Rural Urban (10) Rural areas: Primary flow to a payment accordingly, based on where
Commuting Areas (RUCAs), in the tract without a place of 2,500 or more. the bulk of the population in that zip
definition of ‘‘rural area.’’ Furthermore, census tracts under code resides.
Comment: We received numerous RUCAs can be broken down by zip code Comment: Several commenters were
comments from members of the for every county, allowing us to modify concerned about the impact of the
ambulance industry that were rural and urban areas within a given proposed CBSA-based geographic
concerned about the geographic status county. In the May 26, 2006 proposed changes on the provisions of the
of their pick-up areas. Ambulance rule (71 FR 30358), we did not specify Medicare Modernization Act (MMA) for
companies located in areas that have where we would draw the line on the rural service areas, specifically
been traditionally recognized as rural RUCA scale for urban/rural purposes. concerning the ‘‘Super Rural Bonus’’
areas were concerned that population According to HRSA, the generally areas.
shifts based on whole county accepted breakpoint is to define a level Response: The ‘‘Super Rural Bonus’’
designations might not accurately reflect less than 4.0 on the scale as urban and areas are areas that we determine to be
pockets of rurality within those levels equal to or greater than 4.0 on the in the lowest 25th percentile of all rural
counties. scale as rural. Under section 330A of the populations arrayed by population
Response: The most recent Public Health Service Act, the Office of density in accordance with section
modification of the Goldsmith Rural Health Policy within HRSA 1834(l)(12) of the Act. Ambulance pick-
Modification, which we are adopting in determines eligibility for its rural grant ups in these areas currently receive a
this final rule, uses RUCAs to recognize programs through the use of the RUCA 22.6 percent add-on to their Medicare
levels of rurality in census tracts located code methodology. Under this payments. None of the Super Rural
in every county across the nation. As a methodology, any rural census tract that Bonus areas should be adversely
result, many counties that are is in a RUCA code 4.0 or higher is affected by the proposed CBSA-based
designated urban at the county level determined to be a rural census tract. changes, as our use of RUCA levels will
based on population do, indeed, have We agree with the majority of the preserve the rural status of an area
whether or not it is located in a county Ambulance Services and Revisions to That document and subsequent
which is designated as urban under the the Physician Certification questions and answers related to the
OMB definitions. Areas that do lose Requirements for Coverage of definition of SCT were made available
their rural status to become urban have Nonemergency Ambulance Services’’ to the public on the Ambulance policy
become urban because of a significant that implemented the ambulance fee Web page on the CMS Web site.
increase in the surrounding population. schedule. In that final rule, we defined In addition, we clarified our
Comment: One commenter stated that SCT in § 414.605 as the ‘‘interfacility definition of SCT in the Medicare
the ambulance is dispatched to the transportation of a critically injured or Benefit Policy Manual, Chapter 10—
patient to provide care at his or her ill beneficiary by a ground ambulance Ambulance Services, in which we stated
pick-up point and, therefore, the vehicle, including medically necessary that SCT is regarded as a highly-skilled
ambulance payment system should supplies and services, at a level of level of care of a critically injured or ill
reflect this procedure. Another service beyond the scope of the EMT patient during transfer from one
commenter suggested that we should [(Emergency Medical Technician)]— hospital to another. We have also
retain the Goldsmith Modification in its Paramedic. SCT is necessary when a clarified our policy in Ambulance Open
current form and not update payments beneficiary’s condition requires ongoing Door Forums, conference calls, and oral
under the ambulance fee schedule to care that must be furnished by one or and paper communication written in
reflect the use of RUCAs. more health professionals in an response to questions posed by
Response: We agree that the appropriate specialty area, for example, individuals and groups representing the
ambulance pick-up point is the nursing, emergency medicine, ambulance industry.
determining factor in establishing respiratory care, cardiovascular care, or Despite our previous attempts to
payment under the ambulance fee a paramedic with additional training.’’ clarify the scope of SCT transport, we
schedule, and we intend to retain this Additionally, ambulance vehicle staff continued to receive questions from
procedure in the payment process. In must be certified as emergency medical ambulance suppliers and providers and
addition, we agree that we need to technicians and legally authorized to there was confusion on this point
recognize levels of rurality, and are operate all lifesaving and life-sustaining among the Medicare contractors. For
doing so by adopting the updated equipment that are on board the vehicle this reason, we had proposed to change
Goldsmith Modification which uses as specified in § 410.41(b)(1). Typically, the definition of ‘‘specialty care
RUCAs to identify rural areas within a SCT level of care occurs when the transport’’ at § 414.605 to read
urban counties. We are directed by patient, who is already receiving a high ‘‘hospital-to-hospital’’ transport as
section 1834(l) of the Act to use the level of care in the transferring facility, opposed to ‘‘interfacility’’ transportation
most recent update of the Goldsmith requires a further level of care that the to conform our regulation text to our
Modification in the payment process. transferring facility is not able to existing policy.
Comment: Another commenter provide. Comment: Many commenters
suggested that we allow ambulance We implemented the SCT level of suggested that we expand the SCT level
companies to present data to justify payment for hospital-to-hospital ground of ambulance service to include
rurality, similar to the IPPS hospital ambulance transports upon transportation for neonates and adults
reclassification process. implementation of the ambulance fee transported from the scene of an
Response: Once again, we understand schedule on April 1, 2002 and we accident to a hospital, as well as
the concern of some ambulance defined SCT at § 414.605. The definition transport between hospitals and
companies to retain the rural status of of SCT in § 414.605 refers to between hospitals and skilled nursing
their pick-up areas. However, as ‘‘interfacility transportation.’’ As we facilities (SNFs). In addition,
discussed in this section, we believe stated in the preamble to the February commenters requested a clearer
that, where applicable, the use of the 27, 2002 final rule with comment period definition of the terms ‘‘hospital’’ and
RUCAs, and our ability to identify rural (67 FR 9100), the SCT level of care ‘‘critical care.’’ Some commenters
zip codes within census tracts, will includes the situation where a suggested that we reconvene the
address this concern in a consistent beneficiary is taken by ground Negotiated Rulemaking Committee to
manner. Therefore, we do not believe it ambulance from the hospital to an air develop a definition of ‘‘critical care.’’
is necessary to complicate the payment ambulance and then from the air Response: We carefully considered
process by developing an additional ambulance to the final destination the commenters’’ recommendations to
data submission and evaluation hospital. Also, we stated in the expand our interpretation of the term
methodology. While the commenter preamble for both the September 12, ‘‘interfacility’’ to include other origin
directly referred to the hospital 2000 proposed rule (65 FR 55077) and and destination points in addition to
reclassification process that is the February 27, 2002 final rule (67 FR hospitals. The SCT level of transport is
administered under the IPPS, wherein 9108), that SCT was proposed as a level intended to be used only for transfer of
hospitals can apply for geographic of interhospital service. As stated in our the most critically ill beneficiaries, who
reclassification for purposes of May 26, 2006 proposed rule, we based require ongoing specialized care beyond
determining the wage index adjustment our payment for SCT-level ground the scope of the EMT-paramedic.
to their inpatient payments, the hospital ambulance transports on hospital-to- Typically, SCT level transport occurs
reclassification process was established hospital ambulance transportation data. when a beneficiary who is already
by statute specifically for inpatient Subsequent to the implementation of receiving a high level of specialized care
hospitals. Therefore, this IPPS the ambulance fee schedule, we in one facility is moved to another
reclassification methodology does not clarified our definition of SCT as facility to receive more specialized
apply to ambulance services. hospital-to-hospital transport in a services. Although such specialized care
Program Memorandum to Medicare is usually provided in a hospital, we
2. Specialty Care Transport (SCT) contractors, which was issued on recognize that some beneficiaries
In the February 27, 2002 Federal September 27, 2002. (Program receive specialized care in a skilled
Register (67 FR 9100), we published a Memorandum Intermediaries/Carriers, nursing facility (SNF) and may require
final rule with comment period entitled Transmittal AB–02–130—Change the SCT level of transport from the SNF
‘‘Fee Schedule for Payment of Request 2295, September 27, 2002). to a hospital or from a hospital to a SNF.
Therefore, we are withdrawing our cancer hospitals, children’s hospitals, part of the ongoing care that falls within
proposal to revise § 414.605 to read psychiatric hospitals, Critical Access the definition of SCT.
‘‘hospital-to-hospital’’ instead of Hopitals (CAHs), inpatient acute-care Comment: One commenter stated that
‘‘interfacility’’ and expanding our hospitals, and Sole Community certain modifiers, such as the ‘‘D’’
interpretation of ‘‘interfacility’’ to Hospitals (SCHs). modifier representing a stand-alone
include both hospitals and SNFs. In However, we do not agree with emergency room or the ‘‘I’’ modifier
addition, in response to comments, we commenters who recommended that a used when transferring a patient from
are further clarifying the kinds of more comprehensive definition of the airport or helipad to the ambulance,
facilities that we include as origin or ‘‘critical care’’ is warranted at this time. exclude these types of ambulance
destination points for ‘‘interfacility’’ The Negotiated Rulemaking Committee transports from the SCT level of service.
transport for SCT purposes. was unable to precisely define ‘‘critical Response: The commenter is correct
Many of our Medicare contractors care’’ at the time it originally convened that we generally do not recognize
indicate that they have been and recognized that a definition either ‘‘D’’ or ‘‘I’’ modifier-type
administering the ‘‘interfacility’’ provided at the State or local level ambulance transports to be SCT level
requirement in the SCT definition would be expected to fit, since there are ambulance services. The ‘‘D’’ modifier
broadly, paying claims at the SCT level no national standards available would be used to describe a non-
of service beyond the scope of (Summary Minutes, Medicare hospital-based, non-hospital-owned, or
‘‘hospital-to-hospital.’’ An examination Ambulance Fee Schedule Negotiated non-hospital-operated diagnostic facility
of the latest available claims data shows Rulemaking, October 4 and 5, 1999). We or clinic. We have defined the SCT level
that SCT-level payments are made have no additional data that would of ambulance service as interfacility
predominantly for hospital-to-hospital permit us to develop a more precise ground transportation, involving
transportation, as expected, with a small definition at this time. In addition, we transport between hospitals, hospital-
percentage of SCT-level ambulance believe that a more precise definition based facilities and SNFs. Therefore, a
transports involving other origin and might conflict with State or local stand-alone emergency room that is not
destination points, primarily SNFs. parameters already in place, as well as provider-based or a freestanding clinic
Therefore, for purposes of SCT possibly limiting the scope of SCT that is not provider-based would not
payment, we consider a ‘‘facility’’ to payments in localities where a broader meet the requirements for an origin or
include a SNF or a hospital that State or local definition would destination point for SCT level
participates in the Medicare program. In otherwise apply. transport. The ‘‘I’’ modifier indicates an
addition, we consider the term ‘‘Critical care’’ will continue to be origin or destination that is a transfer
‘‘facility’’ to include a hospital-based interpreted by our Medicare contractors point between ambulances, such as
facility that meets our requirements for in conjunction with directives provided transfer from air to ground ambulance
provider-based status, as specified at at the State or local level. service at a helicopter pad. Unless the
§ 413.65. Facilities that meet our Comment: Many commenters also origin of the first leg of the transport is
requirements for provider-based status, suggested that we consider including a facility and unless the SCT level of
like the main provider with which they the ongoing monitoring of a patient by care is medically necessary after the
are affiliated, are held to high standards a specially-trained health care transfer occurs, we would not consider
of safety and patient care. Therefore, we professional, beyond the scope of the the transport from the transfer point to
believe that such facilities, due to their EMT-Paramedic, to be within the realm the final destination to be SCT level
close association with a Medicare of the SCT level of service. transport.
hospital and their adherence to high Response: We carefully considered
these commenters’ concerns, and we 3. Recalibration of the Ambulance Fee
standards of care under our regulations,
agree that in cases where a critically Schedule Conversion Factor
are also among the facilities equipped to
provide the SCT level of care to patients injured or ill patient requires the SCT- In the February 27, 2002 final rule
and to provide the additional level of transport from one facility to with comment period (67 FR 9102 and
specialized care that is required under another, the ongoing care that must be 9103), we indicated that we would
the SCT level of ambulance transport. furnished by a health professional in an adjust the CF if actual experience under
We will continue to enforce our medical appropriate specialty area, beyond the the fee schedule was significantly
necessity requirements concerning all scope of the EMT-Paramedic, may different from the assumptions used to
interfacility transports so that we can include ongoing determinations as to determine the initial CF and air
remain assured that they are occurring whether the patient requires specialized ambulance rates. We specifically stated
for only the most critical patients. care during the transport. We do not that we would monitor payment data
We appreciate the request by require that specialized treatment and evaluate whether the assumptions
commenters that we clarify the kinds of actually be furnished during the used were accurate.
facilities we consider to be included for transport to satisfy the standard for SCT- We have continued to review our
SCT payment purposes. As explained level transport. However, we do require assumptions annually to determine
above, our claims data indicate that SCT that the need for specialized treatment whether or not a CF adjustment is
level care is needed primarily during can only be ascertained by a health warranted. We examined the effects of
inter-hospital transfers and, in some professional with specialized training the relative volumes of the different
cases, during transfers between a beyond the scope of the EMT- levels of ambulance services (service
hospital and a SNF. Therefore, for Paramedic. We agree with commenters mix) and the extent of low billing
purposes of SCT payment, we consider who indicated that an ambulance charges to determine whether we should
a ‘‘facility’’ to include only a SNF or a service should not be expected to bear adjust the CF to reflect actual practices.
hospital that participates in the the cost of an additional health In the 4 years since the implementation
Medicare program, or a hospital-based professional to accompany a patient of the ambulance fee schedule, no
facility that meets our requirements for ‘‘just in case’’ the need for specialized significant differences from our original
provider-based status. treatment arises during transport. When assumptions have emerged. We have
Medicare hospitals include, but are such ‘‘specialized monitoring’’ is observed only insignificant differences,
not limited to, rehabilitation hospitals, medically necessary, we agree that it is and, to date, no adjustments in any 1
year have been warranted. It is for this at another hospital for either admittance Response: Certainly, this was not our
reason that we believe it is appropriate or treatment. For example, in most of intent. Our view of the problem we were
to discontinue our annual review of the these cases, the beneficiary must be attempting to address was the issue of
original CF assumptions. We also stabilized prior to the transport. ‘‘readiness’’ when responding to a 911
believe that the formal annual review of Therefore, the need to maintain a state call. We expect ‘‘emergency response’’
air ambulance rates should be of readiness to respond immediately to payment to be made only in
discontinued as we will monitor all an urgent call, warranting a higher circumstances where readiness to
ambulance rates and make adjustments emergency response payment, does not respond immediately is truly required.
on an ‘‘as needed’’ basis. The ambulance appear to be applicable to these Therefore, we proposed to clarify the
industry has available multiple venues situations. circumstances under which we
for notifying us of potential issues. Another example occurs when the expected this to occur. However, we
These include the ambulance fee ambulance is owned by the originating agree with comments stating that
schedule open door forums and hospital. We stated in a Program ambulance service calls generally do not
telephone calls to designated CMS Memorandum to the Medicare originate through a 911 service but
personnel. As an additional safeguard, contractors (Transmittal AB–02–130, through the hospital’s radio dispatch at
we generally conduct a review of Change Request 2295, September 27, the location where the ambulance is
ambulance data each year in preparation 2002) that upon receipt of a call for stationed. Private ambulance services
for issuing the Ambulance Inflation ambulance services, the dispatcher stationed at inpatient hospitals would,
Factor (AIF). makes the determination of whether the
Therefore, we are revising § 414.610 therefore, be at a disadvantage if we
call constitutes an Emergency response. specify that responding to hospital radio
(g) to indicate that we will monitor When the ambulance service is already
payment and billing data on an ongoing calls only qualifies as ‘‘emergency
readily available at the originating response’’ when the ambulance entity is
basis and adjust the CF and air hospital, an emergency call may not be
ambulance rates as appropriate to reflect owned or operated by the hospital. This
necessary, much less through a would not affect off-site ambulance
annual practices under the fee schedule. dispatcher for a 911 service.
Comment: Commenters were services whose calls originate through a
While we recognize that there may be 911 or equivalent service. We agree that
supportive of our proposal to instances when an emergency response
discontinue the annual practice of the proposed change in the definition of
payment is warranted for a transport
examining the low biller data and the ‘‘emergency response’’ could have an
between two hospital emergency
CF via the rulemaking process. unintended adverse effect on private
departments, we believe that payment
Response: We appreciate the support ambulance services in these
based on readiness to respond
of the commenters on these points. circumstances.
We are finalizing our proposal to immediately is not justified 100 percent
of the time. For this reason, we believed Comment: Several commenters stated
discontinue the annual practice of
our current definition of Emergency that our existing definition of
examining the low biller data and the
response needed to be clarified to reflect emergency response more clearly
CF, as well as air ambulance rates, and
only circumstances where payment for reflects the intent of the Negotiated
to change the language at § 414.610(g) to
immediate response is truly warranted. Rulemaking Committee in that all
reflect this.
We proposed to revise the definition of ambulance services should have equal
4. Hospital-to-Hospital Ambulance Emergency response to mean that an access to the use of the emergency level
Service: Emergency Response ambulance entity— of service by accessing it through
In § 414.605, we define ‘‘emergency • Maintains readiness to respond to established State protocols, such as 911
response’’ for purposes of ambulance urgent calls at the BLS or ALS1 level of or an equivalent service.
service to mean ‘‘responding service; and Response: We also agree that the
immediately at the BLS (Basic Life • Responds immediately at the BLS current definition of emergency
Support) or ALS1 (Advanced Life or ALS1 level of service to 911 calls, the response is consistent with the
Support Level 1) level of service to a equivalent in areas without a 911 call Negotiated Rulemaking Committee’s
911 call or the equivalent in areas system or radio calls within a hospital intent and does not present other
without a 911 call system. An system when the ambulance entity is problems raised by commenters. For the
immediate response is one in which the owned and operated by the hospital. BLS and ALS1 levels of service, an
ambulance entity begins as quickly as Comment: We received many ambulance service that qualifies for an
possible to take the steps necessary to comments on revising the definition of emergency response is assigned a higher
respond to the call.’’ In our February 27, ‘‘emergency response’’. Most relative value to recognize the
2002 final rule with comment period (67 commenters expressed concern that this additional costs incurred in responding
FR 9100), in our definition of revised definition would put private immediately. We think that requiring an
‘‘emergency response’’ we stated that ambulance services at a disadvantage.
ambulance service to respond to a 911
the additional payment for emergency They interpreted our proposed
call, or the equivalent in areas without
response is for the additional overhead definition to include only ambulance
a 911 call system, satisfies this
cost of maintaining the resources services owned and operated by
requirement.
required to respond immediately to a hospitals that respond to radio calls
call and not for the cost of furnishing a within a hospital system. Essentially, Therefore, we are withdrawing our
certain level of service to the their interpretation of our proposed proposal to revise the ‘‘emergency
beneficiary. definition was that only ambulance response’’ definition and will retain the
The current emergency response services owned and operated by current definition at 414.605. We expect
definition has created confusion for hospitals would be able to transport that the State protocol (a 911 call or the
those transports that originate at a patients at the ‘‘emergency response’’ equivalent in areas without a 911 call
hospital emergency department and the level of service and, therefore, be able to system) for requesting emergency
ambulance is transporting the receive the higher ‘‘emergency ambulance services will be followed in
beneficiary to an emergency department response’’ payment as a result. all instances.
C. Analysis of and Responses to Public fee schedule and the regional in the past 5 years; (4) databases (for
Comments ambulance fee schedule. As of January example, Society of Thoracic Surgeons
We received a total of 102 timely 1, 2007, the combination rate will be 80 (STS), National Surgical Quality
public comments in response to the May percent of the national ambulance fee Improvement Program (NSQIP), and
26, 2006 proposed rule (71 FR 30358). schedule and 20 percent of the regional Medicare diagnosis-related group
Commenters included national trade ambulance fee schedule. (DRG)) were used in lieu of the standard
associations, health care providers, RUC methodology or as a supplement to
IV. Five-Year Refinement of Relative the standard methodology; and (5) the
hospitals, CMS contractors, and private Value Units Under the Physician Fee intra-service work per unit of time
citizens. Schedule: Responses to Public (IWPUT) calculation was used to
All public comments were reviewed Comments on the Five Year Review of determine work RVUs in lieu of the
and grouped by like or related topics. Work Relative Value Units standard RUC process. Although we
Comments are addressed in the
A. Scope of the Five-Year Review recognize that the work values of codes
individual sections of discussion to
may change over time, it is the
which they apply. This final rule includes the
responsibility of the specialty society to
culmination of the third 5-Year Review
D. Ambulance Inflation Factor (AIF) for present compelling evidence that a code
of work RVUs required by the statute.
2007 is misvalued. (For additional
The work RVUs affected by this review
Section 1834(l)(3)(B) of the Act information on the review process,
will be effective for services furnished
provides the basis for updating payment please see the June 29, 2006 proposed
beginning January 1, 2007.
amounts for ambulance services. Our In the June 29, 2006 proposed notice, notice (71 FR 37172).)
regulations at § 414.610(f) provide that ‘‘Five-Year Review of Work Relative B. Review of Comments
the ambulance fee schedule must be Value Units Under the Physician Fee Many commenters expressed support
updated by the AIF annually, based on Schedule and Proposed Changes to the for our proposed valuations of many of
the CPI for all urban consumers (CPI-U) Practice Expense Methodology’’, we the services. However, other
(U.S. city average) for the 12-month explained the process used to conduct commenters expressed specific concern
period ending with June of the previous the 5-Year Review of work RVUs. In or disagreement with the proposed
year. For CY 2007, that percentage is 4.3 response to our solicitation of public valuation of approximately 106 codes,
percent. comments that appeared in the with the major concern being that the
Section 414.620 specifies that changes November 15, 2004 Federal Register (69 codes would be undervalued.
in payment rates resulting from FR 66370), we received comments from We convened a multi-specialty panel
incorporation of the AIF will be approximately 35 specialty groups, of physicians to assist us in the review
announced by notice in the Federal organizations, and individuals involving of comments. The comments we did not
Register without opportunity for prior over 500 Current Procedural submit for panel review are discussed at
comment. We find it unnecessary to Terminology (CPT) codes. After review the end of this section. The panels were
undertake notice and comment by our medical staff, we shared these moderated by our medical staff and
rulemaking because the statute and comments with the AMA’s Relative consisted of:
regulations specify the methods of Value Update Committee (RUC) along • Clinicians representing the
computation of annual updates. This with additional services we had commenting specialty(s), based on our
notice does not change policy, but identified as potentially misvalued. determination of those specialties which
merely applies the update methods After a comprehensive review are most identified with the services in
specified in the statute and regulations. process, the RUC submitted work RVU question. Although commenting
The national fee schedule for recommendations for all of these codes specialties were welcomed to observe
ambulance services has been phased in except for the codes that were the entire refinement process, they were
over a 5-year transition period withdrawn or referred to the CPT only involved in the discussion of those
beginning April 1, 2002 as specified in Editorial Panel for further review or services for which they were invited to
§ 414.615. action, and CPT code 32020 for which participate.
Prior to January 1, 2006, during the no specialty society expressed an • Primary care clinicians nominated
transition period, the AIF was applied interest in conducting a survey. We by the American Academy of Family
separately to both the fee schedule analyzed all of the RUC Physicians (AAFP) and the American
portion of the blended payment amount recommendations by evaluating the College of Physicians.
(regardless of whether a national or methodology used by each workgroup to • Four carrier medical directors.
regional fee schedule applied) and to develop the recommendations, the • One to two clinicians who practice
the reasonable cost or charge portion of recommended work RVUs, and the in related specialties and have
the blended payment amount, rationale for the RUC recommendations. knowledge of the services under review.
respectively, for each ambulance When appropriate and feasible, if we We submitted 30 codes for evaluation
provider or supplier. Then, these two had concerns about the application of a by the panel. The panel discussed the
amounts were added together to particular methodology, we assessed work involved in each procedure under
determine the total payment amount for whether the recommended work RVUs review in comparison to the work
each provider or supplier. Beginning were appropriate by using alternative associated with other services on the fee
January 1, 2006, the total payment for methodologies. schedule. We assembled a set of
air ambulance providers and suppliers In conducting our review of the RUC reference services and asked the panel
is based on 100 percent of the national recommendations we considered members to compare the clinical aspects
ambulance fee schedule, while the total whether: (1) The code was part of a of the work for services they believed
payment amount for ground ambulance completed survey process; (2) the were incorrectly valued to one or more
providers and suppliers is based on methodology used by the specialty of the reference services. In compiling
either 100 percent of the national society followed the standard RUC the reference set, we attempted to
ambulance fee schedule or a process; (3) the survey respondents include: (1) Services that are commonly
combination of the national ambulance stated the work had or had not changed furnished for which work RVUs are not
controversial; (2) services that span the should be modified. We did not modify • Modifier. A modifier -26 is shown if
entire spectrum of work intensity from the RVUs unless there was a clear the work RVUs represent the
the easiest to the most difficult; and (3) indication for a change. If there was professional component (PC) of the
at least three services performed by each agreement across groups for change, but service.
of the major specialties so that each the groups did not agree on what the • Description. This is an abbreviated
specialty would be represented. Group new RVUs should be, we eliminated the version of the narrative description of
members were encouraged to make outlier group, and looked for agreement the code.
comparisons to these reference services. among the remaining groups as to the
The intent of the panel process was to basis for new RVUs. We used the same • Proposed Work RVUs. This column
capture each participant’s independent methodology in analyzing the ratings includes the work RVUs proposed in the
judgment based on the discussion and that we first used in the refinement June 29, 2006 proposed notice for each
his or her clinical experience. Following process for the CY 1993 physician fee reviewed code.
the discussion for each service, each schedule final rule published in the • Requested Work RVUs. This
participant rated the work for that November 25, 1992 Federal Register column identifies the work RVUs
procedure. Ratings were individual and which described the statistical tests in requested by the commenters. If the
confidential; there was no attempt to detail (57 FR 55938). commenters requested different RVUs,
achieve consensus among the panel Our decision to convene a multi- the table lists the highest requested
members. specialty panel of physicians and to RVUs.
apply the statistical tests described
We then analyzed the ratings based on above in this section was based on our • RUC Recommendation. This
a presumption that the RVUs published need to balance the interests of those column identifies the work RVUs
in the proposed notice were correct. To who commented on the work RVUs recommended by the RUC that appeared
overcome that presumption, the against the redistributive effects that in the June 29, 2006 proposed notice.
inaccuracy of the proposed RVUs had to would occur in other specialties. Of the • HCPAC Recommendation. This
be apparent to the broad range of 30 codes reviewed by the multi- column identifies the work RVUs
physicians participating in the panel. specialty panel, all were the subject of recommended by the HCPAC that
Ratings of work were analyzed for requests for increased values. appeared in the June 29, 2006 proposed
consistency among the groups Of the proposed codes that were notice.
represented on the panel. In general reviewed, 11 increased, and 19 were not
terms, we used statistical tests to • 2007 Work RVUs. This column
changed. contains the work RVUs for the CY 2007
determine whether there was enough Table 12 lists the codes reviewed
agreement among the groups on the physician fee schedule.
during the 5-Year Review on which we
panel, and if so, whether the agreed- received comments. This table includes • Basis for Decision. This column
upon RVUs were significantly different the following information: indicates whether the CY 2007 work
from the proposed RVUs that appeared • CPT/HCPCS Code. This is the CPT RVUs resulted from comments received
in the June 29, 2006 proposed notice to or alphanumeric HCPCS code for a or the refinement panel process.
demonstrate that the proposed RVUs service. BILLING CODE 4120–01–P
ER01DE06.007</GPH>
ER01DE06.008</GPH>
BILLING CODE 4120–01–C needed to be changed, as well as the service. We proposed to value CPT code
C. Discussion of Comments by Clinical intra-service descriptor and time to 17004, at the level determined for the
Area reflect only the destruction of pre- 15th lesion, at 1.58 work RVUs by
malignant lesions. The RUC agreed that, adding the 0.07 work RVU increment of
1. Dermatology and Plastic Surgery due to these changes, a work value CPT code 17003 and the 0.6 work RVUs
In addition to comments received in halfway between the 25th and median for the base code, CPT code 17000,
support of our proposed work RVUs for survey percentile was appropriate and which is not billed in conjunction with
services reviewed by the RUC’s recommended work RVUs of 1.80 for CPT code 17004.
Workgroup 1, we received the following CPT code 17004. Comment: While the American
comments. Academy of Dermatology (AAD) was
For CPT code 17004, Destruction (e.g., CMS Proposed Valuation pleased that the RUC-recommended
laser surgery, electrosurgery, For CPT code 17004, we believed that work RVUs were accepted for the 36
cryosurgery, chemosurgery, surgical the work associated with benign and CPT codes for the excision of benign
curettement), all benign or pre- pre-malignant lesions does not really and malignant lesions, both the AADA
malignant lesions (e.g., actinic differ; therefore, the recommended work and the RUC disagreed with our
keratoses) other than skin tags or RVUs for CPT code 17004 were too proposed valuation of 1.58 work RVUs
cutaneous vascular proliferative lesions; high. We used a ‘‘building block’’ for CPT code 17004 and requested that
15 or more lesions, the RUC considered methodology to develop our proposed we accept the RUC-recommended 1.8
a change to the work RVUs for this CPT RVUs for this service. That is, based on work RVUs. They continue to support
code based on the understanding that our proposed valuation of CPT code the premise that benign and pre-
when rank order anomalies arising from 17003 (the code used for 2–14 lesions), malignant lesions are not comparable
the 5-Year Review were identified, the of 0.07 work RVUs for each additional and believe that recent changes to the
specialty could bring these additional lesion, the 14th lesion would equal 0.91 code descriptors made by the CPT
codes forward for re-evaluation at the work RVUs (0.07 × 13 lesions) plus the editorial panel to CPT codes 17000–
February 2006 RUC meeting. A standard 0.6 work RVUs for the initial lesion, 17004 and CPT codes 17110–17111 for
RUC survey was conducted for this base code CPT code 17000, which is CPT 2007 also support this position.
code. During the discussion, the RUC billed once in conjunction with 17003, These descriptor changes specifically
ER01DE06.009</GPH>
agreed that the descriptor of the code for a total of 1.51 work RVUs for the differentiate between destruction of pre-
malignant and benign lesions, compartments with or without patella AAOS acknowledged that the initial
respectively. The RUC and AADA resurfacing (total knee arthroplasty), we recommendations presented by AAOS
maintain that the destruction of pre- originally presented these codes to the in August 2005 were based on NSQIP
malignant lesions in CPT 17004 requires workgroup with data other than survey and DRG data due to flaws in the
a greater mental effort and judgment, data supporting the work RVU requests. original surveys. However, based on
technical skill, intensity and time than Because of concerns regarding the reservations expressed by CMS at that
that for the destruction of benign lesions methodology used by the specialty time, subsequent surveys were
in CPT code 17111. In addition, the society, the codes were temporarily conducted. The RUC-recommended
commenters presented data collected withdrawn with the understanding that work RVU recommendations were then
during the survey process to show that survey data could be presented at the based on this survey data and the
the median number of lesions destroyed October 2006 meeting. After reviewing NSQIP data was used only as an
in the typical service of CPT code 17004 the survey data in October 2006, the adjunctive methodology to credit or
was 22 lesions, and the average number RUC did not find any compelling discredit the survey data.
was 23.439. evidence to change the current work In addition, these codes were
Response: We have reviewed the RVUs assigned to these services. Based compared with other RUC-reviewed
information supplied by the RUC and on this review, the RUC recommended codes to show that the recommended
the AADA, especially for the median maintaining the current work RVUs of values and times placed the codes in
number of lesions destroyed in the 20.09 work RVUs for CPT code 27130, proper rank order. The RUC-
typical service of CPT code 17004. By 15.58 work RVUs for CPT code 27236, recommended values are further
applying the same calculations we used and 21.45 work RVUs for CPT code supported when compared to other
in the proposed rule to value the 15th 27447, but also recommended using the procedures within the associated
lesion at 1.58 work RVUs, we new physician time survey data for each families. The commenters urged us to
determined that the RUC proposed work of these services. reconsider our position and accept the
value of 1.8 work RVUs represents 18 RUC recommendations.
CMS Proposed Valuation Response: The commenters are correct
lesions for a typical service for CPT
code 17004. We disagreed with the RUC- that we based our rejection of the RUC-
Final Decision: Based on these recommended values for CPT codes recommended work RVU for these
comments and our calculations, we now 27130, 27236 and 27447, based on the services (CPT codes 27130, 27236, and
believe that the RUC recommendation is specialty’s presentation to the 27447) on the August workgroup
reasonable and will accept the RUC- workgroup in August. We instead presentation and had inadvertently
recommended work value of 1.80 work proposed alternative work RVUs overlooked the surveys that were
RVUs for CPT 17004. determined by comparing these codes to presented at the October meeting. After
services with similar times and reviewing the more recent survey data,
Other Issues adjusting for any differences in hospital we now agree that the RUC
Comment: The American Society of visits. As a result of this analysis, we recommendations appear reasonable.
Plastic Surgeons (ASPS) was pleased proposed 15.96 work RVUs for CPT Therefore, based on a review of the
that we agreed with the RUC code 27130, 12.77 work RVUs for CPT information provided by the
recommendations for the codes code 27236, and 19.30 work RVUs for commenters, we have decided to accept
performed by plastic surgeons. ASPS CPT code 27447. the RUC recommendation to maintain
also clarified that the reason CPT code Comment: Several commenters, the current work RVUs of 20.09 for CPT
19361 was withdrawn from the 5-Year including societies representing code 27130, 15.58 work RVUs for CPT
Review process and sent to CPT was orthopedics and the RUC, expressed code 27236 and 21.45 work RVUs for
due to the ambiguity of the code concern about the methodology we used CPT code 27447.
descriptor, and not due to an invalid to develop our proposed work RVUs for
these services. Commenters questioned 3. Gynecology, Urology, Pain Medicine,
survey as was listed in Table 3 of the and Neurosurgery
June 29, 2006 proposed notice (71 FR the comparisons we used to arrive at the
37189). proposed values (that is, high volume We received comments disagreeing
Response: We thank the society for orthopedic procedures being compared with our proposed work RVUs on the
the clarification and regret the to rarely furnished non-orthopedic following two services: CPT code 22612,
erroneous rationale that was noted for procedures of lower risk and intensity), Arthrodesis, posterior or posterolateral
the withdrawal of CPT code 19361 from and also stated that our proposed work technique, single level; lumbar (with or
this 5-Year Review process. RVUs would create substantial rank without lateral transverse technique);
order anomalies within the families. and CPT code 63048, Laminectomy,
2. Orthopedic Surgery The American Academy of Orthopaedic facetectomy and foraminotomy
In addition to comments received in Surgeons/American Association of (unilateral or bilateral with
support of our proposed work RVUs for Orthopaedic Surgeons (AAOS) and the decompression of spinal cord, cauda
services reviewed by the RUC’s American Society for Surgery of the equina and/or nerve root(s), (e.g., spinal
Workgroup 2, we received comments on Hand (ASSH) stated that we had or lateral recess stenosis)), single
the following CPT codes. misunderstood the method that was vertebral segment; each additional
For CPT code 27130, Arthroplasty, used to develop the RUC-recommended segment, cervical, thoracic, or lumbar
acetabular and proximal femoral work RVUs for these procedures. They (List separately in addition to code for
prosthetic replacement (total hip indicated that we were incorrect in primary procedure.). The RUC had
arthroplasty), with or without autograft stating that a RUC survey had not been recommended increases in work RVUs
or allograft; CPT code 27236, Open conducted for these codes; the work for these two codes, but less than the
treatment of femoral fracture, proximal RVU recommendations that were increases requested by the specialty
end, neck, internal fixation or prosthetic adopted by the RUC are based on society. The RUC agreed that these
replacement; and CPT code 27447, surveys conducted by AAOS and are the procedures were undervalued due to
Arthroplasty, knee, condyle and result of extensive RUC review and increases in length of stay and the
plateau; medial AND lateral discussion. incorrect assumptions made in the
previous valuation of the service. The workgroup based its recommendation Comment: The AANS disagreed with
specific RUC-recommended work RVUs on the validity of the survey data and the RUC recommendations that we
were 22.00 work RVUs for CPT code the building block methodology proposed to accept for CPT codes 61697,
22612 and 3.55 work RVUs for CPT presented as additional rationale. The 61700 and 61702 because of changes
code 63048. specialty society representing spine made by the workgroup to ‘‘standardize
surgeons also commented that when the the pre-service and post-service times.’’
CMS Proposed Valuation
respondents were asked to rate how the The commenter stated that the standard
We had technical concerns with the complexity and intensity of these 60 minutes of pre-service time was not
recommendations for CPT codes 22612 services had changed in the past 5 years, adequate for such complex neurological
and 63048. The workgroup had the ratings showed that the survey procedures and stated reasons for the
recommended the survey’s 25th respondents believed that the intensity need for extended times. AANS also
percentile for CPT code 22612 to keep and complexity for both codes had objected to the adjustments made by the
the appropriate rank order with the increased. workgroup to the level and number of
reference service, CPT code 22595, that The AAFP questioned why we would post-operative visits by changing each
the RUC stated is a more complex propose a value for CPT code 22612 post-operative critical care visit to a
procedure. However, there was a that, though equal to the current value, single high level subsequent hospital
typographical error in the information was still higher than a more complex care visit. The society stated its belief
presented by the specialty society that reference code. According to the AAFP, that this change ‘‘significantly
listed the work RVUs for the reference the RUC appeared to be recommending understates the post-operative time and
code as 23.36, rather than the correct that the ratio of work between CPT intensity of the work that was described
value of 19.36 work RVUs. Therefore, codes 22612 and 22595 was 0.942 work by survey respondents,’’ and urged us to
the recommended work value of 22.00 RVUs; therefore, we should have add the time and work RVUs of an
RVUs appeared appropriate and we recommended a work value of 18.23 additional critical care code, CPT code
proposed to maintain the current work work RVUs for CPT code 22612. 99233, to all three services.
RVUs of 20.97 for this service. Response: We thank the commenters Response: We do not believe that,
There was what we believed to be an for clarifying the process used in based on this comment, we have
additional typographical error in the surveying for these services. However, sufficient information to make the
specialty society survey data for CPT we still have concerns regarding the requested change. Therefore, we
code 63048. The summary information RUC recommendations for these referred this code to a multi-specialty
presented to the RUC lists the reference services. First, though the survey refinement panel for review.
code as also being CPT code 63048. respondents did not see the erroneous Final Decision: As a result of our
Therefore, there is no information work RVUs listed for CPT code 22595, analysis of the refinement panel ratings,
submitted that compares the the reference code used for CPT code we have assigned 57.31 work RVUs to
respondents’ estimates of complexity 22612, the workgroup did account for CPT code 61697.
and intensity between CPT code 63048 these errors. As a result, the RUC
and a reference code. Because we do not 4. Radiology, Pathology, and Other
recommendation for CPT code 22612
have sufficient information to decide if Miscellaneous Services
was higher than the current work RVUs
the recommended work RVUs are for CPT code 22595, a procedure the In addition to comments received in
appropriate, we proposed to maintain workgroup considered more complex. support of our proposed work RVUs for
the current work RVUs of 3.26 for CPT Second, although the survey services reviewed by the RUC’s
code 63048. respondents may have indicated on the Workgroup 4, we received the following
Comment: We received comments rating scale that CPT codes 22612 and comments.
from the North American Spine Society, 63048 were more complex procedures For CPT code 76075, Dual energy x-
the American Association of in 2005 than they were in 2000, when ray absorptiometry (DXA), bone density
Orthopaedic Surgeons, the American they were asked simply whether the study, one or more sites; axial skeleton
Association of Neurological Surgeons work for these services had changed in (e.g., hips, pelvis, spine), the RUC
(AANS), and the RUC requesting that the last 5 years, 80 percent disagreed for recommended a reduction from the
we do not implement our proposed CPT code 22612 and 50 percent current 0.30 work RVUs for the DXA
RVUs for these services (CPT codes disagreed for CPT code 63048. service because the workgroup believed
22612 and 63048), but rather accept the Therefore, based on the comments that the actual work is less intense and
RUC-recommended work RVUs. The received, we referred this code to a more mechanical than the specialty
commenters stated that we had multi-specialty refinement panel for society’s description of the work. The
misunderstood the process used by the review. RUC-recommended work RVUs for this
presenting societies to develop the Final Decision: As a result of our code were 0.20 and we agreed with this
suggested RVUs for both codes. The analysis of the refinement panel ratings, recommendation.
commenters stated that the survey we have assigned 21.79 work RVUs to Comment: Many commenters,
respondents did not notice the values CPT code 22612 and 3.47 work RVUs to including individual providers, national
for a reference service, but rather were CPT code 63048. and State organizations, specialty
asked to compare the current work and For CPT code 61697 Surgery of societies, manufacturers, and
intensity with the work and intensity of complex intracranial aneurysm, Congressional and State legislators,
furnishing the procedure in 2000. intracranial approach; carotid wrote expressing concern about the
Therefore, the societies contend, the circulation; CPT code 61700 Surgery of proposed reduction in payments for this
misprint of the value for what was listed simple intracranial aneurysm, service, some of which is attributable to
as a ‘‘reference’’ code had no effect on intracranial approach; carotid the proposed work RVUs. These
the valuation of CPT code 22595, nor circulation; and CPT code 61702 commenters expressed concern that the
did the absence of a separate reference Surgery of simple intracranial proposed reduction in payment would
code for CPT code 63048 negatively aneurysm, intracranial approach; have a detrimental impact on
affect its valuation. According to the vertebrobasilar circulation), we received beneficiary health and is contrary to a
commenters, they believe that the the following comments. Surgeon General’s Report that
emphasized the importance of such intra-service time from the current time applauded the E/M proposals because
testing. and multiplied this difference in time ‘‘they correct the dramatic erosion of the
The ACR commented that, while they by the calculated IWPUT using the relative weight accorded to E/M services
participated in the survey process that specialty recommended total work over the past 14 years.’’
resulted in the RUC-recommended work RVUs. Adding these calculated work However, an umbrella specialty
RVU for this service, other specialties RVUs resulted in a work valuation of society for surgery raised several
that provide this service such as family slightly less than 2.00 work RVUs, objections to our proposal. First, the
medicine, internal medicine and which is approximately the same value commenter contended that the
rheumatology were not represented. as the survey median work RVU. In compelling evidence standard was not
ACR encouraged us to consider accordance with this analysis and the met because any false assumptions
comments from other specialty societies survey median, we proposed a work involved in the original valuation of the
and organizations furnishing this RVU of 2.00. codes were corrected in the first 5-Year
service, including those that do not Comment: The RUC believes, and Review and because any increase in
participate in the RUC process (such as specialty societies for neurology agree, work for E/M services has been
the International Society for Clinical that the RUC’s justification to increase compensated by the billing of higher-
Densitometry (ISCD)), so that their the work of CPT code 95872 to 3.00 level office visits. Second, the
views may be considered. ACR work RVUs is reasonable and outweighs commenter expressed concern that the
indicated that it would like to our proposed valuation of 2.00 work proposal will lead to rank order
participate should it be determined that RVUs, which is solely based on IWPUT. anomalies because of the
this will be addressed through a Commenters provided additional disproportionate distribution of values
refinement panel. Other commenters, information concerning the activities within the E/M family and suggested
including specialty organizations and associated with this procedure and that we spread out the increases more
the ISCD, provided additional requested acceptance of the RUC- proportionately by increasing the values
information regarding this service. recommended work RVUs. of lower E/M codes and decreasing the
Many of the commenters also expressed Response: Based on the comments proposed increases to CPT codes 99213
concern about the payment for CPT received, we referred this code to a and 99214. These concerns were also
code 76077, although this code was not multi-specialty refinement panel for echoed in the comments from the
included in the 5-Year Review of work. review. specialty societies representing colon
Changes in payment for this code are Final Decision: As a result of our and rectal surgery, vascular surgery,
attributed to the changes in PE analysis of the refinement panel ratings, orthopaedic surgery, hand surgery,
methodology discussed in section II.A. we have assigned 2.88 work RVUs to prosthetic urology and from other
of this final rule with comment period. CPT code 95872. commenters.
Response: We proposed to accept the 5. Evaluation and Management (E/M) The specialty society representing
RUC-recommended work RVU of 0.20 Services otolaryngology submitted a similar
for CPT code 76075, which was lower comment that also stated that the
than the requested 0.30 work RVUs Comment: There was strong support proposed increases are excessive and
requested by the specialty. Therefore, for the proposal to increase work RVUs unsupported by a careful analysis of the
based on the comments received, we for E/M services from many data, including an analysis of the
referred this code to a multi-specialty commenters, including specialty IWPUT. In addition, the commenter
refinement panel for review. societies, the RUC, MedPAC and stated that the IWPUTs that result from
Final Decision: As a result of our individual physicians. For example, our proposal are illogical within
analysis of the refinement panel ratings, specialty societies or organizations families of codes and exceed the levels
we have assigned 0.20 work RVUs to representing internal medicine, family of many complex surgical procedures.
76075. (Note: For 2007, CPT code 76075 physicians, thoracic medicine, The society recommended that we
has been renumbered to 77080.) rheumatology, endocrinology, either maintain the 2006 work RVUs or
For CPT code 95872, Needle neurology, HIV medicine, clinical transition the new work RVUs over
electromyography using single fiber oncology, group practice, infectious several years.
electrode, with quantitative disease, critical care, physical medicine, The society representing social
measurement of jitter, blocking and/or emergency medicine, geriatrics, geriatric workers, as well as individual social
fiber density, any/all sites of each psychiatry, osteopathy, urology, workers and other NPPs, commented
muscle studied, the RUC agreed that gastroenterology, pediatrics, renal that clinical social workers and other
there was compelling evidence that CPT medicine, as well as the RUC, all NPPs are unable to use the E/M codes
code 95872 was undervalued and expressed their appreciation for our and requested that we withdraw the
recommended increasing the existing acceptance of the RUC proposed increase for E/M services until
work RVUs from 1.50 to 3.00 work recommendations for E/M services. The all Medicare providers can receive fair
RVUs. American College of Physicians stated and adequate increases. The society
that our proposed E/M work RVUs are representing psychologists
CMS Proposed Valuation supported by data from the annual recommended that we reduce the
We had concerns that the work National Ambulatory Medical Care increase for E/M services because it is
recommendation for 95872, which was Survey which show that patients now inequitable to reward some at the
based on the survey’s 75th percentile for have more chronic conditions, are older, expense of others or that they be
work, is inappropriate for this service. and have more diagnoses per encounter. permitted to bill for E/M services.
To determine our proposed valuation In addition, the commenter contended Response: We appreciate the strong
for CPT code 95872, we utilized a multi- that the proposed increased values for support shown for our proposed work
tiered approach. First, we calculated the E/M services would provide an RVUs for E/M services and are
pre-service and post-service work RVUs incentive for appropriate E/M service appreciative of the thoughtful concerns
using the surveyed physician time data. utilization and would also ensure a raised by other commenters. We
Then, to determine an intra-service sufficient supply of primary care certainly understand how contentious
work RVU, we subtracted the surveyed physicians. Another commenter this issue has been, particularly in light
of the large BN adjustment that our suggested by some commenters. The services. Though the surveys will be
acceptance of the RUC work RVUs for E/M services were conducted after the RVUs for E/M
recommendations for these services accepted by a RUC consensus and we services are published, the commenter
would require. The concerns believe them to be reasonable. We have requested that we review the
surrounding the valuation of E/M never before transitioned changes in recommendations and update the
services were discussed during at least work RVUs that we accept based on nursing facility E/M RVUs to become
three RUC meetings before consensus RUC recommendations, and we believe effective in January 2008.
was finally reached. We believe the final it would be unfair in this case to single Response: The commenter is correct.
RUC recommendations represented out these increases for transition when The RUC recommended delaying the
acceptable relative values for the E/M other services that received even greater survey of these services pending RUC
services in question. After reviewing the increases would benefit immediately. recommendations on E/M codes that
comments, we believe that the RUC We did not propose to make any could be used as reference services. If
recommendations for the E/M services changes in our policy regarding the we receive the RUC’s recommendations
should be implemented in full types of suppliers that can bill for E/M in time, we will review the
beginning January 1, 2007. services, and are not making any recommendations for the work RVUs for
With regard to the question of changes at this time. Our Internet Only nursing facility E/M services and
compelling evidence of the need for a Manual 100–02 Chapter 15 Section 160 publish our proposals in next year’s
change to the work RVUs, we believe continues to state that ‘‘any therapeutic proposed rule and will consider this
that the rationale for revision of these services that are billed by clinical part of the third 5-Year Review.
RVUs did not rest solely on previous psychologists (CPs) under CPT Comment: The specialty society
false assumptions, but also on the claim psychotherapy codes that include representing home care physicians
that there has been a change in the medical evaluation and management stated that the home care visit and
complexity of the patient population services are not covered.’’ domiciliary care visit codes were not
resulting in more diagnoses per Comment: Several commenters included in the 5-Year Review; the
encounter and more ambitious representing renal physicians and domiciliary codes so that they could be
management goals. In reviewing the patients, as well as the RUC, requested valued through the RUC and, the home
RUC’s recommendations for the 5-Year that we make an adjustment for the visits so that they could be used as
Review, we found the evidence in ESRD-related services, which have been reference codes. The society
support of a change in the work for E/ valued using the E/M codes as building recommended that we adjust the work
M services as compelling as the blocks, by adding the increase in the RVUs for these codes to reflect the
evidence presented for most of the E/M RVUs to these services. revalued comparable office E/M codes
codes that we proposed to revise in this Response: Since the G-codes now for new and established patients. The
5-Year Review. As to the comments used for these ESRD-related services commenter contended that the home
regarding the IWPUTs of the E/M have markedly different descriptors visit and domiciliary care codes have
services, we are not yet convinced about than the previously valued CPT codes, been ‘‘referenced’’ to the office visit
the validity of the IWPUT analysis when we are unable to determine at this time codes in the past and the changes
applied to such ‘‘cognitive’’ services, which levels of E/M visits are most proposed through the 5-Year Review
particularly if such an analysis were to appropriately associated with these G- process should be reflected in these
be used to negate the findings of codes. As explained in the CY 2004 PFS derivative code families.
acceptable surveys. In addition, even if final rule (68 FR 63218), we established Response: It is unfortunate that these
there might be merit to the contention RVUs for these G-codes to equal the services were not included in the recent
that the RUC recommendations will aggregate payments for the services 5-Year Review and that the specialty did
cause some rank order anomalies, we do provided under the CPT codes that had not propose them for review. We believe
not have the information that would be been previously recognized for these that it would be inappropriate to apply
needed to rectify this; this is an issue services. Because we based our payment increases to these codes without a
that might be better handled by the RUC of the G-codes on the aggregate multi-specialty review of the work
and the specialties involved. payments for CPT codes 90918–90921, involved in these services. However, we
Though we are sympathetic to the the specific CPT codes that are building- would be willing to consider any RUC
concerns of those who would not blocks of this payment system cannot be recommendations that might be
benefit from an increase to E/M services, directly correlated. We suggest that the forthcoming for revised work RVUs for
but would face potential reductions in specialty could request that the CPT the home visit and domiciliary care
payment as a result of the BN panel consider revising the CPT codes codes. Such a RUC review could be
adjustment, we do not believe that the for these ESRD-related services to mirror completed at the same time that the
appropriate answer would be to deprive our current G-codes; these could then be RUC is reviewing the nursing facility
primary care physicians, and other reviewed by the RUC to determine the E/M services previously discussed in
practitioners who provide these level of E/M services that are typically this section. As we indicated for the
services, of an increase that the associated with each code. nursing facility E/M codes in the prior
commenters otherwise appeared to Comment: An organization response, we would consider
consider reasonable and commenters representing long term care providers forthcoming RUC recommendations for
did not suggest other viable alternatives. commented that we stated incorrectly at the home care and domiciliary care E/
We would be happy to work with any the end of the discussion concerning the M codes as part of the third 5-Year
group or individual that believes they RUC recommendations for the E/M Review because of the similarity to the
have been unfairly impacted by this services that nursing facility codes are other E/M services considered in this
change to determine if there is any other not part of the 5-Year Review process. review.
appropriate other measure that might The commenter clarified that the RUC We continue to believe acceptance of
address their concerns. requested that these codes not be the RUC recommendations for E/M
We also do not believe that it would surveyed until after the 5-Year Review, services is appropriate and will
be either equitable or appropriate to when there could be appropriately implement the proposed work RVUs for
transition the E/M increases, as valued codes to use as reference E/M services beginning January 1, 2007.
6. Cardiothoracic Surgery provided specifically addressing the use total) and graft insertion, with or
We received a number of comments of the mean values for the intra-service without patch graft; for aneurysm,
concerning the cardiothoracic surgery time and methodology used to estimate pseudoaneurysm, and associated
proposals. IWPUT, we will accept the RUC- occlusive disease, abdominal aorta
Comment: Commenters were recommended work RVUs for these involving iliac vessels (common,
supportive of the proposed valuation of services. hypogastric, external); CPT code 35556
We note that it is our responsibility to Bypass graft, with vein; femoral-
the congenital cardiac surgery services
assure all medical specialties that we popliteal; CPT code 35566 Bypass graft,
and CPT code 32020, Tube
will review and evaluate their services with vein; femoral-anterior tibial,
thoracostomy with or without water seal
using an approach that is accepted by posterior tibial; CPT code 35583 In-situ
(e.g., for abscess, hemothorax,
the RUC and CMS. We will continue to vein bypass; femoral-popliteal; and CPT
empyema) (separate procedure) .
work with the RUC to better determine code 35585, In-situ vein bypass;
However, commenters did not agree
how to use the alternative data sources femoral-anterior tibial, posterior tibial,
with the proposed work RVUs for the
such as the STS data to compare the or peroneal artery, the RUC reviewed
general thoracic and adult cardiac
relativity of services. Unless an both the survey data and the NSQIP data
surgery codes. One commenter
alternative approach can be found that for these services.
questioned why the work RVUs had not can be applied to all services, we would For these codes, the RUC believed
been maintained at the current levels. not want to see the RUC abandon its that physicians responding to the survey
Commenters representing surgical survey methodology. We understand underestimated the intra-service time
specialties, including thoracic and that the standard RUC survey process is and that the NSQIP data more
cardiac surgery, questioned the not flawless, but it does provide an even accurately reflected the actual intra-
methodology we used to arrive at the playing field for all specialties and we service times for these procedures. For
proposed work RVUs. They believe the would be concerned if each specialty CPT code 33877, the RUC accepted a
proposed work values create rank order was allowed to develop its own unique work value greater than the survey’s
anomalies and disturb the relativity method for estimating work RVUs. 75th percentile that was derived from a
within the cardiothoracic family. Therefore, we will work with the RUC building block approach using the
Additionally, the commenters stated and continue to review this issue to NSQIP data for the service. For CPT
that we failed to include pre- and post- determine the appropriate use of data codes 34201, 35102, 35556, 35566, and
service work in the add-on codes, sources other than the RUC survey. 35585, the RUC used the same
contrary to a policy stated in the CY Comment: The STS and the American methodology and accepted work values
2002 physician fee schedule final rule Association for Thoracic Surgery greater than the survey’s median
(67 FR 79966). The commenters (AATS) requested that we approve the percentile. However, for CPT codes
provided additional detailed RUC-recommended work RVUs of 49.41 35081 and 35583, the recommended
information concerning the STS for CPT code 33548, indicating that this increase was no greater than the
database, as well as their use of mean was submitted as part of the 5-Year surveyed median work RVUs.
values for the intra-service time and the Review process since the valuation of The RUC-recommended work RVUs
intensity survey methods used to this service was based on a reference for these services were: 33877 = 64.04
estimate IWPUT. code (CPT code 33542) that was in the work RVUs; 34201 = 18.31 work RVUs;
Response: As we discussed in the refinement process. The commenter also 35081 = 31.00 work RVUs; 35102 =
June 29, 2006 proposed notice, the stated that this was part of the RUC 36.28 work RVUs; 35556 = 27.25 work
general thoracic and adult cardiac recommendations forwarded in RVUs; 35566 = 32.00 work RVUs; 35583
surgery codes submitted to the RUC for September 2005. = 26.00 work RVUs; and 35585 = 32.00
review did not undergo the standard Response: We did not receive CPT work RVUs.
RUC survey methodology (71 FR 37218). code 33548 as part of the 5-Year Review
Rather, the data pertaining to these CMS Proposed Valuation
process, and therefore, we will maintain
codes were derived from the STS the current value for this service. We agreed with the RUC-
database, a voluntary registry developed recommended work RVUs for CPT
by the STS that has reportedly captured 7. General, Colorectal and Vascular codes 35081 and 35583. We disagreed
data on approximately 70 percent of all Surgery with the RUC recommendations for CPT
cardiac surgical procedures in the For the following services, we codes 33877, 34201, 35102, 35556,
United States. received comments that disagreed with 35566, and 35585. For these services,
We believe the STS database our proposed work RVUs. the RUC used the NSQIP time data to
represents a significant advance in the increase the work values above the
effort to improve the quality of patient a. Vascular Surgery survey median, and for several codes
care and we hope that this kind of data For CPT code 33877, Repair of above the 75th percentile. We rejected
collection will be emulated by other thoracoabdominal aortic aneurysm with this use of the NSQIP data and proposed
specialties. We also believe that the time graft, with or without cardiopulmonary to use the survey median work RVUs for
and visit data contained in this database bypass; CPT code 34201, Embolectomy these CPT codes: 33877 = 53.00 work
could be a useful adjunct to the RUC’s or thrombectomy, with or without RVUs; 34201 = 17.00 work RVUs; 35102
validation of the standard RUC survey catheter; femoropopliteal, aortoiliac = 34.00 work RVUs; 35556 = 25.00 work
results. artery, by leg incision; CPT code 35081, RVUs; 35566 = 30.00 work RVUs; and
We appreciate the detailed Direct repair of aneurysm, 35585 = 30.00 work RVUs. All of these
information provided by the pseudoaneurysm, or excision (partial or proposed work RVUs are higher than
commenters in response to the concerns total) and graft insertion, with or the current values.
we had outlined in the June 29, 2006 without patch graft; for aneurysm, Comment: We received comments
proposed notice. Based upon a review of pseudoaneurysm, and associated from the American College of Surgeons
the specific information provided by the occlusive disease, abdominal aorta; CPT (ACS) and Society for Vascular Surgery
commenters concerning the STS code 35102 Direct repair of aneurysm, (SVS) concerning these CPT codes. The
database, as well as the information pseudoaneurysm, or excision (partial or ACS and the SVS, as well as the RUC,
stated that our proposed work RVUs comparison to other selected IWPUT to the difference in intra-time
would undervalue several of the procedures. The commenters also between the survey and NSQIP is
vascular surgery procedures. Both the provided an additional discussion questionable for the following reasons.
ACS and the RUC maintained that we asserting that the number of hospital It is still not clear whether the NSQIP
should accept the RUC visits assigned by the RUC, and data is truly representative and the
recommendations for all these services. accepted by us, was underestimated for IWPUT applied to the additional time is
For CPT code 33877, the commenters these services (with the exception of higher than the IWPUT for the rest of
contended that the proposed value CPT code 33877.) the intra-time. In addition, this
would create a rank order anomaly with Response: We appreciate the methodology assumes, without
the partial esophagectomy service, CPT comments that were submitted on our evidence, that there is a linear
code 43118, for which we proposed proposed work RVUs for these vascular relationship between the survey
61.08 work RVUs, even though it is a surgery services. However, we note that respondents’ estimate of time and
less intense procedure. The ACS also there is disagreement among the estimate of work RVUs; however, even
maintained that, under our proposal, the commenters, with ACS and the RUC if the survey time estimates had
IWPUT of this service would be too low. requesting that we accept the RUC matched the NSQIP data, it is not clear
For CPT code 34201, the commenters recommendations for these codes and whether or by how much the
disagreed with our proposal to reject the the SVS requesting acceptance of yet respondents would have increased their
NSQIP-derived increase with one noting higher values for all the services (with work value estimate. Finally, until we
that we accepted the NSQIP-derived the exception of CPT code 33877.) In have available valid and representative
reduction in length of stay for CPT code addition, we have concerns that the data such as the NSQIP for all
34201. The RUC commented that the SVS-recommended IWPUTs, for all but procedures, there is the risk that
presenting specialty assumed NSQIP CPT code 33877, might be overstated. applying the data randomly could
time to be more accurate than RUC Therefore, based on the comments, we distort the relativity between services.
survey time and used NSQIP time when are accepting the RUC-recommended Therefore, we proposed to use the
available, whether it increased or work RVUs of 64.04 for CPT code median survey values of 18.00, 20.00
reduced the RUC survey times. 33877, but referred the other seven and 14.00 as the work RVUs for CPT
For CPT code 35102, the commenters codes to a multi-specialty refinement codes 44120, 44130 and 47600,
asserted that we proposed work RVUs panel for review. respectively.
that would decrease the IWPUT to Final Decision: As a result of our Comment: We received comments
0.075, which is inconsistent with other analysis of the refinement panel ratings, from the ACS and the American Society
similar surgical procedures. Therefore, we have assigned 17.94 work RVUs to of Colon and Rectal Surgeons (ASCRS),
they urged us to accept the RUC CPT code 34201, 31.00 work RVUs to as well as the RUC, urging us to accept
recommendation of 36.28 work RVUs CPT code 35081, 34.00 work RVUs to the RUC recommendations for these 3
for this service. CPT code 35102, 25.00 work RVUs to services. These commenters stated that
For CPT codes 35556, 35566, 35583 CPT code 35556, 30.00 work RVUs to the median work value that we
and 35585, the commenters maintained CPT code 35566, 26.00 work RVUs to proposed in the June 29, 2006 proposed
that the NSQIP data demonstrated that CPT code 35583, and 30.00 work RVUs notice for CPT code 44120 was
survey respondents consistently to CPT code 35585. incorrect; CPT code 44120 should be
underestimated their intra-service time. 19.00 work RVUs, not 18.00 work RVUs
The ACS commented that our proposals b. Colorectal Surgery (71 FR 37228).
would lead to low IWPUTs that are For CPT code 44120, Enterectomy, The ACS presented a lengthy defense
considerably less than similar surgical resection of small intestine; single of the NSQIP data that was echoed in
procedures. The RUC commented that resection and anastomosis; CPT code the ASCRS comments. For example,
we would be creating rank order 44130, Enteroenterostomy, anastomosis ACS contended that the NSQIP data on
anomalies between these codes and the of intestine, with or without cutaneous intra-service skin-to-skin time is verified
total colectomy services, CPT codes enterostomy (separate procedure); and through operating room logs and is the
44150 and 44151. CPT code 47600, Cholecystectomy, the ‘‘absolute gold standard’’ for estimating
The SVS also disagreed with our RUC believed the physicians responding surgeon intra-service time. The
proposed work RVUs for seven of its to the survey underestimated their intra- commenters also disagreed that this data
specialty’s services, and disagreed with service time. Therefore, the RUC cannot be used until it is available for
the RUC recommendations for all but applied what was believed to be an all services, since the best data should
one of the codes. In the extensive and appropriate IWPUT to the additional always be used rather than relying on
detailed comments we received, the NSQIP time and added the resulting ‘‘the lowest common denominator.’’ The
society defended the use of the NSQIP work RVUs to the survey median. The ACS further stated that a variety of
data to deviate from the survey median, RUC-recommended work values for different methodologies have been used
stating that NSQIP intra-service time these CPT codes were as follows: 44120 to evaluate physician services and we
and hospital length of stay were used = 20.11 work RVUs; 44130 = 20.87 work have not, until now, required that one
even when it reduced the RVUs; and 47600 = 15.88 work RVUs. methodology be used for all codes.
recommendation compared to the RUC Finally, the ACS disputed our concerns
survey. CMS Proposed Valuation that the NSQIP might not be
The commenter also offered We had concerns with the RUC representative, though it did agree that
additional rationale to support their recommendation to use the NSQIP data the number of Veterans Administration
requested work RVUs for CPT codes to increase the work RVUs, for CPT hospitals currently reporting is greater
33877, 35101, 35081, 35556, 35566, codes 44120, 44130 and 47600, above than the number of community and
35583 and 35585. In each case, the SVS the survey median, and, for 47600, academic hospitals.
presented the building block above the 75th percentile. While we For CPT codes 44120 and 44130,
components for each service, a support the use of such a database as ASCRS and ACS, as well as the RUC,
comparison with other vascular codes validation for survey results, we believe contended that two reference codes
by IWPUT analysis, and a detailed that the application of the NSQIP were considered by the workgroup that
led the RUC to agree that the survey median. The ACP questioned the proposed notice and summarized in this
median work RVUs underestimated the representative nature of the data in the section of this final rule with comment
total work of these procedures and database and stated that allowing work period have been thoroughly discussed.
would create rank order anomalies. values to be adjusted from the survey Therefore, based on the comments
For CPT code 47600, the ACS median, based on dubious relationships received, we referred this code to a
maintained that the RUC’s between work and time, would hurt the multi-specialty refinement panel for
recommendation was based on a belief integrity of the RBRVS and should not review.
that the survey’s median work RVU be allowed.
underestimated the total work for this Response: We appreciate the Final Decision: As a result of our
procedure because the survey comments regarding the use of NSQIP analysis of the refinement panel ratings,
respondents were not considering the data in the valuation of physician work. we have assigned 18.00 work RVUs to
correct patient demographics. The However, we would consider this the CPT code 44120, 20.00 work RVUs to
commenters stated that, if we did not beginning of the discussion, not the end. CPT code 44130, and 15.85 work RVUs
accept the recommendations where the There are still many issues that need to to CPT code 47600.
use of NSQIP resulted in a value greater be fully explored (for example: what the For the proctoscopy-anoscopy family
than the survey median, we should also criteria should be for the acceptance of of codes in Table 13, the RUC agreed
do the same for those recommendations a given database; whether databases can that the surveyed median work RVUs,
that were lower than the median. The take the place of surveys; whether and often even the 25th percentile, were
commenters emphasized that the RUC IWPUT should be used to create work
inconsistent with the reference code.
also used a comparison with a reference RVUs, rather than to validate them; and,
Therefore, the RUC did not reference the
code to develop the recommendation for whether there is a linear relationship
this procedure. between survey respondents’ estimate of surveyed RVUs in arriving at the
Conversely, the American College of work and time.) recommendations. Rather, the RUC used
Physicians (ACP) expressed support for In the case of these three services, the surveyed times for each service and
our decision to reject the RUC CPT codes 44120, 44130 and 47600, applied what the workgroup considered
recommendations that were based on although the commenters offered some an appropriate IWPUT to these times to
extraction of time information from the valid points regarding the use of NSQIP, arrive at the recommended work RVUs
NSQIP database rather than the survey not all the concerns discussed in the for this family.
TABLE 13.—PROCTOSCOPY-ANOSCOPY FAMILY OF CODES

CPT Code Descriptor
45300 ................................... Proctosigmoidoscopy, rigid; diagnostic, with or without collection of specimen(s) by brushing or washing (separate
procedure).
45303 ................................... Proctosigmoidoscopy, rigid; with dilation (e.g., balloon, guide wire, bougie).
45305 ................................... Proctosigmoidoscopy, rigid; with biopsy, single or multiple.
45307 ................................... Proctosigmoidoscopy, rigid; with removal of foreign body.
45308 ................................... Proctosigmoidoscopy, rigid; with removal of single tumor, polyp, or other lesion by hot biopsy forceps or bipolar
cautery.
45309 ................................... Proctosigmoidoscopy, rigid; with removal of single tumor, polyp, or other lesion by snare technique.
45315 ................................... Proctosigmoidoscopy, rigid; with removal of multiple tumors, polyps, or other lesions by hot biopsy forceps, bipo-
lar cautery or snare technique.
45317 ................................... Proctosigmoidoscopy, rigid; with control of bleeding (e.g., injection, bipolar cautery, unipolar cautery, laser, heater
probe, stapler, plasma coagulator).
45320 ................................... Proctosigmoidoscopy, rigid; with ablation of tumor(s), polyp(s), or other lesion(s) not amenable to removal by hot
biopsy forceps, bipolar cautery or snare technique (e.g., laser).
45321 ................................... Proctosigmoidoscopy, rigid; with decompression of volvulus.
45327 ................................... Proctosigmoidoscopy, rigid; with transendoscopic stent placement (includes predilation).
46600 ................................... Anoscopy; diagnostic, with or without collection of specimen(s) by brushing or washing (separate procedure).
46604 ................................... Anoscopy; with dilation (e.g., balloon, guide wire, bougie).
46606 ................................... Anoscopy; with biopsy, single or multiple.
46608 ................................... Anoscopy; with removal of foreign body.
46610 ................................... Anoscopy; with removal of single tumor, polyp, or other lesion by hot biopsy forceps or bipolar cautery.
46611 ................................... Anoscopy; with removal of single tumor, polyp, or other lesion by snare technique.
46612 ................................... Anoscopy; with removal of multiple tumors, polyps, or other lesions by hot biopsy forceps, bipolar cautery or
snare technique.
46614 ................................... Anoscopy; with control of bleeding (e.g., injection, bipolar cautery, unipolar cautery, laser, heater probe, stapler,
plasma coagulator).
46615 ................................... Anoscopy; with ablation of tumor(s), polyp(s), or other lesion(s) not amenable to removal by hot biopsy forceps,
bipolar cautery or snare technique.
The specific RUC work RVU = 1.08 work RVUs; 45320 = 2.43 work RVUs; 46614 = 1.08 work RVUs; and
recommendations for these colon and RVUs; 45321 = 2.76 work RVUs; 45327 46615 = 1.18 work RVUs.
rectal surgery CPT codes were as = 3.63 work RVUs; 46600 = 0.49 work
follows: 45300 = 0.91 work RVUs; 45303 RVUs; 46604 = 1.08 work RVUs; 46606
= 2.22 work RVUs; 45305 = 2.01 work = 1.76 work RVUs; 46608 = 1.95 work We proposed not to accept the RUC
RVUs; 45307 = 2.22 work RVUs; 45308 RVUs; 46610 = 1.95 work RVUs; 46611 recommendations for all the presented
= 2.01 work RVUs; 45309 = 2.22 work = 1.08 work RVUs; 46612 = 2.14 work codes in the proctoscopy-anoscopy
RVUs; 45315 = 2.22 work RVUs; 45317 family. We proposed to maintain the
current work RVUs for CPT codes as this disparity could impact on work RVUs; and 31368 = 36.00 work
45300, 45303, 45305, 45307, 45308, medical decision-making. RVUs.
45309, 45315, 45317, 45320, 45321, Response: As part of the 5-year review For CPT code 41155, Glossectomy;
45327, 46600, 46604, 46606, 46608, process, the specialtysocieties were composite procedure with resection
46610, 46611, 46612, 46614 and 46615. asked to identify whether the RUC- floor of mouth, mandibular resection,
As we stated in the June 29, 2006 recommended changes in the work and radical neck dissection (Commando
proposed notice, we believe that the RVUS created anomalies within a family type), the specialty society presented
method used by the RUC to obtain work of codes. Any such potential anomalies survey data, noting that the current
values for these services was flawed (71 identified by the specialty societies work RVUs create a rank order anomaly.
FR 37229). The calculation of the were then reviewed at subsequent RUC The RUC agreed that increasing the
recommended work RVUs depended meetings. Unfortunately, this potential work RVUs would correct these rank
solely on applying a workgroup-derived anomaly was not identified or reviewed. order anomalies and that these increases
IWPUT to the surveyed physician time However, we will ask the RUC to review were justified by the survey results. The
from surveys that were considered this code (CPT code 19160) and will RUC-recommended 40.00 work RVUs
otherwise unusable. We also stated that consider this RUC recommendation as for CPT code 41155.
we do not believe that the use of part of the third 5-Year Review. For CPT code 42845, Radical
IWPUT, in the absence of other resection of tonsil, tonsillar pillars, and/
8. Otolaryngology and Ophthalmology
supporting data, has been previously or retromolar trigone; closure with other
accepted by the RUC. We believe the In addition to comments received in flap, the specialty society’s survey data
RUC has established rules that state that support of the proposed work RVUs for demonstrated that the code was
IWPUT cannot be the sole rationale for services reviewed by the RUC’s currently undervalued due to a previous
valuation and it appears that this workgroup 8, we received the following flawed methodology. The RUC believed
workgroup might not have adhered to comments. that the survey results reflected the
that standard. However, we stated that, For CPT code 31360, Laryngectomy; appropriate physician work and time
if the specialty society wishes to total, without radical neck dissection; necessary in performing this procedure
resurvey these codes and the RUC CPT code 31365, Laryngectomy; total, and recommended the 32.00 work RVUs
submits work RVU recommendations to with radical neck dissection; CPT code for CPT code 42845.
us, we would certainly be willing to 31390, Pharyngolaryngectomy, with
consider them. radical neck dissection; without
Comment: The ASCRS expressed their reconstruction; and CPT code 31395, For the laryngopharyngectomy
appreciation for the opportunity to Pharyngolaryngectomy, with radical procedures, including CPT codes 31360,
again present survey data to the RUC for neck dissection; with reconstruction, the 31365, 31367, 31368, 31390 and 31395,
these services and the ACS stated that specialty society presented survey data the number of hospital days decreased
it will be working with ASCRS to with the rationale that the current work by at least 2 days and the post-operative
facilitate this process. The RUC RVUs create rank order anomalies, and outpatient visits increased by 1 day.
commented that the specialty society that there also has been a change in the However, in one instance the number of
recommendations for these services patient population. The RUC agreed that outpatient visits decreased (CPT code
were presented at the October 2006 RUC increasing the work RVUs of these 31395). The median values for intra-
meeting. procedures by accepting the 75th service times were accepted by the RUC
Response: At the October 2006 RUC percentile of survey results corrected for these services, which is an
meeting, the Society presented the the specific rank order anomalies and indication that a lower value than the
original surveys with additional also accounted for the change in the 75th percentile for work also may be
rationales to support the requested work patient population. The RUC- appropriate. Therefore, we proposed
RVUs. After much discussion, the RUC recommended work RVUs for these CPT using median values for these services
decided that the original surveys were codes are as follows: 31360 = 28.00 resulting in the following work RVUs
still not usable and that new surveys work RVUs; 31365 = 37.00 work RVUs; for these CPT codes: 31360 = 24.00 work
would be needed before a 31390 = 40.00 work RVUs; and 31395 = RVUs; 31365 = 31.50 work RVUs; 31367
recommendation for revised work RVUs 44.00 work RVUs. = 24.00 work RVUs; 31368 = 30.50 work
could be made. Therefore, we are For CPT code 31367, Laryngectomy; RVUs; 31390 = 35.00 work RVUs; and
maintaining the current work RVUs for subtotal supraglottic, without radical 31395 = 39.50 work RVUs.
this series of codes, as proposed. neck dissection and CPT code 31368, CPT code 41155 was valued by the
Laryngectomy; subtotal supraglottic, RUC at the 75th percentile for work, but
Other Issues CPT code 41150 was valued based on
with radical neck dissection, the
Comment: A few commenters, while specialty society presented survey data the median work value. The median
agreeing with the increase in work with the rationale that the current work values for intra-service times were
RVUs for CPT code 19180 (total values are based on a flawed accepted by the RUC for these services,
mastectomy), expressed concern that the methodology that creates rank order which is an indication that a value other
work RVUs for CPT code 19160 (partial anomalies, and that there also has been than the 75th percentile for work also
mastectomy) were not reviewed. These a change in patient population. The may be appropriate. Therefore, we
commenters believed that the work RUC agreed with the specialty society proposed 36.00 work RVUs of for CPT
RVUs for CPT code 19160 should be and recommended increasing the work code 41155.
addressed in a similar fashion and the RVUs for these services to maintain rank CPT code 42845 was valued by the
work RVUs should be adjusted to avoid order between the codes in the family RUC at the 75th percentile for work
a potentially adverse impact on patient and to establish the correct intensity of rather than the median as the RUC
treatment for breast cancer. One of these the procedure based on the change in recommended for the other procedures
commenters suggested that this patient population. The RUC- in this family (CPT codes 42842 and
disparity in work RVUs needed to be recommended work RVUs for these CPT 42844). Therefore, we proposed 29.00
addressed before the next 5-year review, codes are as follows: 31367 = 27.36 work RVUs for CPT code 42845.
Comment: The RUC and several lowered during the first 5-Year Review Response: We appreciate these
specialty societies, including the to facilitate the linkage process. comments and will consider the
American Head and Neck Society Response: We acknowledge that suggestions made by the commenters.
(AHNS) and the American Academy of currently the work RVUs for 9. HCPAC codes
Otolaryngology-Head and Neck Surgery ophthalmology examination services are
(AAO–HNS), disagree with the linked to the work RVUs for certain E/ In addition to comments received in
proposed work RVUs for CPT codes M codes. However, the work RVUs for support of the proposed work RVUs for
31360, 31365, 31367, 31368, 31390, the E/M codes are being increased based services reviewed by the HCPAC, we
31395, 41135, 42845. They provided on our acceptance of the rationale that received the following comments.
information, data, and rationales the work required to furnish these For CPT code 10060, Incision and
concerning the valuation of these services has itself changed. This drainage of abscess (e.g., carbuncle,
services and, recommended that we increase in work RVUs also implies that suppurative hidradenitis, cutaneous or
accept the RUC recommendations. The the E/M services today are not exactly subcutaneous abscess, cyst, furuncle, or
specialty societies objected to our the same services to which we initially paronychia); simple or single; CPT code
proposed RVUs on the grounds that they linked the eye examination services. 11040, Debridement; skin, partial
created rank order anomalies; they Unfortunately, because the specialty did thickness; CPT code 11041
believe the reference codes used were a not bring the ophthalmology Debridement; skin, full thickness; CPT
poor choice that resulted in an examination codes to the 5-Year review code 11042 Debridement; skin, and
underestimation of work by the survey for evaluation of any change in the work subcutaneous tissue; and CPT code
respondents; and they believe the codes of furnishing these services, it is not 29580 Strapping; Unna boot, the
had been undervalued for years. known to what extent, if at all, the work HCPAC agreed with the specialty
Response: Based on the comments for the ophthalmology examination society that there was compelling
received, we referred these codes to a codes would have mirrored the change evidence that the valuation of these
multi-specialty refinement panel for in the work of the E/M codes. We note services was incorrect due to a flawed
review. Panel review is appropriate for that the E/M increases have been added methodology used in the previous
reasons including the RUC acceptance to other services only when the E/M Harvard valuation for the podiatric
of the median values for intra-service codes were clearly used as the building codes considered under the 5-Year
times, which is an indication that a blocks for valuing the services, for Review.
value other than the 75th percentile for example, for global surgical services For CPT codes 10060 and 29580, the
work may be appropriate, and the need HCPAC supported an increase in the
with post-operative visits. Therefore, we
for further discussion regarding the existing work values for these codes and
will implement the work RVUs for CPT
appropriateness of the reference codes recommended work RVUs of 1.50 for
codes 92002–92014 as proposed.
chosen by the survey respondents as CPT code 10060 and 0.60 work RVUs
However, if received in time for next
comparable services to the codes being for CPT code 29580, both of which
year’s proposed rule, we would be
valued. represent the median of the survey data
Final Decision: As a result of our willing to consider any RUC
recommendations for work RVUs for for these services.
analysis of the refinement panel ratings, For CPT code 11040, the HCPAC did
we have assigned 26.22 work RVUs to these services for implementation in FY
not support the work RVU increase
CPT code 31360, 35.00 work RVUs to 2008 and would consider this as part of
recommended by the specialty society,
CPT code 31365, 27.00 work RVUs to the third 5-Year Review.
but instead recommended 0.55 work
CPT code 31367, 30.50 work RVUs to Comment: For CPT code 69210 RVUs, which represented the 25th
CPT code 31368, 38.33 work RVUs to Removal impacted cerumen (separate percentile work RVU from the survey
CPT code 31390, 39.50 work RVUs to procedure), one or both ears, while we data.
CPT code 31395, 40.00 work RVUs to accepted the RUC-recommended work For CPT code 11041, the HCPAC
CPT code 41155, and 29.00 work RVUs RVUs for this service, in the June 29, recommended a decrease in the work
to CPT code 42845. 2006 proposed notice we had expressed RVUs and, based on the median from
concern about the valuation of this the survey data, recommended 0.80
Miscellaneous Issues service for the use of this code for work RVUs.
Comment: The American Academy of routine removal of ear wax and For CPT code 11042, the HCPAC did
Ophthalmology (AAO) stated its belief indicated we would monitor the use of not agree with the specialty society that
that the 5-Year Review process was fair this code for the appropriate the work RVUs should be increased to
in its consideration of the ophthalmic circumstances (71 FR 37233). The RUC 1.20 work RVUs. The HCPAC
codes. However, the AAO expressed and other specialty societies provided recommended maintaining the current
disappointment in the decrease in value additional information to address our work RVUs of 1.12 for this CPT code,
for cataract surgery (CPT code 66984) concern with this valuation for the use which was slightly higher than the
and its hope that this ‘‘downward of this code for routine removal of ear survey’s 25th percentile work value of
reimbursement reward’’ does not lead to wax during a physical examination of a 1.10 work RVUs.
a decrease in research and innovation in patient. One commenter believes that The HCPAC-recommended work
medical care. The AAO also expressed there is the potential for misuse of this values for these services were as
disappointment in our decision to code due to a lack of understanding by follows: 10060 = 1.50 work RVUs; 11040
unlink the long-standing relationship of other specialties of the physician work = 0.55 work RVUs; 11041 = 0.80 work
the Ophthalmology Examination codes included in this procedure. The RVUs; 11042 = 1.12 work RVUs; and
(92002–92014) to the E/M codes. The commenter recommends that we issue 29580 = 0.60 work RVUs.
AAO urged us to reaffirm this linkage clarifying instructions or an educational
and increase those values to reflect the article so that this code will be used in CMS Proposed Valuation
proposed increases in E/M services. If a manner consistent with the criteria For CPT code 10060, we compared
this is not possible, AAO suggested that outlined by AAO–HNS and contained in the survey times with the current
the work values prior to the linkage in the July 2005 issue of the AMA’s CPT Harvard-based times used to value this
1996 be restored since they were Assistant. service. These times are comparable
and, therefore, we proposed maintaining and the same work RVUs for 11042. understand the specialty’s concern that
the current work RVUs of 1.17 for this Based on their belief that there is the Harvard time data was flawed.
code. increased complexity and inherent risks However, we believe that the lower
For CPT codes 11040, 11041 and in treating the diabetic patient, the times presented from the survey do not
11042, the survey times all reflect APMA and the HCPAC in their warrant the recommended work RVUs.
significant reductions from current comments urged us to accept the Nonetheless, we believe that the HCPAC
Harvard-based times used to value these HCPAC-recommended work RVUs for and the APMA should have the
services. Based on this comparison, this family of codes at 0.55 work RVUs, opportunity to present their evidence
which shows decreases in time ranging 0.80 work RVUs and 1.2 work RVUs, relative to the work RVUs for these five
from 47 percent to 68 percent, we respectively. The commenters also codes to a multi-specialty panel for
believe that the low values from the strongly object to our reliance on a time- review. As such, we have referred CPT
surveys more accurately represent the based comparison from the RUC surveys codes 10060, 11040, 11041, 11042, and
valuation of these services. Therefore, and the Harvard data (which the HCPAC 29580 for refinement.
we proposed to assign work RVUs as and APMA agreed was based on a Final Decision: As a result of our
follows: 11040 = 0.48 work RVUs; 11041 flawed methodology) to derive the work analysis of the refinement panel ratings,
= 0.60 work RVUs; and 11042 = 0.80 RVUs for these debridement codes. we have assigned 1.17 work RVUs to
work RVUs. In addition, to ensure that For CPT code 11060, the APMA and CPT code 10060, 0.50 work RVUs to
the other codes in this family are the HCPAC requested that we accept the CPT code 11040, 0.60 work RVUs to
properly valued, we recommended the HCPAC recommendations for this 10- CPT code 11041, 0.80 work RVUs to
RUC review the valuation of CPT codes day global service based on the lack of CPT code 11042, and 0.55 work RVUs
11043 and 11044. intensity measures in our valuation that to CPT code 29580.
For CPT code 29580, we compared relied on a comparison of the RUC
the current Harvard-based times with surveyed time to the Harvard-based time Other Issues
the survey times. For this code, there which, as mentioned previously, had Other commenters representing
was a small reduction in survey time as been determined to be based on a nutritionists and dietitians referenced
compared to the current Harvard-based flawed methodology. The APMA the medical nutrition codes that were
time used to value this service, and, believes that by using this time-based referred to the CPT Editorial Panel,
therefore, we do not believe the comparison and maintaining the current indicating that these services should be
recommended increase in work RVUs is RVUs at 1.17 work RVUs, we are assigned work RVUs. This issue is
supported. We proposed to assign 0.55 proposing to distort the relativity of CPT discussed in section II.B.4.c. of this final
work RVUs to this service, which 10060 with other comparable services rule with comment period, as it was
represents the 25th percentile of the (for example, CPT codes 10140 and specifically addressed in the CY 2007
survey and more accurately reflects the 11421) and results in an unreasonably PFS proposed rule (71 FR 48982).
time associated with this service. low IWPUT, at 0.009. The HCPAC and
Comment: The American Podiatric the APMA urged us to accept the D. Other Issues Under the 5-Year
Medical Association (APMA) and the recommended work value at 1.5 work Review
HCPAC disagreed with the rationale we RVUs that represents an IWPUT of 1. Anesthesia Services
provided to explain our disagreement 0.031.
with the HCPAC-recommended work For CPT code 29580, the specialty Although anesthesia services are paid
RVUs for 5 CPT codes (11060, 11040, society indicated that the typical patient under the PFS, they are paid on the
11041, 11042, and 29580) that are requiring the application of an Unna basis of an anesthesia code-specific base
predominantly provided by the podiatry boot is a diabetic with lower extremity unit and time units that vary based on
specialty. The commenters noted that edema, often with the presence of an the anesthesia time of the case. Since
our proposed valuation of these services ulcer. The typical patient requires anesthesia services do not have a work
was based solely on a comparison of the repetitive applications of this Unna boot value per code as do other medical and
RUC-surveyed times to the Harvard- strapping, so most applications will also surgical services, a work value must be
based times, despite the HCPAC’s require the removal of the Unna boot, a imputed for each anesthesia code.
concurrence with the specialty that the thorough cleansing of the area, physical As a result of its relationship with the
current Harvard work values were examination, and a careful reapplication RUC and the past recommendations for
incorrect due to a flawed methodology. of the strapping material. The APMA valuing anesthesia services, which were
In addition, the commenters noted that believes that our valuation of 0.55 work discussed in detail in the June 29, 2006
our proposed valuation fails to address RVUs—using just the surveyed time, proposed notice (71 FR 37237), the
the intensity measures inherent to each without specifically addressing the American Society of Anesthesiologists
service. The specialty presented recent intensity measures inherent to the care (ASA) requested that we address the
literature abstracts to demonstrate that of the diabetic patient—undervalues valuation of anesthesia services reported
the treatment of diabetic ulcers has this service. The HCPAC and the APMA under CPT codes 00100 through 01999.
become more complicated in recent urged us to adopt the recommended The ASA furnished an analysis that
years and also supports that the diabetic value (survey median) of 0.60 work builds on the methodology used in the
ulcer is the primary cause of infections RVUs. last 5-Year Review for the valuation of
and, ultimately, leads to amputations in Response: We appreciate the work for anesthesia services. We
this population. The APMA and the comments and information forwarded recommended that the valuation of
HCPAC urged us to consider these by the HCPAC and the APMA. However, anesthesia services, namely the
inherent risks in treating this population based on our review of the data and proposed valuation of the post-
and to accept the HCPAC-recommended literature contained in their comments, induction time, be referred to the AMA
work RVUs. we are not convinced that the RUC for review and consideration.
For CPT codes 11040, 11041 and complexity and intensity measures Comment: The RUC indicated that it
11042, the HCPAC recommended an inherent to the treatment of the diabetic will consider any specific CMS request
increased work RVU for CPT 11040, a patient have changed significantly over and asked that we clarify the scope of
slight decrease in work RVUs for 11041, the past 5 years. In addition, we review and elements of the anesthesia
relativity that is supposed to be components of the anesthesia service than are included in the global period
addressed. Many commenters, including are not uniformly linked to the same E/ for their services. It is also likely that
individuals and a specialty group, M code. Rather, the E/M code can vary some patients require fewer than the
expressed concern that the proposed based on the complexity of the ‘‘typical’’ number of follow-up visits
reductions in payment for anesthesia anesthesia service. For example, for included in the global period.
services may lead to future manpower cataract anesthesia, the pre-anesthesia Although we are not proposing any
shortages and could affect the provision service is linked to a blend of CPT codes changes to our global policy at this time,
of surgical services. They asked us to 99201 and 99202 and the post- we solicited comments concerning our
work with the ASA and the RUC to anesthesia service is linked to CPT code current policy of including these post-
appropriately value the work of 99211. The work values for each of operative visits in the global surgical
anesthesia services. these E/M codes did not change in this packages and what advantages or
Response: We understand that the 5-Year Review of work. Conversely, for disadvantages might be associated with
ASA and the RUC will be reviewing this anesthesia for coronary bypass surgery, proposing a change to this policy in the
issue in an upcoming meeting and will the pre-anesthesia service is linked to future.
make a recommendation to CMS in CPT code 99232 and the post-anesthesia We received several comments
2007. service is linked to a blend of CPT codes concerning incorporating the new E/M
A second issue concerning anesthesia 99231 and 99232. The work value for values into all surgical services with a
services pertains to the impact of the each of these E/M services increased in 10- or 90-day global period. With
revised work values for E/M services this 5-Year Review of work. Thus, in the respect to our request for comments
and their relationship to the valuation of June 29, 2006 proposed notice, we concerning our current policy of
pre- and post-anesthesia services, proposed to increase the work for E/M including these post-operative visits in
components of the building-block services in anesthesia for coronary the global surgical packages, we also
approach. The pre- and post-anesthesia bypass surgery but made no adjustment received many suggestions. These
services derive their work values from in the work for cataract anesthesia (71 comments and suggestions are
the lower level E/M codes for new FR 37237). addressed in this section.
patients, the subsequent hospital care It is not clear how the pre- and post- Comment: Many commenters,
codes, and the initial inpatient anesthesia services of the non-surveyed including specialties representing
consultation codes. anesthesia codes would be tied to the 19
In the June 29, 2006 proposed notice, primary care physicians and surgeons,
surveyed codes and whether the work of
we proposed to increase the work of the as well as the RUC, supported the
the proposed linked E/M services are
pre- and post-anesthesia components of incorporation of the revised E/M work
increased. We will look at this issue in
the 19 anesthesia codes, previously RVUs into the surgical global periods for
context of any proposed changes that
reviewed by the AMA RUC in the last each CPT code with a global of 010 and
may be made to anesthesia work next
5-Year Review of work. Specifically, we 090 as recommended by the RUC.
year.
proposed to increase the anesthesia Commenters, including the RUC, noted
work to reflect the increased work 2. Discussion of Post-Operative Visits that we may have incorrectly
values for the E/M codes where there included in the Global Surgical implemented the RUC recommendation.
were increases in the work of those E/ Packages They indicated that in implementing
M codes. We have established a national this proposal, we used discounted work
Comment: One specialty group noted definition for a global surgical package RVUs, developed for pricing post
that we should refer the valuation of so that payment is made consistently for services under the first 5-Year Review,
pre- and post-anesthesia issues to the the same set of services across all rather than the undiscounted work
RUC for its review and consideration, contractor jurisdictions. In constructing RVUs that reflect the actual RVUs
and should not make any changes in the the RVUs for a global surgery service, all accepted by us for the E/M services.
value of pre- and post-anesthesia services that are believed to be typically This resulted in incorrect, and lower,
services at this time. The ASA requested included in the defined global period work RVUs being added to all of the
that we increase the work of all are built into the final resource-based services with post-operative visits in the
anesthesia services, not just the 19 RVUs and are not separately billable 010 and 090 global periods and was
anesthesia codes, to account for the within the defined global period as contrary to the RUC recommendation
increase in work values for E/M codes. reflected in the proposed work RVUs in that the full increase of the E/M be
They noted that all anesthesia services Addenda B and C. This includes pre- incorporated. The RUC requested that
have E/M services included in the pre- surgery work, the intra-service time of we review the calculations and
and post-anesthesia components and the actually furnishing the surgical implement the correct work RVUs for all
work of all anesthesia services should procedure, and the post-operative procedures that have a 010 and 090
be increased. (follow-up) visits associated with the global period to reflect their
Response: We disagree with the monitoring and recovery of the patient. recommendation. Other commenters
comment asking us to defer action on re- As stated above in this section, we stated that we should verify the
valuing the work of anesthesia services proposed to apply the RUC- accuracy of the data to ensure that the
to account for the increased work of recommended new values for the E/M values, as recommended by the RUC,
certain E/M codes. We are making the services to all surgical services with a are appropriately implemented.
adjustment, but will ask the RUC and 10-or 90-day global period. However, A few commenters also suggested
the ASA to review the E/M codes because of variations in the patient that, should changes be made to the
assigned to the pre- and post-anesthesia population and in practice patterns, valuation of the E/M services, these
periods to ensure that they are still there is some question whether the changes would need to be carried
clinically relevant. While we assumptions about the number and level through to the global package revisions.
understand the concerns of the ASA, we of visits within the global period reflect Response: We have discussed this
are unable to make that type of the actual post-operative work issue with the RUC and will ensure that
adjustment across all anesthesia furnished. Some surgeons have the correct undiscounted values are
services. The pre- and post-anesthesia commented that they furnish more visits incorporated.
Comment: MedPAC stated that in adjustments to preserve budget adjustor to the work RVUs, it caused
comparison to other payment systems, neutrality (BN). This year, we expected considerable confusion among many
the unit of payment under the PFS is that BN adjustments would be required non-Medicare payers, as well as
very narrow and consists of many as a result of changes in RVUs resulting physician practices that use the
discrete services. MedPAC reiterated its from the 5-Year Review. We considered Medicare relative values as efficiency
longstanding concern that such a unit of making the statutorily required BN measures, and that the constant
payment might give physicians a adjustments (under section fluctuations in the work RVUs due to
financial incentive to increase payments 1848(c)(2)(B)(ii)(II) of the Act) to BN adjustments impeded the process of
by increasing the volume of services, account for the 5-Year Review of establishing work RVUs for new and
which could lead to unnecessary physician work by reducing all work revised services.
services being provided. Therefore, in RVUs. We estimated that all work RVUs In addition to these objections,
the absence of information suggesting would have to have been reduced by 10 numerous specialty societies,
that access to appropriate care is being percent under this option. Alternatively, organizations, groups, and providers
compromised, MedPAC supports the we considered making an adjustment to also indicated that an adjustment to the
current concept of packaging/bundling the PFS CF to meet the provisions of CF is preferable because it would
these services to encourage efficient and section 1848(c)(2)(B)(ii)(II) of the Act. recognize that BN is mandated for
appropriate care. Several commenters This option would have required an monetary reasons. Thus, the CF, as the
representing surgical specialties agreed estimated 5 percent reduction to the CF. monetary multiplier in the Medicare
with this position, and additionally one We also noted that the application of the payment formula, is the most
commenter stated that such a change BN adjustments to the CF would appropriate place to adjust for BN.
might also increase the risk of ‘‘fee negatively impact all PFS services; A number of commenters, including
splitting.’’ The commenter also supports whereas the application of the BN representatives of some radiology and
the expansion of the global concept into adjustment to the work RVUs would oncology providers, were supportive of
disease management. impact only those services that have our proposal because it fairly applies
Other commenters suggested that we physician work RVUs. Because the need the required BN adjustment to the
drop the global surgical model and for BN adjustment would be largely due portion of the fee schedule that was the
replace this concept with a system that to changes proposed as a result of the subject of review.
measures the actual amount of post- 5-Year Review of work RVUs, we A few commenters also stated that
service work included in these global believed it was more equitable to apply although the BN adjustment
surgical services. Commenters suggested the adjustment across services that have methodology set forth in the June 29,
that this would ‘‘level’’ the playing field work RVUs. We proposed to establish a 2006 proposed notice is not ideal, they
for documentation requirements and be BN adjustor that would reduce all work believe that it is the best of the available
less detrimental to ‘‘centers for RVUs by an estimated 10 percent to alternatives under the circumstances (71
excellence’’ which usually provide more meet the BN provisions of section FR 37241). These commenters also
care than is currently included within 1848(c)(2)(B)(ii)(II) of the Act. believe that making all BN and scaling
the global period. Commenters also Comment: We received numerous adjustments on a fee-schedule-wide
suggested there are additional comments on this issue. Many of the basis would apparently result in
advantages to eliminating the global commenters were opposed to our unacceptable fee-schedule-wide
surgical model including the valuation proposal and requested that the reductions and is clearly inequitable for
of services being straightforward, the adjustment be made to the CF for the TC services. Another commenter urged
reduction of errors in PE valuation, and following reasons: us to delay the implementation of the
the facilitation of research, quality (1) Applying the BN adjustor to all BN adjustor for 1 year to allow more
improvement and utilization tracking. work RVUs has been problematic in the time to explore ways to increase
However, there would be an associated past. recognition of E/M services without
increase in the volume of claims to be (2) By imposing the full burden of BN imposing such a financial hardship on
processed. on the pool of work values, we would select physician and nonphysician
One commenter suggested that we be significantly mitigating the improved providers and to allow physicians and
meet with stakeholders prior to accuracy of the values that have now nonphysicians the opportunity to work
implementing such a change, while been assigned to E/M services. with us to suggest alternative
another commenter urged us to conduct (3) This approach obfuscates the approaches.
a study on impact of revising the global recommended changes of the RUC and Other commenters also discussed the
surgical concept. could potentially have an inappropriate interaction of the application of the BN
Response: We appreciate these effect on relativity. adjustment and the DRA OPD cap on
comments and suggestions and will (4) The application of a separate work imaging services. As required by the
consider these along with additional adjustor is not consistent with our goal DRA, reductions in imaging payments
information as we continue to study this of cost transparency and may adversely because of the OPD cap result in actual
issue. affect payments by non-Medicare savings to the Medicare program (that is,
payers. they are not done in a budget neutral
3. Budget Neutrality These commenters, which include the manner). The commenters note that if
As discussed in the June 29, 2006 AMA, the RUC, and the AMA-HCPAC, the BN is applied to the CF and not to
proposed notice, section asserted that applying the BN adjustor the work RVUs, then the impact of the
1848(c)(2)(B)(ii) of the Act requires that to the work RVUs is contrary to our DRA cap on total Medicare spending is
increases or decreases in RVUs for a longstanding policy. In addition, they lower. This is because applying BN to
year may not cause the amount of do not believe that we provided an the CF will narrow the payment
expenditures for the year to differ by adequate rationale for shifting to this differential between imaging services
more than $20 million from what new approach, which we have furnished in physicians’ offices and
expenditures would have been in the previously stated is neither appropriate, hospital OPDs, and thus reduce the
absence of these changes. If this nor effective. These associations noted effect of the DRA cap on payments for
threshold is exceeded, we must make that when in the past we applied a BN imaging services.
Response: We appreciate the payment for all services on the fee 5-Year Review, including the
information presented by the schedule. This would include methodology and data sources used in
commenters. We do not have the reductions to RVUs for a number of the review process. MedPAC stated that
authority to delay implementing the BN services that have no physician work it continues to have concerns that
adjustment and we must apply a BNF to and were, therefore, outside the scope of overvalued services are ignored and
offset the increases in work RVUs the 5-Year Review. We believe it would referenced the MedPAC March 2006
effective for 2007. be unfair, given the significant negative Report to Congress. In this report, it
We are very appreciative of the work update to the CF this year, to impose recommended the creation of a standing
the RUC and the specialty societies have additional reducations resulting from panel to—
done in the past several years to prepare the BN adjustment on codes that have
for this 5-Year Review. As a result of no work values associated with them. • Assist in identifying misvalued
their dedication and analysis, the work We share the commenters’ concerns services;
RVUs are now more accurate and about transparency and recognize the • Establish a process for analyzing
reflective of the time and resources Medicare PFS is used by other payors data to ensure automatic review of new
associated with them. We do not believe and for other purposes than just services after a certain period; and
that applying the BN on the work RVUs Medicare payments. To maintain a high
would undermine or diminish the RUC • Periodically review all services.
level of transparency in the fee
or specialty societies’ contributions or schedule, the Addendum B published in Several specialty societies expressed
the resulting improvements. this rule will show the RVUs without support for the existing RUC
Section 1848(c)(2)(B)(ii)(II) of the Act the BN adjustment applied. This will methodologies for estimating intensity,
requires a BN adjustment. Regardless of serve as a reference for any interested but also supported the use of objective
whether the BN is achieved by applying party and should help to minimize any data from large clinical databases and
an adjustment factor to the work RVUs, confusion about the unadjusted codes. urged us not to discount the use of
as we proposed in the proposed rule, or There also is a discussion of the BN alternative data sources.
the CF, which is the preferred option of work adjustor and the payment formula
many of the commenters, the values Response: As indicated earlier in this
for 2007 included in the section IX. of section, we believe that it will be
associated with the work ultimately will this final rule with comment period,
be decreased. Therefore, we do not agree necessary for the RUC and the specialty
‘‘Anesthesia and Physician Fee societies to join us in further dialog
with the commenters’ suggestions that Schedule Conversion Factors for 2007.’’
applying the BN to the work RVUs concerning the role of alternative
Payment for services will be calculated
would do the system a great harm. databases. There are still many
as follows:
Specifically, we disagree that it would questions that need to be fully explored
significantly reverse the improved Payment = [(RVU work × BN adjustor × including: what should the criteria be
accuracy of the values that have now GPCI work) + (RVU PE × GPCI PE) for the acceptance of a given database;
been assigned to E/M services. Further, + (RVU malpractice × GPCI
can databases take the place of surveys;
we do not think that this approach malpractice)] × CF.
can IWPUT be used to create work
would distort the relativity of the RVUs. We appreciate the commenters RVUs, rather than just to validate them;
Because such an adjustment is pointing out to us that the approach is there a linear relationship between
uniformly applied to all the work RVUs, used in applying BN has an interactive
survey respondents’ estimate of work
it does not alter the relationship among effect with the DRA imaging OPD cap
and time; and, can survey respondents
them. and has an effect on the total Medicare
accurately estimate IWPUTs. We are
We also note that this rule finalizes a spending on physicians’ services.
change in the PE methodology. Changes However, as previously described in also continuing to examine how best to
to the PE RVUs are being budget this section, we continue to believe the identify misvalued services. As part of
neutralized within those PE RVUs. most equitable way to adjust for changes this initiative, the RUC has indicated
Applying BN adjustments at this time, in the work RVUs resulting from the 5- that it has established a subcommittee to
within each set of RVUs, maintains Year Review is to apply a BN adjuster suggest approaches to identifying
equity and helps to ensure that the to work RVU. overvalued services and the RUC’s
weights between work, PE and Comment: Some commenters Research Subcommittee has initiated
malpractice are consistent with the suggested that applying the BN discussion regarding existing time data
weighting used in the MEI. adjustment to the CF could also be and indicated its willingness to consider
Therefore, for the reasons discussed applied to the PE BN application, but issues related to any other concerns that
above in this section, we will be only after we have addressed all of the we and the specialty societies wish to
applying the statutorily-required BN RUC’s recommendations related to the address regarding the use of databases
adjustment to the work RVUs as methodology and the PE relativity is in the valuation of physician work. We
proposed in the proposed rule. We note stable. Ultimately, however, PEs for look forward to working with these
that we previously applied a separate individual services should be evaluated groups and will carefully evaluate
adjustor to the work RVUs following the under a 5-Year Review, at which point suggestions and recommendations that
first 5-Year Review of physician work in a similar application for BN to the CF are provided.
1997. We understand that many could be appropriate.
commenters would find it preferable for Response: We appreciate and will V. Refinement of Relative Value Units
us to make the required BN adjustment consider these suggestions as we for Calendar Year 2007 and Response
to the CF. However, we believe the best proceed with the implementation of the to Public Comments on Interim Relative
and most equitable approach to revised PE methodology. Value Units for 2006
applying BN for this 5-Year Review of

work is to adjust the work RVUs for 4. Review Process [If you choose to comment on issues in
2007 using a separate adjustor for those Comment: MedPAC and several this section, please include the caption
RVUs. Achieving BN by adjusting the specialties, as well as the RUC, ‘‘Interim Relative Value Units’’ at the
CF would have the effect of reducing commented on the process used for the beginning of your comments.]
A. Summary of Issues Discussed Related were reviewed by the panel, which are interim RVUs had to be apparent to the
to the Adjustment of Relative Value contained in Table 14, 2006 Interim broad range of physicians participating
Units Work Relative Value Units for Codes in each panel.
Section V.B. and V.C. of this final rule Reviewed Under the Refinement Panel Ratings of work were analyzed for
with comment describes the Process. We invited representatives consistency among the groups
methodology used to review the from the organizations from which we represented on each panel. In general
comments received on the RVUs for received substantive comments to terms, we used statistical tests to
physician work and the process used to attend a panel for discussion of the code determine whether there was enough
establish RVUs for new and revised CPT on which they had commented. The agreement among the groups on the
codes. Changes to codes on the PFS panel was moderated by our medical panel and, if so, whether the agreed-
reflected in Addendum B are effective staff, and consisted of the following upon RVUs were significantly different
for services furnished beginning January voting members: from the interim RVUs published in
1, 2007 • Clinicians representing the Addendum C of the CY 2006 PFS final
commenting specialty(ies), based on our rule with comment to demonstrate that
B. Process for Establishing Work determination of those specialties which the interim RVUs should be modified.
Relative Value Units for the 2006 are most identified with the services in We did not modify the RVUs unless
Physician Fee Schedule question. Although commenting there was a clear indication for a
The CY 2006 PFS final rule with specialties were welcomed to observe change. If there was agreement across
comment period (70 FR 70116) the entire refinement process, they were groups for change, but the groups did
contained the work RVUs for Medicare only involved in the discussion of those not agree on what the new RVUs should
payment for existing procedure codes services for which they were invited to be, we eliminated the outlier group, and
under the PFS and interim RVUs for participate. looked for agreement among the
new and revised codes beginning • Primary care clinicians nominated remaining groups as to the basis for new
January 1, 2006. We considered the by the AAFP and the American College RVUs. We used the same methodology
RVUs for the interim codes to be subject of Physicians. in analyzing the ratings that we first
to public comment under the annual • Four carrier medical directors. used in the refinement process for the
refinement process. In this section, we • One or two clinicians who practice CY 1993 PFS final rule published in the
summarize the refinements to the in related specialties and have November 25, 1992 Federal Register
interim work RVUs published in the CY knowledge of the services under review. which described the statistical tests in
2006 PFS final rule with comment The panel discussed the work detail (57 FR 55938). Our decision to
period and our establishment of the involved in the procedure under review convene a multi-specialty panel of
work RVUs for new and revised codes in comparison to the work associated physicians and to apply the statistical
for the CY 2007 PFS. with other services under the PFS. We tests described above in this section was
C. Work Relative Value Unit assembled a set of reference services based on our need to balance the
Refinements of Interim Relative Value and asked the panel members to interests of those who commented on
Units compare the clinical aspects of the work the work RVUs against the redistributive
for the service a commenter believed effects that would occur in other
1. Methodology (Includes Table titled was incorrectly valued to one or more specialties.
‘‘2006 Interim Work Relative Value of the reference services. In compiling Table 14 lists those interim codes
Units for Codes Reviewed Under the the reference set, we attempted to reviewed under the refinement panel
Refinement Panel Process ‘‘) include: (1) Services that are commonly process described in this section. This
Although the RVUs in the CY 2006 furnished for which work RVUs are not table includes the following
PFS final rule with comment period controversial; (2) services that span the information:
were used to calculate 2006 payment entire spectrum of work intensity from
• CPT Code. This is the CPT code for
amounts, we considered the RVUs for the easiest to the most difficult; and (3)
a service.
the new or revised codes to be interim. at least three services furnished by each
of the major specialties so that each • Description. This is an abbreviated
We accepted comments for a period of
specialty would be represented. The version of the narrative description of
60 days. We received substantive
intent of the panel process was to the code.
comments for 7 CPT codes with interim
work RVUs. capture each participant’s independent • 2006 Work RVU. The work RVUs
To evaluate these comments, we used judgment based on the discussion and that appeared in the CY 2006 final rule
a process similar to the process used his or her clinical experience. Following are shown for each reviewed code.
since 1997. (See the CY 1998 PFS final the discussion for each service, each • Requested Work RVU. This column
rule published in the October 31, 1997 participant rated the work for that identifies the work RVUs requested by
Federal Register (62 FR 59084) for the procedure. Ratings were individual and commenters.
discussion of refinement of CPT codes confidential; there was no attempt to • 2007 Work RVU. This column
with interim work RVUs.) We convened achieve consensus among the panel contains the final RVUs for physician
a multi-specialty panel of physicians to members. work as a result of the multi-specialty
assist us in the review of the comments. We then analyzed the ratings based on panel (Note: Values for 10- and 90-day
The comments that we did not submit a presumption that the interim RVUs global period codes do not reflect E/M
to panel review are discussed at the end were correct. To overcome that increases. Increases due to E/M changes
of this section, as well as those that presumption, the inaccuracy of the are reflected in Addenda B.)
TABLE 14.—2006 INTERIM WORK RELATIVE VALUE UNITS FOR CODES REVIEWED UNDER THE REFINEMENT PANEL
PROCESS
2006 Requested 2007
CPT code 1 Mod Descriptor Interim work RVU work RVU 2
work RVU
22523 ...................................... ........ PERCUT KYPHOPLASTY, THOR ......................................... 8.94 8.94 8.94
22524 ...................................... ........ PERCUT KYPHOPLASTY, LUMBAR .................................... 8.54 8.54 8.54
22525 ...................................... ........ PERCUT KYPHOPLASTY, ADD-ON ..................................... 4.47 4.67 4.47
88334 ...................................... ........ INTRAOP CYTO PATH CONSULT 2 .................................... 0.59 0.80 0.73
95251 ...................................... ........ GLUC MONITOR, CONT, PHYS I&R .................................... 0.52 0.85 0.85
1 All CPT codes and descriptions copyright 2005 AMA. All rights reserved and applicable FARS/DFARS clauses apply.
2 Values for 10- and 90-day global period codes do not reflect E/M increases. Increases due to E/M changes are reflected in Addendum B.
2. Interim 2006 Codes Pathology consultation during surgery; Comment: Commenters disagreed
For CPT code 22523, Percutaneous each additional tissue block, with frozen with our comparison of CPT code 95251
vertebral augmentation, including cavity section(s). The RUC reviewed the to 93268, as they believe the amount
creation (fracture reduction and bone specialty society’s survey data and and complexity of the data that needs to
biopsy included when performed) using noted that the surveyed CPT code be reviewed for CPT code 95251 is
mechanical device, one vertebral body, 88334, when compared to the reference considerable. Based on these comments,
unilateral or bilateral cannulation (e.g., CPT code 88332 has higher intensity/ we referred this code to the multi-
kyphoplasty); thoracic; CPT code 22524, complexity measures (20 minutes) and specialty validation panel for review.
Percutaneous vertebral augmentation, an additional five minutes of intra- Response: As a result of the statistical
including cavity creation (fracture service time (15 minutes). Although analysis of the 2006 multi-specialty
reduction and bone biopsy included CPT code 88334 has an additional 5 validation panel ratings, we have
when performed) using mechanical minutes of intra-service time, we assigned 0.85 work RVUs to CPT code
device, one vertebral body, unilateral or believed that CPT code 88334 is very 95251.
bilateral cannulation (e.g., kyphoplasty); similar in work to CPT code 88332, and For CPT code 61630, Balloon
lumbar; and CPT code 22525, therefore, should be valued the same. angioplasty, intracranial (e.g.,
Percutaneous vertebral augmentation, We assigned 0.59 work RVUs to CPT atherosclerotic stenosis), percutaneous;
including cavity creation (fracture code 88334. CPT code 61635, Transcatheter
reduction and bone biopsy included Comment: Commenters did not agree placement of intravascular stent(s),
when performed) using mechanical with our comparison of CPT code 88334 intracranial (e.g., athersosclerotic
device, one vertebral body, unilateral or to 88332, as there is increased work stenosis), including balloon angioplasty
bilateral cannulation (e.g. kyphoplasty); mainly vested on the necessity to if performed; CPT code 61640, Balloon
each additional thoracic or lumbar examine every field under 10X dilatation of intracranial vasospasm,
vertebral body (List separately in magnification in CPT code 88334, percutaneous, initial vessel; CPT code
addition to code for primary procedure), which is not inherent in the frozen 61641, Balloon dilatation of intracranial
the RUC recommended 8.94 work RVUs section process represented by CPT vasospasm, percutaneous, initial vessel;
for CPT code 22523, 8.54 work RVUs for code 88332. Based on these comments, each additional vessel in same vascular
CPT code 22524 and 4.47 work RVUs we referred this code to the multi- family; and CPT code 61642, Balloon
for CPT code 22525, which we accepted. specialty validation panel for review. dilatation of intracranial vasospasm,
Comment: Commenters disagreed percutaneous, initial vessel; each
with the RUC-recommended work Response: As a result of the statistical additional vessel in different vascular
values for these services, which we had analysis of the 2006 multi-specialty family, the RUC recommended 21.08
accepted. The commenters believed that validation panel ratings, we have work RVUs for CPT code 61630, 23.08
the recommended values were primarily assigned 0.73 work RVUs to CPT code work RVUs for CPT code 61635, 12.32
based on a comparison to vertobroplasty 88334. work RVUs for CPT code 61640, 4.33
services and did not reflect important For CPT code 95251, Ambulatory work RVUs for CPT code 61641 and
data that is associated with kyphoplasty continuous glucose monitoring of 8.66 work RVUs for CPT code 61642.
procedures. Based on these comments, interstitial tissue fluid via a We assigned a status indicator of N for
we referred these codes to the multi- subcutaneous sensor for up to 72 hours; these services because they are
specialty validation panel for review. physician interpretation and report, the noncovered under Medicare due to a
Response: As a result of the statistical RUC recommended a work RVU of 0.85 National Coverage Decision (NCD).
analysis of the 2006 multi-specialty for this service. We disagree with the Comment: Commenters questioned
validation panel ratings, we have RUC’s recommendation because we the assignment of the status indicator of
assigned 8.94 work RVUs to CPT code believe the work for this service is N for these services. Commenters also
22523, 8.54 work RVUs to CPT code similar to CPT code 93268, Patient requested that the RVUS be published
22524 and 4.47 work RVUs to CPT code demand single or multiple event for these services. (Note: In the
22525. recording with presymptom memory correction notice that appeared in the
For CPT code 88334, Pathology loop, 24-hour attended monitoring, per February 24, 2006 Federal Register (71
consultation during surgery; cytologic 30-day period of time; includes FR 9458), RVUs were published for CPT
examination (e.g., touch prep, squash transmission, physician review and codes 61630 and 61635.)
prep), each additional site, the RUC interpretation, which involves the Response: Based on an NCD regarding
recommended a work RVU of 0.80 for review of data over a 30-day period. the non-coverage of performance of
this service based on a comparison of Therefore, we assigned 0.52 work RVUs percutaneous transluminal angioplasty
this procedure to CPT code 88332, to 95251. to treat obstructive lesions of the
vertebral and cerebral arteries we will Additional information on the DSMT additional 15 minutes intra-service
maintain the status indicator of N for benefit is available in § 410.140 through time, the CPT Editorial Panel created six
these services. (Note: The RUC- § 410.146, and on our Web site at new codes to accurately report 2
recommended RVUs for these codes will http://www.cms.hhs.gov/ separate families of moderate sedation.
be reflected in Addendum B.) DiabetesSelfManagement/. We are One family describes the provision of
For CPT codes 98960, Education and available to discuss certification moderate sedation services by the
training for patient self-management by requirements with interested providers. physician who is performing the
a qualified, nonphysician health care As requested by the commenters, we diagnostic or therapeutic service and
professional using a standardized have published the RUC-assigned RVUs supervising an independent trained
curriculum, face-to-face with the patient for these codes. observer while the other family
(could include caregiver/family) each 30 For CPT code 99143, Moderate describes moderate sedation services
minutes; individual patient; CPT code sedation services (other than those performed by a physician (other than an
98961, Education and training for services described by codes 00100– anesthesiologist) other than the
patient self-management by a qualified, 01999) provided by the same physician physician performing a diagnostic or
nonphysician health care professional performing the diagnostic or therapeutic therapeutic service. These new codes
using a standardized curriculum, face- service that the sedation supports, replace CPT code 99141, Sedation with
to-face with the patient (could include requiring the presence of an or without analgesia (conscious
caregiver/family) each 30 minutes; 2–4 independent trained observer to assist sedation); intravenous, intra-muscular
patients; and CPT code 98962, in the monitoring of the patient’s level or inhalation, and CPT code 99142,
Education and training for patient self- Sedation with or without analgesia
of consciousness and physiological
management by a qualified, (conscious sedation); oral, rectal and/or
status, under 5 years of age; first 30
nonphysician health care professional intranasal, which were bundled under
minutes intra-service time, CPT code
using a standardized curriculum, face- the PFS. The RUC recommended 0.70
99144, Moderate sedation services
to-face with the patient (could include work RVUs for CPT code 99143, 0.66
(other than those services described by
caregiver/family) each 30 minutes; 5–8 work RVUs for CPT code 99144, 0.23
codes 00100–01999) provided by the
patients, a status indicator of N was work RVUs for CPT code 99145, 1.75
same physician performing the
erroneously assigned for these services work RVUs for CPT code 99148, 1.65
diagnostic or therapeutic service that
in the CY 2006 PFS final rule published work RVUs for CPT code 99149 and
the sedation supports, requiring the
in the November 21, 2005 Federal 0.47 work RVUs for CPT code 99150.
Register (70 FR 70282). The status presence of an independent trained
We questioned whether the RUC-
indicator was corrected to B in the observer to assist in the monitoring of
assigned values are appropriate and
correction notice that appeared in the the patient’s level of consciousness and
carrier priced these codes in order to
February 24, 2006 Federal Register (71 physiological status, age 5 years or
gather information for utilization and
FR 9458). older; first 30 minutes intra-service time,
proper pricing.
Comment: Commenters questioned CPT code 99145, Moderate sedation Comment: Commenters requested that
the assigned status indicator of N for services (other than those services the RUC-recommended value for these
these services and urged acceptance of described by codes 00100–01999) services be accepted as these values
the RVUs, as physician education is a provided by the same physician were based on valid surveys and vetted
service covered under Medicare Part B performing the diagnostic or therapeutic through the RUC process. The RUC also
and, as one commenter indicated, service that the sedation supports, indicated it would be happy to provide
included and reported in an E/M code. requiring the presence of an any additional information that would
However, the commenter stated that the independent trained observer to assist address any concerns we might have.
E/M service that we might believe is in the monitoring of the patient’s level Response: We will maintain carrier
appropriate (CPT code 99211) is not of consciousness and physiological pricing of these codes and will continue
sufficient for the amount of time and status, age 5 years or older; each to monitor utilization.
work described by these services. Other additional 15 minutes intra-service Comment: Commenters requested that
commenters requested that the RUC- time, CPT code 99148, Moderate we publish the RVUs for noncovered
assigned RVUs be published, even if sedation services (other than those services for which we receive RUC
they are not used for Medicare payment, services described by codes 00100– recommendations.
as other payers use the PFS to establish 01999) provided by a physician other Response: In response to comments,
payment. than the health care professional we have published the RVUs for
Response: As stated above in this performing the diagnostic or therapeutic noncovered services for which we
section, the status indicator for these service that the sedation supports, received RUC recommendations (with
codes was corrected to a status indicator under 5 years of age; first 30 minutes the exception of carrier-priced codes).
of B in the correction notice that intra-service time, CPT code 99149, In the CY 2006 PFS final rule with
appeared in the February 24, 2006 Moderate sedation services (other than comment period (70 FR 66370), we also
Federal Register (71 FR 9458). We those services described by codes responded to the RUC recommendations
believe these services are bundled into 00100–01999) provided by a physician on the PE inputs for the new and
E/M services. Other than the diabetic other than the health care professional revised CPT codes for 2006. We
education services (CPT codes G0108 performing the diagnostic or therapeutic received the following comments:
and G0109) specified by the Congress, service that the sedation supports, age 5 Comment: Although we assigned non-
we do not cover separate education years or older; first 30 minutes intra- facility PE inputs based on information
services outside of demonstrations or service time, and CPT code 99150, provided by the RUC for CPT code
the Medicare Health Support program. Moderate sedation services (other than 28890, Extracorporeal shock wave, high
For diabetic education services, CPT those services described by codes energy, performed by a physician,
codes G0108 and G0109 should be used 00100–01999) provided by a physician requiring anesthesia other than local,
to bill for these services. CPT codes other than the health care professional including ultrasound guidance,
98960–98962 will not be recognized as performing the diagnostic or therapeutic involving the plantar fascia, one
separate services for diabetic education. service that the sedation supports, each commenter expressed concern that the
PE RVUs are not sufficient to cover the codes 36478 and 36479—the entire work RVUs had previously been
actual costs associated with the endovenous family. One commenter established. We also considered the
performance of this procedure in the requested that 15 minutes of clinical relationships among the new and
office setting. The commenter labor time be added to CPT codes 36475 revised codes for which we received
acknowledged that a single payment and 36476. However, the commenters RUC recommendations and agreed with
scheme for the purchase or rental of the disagreed with the addition of 15 the majority of the relative relationships
equipment associated with its service minutes of clinical labor time to CPT reflected in the RUC values. In some
does not exist and believes the expense codes 36475 and 36476, indicating that instances, although we agreed with the
to be higher than what was represented the description of the physician work relationships, we nonetheless revised
in the PE database. The commenter for these codes states that, when the work RVUs to achieve work
indicated that a ‘‘technical fee’’ is needed, the physician places the patient neutrality within families of codes. That
frequently paid when the procedure is in the required position. One of these is, the work RVUs were adjusted so that
performed in the office setting. The commenters indicated that this was also the sum of the new or revised work
costs associated with this ‘‘technical to be addressed at the February 2006 RVUs (weighted by projected frequency
fee’’ can include: The shock wave RUC meeting. of use) for a family will be the same as
equipment, a specialized transport Response: At the February 2006 RUC the sum of the current work RVUs
truck, a service contract with the meeting, the PERC recommended the (weighted by projected frequency of use)
manufacturer, salary/benefits for addition of the tilt table to the family of for the family of codes. We reviewed all
technologist and the transport driver, CPT codes, 36475, 36476, 36478 and the RUC recommendations and accepted
medical director fee, anesthesia fee, 36479. However, the PERC did not approximately 98 percent of the RUC-
supplies and training material, accept the additional clinical labor time. recommended values.
malpractice and liability insurance, and The tilt table was added to the PE We received one recommendation
fuel cost. database for these CPT codes, in concert from the Health Care Professional
Response: Under the PFS, the PE with the PERC recommendations for CY Advisory Committee (HCPAC), which
component is based on the resources 2007, and the PE RVUs in Addendum B we accepted.
used to furnish each service and, for reflect these changes.
Table 15, titled ‘‘AMA RUC and
CPT code 28890, consists of a total of D. Establishment of Interim Work HCPAC Recommendations and CMS
133 minutes of clinical labor, disposable Relative Value Units for New and Decisions for New and Revised 2007
supplies, including the necessary items Revised Physician’s Current Procedural CPT Codes,’’ lists the new or revised
to provide the regional anesthetic block, Terminology (CPT) Codes and New CPT codes, and their associated work
and equipment over $500, including the Healthcare Common Procedure Coding RVUs, that will be interim in 2007. This
‘‘shock-wave’’ machine. The PE System Codes (HCPCS) for 2007 table includes the following
methodology utilizes the price of (Includes Table titled ‘‘American information:
equipment (as if the physician owned it) Medical Association Specialty Relative • A ‘‘#’’ identifies a new code for
and considers the time used for Value Update Committee and Health 2007.
performing the procedure (36 minutes). Care Professionals Advisory Committee • CPT code. This is the CPT code for
Costs of leasing arrangements or per use Recommendations and CMS’s Decisions a service.
fees are not recognized in our PE for New and Revised 2007 CPT Codes’’) • Modifier. A ‘‘26’’ in this column
methodology. Therefore, we are One aspect of establishing RVUs for indicates that the work RVUs are for the
maintaining the direct PE inputs for this 2007 was to assign interim work RVUs PC of the code.
service (except as discussed previously for all new and revised CPT codes. As • Description. This is an abbreviated
in this rule) because they are consistent described in our November 25, 1992 version of the narrative description of
with the typical clinical labor, supplies, notice on the 1993 PFS (57 FR 55951) the code.
and equipment needed to provide this and in section III.B. of the CY 1997 PFS • RUC recommendations. This
service in the physician’s office. final rule (61 FR 59505), we established column identifies the work RVUs
Comment: We received three a process, based on recommendations recommended by the RUC.
comments concerning the PE inputs for received from the AMA’s RUC, for
CPT codes 36475, Endovenous ablation • HCPAC recommendations. This
establishing interim work RVUs for new column identifies the work RVUs
therapy of incompetent vein, extremity, and revised codes.
inclusive of all imaging guidance and recommended by the HCPAC.
This year we received work RVU
monitoring, percutaneous, • CMS decision. This column
recommendations for 230 new and
radiofrequency, first vein treated, and indicates whether we agreed or we
revised CPT codes from the RUC. Of the
36476, Endovenous ablation therapy of disagreed with the RUC
230 codes, 56 were modified by
incompetent vein, extremity, inclusive recommendation. Codes for which we
editorial changes, 57 were renumbered
of all imaging guidance and monitoring, did not accept the RUC
and the work RVUs associated with
percutaneous, radiofrequency, second these services were assigned to the new recommendation are discussed in
and subsequent veins treated in a single codes (not included in Table 15), and 1 greater detail following this table.
extremity, each through separate access code was renumbered and assigned a • 2007 Work RVUs. This column
sites (List separately in addition to code new work RVU (included in Table 15). establishes the interim 2007 work RVUs
for primary location). Two comenters Our staff and medical officers reviewed for physician work. (Note: Values for 10-
supported our proposal to add the tilt the RUC recommendations by and 90-day global period codes reflect
table for these services and also comparing them to our reference set or E/M increases from the 5-Year Review.)
suggested the tilt table be added to CPT to other comparable services for which BILLING CODE 4120–01–P
ER01DE06.010</GPH>
ER01DE06.011</GPH>

ER01DE06.012</GPH>
Table 16, which is titled ‘‘AMA RUC • CPT code. This is the CPT code for disagreed with the RUC
Anesthesia Recommendations and CMS a service. recommendation. Codes for which we
Decisions for New and Revised 2007 • Description. This is an abbreviated did not accept the RUC
CPT Codes,’’ lists the new or revised version of the narrative description of recommendation are discussed in
CPT codes for anesthesia and their base the code. greater detail following this table.
units that will be interim in 2007. This • RUC recommendations. This
column identifies the base units • 2007 Base Units. This column
table includes the following establishes the 2007 base units for these
recommended by the RUC.
information: • CMS decision. This column services.
indicates whether we agreed or we
TABLE 16.—AMA RUC ANESTHESIA RECOMMENDATIONS AND CMS DECISIONS FOR NEW AND REVISED CPT CODES
2007
RUC CMS
*CPT code Description base
recommendation decision units
#00625 ............................... ANES SPINE TRANTHOR W/O VENT ...................... 13.00 Agree ................................ 13.00
#00626 ............................... ANES, SPINE TRANSTHOR W/VENT ...................... 13.00 Agree ................................ 15.00
* All CPT codes copyright 2006 AMA.
# New CPT code.
E. Discussion of Codes for Which There plan (as appropriate), within a calendar For CPT code 99363, Anticoagulant
Were no RUC Recommendations or for month, 30 minutes or more, the RUC- management for an outpatient taking
Which the RUC Recommendations Were recommended 1.50 work RVUs for this warfarin, physician review and
Not Accepted code. We are assigning a status indicator interpretation of International
of B (Bundled) to this service because: Normalized Ratio (INR) testing, patient
The following is a summary of our
(1) The patient is not present when this instructions, dosage adjustment (as
rationale for not accepting particular
service is rendered and (2) we believe needed), and ordering of additional
RUC work RVUs. It is arranged by type
this service is captured in E/M services. tests; initial 90 days of therapy (must
of service in CPT order. This summary
(Note: The RUC-recommended RVUs for include a minimum of 8 INR
refers only to work RVUs.
this code will be reflected in Addendum measurements; and CPT code 99364,
For CPT code 22857, Total disc B.)
arthroplasty (artificial disc), anterior Anticoagulant management for a
For CPT code 96040, Medical genetics patient taking warfarin, physician
approach, including diskectomy to and genetic counseling services, each 30
prepare interspace (other than for review and interpretation of
minutes face-to-face with patient/ International Normalized Ratio (INR)
decompression), lumbar, single family, this procedure does not have
interspace; CPT code 22862, Revision testing, patient instructions, dosage
any physician work and to the extent adjustment (as needed), and ordering of
including replacement of total disc that these services are covered, we
arthroplasty (artificial disc) anterior additional tests; each subsequent 90
consider them bundled into E/M days of therapy (must include a
approach, lumbar, single interspace services and have assigned as status
(includes approach); and CPT code minimum of three INR measurements),
indicator of B. (Note: The RUC- the RUC recommended 1.65 work RVUs
22865, Removal of total disc recommended RVUs for this code will
arthroplasty (artificial disc), anterior for CPT code 99363 and 0.63 work
be reflected in Addendum B.)
approach, lumbar, single interspace, the For CPT code 96904, Whole body RVUs for CPT code 99364. We believe
RUC recommended 25.07 work RVUs integumentary photography, for these services are bundled into E/M
for CPT code 22857, 30.57 work RVUs monitoring of high risk patients with services and have assigned a status
for CPT code 22862 and 29.57 work dysplastic nevus syndrome or a history indicator of B to these codes. (Note: The
RVUs for CPT code 22865. We are of dysplastic nevi, or patients with a RUC-recommended RVUs for these
assigning a status indicator of R personal or familial history of codes will be reflected in Addendum B.)
(Restricted) to these services due to an melanoma, this procedure does not F. Additional Pricing Issue
NCD for non-coverage of Lumbar have any physician work. We have
Artificial Disc Replacement with the assigned a status indicator of R We are carrier-pricing the global and
ChariteTM lumbar artificial disc for (Restricted) to this service, and will only TC for the codes listed in Table 17. The
patients over the age of 60. recognize this code when services are TC is not paid in the facility setting
For CPT code 94005, Home ventilator performed on patients with melanoma under the PFS and the RUC did not
management care plan oversight of a and not when services are performed for forward recommendations in the non-
patient (patient not present) in home, screening based on family history facility setting because these services
domiciliary or rest home (e.g., assisted (because we did not cover screenings). are performed infrequently, if at all in
living) requiring review of status, review We will implement edits for situations the non-facility setting. Work RVUs will
of laboratories and other studies and involving patients with melanoma and/ continue to be used to establish
revision of orders and respiratory care or dysplastic nevus syndrome. payment for the PC.
TABLE 17.—CARRIER PRICED CODES

CPT code * Mod Short descriptor Status indicator
70170 ....... .................. X-RAY EXAM OF TEAR DUCT ....................................................................................................... Carrier Priced.
70170 ....... TC ............ X-RAY EXAM OF TEAR DUCT ....................................................................................................... Carrier Priced.
TABLE 17.—CARRIER PRICED CODES—Continued

70555 ....... .................. FMRI BRAIN BY PHYS/PSYCH ...................................................................................................... Carrier Priced.

70555 ....... TC ............ FMRI BRAIN BY PHYS/PSYCH ...................................................................................................... Carrier Priced.
71090 ....... .................. X-RAY EXAM OF EYE SOCKETS .................................................................................................. Carrier Priced.
71090 ....... TC ............ X-RAY EXAM OF EYE SOCKETS .................................................................................................. Carrier Priced.
73530 ....... .................. X-RAY EXAM OF HIP ..................................................................................................................... Carrier Priced.
73530 ....... TC ............ X-RAY EXAM OF HIP ..................................................................................................................... Carrier Priced.
74190 ....... .................. X-RAY EXAM OF PERITONEUM ................................................................................................... Carrier Priced.
74190 ....... TC ............ X-RAY EXAM OF PERITONEUM ................................................................................................... Carrier Priced.
74305 ....... .................. X-RAY BILE DUCTS/PANCREAS ................................................................................................... Carrier Priced.
74305 ....... TC ............ X-RAY BILE DUCTS/PANCREAS ................................................................................................... Carrier Priced.
74328 ....... .................. X-RAY BILE DUCT ENDOSCOPY .................................................................................................. Carrier Priced.
74328 ....... TC ............ X-RAY BILE DUCT ENDOSCOPY .................................................................................................. Carrier Priced.
74330 ....... .................. X-RAY BILE/PANC ENDOSCOPY .................................................................................................. Carrier Priced.
74330 ....... TC ............ X-RAY BILE/PANC ENDOSCOPY .................................................................................................. Carrier Priced.
74340 ....... .................. X-RAY GUIDE FOR GI TUBE ......................................................................................................... Carrier Priced.
74340 ....... TC ............ X-RAY GUIDE FOR GI TUBE ......................................................................................................... Carrier Priced.
74355 ....... .................. X-RAY GUIDE, INTESTINAL TUBE ................................................................................................ Carrier Priced.
74355 ....... TC ............ X-RAY GUIDE, INTESTINAL TUBE ................................................................................................ Carrier Priced.
74360 ....... .................. X-RAY GUIDE, GI DILATION .......................................................................................................... Carrier Priced.
74360 ....... TC ............ X-RAY GUIDE, GI DILATION .......................................................................................................... Carrier Priced.
74420 ....... .................. CONTRST X-RAY, URINARY TRACT ............................................................................................ Carrier Priced.
74420 ....... TC ............ CONTRST X-RAY, URINARY TRACT ............................................................................................ Carrier Priced.
74425 ....... .................. CONTRST X-RAY, URINARY TRACT ............................................................................................ Carrier Priced.
74425 ....... TC ............ CONTRST X-RAY, URINARY TRACT ............................................................................................ Carrier Priced.
74445 ....... .................. X-RAY EXAM OF PENIS ................................................................................................................. Carrier Priced.
74445 ....... TC ............ X-RAY EXAM OF PENIS ................................................................................................................. Carrier Priced.
74450 ....... .................. X-RAY, URETHRA/BLADDER ......................................................................................................... Carrier Priced.
74450 ....... TC ............ X-RAY, URETHRA/BLADDER ......................................................................................................... Carrier Priced.
74470 ....... .................. X-RAY EXAM OF KIDNEY LESION ................................................................................................ Carrier Priced.
74470 ....... TC ............ X-RAY EXAM OF KIDNEY LESION ................................................................................................ Carrier Priced.
74775 ....... .................. X-RAY EXAM OF PERINEUM ........................................................................................................ Carrier Priced.
74775 ....... TC ............ X-RAY EXAM OF PERINEUM ........................................................................................................ Carrier Priced.
75801 ....... .................. LYMPH VESSEL X-RAY, ARM/LEG ............................................................................................... Carrier Priced.
75801 ....... TC ............ LYMPH VESSEL X-RAY, ARM/LEG ............................................................................................... Carrier Priced.
75803 ....... .................. LYMPH VESSEL X-RAY, ARMS/LEGS .......................................................................................... Carrier Priced.
75803 ....... TC ............ LYMPH VESSEL X-RAY, ARMS/LEGS .......................................................................................... Carrier Priced.
75805 ....... .................. LYMPH VESSEL X-RAY, TRUNK ................................................................................................... Carrier Priced.
75805 ....... TC ............ LYMPH VESSEL X-RAY, TRUNK ................................................................................................... Carrier Priced.
75810 ....... .................. VEIN X-RAY, SPLEEN/LIVER ......................................................................................................... Carrier Priced.
75810 ....... TC ............ VEIN X-RAY, SPLEEN/LIVER ......................................................................................................... Carrier Priced.
75894 ....... .................. X-RAYS, TRANSCATH THERAPY ................................................................................................. Carrier Priced.
75894 ....... TC ............ X-RAYS, TRANSCATH THERAPY ................................................................................................. Carrier Priced.
75896 ....... .................. X-RAYS, TRANSCATH THERAPY ................................................................................................. Carrier Priced.
75896 ....... TC ............ X-RAYS, TRANSCATH THERAPY ................................................................................................. Carrier Priced.
75898 ....... .................. FOLLOW-UP ANGIOGRAPHY ........................................................................................................ Carrier Priced.
75898 ....... TC ............ FOLLOW-UP ANGIOGRAPHY ........................................................................................................ Carrier Priced.
75940 ....... .................. X-RAY PLACEMENT, VEIN FILTER ............................................................................................... Carrier Priced.
75940 ....... TC ............ X-RAY PLACEMENT, VEIN FILTER ............................................................................................... Carrier Priced.
75945 ....... .................. INTRAVASCULAR US ..................................................................................................................... Carrier Priced.
75945 ....... TC ............ INTRAVASCULAR US ..................................................................................................................... Carrier Priced.
75960 ....... .................. TRANSCATH IV STENT RS & I ...................................................................................................... Carrier Priced.
75960 ....... TC ............ TRANSCATH IV STENT RS & I ...................................................................................................... Carrier Priced.
75970 ....... .................. VASCULAR BIOPSY ....................................................................................................................... Carrier Priced.
75970 ....... TC ............ VASCULAR BIOPSY ....................................................................................................................... Carrier Priced.
75980 ....... .................. CONTRAST X-RAY EXAM BILE DUCT .......................................................................................... Carrier Priced.
75980 ....... TC ............ CONTRAST X-RAY EXAM BILE DUCT .......................................................................................... Carrier Priced.
75992 ....... .................. ATHERECTOMY, X-RAY EXAM ..................................................................................................... Carrier Priced.
75992 ....... TC ............ ATHERECTOMY, X-RAY EXAM ..................................................................................................... Carrier Priced.
76001 ....... .................. FLUOROSCOPE EXAM, EXTENSIVE ............................................................................................ Carrier Priced.
76001 ....... TC ............ FLUOROSCOPE EXAM, EXTENSIVE ............................................................................................ Carrier Priced.
76125 ....... .................. CINE/VIDEO X-RAYS ADD-ON ...................................................................................................... Carrier Priced.
76125 ....... TC ............ CINE/VIDEO X-RAYS ADD-ON ...................................................................................................... Carrier Priced.
76932 ....... .................. ECHO GUIDE FOR HEART BIOPSY ............................................................................................. Carrier Priced.
76932 ....... TC ............ ECHO GUIDE FOR HEART BIOPSY ............................................................................................. Carrier Priced.
76940 ....... .................. US GUIDE, TISSUE ABLATION ..................................................................................................... Carrier Priced.
76940 ....... TC ............ US GUIDE, TISSUE ABLATION ..................................................................................................... Carrier Priced.
76941 ....... .................. ECHO GUIDE FOR TRANSFUSION .............................................................................................. Carrier Priced.
76941 ....... TC ............ ECHO GUIDE FOR TRANSFUSION .............................................................................................. Carrier Priced.
76945 ....... .................. ECHO GUIDE, VILLUS SAMPLING ................................................................................................ Carrier Priced.
76945 ....... TC ............ ECHO GUIDE, VILLUS SAMPLING ................................................................................................ Carrier Priced.
76975 ....... .................. GI ENDOSCOPIC ULTRASOUND .................................................................................................. Carrier Priced.
76975 ....... TC ............ GI ENDOSCOPIC ULTRASOUND .................................................................................................. Carrier Priced.

76998 ....... .................. US GUIDE, INTRAOP ..................................................................................................................... Carrier Priced.

76998 ....... TC ............ US GUIDE, INTRAOP ..................................................................................................................... Carrier Priced.
77013 ....... .................. CT GUIDE FOR TISSUE ABLATION .............................................................................................. Carrier Priced.
77013 ....... TC ............ CT GUIDE FOR TISSUE ABLATION .............................................................................................. Carrier Priced.
77022 ....... .................. MRI FOR TISSUE ABLATION ......................................................................................................... Carrier Priced.
77022 ....... TC ............ MRI FOR TISSUE ABLATION ......................................................................................................... Carrier Priced.
92978 ....... .................. INTRAVASC US, HEART ADD-ON ................................................................................................. Carrier Priced.
92978 ....... TC ............ INTRAVASC US, HEART ADD-ON ................................................................................................. Carrier Priced.
92979 ....... .................. INTRAVASC US, HEART ADD-ON ................................................................................................. Carrier Priced.
92979 ....... TC ............ INTRAVASC US, HEART ADD-ON ................................................................................................. Carrier Priced.
93501 ....... .................. RIGHT HEART CATHETERIZATION .............................................................................................. Carrier Priced.
93501 ....... TC ............ RIGHT HEART CATHETERIZATION .............................................................................................. Carrier Priced.
93503 ....... .................. INSERT/PLACE HEART CATHETER ............................................................................................. Carrier Priced.
93505 ....... .................. BIOPSY OF HEART LINING ........................................................................................................... Carrier Priced.
93505 ....... TC ............ BIOPSY OF HEART LINING ........................................................................................................... Carrier Priced.
93508 ....... .................. CATH PLACEMENT, ANGIOGRAPHY ........................................................................................... Carrier Priced.
93508 ....... TC ............ CATH PLACEMENT, ANGIOGRAPHY ........................................................................................... Carrier Priced.
93510 ....... .................. LEFT HEART CATHETERIZATION ................................................................................................ Carrier Priced.
93510 ....... TC ............ LEFT HEART CATHETERIZATION ................................................................................................ Carrier Priced.
93526 ....... .................. RT & LT HEART CATHETERS ....................................................................................................... Carrier Priced.
93526 ....... TC ............ RT & LT HEART CATHETERS ....................................................................................................... Carrier Priced.
93529 ....... .................. RT, LT HEART CATHETERIZATION .............................................................................................. Carrier Priced.
93529 ....... TC ............ RT, LT HEART CATHETERIZATION .............................................................................................. Carrier Priced.
93530 ....... .................. RT HEART CATH, CONGENITAL .................................................................................................. Carrier Priced.
93530 ....... TC ............ RT HEART CATH, CONGENITAL .................................................................................................. Carrier Priced.
93531 ....... .................. R & L HEART CATH, CONGENITAL .............................................................................................. Carrier Priced.
93531 ....... TC ............ R & L HEART CATH, CONGENITAL .............................................................................................. Carrier Priced.
93539 ....... .................. INJECTION, CARDIAC CATH ......................................................................................................... Carrier Priced.
93540 ....... .................. INJECTION, CARDIAC CATH ......................................................................................................... Carrier Priced.
93541 ....... .................. INJECTION FOR LUNG ANGIOGRAM ........................................................................................... Carrier Priced.
93542 ....... .................. INJECTION FOR HEART X-RAYS ................................................................................................. Carrier Priced.
93543 ....... .................. INJECTION FOR HEART X-RAYS ................................................................................................. Carrier Priced.
93544 ....... .................. INJECTION FOR AORTOGRAPHY ................................................................................................ Carrier Priced.
93545 ....... .................. INJECT FOR CORONARY X-RAYS ............................................................................................... Carrier Priced.
93555 ....... .................. IMAGING, CARDIAC CATH ............................................................................................................ Carrier Priced.
93555 ....... TC ............ IMAGING, CARDIAC CATH ............................................................................................................ Carrier Priced.
93556 ....... .................. IMAGING, CARDIAC CATH ............................................................................................................ Carrier Priced.
93556 ....... TC ............ IMAGING, CARDIAC CATH ............................................................................................................ Carrier Priced.
93561 ....... .................. CARDIAC OUTPUT MEASUREMENT ............................................................................................ Carrier Priced.
93561 ....... TC ............ CARDIAC OUTPUT MEASUREMENT ............................................................................................ Carrier Priced.
93562 ....... .................. CARDIAC OUTPUT MEASUREMENT ............................................................................................ Carrier Priced.
93562 ....... TC ............ CARDIAC OUTPUT MEASUREMENT ............................................................................................ Carrier Priced.
93571 ....... .................. HEART FLOW RESERVE MEASURE ............................................................................................ Carrier Priced.
93571 ....... TC ............ HEART FLOW RESERVE MEASURE ............................................................................................ Carrier Priced.
93600 ....... .................. BUNDLE OF HIS RECORDING ...................................................................................................... Carrier Priced.
93600 ....... TC ............ BUNDLE OF HIS RECORDING ...................................................................................................... Carrier Priced.
93602 ....... .................. INTRA-ATRIAL RECORDING ......................................................................................................... Carrier Priced.
93602 ....... TC ............ INTRA-ATRIAL RECORDING ......................................................................................................... Carrier Priced.
93603 ....... .................. RIGHT VENTRICULAR RECORDING ............................................................................................ Carrier Priced.
93603 ....... TC ............ RIGHT VENTRICULAR RECORDING ............................................................................................ Carrier Priced.
93609 ....... .................. MAP TACHYCARDIA, ADD-ON ...................................................................................................... Carrier Priced.
93609 ....... TC ............ MAP TACHYCARDIA, ADD-ON ...................................................................................................... Carrier Priced.
93610 ....... .................. INTRA-ATRIAL PACING .................................................................................................................. Carrier Priced.
93610 ....... TC ............ INTRA-ATRIAL PACING .................................................................................................................. Carrier Priced.
93612 ....... .................. INTRAVENTRICULAR PACING ...................................................................................................... Carrier Priced.
93612 ....... TC ............ INTRAVENTRICULAR PACING ...................................................................................................... Carrier Priced.
93615 ....... .................. ESOPHAGEAL RECORDING ......................................................................................................... Carrier Priced.
93615 ....... TC ............ ESOPHAGEAL RECORDING ......................................................................................................... Carrier Priced.
93618 ....... .................. HEART RHYTHM PACING ............................................................................................................. Carrier Priced.

93618 ....... TC ............ HEART RHYTHM PACING ............................................................................................................. Carrier Priced.
93619 ....... .................. ELECTROPHYSIOLOGY EVALUATION ......................................................................................... Carrier Priced.
93619 ....... TC ............ ELECTROPHYSIOLOGY EVALUATION ......................................................................................... Carrier Priced.
93640 ....... .................. EVALUATION HEART DEVICE ...................................................................................................... Carrier Priced.
93640 ....... TC ............ EVALUATION HEART DEVICE ...................................................................................................... Carrier Priced.

93641 ....... .................. ELECTROPHYSIOLOGY EVALUATION ......................................................................................... Carrier Priced.

93641 ....... TC ............ ELECTROPHYSIOLOGY EVALUATION ......................................................................................... Carrier Priced.
96020 ....... .................. FUNCTIONAL BRAIN MAPPING .................................................................................................... Carrier Priced.
96020 ....... TC ............ FUNCTIONAL BRAIN MAPPING .................................................................................................... Carrier Priced.
* All CPT codes copyright 2006 AMA.
G. Establishment of Interim PE RVUs for markers used in this procedure is 2 or finally divided by 60 (the number
New and Revised Physician’s Current 3 and we entered an interim price of minutes in an hour). We were not able
Procedural Terminology (CPT) Codes $119 per 3-pack. We are asking the to include a price for the pedigree
and New Healthcare Common specialty to provide us with: (a) software equipment as it was not
Procedure Coding System (HCPCS) Verification of the typical number of provided with the PE inputs.
Codes for 2007 gold markers used in this procedure; For CPT code 96904, Whole body
We have developed a process for and (b) documentation as to the typical integumentary photography, for
establishing interim PE RVUs for new price of these markers. monitoring of high risk patients with
and revised codes that is similar to that For CPT code 76776, Ultrasound, dysplastic nevus syndrome or a history
used for work RVUs. Under this process, transplanted kidney, real time and of dysplastic nevi, or patients with a
the RUC recommends the PE direct duplex Doppler with image personal or familial history of
inputs (the staff time, supplies and documentation, we deleted the color melanoma, the payment rate, at $0.383,
equipment) associated with each new laser printer because it is contained in for ‘‘medical photographers’’, was
code. We then review the the ultrasound room that is also used for created from a non-BLS source that gave
recommendations in a manner similar to the procedure. a 2003 national annual average salary of
For CPT code 77371, Radiation
our evaluation of the recommended $36,000. This salary was inflated by a
treatment delivery, stereotactic
work RVUs. The RUC recommendations factor of 1.366 to include fringe benefits,
on the PE inputs for the new and radiosurgery (SRS) (complete course of
then deflated by the MEI to 2002 (the
revised 2007 codes were submitted to us treatment of cerebral lesion[s] consisting
labor base year), then divided by 2080
as interim recommendations. of 1 session); multi-source Cobalt 60
(the number of annual work hours), and
We have accepted, in the interim, the based, we designated, as an interim
lastly, divided by number 60 (the
PE recommendations submitted by the measure, the $15,000 radiation source
number of minutes in an hour). We are
RUC for the codes listed in the table with a specific 1-month life (that was
asking the specialty to submit
titled ‘‘AMA RUC and HCPAC RVU included in the list of direct-expense
acceptable documentation for all of the
Recommendations and CMS Decisions equipment items for this service), as an
cameras and related equipment that are
for New and Revised 2007 CPT Codes’’ indirect expense because we believe it
listed for this service. The prices
except as noted below in this section. does not meet the criteria for inclusion
submitted by the specialty have been
For CPT code 15731, Forehead flap as a direct expense. To the extent that
entered on an interim basis for CY 2007.
with preservation of vascular pedicle the specialty disagrees with our
decision to assign the radiation source For CPT code 58240, Pelvic
(e.g., axial pattern flap, parmedian
cost as an indirect expense, the interim exenteration for gynecologic
forehead flap); and CPT code 15830,
nature of this designation gives the malignancy, with total abdominal
Excision, excessive skin and
specialty the opportunity to provide us hysterectomy or cervicectomy, with or
subcutaneous tissue (includes
with documentation to support their without removal of tube(s), with or
lipectomy); abdomen, infraumbilical
belief that the radiation source should without removal of ovary(s), with
panniculectomy, we assigned 5 minutes
be considered a direct expense. removal of bladder and ureteral
for each post-operative visit for the
For CPT code 94644, Continuous transplantations, and/or
digital camera used in the post-
operative visits, rather than the entire inhalation with aerosol medication for abdominoperineal resection of rectum
clinical labor time for each post- acute airway obstruction; first hour, we and colon and colostomy, or any
operative period. did not include the peak flow meter as combination thereof, the supplies for
For CPT code 22527, Percutaneous a supply item for this service because this service were correctly entered as a
intradiscal electrothermal annuloplasty, this item is reusable and was previously quantity of 6—the number of post-
unilateral or bilateral including removed from the PE database at the operative visits (POVs)—rather than 4,
fluoroscopic guidance; one or more time the supplies were re-priced. as listed on the PE spreadsheet in the
additional levels (List separately in For CPT code 96040, Medical genetics RUC recommendations. The correct
addition to code for primary procedure, and genetics counseling services, each labor and equipment times were entered
we deleted the ambulatory blood 30 minutes face-to-face with patient/ as reflected by the level and number of
pressure monitor because it duplicates family, the payment rate, at $0.567, for POVs.
the function of the 3-channel ECG ‘‘genetic counselor’’ was created from a For CPT code 92025, Computerized
machine. non-BLS source that listed a 2003 corneal topography, unilateral or
For CPT code 55876, Placement of national annual average salary of bilateral with interpretation and report,
interstitial device(s) for radiation $53,377. This salary was inflated to the specific topography equipment (at
guidance (e.g., fiducial markers, include fringe benefits ($53,377 $44,000) requested for this procedure
dosimeter), prostate (via needle, any multiplied by 1.366), then deflated by was not included because we do not
approach), single or multiple, we the MEI to the year 2002 (the same year believe it is the typical unit used in
deleted one package of gold markers as the other labor costs in the PE physician offices. Instead, we used the
(contains 3 markers each) because we database), then divided by 2080 (the existing topography unit (at $13,495)
believe that the typical number of gold number of hours in a work year), and and added a printer and computer with
monitor to the PE database for this with the provisions of the The Code List also identifies those
service. Administrative Procedure Act (APA) (5 items and services that may qualify for
U.S.C. 551 et seq.), we are not required either of the following two exceptions to
VI. Physician Self-Referral Prohibition:
to respond further. Nevertheless, we are the physician self-referral prohibition:
Annual Update to the List of CPT/ • EPO and other dialysis-related
responding to the only comment that
HCPCS Codes drugs furnished in or by an ESRD
provided significant new information.
A. General Specifically, we are responding to the facility (§ 411.355(g)).
following comment from the AMA. • Preventive screening tests,
Section 1877 of the Act prohibits a immunizations or vaccines
physician from referring a Medicare Comment: The AMA stated that it
does not recognize diagnostic and (§ 411.355(h)).
beneficiary for certain designated health The Code List was last updated in the
services (DHS) to a health care entity therapeutic nuclear medicine services as
a subspecialty of radiology, contrary to CY 2006 PFS final rule with comment
with which the physician (or a member period (70 FR 70116).
of the physician’s immediate family) has our statement in the CY 2006 PFS final
a financial relationship, unless an rule (70 FR 70285). In that rule and in 2. Response to Comments
exception applies. Section 1877 of the the proposed rule, we had explained
that radiology and other imaging We did not receive any comments
Act also prohibits the DHS entity from relating to the Code List that became
submitting claims to Medicare or billing services should include diagnostic
nuclear medicine procedures, because, effective January 1, 2006.
the beneficiary or any other entity for
Medicare DHS that are furnished as a among a number of other reasons, the 3. Revisions Effective for 2007
result of a prohibited referral. AMA recognizes nuclear medicine as a The updated, comprehensive Code
As specified in our regulations at subspecialty of radiology. We also noted List effective January 1, 2007 appears as
§ 411.351, the following services are in the CY 2006 PFS final rule (70 FR Addendum J in this final rule with
DHS: 70285) that the AMA had not objected comment and is available on our Web
• Clinical laboratory services. to this statement in the proposed rule. site at http://www.cms.hhs.gov/
• Physical therapy, occupational In its comment, the AMA has now PhysicianSelfReferral. Addendum J
therapy, and speech-language pathology stated that its CPT coding categories are reflects the addition of CPT code 86960
services. not intended to be a determination of to the list of CPT codes in the 80000
• Radiology and certain other imaging subspecialties. The AMA added that series that are excluded from the
services. nuclear medicine should be recognized definition of ‘‘clinical laboratory
• Radiation therapy services and as its own specialty, separate from services.’’ This code was a new CPT
supplies. radiology, because it has its own board code last year and should have been
• Durable medical equipment and certification and residency program. added to the list of excluded 80000
supplies. Response: We accept the explanation series codes at that time. In addition,
• Parenteral and enteral nutrients, by the AMA that it does not recognize Addendum J reflects the changes
equipment, and supplies. diagnostic nuclear medicine services as indicated in Tables 18 and 19.
• Prosthetics, orthotics, and a subspecialty of radiology. However, Tables 18 and 19 identify the
prosthetic devices and supplies. we continue to believe that we should additions and deletions, respectively, to
• Home health services. include all forms of radiological imaging the comprehensive Code List that was
• Outpatient prescription drugs. in the DHS category ‘‘radiology and published in Addendum H of the CY
• Inpatient and outpatient hospital other imaging services.’’ As we noted in 2006 PFS final rule (70 FR 70472
services. both the CY 2006 PFS proposed (70 FR through 70476). Tables 18 and 19 also
45855) and final rules (70 FR 70285), identify the additions and deletions to
B. Nuclear Medicine although there may be differences of the lists of codes used to identify the
In the CY 2006 PFS proposed rule (70 opinion as to whether diagnostic items and services that may qualify for
FR 45764), we sought public comments nuclear medicine is a subset of the exceptions in § 411.355(g) (regarding
on a proposal to amend the definitions radiology, it is an imaging service EPO and other dialysis-related
of ‘‘radiation and certain other imaging covered by 1861(s)(3) of the Act, and of outpatient prescription drugs furnished
services’’ and ‘‘radiation therapy the type for which the Congress in or by an ESRD facility) and in
services and supplies’’ at § 411.351 to intended to prohibit referrals. § 411.355(h) (regarding preventive
include nuclear medicine services and C. Annual Update to the Code List screening tests, immunizations and
supplies. In the CY 2006 PFS final rule vaccines).
with comment (70 FR 70116), we 1. Background The additions specified in Table 18
finalized the proposal and provided a In § 411.351, we specify that the generally reflect new CPT and HCPCS
delayed effective date of January 1, 2007 entire scope of four DHS categories is codes that become effective January 1,
for the new provisions. We included a defined in a list of CPT/HCPCS codes 2007, or that became effective since our
list of the nuclear medicine CPT and (the Code List), which is updated last update. Although we included
HCPCS codes in Table 31 and annually to account for changes in the nuclear medicine codes in Addendum H
Addendum H of the CY 2006 PFS final most recent CPT and HCPCS of the CY 2006 PFS final rule, we are
rule with comment (70 FR 70290 publications. The DHS categories including them as additions in Table 18
through 70295 and 70472 through defined and updated in this manner are: since they will become effective January
70476). • Clinical laboratory services. 1, 2007. In addition, Table 18 also
In response to the CY 2006 PFS final • Physical therapy, occupational reflects our decision to move several
rule with comment period, we received therapy, and speech-language pathology nuclear medicine procedures that had
public comments from three services. been added last year to the DHS
organizations regarding the nuclear • Radiology and certain other imaging category of ‘‘radiology and certain other
medicine issue. Because we had services. imaging services’’ (but not effective
previously provided an opportunity for • Radiation therapy services and until January 1, 2007) to the category of
comment on the proposal in accordance supplies. ‘‘clinical laboratory services.’’ We
determined that the following CPT TABLE 18.—ADDITIONS TO THE PHYSI- TABLE 18.—ADDITIONS TO THE PHYSI-
codes do not involve imaging services CIAN SELF-REFERRAL LIST OF CIAN SELF-REFERRAL LIST OF
and are categorized more appropriately CPT 1/HCPCS CODES—Continued CPT 1/HCPCS CODES—Continued
as clinical laboratory services: 78110,
78111, 78120, 78121, 78122, 78130, 0150T ................... Ccta w/wo, disease strxr. 78414 ................... Non-imaging heart function.
0151T ................... Ct heart funct add-on. 78428 ................... Cardiac shunt imaging.
78191, 78270, 78271, 78272 and 78725. 0159T ................... Cad breast mri. 78445 ................... Vascular flow imaging.
We are also adding CPT code 86960 to 0174T ................... Cad crx with interp. 78456 ................... Acute venous thrombus image.
the excluded portion of the ‘‘clinical 0175T ................... Cad crx remote. 78457 ................... Venous thrombosis imaging.
laboratory services’’ category. 70554 ................... Fmri brain by tech. 78458 ................... Ven thrombosis images, bilat.
70555 ................... Fmri brain by phys/psych. 78459 ................... Heart muscle imaging (PET).
Additionally, we are adding several 76776 ................... Us exam k transpl w/Doppler. 78460 ................... Heart muscle blood, single.
HCPCS codes for radiopharmaceuticals 77014 ................... Ct scan for therapy guide. 78461 ................... Heart muscle blood, multiple.
and high osmolar contrast materials to 77051 ................... Computer dx mammogram 78464 ................... Heart image (3d), single.
the category of ‘‘radiology of and certain add-on. 78465 ................... Heart image (3d), multiple.
77052 ................... Comp screen mammogram 78466 ................... Heart infarct image.
other imaging services. We add-on. 78468 ................... Heart infarct image (ef).
inadvertently omitted these codes in 77055 ................... Mammogram, one breast. 78469 ................... Heart infarct image (3D).
Addendum H of the CY 2006 PFS final 77056 ................... Mammogram, both breasts. 78472 ................... Gated heart, planar, single.
77057 ................... Mammogram, screening. 78473 ................... Gated heart, multiple.
rule with comment. 77058 ................... Mri, one breast. 78478 ................... Heart wall motion add-on.
Table 19 reflects the deletions 77059 ................... Mri, both breasts. 78480 ................... Heart function add-on.
necessary to conform the Code List to 77071 ................... X-ray stress view. 78481 ................... Heart first pass, single.
the most recent publications of CPT and 77072 ................... X-rays for bone age. 78483 ................... Heart first pass, multiple.
HCPCS. It also reflects our decision to 77073 ................... X-rays, bone length studies. 78491 ................... Heart image (pet), single.
77074 ................... X-rays, bone survey, limited. 78492 ................... Heart image (pet), multiple.
delete certain nuclear medicine services 77075 ................... X-rays, bone survey complete. 78494 ................... Heart image, spect.
(CPT codes 78110, 78111, 78120, 78121, 77076 ................... X-rays, bone survey, infant. 78496 ................... Heart first pass add-on.
78122, 78130, 78191, 78270, 78271, 77077 ................... Joint survey, single view. 78499 ................... Cardiovascular nuclear exam.
77078 ................... Ct bone density, axial. 78580 ................... Lung perfusion imaging.
78272 and 78725) from the category of 77079 ................... Ct bone density, peripheral. 78584 ................... Lung V/Q image single breath.
‘‘radiology and certain other imaging 77080 ................... Dxa bone density, axial. 78585 ................... Lung V/Q imaging.
services’’ and to move them to the more 77081 ................... Dxa bone density/peripheral. 78586 ................... Aerosol lung image, single.
appropriate category of ‘‘clinical 77082 ................... Dxa bone density, vert fx. 78587 ................... Aerosol lung image, multiple.
77083 ................... Radiographic absorptiometry. 78588 ................... Perfusion lung image.
laboratory services.’’ 77084 ................... Magnetic image, bone marrow. 78591 ................... Vent image, 1 breath, 1 proj.
We will consider comments regarding 78000 ................... Thyroid, single uptake. 78593 ................... Vent image, 1 proj, gas.
the codes listed in Tables 18 and 19 and 78001 ................... Thyroid, multiple uptakes. 78594 ................... Vent image, mult proj, gas.
the addition on Addendum J of CPT 78003 ................... Thyroid suppress/stimul. 78596 ................... Lung differential function.
78006 ................... Thyroid imaging with uptake. 78599 ................... Respiratory nuclear exam.
code 86960 to the list of CPT codes in 78007 ................... Thyroid image, mult uptakes. 78600 ................... Brain imaging, ltd static.
the 80000 series that are excluded from 78010 ................... Thyroid imaging. 78601 ................... Brain imaging, ltd w/flow.
the definition of ‘‘clinical laboratory 78011 ................... Thyroid imaging with flow. 78605 ................... Brain imaging, complete.
services.’’ Comments will be considered 78015 ................... Thyroid met imaging. 78606 ................... Brain imaging, compl w/flow.
78016 ................... Thyroid met imaging/studies. 78607 ................... Brain imaging (3D).
if we receive them by the date specified 78018 ................... Thyroid met imaging, body. 78608 ................... Brain imaging (PET).
in the DATES section of this final rule 78020 ................... Thyroid met uptake. 78609 ................... Brain imaging (PET).
with comment. We will not consider 78070 ................... Parathyroid nuclear imaging. 78610 ................... Brain flow imaging only.
any comment that advocates a 78075 ................... Adrenal nuclear imaging. 78615 ................... Cerebral vascular flow image.
78099 ................... Endocrine nuclear procedure. 78630 ................... Cerebrospinal fluid scan.
substantive change to any of the DHS 78102 ................... Bone marrow imaging, ltd. 78635 ................... CSF ventriculography.
defined in § 411.351. 78103 ................... Bone marrow imaging, mult. 78645 ................... CSF shunt evaluation.
78104 ................... Bone marrow imaging, body. 78647 ................... Cerebrospinal fluid scan.
TABLE 18.—ADDITIONS TO THE PHYSI- 78135 ................... Red cell survival kinetics. 78650 ................... CSF leakage imaging.
78140 ................... Red cell sequestration. 78660 ................... Nuclear exam of tear flow.
CIAN SELF-REFERRAL LIST OF 78185 ................... Spleen imaging. 78699 ................... Nervous system nuclear exam.
CPT 1/HCPCS CODES 78190 ................... Platelet survival, kinetics. 78700 ................... Kidney imaging, morphol.
78195 ................... Lymph system imaging. 78701 ................... Kidney imaging with flow.
CLINICAL LABORATORY SERVICES 78199 ................... Blood/lymph nuclear exam. 78707 ................... K flow/funct image w/o drug.
78201 ................... Liver imaging. 78708 ................... K flow/funct image w/drug.
78110 ................... Plasma volume, single. 78202 ................... Liver imaging with flow. 78709 ................... K flow/funct image, multiple.
78111 ................... Plasma volume, multiple. 78205 ................... Liver imaging (3D). 78710 ................... Kidney imaging (3D).
78120 ................... Red cell mass, single. 78206 ................... Liver image (3D) with flow. 78730 ................... Urinary bladder retention.
78121 ................... Red cell mass, multiple. 78215 ................... Liver and spleen imaging. 78740 ................... Ureteral reflux study.
78122 ................... Blood volume.
78216 ................... Liver & spleen image/flow. 78761 ................... Testicular imaging w/flow.
78130 ................... Red cell survival study.
78220 ................... Liver function study. 78799 ................... Genitourinary nuclear exam.
78191 ................... Pylatelet survival.
78223 ................... Hepatobiliary imaging. 78800 ................... Tumor imaging, limited area.
78270 ................... Vit B-12 absorption exam.
78230 ................... Salivary gland imaging. 78801 ................... Tumor imaging, mult area.
78271 ................... Vit B-12 absrp exam, int fac.
78272 ................... Vit B-12 absorp, combined. 78231 ................... Serial salivary imaging. 78802 ................... Tumor imaging, whole body.
78725 ................... Kidney function study. 78232 ................... Salivary gland function exam. 78803 ................... Tumor imaging (3D).
G0394 .................. Blood occult test colorectal. 78258 ................... Esophageal motility study. 78804 ................... Tumor imaging, whole body.
78261 ................... Gastric mucosa imaging. 78805 ................... Abscess imaging, ltd area.
PHYSICAL THERAPY, OCCUPATIONAL THER- 78262 ................... Gastroesophageal reflux exam. 78806 ................... Abscess imaging, whole body.
APY, AND SPEECH-LANGUAGE PATHOLOGY 78264 ................... Gastric emptying study. 78807 ................... Nuclear localization/abscess.
SERVICES 78278 ................... Acute GI blood loss imaging. 78811 ................... Tumor imaging (pet), limited.
[No additions]. 78282 ................... GI protein loss exam. 78812 ................... Tumor image (pet)/skull-thigh.
78290 ................... Meckel’s divert exam. 78813 ................... Tumor image (pet) full body.
RADIOLOGY AND CERTAIN OTHER IMAGING 78291 ................... Leveen/shunt patency exam. 78814 ................... Tumor image pet/ct, limited.
SERVICES 78299 ................... GI nuclear procedure. 78815 ................... Tumorimage pet/ct skull-thigh.
0144T ................... Ct heart wo dye; qual calc. 78300 ................... Bone imaging, limited area. 78816 ................... Tumor image pet/ct full body.
0145T ................... Ct heart w/wo dye funct. 78305 ................... Bone imaging, multiple areas. 78890 ................... Nuclear medicine data proc.
0146T ................... Ccta w/wo dye. 78306 ................... Bone imaging, whole body. 78891 ................... Nuclear med data proc.
0147T ................... Ccta w/wo, quan calcium. 78315 ................... Bone imaging, 3 phase. 78999 ................... Nuclear diagnostic exam.
0148T ................... Ccta w/wo, strxr. 78320 ................... Bone imaging (3D). 91111 ................... Esophageal capsule endos-
0149T ................... Ccta w/wo, strxr quan calc. 78399 ................... Musculosketal nuclear exam. copy.
TABLE 18.—ADDITIONS TO THE PHYSI- TABLE 18.—ADDITIONS TO THE PHYSI- TABLE 19.—DELETIONS TO THE PHYSI-
CIAN SELF-REFERRAL LIST OF CIAN SELF-REFERRAL LIST OF CIAN SELF-REFERRAL LIST OF
CPT 1/HCPCS CODES—Continued CPT 1/HCPCS CODES—Continued CPT 1/HCPCS CODES—Continued
A4641 ................... Radiopharm dx agent. RADIATION THERAPY SERVICES AND SUPPLIES 76093 ...................
Magnetic image, breast.
A4642 ................... In111 satumomab. 76094 ...................
Magnetic image, both breasts.
55875 ................... Transperi needle place, pros.
A9500 ................... Tc99m sestamibi. 76370 ...................
Ct scan for therapy guide.
55876 ................... Place rt device/marker, pros.
A9502 ................... Tc99m tetrofosmin. 76400 ...................
Magnetic image, bone marrow.
77371 ................... Srs, multisource.
A9503 ................... Tc99m medronate. 76778 ...................
Us exam kidney transplant.
77372 ................... Srs, linear based.
A9504 ................... Tc99m apcitide. 78110 ...................
Plasma volume, single.
77373 ................... Sbrt delivery.
A9505 ................... TL201 thallium. 78111 ...................
Plasma volume, multiple.
77435 ................... Sbrt management.
A9507 ................... In111 capromab. 78120 ...................
Red cell mass, single.
79005 ................... Nuclear rx, oral admin.
A9508 ................... I131 iodobenguate, dx. 78121 ...................
Red cell mass, multiple.
79101 ................... Nuclear rx, iv admin.
A9510 ................... Tc99m disofenin. 78122 ...................
Blood volume.
79200 ................... Nuclear rx, intracav admin.
A9512 ................... Tc99m pertechnetate. 78130 ...................
Red cell survival study.
79300 ................... Nuclr rx, interstit colloid.
A9516 ................... I123 iodide cap, dx. 78191 ...................
Platelet survival.
79403 ................... Hematopoietic nuclear tx.
A9521 ................... Tc99m exametazime. 78270 ...................
Vit B-12 absorption exam.
79440 ................... Nuclear rx, intra-articular.
A9524 ................... I131 serum albumin, dx. 78271 ...................
Vit B-12 absrp exam, int fac.
79445 ................... Nuclear rx, intra-arterial.
A9526 ................... Nitrogen N–13 ammonia. 78272 ...................
Vit B-12 absorp, combined.
79999 ................... Nuclear medicine therapy.
A9528 ................... Iodine I131 iodide cap, dx. 78704 ...................
Imaging renogram.
92974 ................... Cath place, cardio brachytx.
A9529 ................... I131 iodide sol, dx. 78715 ...................
Renal vascular flow exam.
A9517 ................... I131 iodide cap, rx.
A9531 ................... I131 max 100uCi. 78725 ...................
Kidney function study.
A9527 ................... Iodine I–125 sodium iodide.
A9532 ................... I125 serum albumin, dx. 78760 ...................
Testicular imaging.
A9530 ................... I131 iodide sol, rx.
A9536 ................... Tc99m depreotide. A9511 ...................
Technetium TC 99m
A9543 ................... Y90 ibritumomab, rx.
A9537 ................... Tc99m mebrofenin. depreotide.
A9545 ................... I131 tositumomab, rx.
A9538 ................... Tc99m pyrophosphate. A9513 ................... Technetium tc-99m mebrofenin.
A9563 ................... P32 Na phosphate.
A9539 ................... Tc99m pentetate. A9514 ................... Technetium tc-99m
A9564 ................... P32 chromic phosphate.
A9540 ................... Tc99m MAA. pyrophosphate.
A9600 ................... Sr89 strontium.
A9541 ................... Tc99m sulfur colloid. A9515 ................... Technetium tc-99m pentetate.
A9605 ................... Sm 153 lexidronm.
A9542 ................... In111 ibritumomab, dx. A9519 ................... Technetiumtc-99m macroag
A9699 ................... Radiopharm rx agent noc.
A9544 ................... I131 tositumomab, dx. albu.
Q3001 .................. Brachytherapy Radioelements.
A9546 ................... CO57/58. A9520 ................... Technetiumtc-99m sulfur clld.
A9547 ................... In111 oxyquinoline. DRUGS USED BY PATIENTS UNDERGOING A9522 ................... Indium111ibritumomabtiuxetan.
A9548 ................... In111 pentetate. DIALYSIS A9533 ................... I131 tositumomab diagnostic.
A9550 ................... Tc99m gluceptate. Q4081 .................. Epoetin alfa, 100 units ESRD. Q3000 .................. Rubidium RB–82.
A9551 ................... Tc99m succimer. Q3002 .................. Gallium ga 67.
PREVENTIVE SCREENING TESTS,
A9552 ................... F18 fdg. Q3003 .................. Technetium tc99m bicisate.
IMMUNIZATIONS AND VACCINES
A9553 ................... Cr51 chromate. Q3004 .................. Xenon xe 133.
A9554 ................... I125 iothalamate, dx. 77052 ................... Comp screen mammogram Q3005 .................. Technetium tc99m mertiatide.
A9555 ................... Rb82 rubidium. add-on. Q3006 .................. Technetium tc99m glucepatate.
A9556 ................... Ga67 gallium. 77057 ................... Mammogram, screening. Q3007 .................. Sodium phosphate p32.
A9557 ................... Tc99m bicisate. 82270 ................... Occult blood, feces. Q3008 .................. Indium 111-in pentetreotide.
A9558 ................... Xe133 xenon 10mci. 90660 ................... Flu vaccine, nasal. Q3009 .................. Technetium tc99m oxidronate.
A9559 ................... Co57 cyano. G0389 .................. Ultrasound exam AAA screen. Q3010 .................. Technetium tc99mlabeledrbcs.
A9560 ................... Tc99m labeled rbc. 1 CPT codes and descriptions only are copy- Q3011 .................. Chromic phosphate p32.
A9561 ................... Tc99m oxidronate. Q3012 .................. Cyanocobalamin cobalt co57.
A9562 ................... Tc99m mertiatide. right 2006 AMA. All rights are reserved and ap-
plicable FARS/DFARS clauses apply. RADIATION THERAPY SERVICES AND SUPPLIES
A9565 ................... In111 pentetreotide.
A9566 ................... Tc99m fanolesomab. 0082T ................... Stereotactic rad delivery.
A9567 ................... Technetium TC-99m. TABLE 19.—DELETIONS TO THE PHYSI- 0083T ................... Stereotactic rad tx mngmt.
A9568 ................... Tc99m arcitumomab. 55859 ................... Percut/needle insert, pros.
A9700 ................... Echocardiography contrast.
CIAN SELF-REFERRAL LIST OF A9523 ................... Yttrium90ibritumomabtiuxetan.
G0389 .................. Ultrasound exam AAA screen. CPT 1/HCPCS CODES A9532 ................... I125 serum albumin, dx.
Q9945 .................. LOCM<=149mg/ml iodine, 1 ml. A9534 ................... I131 tositumomab therapeut.
Q9946 .................. LOCM 150–199mg/ml iodine, CLINICAL LABORATORY SERVICES Q3007 .................. Sodium phosphate p32.
1ml. Q3011 .................. Chromic phosphate p32.
G0107 .................. CA screen; fecal blood test.
Q9947 .................. LOCM 200–249mg/ml iodine, DRUGS USED BY PATIENTS UNDERGOING
1ml. PHYSICAL THERAPY, OCCUPATIONAL THER- DIALYSIS
Q9948 .................. LOCM 250–299mg/ml/iodine, APY, AND SPEECH-LANGUAGE PATHOLOGY
SERVICES J0886 ................... Epoetin alfa, esrd.
1ml.
Q9949 .................. LOCM 300–349mg/ml iodine, PREVENTIVE SCREENING TESTS,
[No deletions]. IMMUNIZATIONS AND VACCINES
1ml.
Q9950 .................. LOCM 350–399mg/ml iodine, RADIOLOGY AND CERTAIN OTHER IMAGING 76083 ................... Computer mammogram add-
1ml. SERVICES on.
Q9951 .................. LOCM>=400 mg/ml iodine, 1ml. 76006 ................... X-ray stress view. 76092 ................... Mammogram, screening.
Q9952 .................. Inj Gad-base MR contrast, ml. 76020 ................... X-rays for bone age. G0107 .................. CA screen; fecal blood test.
Q9953 .................. Inj Fe-base MR contrast, ml. 76040 ................... X-rays, bone evaluation.
1 CPT codes and descriptions only are copy-
Q9954 .................. Oral MR contrast, 100 ml. 76061 ................... X-rays, bone survey.
Q9955 .................. Inj perflexane lip micros, ml. 76062 ................... X-rays, bone survey. right 2006 AMA. All rights are reserved and ap-
Q9956 .................. Inj octafluoropropane mic, ml. 76065 ................... X-rays, bone evaluation. plicable FARS/DFARS clauses apply.
Q9957 .................. Inj perflutren lip micros, ml. 76066 ................... Joint survey, single view.
Q9958 .................. HOCM <=149mg/ml iodine, 76070 ................... Ct bone density, axial. VII. Physician Fee Schedule Update for
1ml. 76071 ................... Ct bone density, peripheral. CY 2007
Q9959 .................. HOCM 150–199mg/ml iodine, 76075 ................... Dxa bone density, axial.
1ml. 76076 ................... Dxa bone density/peripheral. A. Physician Fee Schedule Update
Q9960 .................. HOCM 200–249mg/ml iodine, 76077 ................... Dxa bone density/v-fracture.
1ml. 76078 ................... Radiographic absorptiometry.
The PFS update is determined using
Q9961 .................. HOCM 250–299mg/ml iodine, 76082 ................... Computer mammogram add- a formula specified by statute. Under
1ml. on. section 1848(d)(4) of the Act, the update
Q9962 .................. HOCM 300–349mg/ml iodine, 76083 ................... Computer mammogram add- is equal to the product of 1 plus the
1ml. on.
Q9963 .................. HOCM 350–399mg/ml iodine, 76090 ................... Mammogram, one breast.
percentage increase in the MEI (divided
1ml. 76091 ................... Mammogram, both breasts. by 100) and 1 plus the UAF. For CY
Q9964 .................. HOCM>= 400mg/ml iodine, 76092 ................... Mammogram, screening. 2007, the MEI is equal to 2.1 percent
1ml.
(1.021). The UAF is ¥7.0 percent The physician’s own time component other expenses. The components are
(0.930). The product of the MEI (1.021) represents the net income portion of adjusted to reflect productivity growth
and the UAF (0.930) equals the CY 2007 business receipts and primarily reflects in physicians’ offices by the 10-year
update of ¥5.0 percent (0.94953). the input of the physician’s own time moving average of productivity in the
Our calculations of these figures are into the production of physicians’ private nonfarm business sector. Table
explained in this section. services in physicians’ offices. This 20 presents a listing of the MEI cost
category consists of two categories with associated weights and
B. The Percentage Change in the subcomponents: (1) Wages and salaries; percent changes for price proxies for the
Medicare Economic Index (MEI) and (2) fringe benefits. 2007 update. For CY 2007, the increase
The physician’s PE category in the MEI is 2.1 percent, which
The MEI measures the weighted- represents nonphysician inputs used in includes a 1.3 percent productivity
average annual price change for various the production of services in physicians’ offset based on the 10-year moving
inputs needed to produce physicians’ offices. This category consists of wages average of multifactor productivity. This
services. The MEI is a fixed-weight and salaries and fringe benefits for is the result of a 3.3 percent increase in
input price index, with an adjustment nonphysician staff and other nonlabor physician’s own time and a 3.6 percent
for the change in economy-wide inputs. The physician’s PE component increase in physician’s PE. Within the
multifactor productivity. This index, also includes the following categories of physician’s PE, the largest increase
which has CY 2000 base year weights, nonlabor inputs: Office expense; occurred in professional liability
is comprised of two broad categories: medical materials and supplies; insurance, which increased 6.9 percent,
(1) Physician’s own time; and (2) professional liability insurance; medical and prescription drugs, which increased
physician’s PE. equipment; prescription drugs; and 7.7 percent.
TABLE 20.—INCREASE IN THE MEDICARE ECONOMIC INDEX UPDATE FOR CY 2007 1

CY 2007
CY 2000
Cost categories and price measures percent
weights 2 changes
Medicare Economic Index Total, productivity adjusted 3 ................................................................................................. N/A 2.1

Productivity: 10-year moving average of multifactor productivity, private nonfarm business sector 3, 4 .......... N/A 1.3
Medicare Economic Index Total, without productivity adjustment 4 ................................................................................ 100.000 3.5
1. Physician’s Own Time 5 ........................................................................................................................................ 52.466 3.3
a. Wages and Salaries: Average Hourly Earnings, private nonfarm ....................................................................... 42.730 3.3
Fringe Benefits: Employment Cost Index, benefits, private nonfarm ............................................................... 9.735 3.5
2. Physician’s Practice Expense 5 ............................................................................................................................ 47.534 3.6
a. Nonphysician Employee Compensation .............................................................................................................. 18.653 2.9
(1) Wages and Salaries: Employment Cost Index, wages and salaries, weighted by occupation .................. 13.808 2.6
(2) Fringe Benefits: Employment Cost Index, fringe benefits, white collar ...................................................... 4.845 4.0
b. Office Expense: Consumer Price Index for Urban Areas (CPI–U), housing ....................................................... 12.209 3.7
c. Drugs and Medical Materials and Supplies ......................................................................................................... 4.319 4.8
(1) Medical Materials and Supplies: Producer Price Index (PPI), surgical appliances and supplies/CPI–U,
medical equipment and supplies (equally weighted) .................................................................................... 2.011 1.1
(2) Pharmaceuticals: Producer Price Index (PPI ethical prescription drugs) ................................................... 2.308 7.7
d. Professional Liability Insurance: Professional liability insurance Premiums 6 ..................................................... 3.865 6.9
e. Medical Equipment: PPI, medical instruments and equipment ........................................................................... 2.055 ¥0.1
f. Other Expenses ..................................................................................................................................................... 6.433 2.2
1. The rates of historical change are estimated for the 12-month period ending June 30, 2006, which is the period used for computing the CY
2007 update. The price proxy values are based upon the latest available Bureau of Labor Statistics data as of August 31, 2006.
2. 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 physi-
cians’ services.
3. These numbers may not sum due to rounding and the multiplicative nature of their relationship.
4. On March 23, 2006, Bureau of Labor Statistics introduced a new Multi Factor Productivity (MFP) series based on the 1997 NAICS classi-
fication 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
2004) to develop the productivity adjustment for the CY 2007 update.
5. 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 http://stats.bls.gov.
6. Derived from data collected from several major insurers (the latest available historical percent change data are for the period ending second
quarter of 2006).
Comment: Several commenters violation of the APA. The APA requires rules. The CY 2003 final rule adopted
believe we are in violation of the us to propose and solicit comments on the use of BLS’ private nonfarm
Administrative Procedures Act (APA) substantive changes to our payment business multifactor productivity (MFP)
for not proposing and soliciting methodology. The PFS update as the official data used to adjust the
comments on the incorporation of new published in this year’s proposed rule is MEI for productivity. Specifically,
Bureau of Labor Statistics Multifactor based on the same MEI methodology consistent with the proposal made in
Productivity data in the MEI. proposed and adopted in the CY 2003 the CY 2003 proposed rule (67 FR
Response: We disagree with the and CY 2004 PFS proposed and final 43860), the CY 2003 final rule (67 FR
commenters’ claim that we are in
80023) states ‘‘Thus, the productivity is necessary to account for these by physicians for 2000, which would
adjustment will be based on the latest efficiencies to accurately reflect the net reflect changes in the distributions of
available actual historical economy- inflationary pressures encountered by the cost weights associated with the
wide multifactor productivity data, as physicians. government-imposed regulatory
measured by the BLS.’’ For the CY 2007 The intent of the MEI is to represent requirements that applied in 2000. The
proposed rule, we followed this industry-wide output prices for 2000-based cost weights are derived
methodology and incorporated the latest physicians’ services. We note that this from the 2003 AMA Physician
available BLS private nonfarm business index structure is similar to the CPI, Socioeconomic Characteristics
multifactor productivity. which is an economy-wide output price publication (2003 Patient Care
Comment: Several commenters index. The CPI implicitly incorporates a Physician Survey data), which measures
believe the multifactor productivity productivity adjustment. Except when physicians’ earnings and overall PEs for
estimate of 1.3 percent is high in light the statute directs otherwise, the 2000. This is the latest available AMA
of the new Medicare initiatives such as Medicare update for a number of types data on physician expenses. We are
the new Welcome to Medicare benefits, of services (for example, clinical currently researching alternative data
the new comprehensive Part D benefit, diagnostic laboratory services, durable sources for rebasing the MEI.
and compliance related to the Physician medical equipment, prosthetics and Regarding skill mix, the current MEI
Voluntary Reporting Program (PVRP), supplies) is based the CPI with its uses the occupation mix for
which impose numerous time and implicit productivity adjustment. nonphysician wages from the 2000
paperwork burdens on physicians. With respect to updates for other Current Population Survey published by
Response: Our proposed and adopted types of Medicare providers, such as BLS. This reflected the latest occupation
methodology for calculating the MEI institutional providers, we note that the mix at the time of our most recent
utilizes BLS’s private nonfarm business underlying payment methodology is rebasing. We recognize that skill mix
MFP as the proxy for productivity completely different from the payment can change, thus, we will continue to
changes. We recognize that productivity system for physicians’ services. Under use the most recently published data
in physicians’ offices for a given year the Medicare PFS, payments are made available to us for all future rebasings to
may not equate to that of the economy- for unbundled services such as lab tests, ensure the MEI reflects the occupational
wide measure. For that reason, as well follow-up visits, and x-rays. For blend at that time.
as to remove the effect of normal institutions compensated by a PPS, a
Comment: Many commenters objected
business cycles, we employ a 10-year single payment is made for a bundle of
to the 0.5 percentage point reduction of
moving average as the official measure. services linked to treating a particular
the 2007 PFS update relative to the
Also, CMS, in conjunction with the category of case (for instance, the
forecasted update in the President’s
Assistant Secretary for Planning and services within one diagnosis-related
Evaluation, is in the process of group under the IPPS). Adjustments to Budget and urged us to delay or
conducting a study on productivity in payments associated with productivity withdraw any changes in the MEI until
the physicians’ offices. This work is and other payment framework-related the proposed changes and the
being done to determine if the considerations, when paying for solicitation of public comments appear
presently-used economy-wide measure bundled services, are addressed in other in a published Federal Register.
for multi-factor productivity provides a portions of the update process, such as Response: As stated previously, we
reasonable target for physicians. We will via MedPAC recommendations and/or did not make any methodological
analyze the results from this study and in the update itself when approved by changes to the calculation of the MEI,
carefully evaluate its findings and their the Congress. and therefore, it is not necessary to
applicability to future MEI updates. Comment: Several commenters delay use of the MFP-adjusted MEI in
Comment: Several commenters requested that we examine and address order to solicit and respond to public
believe it is not warranted that we the broader problem that the MEI only comments. As we indicated in the 2003
assume and calculate increased measures changes in specific types of and 2004 physician fee schedule
productivity levels for physicians while practice costs that existed in 1973. They proposed and final rules, we are using
the payment update process for other further stated that inputs to the MEI are the latest-available historical data in the
providers does not include assumed or vastly different now than when the MEI calculation of the MEI applicable to a
automatic productivity adjustments. was first developed in the early 1970s year. As such, we are not required to
Response: Since its inception in the and that an array of government- propose or solicit public comments on
mid-1970’s, the MEI has included a imposed regulatory requirements now changes in the MEI that result from use
productivity adjustment. The payment exist that did not in 1973. They claim of latest available data. The inclusion of
system for physicians’ services requires that physician practice costs for these more recent, historical MFP data in the
that factors affecting the payment types of inputs are not currently taken MEI reflects our adopted methodology
update be reflected in the update into account for purposes of measuring as finalized in the CY 2003 PFS final
formula itself. The statutory provision the MEI, and therefore, the MEI rule which states the MEI ‘‘productivity
relating to the MEI contemplates that undervalues actual medical cost adjustment will be based on the latest
the Secretary would not increase increases. One commenter added that available actual historical economy-
payments except to the extent that the employee wages used in the MEI wide multifactor productivity data, as
extent that the Secretary finds, on the formula do not accurately reflect the measured by the BLS.’’
basis of appropriate economic index skill mix of the industry and the MEI Comment: One commenter believes
data, that such higher level is justified needs to be updated to account for the that there are alternative measures of
by year-to-year economic changes. We highly skilled staff necessary to deliver multifactor productivity available from
have long maintained that an MEI today’s level of medical care service. BLS and the Census Bureau. The
framework that focuses solely on the Response: We disagree with the commenter states that we should
inputs portion of the equation commenter’s claim that the MEI only identify and consider these alternatives
effectively ignores the efficiencies that measures changes in specific types of and seek public comment before
are employed to produce the outputs practice costs that existed in 1973. The changing the data used to calculate the
associated with the provision of care. It current MEI is based on costs reported MEI.
Response: In the CY 2003 PFS final years there has been extensive + Multiplying that quotient by 0.75.
rule, we presented the research we had discussion of the upcoming year’s MEI • Cumulative Adjustment
completed on evaluating the most update in the proposed rule. With the Component. An amount determined
appropriate productivity adjustment for exception of those updates that include by—
the MEI. This research included an a rebased and revised MEI, a detailed + Computing the difference (which
evaluation of all currently available discussion, as well as the percent may be positive or negative) between
productivity estimates produced by BLS changes in the MEI cost categories, has the amount of the allowed expenditures
to develop a better understanding of the been provided only in the final rule. for physicians’ services from April 1,
strengths and weaknesses of these When we rebase and revise the MEI, we 1996, through the end of the prior year
measures. It also included a review of do include extensive discussion on the and the amount of the actual
the theoretical foundation of the MEI to MEI and solicit comments on proposed expenditures for those services during
develop a better understanding of how methodological changes. Given the that period;
labor and multifactor productivity relate historical precedent, we disagree with + Dividing that difference by actual
to the current physician payment the commenter’s suggestion that we expenditures for those services for the
system. Additionally, we studied the were hiding any revision in the MEI. prior year as increased by the SGR for
sparse and fragmented publicly- C. The Update Adjustment Factor (UAF) the year for which the UAF is to be
available data to begin to develop determined; and
preliminary estimates of trends in Section 1848(d) of the Act provides
+ Multiplying that quotient by 0.33.
physician specific productivity to better that the PFS update is equal to the
Section 1848(d)(4)(E) of the Act
understand the current market product of the MEI and the UAF. The
requires the Secretary to recalculate
conditions facing physicians. For a list UAF is applied to make actual and
allowed expenditures consistent with
of the experts that participated in this target expenditures (referred to in the
section 1848(f)(3) of the Act. Section
analysis, as well as a full description of statute as ‘‘allowed expenditures’’)
1848(f)(3) specifies that the SGR (and, in
the options that were identified and equal. Allowed expenditures are equal
turn, allowed expenditures) for the
evaluated (67 FR 80019). to actual expenditures in a base period
upcoming CY (2007 in this case), the
As stated earlier, CMS and ASPE are updated each year by the SGR. The SGR
current CY (2006) and the preceding CY
jointly sponsoring a study of physicians’ sets the annual rate of growth in
(2005) are to be determined on the basis
office productivity. We will be allowed expenditures and is determined
of the best data available as of
evaluating the results of that study to by a formula specified in section 1848(f)
September 1 of the current year.
determine if the use of BLS’s private of the Act.
Allowed expenditures are initially
nonfarm business MFP is a reasonable 1. Calculation Under Current Law estimated and subsequently revised
target for physicians to achieve. Under section 1848(d)(4)(B) of the twice. The second revision occurs after
Comment: Several commenters claim Act, the UAF for a year beginning with the CY has ended (that is, we are
that in previous years, there have been 2001 is equal to the sum of the making the final revision to 2005
extensive discussions in the proposed following— allowed expenditures in this final rule
rule of the upcoming year’s update and • Prior Year Adjustment Component. with comment). Once the SGR and
the MEI. They further state that based An amount determined by— allowed expenditures for a year have
on the impact table in the CY 2007 + Computing the difference (which been revised twice, they are final.
proposed rule, a –0.5 percent percentage may be positive or negative) between Table 21 shows annual and
point reduction in the update will result the amount of the allowed expenditures cumulative allowed expenditures for
in a $375 million cut in physician for physicians’ services for the prior physicians’ services from April 1, 1996
payments in 2007. One commenter year (the year prior to the year for which through the end of the current CY,
claimed that our actions this year, in the update is being determined) and the including the transition period to a CY
contrast to previous years, suggest we amount of the actual expenditures for system that occurred in 1999. Also
are attempting to hide the revision in those services for that year; shown is the SGR corresponding with
the MEI for CY 2007. + Dividing that difference by the each period. The calculation of the SGR
Response: We disagree with the amount of the actual expenditures for is discussed in detail below in this
commenters’ claim that in previous those services for that year; and section.
TABLE 21.—ANNUAL AND CUMULATIVE ALLOWED AND ACTUAL EXPENDITURES FOR PHYSICIANS’ SERVICES FROM APRIL 1,
1996 THROUGH THE END OF THE CURRENT CALENDAR YEAR
Annual Cumulative Cumulative
Annual actual
allowed ex- allowed ex- actual expend-
Period expenditures FY/CY SGR
penditures penditures itures
($ in billions)
($ in billions) ($ in billions) ($ in billions)
4/1/96–3/31/97 .................................. $48.9 $48.9 $48.9 $48.9 N/A

4/1/97–3/31/98 .................................. 50.5 49.4 99.4 98.4 FY 1998=3.2%
4/1/98–3/31/99 .................................. 52.6 50.5 152.0 148.9 FY 1999=4.2%
1/1/99–3/31/99 .................................. 13.3 13.1 (1) 148.9 FY 1999=4.2%
4/1/99–12/31/99 ................................ 42.1 39.5 (2) 188.4 FY 2000=6.9%
1/1/99–12/31/99 ................................ 55.3 52.6 194.0 188.4 FY 1999/2000 (3)
1/1/00–12/31/00 ................................ 59.4 58.1 253.4 246.5 CY 2000=7.3%
1/1/01–12/31/01 ................................ 62.0 66.3 315.4 312.8 CY 2001=4.5%

1/1/02–12/31/02 ................................ 67.2 71.0 382.6 383.7 CY 2002=8.3%
1/1/03–12/31/03 ................................ 72.1 78.2 454.6 461.9 CY 2003=7.3%
1/1/04–12/31/04 ................................ 76.8 87.1 531.5 549.0 CY 2004=6.6%
1/1/05–12/31/05 ................................ 80.0 92.0 611.5 641.0 CY 2005=4.2%
1/1/06–12/31/06 ................................ 81.7 94.9 693.3 735.9 CY 2006=2.1%
TABLE 21.—ANNUAL AND CUMULATIVE ALLOWED AND ACTUAL EXPENDITURES FOR PHYSICIANS’ SERVICES FROM APRIL 1,
1996 THROUGH THE END OF THE CURRENT CALENDAR YEAR—Continued
Annual Cumulative Cumulative
Annual actual
allowed ex- allowed ex- actual expend-
Period expenditures FY/CY SGR
penditures penditures itures
($ in billions)
($ in billions) ($ in billions) ($ in billions)
1/1/07–12/31/07 ................................ 83.2 NA 776.5 NA CY 2007=1.8%

(1) Allowedexpenditures for the first quarter of 1999 are based on the FY 1999 SGR.
(2) Allowedexpenditures for the last three quarters of 1999 are based on the FY 2000 SGR.
(3) Allowedexpenditures 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: http://www.
cms.hhs.gov/SustainableGRatesConFact/. We expect to update the web site with the most current information later this month.
Consistent with section 1848(d)(4)(E) and actual expenditures from April 1, 2006, we are using an estimate for this
of the Act, Table 21 includes our final 1996 through December 31, 2006 and period. Any difference between current
revision of allowed expenditures for the 2007 SGR. Consistent with section estimates and final figures will be taken
2005, a recalculation of allowed 1848(d)(4)(E) of the Act, we will be into account in determining the UAF for
expenditures for 2006, and our initial making revisions to the 2006 and 2007 future years.
estimate of allowed expenditures for SGRs and 2006 and 2007 allowed
We are using figures from Table 21 in
2007. To determine the UAF for 2007, expenditures. Because we have
the statute requires that we use allowed incomplete actual expenditure data for the following statutory formula:
Target 06 − Actual06 Target 4/96 −12/06 − Actual4/96 −12/06

UAF = × 0.75 + × 0.33
Actual06 Actual06 × SGR 07
UAF = Update Adjustment Factor Actual06 = Estimated Actual Expenditures for Actual 4/96–12/06 = Estimated Actual
Target06 = Allowed Expenditures for 2006 = 2006 = $94.9 billion Expenditures from 4/1/1996—12/31/
$81.7 billion Target 4/96–12/06 = Allowed Expenditures from 2006 = $735.9 billion
4/1/1996—12/31/2006 = $693.3 billion SGR 07 = 1.8 percent (1.018)
$81.7 − $94.9 $693.3 − $735.9

× .75 + × .33 = −0.250
$94.9 $94.9 × 1.018
Section 1848(d)(4)(D) of the Act based on a comparison of allowed the Act, the SGR is estimated and
indicates that the UAF determined expenditures (determined using the subsequently revised twice (beginning
under section 1848(d)(4)(B) of the Act SGR) and actual expenditures. If actual with the FY and CY 2000 SGRs) based
for a year may not be less than ¥0.070 expenditures exceed allowed on later data. (The Act also provides for
or greater than 0.03. Since ¥0.250 is expenditures, the update is reduced. If adjustments to be made to the SGRs for
less than ¥0.070, the UAF for 2006 will actual expenditures are less than FY 1998 and FY 1999. See the February
be ¥0.070. allowed expenditures, the update is 28, 2003 Federal Register (68 FR 9567)
Section 1848(d)(4)(A)(ii) of the Act increased. for a discussion of these SGRs). Under
indicates that 1.0 should be added to the Section 1848(f)(2) of the Act specifies section 1848(f)(3)(C)(ii) of the Act, there
UAF determined under section that the SGR for a year (beginning with are no further revisions to the SGR once
1848(d)(4)(B) of the Act. Thus, adding 2001) is equal to the product of the it has been estimated and subsequently
1.0 to ¥0.070 makes the UAF equal to following four factors: revised in each of the 2 years following
0.930. (1) The estimated change in fees for the preliminary estimate. In this final
VIII. Allowed Expenditures for physicians’ services; rule with comment, we are making our
Physicians’ Services and the (2) The estimated change in the preliminary estimate of the 2007 SGR, a
Sustainable Growth Rate average number of Medicare fee-for- revision to the 2006 SGR, and our final
service beneficiaries;. revision to the 2005 SGR.
A. Medicare Sustainable Growth Rate (3) The estimated projected growth in B. Physicians’ Services
The SGR is an annual growth rate that real GDP per capita; and
applies to physicians’ services paid by (4) The estimated change in Section 1848(f)(4)(A) of the Act
Medicare. The use of the SGR is expenditures due to changes in statute defines the scope of physicians’ services
intended to control growth in aggregate or regulations. covered by the SGR. The statute
ER01DE06.001</MATH>
Medicare expenditures for physicians’ In general, section 1848(f)(3) of the indicates that ‘‘the term physicians’’
services. Payments for services are not Act requires us to publish SGRs for 3 services includes other items and
withheld if the percentage increase in different time periods, no later than services (such as clinical diagnostic
actual expenditures exceeds the SGR. November 1 of each year, using the best laboratory tests and radiology services),
Rather, the PFS update, as specified in data available as of September 1 of each specified by the Secretary, that are
ER01DE06.000</MATH>
section 1848(d)(4) of the Act, is adjusted year. Under section 1848(f)(3)(C)(i) of commonly performed or furnished by a
physician or in a physician’s office, but Summary of Comments on the estimated at 2.1 percent for 2007, to
does not include services furnished to a Physician Update and the SGR update the CF.
Medicare+Choice plan enrollee.’’ We Commenters suggested that we
published a definition of physicians’ We appreciate the comments we assume the leadership in pushing the
services for use in the SGR in the received expressing concern about the Congress to enact legislation preventing
Federal Register (66 FR 55316) on negative update for 2007 and the SGR a negative update for 2007, and to
November 1, 2001. We defined formula. Those comments are replace the SGR with a more sustainable
physicians’ services to include many of summarized below, along with our system.
the medical and other health services responses. Response: We are fully cognizant of
listed in section 1861(s) of the Act. For Comment: Commenters noted that the potential implications of more than
purposes of determining allowed physicians’ costs are rising, while fees 9 years of negative physician updates.
expenditures, actual expenditures, and are being cut. Under current law, the We remain concerned regarding those
SGRs, we have specified that 2006 Medicare Trustees Report trends, and are closely monitoring
physicians’ services include the projected negative updates of about ¥5 physicians’ participation in the
following medical and other health percent for at least nine consecutive Medicare program, as well as
services if bills for the items and years. The cumulative impact of the beneficiaries’ access to care.
services are processed and paid by projected reductions from 2007 to 2015 The formula for the SGR and the
Medicare carriers (and those paid was estimated to be about ¥37 percent. physician update are dictated by statute.
through intermediaries where Because commercial insurance carriers We are required to follow this
specified): and Medicaid base their payment methodology when calculating the
• Physicians’ services. updates upon Medicare’s PFS, the payment rates under the PFS.
overall negative impact is compounded We are working closely and
• Services and supplies furnished
and affects the entire health care collaboratively with medical
incident to physicians’ services.
industry. In contrast, the MEI increase professionals and the Congress on the
• Outpatient physical therapy services most effective Medicare payment
and outpatient occupational therapy over this same period is projected to be
about 22 percent. methodologies to compensate
services. physicians for providing services to
• Antigens prepared by, or under the Commenters noted that increases in Medicare beneficiaries. We are engaging
direct supervision of, a physician. their practice costs are outpacing most physicians on issues of quality and
• Services of PAs, certified registered inflationary measures, and they performance with the goal of
nurse anesthetists, certified nurse predicted that costs to provide care will encouraging the most effective
midwives, clinical psychologists, soon exceed reimbursement. Many approaches to achieve better health
clinical social workers, NPs, and physician practices are small businesses outcomes for Medicare beneficiaries. We
certified nurse specialists. that operate on slim margins. With ever are committed to developing systems
• Screening tests for prostate cancer, increasing costs, they will not have the that enable us to encourage quality, and
colorectal cancer, and glaucoma. resources to absorb payment cuts to improve care without increasing
• Screening mammography, screening resulting from the SGR formula. The overall Medicare costs.
pap smears, and screening pelvic exams. result will be that patient quality of care Comment: Commenters requested that
• Diabetes outpatient self-management will be compromised, with doctors we implement administrative changes to
training (DSMT) services. taking drastic measures to cut costs of the SGR calculation that would prevent
• MNT services. health care delivery to remain solvent. a negative physician update for 2007.
• Diagnostic x-ray tests, diagnostic Eventually, physicians will be unable to Specifically, many commenters
laboratory tests, and other diagnostic absorb the sustained losses, and they requested that we remove the cost of
tests (including outpatient diagnostic will refuse or limit Medicare patients, Medicare-covered physician-
laboratory tests paid through resulting in reduced access to care. A administered drugs from the SGR on a
intermediaries). survey conducted by the AMA found retrospective basis. Commenters noted
• X-ray, radium, and radioactive that 45 percent of physicians will either that expenditures on these drugs
isotope therapy. stop accepting or decrease the number increased from $1.8 billion in 1996, to
• Surgical dressings, splints, casts, of new Medicare patients they accept if $8.6 billion in 2004, and was estimated
and other devices used for the reduction payments are cut for 2007. Inadequate at $8.2 billion in 2005. The commenters
of fractures and dislocations. access to care will lead to a opined that if we make the
• Bone mass measurements. deterioration in the health status of administrative changes now, worth
• An initial preventive physical Medicare beneficiaries. Beneficiaries about $100 billion, then the cost of
exam. will be forced to seek care in inpatient legislation revising the payment
• Cardiovascular screening blood settings, which will be more costly for methodology for physicians’ services
tests. Medicare, less efficient in delivering will drop, and the likelihood of
• Diabetes screening tests. care, and yield worse health outcomes Congressional action to fix the SGR
• Telehealth services. for beneficiaries. permanently will increase. Commenters
• Physician work and resources to Commenters recommended that the expressed frustration that this
establish and document the need for a SGR be replaced with an appropriate recalculation has been requested
power mobility device (70 FR 50940). inflation rate linked to changes in the numerous times, yet we have never
Telehealth services and the power actual costs of medical practice. implemented the change.
mobility device related services were Commenters cited MedPAC’s Some commenters requested that we
added because they meet the statutory recommendation to replace the SGR remove all nonphysician services from
criteria for services to be included in the with a system that reflects the increases the SGR calculation. Commenters stated
SGR (that is, these services are in practice costs and other medical that the annual spending growth of
commonly performed or furnished by a inflation variables, which would be 2.8 many nonphysician services, including
physician or in a physician’s office) (70 percent for 2007. Other commenters drugs and physical therapy, far outstrip
FR 70305). suggested using the MEI, which is the growth of physician services.
Commenters requested separate funding Comment: Commenters noted that 1861(s) of the Act. Further, we contract
pools for physician and nonphysician payment updates under the SGR are tied with Medicare carriers who may
services, each with its own respective to GDP, which bears little relationship establish local coverage decisions
targets, to calculate separate update to Medicare beneficiaries’ health care (LCDs) for items and services that have
factors for physician and nonphysician needs or physician practice costs. a statutory benefit category.
services. Commenters noted that medical needs Factor 4 of the SGR (1848(f)(2)(D))
Response: We carefully reviewed our of individual patients are not related to requires us to estimate expenditures
authority to make administrative the growth of the overall economy, and ‘‘which will result from changes in law
changes, most notably the feasibility of beneficiaries’ medical needs do not and regulations.’’ NCDs are not required
removing Part B drugs from the SGR decline during economic downturns. to be issued by regulation, and we are
baseline. We indicated in the past (most Commenters stated that MEI is a better not aware of any NCDs that have been
recently in 70 FR 70307) that reflection than GDP of the growth in issued via regulation. Although
administrative changes, such as health care costs. coverage decisions that reduce the
retrospective removal of drugs from the Response: Under section 1848(d)(4) of coverage available for certain items and
SGR, are statutorily difficult. For the Act, the PFS update is equal to the services must be published in the
example, the statute requires estimates product of the percentage increase in Federal Register, they are published as
of the SGR to be refined twice based on the MEI and the UAF. The UAF is notices. Furthermore, as indicated
actual data. We see no legal basis to re- determined by comparing allowed and above, LCDs are issued by contractors
estimate the SGR and recompute actual expenditures from prior years and are not binding on CMS or other
allowed expenditures for a year after the and the current year, and adjusting the contractors. As a result, it is unclear that
SGR has been estimated and revised update to account for the difference. we have the authority to consider NCDs
twice. Further, our current estimates are The SGR is used to calculate allowed or LCDs in our estimate of factor 4 of the
that these administrative changes, expenditures, and the GDP is one of the SGR. Furthermore, while we may
including removing drugs retroactively components used to calculate the SGR establish a national coveragae decision
from the SGR, would not provide relief as specified in section 1848(f)(2)(C) of (NCD) for a new item of service with a
to the negative updates projected for the Act. defined statutory benefit category, the
2007 and the succeeding several years. The percentage change in the MEI is NCD does not necessarily increase
As indicated above in this section, we one of the key components used to Medicare spending to the extent that the
are working with the Congress and update the PFS CF. In accounting for the service has or would have been covered
health professional organizations on weighted-average price change for at local carrier dicretion in the absence
potential reforms that would improve various inputs involved with producing of a NCD. Because Medicare might cover
the effectiveness of the payment physicians’ services, the MEI measures these services without an NCD, it is
methodology for physicians without inflation in physician practice costs and unclear whether there are any
increasing overall Medicare costs. general wage levels. Elements of the additional costs associated with the
In reference to removing all MEI include measures of physicians’ NCDs.
‘‘nonphysician services’’ from the SGR, PEs, including nonphysician employee At this time, we do not intend to
the statute provides the Secretary with compensation, office expenses, medical make any adjustment to the SGR to
clear authority to specify the services material and supplies, professional account for new NCDs. We continue to
that are included in the SGR. Section liability insurance, and medical examine the issue, but we expect that
1848(f)(4)(A) of the Act indicates that equipment. NCDs have, at most, limited impact on
the term ‘‘physicians’’ services’’ The GDP is a general measure of Medicare spending for physicians’
includes other items and services economic growth. It is not intended to services. (For a more detailed discussion
specified by the Secretary that are reflect factors specific to operating a see 70 FR 70308).
commonly performed or furnished by a medical practice because these are Comment: Commenters stated that
physician or in a physician’s office. We captured in the MEI. Currently, the additional funds need to be added to the
published a definition of physicians’ statute requires that we use the GDP as SGR allowed expenditures for all the
services for use in the SGR in the a component of the SGR, which is then ancillary costs associated with new
Federal Register (66 FR 55316) on used to calculate the target level of benefits. New benefits adjust the target,
November 1, 2001. For purposes of expenditures. Although both MEI and but they generate other services whose
determining allowed expenditures, GDP are included in the calculation of costs are not added to the targeted
actual expenditures, and SGRs, we the conversion factor, the MEI has a allowed expenditures. For example, the
defined physicians’ services to include more direct and greater impact on the new AAA ultrasound benefit may reveal
many of the medical and other health physician update than GDP. health problems that will generate
services listed in section 1861(s) of the Comment: Commenters believe that additional visits, tests, and other
Act that meet the criterion of being we continue to underestimate the services that are not reflected in the
commonly performed by a physician or impact of National and Local Coverage SGR’s legislative factor.
are services and supplies furnished Decisions on physician spending. Response: Section 1848(f)(2) of the
incident to physicians’ services. We Through these coverage decisions, we Act specifies that the SGR for a year
disagree with the comments suggesting are directly responsible for volume (beginning with 2001) is equal to the
that the Secretary should not include increases, and must adjust the SGR product of four factors. One of these
drugs and physical therapy services in target accordingly. factors is the estimated change in
the definition of physicians’ services for Response: We do not have the expenditures due to changes in statute
purposes of determining allowed authority to pay for a service lacking a or regulations. For 2007, this factor
expenditures, actual expenditures, and defined statutory benefit listed in includes the AAA ultrasound referenced
the SGR. Further, we have no authority section 1861(s) of the Act. However, we by commenters. Our estimate of changes
to create separate targets and update do have the authority to establish in expenditures arising from changes in
factors for what commenters are national coverage decisions (NCDs) for law and regulations include induced
identifying as ‘‘physician’’ and items and services that are included in spending impacts, when applicable and
‘‘nonphysician’’ services. a benefit category listed in section material. Our estimate of the additional
expenditures associated with this new legislative factor in 2005, 2006, and Overhead costs attributable to
benefit, like all of the figures used to 2007.) compliance programs do not meet the
determine the 2007 SGR, is an estimate Comment: Commenters suggested that definition of physicians’ services for
that will be revised based on subsequent CMS compliance programs, such as determining SGR allowed expenditures.
data. A 2-year look back window allows HIPAA, increased overhead expenses by
15 to 20 percent, but their costs are not C. Preliminary Estimate of the SGR for
adjustments to the estimates to reflect
included in SGR allowed expenditures. 2007
actual impacts. Any differences between
Response: The statute provides the
these estimates and the actual Our preliminary estimate of the 2007
Secretary with clear authority to specify
measurement of these figures will be SGR is 1.8 percent. We first estimated
the services that are included in the
included in future revisions of the SGR SGR. Section 1848(f)(4)(A) of the Act the 2007 SGR in March and made the
and allowed expenditures and indicates that the term ‘‘physicians’’ estimate available to the MedPAC and
incorporated into subsequent PFS services’’ includes other items and on our Web site. Table 22 shows that
updates. (See further discussion below services specified by the Secretary that March 2006 estimate and our current
for all the new benefits that adjusted the are commonly performed or furnished estimates of the factors included in the
by a physician or in a physician’s office. 2007 SGR.
TABLE 22.—2007 SGR CALCULATION
Statutory factors March estimate Current estimate
Fees .................................................................... 2.6 percent (1.026) .......................................... 2.2 percent (1.022).

Enrollment .......................................................... ¥2.9 percent (0.971) ....................................... ¥0.9 percent (0.991).
Real Per Capita GDP ......................................... 2.2 percent (1.022) .......................................... 2.0 percent (1.020).
Law and Regulation ........................................... ¥1.0 percent (0.990) ....................................... ¥1.5 percent (0.985).
Total ............................................................ 0.7 percent (1.007) .......................................... 1.80 percent (1.018).

Note: Consistent with section 1848(f)(2) of the Act, the statutory factors are multiplied, not added, to produce the total (that is, 1.022 × 0.991 ×
1.020 × 0.985 = 1.018). A more detailed explanation of each figure is provided in section VII.F.1 of this preamble.
D. Revised Sustainable Growth Rate for preliminary estimate of the 2006 SGR
2006 that was published in the CY 2006 Final
Our current estimate of the 2006 SGR Rule (70 FR 70309) and our current
is 2.1 percent. Table 23 shows our estimate.

Statutory factors Estimate from CY 2006 final rule Current estimate
Fees .................................................................... 2.7 percent (1.027) .......................................... 2.2 percent (1.022).

Enrollment .......................................................... ¥3.1 percent (0.969) ....................................... ¥2.2 percent (0.978).
Real Per Capita GDP ......................................... 2.2 percent (1.022) .......................................... 2.1 percent (1.021).
Law and Regulation ........................................... 0.0 percent (1.000) .......................................... 0.0 percent (1.000).
Total ............................................................ 1.7 percent (1.017) .......................................... 2.1 percent (1.021).
A more detailed explanation of each E. Final Sustainable Growth Rate for final rule with comment period (69 FR
figure is provided in section VII.F.2 of 2005 66386), our revised estimate from the
this preamble. CY 2006 PFS final rule with comment
The SGR for 2005 is 4.2 percent. Table period (70 FR 70309) and the final
24 shows our preliminary estimate of figures determined using the best
the 2005 SGR from the CY 2005 PFS available data as of September 1, 2006.
Statutory factors Estimate from CY 2005 final rule Estimate from CY 2006 final rule Final
Fees ............................................... 1.3 percent (1.013) ....................... 0.8 percent (1.008) ....................... 0.8 percent (1.008).
Enrollment ...................................... ¥0.3 percent (0.997) ................... 0.3 percent (1.003) ....................... 0.3 percent (1.003).
Real Per Capita GDP .................... 2.2 percent (1.022) ....................... 2.2 percent (1.022) ....................... 2.1 percent (1.021).
Law and Reg ................................. 1.0 percent (1.010) ....................... 1.2 percent (1.010) ....................... 0.9 percent (1.009).
Total ........................................ 4.3 percent (1.043) ....................... 4.6 percent (1.046) ....................... 4.2 percent (1.042).
A more detailed explanation of each The MEI for 2007 is 2.1 percent. TABLE 25—Continued
figure is provided in section VII.F.3. Diagnostic laboratory tests are estimated
to represent approximately 7.5 percent Weight Update
F. Calculation of 2007, 2006, and 2005
of Medicare allowed charges included
Sustainable Growth Rates Drugs ................ 0.111 4.0
in the SGR for 2007. Medicare payments
1. Detail on the 2007 SGR for these tests are updated by the Weighted-aver-
age ................ 1.000 2.2
All of the figures used to determine Consumer Price Index for Urban Areas
the 2007 SGR are estimates that will be (CPI–U). However, section 629 of the
MMA specifies that diagnostic We estimate that the weighted-average
revised based on subsequent data. Any
laboratory services will receive an increase in fees for physicians’ services
differences between these estimates and
update of 0.0 percent from 2004 through in 2007 under the SGR (before applying
the actual measurement of these figures
2008. any legislative adjustments) will be 2.2
will be included in future revisions of
percent.
the SGR and allowed expenditures and Drugs are estimated to represent 11.1
incorporated into subsequent PFS percent of Medicare allowed charges • Factor 2—The Percentage Change in
updates. included in the SGR in 2007. We the Average Number of Part B Enrollees
estimated a weighted-average change in from 2006 to 2007
• Factor 1—Changes in Fees for
fees for drugs included in the SGR
Physicians’ Services (Before Applying This factor is our estimate of the
Legislative Adjustments) for 2007 (using the ASP+6 percent pricing
methodology) of 4.0 percent for 2007. percent change in the average number of
This factor is calculated as a fee-for-service enrollees from 2006 to
Table 25 shows the weighted-average
weighted-average of the 2007 fee 2007. Services provided to Medicare
of the MEI, laboratory and drug price
increases for the different types of Advantage (MA) plan enrollees are
changes for 2007.
services included in the definition of outside the scope of the SGR and are
physicians’ services for the SGR. excluded from this estimate. OACT
TABLE 25
Medical and other health services paid estimates that the average number of
using the PFS are estimated to account Weight Update Medicare Part B fee-for-service enrollees
for approximately 81.4 percent of total will decrease by 0.9 percent from 2006
allowed charges included in the SGR in Physician .......... 0.814 2.1 to 2007. Table 26 illustrates how this
2007 and are updated using the MEI. Laboratory ......... 0.075 0.0 figure was determined.
TABLE 26
2006 2007
Overall ............................................................... 40.136 million ................................................... 40.735 million

Medicare Advantage (MA) ................................. 6.369 million ..................................................... 7.265 million
Net ..................................................................... 33.768 million ................................................... 33.470 million
Percent Increase ............................................... ........................................................................... ¥0.9 percent
An important factor affecting fee-for- • Factor 4—Percentage Change in increases that apply for the different
service enrollment is beneficiary Expenditures for Physicians’ Services types of services included in the
enrollment in MA plans. Because it is Resulting From Changes in Statute or definition of physicians’ services for the
difficult to estimate the size of the MA Regulations in 2007 Compared With SGR.
enrollee population before the start of a 2006 We estimate that services paid using
CY, at this time we do not know how The statutory and regulatory the PFS account for approximately 83.2
actual enrollment in MA plans will provisions that will affect expenditures percent of total allowed charges
compare to current estimates. For this in CY 2007 relative to CY 2006 are included in the SGR in 2006. These
reason, the estimate may change estimated to have an impact on services were updated using the 2006
substantially as actual Medicare fee-for- expenditures of ¥1.5 percent. These MEI of 2.8 percent. We estimate that
service enrollment for 2007 becomes provisions include the expiration of the diagnostic laboratory tests represent
known. work GPCI floor and DRA provisions approximately 7.1 percent of total
adding the AAA ultrasound test to the allowed charges included in the SGR in
• Factor 3—Estimated Real Gross 2006. Medicare payments for these tests
Domestic Product Per Capita Growth in Welcome to Medicare visit as a
preventive benefit, and reducing are updated by the CPI–U. However,
2007 section 629 of the MMA specifies that
payments for imaging services, which
We estimate that the growth in real are discussed elsewhere in this final diagnostic laboratory services will
GDP per capita from 2006 to 2007 will rule with comment. receive an update of 0.0 percent from
be 2.0 percent (based on the 10-year 2004 through 2008.
average GDP over the 10 years of 1998– 2. Detail on the 2006 SGR We estimate that drugs represent 9.7
2007). Our past experience indicates A more detailed discussion of our percent of Medicare-allowed charges
that there have also been changes in revised estimates of the four elements of included in the SGR in 2006. Sections
estimates of real per capita GDP growth the 2006 SGR follows. 303 and 304 of the MMA require
made before the year begins and the Medicare to pay for most drugs at 106
actual change in GDP computed after • Factor 1—Changes in Fees for percent of ASP beginning January 1,
the year is complete. Thus, it is possible Physicians’ Services (Before Applying 2005. We now estimate a weighted-
that this figure will change as actual Legislative Adjustments) for 2006 average change in fees for drugs
information on economic performance This factor was calculated as a included in the SGR of ¥1.7 percent for
becomes available to us in 2007. weighted-average of the 2006 fee 2006. The estimated weighted-average
change in the CY 2006 PFS final rule TABLE 27—Continued estimate of this factor in the CY 2005
was 4.1 percent. The decline in the PFS final rule was 2.7 percent.
estimate is due to the availability of Weight Update
some actual data. • Factor 2—The Percentage Change in
Table 27 shows the weighted-average Drugs ................ 0.097 ¥1.7 the Average Number of Part B Enrollees
of the MEI, laboratory and drug price Weighted-aver- from 2005 to 2006
age ................ 1.000 2.2
changes for 2006. OACT estimates that the average
After taking into account the elements number of Medicare Part B fee-for-
TABLE 27 described in Table 27, we estimate that service enrollees (excluding
Weight Update the weighted-average increase in fees for beneficiaries enrolled in M+C plans)
physicians’ services in 2006 under the decreased by 2.2 percent in 2006. Table
Physician .......... 0.832 2.8 SGR (before applying any legislative 28 illustrates how we determined this
Laboratory ......... 0.071 0.0 adjustments) will be 2.2 percent. Our figure.
TABLE 28
2005 2006
Overall .................................................................................................................................................. 39.601 million .......... 40.136 million.

Medicare+Choice ................................................................................................................................. 5.084 million ............ 6.369 million.
Net ........................................................................................................................................................ 34.518 million .......... 33.768 million.
Percent Increase .................................................................................................................................. ................................. ¥2.2 percent.
OACT’s estimate of the ¥2.2 percent wheelchair code for physicians, and the MMA in an interim final rule making
change in the number of fee-for-service impact of the new IVIG service. changes to the PFS for 2004, which
enrollees, net of M+C enrollment for appeared in the Federal Register on
3. Detail On the 2005 SGR
2006 compared to 2005, is greater than January 7, 2004 (69 FR 1086). Beginning
our original estimate of ¥3.1 percent in A more detailed discussion of our on January 1, 2005, sections 303 and
the CY 2006 PFS final rule (70 FR final revised estimates of the four 304 of the MMA require Medicare to
70310). While our current projection elements of the 2005 SGR follows. pay for most drugs at 106 percent of the
based on data from 8 months of 2006 is • Factor 1—Changes in Fees for ASP. Taking into account sections 303
greater than our original estimate of Physicians’ Services (Before Applying and 304 of the MMA, we estimate a
¥3.1 percent when we had no actual Legislative Adjustments) for 2005 weighted-average change in fees for
data, it is still possible that our final drugs included in the SGR of ¥21.0
estimate of this figure will be different This factor was calculated as a percent for 2005. Table 29 shows the
once we have complete information on weighted-average of the 2005 fee
weighted-average of the MEI, laboratory,
2006 fee-for-service enrollment. increases that apply for the different
and drug price increases for 2005.
types of services included in the
• Factor 3—Estimated Real Gross definition of physicians’ services for the
Domestic Product Per Capita Growth in SGR.
TABLE 29
2006 Services paid using the PFS
Weight Update
We estimate that the growth in real accounted for approximately 84.2
GDP per capita will be 2.1 percent for percent of total Medicare-allowed Physician .......... 0.842 3.1
2006 (based on the 10-year average GDP charges included in the SGR for 2005 Laboratory ......... 0.070 0.0
over the 10 years of 1997–2006). Our and are updated using the MEI. The MEI Drugs ................ 0.088 ¥21.0
past experience indicates that there for 2005 was 3.1 percent. Diagnostic Weighted-aver-
have also been differences between our laboratory tests represented age ................ 1.000 0.8
estimates of real per capita GDP growth approximately 7.0 percent of total 2005
made prior to the year’s end and the Medicare-allowed charges included in After taking into account the elements
actual change in this factor. Thus, it is the SGR and are updated by the CPI–U. described in Table 29, we estimate that
possible that this figure will change However, section 629 of the MMA the weighted-average increase in fees for
further as complete actual information specifies that diagnostic laboratory physicians’ services in 2005 under the
on 2006 economic performance becomes services will receive an update of 0.0 SGR (before applying any legislative
available to us in 2007. percent from 2004 through 2008. Drugs adjustments) was 0.8 percent. This
represented approximately 8.8 percent figure is a final one based on complete
• Factor 4—Percentage Change in of total Medicare-allowed charges data for 2005.
Expenditures for Physicians’ Services included in the SGR for 2005.
Resulting From Changes in Statute or • Factor 2—The Percentage Change in
Historically, Medicare paid for drugs the Average Number of Part B Enrollees
Regulations in 2006 Compared With under section 1842(o) of the Act at 95
2005 from 2004 to 2005
percent of the AWP. However, with
The statutory and regulatory some exceptions, in 2004 sections 303 We estimate the increase in the
provisions that affect expenditures in and 304 of the MMA generally required number of fee-for-service enrollees
CY 2006 relative to CY 2005 are Medicare to pay for drugs at 85 percent (excluding beneficiaries enrolled in
estimated to have a net impact on of the AWP determined as of April 1, M+C plans) from 2004 to 2005 was 0.3
expenditures of less than 0.05. These 2003, or a specified percentage of AWP percent. Our calculation of this factor is
provisions include the expiration of the based on studies by the Government based on complete data from 2005.
temporary higher payments to Accountability Office and the OIG. We Table 30 illustrates the calculation of
physicians in Alaska, the new power implemented section 303 and 304 of the this factor.
TABLE 30 of the MMA improved the procedures Payment = [(RVU work x BN adjustor x
for paying the 10 percent PFS bonus GPCI work) + (RVU PE x GPCI PE)
2004 2005 payment for services provided in health + (RVU malpractice x GPCI
professional shortage areas (HPSAs). malpractice)] x CF.)
Overall .............. 39.099 39.601 Taken together, all of the statutory
million million B. Anesthesia Fee Schedule Conversion
provisions for 2005, increased Medicare
Medicare Factor
+Choice ............ 4.683 5.084 spending for physicians’ services by 0.9
million million percent. Anesthesia services do not have RVUs
Net .................... 34.416 34.518 IX. Anesthesia and Physician Fee like other PFS services. Therefore, we
million million account for any necessary RVU
Percent Increase .................... 0.3 percent
Schedule Conversion Factors for CY
2007 adjustments through an adjustment to
the anesthesia fee schedule CF to
• Factor 3—Estimated Real Gross The 2007 PFS CF will be $35.9848. simulate changes to RVUs. We modeled
Domestic Product Per Capita Growth in The 2007 national average anesthesia CF the resource-based PE methodology
2005 is $15.3328. Both CFs will be subject to using imputed anesthesia RVUs that
a separate, independent BN adjustor, as were made comparable to other PFS
We estimate that the growth in real
described below. services. The adjustment factor in Table
per capita GDP was 2.1 percent in 2005
(based on the 10-year average GDP over A. Physician Fee Schedule Conversion 32 includes the combined effect of the
the 10 years of 1996–2005). This figure Factor PE adjustment and the BN adjustment.
is a final one based on complete data for Under section 1848(d)(1)(A) of the We used the following figures to
2005. Act, the PFS CF is equal to the CF for determine the anesthesia fee schedule
CF as shown in Table 32.
• Factor 4—Percentage Change in the previous year multiplied by the
Expenditures for Physicians’ Services update determined under section
Resulting From Changes in Statute or 1848(d)(4) of the Act. TABLE 32
Regulations in 2005 Compared With We illustrate the calculation for the
2004 2007 PFS CF in Table 31. 2006 Anesthesia Con- $17.7663
version Factor.
There are a number of statutory 2007 Update .............. ¥5.0 percent
provisions that affected the 2005 SGR.
TABLE 31 (0.94953)
Sections 303 and 304 of the MMA 2007 Combined Ad- 0.9089
2006 Conversion Fac- $37.8975 justment PE and
changed Medicare payment for drugs. tor.
These provisions also changed Medicare BN.
2007 Update .............. ¥5.0 percent 2007 Anesthesia Con- $15.3328
payments for the administration of (0.94953) version Factor.
drugs. Section 303(a)(1) of the MMA 2007 Conversion Fac- $35.9848
amended section 1848(c)(2) of the Act to tor.
require the Secretary to make a number X. Telehealth Originating Site Facility
of changes that increased Medicare Section 1848(c)(2)(B)(ii)(II) of the Act Fee Payment Amount Update
payment for drug administration requires that increases or decreases in
Section 1834(m) of the Act establishes
beginning January 1, 2004. Section RVUs for a year may not cause the
the payment amount for the Medicare
303(a)(4) of the MMA required an amount of expenditures for the year to
telehealth originating site facility fee for
additional transitional adjustment differ by more than $20 million from
telehealth services provided from
(temporary increase) to Medicare’s what expenditures would have been in
October 1, 2001 through December 31
payment for drug administration of 32 the absence of these changes. If this
2002, at $20. For telehealth services
percent for 2004 and 3 percent for 2005. threshold is exceeded, we must make
provided on or after January 1 of each
We also adopted changes to the codes adjustments to preserve BN. The 5-Year
subsequent calendar year, the telehealth
and payment amounts for drug Review of work RVUs would result in
originating site facility fee is increased
administration based on a change in expenditures that would
by the percentage increase in the MEI as
recommendations from the AMA’s CPT exceed $20 million if we made no
defined in section 1842(i)(3) of the Act.
Editorial Panel and Relative Value offsetting adjustments to either the CF
The MEI increase for 2007 is 2.1
Update Committee (RUC), under the or RVUs. As discussed in section IV.D
authority of section 1848(c)(2)(J) of the percent.
of this final rule with comment period,
Act. We further increased PFS payments we are applying the following BN Therefore, for CY 2007, the payment
by paying separately for injections adjustor to the work RVUs in order to amount for HCPCS code ‘‘Q3014,
provided on the same day as another calculate payment for a service: telehealth originating site facility fee’’ is
PFS service. 80 percent of the lesser of the actual
Section 413(a) of the MMA 2007 Work Adjustor: 10.1 percent charge or $22.94. The Medicare
established a 5 percent increase in the (0.8994) telehealth originating site facility fee
PFS payment for services provided in Payment for services under the PFS and MEI increase by the applicable time
physician scarcity areas. Section 413(b) will now be calculated as follows: period are shown in Table 33.
TABLE 33
MEI in-
Facility Fee crease Period
(percent)
$20.00 ..................................................................................................................................................... N/A 10/01/2001–12/31/2002.

20.60 ....................................................................................................................................................... 3.0 01/01/2003–12/31/2003.
21.20 ....................................................................................................................................................... 2.9 01/01/2004–12/31/2004.
TABLE 33—Continued
MEI in-
Facility Fee crease Period
(percent)
21.86 ....................................................................................................................................................... 3.1 01/01/2005–12/31/2005.

22.47 ....................................................................................................................................................... 2.8 01/01/2006–12/31/2006.
22.94 ....................................................................................................................................................... 2.1 01/01/2007–12/31/2007.
XI. Provisions of the Final Rule implements the PFS. Yet, it is of finding and its reasons in the notice
The provisions of this final rule with imperative that these coding changes be issued. We find it unnecessary to
comment restate the provisions of the accounted for and recognized timely undertake notice and comment
CY 2007 PFS proposed rule, except as under the PFS for payment because rulemaking in this instance for the
noted elsewhere in the preamble. services represented by these codes will ambulance inflation factor because the
be provided to Medicare beneficiaries law specifies the method of
XII. Waiver of Proposed Rulemaking by physicians during the CY in which computation of annual updates, and we
and Delay in Effective Date they become effective. Moreover, have no discretion in this matter.
We ordinarily publish a notice of regulations implementing HIPAA (42 Further, we are merely applying the
proposed rulemaking in the Federal CFR parts 160 and 162) require that the update method specified in statute and
Register and invite public comment on HCPCS be used to report health care regulation. Therefore, under 5 U.S.C.
the proposed rule. The notice of services, including services paid under 553(b)(B), for good cause, we waive
proposed rulemaking includes a the PFS. We also assign interim RVUs notice and comment procedures for this
reference to the legal authority under to any new codes based on a review of ambulance inflation factor update.
which the rule is proposed, and the the RUC recommendations for valuing
these services. By reviewing these RUC XIII. Collection of Information
terms and substances of the proposed
recommendations for the new codes, we Requirements
rule or a description of the subjects and
issues involved. This procedure can be are able to assign RVUs to services Under the Paperwork Reduction Act
waived, however, if an agency finds based on input from the medical of 1995, we are required to provide 30-
good cause that a notice-and-comment community and to establish payment for day notice in the Federal Register and
procedure is impracticable, them, on an interim basis, that solicit public comment before a
unnecessary, or contrary to the public corresponds to the relative resources collection of information requirement is
interest and incorporates a statement of associated with providing the services. submitted to the OMB for review and
the finding and its reasons in the rule If we did not assign RVUs to new codes approval. In order to fairly evaluate
issued. on an interim basis, the alternative whether an information collection
As discussed in sections IV. and V. of would be to either not pay for these should be approved by OMB, section
this final rule, we utilize HCPCS codes services during the initial CY or have 3506(c)(2)(A) of the Paperwork
for Medicare payment purposes. The each carrier establish a payment rate for Reduction Act of 1995 requires that we
HCPCS is a national drug coding system these new codes. We believe both of solicit comment on the following issues:
comprised of Level I (CPT) codes and these alternatives are contrary to the • The need for the information
Level II (HCPCS National Codes) that public interest, particularly since the collection and its usefulness in carrying
are intended to provide uniformity to RUC process allows for an assessment of out the proper functions of our agency.
coding procedures, services, and the valuation of these services by the • The accuracy of our estimate of the
supplies across all types of medical medical community prior to our information collection burden.
providers and suppliers. Level I (CPT) establishing payment for these codes on • The quality, utility, and clarity of
codes are copyrighted by the AMA and an interim basis. Therefore, we believe the information to be collected.
consist of several categories, including it would be contrary to the public • Recommendations to minimize the
Category I codes which are 5-digit interest to delay establishment of fee information collection burden on the
numeric codes, and Category III codes schedule payment amounts for these affected public, including automated
which are temporary codes to track codes. collection techniques.
emerging technology, services and For the reasons outlined above in this We solicited public comment on each
procedures. section, we find good cause to waive the of these issues for the following sections
The AMA issues an annual update of notice of proposed rulemaking for the of this document that contain
the CPT code set each Fall, with January interim RVUs for selected procedure information collection requirements:
1 as the effective date for implementing codes identified in Addendum C and to
the updated CPT codes. The HCPCS, Section 410.33 Independent
establish RVUs for these codes on an
including both Level I and Level II Diagnostic Testing Facility
interim final basis. We are providing a
codes, is similarly updated annually on 60-day public comment period. Section 410.33(e)(1) imposes a
a CY basis. Annual coding changes are In addition, we ordinarily publish a recordkeeping requirement on multi-
not available to the public until the Fall notice of proposed rulemaking in the State entities. Specifically, an
immediately preceding the annual Federal Register and provide a period independent diagnostic testing facility
January update of the PFS. Because of for public comment before we make (IDTF) that operates across State
the timing of the release of these new final the provisions of the notice. We boundaries must maintain
codes, it is impracticable for CMS to can waive this procedure, however, if documentation that its supervising
provide prior notice and solicit we find good cause that notice-and- physicians and technicians are licensed
comment on these codes and the RVUs comment procedure is impracticable, and certified in each of the States in
assigned to them in advance of unnecessary, or contrary to the public which it operates. The burden
publication of the final rule that interest and we incorporate a statement associated with this requirement is the
time and effort it takes the IDTF to time specified in the ‘‘DATES’’ section Section 1102(b) of the Act requires us
collect and maintain the aforementioned of this preamble, and, when we proceed to prepare a regulatory impact analysis
information. with a subsequent document, we will for any final rule that may have a
While subject to the PRA, we believe respond to the comments in the significant impact on the operations of
this information collection requirement preamble to that document. a substantial number of small rural
is exempt as defined in 5 CFR hospitals. This analysis must conform to
1320.3(b)(2), because the time, effort, XV. Regulatory Impact Analysis the provisions of section 604 of the
and financial resources necessary to We have examined the impact of this RFA. For purposes of section 1102(b) of
comply with the requirement would be rule as required by Executive Order the Act, we define a small rural hospital
incurred by persons in the normal 12866 (September 1993, Regulatory as a hospital that is located outside a
course of their activities (for example, in Planning and Review), the Regulatory Metropolitan Statistical Area and has
compiling and maintaining business Flexibility Act (RFA) (September 19, fewer than 100 beds. We have
records) and is considered to be usual 1980 Pub. L. 96–354), section 1102(b) of determined that this final rule with
and customary. the Social Security Act, the Unfunded comment period would have minimal
Section 410.33(g) discusses the Mandates Reform Act of 1995 (Pub. L. impact on small hospitals located in
application certification standards that 104–4), and Executive Order 13132. rural areas. Of the 201 hospital-based
an IDTF must meet. An IDTF must Executive Order 12866 (as amended ESRD facilities located in rural areas,
complete an enrollment application and by Executive Order 13258, which only 40 are affiliated with hospitals
certify the information contained in the merely reassigns responsibilities of with fewer than 100 beds.
application. The certification is part of duties) directs agencies to assess all For purposes of the RFA, physicians,
an application that is subject to the costs and benefits of available regulatory NPPs, and suppliers are considered
PRA. The burden associated with this alternatives and, when regulation is small businesses if they generate
requirement is the time and effort necessary, to select regulatory revenues of $6 million or less.
necessary to complete the application. approaches that maximize net benefits Approximately 95 percent of physicians
This requirement is currently approved (including potential economic, are considered to be small entities.
in OMB No. 0938–0685, with a current environmental, public health and safety There are about 980,000 physicians,
expiration date of April 30, 2009. effects, distributive impacts, and other practitioners and medical
equity). A regulatory impact analysis suppliers that receive Medicare
Payment for Covered Outpatient Drugs payment under the PFS.
and Biologicals (ASP Issues) must be prepared for final rules with
For purposes of the RFA,
economically significant effects (that is,
Section II.F.1 of the preamble approximately 80 percent of clinical
a final rule that would have an annual diagnostic laboratories are considered
provides background information
effect on the economy of $100 million small businesses according to the Small
pertaining to the use of average sales
or more in any one year, or would Business Administration’s size
price (ASP) as the basis for our drug
adversely affect in a material way the standards.
payment methodology. In accordance
economy, a sector of the economy, In addition, most ESRD facilities are
with section 1857 of the Act, Medicare
productivity, competition, jobs, the considered small entities, either based
Part B covered drugs and biologicals not
environment, public health or safety, or on nonprofit status or by having
paid on a cost of prospective payment
State, local, or tribal governments or revenues of $29 million or less in any
basis are paid based on the ASP. The
communities). As indicated in more year. We consider a substantial number
ASP data reporting requirements are
detail below in this section, we estimate of entities to be affected if the final rule
outlined in section 1927(b) of the Act,
that the PFS provisions included in this is estimated to impact more than 5
and were implemented in the interim
final rule with comment period will percent of the total number of small
final rule with comment period that
redistribute more than $100 million in entities. Based on our analysis of the
published on April 6, 2004 (69 FR
1 year. We are considering this final rule 932 nonprofit ESRD facilities
17935).
The collection of ASP data imposes a with comment period to be considered small entities in accordance
reporting requirement on the public. economically significant because its with the above definitions, we estimate
The burden associated with this provisions are estimated to result in an that the combined impact of the changes
requirement is the time and effort increase, decrease or aggregate to payment for renal dialysis services
required by manufacturers of Medicare redistribution of Medicare spending that included in this final rule with
Part B drugs and biologicals to calculate, will exceed $100 million. Therefore, comment period would have a 0.8
record, and submit the required data to this final rule with comment period is percent increase in overall payments
CMS. While this requirement is subject a major rule and we have prepared a relative to current overall payments.
to the PRA, it is currently approved regulatory impact analysis. IDTFs are suppliers under the
under OMB control number 0938–0921, The RFA requires that we analyze Medicare program. For purposes of the
with an expiration date of May 31, 2009. regulatory options for small businesses RFA, suppliers with annual sales of $6
As required by section 3504(h) of the and other entities. We prepare a million or less are considered to be
Paperwork Reduction Act of 1995, we regulatory flexibility analysis unless we small entities. (Individuals and States
have submitted a copy of this document certify that a rule would not have a are not included in the definition of a
to the OMB for its review of these significant economic impact on a small entity.) We believe that our
information collection requirements. substantial number of small entities. standards for IDTFs will help bar
The analysis must include a justification fraudulent suppliers from participating
XIV. Response to Comments concerning the reason action is being in the Medicare program and provide an
Because of the large number of public taken, the kinds and number of small added level of protection to Medicare
comments we normally receive on entities the rule affects, and an beneficiaries. Therefore, we expect to
Federal Register documents, we are not explanation of any meaningful options have an impact on an unknown number
able to acknowledge or respond to them that achieve the objectives with less of persons and entities who will
individually. We will consider all significant adverse economic impact on effectively be prevented from practicing
comments we receive by the date and the small entities. their aberrant billing activities. The vast
majority of suppliers would not be our methodology for calculating through March 30, 2005, that we
significantly affected by this final rule resource-based PE RVUs and make a estimate are 98 percent complete. To the
with comment period. The reduction in variety of other changes to our extent that there are year-to-year
program overpayments and the added regulations, payments, or payment changes in the volume and mix of
level of protection to beneficiaries that policies to ensure that our payment services provided by physicians, the
we expect to achieve as a result of this systems reflect changes in medical actual impact on total Medicare
final rule with comment period justifies practice and the relative value of revenues will be different than those
the relatively small burden this final services. We provide information for shown in Table 34. The payment
rule with comment period would each of the policy changes in the impacts reflect averages for each
impose on all small entities. relevant sections of this final rule with specialty based on Medicare utilization.
Ambulance providers and suppliers comment period. We are unaware of any The payment impact for an individual
for purposes of the RFA are also relevant Federal rules that duplicate, physician would be different from the
considered to be small entities. While overlap or conflict with this final rule average, based on the mix of services the
we expect the initial change in with comment period. The relevant physician provides. The average change
geographic designations to have little, if sections of this final rule with comment in total revenues would be less than the
any, overall effect on ambulance period contain a description of impact displayed here because
payments, application of the ambulance significant alternatives if applicable. physicians furnish services to both
inflation factor (AIF) will result in an A. RVU Impacts Medicare and non-Medicare patients
increase in payment rates for all and specialties may receive substantial
ambulance services furnished by all 1. Resource-Based Work and PE RVUs Medicare revenues for services that are
types of ambulance providers. Section 1848(c)(2)(B)(ii) of the Act not paid under the PFS. For instance,
The analysis and discussion provided requires that increases or decreases in independent laboratories receive
in this section, as well as elsewhere in RVUs may not cause the amount of approximately 80 percent of their
this final rule with comment period, expenditures for the year to differ by Medicare revenues from clinical
complies with the RFA requirements. more than $20 million from what laboratory services that are not paid
Section 202 of the Unfunded expenditures would have been in the under the PFS.
Mandates Reform Act of 1995 also absence of these changes. If this Table 34 shows only the payment
requires that agencies assess anticipated threshold is exceeded, we make impact on PFS services. The following
costs and benefits before issuing any adjustments to preserve BN. This year, is an explanation of the information
rule that may result in expenditures in the estimated $4 billion impact of represented in Table 34. Note that this
any year by State, local, or tribal changes in work RVUs resulting from table does include the impact of the CY
governments, in the aggregate, or by the the 5-Year Review require that a budget- 2007 update.
private sector, of $120 million. Medicare neutrality adjustment be made.
beneficiaries are considered to be part of • Specialty: The physician specialty
As discussed in the June 29, 2006
the private sector for this purpose. or type of practitioner/supplier.
proposed notice, we proposed making
We have examined this final rule with the statutorily required BN adjustment • Allowed Charges: Allowed charges
comment period in accordance with to account for the 5-Year Review of are the Medicare Fee Schedule amounts
Executive Order 13132 and have physician work by reducing all work for covered services and include
determined that this regulation would RVUs. We estimated that all work RVUs copayments and deductibles (which are
not have any significant impact on the would have to be reduced by 10 percent the financial responsibility of the
rights, roles, or responsibilities of State, under this option. As discussed in beneficiary). These amounts have been
local, or tribal governments. A section IV.D.1 of this final rule with summed across all services provided by
discussion concerning the impact of this comment period, we carefully reviewed physicians, practitioners, or suppliers
rule on beneficiaries is found later in the comments received concerning this with a specialty to arrive at the total
this section. issue, and to meet the BN provisions of allowed charges for the specialty.
We have prepared the following section 1848(c)(2)(B)(ii)(II) of the Act, • Impact of Work RVU Changes from
analysis, which, together with the we are applying a BN adjustor of 0.8994 the five year review of work
information provided in the rest of this or ¥10.1 percent to the work RVUs. • Impact of PE RVU changes. The
preamble, meets all assessment Table 34 shows the specialty-level impact is shown for both 2007, which
requirements. The analysis explains the impact of the work and PE RVU is the first year of the four year
rationale for and purposes of this final changes. transition using the new methodology,
rule with comment period; details the Our estimates of changes in Medicare and 2010, which is the year in which
costs and benefits of the rule; analyzes revenues for PFS services compare
the methodology is fully implemented.
alternatives; and presents the measures payment rates for CY 2006 with
we proposed to use to minimize the proposed payment rates for CY 2007 • Combined impact of the finalized
burden on small entities. As indicated using CY 2005 Medicare utilization for work and PE RVUs for both 2007 and
elsewhere in this final rule with all years. We are using CY 2005 2010.
comment period, we proposed to change Medicare claims processed and paid BILLING CODE 4120–01–P
ER01DE06.013</GPH>
ER01DE06.014</GPH>
BILLING CODE 4120–01–C rule with comment period reflect the Table 35 shows only the payment
2. Section 5102 of the DRA Adjustments use of updated physician time data from impact on PFS services. The following
for Payments for Imaging Services the AMA–RUC. is an explanation of the information
Our estimates of changes in Medicare represented in Table 35.
As required by section 5102(a) of the
revenues for PFS services compare • Specialty: The physician specialty
DRA and described in section II.E.1. of
payment rates for CY 2006 with or type of practitioner/supplier.
this final rule with comment period, we
• Allowed Charges: Allowed charges
are removing, from the PE RVUs under proposed payment rates for CY 2007
are the Medicare Fee Schedule amounts
the PFS the 0.3 percent increase made using CY 2005 Medicare utilization for
for covered services and include
to the PE RVUs in the CY 2006 PFS final all years. We are using CY 2005
copayments and deductibles (which are
rule with comment period to ensure the Medicare claims processed and paid
the financial responsibility of the
BN of the impact of the multiple through March 30, 2005, that we beneficiary.) These amounts have been
imaging policy adopted for CY 2006. estimate are 98 percent complete. To the summed across all services provided by
Section 5102(a) of the DRA exempts the extent that there are year-to-year physicians, practitioners, or suppliers
CY 2006 and 2007 impact of the changes in the volume and mix of with a specialty to arrive at the total
multiple imaging policy from BN. services provided by physicians, the allowed charges for the specialty.
Because we proposed to maintain the actual impact on total Medicare • Impact of Work and PE RVU
current 25 percent payment reduction revenues will be different than those Changes using the methodology
for multiple imaging procedures in CY shown in Table 35. The payment finalized in this rule.
2007, there is no additional impact impacts reflect averages for each • Impact of section 5102 of the DRA:
resulting from our policies for CY 2007. specialty based on Medicare utilization. The CY 2007 percentage decrease in
Section 5102 of the DRA also exempts The payment impact for an individual allowed charges attributed to section
the estimated savings from the physician would be different from the 5102 of the DRA.
application of the OPPS-based payment average, based on the mix of services the • Combined impact of the finalized
limitation on PFS imaging services from
physician provides. The average change work and PE RVUs and section 5102 of
the PFS BN requirement. We estimate
in total revenues would be less than the the DRA.
that the combined impact of the BN
impact displayed here because • CY 2007 Update: The percentage
exemptions in section 5102 of the DRA
physicians furnish services to both decrease in allowed charges attributed
would reduce PFS expenditures by
Medicare and non-Medicare patients to the CY 2007 PFS conversion factor
approximately 0.9 percent in CY 2007.
and specialties may receive substantial update (¥5.0 percent).
3. Combined Impacts Medicare revenues for services that are • Combined impact with CY 2007
Table 35 shows the specialty-level not paid under the PFS. For instance, update: The CY 2007 percentage
impact of: The work and PE RVU independent laboratories receive decrease in allowed charges attributed
changes, section 5102 of the DRA, and approximately 80 percent of their to the impact of the work and PE RVU
our most recent estimate (¥5.0 percent) Medicare revenues from clinical changes, section 5102 of the DRA, and
of the CY 2007 Medicare PFS update. laboratory services that are not paid the CY 2007 update.
Additionally, the impacts in this final under the PFS. BILLING CODE 4120–01–P
ER01DE06.015</GPH>
ER01DE06.016</GPH>
Table 36 shows the impact on total commonly provided by a broad facility and nonfacility PE refer to
payments for selected high-volume spectrum of physician specialties. There Addendum A of this final rule with
procedures of all of the changes are separate columns that show the comment period.
previously discussed. We selected these change in the facility rates and the
procedures because they are the most nonfacility rates. For an explanation of
ER01DE06.017</GPH>
ER01DE06.018</GPH>

ER01DE06.019</GPH>
B. Geographic Practice Cost Indices cost impact on the Medicare program G. Payment for Covered Outpatient
(GPCI)—Payment Localities because of the limited scope of the Drugs and Biologicals (ASP Issues)
As discussed in section II.B. of the benefit. While it is difficult to quantify the
preamble to this final rule with E. DRA 5113: Colorectal Screening impact of clarifications in ASP reporting
comment period, we proposed new Exemption From Part B Deductible guidelines on Medicare expenditures,
GPCIs for 2007. In the CY 2005 PFS we expect that the changes discussed in
final rule with comment period, we As discussed in section II.E.4. of this section II.F. of this final rule with
published 2005 and 2006 GPCI and GAF final rule with comment period, comment period, for payment for
values reflecting the 2-year phase-in of beginning January 1, 2007, colorectal covered outpatient drugs and
updated GPCI data. In 2007, the cancer screening services as described biologicals, will have a minimal impact
proposed GPCI and GAF values will in section 1861(pp)(1) of the Act are no on Medicare expenditures.
reflect the removal of the 1.000 MMA longer subject to the Part B deductible.
While waiver of this deductible will be H. Provisions Related to Payment for
floor from the physician work GPCI. The
beneficial to Medicare beneficiaries, we Renal Dialysis Services Furnished by
negative impact of these changes on a
do not anticipate that this change will End State Renal Disease (ESRD)
number of payment localities is shown
have a significant cost impact on the Facilities
in section II.B. in Table 7.
Medicare program. In section II.G. of this final rule with
C. Global Period for Remote comment period, we discuss the ESRD-
Afterloading High Intensity F. Section 5114: Addition of Diabetes
Outpatient Self-Management Training related provisions. To understand the
Brachytherapy Procedures impact of the changes affecting
Services (DSMT) and Medical Nutrition
As discussed in section II.D.1. of this Therapy (MNT) for the FQHC Program payments to different categories of
final rule with comment period, we are ESRD facilities, it is necessary to
revising the global period for these As discussed in section II.E.5. of this compare estimated payments under the
services. We do not anticipate this final rule with comment period, section current year (2006 payments) to
change will have a significant impact on 5114 of the DRA amended section estimated payments under the revisions
Medicare expenditures. Current 1861(aa)(3) the Act to add DSMT and to the composite rate payment system as
brachytherapy coding allows for billing MNT to the list of Medicare covered and discussed in II.G. of this final rule with
only one time for the entire physician reimbursed services under the Medicare comment period (2007 payments). To
services provided during a 90-day FQHC benefit, effective for services estimate the impact among various
period. Any expected increase in the provided on or after January 1, 2006. classes of ESRD facilities, it is
billing of brachytherapy physician Although this statutory change has imperative that the estimates of current
services is offset by the reduction in the already been implemented in payments and projected payments
work RVUs. administrative instructions, we contain similar inputs. Therefore, we
proposed to conform the regulations to simulated payments only for those
D. DRA 5112: Addition of the meet the new statutory requirement. ESRD facilities that we are able to
Ultrasound Screening for Abdominal FQHCs certified as DSMT and MNT calculate both current 2006 payments
Aortic Aneurysm to ‘‘Welcome to providers have been allowed to bundle and 2007 payments.
Medicare’’ Benefit the cost of those services into their ESRD providers were grouped into the
As discussed in section II.E.3. of this FQHC payment rates. But before the categories based on characteristics
final rule with comment period, section enactment of the DRA, the provision of provided in the Online Survey and
5112 of the DRA authorizes coverage of these services would not generate a Certification and Reporting (OSCAR)
an ultrasound screening for abdominal separate FQHC visit payment. Effective file and the most recent cost report data
aortic aneurysms effective January 1, for services furnished on or after from the Healthcare Cost Report
2007, subject to certain eligibility and January 1, 2006, FQHCs that are Information System (HCRIS). We also
other limitations. We estimate that this certified providers of DSMT and MNT used the June 2006 update of CY 2005
new benefit would result in an increase services can receive per visit payments National Claims History file as a basis
in Medicare expenditures to physicians for covered services furnished by for Medicare dialysis treatments and
and other practitioners and suppliers of registered dietitians or nutrition separately billable drugs and
ultrasound services and related follow- professionals. Because there are a biologicals. Due to data limitations, we
up tests and treatment that may be limited number of qualified centers for are unable to estimate current and
required as a result of the coverage of DSMT and MNT services, the increase proposed payments for 130 of the 4,669
these screening examinations. However, in Medicare expenditures should be ESRD facilities that bill for ESRD
this is not expected to have a significant negligible. dialysis treatments.
TABLE 37.—IMPACT OF CY 2007 CHANGES IN PAYMENTS TO HOSPITAL BASED AND INDEPENDENT ESRD FACILITIES
[Percent change in composite rate payments to ESRD facilities (both program and beneficiaries)]
Number of Effect of
Number of dialysis
facilities treatments changes in Overall effect 2
wage index 1
(in millions)
All Providers ..................................................................................................... 4,539 34.4 0.0 0.5

Independent .............................................................................................. 3,958 30.7 ¥0.1 0.5
Hospital Based ......................................................................................... 581 3.7 0.4 1.0

By Facility Size:
Less than 5000 treatments ....................................................................... 1,628 4.6 ¥0.3 0.2
5000 to 9999 treatments .......................................................................... 1,756 12.9 0.0 0.5
Greater than 9999 treatments .................................................................. 1,155 16.9 0.1 0.6
TABLE 37.—IMPACT OF CY 2007 CHANGES IN PAYMENTS TO HOSPITAL BASED AND INDEPENDENT ESRD FACILITIES—
Continued
[Percent change in composite rate payments to ESRD facilities (both program and beneficiaries)]
Number of Effect of
Number of dialysis Overall effect 2
changes in
facilities treatments wage index 1
(in millions)
By Type of Ownership:
Profit ......................................................................................................... 3,607 27.8 ¥0.1 0.4
Nonprofit ................................................................................................... 932 6.6 0.3 0.8
By Geographic Location:
Rural ......................................................................................................... 1,217 7.0 ¥0.6 0.0
Urban ........................................................................................................ 3,322 27.4 0.1 0.7
By Region:
New England ............................................................................................ 152 1.2 1.1 1.6
Middle Atlantic .......................................................................................... 549 4.4 0.6 1.1
East North Central .................................................................................... 716 5.4 ¥0.5 0.1
West North Central ................................................................................... 341 1.9 ¥0.4 0.1
South Atlantic ........................................................................................... 1,014 7.9 0.0 0.5
East South Central ................................................................................... 358 2.6 ¥1.1 ¥0.6
West South Central .................................................................................. 633 4.7 ¥0.7 ¥0.1
Mountain ................................................................................................... 245 1.6 0.1 0.7
Pacific ....................................................................................................... 500 4.2 1.1 1.7
Puerto Rico ............................................................................................... 31 0.4 ¥1.6 ¥1.1
1 This column shows the 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 2007 wage index changes.
2 This column shows the percent change between CY 2007 and CY 2006 composite rate payments to ESRD facilities. The CY 2007 payments
include the CY 2007 wage adjusted composite rate, and the 15.1 percent drug add-on times treatments. The CY 2006 payments to ESRD facili-
ties includes the CY 2006 wage adjusted composite rate and the 14.5 percent drug add-on times treatments.
Table 37 shows the impact of this regions is primarily due to reducing the ESRD provider count and treatment
year’s changes to CY 2007 payments to wage index floor, as there were areas in count.
hospital-based and independent ESRD these areas with wage index values Response: The impact table shows the
facilities. The first column of Table 37 below the floor. same provider count the commenter
identifies the type of ESRD provider, the The fifth column shows the overall
suggested. However, our tabulation of
second column indicates the number of effect of the changes in composite rate
the 2005 claims data indicates that there
ESRD facilities for each type, and the payments to ESRD providers. The
are 0.4 million treatments rather than
third column indicates the number of overall effect is measured as the
dialysis treatments. difference between the projected CY the 0.55 million treatment count
The fourth column shows the effect of 2007 payment with all changes in this furnished by the commenter.
CY 2007 changes to the ESRD wage final rule and CY 2006 payment. This I. Private Contracts and Opt-out
index as it affects the composite rate payment amount is computed by Provision
payments to ESRD facilities. The fourth multiplying the wage adjusted
column compares aggregate ESRD wage composite rate with the drug add-on for The changes discussed in this final
adjusted composite rate payments in the each provider times the number of rule with comment period, for private
second year of the transition (CY 2007) dialysis treatments from 2005 claims. contracts and the opt-out provision, are
to aggregate ESRD wage adjusted The projected CY 2007 payment is the currently estimated to have no
composite rate payments in first year of transition year 2 wage-adjusted significant impact on Medicare
the transition (CY 2006). In the second composite rate for each provider (with expenditures as the number of
year of the transition (CY 2007), ESRD the 15.1 percent drug add-on) times physicians and practitioners who opt-
facilities receive 50 percent of the CBSA dialysis treatments from CY 2005 out of Medicare is very small.
wage adjusted composite rate and 50 claims. The CY 2006 current payment is
percent of the MSA wage adjusted the transition year 1 wage-adjusted J. Supplier Access to Claims Billed on
composite rate. In the first year of the composite rate for each provider (with Reassignment
transition, ESRD facilities receive 25 the current 14.5 percent drug add-on)
percent of the CBSA wage adjusted times dialysis treatments from CY 2005 The reassignment provisions
composite rate and 75 percent of the claims. discussed in section II.J.2. of this final
MSA wage adjusted composite rate. The The overall impact to ESRD providers rule with comment period are amending
overall effect to all ESRD providers in in aggregate is 0.5 percent. This increase the reassignment regulations so that
aggregate is zero because the CY 2007 corresponds to the 0.5 percent increase employees will have the same
ESRD wage index has been multiplied to the drug add-on. The variation seen ‘‘unrestricted access to billing records,’’
by a BNF to comply with the statutory in column 5 is due to variation in that has been afforded to independent
requirement that any wage index changes in the wage index (column 4). contractors since January 1, 2005. We
revisions be done in a manner that All provider types receive the same 0.5 are simply extending this right to access
results in the same aggregate amount of percent increase to the drug add-on. one’s billing records to employees. This
expenditures as would have been made Comment: We received a comment change should have no impact on
without any changes in the wage index. requesting that we update the impact Medicare expenditures.
The decreases shown among census table to reflect the current Puerto Rico
K. Coverage of Bone Mass Measurement insurance cost of $1 million annually laboratories to provide TC pathology
As discussed in section II.K. of this (559 times $1,800) to the IDTF industry services.
due to this final rule with comment It is unclear if the hospitals
final rule with comment period, we
period. contracting with independent
discuss several revisions to § 410.31
laboratories would pay the laboratories
relative to the definition of the term 2. Primary Business Telephone Listed at the same rates that the laboratories
‘‘Bone Mass Measurement’’ Under the Name of the Business Locally received by billing the Medicare carriers
(§ 410.31(a)(2)), the conditions for or Toll-free for Beneficiaries under the PFS.
coverage (§ 410.31(b)), the examples of Requirement (§ 424.57(c)(9))
exceptions to the standards on N. Public Consultation for Medicare
frequency of coverage (§ 410.31(c)(2)), We estimate that only 1 percent of Payment for New Outpatient Clinical
and the category of individuals IDTFs do not already meet this Diagnostic Laboratory Tests
receiving glucocorticoid (steroid) requirement. Based on Medicare data as
of June 2005, we determined that 1 This codification of our process for
therapy (§ 410.31(d)(3)). We also discuss public consultation for new clinical
the addition of a new paragraph (f) that percent of IDTFs is approximately 56
suppliers. Therefore, 56 times the diagnostic laboratory tests paid under
would allow CMS, through the NCD the Medicare Part B clinical laboratory
process, to identify additional BMM approximate $600 annual cost of
telephone service results in an fee schedule does not increase or
systems for monitoring individuals decrease payment amounts for existing
receiving osteoporosis drug therapy and additional cost of $33,600 annually.
Total Cost = $1 million + $33,600 = clinical diagnostic laboratory tests
for performing confirmatory baseline because it does not alter our current
measurements. We do not expect that approximately $1.04 million annually.
methodology for calculating payment
this addition would have a significant M. Independent Lab Billing for TC amounts for existing clinical diagnostic
cost impact on the Medicare program in Component of Physician Pathology laboratory tests. For new tests, this
the next several years. Services for Hospital Patients change primarily codifies an existing
Based on the projected impact of the process for the determination of
The most current information on the
first three changes that would place payment amounts. Because any new
number of affected hospitals and the
greater reliance on the use of the more laboratory tests to be gapfilled are
impact on laboratories and hospitals
expensive DXA (axial skeleton) devices, unknown to us at the current time, we
comes from a report issued by GAO in
we estimate that this revised benefit do not have any data to estimate the
September 2003.
would result in an increase in Medicare impact of our policy to pay for new
payments for providers who use the The GAO estimated that
approximately 95 percent of the total of gapfilled lab tests at the median of the
DXA (axial skeleton) devices and a local carrier amounts for all carriers
somewhat smaller decrease in payments all Medicare hospitals on the
prospective payment system, as well as rather than the lower of that amount and
to providers who use QCT (axial the local carrier amount.
skeleton) and peripheral devices. CAHs sent the TC of physician
However, we do not expect that these pathology services to independent O. Bad Debt Payment for Services
changes would have a significant cost laboratories and the independent Associated With Reasonable Charge/Fee
impact on the Medicare program laboratories billed the carrier under the Schedules
because, at present, a very small PFS. This is a clarification of a
percentage of our total Medicare The GAO estimated that the median longstanding policy and, therefore, has
payments for bone mass measurements number of services sent by each hospital no associated dollar impact.
are being made to providers who use to outside independent laboratories was
small, approximately 81 services. The P. Revisions to Payment Policies Under
QCT or peripheral devices. In addition,
GAO was unable to identify the number the Ambulance Fee Schedule and the
we estimate that lowering the eligibility
of laboratories billing for the TC service Ambulance Inflation Factor Update for
standard for coverage of individuals on
because a single laboratory may submit CY 2007
steroid therapy from 7.5 mg/day to 5.0
mg/day of prednisone (the fourth claims under multiple provider We believe that the overall effect of
change) would result in an increase in numbers. In general, the impact on the adopting the CBSA-based geographic
Medicare payment for testing of individual hospital is small; however, definitions, as well as the RUCAs will
additional patients, but this modest we do not know the impact on the result in a redistribution of payments
lowering of the steroid standard is not individual independent laboratory. from urban to rural areas in some States
expected to have a significant cost If the independent laboratories had and from rural to urban areas in other
impact on the program. not received payments from the carriers States; however, the RUCAs will enable
for these TC services for hospital rural areas with a rurality level of 4.0 or
L. IDTF Changes patients, the GAO estimates that greater in all counties in all States to
The costs associated with these Medicare spending would have been remain rural rather than only
changes are as follows. $42 million less in 2001 and beneficiary recognizing those rural areas in large
cost sharing obligations for inpatient counties per the Goldsmith
1. Liability Insurance Requirement and outpatient services would have Modification. We have included three
(§ 424.57(c)(10)) been reduced by $2 million. tables to reflect the impact of the
We estimate that only 10 percent of Based on what they learned from the geographic changes. These three tables
IDTFs do not already have liability hospital industry, the GAO thought that reflect the CBSA-based definitions, as
insurance that meets this requirement. Medicare beneficiaries’ access to well as the RUCAs. Table 38 is a State-
Based on Medicare data as of June 2005, pathology services would not likely be by-State analysis of urban and rural
10 percent of the total number of IDTF’s affected if independent laboratories areas after all geographic changes have
is approximately 559 suppliers. Using could no longer bill the carrier for these been implemented. As can be seen in
the previously highest estimate received services. Hospital representatives this table, there is not a great deal of
($1,800 annually), results in an indicated that they would likely difference between the number of zip
approximate additional liability continue to use independent codes that move from rural to urban
(2,328—5.56 percent) and the number of specifically concerned remained rural or more urban trips at the lower rate, we
zip codes that move from urban to rural once the RUCA rurality level was anticipate that the overall payments will
(1,870—4.46 percent). There are a total applied. The third and final table is remain the same. For these reasons, we
of 41,888 zip codes—an average of 89.98 Addendum I which shows all zip codes estimate that this proposed rule will
percent of all zip codes do not change nationally by State and the rurality level have no fiscal impact on the Medicare
their geographic designation. Table 39 is associated with each zip code. program because payments will, in
an analysis of all the areas to which In addition, we contend that with the effect, be redistributed.
commenters referred as specific use of updated geographical areas where We estimate that the total program
concerns for them in response to the rural areas are redesignated as urban expenditure for CY 2007 for ambulance
proposed rule. The table is arranged by areas, it will be more likely than not, services covered by the Medicare
State, and, within each State, by zip that some level of population growth program is approximately $4.8 billion.
code area based on the information has occurred resulting in more Application of an AIF of 4.3 percent
provided by the commenters (some ambulance trips overall than had will result in an additional total
commenters mentioned counties or occurred prior to the use of the updated program expenditure for CY 2007 of
townships). We translated those geographical areas, even though these approximately $206 million over CY
concerns into the appropriate zip code trips are paid at a lower rate per trip 2006 expenditures.
areas within each State. This table (areas designated as rural generally With respect to our SCT policies,
shows the actual RUCA rurality level of receive a higher payment per trip than while we believe ambulance suppliers
each of these zip code areas. If the area areas designated as urban). and providers may now better
is, indeed, designated urban (a rurality In contrast, where urban areas are understand the interfacility
level of less than 4.0), a ‘‘yes’’ is redesignated as rural, there will be requirements and the personnel
indicated in the ‘‘Urban Zip?’’ column, fewer trips than were reported prior to requirements for payment of SCT
and the associated town or city is the use of the updated geographical services, we do not expect any
named in the following column as a areas, but at higher rates. Thus, although significant net impact on Medicare
reference point. Approximately half of ambulance suppliers and providers may expenditures.
the areas about which commenters were bill fewer rural trips at the higher rate BILLING CODE 4120–01–P
ER01DE06.020</GPH>
ER01DE06.021</GPH>
ER01DE06.022</GPH>
ER01DE06.023</GPH>
ER01DE06.024</GPH>
ER01DE06.025</GPH>
BILLING CODE 4120–01–C R. Impact on Beneficiaries benefit (referred to as the Welcome to

Q. Alternatives Considered Medicare benefit) will improve
There are a number of changes made
This final rule with comment period in this final rule with comment period beneficiary access to services that are
contains a range of policies, including that would have an effect on currently covered or expand the
some provisions related to specific beneficiaries. In general, we believe Medicare benefit package to include
MMA provisions. The preamble these changes, particularly the DRA new services. As explained in more
provides descriptions of the statutory provisions that provide for an exception detail below in this section, the
provisions that are addressed, identifies to the application of the Part B regulatory provisions may affect
those policies when discretion has been deductible with respect to colorectal beneficiary liability in some cases. Any
exercised, presents rationale for our cancer screening tests and coverage of changes in aggregate beneficiary liability
decisions and, where relevant, an ultrasound screening for the early from a particular provision would be a
function of the coinsurance (20 percent
ER01DE06.026</GPH>
alternatives that were considered. detection of AAAs as part of the IPPE
if applicable for the particular provision period, the 2007 national payment www.whitehouse.gov/omb/circulars/
after the beneficiary has met the amount in the nonfacility setting for a004/a-4.pdf), in Table 40, we have
deductible) and the effect of the CPT code 99203, as shown in Table 36, prepared an accounting statement
aggregate cost (savings) of the provision is $87.44 which means that, in 2007, the showing the classification of the
on the calculation of the Medicare Part beneficiary coinsurance for this service expenditures associated with this final
B premium rate (generally 25 percent of would be $17.49. rule with comment period. This table
the provision’s cost or savings). Policies discussed above in this provides our best estimate of the
To illustrate this point, as shown in section that do affect overall spending, decrease in Medicare payments under
Table 36, the 2006 national payment such as DRA 5102 imaging provisions, the physician fee schedule as a result of
amount in the nonfacility setting for would similarly impact beneficiaries’ the provisions presented in this final
CPT code 99203 (Office/outpatient visit, coinsurance. rule with comment period for CY 2007.
new), is $97.02 which means that
currently a beneficiary is responsible for S. Accounting Statement All expenditures are classified as
20 percent of this amount, or $19.40. As required by OMB Circular A–4 transfers.
Based on this final rule with comment (available at http://
TABLE 40.—ACCOUNTING STATEMENT: CLASSIFICATION OF ESTIMATED CY 2007 EXPENDITURES ASSOCIATED WITH CY

2007 FINAL RULE PROVISIONS
Category Transfers
Annualized Monetized Transfers .............................................................. Estimated decrease in expenditures of $3.7 billion.

From Whom To Whom? ........................................................................... Federal Government to physicians, other practitioners and suppliers
who receive payment under the Medicare Physician Fee Schedule;
ESRD Medicare Providers; ambulance suppliers, and Medicare sup-
pliers billing for Part B drugs.
In accordance with the provisions of 42 CFR Part 424 she furnishes services to patients or
Executive Order 12866, this final rule clients.
was reviewed by the Office of Emergency medical services, Health
* * * * *
Management and Budget. facilities, Health professions, Medicare,
Reporting and recordkeeping Subpart X—Rural Health Clinic and
List of Subjects requirements. Federally Qualified Health Center
42 CFR Part 405 ■ For the reasons set forth in the Services Payment for Rural Health
preamble, the Centers for Medicare & Clinic and Federally Qualified Health
Administrative practice and Center Services
procedure, Health facilities, Health Medicaid Services amends 42 CFR
professions, Kidney diseases, Medical chapter IV as follows:
■ 3. Section 405.2446 is amended by
devices, Medicare, Reporting and PART 405—FEDERAL HEALTH adding paragraph (b)(10) to read as
recordkeeping requirements, Rural INSURANCE FOR THE AGED AND follows:
areas, X-rays. DISABLED § 405.2446 Scope of services.
42 CFR Part 410 * * * * *
■ 1. The authority citation for part 405
Health facilities, Health professions, (b) * * *
continues to read as follows: (10) Medical nutrition therapy
Kidney diseases, Laboratories,
Authority: Secs. 1102, 1861, 1862(a), 1871, services as specified in part 410, subpart
Medicare, Reporting and recordkeeping 1874, 1881, and 1886(k) of the Social
requirements, Rural areas, X-rays. G of this chapter, and diabetes
Security Act (42 U.S.C. 1302, 1395x, outpatient self-management training
42 CFR Part 411. 1395y(a), 1395hh, 1395kk, 1395rr, and services as specified in part 410, subpart
1395ww(k)), and sec. 353 of the Public
Health Service Act (42 U.S.C. 263a).
H of this chapter.
Kidney diseases, Medicare, Physician
Referral, Reporting and recordkeeping * * * * *
requirements. Subpart D—Private Contracts ■ 4. Section 405.2463 is revised to read
as follows:
42 CFR Part 413
■ 2. Section 405.400 is amended by § 405.2463 What constitutes a visit.
Health facilities, Kidney diseases, revising the definition of ‘‘Practitioner’’ (a) Visit—(1) General. (i) For rural
Medicare, Reporting and recordkeeping to read as follows: health clinics, a visit is a face-to-face
requirements. encounter between a clinic or center
§ 405.400 Definitions.
42 CFR part 414 patient and a physician, physician
* * * * *
assistant, nurse practitioner, nurse
Administrative practice and Practitioner means a physician midwife, visiting nurse, clinical
procedure, Health facilities, Health assistant, nurse practitioner, clinical psychologist, or clinical social worker.
professions, Kidney diseases, Medicare, nurse specialist, certified registered (ii) For FQHCs, a visit is—
Reporting and recordkeeping. nurse anesthetist, certified nurse (A) A face-to-face encounter, as
42 CFR Part 415 midwife, clinical psychologist, clinical described in paragraph (a)(1)(i) of this
social worker, registered dietitian or section; or
Health facilities, Health professions, nutrition professional, who is currently (B) A face-to-face encounter between
Medicare, Reporting and recordkeeping legally authorized to practice in that a patient and a qualified provider of
requirements. capacity by each State in which he or medical nutrition therapy services as
defined in part 410, subpart G of this as a checklist provided to the eligible beneficiaries, as described in
chapter; or a qualified provider of beneficiary for obtaining the appropriate this section, after a referral from a
outpatient diabetes self-management screening and other preventive services physician or a qualified nonphysician
training services as defined in part 410, that are covered as separate Medicare practitioner as defined in § 410.16(a),
subpart H of this chapter. Part B benefits as described in section when the test is performed by a provider
(2) Medical visit. A medical visit is a 1861(s)(10), section 1861(jj), section or supplier that is authorized to provide
face-to-face encounter between a clinic 1861(nn), section 1861(oo), section covered ultrasound diagnostic services.
or center patient and a physician, 1861(pp), section 1861(qq)(1), section (c) Limitation on coverage of
physician assistant, nurse practitioner, 1861(rr), section 1861(uu), section ultrasound screening for abdominal
nurse midwife, or a visiting nurse; and 1861(vv), section 1861(xx)(1), section aortic aneurysms. Payment may not be
for FQHCs only, a medical visit also 1861(yy), and section 1861(bbb) of the made for an ultrasound screening for an
includes a separately billable medical Act. abdominal aortic aneurysm that is
nutrition therapy visit or a diabetes * * * * * performed for an individual that does
outpatient self-management training ■ 7. A new § 410.19 is added to read as
not meet the definition of ‘‘eligible
visit. follows: beneficiary’’ specified in this section.
(3) Other health visit. An other health ■ 8. Section 410.31 is revised to read as
visit is a face-to-face encounter between § 410.19 Ultrasound screening for follows:
a clinic or center patient and a clinical abdominal aortic aneurysms: Condition for
psychologist, clinical social worker, or and limitation on coverage. § 410.31 Bone mass measurement:
other health professional for mental (a) Definitions: As used in this Conditions for coverage and frequency
section, the following definitions apply: standards.
health services.
(b) Encounters. Encounters with more Eligible beneficiary means an (a) Definition. As used in this section
than one health professional and individual who— unless specified otherwise, the
multiple encounters with the same (1) Has received a referral for an following definition applies:
health professional that take place on ultrasound screening for an abdominal Bone mass measurement means a
the same day and at a single location aortic aneurysm as a result of an initial radiologic, radioisotopic, or other
constitute a single visit, except when preventive physical examination (as procedure that meets the following
one of the following conditions exist: defined in section 1861(ww)(1) of the conditions:
(1) After the first encounter, the Act); (1) Is performed for the purpose of
patient suffers illness or injury requiring (2) Has not been previously furnished identifying bone mass, detecting bone
additional diagnosis or treatment. an ultrasound screening for an loss, or determining bone quality.
(2) The patient has a medical visit and abdominal aortic aneurysm under (2) Is performed with either a bone
other health visit(s), as defined in Medicare program; and densitometer (other than single-photon
paragraph (a) of this section. (3) Is included in at least one of the or dual-photon absorptiometry) or with
(c) Payment. Medicare pays for more following risk categories: a bone sonometer system that has been
than one visit per day when the (i) Has a family history of an cleared for marketing for this use by the
conditions in paragraph (b) of this abdominal aortic aneurysm. FDA under 21 CFR part 807, or
section are met or a separate visit under (ii) Is a man age 65 to 75 who has approved for marketing by the FDA for
paragraph (a)(1)(ii)(B) of this section is smoked at least 100 cigarettes in his this use under 21 CFR part 814.
made. lifetime. (3) Includes a physician’s
(iii) Is an individual who manifests interpretation of the results of the
PART 410—SUPPLEMENTARY other risk factors in a beneficiary procedure.
MEDICAL INSURANCE (SMI) category recommended for screening by (b) Conditions for coverage. (1)
BENEFITS the United States Preventive Services Medicare covers a medically necessary
Task Force regarding abdominal aortic bone mass measurement if the following
■ 5. The authority citation for part 410 aneurysms, as specified by the Secretary conditions are met:
continues to read as follows: through a national coverage (i) Following an evaluation of the
Authority: Secs. 1102, 1834, and 1871 of determination process. beneficiary’s need for the measurement,
the Social Security Act (42 U.S.C. 1302, Ultrasound screening for abdominal including a determination as to the
1395m, and 1395hh). aortic aneurysms means the following medically appropriate procedure to be
services furnished to an asymptomatic used for the beneficiary, it is ordered by
Subpart B—Medical and Other Health individual for the early detection of an the physician or a qualified
Services abdominal aortic aneurysm: nonphysician practitioner (as these
(1) A procedure using soundwaves (or terms are defined in § 410.32(a)) treating
■ 6. In § 410.16 paragraph (a) is other procedures using alternative the beneficiary.
amended by revising paragraph (7) of technologies of commensurate accuracy (ii) It is performed under the
the definition of ‘‘initial preventive and cost, as specified by the Secretary appropriate level of supervision of a
physical examination’’ to read as through a national coverage physician (as set forth in § 410.32(b)).
follows: determination process) provided for the (iii) It is reasonable and necessary for
early detection of abdominal aortic diagnosing and treating the condition of
§ 410.16 Initial preventive physical aneurysms. a beneficiary who meets the conditions
examination: Conditions for and limitations (2) Includes a physician’s described in paragraph (d) of this
on coverage. interpretation of the results of the section.
(a) * * * procedure. (2) Medicare covers a medically
* * * * * (b) Conditions for coverage of an necessary bone mass measurement for

Initial preventive physical ultrasound screening for abdominal an individual defined under paragraph
examination * * *. aortic aneurysms. Medicare Part B pays (d)(5) of this section if the conditions
(7) Education, counseling, and for one ultrasound screening for an under paragraph (b)(1) of this section
referral, including a written plan such abdominal aortic aneurysm provided to are met and the monitoring is performed
by the use of a dual energy x-ray (e) Denial as not reasonable and performed at the IDTF, the IDTF is the
absorptiometry system (axial skeleton). necessary. If CMS determines that a place of service.
(3) Medicare covers a medically bone mass measurement does not meet * * * * *
necessary confirmatory baseline bone the conditions for coverage in (g) Application certification
mass measurement for an individual paragraphs (b) or (d) of this section, or standards. The IDTF must certify in its
defined under paragraph (d) of this the standards on frequency of coverage enrollment application that it meets the
section, if the conditions under in paragraph (c) of this section, it is following standards and related
paragraph (b)(1) of this section are met excluded from Medicare coverage as not requirements:
and the confirmatory baseline bone ‘‘reasonable’’ and ‘‘necessary’’ under (1) Operates its business in
mass measurement is performed by a section 1862(a)(1)(A) of the Act and compliance with all applicable Federal
dual energy x-ray absorptiometry system § 411.15(k) of this chapter. and State licensure and regulatory
(axial skeleton) and the initial (f) Use of the National Coverage requirements for the health and safety of
measurement was not performed by a Determination Process. For the purposes patients.
dual energy x-ray absorptiometry system of paragraphs (b)(2) and (b)(3) of this (2) Provides complete and accurate
(axial skeleton). section, CMS may determine through information on its enrollment
(c) Standards on frequency of the National Coverage Determination application. Any change in enrollment
coverage—(1) General rule. Except as process that additional bone mass information must be reported to the
allowed under paragraph (c)(2) of this measurement systems are reasonable designated fee-for-service contractor on
section, Medicare may cover a bone and necessary under section 1862(a)(1) the Medicare enrollment application
mass measurement for a beneficiary if at of the Act for monitoring and within 30 calendar days of the change.
least 23 months have passed since the confirming baseline bone mass (3) Maintains a physical facility on an
month the last bone mass measurement measurements. appropriate site. For the purposes of this
was performed. * * * * * standard, a post office box or
(2) Exception. If medically necessary, commercial mail box is not considered
■ 9. Section 410.33 is amended by—
Medicare may cover a bone mass a physical facility. The physical facility,
■ A. Revising paragraph (b)(1).
measurement for a beneficiary more including mobile units, must contain
frequently than allowed under ■ B. Revising paragraph (e).
space for equipment appropriate to the
paragraph (c)(1) of this section. ■ C. Adding paragraphs (g) and (h).
services designated on the enrollment
Examples of situations where more The revision and additions read as application, facilities for hand washing,
frequent bone mass measurement follows: adequate patient privacy
procedures may be medically necessary § 410.33 Independent diagnostic testing accommodations, and the storage of
include, but are not limited to the facility. both business records and current
following medical circumstances: medical records within the office setting
* * * * *
(i) Monitoring beneficiaries on long- of the IDTF, or IDTF home office, not
term glucocorticoid (steroid) therapy of (b) Supervising physician. (1) Each
within the actual mobile unit.
more than 3 months. supervising physician must be limited
(4) Has all applicable diagnostic
(ii) Allowing for a confirmatory to providing supervision to no more
testing equipment available at the
baseline measurement to permit than three IDTF sites. The IDTF
physical site excluding portable
monitoring of beneficiaries in the future supervising physician is responsible for
diagnostic testing equipment. The IDTF
if the requirements of paragraph (b)(3) of the overall operation and administration
must—
this section are met. of the IDTFs, including the employment
(i) Maintain a catalog of portable
(d) Beneficiaries who may be covered. of personnel who are competent to
diagnostic equipment, including
The following categories of beneficiaries perform test procedures, record and
diagnostic testing equipment serial
may receive Medicare coverage for a report test results promptly, accurately
numbers at the physical site;
medically necessary bone mass and proficiently, and for assuring
(ii) Make portable diagnostic testing
measurement: compliance with the applicable
equipment available for inspection
regulations.
(1) A woman who has been within 2 business days of a CMS
determined by the physician (or a * * * * * inspection request.
qualified nonphysician practitioner) (e) Multi-State entities. (1) An IDTF (iii) Maintain a current inventory of
treating her to be estrogen-deficient and that operates across State boundaries the diagnostic testing equipment,
at clinical risk for osteoporosis, based must— including serial and registration
on her medical history and other (i) Maintain documentation that its numbers and provide this information
findings. supervising physicians and technicians to the designated fee-for-service
(2) An individual with vertebral are licensed and certified in each of the contractor upon request, and notify the
abnormalities as demonstrated by an x- States in which it operates; and contractor of any changes in equipment
ray to be indicative of osteoporosis, (ii) Operate in compliance with all within 90 days.
osteopenia, or vertebral fracture. applicable Federal, State, and local (5) Maintain a primary business
(3) An individual receiving (or licensure and regulatory requirements phone under the name of the designated
expecting to receive) glucocorticoid with regard to the health and safety of business. The IDTF must have its—
(steroid) therapy equivalent to an patients. (i) Primary business phone located at
average of 5.0 mg of prednisone, or (2) The point of the actual delivery of the designated site of the business or
greater, per day for more than 3 months. service means the place of service on within the home office of the mobile
(4) An individual with primary the claim form. When the IDTF IDTF units.
hyperparathyroidism. performs or administers an entire (ii) Telephone or toll free telephone

(5) An individual being monitored to diagnostic test at the beneficiary’s numbers available in a local directory
assess the response to or efficacy of an location, the beneficiary’s location is the and through directory assistance.
FDA-approved osteoporosis drug place of service. When one or more (6) Have a comprehensive liability
therapy. aspects of the diagnostic testing are insurance policy of at least $300,000 per
location that covers both the place of standards in paragraph (g) or (b)(1) of (1) Categorized by the FDA as a
business and all customers and this section. Category A or B device defined in
employees of the IDTF. The policy must § 405.201(b) of this chapter; and
be carried by a nonrelative-owned Subpart I—Payment of SMI Benefits
(2) Furnished in accordance with the
company and list the serial numbers of CMS clinical research policy.
■ 10. Section 410.160 is amended by
any and all diagnostic equipment used
adding paragraphs (b)(7) and (b)(8) to * * * * *
by the IDTF, whether the equipment is
read as follows:
stationary, in a mobile unit, or at the
beneficiary’s residence. PART 413—PRINCIPLES OF
§ 410.160 Part B annual deductible.
(7) Agree not to directly solicit REASONABLE COST
* * * * * REIMBURSEMENT; PAYMENT FOR
patients, which include, but is not (b) * * *
limited to, a prohibition on telephone, (7) Beginning January 1, 2007, END-STAGE RENAL DISEASE
computer, or in-person contacts. The colorectal cancer screening tests as SERVICES; PROSPECTIVELY
IDTF must accept only those patients described in § 410.37. DETERMINED PAYMENT RATES FOR
referred for diagnostic testing by an (8) Beginning January 1, 2007, SKILLED NURSING FACILITIES
attending physician, who is furnishing a ultrasound screening for abdominal
consultation or treating a beneficiary for aortic aneurysms described in § 410.19. ■ 13. The authority citation for part 413
a specific medical problem and who * * * * * continues to read as follows:
uses the results in the management of Authority: Secs. 1102, 1138(b), 1812(d),
the beneficiary’s specific medical PART 411—EXCLUSIONS FROM
1814(b), 1815, 1833(a), (i), and (n), 1871,
problem. Nonphysician practitioners MEDICARE AND LIMITATIONS ON 1881, 1883, and 1886 of the Social Security
may order tests as set forth in MEDICARE PAYMENT Act (42 U.S.C. 1302, 1320b–8(b), 1395d(d),
§ 410.32(a)(3). 1395f(b), 1395g, 1395l(a), (i), and (n), 1395hh,
(8) Answer beneficiaries’ questions ■ 11. The authority citation for part 411
is amended to read as follows: 1395rr, 1395tt, and 1395ww).
and respond to their complaints.
(9) Openly post these standards for Authority: Secs. 1102, 1860D–1 through Subpart F—Specific Categories of
review by patients and the public. 1860D–42, 1871, and 1877 of the Social
Security Act (42 U.S.C. 1302, 1395w–101
Costs
(10) Disclose to the government any through 1395w–152, 1395hh, and 1395nn).
person having ownership, financial, or ■ 14. Section 413.89 is amended by
control interest or any other legal Subpart A—General Exclusions and revising paragraphs (a) and (i) to read as
interest in the supplier at the time of Exclusion of Particular Services follows:
enrollment or within 30 days of a
change. ■ 12. Section 411.15 is amended by— § 413.89 Bad debts, charity, and courtesy
(11) Have its testing equipment ■ A. Revising paragraph (a)(1). allowances.
calibrated and maintained per ■ B. Adding a new paragraph (k)(12).
■ C. Revising paragraph (o). (a) Principle. Bad debts, charity, and
equipment instructions and in
The revisions and addition read as courtesy allowances are deductions
compliance with applicable
follows: from revenue and are not to be included
manufacturers suggested maintenance
and calibration standards. in allowable cost. However, subject to
§ 411.15 Particular services excluded from
(12) Have technical staff on duty with coverage.
the limitations described under
the appropriate credentials to perform paragraph (h) of this section and the
* * * * *
tests. The IDTF must be able to produce exception for services described under
(a) * * *
the applicable Federal or State licenses (1) Examinations performed for a paragraph (i) of this section, bad debts
or certifications of the individuals purpose other than treatment or attributable to the deductibles and
performing these services. diagnosis of a specific illness, coinsurance amounts are reimbursable
(13) Have proper medical record symptoms, complaint, or injury, except under the program.
storage and be able to retrieve medical for screening mammography, colorectal * * * * *
records upon request from CMS or its cancer screening tests, screening pelvic (i) Exception. Bad debts arising from
fee-for-service contractor within 2 exams, prostate cancer screening tests,
covered services paid under a
business days. glaucoma screening exams, initial
reasonable charge-based methodology or
(14) Permit CMS, including its agents, preventive physical examinations, or
ultrasound screening for abdominal a fee schedule are not reimbursable
or its designated fee-for-service
aortic aneurysms that meet the criteria under the program.
contractors, to conduct unannounced,
on-site inspections to confirm the specified in paragraphs (k)(6) through
Subpart H—Payment for End-Stage
IDTF’s compliance with these (k)(12) of this section.
Renal Disease (ESRD) Services and
standards. The IDTF must— * * * * * Organ Procurement Costs
(i) Be accessible during regular (k) * * *
business hours to CMS and (12) In the case of ultrasound
beneficiaries; and screening for abdominal aortic ■ 15. Section 413.178 is amended by
(ii) Maintain a visible sign posting its aneurysms, with the goal of early adding paragraph (d) to read as follows:
normal business hours. detection of abdominal aortic § 413.178 Bad debts.
(h) Failure to meet standards. If an aneurysms, subject to the conditions
IDTF fails to meet one or more of the and limitation specified in § 410.19 of * * * * *
standards in paragraph (g) of this this chapter. (d) Bad debts arising from covered
section at the time of enrollment, its * * * * * ESRD services paid under a reasonable
enrollment will be denied. CMS will (o) Experimental or investigational charge-based methodology or a fee
revoke a supplier’s billing privileges if devices. Experimental or investigational schedule are not reimbursable under the
and IDTF is found not to meet the devices, except for certain devices— program.
PART 414—PAYMENT FOR PART B (b) CMS publishes a Federal Register (i) Charges for the test and routine
MEDICAL AND OTHER HEALTH notice of a meeting to receive public discounts to charges;
SERVICES comments and recommendations (and (ii) Resources required to perform the
data on which recommendations are test;
■ 16. The authority citation for Part 414 based) on the appropriate basis, as (iii) Payment amounts determined by
continues to read as follows: specified in § 414.508, for establishing other payers; and
* * * * * payment amounts for the list of codes (iv) Charges, payment amounts, and
Authority: Secs. 1102, 1871, and 1881(b)(l) made available to the public. resources required for other tests that
of the Social Security Act (42 U.S.C. 1302, (c) Not fewer than 30 days after may be comparable or otherwise
1395hh, and 1395rr(b)(l)). publication of the notice in the Federal relevant.
Register, CMS convenes a meeting that (2) In the second year, the test code
■ 17. A new subpart G is added as includes representatives of CMS is paid at the national limitation
follows: officials involved in determining amount, which is the median of the
Subpart G—Payment for New Clinical payment amounts, to receive public carrier-specific amounts.
Diagnostic Laboratory Tests comments and recommendations (and (3) After the first year of gapfilling,
data on which the recommendations are CMS determines whether the carrier-
Sec. based). specific amounts will pay for the test
414.500 Basis and scope. (d) Considering the comments and appropriately. If CMS determines that
414.502 Definitions. recommendations (and accompanying the carrier-specific amounts will not pay
414.504 [Reserved] data) received at the public meeting, for the test appropriately, CMS may
414.506 Procedures for public consultation
for payment for a new clinical diagnostic
CMS develops and makes available to crosswalk the test.
laboratory test. the public (through an Internet Web site
and other appropriate mechanisms) a § 414.510 Laboratory date of service for
414.508 Payment for a new clinical specimens.
diagnostic laboratory test. list of—
414.510 Laboratory date of service for (1) Proposed determinations with The date of service for a laboratory
specimens. respect to the appropriate basis for test is as follows:
establishing a payment amount for each (a) Except as provided under
Subpart G—Payment for New Clinical code, with an explanation of the reasons paragraph (b) of this section, the date of
Diagnostic Laboratory Tests for each determination, the data on service of the test must be the date the
which the determinations are based, and specimen was collected.
§ 414.500 Basis and scope.
a request for public written comments (b)(1) If a specimen was collected over
This subpart implements provisions a period that spans 2 calendar days,
of 1833(h)(8) of the Act—procedures for within a specified time period on the
proposed determination; and then the date of service must be the date
determining the basis for, and amount the collection ended.
of, payment for a new clinical (2) Final determinations of the
payment amounts for tests, with the (2) In the case of a test performed on
diagnostic laboratory test with respect to a stored specimen, if a specimen was
which a new or substantially revised rationale for each determination, the
data on which the determinations are stored for—
Healthcare Common Procedure Coding
based, and responses to comments and (i) Less than or equal to 30 calendar
System code is assigned on or after
suggestions from the public. days from the date it was collected, the
January 1, 2005.
date of service of the test must be the
§ 414.502 Definitions. § 414.508 Payment for a new clinical date the test was performed only if—
diagnostic laboratory test. (A) The test is ordered by the patient’s
For purposes of this subpart—
Substantially Revised Healthcare For a new clinical diagnostic physician at least 14 days following the
Common Procedure Coding System laboratory test that is assigned a new or date of the patient’s discharge from the
Code means a code for which there has substantially revised code on or after hospital;
been a substantive change to the January 1, 2005, CMS determines the (B) The specimen was collected while
definition of the test or procedure to payment amount based on either of the the patient was undergoing a hospital
which the code applies (such as a new following: surgical procedure;
analyte or a new methodology for (a) Crosswalking. Crosswalking is (C) It would be medically
measuring an existing analyte specific used if it is determined that a new test inappropriate to have collected the
test). is comparable to an existing test, sample other than during the hospital
multiple existing test codes, or a portion procedure for which the patient was
§ 414.504 [Reserved] of an existing test code. admitted;
§ 414.506 Procedures for public (1) CMS assigns to the new test code, (D) The results of the test do not guide
consultation for payment for a new clinical the local fee schedule amounts and treatment provided during the hospital
diagnostic laboratory test. national limitation amount of the stay; and
For a new clinical diagnostic existing test. (E) The test was reasonable and
laboratory test that is assigned a new or (2) Payment for the new test code is medically necessary for the treatment of
substantially revised code on or after made at the lesser of the local fee an illness.
January 1, 2005, CMS determines the schedule amount or the national (ii) More than 30 calendar days before
payment after the performance of the limitation amount. testing, the specimen is considered to
following: (b) Gapfilling. Gapfilling is used when have been archived and the date of
(a) CMS makes available to the public no comparable existing test is available. service of the test must be the date the
(through CMS’s Internet Web site) a list (1) In the first year, carrier-specific specimen was obtained from storage.
that includes codes for which amounts are established for the new test (3) In the case of a chemotherapy
establishment of a payment amount is code using the following sources of sensitivity test performed on live tissue,
being considered for the next calendar information to determine gapfill the date of service of the test must be
year. amounts, if available: the date the test was performed only if—
(i) The decision regarding the specific Subpart J—Submission of (i)(A) For each National Drug Code
chemotherapeutic agents to test is made Manufacturer’s Average Sales Price with at least 12 months of sales
at least 14 days after discharge; Data (including products for which the
(ii) The specimen was collected while manufacturer has redesignated the
the patient was undergoing a hospital ■ 20. Section 414.802 is amended by National Drug Code for the specific
surgical procedure; adding the definition of ‘‘Bona fide product and package size and has 12
(iii) It would be medically service fees’’ in alphabetical order to months of sales across the prior and
inappropriate to have collected the read as follows: current National Drug Codes), after
sample other than during the hospital adjusting for exempted sales, the
§ 414.802 Definitions.
procedure for which the patient was manufacturer calculates a percentage
* * * * * equal to the sum of the price
admitted;
Bona fide service fees means fees paid concessions for the most recent 12-
(iv) The results of the test do not by a manufacturer to an entity, that
guide treatment provided during the month period available associated with
represent fair market value for a bona sales subject to the average sales price
hospital stay; and, fide, itemized service actually
(v) The test was reasonable and reporting requirement divided by the
performed on behalf of the manufacturer total in dollars for the sales subject to
medically necessary for the treatment of that the manufacturer would otherwise
an illness. the average sales price reporting
perform (or contract for) in the absence requirement for the same 12-month
(4) For purposes of this section, of the service arrangement, and that are
‘‘chemotherapy sensitivity test’’ means a period.
not passed on in whole or in part to a (B) For each National Drug Code with
test identified by the Secretary as a test client or customer of an entity, whether less than 12 months of sales, the
that requires a fresh tissue sample to test or not the entity takes title to the drug. calculation described in paragraph (i)(A)
the sensitivity of tumor cells to various
* * * * * of this section is performed for the time
chemotherapeutic agents. The Secretary
■ 21. Section 414.804 is amended by period equaling the total number of
identifies such tests through program months of sales.
instructions. revising paragraphs (a)(1) through (a)(4)
to read as follows: (ii) The manufacturer multiplies the
Subpart H—Fee Schedule for applicable percentage described in
§ 414.804 Basis of payment. paragraph (a)(3)(i)(A) or (a)(3)(i)(B) of
Ambulance Services
(a) * * * this section by the total in dollars for the
■ 18. Section 414.605 is amended by— (1) The manufacturer’s average sales sales subject to the average sales price
■ A. Removing the definition of price for a quarter for a drug represented reporting requirement (after adjusting
‘‘Goldsmith modification.’’ by a particular 11-digit National Drug for exempted sales) for the quarter being
■ B. Revising the definition of ‘‘rural
Code must be calculated as the submitted. (The manufacturer must
area.’’ manufacturer’s sales to all purchasers in carry a sufficient number of decimal
the United States for that particular 11- places in the calculation of the price
■ C. Adding the definition of ‘‘urban
digit National Drug Code (after concessions percentage in order to
area’’ in alphabetical order.
excluding sales as specified in round accurately the net total sales
The revisions and addition read as amount for the quarter to the nearest
follows: paragraph (a)(4) of this section and then
deducting price concessions as specified whole dollar.) The result of this
§ 414.605 Definitions. in paragraphs (a)(2) and (a)(3) of this multiplication is then subtracted from
* * * * * section) divided by the total number of the total in dollars for the sales subject
Rural area means an area located units sold by the manufacturer in that to the average sales price reporting
outside an urban area, or a rural census quarter (after excluding units associated requirement (after adjusting for
with sales as specified in paragraph exempted sales) for the quarter being
tract within a Metropolitan Statistical
(a)(4) of this section). submitted.
Area as determined under the most
(2) Price concessions. (i) In calculating (iii) The manufacturer uses the result
recent version of the Goldsmith of the calculation described in
modification as determined by the the manufacturer’s average sales price, a
manufacturer must deduct price paragraph (a)(3)(ii) of this section as the
Office of Rural Health Policy of the numerator and the number of units sold
Health Resources and Services concessions. Price concessions include
the following types of transactions and in the quarter (after adjusting for
Administration. exempted sales) as the denominator to
items:
* * * * * (A) Volume discounts. calculate the manufacturer’s average
Urban area means a Metropolitan (B) Prompt pay discounts. sales price for the National Drug Code
Statistical Area, as defined by the (C) Cash discounts. for the quarter being submitted.
Executive Office of Management and (D) Free goods that are contingent on (iv) Example. After adjusting for
Budget. any purchase requirement. exempted sales, the total lagged price
■ 19. Section 414.610 is amended by (E) Chargebacks and rebates (other concessions (discounts, rebates, etc.)
revising paragraph (g) to read as follows: than rebates under the Medicaid over the most recent 12-month period
program). available associated with sales for
§ 414.610 Basis of payment. (ii) For the purposes of paragraph National Drug Code 12345–6789–01
* * * * * (a)(2)(i), bona fide services fees are not subject to the ASP reporting
(g) Adjustments. The Secretary considered price concessions. requirement equal $200,000, and the
monitors payment and billing data on (3) To the extent that data on price total in dollars for the sales subject to
an ongoing basis and adjusts the CF and concessions, as described in paragraph the average sales price reporting
air ambulance rates as appropriate to (a)(2) of this section, are available on a requirement for the same period equals
reflect actual practices under the fee lagged basis, the manufacturer must $600,000. The lagged price concessions
schedule. These rates are not adjusted estimate this amount in accordance with percentage for this period equals
solely because of changes in the total the methodology described in this 200,000/600,000 = 0.33333. The total in
number of ambulance transports. paragraph. dollars for the sales subject to the
average sales price reporting payment limit in the quarter following (f) Blood glucose testing. For each
requirement for the quarter being the transmittal of this information to the blood glucose test, the physician must
reported, after accounting for non- Secretary is the lesser of the widely certify that the test is medically
lagged price concessions, equals available market price or 103 percent of necessary. A physician’s standing order
$50,000 for 10,000 units sold. The the average manufacturer price. is not sufficient to order a series of
manufacturer’s average sales price * * * * * blood glucose tests payable under the
calculation for this National Drug Code clinical laboratory fee schedule.
for this quarter is: $50,000¥(0.33333 × PART 415—SERVICES FURNISHED BY * * * * *
$50,000) = $33,334 (net total sales PHYSICIANS IN PROVIDERS,
amount); $33,334/10,000 = $3.33 SUPERVISING PHYSICIANS IN Subpart F—Limitations on Assignment
(average sales price). TEACHING SETTINGS, AND and Reassignment of Claims
(4) Exempted sales. (i) In calculating RESIDENTS IN CERTAIN SETTINGS
the manufacturer’s average sales price, a ■ 27. Section 424.80 is amended by—
manufacturer must exclude sales that ■ 23. The authority citation for part 415 ■ A. Revising the heading of paragraph
are exempt from inclusion in the continues to read as follows: (d).
determination of the best price under Authority: Secs. 1102 and 1871 of the ■ B. Revising paragraph (d)(2)
section 1927(c)(1)(C)(i) of the Act and Social Security Act (42 U.S.C. 1302 and The revisions read as follows:
sales that are merely nominal in amount 1395hh).
§ 424.80 Prohibition of reassignment of
as applied for purposes of section claims by suppliers.
1927(c)(1)(C)(ii)(III) of the Act, as Subpart C—Part B Carrier Payments
limited by section 1927(c)(1)(D) of the for Physician Services to Beneficiaries * * * * *
Act. in Providers (d) Reassignment to an entity under
(ii) In determining nominal sales an employer-employee relationship or
exempted under section ■ 24. Section 415.130 is amended by under a contractual arrangement:
1927(c)(1)(C)(ii)(III) of the Act, the revising paragraph (d) to read as Conditions and limitations. (1) * * *
manufacturer calculates the average follows: (2) Access to records. The supplier
manufacturer price as defined in section who furnishes the service has
§ 415.130 Conditions for payment: unrestricted access to claims submitted
1927(k) of the Act and then identifies Physician pathology services.
sales that are eligible to be considered by an entity for services provided by
* * * * * that supplier. This paragraph applies
a nominal sale under section (d) Physician pathology services
1927(c)(1)(D) of the Act and are at less irrespective of whether the supplier is
furnished by an independent laboratory. an employee or whether the service is
than 10 percent of the average The technical component of physician
manufacturer price. To identify nominal provided under a contractual
pathology services furnished by an arrangement. If an entity refuses to
sales, the manufacturer must use the independent laboratory to a hospital
average manufacturer price for the provide, upon request, the billing
inpatient or outpatient on or before information to the supplier performing
calendar quarter that is the same December 31, 2006 may be paid to the
calendar quarter as the average sales the service, the entity’s right to receive
laboratory by the carrier under the reassigned benefits may be revoked
price reporting period. physician fee schedule if the Medicare under § 424.82(c)(3).
* * * * * beneficiary is a patient of a covered
(Catalog of Federal Domestic Assistance
hospital as defined in paragraph (a)(1) of
Subpart K—Payment for Drugs and Program No. 93.774, Medicare—
this section. For services furnished after Supplementary Medical Insurance Program)
Biologicals Under Part B December 31, 2006, an independent
laboratory may not bill the carrier for Dated: October 31, 2006.
■ 22. Section 414.904 is amended by Leslie V. Norwalk,
revising paragraphs (d)(2)(iii) and (d)(3) the technical component of physician
pathology services furnished to a Acting Adminstrator, Centers for Medicare
to read as follows: & Medicaid Services.
hospital inpatient or outpatient.
§ 414.904 Average sales price as the basis Approved: November 1, 2006.
for payment. PART 424—CONDITIONS FOR Michael O. Leavitt,
* * * * * MEDICARE PAYMENT Secretary.
(d) * * *
(2) * * * ■ 25. The authority citation for part 424 Note: These addenda will not appear in the
continues to read as follows: Code of Federal Regulations.
(iii) Effective for drugs and biologicals
furnished in CY 2006 and subsequent Authority: Secs. 1102 and 1871 of the Addendum A: Explanation and Use of
calendar years, the payment for such Social Security Act (42 U.S.C. 1302 and Addenda B
drugs and biologicals furnished in 1395hh).
The addenda on the following pages
connection with renal dialysis services provide various data pertaining to the
Subpart B—Certification and Plan of
and separately billed by freestanding Medicare fee schedule for physicians’
Treatment Requirements
and hospital-based renal dialysis services furnished in 2007. Addendum B
facilities not paid on a cost basis is the ■ 26. Section 424.24 is amended by— contains the RVUs for work, non-facility PE,
amount determined under section facility PE, and malpractice expense, and
■ A. Redesignating paragraph (f) as other information for all services included in
1847A of the Act. paragraph (g).
(3) Widely available market price and the PFS.
■ B. Adding a new paragraph (f). In previous years, we have listed many
average manufacturer price. If the The addition reads as follows:
services in Addendum B that are not paid

Inspector General finds that the average under the PFS. To avoid publishing as many
sales price exceeds the widely available § 424.24 Requirements for medical and pages of codes for these services, we are not
market price or the average other health services furnished by including clinical laboratory codes or the
manufacturer price by 5 percent or more providers under Medicare Part B. alphanumeric codes (Healthcare Common
in CYs 2005, 2006, and 2007, the * * * * * Procedure Coding System (HCPCS) codes not
included in CPT) not paid under the PFS in shown, they are not used for Medicare the statutory definition of ‘‘physicians’’
Addendum B. payment. If these services are covered, services’’ for PFS payment purposes. No
payment for them is subsumed by the RVUs are shown for these codes, and no
Addendum B—2007 Relative Value Units payment for the services to which they are
and Related Information Used in payment may be made under the PFS.
incident (an example is a telephone call from (Examples are ambulance services and
Determining Medicare Payments for 2007 a hospital nurse regarding care of a patient). clinical diagnostic laboratory services.)
This addendum contains the following C = Carriers price the code. Carriers will 4. Description of code. This is an
information for each CPT code and establish RVUs and payment amounts for abbreviated version of the narrative
alphanumeric HCPCS code, except for: these services, generally on an individual
description of the code.
Alphanumeric codes beginning with B case basis following review of
5. Physician work RVUs. These are the
(enteral and parenteral therapy), E (durable documentation, such as an operative report.
RVUs for the physician work for this service
medical equipment), K (temporary codes for D* = Deleted/discontinued code.
nonphysicians’ services or items), or L E = Excluded from the PFS by regulation. in 2007. As stated in the June 29, 2006
(orthotics); and codes for anesthesiology. These codes are for items and services that proposed notice, the RVUs for codes with a
Please also note the following: CMS chose to exclude from the fee schedule 10-or 90-day global period reflect the
• An ‘‘NA’’ in the ‘‘Non-facility PE RVUs’’ payment by regulation. No RVUs are shown, application of the RUC-recommended values
column of Addendum B means that CMS has and no payment may be made under the PFS for the E/ M services that are included as part
not developed a PE RVU in the non-facility for these codes. Payment for them, when of the global period for the service.
setting for the service because it is typically covered, continues under reasonable charge Note: The separate budget neutrality
performed in the hospital (for example, an procedures. adjustor is not reflected in these physician
open heart surgery is generally performed in F = Deleted/discontinued codes. (Code not work RVUs.
the hospital setting and not a physician’s subject to a 90-day grace period.) These codes 6. Fully implemented non-facility practice
office). If there is an ‘‘NA’’ in the non-facility are deleted effective with the beginning of expense RVUs. These are the fully
PE RVU column, and the contractor the year and are never subject to a grace implemented resource-based PE RVUs for
determines that this service can be performed period. This indicator is no longer effective
non-facility settings.
in the non-facility setting, the service will be beginning with the 2005 fee schedule as of
7. Transitional Non-facility practice
paid at the facility PE RVU rate. January 1, 2005.
expense RVUs. These are the 2007 resource-
• Services that have an ‘‘NA’’ in the G = Code not valid for Medicare purposes.
‘‘Facility PE RVUs’’ column of Addendum B Medicare uses another code for reporting of, based PE RVUs for non-facility settings.
are typically not paid using the PFS when and payment for, these services. (Codes 8. Fully implemented facility practice
provided in a facility setting. These services subject to a 90-day grace period.) This expense RVUs. These are the fully
(which include ‘‘incident to’’ services and indicator is no longer effective with the 2005 implemented resource-based PE RVUs for
the technical portion of diagnostic tests) are PFS as of January 1, 2005. facility settings.
generally paid under either the outpatient H* = Deleted modifier. For 2000 and later 9. Transitional facility practice expense
hospital prospective payment system or years, either the TC or PC component shown RVUs. These are the 2007 resource-based PE
bundled into the hospital inpatient for the code has been deleted and the deleted RVUs for facility settings.
prospective payment system payment. component is shown in the database with the 10. Malpractice expense RVUs. These are
1. CPT/HCPCS code. This is the CPT or H status indicator. the RVUs for the malpractice expense for the
alphanumeric HCPCS number for the service. I = Not valid for Medicare purposes. service for 2006.
Alphanumeric HCPCS codes are included at Medicare uses another code for the reporting 11. Non-facility total. This is the sum of the
the end of this addendum. of, and the payment for these services. (Codes work, fully implemented non-facility PE, and
2. Modifier. A modifier is shown if there not subject to a 90-day grace period.) malpractice expense RVUs.
is a technical component (modifier TC) and L = Local codes. Carriers will apply this 12. Transitional non-facility total. This is
a professional component (PC) (modifier –26) status to all local codes in effect on January the sum of the work, 2007 transitional non-
for the service. If there is a PC and a TC for 1, 1998 or subsequently approved by central facility PE, and malpractice expense RVUs.
the service, Addendum B contains three office for use. Carriers will complete the 13. Facility total. This is the sum of the
entries for the code. A code for: The global RVUs and payment amounts for these codes. work, fully implemented facility PE, and
values (both professional and technical); M = Measurement codes, used for reporting malpractice expense RVUs.
modifier –26 (PC); and, modifier TC. The purposes only. There are no RVUs and no 14. Transitional facility total. This is the
global service is not designated by a modifier, payment amounts for these codes. Medicare sum of the work, 2007 transitional facility
and physicians must bill using the code uses them to aid with performance PE, and malpractice expense RVUs.
without a modifier if the physician furnishes measurement. No separate payment is made. 15. Global period. This indicator shows the
both the PC and the TC of the service. These codes should be billed with a zero number of days in the global period for the
Modifier-53 is shown for a discontinued (($0.00) charge and are denied) on the code (0, 10, or 90 days). An explanation of
procedure, for example, a colonoscopy that is MPFSDB. the alpha codes follows:
not completed. There will be RVUs for a code N = Non-covered service. These codes are
MMM = Code describes a service furnished
with this modifier. noncovered services. Medicare payment may
in uncomplicated maternity cases including
3. Status indicator. This indicator shows not be made for these codes. If RVUs are
antepartum care, delivery, and postpartum
whether the CPT/HCPCS code is in the PFS shown, they are not used for Medicare
and whether it is separately payable if the payment. care. The usual global surgical concept does
service is covered. R = Restricted coverage. Special coverage not apply. See the 1999 Physicians’ Current
A = Active code. These codes are instructions apply. If the service is covered Procedural Terminology for specific
separately payable under the PFS if covered. and no RVUs are shown, it is carrier-priced. definitions.
There will be RVUs for codes with this T = There are RVUs for these services, but XXX = The global concept does not apply.
status. The presence of an ‘‘A’’ indicator does they are only paid if there are no other YYY = The global period is to be set by the
not mean that Medicare has made a national services payable under the PFS billed on the carrier (for example, unlisted surgery codes).
coverage determination regarding the service. same date by the same provider. If any other ZZZ = Code related to another service that
Carriers remain responsible for coverage services payable under the PFS are billed on is always included in the global period of the
decisions in the absence of a national the same date by the same provider, these other service. (Note: Physician work and PE
Medicare policy. services are bundled into the service(s) for are associated with intra service time and in
B = Bundled code. Payments for covered which payment is made. some instances in the post service time.
services are always bundled into payment for X = Statutory exclusion. These codes *Codes with these indicators had a 90-day
other services not specified. If RVUs are represent an item or service that is not within grace period before January 1, 2005.
ADDENDUM B.—2007 RELATIVE VALUE UNITS AND RELATED INFORMATION USED IN DETERMINING MEDICARE PAYMENTS FOR 2007
Year
69790
Year Year
Fully Im- 2007 Fully Im- Fully Im- Year
2007 2007 Fully Im-
Physician plement- Transi- plement- plement- 2007
CPT 1/ Transi- Mal-Prac- Transi- plement-
VerDate Aug<31>2005
Mod Status Description Work ed Non- tional ed Facil- ed Non- Transi- Global
HCPCS 2 tional Fa- tice RVUs tional ed Facil-
RVUs 3 Facility Non-Fa- ity PE Facility tional Fa-
cility PE Non-Fa- ity Total
PE RVUs cility PE RVUs Total cility Total
RVUs cility Total
RVUs
0016T .... .......... C Thermotx choroid vasc lesion .............................. 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 XXX
0017T .... .......... C Photocoagulat macular drusen ............................ 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 XXX
0019T .... .......... C Extracorp shock wv tx,ms nos ............................. 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 XXX
0024T .... .......... C Transcath cardiac reduction ................................. 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 XXX
10:50 Nov 30, 2006

0026T .... .......... C Measure remnant lipoproteins ............................. 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 XXX
0027T .... .......... C Endoscopic epidural lysis ..................................... 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 XXX
0028T .... .......... C Dexa body composition study .............................. 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 XXX
0029T .... .......... C Magnetic tx for incontinence ................................ 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 XXX
0030T .... .......... C Antiprothrombin antibody ..................................... 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 XXX
Jkt 211001
0031T .... .......... C Speculoscopy ....................................................... 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 XXX
0032T .... .......... C Speculoscopy w/direct sample ............................. 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 XXX
0041T .... .......... C Detect ur infect agnt w/cpas ................................ 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 XXX
0042T .... .......... C Ct perfusion w/contrast, cbf ................................. 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 XXX
PO 00000
0043T .... .......... C Co expired gas analysis ....................................... 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 XXX
0046T .... .......... C Cath lavage, mammary duct(s) ............................ 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 XXX
0047T .... .......... C Cath lavage, mammary duct(s) ............................ 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 XXX
0048T .... .......... C Implant ventricular device .................................... 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 XXX
0049T .... .......... C External circulation assist .................................... 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 XXX
Frm 00168
0050T .... .......... C Removal circulation assist ................................... 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 XXX
0051T .... .......... C Implant total heart system .................................... 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 XXX
0052T .... .......... C Replace component heart syst ............................ 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 XXX
0053T .... .......... C Replace component heart syst ............................ 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 XXX
Fmt 4701
0054T .... .......... C Bone surgery using computer .............................. 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 XXX
0058T .... .......... C Cryopreservation, ovary tiss ................................ 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 XXX
0059T .... .......... C Cryopreservation, oocyte ..................................... 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 XXX
Sfmt 4700
0060T .... .......... C Electrical impedance scan ................................... 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 XXX
0061T .... .......... C Destruction of tumor, breast ................................ 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 XXX
0062T .... .......... C Rep intradisc annulus;1 lev .................................. 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 XXX
0063T .... .......... C Rep intradisc annulus;>1lev ................................. 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 XXX
0064T .... .......... C Spectroscop eval expired gas .............................. 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 XXX
0065T .... .......... C Ocular photoscreen bilat ...................................... 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 XXX
0066T .... .......... N Ct colonography;screen ....................................... 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 XXX
0066T .... TC .... N Ct colonography;screen ....................................... 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 XXX
0066T .... 26 ..... N Ct colonography;screen ....................................... 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 XXX
0067T .... .......... C Ct colonography;dx .............................................. 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 XXX
E:\FR\FM\01DER2.SGM
0067T .... TC .... C Ct colonography;dx .............................................. 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 XXX
0067T .... 26 ..... C Ct colonography;dx .............................................. 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 XXX
1 CPT codes and descriptions only are copyright 2006 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply.
01DER2
2 Copyright 2006 American Dental Association. All rights reserved.
3+ Indicates RVUs are not used for Medicare payment.
Federal Register / Vol. 71, No. 231 / Friday, December 1, 2006 / Rules and Regulations
ADDENDUM B.—2007 RELATIVE VALUE UNITS AND RELATED INFORMATION USED IN DETERMINING MEDICARE PAYMENTS FOR 2007—CONTINUED
Year Year Year
2007 2007 Fully Im-
VerDate Aug<31>2005
RVUs cility Total
RVUs
0068T .... .......... C Interp/rept heart sound ......................................... 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 XXX
0069T .... .......... C Analysis only heart sound .................................... 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 XXX
0070T .... .......... C Interp only heart sound ........................................ 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 XXX
0071T .... .......... C U/s leiomyomata ablate <200 .............................. 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 XXX
10:50 Nov 30, 2006

0072T .... .......... C U/s leiomyomata ablate >200 .............................. 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 XXX
0073T .... .......... A Delivery, comp imrt .............................................. 0.00 13.15 16.80 NA NA 0.13 13.28 16.93 NA NA XXX
0074T .... .......... N Online physician e/m ............................................ 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 XXX
0075T .... .......... C Perq stent/chest vert art ....................................... 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 XXX
0075T .... TC .... C Perq stent/chest vert art ....................................... 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 XXX
Jkt 211001
0075T .... 26 ..... C Perq stent/chest vert art ....................................... 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 XXX
0076T .... .......... C S&i stent/chest vert art ......................................... 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 XXX
0076T .... TC .... C S&i stent/chest vert art ......................................... 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 XXX
0076T .... 26 ..... C S&i stent/chest vert art ......................................... 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 XXX
PO 00000
0077T .... .......... C Cereb therm perfusion probe ............................... 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 XXX
0078T .... .......... C Endovasc aort repr w/device ............................... 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 XXX
0079T .... .......... C Endovasc visc extnsn repr ................................... 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 XXX
0080T .... .......... C Endovasc aort repr rad s&i .................................. 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 XXX
0081T .... .......... C Endovasc visc extnsn s&i .................................... 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 XXX
Frm 00169
0084T .... .......... C Temp prostate urethral stent ................................ 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 XXX
0085T .... .......... C Breath test heart reject ........................................ 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 XXX
0086T .... .......... C L ventricle fill pressure ......................................... 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 XXX
0087T .... .......... C Sperm eval hyaluronan ........................................ 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 XXX
Fmt 4701
0088T .... .......... C Rf tongue base vol reduxn ................................... 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 XXX
0089T .... .......... C Actigraphy testing, 3-day ..................................... 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 XXX
0090T .... .......... C Cervical artific disc ............................................... 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 XXX
0092T .... .......... C Artific disc addl ..................................................... 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 XXX
0093T .... .......... C Cervical artific diskectomy ................................... 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 XXX
Sfmt 4700
0095T .... .......... C Artific diskectomy addl ......................................... 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 XXX
0096T .... .......... C Rev cervical artific disc ........................................ 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 XXX
0098T .... .......... C Rev artific disc addl .............................................. 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 XXX
0099T .... .......... C Implant corneal ring ............................................. 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 XXX
0100T .... .......... C Prosth retina receive&gen .................................... 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 XXX
0101T .... .......... C Extracorp shockwv tx,hi enrg ............................... 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 XXX
0102T .... .......... C Extracorp shockwv tx,anesth ............................... 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 XXX
0103T .... .......... C Holotranscobalamin .............................................. 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 XXX
0104T .... .......... C At rest cardio gas rebreathe ................................ 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 XXX
0105T .... .......... C Exerc cardio gas rebreathe .................................. 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 XXX
E:\FR\FM\01DER2.SGM
0106T .... .......... C Touch quant sensory test .................................... 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 XXX
0107T .... .......... C Vibrate quant sensory test ................................... 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 XXX
0108T .... .......... C Cool quant sensory test ....................................... 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 XXX
0109T .... .......... C Heat quant sensory test ....................................... 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 XXX
01DER2
0110T .... .......... C Nos quant sensory test ........................................ 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 XXX
0111T .... .......... C Rbc membranes fatty acids ................................. 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 XXX
69791
Year
69792
Year Year
2007 2007 Fully Im-
VerDate Aug<31>2005
RVUs cility Total
RVUs
0115T .... .......... C Med tx mngmt 15 min .......................................... 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 XXX
0116T .... .......... C Med tx mngmt subsqt .......................................... 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 XXX
0117T .... .......... C Med tx mngmt addl 15 min .................................. 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 XXX
0123T .... .......... C Scleral fistulization ............................................... 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 XXX
10:50 Nov 30, 2006

0124T .... .......... C Conjunctival drug placement ................................ 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 XXX
0126T .... .......... C Chd risk imt study ................................................ 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 XXX
0130T .... .......... C Chron care drug investigatn ................................. 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 XXX
0133T .... .......... C Esophageal implant injexn ................................... 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 XXX
0135T .... .......... C Perq cryoablate renal tumor ................................ 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 XXX
Jkt 211001
0137T .... .......... C Prostate saturation sampling ............................... 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 XXX
0140T .... .......... C Exhaled breath condensate ph ............................ 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 XXX
0141T .... .......... I Perq islet transplant ............................................. 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 XXX
0142T .... .......... I Open islet transplant ............................................ 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 XXX
PO 00000
0143T .... .......... I Laparoscopic islet transplnt ................................. 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 XXX
0144T .... .......... C CT heart wo dye; qual calc .................................. 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 XXX
0144T .... TC .... C CT heart wo dye; qual calc .................................. 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 XXX
0144T .... 26 ..... C CT heart wo dye; qual calc .................................. 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 XXX
0145T .... .......... C CT heart w/wo dye funct ...................................... 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 XXX
Frm 00170
0145T .... TC .... C CT heart w/wo dye funct ...................................... 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 XXX
0145T .... 26 ..... C CT heart w/wo dye funct ...................................... 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 XXX
0146T .... .......... C CCTA w/wo dye ................................................... 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 XXX
0146T .... TC .... C CCTA w/wo dye ................................................... 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 XXX
Fmt 4701
0146T .... 26 ..... C CCTA w/wo dye ................................................... 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 XXX
0147T .... .......... C CCTA w/wo, quan calcium ................................... 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 XXX
0147T .... TC .... C CCTA w/wo, quan calcium ................................... 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 XXX
0147T .... 26 ..... C CCTA w/wo, quan calcium ................................... 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 XXX
0148T .... .......... C CCTA w/wo, strxr ................................................. 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 XXX
Sfmt 4700
0148T .... TC .... C CCTA w/wo, strxr ................................................. 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 XXX
0148T .... 26 ..... C CCTA w/wo, strxr ................................................. 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 XXX
0149T .... .......... C CCTA w/wo, strxr quan calc ................................ 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 XXX
0149T .... TC .... C CCTA w/wo, strxr quan calc ................................ 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 XXX
0149T .... 26 ..... C CCTA w/wo, strxr quan calc ................................ 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 XXX
0150T .... .......... C CCTA w/wo, disease strxr ................................... 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 XXX
0150T .... TC .... C CCTA w/wo, disease strxr ................................... 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 XXX
0150T .... 26 ..... C CCTA w/wo, disease strxr ................................... 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 XXX
0151T .... .......... C CT heart funct add-on .......................................... 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 XXX
0151T .... TC .... C CT heart funct add-on .......................................... 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 XXX
E:\FR\FM\01DER2.SGM
0151T .... 26 ..... C CT heart funct add-on .......................................... 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 XXX
0152T .... .......... C Computer chest add-on ....................................... 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 XXX
0153T .... .......... C Tcath sensor aneurysm sac ................................. 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 XXX
0154T .... .......... C Study sensor aneurysm sac ................................ 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 XXX
01DER2
0155T .... .......... C Lap impl gast curve electrd .................................. 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 XXX
0156T .... .......... C Lap remv gast curve electrd ................................ 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 XXX
Year Year Year
2007 2007 Fully Im-
VerDate Aug<31>2005
RVUs cility Total
RVUs
0157T .... .......... C Open impl gast curve electrd ............................... 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 XXX
0158T .... .......... C Open remv gast curve electrd ............................. 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 XXX
0159T .... .......... C Cad breast mri ..................................................... 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 ZZZ
0159T .... TC .... C Cad breast mri ..................................................... 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 ZZZ
10:50 Nov 30, 2006

0159T .... 26 ..... C Cad breast mri ..................................................... 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 ZZZ
0160T .... .......... C Tcranial magn stim tx plan ................................... 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 XXX
0161T .... .......... C Tcranial magn stim tx deliv .................................. 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 XXX
0162T .... .......... C Anal program gast neurostim ............................... 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 XXX
0163T .... .......... C Lumb artif diskectomy addl .................................. 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 YYY
Jkt 211001
0164T .... .......... C Remove lumb artif disc addl ................................ 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 YYY
0165T .... .......... C Revise lumb artif disc addl ................................... 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 YYY
0166T .... .......... C Tcath vsd close w/o bypass ................................. 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 XXX
0167T .... .......... C Tcath vsd close w bypass .................................... 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 XXX
PO 00000
0168T .... .......... C Rhinophototx light app bilat ................................. 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 XXX
0169T .... .......... C Place stereo cath brain ........................................ 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 XXX
0170T .... .......... C Anorectal fistula plug rpr ...................................... 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 XXX
0171T .... .......... C Lumbar spine proces distract ............................... 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 XXX
0172T .... .......... C Lumbar spine proces addl ................................... 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 XXX
Frm 00171
0173T .... .......... C Iop monit io pressure ........................................... 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 XXX
0174T .... .......... C Cad cxr with interp ............................................... 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 XXX
0175T .... .......... C Cad cxr remote .................................................... 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 XXX
0176T .... .......... C Aqu canal dilat w/o retent .................................... 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 XXX
Fmt 4701
0177T .... .......... C Aqu canal dilat w retent ....................................... 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 XXX
10021 .... .......... A Fna w/o image ..................................................... 1.27 2.11 2.14 0.36 0.50 0.10 3.48 3.51 1.73 1.87 XXX
10022 .... .......... A Fna w/image ......................................................... 1.27 2.02 2.41 0.35 0.40 0.08 3.37 3.76 1.70 1.75 XXX
10040 .... .......... A Acne surgery ........................................................ 1.19 1.32 1.09 0.99 0.84 0.05 2.56 2.33 2.23 2.08 010
10060 .... .......... A Drainage of skin abscess ..................................... 1.19 1.51 1.29 1.09 0.97 0.12 2.82 2.60 2.40 2.28 010
Sfmt 4700
10061 .... .......... A Drainage of skin abscess ..................................... 2.42 2.09 1.89 1.54 1.51 0.26 4.77 4.57 4.22 4.19 010
10080 .... .......... A Drainage of pilonidal cyst ..................................... 1.19 2.65 2.99 1.10 1.11 0.11 3.95 4.29 2.40 2.41 010
10081 .... .......... A Drainage of pilonidal cyst ..................................... 2.47 3.47 3.92 1.45 1.49 0.24 6.18 6.63 4.16 4.20 010
10120 .... .......... A Remove foreign body ........................................... 1.23 1.95 2.12 0.95 0.97 0.12 3.30 3.47 2.30 2.32 010
10121 .... .......... A Remove foreign body ........................................... 2.71 3.51 3.51 1.66 1.75 0.33 6.55 6.55 4.70 4.79 010
10140 .... .......... A Drainage of hematoma/fluid ................................. 1.55 2.26 1.89 1.30 1.29 0.19 4.00 3.63 3.04 3.03 010
10160 .... .......... A Puncture drainage of lesion ................................. 1.22 1.84 1.66 1.07 1.08 0.14 3.20 3.02 2.43 2.44 010
10180 .... .......... A Complex drainage, wound ................................... 2.27 3.28 3.06 1.83 1.94 0.35 5.90 5.68 4.45 4.56 010
11000 .... .......... A Debride infected skin ........................................... 0.60 0.73 0.62 0.17 0.21 0.07 1.40 1.29 0.84 0.88 000
11001 .... .......... A Debride infected skin add-on ............................... 0.30 0.23 0.23 0.08 0.10 0.04 0.57 0.57 0.42 0.44 ZZZ
E:\FR\FM\01DER2.SGM
11004 .... .......... A Debride genitalia & perineum .............................. 10.80 NA NA 3.23 3.73 0.67 NA NA 14.70 15.20 000
11005 .... .......... A Debride abdom wall ............................................. 14.24 NA NA 4.23 5.23 0.96 NA NA 19.43 20.43 000
11006 .... .......... A Debride genit/per/abdom wall .............................. 13.10 NA NA 3.82 4.59 1.28 NA NA 18.20 18.97 000
11008 .... .......... A Remove mesh from abd wall ............................... 5.00 NA NA 1.37 1.86 0.61 NA NA 6.98 7.47 ZZZ
01DER2
11010 .... .......... A Debride skin, fx .................................................... 4.19 6.72 6.83 2.34 2.55 0.66 11.57 11.68 7.19 7.40 010
11011 .... .......... A Debride skin/muscle, fx ........................................ 4.94 7.04 7.88 2.05 2.27 0.74 12.72 13.56 7.73 7.95 000
69793
Year
69794
Year Year
2007 2007 Fully Im-
VerDate Aug<31>2005
RVUs cility Total
RVUs
11012 .... .......... A Debride skin/muscle/bone, fx ............................... 6.87 8.98 11.32 3.14 3.67 1.16 17.01 19.35 11.17 11.70 000
11040 .... .......... A Debride skin, partial ............................................. 0.50 0.68 0.56 0.17 0.20 0.06 1.24 1.12 0.73 0.76 000
11041 .... .......... A Debride skin, full .................................................. 0.60 0.73 0.68 0.19 0.30 0.10 1.43 1.38 0.89 1.00 000
11042 .... .......... A Debride skin/tissue ............................................... 0.80 0.96 0.97 0.25 0.39 0.13 1.89 1.90 1.18 1.32 000
10:50 Nov 30, 2006

11043 .... .......... A Debride tissue/muscle .......................................... 3.04 3.64 3.45 2.71 2.62 0.32 7.00 6.81 6.07 5.98 010
11044 .... .......... A Debride tissue/muscle/bone ................................. 4.11 4.95 4.58 3.68 3.73 0.43 9.49 9.12 8.22 8.27 010
11055 .... .......... R Trim skin lesion .................................................... 0.43 0.82 0.63 0.12 0.16 0.05 1.30 1.11 0.60 0.64 000
11056 .... .......... R Trim skin lesions, 2 to 4 ....................................... 0.61 0.89 0.70 0.17 0.22 0.07 1.57 1.38 0.85 0.90 000
11057 .... .......... R Trim skin lesions, over 4 ...................................... 0.79 1.00 0.81 0.21 0.28 0.10 1.89 1.70 1.10 1.17 000
Jkt 211001
11100 .... .......... A Biopsy, skin lesion ............................................... 0.81 1.89 1.41 0.40 0.38 0.03 2.73 2.25 1.24 1.22 000
11101 .... .......... A Biopsy, skin add-on .............................................. 0.41 0.42 0.35 0.21 0.20 0.02 0.85 0.78 0.64 0.63 ZZZ
11200 .... .......... A Removal of skin tags ........................................... 0.79 1.23 1.09 0.90 0.80 0.04 2.06 1.92 1.73 1.63 010
11201 .... .......... A Remove skin tags add-on .................................... 0.29 0.16 0.16 0.11 0.12 0.02 0.47 0.47 0.42 0.43 ZZZ
PO 00000
11300 .... .......... A Shave skin lesion ................................................. 0.51 1.19 1.04 0.21 0.21 0.03 1.73 1.58 0.75 0.75 000
Frm 00172
Fmt 4701
11400 .... .......... A Exc tr-ext b9+marg 0.5 < cm ............................... 0.87 1.88 1.96 0.94 0.90 0.06 2.81 2.89 1.87 1.83 010
11401 .... .......... A Exc tr-ext b9+marg 0.6–1 cm .............................. 1.25 2.18 2.08 1.15 1.05 0.10 3.53 3.43 2.50 2.40 010
Sfmt 4700
11406 .... .......... A Exc tr-ext b9+marg > 4.0 cm ............................... 3.47 3.50 3.17 2.08 1.76 0.32 7.29 6.96 5.87 5.55 010
11420 .... .......... A Exc h-f-nk-sp b9+marg 0.5 < ............................... 1.00 1.83 1.78 0.94 0.93 0.09 2.92 2.87 2.03 2.02 010
11421 .... .......... A Exc h-f-nk-sp b9+marg 0.6–1 .............................. 1.44 2.22 2.10 1.17 1.13 0.13 3.79 3.67 2.74 2.70 010
11426 .... .......... A Exc h-f-nk-sp b9+marg > 4 cm ............................ 4.04 3.59 3.51 2.32 2.16 0.44 8.07 7.99 6.80 6.64 010
E:\FR\FM\01DER2.SGM
11440 .... .......... A Exc face-mm b9+marg 0.5 < cm ......................... 1.02 2.01 2.15 1.32 1.31 0.08 3.11 3.25 2.42 2.41 010
11441 .... .......... A Exc face-mm b9+marg 0.6–1 cm ......................... 1.50 2.39 2.35 1.56 1.51 0.13 4.02 3.98 3.19 3.14 010
01DER2
11446 .... .......... A Exc face-mm b9+marg > 4 cm ............................ 4.75 4.06 4.05 2.67 2.75 0.43 9.24 9.23 7.85 7.93 010
Year Year Year
2007 2007 Fully Im-
VerDate Aug<31>2005
RVUs cility Total
RVUs
11450 .... .......... A Removal, sweat gland lesion ............................... 3.14 5.14 5.06 2.43 2.12 0.34 8.62 8.54 5.91 5.60 090
10:50 Nov 30, 2006

11600 .... .......... A Exc tr-ext mlg+marg 0.5 < cm ............................. 1.58 2.75 2.66 1.15 1.02 0.10 4.43 4.34 2.83 2.70 010
11601 .... .......... A Exc tr-ext mlg+marg 0.6–1 cm ............................. 2.02 3.46 2.89 1.53 1.30 0.12 5.60 5.03 3.67 3.44 010
Jkt 211001
11606 .... .......... A Exc tr-ext mlg+marg > 4 cm ................................ 4.97 5.49 4.42 2.48 1.92 0.36 10.82 9.75 7.81 7.25 010
11620 .... .......... A Exc h-f-nk-sp mlg+marg 0.5 < ............................. 1.59 2.85 2.66 1.20 1.01 0.09 4.53 4.34 2.88 2.69 010
PO 00000
11621 .... .......... A Exc h-f-nk-sp mlg+marg 0.6–1 ............................. 2.03 3.51 2.90 1.56 1.32 0.12 5.66 5.05 3.71 3.47 010
11626 .... .......... A Exc h-f-nk-sp mlg+mar > 4 cm ............................ 4.56 4.96 4.71 2.35 2.38 0.45 9.97 9.72 7.36 7.39 010
Frm 00173
11640 .... .......... A Exc face-mm malig+marg 0.5 < ........................... 1.62 3.06 2.75 1.30 1.16 0.11 4.79 4.48 3.03 2.89 010
11641 .... .......... A Exc face-mm malig+marg 0.6–1 .......................... 2.12 3.64 3.18 1.63 1.56 0.16 5.92 5.46 3.91 3.84 010
Fmt 4701
11646 .... .......... A Exc face-mm mlg+marg > 4 cm .......................... 6.21 5.88 5.78 3.15 3.39 0.61 12.70 12.60 9.97 10.21 010
11719 .... .......... R Trim nail(s) ........................................................... 0.17 0.38 0.28 0.05 0.07 0.02 0.57 0.47 0.24 0.26 000
11720 .... .......... A Debride nail, 1–5 .................................................. 0.32 0.47 0.37 0.09 0.11 0.04 0.83 0.73 0.45 0.47 000
11721 .... .......... A Debride nail, 6 or more ........................................ 0.54 0.55 0.47 0.15 0.20 0.07 1.16 1.08 0.76 0.81 000
Sfmt 4700
11730 .... .......... A Removal of nail plate ........................................... 1.10 1.35 1.11 0.30 0.40 0.14 2.59 2.35 1.54 1.64 000
11732 .... .......... A Remove nail plate, add-on ................................... 0.57 0.55 0.47 0.15 0.20 0.07 1.19 1.11 0.79 0.84 ZZZ
11740 .... .......... A Drain blood from under nail ................................. 0.37 0.80 0.61 0.44 0.37 0.04 1.21 1.02 0.85 0.78 000
11750 .... .......... A Removal of nail bed ............................................. 2.40 2.99 2.37 1.92 1.79 0.22 5.61 4.99 4.54 4.41 010
11752 .... .......... A Remove nail bed/finger tip ................................... 3.48 4.14 3.28 2.84 2.95 0.35 7.97 7.11 6.67 6.78 010
11755 .... .......... A Biopsy, nail unit .................................................... 1.31 2.04 1.69 0.77 0.77 0.14 3.49 3.14 2.22 2.22 000
11760 .... .......... A Repair of nail bed ................................................. 1.60 3.45 2.83 1.45 1.70 0.21 5.26 4.64 3.26 3.51 010
11762 .... .......... A Reconstruction of nail bed ................................... 2.91 3.74 3.10 1.72 2.19 0.36 7.01 6.37 4.99 5.46 010
11765 .... .......... A Excision of nail fold, toe ....................................... 0.71 2.69 2.01 1.02 0.83 0.08 3.48 2.80 1.81 1.62 010
11770 .... .......... A Removal of pilonidal lesion .................................. 2.63 3.47 3.48 1.54 1.51 0.33 6.43 6.44 4.50 4.47 010
E:\FR\FM\01DER2.SGM
11900 .... .......... A Injection into skin lesions ..................................... 0.52 0.92 0.72 0.26 0.22 0.02 1.46 1.26 0.80 0.76 000
11901 .... .......... A Added skin lesions injection ................................. 0.80 1.02 0.75 0.41 0.37 0.03 1.85 1.58 1.24 1.20 000
01DER2
11920 .... .......... R Correct skin color defects .................................... 1.61 2.42 3.38 1.15 1.11 0.24 4.27 5.23 3.00 2.96 000
11921 .... .......... R Correct skin color defects .................................... 1.93 2.70 3.65 1.30 1.28 0.29 4.92 5.87 3.52 3.50 000
69795
Year
69796
Year Year
2007 2007 Fully Im-
VerDate Aug<31>2005
RVUs cility Total
RVUs
11922 .... .......... R Correct skin color defects .................................... 0.49 0.94 1.09 0.23 0.25 0.07 1.50 1.65 0.79 0.81 ZZZ
11950 .... .......... R Therapy for contour defects ................................. 0.84 0.87 1.07 0.36 0.38 0.06 1.77 1.97 1.26 1.28 000
10:50 Nov 30, 2006

11960 .... .......... A Insert tissue expander(s) ..................................... 11.01 NA NA 10.76 10.48 1.31 NA NA 23.08 22.80 090
11970 .... .......... A Replace tissue expander ..................................... 7.86 NA NA 6.35 6.19 1.05 NA NA 15.26 15.10 090
11971 .... .......... A Remove tissue expander(s) ................................. 3.21 7.48 8.70 4.09 3.87 0.32 11.01 12.23 7.62 7.40 090
11975 .... .......... N Insert contraceptive cap ....................................... 1.48 1.52 1.45 0.34 0.51 0.17 3.17 3.10 1.99 2.16 XXX
Jkt 211001
11976 .... .......... R Removal of contraceptive cap ............................. 1.78 1.70 1.72 0.47 0.63 0.21 3.69 3.71 2.46 2.62 000
11977 .... .......... N Removal/reinsert contra cap ................................ 3.30 1.97 2.20 0.76 1.14 0.37 5.64 5.87 4.43 4.81 XXX
11980 .... .......... A Implant hormone pellet(s) .................................... 1.48 1.16 1.10 0.56 0.55 0.13 2.77 2.71 2.17 2.16 000
11981 .... .......... A Insert drug implant device .................................... 1.48 1.92 1.76 0.60 0.66 0.12 3.52 3.36 2.20 2.26 XXX
PO 00000
11982 .... .......... A Remove drug implant device ............................... 1.78 2.04 1.97 0.73 0.81 0.17 3.99 3.92 2.68 2.76 XXX
11983 .... .......... A Remove/insert drug implant ................................. 3.30 2.68 2.38 1.36 1.44 0.23 6.21 5.91 4.89 4.97 XXX
12001 .... .......... A Repair superficial wound(s) ................................. 1.72 1.73 1.92 0.73 0.76 0.15 3.60 3.79 2.60 2.63 010
Frm 00174
Fmt 4701
12017 .... .......... A Repair superficial wound(s) ................................. 4.72 NA NA 1.50 1.79 0.47 NA NA 6.69 6.98 010
Sfmt 4700
12018 .... .......... A Repair superficial wound(s) ................................. 5.54 NA NA 2.01 2.19 0.64 NA NA 8.19 8.37 010
12020 .... .......... A Closure of split wound ......................................... 2.64 3.75 3.80 1.79 1.89 0.30 6.69 6.74 4.73 4.83 010
12021 .... .......... A Closure of split wound ......................................... 1.86 1.85 1.83 1.33 1.39 0.24 3.95 3.93 3.43 3.49 010
12031 .... .......... A Layer closure of wound(s) ................................... 2.17 3.90 2.69 1.79 1.17 0.17 6.24 5.03 4.13 3.51 010
E:\FR\FM\01DER2.SGM
01DER2
Year Year Year
2007 2007 Fully Im-
VerDate Aug<31>2005
RVUs cility Total
RVUs
10:50 Nov 30, 2006

13100 .... .......... A Repair of wound or lesion .................................... 3.14 4.44 4.15 2.49 2.35 0.26 7.84 7.55 5.89 5.75 010
13102 .... .......... A Repair wound/lesion add-on ................................ 1.24 1.37 1.22 0.55 0.57 0.13 2.74 2.59 1.92 1.94 ZZZ
Jkt 211001
PO 00000
Frm 00175
13160 .... .......... A Late closure of wound .......................................... 11.84 NA NA 7.13 7.15 1.54 NA NA 20.51 20.53 090
14000 .... .......... A Skin tissue rearrangement ................................... 6.83 9.00 8.14 6.12 5.63 0.59 16.42 15.56 13.54 13.05 090
Fmt 4701
Sfmt 4700
14350 .... .......... A Skin tissue rearrangement ................................... 10.82 NA NA 7.05 7.12 1.34 NA NA 19.21 19.28 090
15002 .... .......... A Wnd prep, ch/inf, trk/arm/lg .................................. 3.65 4.12 4.12 1.65 1.65 0.49 8.26 8.26 5.79 5.79 000
15003 .... .......... A Wnd prep, ch/inf addl 100 cm .............................. 0.80 0.92 0.92 0.28 0.28 0.11 1.83 1.83 1.19 1.19 ZZZ
15004 .... .......... A Wnd prep ch/inf, f/n/hf/g ....................................... 4.58 4.77 4.77 1.97 1.97 0.62 9.97 9.97 7.17 7.17 000
15005 .... .......... A Wnd prep, f/n/hf/g, addl cm ................................. 1.60 1.28 1.28 0.56 0.56 0.22 3.10 3.10 2.38 2.38 ZZZ
15040 .... .......... A Harvest cultured skin graft ................................... 2.00 3.86 4.39 1.05 1.11 0.24 6.10 6.63 3.29 3.35 000
15050 .... .......... A Skin pinch graft .................................................... 5.37 7.71 7.11 5.09 5.11 0.57 13.65 13.05 11.03 11.05 090
15100 .... .......... A Skin splt grft, trnk/arm/leg .................................... 9.74 9.91 11.91 6.82 7.57 1.28 20.93 22.93 17.84 18.59 090
E:\FR\FM\01DER2.SGM
15101 .... .......... A Skin splt grft t/a/l, add-on ..................................... 1.72 2.51 3.43 0.88 1.10 0.24 4.47 5.39 2.84 3.06 ZZZ
15110 .... .......... A Epidrm autogrft trnk/arm/leg ................................ 10.88 9.01 10.26 6.61 6.90 1.31 21.20 22.45 18.80 19.09 090
15111 .... .......... A Epidrm autogrft t/a/l add-on ................................. 1.85 0.90 1.19 0.65 0.76 0.26 3.01 3.30 2.76 2.87 ZZZ
15115 .... .......... A Epidrm a-grft face/nck/hf/g ................................... 11.19 9.31 9.24 6.83 7.22 1.15 21.65 21.58 19.17 19.56 090
01DER2
15116 .... .......... A Epidrm a-grft f/n/hf/g addl .................................... 2.50 1.24 1.50 0.91 1.07 0.33 4.07 4.33 3.74 3.90 ZZZ
15120 .... .......... A Skn splt a-grft fac/nck/hf/g ................................... 10.96 11.33 10.87 7.48 7.71 1.16 23.45 22.99 19.60 19.83 090
69797
Year
69798
Year Year
2007 2007 Fully Im-
VerDate Aug<31>2005
RVUs cility Total
RVUs
15121 .... .......... A Skn splt a-grft f/n/hf/g add ................................... 2.67 3.47 4.24 1.34 1.72 0.36 6.50 7.27 4.37 4.75 ZZZ
15130 .... .......... A Derm autograft, trnk/arm/leg ................................ 7.41 8.09 9.42 5.71 6.18 0.97 16.47 17.80 14.09 14.56 090
15131 .... .......... A Derm autograft t/a/l add-on .................................. 1.50 0.71 0.98 0.53 0.61 0.21 2.42 2.69 2.24 2.32 ZZZ
15135 .... .......... A Derm autograft face/nck/hf/g ................................ 10.91 9.56 9.79 7.14 7.88 1.23 21.70 21.93 19.28 20.02 090
10:50 Nov 30, 2006

15136 .... .......... A Derm autograft, f/n/hf/g add ................................. 1.50 0.69 0.84 0.55 0.64 0.20 2.39 2.54 2.25 2.34 ZZZ
15150 .... .......... A Cult epiderm grft t/arm/leg ................................... 9.30 7.29 8.17 6.01 6.33 1.14 17.73 18.61 16.45 16.77 090
15151 .... .......... A Cult epiderm grft t/a/l addl ................................... 2.00 0.92 1.21 0.71 0.82 0.28 3.20 3.49 2.99 3.10 ZZZ
15152 .... .......... A Cult epiderm graft t/a/l +% ................................... 2.50 1.09 1.44 0.89 1.02 0.35 3.94 4.29 3.74 3.87 ZZZ
15155 .... .......... A Cult epiderm graft, f/n/hf/g ................................... 10.05 7.74 7.80 6.40 6.82 1.05 18.84 18.90 17.50 17.92 090
Jkt 211001
15156 .... .......... A Cult epidrm grft f/n/hfg add .................................. 2.75 1.20 1.47 1.00 1.18 0.36 4.31 4.58 4.11 4.29 ZZZ
15157 .... .......... A Cult epiderm grft f/n/hfg +% ................................. 3.00 1.39 1.68 1.09 1.29 0.39 4.78 5.07 4.48 4.68 ZZZ
15170 .... .......... A Acell graft trunk/arms/legs ................................... 5.99 3.68 3.79 2.39 2.37 0.55 10.22 10.33 8.93 8.91 090
15171 .... .......... A Acell graft t/arm/leg add-on .................................. 1.55 0.66 0.68 0.52 0.60 0.19 2.40 2.42 2.26 2.34 ZZZ
PO 00000
15175 .... .......... A Acellular graft, f/n/hf/g .......................................... 7.99 5.33 5.40 3.84 3.96 0.82 14.14 14.21 12.65 12.77 090
15176 .... .......... A Acell graft, f/n/hf/g add-on .................................... 2.45 1.08 1.10 0.83 0.95 0.29 3.82 3.84 3.57 3.69 ZZZ
15200 .... .......... A Skin full graft, trunk .............................................. 8.97 9.97 9.54 6.42 6.26 0.98 19.92 19.49 16.37 16.21 090
15201 .... .......... A Skin full graft trunk add-on ................................... 1.32 2.13 2.45 0.58 0.61 0.19 3.64 3.96 2.09 2.12 ZZZ
15220 .... .......... A Skin full graft sclp/arm/leg .................................... 7.95 10.46 9.50 6.73 6.69 0.84 19.25 18.29 15.52 15.48 090
Frm 00176
15221 .... .......... A Skin full graft add-on ............................................ 1.19 2.03 2.25 0.52 0.55 0.16 3.38 3.60 1.87 1.90 ZZZ
15240 .... .......... A Skin full grft face/genit/hf ..................................... 10.15 12.05 10.66 8.94 8.20 0.92 23.12 21.73 20.01 19.27 090
15260 .... .......... A Skin full graft een & lips ....................................... 11.39 13.08 10.93 9.43 8.79 0.69 25.16 23.01 21.51 20.87 090
Fmt 4701
15300 .... .......... A Apply skinallogrft, t/arm/lg .................................... 4.65 3.38 3.25 2.13 2.21 0.49 8.52 8.39 7.27 7.35 090
15301 .... .......... A Apply sknallogrft t/a/l addl .................................... 1.00 0.48 0.47 0.34 0.39 0.14 1.62 1.61 1.48 1.53 ZZZ
15320 .... .......... A Apply skin allogrft f/n/hf/g ..................................... 5.36 3.77 3.66 2.35 2.49 0.58 9.71 9.60 8.29 8.43 090
15321 .... .......... A Aply sknallogrft f/n/hfg add .................................. 1.50 0.69 0.69 0.51 0.57 0.21 2.40 2.40 2.22 2.28 ZZZ
Sfmt 4700
15330 .... .......... A Aply acell alogrft t/arm/leg ................................... 3.99 3.16 3.18 1.93 2.15 0.49 7.64 7.66 6.41 6.63 090
15331 .... .......... A Aply acell grft t/a/l add-on .................................... 1.00 0.47 0.46 0.34 0.39 0.14 1.61 1.60 1.48 1.53 ZZZ
15335 .... .......... A Apply acell graft, f/n/hf/g ...................................... 4.50 3.42 3.46 2.09 2.35 0.55 8.47 8.51 7.14 7.40 090
15336 .... .......... A Aply acell grft f/n/hf/g add .................................... 1.43 0.72 0.70 0.49 0.55 0.20 2.35 2.33 2.12 2.18 ZZZ
15340 .... .......... A Apply cult skin substitute ..................................... 3.76 3.80 3.95 2.74 2.75 0.41 7.97 8.12 6.91 6.92 010
15341 .... .......... A Apply cult skin sub add-on ................................... 0.50 0.72 0.64 0.17 0.19 0.06 1.28 1.20 0.73 0.75 ZZZ
15360 .... .......... A Apply cult derm sub, t/a/l ..................................... 3.93 4.46 4.47 3.27 3.13 0.43 8.82 8.83 7.63 7.49 090
15361 .... .......... A Aply cult derm sub t/a/l add ................................. 1.15 0.58 0.58 0.39 0.44 0.14 1.87 1.87 1.68 1.73 ZZZ
15365 .... .......... A Apply cult derm sub f/n/hf/g ................................. 4.21 4.36 4.50 3.21 3.20 0.46 9.03 9.17 7.88 7.87 090
15366 .... .......... A Apply cult derm f/hf/g add .................................... 1.45 0.69 0.70 0.49 0.56 0.17 2.31 2.32 2.11 2.18 ZZZ
E:\FR\FM\01DER2.SGM
15400 .... .......... A Apply skin xenograft, t/a/l ..................................... 4.38 4.97 4.25 3.76 3.95 0.47 9.82 9.10 8.61 8.80 090
15401 .... .......... A Apply skn xenogrft t/a/l add ................................. 1.00 1.02 1.67 0.35 0.42 0.14 2.16 2.81 1.49 1.56 ZZZ
15420 .... .......... A Apply skin xgraft, f/n/hf/g ..................................... 4.89 5.11 4.86 3.93 3.83 0.52 10.52 10.27 9.34 9.24 090
15421 .... .......... A Apply skn xgrft f/n/hf/g add .................................. 1.50 1.20 1.29 0.53 0.60 0.21 2.91 3.00 2.24 2.31 ZZZ
01DER2
15430 .... .......... A Apply acellular xenograft ...................................... 5.93 7.11 6.95 6.53 6.59 0.66 13.70 13.54 13.12 13.18 090
15431 .... .......... C Apply acellular xgraft add .................................... 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 ZZZ
Year Year Year
2007 2007 Fully Im-
VerDate Aug<31>2005
RVUs cility Total
RVUs
15570 .... .......... A Form skin pedicle flap .......................................... 10.00 10.45 11.09 6.57 6.71 1.34 21.79 22.43 17.91 18.05 090
10:50 Nov 30, 2006

15600 .... .......... A Skin graft .............................................................. 1.95 5.31 7.03 2.75 2.98 0.27 7.53 9.25 4.97 5.20 090
15610 .... .......... A Skin graft .............................................................. 2.46 5.59 4.92 3.07 3.33 0.35 8.40 7.73 5.88 6.14 090
15620 .... .......... A Skin graft .............................................................. 3.62 6.40 7.44 3.87 3.88 0.35 10.37 11.41 7.84 7.85 090
15630 .... .......... A Skin graft .............................................................. 3.95 7.03 7.04 4.31 4.19 0.34 11.32 11.33 8.60 8.48 090
15650 .... .......... A Transfer skin pedicle flap ..................................... 4.64 7.12 7.14 4.30 4.23 0.42 12.18 12.20 9.36 9.29 090
Jkt 211001
15731 .... .......... A Forehead flap w/vasc pedicle .............................. 14.12 12.13 12.13 9.56 9.56 1.28 27.53 27.53 24.96 24.96 090
15732 .... .......... A Muscle-skin graft, head/neck ............................... 19.70 14.97 17.27 11.41 12.01 2.00 36.67 38.97 33.11 33.71 090
15734 .... .......... A Muscle-skin graft, trunk ........................................ 19.62 16.00 17.58 12.16 12.32 2.62 38.24 39.82 34.40 34.56 090
15736 .... .......... A Muscle-skin graft, arm .......................................... 16.92 13.99 17.17 10.18 10.96 2.46 33.37 36.55 29.56 30.34 090
PO 00000
15738 .... .......... A Muscle-skin graft, leg ........................................... 18.92 14.24 17.04 10.63 11.45 2.66 35.82 38.62 32.21 33.03 090
15740 .... .......... A Island pedicle flap graft ........................................ 11.57 13.63 11.01 9.52 8.58 0.63 25.83 23.21 21.72 20.78 090
15750 .... .......... A Neurovascular pedicle graft ................................. 12.73 NA NA 9.04 9.04 1.42 NA NA 23.19 23.19 090
15756 .... .......... A Free myo/skin flap microvasc .............................. 36.74 NA NA 18.90 20.15 4.62 NA NA 60.26 61.51 090
15757 .... .......... A Free skin flap, microvasc ..................................... 36.95 NA NA 17.08 20.46 3.90 NA NA 57.93 61.31 090
Frm 00177
15758 .... .......... A Free fascial flap, microvasc ................................. 36.70 NA NA 16.92 20.41 4.24 NA NA 57.86 61.35 090
15760 .... .......... A Composite skin graft ............................................ 9.68 10.35 10.10 7.04 7.21 0.85 20.88 20.63 17.57 17.74 090
15770 .... .......... A Derma-fat-fascia graft .......................................... 8.73 NA NA 6.66 6.68 1.05 NA NA 16.44 16.46 090
15775 .... .......... R Hair transplant punch grafts ................................. 3.95 3.50 4.05 1.72 1.41 0.52 7.97 8.52 6.19 5.88 000
Fmt 4701
15776 .... .......... R Hair transplant punch grafts ................................. 5.53 3.91 4.99 1.60 2.50 0.72 10.16 11.24 7.85 8.75 000
15780 .... .......... A Abrasion treatment of skin ................................... 8.50 11.84 11.60 6.91 7.92 0.67 21.01 20.77 16.08 17.09 090
Sfmt 4700
15786 .... .......... A Abrasion, lesion, single ........................................ 2.05 3.81 3.47 1.26 1.31 0.11 5.97 5.63 3.42 3.47 010
15787 .... .......... A Abrasion, lesions, add-on .................................... 0.33 0.83 1.03 0.11 0.15 0.04 1.20 1.40 0.48 0.52 ZZZ
15788 .... .......... R Chemical peel, face, epiderm .............................. 2.09 8.55 7.17 3.73 3.24 0.11 10.75 9.37 5.93 5.44 090
15789 .... .......... R Chemical peel, face, dermal ................................ 4.91 9.26 8.38 5.77 5.04 0.20 14.37 13.49 10.88 10.15 090
15792 .... .......... R Chemical peel, nonfacial ...................................... 1.86 6.83 7.03 3.47 4.21 0.13 8.82 9.02 5.46 6.20 090
15793 .... .......... A Chemical peel, nonfacial ...................................... 3.82 5.56 6.10 3.31 4.11 0.19 9.57 10.11 7.32 8.12 090
15819 .... .......... A Plastic surgery, neck ............................................ 10.45 NA NA 6.83 7.09 0.97 NA NA 18.25 18.51 090
15820 .... .......... A Revision of lower eyelid ....................................... 6.09 6.53 6.86 5.32 5.50 0.40 13.02 13.35 11.81 11.99 090
15821 .... .......... A Revision of lower eyelid ....................................... 6.66 6.78 7.21 5.47 5.65 0.45 13.89 14.32 12.58 12.76 090
15822 .... .......... A Revision of upper eyelid ...................................... 4.51 5.38 5.72 4.23 4.43 0.37 10.26 10.60 9.11 9.31 090
E:\FR\FM\01DER2.SGM
15823 .... .......... A Revision of upper eyelid ...................................... 8.12 7.65 7.80 6.36 6.41 0.50 16.27 16.42 14.98 15.03 090
15824 .... .......... R Removal of forehead wrinkles ............................. 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 000
15825 .... .......... R Removal of neck wrinkles .................................... 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 000
15826 .... .......... R Removal of brow wrinkles .................................... 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 000
01DER2
15828 .... .......... R Removal of face wrinkles ..................................... 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 000
15829 .... .......... R Removal of skin wrinkles ..................................... 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 000
69799
Year
69800
Year Year
2007 2007 Fully Im-
VerDate Aug<31>2005
RVUs cility Total
RVUs
15830 .... .......... R Exc skin abd ......................................................... 16.90 NA NA 10.15 10.15 2.93 NA NA 29.98 29.98 090
15832 .... .......... A Excise excessive skin tissue ................................ 12.65 NA NA 8.43 8.36 1.66 NA NA 22.74 22.67 090
10:50 Nov 30, 2006

15837 .... .......... A Excise excessive skin tissue ................................ 9.37 8.77 8.61 5.80 6.98 1.18 19.32 19.16 16.35 17.53 090
15839 .... .......... A Excise excessive skin tissue ................................ 10.32 9.42 8.97 6.25 6.36 1.22 20.96 20.51 17.79 17.90 090
Jkt 211001
15840 .... .......... A Graft for face nerve palsy .................................... 14.76 NA NA 8.75 9.67 1.32 NA NA 24.83 25.75 090
15841 .... .......... A Graft for face nerve palsy .................................... 25.69 NA NA 13.33 14.58 2.55 NA NA 41.57 42.82 090
15842 .... .......... A Flap for face nerve palsy ..................................... 40.68 NA NA 21.64 22.59 4.94 NA NA 67.26 68.21 090
15845 .... .......... A Skin and muscle repair, face ............................... 14.04 NA NA 8.90 9.20 0.81 NA NA 23.75 24.05 090
PO 00000
15847 .... .......... C Exc skin abd add-on ............................................ 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 YYY
15850 .... .......... B Removal of sutures .............................................. 0.78 1.19 1.47 0.18 0.27 0.05 2.02 2.30 1.01 1.10 XXX
15851 .... .......... A Removal of sutures .............................................. 0.86 1.33 1.59 0.24 0.29 0.06 2.25 2.51 1.16 1.21 000
15852 .... .......... A Dressing change not for burn .............................. 0.86 NA NA 0.26 0.31 0.09 NA NA 1.21 1.26 000
15860 .... .......... A Test for blood flow in graft ................................... 1.95 NA NA 0.71 0.76 0.27 NA NA 2.93 2.98 000
Frm 00178
15876 .... .......... R Suction assisted lipectomy ................................... 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 000
Fmt 4701
15920 .... .......... A Removal of tail bone ulcer ................................... 8.15 NA NA 5.86 5.63 1.04 NA NA 15.05 14.82 090
15922 .... .......... A Removal of tail bone ulcer ................................... 10.23 NA NA 7.11 7.19 1.42 NA NA 18.76 18.84 090
15931 .... .......... A Remove sacrum pressure sore ............................ 9.96 NA NA 5.57 5.65 1.25 NA NA 16.78 16.86 090
Sfmt 4700
15940 .... .......... A Remove hip pressure sore ................................... 10.11 NA NA 5.91 6.11 1.31 NA NA 17.33 17.53 090
15950 .... .......... A Remove thigh pressure sore ................................ 7.91 NA NA 5.43 5.42 1.04 NA NA 14.38 14.37 090
E:\FR\FM\01DER2.SGM
01DER2
15999 .... .......... C Removal of pressure sore .................................... 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 YYY
16000 .... .......... A Initial treatment of burn(s) .................................... 0.89 0.73 0.83 0.24 0.26 0.08 1.70 1.80 1.21 1.23 000
Year Year Year
2007 2007 Fully Im-
VerDate Aug<31>2005
RVUs cility Total
RVUs
16020 .... .......... A Dress/debrid p-thick burn, s ................................. 0.80 1.11 1.25 0.56 0.58 0.08 1.99 2.13 1.44 1.46 000
16025 .... .......... A Dress/debrid p-thick burn, m ................................ 1.85 1.61 1.72 0.89 0.94 0.19 3.65 3.76 2.93 2.98 000
16030 .... .......... A Dress/debrid p-thick burn, l .................................. 2.08 1.98 2.12 0.97 1.08 0.24 4.30 4.44 3.29 3.40 000
16035 .... .......... A Incision of burn scab, initi .................................... 3.74 NA NA 1.29 1.51 0.46 NA NA 5.49 5.71 090
10:50 Nov 30, 2006

16036 .... .......... A Escharotomy; add"l incision ............................... 1.50 NA NA 0.49 0.57 0.20 NA NA 2.19 2.27 ZZZ
17000 .... .......... A Destruct premalg lesion ....................................... 0.62 1.42 1.08 0.75 0.59 0.03 2.07 1.73 1.40 1.24 010
17003 .... .......... A Destruct premalg les, 2–14 .................................. 0.07 0.10 0.11 0.03 0.06 0.01 0.18 0.19 0.11 0.14 ZZZ
17004 .... .......... A Destroy premlg lesions 15+ ................................. 1.82 2.43 2.33 1.39 1.54 0.11 4.36 4.26 3.32 3.47 010
17106 .... .......... A Destruction of skin lesions ................................... 4.62 4.72 4.63 3.32 3.33 0.35 9.69 9.60 8.29 8.30 090
Jkt 211001
17110 .... .......... A Destruct b9 lesion, 1–14 ...................................... 0.67 1.76 1.66 0.87 0.74 0.05 2.48 2.38 1.59 1.46 010
17111 .... .......... A Destruct lesion, 15 or more ................................. 0.94 2.29 1.83 1.14 0.89 0.05 3.28 2.82 2.13 1.88 010
PO 00000
17250 .... .......... A Chemical cautery, tissue ...................................... 0.50 1.32 1.25 0.38 0.35 0.06 1.88 1.81 0.94 0.91 000
Frm 00179
Fmt 4701
Sfmt 4700
17311 .... .......... A Mohs, 1 stage, h/n/hf/g ........................................ 6.20 10.79 10.79 3.16 3.16 0.24 17.23 17.23 9.60 9.60 000
17312 .... .......... A Mohs addl stage ................................................... 3.30 6.92 6.92 1.68 1.68 0.13 10.35 10.35 5.11 5.11 ZZZ
17313 .... .......... A Mohs, 1 stage, t/a/l .............................................. 5.56 9.95 9.95 2.83 2.83 0.22 15.73 15.73 8.61 8.61 000
17314 .... .......... A Mohs, addl stage, t/a/l .......................................... 3.06 6.41 6.41 1.55 1.55 0.12 9.59 9.59 4.73 4.73 ZZZ
17315 .... .......... A Mohs surg, addl block .......................................... 0.87 1.15 1.15 0.44 0.44 0.03 2.05 2.05 1.34 1.34 ZZZ
E:\FR\FM\01DER2.SGM
17340 .... .......... A Cryotherapy of skin .............................................. 0.76 0.34 0.36 0.34 0.36 0.05 1.15 1.17 1.15 1.17 010
17360 .... .......... A Skin peel therapy ................................................. 1.44 1.85 1.54 1.02 0.91 0.06 3.35 3.04 2.52 2.41 010
17380 .... .......... R Hair removal by electrolysis ................................. 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 000
17999 .... .......... C Skin tissue procedure .......................................... 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 YYY
01DER2
19000 .... .......... A Drainage of breast lesion ..................................... 0.84 1.82 1.94 0.23 0.29 0.08 2.74 2.86 1.15 1.21 000
19001 .... .......... A Drain breast lesion add-on ................................... 0.42 0.23 0.25 0.12 0.14 0.04 0.69 0.71 0.58 0.60 ZZZ
69801
Year
69802
Year Year
2007 2007 Fully Im-
VerDate Aug<31>2005
RVUs cility Total
RVUs
19020 .... .......... A Incision of breast lesion ....................................... 3.74 6.58 6.39 3.02 2.76 0.45 10.77 10.58 7.21 6.95 090
19030 .... .......... A Injection for breast x-ray ...................................... 1.53 2.46 2.76 0.43 0.48 0.09 4.08 4.38 2.05 2.10 000
19100 .... .......... A Bx breast percut w/o image ................................. 1.27 2.05 2.07 0.33 0.40 0.16 3.48 3.50 1.76 1.83 000
19101 .... .......... A Biopsy of breast, open ......................................... 3.20 4.28 4.45 1.75 1.87 0.39 7.87 8.04 5.34 5.46 010
10:50 Nov 30, 2006

19102 .... .......... A Bx breast percut w/image .................................... 2.00 3.22 3.68 0.56 0.64 0.14 5.36 5.82 2.70 2.78 000
19103 .... .......... A Bx breast percut w/device .................................... 3.69 9.55 11.01 1.01 1.18 0.30 13.54 15.00 5.00 5.17 000
19105 .... .......... A Cryosurg ablate fa, each ...................................... 3.69 45.93 45.93 1.00 1.00 0.30 49.92 49.92 4.99 4.99 000
19110 .... .......... A Nipple exploration ................................................ 4.35 6.35 5.93 3.24 2.96 0.57 11.27 10.85 8.16 7.88 090
19112 .... .......... A Excise breast duct fistula ..................................... 3.72 6.22 6.10 3.14 2.80 0.48 10.42 10.30 7.34 7.00 090
Jkt 211001
19120 .... .......... A Removal of breast lesion ..................................... 5.84 5.06 4.67 3.36 3.14 0.73 11.63 11.24 9.93 9.71 090
19125 .... .......... A Excision, breast lesion ......................................... 6.59 5.53 4.97 3.64 3.37 0.80 12.92 12.36 11.03 10.76 090
19126 .... .......... A Excision, addl breast lesion ................................. 2.93 NA NA 0.76 0.94 0.38 NA NA 4.07 4.25 ZZZ
19260 .... .......... A Removal of chest wall lesion ............................... 17.60 NA NA 10.26 10.93 2.14 NA NA 30.00 30.67 090
PO 00000
19271 .... .......... A Revision of chest wall .......................................... 21.86 NA NA 15.88 17.43 2.63 NA NA 40.37 41.92 090
19272 .... .......... A Extensive chest wall surgery ............................... 24.82 NA NA 16.99 18.45 3.00 NA NA 44.81 46.27 090
19290 .... .......... A Place needle wire, breast .................................... 1.27 2.68 2.81 0.36 0.41 0.07 4.02 4.15 1.70 1.75 000
19291 .... .......... A Place needle wire, breast .................................... 0.63 1.05 1.17 0.18 0.20 0.04 1.72 1.84 0.85 0.87 ZZZ
19295 .... .......... A Place breast clip, percut ...................................... 0.00 2.19 2.57 0.00 2.02 0.01 2.20 2.58 0.01 2.03 ZZZ
Frm 00180
19296 .... .......... A Place po breast cath for rad ................................ 3.63 83.51 114.92 1.20 1.45 0.36 87.50 118.91 5.19 5.44 000
19297 .... .......... A Place breast cath for rad ..................................... 1.72 NA NA 0.47 0.60 0.17 NA NA 2.36 2.49 ZZZ
19298 .... .......... A Place breast rad tube/caths ................................. 6.00 23.09 37.39 2.20 2.36 0.43 29.52 43.82 8.63 8.79 000
19300 .... .......... A Removal of breast tissue ..................................... 5.20 7.95 7.34 3.82 3.50 0.69 13.84 13.23 9.71 9.39 090
Fmt 4701
19301 .... .......... A Partical mastectomy ............................................. 6.03 NA NA 3.60 3.47 0.79 NA NA 10.42 10.29 090
19302 .... .......... A P-mastectomy w/ln removal ................................. 13.88 NA NA 6.15 6.29 1.80 NA NA 21.83 21.97 090
19303 .... .......... A Mast, simple, complete ........................................ 15.67 NA NA 7.00 5.52 1.18 NA NA 23.85 22.37 090
19304 .... .......... A Mast, subq ............................................................ 7.81 NA NA 4.93 4.80 1.04 NA NA 13.78 13.65 090
19305 .... .......... A Mast, radical ......................................................... 17.23 NA NA 8.16 8.01 1.93 NA NA 27.32 27.17 090
Sfmt 4700
19306 .... .......... A Mast, rad, urban type ........................................... 17.85 NA NA 8.62 8.33 2.08 NA NA 28.55 28.26 090
19307 .... .......... A Mast, mod rad ...................................................... 17.95 NA NA 8.77 8.34 2.13 NA NA 28.85 28.42 090
19316 .... .......... A Suspension of breast ........................................... 10.98 NA NA 7.28 7.45 1.64 NA NA 19.90 20.07 090
19318 .... .......... A Reduction of large breast ..................................... 15.91 NA NA 10.25 10.94 2.93 NA NA 29.09 29.78 090
19324 .... .......... A Enlarge breast ...................................................... 6.65 NA NA 4.69 4.84 0.84 NA NA 12.18 12.33 090
19325 .... .......... A Enlarge breast with implant ................................. 8.52 NA NA 6.62 6.55 1.33 NA NA 16.47 16.40 090
19328 .... .......... A Removal of breast implant ................................... 6.35 NA NA 5.13 5.05 0.91 NA NA 12.39 12.31 090
19330 .... .......... A Removal of implant material ................................ 8.39 NA NA 6.34 6.11 1.26 NA NA 15.99 15.76 090
19340 .... .......... A Immediate breast prosthesis ................................ 6.32 NA NA 2.96 3.07 1.06 NA NA 10.34 10.45 ZZZ
19342 .... .......... A Delayed breast prosthesis ................................... 12.40 NA NA 9.23 9.00 1.84 NA NA 23.47 23.24 090
E:\FR\FM\01DER2.SGM
19350 .... .......... A Breast reconstruction ........................................... 8.99 10.09 12.90 6.77 7.07 1.41 20.49 23.30 17.17 17.47 090
19355 .... .......... A Correct inverted nipple(s) ..................................... 8.37 7.85 9.65 5.03 4.78 0.92 17.14 18.94 14.32 14.07 090
19357 .... .......... A Breast reconstruction ........................................... 20.57 NA NA 15.91 15.69 2.94 NA NA 39.42 39.20 090
19361 .... .......... A Breast reconstr w/lat flap ..................................... 23.17 NA NA 17.30 13.65 2.93 NA NA 43.40 39.75 090
01DER2
Year Year Year
2007 2007 Fully Im-
VerDate Aug<31>2005
RVUs cility Total
RVUs
10:50 Nov 30, 2006

19370 .... .......... A Surgery of breast capsule .................................... 8.99 NA NA 7.02 6.93 1.29 NA NA 17.30 17.21 090
19371 .... .......... A Removal of breast capsule .................................. 10.42 NA NA 7.92 7.85 1.62 NA NA 19.96 19.89 090
19380 .... .......... A Revise breast reconstruction ............................... 10.21 NA NA 7.85 7.74 1.44 NA NA 19.50 19.39 090
19396 .... .......... A Design custom breast implant ............................. 2.17 4.54 1.95 1.27 1.06 0.30 7.01 4.42 3.74 3.53 000
19499 .... .......... C Breast surgery procedure .................................... 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 YYY
Jkt 211001
20000 .... .......... A Incision of abscess ............................................... 2.14 2.78 2.71 1.53 1.68 0.25 5.17 5.10 3.92 4.07 010
20005 .... .......... A Incision of deep abscess ..................................... 3.55 3.70 3.54 2.04 2.20 0.46 7.71 7.55 6.05 6.21 010
20100 .... .......... A Explore wound, neck ............................................ 10.33 NA NA 3.67 4.26 1.21 NA NA 15.21 15.80 010
20101 .... .......... A Explore wound, chest ........................................... 3.22 6.37 6.03 1.51 1.59 0.44 10.03 9.69 5.17 5.25 010
PO 00000
20102 .... .......... A Explore wound, abdomen .................................... 3.95 6.89 7.32 1.85 1.89 0.49 11.33 11.76 6.29 6.33 010
20103 .... .......... A Explore wound, extremity ..................................... 5.31 7.68 8.36 2.75 3.23 0.75 13.74 14.42 8.81 9.29 010
20150 .... .......... A Excise epiphyseal bar .......................................... 14.60 NA NA 7.81 7.23 2.04 NA NA 24.45 23.87 090
20200 .... .......... A Muscle biopsy ...................................................... 1.46 3.13 3.06 0.70 0.74 0.23 4.82 4.75 2.39 2.43 000
Frm 00181
20205 .... .......... A Deep muscle biopsy ............................................. 2.35 3.81 3.87 1.11 1.17 0.33 6.49 6.55 3.79 3.85 000
20206 .... .......... A Needle biopsy, muscle ......................................... 0.99 4.99 6.12 0.50 0.60 0.07 6.05 7.18 1.56 1.66 000
20220 .... .......... A Bone biopsy, trocar/needle .................................. 1.27 2.59 4.07 0.61 0.75 0.08 3.94 5.42 1.96 2.10 000
20225 .... .......... A Bone biopsy, trocar/needle .................................. 1.87 12.62 21.49 0.99 1.10 0.22 14.71 23.58 3.08 3.19 000
Fmt 4701
20240 .... .......... A Bone biopsy, excisional ....................................... 3.25 NA NA 2.09 2.44 0.44 NA NA 5.78 6.13 010
20245 .... .......... A Bone biopsy, excisional ....................................... 8.77 NA NA 5.82 6.38 1.31 NA NA 15.90 16.46 010
20250 .... .......... A Open bone biopsy ................................................ 5.16 NA NA 3.73 3.56 1.02 NA NA 9.91 9.74 010
20251 .... .......... A Open bone biopsy ................................................ 5.69 NA NA 3.91 4.10 1.15 NA NA 10.75 10.94 010
Sfmt 4700
20500 .... .......... A Injection of sinus tract .......................................... 1.25 1.27 2.01 0.83 1.36 0.12 2.64 3.38 2.20 2.73 010
20501 .... .......... A Inject sinus tract for x-ray .................................... 0.76 2.22 2.74 0.22 0.24 0.04 3.02 3.54 1.02 1.04 000
20520 .... .......... A Removal of foreign body ...................................... 1.87 2.58 2.83 1.45 1.68 0.21 4.66 4.91 3.53 3.76 010
20526 .... .......... A Ther injection, carp tunnel ................................... 0.94 0.82 0.93 0.42 0.50 0.13 1.89 2.00 1.49 1.57 000
20550 .... .......... A Inj tendon sheath/ligament ................................... 0.75 0.63 0.69 0.29 0.25 0.09 1.47 1.53 1.13 1.09 000
20551 .... .......... A Inj tendon origin/insertion ..................................... 0.75 0.63 0.67 0.29 0.32 0.08 1.46 1.50 1.12 1.15 000
20552 .... .......... A Inj trigger point, 1/2 muscl ................................... 0.66 0.58 0.69 0.25 0.21 0.05 1.29 1.40 0.96 0.92 000
20553 .... .......... A Inject trigger points, =/> 3 .................................... 0.75 0.64 0.78 0.27 0.23 0.04 1.43 1.57 1.06 1.02 000
E:\FR\FM\01DER2.SGM
20600 .... .......... A Drain/inject, joint/bursa ......................................... 0.66 0.67 0.66 0.32 0.34 0.08 1.41 1.40 1.06 1.08 000
20612 .... .......... A Aspirate/inj ganglion cyst ..................................... 0.70 0.70 0.71 0.32 0.35 0.10 1.50 1.51 1.12 1.15 000
01DER2
20615 .... .......... A Treatment of bone cyst ........................................ 2.30 2.70 3.31 1.41 1.73 0.20 5.20 5.81 3.91 4.23 010
20650 .... .......... A Insert and remove bone pin ................................. 2.25 2.51 2.40 1.49 1.54 0.31 5.07 4.96 4.05 4.10 010
20660 .... .......... A Apply, rem fixation device .................................... 2.51 3.39 3.14 1.52 1.59 0.59 6.49 6.24 4.62 4.69 000
20661 .... .......... A Application of head brace .................................... 5.14 NA NA 6.03 5.19 1.14 NA NA 12.31 11.47 090
20662 .... .......... A Application of pelvis brace ................................... 6.26 NA NA 4.89 5.36 0.56 NA NA 11.71 12.18 090
20663 .... .......... A Application of thigh brace .................................... 5.62 NA NA 5.17 4.92 0.94 NA NA 11.73 11.48 090
69803
Year
69804
Year Year
2007 2007 Fully Im-
VerDate Aug<31>2005
RVUs cility Total
RVUs
20664 .... .......... A Halo brace application ......................................... 9.86 NA NA 8.19 7.33 1.75 NA NA 19.80 18.94 090
20665 .... .......... A Removal of fixation device ................................... 1.33 1.45 1.98 1.03 1.27 0.19 2.97 3.50 2.55 2.79 010
20670 .... .......... A Removal of support implant ................................. 1.76 6.65 10.32 1.69 2.00 0.28 8.69 12.36 3.73 4.04 010
10:50 Nov 30, 2006

20680 .... .......... A Removal of support implant ................................. 5.90 8.16 8.63 4.11 3.82 0.56 14.62 15.09 10.57 10.28 090
20690 .... .......... A Apply bone fixation device ................................... 3.67 NA NA 2.29 2.46 0.59 NA NA 6.55 6.72 090
20692 .... .......... A Apply bone fixation device ................................... 6.40 NA NA 3.30 3.65 1.05 NA NA 10.75 11.10 090
20693 .... .......... A Adjust bone fixation device .................................. 5.97 NA NA 4.54 5.22 0.98 NA NA 11.49 12.17 090
20694 .... .......... A Remove bone fixation device ............................... 4.20 5.35 6.69 3.57 3.92 0.71 10.26 11.60 8.48 8.83 090
Jkt 211001
20802 .... .......... A Replantation, arm, complete ................................ 42.30 NA NA 24.78 21.91 3.82 NA NA 70.90 68.03 090
20805 .... .......... A Replant forearm, complete ................................... 51.14 NA NA 26.11 32.26 4.85 NA NA 82.10 88.25 090
20808 .... .......... A Replantation hand, complete ............................... 62.77 NA NA 39.72 41.60 6.88 NA NA 109.37 111.25 090
20816 .... .......... A Replantation digit, complete ................................. 31.74 NA NA 24.63 34.50 4.53 NA NA 60.90 70.77 090
PO 00000
20822 .... .......... A Replantation digit, complete ................................. 26.42 NA NA 22.54 31.58 4.19 NA NA 53.15 62.19 090
20824 .... .......... A Replantation thumb, complete ............................. 31.74 NA NA 25.93 33.89 4.62 NA NA 62.29 70.25 090
20827 .... .......... A Replantation thumb, complete ............................. 27.24 NA NA 24.10 33.38 3.67 NA NA 55.01 64.29 090
20838 .... .......... A Replantation foot, complete ................................. 42.56 NA NA 13.52 20.09 1.12 NA NA 57.20 63.77 090
Frm 00182
20900 .... .......... A Removal of bone for graft .................................... 5.77 9.30 8.65 4.97 5.50 0.94 16.01 15.36 11.68 12.21 090
20902 .... .......... A Removal of bone for graft .................................... 7.98 NA NA 5.87 6.63 1.30 NA NA 15.15 15.91 090
20910 .... .......... A Remove cartilage for graft ................................... 5.41 NA NA 4.69 5.06 0.71 NA NA 10.81 11.18 090
20912 .... .......... A Remove cartilage for graft ................................... 6.42 NA NA 4.76 5.53 0.69 NA NA 11.87 12.64 090
Fmt 4701
20920 .... .......... A Removal of fascia for graft ................................... 5.42 NA NA 4.40 4.27 0.66 NA NA 10.48 10.35 090
20922 .... .......... A Removal of fascia for graft ................................... 6.84 7.57 7.55 5.02 4.91 0.70 15.11 15.09 12.56 12.45 090
20924 .... .......... A Removal of tendon for graft ................................. 6.59 NA NA 5.04 5.67 1.04 NA NA 12.67 13.30 090
20926 .... .......... A Removal of tissue for graft ................................... 5.70 NA NA 4.44 4.67 0.87 NA NA 11.01 11.24 090
Sfmt 4700
20930 .... .......... B Spinal bone allograft ............................................ 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 XXX
20931 .... .......... A Spinal bone allograft ............................................ 1.81 NA NA 0.70 0.87 0.43 NA NA 2.94 3.11 ZZZ
20936 .... .......... B Spinal bone autograft ........................................... 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 XXX
20937 .... .......... A Spinal bone autograft ........................................... 2.79 NA NA 1.11 1.37 0.54 NA NA 4.44 4.70 ZZZ
20938 .... .......... A Spinal bone autograft ........................................... 3.02 NA NA 1.18 1.47 0.64 NA NA 4.84 5.13 ZZZ
20950 .... .......... A Fluid pressure, muscle ......................................... 1.26 4.14 6.17 0.88 0.96 0.20 5.60 7.63 2.34 2.42 000
20955 .... .......... A Fibula bone graft, microvasc ................................ 40.02 NA NA 18.50 22.83 4.90 NA NA 63.42 67.75 090
20956 .... .......... A Iliac bone graft, microvasc ................................... 40.93 NA NA 20.95 23.79 7.03 NA NA 68.91 71.75 090
20957 .... .......... A Mt bone graft, microvasc ..................................... 42.33 NA NA 19.65 19.12 7.07 NA NA 69.05 68.52 090
E:\FR\FM\01DER2.SGM
20962 .... .......... A Other bone graft, microvasc ................................ 39.21 NA NA 21.46 25.26 6.57 NA NA 67.24 71.04 090
20969 .... .......... A Bone/skin graft, microvasc ................................... 45.11 NA NA 20.79 25.17 4.80 NA NA 70.70 75.08 090
20970 .... .......... A Bone/skin graft, iliac crest .................................... 44.26 NA NA 20.52 24.17 6.62 NA NA 71.40 75.05 090
20972 .... .......... A Bone/skin graft, metatarsal .................................. 44.19 NA NA 17.83 19.89 5.32 NA NA 67.34 69.40 090
01DER2
20973 .... .......... A Bone/skin graft, great toe ..................................... 46.95 NA NA 15.20 22.67 5.56 NA NA 67.71 75.18 090
20974 .... .......... A Electrical bone stimulation ................................... 0.62 0.99 0.77 0.49 0.53 0.11 1.72 1.50 1.22 1.26 000
20975 .... .......... A Electrical bone stimulation ................................... 2.60 NA NA 1.49 1.66 0.51 NA NA 4.60 4.77 000
20979 .... .......... A Us bone stimulation ............................................. 0.62 0.58 0.75 0.20 0.31 0.09 1.29 1.46 0.91 1.02 000
20982 .... .......... A Ablate, bone tumor(s) perq .................................. 7.27 78.40 101.76 2.35 2.82 0.69 86.36 109.72 10.31 10.78 000
20999 .... .......... C Musculoskeletal surgery ....................................... 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 YYY
Year Year Year
2007 2007 Fully Im-
VerDate Aug<31>2005
RVUs cility Total
RVUs
21010 .... .......... A Incision of jaw joint ............................................... 10.90 NA NA 5.97 6.81 1.11 NA NA 17.98 18.82 090
21015 .... .......... A Resection of facial tumor ..................................... 5.59 NA NA 4.35 4.85 0.70 NA NA 10.64 11.14 090
21025 .... .......... A Excision of bone, lower jaw ................................. 11.07 12.54 12.32 8.77 9.21 1.32 24.93 24.71 21.16 21.60 090
10:50 Nov 30, 2006

21026 .... .......... A Excision of facial bone(s) ..................................... 5.54 8.74 8.08 5.89 6.21 0.60 14.88 14.22 12.03 12.35 090
21029 .... .......... A Contour of face bone lesion ................................. 8.26 9.34 9.36 6.37 6.85 0.94 18.54 18.56 15.57 16.05 090
21030 .... .......... A Excise max/zygoma b9 tumor .............................. 4.80 7.20 6.55 4.71 4.95 0.54 12.54 11.89 10.05 10.29 090
21031 .... .......... A Remove exostosis, mandible ............................... 3.26 5.98 5.37 3.53 3.60 0.48 9.72 9.11 7.27 7.34 090
21032 .... .......... A Remove exostosis, maxilla .................................. 3.28 6.07 5.52 3.40 3.48 0.47 9.82 9.27 7.15 7.23 090
Jkt 211001
21034 .... .......... A Excise max/zygoma mlg tumor ............................ 17.17 13.31 15.27 9.67 11.91 1.72 32.20 34.16 28.56 30.80 090
21040 .... .......... A Excise mandible lesion ........................................ 4.80 7.27 6.61 4.71 4.72 0.54 12.61 11.95 10.05 10.06 090
21044 .... .......... A Removal of jaw bone lesion ................................. 12.61 NA NA 7.60 8.93 1.12 NA NA 21.33 22.66 090
21045 .... .......... A Extensive jaw surgery .......................................... 18.13 NA NA 10.18 11.81 1.52 NA NA 29.83 31.46 090
PO 00000
21046 .... .......... A Remove mandible cyst complex .......................... 13.97 NA NA 11.72 11.86 1.86 NA NA 27.55 27.69 090
21047 .... .......... A Excise lwr jaw cyst w/repair ................................. 19.83 NA NA 9.92 12.56 2.13 NA NA 31.88 34.52 090
21048 .... .......... A Remove maxilla cyst complex ............................. 14.47 NA NA 11.48 11.97 1.77 NA NA 27.72 28.21 090
21049 .... .......... A Excis uppr jaw cyst w/repair ................................ 19.08 NA NA 9.25 12.08 1.59 NA NA 29.92 32.75 090
Frm 00183
21050 .... .......... A Removal of jaw joint ............................................. 11.54 NA NA 8.28 9.15 1.47 NA NA 21.29 22.16 090
21060 .... .......... A Remove jaw joint cartilage ................................... 10.91 NA NA 7.61 8.36 1.38 NA NA 19.90 20.65 090
21070 .... .......... A Remove coronoid process ................................... 8.50 NA NA 6.21 6.88 1.27 NA NA 15.98 16.65 090
21076 .... .......... A Prepare face/oral prosthesis ................................ 13.40 7.97 11.26 4.90 8.73 2.00 23.37 26.66 20.30 24.13 010
Fmt 4701
Sfmt 4700
21088 .... .......... C Prepare face/oral prosthesis ................................ 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 090
21089 .... .......... C Prepare face/oral prosthesis ................................ 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 090
21100 .... .......... A Maxillofacial fixation ............................................. 4.56 13.76 12.09 5.11 4.83 0.34 18.66 16.99 10.01 9.73 090
E:\FR\FM\01DER2.SGM
21110 .... .......... A Interdental fixation ................................................ 5.80 13.27 10.49 9.91 8.75 0.72 19.79 17.01 16.43 15.27 090
21116 .... .......... A Injection, jaw joint x-ray ....................................... 0.81 2.38 3.84 0.21 0.30 0.06 3.25 4.71 1.08 1.17 000
21120 .... .......... A Reconstruction of chin ......................................... 4.99 10.09 10.46 6.96 7.36 0.60 15.68 16.05 12.55 12.95 090
21121 .... .......... A Reconstruction of chin ......................................... 7.70 10.63 9.96 7.56 7.76 0.90 19.23 18.56 16.16 16.36 090
01DER2
21122 .... .......... A Reconstruction of chin ......................................... 8.59 NA NA 7.75 8.40 1.07 NA NA 17.41 18.06 090
21123 .... .......... A Reconstruction of chin ......................................... 11.22 NA NA 10.14 10.64 1.40 NA NA 22.76 23.26 090
21125 .... .......... A Augmentation, lower jaw bone ............................. 10.68 68.54 58.55 7.14 8.03 0.79 80.01 70.02 18.61 19.50 090
21127 .... .......... A Augmentation, lower jaw bone ............................. 12.24 87.23 53.91 8.01 9.09 1.52 100.99 67.67 21.77 22.85 090
21137 .... .......... A Reduction of forehead .......................................... 10.12 NA NA 6.43 7.41 1.32 NA NA 17.87 18.85 090
69805
Year
69806
Year Year
2007 2007 Fully Im-
VerDate Aug<31>2005
RVUs cility Total
RVUs
21141 .... .......... A Reconstruct midface, lefort .................................. 19.27 NA NA 11.69 13.16 2.36 NA NA 33.32 34.79 090
10:50 Nov 30, 2006

Jkt 211001
PO 00000
21172 .... .......... A Reconstruct orbit/forehead ................................... 28.07 NA NA 13.88 13.78 3.56 NA NA 45.51 45.41 090
21175 .... .......... A Reconstruct orbit/forehead ................................... 33.43 NA NA 13.17 16.64 4.84 NA NA 51.44 54.91 090
21179 .... .......... A Reconstruct entire forehead ................................. 22.53 NA NA 11.17 13.39 2.81 NA NA 36.51 38.73 090
Frm 00184
21180 .... .......... A Reconstruct entire forehead ................................. 25.46 NA NA 12.78 14.73 3.49 NA NA 41.73 43.68 090
21181 .... .......... A Contour cranial bone lesion ................................. 10.18 NA NA 7.10 7.37 1.32 NA NA 18.60 18.87 090
21182 .... .......... A Reconstruct cranial bone ..................................... 32.45 NA NA 14.40 17.93 2.81 NA NA 49.66 53.19 090
Fmt 4701
21188 .... .......... A Reconstruction of midface ................................... 22.97 NA NA 14.93 17.89 1.70 NA NA 39.60 42.56 090
21193 .... .......... A Reconst lwr jaw w/o graft ..................................... 18.65 NA NA 9.93 11.97 2.24 NA NA 30.82 32.86 090
21194 .... .......... A Reconst lwr jaw w/graft ........................................ 21.54 NA NA 11.48 13.18 2.03 NA NA 35.05 36.75 090
Sfmt 4700
21195 .... .......... A Reconst lwr jaw w/o fixation ................................ 18.88 NA NA 13.47 14.48 1.64 NA NA 33.99 35.00 090
21196 .... .......... A Reconst lwr jaw w/fixation .................................... 20.55 NA NA 13.41 15.12 2.08 NA NA 36.04 37.75 090
21198 .... .......... A Reconstr lwr jaw segment .................................... 15.48 NA NA 11.21 12.33 1.44 NA NA 28.13 29.25 090
21199 .... .......... A Reconstr lwr jaw w/advance ................................ 16.62 NA NA 6.96 8.57 1.39 NA NA 24.97 26.58 090
21206 .... .......... A Reconstruct upper jaw bone ................................ 15.36 NA NA 11.25 12.29 1.33 NA NA 27.94 28.98 090
21208 .... .......... A Augmentation of facial bones .............................. 11.15 32.41 24.85 7.83 9.14 1.09 44.65 37.09 20.07 21.38 090
21209 .... .......... A Reduction of facial bones .................................... 7.58 12.40 11.20 7.52 7.93 0.90 20.88 19.68 16.00 16.41 090
21210 .... .......... A Face bone graft .................................................... 11.40 43.70 29.58 7.81 8.97 1.30 56.40 42.28 20.51 21.67 090
21215 .... .......... A Lower jaw bone graft ........................................... 11.94 86.14 52.95 8.10 9.05 1.53 99.61 66.42 21.57 22.52 090
E:\FR\FM\01DER2.SGM
21230 .... .......... A Rib cartilage graft ................................................. 11.06 NA NA 6.94 7.77 1.29 NA NA 19.29 20.12 090
21235 .... .......... A Ear cartilage graft ................................................. 7.31 9.88 9.85 6.05 6.32 0.61 17.80 17.77 13.97 14.24 090
21240 .... .......... A Reconstruction of jaw joint ................................... 15.77 NA NA 9.64 11.45 2.25 NA NA 27.66 29.47 090
01DER2
21244 .... .......... A Reconstruction of lower jaw ................................. 13.35 NA NA 11.07 11.84 1.25 NA NA 25.67 26.44 090
21245 .... .......... A Reconstruction of jaw ........................................... 12.88 13.48 14.17 8.14 9.42 1.19 27.55 28.24 22.21 23.49 090
21246 .... .......... A Reconstruction of jaw ........................................... 12.78 NA NA 6.81 8.48 1.35 NA NA 20.94 22.61 090
21247 .... .......... A Reconstruct lower jaw bone ................................. 24.05 NA NA 12.11 16.04 2.84 NA NA 39.00 42.93 090
Year Year Year
2007 2007 Fully Im-
VerDate Aug<31>2005
RVUs cility Total
RVUs
21255 .... .......... A Reconstruct lower jaw bone ................................. 18.14 NA NA 13.51 15.48 2.39 NA NA 34.04 36.01 090
21256 .... .......... A Reconstruction of orbit ......................................... 17.42 NA NA 9.98 11.36 1.50 NA NA 28.90 30.28 090
10:50 Nov 30, 2006

21260 .... .......... A Revise eye sockets .............................................. 17.74 NA NA 9.39 11.92 0.97 NA NA 28.10 30.63 090
Jkt 211001
21270 .... .......... A Augmentation, cheek bone .................................. 10.52 11.23 11.55 5.99 6.94 0.72 22.47 22.79 17.23 18.18 090
21275 .... .......... A Revision, orbitofacial bones ................................. 11.65 NA NA 7.58 8.02 1.29 NA NA 20.52 20.96 090
21280 .... .......... A Revision of eyelid ................................................. 6.92 NA NA 5.91 5.92 0.42 NA NA 13.25 13.26 090
21282 .... .......... A Revision of eyelid ................................................. 4.11 NA NA 4.30 4.44 0.26 NA NA 8.67 8.81 090
PO 00000
21295 .... .......... A Revision of jaw muscle/bone ............................... 1.82 NA NA 2.61 2.55 0.16 NA NA 4.59 4.53 090
21296 .... .......... A Revision of jaw muscle/bone ............................... 4.67 NA NA 5.49 5.06 0.34 NA NA 10.50 10.07 090
21299 .... .......... C Cranio/maxillofacial surgery ................................. 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 YYY
21310 .... .......... A Treatment of nose fracture .................................. 0.58 1.96 2.20 0.11 0.14 0.05 2.59 2.83 0.74 0.77 000
Frm 00185
21325 .... .......... A Treatment of nose fracture .................................. 4.07 NA NA 6.79 8.16 0.31 NA NA 11.17 12.54 090
Fmt 4701
21336 .... .......... A Treat nasal septal fracture ................................... 6.56 NA NA 8.24 9.27 0.55 NA NA 15.35 16.38 090
21337 .... .......... A Treat nasal septal fracture ................................... 3.26 5.91 6.07 3.41 3.53 0.28 9.45 9.61 6.95 7.07 090
21338 .... .......... A Treat nasoethmoid fracture .................................. 6.76 NA NA 9.73 12.95 0.82 NA NA 17.31 20.53 090
Sfmt 4700
21339 .... .......... A Treat nasoethmoid fracture .................................. 8.39 NA NA 10.80 13.13 0.96 NA NA 20.15 22.48 090
21343 .... .......... A Treatment of sinus fracture .................................. 14.11 NA NA 12.68 14.77 1.47 NA NA 28.26 30.35 090
21344 .... .......... A Treatment of sinus fracture .................................. 21.36 NA NA 13.37 15.72 2.44 NA NA 37.17 39.52 090
21345 .... .......... A Treat nose/jaw fracture ........................................ 8.87 9.76 9.82 6.07 6.90 0.92 19.55 19.61 15.86 16.69 090
21346 .... .......... A Treat nose/jaw fracture ........................................ 11.29 NA NA 10.87 11.87 1.21 NA NA 23.37 24.37 090
21355 .... .......... A Treat cheek bone fracture .................................... 4.32 5.63 6.08 3.04 3.37 0.34 10.29 10.74 7.70 8.03 010
E:\FR\FM\01DER2.SGM
21356 .... .......... A Treat cheek bone fracture .................................... 4.70 6.84 7.05 3.99 4.41 0.46 12.00 12.21 9.15 9.57 010
21360 .... .......... A Treat cheek bone fracture .................................... 7.03 NA NA 5.35 5.79 0.74 NA NA 13.12 13.56 090
01DER2
21385 .... .......... A Treat eye socket fracture ..................................... 9.46 NA NA 7.01 7.96 0.97 NA NA 17.44 18.39 090
21400 .... .......... A Treat eye socket fracture ..................................... 1.44 2.74 2.64 1.98 1.90 0.15 4.33 4.23 3.57 3.49 090
69807
Year
69808
Year Year
2007 2007 Fully Im-
VerDate Aug<31>2005
RVUs cility Total
RVUs
21401 .... .......... A Treat eye socket fracture ..................................... 3.57 7.24 7.80 3.15 3.41 0.38 11.19 11.75 7.10 7.36 090
10:50 Nov 30, 2006

21421 .... .......... A Treat mouth roof fracture ..................................... 5.80 12.12 10.03 9.01 8.49 0.73 18.65 16.56 15.54 15.02 090
21422 .... .......... A Treat mouth roof fracture ..................................... 8.62 NA NA 6.88 7.78 0.99 NA NA 16.49 17.39 090
21423 .... .......... A Treat mouth roof fracture ..................................... 10.71 NA NA 7.41 8.84 1.27 NA NA 19.39 20.82 090
21431 .... .......... A Treat craniofacial fracture .................................... 7.74 NA NA 9.40 9.49 0.70 NA NA 17.84 17.93 090
Jkt 211001
PO 00000
21440 .... .......... A Treat dental ridge fracture ................................... 3.28 10.30 7.90 7.65 6.53 0.38 13.96 11.56 11.31 10.19 090
21445 .... .......... A Treat dental ridge fracture ................................... 6.04 12.49 10.44 8.65 8.44 0.78 19.31 17.26 15.47 15.26 090
21450 .... .......... A Treat lower jaw fracture ....................................... 3.55 10.39 8.13 7.65 7.07 0.33 14.27 12.01 11.53 10.95 090
Frm 00186
21454 .... .......... A Treat lower jaw fracture ....................................... 7.17 NA NA 5.76 6.14 0.82 NA NA 13.75 14.13 090
Fmt 4701
21480 .... .......... A Reset dislocated jaw ............................................ 0.61 1.50 1.70 0.18 0.19 0.06 2.17 2.37 0.85 0.86 000
Sfmt 4700
21485 .... .......... A Reset dislocated jaw ............................................ 4.58 12.19 9.21 9.19 8.04 0.51 17.28 14.30 14.28 13.13 090
21490 .... .......... A Repair dislocated jaw ........................................... 12.71 NA NA 7.95 9.26 1.97 NA NA 22.63 23.94 090
21495 .... .......... A Treat hyoid bone fracture ..................................... 6.55 NA NA 9.65 8.73 0.46 NA NA 16.66 15.74 090
21497 .... .......... A Interdental wiring .................................................. 4.45 11.98 9.33 9.18 8.03 0.50 16.93 14.28 14.13 12.98 090
21499 .... .......... C Head surgery procedure ...................................... 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 YYY
21501 .... .......... A Drain neck/chest lesion ........................................ 3.87 6.39 6.41 3.44 3.73 0.43 10.69 10.71 7.74 8.03 090
21502 .... .......... A Drain chest lesion ................................................ 7.43 NA NA 4.78 5.42 0.97 NA NA 13.18 13.82 090
21510 .... .......... A Drainage of bone lesion ....................................... 6.06 NA NA 4.74 5.43 0.80 NA NA 11.60 12.29 090
21550 .... .......... A Biopsy of neck/chest ............................................ 2.08 4.26 3.75 1.73 1.72 0.16 6.50 5.99 3.97 3.96 010
E:\FR\FM\01DER2.SGM
21555 .... .......... A Remove lesion, neck/chest .................................. 4.40 5.74 5.57 3.41 3.25 0.56 10.70 10.53 8.37 8.21 090
21556 .... .......... A Remove lesion, neck/chest .................................. 5.63 NA NA 4.02 4.08 0.65 NA NA 10.30 10.36 090
21557 .... .......... A Remove tumor, neck/chest .................................. 8.91 NA NA 4.46 5.13 1.08 NA NA 14.45 15.12 090
21600 .... .......... A Partial removal of rib ............................................ 7.14 NA NA 5.82 5.75 0.99 NA NA 13.95 13.88 090
01DER2
21610 .... .......... A Partial removal of rib ............................................ 15.76 NA NA 8.21 8.70 3.08 NA NA 27.05 27.54 090
21615 .... .......... A Removal of rib ...................................................... 10.31 NA NA 5.47 6.38 1.45 NA NA 17.23 18.14 090
21616 .... .......... A Removal of rib and nerves ................................... 12.54 NA NA 7.12 7.80 1.87 NA NA 21.53 22.21 090
21620 .... .......... A Partial removal of sternum ................................... 7.16 NA NA 4.90 5.70 0.98 NA NA 13.04 13.84 090
21627 .... .......... A Sternal debridement ............................................. 7.18 NA NA 5.64 6.14 1.02 NA NA 13.84 14.34 090
21630 .... .......... A Extensive sternum surgery .................................. 19.01 NA NA 10.75 11.57 2.59 NA NA 32.35 33.17 090
Year Year Year
2007 2007 Fully Im-
VerDate Aug<31>2005
RVUs cility Total
RVUs
21632 .... .......... A Extensive sternum surgery .................................. 19.51 NA NA 9.58 10.73 2.66 NA NA 31.75 32.90 090
21685 .... .......... A Hyoid myotomy & suspension ............................. 14.89 NA NA 7.99 9.48 1.06 NA NA 23.94 25.43 090
21700 .... .......... A Revision of neck muscle ...................................... 6.23 NA NA 4.03 4.34 0.32 NA NA 10.58 10.89 090
10:50 Nov 30, 2006

21705 .... .......... A Revision of neck muscle/rib ................................. 9.83 NA NA 4.71 5.36 1.43 NA NA 15.97 16.62 090
21740 .... .......... A Reconstruction of sternum ................................... 17.47 NA NA 8.85 8.60 2.37 NA NA 28.69 28.44 090
21742 .... .......... C Repair stern/nuss w/o scope ............................... 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 090
Jkt 211001
21743 .... .......... C Repair sternum/nuss w/scope .............................. 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 090
21750 .... .......... A Repair of sternum separation .............................. 11.35 NA NA 5.43 5.94 1.63 NA NA 18.41 18.92 090
21800 .... .......... A Treatment of rib fracture ...................................... 0.98 1.35 1.34 1.35 1.34 0.09 2.42 2.41 2.42 2.41 090
21805 .... .......... A Treatment of rib fracture ...................................... 2.80 NA NA 3.53 3.28 0.38 NA NA 6.71 6.46 090
PO 00000
21810 .... .......... A Treatment of rib fracture(s) .................................. 6.92 NA NA 5.21 5.03 0.94 NA NA 13.07 12.89 090
21820 .... .......... A Treat sternum fracture ......................................... 1.31 1.80 1.82 1.80 1.77 0.16 3.27 3.29 3.27 3.24 090
21825 .... .......... A Treat sternum fracture ......................................... 7.65 NA NA 5.46 6.16 1.11 NA NA 14.22 14.92 090
21899 .... .......... C Neck/chest surgery procedure ............................. 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 YYY
Frm 00187
21920 .... .......... A Biopsy soft tissue of back .................................... 2.08 4.42 3.57 1.89 1.58 0.14 6.64 5.79 4.11 3.80 010
21925 .... .......... A Biopsy soft tissue of back .................................... 4.54 5.44 5.24 3.43 3.29 0.60 10.58 10.38 8.57 8.43 090
21930 .... .......... A Remove lesion, back or flank .............................. 5.06 6.01 5.79 3.76 3.49 0.66 11.73 11.51 9.48 9.21 090
21935 .... .......... A Remove tumor, back ............................................ 18.38 NA NA 8.60 9.37 2.48 NA NA 29.46 30.23 090
Fmt 4701
22010 .... .......... A I&d, p-spine, c/t/cerv-thor ..................................... 12.57 NA NA 7.87 8.63 1.74 NA NA 22.18 22.94 090
22015 .... .......... A I&d, p-spine, l/s/ls ................................................. 12.46 NA NA 7.83 8.57 1.72 NA NA 22.01 22.75 090
22100 .... .......... A Remove part of neck vertebra ............................. 10.80 NA NA 8.09 7.67 2.14 NA NA 21.03 20.61 090
22101 .... .......... A Remove part, thorax vertebra .............................. 10.88 NA NA 8.02 7.82 1.91 NA NA 20.81 20.61 090
Sfmt 4700
22102 .... .......... A Remove part, lumbar vertebra ............................. 10.88 NA NA 7.27 7.90 1.88 NA NA 20.03 20.66 090
22103 .... .......... A Remove extra spine segment .............................. 2.34 NA NA 0.90 1.13 0.44 NA NA 3.68 3.91 ZZZ
22110 .... .......... A Remove part of neck vertebra ............................. 13.80 NA NA 9.17 9.16 2.77 NA NA 25.74 25.73 090
22112 .... .......... A Remove part, thorax vertebra .............................. 13.87 NA NA 9.02 9.21 2.53 NA NA 25.42 25.61 090
22114 .... .......... A Remove part, lumbar vertebra ............................. 13.87 NA NA 9.12 9.22 2.64 NA NA 25.63 25.73 090
22116 .... .......... A Remove extra spine segment .............................. 2.32 NA NA 0.89 1.10 0.50 NA NA 3.71 3.92 ZZZ
22210 .... .......... A Revision of neck spine ......................................... 25.13 NA NA 14.86 15.27 5.46 NA NA 45.45 45.86 090
22212 .... .......... A Revision of thorax spine ...................................... 20.74 NA NA 12.55 13.09 3.91 NA NA 37.20 37.74 090
22214 .... .......... A Revision of lumbar spine ..................................... 20.77 NA NA 12.67 13.53 3.92 NA NA 37.36 38.22 090
E:\FR\FM\01DER2.SGM
22216 .... .......... A Revise, extra spine segment ............................... 6.03 NA NA 2.39 2.95 1.29 NA NA 9.71 10.27 ZZZ
22220 .... .......... A Revision of neck spine ......................................... 22.69 NA NA 13.56 13.61 5.08 NA NA 41.33 41.38 090
22222 .... .......... A Revision of thorax spine ...................................... 22.84 NA NA 12.30 11.42 4.13 NA NA 39.27 38.39 090
22224 .... .......... A Revision of lumbar spine ..................................... 22.84 NA NA 13.25 13.98 4.19 NA NA 40.28 41.01 090
01DER2
22226 .... .......... A Revise, extra spine segment ............................... 6.03 NA NA 2.18 2.86 1.29 NA NA 9.50 10.18 ZZZ
22305 .... .......... A Treat spine process fracture ................................ 2.08 2.15 2.27 1.81 1.89 0.39 4.62 4.74 4.28 4.36 090
22310 .... .......... A Treat spine fracture .............................................. 3.69 3.01 2.85 2.53 2.40 0.50 7.20 7.04 6.72 6.59 090
22315 .... .......... A Treat spine fracture .............................................. 9.91 9.82 9.72 7.43 7.36 1.86 21.59 21.49 19.20 19.13 090
22318 .... .......... A Treat odontoid fx w/o graft ................................... 22.54 NA NA 13.42 13.39 5.30 NA NA 41.26 41.23 090
22319 .... .......... A Treat odontoid fx w/graft ...................................... 25.15 NA NA 14.18 14.58 6.05 NA NA 45.38 45.78 090
69809
Year
69810
Year Year
2007 2007 Fully Im-
VerDate Aug<31>2005
RVUs cility Total
RVUs
22325 .... .......... A Treat spine fracture .............................................. 19.62 NA NA 12.10 12.08 3.88 NA NA 35.60 35.58 090
22326 .... .......... A Treat neck spine fracture ..................................... 20.64 NA NA 12.24 12.59 4.43 NA NA 37.31 37.66 090
22327 .... .......... A Treat thorax spine fracture ................................... 20.52 NA NA 12.37 12.36 3.99 NA NA 36.88 36.87 090
10:50 Nov 30, 2006

22328 .... .......... A Treat each add spine fx ....................................... 4.60 NA NA 1.83 2.15 0.94 NA NA 7.37 7.69 ZZZ
22505 .... .......... A Manipulation of spine ........................................... 1.87 NA NA 1.06 0.97 0.36 NA NA 3.29 3.20 010
22520 .... .......... A Percut vertebroplasty thor .................................... 9.17 42.34 56.83 4.07 4.84 1.72 53.23 67.72 14.96 15.73 010
22521 .... .......... A Percut vertebroplasty lumb .................................. 8.60 43.56 52.87 3.90 4.69 1.60 53.76 63.07 14.10 14.89 010
22522 .... .......... A Percut vertebroplasty add"l ................................ 4.30 NA NA 1.30 1.59 0.82 NA NA 6.42 6.71 ZZZ
Jkt 211001
22523 .... .......... A Percut kyphoplasty, thor ...................................... 9.21 NA NA 4.69 5.60 1.72 NA NA 15.62 16.53 010
22524 .... .......... A Percut kyphoplasty, lumbar .................................. 8.81 NA NA 4.54 5.40 1.60 NA NA 14.95 15.81 010
22525 .... .......... A Percut kyphoplasty, add-on ................................. 4.47 NA NA 1.66 2.12 0.82 NA NA 6.95 7.41 ZZZ
22526 .... .......... A Idet, single level ................................................... 6.07 46.51 46.51 2.08 2.08 1.16 53.74 53.74 9.31 9.31 010
PO 00000
22527 .... .......... A Idet, 1 or more levels ........................................... 3.03 39.89 39.89 0.70 0.70 0.58 43.50 43.50 4.31 4.31 ZZZ
22532 .... .......... A Lat thorax spine fusion ......................................... 25.81 NA NA 13.92 14.60 4.35 NA NA 44.08 44.76 090
22533 .... .......... A Lat lumbar spine fusion ........................................ 24.61 NA NA 13.52 13.57 3.16 NA NA 41.29 41.34 090
22534 .... .......... A Lat thor/lumb, add"l seg ..................................... 5.99 NA NA 2.35 2.86 1.25 NA NA 9.59 10.10 ZZZ
Frm 00188
22548 .... .......... A Neck spine fusion ................................................. 26.86 NA NA 15.32 15.68 5.61 NA NA 47.79 48.15 090
22556 .... .......... A Thorax spine fusion .............................................. 24.50 NA NA 13.15 14.34 4.35 NA NA 42.00 43.19 090
22558 .... .......... A Lumbar spine fusion ............................................. 23.33 NA NA 11.57 12.86 3.16 NA NA 38.06 39.35 090
Fmt 4701
22585 .... .......... A Additional spinal fusion ........................................ 5.52 NA NA 2.12 2.62 1.25 NA NA 8.89 9.39 ZZZ
22590 .... .......... A Spine & skull spinal fusion ................................... 21.56 NA NA 13.24 13.30 4.79 NA NA 39.59 39.65 090
22595 .... .......... A Neck spinal fusion ................................................ 20.44 NA NA 12.74 12.81 4.41 NA NA 37.59 37.66 090
Sfmt 4700
22610 .... .......... A Thorax spine fusion .............................................. 17.08 NA NA 10.96 11.30 3.53 NA NA 31.57 31.91 090
22614 .... .......... A Spine fusion, extra segment ................................ 6.43 NA NA 2.53 3.15 1.38 NA NA 10.34 10.96 ZZZ
22632 .... .......... A Spine fusion, extra segment ................................ 5.22 NA NA 2.04 2.51 1.16 NA NA 8.42 8.89 ZZZ
22800 .... .......... A Fusion of spine ..................................................... 19.30 NA NA 11.22 12.38 3.76 NA NA 34.28 35.44 090
E:\FR\FM\01DER2.SGM
22818 .... .......... A Kyphectomy, 1–2 segments ................................. 34.18 NA NA 16.75 18.34 6.47 NA NA 57.40 58.99 090
22819 .... .......... A Kyphectomy, 3 or more ........................................ 39.18 NA NA 19.61 19.94 7.67 NA NA 66.46 66.79 090
01DER2
22830 .... .......... A Exploration of spinal fusion .................................. 11.13 NA NA 7.15 7.76 2.30 NA NA 20.58 21.19 090
22840 .... .......... A Insert spine fixation device .................................. 12.52 NA NA 4.91 6.10 2.79 NA NA 20.22 21.41 ZZZ
22841 .... .......... B Insert spine fixation device .................................. 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 XXX
Year Year Year
2007 2007 Fully Im-
VerDate Aug<31>2005
RVUs cility Total
RVUs
10:50 Nov 30, 2006

22848 .... .......... A Insert pelv fixation device .................................... 5.99 NA NA 2.39 2.98 1.15 NA NA 9.53 10.12 ZZZ
22849 .... .......... A Reinsert spinal fixation ......................................... 19.08 NA NA 10.37 11.39 3.90 NA NA 33.35 34.37 090
22850 .... .......... A Remove spine fixation device .............................. 9.74 NA NA 6.55 6.88 2.05 NA NA 18.34 18.67 090
22851 .... .......... A Apply spine prosth device .................................... 6.70 NA NA 2.62 3.18 1.49 NA NA 10.81 11.37 ZZZ
Jkt 211001
22857 .... .......... R Lumbar artif diskectomy ....................................... 26.93 NA NA 8.80 8.80 3.56 NA NA 39.29 39.29 090
22862 .... .......... R Revise lumbar artif disc ....................................... 32.43 NA NA 10.07 10.07 5.36 NA NA 47.86 47.86 090
22865 .... .......... R Remove lumb artif disc ........................................ 31.55 NA NA 9.87 9.87 5.18 NA NA 46.60 46.60 090
PO 00000
22899 .... .......... C Spine surgery procedure ...................................... 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 YYY
22900 .... .......... A Remove abdominal wall lesion ............................ 6.14 NA NA 3.53 3.30 0.76 NA NA 10.43 10.20 090
22999 .... .......... C Abdomen surgery procedure ............................... 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 YYY
23000 .... .......... A Removal of calcium deposits ............................... 4.40 7.78 8.34 3.69 4.24 0.68 12.86 13.42 8.77 9.32 090
Frm 00189
23020 .... .......... A Release shoulder joint ......................................... 9.24 NA NA 6.53 7.30 1.54 NA NA 17.31 18.08 090
23030 .... .......... A Drain shoulder lesion ........................................... 3.44 6.27 7.11 2.42 2.78 0.57 10.28 11.12 6.43 6.79 010
23031 .... .......... A Drain shoulder bursa ............................................ 2.76 6.45 7.51 2.22 2.60 0.46 9.67 10.73 5.44 5.82 010
23035 .... .......... A Drain shoulder bone lesion .................................. 9.04 NA NA 7.04 7.96 1.47 NA NA 17.55 18.47 090
Fmt 4701
23040 .... .......... A Exploratory shoulder surgery ............................... 9.63 NA NA 6.82 7.60 1.60 NA NA 18.05 18.83 090
23044 .... .......... A Exploratory shoulder surgery ............................... 7.48 NA NA 5.60 6.22 1.24 NA NA 14.32 14.94 090
23065 .... .......... A Biopsy shoulder tissues ....................................... 2.28 2.96 2.60 1.74 1.65 0.20 5.44 5.08 4.22 4.13 010
23066 .... .......... A Biopsy shoulder tissues ....................................... 4.21 7.64 7.66 3.59 3.88 0.63 12.48 12.50 8.43 8.72 090
Sfmt 4700
23075 .... .......... A Removal of shoulder lesion ................................. 2.41 3.70 3.67 1.74 1.77 0.34 6.45 6.42 4.49 4.52 010
23076 .... .......... A Removal of shoulder lesion ................................. 7.77 NA NA 5.33 5.50 1.13 NA NA 14.23 14.40 090
23077 .... .......... A Remove tumor of shoulder .................................. 18.08 NA NA 9.85 10.12 2.34 NA NA 30.27 30.54 090
23100 .... .......... A Biopsy of shoulder joint ........................................ 6.09 NA NA 5.16 5.53 1.04 NA NA 12.29 12.66 090
23101 .... .......... A Shoulder joint surgery .......................................... 5.63 NA NA 4.58 5.14 0.96 NA NA 11.17 11.73 090
23105 .... .......... A Remove shoulder joint lining ................................ 8.36 NA NA 6.14 6.88 1.42 NA NA 15.92 16.66 090
23106 .... .......... A Incision of collarbone joint ................................... 6.02 NA NA 4.62 5.43 0.99 NA NA 11.63 12.44 090
23107 .... .......... A Explore treat shoulder joint .................................. 8.75 NA NA 6.29 7.12 1.49 NA NA 16.53 17.36 090
23120 .... .......... A Partial removal, collar bone ................................. 7.23 NA NA 5.51 6.22 1.23 NA NA 13.97 14.68 090
E:\FR\FM\01DER2.SGM
23125 .... .......... A Removal of collar bone ........................................ 9.52 NA NA 6.38 7.27 1.62 NA NA 17.52 18.41 090
23130 .... .......... A Remove shoulder bone, part ............................... 7.63 NA NA 6.12 6.88 1.30 NA NA 15.05 15.81 090
23140 .... .......... A Removal of bone lesion ....................................... 7.01 NA NA 4.81 5.12 1.08 NA NA 12.90 13.21 090
01DER2
23150 .... .......... A Removal of humerus lesion ................................. 8.79 NA NA 6.09 6.71 1.32 NA NA 16.20 16.82 090
23170 .... .......... A Remove collar bone lesion .................................. 7.10 NA NA 5.08 5.79 1.12 NA NA 13.30 14.01 090
23172 .... .......... A Remove shoulder blade lesion ............................ 7.20 NA NA 5.03 5.97 1.01 NA NA 13.24 14.18 090
69811
Year
69812
Year Year
2007 2007 Fully Im-
VerDate Aug<31>2005
RVUs cility Total
RVUs
23174 .... .......... A Remove humerus lesion ...................................... 9.90 NA NA 7.33 8.10 1.65 NA NA 18.88 19.65 090
23180 .... .......... A Remove collar bone lesion .................................. 8.85 NA NA 7.09 8.52 1.47 NA NA 17.41 18.84 090
23182 .... .......... A Remove shoulder blade lesion ............................ 8.47 NA NA 6.92 8.14 1.37 NA NA 16.76 17.98 090
10:50 Nov 30, 2006

23190 .... .......... A Partial removal of scapula ................................... 7.36 NA NA 5.44 5.99 1.17 NA NA 13.97 14.52 090
23195 .... .......... A Removal of head of humerus .............................. 10.24 NA NA 6.82 7.50 1.71 NA NA 18.77 19.45 090
23200 .... .......... A Removal of collar bone ........................................ 12.69 NA NA 7.51 8.42 1.94 NA NA 22.14 23.05 090
23210 .... .......... A Removal of shoulder blade .................................. 13.16 NA NA 8.28 8.81 2.03 NA NA 23.47 24.00 090
Jkt 211001
23220 .... .......... A Partial removal of humerus .................................. 15.36 NA NA 9.12 10.40 2.49 NA NA 26.97 28.25 090
23330 .... .......... A Remove shoulder foreign body ............................ 1.87 3.36 3.60 1.54 1.80 0.24 5.47 5.71 3.65 3.91 010
PO 00000
23331 .... .......... A Remove shoulder foreign body ............................ 7.51 NA NA 5.91 6.57 1.27 NA NA 14.69 15.35 090
23332 .... .......... A Remove shoulder foreign body ............................ 12.23 NA NA 8.06 9.01 2.03 NA NA 22.32 23.27 090
23350 .... .......... A Injection for shoulder x-ray .................................. 1.00 2.55 3.23 0.29 0.32 0.06 3.61 4.29 1.35 1.38 000
23395 .... .......... A Muscle transfer,shoulder/arm ............................... 18.29 NA NA 11.32 12.48 2.94 NA NA 32.55 33.71 090
Frm 00190
23397 .... .......... A Muscle transfers ................................................... 16.62 NA NA 9.75 10.97 2.74 NA NA 29.11 30.33 090
23400 .... .......... A Fixation of shoulder blade .................................... 13.73 NA NA 8.60 9.70 2.30 NA NA 24.63 25.73 090
23405 .... .......... A Incision of tendon & muscle ................................. 8.43 NA NA 5.99 6.69 1.45 NA NA 15.87 16.57 090
23406 .... .......... A Incise tendon(s) & muscle(s) ............................... 10.90 NA NA 6.98 8.00 1.88 NA NA 19.76 20.78 090
Fmt 4701
23410 .... .......... A Repair rotator cuff, acute ..................................... 12.63 NA NA 7.87 9.02 2.17 NA NA 22.67 23.82 090
23412 .... .......... A Repair rotator cuff, chronic .................................. 13.55 NA NA 8.27 9.49 2.32 NA NA 24.14 25.36 090
23415 .... .......... A Release of shoulder ligament .............................. 10.09 NA NA 6.64 7.65 1.74 NA NA 18.47 19.48 090
23420 .... .......... A Repair of shoulder ................................................ 14.75 NA NA 9.82 10.59 2.32 NA NA 26.89 27.66 090
Sfmt 4700
23430 .... .......... A Repair biceps tendon ........................................... 10.05 NA NA 6.83 7.78 1.74 NA NA 18.62 19.57 090
23440 .... .......... A Remove/transplant tendon ................................... 10.53 NA NA 6.85 7.91 1.83 NA NA 19.21 20.27 090
23450 .... .......... A Repair shoulder capsule ...................................... 13.58 NA NA 8.24 9.44 2.33 NA NA 24.15 25.35 090
23470 .... .......... A Reconstruct shoulder joint ................................... 17.75 NA NA 10.25 11.75 2.99 NA NA 30.99 32.49 090
E:\FR\FM\01DER2.SGM
23472 .... .......... A Reconstruct shoulder joint ................................... 22.47 NA NA 12.32 13.89 3.67 NA NA 38.46 40.03 090
23480 .... .......... A Revision of collar bone ........................................ 11.42 NA NA 7.40 8.43 1.95 NA NA 20.77 21.80 090
23485 .... .......... A Revision of collar bone ........................................ 13.79 NA NA 8.38 9.51 2.34 NA NA 24.51 25.64 090
23490 .... .......... A Reinforce clavicle ................................................. 12.04 NA NA 6.55 8.16 1.47 NA NA 20.06 21.67 090
01DER2
23491 .... .......... A Reinforce shoulder bones .................................... 14.40 NA NA 8.93 10.27 2.47 NA NA 25.80 27.14 090
23500 .... .......... A Treat clavicle fracture ........................................... 2.13 2.64 2.81 2.64 2.55 0.30 5.07 5.24 5.07 4.98 090
23505 .... .......... A Treat clavicle fracture ........................................... 3.74 4.02 4.31 3.63 3.79 0.61 8.37 8.66 7.98 8.14 090
23515 .... .......... A Treat clavicle fracture ........................................... 7.47 NA NA 5.61 6.32 1.28 NA NA 14.36 15.07 090
23520 .... .......... A Treat clavicle dislocation ...................................... 2.21 2.64 2.80 2.64 2.72 0.34 5.19 5.35 5.19 5.27 090
Year Year Year
2007 2007 Fully Im-
VerDate Aug<31>2005
RVUs cility Total
RVUs
23530 .... .......... A Treat clavicle dislocation ...................................... 7.37 NA NA 5.29 5.77 1.20 NA NA 13.86 14.34 090
10:50 Nov 30, 2006

23570 .... .......... A Treat shoulder blade fx ........................................ 2.28 2.80 2.96 2.80 2.87 0.36 5.44 5.60 5.44 5.51 090
23575 .... .......... A Treat shoulder blade fx ........................................ 4.12 4.36 4.75 3.87 4.20 0.59 9.07 9.46 8.58 8.91 090
Jkt 211001
23585 .... .......... A Treat scapula fracture .......................................... 9.15 NA NA 6.54 7.37 1.54 NA NA 17.23 18.06 090
23600 .... .......... A Treat humerus fracture ........................................ 3.00 4.08 4.43 3.66 3.58 0.48 7.56 7.91 7.14 7.06 090
23615 .... .......... A Treat humerus fracture ........................................ 10.93 NA NA 8.35 8.71 1.62 NA NA 20.90 21.26 090
PO 00000
Frm 00191
23650 .... .......... A Treat shoulder dislocation .................................... 3.44 3.27 3.65 2.81 2.77 0.30 7.01 7.39 6.55 6.51 090
23655 .... .......... A Treat shoulder dislocation .................................... 4.64 NA NA 4.18 4.17 0.69 NA NA 9.51 9.50 090
23660 .... .......... A Treat shoulder dislocation .................................... 7.55 NA NA 5.65 6.20 1.29 NA NA 14.49 15.04 090
23665 .... .......... A Treat dislocation/fracture ...................................... 4.54 4.84 5.21 4.26 4.61 0.71 10.09 10.46 9.51 9.86 090
Fmt 4701
23670 .... .......... A Treat dislocation/fracture ...................................... 8.02 NA NA 5.90 6.60 1.36 NA NA 15.28 15.98 090
23675 .... .......... A Treat dislocation/fracture ...................................... 6.13 6.16 6.66 5.18 5.67 1.01 13.30 13.80 12.32 12.81 090
23680 .... .......... A Treat dislocation/fracture ...................................... 10.30 NA NA 7.04 7.84 1.76 NA NA 19.10 19.90 090
23700 .... .......... A Fixation of shoulder .............................................. 2.54 NA NA 1.92 2.11 0.44 NA NA 4.90 5.09 010
Sfmt 4700
23800 .... .......... A Fusion of shoulder joint ........................................ 14.59 NA NA 7.64 9.72 2.36 NA NA 24.59 26.67 090
23802 .... .......... A Fusion of shoulder joint ........................................ 18.17 NA NA 11.08 10.40 2.71 NA NA 31.96 31.28 090
23900 .... .......... A Amputation of arm & girdle .................................. 20.57 NA NA 10.73 11.47 3.19 NA NA 34.49 35.23 090
23920 .... .......... A Amputation at shoulder joint ................................ 16.03 NA NA 9.60 9.84 2.47 NA NA 28.10 28.34 090
23921 .... .......... A Amputation follow-up surgery .............................. 5.61 NA NA 4.89 5.03 0.78 NA NA 11.28 11.42 090
23929 .... .......... C Shoulder surgery procedure ................................ 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 YYY
23930 .... .......... A Drainage of arm lesion ......................................... 2.96 4.94 5.98 1.98 2.23 0.43 8.33 9.37 5.37 5.62 010
23931 .... .......... A Drainage of arm bursa ......................................... 1.81 4.31 5.51 1.75 2.07 0.28 6.40 7.60 3.84 4.16 010
23935 .... .......... A Drain arm/elbow bone lesion ............................... 6.27 NA NA 5.15 5.72 1.05 NA NA 12.47 13.04 090
E:\FR\FM\01DER2.SGM
24000 .... .......... A Exploratory elbow surgery ................................... 5.99 NA NA 4.79 5.26 0.97 NA NA 11.75 12.22 090
24006 .... .......... A Release elbow joint .............................................. 9.62 NA NA 6.71 7.49 1.50 NA NA 17.83 18.61 090
24065 .... .......... A Biopsy arm/elbow soft tissue ............................... 2.10 4.16 3.45 1.93 1.79 0.17 6.43 5.72 4.20 4.06 010
24066 .... .......... A Biopsy arm/elbow soft tissue ............................... 5.26 8.25 8.76 3.93 4.08 0.80 14.31 14.82 9.99 10.14 090
01DER2
24075 .... .......... A Remove arm/elbow lesion .................................... 3.96 7.16 7.30 3.27 3.37 0.56 11.68 11.82 7.79 7.89 090
24076 .... .......... A Remove arm/elbow lesion .................................... 6.36 NA NA 4.60 4.80 0.95 NA NA 11.91 12.11 090
24077 .... .......... A Remove tumor of arm/elbow ................................ 11.95 NA NA 7.00 7.56 1.73 NA NA 20.68 21.24 090
24100 .... .......... A Biopsy elbow joint lining ....................................... 4.98 NA NA 4.29 4.46 0.85 NA NA 10.12 10.29 090
24101 .... .......... A Explore/treat elbow joint ....................................... 6.19 NA NA 5.10 5.72 1.03 NA NA 12.32 12.94 090
24102 .... .......... A Remove elbow joint lining .................................... 8.15 NA NA 5.85 6.61 1.33 NA NA 15.33 16.09 090
69813
Year
69814
Year Year
2007 2007 Fully Im-
VerDate Aug<31>2005
RVUs cility Total
RVUs
24105 .... .......... A Removal of elbow bursa ...................................... 3.67 NA NA 4.04 4.30 0.61 NA NA 8.32 8.58 090
24115 .... .......... A Remove/graft bone lesion .................................... 10.00 NA NA 6.85 7.12 1.68 NA NA 18.53 18.80 090
10:50 Nov 30, 2006

24120 .... .......... A Remove elbow lesion ........................................... 6.71 NA NA 5.23 5.75 1.10 NA NA 13.04 13.56 090
24130 .... .......... A Removal of head of radius ................................... 6.31 NA NA 5.15 5.80 1.04 NA NA 12.50 13.15 090
Jkt 211001
24134 .... .......... A Removal of arm bone lesion ................................ 10.10 NA NA 7.52 8.52 1.64 NA NA 19.26 20.26 090
24136 .... .......... A Remove radius bone lesion ................................. 8.29 NA NA 5.70 6.84 1.38 NA NA 15.37 16.51 090
24138 .... .......... A Remove elbow bone lesion .................................. 8.33 NA NA 6.74 7.52 1.34 NA NA 16.41 17.19 090
24140 .... .......... A Partial removal of arm bone ................................ 9.43 NA NA 7.24 8.64 1.51 NA NA 18.18 19.58 090
PO 00000
24145 .... .......... A Partial removal of radius ...................................... 7.70 NA NA 6.32 7.63 1.25 NA NA 15.27 16.58 090
24147 .... .......... A Partial removal of elbow ...................................... 7.69 NA NA 6.93 8.18 1.30 NA NA 15.92 17.17 090
24149 .... .......... A Radical resection of elbow ................................... 15.92 NA NA 10.94 11.45 2.35 NA NA 29.21 29.72 090
24150 .... .......... A Extensive humerus surgery ................................. 13.70 NA NA 8.58 9.64 2.33 NA NA 24.61 25.67 090
Frm 00192
24151 .... .......... A Extensive humerus surgery ................................. 16.08 NA NA 9.82 11.09 2.60 NA NA 28.50 29.77 090
24152 .... .......... A Extensive radius surgery ...................................... 10.24 NA NA 6.35 7.39 1.48 NA NA 18.07 19.11 090
24153 .... .......... A Extensive radius surgery ...................................... 11.73 NA NA 4.87 5.40 0.74 NA NA 17.34 17.87 090
24155 .... .......... A Removal of elbow joint ......................................... 11.97 NA NA 7.64 8.21 1.93 NA NA 21.54 22.11 090
Fmt 4701
24160 .... .......... A Remove elbow joint implant ................................. 7.89 NA NA 5.85 6.63 1.30 NA NA 15.04 15.82 090
24164 .... .......... A Remove radius head implant ............................... 6.34 NA NA 4.94 5.56 1.03 NA NA 12.31 12.93 090
24200 .... .......... A Removal of arm foreign body .............................. 1.78 2.76 3.25 1.38 1.57 0.20 4.74 5.23 3.36 3.55 010
24201 .... .......... A Removal of arm foreign body .............................. 4.61 7.85 9.32 3.70 4.10 0.72 13.18 14.65 9.03 9.43 090
Sfmt 4700
24220 .... .......... A Injection for elbow x-ray ....................................... 1.31 2.50 3.35 0.39 0.43 0.08 3.89 4.74 1.78 1.82 000
24300 .... .......... A Manipulate elbow w/anesth .................................. 3.86 NA NA 5.19 5.58 0.65 NA NA 9.70 10.09 090
24301 .... .......... A Muscle/tendon transfer ......................................... 10.26 NA NA 6.91 7.86 1.66 NA NA 18.83 19.78 090
24305 .... .......... A Arm tendon lengthening ....................................... 7.51 NA NA 5.72 6.46 1.15 NA NA 14.38 15.12 090
24310 .... .......... A Revision of arm tendon ........................................ 6.03 NA NA 4.80 5.39 0.96 NA NA 11.79 12.38 090
24320 .... .......... A Repair of arm tendon ........................................... 10.74 NA NA 7.15 7.44 1.74 NA NA 19.63 19.92 090
24330 .... .......... A Revision of arm muscles ...................................... 9.67 NA NA 6.69 7.58 1.60 NA NA 17.96 18.85 090
24331 .... .......... A Revision of arm muscles ...................................... 10.83 NA NA 6.57 8.15 1.78 NA NA 19.18 20.76 090
24332 .... .......... A Tenolysis, triceps ................................................. 7.77 NA NA 5.81 6.53 1.23 NA NA 14.81 15.53 090
E:\FR\FM\01DER2.SGM
24340 .... .......... A Repair of biceps tendon ....................................... 7.96 NA NA 6.02 6.74 1.36 NA NA 15.34 16.06 090
24341 .... .......... A Repair arm tendon/muscle ................................... 9.24 NA NA 7.54 7.83 1.36 NA NA 18.14 18.43 090
24342 .... .......... A Repair of ruptured tendon .................................... 10.74 NA NA 7.15 8.18 1.86 NA NA 19.75 20.78 090
24343 .... .......... A Repr elbow lat ligmnt w/tiss ................................. 8.99 NA NA 7.06 7.88 1.43 NA NA 17.48 18.30 090
01DER2
24344 .... .......... A Reconstruct elbow lat ligmnt ................................ 14.97 NA NA 10.11 11.17 2.37 NA NA 27.45 28.51 090
24345 .... .......... A Repr elbw med ligmnt w/tissu .............................. 8.99 NA NA 7.01 7.77 1.44 NA NA 17.44 18.20 090
24346 .... .......... A Reconstruct elbow med ligmnt ............................. 14.97 NA NA 10.11 11.03 2.34 NA NA 27.42 28.34 090
24350 .... .......... A Repair of tennis elbow ......................................... 5.32 NA NA 4.90 5.41 0.87 NA NA 11.09 11.60 090
Year Year Year
2007 2007 Fully Im-
VerDate Aug<31>2005
RVUs cility Total
RVUs
24356 .... .......... A Revision of tennis elbow ...................................... 6.74 NA NA 5.35 6.07 1.11 NA NA 13.20 13.92 090
24360 .... .......... A Reconstruct elbow joint ........................................ 12.53 NA NA 8.01 9.11 2.06 NA NA 22.60 23.70 090
10:50 Nov 30, 2006

24363 .... .......... A Replace elbow joint .............................................. 22.47 NA NA 12.36 13.37 3.02 NA NA 37.85 38.86 090
24365 .... .......... A Reconstruct head of radius .................................. 8.51 NA NA 5.96 6.89 1.41 NA NA 15.88 16.81 090
24366 .... .......... A Reconstruct head of radius .................................. 9.25 NA NA 6.35 7.24 1.52 NA NA 17.12 18.01 090
Jkt 211001
24400 .... .......... A Revision of humerus ............................................ 11.19 NA NA 7.65 8.55 1.93 NA NA 20.77 21.67 090
24430 .... .......... A Repair of humerus ............................................... 15.07 NA NA 9.34 9.64 2.22 NA NA 26.63 26.93 090
PO 00000
24435 .... .......... A Repair humerus with graft .................................... 14.74 NA NA 9.90 10.64 2.28 NA NA 26.92 27.66 090
24470 .... .......... A Revision of elbow joint ......................................... 8.81 NA NA 6.44 7.40 1.48 NA NA 16.73 17.69 090
24495 .... .......... A Decompression of forearm ................................... 8.30 NA NA 6.65 8.22 1.18 NA NA 16.13 17.70 090
24498 .... .......... A Reinforce humerus ............................................... 12.16 NA NA 7.78 8.89 2.07 NA NA 22.01 23.12 090
Frm 00193
Fmt 4701
Sfmt 4700
E:\FR\FM\01DER2.SGM
24586 .... .......... A Treat elbow fracture ............................................. 15.64 NA NA 9.41 10.78 2.65 NA NA 27.70 29.07 090
24600 .... .......... A Treat elbow dislocation ........................................ 4.28 3.87 4.61 3.30 3.45 0.50 8.65 9.39 8.08 8.23 090
24605 .... .......... A Treat elbow dislocation ........................................ 5.50 NA NA 4.97 5.26 0.89 NA NA 11.36 11.65 090
01DER2
24615 .... .......... A Treat elbow dislocation ........................................ 9.72 NA NA 6.61 7.52 1.60 NA NA 17.93 18.84 090
24640 .... .......... A Treat elbow dislocation ........................................ 1.22 1.47 1.75 0.81 0.80 0.12 2.81 3.09 2.15 2.14 010
24650 .... .......... A Treat radius fracture ............................................. 2.22 3.43 3.69 3.00 2.81 0.35 6.00 6.26 5.57 5.38 090
24655 .... .......... A Treat radius fracture ............................................. 4.48 5.19 5.76 4.42 4.70 0.70 10.37 10.94 9.60 9.88 090
69815
Year
69816
Year Year
2007 2007 Fully Im-
VerDate Aug<31>2005
RVUs cility Total
RVUs
24665 .... .......... A Treat radius fracture ............................................. 8.22 NA NA 6.55 7.27 1.41 NA NA 16.18 16.90 090
24666 .... .......... A Treat radius fracture ............................................. 9.74 NA NA 7.02 7.81 1.62 NA NA 18.38 19.17 090
24670 .... .......... A Treat ulnar fracture .............................................. 2.60 3.73 4.02 3.16 3.09 0.41 6.74 7.03 6.17 6.10 090
10:50 Nov 30, 2006

24675 .... .......... A Treat ulnar fracture .............................................. 4.79 5.30 5.83 4.51 4.86 0.81 10.90 11.43 10.11 10.46 090
24685 .... .......... A Treat ulnar fracture .............................................. 8.92 NA NA 6.50 7.27 1.52 NA NA 16.94 17.71 090
24800 .... .......... A Fusion of elbow joint ............................................ 11.27 NA NA 7.68 8.48 1.63 NA NA 20.58 21.38 090
24802 .... .......... A Fusion/graft of elbow joint .................................... 14.18 NA NA 8.61 9.94 2.38 NA NA 25.17 26.50 090
24900 .... .......... A Amputation of upper arm ..................................... 10.04 NA NA 6.49 6.92 1.53 NA NA 18.06 18.49 090
Jkt 211001
24920 .... .......... A Amputation of upper arm ..................................... 10.02 NA NA 6.50 6.83 1.61 NA NA 18.13 18.46 090
24931 .... .......... A Amputate upper arm & implant ............................ 13.32 NA NA 8.42 6.40 1.90 NA NA 23.64 21.62 090
PO 00000
24935 .... .......... A Revision of amputation ........................................ 16.30 NA NA 8.90 8.24 2.14 NA NA 27.34 26.68 090
24940 .... .......... C Revision of upper arm .......................................... 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 090
24999 .... .......... C Upper arm/elbow surgery ..................................... 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 YYY
25000 .... .......... A Incision of tendon sheath ..................................... 3.44 NA NA 5.06 6.42 0.55 NA NA 9.05 10.41 090
Frm 00194
25001 .... .......... A Incise flexor carpi radialis .................................... 3.68 NA NA 3.87 4.14 0.55 NA NA 8.10 8.37 090
25020 .... .......... A Decompress forearm 1 space .............................. 5.97 NA NA 6.90 8.90 0.93 NA NA 13.80 15.80 090
25023 .... .......... A Decompress forearm 1 space .............................. 13.69 NA NA 11.53 14.09 2.04 NA NA 27.26 29.82 090
25024 .... .......... A Decompress forearm 2 spaces ............................ 10.62 NA NA 7.27 7.42 1.36 NA NA 19.25 19.40 090
Fmt 4701
25025 .... .......... A Decompress forearm 2 spaces ............................ 17.77 NA NA 9.14 9.76 1.83 NA NA 28.74 29.36 090
25028 .... .......... A Drainage of forearm lesion .................................. 5.30 NA NA 6.24 7.68 0.81 NA NA 12.35 13.79 090
25031 .... .......... A Drainage of forearm bursa ................................... 4.18 NA NA 5.46 7.31 0.63 NA NA 10.27 12.12 090
25035 .... .......... A Treat forearm bone lesion .................................... 7.54 NA NA 8.87 12.41 1.24 NA NA 17.65 21.19 090
Sfmt 4700
25040 .... .......... A Explore/treat wrist joint ......................................... 7.41 NA NA 5.93 6.96 1.15 NA NA 14.49 15.52 090
25065 .... .......... A Biopsy forearm soft tissues .................................. 2.01 4.29 3.49 1.97 1.92 0.15 6.45 5.65 4.13 4.08 010
25066 .... .......... A Biopsy forearm soft tissues .................................. 4.18 NA NA 5.46 6.66 0.64 NA NA 10.28 11.48 090
25075 .... .......... A Removal forearm lesion subcu ............................ 3.78 NA NA 4.89 5.64 0.55 NA NA 9.22 9.97 090
25076 .... .......... A Removal forearm lesion deep .............................. 4.97 NA NA 6.89 8.88 0.74 NA NA 12.60 14.59 090
25077 .... .......... A Remove tumor, forearm/wrist ............................... 9.90 NA NA 8.95 11.30 1.42 NA NA 20.27 22.62 090
25085 .... .......... A Incision of wrist capsule ....................................... 5.55 NA NA 5.48 6.71 0.85 NA NA 11.88 13.11 090
25100 .... .......... A Biopsy of wrist joint .............................................. 3.94 NA NA 4.30 5.03 0.59 NA NA 8.83 9.56 090
25101 .... .......... A Explore/treat wrist joint ......................................... 4.74 NA NA 4.84 5.63 0.75 NA NA 10.33 11.12 090
E:\FR\FM\01DER2.SGM
25105 .... .......... A Remove wrist joint lining ...................................... 5.91 NA NA 5.85 6.94 0.92 NA NA 12.68 13.77 090
25107 .... .......... A Remove wrist joint cartilage ................................. 7.50 NA NA 7.20 8.06 0.99 NA NA 15.69 16.55 090
25109 .... .......... A Excise tendon forearm/wrist ................................. 6.81 NA NA 5.32 5.32 0.96 NA NA 13.09 13.09 090
25110 .... .......... A Remove wrist tendon lesion ................................. 3.96 NA NA 5.28 6.61 0.62 NA NA 9.86 11.19 090
01DER2
25111 .... .......... A Remove wrist tendon lesion ................................. 3.44 NA NA 4.11 4.55 0.53 NA NA 8.08 8.52 090
25112 .... .......... A Reremove wrist tendon lesion ............................. 4.58 NA NA 4.56 5.08 0.70 NA NA 9.84 10.36 090
25115 .... .......... A Remove wrist/forearm lesion ............................... 9.89 NA NA 10.27 13.09 1.31 NA NA 21.47 24.29 090
25116 .... .......... A Remove wrist/forearm lesion ............................... 7.38 NA NA 9.11 12.13 1.11 NA NA 17.60 20.62 090
25118 .... .......... A Excise wrist tendon sheath .................................. 4.42 NA NA 4.66 5.47 0.68 NA NA 9.76 10.57 090
25119 .... .......... A Partial removal of ulna ......................................... 6.10 NA NA 5.89 7.17 0.96 NA NA 12.95 14.23 090
Year Year Year
2007 2007 Fully Im-
VerDate Aug<31>2005
RVUs cility Total
RVUs
25120 .... .......... A Removal of forearm lesion ................................... 6.16 NA NA 7.92 11.04 1.00 NA NA 15.08 18.20 090
25125 .... .......... A Remove/graft forearm lesion ................................ 7.55 NA NA 8.77 11.82 1.06 NA NA 17.38 20.43 090
25126 .... .......... A Remove/graft forearm lesion ................................ 7.62 NA NA 8.80 11.96 1.27 NA NA 17.69 20.85 090
10:50 Nov 30, 2006

25130 .... .......... A Removal of wrist lesion ........................................ 5.32 NA NA 5.23 6.12 0.80 NA NA 11.35 12.24 090
25135 .... .......... A Remove & graft wrist lesion ................................. 6.96 NA NA 6.17 7.18 1.02 NA NA 14.15 15.16 090
25136 .... .......... A Remove & graft wrist lesion ................................. 6.03 NA NA 5.55 6.33 1.03 NA NA 12.61 13.39 090
25145 .... .......... A Remove forearm bone lesion ............................... 6.43 NA NA 8.13 11.08 1.01 NA NA 15.57 18.52 090
Jkt 211001
25170 .... .......... A Extensive forearm surgery ................................... 11.34 NA NA 10.54 14.00 1.78 NA NA 23.66 27.12 090
25210 .... .......... A Removal of wrist bone ......................................... 6.01 NA NA 5.58 6.49 0.88 NA NA 12.47 13.38 090
25215 .... .......... A Removal of wrist bones ....................................... 8.02 NA NA 6.88 8.28 1.19 NA NA 16.09 17.49 090
PO 00000
25246 .... .......... A Injection for wrist x-ray ......................................... 1.45 2.55 3.22 0.44 0.47 0.09 4.09 4.76 1.98 2.01 000
25248 .... .......... A Remove forearm foreign body ............................. 5.20 NA NA 6.54 8.03 0.72 NA NA 12.46 13.95 090
Frm 00195
25250 .... .......... A Removal of wrist prosthesis ................................. 6.66 NA NA 5.37 5.92 1.01 NA NA 13.04 13.59 090
25251 .... .......... A Removal of wrist prosthesis ................................. 9.70 NA NA 6.77 7.63 1.26 NA NA 17.73 18.59 090
25259 .... .......... A Manipulate wrist w/anesthes ................................ 3.86 NA NA 5.15 5.58 0.62 NA NA 9.63 10.06 090
25260 .... .......... A Repair forearm tendon/muscle ............................. 7.89 NA NA 9.28 12.30 1.19 NA NA 18.36 21.38 090
Fmt 4701
Sfmt 4700
25275 .... .......... A Repair forearm tendon sheath ............................. 8.82 NA NA 6.57 7.33 1.31 NA NA 16.70 17.46 090
25280 .... .......... A Revise wrist/forearm tendon ................................ 7.28 NA NA 8.49 11.60 1.08 NA NA 16.85 19.96 090
25290 .... .......... A Incise wrist/forearm tendon .................................. 5.34 NA NA 9.15 13.53 0.82 NA NA 15.31 19.69 090
25295 .... .......... A Release wrist/forearm tendon .............................. 6.61 NA NA 8.17 11.16 1.00 NA NA 15.78 18.77 090
25300 .... .......... A Fusion of tendons at wrist .................................... 8.88 NA NA 7.29 8.16 1.26 NA NA 17.43 18.30 090
25301 .... .......... A Fusion of tendons at wrist .................................... 8.47 NA NA 6.80 7.75 1.29 NA NA 16.56 17.51 090
25310 .... .......... A Transplant forearm tendon ................................... 8.26 NA NA 8.85 11.99 1.21 NA NA 18.32 21.46 090
25312 .... .......... A Transplant forearm tendon ................................... 9.70 NA NA 9.65 12.87 1.41 NA NA 20.76 23.98 090
E:\FR\FM\01DER2.SGM
25315 .... .......... A Revise palsy hand tendon(s) ............................... 10.56 NA NA 10.08 13.32 1.58 NA NA 22.22 25.46 090
25316 .... .......... A Revise palsy hand tendon(s) ............................... 12.76 NA NA 11.10 14.94 1.75 NA NA 25.61 29.45 090
25320 .... .......... A Repair/revise wrist joint ........................................ 12.38 NA NA 10.46 11.16 1.61 NA NA 24.45 25.15 090
25332 .... .......... A Revise wrist joint .................................................. 11.60 NA NA 7.81 8.83 1.84 NA NA 21.25 22.27 090
01DER2
25335 .... .......... A Realignment of hand ............................................ 13.25 NA NA 7.07 10.46 1.93 NA NA 22.25 25.64 090
25337 .... .......... A Reconstruct ulna/radioulnar ................................. 11.44 NA NA 9.45 10.67 1.61 NA NA 22.50 23.72 090
25350 .... .......... A Revision of radius ................................................ 8.97 NA NA 9.28 12.80 1.46 NA NA 19.71 23.23 090
25355 .... .......... A Revision of radius ................................................ 10.41 NA NA 10.08 13.48 1.74 NA NA 22.23 25.63 090
25360 .... .......... A Revision of ulna ................................................... 8.62 NA NA 9.12 12.68 1.41 NA NA 19.15 22.71 090
25365 .... .......... A Revise radius & ulna ............................................ 12.77 NA NA 11.08 14.50 2.16 NA NA 26.01 29.43 090
69817
Year
69818
Year Year
2007 2007 Fully Im-
VerDate Aug<31>2005
RVUs cility Total
RVUs
25370 .... .......... A Revise radius or ulna ........................................... 13.93 NA NA 11.96 15.04 2.29 NA NA 28.18 31.26 090
25375 .... .......... A Revise radius & ulna ............................................ 13.41 NA NA 11.32 15.15 2.27 NA NA 27.00 30.83 090
25390 .... .......... A Shorten radius or ulna ......................................... 10.58 NA NA 9.98 13.43 1.65 NA NA 22.21 25.66 090
10:50 Nov 30, 2006

25391 .... .......... A Lengthen radius or ulna ....................................... 14.14 NA NA 11.71 15.34 2.22 NA NA 28.07 31.70 090
25392 .... .......... A Shorten radius & ulna .......................................... 14.44 NA NA 11.86 14.94 2.11 NA NA 28.41 31.49 090
25393 .... .......... A Lengthen radius & ulna ........................................ 16.42 NA NA 13.47 16.55 2.77 NA NA 32.66 35.74 090
25394 .... .......... A Repair carpal bone, shorten ................................ 10.71 NA NA 6.85 7.76 1.59 NA NA 19.15 20.06 090
25400 .... .......... A Repair radius or ulna ........................................... 11.16 NA NA 10.19 13.94 1.83 NA NA 23.18 26.93 090
Jkt 211001
25405 .... .......... A Repair/graft radius or ulna ................................... 14.87 NA NA 11.95 15.94 2.33 NA NA 29.15 33.14 090
25415 .... .......... A Repair radius & ulna ............................................ 13.66 NA NA 11.02 15.14 2.18 NA NA 26.86 30.98 090
25420 .... .......... A Repair/graft radius & ulna .................................... 16.89 NA NA 12.83 16.91 2.62 NA NA 32.34 36.42 090
25425 .... .......... A Repair/graft radius or ulna ................................... 13.58 NA NA 14.17 19.59 2.09 NA NA 29.84 35.26 090
PO 00000
25426 .... .......... A Repair/graft radius & ulna .................................... 16.31 NA NA 12.50 15.54 2.55 NA NA 31.36 34.40 090
25430 .... .......... A Vasc graft into carpal bone .................................. 9.57 NA NA 7.11 7.28 1.27 NA NA 17.95 18.12 090
25431 .... .......... A Repair nonunion carpal bone ............................... 10.75 NA NA 7.33 8.13 1.91 NA NA 19.99 20.79 090
25440 .... .......... A Repair/graft wrist bone ......................................... 10.56 NA NA 7.56 8.94 1.63 NA NA 19.75 21.13 090
Frm 00196
25441 .... .......... A Reconstruct wrist joint .......................................... 13.15 NA NA 8.62 9.66 2.08 NA NA 23.85 24.89 090
Fmt 4701
25446 .... .......... A Wrist replacement ................................................ 17.16 NA NA 9.99 11.44 2.48 NA NA 29.63 31.08 090
25447 .... .......... A Repair wrist joint(s) .............................................. 10.95 NA NA 7.95 8.48 1.61 NA NA 20.51 21.04 090
25449 .... .......... A Remove wrist joint implant ................................... 14.80 NA NA 9.19 10.30 2.22 NA NA 26.21 27.32 090
Sfmt 4700
25450 .... .......... A Revision of wrist joint ........................................... 7.94 NA NA 7.28 9.46 1.36 NA NA 16.58 18.76 090
25455 .... .......... A Revision of wrist joint ........................................... 9.57 NA NA 6.41 9.75 0.96 NA NA 16.94 20.28 090
25490 .... .......... A Reinforce radius ................................................... 9.61 NA NA 9.50 12.67 1.43 NA NA 20.54 23.71 090
25491 .... .......... A Reinforce ulna ...................................................... 10.03 NA NA 9.71 13.27 1.60 NA NA 21.34 24.90 090
25492 .... .......... A Reinforce radius and ulna .................................... 12.52 NA NA 10.56 14.12 2.15 NA NA 25.23 28.79 090
25500 .... .......... A Treat fracture of radius ........................................ 2.51 3.33 3.51 2.89 2.76 0.35 6.19 6.37 5.75 5.62 090
25515 .... .......... A Treat fracture of radius ........................................ 9.37 NA NA 6.78 7.29 1.59 NA NA 17.74 18.25 090
E:\FR\FM\01DER2.SGM
25530 .... .......... A Treat fracture of ulna ........................................... 2.15 3.46 3.69 2.96 2.89 0.34 5.95 6.18 5.45 5.38 090
25535 .... .......... A Treat fracture of ulna ........................................... 5.22 5.69 5.93 4.95 5.21 0.89 11.80 12.04 11.06 11.32 090
01DER2
25545 .... .......... A Treat fracture of ulna ........................................... 9.09 NA NA 6.67 7.41 1.53 NA NA 17.29 18.03 090
25560 .... .......... A Treat fracture radius & ulna ................................. 2.50 3.38 3.61 2.87 2.67 0.35 6.23 6.46 5.72 5.52 090
25565 .... .......... A Treat fracture radius & ulna ................................. 5.71 5.97 6.52 5.00 5.32 0.93 12.61 13.16 11.64 11.96 090
25574 .... .......... A Treat fracture radius & ulna ................................. 7.47 NA NA 6.65 7.06 1.21 NA NA 15.33 15.74 090
25575 .... .......... A Treat fracture radius/ulna ..................................... 12.02 NA NA 9.02 9.39 1.82 NA NA 22.86 23.23 090
25600 .... .......... A Treat fracture radius/ulna ..................................... 2.69 3.68 3.99 3.18 3.02 0.42 6.79 7.10 6.29 6.13 090
Year Year Year
2007 2007 Fully Im-
VerDate Aug<31>2005
RVUs cility Total
RVUs
25605 .... .......... A Treat fracture radius/ulna ..................................... 7.02 6.91 7.15 6.19 6.21 1.00 14.93 15.17 14.21 14.23 090
25606 .... .......... A Treat fx distal radial ............................................. 8.10 NA NA 6.75 8.41 1.26 NA NA 16.11 17.77 090
25607 .... .......... A Treat fx rad extra-articul ....................................... 9.35 NA NA 7.26 7.26 1.36 NA NA 17.97 17.97 090
10:50 Nov 30, 2006

25608 .... .......... A Treat fx rad intra-articul ........................................ 10.86 NA NA 7.88 7.88 1.84 NA NA 20.58 20.58 090
25609 .... .......... A Treat fx radial 3+ frag .......................................... 14.12 NA NA 9.77 9.77 2.38 NA NA 26.27 26.27 090
25622 .... .......... A Treat wrist bone fracture ...................................... 2.68 3.90 4.18 3.36 3.17 0.41 6.99 7.27 6.45 6.26 090
25628 .... .......... A Treat wrist bone fracture ...................................... 9.50 NA NA 7.38 7.71 1.37 NA NA 18.25 18.58 090
Jkt 211001
25645 .... .......... A Treat wrist bone fracture ...................................... 7.31 NA NA 5.84 6.43 1.20 NA NA 14.35 14.94 090
PO 00000
25651 .... .......... A Pin ulnar styloid fracture ...................................... 5.68 NA NA 5.15 5.40 0.86 NA NA 11.69 11.94 090
25652 .... .......... A Treat fracture ulnar styloid ................................... 7.92 NA NA 6.25 6.81 1.21 NA NA 15.38 15.94 090
25660 .... .......... A Treat wrist dislocation .......................................... 4.84 NA NA 4.49 4.66 0.58 NA NA 9.91 10.08 090
Frm 00197
25671 .... .......... A Pin radioulnar dislocation ..................................... 6.32 NA NA 5.55 6.00 1.00 NA NA 12.87 13.32 090
25675 .... .......... A Treat wrist dislocation .......................................... 4.75 4.89 5.46 4.16 4.53 0.62 10.26 10.83 9.53 9.90 090
25680 .... .......... A Treat wrist fracture ............................................... 6.08 NA NA 4.40 4.66 0.78 NA NA 11.26 11.52 090
Fmt 4701
25685 .... .......... A Treat wrist fracture ............................................... 9.97 NA NA 6.74 7.54 1.60 NA NA 18.31 19.11 090
25800 .... .......... A Fusion of wrist joint .............................................. 9.95 NA NA 7.33 8.65 1.57 NA NA 18.85 20.17 090
Sfmt 4700
25805 .... .......... A Fusion/graft of wrist joint ...................................... 11.59 NA NA 8.23 9.75 1.81 NA NA 21.63 23.15 090
25810 .... .......... A Fusion/graft of wrist joint ...................................... 11.75 NA NA 8.62 9.58 1.68 NA NA 22.05 23.01 090
25820 .... .......... A Fusion of hand bones .......................................... 7.52 NA NA 6.32 7.47 1.22 NA NA 15.06 16.21 090
25825 .... .......... A Fuse hand bones with graft ................................. 9.54 NA NA 7.63 8.83 1.41 NA NA 18.58 19.78 090
25830 .... .......... A Fusion, radioulnar jnt/ulna .................................... 10.69 NA NA 10.48 13.43 1.55 NA NA 22.72 25.67 090
25900 .... .......... A Amputation of forearm ......................................... 9.46 NA NA 9.28 11.74 1.30 NA NA 20.04 22.50 090
E:\FR\FM\01DER2.SGM
25920 .... .......... A Amputate hand at wrist ........................................ 8.92 NA NA 6.78 7.58 1.35 NA NA 17.05 17.85 090
25922 .... .......... A Amputate hand at wrist ........................................ 7.54 NA NA 6.55 6.93 1.12 NA NA 15.21 15.59 090
01DER2
25927 .... .......... A Amputation of hand .............................................. 8.98 NA NA 8.65 10.92 1.27 NA NA 18.90 21.17 090
25999 .... .......... C Forearm or wrist surgery ...................................... 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 YYY
26010 .... .......... A Drainage of finger abscess .................................. 1.56 4.00 5.17 1.51 1.60 0.18 5.74 6.91 3.25 3.34 010
26011 .... .......... A Drainage of finger abscess .................................. 2.21 6.26 8.17 1.99 2.24 0.33 8.80 10.71 4.53 4.78 010
69819
Year
69820
Year Year
2007 2007 Fully Im-
VerDate Aug<31>2005
RVUs cility Total
RVUs
26020 .... .......... A Drain hand tendon sheath ................................... 4.97 NA NA 4.78 5.21 0.73 NA NA 10.48 10.91 090
26025 .... .......... A Drainage of palm bursa ....................................... 4.99 NA NA 4.49 4.96 0.76 NA NA 10.24 10.71 090
26030 .... .......... A Drainage of palm bursa(s) ................................... 6.16 NA NA 5.03 5.55 0.92 NA NA 12.11 12.63 090
10:50 Nov 30, 2006

26034 .... .......... A Treat hand bone lesion ........................................ 6.49 NA NA 5.58 6.16 1.01 NA NA 13.08 13.66 090
26035 .... .......... A Decompress fingers/hand .................................... 11.14 NA NA 8.11 7.93 1.47 NA NA 20.72 20.54 090
26037 .... .......... A Decompress fingers/hand .................................... 7.48 NA NA 5.57 6.13 1.13 NA NA 14.18 14.74 090
26040 .... .......... A Release palm contracture .................................... 3.38 NA NA 3.63 3.95 0.53 NA NA 7.54 7.86 090
Jkt 211001
26055 .... .......... A Incise finger tendon sheath .................................. 3.00 9.03 13.02 3.84 3.92 0.43 12.46 16.45 7.27 7.35 090
26060 .... .......... A Incision of finger tendon ....................................... 2.85 NA NA 3.07 3.40 0.45 NA NA 6.37 6.70 090
26070 .... .......... A Explore/treat hand joint ........................................ 3.73 NA NA 3.04 3.28 0.48 NA NA 7.25 7.49 090
26075 .... .......... A Explore/treat finger joint ....................................... 3.83 NA NA 3.43 3.69 0.53 NA NA 7.79 8.05 090
PO 00000
26080 .... .......... A Explore/treat finger joint ....................................... 4.36 NA NA 4.37 4.73 0.66 NA NA 9.39 9.75 090
26100 .... .......... A Biopsy hand joint lining ........................................ 3.71 NA NA 3.58 3.99 0.54 NA NA 7.83 8.24 090
26105 .... .......... A Biopsy finger joint lining ....................................... 3.75 NA NA 3.76 4.11 0.59 NA NA 8.10 8.45 090
26110 .... .......... A Biopsy finger joint lining ....................................... 3.57 NA NA 3.62 3.94 0.53 NA NA 7.72 8.04 090
Frm 00198
26115 .... .......... A Removal hand lesion subcut ................................ 3.92 9.82 12.27 4.25 4.64 0.59 14.33 16.78 8.76 9.15 090
26116 .... .......... A Removal hand lesion, deep ................................. 5.61 NA NA 5.34 5.84 0.84 NA NA 11.79 12.29 090
26117 .... .......... A Remove tumor, hand/finger ................................. 8.62 NA NA 6.29 6.87 1.26 NA NA 16.17 16.75 090
Fmt 4701
26125 .... .......... A Release palm contracture .................................... 4.60 NA NA 1.93 2.31 0.70 NA NA 7.23 7.61 ZZZ
26130 .... .......... A Remove wrist joint lining ...................................... 5.48 NA NA 4.88 5.23 0.94 NA NA 11.30 11.65 090
26135 .... .......... A Revise finger joint, each ...................................... 7.02 NA NA 5.55 6.23 1.07 NA NA 13.64 14.32 090
Sfmt 4700
26140 .... .......... A Revise finger joint, each ...................................... 6.23 NA NA 5.22 5.84 0.92 NA NA 12.37 12.99 090
26145 .... .......... A Tendon excision, palm/finger ............................... 6.38 NA NA 5.23 5.85 0.97 NA NA 12.58 13.20 090
26160 .... .......... A Remove tendon sheath lesion ............................. 3.46 8.99 11.53 3.94 4.08 0.49 12.94 15.48 7.89 8.03 090
26170 .... .......... A Removal of palm tendon, each ............................ 4.82 NA NA 4.40 4.81 0.69 NA NA 9.91 10.32 090
26180 .... .......... A Removal of finger tendon ..................................... 5.24 NA NA 4.81 5.26 0.78 NA NA 10.83 11.28 090
26185 .... .......... A Remove finger bone ............................................. 6.32 NA NA 5.84 5.98 0.81 NA NA 12.97 13.11 090
26200 .... .......... A Remove hand bone lesion ................................... 5.56 NA NA 4.60 5.16 0.88 NA NA 11.04 11.60 090
26210 .... .......... A Removal of finger lesion ...................................... 5.21 NA NA 4.79 5.26 0.79 NA NA 10.79 11.26 090
E:\FR\FM\01DER2.SGM
26215 .... .......... A Remove/graft finger lesion ................................... 7.16 NA NA 5.58 6.13 0.98 NA NA 13.72 14.27 090
26230 .... .......... A Partial removal of hand bone ............................... 6.38 NA NA 5.05 5.70 1.01 NA NA 12.44 13.09 090
26235 .... .......... A Partial removal, finger bone ................................. 6.24 NA NA 5.00 5.61 0.95 NA NA 12.19 12.80 090
26236 .... .......... A Partial removal, finger bone ................................. 5.37 NA NA 4.59 5.14 0.81 NA NA 10.77 11.32 090
01DER2
26250 .... .......... A Extensive hand surgery ....................................... 7.61 NA NA 5.24 6.13 1.07 NA NA 13.92 14.81 090
26255 .... .......... A Extensive hand surgery ....................................... 12.80 NA NA 8.51 9.16 1.69 NA NA 23.00 23.65 090
26260 .... .......... A Extensive finger surgery ...................................... 7.09 NA NA 5.41 5.99 1.01 NA NA 13.51 14.09 090
26261 .... .......... A Extensive finger surgery ...................................... 9.28 NA NA 7.05 6.39 1.14 NA NA 17.47 16.81 090
26262 .... .......... A Partial removal of finger ....................................... 5.72 NA NA 4.70 5.17 0.88 NA NA 11.30 11.77 090
26320 .... .......... A Removal of implant from hand ............................. 4.02 NA NA 3.81 4.19 0.59 NA NA 8.42 8.80 090
Year Year Year
2007 2007 Fully Im-
VerDate Aug<31>2005
RVUs cility Total
RVUs
26340 .... .......... A Manipulate finger w/anesth .................................. 2.62 NA NA 4.63 4.82 0.39 NA NA 7.64 7.83 090
26350 .... .......... A Repair finger/hand tendon ................................... 6.07 NA NA 9.48 13.33 0.93 NA NA 16.48 20.33 090
26352 .... .......... A Repair/graft hand tendon ..................................... 7.75 NA NA 10.05 14.03 1.13 NA NA 18.93 22.91 090
10:50 Nov 30, 2006

Jkt 211001
26390 .... .......... A Revise hand/finger tendon ................................... 9.31 NA NA 9.13 12.24 1.40 NA NA 19.84 22.95 090
26410 .... .......... A Repair hand tendon ............................................. 4.68 NA NA 7.56 10.85 0.73 NA NA 12.97 16.26 090
PO 00000
26415 .... .......... A Excision, hand/finger tendon ................................ 8.40 NA NA 6.73 10.52 0.98 NA NA 16.11 19.90 090
26416 .... .......... A Graft hand or finger tendon ................................. 9.44 NA NA 8.71 13.12 0.79 NA NA 18.94 23.35 090
26418 .... .......... A Repair finger tendon ............................................ 4.33 NA NA 8.08 11.26 0.67 NA NA 13.08 16.26 090
Frm 00199
26420 .... .......... A Repair/graft finger tendon .................................... 6.83 NA NA 8.75 12.41 1.07 NA NA 16.65 20.31 090
Fmt 4701
26437 .... .......... A Realignment of tendons ....................................... 5.88 NA NA 7.73 10.61 0.89 NA NA 14.50 17.38 090
26440 .... .......... A Release palm/finger tendon ................................. 5.07 NA NA 8.44 12.18 0.75 NA NA 14.26 18.00 090
Sfmt 4700
26442 .... .......... A Release palm & finger tendon ............................. 9.50 NA NA 11.66 14.87 1.20 NA NA 22.36 25.57 090
26445 .... .......... A Release hand/finger tendon ................................. 4.36 NA NA 8.10 11.88 0.65 NA NA 13.11 16.89 090
26449 .... .......... A Release forearm/hand tendon ............................. 8.34 NA NA 11.33 14.66 1.06 NA NA 20.73 24.06 090
26450 .... .......... A Incision of palm tendon ........................................ 3.71 NA NA 5.12 6.78 0.59 NA NA 9.42 11.08 090
26455 .... .......... A Incision of finger tendon ....................................... 3.68 NA NA 5.06 6.73 0.58 NA NA 9.32 10.99 090
26460 .... .......... A Incise hand/finger tendon ..................................... 3.50 NA NA 5.02 6.61 0.55 NA NA 9.07 10.66 090
26471 .... .......... A Fusion of finger tendons ...................................... 5.79 NA NA 7.69 10.35 0.88 NA NA 14.36 17.02 090
26474 .... .......... A Fusion of finger tendons ...................................... 5.38 NA NA 7.50 10.42 0.76 NA NA 13.64 16.56 090
26476 .... .......... A Tendon lengthening ............................................. 5.24 NA NA 7.42 10.05 0.79 NA NA 13.45 16.08 090
E:\FR\FM\01DER2.SGM
26477 .... .......... A Tendon shortening ............................................... 5.21 NA NA 7.48 10.17 0.81 NA NA 13.50 16.19 090
26478 .... .......... A Lengthening of hand tendon ................................ 5.86 NA NA 7.65 10.79 0.90 NA NA 14.41 17.55 090
26479 .... .......... A Shortening of hand tendon .................................. 5.80 NA NA 7.71 10.60 0.92 NA NA 14.43 17.32 090
26480 .... .......... A Transplant hand tendon ....................................... 6.76 NA NA 9.58 13.68 1.02 NA NA 17.36 21.46 090
01DER2
26483 .... .......... A Transplant/graft hand tendon ............................... 8.36 NA NA 10.22 14.18 1.26 NA NA 19.84 23.80 090
26485 .... .......... A Transplant palm tendon ....................................... 7.77 NA NA 9.96 14.01 1.15 NA NA 18.88 22.93 090
26489 .... .......... A Transplant/graft palm tendon ............................... 9.74 NA NA 10.29 11.62 1.26 NA NA 21.29 22.62 090
26490 .... .......... A Revise thumb tendon ........................................... 8.48 NA NA 8.94 11.85 1.21 NA NA 18.63 21.54 090
26492 .... .......... A Tendon transfer with graft .................................... 9.70 NA NA 9.82 12.66 1.40 NA NA 20.92 23.76 090
26494 .... .......... A Hand tendon/muscle transfer ............................... 8.54 NA NA 9.02 11.98 1.28 NA NA 18.84 21.80 090
69821
Year
69822
Year Year
2007 2007 Fully Im-
VerDate Aug<31>2005
RVUs cility Total
RVUs
26496 .... .......... A Revise thumb tendon ........................................... 9.66 NA NA 9.50 12.30 1.45 NA NA 20.61 23.41 090
26497 .... .......... A Finger tendon transfer .......................................... 9.64 NA NA 9.46 12.54 1.41 NA NA 20.51 23.59 090
26498 .... .......... A Finger tendon transfer .......................................... 14.07 NA NA 11.58 15.02 2.11 NA NA 27.76 31.20 090
10:50 Nov 30, 2006

26499 .... .......... A Revision of finger ................................................. 9.05 NA NA 8.80 11.98 1.35 NA NA 19.20 22.38 090
26500 .... .......... A Hand tendon reconstruction ................................. 6.02 NA NA 7.82 10.54 0.90 NA NA 14.74 17.46 090
26502 .... .......... A Hand tendon reconstruction ................................. 7.20 NA NA 8.39 11.11 1.13 NA NA 16.72 19.44 090
26508 .... .......... A Release thumb contracture .................................. 6.07 NA NA 7.76 10.70 0.98 NA NA 14.81 17.75 090
26510 .... .......... A Thumb tendon transfer ......................................... 5.49 NA NA 7.59 10.40 0.79 NA NA 13.87 16.68 090
Jkt 211001
26516 .... .......... A Fusion of knuckle joint ......................................... 7.21 NA NA 8.24 11.23 1.10 NA NA 16.55 19.54 090
26517 .... .......... A Fusion of knuckle joints ....................................... 8.96 NA NA 9.28 12.45 1.41 NA NA 19.65 22.82 090
26518 .... .......... A Fusion of knuckle joints ....................................... 9.15 NA NA 9.23 12.35 1.35 NA NA 19.73 22.85 090
26520 .... .......... A Release knuckle contracture ................................ 5.36 NA NA 8.82 12.62 0.80 NA NA 14.98 18.78 090
PO 00000
26525 .... .......... A Release finger contracture ................................... 5.39 NA NA 8.83 12.69 0.81 NA NA 15.03 18.89 090
26530 .... .......... A Revise knuckle joint ............................................. 6.76 NA NA 5.47 5.97 1.04 NA NA 13.27 13.77 090
26531 .... .......... A Revise knuckle with implant ................................. 7.99 NA NA 6.22 6.90 1.17 NA NA 15.38 16.06 090
26535 .... .......... A Revise finger joint ................................................ 5.30 NA NA 4.10 3.83 0.71 NA NA 10.11 9.84 090
Frm 00200
26536 .... .......... A Revise/implant finger joint .................................... 6.44 NA NA 9.16 9.53 0.96 NA NA 16.56 16.93 090
26540 .... .......... A Repair hand joint .................................................. 6.49 NA NA 8.01 10.91 0.99 NA NA 15.49 18.39 090
26541 .... .......... A Repair hand joint with graft .................................. 8.69 NA NA 9.08 12.31 1.28 NA NA 19.05 22.28 090
26542 .... .......... A Repair hand joint with graft .................................. 6.84 NA NA 8.14 11.06 1.02 NA NA 16.00 18.92 090
Fmt 4701
26545 .... .......... A Reconstruct finger joint ........................................ 6.99 NA NA 8.37 11.19 1.05 NA NA 16.41 19.23 090
26546 .... .......... A Repair nonunion hand .......................................... 10.53 NA NA 11.46 14.14 1.44 NA NA 23.43 26.11 090
26548 .... .......... A Reconstruct finger joint ........................................ 8.10 NA NA 8.83 11.85 1.20 NA NA 18.13 21.15 090
26550 .... .......... A Construct thumb replacement .............................. 21.54 NA NA 15.48 17.06 2.46 NA NA 39.48 41.06 090
Sfmt 4700
26551 .... .......... A Great toe-hand transfer ........................................ 48.23 NA NA 21.70 29.76 7.98 NA NA 77.91 85.97 090
26553 .... .......... A Single transfer, toe-hand ...................................... 47.92 NA NA 20.69 22.18 2.42 NA NA 71.03 72.52 090
26554 .... .......... A Double transfer, toe-hand .................................... 56.73 NA NA 19.35 32.99 9.44 NA NA 85.52 99.16 090
26555 .... .......... A Positional change of finger .................................. 16.94 NA NA 13.95 17.12 2.49 NA NA 33.38 36.55 090
26556 .... .......... A Toe joint transfer .................................................. 49.43 NA NA 17.83 29.45 2.58 NA NA 69.84 81.46 090
26560 .... .......... A Repair of web finger ............................................. 5.43 NA NA 7.10 9.13 0.85 NA NA 13.38 15.41 090
26565 .... .......... A Correct metacarpal flaw ....................................... 6.80 NA NA 7.91 10.99 1.00 NA NA 15.71 18.79 090
E:\FR\FM\01DER2.SGM
26567 .... .......... A Correct finger deformity ....................................... 6.88 NA NA 8.18 11.01 1.04 NA NA 16.10 18.93 090
26568 .... .......... A Lengthen metacarpal/finger ................................. 9.15 NA NA 10.18 14.12 1.49 NA NA 20.82 24.76 090
26580 .... .......... A Repair hand deformity .......................................... 19.50 NA NA 11.36 13.07 2.29 NA NA 33.15 34.86 090
26587 .... .......... A Reconstruct extra finger ....................................... 14.36 NA NA 8.49 9.03 1.53 NA NA 24.38 24.92 090
01DER2
26590 .... .......... A Repair finger deformity ......................................... 18.51 NA NA 10.52 13.09 2.78 NA NA 31.81 34.38 090
26591 .... .......... A Repair muscles of hand ....................................... 3.30 NA NA 6.28 8.79 0.48 NA NA 10.06 12.57 090
26593 .... .......... A Release muscles of hand .................................... 5.38 NA NA 7.76 10.29 0.78 NA NA 13.92 16.45 090
26596 .... .......... A Excision constricting tissue .................................. 9.02 NA NA 7.50 8.49 1.43 NA NA 17.95 18.94 090
26600 .... .......... A Treat metacarpal fracture ..................................... 2.48 3.83 3.67 3.48 2.86 0.30 6.61 6.45 6.26 5.64 090
26605 .... .......... A Treat metacarpal fracture ..................................... 2.92 4.08 4.44 3.51 3.62 0.49 7.49 7.85 6.92 7.03 090
Year Year Year
2007 2007 Fully Im-
VerDate Aug<31>2005
RVUs cility Total
RVUs
26607 .... .......... A Treat metacarpal fracture ..................................... 5.40 NA NA 4.91 5.93 0.87 NA NA 11.18 12.20 090
10:50 Nov 30, 2006

26641 .... .......... A Treat thumb dislocation ........................................ 4.01 4.17 4.47 3.52 3.53 0.39 8.57 8.87 7.92 7.93 090
26645 .... .......... A Treat thumb fracture ............................................ 4.47 4.60 5.03 3.92 4.12 0.67 9.74 10.17 9.06 9.26 090
26650 .... .......... A Treat thumb fracture ............................................ 5.80 NA NA 5.65 6.43 0.94 NA NA 12.39 13.17 090
26665 .... .......... A Treat thumb fracture ............................................ 7.72 NA NA 5.93 6.44 0.90 NA NA 14.55 15.06 090
26670 .... .......... A Treat hand dislocation .......................................... 3.74 3.54 4.08 2.96 2.95 0.39 7.67 8.21 7.09 7.08 090
Jkt 211001
26675 .... .......... A Treat hand dislocation .......................................... 4.71 4.88 5.32 4.18 4.40 0.77 10.36 10.80 9.66 9.88 090
26676 .... .......... A Pin hand dislocation ............................................. 5.60 NA NA 5.59 6.42 0.91 NA NA 12.10 12.93 090
26685 .... .......... A Treat hand dislocation .......................................... 7.09 NA NA 5.47 5.97 1.09 NA NA 13.65 14.15 090
26686 .... .......... A Treat hand dislocation .......................................... 8.06 NA NA 6.18 6.72 1.24 NA NA 15.48 16.02 090
PO 00000
26700 .... .......... A Treat knuckle dislocation ..................................... 3.74 3.33 3.65 2.96 2.89 0.35 7.42 7.74 7.05 6.98 090
26705 .... .......... A Treat knuckle dislocation ..................................... 4.26 4.82 5.20 4.11 4.25 0.66 9.74 10.12 9.03 9.17 090
26706 .... .......... A Pin knuckle dislocation ......................................... 5.19 NA NA 4.74 5.00 0.81 NA NA 10.74 11.00 090
26715 .... .......... A Treat knuckle dislocation ..................................... 5.79 NA NA 4.95 5.37 0.91 NA NA 11.65 12.07 090
Frm 00201
26720 .... .......... A Treat finger fracture, each ................................... 1.70 2.58 2.73 2.31 2.12 0.24 4.52 4.67 4.25 4.06 090
26727 .... .......... A Treat finger fracture, each ................................... 5.30 NA NA 5.24 5.98 0.84 NA NA 11.38 12.12 090
Fmt 4701
Sfmt 4700
26756 .... .......... A Pin finger fracture, each ....................................... 4.46 NA NA 4.89 5.51 0.71 NA NA 10.06 10.68 090
26770 .... .......... A Treat finger dislocation ......................................... 3.07 2.91 3.30 2.54 2.44 0.27 6.25 6.64 5.88 5.78 090
26775 .... .......... A Treat finger dislocation ......................................... 3.78 4.56 5.03 3.83 3.82 0.54 8.88 9.35 8.15 8.14 090
26776 .... .......... A Pin finger dislocation ............................................ 4.87 NA NA 5.04 5.76 0.77 NA NA 10.68 11.40 090
26785 .... .......... A Treat finger dislocation ......................................... 4.25 NA NA 4.10 4.42 0.68 NA NA 9.03 9.35 090
26820 .... .......... A Thumb fusion with graft ....................................... 8.33 NA NA 8.71 12.12 1.30 NA NA 18.34 21.75 090
26841 .... .......... A Fusion of thumb ................................................... 7.21 NA NA 8.69 12.10 1.18 NA NA 17.08 20.49 090
E:\FR\FM\01DER2.SGM
26842 .... .......... A Thumb fusion with graft ....................................... 8.37 NA NA 8.97 12.27 1.32 NA NA 18.66 21.96 090
26843 .... .......... A Fusion of hand joint ............................................. 7.67 NA NA 8.19 11.31 1.15 NA NA 17.01 20.13 090
26844 .... .......... A Fusion/graft of hand joint ..................................... 8.86 NA NA 9.18 12.32 1.33 NA NA 19.37 22.51 090
26850 .... .......... A Fusion of knuckle ................................................. 7.03 NA NA 8.31 11.23 1.06 NA NA 16.40 19.32 090
01DER2
26852 .... .......... A Fusion of knuckle with graft ................................. 8.59 NA NA 9.17 11.96 1.22 NA NA 18.98 21.77 090
26860 .... .......... A Fusion of finger joint ............................................ 4.76 NA NA 7.54 10.28 0.73 NA NA 13.03 15.77 090
26861 .... .......... A Fusion of finger jnt, add-on .................................. 1.74 NA NA 0.72 0.88 0.27 NA NA 2.73 2.89 ZZZ
26862 .... .......... A Fusion/graft of finger joint .................................... 7.44 NA NA 8.72 11.44 1.10 NA NA 17.26 19.98 090
26863 .... .......... A Fuse/graft added joint .......................................... 3.89 NA NA 1.61 1.99 0.56 NA NA 6.06 6.44 ZZZ
26910 .... .......... A Amputate metacarpal bone .................................. 7.67 NA NA 8.32 10.50 1.16 NA NA 17.15 19.33 090
69823
Year
69824
Year Year
2007 2007 Fully Im-
VerDate Aug<31>2005
RVUs cility Total
RVUs
26951 .... .......... A Amputation of finger/thumb .................................. 5.85 NA NA 8.39 9.71 0.71 NA NA 14.95 16.27 090
26952 .... .......... A Amputation of finger/thumb .................................. 6.37 NA NA 7.99 10.74 0.95 NA NA 15.31 18.06 090
26989 .... .......... C Hand/finger surgery .............................................. 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 YYY
10:50 Nov 30, 2006

26990 .... .......... A Drainage of pelvis lesion ...................................... 7.84 NA NA 6.28 6.98 1.22 NA NA 15.34 16.04 090
26991 .... .......... A Drainage of pelvis bursa ...................................... 6.97 8.55 10.51 4.86 5.29 1.11 16.63 18.59 12.94 13.37 090
27000 .... .......... A Incision of hip tendon ........................................... 5.66 NA NA 4.57 5.10 0.98 NA NA 11.21 11.74 090
Jkt 211001
27006 .... .......... A Incision of hip tendons ......................................... 9.99 NA NA 6.86 7.70 1.70 NA NA 18.55 19.39 090
27025 .... .......... A Incision of hip/thigh fascia .................................... 12.66 NA NA 8.12 8.44 1.85 NA NA 22.63 22.95 090
PO 00000
27030 .... .......... A Drainage of hip joint ............................................. 13.54 NA NA 8.14 9.27 2.27 NA NA 23.95 25.08 090
27033 .... .......... A Exploration of hip joint ......................................... 13.99 NA NA 8.49 9.56 2.33 NA NA 24.81 25.88 090
27035 .... .......... A Denervation of hip joint ........................................ 17.23 NA NA 9.74 10.86 2.16 NA NA 29.13 30.25 090
27036 .... .......... A Excision of hip joint/muscle .................................. 14.18 NA NA 9.01 9.75 2.27 NA NA 25.46 26.20 090
Frm 00202
27040 .... .......... A Biopsy of soft tissues ........................................... 2.89 4.99 5.17 1.77 1.95 0.27 8.15 8.33 4.93 5.11 010
27041 .... .......... A Biopsy of soft tissues ........................................... 10.07 NA NA 5.70 6.41 1.35 NA NA 17.12 17.83 090
27047 .... .......... A Remove hip/pelvis lesion ..................................... 7.51 7.07 7.10 4.55 4.72 1.03 15.61 15.64 13.09 13.26 090
27048 .... .......... A Remove hip/pelvis lesion ..................................... 6.44 NA NA 4.64 4.76 0.92 NA NA 12.00 12.12 090
Fmt 4701
27049 .... .......... A Remove tumor, hip/pelvis .................................... 15.20 NA NA 8.24 8.36 2.07 NA NA 25.51 25.63 090
27050 .... .......... A Biopsy of sacroiliac joint ...................................... 4.65 NA NA 3.76 4.26 0.60 NA NA 9.01 9.51 090
27052 .... .......... A Biopsy of hip joint ................................................. 7.27 NA NA 5.68 5.83 1.08 NA NA 14.03 14.18 090
27054 .... .......... A Removal of hip joint lining .................................... 9.09 NA NA 6.51 7.13 1.47 NA NA 17.07 17.69 090
Sfmt 4700
27060 .... .......... A Removal of ischial bursa ...................................... 5.78 NA NA 4.43 4.39 0.80 NA NA 11.01 10.97 090
27062 .... .......... A Remove femur lesion/bursa ................................. 5.66 NA NA 4.64 5.05 0.93 NA NA 11.23 11.64 090
27065 .... .......... A Removal of hip bone lesion ................................. 6.44 NA NA 5.12 5.36 1.01 NA NA 12.57 12.81 090
27066 .... .......... A Removal of hip bone lesion ................................. 11.06 NA NA 7.49 8.20 1.80 NA NA 20.35 21.06 090
27067 .... .......... A Remove/graft hip bone lesion .............................. 14.57 NA NA 8.86 10.21 1.85 NA NA 25.28 26.63 090
27070 .... .......... A Partial removal of hip bone .................................. 11.44 NA NA 7.97 8.84 1.75 NA NA 21.16 22.03 090
27071 .... .......... A Partial removal of hip bone .................................. 12.25 NA NA 8.56 9.73 1.93 NA NA 22.74 23.91 090
27075 .... .......... A Extensive hip surgery ........................................... 36.77 NA NA 16.74 18.59 5.66 NA NA 59.17 61.02 090
E:\FR\FM\01DER2.SGM
27080 .... .......... A Removal of tail bone ............................................ 6.80 NA NA 4.75 4.81 0.93 NA NA 12.48 12.54 090
01DER2
27086 .... .......... A Remove hip foreign body ..................................... 1.89 3.75 4.35 1.54 1.75 0.25 5.89 6.49 3.68 3.89 010
27087 .... .......... A Remove hip foreign body ..................................... 8.72 NA NA 5.67 6.41 1.35 NA NA 15.74 16.48 090
27090 .... .......... A Removal of hip prosthesis ................................... 11.57 NA NA 7.47 8.45 1.95 NA NA 20.99 21.97 090
27091 .... .......... A Removal of hip prosthesis ................................... 24.15 NA NA 13.11 13.77 3.85 NA NA 41.11 41.77 090
27093 .... .......... A Injection for hip x-ray ........................................... 1.30 2.97 4.09 0.42 0.47 0.13 4.40 5.52 1.85 1.90 000
27095 .... .......... A Injection for hip x-ray ........................................... 1.50 3.61 5.19 0.48 0.51 0.14 5.25 6.83 2.12 2.15 000
Year Year Year
2007 2007 Fully Im-
VerDate Aug<31>2005
RVUs cility Total
RVUs
27096 .... .......... A Inject sacroiliac joint ............................................. 1.40 2.48 3.88 0.33 0.33 0.08 3.96 5.36 1.81 1.81 000
27097 .... .......... A Revision of hip tendon ......................................... 9.16 NA NA 6.36 6.40 1.57 NA NA 17.09 17.13 090
27098 .... .......... A Transfer tendon to pelvis ..................................... 9.20 NA NA 4.89 6.49 0.95 NA NA 15.04 16.64 090
10:50 Nov 30, 2006

27100 .... .......... A Transfer of abdominal muscle ............................. 11.21 NA NA 7.41 8.35 1.86 NA NA 20.48 21.42 090
27105 .... .......... A Transfer of spinal muscle ..................................... 11.90 NA NA 7.96 8.86 1.73 NA NA 21.59 22.49 090
27110 .... .......... A Transfer of iliopsoas muscle ................................ 13.63 NA NA 8.67 9.00 2.19 NA NA 24.49 24.82 090
27111 .... .......... A Transfer of iliopsoas muscle ................................ 12.46 NA NA 8.17 8.89 1.95 NA NA 22.58 23.30 090
27120 .... .......... A Reconstruction of hip socket ................................ 19.10 NA NA 10.85 11.59 3.09 NA NA 33.04 33.78 090
Jkt 211001
27122 .... .......... A Reconstruction of hip socket ................................ 15.95 NA NA 9.54 10.67 2.62 NA NA 28.11 29.24 090
27125 .... .......... A Partial hip replacement ........................................ 16.46 NA NA 9.72 10.40 2.55 NA NA 28.73 29.41 090
27130 .... .......... A Total hip arthroplasty ........................................... 21.61 NA NA 11.95 12.96 3.51 NA NA 37.07 38.08 090
27132 .... .......... A Total hip arthroplasty ........................................... 25.49 NA NA 13.64 15.13 4.05 NA NA 43.18 44.67 090
PO 00000
27134 .... .......... A Revise hip joint replacement ................................ 30.13 NA NA 14.94 17.08 4.95 NA NA 50.02 52.16 090
27140 .... .......... A Transplant femur ridge ......................................... 12.66 NA NA 7.84 9.02 2.12 NA NA 22.62 23.80 090
Frm 00203
27146 .... .......... A Incision of hip bone .............................................. 18.72 NA NA 10.78 11.79 2.97 NA NA 32.47 33.48 090
27147 .... .......... A Revision of hip bone ............................................ 21.87 NA NA 12.05 12.95 3.58 NA NA 37.50 38.40 090
27151 .... .......... A Incision of hip bones ............................................ 23.92 NA NA 12.50 9.09 3.92 NA NA 40.34 36.93 090
27156 .... .......... A Revision of hip bones .......................................... 26.03 NA NA 13.61 15.45 4.22 NA NA 43.86 45.70 090
Fmt 4701
27158 .... .......... A Revision of pelvis ................................................. 20.89 NA NA 7.12 10.01 3.17 NA NA 31.18 34.07 090
27161 .... .......... A Incision of neck of femur ...................................... 17.74 NA NA 10.47 11.69 2.95 NA NA 31.16 32.38 090
27165 .... .......... A Incision/fixation of femur ...................................... 20.06 NA NA 11.77 12.63 3.11 NA NA 34.94 35.80 090
27170 .... .......... A Repair/graft femur head/neck .............................. 17.46 NA NA 9.86 10.94 2.82 NA NA 30.14 31.22 090
Sfmt 4700
27175 .... .......... A Treat slipped epiphysis ........................................ 9.29 NA NA 5.83 6.46 1.46 NA NA 16.58 17.21 090
27179 .... .......... A Revise head/neck of femur .................................. 13.83 NA NA 8.59 9.64 2.26 NA NA 24.68 25.73 090
27185 .... .......... A Revision of femur epiphysis ................................. 9.67 NA NA 6.71 7.32 2.40 NA NA 18.78 19.39 090
27187 .... .......... A Reinforce hip bones ............................................. 14.09 NA NA 8.76 9.93 2.38 NA NA 25.23 26.40 090
27193 .... .......... A Treat pelvic ring fracture ...................................... 5.98 4.66 4.98 4.66 4.98 0.96 11.60 11.92 11.60 11.92 090
E:\FR\FM\01DER2.SGM
27194 .... .......... A Treat pelvic ring fracture ...................................... 10.08 NA NA 6.65 7.40 1.65 NA NA 18.38 19.13 090
27200 .... .......... A Treat tail bone fracture ......................................... 1.87 2.08 2.19 2.08 2.13 0.28 4.23 4.34 4.23 4.28 090
27202 .... .......... A Treat tail bone fracture ......................................... 7.25 NA NA 11.14 15.43 1.06 NA NA 19.45 23.74 090
27215 .... .......... A Treat pelvic fracture(s) ......................................... 10.45 NA NA 6.55 6.95 1.98 NA NA 18.98 19.38 090
01DER2
27220 .... .......... A Treat hip socket fracture ...................................... 6.72 5.29 5.61 5.19 5.52 1.07 13.08 13.40 12.98 13.31 090
27222 .... .......... A Treat hip socket fracture ...................................... 13.97 NA NA 8.52 9.61 2.20 NA NA 24.69 25.78 090
27226 .... .......... A Treat hip wall fracture .......................................... 15.45 NA NA 9.04 8.12 2.49 NA NA 26.98 26.06 090
69825
Year
69826
Year Year
2007 2007 Fully Im-
VerDate Aug<31>2005
RVUs cility Total
RVUs
27227 .... .......... A Treat hip fracture(s) ............................................. 25.21 NA NA 13.50 14.93 4.06 NA NA 42.77 44.20 090
27228 .... .......... A Treat hip fracture(s) ............................................. 29.13 NA NA 15.10 16.99 4.67 NA NA 48.90 50.79 090
27230 .... .......... A Treat thigh fracture ............................................... 5.69 4.99 5.38 4.92 5.06 0.95 11.63 12.02 11.56 11.70 090
10:50 Nov 30, 2006

27232 .... .......... A Treat thigh fracture ............................................... 11.66 NA NA 6.02 6.88 1.86 NA NA 19.54 20.40 090
Jkt 211001
27246 .... .......... A Treat thigh fracture ............................................... 4.75 3.94 4.33 3.94 4.30 0.81 9.50 9.89 9.50 9.86 090
PO 00000
27250 .... .......... A Treat hip dislocation ............................................. 7.21 NA NA 4.30 4.54 0.62 NA NA 12.13 12.37 090
Frm 00204
27256 .... .......... A Treat hip dislocation ............................................. 4.25 2.40 3.24 1.41 1.91 0.46 7.11 7.95 6.12 6.62 010
Fmt 4701
27275 .... .......... A Manipulation of hip joint ....................................... 2.29 NA NA 1.90 2.05 0.39 NA NA 4.58 4.73 010
27280 .... .......... A Fusion of sacroiliac joint ...................................... 14.49 NA NA 9.10 9.97 2.54 NA NA 26.13 27.00 090
Sfmt 4700
27282 .... .......... A Fusion of pubic bones .......................................... 11.71 NA NA 7.86 7.97 1.87 NA NA 21.44 21.55 090
27284 .... .......... A Fusion of hip joint ................................................. 24.91 NA NA 12.92 14.30 3.93 NA NA 41.76 43.14 090
27286 .... .......... A Fusion of hip joint ................................................. 24.97 NA NA 13.54 15.23 3.13 NA NA 41.64 43.33 090
27290 .... .......... A Amputation of leg at hip ....................................... 24.38 NA NA 12.56 13.69 3.44 NA NA 40.38 41.51 090
27295 .... .......... A Amputation of leg at hip ....................................... 19.54 NA NA 9.83 10.94 2.96 NA NA 32.33 33.44 090
27299 .... .......... C Pelvis/hip joint surgery ......................................... 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 YYY
27301 .... .......... A Drain thigh/knee lesion ........................................ 6.67 8.18 9.60 4.67 5.02 1.04 15.89 17.31 12.38 12.73 090
27305 .... .......... A Incise thigh tendon & fascia ................................. 6.09 NA NA 4.63 5.04 1.01 NA NA 11.73 12.14 090
E:\FR\FM\01DER2.SGM
27306 .... .......... A Incision of thigh tendon ........................................ 4.66 NA NA 4.07 4.56 0.85 NA NA 9.58 10.07 090
27307 .... .......... A Incision of thigh tendons ...................................... 5.97 NA NA 4.82 5.24 1.04 NA NA 11.83 12.25 090
27310 .... .......... A Exploration of knee joint ...................................... 9.88 NA NA 6.85 7.40 1.61 NA NA 18.34 18.89 090
27323 .... .......... A Biopsy, thigh soft tissues ..................................... 2.30 4.12 3.66 1.91 1.89 0.24 6.66 6.20 4.45 4.43 010
01DER2
27324 .... .......... A Biopsy, thigh soft tissues ..................................... 4.95 NA NA 3.84 4.10 0.75 NA NA 9.54 9.80 090
27325 .... .......... A Neurectomy, hamstring ........................................ 7.09 NA NA 5.45 5.08 1.09 NA NA 13.63 13.26 090
27326 .... .......... A Neurectomy, popliteal .......................................... 6.36 NA NA 4.77 5.12 1.06 NA NA 12.19 12.54 090
27327 .... .......... A Removal of thigh lesion ....................................... 4.52 6.04 6.00 3.61 3.69 0.64 11.20 11.16 8.77 8.85 090
27328 .... .......... A Removal of thigh lesion ....................................... 5.62 NA NA 4.06 4.29 0.84 NA NA 10.52 10.75 090
27329 .... .......... A Remove tumor, thigh/knee ................................... 15.68 NA NA 8.58 8.91 2.15 NA NA 26.41 26.74 090
Year Year Year
2007 2007 Fully Im-
VerDate Aug<31>2005
RVUs cility Total
RVUs
27330 .... .......... A Biopsy, knee joint lining ....................................... 5.02 NA NA 4.12 4.46 0.86 NA NA 10.00 10.34 090
27331 .... .......... A Explore/treat knee joint ........................................ 5.93 NA NA 4.85 5.35 1.02 NA NA 11.80 12.30 090
27332 .... .......... A Removal of knee cartilage ................................... 8.34 NA NA 6.17 6.88 1.43 NA NA 15.94 16.65 090
10:50 Nov 30, 2006

27333 .... .......... A Removal of knee cartilage ................................... 7.43 NA NA 5.74 6.44 1.26 NA NA 14.43 15.13 090
27334 .... .......... A Remove knee joint lining ...................................... 9.07 NA NA 6.51 7.19 1.51 NA NA 17.09 17.77 090
27335 .... .......... A Remove knee joint lining ...................................... 10.43 NA NA 7.08 7.94 1.75 NA NA 19.26 20.12 090
27340 .... .......... A Removal of kneecap bursa .................................. 4.23 NA NA 4.05 4.43 0.72 NA NA 9.00 9.38 090
27345 .... .......... A Removal of knee cyst .......................................... 5.98 NA NA 4.90 5.44 1.00 NA NA 11.88 12.42 090
Jkt 211001
27347 .... .......... A Remove knee cyst ............................................... 6.58 NA NA 5.26 5.38 0.98 NA NA 12.82 12.94 090
27350 .... .......... A Removal of kneecap ............................................ 8.54 NA NA 6.30 7.01 1.41 NA NA 16.25 16.96 090
27355 .... .......... A Remove femur lesion ........................................... 7.89 NA NA 5.88 6.55 1.32 NA NA 15.09 15.76 090
27356 .... .......... A Remove femur lesion/graft ................................... 9.97 NA NA 6.88 7.61 1.65 NA NA 18.50 19.23 090
PO 00000
27357 .... .......... A Remove femur lesion/graft ................................... 11.02 NA NA 7.56 8.42 1.96 NA NA 20.54 21.40 090
27358 .... .......... A Remove femur lesion/fixation ............................... 4.73 NA NA 1.91 2.37 0.82 NA NA 7.46 7.92 ZZZ
27360 .... .......... A Partial removal, leg bone(s) ................................. 11.34 NA NA 8.15 9.20 1.84 NA NA 21.33 22.38 090
27365 .... .......... A Extensive leg surgery ........................................... 17.93 NA NA 10.56 11.40 2.80 NA NA 31.29 32.13 090
Frm 00205
27370 .... .......... A Injection for knee x-ray ........................................ 0.96 2.72 3.47 0.32 0.32 0.08 3.76 4.51 1.36 1.36 000
27380 .... .......... A Repair of kneecap tendon .................................... 7.34 NA NA 6.09 6.98 1.24 NA NA 14.67 15.56 090
27381 .... .......... A Repair/graft kneecap tendon ................................ 10.64 NA NA 7.58 8.71 1.80 NA NA 20.02 21.15 090
Fmt 4701
27385 .... .......... A Repair of thigh muscle ......................................... 8.00 NA NA 6.37 7.32 1.36 NA NA 15.73 16.68 090
27386 .... .......... A Repair/graft of thigh muscle ................................. 10.99 NA NA 8.00 9.13 1.86 NA NA 20.85 21.98 090
27390 .... .......... A Incision of thigh tendon ........................................ 5.44 NA NA 4.57 4.98 0.92 NA NA 10.93 11.34 090
Sfmt 4700
27393 .... .......... A Lengthening of thigh tendon ................................ 6.50 NA NA 5.02 5.63 1.10 NA NA 12.62 13.23 090
27394 .... .......... A Lengthening of thigh tendons .............................. 8.68 NA NA 6.21 6.97 1.47 NA NA 16.36 17.12 090
27395 .... .......... A Lengthening of thigh tendons .............................. 12.10 NA NA 8.02 9.00 2.05 NA NA 22.17 23.15 090
27396 .... .......... A Transplant of thigh tendon ................................... 8.04 NA NA 5.94 6.74 1.34 NA NA 15.32 16.12 090
27397 .... .......... A Transplants of thigh tendons ............................... 12.46 NA NA 8.44 8.89 1.83 NA NA 22.73 23.18 090
27400 .... .......... A Revise thigh muscles/tendons ............................. 9.21 NA NA 6.19 6.99 1.31 NA NA 16.71 17.51 090
27403 .... .......... A Repair of knee cartilage ....................................... 8.51 NA NA 6.11 6.91 1.44 NA NA 16.06 16.86 090
27405 .... .......... A Repair of knee ligament ....................................... 8.96 NA NA 6.46 7.23 1.51 NA NA 16.93 17.70 090
E:\FR\FM\01DER2.SGM
27407 .... .......... A Repair of knee ligament ....................................... 10.71 NA NA 6.71 7.92 1.79 NA NA 19.21 20.42 090
27409 .... .......... A Repair of knee ligaments ..................................... 13.57 NA NA 8.47 9.58 2.25 NA NA 24.29 25.40 090
27412 .... .......... A Autochondrocyte implant knee ............................. 24.53 NA NA 13.71 14.53 4.36 NA NA 42.60 43.42 090
27415 .... .......... A Osteochondral knee allograft ............................... 19.79 NA NA 11.90 12.39 4.36 NA NA 36.05 36.54 090
01DER2
27418 .... .......... A Repair degenerated kneecap ............................... 11.46 NA NA 7.64 8.59 1.89 NA NA 20.99 21.94 090
27420 .... .......... A Revision of unstable kneecap .............................. 10.14 NA NA 6.98 7.83 1.72 NA NA 18.84 19.69 090
27422 .... .......... A Revision of unstable kneecap .............................. 10.09 NA NA 6.93 7.82 1.71 NA NA 18.73 19.62 090
27424 .... .......... A Revision/removal of kneecap ............................... 10.12 NA NA 6.94 7.80 1.71 NA NA 18.77 19.63 090
27425 .... .......... A Lat retinacular release open ................................ 5.28 NA NA 4.72 5.32 0.90 NA NA 10.90 11.50 090
27427 .... .......... A Reconstruction, knee ........................................... 9.67 NA NA 6.73 7.53 1.63 NA NA 18.03 18.83 090
69827
Year
69828
Year Year
2007 2007 Fully Im-
VerDate Aug<31>2005
RVUs cility Total
RVUs
27430 .... .......... A Revision of thigh muscles .................................... 10.04 NA NA 6.91 7.73 1.70 NA NA 18.65 19.47 090
10:50 Nov 30, 2006

27435 .... .......... A Incision of knee joint ............................................ 10.68 NA NA 7.71 8.29 1.70 NA NA 20.09 20.67 090
27437 .... .......... A Revise kneecap .................................................... 8.82 NA NA 6.25 6.99 1.49 NA NA 16.56 17.30 090
27438 .... .......... A Revise kneecap with implant ............................... 11.77 NA NA 7.60 8.31 1.96 NA NA 21.33 22.04 090
27440 .... .......... A Revision of knee joint ........................................... 10.97 NA NA 7.19 6.29 1.82 NA NA 19.98 19.08 090
Jkt 211001
PO 00000
27447 .... .......... A Total knee arthroplasty ........................................ 23.04 NA NA 12.75 14.14 3.80 NA NA 39.59 40.98 090
27448 .... .......... A Incision of thigh .................................................... 11.48 NA NA 7.46 8.32 1.95 NA NA 20.89 21.75 090
27450 .... .......... A Incision of thigh .................................................... 14.47 NA NA 8.85 10.15 2.43 NA NA 25.75 27.05 090
27454 .... .......... A Realignment of thigh bone ................................... 18.97 NA NA 10.79 12.07 3.13 NA NA 32.89 34.17 090
Frm 00206
27455 .... .......... A Realignment of knee ............................................ 13.24 NA NA 8.43 9.52 2.25 NA NA 23.92 25.01 090
27457 .... .......... A Realignment of knee ............................................ 13.92 NA NA 8.29 9.51 2.35 NA NA 24.56 25.78 090
27465 .... .......... A Shortening of thigh bone ...................................... 18.44 NA NA 10.40 10.27 2.48 NA NA 31.32 31.19 090
27466 .... .......... A Lengthening of thigh bone ................................... 17.13 NA NA 10.20 11.42 2.78 NA NA 30.11 31.33 090
Fmt 4701
27468 .... .......... A Shorten/lengthen thighs ....................................... 19.82 NA NA 11.33 12.10 3.31 NA NA 34.46 35.23 090
27470 .... .......... A Repair of thigh ...................................................... 16.97 NA NA 10.26 11.41 2.80 NA NA 30.03 31.18 090
27472 .... .......... A Repair/graft of thigh ............................................. 18.57 NA NA 10.77 12.20 3.08 NA NA 32.42 33.85 090
27475 .... .......... A Surgery to stop leg growth ................................... 8.82 NA NA 6.88 7.13 1.36 NA NA 17.06 17.31 090
Sfmt 4700
27486 .... .......... A Revise/replace knee joint ..................................... 20.92 NA NA 11.79 13.07 3.37 NA NA 36.08 37.36 090
27487 .... .......... A Revise/replace knee joint ..................................... 26.91 NA NA 14.21 15.97 4.40 NA NA 45.52 47.28 090
27488 .... .......... A Removal of knee prosthesis ................................ 17.40 NA NA 10.38 11.37 2.75 NA NA 30.53 31.52 090
27495 .... .......... A Reinforce thigh ..................................................... 16.40 NA NA 9.74 10.99 2.72 NA NA 28.86 30.11 090
27496 .... .......... A Decompression of thigh/knee .............................. 6.66 NA NA 5.02 5.46 0.99 NA NA 12.67 13.11 090
E:\FR\FM\01DER2.SGM
27500 .... .......... A Treatment of thigh fracture .................................. 6.21 5.44 5.95 4.66 4.91 1.02 12.67 13.18 11.89 12.14 090
01DER2
27502 .... .......... A Treatment of thigh fracture .................................. 11.24 NA NA 6.95 7.82 1.79 NA NA 19.98 20.85 090
Year Year Year
2007 2007 Fully Im-
VerDate Aug<31>2005
RVUs cility Total
RVUs
10:50 Nov 30, 2006

27516 .... .......... A Treat thigh fx growth plate ................................... 5.45 5.69 6.19 5.06 5.40 0.81 11.95 12.45 11.32 11.66 090
27517 .... .......... A Treat thigh fx growth plate ................................... 8.98 NA NA 6.07 7.11 1.22 NA NA 16.27 17.31 090
27519 .... .......... A Treat thigh fx growth plate ................................... 15.80 NA NA 9.92 11.17 2.56 NA NA 28.28 29.53 090
27520 .... .......... A Treat kneecap fracture ......................................... 2.93 4.10 4.43 3.53 3.46 0.47 7.50 7.83 6.93 6.86 090
Jkt 211001
27524 .... .......... A Treat kneecap fracture ......................................... 10.25 NA NA 7.00 7.92 1.75 NA NA 19.00 19.92 090
27530 .... .......... A Treat knee fracture ............................................... 3.97 4.83 5.19 4.27 4.38 0.65 9.45 9.81 8.89 9.00 090
27532 .... .......... A Treat knee fracture ............................................... 7.43 6.45 7.13 5.68 6.26 1.26 15.14 15.82 14.37 14.95 090
27535 .... .......... A Treat knee fracture ............................................... 11.80 NA NA 8.28 9.65 2.01 NA NA 22.09 23.46 090
PO 00000
27538 .... .......... A Treat knee fracture(s) .......................................... 4.95 5.54 5.98 4.92 5.12 0.84 11.33 11.77 10.71 10.91 090
27550 .... .......... A Treat knee dislocation .......................................... 5.84 5.31 5.84 4.61 4.85 0.76 11.91 12.44 11.21 11.45 090
Frm 00207
27552 .... .......... A Treat knee dislocation .......................................... 8.04 NA NA 6.14 6.75 1.36 NA NA 15.54 16.15 090
Fmt 4701
27560 .... .......... A Treat kneecap dislocation .................................... 3.88 3.93 4.61 3.41 3.24 0.40 8.21 8.89 7.69 7.52 090
27562 .... .......... A Treat kneecap dislocation .................................... 5.86 NA NA 4.46 4.69 0.94 NA NA 11.26 11.49 090
27566 .... .......... A Treat kneecap dislocation .................................... 12.59 NA NA 7.89 8.96 2.13 NA NA 22.61 23.68 090
27570 .... .......... A Fixation of knee joint ............................................ 1.76 NA NA 1.62 1.73 0.30 NA NA 3.68 3.79 010
Sfmt 4700
27580 .... .......... A Fusion of knee ..................................................... 20.90 NA NA 12.38 14.20 3.38 NA NA 36.66 38.48 090
27590 .... .......... A Amputate leg at thigh ........................................... 13.35 NA NA 6.12 6.53 1.75 NA NA 21.22 21.63 090
27598 .... .......... A Amputate lower leg at knee ................................. 11.08 NA NA 6.34 6.85 1.65 NA NA 19.07 19.58 090
27599 .... .......... C Leg surgery procedure ......................................... 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 YYY
27600 .... .......... A Decompression of lower leg ................................ 5.94 NA NA 3.84 4.36 0.86 NA NA 10.64 11.16 090
E:\FR\FM\01DER2.SGM
27603 .... .......... A Drain lower leg lesion .......................................... 5.12 7.01 7.37 3.90 4.10 0.74 12.87 13.23 9.76 9.96 090
27604 .... .......... A Drain lower leg bursa ........................................... 4.51 6.46 6.18 3.44 3.83 0.69 11.66 11.38 8.64 9.03 090
01DER2
27605 .... .......... A Incision of achilles tendon .................................... 2.89 5.27 7.08 1.80 2.19 0.41 8.57 10.38 5.10 5.49 010
27606 .... .......... A Incision of achilles tendon .................................... 4.15 NA NA 2.68 3.19 0.69 NA NA 7.52 8.03 010
27607 .... .......... A Treat lower leg bone lesion ................................. 8.51 NA NA 5.79 6.08 1.31 NA NA 15.61 15.90 090
27610 .... .......... A Explore/treat ankle joint ....................................... 9.01 NA NA 6.20 6.80 1.40 NA NA 16.61 17.21 090
27612 .... .......... A Exploration of ankle joint ...................................... 8.01 NA NA 5.39 5.92 1.13 NA NA 14.53 15.06 090
27613 .... .......... A Biopsy lower leg soft tissue ................................. 2.19 3.86 3.39 1.76 1.79 0.20 6.25 5.78 4.15 4.18 010
69829
Year
69830
Year Year
2007 2007 Fully Im-
VerDate Aug<31>2005
RVUs cility Total
RVUs
27614 .... .......... A Biopsy lower leg soft tissue ................................. 5.71 7.87 7.32 4.03 4.34 0.78 14.36 13.81 10.52 10.83 090
27615 .... .......... A Remove tumor, lower leg ..................................... 12.93 NA NA 8.12 9.07 1.84 NA NA 22.89 23.84 090
27618 .... .......... A Remove lower leg lesion ...................................... 5.14 6.38 6.10 3.79 3.94 0.72 12.24 11.96 9.65 9.80 090
10:50 Nov 30, 2006

27619 .... .......... A Remove lower leg lesion ...................................... 8.47 10.05 9.65 5.32 5.79 1.25 19.77 19.37 15.04 15.51 090
27620 .... .......... A Explore/treat ankle joint ....................................... 6.04 NA NA 4.62 5.25 0.97 NA NA 11.63 12.26 090
27625 .... .......... A Remove ankle joint lining ..................................... 8.37 NA NA 5.63 6.25 1.28 NA NA 15.28 15.90 090
27626 .... .......... A Remove ankle joint lining ..................................... 8.98 NA NA 5.99 6.69 1.48 NA NA 16.45 17.15 090
27630 .... .......... A Removal of tendon lesion .................................... 4.85 7.94 7.66 3.81 4.24 0.74 13.53 13.25 9.40 9.83 090
Jkt 211001
27635 .... .......... A Remove lower leg bone lesion ............................ 7.91 NA NA 5.70 6.48 1.31 NA NA 14.92 15.70 090
27637 .... .......... A Remove/graft leg bone lesion .............................. 10.17 NA NA 7.19 8.02 1.66 NA NA 19.02 19.85 090
27638 .... .......... A Remove/graft leg bone lesion .............................. 10.87 NA NA 7.01 7.97 1.85 NA NA 19.73 20.69 090
27640 .... .......... A Partial removal of tibia ......................................... 12.10 NA NA 8.24 9.79 1.89 NA NA 22.23 23.78 090
PO 00000
27641 .... .......... A Partial removal of fibula ....................................... 9.73 NA NA 6.82 7.96 1.46 NA NA 18.01 19.15 090
27645 .... .......... A Extensive lower leg surgery ................................. 14.78 NA NA 9.54 11.42 2.42 NA NA 26.74 28.62 090
27646 .... .......... A Extensive lower leg surgery ................................. 13.21 NA NA 8.45 10.39 2.06 NA NA 23.72 25.66 090
27647 .... .......... A Extensive ankle/heel surgery ............................... 12.85 NA NA 6.70 7.38 1.76 NA NA 21.31 21.99 090
Frm 00208
27648 .... .......... A Injection for ankle x-ray ........................................ 0.96 2.62 3.30 0.30 0.32 0.08 3.66 4.34 1.34 1.36 000
27650 .... .......... A Repair achilles tendon ......................................... 9.94 NA NA 6.34 7.22 1.59 NA NA 17.87 18.75 090
27652 .... .......... A Repair/graft achilles tendon ................................. 10.64 NA NA 6.51 7.65 1.72 NA NA 18.87 20.01 090
27654 .... .......... A Repair of achilles tendon ..................................... 10.32 NA NA 6.03 6.86 1.58 NA NA 17.93 18.76 090
Fmt 4701
27656 .... .......... A Repair leg fascia defect ....................................... 4.62 8.06 8.41 3.69 3.75 0.69 13.37 13.72 9.00 9.06 090
27658 .... .......... A Repair of leg tendon, each .................................. 5.03 NA NA 3.92 4.40 0.79 NA NA 9.74 10.22 090
Sfmt 4700
27675 .... .......... A Repair lower leg tendons ..................................... 7.24 NA NA 4.78 5.49 1.11 NA NA 13.13 13.84 090
27676 .... .......... A Repair lower leg tendons ..................................... 8.61 NA NA 5.80 6.51 1.37 NA NA 15.78 16.49 090
27680 .... .......... A Release of lower leg tendon ................................ 5.79 NA NA 4.40 4.93 0.93 NA NA 11.12 11.65 090
27681 .... .......... A Release of lower leg tendons .............................. 6.94 NA NA 4.79 5.63 1.15 NA NA 12.88 13.72 090
27685 .... .......... A Revision of lower leg tendon ............................... 6.57 8.84 7.68 4.65 5.26 0.97 16.38 15.22 12.19 12.80 090
27686 .... .......... A Revise lower leg tendons ..................................... 7.64 NA NA 5.41 6.22 1.24 NA NA 14.29 15.10 090
27687 .... .......... A Revision of calf tendon ........................................ 6.30 NA NA 4.56 5.12 1.00 NA NA 11.86 12.42 090
27690 .... .......... A Revise lower leg tendon ...................................... 8.96 NA NA 5.53 6.15 1.33 NA NA 15.82 16.44 090
E:\FR\FM\01DER2.SGM
27691 .... .......... A Revise lower leg tendon ...................................... 10.28 NA NA 6.76 7.51 1.64 NA NA 18.68 19.43 090
27692 .... .......... A Revise additional leg tendon ................................ 1.87 NA NA 0.73 0.88 0.32 NA NA 2.92 3.07 ZZZ
27695 .... .......... A Repair of ankle ligament ...................................... 6.58 NA NA 5.03 5.66 1.05 NA NA 12.66 13.29 090
27696 .... .......... A Repair of ankle ligaments .................................... 8.46 NA NA 5.47 6.19 1.28 NA NA 15.21 15.93 090
01DER2
27698 .... .......... A Repair of ankle ligament ...................................... 9.49 NA NA 5.97 6.70 1.47 NA NA 16.93 17.66 090
27700 .... .......... A Revision of ankle joint .......................................... 9.54 NA NA 5.21 5.56 1.30 NA NA 16.05 16.40 090
27702 .... .......... A Reconstruct ankle joint ......................................... 14.28 NA NA 8.77 10.04 2.38 NA NA 25.43 26.70 090
27703 .... .......... A Reconstruction, ankle joint ................................... 16.79 NA NA 9.95 10.91 2.77 NA NA 29.51 30.47 090
27704 .... .......... A Removal of ankle implant .................................... 7.69 NA NA 5.72 5.62 1.27 NA NA 14.68 14.58 090
27705 .... .......... A Incision of tibia ..................................................... 10.74 NA NA 6.95 7.87 1.81 NA NA 19.50 20.42 090
Year Year Year
2007 2007 Fully Im-
VerDate Aug<31>2005
RVUs cility Total
RVUs
27707 .... .......... A Incision of fibula ................................................... 4.67 NA NA 4.51 4.83 0.76 NA NA 9.94 10.26 090
27709 .... .......... A Incision of tibia & fibula ........................................ 17.32 NA NA 9.99 8.60 1.74 NA NA 29.05 27.66 090
27712 .... .......... A Realignment of lower leg ..................................... 15.67 NA NA 9.23 10.36 2.48 NA NA 27.38 28.51 090
10:50 Nov 30, 2006

27715 .... .......... A Revision of lower leg ............................................ 15.36 NA NA 9.06 10.34 2.50 NA NA 26.92 28.20 090
27720 .... .......... A Repair of tibia ....................................................... 12.22 NA NA 8.00 9.05 2.05 NA NA 22.27 23.32 090
27722 .... .......... A Repair/graft of tibia ............................................... 12.31 NA NA 8.10 8.87 2.06 NA NA 22.47 23.24 090
27724 .... .......... A Repair/graft of tibia ............................................... 19.18 NA NA 10.38 11.87 3.17 NA NA 32.73 34.22 090
27725 .... .......... A Repair of lower leg ............................................... 17.15 NA NA 10.63 11.59 2.72 NA NA 30.50 31.46 090
Jkt 211001
27727 .... .......... A Repair of lower leg ............................................... 14.69 NA NA 8.65 9.92 2.44 NA NA 25.78 27.05 090
27730 .... .......... A Repair of tibia epiphysis ....................................... 7.59 NA NA 5.32 6.15 1.73 NA NA 14.64 15.47 090
27732 .... .......... A Repair of fibula epiphysis ..................................... 5.37 NA NA 4.69 4.87 0.77 NA NA 10.83 11.01 090
27734 .... .......... A Repair lower leg epiphyses .................................. 8.72 NA NA 6.22 6.27 1.35 NA NA 16.29 16.34 090
PO 00000
27740 .... .......... A Repair of leg epiphyses ....................................... 9.49 NA NA 6.67 7.66 1.62 NA NA 17.78 18.77 090
27742 .... .......... A Repair of leg epiphyses ....................................... 10.49 NA NA 5.93 5.65 1.80 NA NA 18.22 17.94 090
27745 .... .......... A Reinforce tibia ...................................................... 10.37 NA NA 7.04 7.89 1.76 NA NA 19.17 20.02 090
27750 .... .......... A Treatment of tibia fracture .................................... 3.26 4.32 4.65 3.74 3.82 0.55 8.13 8.46 7.55 7.63 090
Frm 00209
27752 .... .......... A Treatment of tibia fracture .................................... 6.15 5.98 6.48 5.15 5.54 1.01 13.14 13.64 12.31 12.70 090
27756 .... .......... A Treatment of tibia fracture .................................... 7.33 NA NA 5.78 6.29 1.17 NA NA 14.28 14.79 090
Fmt 4701
27760 .... .......... A Treatment of ankle fracture .................................. 3.09 4.29 4.58 3.69 3.62 0.48 7.86 8.15 7.26 7.19 090
27766 .... .......... A Treatment of ankle fracture .................................. 8.73 NA NA 6.31 6.99 1.44 NA NA 16.48 17.16 090
27780 .... .......... A Treatment of fibula fracture .................................. 2.72 3.89 4.11 3.33 3.24 0.41 7.02 7.24 6.46 6.37 090
Sfmt 4700
27781 .... .......... A Treatment of fibula fracture .................................. 4.47 4.97 5.36 4.35 4.57 0.73 10.17 10.56 9.55 9.77 090
27784 .... .......... A Treatment of fibula fracture .................................. 7.41 NA NA 5.63 6.26 1.23 NA NA 14.27 14.90 090
E:\FR\FM\01DER2.SGM
27824 .... .......... A Treat lower leg fracture ........................................ 3.20 3.74 3.98 3.55 3.56 0.45 7.39 7.63 7.20 7.21 090
01DER2
27825 .... .......... A Treat lower leg fracture ........................................ 6.60 5.88 6.42 4.86 5.25 1.02 13.50 14.04 12.48 12.87 090
27826 .... .......... A Treat lower leg fracture ........................................ 8.97 NA NA 7.03 8.37 1.47 NA NA 17.47 18.81 090
27829 .... .......... A Treat lower leg joint ............................................. 5.68 NA NA 5.53 6.47 0.95 NA NA 12.16 13.10 090
27830 .... .......... A Treat lower leg dislocation ................................... 3.85 4.31 4.37 3.76 3.83 0.54 8.70 8.76 8.15 8.22 090
69831
Year
69832
Year Year
2007 2007 Fully Im-
VerDate Aug<31>2005
RVUs cility Total
RVUs
27831 .... .......... A Treat lower leg dislocation ................................... 4.62 NA NA 4.01 4.35 0.73 NA NA 9.36 9.70 090
27832 .... .......... A Treat lower leg dislocation ................................... 6.67 NA NA 4.77 5.82 1.03 NA NA 12.47 13.52 090
27840 .... .......... A Treat ankle dislocation ......................................... 4.65 NA NA 3.64 3.73 0.46 NA NA 8.75 8.84 090
10:50 Nov 30, 2006

27860 .... .......... A Fixation of ankle joint ........................................... 2.36 NA NA 1.70 1.91 0.39 NA NA 4.45 4.66 010
27870 .... .......... A Fusion of ankle joint, open ................................... 15.21 NA NA 9.24 10.20 2.37 NA NA 26.82 27.78 090
Jkt 211001
27871 .... .......... A Fusion of tibiofibular joint ..................................... 9.42 NA NA 6.55 7.32 1.59 NA NA 17.56 18.33 090
27880 .... .......... A Amputation of lower leg ....................................... 15.24 NA NA 6.77 7.04 1.76 NA NA 23.77 24.04 090
PO 00000
27888 .... .......... A Amputation of foot at ankle .................................. 10.23 NA NA 6.27 7.19 1.51 NA NA 18.01 18.93 090
27889 .... .......... A Amputation of foot at ankle .................................. 10.72 NA NA 5.33 6.19 1.46 NA NA 17.51 18.37 090
Frm 00210
27892 .... .......... A Decompression of leg .......................................... 7.82 NA NA 4.87 5.41 1.10 NA NA 13.79 14.33 090
27899 .... .......... C Leg/ankle surgery procedure ............................... 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 YYY
Fmt 4701
28001 .... .......... A Drainage of bursa of foot ..................................... 2.75 4.05 3.25 1.65 1.88 0.33 7.13 6.33 4.73 4.96 010
28002 .... .......... A Treatment of foot infection ................................... 5.78 6.78 5.44 3.66 3.74 0.61 13.17 11.83 10.05 10.13 010
28003 .... .......... A Treatment of foot infection ................................... 8.95 7.88 6.64 4.67 5.08 1.12 17.95 16.71 14.74 15.15 090
28005 .... .......... A Treat foot bone lesion .......................................... 9.30 NA NA 5.55 5.92 1.16 NA NA 16.01 16.38 090
Sfmt 4700
28008 .... .......... A Incision of foot fascia ........................................... 4.50 6.24 4.97 3.06 3.17 0.57 11.31 10.04 8.13 8.24 090
28010 .... .......... A Incision of toe tendon ........................................... 2.89 2.90 2.50 2.38 2.37 0.36 6.15 5.75 5.63 5.62 090
28011 .... .......... A Incision of toe tendons ......................................... 4.19 3.86 3.44 3.09 3.25 0.59 8.64 8.22 7.87 8.03 090
28020 .... .......... A Exploration of foot joint ........................................ 5.06 7.57 6.40 3.71 4.03 0.72 13.35 12.18 9.49 9.81 090
28022 .... .......... A Exploration of foot joint ........................................ 4.72 6.95 5.63 3.37 3.73 0.62 12.29 10.97 8.71 9.07 090
28024 .... .......... A Exploration of toe joint ......................................... 4.43 6.71 5.59 3.22 3.75 0.58 11.72 10.60 8.23 8.76 090
28035 .... .......... A Decompression of tibia nerve .............................. 5.14 7.51 6.27 3.71 4.00 0.70 13.35 12.11 9.55 9.84 090
28043 .... .......... A Excision of foot lesion .......................................... 3.58 4.85 4.07 2.79 3.08 0.46 8.89 8.11 6.83 7.12 090
28045 .... .......... A Excision of foot lesion .......................................... 4.77 7.13 5.81 3.33 3.53 0.63 12.53 11.21 8.73 8.93 090
E:\FR\FM\01DER2.SGM
28046 .... .......... A Resection of tumor, foot ....................................... 10.55 10.52 9.20 5.91 6.33 1.36 22.43 21.11 17.82 18.24 090
28050 .... .......... A Biopsy of foot joint lining ...................................... 4.30 6.92 5.40 3.30 3.52 0.60 11.82 10.30 8.20 8.42 090
28052 .... .......... A Biopsy of foot joint lining ...................................... 3.98 6.47 5.30 2.98 3.32 0.53 10.98 9.81 7.49 7.83 090
28054 .... .......... A Biopsy of toe joint lining ....................................... 3.49 6.25 5.10 2.81 3.13 0.46 10.20 9.05 6.76 7.08 090
01DER2
28055 .... .......... A Neurectomy, foot .................................................. 6.20 NA NA 3.53 3.62 0.74 NA NA 10.47 10.56 090
28060 .... .......... A Partial removal, foot fascia .................................. 5.29 7.20 5.90 3.64 3.81 0.70 13.19 11.89 9.63 9.80 090
28062 .... .......... A Removal of foot fascia ......................................... 6.58 7.94 6.87 3.92 3.99 0.83 15.35 14.28 11.33 11.40 090
28070 .... .......... A Removal of foot joint lining .................................. 5.15 7.28 5.73 3.52 3.74 0.73 13.16 11.61 9.40 9.62 090
28072 .... .......... A Removal of foot joint lining .................................. 4.63 7.64 6.05 3.67 4.14 0.68 12.95 11.36 8.98 9.45 090
28080 .... .......... A Removal of foot lesion ......................................... 4.65 7.74 5.77 4.26 3.83 0.47 12.86 10.89 9.38 8.95 090
Year Year Year
2007 2007 Fully Im-
VerDate Aug<31>2005
RVUs cility Total
RVUs
28086 .... .......... A Excise foot tendon sheath ................................... 4.83 7.83 7.94 3.82 4.47 0.76 13.42 13.53 9.41 10.06 090
28088 .... .......... A Excise foot tendon sheath ................................... 3.90 7.00 6.06 3.21 3.72 0.61 11.51 10.57 7.72 8.23 090
10:50 Nov 30, 2006

28092 .... .......... A Removal of toe lesions ........................................ 3.69 6.55 5.55 3.05 3.40 0.49 10.73 9.73 7.23 7.58 090
28100 .... .......... A Removal of ankle/heel lesion ............................... 5.72 8.25 8.03 4.12 4.55 0.82 14.79 14.57 10.66 11.09 090
28102 .... .......... A Remove/graft foot lesion ...................................... 7.80 NA NA 5.01 5.71 1.14 NA NA 13.95 14.65 090
Jkt 211001
28107 .... .......... A Remove/graft foot lesion ...................................... 5.62 7.90 6.87 3.80 4.10 0.74 14.26 13.23 10.16 10.46 090
28108 .... .......... A Removal of toe lesions ........................................ 4.21 6.43 5.05 3.05 3.20 0.53 11.17 9.79 7.79 7.94 090
28110 .... .......... A Part removal of metatarsal ................................... 4.13 7.02 5.66 3.13 3.20 0.54 11.69 10.33 7.80 7.87 090
PO 00000
28114 .... .......... A Removal of metatarsal heads .............................. 11.61 13.43 12.07 8.37 8.37 1.42 26.46 25.10 21.40 21.40 090
Frm 00211
28116 .... .......... A Revision of foot .................................................... 8.94 9.60 7.49 5.47 5.25 1.03 19.57 17.46 15.44 15.22 090
28118 .... .......... A Removal of heel bone .......................................... 6.02 8.00 6.68 4.09 4.28 0.84 14.86 13.54 10.95 11.14 090
28119 .... .......... A Removal of heel spur ........................................... 5.45 7.30 5.89 3.65 3.70 0.70 13.45 12.04 9.80 9.85 090
28120 .... .......... A Part removal of ankle/heel ................................... 5.64 8.14 7.50 4.02 4.31 0.77 14.55 13.91 10.43 10.72 090
Fmt 4701
28122 .... .......... A Partial removal of foot bone ................................. 7.56 8.60 7.27 4.89 5.17 0.98 17.14 15.81 13.43 13.71 090
28124 .... .......... A Partial removal of toe ........................................... 4.88 6.85 5.46 3.52 3.62 0.60 12.33 10.94 9.00 9.10 090
28130 .... .......... A Removal of ankle bone ........................................ 9.30 NA NA 5.96 6.52 1.26 NA NA 16.52 17.08 090
Sfmt 4700
28140 .... .......... A Removal of metatarsal ......................................... 7.03 7.91 7.39 4.20 4.62 0.92 15.86 15.34 12.15 12.57 090
28150 .... .......... A Removal of toe ..................................................... 4.14 6.47 5.24 3.06 3.23 0.53 11.14 9.91 7.73 7.90 090
28171 .... .......... A Extensive foot surgery ......................................... 9.85 NA NA 5.43 5.42 1.33 NA NA 16.61 16.60 090
28173 .... .......... A Extensive foot surgery ......................................... 9.05 8.89 7.92 4.75 5.08 1.12 19.06 18.09 14.92 15.25 090
28175 .... .......... A Extensive foot surgery ......................................... 6.17 7.22 6.08 3.70 3.70 0.73 14.12 12.98 10.60 10.60 090
28190 .... .......... A Removal of foot foreign body ............................... 1.98 4.03 3.55 1.36 1.45 0.22 6.23 5.75 3.56 3.65 010
E:\FR\FM\01DER2.SGM
28200 .... .......... A Repair of foot tendon ........................................... 4.65 6.95 5.56 3.29 3.49 0.61 12.21 10.82 8.55 8.75 090
28202 .... .......... A Repair/graft of foot tendon ................................... 6.96 8.05 7.42 4.14 4.40 0.91 15.92 15.29 12.01 12.27 090
28208 .... .......... A Repair of foot tendon ........................................... 4.42 6.73 5.29 3.23 3.28 0.58 11.73 10.29 8.23 8.28 090
01DER2
28210 .... .......... A Repair/graft of foot tendon ................................... 6.41 7.61 6.56 3.96 4.01 0.81 14.83 13.78 11.18 11.23 090
28220 .... .......... A Release of foot tendon ......................................... 4.58 6.47 5.12 3.13 3.35 0.57 11.62 10.27 8.28 8.50 090
28222 .... .......... A Release of foot tendons ....................................... 5.67 6.97 5.67 3.39 3.94 0.69 13.33 12.03 9.75 10.30 090
28225 .... .......... A Release of foot tendon ......................................... 3.70 6.09 4.73 2.78 2.87 0.46 10.25 8.89 6.94 7.03 090
28226 .... .......... A Release of foot tendons ....................................... 4.58 7.03 5.35 3.36 3.65 0.58 12.19 10.51 8.52 8.81 090
28230 .... .......... A Incision of foot tendon(s) ..................................... 4.28 6.35 5.09 2.94 3.49 0.55 11.18 9.92 7.77 8.32 090
69833
Year
69834
Year Year
2007 2007 Fully Im-
VerDate Aug<31>2005
RVUs cility Total
RVUs
28232 .... .......... A Incision of toe tendon ........................................... 3.43 5.99 4.89 2.72 3.16 0.44 9.86 8.76 6.59 7.03 090
28234 .... .......... A Incision of foot tendon .......................................... 3.43 6.33 5.09 3.09 3.29 0.44 10.20 8.96 6.96 7.16 090
28238 .... .......... A Revision of foot tendon ........................................ 7.85 8.43 7.54 4.43 4.81 1.06 17.34 16.45 13.34 13.72 090
10:50 Nov 30, 2006

28240 .... .......... A Release of big toe ................................................ 4.40 6.48 5.09 3.04 3.37 0.58 11.46 10.07 8.02 8.35 090
28250 .... .......... A Revision of foot fascia .......................................... 5.97 7.50 6.09 3.82 4.05 0.82 14.29 12.88 10.61 10.84 090
28260 .... .......... A Release of midfoot joint ....................................... 8.08 8.68 6.91 4.79 4.94 1.14 17.90 16.13 14.01 14.16 090
28261 .... .......... A Revision of foot tendon ........................................ 12.91 10.85 9.17 6.50 7.10 1.57 25.33 23.65 20.98 21.58 090
28262 .... .......... A Revision of foot and ankle ................................... 17.01 15.61 14.07 9.85 10.65 2.60 35.22 33.68 29.46 30.26 090
Jkt 211001
28264 .... .......... A Release of midfoot joint ....................................... 10.53 10.49 8.42 6.11 6.99 1.54 22.56 20.49 18.18 19.06 090
28270 .... .......... A Release of foot contracture .................................. 4.82 6.99 5.42 3.51 3.68 0.62 12.43 10.86 8.95 9.12 090
28272 .... .......... A Release of toe joint, each .................................... 3.84 5.89 4.61 2.70 2.81 0.46 10.19 8.91 7.00 7.11 090
28280 .... .......... A Fusion of toes ...................................................... 5.24 7.41 6.53 3.63 4.27 0.73 13.38 12.50 9.60 10.24 090
PO 00000
28285 .... .......... A Repair of hammertoe ........................................... 4.65 6.78 5.34 3.41 3.42 0.59 12.02 10.58 8.65 8.66 090
28286 .... .......... A Repair of hammertoe ........................................... 4.61 6.56 5.23 3.10 3.21 0.57 11.74 10.41 8.28 8.39 090
28288 .... .......... A Partial removal of foot bone ................................. 5.81 8.70 6.62 4.78 4.86 0.65 15.16 13.08 11.24 11.32 090
28289 .... .......... A Repair hallux rigidus ............................................ 8.11 9.53 8.37 5.44 5.68 1.02 18.66 17.50 14.57 14.81 090
Frm 00212
28290 .... .......... A Correction of bunion ............................................. 5.72 8.24 6.75 4.02 4.55 0.82 14.78 13.29 10.56 11.09 090
Fmt 4701
Sfmt 4700
28300 .... .......... A Incision of heel bone ............................................ 9.61 NA NA 6.15 6.81 1.54 NA NA 17.30 17.96 090
28302 .... .......... A Incision of ankle bone .......................................... 9.62 NA NA 5.81 6.61 1.42 NA NA 16.85 17.65 090
28304 .... .......... A Incision of midfoot bones ..................................... 9.29 9.61 8.36 5.16 5.59 1.27 20.17 18.92 15.72 16.15 090
28305 .... .......... A Incise/graft midfoot bones .................................... 10.63 NA NA 5.70 6.47 1.27 NA NA 17.60 18.37 090
28306 .... .......... A Incision of metatarsal ........................................... 5.91 8.39 7.22 3.91 4.11 0.84 15.14 13.97 10.66 10.86 090
28309 .... .......... A Incision of metatarsals ......................................... 13.96 NA NA 7.85 7.93 2.05 NA NA 23.86 23.94 090
28310 .... .......... A Revision of big toe ............................................... 5.48 7.57 6.20 3.46 3.53 0.70 13.75 12.38 9.64 9.71 090
E:\FR\FM\01DER2.SGM
28312 .... .......... A Revision of toe ..................................................... 4.60 7.42 5.93 3.28 3.54 0.63 12.65 11.16 8.51 8.77 090
28313 .... .......... A Repair deformity of toe ........................................ 5.06 7.39 5.80 3.70 4.55 0.73 13.18 11.59 9.49 10.34 090
28315 .... .......... A Removal of sesamoid bone ................................. 4.91 6.76 5.36 3.30 3.32 0.63 12.30 10.90 8.84 8.86 090
28320 .... .......... A Repair of foot bones ............................................ 9.25 NA NA 5.83 6.49 1.43 NA NA 16.51 17.17 090
01DER2
28322 .... .......... A Repair of metatarsals ........................................... 8.41 10.03 9.39 5.53 6.13 1.27 19.71 19.07 15.21 15.81 090
28340 .... .......... A Resect enlarged toe tissue .................................. 7.04 8.13 6.86 4.14 4.22 0.84 16.01 14.74 12.02 12.10 090
28341 .... .......... A Resect enlarged toe ............................................. 8.60 8.75 7.39 4.55 4.75 1.01 18.36 17.00 14.16 14.36 090
28344 .... .......... A Repair extra toe(s) ............................................... 4.31 6.80 6.01 3.20 3.52 0.51 11.62 10.83 8.02 8.34 090
28345 .... .......... A Repair webbed toe(s) ........................................... 5.98 7.83 6.60 3.94 4.50 0.80 14.61 13.38 10.72 11.28 090
28360 .... .......... A Reconstruct cleft foot ........................................... 14.67 NA NA 6.32 9.45 2.29 NA NA 23.28 26.41 090
Year Year Year
2007 2007 Fully Im-
VerDate Aug<31>2005
RVUs cility Total
RVUs
28400 .... .......... A Treatment of heel fracture ................................... 2.22 3.39 3.57 2.94 3.02 0.35 5.96 6.14 5.51 5.59 090
28405 .... .......... A Treatment of heel fracture ................................... 4.63 4.55 4.76 3.79 4.41 0.73 9.91 10.12 9.15 9.77 090
28406 .... .......... A Treatment of heel fracture ................................... 6.44 NA NA 5.70 6.52 1.11 NA NA 13.25 14.07 090
10:50 Nov 30, 2006

28415 .... .......... A Treat heel fracture ................................................ 17.54 NA NA 10.98 12.71 2.67 NA NA 31.19 32.92 090
28420 .... .......... A Treat/graft heel fracture ....................................... 17.07 NA NA 10.26 12.25 2.81 NA NA 30.14 32.13 090
Jkt 211001
28445 .... .......... A Treat ankle fracture .............................................. 17.07 NA NA 9.80 10.72 2.59 NA NA 29.46 30.38 090
28450 .... .......... A Treat midfoot fracture, each ................................. 1.95 2.94 3.07 2.44 2.46 0.28 5.17 5.30 4.67 4.69 090
28455 .... .......... A Treat midfoot fracture, each ................................. 3.15 3.70 3.49 3.07 3.33 0.44 7.29 7.08 6.66 6.92 090
28456 .... .......... A Treat midfoot fracture ........................................... 2.75 NA NA 3.63 4.02 0.44 NA NA 6.82 7.21 090
PO 00000
28465 .... .......... A Treat midfoot fracture, each ................................. 7.13 NA NA 5.10 6.01 1.10 NA NA 13.33 14.24 090
28470 .... .......... A Treat metatarsal fracture ...................................... 1.99 2.82 3.05 2.38 2.43 0.30 5.11 5.34 4.67 4.72 090
28475 .... .......... A Treat metatarsal fracture ...................................... 2.97 3.18 3.29 2.56 3.05 0.44 6.59 6.70 5.97 6.46 090
28476 .... .......... A Treat metatarsal fracture ...................................... 3.46 NA NA 4.36 4.83 0.54 NA NA 8.36 8.83 090
Frm 00213
28485 .... .......... A Treat metatarsal fracture ...................................... 5.77 NA NA 4.60 5.23 0.83 NA NA 11.20 11.83 090
28490 .... .......... A Treat big toe fracture ........................................... 1.12 2.11 2.04 1.69 1.65 0.14 3.37 3.30 2.95 2.91 090
Fmt 4701
28510 .... .......... A Treatment of toe fracture ..................................... 1.12 1.69 1.57 1.62 1.55 0.14 2.95 2.83 2.88 2.81 090
28515 .... .......... A Treatment of toe fracture ..................................... 1.50 2.26 1.98 1.85 1.88 0.18 3.94 3.66 3.53 3.56 090
28525 .... .......... A Treat toe fracture ................................................. 3.37 6.89 7.36 2.93 3.31 0.49 10.75 11.22 6.79 7.17 090
Sfmt 4700
28530 .... .......... A Treat sesamoid bone fracture .............................. 1.08 1.65 1.49 1.36 1.42 0.14 2.87 2.71 2.58 2.64 090
28531 .... .......... A Treat sesamoid bone fracture .............................. 2.51 5.84 6.91 2.15 2.08 0.34 8.69 9.76 5.00 4.93 090
28540 .... .......... A Treat foot dislocation ............................................ 2.10 2.80 2.50 2.35 2.39 0.26 5.16 4.86 4.71 4.75 090
28555 .... .......... A Repair foot dislocation ......................................... 6.42 9.82 9.88 5.00 5.50 1.04 17.28 17.34 12.46 12.96 090
28576 .... .......... A Treat foot dislocation ............................................ 4.48 NA NA 4.03 4.14 0.69 NA NA 9.20 9.31 090
E:\FR\FM\01DER2.SGM
28585 .... .......... A Repair foot dislocation ......................................... 8.17 9.96 7.98 5.33 5.71 1.25 19.38 17.40 14.75 15.13 090
28606 .... .......... A Treat foot dislocation ............................................ 4.97 NA NA 4.33 4.60 0.82 NA NA 10.12 10.39 090
01DER2
28615 .... .......... A Repair foot dislocation ......................................... 8.96 NA NA 7.02 7.79 1.30 NA NA 17.28 18.05 090
28630 .... .......... A Treat toe dislocation ............................................. 1.72 1.96 1.67 0.96 0.99 0.20 3.88 3.59 2.88 2.91 010
28645 .... .......... A Repair toe dislocation .......................................... 4.27 6.89 5.44 3.23 3.26 0.57 11.73 10.28 8.07 8.10 090
69835
Year
69836
Year Year
2007 2007 Fully Im-
VerDate Aug<31>2005
RVUs cility Total
RVUs
28666 .... .......... A Treat toe dislocation ............................................. 2.66 NA NA 1.93 2.42 0.43 NA NA 5.02 5.51 010
28675 .... .......... A Repair of toe dislocation ...................................... 2.97 6.70 7.03 2.88 3.23 0.45 10.12 10.45 6.30 6.65 090
10:50 Nov 30, 2006

28705 .... .......... A Fusion of foot bones ............................................ 20.12 NA NA 10.85 12.04 3.09 NA NA 34.06 35.25 090
Jkt 211001
28737 .... .......... A Revision of foot bones ......................................... 10.83 NA NA 6.18 6.65 1.47 NA NA 18.48 18.95 090
28740 .... .......... A Fusion of foot bones ............................................ 9.09 10.97 10.89 6.10 6.37 1.22 21.28 21.20 16.41 16.68 090
28750 .... .......... A Fusion of big toe joint .......................................... 8.37 10.88 11.65 5.99 6.49 1.13 20.38 21.15 15.49 15.99 090
PO 00000
28800 .... .......... A Amputation of midfoot .......................................... 8.65 NA NA 5.11 5.62 1.15 NA NA 14.91 15.42 090
28805 .... .......... A Amputation thru metatarsal .................................. 12.55 NA NA 6.04 5.74 1.18 NA NA 19.77 19.47 090
28810 .... .......... A Amputation toe & metatarsal ............................... 6.52 NA NA 4.13 4.39 0.86 NA NA 11.51 11.77 090
Frm 00214
28820 .... .......... A Amputation of toe ................................................. 4.89 7.73 7.60 3.61 3.74 0.61 13.23 13.10 9.11 9.24 090
28825 .... .......... A Partial amputation of toe ...................................... 3.71 7.20 7.04 3.17 3.40 0.50 11.41 11.25 7.38 7.61 090
28890 .... .......... A High energy eswt, plantar f .................................. 3.36 4.79 5.48 2.34 2.15 0.41 8.56 9.25 6.11 5.92 090
28899 .... .......... C Foot/toes surgery procedure ................................ 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 YYY
Fmt 4701
29000 .... .......... A Application of body cast ....................................... 2.25 4.73 3.40 1.85 1.76 0.41 7.39 6.06 4.51 4.42 000
Sfmt 4700
29049 .... .......... A Application of figure eight .................................... 0.89 1.12 1.26 0.60 0.55 0.13 2.14 2.28 1.62 1.57 000
29055 .... .......... A Application of shoulder cast ................................. 1.78 2.90 2.96 1.31 1.43 0.30 4.98 5.04 3.39 3.51 000
29058 .... .......... A Application of shoulder cast ................................. 1.31 1.25 1.48 0.69 0.71 0.17 2.73 2.96 2.17 2.19 000
29065 .... .......... A Application of long arm cast ................................ 0.87 1.27 1.32 0.70 0.74 0.15 2.29 2.34 1.72 1.76 000
E:\FR\FM\01DER2.SGM
29075 .... .......... A Application of forearm cast .................................. 0.77 1.23 1.25 0.66 0.68 0.13 2.13 2.15 1.56 1.58 000
29085 .... .......... A Apply hand/wrist cast ........................................... 0.87 1.26 1.28 0.69 0.65 0.14 2.27 2.29 1.70 1.66 000
29086 .... .......... A Apply finger cast .................................................. 0.62 1.03 0.98 0.53 0.50 0.07 1.72 1.67 1.22 1.19 000
29105 .... .......... A Apply long arm splint ........................................... 0.87 1.09 1.20 0.53 0.52 0.12 2.08 2.19 1.52 1.51 000
01DER2
29125 .... .......... A Apply forearm splint ............................................. 0.59 0.96 1.01 0.43 0.40 0.07 1.62 1.67 1.09 1.06 000
29126 .... .......... A Apply forearm splint ............................................. 0.77 1.01 1.16 0.48 0.47 0.07 1.85 2.00 1.32 1.31 000
29130 .... .......... A Application of finger splint .................................... 0.50 0.43 0.46 0.19 0.18 0.06 0.99 1.02 0.75 0.74 000
29131 .... .......... A Application of finger splint .................................... 0.55 0.62 0.71 0.26 0.25 0.03 1.20 1.29 0.84 0.83 000
29200 .... .......... A Strapping of chest ................................................ 0.65 0.61 0.69 0.35 0.34 0.04 1.30 1.38 1.04 1.03 000
29220 .... .......... A Strapping of low back .......................................... 0.64 0.61 0.69 0.35 0.38 0.04 1.29 1.37 1.03 1.06 000
Year Year Year
2007 2007 Fully Im-
VerDate Aug<31>2005
RVUs cility Total
RVUs
29240 .... .......... A Strapping of shoulder ........................................... 0.71 0.67 0.81 0.39 0.37 0.06 1.44 1.58 1.16 1.14 000
29260 .... .......... A Strapping of elbow or wrist .................................. 0.55 0.65 0.72 0.36 0.33 0.05 1.25 1.32 0.96 0.93 000
29280 .... .......... A Strapping of hand or finger .................................. 0.51 0.66 0.77 0.37 0.33 0.03 1.20 1.31 0.91 0.87 000
10:50 Nov 30, 2006

29305 .... .......... A Application of hip cast .......................................... 2.03 3.37 3.35 1.61 1.72 0.35 5.75 5.73 3.99 4.10 000
29325 .... .......... A Application of hip casts ........................................ 2.32 3.67 3.57 1.75 1.90 0.40 6.39 6.29 4.47 4.62 000
29345 .... .......... A Application of long leg cast .................................. 1.40 1.66 1.74 0.95 1.03 0.24 3.30 3.38 2.59 2.67 000
29358 .... .......... A Apply long leg cast brace .................................... 1.43 2.04 2.06 0.94 1.05 0.25 3.72 3.74 2.62 2.73 000
Jkt 211001
29405 .... .......... A Apply short leg cast ............................................. 0.86 1.20 1.22 0.66 0.70 0.14 2.20 2.22 1.66 1.70 000
PO 00000
29440 .... .......... A Addition of walker to cast ..................................... 0.57 0.62 0.67 0.25 0.27 0.08 1.27 1.32 0.90 0.92 000
29445 .... .......... A Apply rigid leg cast ............................................... 1.78 1.62 1.76 0.94 0.96 0.27 3.67 3.81 2.99 3.01 000
29450 .... .......... A Application of leg cast .......................................... 2.08 1.54 1.49 0.88 1.04 0.27 3.89 3.84 3.23 3.39 000
29505 .... .......... A Application, long leg splint ................................... 0.69 1.06 1.15 0.45 0.45 0.08 1.83 1.92 1.22 1.22 000
Frm 00215
29515 .... .......... A Application lower leg splint .................................. 0.73 0.96 0.89 0.46 0.46 0.09 1.78 1.71 1.28 1.28 000
29520 .... .......... A Strapping of hip .................................................... 0.54 0.67 0.81 0.38 0.45 0.03 1.24 1.38 0.95 1.02 000
29530 .... .......... A Strapping of knee ................................................. 0.57 0.64 0.75 0.36 0.34 0.05 1.26 1.37 0.98 0.96 000
29540 .... .......... A Strapping of ankle and/or ft ................................. 0.51 0.55 0.45 0.32 0.31 0.06 1.12 1.02 0.89 0.88 000
Fmt 4701
29550 .... .......... A Strapping of toes .................................................. 0.47 0.57 0.46 0.31 0.29 0.06 1.10 0.99 0.84 0.82 000
29580 .... .......... A Application of paste boot ..................................... 0.55 0.72 0.67 0.34 0.35 0.07 1.34 1.29 0.96 0.97 000
29590 .... .......... A Application of foot splint ....................................... 0.76 0.61 0.54 0.27 0.29 0.09 1.46 1.39 1.12 1.14 000
29700 .... .......... A Removal/revision of cast ...................................... 0.57 0.96 0.91 0.26 0.28 0.08 1.61 1.56 0.91 0.93 000
Sfmt 4700
29720 .... .......... A Repair of body cast .............................................. 0.68 1.14 1.16 0.34 0.38 0.12 1.94 1.96 1.14 1.18 000
29730 .... .......... A Windowing of cast ................................................ 0.75 0.75 0.80 0.35 0.35 0.12 1.62 1.67 1.22 1.22 000
29740 .... .......... A Wedging of cast ................................................... 1.12 1.05 1.13 0.49 0.49 0.18 2.35 2.43 1.79 1.79 000
29750 .... .......... A Wedging of clubfoot cast ..................................... 1.26 0.92 1.03 0.45 0.55 0.21 2.39 2.50 1.92 2.02 000
29799 .... .......... C Casting/strapping procedure ................................ 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 YYY
29800 .... .......... A Jaw arthroscopy/surgery ...................................... 6.73 NA NA 4.96 6.47 0.99 NA NA 12.68 14.19 090
E:\FR\FM\01DER2.SGM
29804 .... .......... A Jaw arthroscopy/surgery ...................................... 8.71 NA NA 5.70 7.14 1.38 NA NA 15.79 17.23 090
29805 .... .......... A Shoulder arthroscopy, dx ..................................... 5.94 NA NA 4.75 5.44 1.02 NA NA 11.71 12.40 090
29806 .... .......... A Shoulder arthroscopy/surgery .............................. 14.95 NA NA 9.45 10.73 2.50 NA NA 26.90 28.18 090
01DER2
69837
Year
69838
Year Year
2007 2007 Fully Im-
VerDate Aug<31>2005
RVUs cility Total
RVUs
29827 .... .......... A Arthroscop rotator cuff repr .................................. 15.44 NA NA 9.43 11.01 2.67 NA NA 27.54 29.12 090
10:50 Nov 30, 2006

29830 .... .......... A Elbow arthroscopy ................................................ 5.80 NA NA 4.53 5.14 0.99 NA NA 11.32 11.93 090
29834 .... .......... A Elbow arthroscopy/surgery ................................... 6.33 NA NA 4.89 5.60 1.08 NA NA 12.30 13.01 090
Jkt 211001
29840 .... .......... A Wrist arthroscopy ................................................. 5.59 NA NA 4.66 5.16 0.84 NA NA 11.09 11.59 090
29843 .... .......... A Wrist arthroscopy/surgery .................................... 6.06 NA NA 4.95 5.45 0.92 NA NA 11.93 12.43 090
PO 00000
29848 .... .......... A Wrist endoscopy/surgery ...................................... 6.24 NA NA 5.33 5.53 0.86 NA NA 12.43 12.63 090
Frm 00216
29850 .... .......... A Knee arthroscopy/surgery .................................... 8.18 NA NA 5.26 5.10 1.25 NA NA 14.69 14.53 090
29855 .... .......... A Tibial arthroscopy/surgery .................................... 10.60 NA NA 7.38 8.42 1.85 NA NA 19.83 20.87 090
29856 .... .......... A Tibial arthroscopy/surgery .................................... 14.12 NA NA 8.76 10.19 2.40 NA NA 25.28 26.71 090
Fmt 4701
29860 .... .......... A Hip arthroscopy, dx .............................................. 8.85 NA NA 6.25 6.78 1.36 NA NA 16.46 16.99 090
29861 .... .......... A Hip arthroscopy/surgery ....................................... 9.95 NA NA 6.66 7.17 1.59 NA NA 18.20 18.71 090
Sfmt 4700
29866 .... .......... A Autgrft implnt, knee w/scope ................................ 14.48 NA NA 9.57 10.91 2.40 NA NA 26.45 27.79 090
29867 .... .......... A Allgrft implnt, knee w/scope ................................. 18.18 NA NA 11.28 12.74 2.79 NA NA 32.25 33.71 090
29868 .... .......... A Meniscal trnspl, knee w/scpe ............................... 24.89 NA NA 14.00 16.09 4.36 NA NA 43.25 45.34 090
29870 .... .......... A Knee arthroscopy, dx ........................................... 5.11 NA NA 4.19 4.72 0.85 NA NA 10.15 10.68 090
29871 .... .......... A Knee arthroscopy/drainage .................................. 6.60 NA NA 5.04 5.66 1.14 NA NA 12.78 13.40 090
E:\FR\FM\01DER2.SGM
01DER2
Year Year Year
2007 2007 Fully Im-
VerDate Aug<31>2005
RVUs cility Total
RVUs
29891 .... .......... A Ankle arthroscopy/surgery ................................... 9.47 NA NA 6.72 7.31 1.39 NA NA 17.58 18.17 090
10:50 Nov 30, 2006

29893 .... .......... A Scope, plantar fasciotomy .................................... 6.08 8.90 6.94 4.73 4.18 0.63 15.61 13.65 11.44 10.89 090
Jkt 211001
29900 .... .......... A Mcp joint arthroscopy, dx ..................................... 5.74 NA NA 4.80 5.60 0.94 NA NA 11.48 12.28 090
29901 .... .......... A Mcp joint arthroscopy, surg .................................. 6.45 NA NA 5.57 6.09 1.06 NA NA 13.08 13.60 090
PO 00000
29902 .... .......... A Mcp joint arthroscopy, surg .................................. 7.02 NA NA 3.68 5.83 1.12 NA NA 11.82 13.97 090
29999 .... .......... C Arthroscopy of joint .............................................. 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 YYY
30000 .... .......... A Drainage of nose lesion ....................................... 1.45 3.72 3.98 1.24 1.35 0.12 5.29 5.55 2.81 2.92 010
30020 .... .......... A Drainage of nose lesion ....................................... 1.45 3.87 3.42 1.28 1.42 0.12 5.44 4.99 2.85 2.99 010
Frm 00217
30100 .... .......... A Intranasal biopsy .................................................. 0.94 2.42 2.08 0.70 0.79 0.07 3.43 3.09 1.71 1.80 000
30110 .... .......... A Removal of nose polyp(s) .................................... 1.65 3.64 3.34 1.34 1.51 0.14 5.43 5.13 3.13 3.30 010
30115 .... .......... A Removal of nose polyp(s) .................................... 4.38 NA NA 5.51 5.70 0.41 NA NA 10.30 10.49 090
30117 .... .......... A Removal of intranasal lesion ................................ 3.20 16.92 14.09 4.55 4.61 0.26 20.38 17.55 8.01 8.07 090
Fmt 4701
30118 .... .......... A Removal of intranasal lesion ................................ 9.81 NA NA 7.85 8.86 0.78 NA NA 18.44 19.45 090
30120 .... .......... A Revision of nose .................................................. 5.31 6.92 6.60 4.97 5.74 0.52 12.75 12.43 10.80 11.57 090
30124 .... .......... A Removal of nose lesion ....................................... 3.14 NA NA 3.66 3.62 0.25 NA NA 7.05 7.01 090
30125 .... .......... A Removal of nose lesion ....................................... 7.21 NA NA 7.03 8.00 0.63 NA NA 14.87 15.84 090
Sfmt 4700
30130 .... .......... A Excise inferior turbinate ....................................... 3.41 NA NA 5.31 5.52 0.31 NA NA 9.03 9.24 090
30140 .... .......... A Resect inferior turbinate ....................................... 3.48 NA NA 6.58 6.29 0.35 NA NA 10.41 10.12 090
30150 .... .......... A Partial removal of nose ........................................ 9.44 NA NA 8.64 10.42 0.93 NA NA 19.01 20.79 090
30160 .... .......... A Removal of nose .................................................. 9.88 NA NA 8.21 9.71 0.88 NA NA 18.97 20.47 090
30200 .... .......... A Injection treatment of nose .................................. 0.78 1.88 1.69 0.62 0.71 0.06 2.72 2.53 1.46 1.55 000
30210 .... .......... A Nasal sinus therapy ............................................. 1.10 2.32 2.16 1.17 1.28 0.09 3.51 3.35 2.36 2.47 010
30220 .... .......... A Insert nasal septal button ..................................... 1.56 5.41 4.53 1.31 1.48 0.12 7.09 6.21 2.99 3.16 010
30300 .... .......... A Remove nasal foreign body ................................. 1.06 4.13 4.51 1.79 1.88 0.08 5.27 5.65 2.93 3.02 010
30310 .... .......... A Remove nasal foreign body ................................. 1.98 NA NA 2.73 3.01 0.16 NA NA 4.87 5.15 010
E:\FR\FM\01DER2.SGM
30320 .... .......... A Remove nasal foreign body ................................. 4.56 NA NA 5.98 6.78 0.39 NA NA 10.93 11.73 090
30400 .... .......... R Reconstruction of nose ........................................ 10.58 NA NA 13.80 15.07 1.04 NA NA 25.42 26.69 090
01DER2
30430 .... .......... R Revision of nose .................................................. 7.96 NA NA 12.87 15.23 0.77 NA NA 21.60 23.96 090
30460 .... .......... A Revision of nose .................................................. 10.24 NA NA 7.24 9.27 1.03 NA NA 18.51 20.54 090
30462 .... .......... A Revision of nose .................................................. 20.12 NA NA 14.54 18.82 2.54 NA NA 37.20 41.48 090
30465 .... .......... A Repair nasal stenosis ........................................... 12.20 NA NA 10.39 11.58 1.06 NA NA 23.65 24.84 090
69839
Year
69840
Year Year
2007 2007 Fully Im-
VerDate Aug<31>2005
RVUs cility Total
RVUs
30520 .... .......... A Repair of nasal septum ........................................ 6.85 NA NA 7.42 6.85 0.46 NA NA 14.73 14.16 090
30540 .... .......... A Repair nasal defect .............................................. 7.81 NA NA 7.06 8.72 0.67 NA NA 15.54 17.20 090
30545 .... .......... A Repair nasal defect .............................................. 11.50 NA NA 10.15 11.46 1.71 NA NA 23.36 24.67 090
10:50 Nov 30, 2006

30560 .... .......... A Release of nasal adhesions ................................. 1.28 4.94 4.81 1.88 2.07 0.10 6.32 6.19 3.26 3.45 010
30580 .... .......... A Repair upper jaw fistula ....................................... 6.76 8.19 7.88 4.75 5.53 0.89 15.84 15.53 12.40 13.18 090
30600 .... .......... A Repair mouth/nose fistula .................................... 6.07 7.52 7.52 4.10 4.79 0.70 14.29 14.29 10.87 11.56 090
30620 .... .......... A Intranasal reconstruction ...................................... 6.04 NA NA 8.15 8.66 0.57 NA NA 14.76 15.27 090
30630 .... .......... A Repair nasal septum defect ................................. 7.18 NA NA 7.13 7.75 0.61 NA NA 14.92 15.54 090
Jkt 211001
30801 .... .......... A Ablate inf turbinate, superf ................................... 1.11 4.02 4.10 1.97 1.93 0.09 5.22 5.30 3.17 3.13 010
30802 .... .......... A Cauterization, inner nose ..................................... 2.05 4.62 4.61 2.32 2.35 0.16 6.83 6.82 4.53 4.56 010
30901 .... .......... A Control of nosebleed ............................................ 1.21 1.21 1.32 0.29 0.31 0.11 2.53 2.64 1.61 1.63 000
PO 00000
30906 .... .......... A Repeat control of nosebleed ................................ 2.45 3.98 3.91 0.68 1.07 0.20 6.63 6.56 3.33 3.72 000
30915 .... .......... A Ligation, nasal sinus artery .................................. 7.36 NA NA 5.88 6.49 0.58 NA NA 13.82 14.43 090
30920 .... .......... A Ligation, upper jaw artery .................................... 11.03 NA NA 8.23 8.79 0.80 NA NA 20.06 20.62 090
Frm 00218
30930 .... .......... A Ther fx, nasal inf turbinate ................................... 1.28 NA NA 1.53 1.60 0.12 NA NA 2.93 3.00 010
30999 .... .......... C Nasal surgery procedure ...................................... 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 YYY
31000 .... .......... A Irrigation, maxillary sinus ..................................... 1.17 3.01 2.88 1.25 1.36 0.09 4.27 4.14 2.51 2.62 010
31002 .... .......... A Irrigation, sphenoid sinus ..................................... 1.93 NA NA 2.52 3.06 0.15 NA NA 4.60 5.14 010
Fmt 4701
31020 .... .......... A Exploration, maxillary sinus ................................. 2.99 8.07 8.42 5.19 5.18 0.29 11.35 11.70 8.47 8.46 090
31030 .... .......... A Exploration, maxillary sinus ................................. 5.95 9.79 11.07 6.05 6.51 0.60 16.34 17.62 12.60 13.06 090
31032 .... .......... A Explore sinus, remove polyps .............................. 6.61 NA NA 6.53 7.06 0.59 NA NA 13.73 14.26 090
31040 .... .......... A Exploration behind upper jaw .............................. 9.66 NA NA 7.30 9.19 0.87 NA NA 17.83 19.72 090
Sfmt 4700
31050 .... .......... A Exploration, sphenoid sinus ................................. 5.31 NA NA 6.17 6.31 0.49 NA NA 11.97 12.11 090
31051 .... .......... A Sphenoid sinus surgery ....................................... 7.16 NA NA 7.74 8.12 0.62 NA NA 15.52 15.90 090
31070 .... .......... A Exploration of frontal sinus .................................. 4.32 NA NA 5.73 5.88 0.38 NA NA 10.43 10.58 090
31075 .... .......... A Exploration of frontal sinus .................................. 9.40 NA NA 8.59 9.45 0.75 NA NA 18.74 19.60 090
31080 .... .......... A Removal of frontal sinus ...................................... 12.54 NA NA 10.47 12.77 1.23 NA NA 24.24 26.54 090
E:\FR\FM\01DER2.SGM
31090 .... .......... A Exploration of sinuses .......................................... 10.88 NA NA 12.38 12.51 0.94 NA NA 24.20 24.33 090
31200 .... .......... A Removal of ethmoid sinus ................................... 5.03 NA NA 7.45 8.77 0.29 NA NA 12.77 14.09 090
01DER2
31225 .... .......... A Removal of upper jaw .......................................... 26.44 NA NA 16.55 17.50 1.59 NA NA 44.58 45.53 090
31230 .... .......... A Removal of upper jaw .......................................... 30.56 NA NA 17.27 18.84 1.78 NA NA 49.61 51.18 090
31231 .... .......... A Nasal endoscopy, dx ............................................ 1.10 3.34 3.37 0.70 0.84 0.09 4.53 4.56 1.89 2.03 000
31233 .... .......... A Nasal/sinus endoscopy, dx .................................. 2.18 3.95 4.21 1.02 1.37 0.20 6.33 6.59 3.40 3.75 000
31235 .... .......... A Nasal/sinus endoscopy, dx .................................. 2.64 4.30 4.76 1.15 1.58 0.26 7.20 7.66 4.05 4.48 000
Year Year Year
2007 2007 Fully Im-
VerDate Aug<31>2005
RVUs cility Total
RVUs
31237 .... .......... A Nasal/sinus endoscopy, surg ............................... 2.98 4.53 5.03 1.25 1.72 0.28 7.79 8.29 4.51 4.98 000
31238 .... .......... A Nasal/sinus endoscopy, surg ............................... 3.26 4.46 5.04 1.34 1.90 0.27 7.99 8.57 4.87 5.43 000
31239 .... .......... A Nasal/sinus endoscopy, surg ............................... 9.23 NA NA 6.34 7.59 0.62 NA NA 16.19 17.44 010
10:50 Nov 30, 2006

31254 .... .......... A Revision of ethmoid sinus .................................... 4.64 NA NA 1.74 2.57 0.45 NA NA 6.83 7.66 000
31256 .... .......... A Exploration maxillary sinus .................................. 3.29 NA NA 1.34 1.92 0.33 NA NA 4.96 5.54 000
31267 .... .......... A Endoscopy, maxillary sinus .................................. 5.45 NA NA 1.98 2.96 0.55 NA NA 7.98 8.96 000
Jkt 211001
31276 .... .......... A Sinus endoscopy, surgical ................................... 8.84 NA NA 2.97 4.58 0.92 NA NA 12.73 14.34 000
PO 00000
Frm 00219
31299 .... .......... C Sinus surgery procedure ...................................... 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 YYY
31300 .... .......... A Removal of larynx lesion ...................................... 15.71 NA NA 13.59 14.63 1.17 NA NA 30.47 31.51 090
31320 .... .......... A Diagnostic incision, larynx .................................... 5.62 NA NA 9.20 10.03 0.46 NA NA 15.28 16.11 090
31360 .... .......... A Removal of larynx ................................................ 29.57 NA NA 18.32 17.12 1.38 NA NA 49.27 48.07 090
Fmt 4701
31365 .... .......... A Removal of larynx ................................................ 38.47 NA NA 20.91 20.50 1.98 NA NA 61.36 60.95 090
31367 .... .......... A Partial removal of larynx ...................................... 30.23 NA NA 20.48 21.54 1.79 NA NA 52.50 53.56 090
Sfmt 4700
31390 .... .......... A Removal of larynx & pharynx ............................... 42.17 NA NA 23.64 24.20 2.24 NA NA 68.05 68.61 090
31395 .... .......... A Reconstruct larynx & pharynx .............................. 43.46 NA NA 25.96 27.72 2.49 NA NA 71.91 73.67 090
31400 .... .......... A Revision of larynx ................................................. 11.48 NA NA 11.54 13.21 0.83 NA NA 23.85 25.52 090
31420 .... .......... A Removal of epiglottis ............................................ 11.32 NA NA 7.94 9.14 0.83 NA NA 20.09 21.29 090
31500 .... .......... A Insert emergency airway ...................................... 2.33 NA NA 0.44 0.52 0.17 NA NA 2.94 3.02 000
31502 .... .......... A Change of windpipe airway .................................. 0.65 NA NA 0.20 0.26 0.05 NA NA 0.90 0.96 000
E:\FR\FM\01DER2.SGM
31505 .... .......... A Diagnostic laryngoscopy ...................................... 0.61 1.34 1.42 0.55 0.60 0.05 2.00 2.08 1.21 1.26 000
31510 .... .......... A Laryngoscopy with biopsy .................................... 1.92 2.98 3.22 0.92 1.17 0.16 5.06 5.30 3.00 3.25 000
31511 .... .......... A Remove foreign body, larynx ............................... 2.16 2.76 3.03 0.95 1.03 0.19 5.11 5.38 3.30 3.38 000
31512 .... .......... A Removal of larynx lesion ...................................... 2.07 2.73 3.08 0.97 1.26 0.18 4.98 5.33 3.22 3.51 000
01DER2
31513 .... .......... A Injection into vocal cord ....................................... 2.10 NA NA 0.99 1.34 0.17 NA NA 3.26 3.61 000
31515 .... .......... A Laryngoscopy for aspiration ................................. 1.80 3.07 3.42 0.85 1.01 0.14 5.01 5.36 2.79 2.95 000
31520 .... .......... A Dx laryngoscopy, newborn ................................... 2.56 NA NA 1.11 1.45 0.20 NA NA 3.87 4.21 000
31525 .... .......... A Dx laryngoscopy excl nb ...................................... 2.63 3.24 3.54 1.13 1.53 0.21 6.08 6.38 3.97 4.37 000
31526 .... .......... A Dx laryngoscopy w/oper scope ............................ 2.57 NA NA 1.13 1.57 0.21 NA NA 3.91 4.35 000
31527 .... .......... A Laryngoscopy for treatment ................................. 3.27 NA NA 1.31 1.73 0.26 NA NA 4.84 5.26 000
69841
Year
69842
Year Year
2007 2007 Fully Im-
VerDate Aug<31>2005
RVUs cility Total
RVUs
31528 .... .......... A Laryngoscopy and dilation ................................... 2.37 NA NA 0.99 1.34 0.19 NA NA 3.55 3.90 000
31529 .... .......... A Laryngoscopy and dilation ................................... 2.68 NA NA 1.12 1.56 0.22 NA NA 4.02 4.46 000
31530 .... .......... A Laryngoscopy w/fb removal ................................. 3.38 NA NA 1.32 1.79 0.29 NA NA 4.99 5.46 000
10:50 Nov 30, 2006

31531 .... .......... A Laryngoscopy w/fb & op scope ............................ 3.58 NA NA 1.43 2.06 0.29 NA NA 5.30 5.93 000
31535 .... .......... A Laryngoscopy w/biopsy ........................................ 3.16 NA NA 1.30 1.82 0.26 NA NA 4.72 5.24 000
31536 .... .......... A Laryngoscopy w/bx & op scope ........................... 3.55 NA NA 1.42 2.04 0.29 NA NA 5.26 5.88 000
31540 .... .......... A Laryngoscopy w/exc of tumor .............................. 4.12 NA NA 1.59 2.30 0.33 NA NA 6.04 6.75 000
31541 .... .......... A Larynscop w/tumr exc + scope ............................ 4.52 NA NA 1.70 2.51 0.37 NA NA 6.59 7.40 000
Jkt 211001
31545 .... .......... A Remove vc lesion w/scope .................................. 6.30 NA NA 2.26 3.17 0.37 NA NA 8.93 9.84 000
31546 .... .......... A Remove vc lesion scope/graft .............................. 9.73 NA NA 3.77 4.67 0.78 NA NA 14.28 15.18 000
31560 .... .......... A Laryngoscop w/arytenoidectom ........................... 5.45 NA NA 1.92 2.84 0.43 NA NA 7.80 8.72 000
31561 .... .......... A Larynscop, remve cart + scop ............................. 5.99 NA NA 2.08 3.05 0.49 NA NA 8.56 9.53 000
PO 00000
31570 .... .......... A Laryngoscope w/vc inj .......................................... 3.86 3.96 5.24 1.51 2.16 0.31 8.13 9.41 5.68 6.33 000
31571 .... .......... A Laryngoscop w/vc inj + scope .............................. 4.26 NA NA 1.63 2.36 0.35 NA NA 6.24 6.97 000
31576 .... .......... A Laryngoscopy with biopsy .................................... 1.97 3.28 3.57 0.96 1.21 0.14 5.39 5.68 3.07 3.32 000
Frm 00220
31577 .... .......... A Remove foreign body, larynx ............................... 2.47 3.23 3.63 1.11 1.43 0.21 5.91 6.31 3.79 4.11 000
31578 .... .......... A Removal of larynx lesion ...................................... 2.84 3.68 4.13 1.21 1.44 0.23 6.75 7.20 4.28 4.51 000
Fmt 4701
31584 .... .......... A Treat larynx fracture ............................................. 20.35 NA NA 14.32 17.19 1.72 NA NA 36.39 39.26 090
Sfmt 4700
31590 .... .......... A Reinnervate larynx ............................................... 7.63 NA NA 12.10 14.67 0.84 NA NA 20.57 23.14 090
31595 .... .......... A Larynx nerve surgery ........................................... 8.75 NA NA 8.94 10.15 0.68 NA NA 18.37 19.58 090
31599 .... .......... C Larynx surgery procedure .................................... 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 YYY
31600 .... .......... A Incision of windpipe .............................................. 7.17 NA NA 2.22 2.95 0.80 NA NA 10.19 10.92 000
31611 .... .......... A Surgery/speech prosthesis ................................... 5.92 NA NA 6.50 6.92 0.46 NA NA 12.88 13.30 090
E:\FR\FM\01DER2.SGM
31612 .... .......... A Puncture/clear windpipe ....................................... 0.91 1.07 1.09 0.25 0.33 0.08 2.06 2.08 1.24 1.32 000
31613 .... .......... A Repair windpipe opening ..................................... 4.63 NA NA 5.80 5.94 0.42 NA NA 10.85 10.99 090
31614 .... .......... A Repair windpipe opening ..................................... 8.47 NA NA 8.90 8.76 0.58 NA NA 17.95 17.81 090
31615 .... .......... A Visualization of windpipe ...................................... 2.09 2.22 2.50 0.96 1.14 0.16 4.47 4.75 3.21 3.39 000
01DER2
31620 .... .......... A Endobronchial us add-on ..................................... 1.40 6.00 5.73 0.35 0.50 0.11 7.51 7.24 1.86 2.01 ZZZ
31622 .... .......... A Dx bronchoscope/wash ........................................ 2.78 5.23 5.55 0.91 1.02 0.18 8.19 8.51 3.87 3.98 000
31623 .... .......... A Dx bronchoscope/brush ....................................... 2.88 6.01 6.32 0.92 1.02 0.13 9.02 9.33 3.93 4.03 000
31624 .... .......... A Dx bronchoscope/lavage ...................................... 2.88 5.36 5.67 0.92 1.02 0.13 8.37 8.68 3.93 4.03 000
31625 .... .......... A Bronchoscopy w/biopsy(s) ................................... 3.36 5.50 5.73 1.04 1.17 0.18 9.04 9.27 4.58 4.71 000
31628 .... .......... A Bronchoscopy/lung bx, each ................................ 3.80 7.00 7.02 1.14 1.26 0.18 10.98 11.00 5.12 5.24 000
Year Year Year
2007 2007 Fully Im-
VerDate Aug<31>2005
RVUs cility Total
RVUs
31629 .... .......... A Bronchoscopy/needle bx, each ............................ 4.09 12.05 13.70 1.21 1.35 0.16 16.30 17.95 5.46 5.60 000
31630 .... .......... A Bronchoscopy dilate/fx repr ................................. 3.81 NA NA 1.26 1.61 0.32 NA NA 5.39 5.74 000
31631 .... .......... A Bronchoscopy, dilate w/stent ............................... 4.36 NA NA 1.41 1.67 0.34 NA NA 6.11 6.37 000
10:50 Nov 30, 2006

31632 .... .......... A Bronchoscopy/lung bx, add’l ................................ 1.03 0.87 0.83 0.25 0.30 0.18 2.08 2.04 1.46 1.51 ZZZ
31633 .... .......... A Bronchoscopy/needle bx add’l ............................. 1.32 1.00 0.94 0.32 0.38 0.16 2.48 2.42 1.80 1.86 ZZZ
31635 .... .......... A Bronchoscopy w/fb removal ................................. 3.67 5.19 5.88 1.15 1.36 0.24 9.10 9.79 5.06 5.27 000
31636 .... .......... A Bronchoscopy, bronch stents ............................... 4.30 NA NA 1.38 1.67 0.31 NA NA 5.99 6.28 000
31637 .... .......... A Bronchoscopy, stent add-on ................................ 1.58 NA NA 0.42 0.53 0.13 NA NA 2.13 2.24 ZZZ
Jkt 211001
31638 .... .......... A Bronchoscopy, revise stent .................................. 4.88 NA NA 1.56 1.87 0.22 NA NA 6.66 6.97 000
31640 .... .......... A Bronchoscopy w/tumor excise ............................. 4.93 NA NA 1.54 1.94 0.46 NA NA 6.93 7.33 000
31641 .... .......... A Bronchoscopy, treat blockage .............................. 5.02 NA NA 1.51 1.79 0.35 NA NA 6.88 7.16 000
31643 .... .......... A Diag bronchoscope/catheter ................................ 3.49 NA NA 1.07 1.19 0.20 NA NA 4.76 4.88 000
PO 00000
31645 .... .......... A Bronchoscopy, clear airways ............................... 3.16 4.76 5.05 0.99 1.09 0.16 8.08 8.37 4.31 4.41 000
31646 .... .......... A Bronchoscopy, reclear airway .............................. 2.72 4.47 4.76 0.88 0.97 0.14 7.33 7.62 3.74 3.83 000
31656 .... .......... A Bronchoscopy, inj for x-ray .................................. 2.17 5.27 6.79 0.65 0.79 0.15 7.59 9.11 2.97 3.11 000
31715 .... .......... A Injection for bronchus x-ray ................................. 1.11 NA NA 0.28 0.33 0.07 NA NA 1.46 1.51 000
Frm 00221
31717 .... .......... A Bronchial brush biopsy ......................................... 2.12 5.83 7.65 0.77 0.79 0.14 8.09 9.91 3.03 3.05 000
31720 .... .......... A Clearance of airways ........................................... 1.06 NA NA 0.26 0.31 0.07 NA NA 1.39 1.44 000
31725 .... .......... A Clearance of airways ........................................... 1.96 NA NA 0.45 0.55 0.14 NA NA 2.55 2.65 000
31730 .... .......... A Intro, windpipe wire/tube ...................................... 2.85 25.35 7.98 0.74 0.94 0.21 28.41 11.04 3.80 4.00 000
Fmt 4701
31750 .... .......... A Repair of windpipe ............................................... 15.19 NA NA 16.21 17.22 1.05 NA NA 32.45 33.46 090
31766 .... .......... A Reconstruction of windpipe .................................. 31.58 NA NA 11.46 13.10 4.53 NA NA 47.57 49.21 090
Sfmt 4700
31770 .... .......... A Repair/graft of bronchus ...................................... 23.48 NA NA 8.80 9.88 2.84 NA NA 35.12 36.20 090
31775 .... .......... A Reconstruct bronchus .......................................... 24.51 NA NA 8.91 11.07 3.02 NA NA 36.44 38.60 090
31780 .... .......... A Reconstruct windpipe ........................................... 19.70 NA NA 8.12 10.32 1.65 NA NA 29.47 31.67 090
31781 .... .......... A Reconstruct windpipe ........................................... 24.77 NA NA 9.28 11.41 2.25 NA NA 36.30 38.43 090
31785 .... .......... A Remove windpipe lesion ...................................... 18.29 NA NA 5.60 9.04 1.59 NA NA 25.48 28.92 090
31786 .... .......... A Remove windpipe lesion ...................................... 25.34 NA NA 9.79 12.27 3.30 NA NA 38.43 40.91 090
31800 .... .......... A Repair of windpipe injury ..................................... 8.10 NA NA 8.33 9.01 0.79 NA NA 17.22 17.90 090
31805 .... .......... A Repair of windpipe injury ..................................... 13.34 NA NA 6.32 6.99 1.83 NA NA 21.49 22.16 090
31820 .... .......... A Closure of windpipe lesion ................................... 4.58 5.46 5.61 3.02 3.49 0.38 10.42 10.57 7.98 8.45 090
E:\FR\FM\01DER2.SGM
31825 .... .......... A Repair of windpipe defect .................................... 6.98 6.85 7.46 4.08 5.05 0.53 14.36 14.97 11.59 12.56 090
31830 .... .......... A Revise windpipe scar ........................................... 4.54 5.62 5.73 3.37 3.83 0.44 10.60 10.71 8.35 8.81 090
31899 .... .......... C Airways surgical procedure .................................. 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 YYY
32000 .... .......... A Drainage of chest ................................................. 1.54 2.30 2.86 0.41 0.46 0.08 3.92 4.48 2.03 2.08 000
01DER2
32002 .... .......... A Treatment of collapsed lung ................................ 2.19 2.73 3.09 0.94 1.03 0.12 5.04 5.40 3.25 3.34 000
32005 .... .......... A Treat lung lining chemically ................................. 2.19 5.04 6.10 0.59 0.67 0.23 7.46 8.52 3.01 3.09 000
32019 .... .......... A Insert pleural catheter .......................................... 4.17 15.15 18.76 1.42 1.59 0.42 19.74 23.35 6.01 6.18 000
32020 .... .......... A Insertion of chest tube ......................................... 3.29 NA NA 0.94 1.25 0.43 NA NA 4.66 4.97 000
32035 .... .......... A Exploration of chest ............................................. 11.20 NA NA 6.07 5.91 1.26 NA NA 18.53 18.37 090
69843
Year
69844
Year Year
2007 2007 Fully Im-
VerDate Aug<31>2005
RVUs cility Total
RVUs
32095 .... .......... A Biopsy through chest wall .................................... 10.06 NA NA 5.19 5.32 1.22 NA NA 16.47 16.60 090
32100 .... .......... A Exploration/biopsy of chest .................................. 16.08 NA NA 7.06 7.63 2.24 NA NA 25.38 25.95 090
32110 .... .......... A Explore/repair chest ............................................. 25.15 NA NA 9.99 10.55 3.22 NA NA 38.36 38.92 090
10:50 Nov 30, 2006

32120 .... .......... A Re-exploration of chest ........................................ 14.27 NA NA 6.88 7.02 1.63 NA NA 22.78 22.92 090
32124 .... .......... A Explore chest free adhesions .............................. 15.33 NA NA 7.05 7.17 1.90 NA NA 24.28 24.40 090
32140 .... .......... A Removal of lung lesion(s) .................................... 16.54 NA NA 7.44 7.62 1.97 NA NA 25.95 26.13 090
32141 .... .......... A Remove/treat lung lesions ................................... 27.10 NA NA 10.34 8.25 2.01 NA NA 39.45 37.36 090
32150 .... .......... A Removal of lung lesion(s) .................................... 16.70 NA NA 7.50 7.58 2.01 NA NA 26.21 26.29 090
Jkt 211001
32151 .... .......... A Remove lung foreign body ................................... 16.82 NA NA 8.75 8.19 2.04 NA NA 27.61 27.05 090
32160 .... .......... A Open chest heart massage .................................. 13.02 NA NA 5.86 5.41 1.31 NA NA 20.19 19.74 090
32200 .... .......... A Drain, open, lung lesion ....................................... 18.48 NA NA 8.77 8.65 2.14 NA NA 29.39 29.27 090
32201 .... .......... A Drain, percut, lung lesion ..................................... 3.99 18.73 20.21 1.13 1.26 0.24 22.96 24.44 5.36 5.49 000
PO 00000
32215 .... .......... A Treat chest lining .................................................. 12.93 NA NA 6.39 6.77 1.69 NA NA 21.01 21.39 090
32220 .... .......... A Release of lung .................................................... 26.41 NA NA 12.07 12.73 3.57 NA NA 42.05 42.71 090
32225 .... .......... A Partial release of lung .......................................... 16.63 NA NA 7.51 7.62 2.07 NA NA 26.21 26.32 090
32310 .... .......... A Removal of chest lining ........................................ 15.16 NA NA 6.94 7.28 2.00 NA NA 24.10 24.44 090
Frm 00222
32320 .... .......... A Free/remove chest lining ...................................... 27.04 NA NA 11.58 12.01 3.52 NA NA 42.14 42.57 090
32400 .... .......... A Needle biopsy chest lining ................................... 1.76 2.01 2.09 0.48 0.53 0.10 3.87 3.95 2.34 2.39 000
32402 .... .......... A Open biopsy chest lining ...................................... 8.89 NA NA 4.78 5.03 1.07 NA NA 14.74 14.99 090
32405 .... .......... A Biopsy, lung or mediastinum ................................ 1.93 0.55 0.64 0.55 0.61 0.11 2.59 2.68 2.59 2.65 000
Fmt 4701
32420 .... .......... A Puncture/clear lung .............................................. 2.18 NA NA 0.61 0.66 0.12 NA NA 2.91 2.96 000
32440 .... .......... A Removal of lung ................................................... 27.17 NA NA 11.08 12.44 3.69 NA NA 41.94 43.30 090
32442 .... .......... A Sleeve pneumonectomy ....................................... 56.37 NA NA 18.56 15.71 3.85 NA NA 78.78 75.93 090
32445 .... .......... A Removal of lung ................................................... 63.60 NA NA 23.01 16.30 3.72 NA NA 90.33 83.62 090
Sfmt 4700
32480 .... .......... A Partial removal of lung ......................................... 25.71 NA NA 10.34 11.63 3.50 NA NA 39.55 40.84 090
32482 .... .......... A Bilobectomy .......................................................... 27.28 NA NA 11.17 12.48 3.67 NA NA 42.12 43.43 090
32484 .... .......... A Segmentectomy ................................................... 25.30 NA NA 9.64 10.95 3.04 NA NA 37.98 39.29 090
32486 .... .......... A Sleeve lobectomy ................................................. 42.80 NA NA 15.21 13.73 3.52 NA NA 61.53 60.05 090
32488 .... .......... A Completion pneumonectomy ............................... 42.83 NA NA 15.69 14.26 3.81 NA NA 62.33 60.90 090
32491 .... .......... R Lung volume reduction ......................................... 25.09 NA NA 10.65 12.13 2.99 NA NA 38.73 40.21 090
32500 .... .......... A Partial removal of lung ......................................... 24.48 NA NA 10.39 11.86 3.26 NA NA 38.13 39.60 090
32501 .... .......... A Repair bronchus add-on ...................................... 4.68 NA NA 1.37 1.50 0.65 NA NA 6.70 6.83 ZZZ
32503 .... .......... A Resect apical lung tumor ..................................... 31.61 NA NA 12.26 14.37 4.38 NA NA 48.25 50.36 090
E:\FR\FM\01DER2.SGM
32504 .... .......... A Resect apical lung tum/chest ............................... 36.41 NA NA 13.69 15.93 5.09 NA NA 55.19 57.43 090
32540 .... .......... A Removal of lung lesion ........................................ 30.22 NA NA 12.20 10.27 2.08 NA NA 44.50 42.57 090
32601 .... .......... A Thoracoscopy, diagnostic .................................... 5.45 NA NA 2.10 2.29 0.80 NA NA 8.35 8.54 000
01DER2
32650 .... .......... A Thoracoscopy, surgical ........................................ 10.77 NA NA 5.29 6.39 1.58 NA NA 17.64 18.74 090
Year Year Year
2007 2007 Fully Im-
VerDate Aug<31>2005
RVUs cility Total
RVUs
10:50 Nov 30, 2006

Jkt 211001
PO 00000
32800 .... .......... A Repair lung hernia ................................................ 15.59 NA NA 7.10 7.33 1.99 NA NA 24.68 24.91 090
32810 .... .......... A Close chest after drainage ................................... 14.83 NA NA 7.10 7.42 1.94 NA NA 23.87 24.19 090
Frm 00223
32815 .... .......... A Close bronchial fistula .......................................... 49.79 NA NA 18.95 12.97 3.28 NA NA 72.02 66.04 090
32820 .... .......... A Reconstruct injured chest .................................... 22.33 NA NA 11.82 12.08 2.53 NA NA 36.68 36.94 090
32850 .... .......... X Donor pneumonectomy ........................................ 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 XXX
32851 .... .......... A Lung transplant, single ......................................... 40.94 NA NA 20.90 25.97 5.58 NA NA 67.42 72.49 090
Fmt 4701
32852 .... .......... A Lung transplant with bypass ................................ 44.65 NA NA 23.73 30.80 6.02 NA NA 74.40 81.47 090
32853 .... .......... A Lung transplant, double ....................................... 50.11 NA NA 23.29 29.64 7.07 NA NA 80.47 86.82 090
32854 .... .......... A Lung transplant with bypass ................................ 53.88 NA NA 26.52 32.68 7.22 NA NA 87.62 93.78 090
32855 .... .......... C Prepare donor lung, single ................................... 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 XXX
Sfmt 4700
32856 .... .......... C Prepare donor lung, double ................................. 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 XXX
32900 .... .......... A Removal of rib(s) .................................................. 23.69 NA NA 9.79 9.86 2.94 NA NA 36.42 36.49 090
32905 .... .......... A Revise & repair chest wall ................................... 23.17 NA NA 9.62 10.00 3.16 NA NA 35.95 36.33 090
32906 .... .......... A Revise & repair chest wall ................................... 29.18 NA NA 11.32 11.88 3.98 NA NA 44.48 45.04 090
32940 .... .......... A Revision of lung ................................................... 21.22 NA NA 8.62 9.26 2.89 NA NA 32.73 33.37 090
32960 .... .......... A Therapeutic pneumothorax .................................. 1.84 1.53 1.68 0.63 0.58 0.16 3.53 3.68 2.63 2.58 000
32997 .... .......... A Total lung lavage .................................................. 7.31 NA NA 1.87 1.90 0.55 NA NA 9.73 9.76 000
32998 .... .......... A Perq rf ablate tx, pul tumor .................................. 5.68 68.64 68.64 1.77 1.77 0.36 74.68 74.68 7.81 7.81 000
32999 .... .......... C Chest surgery procedure ..................................... 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 YYY
E:\FR\FM\01DER2.SGM
33010 .... .......... A Drainage of heart sac .......................................... 2.24 NA NA 1.04 0.85 0.14 NA NA 3.42 3.23 000
33011 .... .......... A Repeat drainage of heart sac .............................. 2.24 NA NA 1.11 0.89 0.15 NA NA 3.50 3.28 000
33015 .... .......... A Incision of heart sac ............................................. 8.44 NA NA 5.05 4.98 0.65 NA NA 14.14 14.07 090
01DER2
33030 .... .......... A Partial removal of heart sac ................................. 22.27 NA NA 9.22 9.45 2.84 NA NA 34.33 34.56 090
33031 .... .......... A Partial removal of heart sac ................................. 25.30 NA NA 9.93 10.01 3.14 NA NA 38.37 38.45 090
33050 .... .......... A Removal of heart sac lesion ................................ 16.85 NA NA 7.58 7.78 2.15 NA NA 26.58 26.78 090
33120 .... .......... A Removal of heart lesion ....................................... 27.33 NA NA 10.75 11.37 3.70 NA NA 41.78 42.40 090
69845
Year
69846
Year Year
2007 2007 Fully Im-
VerDate Aug<31>2005
RVUs cility Total
RVUs
33140 .... .......... A Heart revascularize (tmr) ..................................... 28.26 NA NA 10.65 10.82 2.86 NA NA 41.77 41.94 090
33141 .... .......... A Heart tmr w/other procedure ................................ 2.54 NA NA 0.80 1.39 0.69 NA NA 4.03 4.62 ZZZ
33202 .... .......... A Insert epicard eltrd, open ..................................... 13.15 NA NA 6.22 6.22 1.71 NA NA 21.08 21.08 090
10:50 Nov 30, 2006

33203 .... .......... A Insert epicard eltrd, endo ..................................... 13.92 NA NA 6.29 6.29 1.39 NA NA 21.60 21.60 090
33206 .... .......... A Insertion of heart pacemaker ............................... 7.31 NA NA 5.19 4.64 0.52 NA NA 13.02 12.47 090
33210 .... .......... A Insertion of heart electrode .................................. 3.30 NA NA 1.73 1.37 0.18 NA NA 5.21 4.85 000
Jkt 211001
33211 .... .......... A Insertion of heart electrode .................................. 3.39 NA NA 1.69 1.41 0.21 NA NA 5.29 5.01 000
33212 .... .......... A Insertion of pulse generator ................................. 5.51 NA NA 3.77 3.46 0.43 NA NA 9.71 9.40 090
33213 .... .......... A Insertion of pulse generator ................................. 6.36 NA NA 4.30 3.87 0.45 NA NA 11.11 10.68 090
33214 .... .......... A Upgrade of pacemaker system ............................ 7.78 NA NA 5.44 5.03 0.58 NA NA 13.80 13.39 090
PO 00000
33215 .... .......... A Reposition pacing-defib lead ................................ 4.89 NA NA 3.55 3.27 0.37 NA NA 8.81 8.53 090
33216 .... .......... A Insert lead pace-defib, one .................................. 5.81 NA NA 4.63 4.31 0.36 NA NA 10.80 10.48 090
33217 .... .......... A Insert lead pace-defib, dual ................................. 5.78 NA NA 4.54 4.31 0.39 NA NA 10.71 10.48 090
33218 .... .......... A Repair lead pace-defib, one ................................. 5.97 NA NA 4.87 4.44 0.37 NA NA 11.21 10.78 090
Frm 00224
33220 .... .......... A Repair lead pace-defib, dual ................................ 6.05 NA NA 4.94 4.44 0.37 NA NA 11.36 10.86 090
33222 .... .......... A Revise pocket, pacemaker ................................... 5.01 NA NA 4.37 4.31 0.42 NA NA 9.80 9.74 090
33223 .... .......... A Revise pocket, pacing-defib ................................. 6.49 NA NA 5.02 4.70 0.45 NA NA 11.96 11.64 090
33224 .... .......... A Insert pacing lead & connect ............................... 9.04 NA NA 5.10 4.28 0.54 NA NA 14.68 13.86 000
Fmt 4701
33225 .... .......... A L ventric pacing lead add-on ............................... 8.33 NA NA 4.53 3.57 0.45 NA NA 13.31 12.35 ZZZ
33226 .... .......... A Reposition l ventric lead ....................................... 8.68 NA NA 4.94 4.10 0.59 NA NA 14.21 13.37 000
33233 .... .......... A Removal of pacemaker system ........................... 3.33 NA NA 3.33 3.29 0.22 NA NA 6.88 6.84 090
33234 .... .......... A Removal of pacemaker system ........................... 7.85 NA NA 5.58 5.08 0.56 NA NA 13.99 13.49 090
Sfmt 4700
33235 .... .......... A Removal pacemaker electrode ............................ 9.93 NA NA 7.41 6.96 0.73 NA NA 18.07 17.62 090
33236 .... .......... A Remove electrode/thoracotomy ........................... 12.64 NA NA 6.67 7.24 1.69 NA NA 21.00 21.57 090
33240 .... .......... A Insert pulse generator .......................................... 7.61 NA NA 5.41 4.79 0.41 NA NA 13.43 12.81 090
33241 .... .......... A Remove pulse generator ...................................... 3.26 NA NA 3.07 2.99 0.18 NA NA 6.51 6.43 090
33243 .... .......... A Remove eltrd/thoracotomy ................................... 23.42 NA NA 11.02 11.35 2.10 NA NA 36.54 36.87 090
33244 .... .......... A Remove eltrd, transven ........................................ 13.84 NA NA 9.66 9.08 0.99 NA NA 24.49 23.91 090
33249 .... .......... A Eltrd/insert pace-defib .......................................... 15.02 NA NA 10.47 8.89 0.77 NA NA 26.26 24.68 090
E:\FR\FM\01DER2.SGM
33250 .... .......... A Ablate heart dysrhythm focus .............................. 25.78 NA NA 10.12 10.80 3.19 NA NA 39.09 39.77 090
33254 .... .......... A Ablate atria, lmtd .................................................. 23.58 NA NA 9.94 9.94 3.35 NA NA 36.87 36.87 090
33255 .... .......... A Ablate atria w/o bypass, ext ................................. 28.91 NA NA 11.57 11.57 3.94 NA NA 44.42 44.42 090
01DER2
33256 .... .......... A Ablate atria w/bypass, exten ................................ 34.77 NA NA 13.37 13.37 4.95 NA NA 53.09 53.09 090
33265 .... .......... A Ablate atria w/bypass, endo ................................. 23.58 NA NA 9.94 9.94 3.35 NA NA 36.87 36.87 090
33266 .... .......... A Ablate atria w/o bypass endo .............................. 32.91 NA NA 12.80 12.80 4.80 NA NA 50.51 50.51 090
33282 .... .......... A Implant pat-active ht record ................................. 4.70 NA NA 4.33 4.10 0.23 NA NA 9.26 9.03 090
33284 .... .......... A Remove pat-active ht record ................................ 3.04 NA NA 3.42 3.50 0.14 NA NA 6.60 6.68 090
Year Year Year
2007 2007 Fully Im-
VerDate Aug<31>2005
RVUs cility Total
RVUs
33300 .... .......... A Repair of heart wound ......................................... 44.89 NA NA 15.61 10.83 2.66 NA NA 63.16 58.38 090
33305 .... .......... A Repair of heart wound ......................................... 76.85 NA NA 25.20 14.26 3.13 NA NA 105.18 94.24 090
33310 .... .......... A Exploratory heart surgery ..................................... 20.22 NA NA 8.80 9.39 2.59 NA NA 31.61 32.20 090
10:50 Nov 30, 2006

33315 .... .......... A Exploratory heart surgery ..................................... 26.05 NA NA 10.42 10.77 3.28 NA NA 39.75 40.10 090
33320 .... .......... A Repair major blood vessel(s) ............................... 18.46 NA NA 8.71 8.34 2.08 NA NA 29.25 28.88 090
33321 .... .......... A Repair major vessel ............................................. 20.71 NA NA 10.31 9.91 2.91 NA NA 33.93 33.53 090
33322 .... .......... A Repair major blood vessel(s) ............................... 24.30 NA NA 9.79 10.22 2.86 NA NA 36.95 37.38 090
33330 .... .......... A Insert major vessel graft ...................................... 25.17 NA NA 9.75 10.13 2.82 NA NA 37.74 38.12 090
Jkt 211001
33400 .... .......... A Repair of aortic valve ........................................... 41.37 NA NA 15.16 15.54 4.11 NA NA 60.64 61.02 090
33401 .... .......... A Valvuloplasty, open .............................................. 24.41 NA NA 9.76 12.57 3.57 NA NA 37.74 40.55 090
PO 00000
33403 .... .......... A Valvuloplasty, w/cp bypass .................................. 25.39 NA NA 10.48 13.35 3.55 NA NA 39.42 42.29 090
33404 .... .......... A Prepare heart-aorta conduit ................................. 31.25 NA NA 12.22 13.96 4.33 NA NA 47.80 49.54 090
33405 .... .......... A Replacement of aortic valve ................................ 41.19 NA NA 15.43 17.58 5.33 NA NA 61.95 64.10 090
Frm 00225
Fmt 4701
33415 .... .......... A Revision, subvalvular tissue ................................. 37.19 NA NA 12.96 12.26 4.14 NA NA 54.29 53.59 090
33416 .... .......... A Revise ventricle muscle ....................................... 36.43 NA NA 13.59 13.52 4.57 NA NA 54.59 54.52 090
Sfmt 4700
33420 .... .......... A Revision of mitral valve ........................................ 25.67 NA NA 8.98 9.42 1.82 NA NA 36.47 36.91 090
33425 .... .......... A Repair of mitral valve ........................................... 49.83 NA NA 17.90 14.26 4.07 NA NA 71.80 68.16 090
33430 .... .......... A Replacement of mitral valve ................................ 50.75 NA NA 18.97 17.71 5.10 NA NA 74.82 73.56 090
33460 .... .......... A Revision of tricuspid valve ................................... 44.62 NA NA 15.50 12.35 3.45 NA NA 63.57 60.42 090
33463 .... .......... A Valvuloplasty, tricuspid ......................................... 56.95 NA NA 19.76 14.62 3.87 NA NA 80.58 75.44 090
33464 .... .......... A Valvuloplasty, tricuspid ......................................... 44.49 NA NA 16.23 14.20 4.15 NA NA 64.87 62.84 090
E:\FR\FM\01DER2.SGM
33465 .... .......... A Replace tricuspid valve ........................................ 50.59 NA NA 17.77 14.16 4.39 NA NA 72.75 69.14 090
33468 .... .......... A Revision of tricuspid valve ................................... 32.82 NA NA 15.37 14.08 4.07 NA NA 52.26 50.97 090
33470 .... .......... A Revision of pulmonary valve ................................ 21.32 NA NA 8.70 10.19 1.03 NA NA 31.05 32.54 090
33471 .... .......... A Valvotomy, pulmonary valve ................................ 22.83 NA NA 7.69 9.24 3.39 NA NA 33.91 35.46 090
01DER2
33475 .... .......... A Replacement, pulmonary valve ............................ 42.27 NA NA 15.72 15.46 4.93 NA NA 62.92 62.66 090
33476 .... .......... A Revision of heart chamber ................................... 26.41 NA NA 11.43 11.83 2.42 NA NA 40.26 40.66 090
33496 .... .......... A Repair, prosth valve clot ...................................... 29.71 NA NA 11.47 12.42 4.13 NA NA 45.31 46.26 090
69847
Year
69848
Year Year
2007 2007 Fully Im-
VerDate Aug<31>2005
RVUs cility Total
RVUs
33500 .... .......... A Repair heart vessel fistula ................................... 27.82 NA NA 11.05 11.36 3.87 NA NA 42.74 43.05 090
33501 .... .......... A Repair heart vessel fistula ................................... 19.43 NA NA 8.27 8.28 1.91 NA NA 29.61 29.62 090
33502 .... .......... A Coronary artery correction ................................... 21.69 NA NA 9.27 10.62 3.00 NA NA 33.96 35.31 090
10:50 Nov 30, 2006

33503 .... .......... A Coronary artery graft ............................................ 22.29 NA NA 10.66 9.96 1.78 NA NA 34.73 34.03 090
33504 .... .......... A Coronary artery graft ............................................ 25.30 NA NA 10.14 11.39 3.36 NA NA 38.80 40.05 090
33505 .... .......... A Repair artery w/tunnel .......................................... 38.35 NA NA 12.28 12.75 2.19 NA NA 52.82 53.29 090
33506 .... .......... A Repair artery, translocation .................................. 37.80 NA NA 15.56 14.81 4.66 NA NA 58.02 57.27 090
33507 .... .......... A Repair art, intramural ........................................... 31.35 NA NA 11.76 13.17 4.06 NA NA 47.17 48.58 090
Jkt 211001
33508 .... .......... A Endoscopic vein harvest ...................................... 0.31 NA NA 0.10 0.10 0.04 NA NA 0.45 0.45 ZZZ
33510 .... .......... A CABG, vein, single ............................................... 34.87 NA NA 13.19 15.55 4.41 NA NA 52.47 54.83 090
33511 .... .......... A CABG, vein, two ................................................... 38.34 NA NA 14.46 16.42 4.56 NA NA 57.36 59.32 090
33512 .... .......... A CABG, vein, three ................................................ 43.87 NA NA 16.24 17.26 4.67 NA NA 64.78 65.80 090
PO 00000
33513 .... .......... A CABG, vein, four .................................................. 45.26 NA NA 16.82 17.54 4.88 NA NA 66.96 67.68 090
33514 .... .......... A CABG, vein, five ................................................... 47.97 NA NA 17.64 17.95 4.77 NA NA 70.38 70.69 090
33516 .... .......... A Cabg, vein, six or more ........................................ 49.65 NA NA 18.57 18.74 5.13 NA NA 73.35 73.52 090
33517 .... .......... A CABG, artery-vein, single .................................... 3.61 NA NA 1.11 0.91 0.39 NA NA 5.11 4.91 ZZZ
Frm 00226
33518 .... .......... A CABG, artery-vein, two ........................................ 7.93 NA NA 2.43 1.79 0.73 NA NA 11.09 10.45 ZZZ
33519 .... .......... A CABG, artery-vein, three ...................................... 10.49 NA NA 3.21 2.54 1.04 NA NA 14.74 14.07 ZZZ
33521 .... .......... A CABG, artery-vein, four ........................................ 12.59 NA NA 3.88 3.27 1.37 NA NA 17.84 17.23 ZZZ
33522 .... .......... A CABG, artery-vein, five ........................................ 14.14 NA NA 4.32 3.94 1.78 NA NA 20.24 19.86 ZZZ
Fmt 4701
33523 .... .......... A Cabg, art-vein, six or more .................................. 16.08 NA NA 4.96 4.64 2.13 NA NA 23.17 22.85 ZZZ
33530 .... .......... A Coronary artery, bypass/reop .............................. 10.13 NA NA 3.10 2.21 0.88 NA NA 14.11 13.22 ZZZ
33533 .... .......... A CABG, arterial, single .......................................... 33.64 NA NA 12.81 15.55 4.56 NA NA 51.01 53.75 090
33534 .... .......... A CABG, arterial, two .............................................. 39.77 NA NA 14.98 17.03 4.70 NA NA 59.45 61.50 090
Sfmt 4700
33535 .... .......... A CABG, arterial, three ............................................ 44.64 NA NA 16.61 17.75 5.03 NA NA 66.28 67.42 090
33536 .... .......... A Cabg, arterial, four or more ................................. 48.32 NA NA 17.55 18.11 5.44 NA NA 71.31 71.87 090
33545 .... .......... A Repair of heart damage ....................................... 56.93 NA NA 20.52 16.85 5.21 NA NA 82.66 78.99 090
33548 .... .......... A Restore/remodel, ventricle ................................... 53.96 NA NA 20.04 19.48 5.53 NA NA 79.53 78.97 090
33572 .... .......... A Open coronary endarterectomy ........................... 4.44 NA NA 1.34 1.42 0.65 NA NA 6.43 6.51 ZZZ
33600 .... .......... A Closure of valve ................................................... 30.15 NA NA 12.45 12.50 4.42 NA NA 47.02 47.07 090
33602 .... .......... A Closure of valve ................................................... 29.18 NA NA 13.60 12.73 3.82 NA NA 46.60 45.73 090
33606 .... .......... A Anastomosis/artery-aorta ..................................... 31.37 NA NA 12.10 13.28 4.41 NA NA 47.88 49.06 090
E:\FR\FM\01DER2.SGM
33608 .... .......... A Repair anomaly w/conduit .................................... 31.72 NA NA 13.40 13.93 4.74 NA NA 49.86 50.39 090
33610 .... .......... A Repair by enlargement ......................................... 31.24 NA NA 11.28 13.02 4.56 NA NA 47.08 48.82 090
33611 .... .......... A Repair double ventricle ........................................ 35.49 NA NA 12.57 13.74 4.37 NA NA 52.43 53.60 090
33612 .... .......... A Repair double ventricle ........................................ 36.49 NA NA 12.91 14.59 5.30 NA NA 54.70 56.38 090
01DER2
33615 .... .......... A Repair, modified fontan ........................................ 35.76 NA NA 12.53 12.99 4.32 NA NA 52.61 53.07 090
33617 .... .......... A Repair single ventricle .......................................... 38.96 NA NA 16.41 16.10 5.66 NA NA 61.03 60.72 090
33619 .... .......... A Repair single ventricle .......................................... 48.60 NA NA 18.25 20.16 6.46 NA NA 73.31 75.22 090
33641 .... .......... A Repair heart septum defect ................................. 29.50 NA NA 11.02 9.93 3.23 NA NA 43.75 42.66 090
33645 .... .......... A Revision of heart veins ........................................ 27.98 NA NA 10.98 11.57 3.79 NA NA 42.75 43.34 090
33647 .... .......... A Repair heart septum defects ................................ 29.37 NA NA 12.30 13.40 3.32 NA NA 44.99 46.09 090
Year Year Year
2007 2007 Fully Im-
VerDate Aug<31>2005
RVUs cility Total
RVUs
33660 .... .......... A Repair of heart defects ........................................ 31.75 NA NA 11.45 12.97 4.49 NA NA 47.69 49.21 090
33670 .... .......... A Repair of heart chambers .................................... 36.58 NA NA 12.25 12.94 4.65 NA NA 53.48 54.17 090
10:50 Nov 30, 2006

33675 .... .......... A Close mult vsd ..................................................... 35.87 NA NA 17.82 17.82 4.95 NA NA 58.64 58.64 090
33676 .... .......... A Close mult vsd w/resection .................................. 36.87 NA NA 18.17 18.17 5.44 NA NA 60.48 60.48 090
33677 .... .......... A Cl mult vsd w/rem pul band ................................. 38.37 NA NA 18.82 18.82 5.68 NA NA 62.87 62.87 090
Jkt 211001
33690 .... .......... A Reinforce pulmonary artery .................................. 20.20 NA NA 8.60 9.77 1.97 NA NA 30.77 31.94 090
PO 00000
33720 .... .......... A Repair of heart defect .......................................... 27.13 NA NA 11.13 11.99 3.84 NA NA 42.10 42.96 090
Frm 00227
33722 .... .......... A Repair of heart defect .......................................... 29.05 NA NA 8.66 12.55 1.30 NA NA 39.01 42.90 090
33724 .... .......... A Repair venous anomaly ....................................... 27.55 NA NA 10.56 10.56 4.00 NA NA 42.11 42.11 090
33726 .... .......... A Repair pul venous stenosis .................................. 37.04 NA NA 13.46 13.46 5.03 NA NA 55.53 55.53 090
33730 .... .......... A Repair heart-vein defect(s) .................................. 36.01 NA NA 13.29 13.91 5.03 NA NA 54.33 54.95 090
Fmt 4701
33732 .... .......... A Repair heart-vein defect ....................................... 28.80 NA NA 14.82 13.74 3.68 NA NA 47.30 46.22 090
Sfmt 4700
33750 .... .......... A Major vessel shunt ............................................... 22.06 NA NA 11.40 10.51 1.16 NA NA 34.62 33.73 090
33764 .... .......... A Major vessel shunt & graft ................................... 22.44 NA NA 9.22 9.97 3.01 NA NA 34.67 35.42 090
33768 .... .......... A Cavopulmonary shunting ..................................... 8.00 NA NA 2.21 2.55 1.19 NA NA 11.40 11.74 ZZZ
33770 .... .......... A Repair great vessels defect ................................. 39.02 NA NA 10.56 13.65 5.74 NA NA 55.32 58.41 090
E:\FR\FM\01DER2.SGM
01DER2
33786 .... .......... A Repair arterial trunk ............................................. 41.74 NA NA 11.42 15.39 5.71 NA NA 58.87 62.84 090
33788 .... .......... A Revision of pulmonary artery ............................... 27.26 NA NA 9.70 11.39 4.03 NA NA 40.99 42.68 090
69849
Year
69850
Year Year
2007 2007 Fully Im-
VerDate Aug<31>2005
RVUs cility Total
RVUs
33800 .... .......... A Aortic suspension ................................................. 17.23 NA NA 7.30 7.91 2.46 NA NA 26.99 27.60 090
33802 .... .......... A Repair vessel defect ............................................ 18.24 NA NA 7.53 8.80 2.27 NA NA 28.04 29.31 090
33803 .... .......... A Repair vessel defect ............................................ 20.18 NA NA 7.93 9.30 3.20 NA NA 31.31 32.68 090
10:50 Nov 30, 2006

33813 .... .......... A Repair septal defect ............................................. 21.23 NA NA 8.96 10.42 3.13 NA NA 33.32 34.78 090
33820 .... .......... A Revise major vessel ............................................. 16.61 NA NA 8.41 8.37 2.35 NA NA 27.37 27.33 090
Jkt 211001
33840 .... .......... A Remove aorta constriction ................................... 21.21 NA NA 8.95 9.96 2.16 NA NA 32.32 33.33 090
PO 00000
33860 .... .......... A Ascending aortic graft .......................................... 59.33 NA NA 20.58 17.48 5.76 NA NA 85.67 82.57 090
Frm 00228
33870 .... .......... A Transverse aortic arch graft ................................. 45.93 NA NA 16.64 17.95 6.62 NA NA 69.19 70.50 090
33875 .... .......... A Thoracic aortic graft ............................................. 35.68 NA NA 13.12 13.85 4.89 NA NA 53.69 54.42 090
33877 .... .......... A Thoracoabdominal graft ....................................... 68.85 NA NA 21.75 17.67 5.94 NA NA 96.54 92.46 090
33880 .... .......... A Endovasc taa repr incl subcl ................................ 34.48 NA NA 10.50 12.73 2.75 NA NA 47.73 49.96 090
Fmt 4701
33881 .... .......... A Endovasc taa repr w/o subcl ............................... 29.48 NA NA 9.27 11.29 2.33 NA NA 41.08 43.10 090
33883 .... .......... A Insert endovasc prosth, taa ................................. 20.99 NA NA 6.95 8.62 2.11 NA NA 30.05 31.72 090
33884 .... .......... A Endovasc prosth, taa, add-on .............................. 8.20 NA NA 2.00 2.43 0.86 NA NA 11.06 11.49 ZZZ
33886 .... .......... A Endovasc prosth, delayed .................................... 17.99 NA NA 6.20 7.72 1.80 NA NA 25.99 27.51 090
Sfmt 4700
33889 .... .......... A Artery transpose/endovas taa .............................. 15.92 NA NA 4.15 4.92 2.18 NA NA 22.25 23.02 000
33891 .... .......... A Car-car bp grft/endovas taa ................................. 20.00 NA NA 6.30 6.80 2.73 NA NA 29.03 29.53 000
33910 .... .......... A Remove lung artery emboli .................................. 29.59 NA NA 11.28 11.39 3.70 NA NA 44.57 44.68 090
33915 .... .......... A Remove lung artery emboli .................................. 24.83 NA NA 9.41 9.58 1.44 NA NA 35.68 35.85 090
33916 .... .......... A Surgery of great vessel ........................................ 28.30 NA NA 10.87 11.22 3.67 NA NA 42.84 43.19 090
33917 .... .......... A Repair pulmonary artery ...................................... 25.14 NA NA 10.38 11.73 3.70 NA NA 39.22 40.57 090
33920 .... .......... A Repair pulmonary atresia ..................................... 32.58 NA NA 11.32 13.20 4.38 NA NA 48.28 50.16 090
33922 .... .......... A Transect pulmonary artery ................................... 24.09 NA NA 11.47 11.04 3.10 NA NA 38.66 38.23 090
33924 .... .......... A Remove pulmonary shunt .................................... 5.49 NA NA 2.14 1.92 0.82 NA NA 8.45 8.23 ZZZ
E:\FR\FM\01DER2.SGM
33925 .... .......... A Rpr pul art unifocal w/o cpb ................................. 31.25 NA NA 10.16 13.54 4.61 NA NA 46.02 49.40 090
33926 .... .......... A Repr pul art, unifocal w/cpb ................................. 44.68 NA NA 14.32 16.84 6.22 NA NA 65.22 67.74 090
33930 .... .......... X Removal of donor heart/lung ............................... 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 XXX
33933 .... .......... C Prepare donor heart/lung ..................................... 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 XXX
01DER2
33935 .... .......... R Transplantation, heart/lung .................................. 61.68 NA NA 23.24 27.39 9.06 NA NA 93.98 98.13 090
33940 .... .......... X Removal of donor heart ....................................... 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 XXX
33944 .... .......... C Prepare donor heart ............................................. 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 XXX
33945 .... .......... R Transplantation of heart ....................................... 89.08 NA NA 30.80 23.74 6.26 NA NA 126.14 119.08 090
33960 .... .......... A External circulation assist .................................... 19.33 NA NA 5.63 5.09 2.67 NA NA 27.63 27.09 000
33961 .... .......... A External circulation assist .................................... 10.91 NA NA 2.95 3.45 0.88 NA NA 14.74 15.24 ZZZ
Year Year Year
2007 2007 Fully Im-
VerDate Aug<31>2005
RVUs cility Total
RVUs
33967 .... .......... A Insert ia percut device .......................................... 4.84 NA NA 2.48 2.00 0.35 NA NA 7.67 7.19 000
33968 .... .......... A Remove aortic assist device ................................ 0.64 NA NA 0.27 0.24 0.07 NA NA 0.98 0.95 000
33970 .... .......... A Aortic circulation assist ........................................ 6.74 NA NA 2.56 2.35 0.82 NA NA 10.12 9.91 000
10:50 Nov 30, 2006

33971 .... .......... A Aortic circulation assist ........................................ 11.91 NA NA 6.08 6.02 1.25 NA NA 19.24 19.18 090
33973 .... .......... A Insert balloon device ............................................ 9.75 NA NA 3.92 3.46 1.26 NA NA 14.93 14.47 000
33974 .... .......... A Remove intra-aortic balloon ................................. 14.93 NA NA 7.81 7.86 1.74 NA NA 24.48 24.53 090
33975 .... .......... A Implant ventricular device .................................... 20.97 NA NA 6.64 6.37 3.07 NA NA 30.68 30.41 XXX
33976 .... .......... A Implant ventricular device .................................... 22.97 NA NA 7.92 7.64 3.26 NA NA 34.15 33.87 XXX
Jkt 211001
33977 .... .......... A Remove ventricular device ................................... 20.07 NA NA 9.36 10.64 2.81 NA NA 32.24 33.52 090
33978 .... .......... A Remove ventricular device ................................... 22.51 NA NA 10.47 11.43 3.31 NA NA 36.29 37.25 090
33979 .... .......... A Insert intracorporeal device .................................. 45.93 NA NA 14.39 14.79 6.97 NA NA 67.29 67.69 XXX
33980 .... .......... A Remove intracorporeal device ............................. 64.86 NA NA 24.94 25.17 8.59 NA NA 98.39 98.62 090
PO 00000
33999 .... .......... C Cardiac surgery procedure .................................. 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 YYY
34001 .... .......... A Removal of artery clot .......................................... 17.78 NA NA 6.62 6.69 1.85 NA NA 26.25 26.32 090
Frm 00229
34111 .... .......... A Removal of arm artery clot .................................. 10.85 NA NA 4.47 5.13 1.40 NA NA 16.72 17.38 090
34203 .... .......... A Removal of leg artery clot .................................... 17.73 NA NA 6.52 7.68 2.36 NA NA 26.61 27.77 090
Fmt 4701
34401 .... .......... A Removal of vein clot ............................................ 26.41 NA NA 9.58 10.39 3.10 NA NA 39.09 39.90 090
Sfmt 4700
34501 .... .......... A Repair valve, femoral vein ................................... 16.74 NA NA 6.91 8.10 2.35 NA NA 26.00 27.19 090
34502 .... .......... A Reconstruct vena cava ........................................ 27.86 NA NA 10.76 11.91 3.63 NA NA 42.25 43.40 090
34510 .... .......... A Transposition of vein valve .................................. 19.80 NA NA 7.24 8.87 2.33 NA NA 29.37 31.00 090
34520 .... .......... A Cross-over vein graft ............................................ 19.05 NA NA 9.25 8.65 2.29 NA NA 30.59 29.99 090
34530 .... .......... A Leg vein fusion ..................................................... 17.77 NA NA 7.87 8.43 1.74 NA NA 27.38 27.94 090
34800 .... .......... A Endovas aaa repr w/sm tube ............................... 21.46 NA NA 7.39 8.72 2.46 NA NA 31.31 32.64 090
34802 .... .......... A Endovas aaa repr w/2-p part ............................... 23.71 NA NA 8.18 9.38 2.33 NA NA 34.22 35.42 090
E:\FR\FM\01DER2.SGM
34805 .... .......... A Endovas aaa repr w/long tube ............................. 22.59 NA NA 7.23 9.04 2.01 NA NA 31.83 33.64 090
34808 .... .......... A Endovas iliac a device addon .............................. 4.12 NA NA 1.10 1.30 0.59 NA NA 5.81 6.01 ZZZ
34812 .... .......... A Xpose for endoprosth, femorl .............................. 6.74 NA NA 1.72 2.10 1.18 NA NA 9.64 10.02 000
01DER2
34813 .... .......... A Femoral endovas graft add-on ............................. 4.79 NA NA 1.20 1.48 0.67 NA NA 6.66 6.94 ZZZ
34820 .... .......... A Xpose for endoprosth, iliac .................................. 9.74 NA NA 2.46 3.04 1.50 NA NA 13.70 14.28 000
34825 .... .......... A Endovasc extend prosth, init ................................ 12.72 NA NA 5.12 5.89 1.28 NA NA 19.12 19.89 090
34826 .... .......... A Endovasc exten prosth, add"l ............................ 4.12 NA NA 1.14 1.31 0.44 NA NA 5.70 5.87 ZZZ
34830 .... .......... A Open aortic tube prosth repr ................................ 35.10 NA NA 10.77 12.96 4.55 NA NA 50.42 52.61 090
34831 .... .......... A Open aortoiliac prosth repr .................................. 37.85 NA NA 12.09 11.82 4.89 NA NA 54.83 54.56 090
69851
Year
69852
Year Year
2007 2007 Fully Im-
VerDate Aug<31>2005
RVUs cility Total
RVUs
34832 .... .......... A Open aortofemor prosth repr ............................... 37.85 NA NA 11.60 13.87 4.85 NA NA 54.30 56.57 090
34833 .... .......... A Xpose for endoprosth, iliac .................................. 11.98 NA NA 3.29 4.15 1.70 NA NA 16.97 17.83 000
34834 .... .......... A Xpose, endoprosth, brachial ................................ 5.34 NA NA 1.60 2.04 0.76 NA NA 7.70 8.14 000
10:50 Nov 30, 2006

34900 .... .......... A Endovasc iliac repr w/graft ................................... 16.77 NA NA 6.22 7.24 2.00 NA NA 24.99 26.01 090
35001 .... .......... A Repair defect of artery ......................................... 20.70 NA NA 7.62 9.07 2.81 NA NA 31.13 32.58 090
35002 .... .......... A Repair artery rupture, neck .................................. 22.12 NA NA 7.80 9.22 3.00 NA NA 32.92 34.34 090
Jkt 211001
35013 .... .......... A Repair artery rupture, arm ................................... 23.10 NA NA 7.93 9.24 3.10 NA NA 34.13 35.44 090
35022 .... .......... A Repair artery rupture, chest ................................. 25.62 NA NA 9.46 9.75 3.17 NA NA 38.25 38.54 090
35045 .... .......... A Repair defect of arm artery .................................. 17.94 NA NA 6.53 7.26 2.45 NA NA 26.92 27.65 090
PO 00000
35082 .... .......... A Repair artery rupture, aorta ................................. 41.93 NA NA 13.12 14.75 5.44 NA NA 60.49 62.12 090
35092 .... .......... A Repair artery rupture, aorta ................................. 50.81 NA NA 15.02 16.98 6.40 NA NA 72.23 74.19 090
Frm 00230
35103 .... .......... A Repair artery rupture, groin .................................. 43.49 NA NA 13.25 15.19 5.76 NA NA 62.50 64.44 090
35112 .... .......... A Repair artery rupture,spleen ................................ 32.44 NA NA 10.48 11.59 4.08 NA NA 47.00 48.11 090
Fmt 4701
35122 .... .......... A Repair artery rupture, belly .................................. 37.76 NA NA 12.07 13.37 4.75 NA NA 54.58 55.88 090
35132 .... .......... A Repair artery rupture, groin .................................. 32.44 NA NA 10.27 11.85 4.30 NA NA 47.01 48.59 090
Sfmt 4700
35142 .... .......... A Repair artery rupture, thigh .................................. 25.03 NA NA 8.41 9.87 3.36 NA NA 36.80 38.26 090
35152 .... .......... A Repair artery rupture, knee .................................. 27.53 NA NA 9.06 10.79 3.61 NA NA 40.20 41.93 090
35180 .... .......... A Repair blood vessel lesion ................................... 15.01 NA NA 5.75 6.64 1.00 NA NA 21.76 22.65 090
E:\FR\FM\01DER2.SGM
01DER2
Year Year Year
2007 2007 Fully Im-
VerDate Aug<31>2005
RVUs cility Total
RVUs
10:50 Nov 30, 2006

Jkt 211001
35301 .... .......... A Rechanneling of artery ......................................... 19.53 NA NA 6.87 8.04 2.68 NA NA 29.08 30.25 090
PO 00000
35306 .... .......... A Rechanneling of artery ......................................... 9.25 NA NA 2.38 2.38 1.34 NA NA 12.97 12.97 ZZZ
Frm 00231
Fmt 4701
Sfmt 4700
35390 .... .......... A Reoperation, carotid add-on ................................ 3.19 NA NA 0.85 1.01 0.46 NA NA 4.50 4.66 ZZZ
35400 .... .......... A Angioscopy ........................................................... 3.00 NA NA 0.75 1.02 0.43 NA NA 4.18 4.45 ZZZ
35450 .... .......... A Repair arterial blockage ....................................... 10.05 NA NA 3.18 3.47 1.25 NA NA 14.48 14.77 000
E:\FR\FM\01DER2.SGM
35460 .... .......... A Repair venous blockage ...................................... 6.03 NA NA 1.78 2.15 0.83 NA NA 8.64 9.01 000
35470 .... .......... A Repair arterial blockage ....................................... 8.62 60.53 81.78 3.41 3.37 0.69 69.84 91.09 12.72 12.68 000
01DER2
35475 .... .......... R Repair arterial blockage ....................................... 9.48 47.48 53.95 3.25 3.48 0.62 57.58 64.05 13.35 13.58 000
35476 .... .......... A Repair venous blockage ...................................... 6.03 35.61 42.45 1.97 2.26 0.34 41.98 48.82 8.34 8.63 000
35480 .... .......... A Atherectomy, open ............................................... 11.06 NA NA 3.98 4.03 1.28 NA NA 16.32 16.37 000
69853
Year
69854
Year Year
2007 2007 Fully Im-
VerDate Aug<31>2005
RVUs cility Total
RVUs
10:50 Nov 30, 2006

35490 .... .......... A Atherectomy, percutaneous ................................. 11.06 NA NA 6.33 5.11 0.71 NA NA 18.10 16.88 000
Jkt 211001
35500 .... .......... A Harvest vein for bypass ....................................... 6.44 NA NA 1.68 1.94 0.93 NA NA 9.05 9.31 ZZZ
PO 00000
35501 .... .......... A Artery bypass graft ............................................... 28.99 NA NA 11.51 9.22 4.10 NA NA 44.60 42.31 090
Frm 00232
Fmt 4701
Sfmt 4700
E:\FR\FM\01DER2.SGM
01DER2
Year Year Year
2007 2007 Fully Im-
VerDate Aug<31>2005
RVUs cility Total
RVUs
35572 .... .......... A Harvest femoropopliteal vein ............................... 6.81 NA NA 1.88 2.15 0.99 NA NA 9.68 9.95 ZZZ
35583 .... .......... A Vein bypass graft ................................................. 27.62 NA NA 8.96 9.85 3.17 NA NA 39.75 40.64 090
10:50 Nov 30, 2006

35600 .... .......... A Harvest artery for cabg ........................................ 4.94 NA NA 1.54 1.60 0.73 NA NA 7.21 7.27 ZZZ
Jkt 211001
35623 .... .......... A Bypass graft, not vein .......................................... 25.79 NA NA 8.60 10.02 3.46 NA NA 37.85 39.27 090
PO 00000
Frm 00233
Fmt 4701
Sfmt 4700
35681 .... .......... A Composite bypass graft ....................................... 1.60 NA NA 0.42 0.50 0.23 NA NA 2.25 2.33 ZZZ
35685 .... .......... A Bypass graft patency/patch .................................. 4.04 NA NA 1.00 1.26 0.58 NA NA 5.62 5.88 ZZZ
E:\FR\FM\01DER2.SGM
35686 .... .......... A Bypass graft/av fist patency ................................. 3.34 NA NA 0.84 1.06 0.47 NA NA 4.65 4.87 ZZZ
35691 .... .......... A Arterial transposition ............................................ 18.32 NA NA 6.29 7.87 2.59 NA NA 27.20 28.78 090
01DER2
35697 .... .......... A Reimplant artery each .......................................... 3.00 NA NA 0.77 0.96 0.41 NA NA 4.18 4.37 ZZZ
35700 .... .......... A Reoperation, bypass graft .................................... 3.08 NA NA 0.80 0.97 0.44 NA NA 4.32 4.49 ZZZ
35701 .... .......... A Exploration, carotid artery .................................... 9.11 NA NA 4.27 4.93 1.12 NA NA 14.50 15.16 090
35721 .... .......... A Exploration, femoral artery ................................... 7.66 NA NA 3.74 4.26 1.03 NA NA 12.43 12.95 090
35741 .... .......... A Exploration popliteal artery .................................. 8.61 NA NA 3.96 4.49 1.12 NA NA 13.69 14.22 090
69855
Year
69856
Year Year
2007 2007 Fully Im-
VerDate Aug<31>2005
RVUs cility Total
RVUs
35761 .... .......... A Exploration of artery/vein ..................................... 5.84 NA NA 3.47 3.88 0.75 NA NA 10.06 10.47 090
35800 .... .......... A Explore neck vessels ........................................... 7.99 NA NA 3.95 4.48 0.95 NA NA 12.89 13.42 090
35820 .... .......... A Explore chest vessels .......................................... 36.81 NA NA 13.20 8.70 1.95 NA NA 51.96 47.46 090
10:50 Nov 30, 2006

35840 .... .......... A Explore abdominal vessels .................................. 10.87 NA NA 4.86 5.18 1.34 NA NA 17.07 17.39 090
35860 .... .......... A Explore limb vessels ............................................ 6.72 NA NA 3.47 3.89 0.78 NA NA 10.97 11.39 090
35870 .... .......... A Repair vessel graft defect .................................... 24.39 NA NA 8.19 9.37 3.01 NA NA 35.59 36.77 090
35875 .... .......... A Removal of clot in graft ........................................ 10.64 NA NA 4.39 4.98 1.41 NA NA 16.44 17.03 090
35876 .... .......... A Removal of clot in graft ........................................ 17.74 NA NA 6.12 7.16 2.40 NA NA 26.26 27.30 090
Jkt 211001
35879 .... .......... A Revise graft w/vein ............................................... 17.28 NA NA 6.12 7.30 2.28 NA NA 25.68 26.86 090
35883 .... .......... A Revise graft w/nonauto graft ................................ 23.07 NA NA 8.96 8.96 3.19 NA NA 35.22 35.22 090
PO 00000
35901 .... .......... A Excision, graft, neck ............................................. 8.26 NA NA 4.29 5.05 1.15 NA NA 13.70 14.46 090
35903 .... .......... A Excision, graft, extremity ...................................... 9.44 NA NA 4.69 5.79 1.30 NA NA 15.43 16.53 090
35905 .... .......... A Excision, graft, thorax .......................................... 33.39 NA NA 10.72 12.57 4.44 NA NA 48.55 50.40 090
35907 .... .......... A Excision, graft, abdomen ..................................... 37.14 NA NA 11.28 13.44 4.92 NA NA 53.34 55.50 090
Frm 00234
36000 .... .......... A Place needle in vein ............................................. 0.18 0.46 0.54 0.06 0.05 0.01 0.65 0.73 0.25 0.24 XXX
36002 .... .......... A Pseudoaneurysm injection trt ............................... 1.96 2.12 2.68 0.77 0.92 0.17 4.25 4.81 2.90 3.05 000
36005 .... .......... A Injection ext venography ...................................... 0.95 8.25 7.80 0.35 0.32 0.05 9.25 8.80 1.35 1.32 000
36010 .... .......... A Place catheter in vein .......................................... 2.43 10.77 17.17 0.71 0.77 0.20 13.40 19.80 3.34 3.40 XXX
Fmt 4701
36013 .... .......... A Place catheter in artery ........................................ 2.52 19.05 20.78 0.97 0.76 0.25 21.82 23.55 3.74 3.53 XXX
Sfmt 4700
36100 .... .......... A Establish access to artery .................................... 3.02 11.13 11.84 1.21 1.14 0.26 14.41 15.12 4.49 4.42 XXX
36145 .... .......... A Artery to vein shunt .............................................. 2.01 9.84 11.87 0.57 0.64 0.11 11.96 13.99 2.69 2.76 XXX
36160 .... .......... A Establish access to aorta ..................................... 2.52 11.52 12.99 0.74 0.82 0.26 14.30 15.77 3.52 3.60 XXX
36200 .... .......... A Place catheter in aorta ......................................... 3.02 13.27 15.70 0.96 1.00 0.24 16.53 18.96 4.22 4.26 XXX
E:\FR\FM\01DER2.SGM
36218 .... .......... A Place catheter in artery ........................................ 1.01 3.61 4.72 0.34 0.34 0.07 4.69 5.80 1.42 1.42 ZZZ
01DER2
36248 .... .......... A Place catheter in artery ........................................ 1.01 3.10 3.81 0.36 0.35 0.07 4.18 4.89 1.44 1.43 ZZZ
36260 .... .......... A Insertion of infusion pump .................................... 9.82 NA NA 4.82 4.87 1.29 NA NA 15.93 15.98 090
36261 .... .......... A Revision of infusion pump .................................... 5.55 NA NA 3.19 3.54 0.70 NA NA 9.44 9.79 090
36262 .... .......... A Removal of infusion pump ................................... 4.05 NA NA 2.66 2.73 0.54 NA NA 7.25 7.32 090
36299 .... .......... C Vessel injection procedure ................................... 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 YYY
Year Year Year
2007 2007 Fully Im-
VerDate Aug<31>2005
RVUs cility Total
RVUs
36400 .... .......... A Bl draw < 3 yrs fem/jugular .................................. 0.38 0.33 0.29 0.11 0.10 0.03 0.74 0.70 0.52 0.51 XXX
36405 .... .......... A Bl draw < 3 yrs scalp vein ................................... 0.31 0.29 0.27 0.08 0.08 0.03 0.63 0.61 0.42 0.42 XXX
36406 .... .......... A Bl draw < 3 yrs other vein .................................... 0.18 0.30 0.29 0.08 0.06 0.01 0.49 0.48 0.27 0.25 XXX
10:50 Nov 30, 2006

36410 .... .......... A Non-routine bl draw > 3 yrs ................................. 0.18 0.31 0.30 0.05 0.05 0.01 0.50 0.49 0.24 0.24 XXX
36415 .... .......... X Routine venipuncture ........................................... 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 XXX
36416 .... .......... B Capillary blood draw ............................................ 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 XXX
36420 .... .......... A Vein access cutdown < 1 yr ................................. 1.01 NA NA 0.21 0.26 0.07 NA NA 1.29 1.34 XXX
36425 .... .......... A Vein access cutdown > 1 yr ................................. 0.76 NA NA 0.22 0.22 0.06 NA NA 1.04 1.04 XXX
Jkt 211001
36430 .... .......... A Blood transfusion service ..................................... 0.00 0.93 0.99 0.00 0.76 0.06 0.99 1.05 0.06 0.82 XXX
36440 .... .......... A Bl push transfuse, 2 yr or .................................... 1.03 NA NA 0.44 0.33 0.10 NA NA 1.57 1.46 XXX
36450 .... .......... A Bl exchange/transfuse, nb ................................... 2.23 NA NA 0.80 0.73 0.21 NA NA 3.24 3.17 XXX
36455 .... .......... A Bl exchange/transfuse non-nb ............................. 2.43 NA NA 0.75 0.95 0.15 NA NA 3.33 3.53 XXX
PO 00000
36460 .... .......... A Transfusion service, fetal ..................................... 6.58 NA NA 1.69 2.10 0.79 NA NA 9.06 9.47 XXX
36468 .... .......... R Injection(s), spider veins ...................................... 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 000
36469 .... .......... R Injection(s), spider veins ...................................... 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 000
36470 .... .......... A Injection therapy of vein ....................................... 1.09 2.42 2.62 0.65 0.71 0.12 3.63 3.83 1.86 1.92 010
Frm 00235
36471 .... .......... A Injection therapy of veins ..................................... 1.60 2.56 2.94 0.80 0.92 0.19 4.35 4.73 2.59 2.71 010
36475 .... .......... A Endovenous rf, 1st vein ....................................... 6.72 36.10 47.57 1.95 2.39 0.37 43.19 54.66 9.04 9.48 000
36476 .... .......... A Endovenous rf, vein add-on ................................. 3.38 5.92 7.39 0.88 1.08 0.18 9.48 10.95 4.44 4.64 ZZZ
36478 .... .......... A Endovenous laser, 1st vein .................................. 6.72 31.10 42.85 2.03 2.41 0.37 38.19 49.94 9.12 9.50 000
Fmt 4701
36479 .... .......... A Endovenous laser vein addon ............................. 3.38 6.38 7.59 0.99 1.10 0.18 9.94 11.15 4.55 4.66 ZZZ
36481 .... .......... A Insertion of catheter, vein .................................... 6.98 NA NA 2.08 2.46 0.55 NA NA 9.61 9.99 000
36500 .... .......... A Insertion of catheter, vein .................................... 3.51 NA NA 1.17 1.32 0.20 NA NA 4.88 5.03 000
36510 .... .......... A Insertion of catheter, vein .................................... 1.09 1.09 3.19 0.31 0.54 0.10 2.28 4.38 1.50 1.73 000
Sfmt 4700
36511 .... .......... A Apheresis wbc ...................................................... 1.74 NA NA 0.58 0.69 0.08 NA NA 2.40 2.51 000
36512 .... .......... A Apheresis rbc ....................................................... 1.74 NA NA 0.61 0.71 0.08 NA NA 2.43 2.53 000
36513 .... .......... A Apheresis platelets ............................................... 1.74 NA NA 0.52 0.68 0.17 NA NA 2.43 2.59 000
36514 .... .......... A Apheresis plasma ................................................. 1.74 10.42 15.33 0.54 0.67 0.08 12.24 17.15 2.36 2.49 000
36515 .... .......... A Apheresis, adsorp/reinfuse .................................. 1.74 44.78 60.92 0.52 0.63 0.08 46.60 62.74 2.34 2.45 000
36516 .... .......... A Apheresis, selective ............................................. 1.22 49.33 75.37 0.39 0.46 0.08 50.63 76.67 1.69 1.76 000
36522 .... .......... A Photopheresis ...................................................... 1.67 34.98 33.02 0.87 0.94 0.13 36.78 34.82 2.67 2.74 000
36540 .... .......... B Collect blood venous device ................................ 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 XXX
36550 .... .......... A Declot vascular device ......................................... 0.00 0.32 0.37 0.06 0.31 0.37 0.69 0.74 0.43 0.68 XXX
E:\FR\FM\01DER2.SGM
36555 .... .......... A Insert non-tunnel cv cath ..................................... 2.68 4.09 5.34 0.62 0.76 0.11 6.88 8.13 3.41 3.55 000
36556 .... .......... A Insert non-tunnel cv cath ..................................... 2.50 2.85 4.93 0.57 0.70 0.19 5.54 7.62 3.26 3.39 000
36557 .... .......... A Insert tunneled cv cath ......................................... 5.11 14.29 19.43 2.24 2.55 0.57 19.97 25.11 7.92 8.23 010
01DER2
36568 .... .......... A Insert picc cath ..................................................... 1.92 5.53 7.03 0.55 0.57 0.11 7.56 9.06 2.58 2.60 000
69857
Year
69858
Year Year
2007 2007 Fully Im-
VerDate Aug<31>2005
RVUs cility Total
RVUs
36569 .... .......... A Insert picc cath ..................................................... 1.82 4.19 6.55 0.55 0.57 0.19 6.20 8.56 2.56 2.58 000
36570 .... .......... A Insert picvad cath ................................................. 5.33 22.38 30.47 2.26 2.61 0.57 28.28 36.37 8.16 8.51 010
36571 .... .......... A Insert picvad cath ................................................. 5.31 24.27 31.00 2.36 2.62 0.57 30.15 36.88 8.24 8.50 010
10:50 Nov 30, 2006

36575 .... .......... A Repair tunneled cv cath ....................................... 0.67 3.19 3.84 0.21 0.25 0.20 4.06 4.71 1.08 1.12 000
36576 .... .......... A Repair tunneled cv cath ....................................... 3.21 5.69 6.63 1.50 1.76 0.19 9.09 10.03 4.90 5.16 010
36578 .... .......... A Replace tunneled cv cath .................................... 3.51 8.70 10.52 1.82 2.18 0.19 12.40 14.22 5.52 5.88 010
36580 .... .......... A Replace cvad cath ............................................... 1.31 3.82 6.16 0.39 0.41 0.19 5.32 7.66 1.89 1.91 000
Jkt 211001
36584 .... .......... A Replace picc cath ................................................. 1.20 3.73 6.16 0.52 0.54 0.19 5.12 7.55 1.91 1.93 000
36585 .... .......... A Replace picvad cath ............................................. 4.81 21.71 26.29 2.17 2.59 0.19 26.71 31.29 7.17 7.59 010
PO 00000
36589 .... .......... A Removal tunneled cv cath ................................... 2.27 1.79 2.13 1.17 1.34 0.24 4.30 4.64 3.68 3.85 010
36590 .... .......... A Removal tunneled cv cath ................................... 3.32 3.55 3.42 1.56 1.68 0.44 7.31 7.18 5.32 5.44 010
36595 .... .......... A Mech remov tunneled cv cath .............................. 3.59 10.24 15.50 1.20 1.39 0.21 14.04 19.30 5.00 5.19 000
36596 .... .......... A Mech remov tunneled cv cath .............................. 0.75 2.44 3.38 0.39 0.47 0.05 3.24 4.18 1.19 1.27 000
Frm 00236
36597 .... .......... A Reposition venous catheter ................................. 1.21 1.90 2.28 0.38 0.43 0.07 3.18 3.56 1.66 1.71 000
36598 .... .......... T Inj w/fluor, eval cv device ..................................... 0.74 2.15 2.52 0.24 2.04 0.05 2.94 3.31 1.03 2.83 000
36600 .... .......... A Withdrawal of arterial blood ................................. 0.32 0.50 0.49 0.08 0.09 0.02 0.84 0.83 0.42 0.43 XXX
36620 .... .......... A Insertion catheter, artery ...................................... 1.15 NA NA 0.17 0.22 0.07 NA NA 1.39 1.44 000
Fmt 4701
36680 .... .......... A Insert needle, bone cavity .................................... 1.20 NA NA 0.33 0.45 0.11 NA NA 1.64 1.76 000
Sfmt 4700
36800 .... .......... A Insertion of cannula .............................................. 2.43 NA NA 1.55 1.74 0.25 NA NA 4.23 4.42 000
36818 .... .......... A Av fuse, uppr arm, cephalic ................................. 11.81 NA NA 4.81 5.73 1.90 NA NA 18.52 19.44 090
36819 .... .......... A Av fuse, uppr arm, basilic .................................... 14.39 NA NA 5.22 6.08 1.96 NA NA 21.57 22.43 090
36820 .... .......... A Av fusion/forearm vein ......................................... 14.39 NA NA 5.31 6.11 1.95 NA NA 21.65 22.45 090
36821 .... .......... A Av fusion direct any site ....................................... 9.15 NA NA 4.01 4.49 1.23 NA NA 14.39 14.87 090
36822 .... .......... A Insertion of cannula(s) ......................................... 5.51 NA NA 3.79 4.23 0.79 NA NA 10.09 10.53 090
36823 .... .......... A Insertion of cannula(s) ......................................... 22.82 NA NA 8.80 9.23 2.89 NA NA 34.51 34.94 090
E:\FR\FM\01DER2.SGM
36825 .... .......... A Artery-vein autograft ............................................. 10.00 NA NA 4.31 4.87 1.35 NA NA 15.66 16.22 090
36830 .... .......... A Artery-vein nonautograft ....................................... 12.00 NA NA 4.23 4.98 1.66 NA NA 17.89 18.64 090
36831 .... .......... A Open thrombect av fistula .................................... 8.01 NA NA 3.25 3.77 1.09 NA NA 12.35 12.87 090
36832 .... .......... A Av fistula revision, open ....................................... 10.50 NA NA 3.84 4.50 1.44 NA NA 15.78 16.44 090
01DER2
36833 .... .......... A Av fistula revision ................................................. 11.95 NA NA 4.23 4.96 1.65 NA NA 17.83 18.56 090
36834 .... .......... A Repair A-V aneurysm ........................................... 11.11 NA NA 4.33 4.68 1.37 NA NA 16.81 17.16 090
36835 .... .......... A Artery to vein shunt .............................................. 7.43 NA NA 3.88 4.21 0.98 NA NA 12.29 12.62 090
36838 .... .......... A Dist revas ligation, hemo ..................................... 21.59 NA NA 7.09 8.81 3.02 NA NA 31.70 33.42 090
36860 .... .......... A External cannula declotting .................................. 2.01 3.32 2.16 0.62 0.67 0.11 5.44 4.28 2.74 2.79 000
36861 .... .......... A Cannula declotting ............................................... 2.52 NA NA 1.22 1.42 0.27 NA NA 4.01 4.21 000
Year Year Year
2007 2007 Fully Im-
VerDate Aug<31>2005
RVUs cility Total
RVUs
36870 .... .......... A Percut thrombect av fistula .................................. 5.17 39.08 49.54 2.50 2.99 0.29 44.54 55.00 7.96 8.45 090
37140 .... .......... A Revision of circulation .......................................... 25.12 NA NA 8.82 10.07 2.02 NA NA 35.96 37.21 090
10:50 Nov 30, 2006

37181 .... .......... A Splice spleen/kidney veins ................................... 28.26 NA NA 9.32 10.58 3.41 NA NA 40.99 42.25 090
37182 .... .......... A Insert hepatic shunt (tips) .................................... 16.97 NA NA 5.11 5.82 1.00 NA NA 23.08 23.79 000
37183 .... .......... A Remove hepatic shunt (tips) ................................ 7.99 NA NA 2.51 2.89 0.47 NA NA 10.97 11.35 000
Jkt 211001
37184 .... .......... A Prim art mech thrombectomy ............................... 8.66 47.39 65.62 2.78 3.21 0.55 56.60 74.83 11.99 12.42 000
37185 .... .......... A Prim art m-thrombect add-on ............................... 3.28 15.41 21.01 0.94 1.07 0.21 18.90 24.50 4.43 4.56 ZZZ
37186 .... .......... A Sec art m-thrombect add-on ................................ 4.92 32.55 45.18 1.41 1.60 0.32 37.79 50.42 6.65 6.84 ZZZ
37187 .... .......... A Venous mech thrombectomy ............................... 8.03 46.31 64.21 2.59 3.00 0.51 54.85 72.75 11.13 11.54 000
PO 00000
37188 .... .......... A Venous m-thrombectomy add-on ......................... 5.71 40.43 56.59 1.93 2.25 0.37 46.51 62.67 8.01 8.33 000
37195 .... .......... C Thrombolytic therapy, stroke ................................ 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 XXX
37200 .... .......... A Transcatheter biopsy ............................................ 4.55 NA NA 1.32 1.46 0.27 NA NA 6.14 6.28 000
37201 .... .......... A Transcatheter therapy infuse ............................... 4.99 NA NA 2.11 2.43 0.33 NA NA 7.43 7.75 000
Frm 00237
37202 .... .......... A Transcatheter therapy infuse ............................... 5.67 NA NA 3.42 3.13 0.43 NA NA 9.52 9.23 000
37203 .... .......... A Transcatheter retrieval ......................................... 5.02 28.86 31.87 1.81 1.98 0.29 34.17 37.18 7.12 7.29 000
37204 .... .......... A Transcatheter occlusion ....................................... 18.11 NA NA 5.30 5.75 1.48 NA NA 24.89 25.34 000
37205 .... .......... A Transcath iv stent, percut .................................... 8.27 NA NA 3.81 3.77 0.60 NA NA 12.68 12.64 000
Fmt 4701
37206 .... .......... A Transcath iv stent/perc addl ................................. 4.12 NA NA 1.56 1.46 0.31 NA NA 5.99 5.89 ZZZ
37207 .... .......... A Transcath iv stent, open ...................................... 8.27 NA NA 2.43 2.98 1.17 NA NA 11.87 12.42 000
37208 .... .......... A Transcath iv stent/open addl ................................ 4.12 NA NA 1.05 1.30 0.59 NA NA 5.76 6.01 ZZZ
37209 .... .......... A Change iv cath at thromb tx ................................ 2.27 NA NA 0.67 0.72 0.15 NA NA 3.09 3.14 000
Sfmt 4700
37210 .... .......... A Embolization uterine fibroid .................................. 10.60 46.03 46.03 3.13 3.13 0.60 57.23 57.23 14.33 14.33 000
37215 .... .......... R Transcath stent, cca w/eps .................................. 19.58 NA NA 10.08 9.34 1.09 NA NA 30.75 30.01 090
37216 .... .......... N Transcath stent, cca w/o eps ............................... 18.85 NA NA 5.75 8.05 1.04 NA NA 25.64 27.94 090
37250 .... .......... A Iv us first vessel add-on ....................................... 2.10 NA NA 0.81 0.77 0.21 NA NA 3.12 3.08 ZZZ
37251 .... .......... A Iv us each add vessel add-on .............................. 1.60 NA NA 0.52 0.54 0.19 NA NA 2.31 2.33 ZZZ
37500 .... .......... A Endoscopy ligate perf veins ................................. 11.54 NA NA 5.42 6.49 1.54 NA NA 18.50 19.57 090
37501 .... .......... C Vascular endoscopy procedure ........................... 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 YYY
37565 .... .......... A Ligation of neck vein ............................................ 11.97 NA NA 5.11 5.49 1.33 NA NA 18.41 18.79 090
37600 .... .......... A Ligation of neck artery ......................................... 12.34 NA NA 4.81 6.18 1.41 NA NA 18.56 19.93 090
E:\FR\FM\01DER2.SGM
37607 .... .......... A Ligation of a-v fistula ............................................ 6.19 NA NA 3.08 3.44 0.85 NA NA 10.12 10.48 090
37609 .... .......... A Temporal artery procedure .................................. 3.02 4.20 4.43 1.84 1.93 0.36 7.58 7.81 5.22 5.31 010
01DER2
37616 .... .......... A Ligation of chest artery ........................................ 18.89 NA NA 7.92 8.04 2.33 NA NA 29.14 29.26 090
37617 .... .......... A Ligation of abdomen artery .................................. 23.71 NA NA 7.89 8.85 2.98 NA NA 34.58 35.54 090
37618 .... .......... A Ligation of extremity artery .................................. 5.95 NA NA 3.37 3.55 0.67 NA NA 9.99 10.17 090
37620 .... .......... A Revision of major vein ......................................... 11.49 NA NA 4.94 5.52 0.91 NA NA 17.34 17.92 090
69859
Year
69860
Year Year
2007 2007 Fully Im-
VerDate Aug<31>2005
RVUs cility Total
RVUs
37700 .... .......... A Revise leg vein ..................................................... 3.76 NA NA 2.43 2.70 0.53 NA NA 6.72 6.99 090
37718 .... .......... A Ligate/strip short leg vein ..................................... 7.05 NA NA 3.51 3.92 0.14 NA NA 10.70 11.11 090
10:50 Nov 30, 2006

37722 .... .......... A Ligate/strip long leg vein ...................................... 8.08 NA NA 3.77 4.25 0.86 NA NA 12.71 13.19 090
37735 .... .......... A Removal of leg veins/lesion ................................. 10.81 NA NA 4.65 5.29 1.48 NA NA 16.94 17.58 090
37760 .... .......... A Ligation, leg veins, open ...................................... 10.69 NA NA 4.53 5.14 1.44 NA NA 16.66 17.27 090
37765 .... .......... A Phleb veins—extrem—to 20 ................................ 7.63 NA NA 3.56 4.36 0.48 NA NA 11.67 12.47 090
37766 .... .......... A Phleb veins—extrem 20+ ..................................... 9.58 NA NA 4.09 5.01 0.48 NA NA 14.15 15.07 090
Jkt 211001
37780 .... .......... A Revision of leg vein .............................................. 3.87 NA NA 2.48 2.76 0.53 NA NA 6.88 7.16 090
37785 .... .......... A Ligate/divide/excise vein ...................................... 3.87 4.90 5.12 2.58 2.69 0.54 9.31 9.53 6.99 7.10 090
37788 .... .......... A Revascularization, penis ...................................... 23.21 NA NA 12.15 9.85 2.26 NA NA 37.62 35.32 090
37790 .... .......... A Penile venous occlusion ...................................... 8.37 NA NA 5.13 4.56 0.59 NA NA 14.09 13.52 090
PO 00000
37799 .... .......... C Vascular surgery procedure ................................. 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 YYY
38100 .... .......... A Removal of spleen, total ...................................... 19.47 NA NA 6.90 6.35 1.92 NA NA 28.29 27.74 090
38101 .... .......... A Removal of spleen, partial ................................... 19.47 NA NA 7.31 6.72 2.05 NA NA 28.83 28.24 090
38102 .... .......... A Removal of spleen, total ...................................... 4.79 NA NA 1.26 1.55 0.63 NA NA 6.68 6.97 ZZZ
Frm 00238
38115 .... .......... A Repair of ruptured spleen .................................... 21.80 NA NA 7.56 6.87 2.09 NA NA 31.45 30.76 090
38120 .... .......... A Laparoscopy, splenectomy .................................. 16.97 NA NA 6.94 7.27 2.25 NA NA 26.16 26.49 090
38129 .... .......... C Laparoscope proc, spleen .................................... 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 YYY
38200 .... .......... A Injection for spleen x-ray ...................................... 2.64 NA NA 0.96 0.91 0.14 NA NA 3.74 3.69 000
Fmt 4701
38204 .... .......... B Bl donor search management .............................. 2.00 0.00 0.00 0.00 0.00 0.06 2.06 2.06 2.06 2.06 XXX
38205 .... .......... R Harvest allogenic stem cells ................................ 1.50 NA NA 0.55 0.64 0.07 NA NA 2.12 2.21 000
38206 .... .......... R Harvest auto stem cells ....................................... 1.50 NA NA 0.55 0.64 0.07 NA NA 2.12 2.21 000
38207 .... .......... I Cryopreserve stem cells ...................................... 0.47 0.00 0.00 0.00 0.00 0.01 0.48 0.48 0.48 0.48 XXX
Sfmt 4700
38208 .... .......... I Thaw preserved stem cells .................................. 0.56 0.00 0.00 0.00 0.00 0.02 0.58 0.58 0.58 0.58 XXX
38209 .... .......... I Wash harvest stem cells ...................................... 0.24 0.00 0.00 0.00 0.00 0.01 0.25 0.25 0.25 0.25 XXX
38210 .... .......... I T-cell depletion of harvest .................................... 0.94 0.00 0.00 0.00 0.00 0.03 0.97 0.97 0.97 0.97 XXX
38211 .... .......... I Tumor cell deplete of harvst ................................ 0.71 0.00 0.00 0.00 0.00 0.02 0.73 0.73 0.73 0.73 XXX
38212 .... .......... I Rbc depletion of harvest ...................................... 0.47 0.00 0.00 0.00 0.00 0.02 0.49 0.49 0.49 0.49 XXX
38213 .... .......... I Platelet deplete of harvest ................................... 0.24 0.00 0.00 0.00 0.00 0.01 0.25 0.25 0.25 0.25 XXX
38214 .... .......... I Volume deplete of harvest ................................... 0.24 0.00 0.00 0.00 0.00 0.01 0.25 0.25 0.25 0.25 XXX
38215 .... .......... I Harvest stem cell concentrte ............................... 0.55 0.00 0.00 0.00 0.00 0.02 0.57 0.57 0.57 0.57 XXX
38220 .... .......... A Bone marrow aspiration ....................................... 1.08 2.66 3.46 0.45 0.50 0.05 3.79 4.59 1.58 1.63 XXX
E:\FR\FM\01DER2.SGM
38221 .... .......... A Bone marrow biopsy ............................................ 1.37 2.78 3.64 0.58 0.63 0.07 4.22 5.08 2.02 2.07 XXX
38230 .... .......... R Bone marrow collection ........................................ 4.80 NA NA 2.80 3.12 0.48 NA NA 8.08 8.40 010
38240 .... .......... R Bone marrow/stem transplant .............................. 2.24 NA NA 0.96 1.01 0.11 NA NA 3.31 3.36 XXX
38241 .... .......... R Bone marrow/stem transplant .............................. 2.24 NA NA 0.95 1.02 0.11 NA NA 3.30 3.37 XXX
01DER2
38242 .... .......... A Lymphocyte infuse transplant .............................. 1.71 NA NA 0.71 0.76 0.08 NA NA 2.50 2.55 000
38300 .... .......... A Drainage, lymph node lesion ............................... 2.28 3.58 4.12 1.74 1.97 0.25 6.11 6.65 4.27 4.50 010
38305 .... .......... A Drainage, lymph node lesion ............................... 6.55 NA NA 3.38 4.18 0.88 NA NA 10.81 11.61 090
38308 .... .......... A Incision of lymph channels ................................... 6.73 NA NA 3.54 3.69 0.85 NA NA 11.12 11.27 090
38380 .... .......... A Thoracic duct procedure ...................................... 8.34 NA NA 4.70 5.44 0.74 NA NA 13.78 14.52 090
Year Year Year
2007 2007 Fully Im-
VerDate Aug<31>2005
RVUs cility Total
RVUs
38500 .... .......... A Biopsy/removal, lymph nodes .............................. 3.76 3.73 3.70 2.02 2.07 0.49 7.98 7.95 6.27 6.32 010
38505 .... .......... A Needle biopsy, lymph nodes ................................ 1.14 2.00 2.04 0.67 0.75 0.09 3.23 3.27 1.90 1.98 000
10:50 Nov 30, 2006

38510 .... .......... A Biopsy/removal, lymph nodes .............................. 6.69 5.20 5.46 2.98 3.36 0.72 12.61 12.87 10.39 10.77 010
38520 .... .......... A Biopsy/removal, lymph nodes .............................. 6.95 NA NA 3.70 3.96 0.84 NA NA 11.49 11.75 090
38542 .... .......... A Explore deep node(s), neck ................................. 6.08 NA NA 3.77 4.30 0.60 NA NA 10.45 10.98 090
Jkt 211001
38550 .... .......... A Removal, neck/armpit lesion ................................ 6.99 NA NA 4.22 3.99 0.88 NA NA 12.09 11.86 090
38555 .... .......... A Removal, neck/armpit lesion ................................ 15.42 NA NA 7.27 8.22 1.76 NA NA 24.45 25.40 090
38562 .... .......... A Removal, pelvic lymph nodes .............................. 10.92 NA NA 5.77 5.77 1.20 NA NA 17.89 17.89 090
38564 .... .......... A Removal, abdomen lymph nodes ........................ 11.29 NA NA 5.23 5.24 1.32 NA NA 17.84 17.85 090
PO 00000
38570 .... .......... A Laparoscopy, lymph node biop ............................ 9.28 NA NA 3.99 3.98 1.13 NA NA 14.40 14.39 010
38571 .... .......... A Laparoscopy, lymphadenectomy ......................... 14.70 NA NA 6.95 5.97 1.15 NA NA 22.80 21.82 010
38572 .... .......... A Laparoscopy, lymphadenectomy ......................... 16.86 NA NA 6.21 6.86 1.91 NA NA 24.98 25.63 010
38589 .... .......... C Laparoscope proc, lymphatic ............................... 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 YYY
Frm 00239
38700 .... .......... A Removal of lymph nodes, neck ........................... 12.68 NA NA 6.01 6.18 0.72 NA NA 19.41 19.58 090
38740 .... .......... A Remove armpit lymph nodes ............................... 10.57 NA NA 5.02 4.96 1.32 NA NA 16.91 16.85 090
Fmt 4701
38745 .... .......... A Remove armpit lymph nodes ............................... 13.71 NA NA 6.06 6.07 1.74 NA NA 21.51 21.52 090
38746 .... .......... A Remove thoracic lymph nodes ............................ 4.88 NA NA 1.45 1.57 0.72 NA NA 7.05 7.17 ZZZ
38747 .... .......... A Remove abdominal lymph nodes ........................ 4.88 NA NA 1.27 1.57 0.64 NA NA 6.79 7.09 ZZZ
38760 .... .......... A Remove groin lymph nodes ................................. 13.49 NA NA 5.98 6.09 1.72 NA NA 21.19 21.30 090
Sfmt 4700
38765 .... .......... A Remove groin lymph nodes ................................. 21.78 NA NA 8.66 8.77 2.48 NA NA 32.92 33.03 090
38770 .... .......... A Remove pelvis lymph nodes ................................ 13.98 NA NA 6.97 6.05 1.40 NA NA 22.35 21.43 090
38780 .... .......... A Remove abdomen lymph nodes .......................... 17.56 NA NA 8.02 8.16 1.89 NA NA 27.47 27.61 090
38790 .... .......... A Inject for lymphatic x-ray ...................................... 1.29 NA NA 0.70 0.75 0.13 NA NA 2.12 2.17 000
38792 .... .......... A Identify sentinel node ........................................... 0.52 NA NA 0.46 0.45 0.06 NA NA 1.04 1.03 000
38794 .... .......... A Access thoracic lymph duct ................................. 4.51 NA NA 2.84 3.30 0.32 NA NA 7.67 8.13 090
38999 .... .......... C Blood/lymph system procedure ............................ 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 YYY
E:\FR\FM\01DER2.SGM
39200 .... .......... A Removal chest lesion ........................................... 15.04 NA NA 6.26 7.21 2.03 NA NA 23.33 24.28 090
39220 .... .......... A Removal chest lesion ........................................... 19.47 NA NA 8.06 9.04 2.46 NA NA 29.99 30.97 090
39400 .... .......... A Visualization of chest ........................................... 8.00 NA NA 4.18 4.68 0.82 NA NA 13.00 13.50 010
39499 .... .......... C Chest procedure ................................................... 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 YYY
01DER2
39501 .... .......... A Repair diaphragm laceration ................................ 13.89 NA NA 5.92 6.32 1.78 NA NA 21.59 21.99 090
39502 .... .......... A Repair paraesophageal hernia ............................. 17.09 NA NA 6.63 7.01 2.17 NA NA 25.89 26.27 090
39503 .... .......... A Repair of diaphragm hernia ................................. 108.67 NA NA 30.82 32.73 10.98 NA NA 150.47 152.38 090
69861
Year
69862
Year Year
2007 2007 Fully Im-
VerDate Aug<31>2005
RVUs cility Total
RVUs
39545 .... .......... A Revision of diaphragm ......................................... 14.58 NA NA 7.21 7.46 1.84 NA NA 23.63 23.88 090
10:50 Nov 30, 2006

39560 .... .......... A Resect diaphragm, simple ................................... 12.97 NA NA 5.54 6.10 1.59 NA NA 20.10 20.66 090
39561 .... .......... A Resect diaphragm, complex ................................ 19.75 NA NA 9.35 9.34 2.45 NA NA 31.55 31.54 090
39599 .... .......... C Diaphragm surgery procedure ............................. 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 YYY
40490 .... .......... A Biopsy of lip .......................................................... 1.22 2.09 1.75 0.59 0.61 0.05 3.36 3.02 1.86 1.88 000
40500 .... .......... A Partial excision of lip ............................................ 4.35 7.79 7.12 4.30 4.32 0.38 12.52 11.85 9.03 9.05 090
Jkt 211001
40525 .... .......... A Reconstruct lip with flap ....................................... 7.61 NA NA 5.34 6.06 0.85 NA NA 13.80 14.52 090
40527 .... .......... A Reconstruct lip with flap ....................................... 9.20 NA NA 5.97 7.01 0.97 NA NA 16.14 17.18 090
PO 00000
40530 .... .......... A Partial removal of lip ............................................ 5.45 7.35 7.70 4.15 4.47 0.55 13.35 13.70 10.15 10.47 090
40650 .... .......... A Repair lip .............................................................. 3.69 5.94 6.58 3.16 3.26 0.38 10.01 10.65 7.23 7.33 090
40652 .... .......... A Repair lip .............................................................. 4.32 7.07 7.57 4.04 4.21 0.52 11.91 12.41 8.88 9.05 090
40654 .... .......... A Repair lip .............................................................. 5.37 8.13 8.48 4.73 4.88 0.60 14.10 14.45 10.70 10.85 090
Frm 00240
40700 .... .......... A Repair cleft lip/nasal ............................................. 13.97 NA NA 9.32 9.13 0.95 NA NA 24.24 24.05 090
Fmt 4701
40799 .... .......... C Lip surgery procedure .......................................... 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 YYY
40800 .... .......... A Drainage of mouth lesion ..................................... 1.19 3.83 3.18 1.88 1.80 0.13 5.15 4.50 3.20 3.12 010
Sfmt 4700
40804 .... .......... A Removal, foreign body, mouth ............................. 1.26 3.63 3.45 1.76 1.83 0.11 5.00 4.82 3.13 3.20 010
40805 .... .......... A Removal, foreign body, mouth ............................. 2.73 5.06 4.63 2.59 2.76 0.32 8.11 7.68 5.64 5.81 010
40806 .... .......... A Incision of lip fold ................................................. 0.31 2.37 1.97 0.50 0.50 0.04 2.72 2.32 0.85 0.85 000
40808 .... .......... A Biopsy of mouth lesion ......................................... 0.98 3.52 2.87 1.58 1.51 0.10 4.60 3.95 2.66 2.59 010
40810 .... .......... A Excision of mouth lesion ...................................... 1.33 3.57 3.05 1.67 1.66 0.13 5.03 4.51 3.13 3.12 010
40812 .... .......... A Excise/repair mouth lesion ................................... 2.33 4.51 3.92 2.28 2.37 0.28 7.12 6.53 4.89 4.98 010
40814 .... .......... A Excise/repair mouth lesion ................................... 3.45 5.63 5.11 3.66 3.83 0.41 9.49 8.97 7.52 7.69 090
40818 .... .......... A Excise oral mucosa for graft ................................ 2.72 5.78 5.32 3.73 3.91 0.21 8.71 8.25 6.66 6.84 090
E:\FR\FM\01DER2.SGM
40819 .... .......... A Excise lip or cheek fold ........................................ 2.45 4.87 4.28 3.07 3.09 0.29 7.61 7.02 5.81 5.83 090
40820 .... .......... A Treatment of mouth lesion ................................... 1.30 5.14 4.23 2.85 2.54 0.11 6.55 5.64 4.26 3.95 010
40830 .... .......... A Repair mouth laceration ....................................... 1.78 4.09 3.81 2.02 2.07 0.19 6.06 5.78 3.99 4.04 010
40831 .... .......... A Repair mouth laceration ....................................... 2.50 5.35 4.83 2.76 2.98 0.30 8.15 7.63 5.56 5.78 010
01DER2
40840 .... .......... R Reconstruction of mouth ...................................... 9.03 10.06 9.85 5.63 6.64 1.08 20.17 19.96 15.74 16.75 090
40899 .... .......... C Mouth surgery procedure ..................................... 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 YYY
Year Year Year
2007 2007 Fully Im-
VerDate Aug<31>2005
RVUs cility Total
RVUs
10:50 Nov 30, 2006

41010 .... .......... A Incision of tongue fold .......................................... 1.08 3.36 3.41 1.35 1.54 0.07 4.51 4.56 2.50 2.69 010
Jkt 211001
41100 .... .......... A Biopsy of tongue .................................................. 1.39 2.58 2.46 1.13 1.35 0.15 4.12 4.00 2.67 2.89 010
PO 00000
41105 .... .......... A Biopsy of tongue .................................................. 1.44 2.57 2.37 1.15 1.28 0.13 4.14 3.94 2.72 2.85 010
41108 .... .......... A Biopsy of floor of mouth ....................................... 1.07 2.40 2.15 1.03 1.11 0.10 3.57 3.32 2.20 2.28 010
41110 .... .......... A Excision of tongue lesion ..................................... 1.53 3.47 3.10 1.55 1.62 0.13 5.13 4.76 3.21 3.28 010
Frm 00241
41114 .... .......... A Excision of tongue lesion ..................................... 8.71 NA NA 6.02 6.90 0.83 NA NA 15.56 16.44 090
41115 .... .......... A Excision of tongue fold ......................................... 1.76 4.26 3.53 1.76 1.83 0.18 6.20 5.47 3.70 3.77 010
Fmt 4701
41120 .... .......... A Partial removal of tongue ..................................... 10.91 NA NA 13.31 14.81 0.79 NA NA 25.01 26.51 090
41130 .... .......... A Partial removal of tongue ..................................... 15.51 NA NA 14.68 15.81 0.93 NA NA 31.12 32.25 090
41135 .... .......... A Tongue and neck surgery .................................... 29.83 NA NA 20.15 22.45 1.89 NA NA 51.87 54.17 090
41140 .... .......... A Removal of tongue ............................................... 28.81 NA NA 21.56 25.39 2.27 NA NA 52.64 56.47 090
Sfmt 4700
41145 .... .......... A Tongue removal, neck surgery ............................ 37.59 NA NA 26.62 29.56 2.55 NA NA 66.76 69.70 090
41150 .... .......... A Tongue, mouth, jaw surgery ................................ 29.52 NA NA 21.36 23.87 1.95 NA NA 52.83 55.34 090
41153 .... .......... A Tongue, mouth, neck surgery .............................. 33.28 NA NA 22.13 24.30 2.01 NA NA 57.42 59.59 090
41155 .... .......... A Tongue, jaw, & neck surgery ............................... 43.96 NA NA 25.50 26.48 2.34 NA NA 71.80 72.78 090
41250 .... .......... A Repair tongue laceration ...................................... 1.93 3.79 3.00 1.59 1.28 0.18 5.90 5.11 3.70 3.39 010
41500 .... .......... A Fixation of tongue ................................................ 3.74 NA NA 6.54 7.22 0.30 NA NA 10.58 11.26 090
41510 .... .......... A Tongue to lip surgery ........................................... 3.45 NA NA 7.05 7.71 0.20 NA NA 10.70 11.36 090
E:\FR\FM\01DER2.SGM
41520 .... .......... A Reconstruction, tongue fold ................................. 2.77 5.72 4.90 3.22 3.52 0.27 8.76 7.94 6.26 6.56 090
41599 .... .......... C Tongue and mouth surgery .................................. 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 YYY
41800 .... .......... A Drainage of gum lesion ........................................ 1.21 4.74 3.13 2.10 1.49 0.12 6.07 4.46 3.43 2.82 010
41805 .... .......... A Removal foreign body, gum ................................. 1.28 4.72 3.18 2.75 2.35 0.13 6.13 4.59 4.16 3.76 010
01DER2
41806 .... .......... A Removal foreign body,jawbone ............................ 2.73 5.91 4.16 3.41 3.13 0.37 9.01 7.26 6.51 6.23 010
41820 .... .......... R Excision, gum, each quadrant ............................. 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 000
41821 .... .......... R Excision of gum flap ............................................. 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 000
41822 .... .......... R Excision of gum lesion ......................................... 2.35 4.66 4.08 1.80 1.85 0.31 7.32 6.74 4.46 4.51 010
41825 .... .......... A Excision of gum lesion ......................................... 1.35 3.62 3.20 1.44 2.04 0.15 5.12 4.70 2.94 3.54 010
69863
Year
69864
Year Year
2007 2007 Fully Im-
VerDate Aug<31>2005
RVUs cility Total
RVUs
10:50 Nov 30, 2006

41830 .... .......... R Removal of gum tissue ........................................ 3.38 6.04 5.23 3.16 3.51 0.44 9.86 9.05 6.98 7.33 010
41850 .... .......... R Treatment of gum lesion ...................................... 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 000
41870 .... .......... R Gum graft ............................................................. 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 000
41872 .... .......... R Repair gum ........................................................... 2.90 5.89 5.24 3.28 3.42 0.30 9.09 8.44 6.48 6.62 090
41874 .... .......... R Repair tooth socket .............................................. 3.13 5.76 5.07 2.79 3.08 0.45 9.34 8.65 6.37 6.66 090
Jkt 211001
41899 .... .......... C Dental surgery procedure .................................... 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 YYY
42000 .... .......... A Drainage mouth roof lesion .................................. 1.25 2.34 2.51 1.15 1.23 0.12 3.71 3.88 2.52 2.60 010
42100 .... .......... A Biopsy roof of mouth ............................................ 1.33 2.19 2.11 1.22 1.33 0.13 3.65 3.57 2.68 2.79 010
42104 .... .......... A Excision lesion, mouth roof .................................. 1.66 3.43 2.76 1.60 1.56 0.16 5.25 4.58 3.42 3.38 010
PO 00000
42120 .... .......... A Remove palate/lesion ........................................... 11.70 NA NA 11.51 11.71 0.52 NA NA 23.73 23.93 090
42140 .... .......... A Excision of uvula .................................................. 1.65 4.24 3.85 1.95 2.06 0.13 6.02 5.63 3.73 3.84 090
Frm 00242
42145 .... .......... A Repair palate, pharynx/uvula ............................... 9.63 NA NA 6.85 7.33 0.65 NA NA 17.13 17.61 090
42160 .... .......... A Treatment mouth roof lesion ................................ 1.82 3.63 4.10 1.62 2.12 0.17 5.62 6.09 3.61 4.11 010
42180 .... .......... A Repair palate ........................................................ 2.52 3.22 3.11 1.79 2.02 0.21 5.95 5.84 4.52 4.75 010
42182 .... .......... A Repair palate ........................................................ 3.84 4.05 3.92 2.41 2.88 0.40 8.29 8.16 6.65 7.12 010
Fmt 4701
42200 .... .......... A Reconstruct cleft palate ....................................... 12.41 NA NA 8.26 9.72 1.27 NA NA 21.94 23.40 090
Sfmt 4700
42226 .... .......... A Lengthening of palate .......................................... 10.24 NA NA 11.44 13.89 1.01 NA NA 22.69 25.14 090
42227 .... .......... A Lengthening of palate .......................................... 9.81 NA NA 9.78 14.10 0.98 NA NA 20.57 24.89 090
42235 .... .......... A Repair palate ........................................................ 7.92 NA NA 10.34 11.48 0.72 NA NA 18.98 20.12 090
42260 .... .......... A Repair nose to lip fistula ...................................... 10.10 9.65 10.06 5.93 6.78 1.26 21.01 21.42 17.29 18.14 090
42280 .... .......... A Preparation, palate mold ...................................... 1.56 2.25 2.03 0.85 1.07 0.19 4.00 3.78 2.60 2.82 010
42281 .... .......... A Insertion, palate prosthesis .................................. 1.95 2.83 2.68 1.57 1.80 0.17 4.95 4.80 3.69 3.92 010
42299 .... .......... C Palate/uvula surgery ............................................ 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 YYY
E:\FR\FM\01DER2.SGM
42300 .... .......... A Drainage of salivary gland ................................... 1.95 2.93 2.85 1.61 1.76 0.16 5.04 4.96 3.72 3.87 010
42305 .... .......... A Drainage of salivary gland ................................... 6.23 NA NA 3.71 4.47 0.51 NA NA 10.45 11.21 090
01DER2
42330 .... .......... A Removal of salivary stone .................................... 2.23 3.20 3.16 1.62 1.79 0.19 5.62 5.58 4.04 4.21 010
42400 .... .......... A Biopsy of salivary gland ....................................... 0.78 1.88 1.71 0.59 0.69 0.06 2.72 2.55 1.43 1.53 000
42405 .... .......... A Biopsy of salivary gland ....................................... 3.31 3.74 3.94 2.02 2.34 0.28 7.33 7.53 5.61 5.93 010
42408 .... .......... A Excision of salivary cyst ....................................... 4.58 6.10 5.96 3.10 3.48 0.45 11.13 10.99 8.13 8.51 090
Year Year Year
2007 2007 Fully Im-
VerDate Aug<31>2005
RVUs cility Total
RVUs
42409 .... .......... A Drainage of salivary cyst ...................................... 2.85 5.07 4.66 2.40 2.67 0.27 8.19 7.78 5.52 5.79 090
42410 .... .......... A Excise parotid gland/lesion .................................. 9.46 NA NA 4.99 5.91 0.91 NA NA 15.36 16.28 090
10:50 Nov 30, 2006

42440 .... .......... A Excise submaxillary gland .................................... 7.05 NA NA 3.53 4.48 0.59 NA NA 11.17 12.12 090
42450 .... .......... A Excise sublingual gland ....................................... 4.66 5.90 5.90 3.70 4.11 0.42 10.98 10.98 8.78 9.19 090
Jkt 211001
42500 .... .......... A Repair salivary duct ............................................. 4.34 5.82 5.72 3.66 4.05 0.41 10.57 10.47 8.41 8.80 090
42505 .... .......... A Repair salivary duct ............................................. 6.23 6.80 7.04 4.39 5.12 0.55 13.58 13.82 11.17 11.90 090
42507 .... .......... A Parotid duct diversion .......................................... 6.16 NA NA 5.95 6.39 0.49 NA NA 12.60 13.04 090
PO 00000
42550 .... .......... A Injection for salivary x-ray .................................... 1.25 2.10 2.93 0.35 0.40 0.07 3.42 4.25 1.67 1.72 000
42600 .... .......... A Closure of salivary fistula ..................................... 4.86 6.51 6.56 3.38 3.94 0.43 11.80 11.85 8.67 9.23 090
Frm 00243
42650 .... .......... A Dilation of salivary duct ........................................ 0.77 1.20 1.13 0.61 0.69 0.07 2.04 1.97 1.45 1.53 000
42660 .... .......... A Dilation of salivary duct ........................................ 1.13 1.42 1.37 0.73 0.82 0.09 2.64 2.59 1.95 2.04 000
42665 .... .......... A Ligation of salivary duct ....................................... 2.57 4.74 4.31 2.24 2.50 0.23 7.54 7.11 5.04 5.30 090
42699 .... .......... C Salivary surgery procedure .................................. 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 YYY
Fmt 4701
42700 .... .......... A Drainage of tonsil abscess ................................... 1.64 2.76 2.68 1.53 1.66 0.13 4.53 4.45 3.30 3.43 010
42720 .... .......... A Drainage of throat abscess .................................. 6.31 4.34 4.71 2.91 3.57 0.44 11.09 11.46 9.66 10.32 010
42725 .... .......... A Drainage of throat abscess .................................. 12.28 NA NA 6.69 7.84 0.91 NA NA 19.88 21.03 090
42800 .... .......... A Biopsy of throat .................................................... 1.41 2.28 2.21 1.19 1.35 0.11 3.80 3.73 2.71 2.87 010
Sfmt 4700
42802 .... .......... A Biopsy of throat .................................................... 1.56 3.84 4.53 1.54 1.93 0.12 5.52 6.21 3.22 3.61 010
42804 .... .......... A Biopsy of upper nose/throat ................................. 1.26 3.34 3.64 1.38 1.64 0.10 4.70 5.00 2.74 3.00 010
42806 .... .......... A Biopsy of upper nose/throat ................................. 1.60 3.56 3.94 1.49 1.82 0.13 5.29 5.67 3.22 3.55 010
42808 .... .......... A Excise pharynx lesion .......................................... 2.32 2.99 3.07 1.47 1.82 0.19 5.50 5.58 3.98 4.33 010
42809 .... .......... A Remove pharynx foreign body ............................. 1.83 2.14 2.28 1.26 1.31 0.16 4.13 4.27 3.25 3.30 010
42810 .... .......... A Excision of neck cyst ........................................... 3.30 5.75 5.72 3.43 3.51 0.29 9.34 9.31 7.02 7.10 090
42815 .... .......... A Excision of neck cyst ........................................... 7.23 NA NA 5.77 6.25 0.61 NA NA 13.61 14.09 090
42820 .... .......... A Remove tonsils and adenoids .............................. 4.17 NA NA 2.57 3.11 0.31 NA NA 7.05 7.59 090
42821 .... .......... A Remove tonsils and adenoids .............................. 4.31 NA NA 2.73 3.31 0.35 NA NA 7.39 7.97 090
E:\FR\FM\01DER2.SGM
42825 .... .......... A Removal of tonsils ................................................ 3.45 NA NA 2.45 2.99 0.25 NA NA 6.15 6.69 090
42826 .... .......... A Removal of tonsils ................................................ 3.40 NA NA 2.46 2.89 0.27 NA NA 6.13 6.56 090
42830 .... .......... A Removal of adenoids ........................................... 2.60 NA NA 2.23 2.48 0.20 NA NA 5.03 5.28 090
01DER2
42842 .... .......... A Extensive surgery of throat .................................. 12.02 NA NA 11.08 11.01 0.71 NA NA 23.81 23.74 090
42860 .... .......... A Excision of tonsil tags .......................................... 2.25 NA NA 2.13 2.33 0.18 NA NA 4.56 4.76 090
69865
Year
69866
Year Year
2007 2007 Fully Im-
VerDate Aug<31>2005
RVUs cility Total
RVUs
42870 .... .......... A Excision of lingual tonsil ....................................... 5.44 NA NA 8.02 8.43 0.44 NA NA 13.90 14.31 090
42890 .... .......... A Partial removal of pharynx ................................... 18.92 NA NA 13.98 14.11 1.05 NA NA 33.95 34.08 090
42892 .... .......... A Revision of pharyngeal walls ............................... 25.77 NA NA 17.59 17.28 1.28 NA NA 44.64 44.33 090
10:50 Nov 30, 2006

42894 .... .......... A Revision of pharyngeal walls ............................... 33.61 NA NA 21.36 21.86 1.87 NA NA 56.84 57.34 090
42900 .... .......... A Repair throat wound ............................................. 5.26 NA NA 2.75 3.43 0.50 NA NA 8.51 9.19 010
42950 .... .......... A Reconstruction of throat ....................................... 8.16 NA NA 10.30 11.48 0.72 NA NA 19.18 20.36 090
42953 .... .......... A Repair throat, esophagus ..................................... 9.33 NA NA 12.97 16.24 0.88 NA NA 23.18 26.45 090
42955 .... .......... A Surgical opening of throat .................................... 7.92 NA NA 9.34 10.34 0.80 NA NA 18.06 19.06 090
Jkt 211001
42960 .... .......... A Control throat bleeding ......................................... 2.35 NA NA 1.61 1.87 0.19 NA NA 4.15 4.41 010
42970 .... .......... A Control nose/throat bleeding ................................ 5.76 NA NA 3.52 4.02 0.39 NA NA 9.67 10.17 090
PO 00000
42999 .... .......... C Throat surgery procedure .................................... 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 YYY
43020 .... .......... A Incision of esophagus .......................................... 8.14 NA NA 4.35 5.15 0.87 NA NA 13.36 14.16 090
Frm 00244
43030 .... .......... A Throat muscle surgery ......................................... 7.91 NA NA 4.20 5.17 0.70 NA NA 12.81 13.78 090
43045 .... .......... A Incision of esophagus .......................................... 21.70 NA NA 10.06 10.54 2.59 NA NA 34.35 34.83 090
43100 .... .......... A Excision of esophagus lesion .............................. 9.55 NA NA 5.10 5.94 0.93 NA NA 15.58 16.42 090
43101 .... .......... A Excision of esophagus lesion .............................. 16.99 NA NA 7.22 7.72 2.32 NA NA 26.53 27.03 090
Fmt 4701
43107 .... .......... A Removal of esophagus ........................................ 43.97 NA NA 16.57 17.84 5.24 NA NA 65.78 67.05 090
Sfmt 4700
43116 .... .......... A Partial removal of esophagus .............................. 92.78 NA NA 28.93 19.75 3.06 NA NA 124.77 115.59 090
43130 .... .......... A Removal of esophagus pouch ............................. 12.41 NA NA 6.01 7.17 1.16 NA NA 19.58 20.74 090
43135 .... .......... A Removal of esophagus pouch ............................. 26.09 NA NA 9.99 8.57 2.34 NA NA 38.42 37.00 090
E:\FR\FM\01DER2.SGM
43200 .... .......... A Esophagus endoscopy ......................................... 1.59 3.54 3.98 0.93 1.04 0.13 5.26 5.70 2.65 2.76 000
43201 .... .......... A Esoph scope w/submucous inj ............................ 2.09 5.55 4.86 1.19 1.12 0.15 7.79 7.10 3.43 3.36 000
43202 .... .......... A Esophagus endoscopy, biopsy ............................ 1.89 5.12 5.44 0.99 0.95 0.15 7.16 7.48 3.03 2.99 000
43204 .... .......... A Esoph scope w/sclerosis inj ................................. 3.76 NA NA 1.97 1.63 0.30 NA NA 6.03 5.69 000
01DER2
43205 .... .......... A Esophagus endoscopy/ligation ............................ 3.78 NA NA 2.07 1.66 0.28 NA NA 6.13 5.72 000
43215 .... .......... A Esophagus endoscopy ......................................... 2.60 NA NA 1.28 1.22 0.22 NA NA 4.10 4.04 000
43216 .... .......... A Esophagus endoscopy/lesion .............................. 2.40 3.00 1.55 1.23 1.10 0.20 5.60 4.15 3.83 3.70 000
43217 .... .......... A Esophagus endoscopy ......................................... 2.90 6.55 6.85 1.42 1.25 0.26 9.71 10.01 4.58 4.41 000
43219 .... .......... A Esophagus endoscopy ......................................... 2.80 NA NA 1.55 1.40 0.24 NA NA 4.59 4.44 000
43220 .... .......... A Esoph endoscopy, dilation ................................... 2.10 NA NA 1.13 1.01 0.17 NA NA 3.40 3.28 000
Year Year Year
2007 2007 Fully Im-
VerDate Aug<31>2005
RVUs cility Total
RVUs
43227 .... .......... A Esoph endoscopy, repair ..................................... 3.59 NA NA 1.84 1.55 0.28 NA NA 5.71 5.42 000
43228 .... .......... A Esoph endoscopy, ablation .................................. 3.76 NA NA 1.87 1.63 0.34 NA NA 5.97 5.73 000
10:50 Nov 30, 2006

43231 .... .......... A Esoph endoscopy w/us exam .............................. 3.19 NA NA 1.75 1.42 0.23 NA NA 5.17 4.84 000
43232 .... .......... A Esoph endoscopy w/us fn bx ............................... 4.47 NA NA 2.39 1.96 0.34 NA NA 7.20 6.77 000
43234 .... .......... A Upper GI endoscopy, exam ................................. 2.01 4.96 5.23 1.02 0.91 0.17 7.14 7.41 3.20 3.09 000
43235 .... .......... A Uppr gi endoscopy, diagnosis .............................. 2.39 5.26 5.19 1.37 1.11 0.19 7.84 7.77 3.95 3.69 000
43236 .... .......... A Uppr gi scope w/submuc inj ................................. 2.92 6.69 6.47 1.67 1.33 0.21 9.82 9.60 4.80 4.46 000
Jkt 211001
43237 .... .......... A Endoscopic us exam, esoph ................................ 3.98 NA NA 2.17 1.74 0.43 NA NA 6.58 6.15 000
43238 .... .......... A Uppr gi endoscopy w/us fn bx ............................. 5.02 NA NA 2.57 2.11 0.43 NA NA 8.02 7.56 000
43239 .... .......... A Upper GI endoscopy, biopsy ............................... 2.87 6.02 5.79 1.57 1.29 0.22 9.11 8.88 4.66 4.38 000
43240 .... .......... A Esoph endoscope w/drain cyst ............................ 6.85 NA NA 3.49 2.82 0.56 NA NA 10.90 10.23 000
PO 00000
43241 .... .......... A Upper GI endoscopy with tube ............................ 2.59 NA NA 1.43 1.18 0.21 NA NA 4.23 3.98 000
43242 .... .......... A Uppr gi endoscopy w/us fn bx ............................. 7.30 NA NA 3.73 2.98 0.53 NA NA 11.56 10.81 000
43243 .... .......... A Upper gi endoscopy & inject ................................ 4.56 NA NA 2.40 1.94 0.33 NA NA 7.29 6.83 000
43244 .... .......... A Upper GI endoscopy/ligation ................................ 5.04 NA NA 2.68 2.14 0.37 NA NA 8.09 7.55 000
Frm 00245
43245 .... .......... A Uppr gi scope dilate strictr ................................... 3.18 NA NA 1.65 1.39 0.26 NA NA 5.09 4.83 000
43246 .... .......... A Place gastrostomy tube ....................................... 4.32 NA NA 2.14 1.80 0.34 NA NA 6.80 6.46 000
43247 .... .......... A Operative upper GI endoscopy ............................ 3.38 NA NA 1.80 1.48 0.27 NA NA 5.45 5.13 000
43248 .... .......... A Uppr gi endoscopy/guide wire ............................. 3.15 NA NA 1.80 1.43 0.23 NA NA 5.18 4.81 000
Fmt 4701
43250 .... .......... A Upper GI endoscopy/tumor .................................. 3.20 NA NA 1.65 1.40 0.26 NA NA 5.11 4.86 000
Sfmt 4700
43256 .... .......... A Uppr gi endoscopy w/stent .................................. 4.34 NA NA 2.28 1.85 0.32 NA NA 6.94 6.51 000
43257 .... .......... A Uppr gi scope w/thrml txmnt ................................ 5.50 NA NA 2.04 2.16 0.36 NA NA 7.90 8.02 000
43259 .... .......... A Endoscopic ultrasound exam ............................... 5.19 NA NA 2.72 2.17 0.35 NA NA 8.26 7.71 000
43260 .... .......... A Endo cholangiopancreatograph ........................... 5.95 NA NA 3.11 2.49 0.43 NA NA 9.49 8.87 000
E:\FR\FM\01DER2.SGM
01DER2
43280 .... .......... A Laparoscopy, fundoplasty .................................... 18.00 NA NA 6.70 7.13 2.28 NA NA 26.98 27.41 090
43289 .... .......... C Laparoscope proc, esoph .................................... 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 YYY
43300 .... .......... A Repair of esophagus ............................................ 9.21 NA NA 5.20 6.08 1.12 NA NA 15.53 16.41 090
43305 .... .......... A Repair esophagus and fistula .............................. 17.98 NA NA 7.65 9.93 1.54 NA NA 27.17 29.45 090
69867
Year
69868
Year Year
2007 2007 Fully Im-
VerDate Aug<31>2005
RVUs cility Total
RVUs
43312 .... .......... A Repair esophagus and fistula .............................. 29.23 NA NA 9.97 11.41 4.01 NA NA 43.21 44.65 090
43313 .... .......... A Esophagoplasty congenital .................................. 48.17 NA NA 17.28 18.43 5.47 NA NA 70.92 72.07 090
10:50 Nov 30, 2006

43314 .... .......... A Tracheo-esophagoplasty cong ............................. 53.15 NA NA 18.37 18.98 6.65 NA NA 78.17 78.78 090
43320 .... .......... A Fuse esophagus & stomach ................................ 23.18 NA NA 8.83 9.11 2.74 NA NA 34.75 35.03 090
43324 .... .......... A Revise esophagus & stomach ............................. 22.86 NA NA 8.39 8.67 2.76 NA NA 34.01 34.29 090
Jkt 211001
43340 .... .......... A Fuse esophagus & intestine ................................ 22.86 NA NA 9.09 8.99 2.46 NA NA 34.41 34.31 090
43341 .... .......... A Fuse esophagus & intestine ................................ 24.10 NA NA 10.08 10.03 2.92 NA NA 37.10 37.05 090
PO 00000
43350 .... .......... A Surgical opening, esophagus ............................... 19.31 NA NA 8.02 8.34 1.42 NA NA 28.75 29.07 090
43360 .... .......... A Gastrointestinal repair .......................................... 39.90 NA NA 15.81 15.26 4.97 NA NA 60.68 60.13 090
Frm 00246
43361 .... .......... A Gastrointestinal repair .......................................... 45.50 NA NA 16.89 16.88 4.50 NA NA 66.89 66.88 090
43400 .... .......... A Ligate esophagus veins ....................................... 25.47 NA NA 13.73 10.51 1.96 NA NA 41.16 37.94 090
43401 .... .......... A Esophagus surgery for veins ............................... 26.36 NA NA 9.44 9.47 3.05 NA NA 38.85 38.88 090
43405 .... .......... A Ligate/staple esophagus ...................................... 24.55 NA NA 10.37 9.78 2.84 NA NA 37.76 37.17 090
Fmt 4701
43410 .... .......... A Repair esophagus wound .................................... 16.28 NA NA 7.55 7.61 1.72 NA NA 25.55 25.61 090
43415 .... .......... A Repair esophagus wound .................................... 28.70 NA NA 11.93 11.79 3.53 NA NA 44.16 44.02 090
43420 .... .......... A Repair esophagus opening .................................. 16.65 NA NA 6.96 7.29 1.43 NA NA 25.04 25.37 090
43425 .... .......... A Repair esophagus opening .................................. 24.91 NA NA 10.37 10.07 3.03 NA NA 38.31 38.01 090
Sfmt 4700
43450 .... .......... A Dilate esophagus ................................................. 1.38 2.66 2.64 0.93 0.75 0.11 4.15 4.13 2.42 2.24 000
43460 .... .......... A Pressure treatment esophagus ............................ 3.79 NA NA 1.74 1.55 0.31 NA NA 5.84 5.65 000
43496 .... .......... C Free jejunum flap, microvasc ............................... 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 090
43499 .... .......... C Esophagus surgery procedure ............................. 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 YYY
43500 .... .......... A Surgical opening of stomach ............................... 12.71 NA NA 5.24 5.04 1.45 NA NA 19.40 19.20 090
43501 .... .......... A Surgical repair of stomach ................................... 22.47 NA NA 8.13 8.26 2.65 NA NA 33.25 33.38 090
E:\FR\FM\01DER2.SGM
43502 .... .......... A Surgical repair of stomach ................................... 25.56 NA NA 9.02 9.34 3.10 NA NA 37.68 38.00 090
43510 .... .......... A Surgical opening of stomach ............................... 15.01 NA NA 6.86 6.65 1.48 NA NA 23.35 23.14 090
43520 .... .......... A Incision of pyloric muscle ..................................... 11.21 NA NA 4.85 5.15 1.36 NA NA 17.42 17.72 090
43600 .... .......... A Biopsy of stomach ................................................ 1.91 NA NA 0.82 0.70 0.14 NA NA 2.87 2.75 000
01DER2
43605 .... .......... A Biopsy of stomach ................................................ 13.64 NA NA 5.43 5.32 1.58 NA NA 20.65 20.54 090
43610 .... .......... A Excision of stomach lesion .................................. 16.26 NA NA 6.08 6.13 1.94 NA NA 24.28 24.33 090
43611 .... .......... A Excision of stomach lesion .................................. 20.25 NA NA 7.55 7.56 2.36 NA NA 30.16 30.17 090
43620 .... .......... A Removal of stomach ............................................ 33.91 NA NA 11.09 11.62 3.96 NA NA 48.96 49.49 090
Year Year Year
2007 2007 Fully Im-
VerDate Aug<31>2005
RVUs cility Total
RVUs
43631 .... .......... A Removal of stomach, partial ................................ 24.38 NA NA 8.63 9.02 2.99 NA NA 36.00 36.39 090
10:50 Nov 30, 2006

43635 .... .......... A Removal of stomach, partial ................................ 2.06 NA NA 0.53 0.66 0.27 NA NA 2.86 2.99 ZZZ
43640 .... .......... A Vagotomy & pylorus repair .................................. 19.43 NA NA 7.37 7.28 2.26 NA NA 29.06 28.97 090
43641 .... .......... A Vagotomy & pylorus repair .................................. 19.68 NA NA 7.72 7.45 2.25 NA NA 29.65 29.38 090
43644 .... .......... A Lap gastric bypass/roux-en-y ............................... 29.24 NA NA 10.23 10.97 3.16 NA NA 42.63 43.37 090
Jkt 211001
43645 .... .......... A Lap gastr bypass incl smll i ................................. 31.37 NA NA 11.14 11.79 3.54 NA NA 46.05 46.70 090
43647 .... .......... C Lap impl electrode, antrum .................................. 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 YYY
43648 .... .......... C Lap revise/remv eltrd antrum ............................... 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 YYY
43651 .... .......... A Laparoscopy, vagus nerve ................................... 10.13 NA NA 4.63 4.73 1.33 NA NA 16.09 16.19 090
PO 00000
43652 .... .......... A Laparoscopy, vagus nerve ................................... 12.13 NA NA 5.18 5.61 1.55 NA NA 18.86 19.29 090
43653 .... .......... A Laparoscopy, gastrostomy ................................... 8.38 NA NA 4.39 4.23 1.01 NA NA 13.78 13.62 090
43659 .... .......... C Laparoscope proc, stom ...................................... 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 YYY
Frm 00247
43752 .... .......... A Nasal/orogastric w/stent ....................................... 0.81 NA NA 0.23 0.25 0.02 NA NA 1.06 1.08 000
43760 .... .......... A Change gastrostomy tube .................................... 1.10 12.83 4.77 0.39 0.44 0.09 14.02 5.96 1.58 1.63 000
43761 .... .......... A Reposition gastrostomy tube ............................... 2.01 0.91 1.11 0.59 0.64 0.13 3.05 3.25 2.73 2.78 000
43770 .... .......... A Lap, place gastr adjust band ............................... 17.85 NA NA 7.47 7.65 2.19 NA NA 27.51 27.69 090
Fmt 4701
43771 .... .......... A Lap, revise adjust gast band ................................ 20.64 NA NA 8.16 8.48 2.55 NA NA 31.35 31.67 090
43772 .... .......... A Lap, remove adjust gast band ............................. 15.62 NA NA 5.99 6.31 1.93 NA NA 23.54 23.86 090
43773 .... .......... A Lap, change adjust gast band ............................. 20.64 NA NA 8.16 8.48 2.56 NA NA 31.36 31.68 090
43774 .... .......... A Lap remov adj gast band/port .............................. 15.66 NA NA 6.14 6.46 1.85 NA NA 23.65 23.97 090
Sfmt 4700
43800 .... .......... A Reconstruction of pylorus .................................... 15.35 NA NA 5.88 5.89 1.82 NA NA 23.05 23.06 090
43810 .... .......... A Fusion of stomach and bowel .............................. 16.80 NA NA 6.28 6.20 1.94 NA NA 25.02 24.94 090
43840 .... .......... A Repair of stomach lesion ..................................... 22.70 NA NA 8.22 7.13 2.06 NA NA 32.98 31.89 090
43842 .... .......... N V-band gastroplasty ............................................. 20.90 NA NA 6.75 7.53 2.45 NA NA 30.10 30.88 090
E:\FR\FM\01DER2.SGM
43843 .... .......... A Gastroplasty w/o v-band ...................................... 21.08 NA NA 7.81 7.77 2.46 NA NA 31.35 31.31 090
43845 .... .......... A Gastroplasty duodenal switch .............................. 33.12 NA NA 12.43 11.19 4.06 NA NA 49.61 48.37 090
43846 .... .......... A Gastric bypass for obesity ................................... 27.23 NA NA 10.05 10.03 3.19 NA NA 40.47 40.45 090
43847 .... .......... A Gastric bypass incl small i ................................... 30.10 NA NA 10.67 10.84 3.56 NA NA 44.33 44.50 090
01DER2
43848 .... .......... A Revision gastroplasty ........................................... 32.57 NA NA 11.35 11.70 3.88 NA NA 47.80 48.15 090
43850 .... .......... A Revise stomach-bowel fusion .............................. 27.45 NA NA 9.44 9.72 3.28 NA NA 40.17 40.45 090
43870 .... .......... A Repair stomach opening ...................................... 11.36 NA NA 5.04 4.64 1.27 NA NA 17.67 17.27 090
69869
Year
69870
Year Year
2007 2007 Fully Im-
VerDate Aug<31>2005
RVUs cility Total
RVUs
43880 .... .......... A Repair stomach-bowel fistula ............................... 27.05 NA NA 9.37 9.76 3.27 NA NA 39.69 40.08 090
43881 .... .......... C Impl/redo electrd, antrum ..................................... 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 YYY
43882 .... .......... C Revise/remove electrd antrum ............................. 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 YYY
10:50 Nov 30, 2006

43886 .... .......... A Revise gastric port, open ..................................... 4.54 NA NA 3.38 3.19 0.25 NA NA 8.17 7.98 090
43887 .... .......... A Remove gastric port, open ................................... 4.24 NA NA 2.94 2.81 0.51 NA NA 7.69 7.56 090
43888 .... .......... A Change gastric port, open ................................... 6.34 NA NA 3.86 3.79 0.70 NA NA 10.90 10.83 090
43999 .... .......... C Stomach surgery procedure ................................. 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 YYY
44005 .... .......... A Freeing of bowel adhesion ................................... 18.38 NA NA 6.64 6.69 2.15 NA NA 27.17 27.22 090
Jkt 211001
44010 .... .......... A Incision of small bowel ......................................... 14.18 NA NA 5.55 5.47 1.64 NA NA 21.37 21.29 090
44015 .... .......... A Insert needle cath bowel ...................................... 2.62 NA NA 0.69 0.83 0.35 NA NA 3.66 3.80 ZZZ
44020 .... .......... A Explore small intestine ......................................... 16.14 NA NA 6.03 5.96 1.86 NA NA 24.03 23.96 090
44021 .... .......... A Decompress small bowel ..................................... 16.23 NA NA 6.31 6.05 1.87 NA NA 24.41 24.15 090
PO 00000
44025 .... .......... A Incision of large bowel ......................................... 16.43 NA NA 6.16 6.06 1.90 NA NA 24.49 24.39 090
44050 .... .......... A Reduce bowel obstruction .................................... 15.44 NA NA 5.86 5.93 1.86 NA NA 23.16 23.23 090
44055 .... .......... A Correct malrotation of bowel ................................ 25.53 NA NA 8.56 8.68 2.91 NA NA 37.00 37.12 090
44100 .... .......... A Biopsy of bowel .................................................... 2.01 NA NA 0.90 0.76 0.17 NA NA 3.08 2.94 000
Frm 00248
44110 .... .......... A Excise intestine lesion(s) ..................................... 13.96 NA NA 5.56 5.31 1.55 NA NA 21.07 20.82 090
44111 .... .......... A Excision of bowel lesion(s) .................................. 16.44 NA NA 6.18 6.12 1.87 NA NA 24.49 24.43 090
44120 .... .......... A Removal of small intestine ................................... 20.74 NA NA 7.21 7.11 2.25 NA NA 30.20 30.10 090
44121 .... .......... A Removal of small intestine ................................... 4.44 NA NA 1.14 1.43 0.58 NA NA 6.16 6.45 ZZZ
Fmt 4701
44125 .... .......... A Removal of small intestine ................................... 19.93 NA NA 7.08 7.21 2.27 NA NA 29.28 29.41 090
44126 .... .......... A Enterectomy w/o taper, cong ............................... 42.02 NA NA 13.91 14.06 4.69 NA NA 60.62 60.77 090
44127 .... .......... A Enterectomy w/taper, cong .................................. 49.09 NA NA 14.80 15.48 5.77 NA NA 69.66 70.34 090
44128 .... .......... A Enterectomy cong, add-on ................................... 4.44 NA NA 1.05 1.41 0.61 NA NA 6.10 6.46 ZZZ
Sfmt 4700
44130 .... .......... A Bowel to bowel fusion .......................................... 21.98 NA NA 8.02 6.66 1.88 NA NA 31.88 30.52 090
44132 .... .......... R Enterectomy, cadaver donor ................................ 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 XXX
44133 .... .......... R Enterectomy, live donor ....................................... 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 XXX
44135 .... .......... R Intestine transplnt, cadaver .................................. 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 XXX
44136 .... .......... R Intestine transplant, live ....................................... 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 XXX
44137 .... .......... C Remove intestinal allograft ................................... 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 XXX
44139 .... .......... A Mobilization of colon ............................................ 2.23 NA NA 0.57 0.71 0.28 NA NA 3.08 3.22 ZZZ
44140 .... .......... A Partial removal of colon ....................................... 22.46 NA NA 8.14 8.52 2.71 NA NA 33.31 33.69 090
E:\FR\FM\01DER2.SGM
01DER2
44150 .... .......... A Removal of colon ................................................. 29.99 NA NA 12.68 12.19 3.04 NA NA 45.71 45.22 090
44151 .... .......... A Removal of colon/ileostomy ................................. 34.73 NA NA 14.10 13.57 3.49 NA NA 52.32 51.79 090
44157 .... .......... A Colectomy w/ileoanal anast ................................. 35.49 NA NA 15.67 15.67 3.93 NA NA 55.09 55.09 090
Year Year Year
2007 2007 Fully Im-
VerDate Aug<31>2005
RVUs cility Total
RVUs
44158 .... .......... A Colectomy w/neo-rectum pouch .......................... 36.49 NA NA 15.97 15.97 4.06 NA NA 56.52 56.52 090
44160 .... .......... A Removal of colon ................................................. 20.78 NA NA 7.57 7.70 2.37 NA NA 30.72 30.85 090
44180 .... .......... A Lap, enterolysis .................................................... 0.77 NA NA 2.15 5.21 1.86 NA NA 4.78 7.84 090
10:50 Nov 30, 2006

44186 .... .......... A Lap, jejunostomy .................................................. 0.53 NA NA 2.15 4.13 1.27 NA NA 3.95 5.93 090
44187 .... .......... A Lap, ileo/jejuno-stomy .......................................... 17.27 NA NA 8.19 8.25 1.96 NA NA 27.42 27.48 090
44188 .... .......... A Lap, colostomy ..................................................... 19.20 NA NA 8.77 8.82 2.24 NA NA 30.21 30.26 090
44202 .... .......... A Lap, enterectomy ................................................. 23.26 NA NA 8.37 8.78 2.85 NA NA 34.48 34.89 090
44203 .... .......... A Lap resect s/intestine, addl .................................. 4.44 NA NA 1.14 1.41 0.57 NA NA 6.15 6.42 ZZZ
Jkt 211001
44204 .... .......... A Laparo partial colectomy ...................................... 26.29 NA NA 9.00 9.71 3.11 NA NA 38.40 39.11 090
44205 .... .......... A Lap colectomy part w/ileum ................................. 22.86 NA NA 7.88 8.60 2.75 NA NA 33.49 34.21 090
44206 .... .......... A Lap part colectomy w/stoma ................................ 29.63 NA NA 10.58 11.08 3.46 NA NA 43.67 44.17 090
44207 .... .......... A L colectomy/coloproctostomy ............................... 31.79 NA NA 10.24 11.17 3.67 NA NA 45.70 46.63 090
PO 00000
44208 .... .......... A L colectomy/coloproctostomy ............................... 33.86 NA NA 12.17 12.89 3.88 NA NA 49.91 50.63 090
44210 .... .......... A Laparo total proctocolectomy ............................... 29.88 NA NA 11.27 11.72 3.42 NA NA 44.57 45.02 090
44211 .... .......... A Lap colectomy w/proctectomy .............................. 36.87 NA NA 13.85 14.47 4.17 NA NA 54.89 55.51 090
44212 .... .......... A Laparo total proctocolectomy ............................... 34.37 NA NA 13.26 13.58 3.78 NA NA 51.41 51.73 090
Frm 00249
44213 .... .......... A Lap, mobil splenic fl add-on ................................. 3.50 NA NA 0.89 1.14 0.44 NA NA 4.83 5.08 ZZZ
44227 .... .......... A Lap, close enterostomy ........................................ 28.49 NA NA 9.59 10.36 3.38 NA NA 41.46 42.23 090
44238 .... .......... C Laparoscope proc, intestine ................................. 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 YYY
44300 .... .......... A Open bowel to skin .............................................. 13.65 NA NA 5.58 5.51 1.60 NA NA 20.83 20.76 090
Fmt 4701
44310 .... .......... A Ileostomy/jejunostomy .......................................... 17.49 NA NA 6.45 6.63 1.99 NA NA 25.93 26.11 090
44312 .... .......... A Revision of ileostomy ........................................... 9.33 NA NA 4.65 4.16 0.92 NA NA 14.90 14.41 090
44314 .... .......... A Revision of ileostomy ........................................... 16.61 NA NA 6.88 6.63 1.75 NA NA 25.24 24.99 090
44316 .... .......... A Devise bowel pouch ............................................. 23.46 NA NA 9.35 8.74 2.38 NA NA 35.19 34.58 090
Sfmt 4700
44320 .... .......... A Colostomy ............................................................ 19.75 NA NA 7.66 7.65 2.26 NA NA 29.67 29.66 090
44322 .... .......... A Colostomy with biopsies ...................................... 13.15 NA NA 9.41 8.78 1.54 NA NA 24.10 23.47 090
44340 .... .......... A Revision of colostomy .......................................... 9.12 NA NA 4.96 4.44 0.99 NA NA 15.07 14.55 090
44360 .... .......... A Small bowel endoscopy ....................................... 2.59 NA NA 1.53 1.21 0.19 NA NA 4.31 3.99 000
44361 .... .......... A Small bowel endoscopy/biopsy ............................ 2.87 NA NA 1.67 1.32 0.21 NA NA 4.75 4.40 000
E:\FR\FM\01DER2.SGM
44370 .... .......... A Small bowel endoscopy/stent .............................. 4.79 NA NA 2.58 2.12 0.37 NA NA 7.74 7.28 000
01DER2
44377 .... .......... A Small bowel endoscopy/biopsy ............................ 5.52 NA NA 2.84 2.31 0.40 NA NA 8.76 8.23 000
44379 .... .......... A S bowel endoscope w/stent ................................. 7.46 NA NA 3.34 3.02 0.62 NA NA 11.42 11.10 000
69871
Year
69872
Year Year
2007 2007 Fully Im-
VerDate Aug<31>2005
RVUs cility Total
RVUs
44383 .... .......... A Ileoscopy w/stent .................................................. 2.94 NA NA 1.64 1.36 0.21 NA NA 4.79 4.51 000
10:50 Nov 30, 2006

44385 .... .......... A Endoscopy of bowel pouch .................................. 1.82 4.88 3.73 0.90 0.79 0.15 6.85 5.70 2.87 2.76 000
44386 .... .......... A Endoscopy, bowel pouch/biop ............................. 2.12 6.73 6.66 1.06 0.93 0.20 9.05 8.98 3.38 3.25 000
44388 .... .......... A Colonoscopy ......................................................... 2.82 6.10 5.34 1.37 1.21 0.26 9.18 8.42 4.45 4.29 000
44389 .... .......... A Colonoscopy with biopsy ..................................... 3.13 7.07 6.73 1.60 1.35 0.27 10.47 10.13 5.00 4.75 000
44390 .... .......... A Colonoscopy for foreign body .............................. 3.82 7.96 7.32 1.81 1.57 0.32 12.10 11.46 5.95 5.71 000
Jkt 211001
44391 .... .......... A Colonoscopy for bleeding .................................... 4.31 8.95 8.78 2.24 1.83 0.34 13.60 13.43 6.89 6.48 000
44392 .... .......... A Colonoscopy & polypectomy ................................ 3.81 7.37 6.78 1.74 1.55 0.34 11.52 10.93 5.89 5.70 000
44393 .... .......... A Colonoscopy, lesion removal ............................... 4.83 7.87 7.14 2.07 1.91 0.42 13.12 12.39 7.32 7.16 000
44394 .... .......... A Colonoscopy w/snare ........................................... 4.42 8.46 7.97 2.09 1.81 0.38 13.26 12.77 6.89 6.61 000
PO 00000
44397 .... .......... A Colonoscopy w/stent ............................................ 4.70 NA NA 2.33 1.93 0.39 NA NA 7.42 7.02 000
44500 .... .......... A Intro, gastrointestinal tube .................................... 0.49 NA NA 0.14 0.16 0.03 NA NA 0.66 0.68 000
44602 .... .......... A Suture, small intestine .......................................... 24.64 NA NA 7.71 6.72 2.12 NA NA 34.47 33.48 090
44603 .... .......... A Suture, small intestine .......................................... 28.03 NA NA 9.08 7.72 2.42 NA NA 39.53 38.17 090
Frm 00250
44604 .... .......... A Suture, large intestine .......................................... 18.06 NA NA 6.12 6.37 2.12 NA NA 26.30 26.55 090
44605 .... .......... A Repair of bowel lesion ......................................... 22.00 NA NA 7.95 8.28 2.52 NA NA 32.47 32.80 090
44615 .... .......... A Intestinal stricturoplasty ........................................ 18.08 NA NA 6.61 6.66 2.07 NA NA 26.76 26.81 090
44620 .... .......... A Repair bowel opening .......................................... 14.35 NA NA 5.54 5.38 1.51 NA NA 21.40 21.24 090
Fmt 4701
44640 .... .......... A Repair bowel-skin fistula ...................................... 24.12 NA NA 8.13 8.46 2.78 NA NA 35.03 35.36 090
44650 .... .......... A Repair bowel fistula .............................................. 25.04 NA NA 8.38 8.76 2.93 NA NA 36.35 36.73 090
Sfmt 4700
44660 .... .......... A Repair bowel-bladder fistula ................................ 23.83 NA NA 9.79 8.70 2.14 NA NA 35.76 34.67 090
44661 .... .......... A Repair bowel-bladder fistula ................................ 27.27 NA NA 9.48 9.53 2.81 NA NA 39.56 39.61 090
44680 .... .......... A Surgical revision, intestine ................................... 17.88 NA NA 6.59 6.48 2.00 NA NA 26.47 26.36 090
44700 .... .......... A Suspend bowel w/prosthesis ............................... 17.40 NA NA 6.29 6.57 1.84 NA NA 25.53 25.81 090
44701 .... .......... A Intraop colon lavage add-on ................................ 3.10 NA NA 0.78 0.99 0.37 NA NA 4.25 4.46 ZZZ
44715 .... .......... C Prepare donor intestine ........................................ 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 XXX
44720 .... .......... A Prep donor intestine/venous ................................ 5.00 NA NA 1.26 1.60 0.37 NA NA 6.63 6.97 XXX
44721 .... .......... A Prep donor intestine/artery ................................... 7.00 NA NA 1.83 2.25 0.97 NA NA 9.80 10.22 XXX
44799 .... .......... C Unlisted procedure intestine ................................ 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 YYY
E:\FR\FM\01DER2.SGM
44800 .... .......... A Excision of bowel pouch ...................................... 11.94 NA NA 5.54 5.42 1.47 NA NA 18.95 18.83 090
44820 .... .......... A Excision of mesentery lesion ............................... 13.63 NA NA 5.63 5.52 1.59 NA NA 20.85 20.74 090
44850 .... .......... A Repair of mesentery ............................................. 12.03 NA NA 5.03 5.01 1.39 NA NA 18.45 18.43 090
44899 .... .......... C Bowel surgery procedure ..................................... 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 YYY
01DER2
44900 .... .......... A Drain app abscess, open ..................................... 12.44 NA NA 5.04 4.78 1.33 NA NA 18.81 18.55 090
44901 .... .......... A Drain app abscess, percut ................................... 3.37 18.75 25.61 0.95 1.07 0.22 22.34 29.20 4.54 4.66 000
44950 .... .......... A Appendectomy ..................................................... 10.52 NA NA 4.07 4.25 1.31 NA NA 15.90 16.08 090
44955 .... .......... A Appendectomy add-on ......................................... 1.53 NA NA 0.41 0.51 0.20 NA NA 2.14 2.24 ZZZ
44960 .... .......... A Appendectomy ..................................................... 14.39 NA NA 5.44 5.36 1.63 NA NA 21.46 21.38 090
44970 .... .......... A Laparoscopy, appendectomy ............................... 9.35 NA NA 4.21 4.11 1.14 NA NA 14.70 14.60 090
Year Year Year
2007 2007 Fully Im-
VerDate Aug<31>2005
RVUs cility Total
RVUs
44979 .... .......... C Laparoscope proc, app ........................................ 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 YYY
45000 .... .......... A Drainage of pelvic abscess .................................. 6.20 NA NA 3.50 3.10 0.52 NA NA 10.22 9.82 090
45005 .... .......... A Drainage of rectal abscess .................................. 2.00 3.94 4.02 1.58 1.58 0.25 6.19 6.27 3.83 3.83 010
10:50 Nov 30, 2006

45020 .... .......... A Drainage of rectal abscess .................................. 8.43 NA NA 4.52 3.58 0.55 NA NA 13.50 12.56 090
45100 .... .......... A Biopsy of rectum .................................................. 3.96 NA NA 2.83 2.48 0.44 NA NA 7.23 6.88 090
45108 .... .......... A Removal of anorectal lesion ................................ 5.04 NA NA 3.06 2.84 0.59 NA NA 8.69 8.47 090
45110 .... .......... A Removal of rectum ............................................... 30.57 NA NA 11.97 12.29 3.36 NA NA 45.90 46.22 090
45111 .... .......... A Partial removal of rectum ..................................... 17.89 NA NA 7.05 7.13 2.07 NA NA 27.01 27.09 090
Jkt 211001
45113 .... .......... A Partial proctectomy .............................................. 33.09 NA NA 11.67 12.36 3.49 NA NA 48.25 48.94 090
PO 00000
45119 .... .......... A Remove rectum w/reservoir ................................. 33.35 NA NA 11.79 12.29 3.36 NA NA 48.50 49.00 090
45121 .... .......... A Removal of rectum and colon .............................. 28.93 NA NA 10.33 10.91 3.25 NA NA 42.51 43.09 090
45123 .... .......... A Partial proctectomy .............................................. 18.70 NA NA 7.12 6.92 1.86 NA NA 27.68 27.48 090
Frm 00251
45126 .... .......... A Pelvic exenteration ............................................... 48.89 NA NA 17.38 18.75 4.33 NA NA 70.60 71.97 090
45130 .... .......... A Excision of rectal prolapse ................................... 18.37 NA NA 6.79 6.77 1.80 NA NA 26.96 26.94 090
45135 .... .......... A Excision of rectal prolapse ................................... 22.15 NA NA 9.35 8.65 2.36 NA NA 33.86 33.16 090
45136 .... .......... A Excise ileoanal reservior ...................................... 30.63 NA NA 11.94 12.37 2.82 NA NA 45.39 45.82 090
Fmt 4701
45150 .... .......... A Excision of rectal stricture .................................... 5.77 NA NA 3.42 3.08 0.61 NA NA 9.80 9.46 090
45160 .... .......... A Excision of rectal lesion ....................................... 16.17 NA NA 6.61 6.63 1.68 NA NA 24.46 24.48 090
45170 .... .......... A Excision of rectal lesion ....................................... 12.48 NA NA 5.41 5.28 1.35 NA NA 19.24 19.11 090
45190 .... .......... A Destruction, rectal tumor ...................................... 10.29 NA NA 5.60 4.87 1.13 NA NA 17.02 16.29 090
Sfmt 4700
45300 .... .......... A Proctosigmoidoscopy dx ...................................... 0.38 1.93 1.63 0.35 0.30 0.04 2.35 2.05 0.77 0.72 000
45303 .... .......... A Proctosigmoidoscopy dilate ................................. 0.44 19.40 18.86 0.38 0.34 0.05 19.89 19.35 0.87 0.83 000
45305 .... .......... A Proctosigmoidoscopy w/bx ................................... 1.01 3.24 2.78 0.53 0.51 0.11 4.36 3.90 1.65 1.63 000
45307 .... .......... A Proctosigmoidoscopy fb ....................................... 0.94 3.30 3.10 0.51 0.49 0.11 4.35 4.15 1.56 1.54 000
45308 .... .......... A Proctosigmoidoscopy removal ............................. 0.83 3.27 2.31 0.49 0.45 0.09 4.19 3.23 1.41 1.37 000
45317 .... .......... A Proctosigmoidoscopy bleed ................................. 1.50 3.48 2.69 0.66 0.66 0.15 5.13 4.34 2.31 2.31 000
45320 .... .......... A Proctosigmoidoscopy ablate ................................ 1.58 3.95 3.17 0.75 0.72 0.16 5.69 4.91 2.49 2.46 000
E:\FR\FM\01DER2.SGM
45321 .... .......... A Proctosigmoidoscopy volvul ................................. 1.17 NA NA 0.65 0.58 0.13 NA NA 1.95 1.88 000
45327 .... .......... A Proctosigmoidoscopy w/stent ............................... 1.65 NA NA 0.82 0.72 0.16 NA NA 2.63 2.53 000
45330 .... .......... A Diagnostic sigmoidoscopy .................................... 0.96 2.49 2.33 0.62 0.53 0.08 3.53 3.37 1.66 1.57 000
45331 .... .......... A Sigmoidoscopy and biopsy .................................. 1.15 3.24 3.11 0.79 0.64 0.09 4.48 4.35 2.03 1.88 000
01DER2
45332 .... .......... A Sigmoidoscopy w/fb removal ............................... 1.79 5.60 5.15 1.04 0.86 0.16 7.55 7.10 2.99 2.81 000
45333 .... .......... A Sigmoidoscopy & polypectomy ............................ 1.79 5.61 5.06 0.99 0.85 0.15 7.55 7.00 2.93 2.79 000
45334 .... .......... A Sigmoidoscopy for bleeding ................................. 2.73 NA NA 1.55 1.24 0.20 NA NA 4.48 4.17 000
45335 .... .......... A Sigmoidoscopy w/submuc inj ............................... 1.46 5.31 3.74 0.91 0.75 0.11 6.88 5.31 2.48 2.32 000
45337 .... .......... A Sigmoidoscopy & decompress ............................. 2.36 NA NA 1.25 1.06 0.21 NA NA 3.82 3.63 000
45338 .... .......... A Sigmoidoscopy w/tumr remove ............................ 2.34 5.84 5.37 1.28 1.07 0.19 8.37 7.90 3.81 3.60 000
69873
Year
69874
Year Year
2007 2007 Fully Im-
VerDate Aug<31>2005
RVUs cility Total
RVUs
45339 .... .......... A Sigmoidoscopy w/ablate tumr .............................. 3.14 5.74 4.03 1.69 1.38 0.26 9.14 7.43 5.09 4.78 000
45340 .... .......... A Sig w/balloon dilation ........................................... 1.89 10.20 7.18 1.05 0.89 0.15 12.24 9.22 3.09 2.93 000
45341 .... .......... A Sigmoidoscopy w/ultrasound ............................... 2.60 NA NA 1.48 1.17 0.19 NA NA 4.27 3.96 000
10:50 Nov 30, 2006

45342 .... .......... A Sigmoidoscopy w/us guide bx ............................. 4.05 NA NA 2.20 1.71 0.30 NA NA 6.55 6.06 000
45345 .... .......... A Sigmoidoscopy w/stent ........................................ 2.92 NA NA 1.56 1.26 0.23 NA NA 4.71 4.41 000
45355 .... .......... A Surgical colonoscopy ........................................... 3.51 NA NA 1.57 1.43 0.36 NA NA 5.44 5.30 000
45378 .... .......... A Diagnostic colonoscopy ....................................... 3.69 6.37 6.20 1.85 1.57 0.30 10.36 10.19 5.84 5.56 000
45378 .... 53 ..... A Diagnostic colonoscopy ....................................... 0.96 2.49 2.33 0.62 0.53 0.08 3.53 3.37 1.66 1.57 000
Jkt 211001
45379 .... .......... A Colonoscopy w/fb removal ................................... 4.68 8.15 7.78 2.25 1.92 0.39 13.22 12.85 7.32 6.99 000
45380 .... .......... A Colonoscopy and biopsy ...................................... 4.43 7.73 7.33 2.27 1.87 0.35 12.51 12.11 7.05 6.65 000
45381 .... .......... A Colonoscopy, submucous inj ............................... 4.19 7.71 7.26 2.19 1.79 0.30 12.20 11.75 6.68 6.28 000
45382 .... .......... A Colonoscopy/control bleeding .............................. 5.68 10.34 10.04 2.93 2.37 0.41 16.43 16.13 9.02 8.46 000
PO 00000
45383 .... .......... A Lesion removal colonoscopy ................................ 5.86 8.56 8.08 2.69 2.34 0.48 14.90 14.42 9.03 8.68 000
45384 .... .......... A Lesion remove colonoscopy ................................ 4.69 7.21 6.90 2.24 1.93 0.38 12.28 11.97 7.31 7.00 000
45385 .... .......... A Lesion removal colonoscopy ................................ 5.30 8.35 7.94 2.63 2.18 0.42 14.07 13.66 8.35 7.90 000
45386 .... .......... A Colonoscopy dilate stricture ................................. 4.57 12.29 12.37 2.21 1.89 0.39 17.25 17.33 7.17 6.85 000
Frm 00252
45387 .... .......... A Colonoscopy w/stent ............................................ 5.90 NA NA 2.95 2.49 0.48 NA NA 9.33 8.87 000
45391 .... .......... A Colonoscopy w/endoscope us ............................. 5.09 NA NA 2.60 2.13 0.42 NA NA 8.11 7.64 000
45392 .... .......... A Colonoscopy w/endoscopic fnb ........................... 6.54 NA NA 3.17 2.65 0.42 NA NA 10.13 9.61 000
45395 .... .......... A Lap, removal of rectum ........................................ 32.79 NA NA 13.03 13.51 3.63 NA NA 49.45 49.93 090
Fmt 4701
45397 .... .......... A Lap, remove rectum w/pouch .............................. 36.29 NA NA 13.67 14.11 3.67 NA NA 53.63 54.07 090
45400 .... .......... A Laparoscopic proc ................................................ 19.31 NA NA 7.21 7.68 2.03 NA NA 28.55 29.02 090
45402 .... .......... A Lap proctopexy w/sig resect ................................ 26.38 NA NA 8.91 9.71 2.82 NA NA 38.11 38.91 090
45499 .... .......... C Laparoscope proc, rectum ................................... 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 YYY
Sfmt 4700
45500 .... .......... A Repair of rectum .................................................. 7.64 NA NA 4.39 3.75 0.75 NA NA 12.78 12.14 090
45505 .... .......... A Repair of rectum .................................................. 8.20 NA NA 5.14 4.17 0.86 NA NA 14.20 13.23 090
45520 .... .......... A Treatment of rectal prolapse ................................ 0.55 3.04 1.99 0.41 0.38 0.05 3.64 2.59 1.01 0.98 000
45540 .... .......... A Correct rectal prolapse ......................................... 18.02 NA NA 5.83 6.55 1.85 NA NA 25.70 26.42 090
45541 .... .......... A Correct rectal prolapse ......................................... 14.72 NA NA 6.63 6.11 1.55 NA NA 22.90 22.38 090
45550 .... .......... A Repair rectum/remove sigmoid ............................ 24.67 NA NA 9.06 9.17 2.62 NA NA 36.35 36.46 090
45560 .... .......... A Repair of rectocele ............................................... 11.42 NA NA 5.55 5.18 1.13 NA NA 18.10 17.73 090
45562 .... .......... A Exploration/repair of rectum ................................. 17.82 NA NA 8.18 7.28 1.84 NA NA 27.84 26.94 090
45563 .... .......... A Exploration/repair of rectum ................................. 26.22 NA NA 10.95 10.62 3.11 NA NA 40.28 39.95 090
E:\FR\FM\01DER2.SGM
45800 .... .......... A Repair rect/bladder fistula .................................... 20.18 NA NA 9.30 7.89 1.86 NA NA 31.34 29.93 090
45805 .... .......... A Repair fistula w/colostomy ................................... 23.19 NA NA 9.27 9.44 2.03 NA NA 34.49 34.66 090
45820 .... .......... A Repair rectourethral fistula ................................... 20.24 NA NA 9.39 8.06 1.58 NA NA 31.21 29.88 090
45825 .... .......... A Repair fistula w/colostomy ................................... 24.01 NA NA 11.05 10.12 2.32 NA NA 37.38 36.45 090
01DER2
45900 .... .......... A Reduction of rectal prolapse ................................ 2.96 NA NA 1.69 1.55 0.30 NA NA 4.95 4.81 010
45905 .... .......... A Dilation of anal sphincter ..................................... 2.32 NA NA 1.65 1.49 0.27 NA NA 4.24 4.08 010
45910 .... .......... A Dilation of rectal narrowing .................................. 2.82 NA NA 1.81 1.70 0.30 NA NA 4.93 4.82 010
45915 .... .......... A Remove rectal obstruction ................................... 3.16 4.25 4.30 2.05 2.08 0.30 7.71 7.76 5.51 5.54 010
45990 .... .......... A Surg dx exam, anorectal ...................................... 1.80 NA NA 0.80 0.79 0.17 NA NA 2.77 2.76 000
45999 .... .......... C Rectum surgery procedure .................................. 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 YYY
Year Year Year
2007 2007 Fully Im-
VerDate Aug<31>2005
RVUs cility Total
RVUs
46020 .... .......... A Placement of seton .............................................. 2.94 3.26 2.56 2.36 1.98 0.31 6.51 5.81 5.61 5.23 010
46030 .... .......... A Removal of rectal marker ..................................... 1.24 1.88 1.48 0.82 0.74 0.14 3.26 2.86 2.20 2.12 010
46040 .... .......... A Incision of rectal abscess ..................................... 5.26 6.51 5.75 3.98 3.68 0.62 12.39 11.63 9.86 9.56 090
10:50 Nov 30, 2006

46045 .... .......... A Incision of rectal abscess ..................................... 5.79 NA NA 3.94 3.15 0.54 NA NA 10.27 9.48 090
46050 .... .......... A Incision of anal abscess ....................................... 1.21 3.17 2.70 0.98 0.88 0.14 4.52 4.05 2.33 2.23 010
46060 .... .......... A Incision of rectal abscess ..................................... 6.24 NA NA 4.42 3.54 0.67 NA NA 11.33 10.45 090
46070 .... .......... A Incision of anal septum ........................................ 2.74 NA NA 2.33 1.96 0.36 NA NA 5.43 5.06 090
46080 .... .......... A Incision of anal sphincter ..................................... 2.50 3.05 2.53 1.13 1.13 0.30 5.85 5.33 3.93 3.93 010
Jkt 211001
46083 .... .......... A Incise external hemorrhoid ................................... 1.42 2.34 2.48 0.96 0.93 0.15 3.91 4.05 2.53 2.50 010
46200 .... .......... A Removal of anal fissure ....................................... 3.48 6.28 4.46 3.73 3.08 0.39 10.15 8.33 7.60 6.95 090
46210 .... .......... A Removal of anal crypt .......................................... 2.73 5.93 5.32 3.36 2.81 0.31 8.97 8.36 6.40 5.85 090
46211 .... .......... A Removal of anal crypts ........................................ 4.31 7.12 5.83 4.11 3.65 0.48 11.91 10.62 8.90 8.44 090
PO 00000
46220 .... .......... A Removal of anal tag ............................................. 1.58 2.98 2.46 1.09 0.99 0.17 4.73 4.21 2.84 2.74 010
46221 .... .......... A Ligation of hemorrhoid(s) ..................................... 2.31 3.72 2.91 2.00 1.81 0.23 6.26 5.45 4.54 4.35 010
46230 .... .......... A Removal of anal tags ........................................... 2.59 3.49 3.18 1.34 1.30 0.30 6.38 6.07 4.23 4.19 010
46250 .... .......... A Hemorrhoidectomy ............................................... 4.17 5.95 5.46 2.85 2.67 0.48 10.60 10.11 7.50 7.32 090
Frm 00253
46255 .... .......... A Hemorrhoidectomy ............................................... 4.88 6.37 5.97 3.10 2.90 0.58 11.83 11.43 8.56 8.36 090
46257 .... .......... A Remove hemorrhoids & fissure ........................... 5.68 NA NA 3.82 3.11 0.64 NA NA 10.14 9.43 090
46258 .... .......... A Remove hemorrhoids & fistula ............................. 6.28 NA NA 4.02 3.46 0.68 NA NA 10.98 10.42 090
46260 .... .......... A Hemorrhoidectomy ............................................... 6.65 NA NA 4.07 3.40 0.76 NA NA 11.48 10.81 090
Fmt 4701
46261 .... .......... A Remove hemorrhoids & fissure ........................... 7.63 NA NA 4.35 3.79 0.79 NA NA 12.77 12.21 090
46262 .... .......... A Remove hemorrhoids & fistula ............................. 7.80 NA NA 4.70 3.97 0.83 NA NA 13.33 12.60 090
46270 .... .......... A Removal of anal fistula ........................................ 4.81 6.26 5.31 3.85 3.09 0.46 11.53 10.58 9.12 8.36 090
Sfmt 4700
46280 .... .......... A Removal of anal fistula ........................................ 6.28 NA NA 4.29 3.51 0.66 NA NA 11.23 10.45 090
46288 .... .......... A Repair anal fistula ................................................ 7.68 NA NA 4.70 3.93 0.79 NA NA 13.17 12.40 090
46320 .... .......... A Removal of hemorrhoid clot ................................. 1.62 2.40 2.19 0.89 0.86 0.18 4.20 3.99 2.69 2.66 010
46500 .... .......... A Injection into hemorrhoid(s) ................................. 1.64 3.60 2.48 1.26 1.18 0.16 5.40 4.28 3.06 2.98 010
46505 .... .......... A Chemodenervation anal musc ............................. 3.13 3.29 3.10 2.31 2.05 0.14 6.56 6.37 5.58 5.32 010
46600 .... .......... A Diagnostic anoscopy ............................................ 0.50 1.43 1.53 0.37 0.35 0.05 1.98 2.08 0.92 0.90 000
46604 .... .......... A Anoscopy and dilation .......................................... 1.31 12.51 9.97 0.58 0.61 0.12 13.94 11.40 2.01 2.04 000
46606 .... .......... A Anoscopy and biopsy ........................................... 0.81 3.88 3.81 0.48 0.44 0.09 4.78 4.71 1.38 1.34 000
E:\FR\FM\01DER2.SGM
46608 .... .......... A Anoscopy, remove for body ................................. 1.51 3.90 4.28 0.62 0.64 0.16 5.57 5.95 2.29 2.31 000
46610 .... .......... A Anoscopy, remove lesion ..................................... 1.32 4.12 4.05 0.67 0.63 0.15 5.59 5.52 2.14 2.10 000
46611 .... .......... A Anoscopy .............................................................. 1.81 2.80 3.20 0.72 0.77 0.19 4.80 5.20 2.72 2.77 000
46612 .... .......... A Anoscopy, remove lesions ................................... 2.34 5.24 5.20 0.96 0.98 0.28 7.86 7.82 3.58 3.60 000
01DER2
46614 .... .......... A Anoscopy, control bleeding .................................. 2.01 2.56 2.38 0.83 0.84 0.20 4.77 4.59 3.04 3.05 000
46615 .... .......... A Anoscopy .............................................................. 2.68 2.26 2.43 0.97 1.05 0.33 5.27 5.44 3.98 4.06 000
46700 .... .......... A Repair of anal stricture ......................................... 9.68 NA NA 5.19 4.45 0.94 NA NA 15.81 15.07 090
46705 .... .......... A Repair of anal stricture ......................................... 7.32 NA NA 4.04 3.77 0.91 NA NA 12.27 12.00 090
46706 .... .......... A Repr of anal fistula w/glue ................................... 2.41 NA NA 1.45 1.30 0.28 NA NA 4.14 3.99 010
46710 .... .......... A Repr per/vag pouch sngl proc ............................. 17.01 NA NA 7.83 7.77 1.38 NA NA 26.22 26.16 090
69875
Year
69876
Year Year
2007 2007 Fully Im-
VerDate Aug<31>2005
RVUs cility Total
RVUs
46712 .... .......... A Repr per/vag pouch dbl proc ............................... 36.32 NA NA 14.26 14.85 3.67 NA NA 54.25 54.84 090
46715 .... .......... A Rep perf anoper fistu ........................................... 7.54 NA NA 3.74 3.61 0.92 NA NA 12.20 12.07 090
46716 .... .......... A Rep perf anoper/vestib fistu ................................. 17.14 NA NA 9.59 8.38 1.58 NA NA 28.31 27.10 090
10:50 Nov 30, 2006

46730 .... .......... A Construction of absent anus ................................ 30.17 NA NA 11.55 11.90 2.47 NA NA 44.19 44.54 090
46742 .... .......... A Repair of imperforated anus ................................ 39.66 NA NA 16.09 17.06 3.20 NA NA 58.95 59.92 090
46744 .... .......... A Repair of cloacal anomaly ................................... 58.46 NA NA 21.37 21.18 6.40 NA NA 86.23 86.04 090
Jkt 211001
46750 .... .......... A Repair of anal sphincter ....................................... 12.02 NA NA 5.83 5.25 1.10 NA NA 18.95 18.37 090
PO 00000
46753 .... .......... A Reconstruction of anus ........................................ 8.81 NA NA 4.63 4.04 0.94 NA NA 14.38 13.79 090
46754 .... .......... A Removal of suture from anus .............................. 2.88 3.72 3.62 2.28 1.82 0.19 6.79 6.69 5.35 4.89 010
Frm 00254
46762 .... .......... A Implant artificial sphincter .................................... 14.66 NA NA 6.87 5.85 1.24 NA NA 22.77 21.75 090
46900 .... .......... A Destruction, anal lesion(s) ................................... 1.91 3.63 2.84 1.31 1.28 0.17 5.71 4.92 3.39 3.36 010
46916 .... .......... A Cryosurgery, anal lesion(s) .................................. 1.88 3.80 3.31 1.61 1.45 0.11 5.79 5.30 3.60 3.44 010
Fmt 4701
46917 .... .......... A Laser surgery, anal lesions .................................. 1.88 8.62 9.00 1.21 1.14 0.21 10.71 11.09 3.30 3.23 010
46922 .... .......... A Excision of anal lesion(s) ..................................... 1.88 4.10 3.48 1.20 1.10 0.22 6.20 5.58 3.30 3.20 010
46934 .... .......... A Destruction of hemorrhoids .................................. 3.79 5.40 5.15 2.81 2.92 0.32 9.51 9.26 6.92 7.03 090
Sfmt 4700
46937 .... .......... A Cryotherapy of rectal lesion ................................. 2.70 4.16 3.12 1.90 1.39 0.14 7.00 5.96 4.74 4.23 010
46938 .... .......... A Cryotherapy of rectal lesion ................................. 4.70 5.78 4.44 3.64 3.20 0.58 11.06 9.72 8.92 8.48 090
46940 .... .......... A Treatment of anal fissure ..................................... 2.33 2.84 2.20 1.05 1.08 0.23 5.40 4.76 3.61 3.64 010
46942 .... .......... A Treatment of anal fissure ..................................... 2.05 2.79 2.07 0.96 1.01 0.19 5.03 4.31 3.20 3.25 010
46945 .... .......... A Ligation of hemorrhoids ....................................... 2.13 4.81 3.65 2.99 2.60 0.19 7.13 5.97 5.31 4.92 090
46946 .... .......... A Ligation of hemorrhoids ....................................... 2.60 4.64 3.95 2.66 2.46 0.27 7.51 6.82 5.53 5.33 090
46947 .... .......... A Hemorrhoidopexy by stapling .............................. 5.49 NA NA 3.11 2.81 0.75 NA NA 9.35 9.05 090
E:\FR\FM\01DER2.SGM
46999 .... .......... C Anus surgery procedure ....................................... 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 YYY
47000 .... .......... A Needle biopsy of liver .......................................... 1.90 7.28 4.12 0.58 0.62 0.12 9.30 6.14 2.60 2.64 000
47001 .... .......... A Needle biopsy, liver add-on ................................. 1.90 NA NA 0.49 0.61 0.25 NA NA 2.64 2.76 ZZZ
47010 .... .......... A Open drainage, liver lesion .................................. 19.27 NA NA 8.15 8.33 1.81 NA NA 29.23 29.41 090
01DER2
47011 .... .......... A Percut drain, liver lesion ...................................... 3.69 NA NA 1.05 1.17 0.22 NA NA 4.96 5.08 000
47015 .... .......... A Inject/aspirate liver cyst ........................................ 18.37 NA NA 7.80 7.56 1.84 NA NA 28.01 27.77 090
47100 .... .......... A Wedge biopsy of liver .......................................... 12.78 NA NA 6.33 6.11 1.53 NA NA 20.64 20.42 090
47120 .... .......... A Partial removal of liver ......................................... 38.82 NA NA 14.08 14.88 4.66 NA NA 57.56 58.36 090
47122 .... .......... A Extensive removal of liver .................................... 59.35 NA NA 18.83 20.79 7.21 NA NA 85.39 87.35 090
Year Year Year
2007 2007 Fully Im-
VerDate Aug<31>2005
RVUs cility Total
RVUs
47133 .... .......... X Removal of donor liver ......................................... 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 XXX
47135 .... .......... R Transplantation of liver ......................................... 83.29 NA NA 27.87 30.59 9.96 NA NA 121.12 123.84 090
10:50 Nov 30, 2006

47136 .... .......... R Transplantation of liver ......................................... 70.39 NA NA 23.77 26.20 8.44 NA NA 102.60 105.03 090
47140 .... .......... A Partial removal, donor liver .................................. 59.22 NA NA 21.75 22.14 5.19 NA NA 86.16 86.55 090
47143 .... .......... C Prep donor liver, whole ........................................ 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 XXX
Jkt 211001
47144 .... .......... C Prep donor liver, 3-segment ................................ 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 090
47145 .... .......... C Prep donor liver, lobe split ................................... 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 XXX
47146 .... .......... A Prep donor liver/venous ....................................... 6.00 NA NA 1.54 1.92 0.83 NA NA 8.37 8.75 XXX
47147 .... .......... A Prep donor liver/arterial ........................................ 7.00 NA NA 1.79 2.24 0.97 NA NA 9.76 10.21 XXX
PO 00000
47300 .... .......... A Surgery for liver lesion ......................................... 18.01 NA NA 7.67 7.33 1.99 NA NA 27.67 27.33 090
47350 .... .......... A Repair liver wound ............................................... 22.36 NA NA 8.89 8.87 2.59 NA NA 33.84 33.82 090
Frm 00255
47370 .... .......... A Laparo ablate liver tumor rf .................................. 20.67 NA NA 7.67 8.02 2.56 NA NA 30.90 31.25 090
47371 .... .......... A Laparo ablate liver cryosurg ................................ 20.67 NA NA 8.14 8.14 2.61 NA NA 31.42 31.42 090
47379 .... .......... C Laparoscope procedure, liver .............................. 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 YYY
Fmt 4701
47380 .... .......... A Open ablate liver tumor rf .................................... 24.43 NA NA 8.52 9.14 2.87 NA NA 35.82 36.44 090
47381 .... .......... A Open ablate liver tumor cryo ............................... 24.72 NA NA 9.01 9.44 2.85 NA NA 36.58 37.01 090
47382 .... .......... A Percut ablate liver rf ............................................. 15.19 NA NA 5.12 5.83 0.96 NA NA 21.27 21.98 010
47399 .... .......... C Liver surgery procedure ....................................... 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 YYY
Sfmt 4700
47400 .... .......... A Incision of liver duct ............................................. 36.23 NA NA 13.12 13.35 3.08 NA NA 52.43 52.66 090
47420 .... .......... A Incision of bile duct .............................................. 21.92 NA NA 8.63 8.72 2.63 NA NA 33.18 33.27 090
47425 .... .......... A Incision of bile duct .............................................. 22.20 NA NA 8.59 8.75 2.62 NA NA 33.41 33.57 090
47460 .... .......... A Incise bile duct sphincter ..................................... 20.41 NA NA 9.01 8.52 2.21 NA NA 31.63 31.14 090
47480 .... .......... A Incision of gallbladder .......................................... 13.12 NA NA 6.65 6.09 1.42 NA NA 21.19 20.63 090
47490 .... .......... A Incision of gallbladder .......................................... 8.05 NA NA 4.61 5.32 0.43 NA NA 13.09 13.80 090
47500 .... .......... A Injection for liver x-rays ........................................ 1.96 NA NA 0.57 0.62 0.12 NA NA 2.65 2.70 000
47505 .... .......... A Injection for liver x-rays ........................................ 0.76 NA NA 0.22 0.24 0.04 NA NA 1.02 1.04 000
47510 .... .......... A Insert catheter, bile duct ...................................... 7.94 NA NA 3.99 4.76 0.46 NA NA 12.39 13.16 090
E:\FR\FM\01DER2.SGM
47511 .... .......... A Insert bile duct drain ............................................ 10.74 NA NA 4.22 4.87 0.62 NA NA 15.58 16.23 090
47525 .... .......... A Change bile duct catheter .................................... 5.55 13.94 14.80 2.27 2.67 0.33 19.82 20.68 8.15 8.55 010
47530 .... .......... A Revise/reinsert bile tube ...................................... 5.96 28.88 32.56 2.98 3.53 0.37 35.21 38.89 9.31 9.86 090
47550 .... .......... A Bile duct endoscopy add-on ................................ 3.02 NA NA 0.78 0.96 0.40 NA NA 4.20 4.38 ZZZ
01DER2
47552 .... .......... A Biliary endoscopy thru skin .................................. 6.03 NA NA 2.10 2.30 0.42 NA NA 8.55 8.75 000
47560 .... .......... A Laparoscopy w/cholangio ..................................... 4.88 NA NA 1.25 1.57 0.65 NA NA 6.78 7.10 000
69877
Year
69878
Year Year
2007 2007 Fully Im-
VerDate Aug<31>2005
RVUs cility Total
RVUs
47561 .... .......... A Laparo w/cholangio/biopsy ................................... 5.17 NA NA 1.56 1.82 0.66 NA NA 7.39 7.65 000
47562 .... .......... A Laparoscopic cholecystectomy ............................ 11.63 NA NA 5.29 5.06 1.46 NA NA 18.38 18.15 090
47563 .... .......... A Laparo cholecystectomy/graph ............................ 12.03 NA NA 5.09 5.24 1.58 NA NA 18.70 18.85 090
10:50 Nov 30, 2006

47564 .... .......... A Laparo cholecystectomy/explr .............................. 14.21 NA NA 5.46 5.82 1.89 NA NA 21.56 21.92 090
47570 .... .......... A Laparo cholecystoenterostomy ............................ 12.56 NA NA 5.04 5.28 1.65 NA NA 19.25 19.49 090
47579 .... .......... C Laparoscope proc, biliary ..................................... 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 YYY
47600 .... .......... A Removal of gallbladder ........................................ 17.35 NA NA 7.25 6.40 1.80 NA NA 26.40 25.55 090
Jkt 211001
47630 .... .......... A Remove bile duct stone ....................................... 9.57 NA NA 4.18 4.71 0.65 NA NA 14.40 14.93 090
PO 00000
47700 .... .......... A Exploration of bile ducts ....................................... 16.39 NA NA 7.27 7.37 2.07 NA NA 25.73 25.83 090
47701 .... .......... A Bile duct revision .................................................. 28.62 NA NA 10.11 11.13 3.68 NA NA 42.41 43.43 090
47711 .... .......... A Excision of bile duct tumor ................................... 25.77 NA NA 9.59 9.83 3.05 NA NA 38.41 38.65 090
47712 .... .......... A Excision of bile duct tumor ................................... 33.59 NA NA 11.59 12.20 3.93 NA NA 49.11 49.72 090
Frm 00256
47715 .... .......... A Excision of bile duct cyst ..................................... 21.42 NA NA 8.59 8.46 2.49 NA NA 32.50 32.37 090
47719 .... .......... A Fusion of bile duct cyst ........................................ 19.07 NA NA 7.97 7.85 2.15 NA NA 29.19 29.07 090
47720 .... .......... A Fuse gallbladder & bowel .................................... 18.21 NA NA 7.74 7.53 2.11 NA NA 28.06 27.85 090
47721 .... .......... A Fuse upper gi structures ...................................... 21.86 NA NA 8.62 8.57 2.53 NA NA 33.01 32.96 090
Fmt 4701
47760 .... .......... A Fuse bile ducts and bowel ................................... 38.14 NA NA 13.14 11.41 3.42 NA NA 54.70 52.97 090
47765 .... .......... A Fuse liver ducts & bowel ...................................... 52.01 NA NA 16.99 12.33 3.30 NA NA 72.30 67.64 090
Sfmt 4700
47800 .... .......... A Reconstruction of bile ducts ................................. 26.04 NA NA 9.78 9.98 3.08 NA NA 38.90 39.10 090
47801 .... .......... A Placement, bile duct support ............................... 17.47 NA NA 7.60 8.01 1.16 NA NA 26.23 26.64 090
47802 .... .......... A Fuse liver duct & intestine ................................... 24.80 NA NA 9.54 9.62 2.86 NA NA 37.20 37.28 090
47900 .... .......... A Suture bile duct injury .......................................... 22.31 NA NA 8.77 8.83 2.65 NA NA 33.73 33.79 090
47999 .... .......... C Bile tract surgery procedure ................................. 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 YYY
48000 .... .......... A Drainage of abdomen .......................................... 31.82 NA NA 10.87 11.34 3.48 NA NA 46.17 46.64 090
48001 .... .......... A Placement of drain, pancreas .............................. 39.56 NA NA 12.74 13.58 4.69 NA NA 56.99 57.83 090
E:\FR\FM\01DER2.SGM
48020 .... .......... A Removal of pancreatic stone ............................... 18.96 NA NA 7.63 7.38 2.13 NA NA 28.72 28.47 090
48100 .... .......... A Biopsy of pancreas, open .................................... 14.38 NA NA 5.88 5.66 1.62 NA NA 21.88 21.66 090
48102 .... .......... A Needle biopsy, pancreas ..................................... 4.68 8.98 8.21 1.58 1.85 0.28 13.94 13.17 6.54 6.81 010
48105 .... .......... A Resect/debride pancreas ..................................... 49.05 NA NA 16.00 16.41 5.56 NA NA 70.61 71.02 090
01DER2
48120 .... .......... A Removal of pancreas lesion ................................ 18.33 NA NA 6.93 6.86 2.10 NA NA 27.36 27.29 090
48140 .... .......... A Partial removal of pancreas ................................. 26.19 NA NA 9.40 9.49 3.03 NA NA 38.62 38.71 090
48146 .... .......... A Pancreatectomy ................................................... 30.42 NA NA 11.87 11.95 3.50 NA NA 45.79 45.87 090
48148 .... .......... A Removal of pancreatic duct ................................. 20.26 NA NA 8.09 7.72 2.30 NA NA 30.65 30.28 090
Year Year Year
2007 2007 Fully Im-
VerDate Aug<31>2005
RVUs cility Total
RVUs
10:50 Nov 30, 2006

48155 .... .......... A Removal of pancreas ........................................... 29.27 NA NA 11.98 11.73 3.27 NA NA 44.52 44.27 090
48160 .... .......... N Pancreas removal/transplant ............................... 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 XXX
48400 .... .......... A Injection, intraop add-on ...................................... 1.95 NA NA 0.85 0.69 0.15 NA NA 2.95 2.79 ZZZ
48500 .... .......... A Surgery of pancreatic cyst ................................... 18.03 NA NA 8.04 7.50 2.03 NA NA 28.10 27.56 090
48510 .... .......... A Drain pancreatic pseudocyst ................................ 17.06 NA NA 7.53 7.46 1.83 NA NA 26.42 26.35 090
Jkt 211001
48511 .... .......... A Drain pancreatic pseudocyst ................................ 3.99 19.06 20.43 1.14 1.27 0.24 23.29 24.66 5.37 5.50 000
48520 .... .......... A Fuse pancreas cyst and bowel ............................ 18.07 NA NA 6.80 6.72 2.06 NA NA 26.93 26.85 090
48540 .... .......... A Fuse pancreas cyst and bowel ............................ 21.86 NA NA 7.76 8.02 2.61 NA NA 32.23 32.49 090
48545 .... .......... A Pancreatorrhaphy ................................................. 22.10 NA NA 8.11 8.01 2.38 NA NA 32.59 32.49 090
PO 00000
48547 .... .......... A Duodenal exclusion .............................................. 30.25 NA NA 10.32 10.43 3.42 NA NA 43.99 44.10 090
48548 .... .......... A Fuse pancreas and bowel .................................... 27.96 NA NA 9.93 10.09 3.28 NA NA 41.17 41.33 090
48550 .... .......... X Donor pancreatectomy ......................................... 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 XXX
48551 .... .......... C Prep donor pancreas ........................................... 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 XXX
Frm 00257
48552 .... .......... A Prep donor pancreas/venous ............................... 4.30 NA NA 1.14 1.38 0.31 NA NA 5.75 5.99 XXX
48554 .... .......... R Transpl allograft pancreas ................................... 37.03 NA NA 20.54 18.82 4.19 NA NA 61.76 60.04 090
48556 .... .......... A Removal, allograft pancreas ................................ 19.24 NA NA 9.42 8.40 2.08 NA NA 30.74 29.72 090
48999 .... .......... C Pancreas surgery procedure ................................ 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 YYY
Fmt 4701
49000 .... .......... A Exploration of abdomen ....................................... 12.44 NA NA 5.22 5.33 1.52 NA NA 19.18 19.29 090
49002 .... .......... A Reopening of abdomen ........................................ 17.55 NA NA 6.44 5.37 1.37 NA NA 25.36 24.29 090
49010 .... .......... A Exploration behind abdomen ............................... 15.98 NA NA 6.34 6.00 1.51 NA NA 23.83 23.49 090
49020 .... .......... A Drain abdominal abscess ..................................... 26.46 NA NA 9.84 10.10 2.85 NA NA 39.15 39.41 090
Sfmt 4700
49021 .... .......... A Drain abdominal abscess ..................................... 3.37 18.57 20.43 0.96 1.07 0.20 22.14 24.00 4.53 4.64 000
49040 .... .......... A Drain, open, abdom abscess ............................... 16.41 NA NA 6.51 6.44 1.70 NA NA 24.62 24.55 090
49041 .... .......... A Drain, percut, abdom abscess ............................. 3.99 18.77 19.33 1.14 1.27 0.24 23.00 23.56 5.37 5.50 000
49060 .... .......... A Drain, open, retrop abscess ................................. 18.42 NA NA 7.17 7.36 1.75 NA NA 27.34 27.53 090
49061 .... .......... A Drain, percut, retroper absc ................................. 3.69 18.66 19.38 1.06 1.17 0.22 22.57 23.29 4.97 5.08 000
49062 .... .......... A Drain to peritoneal cavity ..................................... 12.12 NA NA 5.23 5.37 1.39 NA NA 18.74 18.88 090
49080 .... .......... A Puncture, peritoneal cavity ................................... 1.35 2.58 3.63 0.40 0.45 0.08 4.01 5.06 1.83 1.88 000
49081 .... .......... A Removal of abdominal fluid ................................. 1.26 2.85 2.65 0.43 0.43 0.09 4.20 4.00 1.78 1.78 000
49180 .... .......... A Biopsy, abdominal mass ...................................... 1.73 2.27 2.89 0.50 0.55 0.10 4.10 4.72 2.33 2.38 000
E:\FR\FM\01DER2.SGM
49200 .... .......... A Removal of abdominal lesion ............................... 10.94 NA NA 4.86 4.98 1.24 NA NA 17.04 17.16 090
49201 .... .......... A Remove abdom lesion, complex .......................... 15.67 NA NA 6.46 6.88 1.88 NA NA 24.01 24.43 090
49215 .... .......... A Excise sacral spine tumor .................................... 37.66 NA NA 12.77 13.72 4.38 NA NA 54.81 55.76 090
49220 .... .......... A Multiple surgery, abdomen ................................... 15.70 NA NA 6.26 6.53 1.89 NA NA 23.85 24.12 090
01DER2
49250 .... .......... A Excision of umbilicus ............................................ 8.93 NA NA 4.30 4.27 1.08 NA NA 14.31 14.28 090
49255 .... .......... A Removal of omentum ........................................... 12.41 NA NA 5.65 5.61 1.43 NA NA 19.49 19.45 090
49320 .... .......... A Diag laparo separate proc ................................... 5.09 NA NA 2.45 2.59 0.65 NA NA 8.19 8.33 010
49321 .... .......... A Laparoscopy, biopsy ............................................ 5.39 NA NA 2.56 2.62 0.70 NA NA 8.65 8.71 010
49322 .... .......... A Laparoscopy, aspiration ....................................... 5.96 NA NA 2.64 2.90 0.71 NA NA 9.31 9.57 010
49323 .... .......... A Laparo drain lymphocele ...................................... 10.13 NA NA 4.69 4.54 1.20 NA NA 16.02 15.87 090
69879
Year
69880
Year Year
2007 2007 Fully Im-
VerDate Aug<31>2005
RVUs cility Total
RVUs
49324 .... .......... A Lap insertion perm ip cath ................................... 6.27 NA NA 2.80 2.80 0.73 NA NA 9.80 9.80 010
49325 .... .......... A Lap revision perm ip cath .................................... 6.77 NA NA 2.93 2.93 0.86 NA NA 10.56 10.56 010
49326 .... .......... A Lap w/omentopexy add-on ................................... 3.50 NA NA 0.92 0.92 0.44 NA NA 4.86 4.86 ZZZ
10:50 Nov 30, 2006

49329 .... .......... C Laparo proc, abdm/per/oment .............................. 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 YYY
49400 .... .......... A Air injection into abdomen ................................... 1.88 2.30 2.88 0.53 0.60 0.15 4.33 4.91 2.56 2.63 000
49402 .... .......... A Remove foreign body, adbomen .......................... 14.01 NA NA 5.58 5.51 1.62 NA NA 21.21 21.14 090
49419 .... .......... A Insrt abdom cath for chemotx .............................. 7.03 NA NA 3.39 3.52 0.81 NA NA 11.23 11.36 090
49420 .... .......... A Insert abdom drain, temp ..................................... 2.22 NA NA 1.15 1.11 0.21 NA NA 3.58 3.54 000
Jkt 211001
49421 .... .......... A Insert abdom drain, perm ..................................... 5.87 NA NA 3.13 3.15 0.74 NA NA 9.74 9.76 090
49422 .... .......... A Remove perm cannula/catheter ........................... 6.26 NA NA 2.62 2.82 0.83 NA NA 9.71 9.91 010
49423 .... .......... A Exchange drainage catheter ................................ 1.46 12.46 13.67 0.46 0.51 0.09 14.01 15.22 2.01 2.06 000
49424 .... .......... A Assess cyst, contrast inject .................................. 0.76 2.90 3.51 0.25 0.28 0.04 3.70 4.31 1.05 1.08 000
PO 00000
49425 .... .......... A Insert abdomen-venous drain .............................. 12.13 NA NA 5.27 5.51 1.54 NA NA 18.94 19.18 090
49426 .... .......... A Revise abdomen-venous shunt ........................... 10.33 NA NA 4.50 4.70 1.28 NA NA 16.11 16.31 090
49427 .... .......... A Injection, abdominal shunt ................................... 0.89 NA NA 0.26 0.29 0.07 NA NA 1.22 1.25 000
49428 .... .......... A Ligation of shunt ................................................... 6.79 NA NA 3.08 3.71 0.80 NA NA 10.67 11.30 010
Frm 00258
49429 .... .......... A Removal of shunt ................................................. 7.41 NA NA 2.99 3.31 1.02 NA NA 11.42 11.74 010
49435 .... .......... A Insert subq exten to ip cath ................................. 2.25 NA NA 0.60 0.60 0.28 NA NA 3.13 3.13 ZZZ
49436 .... .......... A Embedded ip cath exit-site .................................. 2.69 NA NA 1.63 1.63 0.28 NA NA 4.60 4.60 010
49491 .... .......... A Rpr hern preemie reduc ....................................... 12.42 NA NA 5.43 5.15 1.40 NA NA 19.25 18.97 090
Fmt 4701
49492 .... .......... A Rpr ing hern premie, blocked .............................. 15.32 NA NA 5.85 6.04 1.81 NA NA 22.98 23.17 090
49495 .... .......... A Rpr ing hernia baby, reduc .................................. 6.15 NA NA 2.99 2.96 0.74 NA NA 9.88 9.85 090
49496 .... .......... A Rpr ing hernia baby, blocked ............................... 9.32 NA NA 4.36 4.29 1.07 NA NA 14.75 14.68 090
49500 .... .......... A Rpr ing hernia, init, reduce .................................. 5.76 NA NA 3.62 3.24 0.71 NA NA 10.09 9.71 090
Sfmt 4700
49501 .... .......... A Rpr ing hernia, init blocked .................................. 9.28 NA NA 4.25 4.21 1.12 NA NA 14.65 14.61 090
49505 .... .......... A Prp i/hern init reduc >5 yr .................................... 7.88 NA NA 3.89 3.78 1.03 NA NA 12.80 12.69 090
49507 .... .......... A Prp i/hern init block >5 yr ..................................... 9.97 NA NA 4.47 4.46 1.27 NA NA 15.71 15.70 090
49520 .... .......... A Rerepair ing hernia, reduce ................................. 9.91 NA NA 4.39 4.42 1.28 NA NA 15.58 15.61 090
49521 .... .......... A Rerepair ing hernia, blocked ................................ 12.36 NA NA 5.01 5.18 1.59 NA NA 18.96 19.13 090
49525 .... .......... A Repair ing hernia, sliding ..................................... 8.85 NA NA 4.14 4.09 1.13 NA NA 14.12 14.07 090
49540 .... .......... A Repair lumbar hernia ........................................... 10.66 NA NA 4.65 4.72 1.37 NA NA 16.68 16.75 090
49550 .... .......... A Rpr rem hernia, init, reduce ................................. 8.91 NA NA 4.12 4.12 1.14 NA NA 14.17 14.17 090
49553 .... .......... A Rpr fem hernia, init blocked ................................. 9.84 NA NA 4.42 4.41 1.24 NA NA 15.50 15.49 090
E:\FR\FM\01DER2.SGM
49555 .... .......... A Rerepair fem hernia, reduce ................................ 9.31 NA NA 4.23 4.25 1.20 NA NA 14.74 14.76 090
49557 .... .......... A Rerepair fem hernia, blocked ............................... 11.54 NA NA 4.87 4.95 1.47 NA NA 17.88 17.96 090
49560 .... .......... A Rpr ventral hern init, reduc .................................. 11.84 NA NA 4.90 5.08 1.52 NA NA 18.26 18.44 090
49561 .... .......... A Rpr ventral hern init, block ................................... 15.30 NA NA 5.83 6.00 1.89 NA NA 23.02 23.19 090
01DER2
49565 .... .......... A Rerepair ventrl hern, reduce ................................ 12.29 NA NA 5.14 5.19 1.52 NA NA 18.95 19.00 090
49566 .... .......... A Rerepair ventrl hern, block ................................... 15.45 NA NA 5.89 6.06 1.91 NA NA 23.25 23.42 090
49568 .... .......... A Hernia repair w/mesh ........................................... 4.88 NA NA 1.26 1.57 0.64 NA NA 6.78 7.09 ZZZ
49570 .... .......... A Rpr epigastric hern, reduce ................................. 5.97 NA NA 3.34 3.21 0.75 NA NA 10.06 9.93 090
49572 .... .......... A Rpr epigastric hern, blocked ................................ 7.79 NA NA 3.84 3.56 0.88 NA NA 12.51 12.23 090
49580 .... .......... A Rpr umbil hern, reduc < 5 yr ................................ 4.39 NA NA 3.00 2.69 0.54 NA NA 7.93 7.62 090
Year Year Year
2007 2007 Fully Im-
VerDate Aug<31>2005
RVUs cility Total
RVUs
49582 .... .......... A Rpr umbil hern, block < 5 yr ................................ 7.05 NA NA 3.62 3.50 0.88 NA NA 11.55 11.43 090
49585 .... .......... A Rpr umbil hern, reduc > 5 yr ................................ 6.51 NA NA 3.52 3.35 0.82 NA NA 10.85 10.68 090
49587 .... .......... A Rpr umbil hern, block > 5 yr ................................ 7.96 NA NA 3.88 3.77 0.99 NA NA 12.83 12.72 090
10:50 Nov 30, 2006

49590 .... .......... A Repair spigelian hernia ........................................ 8.82 NA NA 4.11 4.09 1.13 NA NA 14.06 14.04 090
49600 .... .......... A Repair umbilical lesion ......................................... 11.47 NA NA 5.19 5.29 1.32 NA NA 17.98 18.08 090
Jkt 211001
49650 .... .......... A Laparo hernia repair initial ................................... 6.30 NA NA 3.35 3.23 0.93 NA NA 10.58 10.46 090
49651 .... .......... A Laparo hernia repair recur ................................... 8.29 NA NA 4.23 4.09 1.14 NA NA 13.66 13.52 090
49659 .... .......... C Laparo proc, hernia repair ................................... 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 YYY
PO 00000
49900 .... .......... A Repair of abdominal wall ..................................... 12.26 NA NA 6.30 6.24 1.62 NA NA 20.18 20.12 090
49904 .... .......... A Omental flap, extra-abdom .................................. 22.16 NA NA 12.34 14.49 2.70 NA NA 37.20 39.35 090
49905 .... .......... A Omental flap, intra-abdom ................................... 6.54 NA NA 1.75 2.16 0.75 NA NA 9.04 9.45 ZZZ
49906 .... .......... C Free omental flap, microvasc ............................... 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 090
Frm 00259
49999 .... .......... C Abdomen surgery procedure ............................... 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 YYY
50010 .... .......... A Exploration of kidney ............................................ 12.13 NA NA 6.94 5.64 0.93 NA NA 20.00 18.70 090
50020 .... .......... A Renal abscess, open drain .................................. 17.88 NA NA 8.51 7.93 1.34 NA NA 27.73 27.15 090
50021 .... .......... A Renal abscess, percut drain ................................ 3.37 19.98 21.23 0.97 1.07 0.20 23.55 24.80 4.54 4.64 000
Fmt 4701
50040 .... .......... A Drainage of kidney ............................................... 16.48 NA NA 8.91 7.33 1.03 NA NA 26.42 24.84 090
50060 .... .......... A Removal of kidney stone ..................................... 20.80 NA NA 11.24 8.68 1.36 NA NA 33.40 30.84 090
50065 .... .......... A Incision of kidney ................................................. 22.17 NA NA 11.84 7.51 1.59 NA NA 35.60 31.27 090
Sfmt 4700
50070 .... .......... A Incision of kidney ................................................. 21.70 NA NA 11.65 9.07 1.44 NA NA 34.79 32.21 090
50100 .... .......... A Revise kidney blood vessels ................................ 17.30 NA NA 7.20 7.64 2.07 NA NA 26.57 27.01 090
50125 .... .......... A Explore and drain kidney ..................................... 17.67 NA NA 9.97 7.71 1.43 NA NA 29.07 26.81 090
E:\FR\FM\01DER2.SGM
50200 .... .......... A Biopsy of kidney ................................................... 2.63 NA NA 1.08 1.24 0.16 NA NA 3.87 4.03 000
50205 .... .......... A Biopsy of kidney ................................................... 12.19 NA NA 5.60 5.16 1.30 NA NA 19.09 18.65 090
50220 .... .......... A Remove kidney, open .......................................... 18.53 NA NA 9.74 7.86 1.35 NA NA 29.62 27.74 090
50225 .... .......... A Removal kidney open, complex ........................... 21.73 NA NA 11.27 8.92 1.50 NA NA 34.50 32.15 090
01DER2
50230 .... .......... A Removal kidney open, radical .............................. 23.68 NA NA 11.96 9.42 1.55 NA NA 37.19 34.65 090
50234 .... .......... A Removal of kidney & ureter ................................. 23.90 NA NA 12.36 9.71 1.59 NA NA 37.85 35.20 090
50236 .... .......... A Removal of kidney & ureter ................................. 26.74 NA NA 14.28 11.25 1.77 NA NA 42.79 39.76 090
50240 .... .......... A Partial removal of kidney ..................................... 24.01 NA NA 12.93 9.98 1.55 NA NA 38.49 35.54 090
50250 .... .......... A Cryoablate renal mass open ................................ 22.06 NA NA 10.79 9.56 1.39 NA NA 34.24 33.01 090
50280 .... .......... A Removal of kidney lesion ..................................... 16.94 NA NA 9.45 7.37 1.19 NA NA 27.58 25.50 090
69881
Year
69882
Year Year
2007 2007 Fully Im-
VerDate Aug<31>2005
RVUs cility Total
RVUs
50290 .... .......... A Removal of kidney lesion ..................................... 16.00 NA NA 8.27 6.91 1.41 NA NA 25.68 24.32 090
50300 .... .......... X Remove cadaver donor kidney ............................ 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 XXX
50320 .... .......... A Remove kidney, living donor ................................ 22.28 NA NA 12.46 11.10 2.36 NA NA 37.10 35.74 090
10:50 Nov 30, 2006

50323 .... .......... C Prep cadaver renal allograft ................................. 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 XXX
50325 .... .......... C Prep donor renal graft .......................................... 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 XXX
50327 .... .......... A Prep renal graft/venous ........................................ 4.00 NA NA 1.11 1.29 0.29 NA NA 5.40 5.58 XXX
50328 .... .......... A Prep renal graft/arterial ........................................ 3.50 NA NA 0.98 1.13 0.26 NA NA 4.74 4.89 XXX
50329 .... .......... A Prep renal graft/ureteral ....................................... 3.34 NA NA 0.97 1.09 0.25 NA NA 4.56 4.68 XXX
Jkt 211001
50340 .... .......... A Removal of kidney ............................................... 13.86 NA NA 7.64 6.78 1.65 NA NA 23.15 22.29 090
50360 .... .......... A Transplantation of kidney ..................................... 40.45 NA NA 18.86 16.32 3.82 NA NA 63.13 60.59 090
50365 .... .......... A Transplantation of kidney ..................................... 45.68 NA NA 19.55 18.53 4.43 NA NA 69.66 68.64 090
50370 .... .......... A Remove transplanted kidney ............................... 18.68 NA NA 9.31 7.68 1.68 NA NA 29.67 28.04 090
PO 00000
50380 .... .......... A Reimplantation of kidney ...................................... 29.66 NA NA 16.42 13.12 2.51 NA NA 48.59 45.29 090
50382 .... .......... A Change ureter stent, percut ................................. 5.50 24.85 33.30 1.67 1.81 0.34 30.69 39.14 7.51 7.65 000
50384 .... .......... A Remove ureter stent, percut ................................ 5.00 19.53 31.30 1.52 1.66 0.31 24.84 36.61 6.83 6.97 000
50387 .... .......... A Change ext/int ureter stent .................................. 2.00 12.00 16.66 0.60 0.65 0.12 14.12 18.78 2.72 2.77 000
Frm 00260
50389 .... .......... A Remove renal tube w/fluoro ................................. 1.10 6.36 11.15 0.33 0.36 0.07 7.53 12.32 1.50 1.53 000
50390 .... .......... A Drainage of kidney lesion .................................... 1.96 NA NA 0.57 0.62 0.12 NA NA 2.65 2.70 000
50391 .... .......... A Instll rx agnt into rnal tub ..................................... 1.96 1.51 1.56 0.80 0.67 0.14 3.61 3.66 2.90 2.77 000
50392 .... .......... A Insert kidney drain ................................................ 3.37 NA NA 1.26 1.46 0.20 NA NA 4.83 5.03 000
Fmt 4701
50393 .... .......... A Insert ureteral tube ............................................... 4.15 NA NA 1.50 1.71 0.25 NA NA 5.90 6.11 000
50394 .... .......... A Injection for kidney x-ray ...................................... 0.76 1.76 2.45 0.52 0.63 0.05 2.57 3.26 1.33 1.44 000
50395 .... .......... A Create passage to kidney .................................... 3.37 NA NA 1.37 1.47 0.21 NA NA 4.95 5.05 000
50396 .... .......... A Measure kidney pressure ..................................... 2.09 NA NA 0.93 1.04 0.13 NA NA 3.15 3.26 000
Sfmt 4700
50398 .... .......... A Change kidney tube ............................................. 1.46 11.29 15.06 0.46 0.51 0.09 12.84 16.61 2.01 2.06 000
50400 .... .......... A Revision of kidney/ureter ..................................... 21.12 NA NA 11.26 8.72 1.38 NA NA 33.76 31.22 090
50405 .... .......... A Revision of kidney/ureter ..................................... 25.68 NA NA 13.34 10.10 1.79 NA NA 40.81 37.57 090
50500 .... .......... A Repair of kidney wound ....................................... 21.07 NA NA 9.32 8.62 2.02 NA NA 32.41 31.71 090
50520 .... .......... A Close kidney-skin fistula ...................................... 18.73 NA NA 9.52 7.95 1.49 NA NA 29.74 28.17 090
50525 .... .......... A Repair renal-abdomen fistula ............................... 24.21 NA NA 11.06 9.51 1.84 NA NA 37.11 35.56 090
50526 .... .......... A Repair renal-abdomen fistula ............................... 26.13 NA NA 8.15 9.43 1.97 NA NA 36.25 37.53 090
50540 .... .......... A Revision of horseshoe kidney .............................. 20.95 NA NA 10.92 8.97 1.36 NA NA 33.23 31.28 090
50541 .... .......... A Laparo ablate renal cyst ...................................... 16.76 NA NA 8.89 7.08 1.13 NA NA 26.78 24.97 090
E:\FR\FM\01DER2.SGM
50542 .... .......... A Laparo ablate renal mass .................................... 21.18 NA NA 11.33 8.93 1.39 NA NA 33.90 31.50 090
50543 .... .......... A Laparo partial nephrectomy ................................. 27.18 NA NA 14.39 11.24 1.81 NA NA 43.38 40.23 090
50544 .... .......... A Laparoscopy, pyeloplasty ..................................... 23.27 NA NA 11.66 9.31 1.58 NA NA 36.51 34.16 090
50545 .... .......... A Laparo radical nephrectomy ................................ 24.93 NA NA 12.51 10.01 1.71 NA NA 39.15 36.65 090
01DER2
50546 .... .......... A Laparoscopic nephrectomy .................................. 21.69 NA NA 11.52 9.15 1.57 NA NA 34.78 32.41 090
50547 .... .......... A Laparo removal donor kidney .............................. 26.24 NA NA 12.68 11.50 2.77 NA NA 41.69 40.51 090
50548 .... .......... A Laparo remove w/ureter ....................................... 25.26 NA NA 12.44 9.99 1.73 NA NA 39.43 36.98 090
50549 .... .......... C Laparoscope proc, renal ...................................... 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 YYY
50551 .... .......... A Kidney endoscopy ................................................ 5.59 4.62 4.26 2.69 2.15 0.40 10.61 10.25 8.68 8.14 000
50553 .... .......... A Kidney endoscopy ................................................ 5.98 4.32 4.35 2.48 2.25 0.39 10.69 10.72 8.85 8.62 000
Year Year Year
2007 2007 Fully Im-
VerDate Aug<31>2005
RVUs cility Total
RVUs
50555 .... .......... A Kidney endoscopy & biopsy ................................. 6.52 5.13 4.89 3.06 2.51 0.45 12.10 11.86 10.03 9.48 000
50557 .... .......... A Kidney endoscopy & treatment ............................ 6.61 5.30 4.76 3.11 2.50 0.47 12.38 11.84 10.19 9.58 000
50561 .... .......... A Kidney endoscopy & treatment ............................ 7.58 5.76 5.25 3.43 2.84 0.54 13.88 13.37 11.55 10.96 000
10:50 Nov 30, 2006

50562 .... .......... A Renal scope w/tumor resect ................................ 10.90 NA NA 5.48 4.60 0.73 NA NA 17.11 16.23 090
50570 .... .......... A Kidney endoscopy ................................................ 9.53 NA NA 4.33 3.49 0.68 NA NA 14.54 13.70 000
50574 .... .......... A Kidney endoscopy & biopsy ................................. 11.00 NA NA 4.82 4.01 0.77 NA NA 16.59 15.78 000
Jkt 211001
50576 .... .......... A Kidney endoscopy & treatment ............................ 10.97 NA NA 4.94 3.98 0.78 NA NA 16.69 15.73 000
50580 .... .......... A Kidney endoscopy & treatment ............................ 11.84 NA NA 5.24 4.28 0.83 NA NA 17.91 16.95 000
50590 .... .......... A Fragmenting of kidney stone ............................... 9.64 17.21 13.60 6.26 4.65 0.65 27.50 23.89 16.55 14.94 090
50592 .... .......... A Perc rf ablate renal tumor .................................... 6.77 73.56 130.16 2.65 2.90 0.43 80.76 137.36 9.85 10.10 010
PO 00000
50600 .... .......... A Exploration of ureter ............................................. 17.04 NA NA 8.70 7.17 1.13 NA NA 26.87 25.34 090
50605 .... .......... A Insert ureteral support .......................................... 16.66 NA NA 8.04 7.06 1.45 NA NA 26.15 25.17 090
50610 .... .......... A Removal of ureter stone ...................................... 17.12 NA NA 9.22 7.53 1.43 NA NA 27.77 26.08 090
Frm 00261
50650 .... .......... A Removal of ureter ................................................ 18.67 NA NA 10.27 7.98 1.23 NA NA 30.17 27.88 090
50660 .... .......... A Removal of ureter ................................................ 20.87 NA NA 11.00 8.71 1.38 NA NA 33.25 30.96 090
50684 .... .......... A Injection for ureter x-ray ....................................... 0.76 4.00 4.73 0.62 0.51 0.05 4.81 5.54 1.43 1.32 000
Fmt 4701
50686 .... .......... A Measure ureter pressure ...................................... 1.51 2.03 3.09 0.70 0.79 0.11 3.65 4.71 2.32 2.41 000
50688 .... .......... A Change of ureter tube/stent ................................. 1.18 NA NA 0.85 1.01 0.07 NA NA 2.10 2.26 010
50690 .... .......... A Injection for ureter x-ray ....................................... 1.16 1.36 1.71 0.68 0.71 0.07 2.59 2.94 1.91 1.94 000
50700 .... .......... A Revision of ureter ................................................. 16.54 NA NA 8.41 7.44 1.27 NA NA 26.22 25.25 090
Sfmt 4700
50715 .... .......... A Release of ureter ................................................. 20.49 NA NA 8.71 8.73 2.14 NA NA 31.34 31.36 090
50725 .... .......... A Release/revise ureter ........................................... 20.05 NA NA 9.77 8.47 1.52 NA NA 31.34 30.04 090
50727 .... .......... A Revise ureter ........................................................ 8.17 NA NA 5.79 4.65 0.61 NA NA 14.57 13.43 090
50728 .... .......... A Revise ureter ........................................................ 12.00 NA NA 7.25 5.98 1.00 NA NA 20.25 18.98 090
50740 .... .......... A Fusion of ureter & kidney ..................................... 19.92 NA NA 9.07 8.07 1.97 NA NA 30.96 29.96 090
50750 .... .......... A Fusion of ureter & kidney ..................................... 21.07 NA NA 9.90 8.46 1.38 NA NA 32.35 30.91 090
50760 .... .......... A Fusion of ureters .................................................. 19.92 NA NA 9.91 8.23 1.55 NA NA 31.38 29.70 090
50770 .... .......... A Splicing of ureters ................................................ 21.07 NA NA 10.83 8.69 1.45 NA NA 33.35 31.21 090
E:\FR\FM\01DER2.SGM
50780 .... .......... A Reimplant ureter in bladder ................................. 19.80 NA NA 10.25 8.25 1.51 NA NA 31.56 29.56 090
01DER2
50800 .... .......... A Implant ureter in bowel ........................................ 16.23 NA NA 9.43 7.20 1.19 NA NA 26.85 24.62 090
50810 .... .......... A Fusion of ureter & bowel ...................................... 22.38 NA NA 9.65 9.22 2.32 NA NA 34.35 33.92 090
50815 .... .......... A Urine shunt to intestine ........................................ 22.06 NA NA 11.76 9.27 1.54 NA NA 35.36 32.87 090
50820 .... .......... A Construct bowel bladder ...................................... 23.89 NA NA 12.14 9.51 1.90 NA NA 37.93 35.30 090
50825 .... .......... A Construct bowel bladder ...................................... 30.48 NA NA 15.28 12.16 2.08 NA NA 47.84 44.72 090
50830 .... .......... A Revise urine flow .................................................. 33.57 NA NA 16.11 13.15 2.38 NA NA 52.06 49.10 090
69883
Year
69884
Year Year
2007 2007 Fully Im-
VerDate Aug<31>2005
RVUs cility Total
RVUs
50840 .... .......... A Replace ureter by bowel ...................................... 22.19 NA NA 12.08 9.34 1.47 NA NA 35.74 33.00 090
50845 .... .......... A Appendico-vesicostomy ....................................... 22.21 NA NA 12.57 9.81 1.57 NA NA 36.35 33.59 090
50860 .... .......... A Transplant ureter to skin ...................................... 16.93 NA NA 9.17 7.25 1.29 NA NA 27.39 25.47 090
10:50 Nov 30, 2006

50900 .... .......... A Repair of ureter .................................................... 14.89 NA NA 8.18 6.64 1.14 NA NA 24.21 22.67 090
50920 .... .......... A Closure ureter/skin fistula .................................... 15.66 NA NA 8.50 7.05 1.01 NA NA 25.17 23.72 090
50930 .... .......... A Closure ureter/bowel fistula ................................. 20.04 NA NA 10.38 8.57 1.28 NA NA 31.70 29.89 090
50945 .... .......... A Laparoscopy ureterolithotomy .............................. 17.87 NA NA 8.89 7.50 1.36 NA NA 28.12 26.73 090
Jkt 211001
50947 .... .......... A Laparo new ureter/bladder ................................... 25.63 NA NA 12.65 10.42 2.17 NA NA 40.45 38.22 090
50948 .... .......... A Laparo new ureter/bladder ................................... 23.69 NA NA 12.18 9.56 1.71 NA NA 37.58 34.96 090
50949 .... .......... C Laparoscope proc, ureter ..................................... 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 YYY
50951 .... .......... A Endoscopy of ureter ............................................. 5.83 4.88 4.44 2.82 2.24 0.41 11.12 10.68 9.06 8.48 000
PO 00000
50953 .... .......... A Endoscopy of ureter ............................................. 6.23 5.04 4.56 3.32 2.60 0.43 11.70 11.22 9.98 9.26 000
50955 .... .......... A Ureter endoscopy & biopsy .................................. 6.74 5.23 6.12 3.51 2.89 0.48 12.45 13.34 10.73 10.11 000
50957 .... .......... A Ureter endoscopy & treatment ............................. 6.78 5.37 4.76 3.18 2.57 0.48 12.63 12.02 10.44 9.83 000
50961 .... .......... A Ureter endoscopy & treatment ............................. 6.04 4.78 4.47 2.79 2.33 0.41 11.23 10.92 9.24 8.78 000
Frm 00262
50970 .... .......... A Ureter endoscopy ................................................. 7.13 NA NA 3.34 2.68 0.52 NA NA 10.99 10.33 000
50972 .... .......... A Ureter endoscopy & catheter ............................... 6.88 NA NA 3.05 2.61 0.49 NA NA 10.42 9.98 000
50974 .... .......... A Ureter endoscopy & biopsy .................................. 9.16 NA NA 3.98 3.32 0.64 NA NA 13.78 13.12 000
50976 .... .......... A Ureter endoscopy & treatment ............................. 9.03 NA NA 3.70 3.22 0.66 NA NA 13.39 12.91 000
Fmt 4701
50980 .... .......... A Ureter endoscopy & treatment ............................. 6.84 NA NA 3.13 2.56 0.48 NA NA 10.45 9.88 000
51000 .... .......... A Drainage of bladder ............................................. 0.78 0.94 1.69 0.28 0.25 0.05 1.77 2.52 1.11 1.08 000
Sfmt 4700
51020 .... .......... A Incise & treat bladder ........................................... 7.56 NA NA 5.37 4.23 0.47 NA NA 13.40 12.26 090
51030 .... .......... A Incise & treat bladder ........................................... 7.68 NA NA 4.83 4.19 0.58 NA NA 13.09 12.45 090
51040 .... .......... A Incise & drain bladder .......................................... 4.43 NA NA 3.74 3.01 0.31 NA NA 8.48 7.75 090
51045 .... .......... A Incise bladder/drain ureter ................................... 7.68 NA NA 5.27 4.26 0.52 NA NA 13.47 12.46 090
51050 .... .......... A Removal of bladder stone .................................... 7.87 NA NA 5.43 4.09 0.49 NA NA 13.79 12.45 090
51065 .... .......... A Remove ureter calculus ....................................... 9.82 NA NA 6.42 4.87 0.63 NA NA 16.87 15.32 090
51080 .... .......... A Drainage of bladder abscess ............................... 6.61 NA NA 4.28 3.73 0.43 NA NA 11.32 10.77 090
51500 .... .......... A Removal of bladder cyst ...................................... 10.92 NA NA 5.86 5.22 1.03 NA NA 17.81 17.17 090
E:\FR\FM\01DER2.SGM
51520 .... .......... A Removal of bladder lesion ................................... 10.08 NA NA 6.58 5.15 0.69 NA NA 17.35 15.92 090
51535 .... .......... A Repair of ureter lesion ......................................... 13.77 NA NA 7.60 6.48 1.23 NA NA 22.60 21.48 090
01DER2
51550 .... .......... A Partial removal of bladder .................................... 17.10 NA NA 9.00 7.29 1.31 NA NA 27.41 25.70 090
51555 .... .......... A Partial removal of bladder .................................... 23.03 NA NA 11.64 9.40 1.70 NA NA 36.37 34.13 090
51565 .... .......... A Revise bladder & ureter(s) ................................... 23.50 NA NA 12.22 9.77 1.63 NA NA 37.35 34.90 090
51570 .... .......... A Removal of bladder .............................................. 27.31 NA NA 13.55 10.69 1.72 NA NA 42.58 39.72 090
51575 .... .......... A Removal of bladder & nodes ............................... 34.00 NA NA 17.03 13.27 2.17 NA NA 53.20 49.44 090
51580 .... .......... A Remove bladder/revise tract ................................ 35.14 NA NA 17.87 13.83 2.25 NA NA 55.26 51.22 090
Year Year Year
2007 2007 Fully Im-
VerDate Aug<31>2005
RVUs cility Total
RVUs
51585 .... .......... A Removal of bladder & nodes ............................... 39.41 NA NA 19.91 15.25 2.49 NA NA 61.81 57.15 090
10:50 Nov 30, 2006

51596 .... .......... A Remove bladder/create pouch ............................. 44.01 NA NA 21.67 16.83 2.78 NA NA 68.46 63.62 090
51597 .... .......... A Removal of pelvic structures ................................ 42.61 NA NA 20.37 16.21 2.82 NA NA 65.80 61.64 090
51600 .... .......... A Injection for bladder x-ray .................................... 0.88 4.09 4.81 0.29 0.29 0.06 5.03 5.75 1.23 1.23 000
51605 .... .......... A Preparation for bladder xray ................................ 0.64 NA NA 0.41 0.37 0.04 NA NA 1.09 1.05 000
51610 .... .......... A Injection for bladder x-ray .................................... 1.05 1.87 2.18 0.68 0.62 0.07 2.99 3.30 1.80 1.74 000
Jkt 211001
51700 .... .......... A Irrigation of bladder .............................................. 0.88 1.51 1.58 0.35 0.30 0.06 2.45 2.52 1.29 1.24 000
51701 .... .......... A Insert bladder catheter ......................................... 0.50 1.04 1.45 0.25 0.21 0.04 1.58 1.99 0.79 0.75 000
51702 .... .......... A Insert temp bladder cath ...................................... 0.50 1.53 1.94 0.34 0.27 0.04 2.07 2.48 0.88 0.81 000
51703 .... .......... A Insert bladder cath, complex ................................ 1.47 2.28 2.62 0.82 0.63 0.10 3.85 4.19 2.39 2.20 000
PO 00000
51705 .... .......... A Change of bladder tube ....................................... 1.03 2.03 2.21 0.86 0.67 0.07 3.13 3.31 1.96 1.77 010
51710 .... .......... A Change of bladder tube ....................................... 1.50 2.74 3.18 1.20 0.88 0.11 4.35 4.79 2.81 2.49 010
51715 .... .......... A Endoscopic injection/implant ................................ 3.73 4.46 4.04 1.78 1.46 0.29 8.48 8.06 5.80 5.48 000
51720 .... .......... A Treatment of bladder lesion ................................. 1.50 1.64 1.72 0.76 0.71 0.14 3.28 3.36 2.40 2.35 000
Frm 00263
51725 .... .......... A Simple cystometrogram ....................................... 1.51 4.28 5.26 4.28 5.26 0.16 5.95 6.93 5.95 6.93 000
51725 .... TC .... A Simple cystometrogram ....................................... 0.00 3.70 4.75 3.70 4.75 0.04 3.74 4.79 3.74 4.79 000
51725 .... 26 ..... A Simple cystometrogram ....................................... 1.51 0.58 0.51 0.58 0.51 0.12 2.21 2.14 2.21 2.14 000
51726 .... .......... A Complex cystometrogram .................................... 1.71 7.11 7.41 7.11 7.41 0.18 9.00 9.30 9.00 9.30 000
Fmt 4701
51726 .... TC .... A Complex cystometrogram .................................... 0.00 6.45 6.82 6.45 6.82 0.05 6.50 6.87 6.50 6.87 000
51726 .... 26 ..... A Complex cystometrogram .................................... 1.71 0.66 0.59 0.66 0.59 0.13 2.50 2.43 2.50 2.43 000
51736 .... .......... A Urine flow measurement ...................................... 0.61 0.91 0.67 0.91 0.67 0.06 1.58 1.34 1.58 1.34 000
51736 .... TC .... A Urine flow measurement ...................................... 0.00 0.68 0.46 0.68 0.46 0.01 0.69 0.47 0.69 0.47 000
Sfmt 4700
51736 .... 26 ..... A Urine flow measurement ...................................... 0.61 0.23 0.21 0.23 0.21 0.05 0.89 0.87 0.89 0.87 000
51741 .... .......... A Electro-uroflowmetry, first .................................... 1.14 1.27 0.91 1.27 0.91 0.11 2.52 2.16 2.52 2.16 000
51741 .... TC .... A Electro-uroflowmetry, first .................................... 0.00 0.82 0.52 0.82 0.52 0.02 0.84 0.54 0.84 0.54 000
51741 .... 26 ..... A Electro-uroflowmetry, first .................................... 1.14 0.45 0.39 0.45 0.39 0.09 1.68 1.62 1.68 1.62 000
51772 .... .......... A Urethra pressure profile ....................................... 1.61 5.03 5.44 5.03 5.44 0.20 6.84 7.25 6.84 7.25 000
51772 .... TC .... A Urethra pressure profile ....................................... 0.00 4.47 4.89 4.47 4.89 0.05 4.52 4.94 4.52 4.94 000
51772 .... 26 ..... A Urethra pressure profile ....................................... 1.61 0.56 0.55 0.56 0.55 0.15 2.32 2.31 2.32 2.31 000
51784 .... .......... A Anal/urinary muscle study .................................... 1.53 3.83 3.95 3.83 3.95 0.16 5.52 5.64 5.52 5.64 000
51784 .... TC .... A Anal/urinary muscle study .................................... 0.00 3.30 3.44 3.30 3.44 0.04 3.34 3.48 3.34 3.48 000
E:\FR\FM\01DER2.SGM
51784 .... 26 ..... A Anal/urinary muscle study .................................... 1.53 0.53 0.51 0.53 0.51 0.12 2.18 2.16 2.18 2.16 000
51785 .... .......... A Anal/urinary muscle study .................................... 1.53 4.50 4.46 4.50 4.46 0.15 6.18 6.14 6.18 6.14 000
51785 .... TC .... A Anal/urinary muscle study .................................... 0.00 3.93 3.94 3.93 3.94 0.04 3.97 3.98 3.97 3.98 000
51785 .... 26 ..... A Anal/urinary muscle study .................................... 1.53 0.57 0.52 0.57 0.52 0.11 2.21 2.16 2.21 2.16 000
01DER2
51792 .... .......... A Urinary reflex study .............................................. 1.10 4.96 5.74 4.96 5.74 0.20 6.26 7.04 6.26 7.04 000
51792 .... TC .... A Urinary reflex study .............................................. 0.00 4.56 5.33 4.56 5.33 0.13 4.69 5.46 4.69 5.46 000
51792 .... 26 ..... A Urinary reflex study .............................................. 1.10 0.40 0.41 0.40 0.41 0.07 1.57 1.58 1.57 1.58 000
51795 .... .......... A Urine voiding pressure study ............................... 1.53 6.72 7.15 6.72 7.15 0.22 8.47 8.90 8.47 8.90 000
51795 .... TC .... A Urine voiding pressure study ............................... 0.00 6.13 6.63 6.13 6.63 0.10 6.23 6.73 6.23 6.73 000
51795 .... 26 ..... A Urine voiding pressure study ............................... 1.53 0.59 0.52 0.59 0.52 0.12 2.24 2.17 2.24 2.17 000
69885
Year
69886
Year Year
2007 2007 Fully Im-
VerDate Aug<31>2005
RVUs cility Total
RVUs
51797 .... .......... A Intraabdominal pressure test ............................... 1.60 4.84 5.55 4.84 5.55 0.17 6.61 7.32 6.61 7.32 000
51797 .... TC .... A Intraabdominal pressure test ............................... 0.00 4.23 5.00 4.23 5.00 0.05 4.28 5.05 4.28 5.05 000
51797 .... 26 ..... A Intraabdominal pressure test ............................... 1.60 0.61 0.55 0.61 0.55 0.12 2.33 2.27 2.33 2.27 000
10:50 Nov 30, 2006

51798 .... .......... A Us urine capacity measure .................................. 0.00 0.59 0.40 NA NA 0.08 0.67 0.48 NA NA XXX
51800 .... .......... A Revision of bladder/urethra .................................. 18.74 NA NA 10.21 8.22 1.32 NA NA 30.27 28.28 090
51820 .... .......... A Revision of urinary tract ....................................... 19.41 NA NA 10.65 8.87 1.75 NA NA 31.81 30.03 090
51840 .... .......... A Attach bladder/urethra .......................................... 11.28 NA NA 5.81 5.62 1.06 NA NA 18.15 17.96 090
51841 .... .......... A Attach bladder/urethra .......................................... 13.60 NA NA 6.87 6.50 1.24 NA NA 21.71 21.34 090
Jkt 211001
51845 .... .......... A Repair bladder neck ............................................. 10.07 NA NA 5.92 5.04 0.79 NA NA 16.78 15.90 090
51860 .... .......... A Repair of bladder wound ...................................... 12.49 NA NA 6.87 6.03 1.16 NA NA 20.52 19.68 090
51865 .... .......... A Repair of bladder wound ...................................... 15.69 NA NA 8.56 7.14 1.23 NA NA 25.48 24.06 090
51880 .... .......... A Repair of bladder opening ................................... 7.81 NA NA 4.76 4.15 0.72 NA NA 13.29 12.68 090
PO 00000
51900 .... .......... A Repair bladder/vagina lesion ............................... 14.48 NA NA 8.11 6.57 1.21 NA NA 23.80 22.26 090
51920 .... .......... A Close bladder-uterus fistula ................................. 13.26 NA NA 7.86 6.19 1.18 NA NA 22.30 20.63 090
51925 .... .......... A Hysterectomy/bladder repair ................................ 17.35 NA NA 10.38 9.05 2.04 NA NA 29.77 28.44 090
51940 .... .......... A Correction of bladder defect ................................ 30.48 NA NA 11.52 11.93 2.15 NA NA 44.15 44.56 090
Frm 00264
51960 .... .......... A Revision of bladder & bowel ................................ 25.20 NA NA 13.31 10.55 1.63 NA NA 40.14 37.38 090
51980 .... .......... A Construct bladder opening ................................... 12.44 NA NA 7.36 5.87 0.86 NA NA 20.66 19.17 090
51990 .... .......... A Laparo urethral suspension ................................. 13.26 NA NA 5.98 6.10 1.39 NA NA 20.63 20.75 090
51992 .... .......... A Laparo sling operation ......................................... 14.77 NA NA 6.66 6.32 1.41 NA NA 22.84 22.50 090
Fmt 4701
51999 .... .......... C Laparoscope proc, bla ......................................... 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 YYY
52000 .... .......... A Cystoscopy ........................................................... 2.23 3.69 3.40 1.34 0.91 0.14 6.06 5.77 3.71 3.28 000
52001 .... .......... A Cystoscopy, removal of clots ............................... 5.44 5.14 5.09 2.65 2.06 0.39 10.97 10.92 8.48 7.89 000
52005 .... .......... A Cystoscopy & ureter catheter .............................. 2.37 5.76 5.61 1.40 1.02 0.17 8.30 8.15 3.94 3.56 000
Sfmt 4700
52007 .... .......... A Cystoscopy and biopsy ........................................ 3.02 10.73 15.01 1.65 1.28 0.22 13.97 18.25 4.89 4.52 000
52010 .... .......... A Cystoscopy & duct catheter ................................. 3.02 8.15 10.10 1.66 1.28 0.21 11.38 13.33 4.89 4.51 000
52204 .... .......... A Cystoscopy w/biopsy(s) ....................................... 2.59 8.34 12.97 1.41 1.03 0.17 11.10 15.73 4.17 3.79 000
52214 .... .......... A Cystoscopy and treatment ................................... 3.70 19.90 33.55 1.88 1.47 0.26 23.86 37.51 5.84 5.43 000
52234 .... .......... A Cystoscopy and treatment ................................... 4.62 NA NA 2.34 1.83 0.33 NA NA 7.29 6.78 000
52250 .... .......... A Cystoscopy and radiotracer ................................. 4.49 NA NA 2.38 1.83 0.32 NA NA 7.19 6.64 000
E:\FR\FM\01DER2.SGM
52270 .... .......... A Cystoscopy & revise urethra ................................ 3.36 7.05 10.04 1.78 1.38 0.24 10.65 13.64 5.38 4.98 000
52275 .... .......... A Cystoscopy & revise urethra ................................ 4.69 9.34 14.00 2.34 1.83 0.33 14.36 19.02 7.36 6.85 000
01DER2
52282 .... .......... A Cystoscopy, implant stent .................................... 6.39 NA NA 3.05 2.44 0.45 NA NA 9.89 9.28 000
Year Year Year
2007 2007 Fully Im-
VerDate Aug<31>2005
RVUs cility Total
RVUs
10:50 Nov 30, 2006

52317 .... .......... A Remove bladder stone ......................................... 6.71 17.14 25.99 3.09 2.48 0.48 24.33 33.18 10.28 9.67 000
52318 .... .......... A Remove bladder stone ......................................... 9.18 NA NA 4.17 3.36 0.65 NA NA 14.00 13.19 000
Jkt 211001
52325 .... .......... A Cystoscopy, stone removal .................................. 6.15 NA NA 2.89 2.31 0.44 NA NA 9.48 8.90 000
52327 .... .......... A Cystoscopy, inject material .................................. 5.18 17.83 28.32 2.39 1.96 0.37 23.38 33.87 7.94 7.51 000
PO 00000
52334 .... .......... A Create passage to kidney .................................... 4.82 NA NA 2.35 1.89 0.35 NA NA 7.52 7.06 000
52341 .... .......... A Cysto w/ureter stricture tx .................................... 6.11 NA NA 3.11 2.44 0.43 NA NA 9.65 8.98 000
52342 .... .......... A Cysto w/up stricture tx ......................................... 6.61 NA NA 3.35 2.59 0.46 NA NA 10.42 9.66 000
Frm 00265
52343 .... .......... A Cysto w/renal stricture tx ..................................... 7.31 NA NA 3.62 2.84 0.51 NA NA 11.44 10.66 000
52344 .... .......... A Cysto/uretero, stricture tx ..................................... 7.81 NA NA 4.00 3.09 0.55 NA NA 12.36 11.45 000
52345 .... .......... A Cysto/uretero w/up stricture ................................. 8.31 NA NA 4.22 3.27 0.58 NA NA 13.11 12.16 000
52346 .... .......... A Cystouretero w/renal strict ................................... 9.34 NA NA 4.62 3.62 0.65 NA NA 14.61 13.61 000
Fmt 4701
52351 .... .......... A Cystouretero & or pyeloscope ............................. 5.85 NA NA 3.03 2.36 0.41 NA NA 9.29 8.62 000
52352 .... .......... A Cystouretero w/stone remove .............................. 6.87 NA NA 3.56 2.77 0.49 NA NA 10.92 10.13 000
52353 .... .......... A Cystouretero w/lithotripsy ..................................... 7.96 NA NA 4.01 3.14 0.57 NA NA 12.54 11.67 000
52354 .... .......... A Cystouretero w/biopsy .......................................... 7.33 NA NA 3.75 2.94 0.52 NA NA 11.60 10.79 000
Sfmt 4700
52355 .... .......... A Cystouretero w/excise tumor ............................... 8.81 NA NA 4.35 3.44 0.63 NA NA 13.79 12.88 000
52400 .... .......... A Cystouretero w/congen repr ................................. 10.06 NA NA 5.54 4.18 0.68 NA NA 16.28 14.92 090
52402 .... .......... A Cystourethro cut ejacul duct ................................ 5.27 NA NA 2.24 1.84 0.40 NA NA 7.91 7.51 000
52450 .... .......... A Incision of prostate ............................................... 7.63 NA NA 5.59 4.15 0.54 NA NA 13.76 12.32 090
52500 .... .......... A Revision of bladder neck ..................................... 9.39 NA NA 6.31 4.52 0.60 NA NA 16.30 14.51 090
52510 .... .......... A Dilation prostatic urethra ...................................... 7.49 NA NA 5.00 3.58 0.48 NA NA 12.97 11.55 090
52601 .... .......... A Prostatectomy (TURP) ......................................... 15.13 NA NA 8.64 5.99 0.87 NA NA 24.64 21.99 090
52606 .... .......... A Control postop bleeding ....................................... 8.84 NA NA 5.63 4.07 0.57 NA NA 15.04 13.48 090
52612 .... .......... A Prostatectomy, first stage .................................... 9.07 NA NA 6.00 4.30 0.56 NA NA 15.63 13.93 090
E:\FR\FM\01DER2.SGM
52614 .... .......... A Prostatectomy, second stage ............................... 7.81 NA NA 5.49 3.88 0.48 NA NA 13.78 12.17 090
52620 .... .......... A Remove residual prostate .................................... 7.19 NA NA 4.68 3.41 0.47 NA NA 12.34 11.07 090
52630 .... .......... A Remove prostate regrowth ................................... 7.65 NA NA 4.90 3.62 0.51 NA NA 13.06 11.78 090
52640 .... .......... A Relieve bladder contracture ................................. 6.89 NA NA 4.50 3.35 0.47 NA NA 11.86 10.71 090
01DER2
52647 .... .......... A Laser surgery of prostate ..................................... 11.15 42.04 65.97 7.05 5.16 0.73 53.92 77.85 18.93 17.04 090
52648 .... .......... A Laser surgery of prostate ..................................... 12.00 42.58 66.10 7.38 5.44 0.79 55.37 78.89 20.17 18.23 090
52700 .... .......... A Drainage of prostate abscess .............................. 7.39 NA NA 5.05 3.65 0.48 NA NA 12.92 11.52 090
53000 .... .......... A Incision of urethra ................................................ 2.30 NA NA 1.83 1.61 0.16 NA NA 4.29 4.07 010
69887
Year
69888
Year Year
2007 2007 Fully Im-
VerDate Aug<31>2005
RVUs cility Total
RVUs
53040 .... .......... A Drainage of urethra abscess ................................ 6.49 NA NA 4.48 3.69 0.45 NA NA 11.42 10.63 090
53060 .... .......... A Drainage of urethra abscess ................................ 2.65 1.99 2.06 1.46 1.39 0.28 4.92 4.99 4.39 4.32 010
10:50 Nov 30, 2006

53080 .... .......... A Drainage of urinary leakage ................................. 6.82 NA NA 4.98 5.71 0.52 NA NA 12.32 13.05 090
53085 .... .......... A Drainage of urinary leakage ................................. 11.05 NA NA 4.60 6.70 0.92 NA NA 16.57 18.67 090
53200 .... .......... A Biopsy of urethra .................................................. 2.59 1.72 1.42 1.32 1.07 0.20 4.51 4.21 4.11 3.86 000
53210 .... .......... A Removal of urethra .............................................. 13.59 NA NA 7.88 6.34 0.89 NA NA 22.36 20.82 090
53215 .... .......... A Removal of urethra .............................................. 16.72 NA NA 9.34 7.30 1.10 NA NA 27.16 25.12 090
Jkt 211001
53220 .... .......... A Treatment of urethra lesion .................................. 7.53 NA NA 5.08 4.05 0.49 NA NA 13.10 12.07 090
53230 .... .......... A Removal of urethra lesion .................................... 10.31 NA NA 6.55 5.17 0.73 NA NA 17.59 16.21 090
53235 .... .......... A Removal of urethra lesion .................................... 10.86 NA NA 7.04 5.44 0.72 NA NA 18.62 17.02 090
53240 .... .......... A Surgery for urethra pouch .................................... 6.98 NA NA 4.84 3.85 0.52 NA NA 12.34 11.35 090
PO 00000
53250 .... .......... A Removal of urethra gland .................................... 6.42 NA NA 4.76 3.66 0.49 NA NA 11.67 10.57 090
53260 .... .......... A Treatment of urethra lesion .................................. 3.00 2.48 2.30 1.87 1.53 0.25 5.73 5.55 5.12 4.78 010
53265 .... .......... A Treatment of urethra lesion .................................. 3.14 2.99 2.78 2.03 1.57 0.24 6.37 6.16 5.41 4.95 010
53270 .... .......... A Removal of urethra gland .................................... 3.11 2.30 2.23 1.73 1.59 0.30 5.71 5.64 5.14 5.00 010
Frm 00266
53275 .... .......... A Repair of urethra defect ....................................... 4.54 NA NA 2.82 2.39 0.32 NA NA 7.68 7.25 010
53400 .... .......... A Revise urethra, stage 1 ........................................ 13.98 NA NA 8.31 6.59 0.98 NA NA 23.27 21.55 090
53405 .... .......... A Revise urethra, stage 2 ........................................ 15.51 NA NA 9.07 7.00 1.10 NA NA 25.68 23.61 090
53410 .... .......... A Reconstruction of urethra ..................................... 17.53 NA NA 9.97 7.78 1.16 NA NA 28.66 26.47 090
Fmt 4701
53420 .... .......... A Reconstruct urethra, stage 1 ............................... 15.04 NA NA 6.61 6.36 0.96 NA NA 22.61 22.36 090
53425 .... .......... A Reconstruct urethra, stage 2 ............................... 16.94 NA NA 9.42 7.52 1.13 NA NA 27.49 25.59 090
Sfmt 4700
53431 .... .......... A Reconstruct urethra/bladder ................................. 21.03 NA NA 11.21 8.84 1.41 NA NA 33.65 31.28 090
53440 .... .......... A Male sling procedure ............................................ 15.34 NA NA 9.39 6.83 0.96 NA NA 25.69 23.13 090
53442 .... .......... A Remove/revise male sling .................................... 13.29 NA NA 8.56 6.21 0.82 NA NA 22.67 20.32 090
53444 .... .......... A Insert tandem cuff ................................................ 14.06 NA NA 8.18 6.45 0.94 NA NA 23.18 21.45 090
53445 .... .......... A Insert uro/ves nck sphincter ................................. 15.21 NA NA 8.96 7.55 0.99 NA NA 25.16 23.75 090
53446 .... .......... A Remove uro sphincter .......................................... 10.89 NA NA 7.17 5.70 0.72 NA NA 18.78 17.31 090
53447 .... .......... A Remove/replace ur sphincter ............................... 14.15 NA NA 8.58 6.96 0.95 NA NA 23.68 22.06 090
53448 .... .......... A Remov/replc ur sphinctr comp ............................. 23.26 NA NA 12.68 9.95 1.50 NA NA 37.44 34.71 090
53449 .... .......... A Repair uro sphincter ............................................. 10.43 NA NA 6.76 5.23 0.68 NA NA 17.87 16.34 090
E:\FR\FM\01DER2.SGM
53450 .... .......... A Revision of urethra ............................................... 6.67 NA NA 4.85 3.68 0.43 NA NA 11.95 10.78 090
53500 .... .......... A Urethrlys, transvag w/ scope ............................... 12.87 NA NA 7.53 6.53 0.90 NA NA 21.30 20.30 090
53502 .... .......... A Repair of urethra injury ........................................ 8.16 NA NA 5.09 4.26 0.62 NA NA 13.87 13.04 090
01DER2
53520 .... .......... A Repair of urethra defect ....................................... 9.35 NA NA 6.23 4.91 0.61 NA NA 16.19 14.87 090
53600 .... .......... A Dilate urethra stricture .......................................... 1.21 1.16 1.15 0.58 0.47 0.09 2.46 2.45 1.88 1.77 000
Year Year Year
2007 2007 Fully Im-
VerDate Aug<31>2005
RVUs cility Total
RVUs
53605 .... .......... A Dilate urethra stricture .......................................... 1.28 NA NA 0.53 0.44 0.09 NA NA 1.90 1.81 000
10:50 Nov 30, 2006

53660 .... .......... A Dilation of urethra ................................................. 0.71 1.32 1.31 0.46 0.35 0.05 2.08 2.07 1.22 1.11 000
53661 .... .......... A Dilation of urethra ................................................. 0.72 1.30 1.30 0.43 0.33 0.05 2.07 2.07 1.20 1.10 000
53665 .... .......... A Dilation of urethra ................................................. 0.76 NA NA 0.27 0.26 0.06 NA NA 1.09 1.08 000
53850 .... .......... A Prostatic microwave thermotx .............................. 9.98 49.30 82.87 6.01 4.46 0.67 59.95 93.52 16.66 15.11 090
53852 .... .......... A Prostatic rf thermotx ............................................. 10.68 46.49 78.20 6.82 4.98 0.70 57.87 89.58 18.20 16.36 090
Jkt 211001
53853 .... .......... A Prostatic water thermother ................................... 5.54 29.12 48.79 4.43 3.25 0.37 35.03 54.70 10.34 9.16 090
53899 .... .......... C Urology surgery procedure .................................. 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 YYY
54000 .... .......... A Slitting of prepuce ................................................ 1.56 2.72 2.86 1.50 1.07 0.11 4.39 4.53 3.17 2.74 010
54001 .... .......... A Slitting of prepuce ................................................ 2.21 3.07 3.15 1.69 1.26 0.15 5.43 5.51 4.05 3.62 010
PO 00000
54015 .... .......... A Drain penis lesion ................................................ 5.33 NA NA 3.24 2.72 0.38 NA NA 8.95 8.43 010
54050 .... .......... A Destruction, penis lesion(s) .................................. 1.26 2.08 1.77 1.39 1.12 0.08 3.42 3.11 2.73 2.46 010
54056 .... .......... A Cryosurgery, penis lesion(s) ................................ 1.26 2.37 1.86 1.54 1.23 0.06 3.69 3.18 2.86 2.55 010
Frm 00267
54057 .... .......... A Laser surg, penis lesion(s) ................................... 1.26 2.61 2.31 1.36 0.96 0.09 3.96 3.66 2.71 2.31 010
54060 .... .......... A Excision of penis lesion(s) ................................... 1.95 3.11 3.10 1.66 1.21 0.13 5.19 5.18 3.74 3.29 010
54100 .... .......... A Biopsy of penis ..................................................... 1.90 3.37 2.94 1.39 0.96 0.10 5.37 4.94 3.39 2.96 000
Fmt 4701
54105 .... .......... A Biopsy of penis ..................................................... 3.51 4.04 4.22 2.49 2.07 0.25 7.80 7.98 6.25 5.83 010
54110 .... .......... A Treatment of penis lesion .................................... 10.79 NA NA 6.65 5.23 0.72 NA NA 18.16 16.74 090
54111 .... .......... A Treat penis lesion, graft ....................................... 14.29 NA NA 8.22 6.38 0.96 NA NA 23.47 21.63 090
54112 .... .......... A Treat penis lesion, graft ....................................... 16.83 NA NA 9.54 7.48 1.11 NA NA 27.48 25.42 090
Sfmt 4700
54115 .... .......... A Treatment of penis lesion .................................... 6.82 5.90 4.75 5.07 3.86 0.43 13.15 12.00 12.32 11.11 090
54120 .... .......... A Partial removal of penis ....................................... 10.88 NA NA 6.89 5.23 0.68 NA NA 18.45 16.79 090
54125 .... .......... A Removal of penis ................................................. 14.43 NA NA 8.35 6.45 0.95 NA NA 23.73 21.83 090
54130 .... .......... A Remove penis & nodes ........................................ 21.66 NA NA 11.56 9.02 1.52 NA NA 34.74 32.20 090
54135 .... .......... A Remove penis & nodes ........................................ 27.99 NA NA 14.51 11.25 1.88 NA NA 44.38 41.12 090
54150 .... .......... A Circumcision w/regionl block ................................ 1.90 2.40 1.50 0.75 1.09 0.16 4.46 3.56 2.81 3.15 000
54160 .... .......... A Circumcision, neonate .......................................... 2.50 3.69 4.03 1.47 1.19 0.19 6.38 6.72 4.16 3.88 010
54161 .... .......... A Circum 28 days or older ...................................... 3.29 NA NA 2.24 1.73 0.23 NA NA 5.76 5.25 010
54162 .... .......... A Lysis penil circumic lesion ................................... 3.27 4.02 4.49 2.28 1.65 0.21 7.50 7.97 5.76 5.13 010
E:\FR\FM\01DER2.SGM
54163 .... .......... A Repair of circumcision .......................................... 3.27 NA NA 2.91 2.23 0.21 NA NA 6.39 5.71 010
54164 .... .......... A Frenulotomy of penis ........................................... 2.77 NA NA 2.66 2.04 0.18 NA NA 5.61 4.99 010
54205 .... .......... A Treatment of penis lesion .................................... 8.84 NA NA 6.18 5.06 0.56 NA NA 15.58 14.46 090
01DER2
54230 .... .......... A Prepare penis study ............................................. 1.34 1.41 1.16 0.91 0.70 0.09 2.84 2.59 2.34 2.13 000
54231 .... .......... A Dynamic cavernosometry ..................................... 2.04 1.87 1.50 1.19 0.95 0.16 4.07 3.70 3.39 3.15 000
54235 .... .......... A Penile injection ..................................................... 1.19 1.40 1.07 0.90 0.66 0.08 2.67 2.34 2.17 1.93 000
54240 .... .......... A Penis study ........................................................... 1.31 1.52 1.16 1.52 1.16 0.17 3.00 2.64 3.00 2.64 000
54240 .... TC .... A Penis study ........................................................... 0.00 1.02 0.71 1.02 0.71 0.06 1.08 0.77 1.08 0.77 000
69889
Year
69890
Year Year
2007 2007 Fully Im-
VerDate Aug<31>2005
RVUs cility Total
RVUs
54240 .... 26 ..... A Penis study ........................................................... 1.31 0.50 0.45 0.50 0.45 0.11 1.92 1.87 1.92 1.87 000
54250 .... .......... A Penis study ........................................................... 2.22 1.26 1.00 1.26 1.00 0.18 3.66 3.40 3.66 3.40 000
54250 .... TC .... A Penis study ........................................................... 0.00 0.37 0.24 0.37 0.24 0.02 0.39 0.26 0.39 0.26 000
10:50 Nov 30, 2006

54250 .... 26 ..... A Penis study ........................................................... 2.22 0.89 0.76 0.89 0.76 0.16 3.27 3.14 3.27 3.14 000
54300 .... .......... A Revision of penis .................................................. 11.07 NA NA 6.88 5.89 0.76 NA NA 18.71 17.72 090
Jkt 211001
PO 00000
54328 .... .......... A Revise penis/urethra ............................................ 16.74 NA NA 9.87 7.90 0.98 NA NA 27.59 25.62 090
Frm 00268
54340 .... .......... A Secondary urethral surgery .................................. 9.58 NA NA 6.50 5.40 0.63 NA NA 16.71 15.61 090
54352 .... .......... A Reconstruct urethra/penis .................................... 25.95 NA NA 13.90 11.85 2.25 NA NA 42.10 40.05 090
Fmt 4701
54360 .... .......... A Penis plastic surgery ............................................ 12.65 NA NA 7.63 6.42 0.84 NA NA 21.12 19.91 090
54380 .... .......... A Repair penis ......................................................... 14.03 NA NA 5.67 6.37 0.93 NA NA 20.63 21.33 090
54385 .... .......... A Repair penis ......................................................... 16.38 NA NA 8.41 8.29 0.86 NA NA 25.65 25.53 090
54390 .... .......... A Repair penis and bladder ..................................... 22.59 NA NA 7.41 8.90 1.54 NA NA 31.54 33.03 090
Sfmt 4700
54400 .... .......... A Insert semi-rigid prosthesis .................................. 9.09 NA NA 5.87 4.72 0.64 NA NA 15.60 14.45 090
54401 .... .......... A Insert self-contd prosthesis .................................. 10.26 NA NA 8.29 6.36 0.73 NA NA 19.28 17.35 090
54405 .... .......... A Insert multi-comp penis pros ................................ 14.39 NA NA 8.32 6.51 0.95 NA NA 23.66 21.85 090
54406 .... .......... A Remove muti-comp penis pros ............................ 12.76 NA NA 7.79 6.01 0.86 NA NA 21.41 19.63 090
54408 .... .......... A Repair multi-comp penis pros .............................. 13.73 NA NA 8.40 6.39 0.90 NA NA 23.03 21.02 090
54410 .... .......... A Remove/replace penis prosth .............................. 16.48 NA NA 9.56 7.35 1.10 NA NA 27.14 24.93 090
54411 .... .......... A Remov/replc penis pros, comp ............................ 18.14 NA NA 10.63 7.93 1.13 NA NA 29.90 27.20 090
54415 .... .......... A Remove self-contd penis pros ............................. 8.75 NA NA 6.12 4.67 0.58 NA NA 15.45 14.00 090
54416 .... .......... A Remv/repl penis contain pros .............................. 11.87 NA NA 8.04 6.03 0.77 NA NA 20.68 18.67 090
E:\FR\FM\01DER2.SGM
54417 .... .......... A Remv/replc penis pros, compl ............................. 15.94 NA NA 9.33 6.95 1.00 NA NA 26.27 23.89 090
01DER2
54440 .... .......... C Repair of penis ..................................................... 0.00 NA NA 0.00 0.00 0.00 NA NA 0.00 0.00 090
54450 .... .......... A Preputial stretching .............................................. 1.12 0.86 0.93 0.49 0.45 0.08 2.06 2.13 1.69 1.65 000
54500 .... .......... A Biopsy of testis ..................................................... 1.31 NA NA 0.80 0.62 0.10 NA NA 2.21 2.03 000
54505 .... .......... A Biopsy of testis ..................................................... 3.47 NA NA 2.44 2.04 0.27 NA NA 6.18 5.78 010
54512 .... .......... A Excise lesion testis ............................................... 9.23 NA NA 5.77 4.53 0.67 NA NA 15.67 14.43 090
54520 .... .......... A Removal of testis ................................................. 5.25 NA NA 3.78 3.03 0.50 NA NA 9.53 8.78 090
Year Year Year
2007 2007 Fully Im-
VerDate Aug<31>2005
RVUs cility Total
RVUs
54522 .... .......... A Orchiectomy, partial ............................................. 10.15 NA NA 5.82 5.10 0.89 NA NA 16.86 16.14 090
54530 .... .......... A Removal of testis ................................................. 9.31 NA NA 6.19 4.72 0.66 NA NA 16.16 14.69 090
54535 .... .......... A Extensive testis surgery ....................................... 13.06 NA NA 7.67 6.07 0.95 NA NA 21.68 20.08 090
10:50 Nov 30, 2006

54550 .... .......... A Exploration for testis ............................................ 8.31 NA NA 5.42 4.21 0.59 NA NA 14.32 13.11 090
54560 .... .......... A Exploration for testis ............................................ 11.97 NA NA 6.34 5.45 0.90 NA NA 19.21 18.32 090
54600 .... .......... A Reduce testis torsion ........................................... 7.54 NA NA 5.23 3.96 0.51 NA NA 13.28 12.01 090
54620 .... .......... A Suspension of testis ............................................. 5.16 NA NA 3.31 2.65 0.37 NA NA 8.84 8.18 010
54640 .... .......... A Suspension of testis ............................................. 7.57 NA NA 5.53 4.18 0.62 NA NA 13.72 12.37 090
Jkt 211001
54650 .... .......... A Orchiopexy (Fowler-Stephens) ............................ 12.24 NA NA 7.81 6.00 1.16 NA NA 21.21 19.40 090
54660 .... .......... A Revision of testis .................................................. 5.64 NA NA 4.47 3.36 0.44 NA NA 10.55 9.44 090
54670 .... .......... A Repair testis injury ............................................... 6.57 NA NA 4.88 3.87 0.47 NA NA 11.92 10.91 090
54680 .... .......... A Relocation of testis(es) ........................................ 13.91 NA NA 7.86 6.57 1.16 NA NA 22.93 21.64 090
PO 00000
54690 .... .......... A Laparoscopy, orchiectomy ................................... 11.60 NA NA 6.24 5.26 1.02 NA NA 18.86 17.88 090
54692 .... .......... A Laparoscopy, orchiopexy ..................................... 13.64 NA NA 7.75 6.00 1.30 NA NA 22.69 20.94 090
54699 .... .......... C Laparoscope proc, testis ...................................... 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 YYY
54700 .... .......... A Drainage of scrotum ............................................. 3.44 NA NA 2.42 2.05 0.28 NA NA 6.14 5.77 010
Frm 00269
54800 .... .......... A Biopsy of epididymis ............................................ 2.33 NA NA 1.00 0.93 0.23 NA NA 3.56 3.49 000
54830 .... .......... A Remove epididymis lesion ................................... 5.91 NA NA 4.51 3.39 0.41 NA NA 10.83 9.71 090
54840 .... .......... A Remove epididymis lesion ................................... 5.22 NA NA 3.87 3.05 0.37 NA NA 9.46 8.64 090
54860 .... .......... A Removal of epididymis ......................................... 6.85 NA NA 4.96 3.72 0.45 NA NA 12.26 11.02 090
Fmt 4701
54861 .... .......... A Removal of epididymis ......................................... 9.57 NA NA 6.38 4.82 0.63 NA NA 16.58 15.02 090
54865 .... .......... A Explore epididymis ............................................... 5.67 NA NA 4.35 3.29 0.40 NA NA 10.42 9.36 090
54900 .... .......... A Fusion of spermatic ducts .................................... 14.05 NA NA 5.23 5.64 0.93 NA NA 20.21 20.62 090
54901 .... .......... A Fusion of spermatic ducts .................................... 18.92 NA NA 6.57 7.28 1.83 NA NA 27.32 28.03 090
Sfmt 4700
55000 .... .......... A Drainage of hydrocele .......................................... 1.43 1.86 2.01 0.92 0.72 0.11 3.40 3.55 2.46 2.26 000
55040 .... .......... A Removal of hydrocele .......................................... 5.39 NA NA 4.01 3.17 0.43 NA NA 9.83 8.99 090
55041 .... .......... A Removal of hydroceles ........................................ 8.41 NA NA 5.78 4.42 0.60 NA NA 14.79 13.43 090
55060 .... .......... A Repair of hydrocele .............................................. 6.05 NA NA 4.50 3.43 0.46 NA NA 11.01 9.94 090
55100 .... .......... A Drainage of scrotum abscess .............................. 2.40 3.51 3.63 2.13 1.70 0.17 6.08 6.20 4.70 4.27 010
55110 .... .......... A Explore scrotum ................................................... 6.23 NA NA 4.55 3.48 0.43 NA NA 11.21 10.14 090
55120 .... .......... A Removal of scrotum lesion .................................. 5.62 NA NA 4.33 3.29 0.39 NA NA 10.34 9.30 090
55150 .... .......... A Removal of scrotum ............................................. 8.01 NA NA 5.53 4.26 0.56 NA NA 14.10 12.83 090
55175 .... .......... A Revision of scrotum ............................................. 5.77 NA NA 4.41 3.35 0.37 NA NA 10.55 9.49 090
E:\FR\FM\01DER2.SGM
55180 .... .......... A Revision of scrotum ............................................. 11.63 NA NA 7.41 5.87 0.90 NA NA 19.94 18.40 090
55200 .... .......... A Incision of sperm duct .......................................... 4.50 8.24 11.29 3.40 2.63 0.33 13.07 16.12 8.23 7.46 090
55250 .... .......... A Removal of sperm duct(s) .................................... 3.32 7.70 10.53 3.02 2.41 0.25 11.27 14.10 6.59 5.98 090
55300 .... .......... A Prepare, sperm duct x-ray ................................... 3.50 NA NA 1.61 1.39 0.25 NA NA 5.36 5.14 000
01DER2
55400 .... .......... A Repair of sperm duct ........................................... 8.53 NA NA 5.56 4.43 0.64 NA NA 14.73 13.60 090
55450 .... .......... A Ligation of sperm duct ......................................... 4.38 6.00 6.74 2.89 2.12 0.29 10.67 11.41 7.56 6.79 010
55500 .... .......... A Removal of hydrocele .......................................... 6.12 NA NA 4.27 3.38 0.55 NA NA 10.94 10.05 090
55520 .... .......... A Removal of sperm cord lesion ............................. 6.56 NA NA 3.83 3.39 0.75 NA NA 11.14 10.70 090
55530 .... .......... A Revise spermatic cord veins ................................ 5.69 NA NA 4.19 3.30 0.45 NA NA 10.33 9.44 090
55535 .... .......... A Revise spermatic cord veins ................................ 7.09 NA NA 4.92 3.77 0.47 NA NA 12.48 11.33 090
69891
Year
69892
Year Year
2007 2007 Fully Im-
VerDate Aug<31>2005
RVUs cility Total
RVUs
55540 .... .......... A Revise hernia & sperm veins ............................... 8.20 NA NA 4.30 3.92 0.94 NA NA 13.44 13.06 090
55550 .... .......... A Laparo ligate spermatic vein ................................ 7.10 NA NA 4.60 3.62 0.57 NA NA 12.27 11.29 090
55559 .... .......... C Laparo proc, spermatic cord ................................ 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 YYY
10:50 Nov 30, 2006

55600 .... .......... A Incise sperm duct pouch ...................................... 6.91 NA NA 4.99 3.74 0.62 NA NA 12.52 11.27 090
55605 .... .......... A Incise sperm duct pouch ...................................... 8.63 NA NA 4.95 4.45 0.64 NA NA 14.22 13.72 090
55650 .... .......... A Remove sperm duct pouch .................................. 12.52 NA NA 7.38 5.79 0.92 NA NA 20.82 19.23 090
55680 .... .......... A Remove sperm pouch lesion ............................... 5.59 NA NA 3.91 3.20 0.47 NA NA 9.97 9.26 090
55700 .... .......... A Biopsy of prostate ................................................ 2.58 3.74 4.08 1.36 0.82 0.11 6.43 6.77 4.05 3.51 000
Jkt 211001
55705 .... .......... A Biopsy of prostate ................................................ 4.58 NA NA 2.92 2.45 0.32 NA NA 7.82 7.35 010
55801 .... .......... A Removal of prostate ............................................. 19.62 NA NA 10.80 8.40 1.34 NA NA 31.76 29.36 090
PO 00000
55810 .... .......... A Extensive prostate surgery .................................. 24.14 NA NA 12.66 9.86 1.60 NA NA 38.40 35.60 090
Frm 00270
Fmt 4701
55860 .... .......... A Surgical exposure, prostate ................................. 15.71 NA NA 8.84 7.00 1.02 NA NA 25.57 23.73 090
55866 .... .......... A Laparo radical prostatectomy ............................... 32.25 NA NA 16.38 12.87 2.17 NA NA 50.80 47.29 090
Sfmt 4700
55870 .... .......... A Electroejaculation ................................................. 2.58 2.47 1.77 1.46 1.18 0.16 5.21 4.51 4.20 3.92 000
55873 .... .......... A Cryoablate prostate .............................................. 20.25 NA NA 11.57 9.59 1.38 NA NA 33.20 31.22 090
55875 .... .......... A Transperi needle place, pros ............................... 13.31 NA NA 8.03 6.38 0.89 NA NA 22.23 20.58 090
55876 .... .......... A Place rt device/marker, pros ................................ 1.73 2.04 2.04 1.03 1.03 0.28 4.05 4.05 3.04 3.04 000
55899 .... .......... C Genital surgery procedure ................................... 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 YYY
55970 .... .......... N Sex transformation, M to F .................................. 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 XXX
55980 .... .......... N Sex transformation, F to M .................................. 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 XXX
56405 .... .......... A I & D of vulva/perineum ....................................... 1.46 1.17 1.29 1.15 1.14 0.17 2.80 2.92 2.78 2.77 010
56420 .... .......... A Drainage of gland abscess .................................. 1.41 1.50 2.08 0.77 0.97 0.16 3.07 3.65 2.34 2.54 010
E:\FR\FM\01DER2.SGM
56440 .... .......... A Surgery for vulva lesion ....................................... 2.86 NA NA 1.58 1.68 0.34 NA NA 4.78 4.88 010
56441 .... .......... A Lysis of labial lesion(s) ......................................... 1.99 1.71 1.79 1.56 1.45 0.20 3.90 3.98 3.75 3.64 010
56442 .... .......... A Hymenotomy ........................................................ 0.68 NA NA 0.51 0.51 0.08 NA NA 1.27 1.27 000
56501 .... .......... A Destroy, vulva lesions, sim .................................. 1.55 1.63 1.74 1.22 1.24 0.18 3.36 3.47 2.95 2.97 010
01DER2
56515 .... .......... A Destroy vulva lesion/s compl ............................... 3.03 2.36 2.50 1.72 1.79 0.33 5.72 5.86 5.08 5.15 010
56605 .... .......... A Biopsy of vulva/perineum ..................................... 1.10 0.90 1.03 0.35 0.43 0.13 2.13 2.26 1.58 1.66 000
56606 .... .......... A Biopsy of vulva/perineum ..................................... 0.55 0.36 0.46 0.15 0.20 0.07 0.98 1.08 0.77 0.82 ZZZ
56620 .... .......... A Partial removal of vulva ....................................... 8.44 NA NA 4.41 4.70 0.90 NA NA 13.75 14.04 090
56625 .... .......... A Complete removal of vulva .................................. 9.55 NA NA 4.78 5.18 1.02 NA NA 15.35 15.75 090
56630 .... .......... A Extensive vulva surgery ....................................... 14.67 NA NA 6.31 6.70 1.49 NA NA 22.47 22.86 090
Year Year Year
2007 2007 Fully Im-
VerDate Aug<31>2005
RVUs cility Total
RVUs
10:50 Nov 30, 2006

56700 .... .......... A Partial removal of hymen ..................................... 2.79 NA NA 1.76 1.81 0.30 NA NA 4.85 4.90 010
56740 .... .......... A Remove vagina gland lesion ................................ 4.83 NA NA 2.30 2.50 0.56 NA NA 7.69 7.89 010
Jkt 211001
56800 .... .......... A Repair of vagina ................................................... 3.90 NA NA 1.99 2.14 0.44 NA NA 6.33 6.48 010
56805 .... .......... A Repair clitoris ....................................................... 19.75 NA NA 9.31 9.39 2.15 NA NA 31.21 31.29 090
56810 .... .......... A Repair of perineum .............................................. 4.26 NA NA 2.05 2.23 0.49 NA NA 6.80 6.98 010
56820 .... .......... A Exam of vulva w/scope ........................................ 1.50 1.19 1.28 0.53 0.62 0.18 2.87 2.96 2.21 2.30 000
PO 00000
56821 .... .......... A Exam/biopsy of vulva w/scope ............................. 2.05 1.52 1.69 0.69 0.86 0.25 3.82 3.99 2.99 3.16 000
57000 .... .......... A Exploration of vagina ........................................... 2.99 NA NA 1.71 1.72 0.31 NA NA 5.01 5.02 010
57010 .... .......... A Drainage of pelvic abscess .................................. 6.74 NA NA 3.82 3.81 0.71 NA NA 11.27 11.26 090
57020 .... .......... A Drainage of pelvic fluid ........................................ 1.50 0.75 0.89 0.44 0.55 0.18 2.43 2.57 2.12 2.23 000
Frm 00271
57022 .... .......... A I & d vaginal hematoma, pp ................................. 2.70 NA NA 1.43 1.48 0.26 NA NA 4.39 4.44 010
57023 .... .......... A I & d vag hematoma, non-ob ............................... 5.13 NA NA 2.39 2.53 0.58 NA NA 8.10 8.24 010
57061 .... .......... A Destroy vag lesions, simple ................................. 1.27 1.50 1.61 1.11 1.12 0.15 2.92 3.03 2.53 2.54 010
57065 .... .......... A Destroy vag lesions, complex .............................. 2.63 2.01 2.22 1.49 1.63 0.31 4.95 5.16 4.43 4.57 010
Fmt 4701
57100 .... .......... A Biopsy of vagina ................................................... 1.20 0.92 1.04 0.37 0.45 0.14 2.26 2.38 1.71 1.79 000
57105 .... .......... A Biopsy of vagina ................................................... 1.71 1.58 1.74 1.33 1.40 0.20 3.49 3.65 3.24 3.31 010
57106 .... .......... A Remove vagina wall, partial ................................. 7.35 NA NA 4.25 4.20 0.73 NA NA 12.33 12.28 090
57107 .... .......... A Remove vagina tissue, part ................................. 24.43 NA NA 9.10 10.12 2.72 NA NA 36.25 37.27 090
Sfmt 4700
57109 .... .......... A Vaginectomy partial w/nodes ............................... 28.25 NA NA 10.40 11.03 3.22 NA NA 41.87 42.50 090
57110 .... .......... A Remove vagina wall, complete ............................ 15.38 NA NA 6.22 7.01 1.74 NA NA 23.34 24.13 090
57111 .... .......... A Remove vagina tissue, compl .............................. 28.25 NA NA 10.26 12.02 3.18 NA NA 41.69 43.45 090
57112 .... .......... A Vaginectomy w/nodes, compl .............................. 30.37 NA NA 11.67 11.99 3.08 NA NA 45.12 45.44 090
57120 .... .......... A Closure of vagina ................................................. 8.18 NA NA 4.17 4.49 0.89 NA NA 13.24 13.56 090
57130 .... .......... A Remove vagina lesion .......................................... 2.44 1.97 2.11 1.48 1.53 0.29 4.70 4.84 4.21 4.26 010
57135 .... .......... A Remove vagina lesion .......................................... 2.68 2.01 2.20 1.52 1.62 0.31 5.00 5.19 4.51 4.61 010
57150 .... .......... A Treat vagina infection ........................................... 0.55 0.57 0.97 0.15 0.20 0.07 1.19 1.59 0.77 0.82 000
57155 .... .......... A Insert uteri tandems/ovoids .................................. 6.79 NA NA 3.53 4.30 0.43 NA NA 10.75 11.52 090
E:\FR\FM\01DER2.SGM
57160 .... .......... A Insert pessary/other device .................................. 0.89 1.03 1.02 0.26 0.32 0.10 2.02 2.01 1.25 1.31 000
57170 .... .......... A Fitting of diaphragm/cap ...................................... 0.91 0.56 1.25 0.25 0.31 0.11 1.58 2.27 1.27 1.33 000
57180 .... .......... A Treat vaginal bleeding .......................................... 1.60 1.83 2.08 0.92 1.18 0.19 3.62 3.87 2.71 2.97 010
01DER2
57210 .... .......... A Repair vagina/perineum ....................................... 5.63 NA NA 3.25 3.39 0.62 NA NA 9.50 9.64 090
57230 .... .......... A Repair of urethral lesion ....................................... 6.22 NA NA 3.77 3.49 0.54 NA NA 10.53 10.25 090
57240 .... .......... A Repair bladder & vagina ...................................... 11.42 NA NA 5.46 4.22 0.62 NA NA 17.50 16.26 090
57250 .... .......... A Repair rectum & vagina ....................................... 11.42 NA NA 5.01 3.93 0.65 NA NA 17.08 16.00 090
69893
Year
69894
Year Year
2007 2007 Fully Im-
VerDate Aug<31>2005
RVUs cility Total
RVUs
57265 .... .......... A Extensive repair of vagina ................................... 15.86 NA NA 6.29 6.10 1.32 NA NA 23.47 23.28 090
57267 .... .......... A Insert mesh/pelvic flr addon ................................. 4.88 NA NA 1.53 1.86 0.64 NA NA 7.05 7.38 ZZZ
57268 .... .......... A Repair of bowel bulge .......................................... 7.47 NA NA 4.28 4.21 0.79 NA NA 12.54 12.47 090
10:50 Nov 30, 2006

57270 .... .......... A Repair of bowel pouch ......................................... 13.57 NA NA 5.68 6.10 1.42 NA NA 20.67 21.09 090
57280 .... .......... A Suspension of vagina ........................................... 16.62 NA NA 7.01 7.27 1.68 NA NA 25.31 25.57 090
57282 .... .......... A Colpopexy, extraperitoneal .................................. 7.84 NA NA 4.40 4.48 1.02 NA NA 13.26 13.34 090
57283 .... .......... A Colpopexy, intraperitoneal ................................... 11.58 NA NA 5.21 5.74 1.02 NA NA 17.81 18.34 090
57284 .... .......... A Repair paravaginal defect .................................... 13.51 NA NA 6.75 7.04 1.41 NA NA 21.67 21.96 090
Jkt 211001
57287 .... .......... A Revise/remove sling repair .................................. 11.49 NA NA 6.50 5.73 0.90 NA NA 18.89 18.12 090
57288 .... .......... A Repair bladder defect ........................................... 14.01 NA NA 7.13 6.21 1.12 NA NA 22.26 21.34 090
57289 .... .......... A Repair bladder & vagina ...................................... 12.69 NA NA 6.21 6.08 1.21 NA NA 20.11 19.98 090
57291 .... .......... A Construction of vagina ......................................... 8.54 NA NA 4.37 4.78 0.93 NA NA 13.84 14.25 090
PO 00000
57292 .... .......... A Construct vagina with graft .................................. 13.91 NA NA 6.06 6.71 1.58 NA NA 21.55 22.20 090
57295 .... .......... A Revise vag graft via vagina ................................. 7.74 NA NA 4.01 4.33 0.91 NA NA 12.66 12.98 090
57296 .... .......... A Revise vag graft, open abd .................................. 16.46 NA NA 6.75 6.75 1.68 NA NA 24.89 24.89 090
57300 .... .......... A Repair rectum-vagina fistula ................................ 8.58 NA NA 4.47 4.33 0.87 NA NA 13.92 13.78 090
Frm 00272
57305 .... .......... A Repair rectum-vagina fistula ................................ 15.24 NA NA 6.19 6.24 1.73 NA NA 23.16 23.21 090
57307 .... .......... A Fistula repair & colostomy ................................... 17.02 NA NA 7.02 7.00 2.02 NA NA 26.06 26.04 090
57308 .... .......... A Fistula repair, transperine .................................... 10.48 NA NA 4.90 5.04 1.14 NA NA 16.52 16.66 090
57310 .... .......... A Repair urethrovaginal lesion ................................ 7.55 NA NA 5.12 4.15 0.54 NA NA 13.21 12.24 090
Fmt 4701
57311 .... .......... A Repair urethrovaginal lesion ................................ 8.81 NA NA 5.22 4.39 0.65 NA NA 14.68 13.85 090
57320 .... .......... A Repair bladder-vagina lesion ............................... 8.78 NA NA 5.41 4.62 0.69 NA NA 14.88 14.09 090
57330 .... .......... A Repair bladder-vagina lesion ............................... 13.11 NA NA 7.25 6.09 1.06 NA NA 21.42 20.26 090
57335 .... .......... A Repair vagina ....................................................... 19.87 NA NA 9.05 9.03 1.92 NA NA 30.84 30.82 090
Sfmt 4700
57400 .... .......... A Dilation of vagina ................................................. 2.27 NA NA 0.98 1.08 0.26 NA NA 3.51 3.61 000
57410 .... .......... A Pelvic examination ............................................... 1.75 NA NA 0.92 0.90 0.18 NA NA 2.85 2.83 000
57415 .... .......... A Remove vaginal foreign body .............................. 2.44 NA NA 1.50 1.44 0.24 NA NA 4.18 4.12 010
57420 .... .......... A Exam of vagina w/scope ...................................... 1.60 1.23 1.32 0.57 0.65 0.19 3.02 3.11 2.36 2.44 000
57421 .... .......... A Exam/biopsy of vag w/scope ............................... 2.20 1.59 1.78 0.73 0.90 0.27 4.06 4.25 3.20 3.37 000
57425 .... .......... A Laparoscopy, surg, colpopexy ............................. 16.93 NA NA 6.96 6.71 1.76 NA NA 25.65 25.40 090
57452 .... .......... A Exam of cervix w/scope ....................................... 1.50 1.17 1.25 0.74 0.76 0.18 2.85 2.93 2.42 2.44 000
57454 .... .......... A Bx/curett of cervix w/scope .................................. 2.33 1.39 1.58 0.96 1.10 0.28 4.00 4.19 3.57 3.71 000
57455 .... .......... A Biopsy of cervix w/scope ..................................... 1.99 1.49 1.66 0.66 0.82 0.24 3.72 3.89 2.89 3.05 000
E:\FR\FM\01DER2.SGM
57456 .... .......... A Endocerv curettage w/scope ................................ 1.85 1.45 1.60 0.63 0.77 0.22 3.52 3.67 2.70 2.84 000
57460 .... .......... A Bx of cervix w/scope, leep ................................... 2.83 4.26 5.45 1.10 1.31 0.34 7.43 8.62 4.27 4.48 000
57461 .... .......... A Conz of cervix w/scope, leep ............................... 3.43 4.55 5.71 1.07 1.37 0.41 8.39 9.55 4.91 5.21 000
57500 .... .......... A Biopsy of cervix .................................................... 1.20 1.99 2.40 0.64 0.63 0.12 3.31 3.72 1.96 1.95 000
01DER2
57505 .... .......... A Endocervical curettage ......................................... 1.16 1.30 1.42 1.06 1.09 0.14 2.60 2.72 2.36 2.39 010
57510 .... .......... A Cauterization of cervix ......................................... 1.90 1.30 1.50 0.90 1.01 0.23 3.43 3.63 3.03 3.14 010
57511 .... .......... A Cryocautery of cervix ........................................... 1.92 1.59 1.76 1.26 1.34 0.23 3.74 3.91 3.41 3.49 010
57513 .... .......... A Laser surgery of cervix ........................................ 1.92 1.56 1.68 1.27 1.37 0.23 3.71 3.83 3.42 3.52 010
57520 .... .......... A Conization of cervix .............................................. 4.06 3.35 3.79 2.50 2.78 0.49 7.90 8.34 7.05 7.33 090
57522 .... .......... A Conization of cervix .............................................. 3.62 2.75 3.05 2.25 2.40 0.41 6.78 7.08 6.28 6.43 090
Year Year Year
2007 2007 Fully Im-
VerDate Aug<31>2005
RVUs cility Total
RVUs
57530 .... .......... A Removal of cervix ................................................ 5.19 NA NA 3.09 3.31 0.58 NA NA 8.86 9.08 090
57531 .... .......... A Removal of cervix, radical .................................... 29.77 NA NA 10.74 12.56 3.35 NA NA 43.86 45.68 090
57540 .... .......... A Removal of residual cervix ................................... 13.19 NA NA 5.61 6.08 1.49 NA NA 20.29 20.76 090
10:50 Nov 30, 2006

57545 .... .......... A Remove cervix/repair pelvis ................................. 14.00 NA NA 6.21 6.56 1.52 NA NA 21.73 22.08 090
57550 .... .......... A Removal of residual cervix ................................... 6.24 NA NA 3.62 3.77 0.67 NA NA 10.53 10.68 090
57555 .... .......... A Remove cervix/repair vagina ............................... 9.84 NA NA 4.76 5.00 1.09 NA NA 15.69 15.93 090
57556 .... .......... A Remove cervix, repair bowel ............................... 9.26 NA NA 4.66 4.80 0.92 NA NA 14.84 14.98 090
57558 .... .......... A D&c of cervical stump .......................................... 1.69 1.34 1.44 1.05 1.12 0.20 3.23 3.33 2.94 3.01 010
Jkt 211001
57700 .... .......... A Revision of cervix ................................................. 4.22 NA NA 3.27 3.14 0.41 NA NA 7.90 7.77 090
57800 .... .......... A Dilation of cervical canal ...................................... 0.77 0.70 0.75 0.41 0.46 0.09 1.56 1.61 1.27 1.32 000
58100 .... .......... A Biopsy of uterus lining .......................................... 1.53 1.12 1.27 0.58 0.69 0.18 2.83 2.98 2.29 2.40 000
PO 00000
58110 .... .......... A Bx done w/colposcopy add-on ............................. 0.77 0.39 0.51 0.21 0.29 0.09 1.25 1.37 1.07 1.15 ZZZ
58120 .... .......... A Dilation and curettage .......................................... 3.54 2.68 2.40 1.65 1.82 0.39 6.61 6.33 5.58 5.75 010
58140 .... .......... A Myomectomy abdom method ............................... 15.69 NA NA 6.21 6.88 1.82 NA NA 23.72 24.39 090
58145 .... .......... A Myomectomy vag method .................................... 8.81 NA NA 4.24 4.65 0.97 NA NA 14.02 14.43 090
Frm 00273
58146 .... .......... A Myomectomy abdom complex ............................. 20.24 NA NA 7.30 8.58 2.33 NA NA 29.87 31.15 090
58150 .... .......... A Total hysterectomy ............................................... 17.21 NA NA 6.55 7.25 1.85 NA NA 25.61 26.31 090
58152 .... .......... A Total hysterectomy ............................................... 21.73 NA NA 8.12 9.42 2.48 NA NA 32.33 33.63 090
58180 .... .......... A Partial hysterectomy ............................................. 16.50 NA NA 6.34 7.17 1.64 NA NA 24.48 25.31 090
Fmt 4701
58200 .... .......... A Extensive hysterectomy ....................................... 23.00 NA NA 8.18 9.54 2.55 NA NA 33.73 35.09 090
58240 .... .......... A Removal of pelvis contents .................................. 49.02 NA NA 17.78 17.65 4.23 NA NA 71.03 70.90 090
58260 .... .......... A Vaginal hysterectomy ........................................... 14.02 NA NA 5.78 6.46 1.57 NA NA 21.37 22.05 090
Sfmt 4700
58262 .... .......... A Vag hyst including t/o ........................................... 15.81 NA NA 6.25 7.10 1.80 NA NA 23.86 24.71 090
58263 .... .......... A Vag hyst w/t/o & vag repair ................................. 17.10 NA NA 6.62 7.57 1.95 NA NA 25.67 26.62 090
58267 .... .......... A Vag hyst w/urinary repair ..................................... 18.23 NA NA 7.01 8.03 2.07 NA NA 27.31 28.33 090
58270 .... .......... A Vag hyst w/enterocele repair ............................... 15.20 NA NA 5.94 6.78 1.74 NA NA 22.88 23.72 090
58275 .... .......... A Hysterectomy/revise vagina ................................. 16.90 NA NA 6.66 7.49 1.92 NA NA 25.48 26.31 090
58280 .... .......... A Hysterectomy/revise vagina ................................. 18.20 NA NA 7.03 7.95 2.07 NA NA 27.30 28.22 090
58290 .... .......... A Vag hyst complex ................................................. 20.17 NA NA 7.38 8.69 2.30 NA NA 29.85 31.16 090
58291 .... .......... A Vag hyst incl t/o, complex .................................... 21.96 NA NA 7.81 9.36 2.53 NA NA 32.30 33.85 090
E:\FR\FM\01DER2.SGM
58292 .... .......... A Vag hyst t/o & repair, compl ................................ 23.25 NA NA 8.29 9.84 2.68 NA NA 34.22 35.77 090
58293 .... .......... A Vag hyst w/uro repair, compl ............................... 24.23 NA NA 8.48 10.11 2.79 NA NA 35.50 37.13 090
58294 .... .......... A Vag hyst w/enterocele, compl .............................. 21.45 NA NA 7.24 8.97 2.40 NA NA 31.09 32.82 090
58300 .... .......... N Insert intrauterine device ...................................... 1.01 0.62 1.22 0.23 0.34 0.12 1.75 2.35 1.36 1.47 XXX
01DER2
58301 .... .......... A Remove intrauterine device ................................. 1.27 1.04 1.25 0.35 0.45 0.15 2.46 2.67 1.77 1.87 000
58321 .... .......... A Artificial insemination ........................................... 0.92 0.96 1.10 0.25 0.34 0.10 1.98 2.12 1.27 1.36 000
58322 .... .......... A Artificial insemination ........................................... 1.10 1.03 1.16 0.31 0.39 0.13 2.26 2.39 1.54 1.62 000
58323 .... .......... A Sperm washing .................................................... 0.23 0.15 0.44 0.07 0.09 0.03 0.41 0.70 0.33 0.35 000
58340 .... .......... A Catheter for hysterography .................................. 0.88 2.11 2.90 0.55 0.63 0.09 3.08 3.87 1.52 1.60 000
58345 .... .......... A Reopen fallopian tube .......................................... 4.67 NA NA 2.04 2.33 0.41 NA NA 7.12 7.41 010
69895
Year
69896
Year Year
2007 2007 Fully Im-
VerDate Aug<31>2005
RVUs cility Total
RVUs
58346 .... .......... A Insert heyman uteri capsule ................................. 7.48 NA NA 3.81 3.89 0.56 NA NA 11.85 11.93 090
58350 .... .......... A Reopen fallopian tube .......................................... 1.03 1.32 1.45 0.87 0.91 0.12 2.47 2.60 2.02 2.06 010
58353 .... .......... A Endometr ablate, thermal ..................................... 3.57 22.66 32.41 1.71 1.97 0.43 26.66 36.41 5.71 5.97 010
10:50 Nov 30, 2006

58356 .... .......... A Endometrial cryoablation ...................................... 6.36 42.90 56.80 1.85 2.48 0.82 50.08 63.98 9.03 9.66 010
58400 .... .......... A Suspension of uterus ........................................... 7.06 NA NA 3.82 3.90 0.75 NA NA 11.63 11.71 090
58410 .... .......... A Suspension of uterus ........................................... 13.70 NA NA 5.88 6.29 1.45 NA NA 21.03 21.44 090
58520 .... .......... A Repair of ruptured uterus ..................................... 13.38 NA NA 5.45 5.89 1.47 NA NA 20.30 20.74 090
58540 .... .......... A Revision of uterus ................................................ 15.61 NA NA 6.20 6.76 1.79 NA NA 23.60 24.16 090
Jkt 211001
58541 .... .......... A Lsh, uterus 250 g or less ..................................... 14.57 NA NA 6.14 6.14 1.68 NA NA 22.39 22.39 090
58542 .... .......... A Lsh w/t/o ut 250 g or less .................................... 16.43 NA NA 6.66 6.66 1.69 NA NA 24.78 24.78 090
58543 .... .......... A Lsh uterus above 250 g ....................................... 16.74 NA NA 6.73 6.73 1.73 NA NA 25.20 25.20 090
58544 .... .......... A Lsh w/t/o uterus above 250 g .............................. 18.24 NA NA 7.16 7.16 1.89 NA NA 27.29 27.29 090
PO 00000
58545 .... .......... A Laparoscopic myomectomy ................................. 15.45 NA NA 5.93 6.87 1.78 NA NA 23.16 24.10 090
58546 .... .......... A Laparo-myomectomy, complex ............................ 19.84 NA NA 7.10 8.46 2.31 NA NA 29.25 30.61 090
58548 .... .......... A Lap radical hyst .................................................... 31.45 NA NA 12.74 12.74 3.52 NA NA 47.71 47.71 090
58550 .... .......... A Laparo-asst vag hysterectomy ............................. 14.97 NA NA 6.16 7.01 1.73 NA NA 22.86 23.71 090
Frm 00274
58552 .... .......... A Laparo-vag hyst incl t/o ........................................ 16.78 NA NA 6.59 7.66 1.73 NA NA 25.10 26.17 090
58553 .... .......... A Laparo-vag hyst, complex .................................... 19.96 NA NA 7.13 8.47 2.31 NA NA 29.40 30.74 090
58554 .... .......... A Laparo-vag hyst w/t/o, compl ............................... 22.98 NA NA 8.33 9.88 2.28 NA NA 33.59 35.14 090
58555 .... .......... A Hysteroscopy, dx, sep proc ................................. 3.33 2.72 2.32 1.24 1.47 0.40 6.45 6.05 4.97 5.20 000
Fmt 4701
58558 .... .......... A Hysteroscopy, biopsy ........................................... 4.74 3.57 2.52 1.67 2.05 0.57 8.88 7.83 6.98 7.36 000
58559 .... .......... A Hysteroscopy, lysis .............................................. 6.16 NA NA 2.05 2.56 0.74 NA NA 8.95 9.46 000
58560 .... .......... A Hysteroscopy, resect septum ............................... 6.99 NA NA 2.29 2.88 0.84 NA NA 10.12 10.71 000
58561 .... .......... A Hysteroscopy, remove myoma ............................ 9.99 NA NA 3.14 4.00 1.21 NA NA 14.34 15.20 000
Sfmt 4700
58562 .... .......... A Hysteroscopy, remove fb ..................................... 5.20 3.48 2.63 1.77 2.21 0.63 9.31 8.46 7.60 8.04 000
58563 .... .......... A Hysteroscopy, ablation ......................................... 6.16 36.94 51.38 2.06 2.58 0.74 43.84 58.28 8.96 9.48 000
58565 .... .......... A Hysteroscopy, sterilization ................................... 7.06 34.05 45.68 3.36 3.77 1.19 42.30 53.93 11.61 12.02 090
58578 .... .......... C Laparo proc, uterus .............................................. 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 YYY
58579 .... .......... C Hysteroscope procedure ...................................... 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 YYY
58600 .... .......... A Division of fallopian tube ...................................... 5.86 NA NA 2.91 3.23 0.66 NA NA 9.43 9.75 090
58605 .... .......... A Division of fallopian tube ...................................... 5.25 NA NA 2.67 3.00 0.59 NA NA 8.51 8.84 090
58611 .... .......... A Ligate oviduct(s) add-on ...................................... 1.45 NA NA 0.40 0.53 0.18 NA NA 2.03 2.16 ZZZ
58615 .... .......... A Occlude fallopian tube(s) ..................................... 3.91 NA NA 1.98 2.52 0.47 NA NA 6.36 6.90 010
E:\FR\FM\01DER2.SGM
58660 .... .......... A Laparoscopy, lysis ................................................ 11.54 NA NA 4.52 5.07 1.40 NA NA 17.46 18.01 090
58661 .... .......... A Laparoscopy, remove adnexa .............................. 11.30 NA NA 4.01 4.84 1.34 NA NA 16.65 17.48 010
58662 .... .......... A Laparoscopy, excise lesions ................................ 12.08 NA NA 4.78 5.53 1.43 NA NA 18.29 19.04 090
58670 .... .......... A Laparoscopy, tubal cautery .................................. 5.86 NA NA 2.95 3.19 0.67 NA NA 9.48 9.72 090
01DER2
58671 .... .......... A Laparoscopy, tubal block ..................................... 5.86 NA NA 2.94 3.19 0.68 NA NA 9.48 9.73 090
58672 .... .......... A Laparoscopy, fimbrioplasty .................................. 12.88 NA NA 4.75 5.82 1.60 NA NA 19.23 20.30 090
58673 .... .......... A Laparoscopy, salpingostomy ................................ 13.99 NA NA 5.19 6.23 1.70 NA NA 20.88 21.92 090
58679 .... .......... C Laparo proc, oviduct-ovary .................................. 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 YYY
58700 .... .......... A Removal of fallopian tube .................................... 12.84 NA NA 5.53 5.87 1.51 NA NA 19.88 20.22 090
58720 .... .......... A Removal of ovary/tube(s) ..................................... 12.08 NA NA 5.10 5.60 1.39 NA NA 18.57 19.07 090
Year Year Year
2007 2007 Fully Im-
VerDate Aug<31>2005
RVUs cility Total
RVUs
58740 .... .......... A Revise fallopian tube(s) ....................................... 14.79 NA NA 6.07 6.87 1.72 NA NA 22.58 23.38 090
58750 .... .......... A Repair oviduct ...................................................... 15.56 NA NA 6.08 7.04 1.85 NA NA 23.49 24.45 090
58752 .... .......... A Revise ovarian tube(s) ......................................... 15.56 NA NA 6.00 6.71 1.81 NA NA 23.37 24.08 090
10:50 Nov 30, 2006

58760 .... .......... A Remove tubal obstruction .................................... 13.85 NA NA 5.61 6.44 1.80 NA NA 21.26 22.09 090
58770 .... .......... A Create new tubal opening .................................... 14.69 NA NA 5.76 6.62 1.74 NA NA 22.19 23.05 090
58800 .... .......... A Drainage of ovarian cyst(s) .................................. 4.54 3.10 3.51 2.60 2.83 0.43 8.07 8.48 7.57 7.80 090
58805 .... .......... A Drainage of ovarian cyst(s) .................................. 6.34 NA NA 3.40 3.48 0.69 NA NA 10.43 10.51 090
58820 .... .......... A Drain ovary abscess, open .................................. 4.62 NA NA 2.88 3.19 0.52 NA NA 8.02 8.33 090
Jkt 211001
58822 .... .......... A Drain ovary abscess, percut ................................ 11.71 NA NA 5.05 5.17 1.16 NA NA 17.92 18.04 090
58823 .... .......... A Drain pelvic abscess, percut ................................ 3.37 19.03 20.75 0.95 1.08 0.24 22.64 24.36 4.56 4.69 000
58825 .... .......... A Transposition, ovary(s) ......................................... 11.70 NA NA 4.98 5.59 1.32 NA NA 18.00 18.61 090
58900 .... .......... A Biopsy of ovary(s) ................................................ 6.51 NA NA 3.42 3.53 0.69 NA NA 10.62 10.73 090
PO 00000
58920 .... .......... A Partial removal of ovary(s) ................................... 11.87 NA NA 5.23 5.49 1.43 NA NA 18.53 18.79 090
58925 .... .......... A Removal of ovarian cyst(s) .................................. 12.33 NA NA 5.27 5.58 1.41 NA NA 19.01 19.32 090
58940 .... .......... A Removal of ovary(s) ............................................. 8.12 NA NA 4.04 4.09 0.91 NA NA 13.07 13.12 090
58943 .... .......... A Removal of ovary(s) ............................................. 19.42 NA NA 7.24 8.29 2.23 NA NA 28.89 29.94 090
Frm 00275
58950 .... .......... A Resect ovarian malignancy .................................. 18.24 NA NA 7.30 8.13 2.05 NA NA 27.59 28.42 090
58953 .... .......... A Tah, rad dissect for debulk .................................. 33.97 NA NA 11.71 13.83 3.84 NA NA 49.52 51.64 090
Fmt 4701
58954 .... .......... A Tah rad debulk/lymph remove ............................. 36.97 NA NA 12.56 14.92 4.18 NA NA 53.71 56.07 090
58956 .... .......... A Bso, omentectomy w/tah ...................................... 22.65 NA NA 8.63 9.89 4.01 NA NA 35.29 36.55 090
58957 .... .......... A Resect recurrent gyn mal ..................................... 26.06 NA NA 9.63 9.63 2.95 NA NA 38.64 38.64 090
58958 .... .......... A Resect recur gyn mal w/lym ................................ 29.06 NA NA 10.44 10.44 3.29 NA NA 42.79 42.79 090
Sfmt 4700
58960 .... .......... A Exploration of abdomen ....................................... 15.68 NA NA 6.29 7.09 1.80 NA NA 23.77 24.57 090
58970 .... .......... A Retrieval of oocyte ............................................... 3.52 1.82 2.19 1.26 1.43 0.43 5.77 6.14 5.21 5.38 000
58974 .... .......... C Transfer of embryo ............................................... 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 000
58976 .... .......... A Transfer of embryo ............................................... 3.82 1.93 2.49 1.20 1.67 0.47 6.22 6.78 5.49 5.96 000
58999 .... .......... C Genital surgery procedure ................................... 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 YYY
59000 .... .......... A Amniocentesis, diagnostic .................................... 1.30 1.72 1.98 0.55 0.64 0.31 3.33 3.59 2.16 2.25 000
59001 .... .......... A Amniocentesis, therapeutic .................................. 3.00 NA NA 1.08 1.33 0.71 NA NA 4.79 5.04 000
59012 .... .......... A Fetal cord puncture,prenatal ................................ 3.44 NA NA 1.15 1.44 0.82 NA NA 5.41 5.70 000
59015 .... .......... A Chorion biopsy ..................................................... 2.20 1.41 1.52 0.80 0.98 0.52 4.13 4.24 3.52 3.70 000
E:\FR\FM\01DER2.SGM
59020 .... .......... A Fetal contract stress test ...................................... 0.66 1.06 0.85 1.06 0.85 0.26 1.98 1.77 1.98 1.77 000
59020 .... TC .... A Fetal contract stress test ...................................... 0.00 0.88 0.61 0.88 0.61 0.10 0.98 0.71 0.98 0.71 000
59020 .... 26 ..... A Fetal contract stress test ...................................... 0.66 0.18 0.24 0.18 0.24 0.16 1.00 1.06 1.00 1.06 000
59025 .... .......... A Fetal non-stress test ............................................ 0.53 0.63 0.49 0.63 0.49 0.15 1.31 1.17 1.31 1.17 000
01DER2
59025 .... TC .... A Fetal non-stress test ............................................ 0.00 0.48 0.29 0.48 0.29 0.02 0.50 0.31 0.50 0.31 000
59025 .... 26 ..... A Fetal non-stress test ............................................ 0.53 0.15 0.20 0.15 0.20 0.13 0.81 0.86 0.81 0.86 000
59030 .... .......... A Fetal scalp blood sample ..................................... 1.99 NA NA 0.56 0.72 0.47 NA NA 3.02 3.18 000
59050 .... .......... A Fetal monitor w/report .......................................... 0.89 NA NA 0.25 0.33 0.21 NA NA 1.35 1.43 XXX
59051 .... .......... A Fetal monitor/interpret only .................................. 0.74 NA NA 0.21 0.27 0.17 NA NA 1.12 1.18 XXX
59070 .... .......... A Transabdom amnioinfus w/us .............................. 5.24 4.33 4.95 1.76 2.17 0.28 9.85 10.47 7.28 7.69 000
69897
Year
69898
Year Year
2007 2007 Fully Im-
VerDate Aug<31>2005
RVUs cility Total
RVUs
59072 .... .......... A Umbilical cord occlud w/us .................................. 8.99 NA NA 2.86 3.06 0.16 NA NA 12.01 12.21 000
59074 .... .......... A Fetal fluid drainage w/us ...................................... 5.24 3.86 4.39 1.70 2.16 0.28 9.38 9.91 7.22 7.68 000
59076 .... .......... A Fetal shunt placement, w/us ................................ 8.99 NA NA 2.40 2.94 0.16 NA NA 11.55 12.09 000
10:50 Nov 30, 2006

59100 .... .......... A Remove uterus lesion .......................................... 13.26 NA NA 5.81 6.29 2.95 NA NA 22.02 22.50 090
59120 .... .......... A Treat ectopic pregnancy ...................................... 12.56 NA NA 5.42 6.04 2.73 NA NA 20.71 21.33 090
Jkt 211001
PO 00000
59160 .... .......... A D & c after delivery .............................................. 2.73 1.98 2.96 1.18 1.89 0.64 5.35 6.33 4.55 5.26 010
59200 .... .......... A Insert cervical dilator ............................................ 0.79 0.93 1.13 0.22 0.28 0.19 1.91 2.11 1.20 1.26 000
59300 .... .......... A Episiotomy or vaginal repair ................................ 2.41 2.19 2.18 1.03 0.98 0.57 5.17 5.16 4.01 3.96 000
Frm 00276
59350 .... .......... A Repair of uterus ................................................... 4.94 NA NA 1.40 1.75 1.17 NA NA 7.51 7.86 000
59400 .... .......... A Obstetrical care .................................................... 26.80 NA NA 14.26 15.06 5.50 NA NA 46.56 47.36 MMM
Fmt 4701
59412 .... .......... A Antepartum manipulation ..................................... 1.71 NA NA 0.64 0.77 0.40 NA NA 2.75 2.88 MMM
59414 .... .......... A Deliver placenta ................................................... 1.61 NA NA 0.44 0.59 0.38 NA NA 2.43 2.58 MMM
59425 .... .......... A Antepartum care only ........................................... 6.22 4.22 4.21 1.70 1.81 1.14 11.58 11.57 9.06 9.17 MMM
Sfmt 4700
59426 .... .......... A Antepartum care only ........................................... 11.04 7.77 7.60 3.02 3.17 1.98 20.79 20.62 16.04 16.19 MMM
59430 .... .......... A Care after delivery ................................................ 2.13 1.08 1.19 0.71 0.88 0.50 3.71 3.82 3.34 3.51 MMM
59510 .... .......... A Cesarean delivery ................................................ 30.34 NA NA 15.91 16.92 6.25 NA NA 52.50 53.51 MMM
59514 .... .......... A Cesarean delivery only ........................................ 15.95 NA NA 4.49 5.78 3.80 NA NA 24.24 25.53 MMM
59515 .... .......... A Cesarean delivery ................................................ 18.26 NA NA 6.21 7.43 4.13 NA NA 28.60 29.82 MMM
59525 .... .......... A Remove uterus after cesarean ............................ 8.53 NA NA 2.39 3.07 1.95 NA NA 12.87 13.55 ZZZ
59610 .... .......... A Vbac delivery ........................................................ 28.21 NA NA 14.51 15.52 5.87 NA NA 48.59 49.60 MMM
59612 .... .......... A Vbac delivery only ................................................ 15.04 NA NA 4.26 5.60 3.59 NA NA 22.89 24.23 MMM
59614 .... .......... A Vbac care after delivery ....................................... 16.59 NA NA 5.15 6.49 3.89 NA NA 25.63 26.97 MMM
E:\FR\FM\01DER2.SGM
59618 .... .......... A Attempted vbac delivery ....................................... 31.78 NA NA 16.28 17.74 6.61 NA NA 54.67 56.13 MMM
59620 .... .......... A Attempted vbac delivery only ............................... 17.50 NA NA 4.80 6.27 4.17 NA NA 26.47 27.94 MMM
59622 .... .......... A Attempted vbac after care .................................... 19.70 NA NA 6.66 8.14 4.50 NA NA 30.86 32.34 MMM
59812 .... .......... A Treatment of miscarriage ..................................... 4.39 3.08 2.68 2.35 2.49 0.95 8.42 8.02 7.69 7.83 090
01DER2
59820 .... .......... A Care of miscarriage .............................................. 4.68 4.04 4.33 3.45 3.53 0.95 9.67 9.96 9.08 9.16 090
59821 .... .......... A Treatment of miscarriage ..................................... 4.97 3.80 4.15 3.15 3.34 1.06 9.83 10.18 9.18 9.37 090
59830 .... .......... A Treat uterus infection ........................................... 6.51 NA NA 3.44 3.85 1.44 NA NA 11.39 11.80 090
59840 .... .......... R Abortion ................................................................ 3.01 2.01 2.09 1.79 2.04 0.71 5.73 5.81 5.51 5.76 010
59841 .... .......... R Abortion ................................................................ 5.57 3.15 3.41 2.59 2.88 1.24 9.96 10.22 9.40 9.69 010
59850 .... .......... R Abortion ................................................................ 5.90 NA NA 2.63 3.10 1.28 NA NA 9.81 10.28 090
Year Year Year
2007 2007 Fully Im-
VerDate Aug<31>2005
RVUs cility Total
RVUs
10:50 Nov 30, 2006

59866 .... .......... R Abortion (mpr) ...................................................... 3.99 NA NA 1.24 1.73 0.87 NA NA 6.10 6.59 000
59870 .... .......... A Evacuate mole of uterus ...................................... 6.40 NA NA 4.28 4.43 1.42 NA NA 12.10 12.25 090
59871 .... .......... A Remove cerclage suture ...................................... 2.13 NA NA 0.93 1.08 0.50 NA NA 3.56 3.71 000
Jkt 211001
59897 .... .......... C Fetal invas px w/us .............................................. 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 YYY
59898 .... .......... C Laparo proc, ob care/deliver ................................ 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 YYY
59899 .... .......... C Maternity care procedure ..................................... 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 YYY
60000 .... .......... A Drain thyroid/tongue cyst ..................................... 1.78 2.03 1.95 1.65 1.70 0.15 3.96 3.88 3.58 3.63 010
PO 00000
60001 .... .......... A Aspirate/inject thyriod cyst ................................... 0.97 1.86 1.52 0.27 0.32 0.07 2.90 2.56 1.31 1.36 000
60100 .... .......... A Biopsy of thyroid .................................................. 1.56 1.20 1.35 0.43 0.51 0.10 2.86 3.01 2.09 2.17 000
60200 .... .......... A Remove thyroid lesion ......................................... 9.91 NA NA 5.25 5.80 1.01 NA NA 16.17 16.72 090
60210 .... .......... A Partial thyroid excision ......................................... 11.15 NA NA 5.05 5.49 1.23 NA NA 17.43 17.87 090
Frm 00277
60212 .... .......... A Partial thyroid excision ......................................... 16.32 NA NA 6.80 7.45 1.95 NA NA 25.07 25.72 090
60220 .... .......... A Partial removal of thyroid ..................................... 12.29 NA NA 5.40 5.96 1.32 NA NA 19.01 19.57 090
60225 .... .......... A Partial removal of thyroid ..................................... 14.67 NA NA 6.69 7.22 1.64 NA NA 23.00 23.53 090
60240 .... .......... A Removal of thyroid ............................................... 16.18 NA NA 6.16 7.23 1.86 NA NA 24.20 25.27 090
Fmt 4701
60254 .... .......... A Extensive thyroid surgery ..................................... 28.29 NA NA 10.44 13.22 2.61 NA NA 41.34 44.12 090
60260 .... .......... A Repeat thyroid surgery ......................................... 18.18 NA NA 7.02 8.24 1.94 NA NA 27.14 28.36 090
Sfmt 4700
60280 .... .......... A Remove thyroid duct lesion ................................. 6.05 NA NA 4.12 4.53 0.54 NA NA 10.71 11.12 090
60281 .... .......... A Remove thyroid duct lesion ................................. 8.71 NA NA 4.67 5.54 0.73 NA NA 14.11 14.98 090
60500 .... .......... A Explore parathyroid glands .................................. 16.69 NA NA 6.73 7.23 2.01 NA NA 25.43 25.93 090
60502 .... .......... A Re-explore parathyroids ....................................... 21.01 NA NA 8.46 9.13 2.54 NA NA 32.01 32.68 090
60505 .... .......... A Explore parathyroid glands .................................. 22.91 NA NA 9.24 10.50 2.65 NA NA 34.80 36.06 090
60512 .... .......... A Autotransplant parathyroid ................................... 4.44 NA NA 1.19 1.51 0.53 NA NA 6.16 6.48 ZZZ
60520 .... .......... A Removal of thymus gland .................................... 17.07 NA NA 6.93 7.95 2.20 NA NA 26.20 27.22 090
E:\FR\FM\01DER2.SGM
60540 .... .......... A Explore adrenal gland .......................................... 17.91 NA NA 8.12 7.72 1.75 NA NA 27.78 27.38 090
60545 .... .......... A Explore adrenal gland .......................................... 20.82 NA NA 8.89 8.62 2.08 NA NA 31.79 31.52 090
60600 .... .......... A Remove carotid body lesion ................................ 24.99 NA NA 8.77 10.41 2.20 NA NA 35.96 37.60 090
01DER2
60605 .... .......... A Remove carotid body lesion ................................ 31.86 NA NA 12.23 12.25 2.50 NA NA 46.59 46.61 090
60650 .... .......... A Laparoscopy adrenalectomy ................................ 20.63 NA NA 8.20 8.04 2.29 NA NA 31.12 30.96 090
60659 .... .......... C Laparo proc, endocrine ........................................ 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 YYY
60699 .... .......... C Endocrine surgery procedure ............................... 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 YYY
61000 .... .......... A Remove cranial cavity fluid .................................. 1.58 NA NA 1.23 1.02 0.13 NA NA 2.94 2.73 000
61001 .... .......... A Remove cranial cavity fluid .................................. 1.49 NA NA 1.21 1.10 0.16 NA NA 2.86 2.75 000
69899
Year
69900
Year Year
2007 2007 Fully Im-
VerDate Aug<31>2005
RVUs cility Total
RVUs
61020 .... .......... A Remove brain cavity fluid ..................................... 1.51 NA NA 1.59 1.40 0.34 NA NA 3.44 3.25 000
61026 .... .......... A Injection into brain canal ...................................... 1.69 NA NA 1.49 1.42 0.33 NA NA 3.51 3.44 000
61050 .... .......... A Remove brain canal fluid ..................................... 1.51 NA NA 1.09 1.23 0.11 NA NA 2.71 2.85 000
10:50 Nov 30, 2006

61055 .... .......... A Injection into brain canal ...................................... 2.10 NA NA 1.21 1.37 0.17 NA NA 3.48 3.64 000
61070 .... .......... A Brain canal shunt procedure ................................ 0.89 NA NA 1.15 1.05 0.17 NA NA 2.21 2.11 000
61105 .... .......... A Twist drill hole ...................................................... 5.40 NA NA 4.93 4.18 1.32 NA NA 11.65 10.90 090
61107 .... .......... A Drill skull for implantation ..................................... 4.99 NA NA 1.89 2.37 1.29 NA NA 8.17 8.65 000
61108 .... .......... A Drill skull for drainage .......................................... 11.51 NA NA 8.52 7.49 2.64 NA NA 22.67 21.64 090
Jkt 211001
61120 .... .......... A Burr hole for puncture .......................................... 9.52 NA NA 6.75 6.18 2.10 NA NA 18.37 17.80 090
61140 .... .......... A Pierce skull for biopsy .......................................... 17.10 NA NA 10.52 10.04 4.12 NA NA 31.74 31.26 090
61150 .... .......... A Pierce skull for drainage ...................................... 18.80 NA NA 10.88 10.50 4.32 NA NA 34.00 33.62 090
PO 00000
61154 .... .......... A Pierce skull & remove clot ................................... 16.92 NA NA 10.89 9.83 4.21 NA NA 32.02 30.96 090
61210 .... .......... A Pierce skull, implant device ................................. 5.83 NA NA 2.23 2.74 1.50 NA NA 9.56 10.07 000
61215 .... .......... A Insert brain-fluid device ........................................ 5.77 NA NA 5.48 4.37 1.26 NA NA 12.51 11.40 090
Frm 00278
61250 .... .......... A Pierce skull & explore .......................................... 11.41 NA NA 7.64 7.05 2.77 NA NA 21.82 21.23 090
61253 .... .......... A Pierce skull & explore .......................................... 13.41 NA NA 7.87 7.76 2.62 NA NA 23.90 23.79 090
61304 .... .......... A Open skull for exploration .................................... 23.31 NA NA 12.79 12.82 5.63 NA NA 41.73 41.76 090
61305 .... .......... A Open skull for exploration .................................... 28.51 NA NA 15.30 15.31 6.09 NA NA 49.90 49.91 090
Fmt 4701
61312 .... .......... A Open skull for drainage ........................................ 30.07 NA NA 15.57 15.17 6.36 NA NA 52.00 51.60 090
Sfmt 4700
61316 .... .......... A Implt cran bone flap to abdo ................................ 1.39 NA NA 0.53 0.58 0.35 NA NA 2.27 2.32 ZZZ
61322 .... .......... A Decompressive craniotomy .................................. 34.08 NA NA 18.05 16.26 7.63 NA NA 59.76 57.97 090
61323 .... .......... A Decompressive lobectomy ................................... 34.93 NA NA 17.28 16.38 8.03 NA NA 60.24 59.34 090
61330 .... .......... A Decompress eye socket ....................................... 25.17 NA NA 12.08 13.31 2.32 NA NA 39.57 40.80 090
61332 .... .......... A Explore/biopsy eye socket ................................... 28.50 NA NA 13.68 15.11 4.83 NA NA 47.01 48.44 090
61333 .... .......... A Explore orbit/remove lesion ................................. 29.17 NA NA 13.56 15.07 3.92 NA NA 46.65 48.16 090
61334 .... .......... A Explore orbit/remove object ................................. 19.50 NA NA 9.25 10.29 1.75 NA NA 30.50 31.54 090
E:\FR\FM\01DER2.SGM
61340 .... .......... A Subtemporal decompression ............................... 20.01 NA NA 11.55 11.23 4.84 NA NA 36.40 36.08 090
61343 .... .......... A Incise skull (press relief) ...................................... 31.73 NA NA 16.38 16.70 7.64 NA NA 55.75 56.07 090
61345 .... .......... A Relieve cranial pressure ...................................... 29.10 NA NA 15.47 15.41 7.04 NA NA 51.61 51.55 090
61440 .... .......... A Incise skull for surgery ......................................... 28.53 NA NA 14.27 14.22 6.90 NA NA 49.70 49.65 090
01DER2
61458 .... .......... A Incise skull for brain wound ................................. 28.71 NA NA 15.23 15.44 7.03 NA NA 50.97 51.18 090
Year Year Year
2007 2007 Fully Im-
VerDate Aug<31>2005
RVUs cility Total
RVUs
61500 .... .......... A Removal of skull lesion ........................................ 19.05 NA NA 10.77 10.79 4.11 NA NA 33.93 33.95 090
61501 .... .......... A Remove infected skull bone ................................. 16.22 NA NA 9.66 9.32 3.22 NA NA 29.10 28.76 090
61510 .... .......... A Removal of brain lesion ....................................... 30.63 NA NA 17.32 16.85 7.35 NA NA 55.30 54.83 090
10:50 Nov 30, 2006

61512 .... .......... A Remove brain lining lesion ................................... 36.99 NA NA 18.85 19.47 9.08 NA NA 64.92 65.54 090
61514 .... .......... A Removal of brain abscess ................................... 27.10 NA NA 14.74 14.51 6.54 NA NA 48.38 48.15 090
61517 .... .......... A Implt brain chemotx add-on ................................. 1.38 NA NA 0.52 0.61 0.35 NA NA 2.25 2.34 ZZZ
Jkt 211001
61519 .... .......... A Remove brain lining lesion ................................... 43.28 NA NA 21.16 22.27 10.63 NA NA 75.07 76.18 090
61522 .... .......... A Removal of brain abscess ................................... 31.41 NA NA 15.77 16.25 7.62 NA NA 54.80 55.28 090
PO 00000
61531 .... .......... A Implant brain electrodes ....................................... 16.28 NA NA 10.39 9.44 3.79 NA NA 30.46 29.51 090
Frm 00279
61535 .... .......... A Remove brain electrodes ..................................... 13.05 NA NA 9.03 7.82 3.02 NA NA 25.10 23.89 090
Fmt 4701
61537 .... .......... A Removal of brain tissue ....................................... 36.35 NA NA 17.80 15.51 6.94 NA NA 61.09 58.80 090
Sfmt 4700
61541 .... .......... A Incision of brain tissue ......................................... 30.81 NA NA 16.34 16.24 6.60 NA NA 53.75 53.65 090
61544 .... .......... A Remove & treat brain lesion ................................ 27.26 NA NA 14.60 14.02 5.97 NA NA 47.83 47.25 090
61545 .... .......... A Excision of brain tumor ........................................ 46.23 NA NA 22.72 23.84 10.63 NA NA 79.58 80.70 090
61546 .... .......... A Removal of pituitary gland ................................... 33.31 NA NA 16.89 17.34 7.67 NA NA 57.87 58.32 090
61548 .... .......... A Removal of pituitary gland ................................... 23.27 NA NA 11.56 12.48 3.43 NA NA 38.26 39.18 090
61550 .... .......... A Release of skull seams ........................................ 15.44 NA NA 5.64 6.61 0.98 NA NA 22.06 23.03 090
61552 .... .......... A Release of skull seams ........................................ 20.27 NA NA 6.64 8.49 1.06 NA NA 27.97 29.82 090
E:\FR\FM\01DER2.SGM
61556 .... .......... A Incise skull/sutures ............................................... 24.00 NA NA 12.94 11.76 4.65 NA NA 41.59 40.41 090
61557 .... .......... A Incise skull/sutures ............................................... 23.16 NA NA 13.91 13.69 5.80 NA NA 42.87 42.65 090
61558 .... .......... A Excision of skull/sutures ....................................... 26.35 NA NA 8.16 12.68 1.36 NA NA 35.87 40.39 090
61559 .... .......... A Excision of skull/sutures ....................................... 33.82 NA NA 19.40 19.33 8.51 NA NA 61.73 61.66 090
01DER2
61563 .... .......... A Excision of skull tumor ......................................... 28.35 NA NA 14.57 15.07 5.17 NA NA 48.09 48.59 090
61564 .... .......... A Excision of skull tumor ......................................... 34.59 NA NA 16.53 17.84 8.78 NA NA 59.90 61.21 090
61567 .... .......... A Incision of brain tissue ......................................... 36.84 NA NA 17.10 19.78 6.54 NA NA 60.48 63.16 090
61570 .... .......... A Remove foreign body, brain ................................. 26.38 NA NA 14.37 14.03 5.88 NA NA 46.63 46.29 090
61571 .... .......... A Incise skull for brain wound ................................. 28.29 NA NA 15.43 15.21 6.79 NA NA 50.51 50.29 090
69901
Year
69902
Year Year
2007 2007 Fully Im-
VerDate Aug<31>2005
RVUs cility Total
RVUs
61575 .... .......... A Skull base/brainstem surgery ............................... 36.43 NA NA 15.92 18.70 5.34 NA NA 57.69 60.47 090
61576 .... .......... A Skull base/brainstem surgery ............................... 55.11 NA NA 26.26 32.61 5.58 NA NA 86.95 93.30 090
61580 .... .......... A Craniofacial approach, skull ................................. 34.34 NA NA 21.02 24.44 3.37 NA NA 58.73 62.15 090
10:50 Nov 30, 2006

61584 .... .......... A Orbitocranial approach/skull ................................. 37.61 NA NA 25.81 24.84 8.18 NA NA 71.60 70.63 090
Jkt 211001
61586 .... .......... A Resect nasopharynx, skull ................................... 27.28 NA NA 24.16 22.98 4.37 NA NA 55.81 54.63 090
61590 .... .......... A Infratemporal approach/skull ................................ 46.87 NA NA 23.59 27.36 5.31 NA NA 75.77 79.54 090
61591 .... .......... A Infratemporal approach/skull ................................ 46.87 NA NA 24.23 28.20 5.66 NA NA 76.76 80.73 090
PO 00000
61595 .... .......... A Transtemporal approach/skull .............................. 33.57 NA NA 19.59 21.66 3.98 NA NA 57.14 59.21 090
61596 .... .......... A Transcochlear approach/skull .............................. 39.31 NA NA 18.79 23.03 3.40 NA NA 61.50 65.74 090
61597 .... .......... A Transcondylar approach/skull .............................. 40.73 NA NA 23.14 23.03 8.84 NA NA 72.71 72.60 090
61598 .... .......... A Transpetrosal approach/skull ............................... 36.41 NA NA 21.31 22.75 5.70 NA NA 63.42 64.86 090
Frm 00280
61600 .... .......... A Resect/excise cranial lesion ................................. 29.84 NA NA 18.60 19.48 3.79 NA NA 52.23 53.11 090
Fmt 4701
61609 .... .......... A Transect artery, sinus .......................................... 9.88 NA NA 3.81 4.59 2.56 NA NA 16.25 17.03 ZZZ
Sfmt 4700
61613 .... .......... A Remove aneurysm, sinus .................................... 44.94 NA NA 27.87 26.66 8.45 NA NA 81.26 80.05 090
61615 .... .......... A Resect/excise lesion, skull ................................... 35.63 NA NA 19.60 21.94 4.73 NA NA 59.96 62.30 090
61616 .... .......... A Resect/excise lesion, skull ................................... 46.60 NA NA 26.91 28.22 8.26 NA NA 81.77 83.08 090
61618 .... .......... A Repair dura .......................................................... 18.58 NA NA 10.25 10.39 3.72 NA NA 32.55 32.69 090
61619 .... .......... A Repair dura .......................................................... 22.01 NA NA 11.17 11.97 3.95 NA NA 37.13 37.93 090
61623 .... .......... A Endovasc tempory vessel occl ............................ 9.95 NA NA 3.16 3.85 1.05 NA NA 14.16 14.85 000
61624 .... .......... A Transcath occlusion, cns ..................................... 20.12 NA NA 6.30 6.74 1.96 NA NA 28.38 28.82 000
E:\FR\FM\01DER2.SGM
61626 .... .......... A Transcath occlusion, non-cns .............................. 16.60 NA NA 4.91 5.36 1.24 NA NA 22.75 23.20 000
61630 .... .......... N Intracranial angioplasty ........................................ 22.07 NA NA 6.44 10.98 2.02 NA NA 30.53 35.07 090
61635 .... .......... N Intracran angioplsty w/stent ................................. 24.28 NA NA 6.95 11.89 2.21 NA NA 33.44 38.38 090
61640 .... .......... N Dilate ic vasospasm, init ...................................... 12.32 NA NA 2.85 2.85 0.71 NA NA 15.88 15.88 000
01DER2
61641 .... .......... N Dilate ic vasospasm add-on ................................. 4.33 NA NA 1.00 1.00 0.25 NA NA 5.58 5.58 ZZZ
61642 .... .......... N Dilate ic vasospasm add-on ................................. 8.66 NA NA 2.00 2.00 0.50 NA NA 11.16 11.16 ZZZ
61680 .... .......... A Intracranial vessel surgery ................................... 32.40 NA NA 17.11 17.35 7.95 NA NA 57.46 57.70 090
Year Year Year
2007 2007 Fully Im-
VerDate Aug<31>2005
RVUs cility Total
RVUs
61697 .... .......... A Brain aneurysm repr, complx ............................... 63.22 NA NA 29.29 28.33 12.85 NA NA 105.36 104.40 090
10:50 Nov 30, 2006

61698 .... .......... A Brain aneurysm repr, complx ............................... 69.45 NA NA 31.45 27.88 12.54 NA NA 113.44 109.87 090
61700 .... .......... A Brain aneurysm repr, simple ................................ 50.44 NA NA 24.39 26.95 13.02 NA NA 87.85 90.41 090
61702 .... .......... A Inner skull vessel surgery .................................... 59.86 NA NA 28.41 26.63 10.79 NA NA 99.06 97.28 090
61703 .... .......... A Clamp neck artery ................................................ 18.70 NA NA 10.98 10.59 4.06 NA NA 33.74 33.35 090
61705 .... .......... A Revise circulation to head .................................... 37.97 NA NA 17.87 18.91 8.87 NA NA 64.71 65.75 090
Jkt 211001
61711 .... .......... A Fusion of skull arteries ......................................... 38.10 NA NA 18.86 19.57 9.42 NA NA 66.38 67.09 090
61720 .... .......... A Incise skull/brain surgery ..................................... 17.52 NA NA 8.24 9.54 2.79 NA NA 28.55 29.85 090
PO 00000
61735 .... .......... A Incise skull/brain surgery ..................................... 22.22 NA NA 11.48 11.99 2.73 NA NA 36.43 36.94 090
61750 .... .......... A Incise skull/brain biopsy ....................................... 19.73 NA NA 11.13 10.74 4.72 NA NA 35.58 35.19 090
61751 .... .......... A Brain biopsy w/ct/mr guide ................................... 18.64 NA NA 11.57 11.01 4.56 NA NA 34.77 34.21 090
Frm 00281
61770 .... .......... A Incise skull for treatment ...................................... 23.09 NA NA 10.06 11.70 3.55 NA NA 36.70 38.34 090
61790 .... .......... A Treat trigeminal nerve .......................................... 11.50 NA NA 7.87 6.40 2.82 NA NA 22.19 20.72 090
61791 .... .......... A Treat trigeminal tract ............................................ 15.31 NA NA 7.70 8.61 3.40 NA NA 26.41 27.32 090
61793 .... .......... A Focus radiation beam .......................................... 17.75 NA NA 9.94 10.08 4.46 NA NA 32.15 32.29 090
Fmt 4701
61795 .... .......... A Brain surgery using computer .............................. 4.03 NA NA 1.40 1.87 0.79 NA NA 6.22 6.69 ZZZ
61850 .... .......... A Implant neuroelectrodes ....................................... 13.26 NA NA 5.63 7.16 3.22 NA NA 22.11 23.64 090
61863 .... .......... A Implant neuroelectrode ........................................ 20.56 NA NA 12.64 11.99 5.43 NA NA 38.63 37.98 090
Sfmt 4700
61864 .... .......... A Implant neuroelectrde, addl ................................. 4.49 NA NA 1.73 2.14 5.43 NA NA 11.65 12.06 ZZZ
61867 .... .......... A Implant neuroelectrode ........................................ 32.88 NA NA 16.95 17.75 5.43 NA NA 55.26 56.06 090
61868 .... .......... A Implant neuroelectrde, add"l .............................. 7.91 NA NA 3.02 3.76 5.43 NA NA 16.36 17.10 ZZZ
61880 .... .......... A Revise/remove neuroelectrode ............................ 6.87 NA NA 5.53 4.81 1.66 NA NA 14.06 13.34 090
61885 .... .......... A Insrt/redo neurostim 1 array ................................. 7.37 NA NA 7.48 5.85 1.59 NA NA 16.44 14.81 090
61886 .... .......... A Implant neurostim arrays ..................................... 9.73 NA NA 8.82 6.97 1.97 NA NA 20.52 18.67 090
61888 .... .......... A Revise/remove neuroreceiver .............................. 5.20 NA NA 3.63 3.66 1.33 NA NA 10.16 10.19 010
E:\FR\FM\01DER2.SGM
62000 .... .......... A Treat skull fracture ............................................... 13.83 NA NA 7.28 5.95 1.06 NA NA 22.17 20.84 090
62005 .... .......... A Treat skull fracture ............................................... 17.53 NA NA 9.61 9.00 3.87 NA NA 31.01 30.40 090
62010 .... .......... A Treatment of head injury ...................................... 21.30 NA NA 12.08 11.80 5.14 NA NA 38.52 38.24 090
62100 .... .......... A Repair brain fluid leakage .................................... 23.40 NA NA 12.05 12.60 4.84 NA NA 40.29 40.84 090
01DER2
62115 .... .......... A Reduction of skull defect ...................................... 22.71 NA NA 14.15 12.27 5.51 NA NA 42.37 40.49 090
62120 .... .......... A Repair skull cavity lesion ..................................... 24.39 NA NA 15.93 17.84 3.00 NA NA 43.32 45.23 090
62121 .... .......... A Incise skull repair ................................................. 22.93 NA NA 14.22 15.14 4.17 NA NA 41.32 42.24 090
62140 .... .......... A Repair of skull defect ........................................... 14.45 NA NA 8.71 8.42 3.47 NA NA 26.63 26.34 090
69903
Year
69904
Year Year
2007 2007 Fully Im-
VerDate Aug<31>2005
RVUs cility Total
RVUs
62141 .... .......... A Repair of skull defect ........................................... 15.97 NA NA 9.43 9.14 3.76 NA NA 29.16 28.87 090
62142 .... .......... A Remove skull plate/flap ........................................ 11.73 NA NA 7.81 7.20 2.73 NA NA 22.27 21.66 090
62143 .... .......... A Replace skull plate/flap ........................................ 14.05 NA NA 8.89 8.25 3.37 NA NA 26.31 25.67 090
10:50 Nov 30, 2006

62145 .... .......... A Repair of skull & brain ......................................... 19.99 NA NA 10.35 10.76 4.50 NA NA 34.84 35.25 090
62146 .... .......... A Repair of skull with graft ...................................... 17.18 NA NA 9.21 9.53 3.62 NA NA 30.01 30.33 090
62147 .... .......... A Repair of skull with graft ...................................... 20.57 NA NA 10.75 11.16 4.32 NA NA 35.64 36.05 090
62148 .... .......... A Retr bone flap to fix skull ..................................... 2.00 NA NA 0.78 0.84 0.48 NA NA 3.26 3.32 ZZZ
62160 .... .......... A Neuroendoscopy add-on ...................................... 3.00 NA NA 1.15 1.44 0.77 NA NA 4.92 5.21 ZZZ
Jkt 211001
62161 .... .......... A Dissect brain w/scope .......................................... 21.10 NA NA 12.29 12.14 5.19 NA NA 38.58 38.43 090
62162 .... .......... A Remove colloid cyst w/scope ............................... 26.67 NA NA 14.05 14.65 5.91 NA NA 46.63 47.23 090
62163 .... .......... A Neuroendoscopy w/fb removal ............................ 16.40 NA NA 10.66 10.11 4.01 NA NA 31.07 30.52 090
62164 .... .......... A Remove brain tumor w/scope .............................. 29.27 NA NA 15.15 15.00 5.38 NA NA 49.80 49.65 090
PO 00000
62165 .... .......... A Remove pituit tumor w/scope .............................. 23.10 NA NA 11.67 12.95 3.01 NA NA 37.78 39.06 090
62180 .... .......... A Establish brain cavity shunt ................................. 22.45 NA NA 12.17 12.25 4.98 NA NA 39.60 39.68 090
Frm 00282
62194 .... .......... A Replace/irrigate catheter ...................................... 5.68 NA NA 3.75 2.76 0.92 NA NA 10.35 9.36 010
62201 .... .......... A Brain cavity shunt w/scope .................................. 15.89 NA NA 10.64 9.74 3.68 NA NA 30.21 29.31 090
Fmt 4701
62225 .... .......... A Replace/irrigate catheter ...................................... 6.11 NA NA 5.54 4.45 1.39 NA NA 13.04 11.95 090
62230 .... .......... A Replace/revise brain shunt .................................. 11.35 NA NA 7.36 6.70 2.71 NA NA 21.42 20.76 090
62252 .... .......... A Csf shunt reprogram ............................................ 0.74 1.78 1.55 NA NA 0.21 2.73 2.50 NA NA XXX
Sfmt 4700
62252 .... TC .... A Csf shunt reprogram ............................................ 0.00 1.50 1.20 NA NA 0.02 1.52 1.22 NA NA XXX
62252 .... 26 ..... A Csf shunt reprogram ............................................ 0.74 0.28 0.35 0.28 0.35 0.19 1.21 1.28 1.21 1.28 XXX
62256 .... .......... A Remove brain cavity shunt .................................. 7.30 NA NA 5.94 5.00 1.72 NA NA 14.96 14.02 090
62258 .... .......... A Replace brain cavity shunt ................................... 15.54 NA NA 9.37 8.88 3.74 NA NA 28.65 28.16 090
62263 .... .......... A Epidural lysis mult sessions ................................. 6.41 9.04 11.78 2.86 3.11 0.41 15.86 18.60 9.68 9.93 010
62264 .... .......... A Epidural lysis on single day ................................. 4.42 5.62 7.20 1.27 1.38 0.27 10.31 11.89 5.96 6.07 010
62268 .... .......... A Drain spinal cord cyst .......................................... 4.73 6.44 10.26 1.63 2.01 0.43 11.60 15.42 6.79 7.17 000
62269 .... .......... A Needle biopsy, spinal cord ................................... 5.01 6.62 12.67 1.61 1.88 0.37 12.00 18.05 6.99 7.26 000
62270 .... .......... A Spinal fluid tap, diagnostic ................................... 1.37 2.30 2.82 0.53 0.55 0.08 3.75 4.27 1.98 2.00 000
E:\FR\FM\01DER2.SGM
62272 .... .......... A Drain cerebro spinal fluid ..................................... 1.35 3.06 3.47 0.60 0.68 0.18 4.59 5.00 2.13 2.21 000
62273 .... .......... A Inject epidural patch ............................................. 2.15 1.66 2.45 0.57 0.68 0.13 3.94 4.73 2.85 2.96 000
62280 .... .......... A Treat spinal cord lesion ........................................ 2.63 4.21 6.25 1.06 1.02 0.30 7.14 9.18 3.99 3.95 010
62281 .... .......... A Treat spinal cord lesion ........................................ 2.66 3.69 5.16 0.89 0.89 0.19 6.54 8.01 3.74 3.74 010
01DER2
62282 .... .......... A Treat spinal canal lesion ...................................... 2.33 3.90 7.25 1.06 0.96 0.17 6.40 9.75 3.56 3.46 010
62284 .... .......... A Injection for myelogram ........................................ 1.54 3.58 4.62 0.62 0.67 0.13 5.25 6.29 2.29 2.34 000
62287 .... .......... A Percutaneous diskectomy .................................... 8.88 NA NA 4.08 5.18 0.58 NA NA 13.54 14.64 090
62290 .... .......... A Inject for spine disk x-ray ..................................... 3.00 4.31 6.43 1.09 1.31 0.23 7.54 9.66 4.32 4.54 000
62291 .... .......... A Inject for spine disk x-ray ..................................... 2.91 4.09 5.47 1.02 1.18 0.26 7.26 8.64 4.19 4.35 000
62292 .... .......... A Injection into disk lesion ....................................... 9.14 NA NA 3.19 4.15 0.82 NA NA 13.15 14.11 090
Year Year Year
2007 2007 Fully Im-
VerDate Aug<31>2005
RVUs cility Total
RVUs
62294 .... .......... A Injection into spinal artery .................................... 12.77 NA NA 5.56 5.58 1.24 NA NA 19.57 19.59 090
62310 .... .......... A Inject spine c/t ...................................................... 1.91 2.98 4.35 0.57 0.63 0.12 5.01 6.38 2.60 2.66 000
62311 .... .......... A Inject spine l/s (cd) ............................................... 1.54 2.65 4.35 0.53 0.58 0.09 4.28 5.98 2.16 2.21 000
10:50 Nov 30, 2006

62318 .... .......... A Inject spine w/cath, c/t ......................................... 2.04 3.19 5.09 0.48 0.61 0.12 5.35 7.25 2.64 2.77 000
62319 .... .......... A Inject spine w/cath l/s (cd) ................................... 1.87 2.85 4.45 0.47 0.58 0.11 4.83 6.43 2.45 2.56 000
62350 .... .......... A Implant spinal canal cath ..................................... 8.04 NA NA 4.16 4.00 1.02 NA NA 13.22 13.06 090
62351 .... .......... A Implant spinal canal cath ..................................... 11.54 NA NA 7.79 7.29 2.25 NA NA 21.58 21.08 090
62355 .... .......... A Remove spinal canal catheter ............................. 6.60 NA NA 3.61 3.27 0.71 NA NA 10.92 10.58 090
Jkt 211001
62360 .... .......... A Insert spine infusion device ................................. 3.68 NA NA 3.45 2.87 0.34 NA NA 7.47 6.89 090
62361 .... .......... A Implant spine infusion pump ................................ 6.59 NA NA 4.00 3.94 0.80 NA NA 11.39 11.33 090
62362 .... .......... A Implant spine infusion pump ................................ 8.58 NA NA 4.77 4.46 1.18 NA NA 14.53 14.22 090
62365 .... .......... A Remove spine infusion device ............................. 6.57 NA NA 3.85 3.65 0.86 NA NA 11.28 11.08 090
PO 00000
62367 .... .......... A Analyze spine infusion pump ............................... 0.48 0.41 0.56 0.11 0.10 0.03 0.92 1.07 0.62 0.61 XXX
62368 .... .......... A Analyze spine infusion pump ............................... 0.75 0.59 0.67 0.18 0.17 0.06 1.40 1.48 0.99 0.98 XXX
63001 .... .......... A Removal of spinal lamina ..................................... 17.51 NA NA 10.01 9.64 3.77 NA NA 31.29 30.92 090
Frm 00283
Fmt 4701
63020 .... .......... A Neck spine disk surgery ....................................... 16.05 NA NA 10.09 9.78 3.72 NA NA 29.86 29.55 090
63030 .... .......... A Low back disk surgery ......................................... 13.03 NA NA 8.74 8.50 3.01 NA NA 24.78 24.54 090
Sfmt 4700
63035 .... .......... A Spinal disk surgery add-on .................................. 3.15 NA NA 1.22 1.50 0.79 NA NA 5.16 5.44 ZZZ
63040 .... .......... A Laminotomy, single cervical ................................. 20.18 NA NA 11.20 11.43 4.68 NA NA 36.06 36.29 090
63042 .... .......... A Laminotomy, single lumbar .................................. 18.61 NA NA 10.78 11.20 4.26 NA NA 33.65 34.07 090
63043 .... .......... C Laminotomy, add"l cervical ................................ 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 ZZZ
63044 .... .......... C Laminotomy, add"l lumbar ................................. 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 ZZZ
63048 .... .......... A Remove spinal lamina add-on ............................. 3.47 NA NA 1.35 1.58 0.72 NA NA 5.54 5.77 ZZZ
E:\FR\FM\01DER2.SGM
63050 .... .......... A Cervical laminoplasty ........................................... 21.88 NA NA 8.91 11.11 4.67 NA NA 35.46 37.66 090
63051 .... .......... A C-laminoplasty w/graft/plate ................................. 25.38 NA NA 11.79 13.05 4.67 NA NA 41.84 43.10 090
63055 .... .......... A Decompress spinal cord ...................................... 23.42 NA NA 12.55 12.99 5.29 NA NA 41.26 41.70 090
01DER2
63057 .... .......... A Decompress spine cord add-on ........................... 5.25 NA NA 2.00 2.47 1.22 NA NA 8.47 8.94 ZZZ
63066 .... .......... A Decompress spine cord add-on ........................... 3.26 NA NA 1.26 1.56 0.69 NA NA 5.21 5.51 ZZZ
63075 .... .......... A Neck spine disk surgery ....................................... 19.47 NA NA 11.24 11.87 4.63 NA NA 35.34 35.97 090
63076 .... .......... A Neck spine disk surgery ....................................... 4.04 NA NA 1.56 1.93 0.96 NA NA 6.56 6.93 ZZZ
63077 .... .......... A Spine disk surgery, thorax ................................... 22.75 NA NA 11.28 12.41 3.99 NA NA 38.02 39.15 090
69905
Year
69906
Year Year
2007 2007 Fully Im-
VerDate Aug<31>2005
RVUs cility Total
RVUs
63078 .... .......... A Spine disk surgery, thorax ................................... 3.28 NA NA 1.22 1.54 0.66 NA NA 5.16 5.48 ZZZ
63081 .... .......... A Removal of vertebral body ................................... 25.97 NA NA 13.78 14.19 5.56 NA NA 45.31 45.72 090
63082 .... .......... A Remove vertebral body add-on ........................... 4.36 NA NA 1.69 2.09 1.02 NA NA 7.07 7.47 ZZZ
10:50 Nov 30, 2006

Jkt 211001
PO 00000
63170 .... .......... A Incise spinal cord tract(s) ..................................... 22.08 NA NA 12.80 12.10 4.87 NA NA 39.75 39.05 090
63172 .... .......... A Drainage of spinal cyst ........................................ 19.66 NA NA 11.44 10.84 4.49 NA NA 35.59 34.99 090
63173 .... .......... A Drainage of spinal cyst ........................................ 24.18 NA NA 13.56 12.99 5.70 NA NA 43.44 42.87 090
63180 .... .......... A Revise spinal cord ligaments ............................... 20.40 NA NA 10.98 10.98 3.96 NA NA 35.34 35.34 090
Frm 00284
63182 .... .......... A Revise spinal cord ligaments ............................... 22.69 NA NA 7.18 10.01 5.32 NA NA 35.19 38.02 090
63185 .... .......... A Incise spinal column/nerves ................................. 16.36 NA NA 10.19 8.62 2.80 NA NA 29.35 27.78 090
Fmt 4701
63194 .... .......... A Incise spinal column & cord ................................. 21.97 NA NA 8.89 11.01 3.27 NA NA 34.13 36.25 090
Sfmt 4700
63200 .... .......... A Release of spinal cord ......................................... 21.31 NA NA 11.92 11.45 4.97 NA NA 38.20 37.73 090
63250 .... .......... A Revise spinal cord vessels .................................. 43.73 NA NA 21.43 20.30 9.04 NA NA 74.20 73.07 090
63265 .... .......... A Excise intraspinal lesion ....................................... 23.69 NA NA 13.27 12.89 5.45 NA NA 42.41 42.03 090
E:\FR\FM\01DER2.SGM
01DER2
63275 .... .......... A Biopsy/excise spinal tumor .................................. 25.73 NA NA 13.67 13.74 5.82 NA NA 45.22 45.29 090
Year Year Year
2007 2007 Fully Im-
VerDate Aug<31>2005
RVUs cility Total
RVUs
10:50 Nov 30, 2006

63295 .... .......... A Repair of laminectomy defect .............................. 5.25 NA NA 1.34 1.94 1.03 NA NA 7.62 8.22 ZZZ
Jkt 211001
PO 00000
Frm 00285
63600 .... .......... A Remove spinal cord lesion ................................... 15.02 NA NA 4.54 5.18 1.52 NA NA 21.08 21.72 090
63610 .... .......... A Stimulation of spinal cord ..................................... 8.72 13.95 48.25 1.57 2.08 0.86 23.53 57.83 11.15 11.66 000
63615 .... .......... A Remove lesion of spinal cord .............................. 17.22 NA NA 6.06 8.46 2.85 NA NA 26.13 28.53 090
Fmt 4701
63660 .... .......... A Revise/remove neuroelectrode ............................ 6.87 NA NA 3.33 3.54 0.78 NA NA 10.98 11.19 090
63685 .... .......... A Insrt/redo spine n generator ................................. 7.87 NA NA 3.71 4.03 1.05 NA NA 12.63 12.95 090
Sfmt 4700
63688 .... .......... A Revise/remove neuroreceiver .............................. 6.10 NA NA 3.59 3.56 0.89 NA NA 10.58 10.55 090
63700 .... .......... A Repair of spinal herniation ................................... 17.32 NA NA 9.88 10.20 3.53 NA NA 30.73 31.05 090
63707 .... .......... A Repair spinal fluid leakage ................................... 12.52 NA NA 7.96 7.77 2.52 NA NA 23.00 22.81 090
63709 .... .......... A Repair spinal fluid leakage ................................... 15.52 NA NA 9.14 9.33 3.10 NA NA 27.76 27.95 090
63710 .... .......... A Graft repair of spine defect .................................. 15.27 NA NA 9.35 9.11 3.41 NA NA 28.03 27.79 090
63740 .... .......... A Install spinal shunt ............................................... 12.50 NA NA 8.33 7.59 2.94 NA NA 23.77 23.03 090
E:\FR\FM\01DER2.SGM
63741 .... .......... A Install spinal shunt ............................................... 9.02 NA NA 4.85 4.78 1.66 NA NA 15.53 15.46 090
63744 .... .......... A Revision of spinal shunt ....................................... 8.86 NA NA 6.12 5.47 1.90 NA NA 16.88 16.23 090
63746 .... .......... A Removal of spinal shunt ...................................... 7.25 NA NA 4.78 4.02 1.53 NA NA 13.56 12.80 090
64400 .... .......... A N block inj, trigeminal ........................................... 1.11 1.39 1.77 0.45 0.44 0.07 2.57 2.95 1.63 1.62 000
01DER2
64402 .... .......... A N block inj, facial .................................................. 1.25 1.45 1.57 0.53 0.58 0.09 2.79 2.91 1.87 1.92 000
64405 .... .......... A N block inj, occipital ............................................. 1.32 1.16 1.39 0.51 0.47 0.08 2.56 2.79 1.91 1.87 000
64408 .... .......... A N block inj, vagus ................................................. 1.41 1.46 1.55 0.72 0.82 0.10 2.97 3.06 2.23 2.33 000
64410 .... .......... A N block inj, phrenic .............................................. 1.43 1.80 2.33 0.52 0.48 0.09 3.32 3.85 2.04 2.00 000
64412 .... .......... A N block inj, spinal accessor ................................. 1.18 2.03 2.50 0.55 0.46 0.08 3.29 3.76 1.81 1.72 000
64413 .... .......... A N block inj, cervical plexus .................................. 1.40 1.28 1.70 0.47 0.49 0.08 2.76 3.18 1.95 1.97 000
69907
Year
69908
Year Year
2007 2007 Fully Im-
VerDate Aug<31>2005
RVUs cility Total
RVUs
64415 .... .......... A N block inj, brachial plexus .................................. 1.48 1.48 2.47 0.34 0.43 0.09 3.05 4.04 1.91 2.00 000
64416 .... .......... A N block cont infuse, b plex .................................. 3.85 NA NA 0.58 0.74 0.31 NA NA 4.74 4.90 010
64417 .... .......... A N block inj, axillary ............................................... 1.44 1.49 2.65 0.35 0.46 0.11 3.04 4.20 1.90 2.01 000
10:50 Nov 30, 2006

64418 .... .......... A N block inj, suprascapular .................................... 1.32 1.87 2.43 0.52 0.46 0.07 3.26 3.82 1.91 1.85 000
64420 .... .......... A N block inj, intercost, sng ..................................... 1.18 2.36 3.50 0.44 0.43 0.08 3.62 4.76 1.70 1.69 000
64421 .... .......... A N block inj, intercost, mlt ...................................... 1.68 3.48 5.43 0.52 0.52 0.11 5.27 7.22 2.31 2.31 000
64425 .... .......... A N block inj, ilio-ing/hypogi .................................... 1.75 1.32 1.57 0.55 0.54 0.13 3.20 3.45 2.43 2.42 000
64430 .... .......... A N block inj, pudendal ........................................... 1.46 2.40 2.48 0.79 0.61 0.10 3.96 4.04 2.35 2.17 000
Jkt 211001
64435 .... .......... A N block inj, paracervical ....................................... 1.45 1.97 2.38 0.55 0.66 0.16 3.58 3.99 2.16 2.27 000
64445 .... .......... A N block inj, sciatic, sng ........................................ 1.48 1.65 2.42 0.52 0.51 0.10 3.23 4.00 2.10 2.09 000
64446 .... .......... A N blk inj, sciatic, cont inf ...................................... 3.61 NA NA 0.59 0.90 0.20 NA NA 4.40 4.71 010
64447 .... .......... A N block inj fem, single .......................................... 1.50 NA NA 0.21 0.38 0.09 NA NA 1.80 1.97 000
PO 00000
64448 .... .......... A N block inj fem, cont inf ....................................... 3.36 NA NA 0.47 0.73 0.18 NA NA 4.01 4.27 010
64449 .... .......... A N block inj, lumbar plexus .................................... 3.24 NA NA 0.49 0.84 0.15 NA NA 3.88 4.23 010
64450 .... .......... A N block, other peripheral ...................................... 1.27 1.29 1.25 0.50 0.49 0.13 2.69 2.65 1.90 1.89 000
64470 .... .......... A Inj paravertebral c/t .............................................. 1.85 3.79 6.37 0.70 0.71 0.11 5.75 8.33 2.66 2.67 000
Frm 00286
64472 .... .......... A Inj paravertebral c/t add-on .................................. 1.29 1.20 2.05 0.33 0.34 0.08 2.57 3.42 1.70 1.71 ZZZ
64475 .... .......... A Inj paravertebral l/s .............................................. 1.41 3.64 6.07 0.59 0.62 0.10 5.15 7.58 2.10 2.13 000
64476 .... .......... A Inj paravertebral l/s add-on .................................. 0.98 1.09 1.86 0.23 0.24 0.07 2.14 2.91 1.28 1.29 ZZZ
64479 .... .......... A Inj foramen epidural c/t ........................................ 2.20 3.71 6.55 0.80 0.87 0.12 6.03 8.87 3.12 3.19 000
Fmt 4701
64480 .... .......... A Inj foramen epidural add-on ................................. 1.54 1.46 2.50 0.37 0.45 0.10 3.10 4.14 2.01 2.09 ZZZ
64483 .... .......... A Inj foramen epidural l/s ........................................ 1.90 3.76 6.86 0.74 0.81 0.11 5.77 8.87 2.75 2.82 000
64484 .... .......... A Inj foramen epidural add-on ................................. 1.33 1.59 2.86 0.32 0.36 0.08 3.00 4.27 1.73 1.77 ZZZ
64505 .... .......... A N block, spenopalatine gangl ............................... 1.36 1.10 1.21 0.73 0.68 0.10 2.56 2.67 2.19 2.14 000
Sfmt 4700
64508 .... .......... A N block, carotid sinus s/p ..................................... 1.12 1.87 2.96 0.49 0.68 0.07 3.06 4.15 1.68 1.87 000
64510 .... .......... A N block, stellate ganglion ..................................... 1.22 1.88 3.06 0.43 0.49 0.07 3.17 4.35 1.72 1.78 000
64517 .... .......... A N block inj, hypogas plxs ..................................... 2.20 1.65 2.45 0.64 0.81 0.11 3.96 4.76 2.95 3.12 000
64520 .... .......... A N block, lumbar/thoracic ...................................... 1.35 2.56 4.50 0.51 0.54 0.08 3.99 5.93 1.94 1.97 000
64530 .... .......... A N block inj, celiac pelus ....................................... 1.58 2.58 3.98 0.58 0.63 0.10 4.26 5.66 2.26 2.31 000
64550 .... .......... A Apply neurostimulator .......................................... 0.18 0.20 0.26 0.06 0.05 0.01 0.39 0.45 0.25 0.24 000
64553 .... .......... A Implant neuroelectrodes ....................................... 2.33 2.50 2.75 1.37 1.73 0.18 5.01 5.26 3.88 4.24 010
E:\FR\FM\01DER2.SGM
01DER2
64585 .... .......... A Revise/remove neuroelectrode ............................ 2.08 5.74 9.90 2.23 2.16 0.20 8.02 12.18 4.51 4.44 010
64590 .... .......... A Insrt/redo pn/gastr stimul ..................................... 2.42 6.39 6.95 2.47 2.33 0.19 9.00 9.56 5.08 4.94 010
64595 .... .......... A Revise/rmv pn/gastr stimul ................................... 1.75 6.46 9.41 2.20 1.99 0.19 8.40 11.35 4.14 3.93 010
Year Year Year
2007 2007 Fully Im-
VerDate Aug<31>2005
RVUs cility Total
RVUs
64600 .... .......... A Injection treatment of nerve ................................. 3.46 5.24 8.32 1.59 1.64 0.34 9.04 12.12 5.39 5.44 010
10:50 Nov 30, 2006

64612 .... .......... A Destroy nerve, face muscle ................................. 1.98 1.63 2.27 1.38 1.34 0.11 3.72 4.36 3.47 3.43 010
64613 .... .......... A Destroy nerve, neck muscle ................................ 1.98 1.37 2.54 1.14 1.20 0.11 3.46 4.63 3.23 3.29 010
64614 .... .......... A Destroy nerve, extrem musc ................................ 2.20 1.62 2.82 1.32 1.31 0.10 3.92 5.12 3.62 3.61 010
64622 .... .......... A Destr paravertebrl nerve l/s ................................. 3.02 4.00 6.82 1.25 1.34 0.18 7.20 10.02 4.45 4.54 010
Jkt 211001
64623 .... .......... A Destr paravertebral n add-on ............................... 0.99 1.61 2.62 0.21 0.22 0.06 2.66 3.67 1.26 1.27 ZZZ
64626 .... .......... A Destr paravertebrl nerve c/t ................................. 3.82 4.60 6.99 1.82 1.93 0.20 8.62 11.01 5.84 5.95 010
64627 .... .......... A Destr paravertebral n add-on ............................... 1.16 2.31 3.98 0.24 0.26 0.07 3.54 5.21 1.47 1.49 ZZZ
PO 00000
64650 .... .......... A Chemodenerv eccrine glands .............................. 0.70 0.77 0.85 0.18 0.27 0.06 1.53 1.61 0.94 1.03 000
64653 .... .......... A Chemodenerv eccrine glands .............................. 0.88 0.82 0.90 0.22 0.34 0.08 1.78 1.86 1.18 1.30 000
Frm 00287
64702 .... .......... A Revise finger/toe nerve ........................................ 6.10 NA NA 5.33 4.23 0.61 NA NA 12.04 10.94 090
64704 .... .......... A Revise hand/foot nerve ........................................ 4.61 NA NA 3.23 3.29 0.61 NA NA 8.45 8.51 090
64708 .... .......... A Revise arm/leg nerve ........................................... 6.22 NA NA 4.32 4.73 0.96 NA NA 11.50 11.91 090
Fmt 4701
64712 .... .......... A Revision of sciatic nerve ...................................... 7.98 NA NA 4.56 4.86 0.95 NA NA 13.49 13.79 090
64713 .... .......... A Revision of arm nerve(s) ...................................... 11.29 NA NA 6.50 6.03 1.83 NA NA 19.62 19.15 090
64714 .... .......... A Revise low back nerve(s) ..................................... 10.44 NA NA 4.93 4.38 1.19 NA NA 16.56 16.01 090
64716 .... .......... A Revision of cranial nerve ..................................... 6.86 NA NA 5.23 5.79 0.63 NA NA 12.72 13.28 090
Sfmt 4700
64718 .... .......... A Revise ulnar nerve at elbow ................................ 7.06 NA NA 6.27 6.06 1.05 NA NA 14.38 14.17 090
64719 .... .......... A Revise ulnar nerve at wrist .................................. 4.89 NA NA 4.19 4.44 0.77 NA NA 9.85 10.10 090
64721 .... .......... A Carpal tunnel surgery ........................................... 4.84 4.74 5.21 4.68 5.19 0.73 10.31 10.78 10.25 10.76 090
64722 .... .......... A Relieve pressure on nerve(s) ............................... 4.74 NA NA 2.83 2.99 0.48 NA NA 8.05 8.21 090
64726 .... .......... A Release foot/toe nerve ......................................... 4.21 NA NA 2.76 2.78 0.54 NA NA 7.51 7.53 090
64727 .... .......... A Internal nerve revision .......................................... 3.10 NA NA 1.25 1.44 0.48 NA NA 4.83 5.02 ZZZ
64732 .... .......... A Incision of brow nerve .......................................... 4.81 NA NA 4.33 3.71 0.98 NA NA 10.12 9.50 090
64734 .... .......... A Incision of cheek nerve ........................................ 5.45 NA NA 4.67 4.21 0.89 NA NA 11.01 10.55 090
64736 .... .......... A Incision of chin nerve ........................................... 5.13 NA NA 3.91 3.99 0.52 NA NA 9.56 9.64 090
E:\FR\FM\01DER2.SGM
64738 .... .......... A Incision of jaw nerve ............................................ 6.26 NA NA 4.28 4.53 1.08 NA NA 11.62 11.87 090
64740 .... .......... A Incision of tongue nerve ....................................... 6.12 NA NA 4.44 4.95 0.69 NA NA 11.25 11.76 090
64742 .... .......... A Incision of facial nerve ......................................... 6.75 NA NA 4.41 4.63 0.73 NA NA 11.89 12.11 090
64744 .... .......... A Incise nerve, back of head ................................... 5.64 NA NA 4.62 3.98 1.16 NA NA 11.42 10.78 090
01DER2
64746 .... .......... A Incise diaphragm nerve ........................................ 6.46 NA NA 3.87 4.34 0.82 NA NA 11.15 11.62 090
64752 .... .......... A Incision of vagus nerve ........................................ 7.59 NA NA 4.04 4.22 0.93 NA NA 12.56 12.74 090
64755 .... .......... A Incision of stomach nerves .................................. 14.97 NA NA 5.80 5.67 1.84 NA NA 22.61 22.48 090
64760 .... .......... A Incision of vagus nerve ........................................ 7.49 NA NA 3.84 3.55 0.81 NA NA 12.14 11.85 090
64761 .... .......... A Incision of pelvis nerve ........................................ 6.94 NA NA 3.95 3.63 0.53 NA NA 11.42 11.10 090
64763 .... .......... A Incise hip/thigh nerve ........................................... 7.46 NA NA 5.13 5.18 0.94 NA NA 13.53 13.58 090
69909
Year
69910
Year Year
2007 2007 Fully Im-
VerDate Aug<31>2005
RVUs cility Total
RVUs
64766 .... .......... A Incise hip/thigh nerve ........................................... 9.34 NA NA 5.31 5.26 1.06 NA NA 15.71 15.66 090
64771 .... .......... A Sever cranial nerve .............................................. 8.02 NA NA 5.36 5.50 1.23 NA NA 14.61 14.75 090
64772 .... .......... A Incision of spinal nerve ........................................ 7.74 NA NA 5.35 5.03 1.40 NA NA 14.49 14.17 090
10:50 Nov 30, 2006

64774 .... .......... A Remove skin nerve lesion .................................... 5.70 NA NA 4.00 3.87 0.74 NA NA 10.44 10.31 090
64776 .... .......... A Remove digit nerve lesion ................................... 5.52 NA NA 3.77 3.70 0.76 NA NA 10.05 9.98 090
64778 .... .......... A Digit nerve surgery add-on .................................. 3.11 NA NA 1.22 1.43 0.46 NA NA 4.79 5.00 ZZZ
64782 .... .......... A Remove limb nerve lesion ................................... 6.76 NA NA 4.14 3.86 0.86 NA NA 11.76 11.48 090
64783 .... .......... A Limb nerve surgery add-on .................................. 3.71 NA NA 1.44 1.73 0.51 NA NA 5.66 5.95 ZZZ
Jkt 211001
64784 .... .......... A Remove nerve lesion ........................................... 10.49 NA NA 6.26 6.51 1.38 NA NA 18.13 18.38 090
64786 .... .......... A Remove sciatic nerve lesion ................................ 16.12 NA NA 9.10 9.65 2.61 NA NA 27.83 28.38 090
64787 .... .......... A Implant nerve end ................................................ 4.29 NA NA 1.64 2.00 0.58 NA NA 6.51 6.87 ZZZ
64788 .... .......... A Remove skin nerve lesion .................................... 5.14 NA NA 3.91 3.57 0.73 NA NA 9.78 9.44 090
PO 00000
64790 .... .......... A Removal of nerve lesion ...................................... 11.97 NA NA 6.89 7.12 2.11 NA NA 20.97 21.20 090
64792 .... .......... A Removal of nerve lesion ...................................... 15.71 NA NA 8.50 8.74 2.49 NA NA 26.70 26.94 090
64795 .... .......... A Biopsy of nerve .................................................... 3.01 NA NA 1.45 1.53 0.52 NA NA 4.98 5.06 000
64802 .... .......... A Remove sympathetic nerves ................................ 10.24 NA NA 4.23 4.91 1.29 NA NA 15.76 16.44 090
Frm 00288
Fmt 4701
64831 .... .......... A Repair of digit nerve ............................................. 10.23 NA NA 6.77 7.00 1.41 NA NA 18.41 18.64 090
Sfmt 4700
64832 .... .......... A Repair nerve add-on ............................................ 5.65 NA NA 2.41 2.80 0.85 NA NA 8.91 9.30 ZZZ
64834 .... .......... A Repair of hand or foot nerve ................................ 10.71 NA NA 6.67 6.99 1.54 NA NA 18.92 19.24 090
64837 .... .......... A Repair nerve add-on ............................................ 6.25 NA NA 2.74 3.11 0.97 NA NA 9.96 10.33 ZZZ
64840 .... .......... A Repair of leg nerve .............................................. 13.87 NA NA 5.16 7.48 1.37 NA NA 20.40 22.72 090
64856 .... .......... A Repair/transpose nerve ........................................ 14.94 NA NA 8.74 9.07 2.13 NA NA 25.81 26.14 090
64857 .... .......... A Repair arm/leg nerve ........................................... 15.69 NA NA 9.08 9.49 2.22 NA NA 26.99 27.40 090
64858 .... .......... A Repair sciatic nerve ............................................. 17.69 NA NA 10.42 10.68 3.34 NA NA 31.45 31.71 090
E:\FR\FM\01DER2.SGM
64859 .... .......... A Nerve surgery ....................................................... 4.25 NA NA 1.94 2.13 0.67 NA NA 6.86 7.05 ZZZ
64861 .... .......... A Repair of arm nerves ........................................... 20.74 NA NA 10.16 11.37 4.09 NA NA 34.99 36.20 090
64862 .... .......... A Repair of low back nerves ................................... 20.94 NA NA 6.76 10.64 4.32 NA NA 32.02 35.90 090
64864 .... .......... A Repair of facial nerve ........................................... 13.31 NA NA 7.20 8.37 1.26 NA NA 21.77 22.94 090
01DER2
64865 .... .......... A Repair of facial nerve ........................................... 15.96 NA NA 10.06 12.66 1.50 NA NA 27.52 30.12 090
64866 .... .......... A Fusion of facial/other nerve ................................. 16.70 NA NA 12.44 12.98 2.05 NA NA 31.19 31.73 090
64872 .... .......... A Subsequent repair of nerve ................................. 1.99 NA NA 0.83 1.02 0.29 NA NA 3.11 3.30 ZZZ
64874 .... .......... A Repair & revise nerve add-on .............................. 2.98 NA NA 1.24 1.46 0.42 NA NA 4.64 4.86 ZZZ
Year Year Year
2007 2007 Fully Im-
VerDate Aug<31>2005
RVUs cility Total
RVUs
64876 .... .......... A Repair nerve/shorten bone .................................. 3.37 NA NA 0.78 1.50 0.47 NA NA 4.62 5.34 ZZZ
64885 .... .......... A Nerve graft, head or neck .................................... 17.50 NA NA 9.04 10.96 1.63 NA NA 28.17 30.09 090
64886 .... .......... A Nerve graft, head or neck .................................... 20.72 NA NA 9.96 12.65 2.09 NA NA 32.77 35.46 090
10:50 Nov 30, 2006

64890 .... .......... A Nerve graft, hand or foot ...................................... 16.11 NA NA 9.24 9.80 2.30 NA NA 27.65 28.21 090
64892 .... .......... A Nerve graft, arm or leg ......................................... 15.61 NA NA 9.09 8.92 2.48 NA NA 27.18 27.01 090
Jkt 211001
64901 .... .......... A Nerve graft add-on ............................................... 10.20 NA NA 3.94 4.93 1.37 NA NA 15.51 16.50 ZZZ
PO 00000
64902 .... .......... A Nerve graft add-on ............................................... 11.81 NA NA 4.38 5.57 1.55 NA NA 17.74 18.93 ZZZ
64905 .... .......... A Nerve pedicle transfer .......................................... 14.98 NA NA 7.01 8.12 2.01 NA NA 24.00 25.11 090
64907 .... .......... A Nerve pedicle transfer .......................................... 19.90 NA NA 6.35 10.98 3.17 NA NA 29.42 34.05 090
64910 .... .......... A Nerve repair w/allograft ........................................ 11.21 NA NA 5.21 5.21 1.74 NA NA 18.16 18.16 090
Frm 00289
64911 .... .......... A Neurorraphy w/vein autograft ............................... 14.21 NA NA 5.97 5.97 1.91 NA NA 22.09 22.09 090
64999 .... .......... C Nervous system surgery ...................................... 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 YYY
65091 .... .......... A Revise eye ........................................................... 7.13 NA NA 6.95 8.00 0.32 NA NA 14.40 15.45 090
65093 .... .......... A Revise eye with implant ....................................... 6.93 NA NA 7.04 8.29 0.34 NA NA 14.31 15.56 090
Fmt 4701
65101 .... .......... A Removal of eye .................................................... 8.10 NA NA 8.19 9.19 0.35 NA NA 16.64 17.64 090
65103 .... .......... A Remove eye/insert implant .................................. 8.64 NA NA 8.42 9.40 0.37 NA NA 17.43 18.41 090
65105 .... .......... A Remove eye/attach implant ................................. 9.70 NA NA 9.12 10.13 0.42 NA NA 19.24 20.25 090
65110 .... .......... A Removal of eye .................................................... 15.42 NA NA 11.71 13.18 0.81 NA NA 27.94 29.41 090
Sfmt 4700
65112 .... .......... A Remove eye/revise socket ................................... 18.18 NA NA 13.21 15.40 1.30 NA NA 32.69 34.88 090
65114 .... .......... A Remove eye/revise socket ................................... 19.32 NA NA 13.86 15.72 1.02 NA NA 34.20 36.06 090
65125 .... .......... A Revise ocular implant ........................................... 3.18 6.78 8.30 3.18 3.50 0.19 10.15 11.67 6.55 6.87 090
65130 .... .......... A Insert ocular implant ............................................. 8.22 NA NA 8.03 8.88 0.35 NA NA 16.60 17.45 090
65135 .... .......... A Insert ocular implant ............................................. 8.40 NA NA 8.01 8.99 0.36 NA NA 16.77 17.75 090
65140 .... .......... A Attach ocular implant ........................................... 9.23 NA NA 8.65 9.57 0.40 NA NA 18.28 19.20 090
65150 .... .......... A Revise ocular implant ........................................... 6.32 NA NA 6.51 7.61 0.31 NA NA 13.14 14.24 090
65155 .... .......... A Reinsert ocular implant ........................................ 9.87 NA NA 8.92 10.09 0.50 NA NA 19.29 20.46 090
65175 .... .......... A Removal of ocular implant ................................... 7.22 NA NA 7.32 8.19 0.31 NA NA 14.85 15.72 090
E:\FR\FM\01DER2.SGM
65205 .... .......... A Remove foreign body from eye ........................... 0.71 0.59 0.63 0.34 0.30 0.03 1.33 1.37 1.08 1.04 000
01DER2
65235 .... .......... A Remove foreign body from eye ........................... 8.78 NA NA 7.05 6.82 0.37 NA NA 16.20 15.97 090
65270 .... .......... A Repair of eye wound ............................................ 1.92 3.87 4.88 1.24 1.35 0.09 5.88 6.89 3.25 3.36 010
65273 .... .......... A Repair of eye wound ............................................ 5.03 NA NA 3.47 3.55 0.22 NA NA 8.72 8.80 090
69911
Year
69912
Year Year
2007 2007 Fully Im-
VerDate Aug<31>2005
RVUs cility Total
RVUs
10:50 Nov 30, 2006

65290 .... .......... A Repair of eye socket wound ................................ 6.35 NA NA 4.61 4.71 0.31 NA NA 11.27 11.37 090
65400 .... .......... A Removal of eye lesion ......................................... 7.27 7.71 8.18 6.09 6.11 0.30 15.28 15.75 13.66 13.68 090
65410 .... .......... A Biopsy of cornea .................................................. 1.47 1.72 2.01 0.90 0.95 0.07 3.26 3.55 2.44 2.49 000
Jkt 211001
65430 .... .......... A Corneal smear ...................................................... 1.47 1.13 1.25 0.90 0.96 0.07 2.67 2.79 2.44 2.50 000
65435 .... .......... A Curette/treat cornea ............................................. 0.92 0.89 0.97 0.68 0.70 0.04 1.85 1.93 1.64 1.66 000
65436 .... .......... A Curette/treat cornea ............................................. 4.72 3.92 4.05 3.58 3.65 0.21 8.85 8.98 8.51 8.58 090
PO 00000
65450 .... .......... A Treatment of corneal lesion ................................. 3.35 3.79 4.00 3.71 3.88 0.16 7.30 7.51 7.22 7.39 090
65600 .... .......... A Revision of cornea ............................................... 4.07 4.60 4.91 3.54 3.40 0.17 8.84 9.15 7.78 7.64 090
65710 .... .......... A Corneal transplant ................................................ 14.09 NA NA 10.60 11.05 0.61 NA NA 25.30 25.75 090
Frm 00290
65760 .... .......... N Revision of cornea ............................................... 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 XXX
65765 .... .......... N Revision of cornea ............................................... 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 XXX
Fmt 4701
65767 .... .......... N Corneal tissue transplant ..................................... 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 XXX
65770 .... .......... A Revise cornea with implant .................................. 19.41 NA NA 12.24 12.96 0.87 NA NA 32.52 33.24 090
65771 .... .......... N Radial keratotomy ................................................ 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 XXX
65772 .... .......... A Correction of astigmatism .................................... 4.96 5.02 5.40 4.08 4.12 0.21 10.19 10.57 9.25 9.29 090
Sfmt 4700
65775 .... .......... A Correction of astigmatism .................................... 6.73 NA NA 5.52 5.84 0.28 NA NA 12.53 12.85 090
65780 .... .......... A Ocular reconst, transplant .................................... 10.43 NA NA 9.29 10.04 0.44 NA NA 20.16 20.91 090
65800 .... .......... A Drainage of eye .................................................... 1.91 1.46 1.71 1.08 1.16 0.09 3.46 3.71 3.08 3.16 000
65805 .... .......... A Drainage of eye .................................................... 1.91 1.77 2.07 1.08 1.16 0.09 3.77 4.07 3.08 3.16 000
65810 .... .......... A Drainage of eye .................................................... 5.67 NA NA 4.87 4.74 0.24 NA NA 10.78 10.65 090
65815 .... .......... A Drainage of eye .................................................... 5.85 8.15 9.54 4.76 4.80 0.25 14.25 15.64 10.86 10.90 090
65820 .... .......... A Relieve inner eye pressure .................................. 8.72 NA NA 7.94 8.77 0.40 NA NA 17.06 17.89 090
E:\FR\FM\01DER2.SGM
65850 .... .......... A Incision of eye ...................................................... 11.24 NA NA 7.65 8.24 0.52 NA NA 19.41 20.00 090
65855 .... .......... A Laser surgery of eye ............................................ 3.90 3.63 4.14 2.75 3.01 0.19 7.72 8.23 6.84 7.10 010
65860 .... .......... A Incise inner eye adhesions .................................. 3.56 3.38 3.88 2.18 2.42 0.18 7.12 7.62 5.92 6.16 090
65865 .... .......... A Incise inner eye adhesions .................................. 5.66 NA NA 4.88 5.44 0.28 NA NA 10.82 11.38 090
01DER2
65900 .... .......... A Remove eye lesion .............................................. 12.26 NA NA 9.25 10.00 0.54 NA NA 22.05 22.80 090
65920 .... .......... A Remove implant of eye ........................................ 9.74 NA NA 7.80 8.08 0.41 NA NA 17.95 18.23 090
65930 .... .......... A Remove blood clot from eye ................................ 8.24 NA NA 6.04 6.63 0.37 NA NA 14.65 15.24 090
Year Year Year
2007 2007 Fully Im-
VerDate Aug<31>2005
RVUs cility Total
RVUs
66020 .... .......... A Injection treatment of eye .................................... 1.61 2.49 2.96 1.33 1.41 0.08 4.18 4.65 3.02 3.10 010
66030 .... .......... A Injection treatment of eye .................................... 1.27 2.36 2.81 1.19 1.26 0.06 3.69 4.14 2.52 2.59 010
66130 .... .......... A Remove eye lesion .............................................. 7.74 7.79 9.16 5.11 5.49 0.38 15.91 17.28 13.23 13.61 090
10:50 Nov 30, 2006

66150 .... .......... A Glaucoma surgery ................................................ 10.18 NA NA 9.13 9.33 0.46 NA NA 19.77 19.97 090
Jkt 211001
66172 .... .......... A Incision of eye ...................................................... 18.26 NA NA 15.25 15.21 0.74 NA NA 34.25 34.21 090
66180 .... .......... A Implant eye shunt ................................................. 16.02 NA NA 10.18 10.62 0.71 NA NA 26.91 27.35 090
66185 .... .......... A Revise eye shunt ................................................. 9.35 NA NA 7.35 7.37 0.40 NA NA 17.10 17.12 090
66220 .... .......... A Repair eye lesion ................................................. 8.98 NA NA 7.28 7.15 0.40 NA NA 16.66 16.53 090
PO 00000
66225 .... .......... A Repair/graft eye lesion ......................................... 12.38 NA NA 8.51 8.68 0.55 NA NA 21.44 21.61 090
66250 .... .......... A Follow-up surgery of eye ..................................... 6.92 9.53 11.15 5.48 5.48 0.30 16.75 18.37 12.70 12.70 090
66500 .... .......... A Incision of iris ....................................................... 3.75 NA NA 4.09 4.50 0.18 NA NA 8.02 8.43 090
66505 .... .......... A Incision of iris ....................................................... 4.13 NA NA 4.46 4.86 0.20 NA NA 8.79 9.19 090
Frm 00291
66600 .... .......... A Remove iris and lesion ........................................ 9.89 NA NA 8.62 8.32 0.43 NA NA 18.94 18.64 090
66605 .... .......... A Removal of iris ..................................................... 13.99 NA NA 9.51 9.89 0.77 NA NA 24.27 24.65 090
Fmt 4701
66680 .... .......... A Repair iris & ciliary body ...................................... 6.24 NA NA 5.27 5.27 0.27 NA NA 11.78 11.78 090
66682 .... .......... A Repair iris & ciliary body ...................................... 7.15 NA NA 6.97 6.70 0.31 NA NA 14.43 14.16 090
66700 .... .......... A Destruction, ciliary body ....................................... 5.06 4.98 5.18 3.77 3.89 0.24 10.28 10.48 9.07 9.19 090
Sfmt 4700
66710 .... .......... A Ciliary transsleral therapy .................................... 5.06 4.76 5.07 3.74 3.82 0.23 10.05 10.36 9.03 9.11 090
66711 .... .......... A Ciliary endoscopic ablation .................................. 7.70 NA NA 6.56 6.49 0.30 NA NA 14.56 14.49 090
66761 .... .......... A Revision of iris ...................................................... 4.87 5.20 5.49 4.36 4.32 0.20 10.27 10.56 9.43 9.39 090
66762 .... .......... A Revision of iris ...................................................... 5.25 5.29 5.56 4.24 4.28 0.23 10.77 11.04 9.72 9.76 090
66770 .... .......... A Removal of inner eye lesion ................................ 5.98 5.75 6.00 4.79 4.80 0.26 11.99 12.24 11.03 11.04 090
66820 .... .......... A Incision, secondary cataract ................................ 3.93 NA NA 4.78 5.55 0.19 NA NA 8.90 9.67 090
66821 .... .......... A After cataract laser surgery .................................. 3.32 3.94 4.05 3.53 3.60 0.11 7.37 7.48 6.96 7.03 090
E:\FR\FM\01DER2.SGM
66825 .... .......... A Reposition intraocular lens ................................... 8.82 NA NA 8.07 8.81 0.40 NA NA 17.29 18.03 090
66830 .... .......... A Removal of lens lesion ......................................... 9.27 NA NA 6.65 6.88 0.36 NA NA 16.28 16.51 090
66840 .... .......... A Removal of lens material ..................................... 8.98 NA NA 6.59 6.79 0.39 NA NA 15.96 16.16 090
01DER2
66920 .... .......... A Extraction of lens ................................................. 9.93 NA NA 6.95 7.21 0.44 NA NA 17.32 17.58 090
66982 .... .......... A Cataract surgery, complex ................................... 14.83 NA NA 9.40 9.75 0.63 NA NA 24.86 25.21 090
66983 .... .......... A Cataract surg w/iol, 1 stage ................................. 10.20 NA NA 6.37 6.18 0.14 NA NA 16.71 16.52 090
69913
Year
69914
Year Year
2007 2007 Fully Im-
VerDate Aug<31>2005
RVUs cility Total
RVUs
66984 .... .......... A Cataract surg w/iol, 1 stage ................................. 10.36 NA NA 6.70 7.24 0.39 NA NA 17.45 17.99 090
66985 .... .......... A Insert lens prosthesis ........................................... 9.73 NA NA 7.41 7.44 0.36 NA NA 17.50 17.53 090
66986 .... .......... A Exchange lens prosthesis .................................... 12.26 NA NA 8.44 8.99 0.60 NA NA 21.30 21.85 090
10:50 Nov 30, 2006

66990 .... .......... A Ophthalmic endoscope add-on ............................ 1.51 NA NA 0.58 0.66 0.07 NA NA 2.16 2.24 ZZZ
66999 .... .......... C Eye surgery procedure ......................................... 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 YYY
67005 .... .......... A Partial removal of eye fluid .................................. 5.77 NA NA 4.77 4.84 0.28 NA NA 10.82 10.89 090
67010 .... .......... A Partial removal of eye fluid .................................. 6.94 NA NA 5.22 5.36 0.34 NA NA 12.50 12.64 090
67015 .... .......... A Release of eye fluid ............................................. 7.00 NA NA 5.94 6.32 0.34 NA NA 13.28 13.66 090
Jkt 211001
67025 .... .......... A Replace eye fluid ................................................. 7.91 8.15 8.95 6.17 6.21 0.34 16.40 17.20 14.42 14.46 090
67027 .... .......... A Implant eye drug system ...................................... 11.43 NA NA 7.71 7.93 0.54 NA NA 19.68 19.90 090
67028 .... .......... A Injection eye drug ................................................. 2.52 2.24 2.59 1.31 1.42 0.12 4.88 5.23 3.95 4.06 000
67030 .... .......... A Incise inner eye strands ....................................... 5.91 NA NA 5.81 5.84 0.24 NA NA 11.96 11.99 090
PO 00000
67031 .... .......... A Laser surgery, eye strands .................................. 4.34 4.24 4.51 3.56 3.62 0.18 8.76 9.03 8.08 8.14 090
67036 .... .......... A Removal of inner eye fluid ................................... 13.09 NA NA 8.46 8.96 0.58 NA NA 22.13 22.63 090
67038 .... .......... A Strip retinal membrane ......................................... 23.30 NA NA 14.16 15.16 1.04 NA NA 38.50 39.50 090
67039 .... .......... A Laser treatment of retina ...................................... 16.39 NA NA 11.22 11.94 0.71 NA NA 28.32 29.04 090
Frm 00292
67040 .... .......... A Laser treatment of retina ...................................... 19.23 NA NA 12.61 13.41 0.85 NA NA 32.69 33.49 090
67101 .... .......... A Repair detached retina ......................................... 8.60 8.80 9.04 6.45 6.51 0.37 17.77 18.01 15.42 15.48 090
67107 .... .......... A Repair detached retina ......................................... 16.35 NA NA 10.86 11.19 0.73 NA NA 27.94 28.27 090
Fmt 4701
67108 .... .......... A Repair detached retina ......................................... 22.49 NA NA 13.62 14.22 1.02 NA NA 37.13 37.73 090
67112 .... .......... A Rerepair detached retina ..................................... 18.45 NA NA 11.42 11.71 0.83 NA NA 30.70 30.99 090
67115 .... .......... A Release encircling material .................................. 5.93 NA NA 5.11 5.09 0.25 NA NA 11.29 11.27 090
Sfmt 4700
67120 .... .......... A Remove eye implant material .............................. 6.92 7.61 8.34 5.50 5.52 0.29 14.82 15.55 12.71 12.73 090
67121 .... .......... A Remove eye implant material .............................. 12.00 NA NA 8.35 8.49 0.53 NA NA 20.88 21.02 090
67141 .... .......... A Treatment of retina ............................................... 6.00 5.63 5.80 4.86 4.86 0.26 11.89 12.06 11.12 11.12 090
67145 .... .......... A Treatment of retina ............................................... 6.17 5.55 5.68 4.92 4.93 0.27 11.99 12.12 11.36 11.37 090
67208 .... .......... A Treatment of retinal lesion ................................... 7.50 5.89 6.06 5.44 5.49 0.33 13.72 13.89 13.27 13.32 090
67218 .... .......... A Treatment of retinal lesion ................................... 20.22 NA NA 11.24 11.92 0.92 NA NA 32.38 33.06 090
67220 .... .......... A Treatment of choroid lesion ................................. 14.19 9.66 10.23 8.58 8.90 0.65 24.50 25.07 23.42 23.74 090
67221 .... .......... R Ocular photodynamic ther .................................... 3.45 3.04 4.01 1.47 1.72 0.20 6.69 7.66 5.12 5.37 000
E:\FR\FM\01DER2.SGM
67225 .... .......... A Eye photodynamic ther add-on ............................ 0.47 0.24 0.25 0.18 0.20 0.02 0.73 0.74 0.67 0.69 ZZZ
67250 .... .......... A Reinforce eye wall ................................................ 9.46 NA NA 7.95 8.87 0.47 NA NA 17.88 18.80 090
01DER2
67255 .... .......... A Reinforce/graft eye wall ....................................... 9.97 NA NA 8.78 9.61 0.44 NA NA 19.19 20.02 090
67299 .... .......... C Eye surgery procedure ......................................... 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 YYY
67311 .... .......... A Revise eye muscle ............................................... 7.59 NA NA 5.74 5.95 0.37 NA NA 13.70 13.91 090
67312 .... .......... A Revise two eye muscles ...................................... 9.48 NA NA 6.49 6.69 0.43 NA NA 16.40 16.60 090
67314 .... .......... A Revise eye muscle ............................................... 8.59 NA NA 6.44 6.52 0.39 NA NA 15.42 15.50 090
67316 .... .......... A Revise two eye muscles ...................................... 10.73 NA NA 7.26 7.44 0.49 NA NA 18.48 18.66 090
Year Year Year
2007 2007 Fully Im-
VerDate Aug<31>2005
RVUs cility Total
RVUs
67318 .... .......... A Revise eye muscle(s) ........................................... 8.92 NA NA 6.83 6.91 0.41 NA NA 16.16 16.24 090
67320 .... .......... A Revise eye muscle(s) add-on .............................. 5.40 NA NA 2.07 1.98 0.22 NA NA 7.69 7.60 ZZZ
67331 .... .......... A Eye surgery follow-up add-on .............................. 5.13 NA NA 1.95 1.86 0.21 NA NA 7.29 7.20 ZZZ
10:50 Nov 30, 2006

67332 .... .......... A Rerevise eye muscles add-on ............................. 5.56 NA NA 2.13 2.05 0.23 NA NA 7.92 7.84 ZZZ
67334 .... .......... A Revise eye muscle w/suture ................................ 5.05 NA NA 1.92 1.82 0.20 NA NA 7.17 7.07 ZZZ
67335 .... .......... A Eye suture during surgery .................................... 2.49 NA NA 0.95 1.08 0.13 NA NA 3.57 3.70 ZZZ
67340 .... .......... A Revise eye muscle add-on .................................. 6.00 NA NA 2.29 2.22 0.25 NA NA 8.54 8.47 ZZZ
67343 .... .......... A Release eye tissue ............................................... 8.29 NA NA 6.32 6.46 0.37 NA NA 14.98 15.12 090
Jkt 211001
67345 .... .......... A Destroy nerve of eye muscle ............................... 2.98 2.29 2.51 1.80 1.96 0.17 5.44 5.66 4.95 5.11 010
67346 .... .......... A Biopsy, eye muscle .............................................. 2.87 NA NA 1.71 1.83 0.15 NA NA 4.73 4.85 000
67399 .... .......... C Eye muscle surgery procedure ............................ 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 YYY
PO 00000
67405 .... .......... A Explore/drain eye socket ...................................... 9.00 NA NA 8.53 9.46 0.44 NA NA 17.97 18.90 090
67412 .... .......... A Explore/treat eye socket ...................................... 10.17 NA NA 8.87 10.42 0.48 NA NA 19.52 21.07 090
67414 .... .......... A Explr/decompress eye socket .............................. 17.78 NA NA 12.12 12.06 0.65 NA NA 30.55 30.49 090
Frm 00293
67415 .... .......... A Aspiration, orbital contents ................................... 1.76 NA NA 0.64 0.73 0.09 NA NA 2.49 2.58 000
67440 .... .......... A Explore/drain eye socket ...................................... 14.56 NA NA 12.23 13.75 0.70 NA NA 27.49 29.01 090
Fmt 4701
67445 .... .......... A Explr/decompress eye socket .............................. 18.96 NA NA 12.71 13.61 0.90 NA NA 32.57 33.47 090
67500 .... .......... A Inject/treat eye socket .......................................... 1.44 0.62 0.66 0.49 0.34 0.05 2.11 2.15 1.98 1.83 000
Sfmt 4700
67550 .... .......... A Insert eye socket implant ..................................... 11.52 NA NA 10.13 11.01 0.72 NA NA 22.37 23.25 090
67560 .... .......... A Revise eye socket implant ................................... 11.93 NA NA 10.16 11.07 0.60 NA NA 22.69 23.60 090
67570 .... .......... A Decompress optic nerve ...................................... 14.21 NA NA 11.42 13.04 0.68 NA NA 26.31 27.93 090
67599 .... .......... C Orbit surgery procedure ....................................... 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 YYY
67700 .... .......... A Drainage of eyelid abscess .................................. 1.37 4.41 5.62 1.22 1.26 0.07 5.85 7.06 2.66 2.70 010
67710 .... .......... A Incision of eyelid .................................................. 1.04 3.78 4.97 1.12 1.19 0.05 4.87 6.06 2.21 2.28 010
67715 .... .......... A Incision of eyelid fold ........................................... 1.24 3.90 5.00 1.20 1.27 0.06 5.20 6.30 2.50 2.57 010
67800 .... .......... A Remove eyelid lesion ........................................... 1.39 1.44 1.58 0.94 1.02 0.07 2.90 3.04 2.40 2.48 010
E:\FR\FM\01DER2.SGM
67801 .... .......... A Remove eyelid lesions ......................................... 1.89 1.74 1.91 1.13 1.23 0.09 3.72 3.89 3.11 3.21 010
67805 .... .......... A Remove eyelid lesions ......................................... 2.24 2.26 2.46 1.48 1.61 0.11 4.61 4.81 3.83 3.96 010
67808 .... .......... A Remove eyelid lesion(s) ....................................... 4.47 NA NA 3.74 3.76 0.19 NA NA 8.40 8.42 090
67810 .... .......... A Biopsy of eyelid .................................................... 1.48 3.96 3.49 0.70 0.69 0.06 5.50 5.03 2.24 2.23 000
01DER2
67820 .... .......... A Revise eyelashes ................................................. 0.71 0.46 0.57 0.46 0.54 0.04 1.21 1.32 1.21 1.29 000
67835 .... .......... A Revise eyelashes ................................................. 5.61 NA NA 4.23 4.52 0.28 NA NA 10.12 10.41 090
67840 .... .......... A Remove eyelid lesion ........................................... 2.06 4.00 5.10 1.52 1.62 0.10 6.16 7.26 3.68 3.78 010
67850 .... .......... A Treat eyelid lesion ................................................ 1.71 3.31 3.36 1.47 1.47 0.07 5.09 5.14 3.25 3.25 010
69915
Year
69916
Year Year
2007 2007 Fully Im-
VerDate Aug<31>2005
RVUs cility Total
RVUs
67875 .... .......... A Closure of eyelid by suture .................................. 1.35 2.44 3.09 0.87 0.92 0.07 3.86 4.51 2.29 2.34 000
67880 .... .......... A Revision of eyelid ................................................. 4.47 5.60 6.36 3.71 3.78 0.19 10.26 11.02 8.37 8.44 090
10:50 Nov 30, 2006

67900 .... .......... A Repair brow defect ............................................... 6.69 7.56 8.69 4.78 5.13 0.38 14.63 15.76 11.85 12.20 090
67901 .... .......... A Repair eyelid defect ............................................. 7.47 9.29 6.37 5.53 5.43 0.54 17.30 14.38 13.54 13.44 090
67902 .... .......... A Repair eyelid defect ............................................. 9.68 NA NA 6.67 5.76 0.60 NA NA 16.95 16.04 090
Jkt 211001
67906 .... .......... A Repair eyelid defect ............................................. 6.84 NA NA 4.69 4.95 0.46 NA NA 11.99 12.25 090
67909 .... .......... A Revise eyelid defect ............................................. 5.46 6.42 7.63 4.37 4.81 0.31 12.19 13.40 10.14 10.58 090
67911 .... .......... A Revise eyelid defect ............................................. 7.38 NA NA 5.28 4.91 0.31 NA NA 12.97 12.60 090
PO 00000
67912 .... .......... A Correction eyelid w/implant .................................. 6.23 13.17 17.49 4.80 5.35 0.28 19.68 24.00 11.31 11.86 090
Frm 00294
Fmt 4701
67930 .... .......... A Repair eyelid wound ............................................ 3.62 4.51 5.41 1.88 2.10 0.19 8.32 9.22 5.69 5.91 010
67935 .... .......... A Repair eyelid wound ............................................ 6.27 6.99 8.14 3.77 4.25 0.39 13.65 14.80 10.43 10.91 090
67938 .... .......... A Remove eyelid foreign body ................................ 1.35 3.94 5.02 1.27 1.26 0.06 5.35 6.43 2.68 2.67 010
Sfmt 4700
67971 .... .......... A Reconstruction of eyelid ....................................... 9.87 NA NA 6.49 7.08 0.53 NA NA 16.89 17.48 090
67999 .... .......... C Revision of eyelid ................................................. 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 YYY
68020 .... .......... A Incise/drain eyelid lining ....................................... 1.39 1.28 1.38 1.10 1.18 0.06 2.73 2.83 2.55 2.63 010
E:\FR\FM\01DER2.SGM
68040 .... .......... A Treatment of eyelid lesions .................................. 0.85 0.62 0.69 0.37 0.42 0.04 1.51 1.58 1.26 1.31 000
68100 .... .......... A Biopsy of eyelid lining .......................................... 1.35 2.40 3.04 0.89 0.94 0.07 3.82 4.46 2.31 2.36 000
68110 .... .......... A Remove eyelid lining lesion ................................. 1.79 3.15 3.86 1.54 1.62 0.09 5.03 5.74 3.42 3.50 010
01DER2
68200 .... .......... A Treat eyelid by injection ....................................... 0.49 0.47 0.52 0.30 0.32 0.02 0.98 1.03 0.81 0.83 000
68320 .... .......... A Revise/graft eyelid lining ...................................... 6.44 9.44 10.82 5.52 5.52 0.27 16.15 17.53 12.23 12.23 090
68325 .... .......... A Revise/graft eyelid lining ...................................... 8.43 NA NA 6.23 6.46 0.44 NA NA 15.10 15.33 090
Year Year Year
2007 2007 Fully Im-
VerDate Aug<31>2005
RVUs cility Total
RVUs
68330 .... .......... A Revise eyelid lining .............................................. 5.63 7.65 8.97 4.64 4.70 0.24 13.52 14.84 10.51 10.57 090
10:50 Nov 30, 2006

68340 .... .......... A Separate eyelid adhesions ................................... 4.84 7.08 8.42 4.02 4.08 0.21 12.13 13.47 9.07 9.13 090
68360 .... .......... A Revise eyelid lining .............................................. 5.04 6.62 7.69 4.11 4.16 0.22 11.88 12.95 9.37 9.42 090
68362 .... .......... A Revise eyelid lining .............................................. 8.41 NA NA 6.24 6.36 0.36 NA NA 15.01 15.13 090
68371 .... .......... A Harvest eye tissue, alograft ................................. 4.97 NA NA 4.23 4.61 0.44 NA NA 9.64 10.02 010
68399 .... .......... C Eyelid lining surgery ............................................. 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 YYY
Jkt 211001
68400 .... .......... A Incise/drain tear gland .......................................... 1.71 4.42 5.53 1.24 1.68 0.08 6.21 7.32 3.03 3.47 010
68420 .... .......... A Incise/drain tear sac ............................................. 2.32 4.69 5.82 1.48 1.95 0.11 7.12 8.25 3.91 4.38 010
68440 .... .......... A Incise tear duct opening ....................................... 0.96 1.28 1.88 1.22 1.26 0.05 2.29 2.89 2.23 2.27 010
68500 .... .......... A Removal of tear gland .......................................... 12.49 NA NA 9.07 9.57 0.55 NA NA 22.11 22.61 090
PO 00000
68505 .... .......... A Partial removal, tear gland ................................... 12.41 NA NA 9.21 10.29 0.55 NA NA 22.17 23.25 090
68510 .... .......... A Biopsy of tear gland ............................................. 4.60 5.38 6.84 2.14 2.10 0.23 10.21 11.67 6.97 6.93 000
68520 .... .......... A Removal of tear sac ............................................. 8.58 NA NA 6.74 7.25 0.37 NA NA 15.69 16.20 090
68525 .... .......... A Biopsy of tear sac ................................................ 4.42 NA NA 1.68 1.94 0.22 NA NA 6.32 6.58 000
Frm 00295
68530 .... .......... A Clearance of tear duct ......................................... 3.67 5.74 7.56 2.17 2.52 0.18 9.59 11.41 6.02 6.37 010
68540 .... .......... A Remove tear gland lesion .................................... 11.93 NA NA 8.81 9.25 0.52 NA NA 21.26 21.70 090
68550 .... .......... A Remove tear gland lesion .................................... 14.86 NA NA 10.64 11.17 0.80 NA NA 26.30 26.83 090
68700 .... .......... A Repair tear ducts .................................................. 7.67 NA NA 5.81 5.94 0.32 NA NA 13.80 13.93 090
Fmt 4701
68705 .... .......... A Revise tear duct opening ..................................... 2.08 3.12 3.91 1.65 1.76 0.10 5.30 6.09 3.83 3.94 010
68720 .... .......... A Create tear sac drain ........................................... 9.78 NA NA 7.18 7.69 0.44 NA NA 17.40 17.91 090
68745 .... .......... A Create tear duct drain .......................................... 9.70 NA NA 7.54 7.78 0.52 NA NA 17.76 18.00 090
68750 .... .......... A Create tear duct drain .......................................... 9.87 NA NA 7.72 8.13 0.43 NA NA 18.02 18.43 090
Sfmt 4700
68760 .... .......... A Close tear duct opening ....................................... 1.75 2.66 3.32 1.51 1.60 0.09 4.50 5.16 3.35 3.44 010
68761 .... .......... A Close tear duct opening ....................................... 1.38 1.88 2.17 1.29 1.31 0.06 3.32 3.61 2.73 2.75 010
68770 .... .......... A Close tear system fistula ...................................... 8.09 NA NA 5.95 3.87 0.35 NA NA 14.39 12.31 090
68801 .... .......... A Dilate tear duct opening ....................................... 0.96 1.82 1.91 1.46 1.48 0.05 2.83 2.92 2.47 2.49 010
68810 .... .......... A Probe nasolacrimal duct ...................................... 2.63 3.50 3.62 2.78 2.70 0.10 6.23 6.35 5.51 5.43 010
68811 .... .......... A Probe nasolacrimal duct ...................................... 2.39 NA NA 2.19 2.36 0.13 NA NA 4.71 4.88 010
68815 .... .......... A Probe nasolacrimal duct ...................................... 3.24 6.56 7.82 2.52 2.74 0.17 9.97 11.23 5.93 6.15 010
68840 .... .......... A Explore/irrigate tear ducts .................................... 1.27 1.56 1.59 1.33 1.17 0.06 2.89 2.92 2.66 2.50 010
68850 .... .......... A Injection for tear sac x-ray ................................... 0.80 0.69 0.83 0.57 0.65 0.04 1.53 1.67 1.41 1.49 000
E:\FR\FM\01DER2.SGM
68899 .... .......... C Tear duct system surgery .................................... 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 YYY
69000 .... .......... A Drain external ear lesion ...................................... 1.47 2.71 2.84 1.26 1.34 0.12 4.30 4.43 2.85 2.93 010
69005 .... .......... A Drain external ear lesion ...................................... 2.13 2.76 2.89 1.48 1.74 0.17 5.06 5.19 3.78 4.04 010
69020 .... .......... A Drain outer ear canal lesion ................................. 1.50 3.85 3.96 1.78 1.99 0.12 5.47 5.58 3.40 3.61 010
01DER2
69090 .... .......... N Pierce earlobes .................................................... 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 XXX
69100 .... .......... A Biopsy of external ear .......................................... 0.81 1.86 1.75 0.41 0.40 0.03 2.70 2.59 1.25 1.24 000
69105 .... .......... A Biopsy of external ear canal ................................ 0.85 2.49 2.38 0.66 0.74 0.07 3.41 3.30 1.58 1.66 000
69110 .... .......... A Remove external ear, partial ................................ 3.47 7.62 6.96 4.32 4.43 0.30 11.39 10.73 8.09 8.20 090
69120 .... .......... A Removal of external ear ....................................... 4.08 NA NA 5.11 5.91 0.38 NA NA 9.57 10.37 090
69140 .... .......... A Remove ear canal lesion(s) ................................. 8.03 NA NA 12.39 13.06 0.65 NA NA 21.07 21.74 090
69917
Year
69918
Year Year
2007 2007 Fully Im-
VerDate Aug<31>2005
RVUs cility Total
RVUs
69145 .... .......... A Remove ear canal lesion(s) ................................. 2.65 6.55 5.97 3.13 3.26 0.21 9.41 8.83 5.99 6.12 090
69150 .... .......... A Extensive ear canal surgery ................................ 13.49 NA NA 10.66 12.72 1.22 NA NA 25.37 27.43 090
69155 .... .......... A Extensive ear/neck surgery .................................. 23.06 NA NA 15.03 18.41 1.93 NA NA 40.02 43.40 090
10:50 Nov 30, 2006

69200 .... .......... A Clear outer ear canal ........................................... 0.77 2.03 2.29 0.57 0.56 0.06 2.86 3.12 1.40 1.39 000
69205 .... .......... A Clear outer ear canal ........................................... 1.20 NA NA 1.15 1.31 0.10 NA NA 2.45 2.61 010
69210 .... .......... A Remove impacted ear wax .................................. 0.61 0.56 0.61 0.16 0.21 0.05 1.22 1.27 0.82 0.87 000
69220 .... .......... A Clean out mastoid cavity ...................................... 0.83 2.38 2.37 0.62 0.70 0.07 3.28 3.27 1.52 1.60 000
69222 .... .......... A Clean out mastoid cavity ...................................... 1.42 3.68 3.81 1.75 1.98 0.12 5.22 5.35 3.29 3.52 010
Jkt 211001
69300 .... .......... R Revise external ear .............................................. 6.69 9.77 5.61 4.69 4.34 0.72 17.18 13.02 12.10 11.75 YYY
69310 .... .......... A Rebuild outer ear canal ........................................ 10.85 NA NA 14.30 15.79 0.85 NA NA 26.00 27.49 090
69320 .... .......... A Rebuild outer ear canal ........................................ 17.03 NA NA 18.32 20.96 1.37 NA NA 36.72 39.36 090
69399 .... .......... C Outer ear surgery procedure ............................... 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 YYY
PO 00000
69400 .... .......... A Inflate middle ear canal ........................................ 0.83 2.61 2.27 0.62 0.66 0.07 3.51 3.17 1.52 1.56 000
69401 .... .......... A Inflate middle ear canal ........................................ 0.63 1.47 1.30 0.56 0.63 0.05 2.15 1.98 1.24 1.31 000
69405 .... .......... A Catheterize middle ear canal ............................... 2.65 3.41 3.48 1.81 2.19 0.21 6.27 6.34 4.67 5.05 010
69420 .... .......... A Incision of eardrum .............................................. 1.35 3.06 3.13 1.43 1.55 0.11 4.52 4.59 2.89 3.01 010
Frm 00296
69421 .... .......... A Incision of eardrum .............................................. 1.75 NA NA 1.70 2.05 0.15 NA NA 3.60 3.95 010
69424 .... .......... A Remove ventilating tube ...................................... 0.85 2.18 2.18 0.62 0.67 0.07 3.10 3.10 1.54 1.59 000
69433 .... .......... A Create eardrum opening ...................................... 1.54 3.07 3.09 1.47 1.60 0.13 4.74 4.76 3.14 3.27 010
69436 .... .......... A Create eardrum opening ...................................... 1.98 NA NA 1.74 2.15 0.19 NA NA 3.91 4.32 010
Fmt 4701
69440 .... .......... A Exploration of middle ear ..................................... 7.62 NA NA 8.39 8.68 0.61 NA NA 16.62 16.91 090
69450 .... .......... A Eardrum revision .................................................. 5.61 NA NA 7.03 7.03 0.45 NA NA 13.09 13.09 090
69501 .... .......... A Mastoidectomy ..................................................... 9.12 NA NA 7.90 8.73 0.73 NA NA 17.75 18.58 090
69502 .... .......... A Mastoidectomy ..................................................... 12.44 NA NA 10.15 11.23 1.00 NA NA 23.59 24.67 090
Sfmt 4700
69505 .... .......... A Remove mastoid structures ................................. 13.05 NA NA 14.94 16.63 1.05 NA NA 29.04 30.73 090
69511 .... .......... A Extensive mastoid surgery ................................... 13.58 NA NA 15.02 16.86 1.09 NA NA 29.69 31.53 090
69530 .... .......... A Extensive mastoid surgery ................................... 20.24 NA NA 18.19 20.77 1.54 NA NA 39.97 42.55 090
69535 .... .......... A Remove part of temporal bone ............................ 37.27 NA NA 24.53 30.10 2.93 NA NA 64.73 70.30 090
69540 .... .......... A Remove ear lesion ............................................... 1.22 3.63 3.71 1.72 1.91 0.10 4.95 5.03 3.04 3.23 010
69550 .... .......... A Remove ear lesion ............................................... 11.04 NA NA 13.17 14.44 0.89 NA NA 25.10 26.37 090
69601 .... .......... A Mastoid surgery revision ...................................... 13.31 NA NA 10.98 12.25 1.07 NA NA 25.36 26.63 090
E:\FR\FM\01DER2.SGM
01DER2
69610 .... .......... A Repair of eardrum ................................................ 4.44 4.52 5.29 2.35 3.04 0.36 9.32 10.09 7.15 7.84 010
69620 .... .......... A Repair of eardrum ................................................ 5.94 10.10 10.87 5.36 6.06 0.48 16.52 17.29 11.78 12.48 090
69631 .... .......... A Repair eardrum structures ................................... 9.93 NA NA 10.61 11.05 0.80 NA NA 21.34 21.78 090
69632 .... .......... A Rebuild eardrum structures .................................. 12.82 NA NA 12.22 13.16 1.03 NA NA 26.07 27.01 090
69635 .... .......... A Repair eardrum structures ................................... 13.39 NA NA 14.97 16.30 1.08 NA NA 29.44 30.77 090
Year Year Year
2007 2007 Fully Im-
VerDate Aug<31>2005
RVUs cility Total
RVUs
69641 .... .......... A Revise middle ear & mastoid ............................... 12.77 NA NA 11.45 12.45 1.03 NA NA 25.25 26.25 090
10:50 Nov 30, 2006

Jkt 211001
69650 .... .......... A Release middle ear bone ..................................... 9.71 NA NA 8.74 9.62 0.78 NA NA 19.23 20.11 090
69660 .... .......... A Revise middle ear bone ....................................... 11.94 NA NA 9.64 10.80 0.96 NA NA 22.54 23.70 090
PO 00000
69666 .... .......... A Repair middle ear structures ................................ 9.80 NA NA 9.02 9.73 0.79 NA NA 19.61 20.32 090
69667 .... .......... A Repair middle ear structures ................................ 9.81 NA NA 8.93 9.72 0.79 NA NA 19.53 20.32 090
69670 .... .......... A Remove mastoid air cells ..................................... 11.62 NA NA 10.27 11.35 0.93 NA NA 22.82 23.90 090
69676 .... .......... A Remove middle ear nerve .................................... 9.58 NA NA 9.74 10.50 0.81 NA NA 20.13 20.89 090
Frm 00297
69700 .... .......... A Close mastoid fistula ............................................ 8.28 NA NA 7.75 8.87 0.67 NA NA 16.70 17.82 090
69710 .... .......... N Implant/replace hearing aid .................................. 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 XXX
69711 .... .......... A Remove/repair hearing aid ................................... 10.50 NA NA 9.54 10.48 0.83 NA NA 20.87 21.81 090
69714 .... .......... A Implant temple bone w/stimul .............................. 14.31 NA NA 10.72 12.18 1.13 NA NA 26.16 27.62 090
Fmt 4701
69715 .... .......... A Temple bne implnt w/stimulat .............................. 18.80 NA NA 12.14 14.31 1.48 NA NA 32.42 34.59 090
69717 .... .......... A Temple bone implant revision .............................. 15.29 NA NA 11.42 13.71 0.90 NA NA 27.61 29.90 090
69718 .... .......... A Revise temple bone implant ................................ 19.05 NA NA 20.38 16.57 3.22 NA NA 42.65 38.84 090
69720 .... .......... A Release facial nerve ............................................ 14.57 NA NA 12.90 14.12 1.16 NA NA 28.63 29.85 090
Sfmt 4700
69740 .... .......... A Repair facial nerve ............................................... 16.18 NA NA 11.32 12.89 1.27 NA NA 28.77 30.34 090
69745 .... .......... A Repair facial nerve ............................................... 16.91 NA NA 12.06 14.24 1.14 NA NA 30.11 32.29 090
69799 .... .......... C Middle ear surgery procedure .............................. 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 YYY
69801 .... .......... A Incise inner ear .................................................... 8.61 NA NA 8.84 9.31 0.69 NA NA 18.14 18.61 090
69802 .... .......... A Incise inner ear .................................................... 13.39 NA NA 10.68 11.91 1.06 NA NA 25.13 26.36 090
69805 .... .......... A Explore inner ear .................................................. 14.55 NA NA 9.96 11.40 1.12 NA NA 25.63 27.07 090
69806 .... .......... A Explore inner ear .................................................. 12.52 NA NA 9.50 10.66 1.00 NA NA 23.02 24.18 090
69820 .... .......... A Establish inner ear window .................................. 10.40 NA NA 9.91 10.89 0.90 NA NA 21.21 22.19 090
E:\FR\FM\01DER2.SGM
69840 .... .......... A Revise inner ear window ...................................... 10.32 NA NA 11.73 12.81 0.79 NA NA 22.84 23.92 090
69905 .... .......... A Remove inner ear ................................................ 11.15 NA NA 10.20 11.06 0.90 NA NA 22.25 23.11 090
69910 .... .......... A Remove inner ear & mastoid ............................... 13.80 NA NA 9.94 11.43 1.07 NA NA 24.81 26.30 090
69915 .... .......... A Incise inner ear nerve .......................................... 22.65 NA NA 13.59 15.74 1.70 NA NA 37.94 40.09 090
01DER2
69930 .... .......... A Implant cochlear device ....................................... 17.60 NA NA 11.99 14.06 1.36 NA NA 30.95 33.02 090
69949 .... .......... C Inner ear surgery procedure ................................ 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 YYY
69950 .... .......... A Incise inner ear nerve .......................................... 27.44 NA NA 15.54 18.06 2.29 NA NA 45.27 47.79 090
69960 .... .......... A Release inner ear canal ....................................... 29.22 NA NA 15.70 18.96 2.18 NA NA 47.10 50.36 090
69970 .... .......... A Remove inner ear lesion ...................................... 32.21 NA NA 18.08 21.97 2.42 NA NA 52.71 56.60 090
69919
Year
69920
Year Year
2007 2007 Fully Im-
VerDate Aug<31>2005
RVUs cility Total
RVUs
69979 .... .......... C Temporal bone surgery ........................................ 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 YYY
69990 .... .......... R Microsurgery add-on ............................................ 3.46 NA NA 1.31 1.67 0.89 NA NA 5.66 6.02 ZZZ
70010 .... .......... A Contrast x-ray of brain ......................................... 1.19 2.61 4.20 NA NA 0.27 4.07 5.66 NA NA XXX
10:50 Nov 30, 2006

70010 .... TC .... A Contrast x-ray of brain ......................................... 0.00 2.27 3.82 NA NA 0.22 2.49 4.04 NA NA XXX
70010 .... 26 ..... A Contrast x-ray of brain ......................................... 1.19 0.34 0.38 0.34 0.38 0.05 1.58 1.62 1.58 1.62 XXX
70015 .... .......... A Contrast x-ray of brain ......................................... 1.19 2.68 1.98 NA NA 0.16 4.03 3.33 NA NA XXX
70015 .... TC .... A Contrast x-ray of brain ......................................... 0.00 2.33 1.60 NA NA 0.08 2.41 1.68 NA NA XXX
70015 .... 26 ..... A Contrast x-ray of brain ......................................... 1.19 0.35 0.38 0.35 0.38 0.08 1.62 1.65 1.62 1.65 XXX
Jkt 211001
70030 .... .......... A X-ray eye for foreign body ................................... 0.17 0.57 0.51 NA NA 0.03 0.77 0.71 NA NA XXX
70030 .... TC .... A X-ray eye for foreign body ................................... 0.00 0.52 0.45 NA NA 0.02 0.54 0.47 NA NA XXX
70030 .... 26 ..... A X-ray eye for foreign body ................................... 0.17 0.05 0.06 0.05 0.06 0.01 0.23 0.24 0.23 0.24 XXX
70100 .... .......... A X-ray exam of jaw ................................................ 0.18 0.59 0.59 NA NA 0.03 0.80 0.80 NA NA XXX
PO 00000
70100 .... TC .... A X-ray exam of jaw ................................................ 0.00 0.55 0.53 NA NA 0.02 0.57 0.55 NA NA XXX
70100 .... 26 ..... A X-ray exam of jaw ................................................ 0.18 0.04 0.06 0.04 0.06 0.01 0.23 0.25 0.23 0.25 XXX
70110 .... .......... A X-ray exam of jaw ................................................ 0.25 0.75 0.72 NA NA 0.05 1.05 1.02 NA NA XXX
70110 .... TC .... A X-ray exam of jaw ................................................ 0.00 0.68 0.64 NA NA 0.04 0.72 0.68 NA NA XXX
Frm 00298
70110 .... 26 ..... A X-ray exam of jaw ................................................ 0.25 0.07 0.08 0.07 0.08 0.01 0.33 0.34 0.33 0.34 XXX
70120 .... .......... A X-ray exam of mastoids ....................................... 0.18 0.66 0.68 NA NA 0.05 0.89 0.91 NA NA XXX
70120 .... TC .... A X-ray exam of mastoids ....................................... 0.00 0.61 0.62 NA NA 0.04 0.65 0.66 NA NA XXX
70120 .... 26 ..... A X-ray exam of mastoids ....................................... 0.18 0.05 0.06 0.05 0.06 0.01 0.24 0.25 0.24 0.25 XXX
Fmt 4701
70130 .... .......... A X-ray exam of mastoids ....................................... 0.34 1.10 0.95 NA NA 0.07 1.51 1.36 NA NA XXX
70130 .... TC .... A X-ray exam of mastoids ....................................... 0.00 1.00 0.84 NA NA 0.05 1.05 0.89 NA NA XXX
70130 .... 26 ..... A X-ray exam of mastoids ....................................... 0.34 0.10 0.11 0.10 0.11 0.02 0.46 0.47 0.46 0.47 XXX
70134 .... .......... A X-ray exam of middle ear .................................... 0.34 0.88 0.85 NA NA 0.07 1.29 1.26 NA NA XXX
Sfmt 4700
70134 .... TC .... A X-ray exam of middle ear .................................... 0.00 0.78 0.74 NA NA 0.05 0.83 0.79 NA NA XXX
70134 .... 26 ..... A X-ray exam of middle ear .................................... 0.34 0.10 0.11 0.10 0.11 0.02 0.46 0.47 0.46 0.47 XXX
70140 .... .......... A X-ray exam of facial bones .................................. 0.19 0.51 0.64 NA NA 0.05 0.75 0.88 NA NA XXX
70140 .... TC .... A X-ray exam of facial bones .................................. 0.00 0.47 0.58 NA NA 0.04 0.51 0.62 NA NA XXX
70140 .... 26 ..... A X-ray exam of facial bones .................................. 0.19 0.04 0.06 0.04 0.06 0.01 0.24 0.26 0.24 0.26 XXX
70150 .... .......... A X-ray exam of facial bones .................................. 0.26 0.80 0.85 NA NA 0.06 1.12 1.17 NA NA XXX
70150 .... TC .... A X-ray exam of facial bones .................................. 0.00 0.73 0.77 NA NA 0.05 0.78 0.82 NA NA XXX
70150 .... 26 ..... A X-ray exam of facial bones .................................. 0.26 0.07 0.08 0.07 0.08 0.01 0.34 0.35 0.34 0.35 XXX
70160 .... .......... A X-ray exam of nasal bones .................................. 0.17 0.65 0.60 NA NA 0.03 0.85 0.80 NA NA XXX
E:\FR\FM\01DER2.SGM
70160 .... TC .... A X-ray exam of nasal bones .................................. 0.00 0.61 0.54 NA NA 0.02 0.63 0.56 NA NA XXX
70160 .... 26 ..... A X-ray exam of nasal bones .................................. 0.17 0.04 0.06 0.04 0.06 0.01 0.22 0.24 0.22 0.24 XXX
70170 .... .......... C X-ray exam of tear duct ....................................... 0.00 NA NA NA NA 0.00 NA NA NA NA XXX
70170 .... TC .... C X-ray exam of tear duct ....................................... 0.00 NA NA NA NA 0.00 NA NA NA NA XXX
01DER2
70170 .... 26 ..... A X-ray exam of tear duct ....................................... 0.30 0.08 0.10 0.08 0.10 0.01 0.39 0.41 0.39 0.41 XXX
70190 .... .......... A X-ray exam of eye sockets .................................. 0.21 0.68 0.69 NA NA 0.05 0.94 0.95 NA NA XXX
70190 .... TC .... A X-ray exam of eye sockets .................................. 0.00 0.62 0.62 NA NA 0.04 0.66 0.66 NA NA XXX
70190 .... 26 ..... A X-ray exam of eye sockets .................................. 0.21 0.06 0.07 0.06 0.07 0.01 0.28 0.29 0.28 0.29 XXX
70200 .... .......... A X-ray exam of eye sockets .................................. 0.28 0.82 0.86 NA NA 0.06 1.16 1.20 NA NA XXX
70200 .... TC .... A X-ray exam of eye sockets .................................. 0.00 0.74 0.77 NA NA 0.05 0.79 0.82 NA NA XXX
Year Year Year
2007 2007 Fully Im-
VerDate Aug<31>2005
RVUs cility Total
RVUs
70200 .... 26 ..... A X-ray exam of eye sockets .................................. 0.28 0.08 0.09 0.08 0.09 0.01 0.37 0.38 0.37 0.38 XXX
70210 .... .......... A X-ray exam of sinuses ......................................... 0.17 0.55 0.65 NA NA 0.05 0.77 0.87 NA NA XXX
70210 .... TC .... A X-ray exam of sinuses ......................................... 0.00 0.51 0.59 NA NA 0.04 0.55 0.63 NA NA XXX
10:50 Nov 30, 2006

70210 .... 26 ..... A X-ray exam of sinuses ......................................... 0.17 0.04 0.06 0.04 0.06 0.01 0.22 0.24 0.22 0.24 XXX
70220 .... .......... A X-ray exam of sinuses ......................................... 0.25 0.69 0.82 NA NA 0.06 1.00 1.13 NA NA XXX
70220 .... TC .... A X-ray exam of sinuses ......................................... 0.00 0.62 0.74 NA NA 0.05 0.67 0.79 NA NA XXX
70220 .... 26 ..... A X-ray exam of sinuses ......................................... 0.25 0.07 0.08 0.07 0.08 0.01 0.33 0.34 0.33 0.34 XXX
70240 .... .......... A X-ray exam, pituitary saddle ................................ 0.19 0.58 0.51 NA NA 0.03 0.80 0.73 NA NA XXX
Jkt 211001
70240 .... TC .... A X-ray exam, pituitary saddle ................................ 0.00 0.53 0.45 NA NA 0.02 0.55 0.47 NA NA XXX
70240 .... 26 ..... A X-ray exam, pituitary saddle ................................ 0.19 0.05 0.06 0.05 0.06 0.01 0.25 0.26 0.25 0.26 XXX
70250 .... .......... A X-ray exam of skull .............................................. 0.24 0.66 0.70 NA NA 0.05 0.95 0.99 NA NA XXX
70250 .... TC .... A X-ray exam of skull .............................................. 0.00 0.60 0.62 NA NA 0.04 0.64 0.66 NA NA XXX
PO 00000
70250 .... 26 ..... A X-ray exam of skull .............................................. 0.24 0.06 0.08 0.06 0.08 0.01 0.31 0.33 0.31 0.33 XXX
70260 .... .......... A X-ray exam of skull .............................................. 0.34 0.83 0.96 NA NA 0.08 1.25 1.38 NA NA XXX
70260 .... TC .... A X-ray exam of skull .............................................. 0.00 0.74 0.85 NA NA 0.06 0.80 0.91 NA NA XXX
70260 .... 26 ..... A X-ray exam of skull .............................................. 0.34 0.09 0.11 0.09 0.11 0.02 0.45 0.47 0.45 0.47 XXX
Frm 00299
70300 .... .......... A X-ray exam of teeth ............................................. 0.10 0.24 0.30 NA NA 0.03 0.37 0.43 NA NA XXX
70300 .... TC .... A X-ray exam of teeth ............................................. 0.00 0.21 0.25 NA NA 0.02 0.23 0.27 NA NA XXX
70300 .... 26 ..... A X-ray exam of teeth ............................................. 0.10 0.03 0.05 0.03 0.05 0.01 0.14 0.16 0.14 0.16 XXX
70310 .... .......... A X-ray exam of teeth ............................................. 0.16 0.82 0.58 NA NA 0.03 1.01 0.77 NA NA XXX
Fmt 4701
70310 .... TC .... A X-ray exam of teeth ............................................. 0.00 0.77 0.51 NA NA 0.02 0.79 0.53 NA NA XXX
70310 .... 26 ..... A X-ray exam of teeth ............................................. 0.16 0.05 0.07 0.05 0.07 0.01 0.22 0.24 0.22 0.24 XXX
70320 .... .......... A Full mouth x-ray of teeth ...................................... 0.22 0.96 0.89 NA NA 0.06 1.24 1.17 NA NA XXX
70320 .... TC .... A Full mouth x-ray of teeth ...................................... 0.00 0.90 0.81 NA NA 0.05 0.95 0.86 NA NA XXX
Sfmt 4700
70320 .... 26 ..... A Full mouth x-ray of teeth ...................................... 0.22 0.06 0.08 0.06 0.08 0.01 0.29 0.31 0.29 0.31 XXX
70328 .... .......... A X-ray exam of jaw joint ........................................ 0.18 0.59 0.56 NA NA 0.03 0.80 0.77 NA NA XXX
70328 .... TC .... A X-ray exam of jaw joint ........................................ 0.00 0.54 0.50 NA NA 0.02 0.56 0.52 NA NA XXX
70328 .... 26 ..... A X-ray exam of jaw joint ........................................ 0.18 0.05 0.06 0.05 0.06 0.01 0.24 0.25 0.24 0.25 XXX
70330 .... .......... A X-ray exam of jaw joints ...................................... 0.24 0.96 0.93 NA NA 0.06 1.26 1.23 NA NA XXX
70330 .... TC .... A X-ray exam of jaw joints ...................................... 0.00 0.89 0.85 NA NA 0.05 0.94 0.90 NA NA XXX
70330 .... 26 ..... A X-ray exam of jaw joints ...................................... 0.24 0.07 0.08 0.07 0.08 0.01 0.32 0.33 0.32 0.33 XXX
70332 .... .......... A X-ray exam of jaw joint ........................................ 0.54 1.42 2.08 NA NA 0.14 2.10 2.76 NA NA XXX
70332 .... TC .... A X-ray exam of jaw joint ........................................ 0.00 1.26 1.89 NA NA 0.12 1.38 2.01 NA NA XXX
E:\FR\FM\01DER2.SGM
70332 .... 26 ..... A X-ray exam of jaw joint ........................................ 0.54 0.16 0.19 0.16 0.19 0.02 0.72 0.75 0.72 0.75 XXX
70336 .... .......... A Magnetic image, jaw joint .................................... 1.48 11.62 11.67 NA NA 0.66 13.76 13.81 NA NA XXX
70336 .... TC .... A Magnetic image, jaw joint .................................... 0.00 11.20 11.20 NA NA 0.59 11.79 11.79 NA NA XXX
70336 .... 26 ..... A Magnetic image, jaw joint .................................... 1.48 0.42 0.47 0.42 0.47 0.07 1.97 2.02 1.97 2.02 XXX
01DER2
70350 .... .......... A X-ray head for orthodontia ................................... 0.17 0.32 0.42 NA NA 0.03 0.52 0.62 NA NA XXX
70350 .... TC .... A X-ray head for orthodontia ................................... 0.00 0.27 0.35 NA NA 0.02 0.29 0.37 NA NA XXX
70350 .... 26 ..... A X-ray head for orthodontia ................................... 0.17 0.05 0.07 0.05 0.07 0.01 0.23 0.25 0.23 0.25 XXX
70355 .... .......... A Panoramic x-ray of jaws ...................................... 0.20 0.29 0.56 NA NA 0.05 0.54 0.81 NA NA XXX
70355 .... TC .... A Panoramic x-ray of jaws ...................................... 0.00 0.23 0.49 NA NA 0.04 0.27 0.53 NA NA XXX
70355 .... 26 ..... A Panoramic x-ray of jaws ...................................... 0.20 0.06 0.07 0.06 0.07 0.01 0.27 0.28 0.27 0.28 XXX
69921
Year
69922
Year Year
2007 2007 Fully Im-
VerDate Aug<31>2005
RVUs cility Total
RVUs
70360 .... .......... A X-ray exam of neck .............................................. 0.17 0.53 0.50 NA NA 0.03 0.73 0.70 NA NA XXX
70360 .... TC .... A X-ray exam of neck .............................................. 0.00 0.48 0.44 NA NA 0.02 0.50 0.46 NA NA XXX
70360 .... 26 ..... A X-ray exam of neck .............................................. 0.17 0.05 0.06 0.05 0.06 0.01 0.23 0.24 0.23 0.24 XXX
10:50 Nov 30, 2006

70370 .... .......... A Throat x-ray & fluoroscopy ................................... 0.32 1.59 1.46 NA NA 0.08 1.99 1.86 NA NA XXX
70370 .... TC .... A Throat x-ray & fluoroscopy ................................... 0.00 1.50 1.36 NA NA 0.07 1.57 1.43 NA NA XXX
70370 .... 26 ..... A Throat x-ray & fluoroscopy ................................... 0.32 0.09 0.10 0.09 0.10 0.01 0.42 0.43 0.42 0.43 XXX
70371 .... .......... A Speech evaluation, complex ................................ 0.84 1.40 2.14 NA NA 0.16 2.40 3.14 NA NA XXX
70371 .... TC .... A Speech evaluation, complex ................................ 0.00 1.17 1.87 NA NA 0.12 1.29 1.99 NA NA XXX
Jkt 211001
70371 .... 26 ..... A Speech evaluation, complex ................................ 0.84 0.23 0.27 0.23 0.27 0.04 1.11 1.15 1.11 1.15 XXX
70373 .... .......... A Contrast x-ray of larynx ........................................ 0.44 1.57 1.83 NA NA 0.13 2.14 2.40 NA NA XXX
70373 .... TC .... A Contrast x-ray of larynx ........................................ 0.00 1.46 1.70 NA NA 0.11 1.57 1.81 NA NA XXX
70373 .... 26 ..... A Contrast x-ray of larynx ........................................ 0.44 0.11 0.13 0.11 0.13 0.02 0.57 0.59 0.57 0.59 XXX
PO 00000
70380 .... .......... A X-ray exam of salivary gland ............................... 0.17 0.80 0.75 NA NA 0.05 1.02 0.97 NA NA XXX
70380 .... TC .... A X-ray exam of salivary gland ............................... 0.00 0.75 0.69 NA NA 0.04 0.79 0.73 NA NA XXX
70380 .... 26 ..... A X-ray exam of salivary gland ............................... 0.17 0.05 0.06 0.05 0.06 0.01 0.23 0.24 0.23 0.24 XXX
70390 .... .......... A X-ray exam of salivary duct ................................. 0.38 2.20 1.98 NA NA 0.13 2.71 2.49 NA NA XXX
Frm 00300
70390 .... TC .... A X-ray exam of salivary duct ................................. 0.00 2.09 1.86 NA NA 0.11 2.20 1.97 NA NA XXX
70390 .... 26 ..... A X-ray exam of salivary duct ................................. 0.38 0.11 0.12 0.11 0.12 0.02 0.51 0.52 0.51 0.52 XXX
70450 .... .......... A Ct head/brain w/o dye .......................................... 0.85 4.62 4.91 NA NA 0.29 5.76 6.05 NA NA XXX
70450 .... TC .... A Ct head/brain w/o dye .......................................... 0.00 4.38 4.64 NA NA 0.25 4.63 4.89 NA NA XXX
Fmt 4701
70450 .... 26 ..... A Ct head/brain w/o dye .......................................... 0.85 0.24 0.27 0.24 0.27 0.04 1.13 1.16 1.13 1.16 XXX
70460 .... .......... A Ct head/brain w/dye ............................................. 1.13 6.14 6.06 NA NA 0.35 7.62 7.54 NA NA XXX
70460 .... TC .... A Ct head/brain w/dye ............................................. 0.00 5.82 5.70 NA NA 0.30 6.12 6.00 NA NA XXX
70460 .... 26 ..... A Ct head/brain w/dye ............................................. 1.13 0.32 0.36 0.32 0.36 0.05 1.50 1.54 1.50 1.54 XXX
Sfmt 4700
70470 .... .......... A Ct head/brain w/o & w/dye ................................... 1.27 7.48 7.49 NA NA 0.43 9.18 9.19 NA NA XXX
70470 .... TC .... A Ct head/brain w/o & w/dye ................................... 0.00 7.12 7.08 NA NA 0.37 7.49 7.45 NA NA XXX
70470 .... 26 ..... A Ct head/brain w/o & w/dye ................................... 1.27 0.36 0.41 0.36 0.41 0.06 1.69 1.74 1.69 1.74 XXX
70480 .... .......... A Ct orbit/ear/fossa w/o dye .................................... 1.28 7.99 5.86 NA NA 0.31 9.58 7.45 NA NA XXX
70480 .... TC .... A Ct orbit/ear/fossa w/o dye .................................... 0.00 7.63 5.45 NA NA 0.25 7.88 5.70 NA NA XXX
70480 .... 26 ..... A Ct orbit/ear/fossa w/o dye .................................... 1.28 0.36 0.41 0.36 0.41 0.06 1.70 1.75 1.70 1.75 XXX
70481 .... .......... A Ct orbit/ear/fossa w/dye ....................................... 1.38 9.43 6.95 NA NA 0.36 11.17 8.69 NA NA XXX
70481 .... TC .... A Ct orbit/ear/fossa w/dye ....................................... 0.00 9.04 6.51 NA NA 0.30 9.34 6.81 NA NA XXX
70481 .... 26 ..... A Ct orbit/ear/fossa w/dye ....................................... 1.38 0.39 0.44 0.39 0.44 0.06 1.83 1.88 1.83 1.88 XXX
E:\FR\FM\01DER2.SGM
70482 .... .......... A Ct orbit/ear/fossa w/o&w/dye ............................... 1.45 10.81 8.36 NA NA 0.43 12.69 10.24 NA NA XXX
70482 .... TC .... A Ct orbit/ear/fossa w/o&w/dye ............................... 0.00 10.40 7.90 NA NA 0.37 10.77 8.27 NA NA XXX
70482 .... 26 ..... A Ct orbit/ear/fossa w/o&w/dye ............................... 1.45 0.41 0.46 0.41 0.46 0.06 1.92 1.97 1.92 1.97 XXX
70486 .... .......... A Ct maxillofacial w/o dye ....................................... 1.14 6.39 5.42 NA NA 0.30 7.83 6.86 NA NA XXX
01DER2
70486 .... TC .... A Ct maxillofacial w/o dye ....................................... 0.00 6.07 5.06 NA NA 0.25 6.32 5.31 NA NA XXX
70486 .... 26 ..... A Ct maxillofacial w/o dye ....................................... 1.14 0.32 0.36 0.32 0.36 0.05 1.51 1.55 1.51 1.55 XXX
70487 .... .......... A Ct maxillofacial w/dye .......................................... 1.30 7.89 6.55 NA NA 0.36 9.55 8.21 NA NA XXX
70487 .... TC .... A Ct maxillofacial w/dye .......................................... 0.00 7.52 6.13 NA NA 0.30 7.82 6.43 NA NA XXX
70487 .... 26 ..... A Ct maxillofacial w/dye .......................................... 1.30 0.37 0.42 0.37 0.42 0.06 1.73 1.78 1.73 1.78 XXX
70488 .... .......... A Ct maxillofacial w/o & w/dye ................................ 1.42 9.81 8.11 NA NA 0.43 11.66 9.96 NA NA XXX
Year Year Year
2007 2007 Fully Im-
VerDate Aug<31>2005
RVUs cility Total
RVUs
70488 .... TC .... A Ct maxillofacial w/o & w/dye ................................ 0.00 9.41 7.66 NA NA 0.37 9.78 8.03 NA NA XXX
70488 .... 26 ..... A Ct maxillofacial w/o & w/dye ................................ 1.42 0.40 0.45 0.40 0.45 0.06 1.88 1.93 1.88 1.93 XXX
70490 .... .......... A Ct soft tissue neck w/o dye .................................. 1.28 6.12 5.39 NA NA 0.31 7.71 6.98 NA NA XXX
10:50 Nov 30, 2006

70490 .... TC .... A Ct soft tissue neck w/o dye .................................. 0.00 5.75 4.98 NA NA 0.25 6.00 5.23 NA NA XXX
70490 .... 26 ..... A Ct soft tissue neck w/o dye .................................. 1.28 0.37 0.41 0.37 0.41 0.06 1.71 1.75 1.71 1.75 XXX
70491 .... .......... A Ct soft tissue neck w/dye ..................................... 1.38 7.58 6.48 NA NA 0.36 9.32 8.22 NA NA XXX
70491 .... TC .... A Ct soft tissue neck w/dye ..................................... 0.00 7.19 6.04 NA NA 0.30 7.49 6.34 NA NA XXX
70491 .... 26 ..... A Ct soft tissue neck w/dye ..................................... 1.38 0.39 0.44 0.39 0.44 0.06 1.83 1.88 1.83 1.88 XXX
Jkt 211001
70492 .... .......... A Ct sft tsue nck w/o & w/dye ................................. 1.45 9.50 8.04 NA NA 0.43 11.38 9.92 NA NA XXX
70492 .... TC .... A Ct sft tsue nck w/o & w/dye ................................. 0.00 9.09 7.58 NA NA 0.37 9.46 7.95 NA NA XXX
70492 .... 26 ..... A Ct sft tsue nck w/o & w/dye ................................. 1.45 0.41 0.46 0.41 0.46 0.06 1.92 1.97 1.92 1.97 XXX
70496 .... .......... A Ct angiography, head ........................................... 1.75 16.19 12.43 NA NA 0.66 18.60 14.84 NA NA XXX
PO 00000
70496 .... TC .... A Ct angiography, head ........................................... 0.00 15.68 11.87 NA NA 0.58 16.26 12.45 NA NA XXX
70496 .... 26 ..... A Ct angiography, head ........................................... 1.75 0.51 0.56 0.51 0.56 0.08 2.34 2.39 2.34 2.39 XXX
70498 .... .......... A Ct angiography, neck ........................................... 1.75 16.29 12.45 NA NA 0.66 18.70 14.86 NA NA XXX
70498 .... TC .... A Ct angiography, neck ........................................... 0.00 15.77 11.89 NA NA 0.58 16.35 12.47 NA NA XXX
Frm 00301
70498 .... 26 ..... A Ct angiography, neck ........................................... 1.75 0.52 0.56 0.52 0.56 0.08 2.35 2.39 2.35 2.39 XXX
70540 .... .......... A Mri orbit/face/neck w/o dye .................................. 1.35 13.49 12.11 NA NA 0.45 15.29 13.91 NA NA XXX
70540 .... TC .... A Mri orbit/face/neck w/o dye .................................. 0.00 13.11 11.68 NA NA 0.39 13.50 12.07 NA NA XXX
70540 .... 26 ..... A Mri orbit/face/neck w/o dye .................................. 1.35 0.38 0.43 0.38 0.43 0.06 1.79 1.84 1.79 1.84 XXX
Fmt 4701
70542 .... .......... A Mri orbit/face/neck w/dye ..................................... 1.62 14.46 14.09 NA NA 0.54 16.62 16.25 NA NA XXX
70542 .... TC .... A Mri orbit/face/neck w/dye ..................................... 0.00 14.00 13.58 NA NA 0.47 14.47 14.05 NA NA XXX
70542 .... 26 ..... A Mri orbit/face/neck w/dye ..................................... 1.62 0.46 0.51 0.46 0.51 0.07 2.15 2.20 2.15 2.20 XXX
70543 .... .......... A Mri orbt/fac/nck w/o & w/dye ................................ 2.15 17.82 23.65 NA NA 0.94 20.91 26.74 NA NA XXX
Sfmt 4700
70543 .... TC .... A Mri orbt/fac/nck w/o & w/dye ................................ 0.00 17.21 22.96 NA NA 0.84 18.05 23.80 NA NA XXX
70543 .... 26 ..... A Mri orbt/fac/nck w/o & w/dye ................................ 2.15 0.61 0.69 0.61 0.69 0.10 2.86 2.94 2.86 2.94 XXX
70544 .... .......... A Mr angiography head w/o dye ............................. 1.20 15.03 12.46 NA NA 0.64 16.87 14.30 NA NA XXX
70544 .... TC .... A Mr angiography head w/o dye ............................. 0.00 14.69 12.07 NA NA 0.59 15.28 12.66 NA NA XXX
70544 .... 26 ..... A Mr angiography head w/o dye ............................. 1.20 0.34 0.39 0.34 0.39 0.05 1.59 1.64 1.59 1.64 XXX
70545 .... .......... A Mr angiography head w/dye ................................ 1.20 14.98 12.44 NA NA 0.64 16.82 14.28 NA NA XXX
70545 .... TC .... A Mr angiography head w/dye ................................ 0.00 14.64 12.06 NA NA 0.59 15.23 12.65 NA NA XXX
70545 .... 26 ..... A Mr angiography head w/dye ................................ 1.20 0.34 0.38 0.34 0.38 0.05 1.59 1.63 1.59 1.63 XXX
70546 .... .......... A Mr angiograph head w/o&w/dye .......................... 1.80 22.88 22.97 NA NA 0.67 25.35 25.44 NA NA XXX
E:\FR\FM\01DER2.SGM
70546 .... TC .... A Mr angiograph head w/o&w/dye .......................... 0.00 22.37 22.40 NA NA 0.59 22.96 22.99 NA NA XXX
70546 .... 26 ..... A Mr angiograph head w/o&w/dye .......................... 1.80 0.51 0.57 0.51 0.57 0.08 2.39 2.45 2.39 2.45 XXX
70547 .... .......... A Mr angiography neck w/o dye .............................. 1.20 15.01 12.45 NA NA 0.64 16.85 14.29 NA NA XXX
70547 .... TC .... A Mr angiography neck w/o dye .............................. 0.00 14.67 12.07 NA NA 0.59 15.26 12.66 NA NA XXX
01DER2
70547 .... 26 ..... A Mr angiography neck w/o dye .............................. 1.20 0.34 0.38 0.34 0.38 0.05 1.59 1.63 1.59 1.63 XXX
70548 .... .......... A Mr angiography neck w/dye ................................. 1.20 15.81 12.65 NA NA 0.64 17.65 14.49 NA NA XXX
70548 .... TC .... A Mr angiography neck w/dye ................................. 0.00 15.47 12.27 NA NA 0.59 16.06 12.86 NA NA XXX
70548 .... 26 ..... A Mr angiography neck w/dye ................................. 1.20 0.34 0.38 0.34 0.38 0.05 1.59 1.63 1.59 1.63 XXX
70549 .... .......... A Mr angiograph neck w/o&w/dye ........................... 1.80 22.85 22.96 NA NA 0.67 25.32 25.43 NA NA XXX
70549 .... TC .... A Mr angiograph neck w/o&w/dye ........................... 0.00 22.34 22.39 NA NA 0.59 22.93 22.98 NA NA XXX
69923
Year
69924
Year Year
2007 2007 Fully Im-
VerDate Aug<31>2005
RVUs cility Total
RVUs
70549 .... 26 ..... A Mr angiograph neck w/o&w/dye ........................... 1.80 0.51 0.57 0.51 0.57 0.08 2.39 2.45 2.39 2.45 XXX
70551 .... .......... A Mri brain w/o dye ................................................. 1.48 13.72 12.20 NA NA 0.66 15.86 14.34 NA NA XXX
70551 .... TC .... A Mri brain w/o dye ................................................. 0.00 13.30 11.73 NA NA 0.59 13.89 12.32 NA NA XXX
10:50 Nov 30, 2006

70551 .... 26 ..... A Mri brain w/o dye ................................................. 1.48 0.42 0.47 0.42 0.47 0.07 1.97 2.02 1.97 2.02 XXX
70552 .... .......... A Mri brain w/dye ..................................................... 1.78 14.76 14.22 NA NA 0.78 17.32 16.78 NA NA XXX
70552 .... TC .... A Mri brain w/dye ..................................................... 0.00 14.26 13.65 NA NA 0.70 14.96 14.35 NA NA XXX
70552 .... 26 ..... A Mri brain w/dye ..................................................... 1.78 0.50 0.57 0.50 0.57 0.08 2.36 2.43 2.36 2.43 XXX
70553 .... .......... A Mri brain w/o & w/dye .......................................... 2.36 17.15 23.53 NA NA 1.41 20.92 27.30 NA NA XXX
Jkt 211001
70553 .... TC .... A Mri brain w/o & w/dye .......................................... 0.00 16.48 22.78 NA NA 1.31 17.79 24.09 NA NA XXX
70553 .... 26 ..... A Mri brain w/o & w/dye .......................................... 2.36 0.67 0.75 0.67 0.75 0.10 3.13 3.21 3.13 3.21 XXX
70554 .... .......... A Fmri brain by tech ................................................ 2.11 13.49 13.49 NA NA 0.92 16.52 16.52 NA NA XXX
70554 .... TC .... A Fmri brain by tech ................................................ 0.00 12.89 12.89 NA NA 0.82 13.71 13.71 NA NA XXX
PO 00000
70554 .... 26 ..... A Fmri brain by tech ................................................ 2.11 0.60 0.60 0.60 0.60 0.10 2.81 2.81 2.81 2.81 XXX
70555 .... .......... C Fmri brain by phys/psych ..................................... 0.00 NA NA NA NA 0.00 NA NA NA NA XXX
70555 .... TC .... C Fmri brain by phys/psych ..................................... 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 XXX
70555 .... 26 ..... A Fmri brain by phys/psych ..................................... 2.54 0.72 0.72 0.72 0.72 0.11 3.37 3.37 3.37 3.37 XXX
Frm 00302
70557 .... .......... C Mri brain w/o dye ................................................. 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 XXX
70557 .... TC .... C Mri brain w/o dye ................................................. 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 XXX
70557 .... 26 ..... A Mri brain w/o dye ................................................. 2.90 0.84 1.06 0.84 1.06 0.08 3.82 4.04 3.82 4.04 XXX
70558 .... .......... C Mri brain w/dye ..................................................... 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 XXX
Fmt 4701
70558 .... TC .... C Mri brain w/dye ..................................................... 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 XXX
70558 .... 26 ..... A Mri brain w/dye ..................................................... 3.20 1.02 1.19 1.02 1.19 0.10 4.32 4.49 4.32 4.49 XXX
70559 .... .......... C Mri brain w/o & w/dye .......................................... 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 XXX
70559 .... TC .... C Mri brain w/o & w/dye .......................................... 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 XXX
Sfmt 4700
70559 .... 26 ..... A Mri brain w/o & w/dye .......................................... 3.20 0.95 1.17 0.95 1.17 0.12 4.27 4.49 4.27 4.49 XXX
71010 .... .......... A Chest x-ray ........................................................... 0.18 0.40 0.50 NA NA 0.03 0.61 0.71 NA NA XXX
71010 .... TC .... A Chest x-ray ........................................................... 0.00 0.35 0.44 NA NA 0.02 0.37 0.46 NA NA XXX
71010 .... 26 ..... A Chest x-ray ........................................................... 0.18 0.05 0.06 0.05 0.06 0.01 0.24 0.25 0.24 0.25 XXX
71015 .... 26 ..... A Chest x-ray ........................................................... 0.21 0.06 0.07 0.06 0.07 0.01 0.28 0.29 0.28 0.29 XXX
E:\FR\FM\01DER2.SGM
71020 .... 26 ..... A Chest x-ray ........................................................... 0.22 0.06 0.07 0.06 0.07 0.01 0.29 0.30 0.29 0.30 XXX
71021 .... 26 ..... A Chest x-ray ........................................................... 0.27 0.07 0.09 0.07 0.09 0.01 0.35 0.37 0.35 0.37 XXX
01DER2
71022 .... 26 ..... A Chest x-ray ........................................................... 0.31 0.08 0.10 0.08 0.10 0.01 0.40 0.42 0.40 0.42 XXX
71023 .... .......... A Chest x-ray and fluoroscopy ................................ 0.38 1.53 1.06 NA NA 0.06 1.97 1.50 NA NA XXX
71023 .... TC .... A Chest x-ray and fluoroscopy ................................ 0.00 1.39 0.93 NA NA 0.05 1.44 0.98 NA NA XXX
71023 .... 26 ..... A Chest x-ray and fluoroscopy ................................ 0.38 0.14 0.13 0.14 0.13 0.01 0.53 0.52 0.53 0.52 XXX
Year Year Year
2007 2007 Fully Im-
VerDate Aug<31>2005
RVUs cility Total
RVUs
71030 .... 26 ..... A Chest x-ray ........................................................... 0.31 0.09 0.10 0.09 0.10 0.01 0.41 0.42 0.41 0.42 XXX
10:50 Nov 30, 2006

71034 .... .......... A Chest x-ray and fluoroscopy ................................ 0.46 1.96 1.69 NA NA 0.10 2.52 2.25 NA NA XXX
71034 .... TC .... A Chest x-ray and fluoroscopy ................................ 0.00 1.79 1.53 NA NA 0.08 1.87 1.61 NA NA XXX
71034 .... 26 ..... A Chest x-ray and fluoroscopy ................................ 0.46 0.17 0.16 0.17 0.16 0.02 0.65 0.64 0.65 0.64 XXX
Jkt 211001
71035 .... 26 ..... A Chest x-ray ........................................................... 0.18 0.05 0.06 0.05 0.06 0.01 0.24 0.25 0.24 0.25 XXX
71040 .... .......... A Contrast x-ray of bronchi ..................................... 0.58 1.99 1.74 NA NA 0.11 2.68 2.43 NA NA XXX
71040 .... TC .... A Contrast x-ray of bronchi ..................................... 0.00 1.84 1.56 NA NA 0.08 1.92 1.64 NA NA XXX
71040 .... 26 ..... A Contrast x-ray of bronchi ..................................... 0.58 0.15 0.18 0.15 0.18 0.03 0.76 0.79 0.76 0.79 XXX
PO 00000
71060 .... .......... A Contrast x-ray of bronchi ..................................... 0.74 2.91 2.56 NA NA 0.16 3.81 3.46 NA NA XXX
71060 .... TC .... A Contrast x-ray of bronchi ..................................... 0.00 2.70 2.33 NA NA 0.13 2.83 2.46 NA NA XXX
71060 .... 26 ..... A Contrast x-ray of bronchi ..................................... 0.74 0.21 0.23 0.21 0.23 0.03 0.98 1.00 0.98 1.00 XXX
71090 .... .......... C X-ray & pacemaker insertion ............................... 0.00 NA NA NA NA 0.00 NA NA NA NA XXX
Frm 00303
71090 .... TC .... C X-ray & pacemaker insertion ............................... 0.00 NA NA NA NA 0.00 NA NA NA NA XXX
71090 .... 26 ..... A X-ray & pacemaker insertion ............................... 0.54 0.29 0.23 0.29 0.23 0.02 0.85 0.79 0.85 0.79 XXX
71100 .... .......... A X-ray exam of ribs ................................................ 0.22 0.58 0.63 NA NA 0.05 0.85 0.90 NA NA XXX
71100 .... TC .... A X-ray exam of ribs ................................................ 0.00 0.52 0.56 NA NA 0.04 0.56 0.60 NA NA XXX
Fmt 4701
71100 .... 26 ..... A X-ray exam of ribs ................................................ 0.22 0.06 0.07 0.06 0.07 0.01 0.29 0.30 0.29 0.30 XXX
71101 .... .......... A X-ray exam of ribs/chest ...................................... 0.27 0.71 0.75 NA NA 0.05 1.03 1.07 NA NA XXX
71101 .... TC .... A X-ray exam of ribs/chest ...................................... 0.00 0.64 0.66 NA NA 0.04 0.68 0.70 NA NA XXX
71101 .... 26 ..... A X-ray exam of ribs/chest ...................................... 0.27 0.07 0.09 0.07 0.09 0.01 0.35 0.37 0.35 0.37 XXX
Sfmt 4700
71110 .... .......... A X-ray exam of ribs ................................................ 0.27 0.73 0.84 NA NA 0.06 1.06 1.17 NA NA XXX
71110 .... TC .... A X-ray exam of ribs ................................................ 0.00 0.66 0.75 NA NA 0.05 0.71 0.80 NA NA XXX
71110 .... 26 ..... A X-ray exam of ribs ................................................ 0.27 0.07 0.09 0.07 0.09 0.01 0.35 0.37 0.35 0.37 XXX
71111 .... .......... A X-ray exam of ribs/chest ...................................... 0.32 1.00 1.00 NA NA 0.07 1.39 1.39 NA NA XXX
71111 .... TC .... A X-ray exam of ribs/chest ...................................... 0.00 0.92 0.90 NA NA 0.06 0.98 0.96 NA NA XXX
71111 .... 26 ..... A X-ray exam of ribs/chest ...................................... 0.32 0.08 0.10 0.08 0.10 0.01 0.41 0.43 0.41 0.43 XXX
71120 .... .......... A X-ray exam of breastbone ................................... 0.20 0.59 0.69 NA NA 0.05 0.84 0.94 NA NA XXX
71120 .... TC .... A X-ray exam of breastbone ................................... 0.00 0.53 0.62 NA NA 0.04 0.57 0.66 NA NA XXX
71120 .... 26 ..... A X-ray exam of breastbone ................................... 0.20 0.06 0.07 0.06 0.07 0.01 0.27 0.28 0.27 0.28 XXX
E:\FR\FM\01DER2.SGM
71130 .... .......... A X-ray exam of breastbone ................................... 0.22 0.72 0.77 NA NA 0.05 0.99 1.04 NA NA XXX
71130 .... TC .... A X-ray exam of breastbone ................................... 0.00 0.65 0.70 NA NA 0.04 0.69 0.74 NA NA XXX
71130 .... 26 ..... A X-ray exam of breastbone ................................... 0.22 0.07 0.07 0.07 0.07 0.01 0.30 0.30 0.30 0.30 XXX
71250 .... .......... A Ct thorax w/o dye ................................................. 1.16 6.08 6.24 NA NA 0.36 7.60 7.76 NA NA XXX
01DER2
71250 .... TC .... A Ct thorax w/o dye ................................................. 0.00 5.75 5.87 NA NA 0.31 6.06 6.18 NA NA XXX
71250 .... 26 ..... A Ct thorax w/o dye ................................................. 1.16 0.33 0.37 0.33 0.37 0.05 1.54 1.58 1.54 1.58 XXX
71260 .... .......... A Ct thorax w/dye .................................................... 1.24 7.54 7.50 NA NA 0.42 9.20 9.16 NA NA XXX
71260 .... TC .... A Ct thorax w/dye .................................................... 0.00 7.19 7.10 NA NA 0.37 7.56 7.47 NA NA XXX
71260 .... 26 ..... A Ct thorax w/dye .................................................... 1.24 0.35 0.40 0.35 0.40 0.05 1.64 1.69 1.64 1.69 XXX
71270 .... .......... A Ct thorax w/o & w/dye .......................................... 1.38 9.52 9.36 NA NA 0.52 11.42 11.26 NA NA XXX
69925
Year
69926
Year Year
2007 2007 Fully Im-
VerDate Aug<31>2005
RVUs cility Total
RVUs
71270 .... TC .... A Ct thorax w/o & w/dye .......................................... 0.00 9.13 8.92 NA NA 0.46 9.59 9.38 NA NA XXX
71270 .... 26 ..... A Ct thorax w/o & w/dye .......................................... 1.38 0.39 0.44 0.39 0.44 0.06 1.83 1.88 1.83 1.88 XXX
71275 .... .......... A Ct angiography, chest .......................................... 1.92 11.10 12.53 NA NA 0.48 13.50 14.93 NA NA XXX
10:50 Nov 30, 2006

71275 .... TC .... A Ct angiography, chest .......................................... 0.00 10.54 11.92 NA NA 0.39 10.93 12.31 NA NA XXX
71275 .... 26 ..... A Ct angiography, chest .......................................... 1.92 0.56 0.61 0.56 0.61 0.09 2.57 2.62 2.57 2.62 XXX
71550 .... .......... A Mri chest w/o dye ................................................. 1.46 15.58 12.65 NA NA 0.51 17.55 14.62 NA NA XXX
71550 .... TC .... A Mri chest w/o dye ................................................. 0.00 15.17 12.19 NA NA 0.45 15.62 12.64 NA NA XXX
71550 .... 26 ..... A Mri chest w/o dye ................................................. 1.46 0.41 0.46 0.41 0.46 0.06 1.93 1.98 1.93 1.98 XXX
Jkt 211001
71551 .... .......... A Mri chest w/dye .................................................... 1.73 17.01 14.76 NA NA 0.60 19.34 17.09 NA NA XXX
71551 .... TC .... A Mri chest w/dye .................................................... 0.00 16.51 14.21 NA NA 0.52 17.03 14.73 NA NA XXX
71551 .... 26 ..... A Mri chest w/dye .................................................... 1.73 0.50 0.55 0.50 0.55 0.08 2.31 2.36 2.31 2.36 XXX
71552 .... .......... A Mri chest w/o & w/dye .......................................... 2.26 21.36 24.56 NA NA 0.78 24.40 27.60 NA NA XXX
PO 00000
71552 .... TC .... A Mri chest w/o & w/dye .......................................... 0.00 20.71 23.84 NA NA 0.68 21.39 24.52 NA NA XXX
71552 .... 26 ..... A Mri chest w/o & w/dye .......................................... 2.26 0.65 0.72 0.65 0.72 0.10 3.01 3.08 3.01 3.08 XXX
71555 .... .......... R Mri angio chest w or w/o dye ............................... 1.81 14.67 12.52 NA NA 0.67 17.15 15.00 NA NA XXX
71555 .... TC .... R Mri angio chest w or w/o dye ............................... 0.00 14.11 11.93 NA NA 0.59 14.70 12.52 NA NA XXX
Frm 00304
71555 .... 26 ..... R Mri angio chest w or w/o dye ............................... 1.81 0.56 0.59 0.56 0.59 0.08 2.45 2.48 2.45 2.48 XXX
72010 .... .......... A X-ray exam of spine ............................................. 0.45 1.40 1.23 NA NA 0.08 1.93 1.76 NA NA XXX
72010 .... TC .... A X-ray exam of spine ............................................. 0.00 1.28 1.09 NA NA 0.06 1.34 1.15 NA NA XXX
72010 .... 26 ..... A X-ray exam of spine ............................................. 0.45 0.12 0.14 0.12 0.14 0.02 0.59 0.61 0.59 0.61 XXX
Fmt 4701
72020 .... .......... A X-ray exam of spine ............................................. 0.15 0.43 0.46 NA NA 0.03 0.61 0.64 NA NA XXX
72020 .... TC .... A X-ray exam of spine ............................................. 0.00 0.39 0.41 NA NA 0.02 0.41 0.43 NA NA XXX
72020 .... 26 ..... A X-ray exam of spine ............................................. 0.15 0.04 0.05 0.04 0.05 0.01 0.20 0.21 0.20 0.21 XXX
72040 .... .......... A X-ray exam of neck spine .................................... 0.22 0.73 0.69 NA NA 0.05 1.00 0.96 NA NA XXX
Sfmt 4700
72040 .... TC .... A X-ray exam of neck spine .................................... 0.00 0.67 0.62 NA NA 0.04 0.71 0.66 NA NA XXX
72040 .... 26 ..... A X-ray exam of neck spine .................................... 0.22 0.06 0.07 0.06 0.07 0.01 0.29 0.30 0.29 0.30 XXX
72069 .... .......... A X-ray exam of trunk spine .................................... 0.22 0.73 0.61 NA NA 0.03 0.98 0.86 NA NA XXX
E:\FR\FM\01DER2.SGM
72069 .... TC .... A X-ray exam of trunk spine .................................... 0.00 0.66 0.53 NA NA 0.02 0.68 0.55 NA NA XXX
72069 .... 26 ..... A X-ray exam of trunk spine .................................... 0.22 0.07 0.08 0.07 0.08 0.01 0.30 0.31 0.30 0.31 XXX
72070 .... .......... A X-ray exam of thoracic spine ............................... 0.22 0.60 0.69 NA NA 0.05 0.87 0.96 NA NA XXX
72070 .... TC .... A X-ray exam of thoracic spine ............................... 0.00 0.54 0.62 NA NA 0.04 0.58 0.66 NA NA XXX
01DER2
72070 .... 26 ..... A X-ray exam of thoracic spine ............................... 0.22 0.06 0.07 0.06 0.07 0.01 0.29 0.30 0.29 0.30 XXX
Year Year Year
2007 2007 Fully Im-
VerDate Aug<31>2005
RVUs cility Total
RVUs
10:50 Nov 30, 2006

72100 .... .......... A X-ray exam of lower spine ................................... 0.22 0.78 0.75 NA NA 0.05 1.05 1.02 NA NA XXX
Jkt 211001
72100 .... TC .... A X-ray exam of lower spine ................................... 0.00 0.71 0.68 NA NA 0.04 0.75 0.72 NA NA XXX
72100 .... 26 ..... A X-ray exam of lower spine ................................... 0.22 0.07 0.07 0.07 0.07 0.01 0.30 0.30 0.30 0.30 XXX
PO 00000
Frm 00305
72125 .... .......... A Ct neck spine w/o dye ......................................... 1.16 6.08 6.24 NA NA 0.36 7.60 7.76 NA NA XXX
Fmt 4701
72125 .... TC .... A Ct neck spine w/o dye ......................................... 0.00 5.75 5.87 NA NA 0.31 6.06 6.18 NA NA XXX
72125 .... 26 ..... A Ct neck spine w/o dye ......................................... 1.16 0.33 0.37 0.33 0.37 0.05 1.54 1.58 1.54 1.58 XXX
72126 .... .......... A Ct neck spine w/dye ............................................. 1.22 7.54 7.49 NA NA 0.42 9.18 9.13 NA NA XXX
72126 .... TC .... A Ct neck spine w/dye ............................................. 0.00 7.19 7.10 NA NA 0.37 7.56 7.47 NA NA XXX
Sfmt 4700
72126 .... 26 ..... A Ct neck spine w/dye ............................................. 1.22 0.35 0.39 0.35 0.39 0.05 1.62 1.66 1.62 1.66 XXX
72127 .... .......... A Ct neck spine w/o & w/dye .................................. 1.27 9.36 9.30 NA NA 0.52 11.15 11.09 NA NA XXX
72127 .... TC .... A Ct neck spine w/o & w/dye .................................. 0.00 9.00 8.89 NA NA 0.46 9.46 9.35 NA NA XXX
72127 .... 26 ..... A Ct neck spine w/o & w/dye .................................. 1.27 0.36 0.41 0.36 0.41 0.06 1.69 1.74 1.69 1.74 XXX
72128 .... .......... A Ct chest spine w/o dye ........................................ 1.16 6.08 6.24 NA NA 0.36 7.60 7.76 NA NA XXX
72128 .... TC .... A Ct chest spine w/o dye ........................................ 0.00 5.75 5.87 NA NA 0.31 6.06 6.18 NA NA XXX
72128 .... 26 ..... A Ct chest spine w/o dye ........................................ 1.16 0.33 0.37 0.33 0.37 0.05 1.54 1.58 1.54 1.58 XXX
72129 .... .......... A Ct chest spine w/dye ............................................ 1.22 7.54 7.49 NA NA 0.42 9.18 9.13 NA NA XXX
72129 .... TC .... A Ct chest spine w/dye ............................................ 0.00 7.19 7.10 NA NA 0.37 7.56 7.47 NA NA XXX
E:\FR\FM\01DER2.SGM
72129 .... 26 ..... A Ct chest spine w/dye ............................................ 1.22 0.35 0.39 0.35 0.39 0.05 1.62 1.66 1.62 1.66 XXX
72130 .... .......... A Ct chest spine w/o & w/dye ................................. 1.27 9.31 9.29 NA NA 0.52 11.10 11.08 NA NA XXX
72130 .... TC .... A Ct chest spine w/o & w/dye ................................. 0.00 8.95 8.88 NA NA 0.46 9.41 9.34 NA NA XXX
72130 .... 26 ..... A Ct chest spine w/o & w/dye ................................. 1.27 0.36 0.41 0.36 0.41 0.06 1.69 1.74 1.69 1.74 XXX
01DER2
72131 .... .......... A Ct lumbar spine w/o dye ...................................... 1.16 6.07 6.24 NA NA 0.36 7.59 7.76 NA NA XXX
72131 .... TC .... A Ct lumbar spine w/o dye ...................................... 0.00 5.74 5.87 NA NA 0.31 6.05 6.18 NA NA XXX
72131 .... 26 ..... A Ct lumbar spine w/o dye ...................................... 1.16 0.33 0.37 0.33 0.37 0.05 1.54 1.58 1.54 1.58 XXX
72132 .... .......... A Ct lumbar spine w/dye ......................................... 1.22 7.52 7.49 NA NA 0.42 9.16 9.13 NA NA XXX
72132 .... TC .... A Ct lumbar spine w/dye ......................................... 0.00 7.17 7.10 NA NA 0.37 7.54 7.47 NA NA XXX
72132 .... 26 ..... A Ct lumbar spine w/dye ......................................... 1.22 0.35 0.39 0.35 0.39 0.05 1.62 1.66 1.62 1.66 XXX
69927
Year
69928
Year Year
2007 2007 Fully Im-
VerDate Aug<31>2005
RVUs cility Total
RVUs
72133 .... .......... A Ct lumbar spine w/o & w/dye ............................... 1.27 9.54 9.34 NA NA 0.52 11.33 11.13 NA NA XXX
72133 .... TC .... A Ct lumbar spine w/o & w/dye ............................... 0.00 9.18 8.93 NA NA 0.46 9.64 9.39 NA NA XXX
72133 .... 26 ..... A Ct lumbar spine w/o & w/dye ............................... 1.27 0.36 0.41 0.36 0.41 0.06 1.69 1.74 1.69 1.74 XXX
10:50 Nov 30, 2006

72141 .... .......... A Mri neck spine w/o dye ........................................ 1.60 11.86 11.76 NA NA 0.66 14.12 14.02 NA NA XXX
72141 .... TC .... A Mri neck spine w/o dye ........................................ 0.00 11.40 11.25 NA NA 0.59 11.99 11.84 NA NA XXX
72141 .... 26 ..... A Mri neck spine w/o dye ........................................ 1.60 0.46 0.51 0.46 0.51 0.07 2.13 2.18 2.13 2.18 XXX
72142 .... .......... A Mri neck spine w/dye ........................................... 1.92 14.80 14.26 NA NA 0.79 17.51 16.97 NA NA XXX
72142 .... TC .... A Mri neck spine w/dye ........................................... 0.00 14.25 13.64 NA NA 0.70 14.95 14.34 NA NA XXX
Jkt 211001
72142 .... 26 ..... A Mri neck spine w/dye ........................................... 1.92 0.55 0.62 0.55 0.62 0.09 2.56 2.63 2.56 2.63 XXX
72146 .... .......... A Mri chest spine w/o dye ....................................... 1.60 11.87 12.69 NA NA 0.71 14.18 15.00 NA NA XXX
72146 .... TC .... A Mri chest spine w/o dye ....................................... 0.00 11.41 12.18 NA NA 0.64 12.05 12.82 NA NA XXX
72146 .... 26 ..... A Mri chest spine w/o dye ....................................... 1.60 0.46 0.51 0.46 0.51 0.07 2.13 2.18 2.13 2.18 XXX
PO 00000
72147 .... .......... A Mri chest spine w/dye .......................................... 1.92 12.81 13.76 NA NA 0.79 15.52 16.47 NA NA XXX
72147 .... TC .... A Mri chest spine w/dye .......................................... 0.00 12.27 13.15 NA NA 0.70 12.97 13.85 NA NA XXX
72147 .... 26 ..... A Mri chest spine w/dye .......................................... 1.92 0.54 0.61 0.54 0.61 0.09 2.55 2.62 2.55 2.62 XXX
72148 .... .......... A Mri lumbar spine w/o dye ..................................... 1.48 11.84 12.66 NA NA 0.71 14.03 14.85 NA NA XXX
Frm 00306
72148 .... TC .... A Mri lumbar spine w/o dye ..................................... 0.00 11.41 12.18 NA NA 0.64 12.05 12.82 NA NA XXX
72148 .... 26 ..... A Mri lumbar spine w/o dye ..................................... 1.48 0.43 0.48 0.43 0.48 0.07 1.98 2.03 1.98 2.03 XXX
72149 .... .......... A Mri lumbar spine w/dye ........................................ 1.78 14.77 14.23 NA NA 0.78 17.33 16.79 NA NA XXX
72149 .... TC .... A Mri lumbar spine w/dye ........................................ 0.00 14.26 13.65 NA NA 0.70 14.96 14.35 NA NA XXX
Fmt 4701
72149 .... 26 ..... A Mri lumbar spine w/dye ........................................ 1.78 0.51 0.58 0.51 0.58 0.08 2.37 2.44 2.37 2.44 XXX
72156 .... .......... A Mri neck spine w/o & w/dye ................................. 2.57 16.87 23.52 NA NA 1.42 20.86 27.51 NA NA XXX
72156 .... TC .... A Mri neck spine w/o & w/dye ................................. 0.00 16.14 22.70 NA NA 1.31 17.45 24.01 NA NA XXX
72156 .... 26 ..... A Mri neck spine w/o & w/dye ................................. 2.57 0.73 0.82 0.73 0.82 0.11 3.41 3.50 3.41 3.50 XXX
Sfmt 4700
72157 .... .......... A Mri chest spine w/o & w/dye ................................ 2.57 15.34 23.12 NA NA 1.42 19.33 27.11 NA NA XXX
72157 .... TC .... A Mri chest spine w/o & w/dye ................................ 0.00 14.61 22.31 NA NA 1.31 15.92 23.62 NA NA XXX
72157 .... 26 ..... A Mri chest spine w/o & w/dye ................................ 2.57 0.73 0.81 0.73 0.81 0.11 3.41 3.49 3.41 3.49 XXX
72158 .... .......... A Mri lumbar spine w/o & w/dye ............................. 2.36 16.81 23.45 NA NA 1.41 20.58 27.22 NA NA XXX
72158 .... TC .... A Mri lumbar spine w/o & w/dye ............................. 0.00 16.14 22.70 NA NA 1.31 17.45 24.01 NA NA XXX
72158 .... 26 ..... A Mri lumbar spine w/o & w/dye ............................. 2.36 0.67 0.75 0.67 0.75 0.10 3.13 3.21 3.13 3.21 XXX
72159 .... .......... N Mr angio spine w/o&w/dye ................................... 1.80 14.49 13.31 NA NA 0.74 17.03 15.85 NA NA XXX
72159 .... TC .... N Mr angio spine w/o&w/dye ................................... 0.00 14.07 12.69 NA NA 0.64 14.71 13.33 NA NA XXX
72159 .... 26 ..... N Mr angio spine w/o&w/dye ................................... 1.80 0.42 0.62 0.42 0.62 0.10 2.32 2.52 2.32 2.52 XXX
E:\FR\FM\01DER2.SGM
72170 .... .......... A X-ray exam of pelvis ............................................ 0.17 0.47 0.56 NA NA 0.03 0.67 0.76 NA NA XXX
72170 .... TC .... A X-ray exam of pelvis ............................................ 0.00 0.42 0.50 NA NA 0.02 0.44 0.52 NA NA XXX
72170 .... 26 ..... A X-ray exam of pelvis ............................................ 0.17 0.05 0.06 0.05 0.06 0.01 0.23 0.24 0.23 0.24 XXX
72190 .... .......... A X-ray exam of pelvis ............................................ 0.21 0.81 0.76 NA NA 0.05 1.07 1.02 NA NA XXX
01DER2
72190 .... TC .... A X-ray exam of pelvis ............................................ 0.00 0.74 0.69 NA NA 0.04 0.78 0.73 NA NA XXX
72190 .... 26 ..... A X-ray exam of pelvis ............................................ 0.21 0.07 0.07 0.07 0.07 0.01 0.29 0.29 0.29 0.29 XXX
72191 .... .......... A Ct angiograph pelv w/o&w/dye ............................ 1.81 10.72 12.15 NA NA 0.47 13.00 14.43 NA NA XXX
72191 .... TC .... A Ct angiograph pelv w/o&w/dye ............................ 0.00 10.19 11.57 NA NA 0.39 10.58 11.96 NA NA XXX
72191 .... 26 ..... A Ct angiograph pelv w/o&w/dye ............................ 1.81 0.53 0.58 0.53 0.58 0.08 2.42 2.47 2.42 2.47 XXX
72192 .... .......... A Ct pelvis w/o dye .................................................. 1.09 5.67 6.12 NA NA 0.36 7.12 7.57 NA NA XXX
Year Year Year
2007 2007 Fully Im-
VerDate Aug<31>2005
RVUs cility Total
RVUs
72192 .... TC .... A Ct pelvis w/o dye .................................................. 0.00 5.36 5.77 NA NA 0.31 5.67 6.08 NA NA XXX
72192 .... 26 ..... A Ct pelvis w/o dye .................................................. 1.09 0.31 0.35 0.31 0.35 0.05 1.45 1.49 1.45 1.49 XXX
72193 .... .......... A Ct pelvis w/dye ..................................................... 1.16 7.11 7.20 NA NA 0.41 8.68 8.77 NA NA XXX
10:50 Nov 30, 2006

72193 .... TC .... A Ct pelvis w/dye ..................................................... 0.00 6.78 6.83 NA NA 0.36 7.14 7.19 NA NA XXX
72193 .... 26 ..... A Ct pelvis w/dye ..................................................... 1.16 0.33 0.37 0.33 0.37 0.05 1.54 1.58 1.54 1.58 XXX
72194 .... .......... A Ct pelvis w/o & w/dye .......................................... 1.22 9.56 9.06 NA NA 0.48 11.26 10.76 NA NA XXX
72194 .... TC .... A Ct pelvis w/o & w/dye .......................................... 0.00 9.21 8.67 NA NA 0.43 9.64 9.10 NA NA XXX
72194 .... 26 ..... A Ct pelvis w/o & w/dye .......................................... 1.22 0.35 0.39 0.35 0.39 0.05 1.62 1.66 1.62 1.66 XXX
Jkt 211001
72195 .... .......... A Mri pelvis w/o dye ................................................ 1.46 13.71 12.19 NA NA 0.51 15.68 14.16 NA NA XXX
72195 .... TC .... A Mri pelvis w/o dye ................................................ 0.00 13.29 11.72 NA NA 0.45 13.74 12.17 NA NA XXX
72195 .... 26 ..... A Mri pelvis w/o dye ................................................ 1.46 0.42 0.47 0.42 0.47 0.06 1.94 1.99 1.94 1.99 XXX
72196 .... .......... A Mri pelvis w/dye ................................................... 1.73 14.67 14.18 NA NA 0.60 17.00 16.51 NA NA XXX
PO 00000
72196 .... TC .... A Mri pelvis w/dye ................................................... 0.00 14.18 13.63 NA NA 0.52 14.70 14.15 NA NA XXX
72196 .... 26 ..... A Mri pelvis w/dye ................................................... 1.73 0.49 0.55 0.49 0.55 0.08 2.30 2.36 2.30 2.36 XXX
72197 .... .......... A Mri pelvis w/o & w/dye ......................................... 2.26 17.96 23.71 NA NA 1.02 21.24 26.99 NA NA XXX
72197 .... TC .... A Mri pelvis w/o & w/dye ......................................... 0.00 17.32 22.99 NA NA 0.92 18.24 23.91 NA NA XXX
Frm 00307
72197 .... 26 ..... A Mri pelvis w/o & w/dye ......................................... 2.26 0.64 0.72 0.64 0.72 0.10 3.00 3.08 3.00 3.08 XXX
72198 .... .......... A Mr angio pelvis w/o & w/dye ................................ 1.80 14.29 12.41 NA NA 0.67 16.76 14.88 NA NA XXX
72198 .... TC .... A Mr angio pelvis w/o & w/dye ................................ 0.00 13.77 11.84 NA NA 0.59 14.36 12.43 NA NA XXX
72198 .... 26 ..... A Mr angio pelvis w/o & w/dye ................................ 1.80 0.52 0.57 0.52 0.57 0.08 2.40 2.45 2.40 2.45 XXX
Fmt 4701
72200 .... .......... A X-ray exam sacroiliac joints ................................. 0.17 0.57 0.58 NA NA 0.03 0.77 0.78 NA NA XXX
72200 .... TC .... A X-ray exam sacroiliac joints ................................. 0.00 0.52 0.52 NA NA 0.02 0.54 0.54 NA NA XXX
72200 .... 26 ..... A X-ray exam sacroiliac joints ................................. 0.17 0.05 0.06 0.05 0.06 0.01 0.23 0.24 0.23 0.24 XXX
72202 .... .......... A X-ray exam sacroiliac joints ................................. 0.19 0.69 0.69 NA NA 0.05 0.93 0.93 NA NA XXX
Sfmt 4700
72202 .... TC .... A X-ray exam sacroiliac joints ................................. 0.00 0.64 0.63 NA NA 0.04 0.68 0.67 NA NA XXX
72202 .... 26 ..... A X-ray exam sacroiliac joints ................................. 0.19 0.05 0.06 0.05 0.06 0.01 0.25 0.26 0.25 0.26 XXX
72220 .... .......... A X-ray exam of tailbone ......................................... 0.17 0.54 0.61 NA NA 0.05 0.76 0.83 NA NA XXX
72220 .... TC .... A X-ray exam of tailbone ......................................... 0.00 0.50 0.55 NA NA 0.04 0.54 0.59 NA NA XXX
72220 .... 26 ..... A X-ray exam of tailbone ......................................... 0.17 0.04 0.06 0.04 0.06 0.01 0.22 0.24 0.22 0.24 XXX
72240 .... .......... A Contrast x-ray of neck spine ................................ 0.91 2.37 4.37 NA NA 0.29 3.57 5.57 NA NA XXX
72240 .... TC .... A Contrast x-ray of neck spine ................................ 0.00 2.12 4.09 NA NA 0.25 2.37 4.34 NA NA XXX
72240 .... 26 ..... A Contrast x-ray of neck spine ................................ 0.91 0.25 0.28 0.25 0.28 0.04 1.20 1.23 1.20 1.23 XXX
72255 .... .......... A Contrast x-ray, thorax spine ................................. 0.91 2.13 3.98 NA NA 0.26 3.30 5.15 NA NA XXX
E:\FR\FM\01DER2.SGM
72255 .... TC .... A Contrast x-ray, thorax spine ................................. 0.00 1.89 3.72 NA NA 0.22 2.11 3.94 NA NA XXX
72255 .... 26 ..... A Contrast x-ray, thorax spine ................................. 0.91 0.24 0.26 0.24 0.26 0.04 1.19 1.21 1.19 1.21 XXX
72265 .... .......... A Contrast x-ray, lower spine .................................. 0.83 2.34 3.83 NA NA 0.26 3.43 4.92 NA NA XXX
72265 .... TC .... A Contrast x-ray, lower spine .................................. 0.00 2.11 3.58 NA NA 0.22 2.33 3.80 NA NA XXX
01DER2
72265 .... 26 ..... A Contrast x-ray, lower spine .................................. 0.83 0.23 0.25 0.23 0.25 0.04 1.10 1.12 1.10 1.12 XXX
72270 .... .......... A Contrast x-ray, spine ............................................ 1.33 3.69 5.81 NA NA 0.39 5.41 7.53 NA NA XXX
72270 .... TC .... A Contrast x-ray, spine ............................................ 0.00 3.31 5.40 NA NA 0.33 3.64 5.73 NA NA XXX
72270 .... 26 ..... A Contrast x-ray, spine ............................................ 1.33 0.38 0.41 0.38 0.41 0.06 1.77 1.80 1.77 1.80 XXX
72275 .... .......... A Epidurography ...................................................... 0.76 1.67 2.15 NA NA 0.26 2.69 3.17 NA NA XXX
72275 .... TC .... A Epidurography ...................................................... 0.00 1.48 1.95 NA NA 0.22 1.70 2.17 NA NA XXX
69929
Year
69930
Year Year
2007 2007 Fully Im-
VerDate Aug<31>2005
RVUs cility Total
RVUs
72275 .... 26 ..... A Epidurography ...................................................... 0.76 0.19 0.20 0.19 0.20 0.04 0.99 1.00 0.99 1.00 XXX
72285 .... .......... A X-ray c/t spine disk .............................................. 1.16 1.36 6.90 NA NA 0.50 3.02 8.56 NA NA XXX
72285 .... TC .... A X-ray c/t spine disk .............................................. 0.00 1.09 6.56 NA NA 0.43 1.52 6.99 NA NA XXX
10:50 Nov 30, 2006

72285 .... 26 ..... A X-ray c/t spine disk .............................................. 1.16 0.27 0.34 0.27 0.34 0.07 1.50 1.57 1.50 1.57 XXX
72291 .... .......... C Perq vertebroplasty, fluor ..................................... 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 XXX
72291 .... TC .... C Perq vertebroplasty, fluor ..................................... 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 XXX
72291 .... 26 ..... A Perq vertebroplasty, fluor ..................................... 1.31 0.41 0.46 0.41 0.46 0.10 1.82 1.87 1.82 1.87 XXX
72292 .... .......... C Perq vertebroplasty, ct ......................................... 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 XXX
Jkt 211001
72292 .... TC .... C Perq vertebroplasty, ct ......................................... 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 XXX
72292 .... 26 ..... A Perq vertebroplasty, ct ......................................... 1.38 0.41 0.46 0.41 0.46 0.07 1.86 1.91 1.86 1.91 XXX
72295 .... .......... A X-ray of lower spine disk ..................................... 0.83 1.36 6.44 NA NA 0.46 2.65 7.73 NA NA XXX
72295 .... TC .... A X-ray of lower spine disk ..................................... 0.00 1.14 6.18 NA NA 0.40 1.54 6.58 NA NA XXX
PO 00000
72295 .... 26 ..... A X-ray of lower spine disk ..................................... 0.83 0.22 0.26 0.22 0.26 0.06 1.11 1.15 1.11 1.15 XXX
73000 .... .......... A X-ray exam of collar bone .................................... 0.16 0.53 0.56 NA NA 0.03 0.72 0.75 NA NA XXX
73000 .... TC .... A X-ray exam of collar bone .................................... 0.00 0.48 0.51 NA NA 0.02 0.50 0.53 NA NA XXX
73000 .... 26 ..... A X-ray exam of collar bone .................................... 0.16 0.05 0.05 0.05 0.05 0.01 0.22 0.22 0.22 0.22 XXX
Frm 00308
73010 .... .......... A X-ray exam of shoulder blade .............................. 0.17 0.56 0.58 NA NA 0.03 0.76 0.78 NA NA XXX
73010 .... TC .... A X-ray exam of shoulder blade .............................. 0.00 0.51 0.52 NA NA 0.02 0.53 0.54 NA NA XXX
73010 .... 26 ..... A X-ray exam of shoulder blade .............................. 0.17 0.05 0.06 0.05 0.06 0.01 0.23 0.24 0.23 0.24 XXX
73020 .... .......... A X-ray exam of shoulder ........................................ 0.15 0.43 0.50 NA NA 0.03 0.61 0.68 NA NA XXX
Fmt 4701
73020 .... TC .... A X-ray exam of shoulder ........................................ 0.00 0.38 0.45 NA NA 0.02 0.40 0.47 NA NA XXX
73020 .... 26 ..... A X-ray exam of shoulder ........................................ 0.15 0.05 0.05 0.05 0.05 0.01 0.21 0.21 0.21 0.21 XXX
73030 .... .......... A X-ray exam of shoulder ........................................ 0.18 0.55 0.61 NA NA 0.05 0.78 0.84 NA NA XXX
73030 .... TC .... A X-ray exam of shoulder ........................................ 0.00 0.49 0.55 NA NA 0.04 0.53 0.59 NA NA XXX
Sfmt 4700
73030 .... 26 ..... A X-ray exam of shoulder ........................................ 0.18 0.06 0.06 0.06 0.06 0.01 0.25 0.25 0.25 0.25 XXX
73040 .... .......... A Contrast x-ray of shoulder ................................... 0.54 2.11 2.24 NA NA 0.14 2.79 2.92 NA NA XXX
73040 .... TC .... A Contrast x-ray of shoulder ................................... 0.00 1.95 2.06 NA NA 0.12 2.07 2.18 NA NA XXX
73040 .... 26 ..... A Contrast x-ray of shoulder ................................... 0.54 0.16 0.18 0.16 0.18 0.02 0.72 0.74 0.72 0.74 XXX
73050 .... .......... A X-ray exam of shoulders ...................................... 0.20 0.71 0.73 NA NA 0.05 0.96 0.98 NA NA XXX
73050 .... TC .... A X-ray exam of shoulders ...................................... 0.00 0.64 0.66 NA NA 0.04 0.68 0.70 NA NA XXX
73050 .... 26 ..... A X-ray exam of shoulders ...................................... 0.20 0.07 0.07 0.07 0.07 0.01 0.28 0.28 0.28 0.28 XXX
73060 .... .......... A X-ray exam of humerus ....................................... 0.17 0.55 0.61 NA NA 0.05 0.77 0.83 NA NA XXX
73060 .... TC .... A X-ray exam of humerus ....................................... 0.00 0.50 0.55 NA NA 0.04 0.54 0.59 NA NA XXX
E:\FR\FM\01DER2.SGM
73060 .... 26 ..... A X-ray exam of humerus ....................................... 0.17 0.05 0.06 0.05 0.06 0.01 0.23 0.24 0.23 0.24 XXX
73070 .... .......... A X-ray exam of elbow ............................................ 0.15 0.54 0.56 NA NA 0.03 0.72 0.74 NA NA XXX
73070 .... TC .... A X-ray exam of elbow ............................................ 0.00 0.49 0.51 NA NA 0.02 0.51 0.53 NA NA XXX
73070 .... 26 ..... A X-ray exam of elbow ............................................ 0.15 0.05 0.05 0.05 0.05 0.01 0.21 0.21 0.21 0.21 XXX
01DER2
73080 .... .......... A X-ray exam of elbow ............................................ 0.17 0.72 0.66 NA NA 0.05 0.94 0.88 NA NA XXX
73080 .... TC .... A X-ray exam of elbow ............................................ 0.00 0.67 0.60 NA NA 0.04 0.71 0.64 NA NA XXX
73080 .... 26 ..... A X-ray exam of elbow ............................................ 0.17 0.05 0.06 0.05 0.06 0.01 0.23 0.24 0.23 0.24 XXX
73085 .... .......... A Contrast x-ray of elbow ........................................ 0.54 1.74 2.15 NA NA 0.14 2.42 2.83 NA NA XXX
73085 .... TC .... A Contrast x-ray of elbow ........................................ 0.00 1.58 1.97 NA NA 0.12 1.70 2.09 NA NA XXX
73085 .... 26 ..... A Contrast x-ray of elbow ........................................ 0.54 0.16 0.18 0.16 0.18 0.02 0.72 0.74 0.72 0.74 XXX
Year Year Year
2007 2007 Fully Im-
VerDate Aug<31>2005
RVUs cility Total
RVUs
73090 .... .......... A X-ray exam of forearm ......................................... 0.16 0.52 0.56 NA NA 0.03 0.71 0.75 NA NA XXX
73090 .... TC .... A X-ray exam of forearm ......................................... 0.00 0.48 0.51 NA NA 0.02 0.50 0.53 NA NA XXX
73090 .... 26 ..... A X-ray exam of forearm ......................................... 0.16 0.04 0.05 0.04 0.05 0.01 0.21 0.22 0.21 0.22 XXX
10:50 Nov 30, 2006

73092 .... .......... A X-ray exam of arm, infant .................................... 0.16 0.55 0.55 NA NA 0.03 0.74 0.74 NA NA XXX
73092 .... TC .... A X-ray exam of arm, infant .................................... 0.00 0.51 0.50 NA NA 0.02 0.53 0.52 NA NA XXX
73092 .... 26 ..... A X-ray exam of arm, infant .................................... 0.16 0.04 0.05 0.04 0.05 0.01 0.21 0.22 0.21 0.22 XXX
73100 .... .......... A X-ray exam of wrist .............................................. 0.16 0.59 0.55 NA NA 0.03 0.78 0.74 NA NA XXX
73100 .... TC .... A X-ray exam of wrist .............................................. 0.00 0.54 0.50 NA NA 0.02 0.56 0.52 NA NA XXX
Jkt 211001
73100 .... 26 ..... A X-ray exam of wrist .............................................. 0.16 0.05 0.05 0.05 0.05 0.01 0.22 0.22 0.22 0.22 XXX
73110 .... .......... A X-ray exam of wrist .............................................. 0.17 0.74 0.63 NA NA 0.03 0.94 0.83 NA NA XXX
73110 .... TC .... A X-ray exam of wrist .............................................. 0.00 0.69 0.57 NA NA 0.02 0.71 0.59 NA NA XXX
73110 .... 26 ..... A X-ray exam of wrist .............................................. 0.17 0.05 0.06 0.05 0.06 0.01 0.23 0.24 0.23 0.24 XXX
PO 00000
73115 .... .......... A Contrast x-ray of wrist .......................................... 0.54 2.28 1.89 NA NA 0.12 2.94 2.55 NA NA XXX
73115 .... TC .... A Contrast x-ray of wrist .......................................... 0.00 2.11 1.71 NA NA 0.10 2.21 1.81 NA NA XXX
73115 .... 26 ..... A Contrast x-ray of wrist .......................................... 0.54 0.17 0.18 0.17 0.18 0.02 0.73 0.74 0.73 0.74 XXX
73120 .... .......... A X-ray exam of hand ............................................. 0.16 0.54 0.54 NA NA 0.03 0.73 0.73 NA NA XXX
Frm 00309
73120 .... TC .... A X-ray exam of hand ............................................. 0.00 0.49 0.49 NA NA 0.02 0.51 0.51 NA NA XXX
73120 .... 26 ..... A X-ray exam of hand ............................................. 0.16 0.05 0.05 0.05 0.05 0.01 0.22 0.22 0.22 0.22 XXX
73130 .... .......... A X-ray exam of hand ............................................. 0.17 0.63 0.60 NA NA 0.03 0.83 0.80 NA NA XXX
73130 .... TC .... A X-ray exam of hand ............................................. 0.00 0.58 0.54 NA NA 0.02 0.60 0.56 NA NA XXX
Fmt 4701
73130 .... 26 ..... A X-ray exam of hand ............................................. 0.17 0.05 0.06 0.05 0.06 0.01 0.23 0.24 0.23 0.24 XXX
73140 .... .......... A X-ray exam of finger(s) ........................................ 0.13 0.65 0.51 NA NA 0.03 0.81 0.67 NA NA XXX
73140 .... TC .... A X-ray exam of finger(s) ........................................ 0.00 0.61 0.47 NA NA 0.02 0.63 0.49 NA NA XXX
73140 .... 26 ..... A X-ray exam of finger(s) ........................................ 0.13 0.04 0.04 0.04 0.04 0.01 0.18 0.18 0.18 0.18 XXX
Sfmt 4700
73200 .... .......... A Ct upper extremity w/o dye .................................. 1.09 6.03 5.50 NA NA 0.30 7.42 6.89 NA NA XXX
73200 .... TC .... A Ct upper extremity w/o dye .................................. 0.00 5.72 5.15 NA NA 0.25 5.97 5.40 NA NA XXX
73200 .... 26 ..... A Ct upper extremity w/o dye .................................. 1.09 0.31 0.35 0.31 0.35 0.05 1.45 1.49 1.45 1.49 XXX
73201 .... .......... A Ct upper extremity w/dye ..................................... 1.16 7.45 6.58 NA NA 0.36 8.97 8.10 NA NA XXX
73201 .... TC .... A Ct upper extremity w/dye ..................................... 0.00 7.12 6.21 NA NA 0.31 7.43 6.52 NA NA XXX
73201 .... 26 ..... A Ct upper extremity w/dye ..................................... 1.16 0.33 0.37 0.33 0.37 0.05 1.54 1.58 1.54 1.58 XXX
73202 .... .......... A Ct uppr extremity w/o&w/dye ............................... 1.22 10.06 8.38 NA NA 0.44 11.72 10.04 NA NA XXX
73202 .... TC .... A Ct uppr extremity w/o&w/dye ............................... 0.00 9.71 7.99 NA NA 0.39 10.10 8.38 NA NA XXX
73202 .... 26 ..... A Ct uppr extremity w/o&w/dye ............................... 1.22 0.35 0.39 0.35 0.39 0.05 1.62 1.66 1.62 1.66 XXX
E:\FR\FM\01DER2.SGM
73206 .... .......... A Ct angio upr extrm w/o&w/dye ............................. 1.81 10.21 11.22 NA NA 0.47 12.49 13.50 NA NA XXX
73206 .... TC .... A Ct angio upr extrm w/o&w/dye ............................. 0.00 9.67 10.64 NA NA 0.39 10.06 11.03 NA NA XXX
73206 .... 26 ..... A Ct angio upr extrm w/o&w/dye ............................. 1.81 0.54 0.58 0.54 0.58 0.08 2.43 2.47 2.43 2.47 XXX
73218 .... .......... A Mri upper extremity w/o dye ................................ 1.35 14.04 12.24 NA NA 0.45 15.84 14.04 NA NA XXX
01DER2
73218 .... TC .... A Mri upper extremity w/o dye ................................ 0.00 13.65 11.81 NA NA 0.39 14.04 12.20 NA NA XXX
73218 .... 26 ..... A Mri upper extremity w/o dye ................................ 1.35 0.39 0.43 0.39 0.43 0.06 1.80 1.84 1.80 1.84 XXX
73219 .... .......... A Mri upper extremity w/dye .................................... 1.62 14.65 14.15 NA NA 0.54 16.81 16.31 NA NA XXX
73219 .... TC .... A Mri upper extremity w/dye .................................... 0.00 14.18 13.63 NA NA 0.47 14.65 14.10 NA NA XXX
73219 .... 26 ..... A Mri upper extremity w/dye .................................... 1.62 0.47 0.52 0.47 0.52 0.07 2.16 2.21 2.16 2.21 XXX
73220 .... .......... A Mri uppr extremity w/o&w/dye .............................. 2.15 18.09 23.72 NA NA 0.94 21.18 26.81 NA NA XXX
69931
Year
69932
Year Year
2007 2007 Fully Im-
VerDate Aug<31>2005
RVUs cility Total
RVUs
73220 .... TC .... A Mri uppr extremity w/o&w/dye .............................. 0.00 17.48 23.03 NA NA 0.84 18.32 23.87 NA NA XXX
73220 .... 26 ..... A Mri uppr extremity w/o&w/dye .............................. 2.15 0.61 0.69 0.61 0.69 0.10 2.86 2.94 2.86 2.94 XXX
73221 .... .......... A Mri joint upr extrem w/o dye ................................ 1.35 12.98 11.98 NA NA 0.45 14.78 13.78 NA NA XXX
10:50 Nov 30, 2006

73221 .... TC .... A Mri joint upr extrem w/o dye ................................ 0.00 12.58 11.55 NA NA 0.39 12.97 11.94 NA NA XXX
73221 .... 26 ..... A Mri joint upr extrem w/o dye ................................ 1.35 0.40 0.43 0.40 0.43 0.06 1.81 1.84 1.81 1.84 XXX
73222 .... .......... A Mri joint upr extrem w/dye ................................... 1.62 13.63 13.89 NA NA 0.54 15.79 16.05 NA NA XXX
73222 .... TC .... A Mri joint upr extrem w/dye ................................... 0.00 13.16 13.37 NA NA 0.47 13.63 13.84 NA NA XXX
73222 .... 26 ..... A Mri joint upr extrem w/dye ................................... 1.62 0.47 0.52 0.47 0.52 0.07 2.16 2.21 2.16 2.21 XXX
Jkt 211001
73223 .... .......... A Mri joint upr extr w/o&w/dye ................................ 2.15 16.13 23.40 NA NA 0.94 19.22 26.49 NA NA XXX
73223 .... TC .... A Mri joint upr extr w/o&w/dye ................................ 0.00 16.13 22.69 NA NA 0.84 16.97 23.53 NA NA XXX
73223 .... 26 ..... A Mri joint upr extr w/o&w/dye ................................ 2.15 0.00 0.71 0.00 0.71 0.10 2.25 2.96 2.25 2.96 XXX
73225 .... .......... N Mr angio upr extr w/o&w/dye ............................... 1.73 14.47 12.38 NA NA 0.69 16.89 14.80 NA NA XXX
PO 00000
73225 .... TC .... N Mr angio upr extr w/o&w/dye ............................... 0.00 14.07 11.78 NA NA 0.59 14.66 12.37 NA NA XXX
73225 .... 26 ..... N Mr angio upr extr w/o&w/dye ............................... 1.73 0.40 0.60 0.40 0.60 0.10 2.23 2.43 2.23 2.43 XXX
73500 .... .......... A X-ray exam of hip ................................................. 0.17 0.46 0.52 NA NA 0.03 0.66 0.72 NA NA XXX
73500 .... TC .... A X-ray exam of hip ................................................. 0.00 0.41 0.46 NA NA 0.02 0.43 0.48 NA NA XXX
Frm 00310
73500 .... 26 ..... A X-ray exam of hip ................................................. 0.17 0.05 0.06 0.05 0.06 0.01 0.23 0.24 0.23 0.24 XXX
73510 .... .......... A X-ray exam of hip ................................................. 0.21 0.74 0.67 NA NA 0.05 1.00 0.93 NA NA XXX
73510 .... TC .... A X-ray exam of hip ................................................. 0.00 0.68 0.60 NA NA 0.04 0.72 0.64 NA NA XXX
Fmt 4701
73520 .... .......... A X-ray exam of hips ............................................... 0.26 0.75 0.76 NA NA 0.05 1.06 1.07 NA NA XXX
73520 .... TC .... A X-ray exam of hips ............................................... 0.00 0.67 0.67 NA NA 0.04 0.71 0.71 NA NA XXX
73520 .... 26 ..... A X-ray exam of hips ............................................... 0.26 0.08 0.09 0.08 0.09 0.01 0.35 0.36 0.35 0.36 XXX
73525 .... .......... A Contrast x-ray of hip ............................................ 0.54 1.72 2.15 NA NA 0.15 2.41 2.84 NA NA XXX
Sfmt 4700
73525 .... TC .... A Contrast x-ray of hip ............................................ 0.00 1.56 1.97 NA NA 0.12 1.68 2.09 NA NA XXX
73525 .... 26 ..... A Contrast x-ray of hip ............................................ 0.54 0.16 0.18 0.16 0.18 0.03 0.73 0.75 0.73 0.75 XXX
73530 .... .......... C X-ray exam of hip ................................................. 0.00 NA NA NA NA 0.00 NA NA NA NA XXX
73530 .... TC .... C X-ray exam of hip ................................................. 0.00 NA NA NA NA 0.00 NA NA NA NA XXX
73540 .... .......... A X-ray exam of pelvis & hips ................................. 0.20 0.78 0.68 NA NA 0.05 1.03 0.93 NA NA XXX
73540 .... TC .... A X-ray exam of pelvis & hips ................................. 0.00 0.71 0.61 NA NA 0.04 0.75 0.65 NA NA XXX
73540 .... 26 ..... A X-ray exam of pelvis & hips ................................. 0.20 0.07 0.07 0.07 0.07 0.01 0.28 0.28 0.28 0.28 XXX
73542 .... .......... A X-ray exam, sacroiliac joint .................................. 0.59 1.10 1.98 NA NA 0.15 1.84 2.72 NA NA XXX
E:\FR\FM\01DER2.SGM
73542 .... TC .... A X-ray exam, sacroiliac joint .................................. 0.00 0.96 1.82 NA NA 0.12 1.08 1.94 NA NA XXX
73542 .... 26 ..... A X-ray exam, sacroiliac joint .................................. 0.59 0.14 0.16 0.14 0.16 0.03 0.76 0.78 0.76 0.78 XXX
73550 .... .......... A X-ray exam of thigh .............................................. 0.17 0.52 0.61 NA NA 0.05 0.74 0.83 NA NA XXX
73550 .... TC .... A X-ray exam of thigh .............................................. 0.00 0.47 0.55 NA NA 0.04 0.51 0.59 NA NA XXX
01DER2
73550 .... 26 ..... A X-ray exam of thigh .............................................. 0.17 0.05 0.06 0.05 0.06 0.01 0.23 0.24 0.23 0.24 XXX
73560 .... .......... A X-ray exam of knee, 1 or 2 .................................. 0.17 0.56 0.58 NA NA 0.03 0.76 0.78 NA NA XXX
73560 .... TC .... A X-ray exam of knee, 1 or 2 .................................. 0.00 0.51 0.52 NA NA 0.02 0.53 0.54 NA NA XXX
73560 .... 26 ..... A X-ray exam of knee, 1 or 2 .................................. 0.17 0.05 0.06 0.05 0.06 0.01 0.23 0.24 0.23 0.24 XXX
73562 .... .......... A X-ray exam of knee, 3 ......................................... 0.18 0.71 0.65 NA NA 0.05 0.94 0.88 NA NA XXX
73562 .... TC .... A X-ray exam of knee, 3 ......................................... 0.00 0.65 0.59 NA NA 0.04 0.69 0.63 NA NA XXX
Year Year Year
2007 2007 Fully Im-
VerDate Aug<31>2005
RVUs cility Total
RVUs
73562 .... 26 ..... A X-ray exam of knee, 3 ......................................... 0.18 0.06 0.06 0.06 0.06 0.01 0.25 0.25 0.25 0.25 XXX
73564 .... .......... A X-ray exam, knee, 4 or more ............................... 0.22 0.83 0.73 NA NA 0.05 1.10 1.00 NA NA XXX
73564 .... TC .... A X-ray exam, knee, 4 or more ............................... 0.00 0.76 0.66 NA NA 0.04 0.80 0.70 NA NA XXX
10:50 Nov 30, 2006

73564 .... 26 ..... A X-ray exam, knee, 4 or more ............................... 0.22 0.07 0.07 0.07 0.07 0.01 0.30 0.30 0.30 0.30 XXX
73565 .... .......... A X-ray exam of knees ............................................ 0.17 0.64 0.57 NA NA 0.03 0.84 0.77 NA NA XXX
73565 .... TC .... A X-ray exam of knees ............................................ 0.00 0.58 0.51 NA NA 0.02 0.60 0.53 NA NA XXX
73565 .... 26 ..... A X-ray exam of knees ............................................ 0.17 0.06 0.06 0.06 0.06 0.01 0.24 0.24 0.24 0.24 XXX
73580 .... .......... A Contrast x-ray of knee joint .................................. 0.54 2.32 2.67 NA NA 0.17 3.03 3.38 NA NA XXX
Jkt 211001
73580 .... TC .... A Contrast x-ray of knee joint .................................. 0.00 2.15 2.50 NA NA 0.14 2.29 2.64 NA NA XXX
73580 .... 26 ..... A Contrast x-ray of knee joint .................................. 0.54 0.17 0.17 0.17 0.17 0.03 0.74 0.74 0.74 0.74 XXX
73590 .... .......... A X-ray exam of lower leg ....................................... 0.17 0.51 0.57 NA NA 0.03 0.71 0.77 NA NA XXX
73590 .... TC .... A X-ray exam of lower leg ....................................... 0.00 0.46 0.51 NA NA 0.02 0.48 0.53 NA NA XXX
PO 00000
73590 .... 26 ..... A X-ray exam of lower leg ....................................... 0.17 0.05 0.06 0.05 0.06 0.01 0.23 0.24 0.23 0.24 XXX
73592 .... .......... A X-ray exam of leg, infant ...................................... 0.16 0.57 0.55 NA NA 0.03 0.76 0.74 NA NA XXX
73592 .... TC .... A X-ray exam of leg, infant ...................................... 0.00 0.53 0.50 NA NA 0.02 0.55 0.52 NA NA XXX
73592 .... 26 ..... A X-ray exam of leg, infant ...................................... 0.16 0.04 0.05 0.04 0.05 0.01 0.21 0.22 0.21 0.22 XXX
Frm 00311
73600 .... .......... A X-ray exam of ankle ............................................. 0.16 0.55 0.54 NA NA 0.03 0.74 0.73 NA NA XXX
73600 .... TC .... A X-ray exam of ankle ............................................. 0.00 0.50 0.49 NA NA 0.02 0.52 0.51 NA NA XXX
73600 .... 26 ..... A X-ray exam of ankle ............................................. 0.16 0.05 0.05 0.05 0.05 0.01 0.22 0.22 0.22 0.22 XXX
73610 .... .......... A X-ray exam of ankle ............................................. 0.17 0.64 0.61 NA NA 0.03 0.84 0.81 NA NA XXX
Fmt 4701
73610 .... TC .... A X-ray exam of ankle ............................................. 0.00 0.59 0.55 NA NA 0.02 0.61 0.57 NA NA XXX
73610 .... 26 ..... A X-ray exam of ankle ............................................. 0.17 0.05 0.06 0.05 0.06 0.01 0.23 0.24 0.23 0.24 XXX
73615 .... .......... A Contrast x-ray of ankle ......................................... 0.54 1.83 2.17 NA NA 0.15 2.52 2.86 NA NA XXX
73615 .... TC .... A Contrast x-ray of ankle ......................................... 0.00 1.67 1.99 NA NA 0.12 1.79 2.11 NA NA XXX
Sfmt 4700
73615 .... 26 ..... A Contrast x-ray of ankle ......................................... 0.54 0.16 0.18 0.16 0.18 0.03 0.73 0.75 0.73 0.75 XXX
73620 .... .......... A X-ray exam of foot ............................................... 0.16 0.52 0.54 NA NA 0.03 0.71 0.73 NA NA XXX
73620 .... TC .... A X-ray exam of foot ............................................... 0.00 0.48 0.49 NA NA 0.02 0.50 0.51 NA NA XXX
73620 .... 26 ..... A X-ray exam of foot ............................................... 0.16 0.04 0.05 0.04 0.05 0.01 0.21 0.22 0.21 0.22 XXX
73630 .... .......... A X-ray exam of foot ............................................... 0.17 0.63 0.60 NA NA 0.03 0.83 0.80 NA NA XXX
73630 .... TC .... A X-ray exam of foot ............................................... 0.00 0.58 0.54 NA NA 0.02 0.60 0.56 NA NA XXX
73630 .... 26 ..... A X-ray exam of foot ............................................... 0.17 0.05 0.06 0.05 0.06 0.01 0.23 0.24 0.23 0.24 XXX
73650 .... .......... A X-ray exam of heel ............................................... 0.16 0.54 0.53 NA NA 0.03 0.73 0.72 NA NA XXX
73650 .... TC .... A X-ray exam of heel ............................................... 0.00 0.49 0.48 NA NA 0.02 0.51 0.50 NA NA XXX
E:\FR\FM\01DER2.SGM
73650 .... 26 ..... A X-ray exam of heel ............................................... 0.16 0.05 0.05 0.05 0.05 0.01 0.22 0.22 0.22 0.22 XXX
73660 .... .......... A X-ray exam of toe(s) ............................................ 0.13 0.62 0.50 NA NA 0.03 0.78 0.66 NA NA XXX
73660 .... TC .... A X-ray exam of toe(s) ............................................ 0.00 0.58 0.46 NA NA 0.02 0.60 0.48 NA NA XXX
73660 .... 26 ..... A X-ray exam of toe(s) ............................................ 0.13 0.04 0.04 0.04 0.04 0.01 0.18 0.18 0.18 0.18 XXX
01DER2
73700 .... .......... A Ct lower extremity w/o dye .................................. 1.09 6.04 5.50 NA NA 0.30 7.43 6.89 NA NA XXX
73700 .... TC .... A Ct lower extremity w/o dye .................................. 0.00 5.73 5.15 NA NA 0.25 5.98 5.40 NA NA XXX
73700 .... 26 ..... A Ct lower extremity w/o dye .................................. 1.09 0.31 0.35 0.31 0.35 0.05 1.45 1.49 1.45 1.49 XXX
73701 .... .......... A Ct lower extremity w/dye ...................................... 1.16 7.50 6.60 NA NA 0.36 9.02 8.12 NA NA XXX
73701 .... TC .... A Ct lower extremity w/dye ...................................... 0.00 7.17 6.23 NA NA 0.31 7.48 6.54 NA NA XXX
73701 .... 26 ..... A Ct lower extremity w/dye ...................................... 1.16 0.33 0.37 0.33 0.37 0.05 1.54 1.58 1.54 1.58 XXX
69933
Year
69934
Year Year
2007 2007 Fully Im-
VerDate Aug<31>2005
RVUs cility Total
RVUs
73702 .... .......... A Ct lwr extremity w/o&w/dye .................................. 1.22 10.14 8.40 NA NA 0.44 11.80 10.06 NA NA XXX
73702 .... TC .... A Ct lwr extremity w/o&w/dye .................................. 0.00 9.78 8.01 NA NA 0.39 10.17 8.40 NA NA XXX
73702 .... 26 ..... A Ct lwr extremity w/o&w/dye .................................. 1.22 0.36 0.39 0.36 0.39 0.05 1.63 1.66 1.63 1.66 XXX
10:50 Nov 30, 2006

73706 .... .......... A Ct angio lwr extr w/o&w/dye ................................ 1.90 11.69 11.61 NA NA 0.47 14.06 13.98 NA NA XXX
73706 .... TC .... A Ct angio lwr extr w/o&w/dye ................................ 0.00 11.09 10.99 NA NA 0.39 11.48 11.38 NA NA XXX
73706 .... 26 ..... A Ct angio lwr extr w/o&w/dye ................................ 1.90 0.60 0.62 0.60 0.62 0.08 2.58 2.60 2.58 2.60 XXX
73718 .... .......... A Mri lower extremity w/o dye ................................. 1.35 13.64 12.14 NA NA 0.45 15.44 13.94 NA NA XXX
73718 .... TC .... A Mri lower extremity w/o dye ................................. 0.00 13.25 11.71 NA NA 0.39 13.64 12.10 NA NA XXX
Jkt 211001
73718 .... 26 ..... A Mri lower extremity w/o dye ................................. 1.35 0.39 0.43 0.39 0.43 0.06 1.80 1.84 1.80 1.84 XXX
73719 .... .......... A Mri lower extremity w/dye .................................... 1.62 14.58 14.12 NA NA 0.54 16.74 16.28 NA NA XXX
73719 .... TC .... A Mri lower extremity w/dye .................................... 0.00 14.12 13.61 NA NA 0.47 14.59 14.08 NA NA XXX
73719 .... 26 ..... A Mri lower extremity w/dye .................................... 1.62 0.46 0.51 0.46 0.51 0.07 2.15 2.20 2.15 2.20 XXX
PO 00000
73720 .... .......... A Mri lwr extremity w/o&w/dye ................................ 2.15 18.05 23.70 NA NA 0.94 21.14 26.79 NA NA XXX
73720 .... TC .... A Mri lwr extremity w/o&w/dye ................................ 0.00 17.44 23.02 NA NA 0.84 18.28 23.86 NA NA XXX
73720 .... 26 ..... A Mri lwr extremity w/o&w/dye ................................ 2.15 0.61 0.68 0.61 0.68 0.10 2.86 2.93 2.86 2.93 XXX
73721 .... .......... A Mri jnt of lwr extre w/o dye .................................. 1.35 13.26 12.05 NA NA 0.45 15.06 13.85 NA NA XXX
Frm 00312
73721 .... TC .... A Mri jnt of lwr extre w/o dye .................................. 0.00 12.86 11.62 NA NA 0.39 13.25 12.01 NA NA XXX
73721 .... 26 ..... A Mri jnt of lwr extre w/o dye .................................. 1.35 0.40 0.43 0.40 0.43 0.06 1.81 1.84 1.81 1.84 XXX
73722 .... .......... A Mri joint of lwr extr w/dye ..................................... 1.62 13.88 13.95 NA NA 0.54 16.04 16.11 NA NA XXX
73722 .... TC .... A Mri joint of lwr extr w/dye ..................................... 0.00 13.40 13.43 NA NA 0.47 13.87 13.90 NA NA XXX
Fmt 4701
73722 .... 26 ..... A Mri joint of lwr extr w/dye ..................................... 1.62 0.48 0.52 0.48 0.52 0.07 2.17 2.21 2.17 2.21 XXX
73723 .... .......... A Mri joint lwr extr w/o&w/dye ................................. 2.15 16.70 23.37 NA NA 0.94 19.79 26.46 NA NA XXX
73723 .... TC .... A Mri joint lwr extr w/o&w/dye ................................. 0.00 16.09 22.68 NA NA 0.84 16.93 23.52 NA NA XXX
73723 .... 26 ..... A Mri joint lwr extr w/o&w/dye ................................. 2.15 0.61 0.69 0.61 0.69 0.10 2.86 2.94 2.86 2.94 XXX
Sfmt 4700
73725 .... .......... R Mr ang lwr ext w or w/o dye ................................ 1.82 14.34 12.44 NA NA 0.67 16.83 14.93 NA NA XXX
73725 .... TC .... R Mr ang lwr ext w or w/o dye ................................ 0.00 13.82 11.86 NA NA 0.59 14.41 12.45 NA NA XXX
73725 .... 26 ..... R Mr ang lwr ext w or w/o dye ................................ 1.82 0.52 0.58 0.52 0.58 0.08 2.42 2.48 2.42 2.48 XXX
74000 .... .......... A X-ray exam of abdomen ...................................... 0.18 0.43 0.55 NA NA 0.03 0.64 0.76 NA NA XXX
74000 .... TC .... A X-ray exam of abdomen ...................................... 0.00 0.38 0.49 NA NA 0.02 0.40 0.51 NA NA XXX
74000 .... 26 ..... A X-ray exam of abdomen ...................................... 0.18 0.05 0.06 0.05 0.06 0.01 0.24 0.25 0.24 0.25 XXX
E:\FR\FM\01DER2.SGM
74022 .... .......... A X-ray exam series, abdomen ............................... 0.32 0.91 0.85 NA NA 0.06 1.29 1.23 NA NA XXX
01DER2
74022 .... TC .... A X-ray exam series, abdomen ............................... 0.00 0.82 0.75 NA NA 0.05 0.87 0.80 NA NA XXX
74022 .... 26 ..... A X-ray exam series, abdomen ............................... 0.32 0.09 0.10 0.09 0.10 0.01 0.42 0.43 0.42 0.43 XXX
74150 .... .......... A Ct abdomen w/o dye ............................................ 1.19 5.70 5.97 NA NA 0.35 7.24 7.51 NA NA XXX
74150 .... TC .... A Ct abdomen w/o dye ............................................ 0.00 5.36 5.59 NA NA 0.30 5.66 5.89 NA NA XXX
74150 .... 26 ..... A Ct abdomen w/o dye ............................................ 1.19 0.34 0.38 0.34 0.38 0.05 1.58 1.62 1.58 1.62 XXX
74160 .... .......... A Ct abdomen w/dye ............................................... 1.27 8.32 7.53 NA NA 0.42 10.01 9.22 NA NA XXX
Year Year Year
2007 2007 Fully Im-
VerDate Aug<31>2005
RVUs cility Total
RVUs
74160 .... TC .... A Ct abdomen w/dye ............................................... 0.00 7.96 7.12 NA NA 0.36 8.32 7.48 NA NA XXX
74160 .... 26 ..... A Ct abdomen w/dye ............................................... 1.27 0.36 0.41 0.36 0.41 0.06 1.69 1.74 1.69 1.74 XXX
74170 .... .......... A Ct abdomen w/o & w/dye ..................................... 1.40 11.54 9.60 NA NA 0.49 13.43 11.49 NA NA XXX
10:50 Nov 30, 2006

74170 .... TC .... A Ct abdomen w/o & w/dye ..................................... 0.00 11.14 9.15 NA NA 0.43 11.57 9.58 NA NA XXX
74170 .... 26 ..... A Ct abdomen w/o & w/dye ..................................... 1.40 0.40 0.45 0.40 0.45 0.06 1.86 1.91 1.86 1.91 XXX
74175 .... .......... A Ct angio abdom w/o & w/dye ............................... 1.90 11.60 12.39 NA NA 0.47 13.97 14.76 NA NA XXX
74175 .... TC .... A Ct angio abdom w/o & w/dye ............................... 0.00 11.04 11.78 NA NA 0.39 11.43 12.17 NA NA XXX
74175 .... 26 ..... A Ct angio abdom w/o & w/dye ............................... 1.90 0.56 0.61 0.56 0.61 0.08 2.54 2.59 2.54 2.59 XXX
Jkt 211001
74181 .... .......... A Mri abdomen w/o dye .......................................... 1.46 11.79 11.71 NA NA 0.51 13.76 13.68 NA NA XXX
74181 .... TC .... A Mri abdomen w/o dye .......................................... 0.00 11.38 11.25 NA NA 0.45 11.83 11.70 NA NA XXX
74181 .... 26 ..... A Mri abdomen w/o dye .......................................... 1.46 0.41 0.46 0.41 0.46 0.06 1.93 1.98 1.93 1.98 XXX
74182 .... .......... A Mri abdomen w/dye .............................................. 1.73 16.49 14.63 NA NA 0.60 18.82 16.96 NA NA XXX
PO 00000
74182 .... TC .... A Mri abdomen w/dye .............................................. 0.00 16.00 14.08 NA NA 0.52 16.52 14.60 NA NA XXX
74182 .... 26 ..... A Mri abdomen w/dye .............................................. 1.73 0.49 0.55 0.49 0.55 0.08 2.30 2.36 2.30 2.36 XXX
74183 .... .......... A Mri abdomen w/o & w/dye ................................... 2.26 18.00 23.72 NA NA 1.02 21.28 27.00 NA NA XXX
74183 .... TC .... A Mri abdomen w/o & w/dye ................................... 0.00 17.36 23.00 NA NA 0.92 18.28 23.92 NA NA XXX
Frm 00313
74183 .... 26 ..... A Mri abdomen w/o & w/dye ................................... 2.26 0.64 0.72 0.64 0.72 0.10 3.00 3.08 3.00 3.08 XXX
74185 .... .......... R Mri angio, abdom w orw/o dye ............................ 1.80 14.30 12.42 NA NA 0.67 16.77 14.89 NA NA XXX
74185 .... TC .... R Mri angio, abdom w orw/o dye ............................ 0.00 13.78 11.85 NA NA 0.59 14.37 12.44 NA NA XXX
74185 .... 26 ..... R Mri angio, abdom w orw/o dye ............................ 1.80 0.52 0.57 0.52 0.57 0.08 2.40 2.45 2.40 2.45 XXX
Fmt 4701
74190 .... .......... C X-ray exam of peritoneum ................................... 0.00 NA NA NA NA 0.00 NA NA NA NA XXX
74190 .... TC .... C X-ray exam of peritoneum ................................... 0.00 NA NA NA NA 0.00 NA NA NA NA XXX
74190 .... 26 ..... A X-ray exam of peritoneum ................................... 0.48 0.14 0.16 0.14 0.16 0.02 0.64 0.66 0.64 0.66 XXX
74210 .... .......... A Contrst x-ray exam of throat ................................ 0.36 1.65 1.40 NA NA 0.08 2.09 1.84 NA NA XXX
Sfmt 4700
74210 .... TC .... A Contrst x-ray exam of throat ................................ 0.00 1.55 1.28 NA NA 0.06 1.61 1.34 NA NA XXX
74210 .... 26 ..... A Contrst x-ray exam of throat ................................ 0.36 0.10 0.12 0.10 0.12 0.02 0.48 0.50 0.48 0.50 XXX
74220 .... .......... A Contrast x-ray, esophagus ................................... 0.46 1.89 1.48 NA NA 0.08 2.43 2.02 NA NA XXX
74220 .... TC .... A Contrast x-ray, esophagus ................................... 0.00 1.76 1.33 NA NA 0.06 1.82 1.39 NA NA XXX
74220 .... 26 ..... A Contrast x-ray, esophagus ................................... 0.46 0.13 0.15 0.13 0.15 0.02 0.61 0.63 0.61 0.63 XXX
74230 .... .......... A Cine/vid x-ray, throat/esoph ................................. 0.53 1.81 1.57 NA NA 0.09 2.43 2.19 NA NA XXX
74230 .... TC .... A Cine/vid x-ray, throat/esoph ................................. 0.00 1.66 1.40 NA NA 0.07 1.73 1.47 NA NA XXX
74230 .... 26 ..... A Cine/vid x-ray, throat/esoph ................................. 0.53 0.15 0.17 0.15 0.17 0.02 0.70 0.72 0.70 0.72 XXX
74235 .... .......... C Remove esophagus obstruction .......................... 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 XXX
E:\FR\FM\01DER2.SGM
74235 .... TC .... C Remove esophagus obstruction .......................... 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 XXX
74235 .... 26 ..... A Remove esophagus obstruction .......................... 1.19 0.38 0.39 0.38 0.39 0.05 1.62 1.63 1.62 1.63 XXX
74240 .... .......... A X-ray exam, upper gi tract ................................... 0.69 2.14 1.80 NA NA 0.11 2.94 2.60 NA NA XXX
74240 .... TC .... A X-ray exam, upper gi tract ................................... 0.00 1.95 1.58 NA NA 0.08 2.03 1.66 NA NA XXX
01DER2
74240 .... 26 ..... A X-ray exam, upper gi tract ................................... 0.69 0.19 0.22 0.19 0.22 0.03 0.91 0.94 0.91 0.94 XXX
69935
Year
69936
Year Year
2007 2007 Fully Im-
VerDate Aug<31>2005
RVUs cility Total
RVUs
74246 .... .......... A Contrst x-ray uppr gi tract .................................... 0.69 2.62 2.06 NA NA 0.13 3.44 2.88 NA NA XXX
74246 .... TC .... A Contrst x-ray uppr gi tract .................................... 0.00 2.42 1.84 NA NA 0.10 2.52 1.94 NA NA XXX
10:50 Nov 30, 2006

74246 .... 26 ..... A Contrst x-ray uppr gi tract .................................... 0.69 0.20 0.22 0.20 0.22 0.03 0.92 0.94 0.92 0.94 XXX
Jkt 211001
74250 .... .......... A X-ray exam of small bowel .................................. 0.47 2.33 1.68 NA NA 0.09 2.89 2.24 NA NA XXX
74250 .... TC .... A X-ray exam of small bowel .................................. 0.00 2.20 1.53 NA NA 0.07 2.27 1.60 NA NA XXX
PO 00000
74250 .... 26 ..... A X-ray exam of small bowel .................................. 0.47 0.13 0.15 0.13 0.15 0.02 0.62 0.64 0.62 0.64 XXX
Frm 00314
74270 .... .......... A Contrast x-ray exam of colon ............................... 0.69 3.35 2.29 NA NA 0.14 4.18 3.12 NA NA XXX
Fmt 4701
74270 .... TC .... A Contrast x-ray exam of colon ............................... 0.00 3.16 2.07 NA NA 0.11 3.27 2.18 NA NA XXX
74270 .... 26 ..... A Contrast x-ray exam of colon ............................... 0.69 0.19 0.22 0.19 0.22 0.03 0.91 0.94 0.91 0.94 XXX
Sfmt 4700
74290 .... .......... A Contrast x-ray, gallbladder ................................... 0.32 1.47 0.99 NA NA 0.06 1.85 1.37 NA NA XXX
74290 .... TC .... A Contrast x-ray, gallbladder ................................... 0.00 1.38 0.89 NA NA 0.05 1.43 0.94 NA NA XXX
74290 .... 26 ..... A Contrast x-ray, gallbladder ................................... 0.32 0.09 0.10 0.09 0.10 0.01 0.42 0.43 0.42 0.43 XXX
74291 .... .......... A Contrast x-rays, gallbladder ................................. 0.20 1.55 0.76 NA NA 0.03 1.78 0.99 NA NA XXX
74291 .... TC .... A Contrast x-rays, gallbladder ................................. 0.00 1.49 0.69 NA NA 0.02 1.51 0.71 NA NA XXX
E:\FR\FM\01DER2.SGM
74291 .... 26 ..... A Contrast x-rays, gallbladder ................................. 0.20 0.06 0.07 0.06 0.07 0.01 0.27 0.28 0.27 0.28 XXX
74300 .... .......... C X-ray bile ducts/pancreas .................................... 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 XXX
74300 .... TC .... C X-ray bile ducts/pancreas .................................... 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 XXX
74300 .... 26 ..... A X-ray bile ducts/pancreas .................................... 0.36 0.10 0.12 0.10 0.12 0.02 0.48 0.50 0.48 0.50 XXX
01DER2
74301 .... .......... C X-rays at surgery add-on ..................................... 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 ZZZ
74301 .... TC .... C X-rays at surgery add-on ..................................... 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 ZZZ
74301 .... 26 ..... A X-rays at surgery add-on ..................................... 0.21 0.06 0.07 0.06 0.07 0.01 0.28 0.29 0.28 0.29 ZZZ
74305 .... .......... C X-ray bile ducts/pancreas .................................... 0.00 NA NA NA NA 0.00 NA NA NA NA XXX
74305 .... TC .... C X-ray bile ducts/pancreas .................................... 0.00 NA NA NA NA 0.00 NA NA NA NA XXX
74305 .... 26 ..... A X-ray bile ducts/pancreas .................................... 0.42 0.12 0.14 0.12 0.14 0.02 0.56 0.58 0.56 0.58 XXX
Year Year Year
2007 2007 Fully Im-
VerDate Aug<31>2005
RVUs cility Total
RVUs
74320 .... .......... A Contrast x-ray of bile ducts .................................. 0.54 2.00 3.00 NA NA 0.19 2.73 3.73 NA NA XXX
74320 .... TC .... A Contrast x-ray of bile ducts .................................. 0.00 1.84 2.82 NA NA 0.17 2.01 2.99 NA NA XXX
74320 .... 26 ..... A Contrast x-ray of bile ducts .................................. 0.54 0.16 0.18 0.16 0.18 0.02 0.72 0.74 0.72 0.74 XXX
10:50 Nov 30, 2006

74327 .... .......... A X-ray bile stone removal ...................................... 0.70 2.78 2.19 NA NA 0.14 3.62 3.03 NA NA XXX
74327 .... TC .... A X-ray bile stone removal ...................................... 0.00 2.58 1.97 NA NA 0.11 2.69 2.08 NA NA XXX
74327 .... 26 ..... A X-ray bile stone removal ...................................... 0.70 0.20 0.22 0.20 0.22 0.03 0.93 0.95 0.93 0.95 XXX
74328 .... .......... C X-ray bile duct endoscopy ................................... 0.00 NA NA NA NA 0.00 NA NA NA NA XXX
74328 .... TC .... C X-ray bile duct endoscopy ................................... 0.00 NA NA NA NA 0.00 NA NA NA NA XXX
Jkt 211001
74328 .... 26 ..... A X-ray bile duct endoscopy ................................... 0.70 0.22 0.23 0.22 0.23 0.03 0.95 0.96 0.95 0.96 XXX
74329 .... .......... C X-ray for pancreas endoscopy ............................. 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 XXX
74329 .... TC .... C X-ray for pancreas endoscopy ............................. 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 XXX
74329 .... 26 ..... A X-ray for pancreas endoscopy ............................. 0.70 0.22 0.23 0.22 0.23 0.03 0.95 0.96 0.95 0.96 XXX
PO 00000
74330 .... .......... C X-ray bile/panc endoscopy ................................... 0.00 NA NA NA NA 0.00 NA NA NA NA XXX
74330 .... TC .... C X-ray bile/panc endoscopy ................................... 0.00 NA NA NA NA 0.00 NA NA NA NA XXX
74330 .... 26 ..... A X-ray bile/panc endoscopy ................................... 0.90 0.27 0.29 0.27 0.29 0.04 1.21 1.23 1.21 1.23 XXX
74340 .... .......... C X-ray guide for GI tube ........................................ 0.00 NA NA NA NA 0.00 NA NA NA NA XXX
Frm 00315
74340 .... TC .... C X-ray guide for GI tube ........................................ 0.00 NA NA NA NA 0.00 NA NA NA NA XXX
74340 .... 26 ..... A X-ray guide for GI tube ........................................ 0.54 0.16 0.18 0.16 0.18 0.02 0.72 0.74 0.72 0.74 XXX
74350 .... .......... A X-ray guide, stomach tube ................................... 0.76 2.07 3.07 NA NA 0.20 3.03 4.03 NA NA XXX
74350 .... TC .... A X-ray guide, stomach tube ................................... 0.00 1.85 2.83 NA NA 0.17 2.02 3.00 NA NA XXX
Fmt 4701
74350 .... 26 ..... A X-ray guide, stomach tube ................................... 0.76 0.22 0.24 0.22 0.24 0.03 1.01 1.03 1.01 1.03 XXX
74355 .... .......... C X-ray guide, intestinal tube .................................. 0.00 NA NA NA NA 0.00 NA NA NA NA XXX
74355 .... TC .... C X-ray guide, intestinal tube .................................. 0.00 NA NA NA NA 0.00 NA NA NA NA XXX
74355 .... 26 ..... A X-ray guide, intestinal tube .................................. 0.76 0.22 0.24 0.22 0.24 0.03 1.01 1.03 1.01 1.03 XXX
Sfmt 4700
74360 .... .......... C X-ray guide, GI dilation ........................................ 0.00 NA NA NA NA 0.00 NA NA NA NA XXX
74360 .... TC .... C X-ray guide, GI dilation ........................................ 0.00 NA NA NA NA 0.00 NA NA NA NA XXX
74360 .... 26 ..... A X-ray guide, GI dilation ........................................ 0.54 0.24 0.20 0.24 0.20 0.02 0.80 0.76 0.80 0.76 XXX
74363 .... .......... C X-ray, bile duct dilation ........................................ 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 XXX
74363 .... TC .... C X-ray, bile duct dilation ........................................ 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 XXX
74363 .... 26 ..... A X-ray, bile duct dilation ........................................ 0.88 0.26 0.28 0.26 0.28 0.04 1.18 1.20 1.18 1.20 XXX
74400 .... .......... A Contrst x-ray, urinary tract ................................... 0.49 2.45 2.00 NA NA 0.13 3.07 2.62 NA NA XXX
74400 .... TC .... A Contrst x-ray, urinary tract ................................... 0.00 2.31 1.84 NA NA 0.11 2.42 1.95 NA NA XXX
74400 .... 26 ..... A Contrst x-ray, urinary tract ................................... 0.49 0.14 0.16 0.14 0.16 0.02 0.65 0.67 0.65 0.67 XXX
E:\FR\FM\01DER2.SGM
01DER2
74420 .... .......... C Contrst x-ray, urinary tract ................................... 0.00 NA NA NA NA 0.00 NA NA NA NA XXX
74420 .... TC .... C Contrst x-ray, urinary tract ................................... 0.00 NA NA NA NA 0.00 NA NA NA NA XXX
74425 .... .......... C Contrst x-ray, urinary tract ................................... 0.00 NA NA NA NA 0.00 NA NA NA NA XXX
69937
Year
69938
Year Year
2007 2007 Fully Im-
VerDate Aug<31>2005
RVUs cility Total
RVUs
74425 .... TC .... C Contrst x-ray, urinary tract ................................... 0.00 NA NA NA NA 0.00 NA NA NA NA XXX
74430 .... .......... A Contrast x-ray, bladder ........................................ 0.32 1.87 1.33 NA NA 0.08 2.27 1.73 NA NA XXX
10:50 Nov 30, 2006

74430 .... TC .... A Contrast x-ray, bladder ........................................ 0.00 1.77 1.23 NA NA 0.06 1.83 1.29 NA NA XXX
74430 .... 26 ..... A Contrast x-ray, bladder ........................................ 0.32 0.10 0.10 0.10 0.10 0.02 0.44 0.44 0.44 0.44 XXX
74440 .... .......... A X-ray, male genital tract ....................................... 0.38 2.17 1.48 NA NA 0.08 2.63 1.94 NA NA XXX
74440 .... TC .... A X-ray, male genital tract ....................................... 0.00 2.02 1.35 NA NA 0.06 2.08 1.41 NA NA XXX
74440 .... 26 ..... A X-ray, male genital tract ....................................... 0.38 0.15 0.13 0.15 0.13 0.02 0.55 0.53 0.55 0.53 XXX
Jkt 211001
74445 .... .......... C X-ray exam of penis ............................................. 0.00 NA NA NA NA 0.00 NA NA NA NA XXX
74445 .... TC .... C X-ray exam of penis ............................................. 0.00 NA NA NA NA 0.00 NA NA NA NA XXX
74445 .... 26 ..... A X-ray exam of penis ............................................. 1.14 0.43 0.39 0.43 0.39 0.07 1.64 1.60 1.64 1.60 XXX
74450 .... .......... C X-ray, urethra/bladder .......................................... 0.00 NA NA NA NA 0.00 NA NA NA NA XXX
PO 00000
74450 .... TC .... C X-ray, urethra/bladder .......................................... 0.00 NA NA NA NA 0.00 NA NA NA NA XXX
74450 .... 26 ..... A X-ray, urethra/bladder .......................................... 0.33 0.11 0.11 0.11 0.11 0.02 0.46 0.46 0.46 0.46 XXX
74455 .... .......... A X-ray, urethra/bladder .......................................... 0.33 2.11 1.79 NA NA 0.12 2.56 2.24 NA NA XXX
74455 .... TC .... A X-ray, urethra/bladder .......................................... 0.00 1.99 1.68 NA NA 0.10 2.09 1.78 NA NA XXX
Frm 00316
74455 .... 26 ..... A X-ray, urethra/bladder .......................................... 0.33 0.12 0.11 0.12 0.11 0.02 0.47 0.46 0.47 0.46 XXX
74470 .... .......... C X-ray exam of kidney lesion ................................ 0.00 NA NA NA NA 0.00 NA NA NA NA XXX
74470 .... TC .... C X-ray exam of kidney lesion ................................ 0.00 NA NA NA NA 0.00 NA NA NA NA XXX
74470 .... 26 ..... A X-ray exam of kidney lesion ................................ 0.54 0.15 0.17 0.15 0.17 0.02 0.71 0.73 0.71 0.73 XXX
Fmt 4701
74475 .... .......... A X-ray control, cath insert ...................................... 0.54 1.99 3.69 NA NA 0.24 2.77 4.47 NA NA XXX
74475 .... TC .... A X-ray control, cath insert ...................................... 0.00 1.83 3.51 NA NA 0.22 2.05 3.73 NA NA XXX
74475 .... 26 ..... A X-ray control, cath insert ...................................... 0.54 0.16 0.18 0.16 0.18 0.02 0.72 0.74 0.72 0.74 XXX
74480 .... .......... A X-ray control, cath insert ...................................... 0.54 2.00 3.69 NA NA 0.24 2.78 4.47 NA NA XXX
Sfmt 4700
74480 .... TC .... A X-ray control, cath insert ...................................... 0.00 1.84 3.51 NA NA 0.22 2.06 3.73 NA NA XXX
74480 .... 26 ..... A X-ray control, cath insert ...................................... 0.54 0.16 0.18 0.16 0.18 0.02 0.72 0.74 0.72 0.74 XXX
74485 .... .......... A X-ray guide, GU dilation ....................................... 0.54 2.18 3.03 NA NA 0.20 2.92 3.77 NA NA XXX
74485 .... TC .... A X-ray guide, GU dilation ....................................... 0.00 2.00 2.86 NA NA 0.17 2.17 3.03 NA NA XXX
74485 .... 26 ..... A X-ray guide, GU dilation ....................................... 0.54 0.18 0.17 0.18 0.17 0.03 0.75 0.74 0.75 0.74 XXX
74710 .... .......... A X-ray measurement of pelvis ............................... 0.34 0.61 1.03 NA NA 0.08 1.03 1.45 NA NA XXX
74710 .... TC .... A X-ray measurement of pelvis ............................... 0.00 0.51 0.92 NA NA 0.06 0.57 0.98 NA NA XXX
74710 .... 26 ..... A X-ray measurement of pelvis ............................... 0.34 0.10 0.11 0.10 0.11 0.02 0.46 0.47 0.46 0.47 XXX
74740 .... .......... A X-ray, female genital tract .................................... 0.38 1.67 1.50 NA NA 0.09 2.14 1.97 NA NA XXX
E:\FR\FM\01DER2.SGM
74740 .... TC .... A X-ray, female genital tract .................................... 0.00 1.56 1.37 NA NA 0.07 1.63 1.44 NA NA XXX
74740 .... 26 ..... A X-ray, female genital tract .................................... 0.38 0.11 0.13 0.11 0.13 0.02 0.51 0.53 0.51 0.53 XXX
74742 .... .......... C X-ray, fallopian tube ............................................. 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 XXX
74742 .... TC .... C X-ray, fallopian tube ............................................. 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 XXX
01DER2
74742 .... 26 ..... A X-ray, fallopian tube ............................................. 0.61 0.15 0.19 0.15 0.19 0.03 0.79 0.83 0.79 0.83 XXX
74775 .... .......... C X-ray exam of perineum ...................................... 0.00 NA NA NA NA 0.00 NA NA NA NA XXX
74775 .... TC .... C X-ray exam of perineum ...................................... 0.00 NA NA NA NA 0.00 NA NA NA NA XXX
74775 .... 26 ..... A X-ray exam of perineum ...................................... 0.62 0.17 0.20 0.17 0.20 0.03 0.82 0.85 0.82 0.85 XXX
75552 .... .......... A Heart mri for morph w/o dye ................................ 1.60 18.32 13.38 NA NA 0.66 20.58 15.64 NA NA XXX
75552 .... TC .... A Heart mri for morph w/o dye ................................ 0.00 17.80 12.85 NA NA 0.59 18.39 13.44 NA NA XXX
Year Year Year
2007 2007 Fully Im-
VerDate Aug<31>2005
RVUs cility Total
RVUs
75552 .... 26 ..... A Heart mri for morph w/o dye ................................ 1.60 0.52 0.53 0.52 0.53 0.07 2.19 2.20 2.19 2.20 XXX
75553 .... .......... A Heart mri for morph w/dye ................................... 2.00 23.65 14.80 NA NA 0.66 26.31 17.46 NA NA XXX
75553 .... TC .... A Heart mri for morph w/dye ................................... 0.00 22.72 14.08 NA NA 0.59 23.31 14.67 NA NA XXX
10:50 Nov 30, 2006

75553 .... 26 ..... A Heart mri for morph w/dye ................................... 2.00 0.93 0.72 0.93 0.72 0.07 3.00 2.79 3.00 2.79 XXX
75554 .... .......... A Cardiac MRI/function ............................................ 1.83 26.45 15.50 NA NA 0.66 28.94 17.99 NA NA XXX
75554 .... TC .... A Cardiac MRI/function ............................................ 0.00 25.67 14.82 NA NA 0.59 26.26 15.41 NA NA XXX
75554 .... 26 ..... A Cardiac MRI/function ............................................ 1.83 0.78 0.68 0.78 0.68 0.07 2.68 2.58 2.68 2.58 XXX
75555 .... .......... A Cardiac MRI/limited study .................................... 1.74 27.01 15.64 NA NA 0.66 29.41 18.04 NA NA XXX
Jkt 211001
75555 .... TC .... A Cardiac MRI/limited study .................................... 0.00 26.18 14.95 NA NA 0.59 26.77 15.54 NA NA XXX
75555 .... 26 ..... A Cardiac MRI/limited study .................................... 1.74 0.83 0.69 0.83 0.69 0.07 2.64 2.50 2.64 2.50 XXX
75556 .... .......... N Cardiac MRI/flow mapping ................................... 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 XXX
75600 .... .......... A Contrast x-ray exam of aorta ............................... 0.49 6.39 11.20 NA NA 0.67 7.55 12.36 NA NA XXX
PO 00000
75600 .... TC .... A Contrast x-ray exam of aorta ............................... 0.00 6.14 10.99 NA NA 0.65 6.79 11.64 NA NA XXX
75600 .... 26 ..... A Contrast x-ray exam of aorta ............................... 0.49 0.25 0.21 0.25 0.21 0.02 0.76 0.72 0.76 0.72 XXX
Frm 00317
Fmt 4701
75630 .... .......... A X-ray aorta, leg arteries ....................................... 1.79 3.72 11.24 NA NA 0.80 6.31 13.83 NA NA XXX
75630 .... TC .... A X-ray aorta, leg arteries ....................................... 0.00 3.01 10.60 NA NA 0.69 3.70 11.29 NA NA XXX
75630 .... 26 ..... A X-ray aorta, leg arteries ....................................... 1.79 0.71 0.64 0.71 0.64 0.11 2.61 2.54 2.61 2.54 XXX
75635 .... .......... A Ct angio abdominal arteries ................................. 2.40 12.15 15.56 NA NA 0.50 15.05 18.46 NA NA XXX
Sfmt 4700
75635 .... TC .... A Ct angio abdominal arteries ................................. 0.00 11.40 14.78 NA NA 0.39 11.79 15.17 NA NA XXX
75635 .... 26 ..... A Ct angio abdominal arteries ................................. 2.40 0.75 0.78 0.75 0.78 0.11 3.26 3.29 3.26 3.29 XXX
75650 .... .......... A Artery x-rays, head & neck .................................. 1.49 3.37 10.66 NA NA 0.72 5.58 12.87 NA NA XXX
75650 .... TC .... A Artery x-rays, head & neck .................................. 0.00 2.85 10.16 NA NA 0.65 3.50 10.81 NA NA XXX
75650 .... 26 ..... A Artery x-rays, head & neck .................................. 1.49 0.52 0.50 0.52 0.50 0.07 2.08 2.06 2.08 2.06 XXX
75658 .... .......... A Artery x-rays, arm ................................................ 1.31 3.73 10.74 NA NA 0.72 5.76 12.77 NA NA XXX
75658 .... TC .... A Artery x-rays, arm ................................................ 0.00 3.26 10.27 NA NA 0.65 3.91 10.92 NA NA XXX
75658 .... 26 ..... A Artery x-rays, arm ................................................ 1.31 0.47 0.47 0.47 0.47 0.07 1.85 1.85 1.85 1.85 XXX
E:\FR\FM\01DER2.SGM
01DER2
69939
Year
69940
Year Year
2007 2007 Fully Im-
VerDate Aug<31>2005
RVUs cility Total
RVUs
75676 .... .......... A Artery x-rays, neck ............................................... 1.31 3.71 10.71 NA NA 0.72 5.74 12.74 NA NA XXX
75676 .... TC .... A Artery x-rays, neck ............................................... 0.00 3.26 10.27 NA NA 0.65 3.91 10.92 NA NA XXX
10:50 Nov 30, 2006

75676 .... 26 ..... A Artery x-rays, neck ............................................... 1.31 0.45 0.44 0.45 0.44 0.07 1.83 1.82 1.83 1.82 XXX
75680 .... .......... A Artery x-rays, neck ............................................... 1.66 4.41 10.96 NA NA 0.72 6.79 13.34 NA NA XXX
75680 .... TC .... A Artery x-rays, neck ............................................... 0.00 3.81 10.40 NA NA 0.65 4.46 11.05 NA NA XXX
75680 .... 26 ..... A Artery x-rays, neck ............................................... 1.66 0.60 0.56 0.60 0.56 0.07 2.33 2.29 2.33 2.29 XXX
75685 .... .......... A Artery x-rays, spine .............................................. 1.31 3.71 10.70 NA NA 0.71 5.73 12.72 NA NA XXX
Jkt 211001
75685 .... TC .... A Artery x-rays, spine .............................................. 0.00 3.25 10.26 NA NA 0.65 3.90 10.91 NA NA XXX
75685 .... 26 ..... A Artery x-rays, spine .............................................. 1.31 0.46 0.44 0.46 0.44 0.06 1.83 1.81 1.83 1.81 XXX
75705 .... .......... A Artery x-rays, spine .............................................. 2.18 3.81 10.95 NA NA 0.78 6.77 13.91 NA NA XXX
75705 .... TC .... A Artery x-rays, spine .............................................. 0.00 3.15 10.24 NA NA 0.65 3.80 10.89 NA NA XXX
PO 00000
75705 .... 26 ..... A Artery x-rays, spine .............................................. 2.18 0.66 0.71 0.66 0.71 0.13 2.97 3.02 2.97 3.02 XXX
75710 .... .......... A Artery x-rays, arm/leg ........................................... 1.14 3.87 10.72 NA NA 0.72 5.73 12.58 NA NA XXX
75710 .... TC .... A Artery x-rays, arm/leg ........................................... 0.00 3.46 10.32 NA NA 0.65 4.11 10.97 NA NA XXX
75710 .... 26 ..... A Artery x-rays, arm/leg ........................................... 1.14 0.41 0.40 0.41 0.40 0.07 1.62 1.61 1.62 1.61 XXX
Frm 00318
75716 .... .......... A Artery x-rays, arms/legs ....................................... 1.31 4.75 10.96 NA NA 0.72 6.78 12.99 NA NA XXX
75716 .... TC .... A Artery x-rays, arms/legs ....................................... 0.00 4.28 10.52 NA NA 0.65 4.93 11.17 NA NA XXX
75716 .... 26 ..... A Artery x-rays, arms/legs ....................................... 1.31 0.47 0.44 0.47 0.44 0.07 1.85 1.82 1.85 1.82 XXX
75722 .... .......... A Artery x-rays, kidney ............................................ 1.14 3.78 10.70 NA NA 0.70 5.62 12.54 NA NA XXX
Fmt 4701
75722 .... TC .... A Artery x-rays, kidney ............................................ 0.00 3.32 10.28 NA NA 0.65 3.97 10.93 NA NA XXX
75722 .... 26 ..... A Artery x-rays, kidney ............................................ 1.14 0.46 0.42 0.46 0.42 0.05 1.65 1.61 1.65 1.61 XXX
75724 .... .......... A Artery x-rays, kidneys .......................................... 1.49 5.13 11.15 NA NA 0.70 7.32 13.34 NA NA XXX
75724 .... TC .... A Artery x-rays, kidneys .......................................... 0.00 4.37 10.54 NA NA 0.65 5.02 11.19 NA NA XXX
Sfmt 4700
75724 .... 26 ..... A Artery x-rays, kidneys .......................................... 1.49 0.76 0.61 0.76 0.61 0.05 2.30 2.15 2.30 2.15 XXX
75726 .... .......... A Artery x-rays, abdomen ........................................ 1.14 3.51 10.61 NA NA 0.70 5.35 12.45 NA NA XXX
75726 .... TC .... A Artery x-rays, abdomen ........................................ 0.00 3.16 10.24 NA NA 0.65 3.81 10.89 NA NA XXX
75726 .... 26 ..... A Artery x-rays, abdomen ........................................ 1.14 0.35 0.37 0.35 0.37 0.05 1.54 1.56 1.54 1.56 XXX
75731 .... .......... A Artery x-rays, adrenal gland ................................. 1.14 3.72 10.66 NA NA 0.71 5.57 12.51 NA NA XXX
75731 .... TC .... A Artery x-rays, adrenal gland ................................. 0.00 3.32 10.28 NA NA 0.65 3.97 10.93 NA NA XXX
75731 .... 26 ..... A Artery x-rays, adrenal gland ................................. 1.14 0.40 0.38 0.40 0.38 0.06 1.60 1.58 1.60 1.58 XXX
75733 .... .......... A Artery x-rays, adrenals ......................................... 1.31 5.11 11.06 NA NA 0.71 7.13 13.08 NA NA XXX
75733 .... TC .... A Artery x-rays, adrenals ......................................... 0.00 4.53 10.58 NA NA 0.65 5.18 11.23 NA NA XXX
E:\FR\FM\01DER2.SGM
75733 .... 26 ..... A Artery x-rays, adrenals ......................................... 1.31 0.58 0.48 0.58 0.48 0.06 1.95 1.85 1.95 1.85 XXX
75736 .... .......... A Artery x-rays, pelvis ............................................. 1.14 3.69 10.66 NA NA 0.71 5.54 12.51 NA NA XXX
75736 .... TC .... A Artery x-rays, pelvis ............................................. 0.00 3.30 10.28 NA NA 0.65 3.95 10.93 NA NA XXX
75736 .... 26 ..... A Artery x-rays, pelvis ............................................. 1.14 0.39 0.38 0.39 0.38 0.06 1.59 1.58 1.59 1.58 XXX
01DER2
75741 .... .......... A Artery x-rays, lung ................................................ 1.31 2.96 10.52 NA NA 0.71 4.98 12.54 NA NA XXX
75741 .... TC .... A Artery x-rays, lung ................................................ 0.00 2.55 10.09 NA NA 0.65 3.20 10.74 NA NA XXX
75741 .... 26 ..... A Artery x-rays, lung ................................................ 1.31 0.41 0.43 0.41 0.43 0.06 1.78 1.80 1.78 1.80 XXX
75743 .... .......... A Artery x-rays, lungs .............................................. 1.66 3.30 10.68 NA NA 0.72 5.68 13.06 NA NA XXX
75743 .... TC .... A Artery x-rays, lungs .............................................. 0.00 2.79 10.15 NA NA 0.65 3.44 10.80 NA NA XXX
75743 .... 26 ..... A Artery x-rays, lungs .............................................. 1.66 0.51 0.53 0.51 0.53 0.07 2.24 2.26 2.24 2.26 XXX
Year Year Year
2007 2007 Fully Im-
VerDate Aug<31>2005
RVUs cility Total
RVUs
75746 .... .......... A Artery x-rays, lung ................................................ 1.14 3.30 10.56 NA NA 0.70 5.14 12.40 NA NA XXX
75746 .... TC .... A Artery x-rays, lung ................................................ 0.00 2.96 10.19 NA NA 0.65 3.61 10.84 NA NA XXX
75746 .... 26 ..... A Artery x-rays, lung ................................................ 1.14 0.34 0.37 0.34 0.37 0.05 1.53 1.56 1.53 1.56 XXX
10:50 Nov 30, 2006

75756 .... .......... A Artery x-rays, chest .............................................. 1.14 4.38 10.88 NA NA 0.69 6.21 12.71 NA NA XXX
75756 .... TC .... A Artery x-rays, chest .............................................. 0.00 3.77 10.39 NA NA 0.65 4.42 11.04 NA NA XXX
75756 .... 26 ..... A Artery x-rays, chest .............................................. 1.14 0.61 0.49 0.61 0.49 0.04 1.79 1.67 1.79 1.67 XXX
75774 .... .......... A Artery x-ray, each vessel ..................................... 0.36 2.43 10.15 2.43 10.15 0.67 3.46 11.18 3.46 11.18 ZZZ
75774 .... TC .... A Artery x-ray, each vessel ..................................... 0.00 2.31 10.03 2.31 10.03 0.65 2.96 10.68 2.96 10.68 ZZZ
Jkt 211001
75774 .... 26 ..... A Artery x-ray, each vessel ..................................... 0.36 0.12 0.12 0.12 0.12 0.02 0.50 0.50 0.50 0.50 ZZZ
75790 .... .......... A Visualize A–V shunt ............................................. 1.84 2.94 2.20 NA NA 0.17 4.95 4.21 NA NA XXX
75790 .... TC .... A Visualize A–V shunt ............................................. 0.00 2.42 1.62 NA NA 0.08 2.50 1.70 NA NA XXX
75790 .... 26 ..... A Visualize A–V shunt ............................................. 1.84 0.52 0.58 0.52 0.58 0.09 2.45 2.51 2.45 2.51 XXX
PO 00000
75801 .... .......... C Lymph vessel x-ray, arm/leg ................................ 0.00 NA NA NA NA 0.00 NA NA NA NA XXX
75801 .... TC .... C Lymph vessel x-ray, arm/leg ................................ 0.00 NA NA NA NA 0.00 NA NA NA NA XXX
75801 .... 26 ..... A Lymph vessel x-ray, arm/leg ................................ 0.81 0.22 0.26 0.22 0.26 0.08 1.11 1.15 1.11 1.15 XXX
75803 .... .......... C Lymph vessel x-ray,arms/legs ............................. 0.00 NA NA NA NA 0.00 NA NA NA NA XXX
Frm 00319
75803 .... TC .... C Lymph vessel x-ray,arms/legs ............................. 0.00 NA NA NA NA 0.00 NA NA NA NA XXX
75803 .... 26 ..... A Lymph vessel x-ray,arms/legs ............................. 1.17 0.31 0.36 0.31 0.36 0.05 1.53 1.58 1.53 1.58 XXX
75805 .... .......... C Lymph vessel x-ray, trunk .................................... 0.00 NA NA NA NA 0.00 NA NA NA NA XXX
75805 .... TC .... C Lymph vessel x-ray, trunk .................................... 0.00 NA NA NA NA 0.00 NA NA NA NA XXX
Fmt 4701
75805 .... 26 ..... A Lymph vessel x-ray, trunk .................................... 0.81 0.22 0.26 0.22 0.26 0.05 1.08 1.12 1.08 1.12 XXX
75807 .... .......... C Lymph vessel x-ray, trunk .................................... 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 XXX
75807 .... TC .... C Lymph vessel x-ray, trunk .................................... 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 XXX
75807 .... 26 ..... A Lymph vessel x-ray, trunk .................................... 1.17 0.34 0.37 0.34 0.37 0.05 1.56 1.59 1.56 1.59 XXX
Sfmt 4700
75809 .... .......... A Nonvascular shunt, x-ray ..................................... 0.47 2.05 1.22 NA NA 0.07 2.59 1.76 NA NA XXX
75809 .... TC .... A Nonvascular shunt, x-ray ..................................... 0.00 1.92 1.07 NA NA 0.05 1.97 1.12 NA NA XXX
75809 .... 26 ..... A Nonvascular shunt, x-ray ..................................... 0.47 0.13 0.15 0.13 0.15 0.02 0.62 0.64 0.62 0.64 XXX
75810 .... .......... C Vein x-ray, spleen/liver ......................................... 0.00 NA NA NA NA 0.00 NA NA NA NA XXX
75810 .... TC .... C Vein x-ray, spleen/liver ......................................... 0.00 NA NA NA NA 0.00 NA NA NA NA XXX
75810 .... 26 ..... A Vein x-ray, spleen/liver ......................................... 1.14 0.34 0.36 0.34 0.36 0.05 1.53 1.55 1.53 1.55 XXX
75820 .... .......... A Vein x-ray, arm/leg ............................................... 0.70 2.92 1.62 NA NA 0.09 3.71 2.41 NA NA XXX
75820 .... TC .... A Vein x-ray, arm/leg ............................................... 0.00 2.65 1.38 NA NA 0.06 2.71 1.44 NA NA XXX
75820 .... 26 ..... A Vein x-ray, arm/leg ............................................... 0.70 0.27 0.24 0.27 0.24 0.03 1.00 0.97 1.00 0.97 XXX
E:\FR\FM\01DER2.SGM
75822 .... .......... A Vein x-ray, arms/legs ........................................... 1.06 3.00 2.12 NA NA 0.13 4.19 3.31 NA NA XXX
75822 .... TC .... A Vein x-ray, arms/legs ........................................... 0.00 2.68 1.78 NA NA 0.08 2.76 1.86 NA NA XXX
75822 .... 26 ..... A Vein x-ray, arms/legs ........................................... 1.06 0.32 0.34 0.32 0.34 0.05 1.43 1.45 1.43 1.45 XXX
75825 .... .......... A Vein x-ray, trunk ................................................... 1.14 2.77 10.42 NA NA 0.72 4.63 12.28 NA NA XXX
01DER2
75825 .... TC .... A Vein x-ray, trunk ................................................... 0.00 2.44 10.06 NA NA 0.65 3.09 10.71 NA NA XXX
75825 .... 26 ..... A Vein x-ray, trunk ................................................... 1.14 0.33 0.36 0.33 0.36 0.07 1.54 1.57 1.54 1.57 XXX
75827 .... .......... A Vein x-ray, chest .................................................. 1.14 2.81 10.43 NA NA 0.70 4.65 12.27 NA NA XXX
75827 .... TC .... A Vein x-ray, chest .................................................. 0.00 2.48 10.07 NA NA 0.65 3.13 10.72 NA NA XXX
75827 .... 26 ..... A Vein x-ray, chest .................................................. 1.14 0.33 0.36 0.33 0.36 0.05 1.52 1.55 1.52 1.55 XXX
75831 .... .......... A Vein x-ray, kidney ................................................ 1.14 2.88 10.45 NA NA 0.71 4.73 12.30 NA NA XXX
69941
Year
69942
Year Year
2007 2007 Fully Im-
VerDate Aug<31>2005
RVUs cility Total
RVUs
75831 .... TC .... A Vein x-ray, kidney ................................................ 0.00 2.55 10.09 NA NA 0.65 3.20 10.74 NA NA XXX
75831 .... 26 ..... A Vein x-ray, kidney ................................................ 1.14 0.33 0.36 0.33 0.36 0.06 1.53 1.56 1.53 1.56 XXX
75833 .... .......... A Vein x-ray, kidneys ............................................... 1.49 3.50 10.70 NA NA 0.74 5.73 12.93 NA NA XXX
10:50 Nov 30, 2006

75833 .... TC .... A Vein x-ray, kidneys ............................................... 0.00 3.06 10.22 NA NA 0.65 3.71 10.87 NA NA XXX
75833 .... 26 ..... A Vein x-ray, kidneys ............................................... 1.49 0.44 0.48 0.44 0.48 0.09 2.02 2.06 2.02 2.06 XXX
75840 .... .......... A Vein x-ray, adrenal gland ..................................... 1.14 3.17 10.53 NA NA 0.72 5.03 12.39 NA NA XXX
75840 .... TC .... A Vein x-ray, adrenal gland ..................................... 0.00 2.74 10.14 NA NA 0.65 3.39 10.79 NA NA XXX
75840 .... 26 ..... A Vein x-ray, adrenal gland ..................................... 1.14 0.43 0.39 0.43 0.39 0.07 1.64 1.60 1.64 1.60 XXX
Jkt 211001
75842 .... .......... A Vein x-ray, adrenal glands ................................... 1.49 3.44 10.67 NA NA 0.72 5.65 12.88 NA NA XXX
75842 .... TC .... A Vein x-ray, adrenal glands ................................... 0.00 3.00 10.20 NA NA 0.65 3.65 10.85 NA NA XXX
75842 .... 26 ..... A Vein x-ray, adrenal glands ................................... 1.49 0.44 0.47 0.44 0.47 0.07 2.00 2.03 2.00 2.03 XXX
75860 .... .......... A Vein x-ray, neck ................................................... 1.14 3.37 10.59 NA NA 0.69 5.20 12.42 NA NA XXX
PO 00000
75860 .... TC .... A Vein x-ray, neck ................................................... 0.00 2.88 10.17 NA NA 0.65 3.53 10.82 NA NA XXX
75860 .... 26 ..... A Vein x-ray, neck ................................................... 1.14 0.49 0.42 0.49 0.42 0.04 1.67 1.60 1.67 1.60 XXX
75870 .... .......... A Vein x-ray, skull .................................................... 1.14 3.11 10.52 NA NA 0.70 4.95 12.36 NA NA XXX
75870 .... TC .... A Vein x-ray, skull .................................................... 0.00 2.73 10.13 NA NA 0.65 3.38 10.78 NA NA XXX
Frm 00320
75870 .... 26 ..... A Vein x-ray, skull .................................................... 1.14 0.38 0.39 0.38 0.39 0.05 1.57 1.58 1.57 1.58 XXX
75872 .... .......... A Vein x-ray, skull .................................................... 1.14 3.85 10.70 NA NA 0.79 5.78 12.63 NA NA XXX
75872 .... TC .... A Vein x-ray, skull .................................................... 0.00 3.42 10.31 NA NA 0.65 4.07 10.96 NA NA XXX
75872 .... 26 ..... A Vein x-ray, skull .................................................... 1.14 0.43 0.39 0.43 0.39 0.14 1.71 1.67 1.71 1.67 XXX
Fmt 4701
75880 .... .......... A Vein x-ray, eye socket ......................................... 0.70 2.87 1.61 NA NA 0.09 3.66 2.40 NA NA XXX
75880 .... TC .... A Vein x-ray, eye socket ......................................... 0.00 2.65 1.38 NA NA 0.06 2.71 1.44 NA NA XXX
75880 .... 26 ..... A Vein x-ray, eye socket ......................................... 0.70 0.22 0.23 0.22 0.23 0.03 0.95 0.96 0.95 0.96 XXX
75885 .... .......... A Vein x-ray, liver .................................................... 1.44 2.95 10.54 NA NA 0.71 5.10 12.69 NA NA XXX
Sfmt 4700
75885 .... TC .... A Vein x-ray, liver .................................................... 0.00 2.53 10.08 NA NA 0.65 3.18 10.73 NA NA XXX
75885 .... 26 ..... A Vein x-ray, liver .................................................... 1.44 0.42 0.46 0.42 0.46 0.06 1.92 1.96 1.92 1.96 XXX
E:\FR\FM\01DER2.SGM
75893 .... .......... A Venous sampling by catheter .............................. 0.54 2.71 10.27 NA NA 0.67 3.92 11.48 NA NA XXX
75893 .... TC .... A Venous sampling by catheter .............................. 0.00 2.55 10.09 NA NA 0.65 3.20 10.74 NA NA XXX
01DER2
75893 .... 26 ..... A Venous sampling by catheter .............................. 0.54 0.16 0.18 0.16 0.18 0.02 0.72 0.74 0.72 0.74 XXX
75894 .... .......... C X-rays, transcath therapy ..................................... 0.00 NA NA NA NA 0.00 NA NA NA NA XXX
75894 .... TC .... C X-rays, transcath therapy ..................................... 0.00 NA NA NA NA 0.00 NA NA NA NA XXX
75894 .... 26 ..... A X-rays, transcath therapy ..................................... 1.31 0.39 0.42 0.39 0.42 0.08 1.78 1.81 1.78 1.81 XXX
75896 .... .......... C X-rays, transcath therapy ..................................... 0.00 NA NA NA NA 0.00 NA NA NA NA XXX
75896 .... TC .... C X-rays, transcath therapy ..................................... 0.00 NA NA NA NA 0.00 NA NA NA NA XXX
Year Year Year
2007 2007 Fully Im-
VerDate Aug<31>2005
RVUs cility Total
RVUs
75896 .... 26 ..... A X-rays, transcath therapy ..................................... 1.31 0.49 0.46 0.49 0.46 0.05 1.85 1.82 1.85 1.82 XXX
75898 .... .......... C Follow-up angiography ......................................... 0.00 NA NA NA NA 0.00 NA NA NA NA XXX
75898 .... TC .... C Follow-up angiography ......................................... 0.00 NA NA NA NA 0.00 NA NA NA NA XXX
10:50 Nov 30, 2006

75898 .... 26 ..... A Follow-up angiography ......................................... 1.65 0.56 0.55 0.56 0.55 0.07 2.28 2.27 2.28 2.27 XXX
75900 .... .......... C Intravascular cath exchange ................................ 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 XXX
75900 .... TC .... C Intravascular cath exchange ................................ 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 XXX
75900 .... 26 ..... A Intravascular cath exchange ................................ 0.49 0.15 0.16 0.15 0.16 0.03 0.67 0.68 0.67 0.68 XXX
75901 .... .......... A Remove cva device obstruct ................................ 0.49 3.94 2.09 NA NA 0.85 5.28 3.43 NA NA XXX
Jkt 211001
75901 .... TC .... A Remove cva device obstruct ................................ 0.00 3.80 1.93 NA NA 0.83 4.63 2.76 NA NA XXX
75901 .... 26 ..... A Remove cva device obstruct ................................ 0.49 0.14 0.16 0.14 0.16 0.02 0.65 0.67 0.65 0.67 XXX
75902 .... .......... A Remove cva lumen obstruct ................................ 0.39 1.54 1.47 NA NA 0.85 2.78 2.71 NA NA XXX
75902 .... TC .... A Remove cva lumen obstruct ................................ 0.00 1.43 1.34 NA NA 0.83 2.26 2.17 NA NA XXX
PO 00000
75902 .... 26 ..... A Remove cva lumen obstruct ................................ 0.39 0.11 0.13 0.11 0.13 0.02 0.52 0.54 0.52 0.54 XXX
75940 .... .......... C X-ray placement, vein filter .................................. 0.00 NA NA NA NA 0.00 NA NA NA NA XXX
75940 .... TC .... C X-ray placement, vein filter .................................. 0.00 NA NA NA NA 0.00 NA NA NA NA XXX
75940 .... 26 ..... A X-ray placement, vein filter .................................. 0.54 0.16 0.18 0.16 0.18 0.04 0.74 0.76 0.74 0.76 XXX
Frm 00321
75945 .... .......... C Intravascular us .................................................... 0.00 NA NA NA NA 0.00 NA NA NA NA XXX
75945 .... TC .... C Intravascular us .................................................... 0.00 NA NA NA NA 0.00 NA NA NA NA XXX
75945 .... 26 ..... A Intravascular us .................................................... 0.40 0.15 0.14 0.15 0.14 0.04 0.59 0.58 0.59 0.58 XXX
75946 .... .......... C Intravascular us add-on ....................................... 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 ZZZ
Fmt 4701
75946 .... TC .... C Intravascular us add-on ....................................... 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 ZZZ
75946 .... 26 ..... A Intravascular us add-on ....................................... 0.40 0.13 0.14 0.13 0.14 0.05 0.58 0.59 0.58 0.59 ZZZ
75952 .... .......... C Endovasc repair abdom aorta .............................. 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 XXX
75952 .... TC .... C Endovasc repair abdom aorta .............................. 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 XXX
Sfmt 4700
75952 .... 26 ..... A Endovasc repair abdom aorta .............................. 4.49 1.27 1.44 1.27 1.44 0.43 6.19 6.36 6.19 6.36 XXX
75953 .... .......... C Abdom aneurysm endovas rpr ............................. 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 XXX
75953 .... TC .... C Abdom aneurysm endovas rpr ............................. 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 XXX
75953 .... 26 ..... A Abdom aneurysm endovas rpr ............................. 1.36 0.39 0.44 0.39 0.44 0.13 1.88 1.93 1.88 1.93 XXX
75954 .... .......... C Iliac aneurysm endovas rpr .................................. 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 XXX
75954 .... TC .... C Iliac aneurysm endovas rpr .................................. 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 XXX
75954 .... 26 ..... A Iliac aneurysm endovas rpr .................................. 2.25 0.64 0.75 0.64 0.75 0.15 3.04 3.15 3.04 3.15 XXX
75956 .... .......... C Xray, endovasc thor ao repr ................................ 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 XXX
75956 .... TC .... C Xray, endovasc thor ao repr ................................ 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 XXX
E:\FR\FM\01DER2.SGM
75956 .... 26 ..... A Xray, endovasc thor ao repr ................................ 7.00 1.78 2.47 1.78 2.47 0.69 9.47 10.16 9.47 10.16 XXX
75957 .... .......... C Xray, endovasc thor ao repr ................................ 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 XXX
75957 .... TC .... C Xray, endovasc thor ao repr ................................ 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 XXX
75957 .... 26 ..... A Xray, endovasc thor ao repr ................................ 6.00 1.56 2.12 1.56 2.12 0.59 8.15 8.71 8.15 8.71 XXX
01DER2
75958 .... .......... C Xray, place prox ext thor ao ................................ 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 XXX
75958 .... TC .... C Xray, place prox ext thor ao ................................ 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 XXX
75958 .... 26 ..... A Xray, place prox ext thor ao ................................ 4.00 0.98 1.41 0.98 1.41 0.39 5.37 5.80 5.37 5.80 XXX
75959 .... .......... C Xray, place dist ext thor ao .................................. 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 XXX
75959 .... TC .... C Xray, place dist ext thor ao .................................. 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 XXX
75959 .... 26 ..... A Xray, place dist ext thor ao .................................. 3.50 0.86 1.24 0.86 1.24 0.34 4.70 5.08 4.70 5.08 XXX
69943
Year
69944
Year Year
2007 2007 Fully Im-
VerDate Aug<31>2005
RVUs cility Total
RVUs
75960 .... .......... C Transcath iv stent rs&i ......................................... 0.00 NA NA NA NA 0.00 NA NA NA NA XXX
75960 .... TC .... C Transcath iv stent rs&i ......................................... 0.00 NA NA NA NA 0.00 NA NA NA NA XXX
75960 .... 26 ..... A Transcath iv stent rs&i ......................................... 0.82 0.31 0.29 0.31 0.29 0.05 1.18 1.16 1.18 1.16 XXX
10:50 Nov 30, 2006

75961 .... .......... A Retrieval, broken catheter .................................... 4.24 4.30 9.99 NA NA 0.73 9.27 14.96 NA NA XXX
75961 .... TC .... A Retrieval, broken catheter .................................... 0.00 3.03 8.63 NA NA 0.55 3.58 9.18 NA NA XXX
75961 .... 26 ..... A Retrieval, broken catheter .................................... 4.24 1.27 1.36 1.27 1.36 0.18 5.69 5.78 5.69 5.78 XXX
75962 .... .......... A Repair arterial blockage ....................................... 0.54 3.43 12.80 NA NA 0.86 4.83 14.20 NA NA XXX
75962 .... TC .... A Repair arterial blockage ....................................... 0.00 3.24 12.62 NA NA 0.83 4.07 13.45 NA NA XXX
Jkt 211001
75962 .... 26 ..... A Repair arterial blockage ....................................... 0.54 0.19 0.18 0.19 0.18 0.03 0.76 0.75 0.76 0.75 XXX
75964 .... .......... A Repair artery blockage, each ............................... 0.36 2.31 6.96 2.31 6.96 0.46 3.13 7.78 3.13 7.78 ZZZ
75964 .... TC .... A Repair artery blockage, each ............................... 0.00 2.19 6.84 2.19 6.84 0.43 2.62 7.27 2.62 7.27 ZZZ
75964 .... 26 ..... A Repair artery blockage, each ............................... 0.36 0.12 0.12 0.12 0.12 0.03 0.51 0.51 0.51 0.51 ZZZ
PO 00000
75966 .... .......... A Repair arterial blockage ....................................... 1.31 4.12 13.18 NA NA 0.89 6.32 15.38 NA NA XXX
75966 .... TC .... A Repair arterial blockage ....................................... 0.00 3.55 12.69 NA NA 0.83 4.38 13.52 NA NA XXX
75966 .... 26 ..... A Repair arterial blockage ....................................... 1.31 0.57 0.49 0.57 0.49 0.06 1.94 1.86 1.94 1.86 XXX
75968 .... .......... A Repair artery blockage, each ............................... 0.36 2.38 6.99 2.38 6.99 0.45 3.19 7.80 3.19 7.80 ZZZ
Frm 00322
75968 .... TC .... A Repair artery blockage, each ............................... 0.00 2.23 6.85 2.23 6.85 0.43 2.66 7.28 2.66 7.28 ZZZ
75968 .... 26 ..... A Repair artery blockage, each ............................... 0.36 0.15 0.14 0.15 0.14 0.02 0.53 0.52 0.53 0.52 ZZZ
75970 .... .......... C Vascular biopsy .................................................... 0.00 NA NA NA NA 0.00 NA NA NA NA XXX
75970 .... TC .... C Vascular biopsy .................................................... 0.00 NA NA NA NA 0.00 NA NA NA NA XXX
Fmt 4701
75970 .... 26 ..... A Vascular biopsy .................................................... 0.83 0.26 0.28 0.26 0.28 0.04 1.13 1.15 1.13 1.15 XXX
75978 .... .......... A Repair venous blockage ...................................... 0.54 3.11 12.72 NA NA 0.85 4.50 14.11 NA NA XXX
75978 .... TC .... A Repair venous blockage ...................................... 0.00 2.95 12.54 NA NA 0.83 3.78 13.37 NA NA XXX
75978 .... 26 ..... A Repair venous blockage ...................................... 0.54 0.16 0.18 0.16 0.18 0.02 0.72 0.74 0.72 0.74 XXX
Sfmt 4700
75980 .... .......... C Contrast xray exam bile duct ............................... 0.00 NA NA NA NA 0.00 NA NA NA NA XXX
75980 .... TC .... C Contrast xray exam bile duct ............................... 0.00 NA NA NA NA 0.00 NA NA NA NA XXX
75980 .... 26 ..... A Contrast xray exam bile duct ............................... 1.44 0.42 0.46 0.42 0.46 0.06 1.92 1.96 1.92 1.96 XXX
75982 .... .......... C Contrast xray exam bile duct ............................... 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 XXX
75982 .... TC .... C Contrast xray exam bile duct ............................... 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 XXX
75982 .... 26 ..... A Contrast xray exam bile duct ............................... 1.44 0.42 0.46 0.42 0.46 0.06 1.92 1.96 1.92 1.96 XXX
75984 .... .......... A Xray control catheter change ............................... 0.72 2.16 2.18 NA NA 0.14 3.02 3.04 NA NA XXX
75984 .... TC .... A Xray control catheter change ............................... 0.00 1.95 1.95 NA NA 0.11 2.06 2.06 NA NA XXX
75984 .... 26 ..... A Xray control catheter change ............................... 0.72 0.21 0.23 0.21 0.23 0.03 0.96 0.98 0.96 0.98 XXX
E:\FR\FM\01DER2.SGM
75989 .... .......... A Abscess drainage under x-ray ............................. 1.19 2.07 3.18 NA NA 0.22 3.48 4.59 NA NA XXX
75989 .... TC .... A Abscess drainage under x-ray ............................. 0.00 1.73 2.80 NA NA 0.17 1.90 2.97 NA NA XXX
75989 .... 26 ..... A Abscess drainage under x-ray ............................. 1.19 0.34 0.38 0.34 0.38 0.05 1.58 1.62 1.58 1.62 XXX
75992 .... .......... C Atherectomy, x-ray exam ..................................... 0.00 NA NA NA NA 0.00 NA NA NA NA XXX
01DER2
75992 .... TC .... C Atherectomy, x-ray exam ..................................... 0.00 NA NA NA NA 0.00 NA NA NA NA XXX
75992 .... 26 ..... A Atherectomy, x-ray exam ..................................... 0.54 0.23 0.20 0.23 0.20 0.03 0.80 0.77 0.80 0.77 XXX
75993 .... .......... C Atherectomy, x-ray exam ..................................... 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 ZZZ
75993 .... TC .... C Atherectomy, x-ray exam ..................................... 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 ZZZ
75993 .... 26 ..... A Atherectomy, x-ray exam ..................................... 0.36 0.15 0.14 0.15 0.14 0.02 0.53 0.52 0.53 0.52 ZZZ
75994 .... .......... C Atherectomy, x-ray exam ..................................... 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 XXX
Year Year Year
2007 2007 Fully Im-
VerDate Aug<31>2005
RVUs cility Total
RVUs
75994 .... TC .... C Atherectomy, x-ray exam ..................................... 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 XXX
75995 .... .......... C Atherectomy, x-ray exam ..................................... 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 XXX
10:50 Nov 30, 2006

75995 .... TC .... C Atherectomy, x-ray exam ..................................... 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 XXX
75996 .... .......... C Atherectomy, x-ray exam ..................................... 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 ZZZ
75996 .... TC .... C Atherectomy, x-ray exam ..................................... 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 ZZZ
75996 .... 26 ..... A Atherectomy, x-ray exam ..................................... 0.36 0.14 0.13 0.14 0.13 0.02 0.52 0.51 0.52 0.51 ZZZ
Jkt 211001
76000 .... .......... A Fluoroscope examination ..................................... 0.17 2.64 1.68 NA NA 0.08 2.89 1.93 NA NA XXX
76000 .... TC .... A Fluoroscope examination ..................................... 0.00 2.59 1.63 NA NA 0.07 2.66 1.70 NA NA XXX
76000 .... 26 ..... A Fluoroscope examination ..................................... 0.17 0.05 0.05 0.05 0.05 0.01 0.23 0.23 0.23 0.23 XXX
76001 .... .......... C Fluoroscope exam, extensive .............................. 0.00 NA NA NA NA 0.00 NA NA NA NA XXX
PO 00000
76001 .... TC .... C Fluoroscope exam, extensive .............................. 0.00 NA NA NA NA 0.00 NA NA NA NA XXX
76001 .... 26 ..... A Fluoroscope exam, extensive .............................. 0.67 0.21 0.22 0.21 0.22 0.05 0.93 0.94 0.93 0.94 XXX
76010 .... .......... A X-ray, nose to rectum .......................................... 0.18 0.51 0.57 NA NA 0.03 0.72 0.78 NA NA XXX
76010 .... TC .... A X-ray, nose to rectum .......................................... 0.00 0.46 0.51 NA NA 0.02 0.48 0.53 NA NA XXX
Frm 00323
76010 .... 26 ..... A X-ray, nose to rectum .......................................... 0.18 0.05 0.06 0.05 0.06 0.01 0.24 0.25 0.24 0.25 XXX
76080 .... .......... A X-ray exam of fistula ............................................ 0.54 1.01 1.18 NA NA 0.08 1.63 1.80 NA NA XXX
76080 .... TC .... A X-ray exam of fistula ............................................ 0.00 0.85 1.00 NA NA 0.06 0.91 1.06 NA NA XXX
76080 .... 26 ..... A X-ray exam of fistula ............................................ 0.54 0.16 0.18 0.16 0.18 0.02 0.72 0.74 0.72 0.74 XXX
Fmt 4701
76098 .... .......... A X-ray exam, breast specimen .............................. 0.16 0.29 0.43 NA NA 0.03 0.48 0.62 NA NA XXX
76098 .... TC .... A X-ray exam, breast specimen .............................. 0.00 0.25 0.38 NA NA 0.02 0.27 0.40 NA NA XXX
76098 .... 26 ..... A X-ray exam, breast specimen .............................. 0.16 0.04 0.05 0.04 0.05 0.01 0.21 0.22 0.21 0.22 XXX
76100 .... .......... A X-ray exam of body section ................................. 0.58 3.41 1.93 NA NA 0.10 4.09 2.61 NA NA XXX
Sfmt 4700
76100 .... TC .... A X-ray exam of body section ................................. 0.00 3.22 1.74 NA NA 0.07 3.29 1.81 NA NA XXX
76100 .... 26 ..... A X-ray exam of body section ................................. 0.58 0.19 0.19 0.19 0.19 0.03 0.80 0.80 0.80 0.80 XXX
76101 .... .......... A Complex body section x-ray ................................ 0.58 5.17 2.50 NA NA 0.11 5.86 3.19 NA NA XXX
76101 .... TC .... A Complex body section x-ray ................................ 0.00 4.99 2.31 NA NA 0.08 5.07 2.39 NA NA XXX
76101 .... 26 ..... A Complex body section x-ray ................................ 0.58 0.18 0.19 0.18 0.19 0.03 0.79 0.80 0.79 0.80 XXX
76102 .... .......... A Complex body section x-rays ............................... 0.58 7.61 3.35 NA NA 0.14 8.33 4.07 NA NA XXX
76102 .... TC .... A Complex body section x-rays ............................... 0.00 7.43 3.16 NA NA 0.11 7.54 3.27 NA NA XXX
76102 .... 26 ..... A Complex body section x-rays ............................... 0.58 0.18 0.19 0.18 0.19 0.03 0.79 0.80 0.79 0.80 XXX
76120 .... .......... A Cine/video x-rays ................................................. 0.38 1.83 1.34 NA NA 0.08 2.29 1.80 NA NA XXX
E:\FR\FM\01DER2.SGM
76120 .... TC .... A Cine/video x-rays ................................................. 0.00 1.70 1.21 NA NA 0.06 1.76 1.27 NA NA XXX
76120 .... 26 ..... A Cine/video x-rays ................................................. 0.38 0.13 0.13 0.13 0.13 0.02 0.53 0.53 0.53 0.53 XXX
76125 .... .......... C Cine/video x-rays add-on ..................................... 0.00 NA NA NA NA 0.00 NA NA NA NA ZZZ
76125 .... TC .... C Cine/video x-rays add-on ..................................... 0.00 NA NA NA NA 0.00 NA NA NA NA ZZZ
01DER2
76125 .... 26 ..... A Cine/video x-rays add-on ..................................... 0.27 0.10 0.09 0.10 0.09 0.01 0.38 0.37 0.38 0.37 ZZZ
76140 .... .......... I X-ray consultation ................................................ 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 XXX
76150 .... .......... A X-ray exam, dry process ...................................... 0.00 0.67 0.48 NA NA 0.02 0.69 0.50 NA NA XXX
76350 .... .......... C Special x-ray contrast study ................................. 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 XXX
76376 .... .......... A 3d render w/o postprocess .................................. 0.20 1.32 2.95 NA NA 0.10 1.62 3.25 NA NA XXX
76376 .... TC .... A 3d render w/o postprocess .................................. 0.00 1.26 2.88 NA NA 0.08 1.34 2.96 NA NA XXX
69945
Year
69946
Year Year
2007 2007 Fully Im-
VerDate Aug<31>2005
RVUs cility Total
RVUs
76376 .... 26 ..... A 3d render w/o postprocess .................................. 0.20 0.06 0.07 0.06 0.07 0.02 0.28 0.29 0.28 0.29 XXX
76377 .... .......... A 3d rendering w/postprocess ................................. 0.79 1.28 3.09 NA NA 0.39 2.46 4.27 NA NA XXX
76377 .... TC .... A 3d rendering w/postprocess ................................. 0.00 1.05 2.83 NA NA 0.31 1.36 3.14 NA NA XXX
10:50 Nov 30, 2006

76377 .... 26 ..... A 3d rendering w/postprocess ................................. 0.79 0.23 0.26 0.23 0.26 0.08 1.10 1.13 1.10 1.13 XXX
76380 .... .......... A CAT scan follow-up study .................................... 0.98 4.45 3.98 NA NA 0.22 5.65 5.18 NA NA XXX
76380 .... TC .... A CAT scan follow-up study .................................... 0.00 4.17 3.67 NA NA 0.18 4.35 3.85 NA NA XXX
76380 .... 26 ..... A CAT scan follow-up study .................................... 0.98 0.28 0.31 0.28 0.31 0.04 1.30 1.33 1.30 1.33 XXX
76390 .... .......... N Mr spectroscopy ................................................... 1.40 9.31 10.94 NA NA 0.66 11.37 13.00 NA NA XXX
Jkt 211001
76390 .... TC .... N Mr spectroscopy ................................................... 0.00 8.99 10.51 NA NA 0.59 9.58 11.10 NA NA XXX
76390 .... 26 ..... N Mr spectroscopy ................................................... 1.40 0.32 0.43 0.32 0.43 0.07 1.79 1.90 1.79 1.90 XXX
76496 .... .......... C Fluoroscopic procedure ........................................ 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 XXX
76496 .... TC .... C Fluoroscopic procedure ........................................ 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 XXX
PO 00000
76496 .... 26 ..... C Fluoroscopic procedure ........................................ 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 XXX
76497 .... .......... C Ct procedure ........................................................ 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 XXX
76497 .... TC .... C Ct procedure ........................................................ 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 XXX
76497 .... 26 ..... C Ct procedure ........................................................ 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 XXX
Frm 00324
76498 .... .......... C Mri procedure ....................................................... 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 XXX
76498 .... TC .... C Mri procedure ....................................................... 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 XXX
76498 .... 26 ..... C Mri procedure ....................................................... 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 XXX
76499 .... .......... C Radiographic procedure ....................................... 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 XXX
Fmt 4701
76499 .... TC .... C Radiographic procedure ....................................... 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 XXX
76499 .... 26 ..... C Radiographic procedure ....................................... 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 XXX
76506 .... .......... A Echo exam of head .............................................. 0.63 2.70 1.92 NA NA 0.14 3.47 2.69 NA NA XXX
76506 .... TC .... A Echo exam of head .............................................. 0.00 2.51 1.69 NA NA 0.08 2.59 1.77 NA NA XXX
Sfmt 4700
76506 .... 26 ..... A Echo exam of head .............................................. 0.63 0.19 0.23 0.19 0.23 0.06 0.88 0.92 0.88 0.92 XXX
76510 .... .......... A Ophth us, b & quant a ......................................... 1.55 2.31 2.73 NA NA 0.10 3.96 4.38 NA NA XXX
76510 .... TC .... A Ophth us, b & quant a ......................................... 0.00 1.72 2.07 NA NA 0.07 1.79 2.14 NA NA XXX
76510 .... 26 ..... A Ophth us, b & quant a ......................................... 1.55 0.59 0.66 0.59 0.66 0.03 2.17 2.24 2.17 2.24 XXX
76511 .... .......... A Ophth us, quant a only ........................................ 0.94 1.40 2.17 NA NA 0.10 2.44 3.21 NA NA XXX
76511 .... TC .... A Ophth us, quant a only ........................................ 0.00 1.04 1.78 NA NA 0.07 1.11 1.85 NA NA XXX
76511 .... 26 ..... A Ophth us, quant a only ........................................ 0.94 0.36 0.39 0.36 0.39 0.03 1.33 1.36 1.33 1.36 XXX
76512 .... .......... A Ophth us, b w/non-quant a .................................. 0.94 1.19 1.97 NA NA 0.12 2.25 3.03 NA NA XXX
76512 .... TC .... A Ophth us, b w/non-quant a .................................. 0.00 0.84 1.57 NA NA 0.10 0.94 1.67 NA NA XXX
E:\FR\FM\01DER2.SGM
76512 .... 26 ..... A Ophth us, b w/non-quant a .................................. 0.94 0.35 0.40 0.35 0.40 0.02 1.31 1.36 1.31 1.36 XXX
76513 .... .......... A Echo exam of eye, water bath ............................. 0.66 1.57 1.75 NA NA 0.12 2.35 2.53 NA NA XXX
76513 .... TC .... A Echo exam of eye, water bath ............................. 0.00 1.32 1.47 NA NA 0.10 1.42 1.57 NA NA XXX
76513 .... 26 ..... A Echo exam of eye, water bath ............................. 0.66 0.25 0.28 0.25 0.28 0.02 0.93 0.96 0.93 0.96 XXX
01DER2
76514 .... .......... A Echo exam of eye, thickness ............................... 0.17 0.17 0.15 NA NA 0.02 0.36 0.34 NA NA XXX
76514 .... TC .... A Echo exam of eye, thickness ............................... 0.00 0.11 0.07 NA NA 0.01 0.12 0.08 NA NA XXX
76514 .... 26 ..... A Echo exam of eye, thickness ............................... 0.17 0.06 0.08 0.06 0.08 0.01 0.24 0.26 0.24 0.26 XXX
76516 .... .......... A Echo exam of eye ................................................ 0.54 1.19 1.39 NA NA 0.08 1.81 2.01 NA NA XXX
76516 .... TC .... A Echo exam of eye ................................................ 0.00 0.99 1.16 NA NA 0.07 1.06 1.23 NA NA XXX
76516 .... 26 ..... A Echo exam of eye ................................................ 0.54 0.20 0.23 0.20 0.23 0.01 0.75 0.78 0.75 0.78 XXX
Year Year Year
2007 2007 Fully Im-
VerDate Aug<31>2005
RVUs cility Total
RVUs
10:50 Nov 30, 2006

76536 .... .......... A Us exam of head and neck .................................. 0.56 2.53 1.83 NA NA 0.10 3.19 2.49 NA NA XXX
76536 .... TC .... A Us exam of head and neck .................................. 0.00 2.38 1.66 NA NA 0.08 2.46 1.74 NA NA XXX
Jkt 211001
76536 .... 26 ..... A Us exam of head and neck .................................. 0.56 0.15 0.17 0.15 0.17 0.02 0.73 0.75 0.73 0.75 XXX
76604 .... .......... A Us exam, chest .................................................... 0.55 1.70 1.54 NA NA 0.09 2.34 2.18 NA NA XXX
76604 .... TC .... A Us exam, chest .................................................... 0.00 1.55 1.37 NA NA 0.07 1.62 1.44 NA NA XXX
76604 .... 26 ..... A Us exam, chest .................................................... 0.55 0.15 0.17 0.15 0.17 0.02 0.72 0.74 0.72 0.74 XXX
PO 00000
76645 .... .......... A Us exam, breast(s) ............................................... 0.54 1.97 1.41 NA NA 0.08 2.59 2.03 NA NA XXX
76645 .... TC .... A Us exam, breast(s) ............................................... 0.00 1.82 1.24 NA NA 0.06 1.88 1.30 NA NA XXX
76645 .... 26 ..... A Us exam, breast(s) ............................................... 0.54 0.15 0.17 0.15 0.17 0.02 0.71 0.73 0.71 0.73 XXX
76700 .... .......... A Us exam, abdom, complete ................................. 0.81 2.84 2.39 NA NA 0.15 3.80 3.35 NA NA XXX
Frm 00325
76700 .... TC .... A Us exam, abdom, complete ................................. 0.00 2.61 2.13 NA NA 0.11 2.72 2.24 NA NA XXX
76700 .... 26 ..... A Us exam, abdom, complete ................................. 0.81 0.23 0.26 0.23 0.26 0.04 1.08 1.11 1.08 1.11 XXX
76705 .... .......... A Echo exam of abdomen ....................................... 0.59 2.21 1.77 NA NA 0.11 2.91 2.47 NA NA XXX
76705 .... TC .... A Echo exam of abdomen ....................................... 0.00 2.04 1.58 NA NA 0.08 2.12 1.66 NA NA XXX
Fmt 4701
76705 .... 26 ..... A Echo exam of abdomen ....................................... 0.59 0.17 0.19 0.17 0.19 0.03 0.79 0.81 0.79 0.81 XXX
76770 .... .......... A Us exam abdo back wall, comp ........................... 0.74 2.77 2.36 NA NA 0.14 3.65 3.24 NA NA XXX
76770 .... TC .... A Us exam abdo back wall, comp ........................... 0.00 2.55 2.12 NA NA 0.11 2.66 2.23 NA NA XXX
76770 .... 26 ..... A Us exam abdo back wall, comp ........................... 0.74 0.22 0.24 0.22 0.24 0.03 0.99 1.01 0.99 1.01 XXX
Sfmt 4700
76775 .... .......... A Us exam abdo back wall, lim ............................... 0.58 0.00 1.61 NA NA 0.11 0.69 2.30 NA NA XXX
76775 .... TC .... A Us exam abdo back wall, lim ............................... 0.00 0.00 1.42 NA NA 0.08 0.08 1.50 NA NA XXX
76775 .... 26 ..... A Us exam abdo back wall, lim ............................... 0.58 0.00 0.19 0.00 0.19 0.03 0.61 0.80 0.61 0.80 XXX
76776 .... .......... A Us exam k transpl w/doppler ............................... 0.76 3.19 2.45 NA NA 0.14 4.09 3.35 NA NA XXX
76776 .... TC .... A Us exam k transpl w/doppler ............................... 0.00 2.98 2.22 NA NA 0.11 3.09 2.33 NA NA XXX
76776 .... 26 ..... A Us exam k transpl w/doppler ............................... 0.76 0.21 0.23 0.21 0.23 0.03 1.00 1.02 1.00 1.02 XXX
76800 .... .......... A Us exam, spinal canal .......................................... 1.13 2.26 1.89 NA NA 0.13 3.52 3.15 NA NA XXX
76800 .... TC .... A Us exam, spinal canal .......................................... 0.00 1.97 1.56 NA NA 0.08 2.05 1.64 NA NA XXX
76800 .... 26 ..... A Us exam, spinal canal .......................................... 1.13 0.29 0.33 0.29 0.33 0.05 1.47 1.51 1.47 1.51 XXX
E:\FR\FM\01DER2.SGM
76801 .... .......... A Ob us < 14 wks, single fetus ............................... 0.99 2.36 2.43 NA NA 0.16 3.51 3.58 NA NA XXX
76801 .... TC .... A Ob us < 14 wks, single fetus ............................... 0.00 2.08 2.10 NA NA 0.12 2.20 2.22 NA NA XXX
76801 .... 26 ..... A Ob us < 14 wks, single fetus ............................... 0.99 0.28 0.33 0.28 0.33 0.04 1.31 1.36 1.31 1.36 XXX
76802 .... .......... A Ob us < 14 wks, add"l fetus .............................. 0.83 0.93 1.24 0.93 1.24 0.16 1.92 2.23 1.92 2.23 ZZZ
01DER2
76802 .... TC .... A Ob us < 14 wks, add"l fetus .............................. 0.00 0.69 0.96 0.69 0.96 0.12 0.81 1.08 0.81 1.08 ZZZ
76802 .... 26 ..... A Ob us < 14 wks, add"l fetus .............................. 0.83 0.24 0.28 0.24 0.28 0.04 1.11 1.15 1.11 1.15 ZZZ
76805 .... .......... A Ob us >/= 14 wks, sngl fetus ............................... 0.99 2.91 2.56 NA NA 0.16 4.06 3.71 NA NA XXX
76805 .... TC .... A Ob us >/= 14 wks, sngl fetus ............................... 0.00 2.63 2.23 NA NA 0.12 2.75 2.35 NA NA XXX
76805 .... 26 ..... A Ob us >/= 14 wks, sngl fetus ............................... 0.99 0.28 0.33 0.28 0.33 0.04 1.31 1.36 1.31 1.36 XXX
76810 .... .......... A Ob us >/= 14 wks, addl fetus ............................... 0.98 1.59 1.44 1.59 1.44 0.26 2.83 2.68 2.83 2.68 ZZZ
69947
Year
69948
Year Year
2007 2007 Fully Im-
VerDate Aug<31>2005
RVUs cility Total
RVUs
76810 .... TC .... A Ob us >/= 14 wks, addl fetus ............................... 0.00 1.32 1.12 1.32 1.12 0.22 1.54 1.34 1.54 1.34 ZZZ
76810 .... 26 ..... A Ob us >/= 14 wks, addl fetus ............................... 0.98 0.27 0.32 0.27 0.32 0.04 1.29 1.34 1.29 1.34 ZZZ
76811 .... .......... A Ob us, detailed, sngl fetus ................................... 1.90 2.98 3.93 NA NA 0.52 5.40 6.35 NA NA XXX
10:50 Nov 30, 2006

76811 .... TC .... A Ob us, detailed, sngl fetus ................................... 0.00 2.45 3.26 NA NA 0.43 2.88 3.69 NA NA XXX
76811 .... 26 ..... A Ob us, detailed, sngl fetus ................................... 1.90 0.53 0.67 0.53 0.67 0.09 2.52 2.66 2.52 2.66 XXX
76812 .... .......... A Ob us, detailed, addl fetus ................................... 1.78 3.87 2.25 3.87 2.25 0.49 6.14 4.52 6.14 4.52 ZZZ
76812 .... TC .... A Ob us, detailed, addl fetus ................................... 0.00 3.37 1.63 3.37 1.63 0.41 3.78 2.04 3.78 2.04 ZZZ
76812 .... 26 ..... A Ob us, detailed, addl fetus ................................... 1.78 0.50 0.62 0.50 0.62 0.08 2.36 2.48 2.36 2.48 ZZZ
Jkt 211001
76813 .... .......... A Ob us nuchal meas, 1 gest .................................. 1.18 2.06 2.06 NA NA 0.19 3.43 3.43 NA NA XXX
76813 .... TC .... A Ob us nuchal meas, 1 gest .................................. 0.00 1.73 1.73 NA NA 0.14 1.87 1.87 NA NA XXX
76813 .... 26 ..... A Ob us nuchal meas, 1 gest .................................. 1.18 0.33 0.33 0.33 0.33 0.05 1.56 1.56 1.56 1.56 XXX
76814 .... .......... A Ob us nuchal meas, add-on ................................ 0.99 1.11 1.11 NA NA 0.19 2.29 2.29 NA NA XXX
PO 00000
76814 .... TC .... A Ob us nuchal meas, add-on ................................ 0.00 0.84 0.84 NA NA 0.14 0.98 0.98 NA NA XXX
76814 .... 26 ..... A Ob us nuchal meas, add-on ................................ 0.99 0.27 0.27 0.27 0.27 0.05 1.31 1.31 1.31 1.31 XXX
76815 .... .......... A Ob us, limited, fetus(s) ......................................... 0.65 1.73 1.67 NA NA 0.11 2.49 2.43 NA NA XXX
76815 .... TC .... A Ob us, limited, fetus(s) ......................................... 0.00 1.55 1.45 NA NA 0.08 1.63 1.53 NA NA XXX
Frm 00326
76815 .... 26 ..... A Ob us, limited, fetus(s) ......................................... 0.65 0.18 0.22 0.18 0.22 0.03 0.86 0.90 0.86 0.90 XXX
76816 .... .......... A Ob us, follow-up, per fetus ................................... 0.85 2.33 1.66 NA NA 0.10 3.28 2.61 NA NA XXX
76816 .... TC .... A Ob us, follow-up, per fetus ................................... 0.00 2.09 1.36 NA NA 0.06 2.15 1.42 NA NA XXX
76816 .... 26 ..... A Ob us, follow-up, per fetus ................................... 0.85 0.24 0.30 0.24 0.30 0.04 1.13 1.19 1.13 1.19 XXX
Fmt 4701
76817 .... .......... A Transvaginal us, obstetric .................................... 0.75 1.94 1.82 NA NA 0.09 2.78 2.66 NA NA XXX
76817 .... TC .... A Transvaginal us, obstetric .................................... 0.00 1.73 1.57 NA NA 0.06 1.79 1.63 NA NA XXX
76817 .... 26 ..... A Transvaginal us, obstetric .................................... 0.75 0.21 0.25 0.21 0.25 0.03 0.99 1.03 0.99 1.03 XXX
76818 .... .......... A Fetal biophys profile w/nst ................................... 1.05 2.15 2.04 NA NA 0.15 3.35 3.24 NA NA XXX
Sfmt 4700
76818 .... TC .... A Fetal biophys profile w/nst ................................... 0.00 1.86 1.67 NA NA 0.10 1.96 1.77 NA NA XXX
76818 .... 26 ..... A Fetal biophys profile w/nst ................................... 1.05 0.29 0.37 0.29 0.37 0.05 1.39 1.47 1.39 1.47 XXX
76819 .... .......... A Fetal biophys profil w/o nst .................................. 0.77 1.57 1.81 NA NA 0.13 2.47 2.71 NA NA XXX
76819 .... TC .... A Fetal biophys profil w/o nst .................................. 0.00 1.36 1.55 NA NA 0.10 1.46 1.65 NA NA XXX
76819 .... 26 ..... A Fetal biophys profil w/o nst .................................. 0.77 0.21 0.26 0.21 0.26 0.03 1.01 1.06 1.01 1.06 XXX
76820 .... .......... A Umbilical artery echo ........................................... 0.50 0.55 1.49 NA NA 0.15 1.20 2.14 NA NA XXX
76820 .... TC .... A Umbilical artery echo ........................................... 0.00 0.41 1.31 NA NA 0.12 0.53 1.43 NA NA XXX
76820 .... 26 ..... A Umbilical artery echo ........................................... 0.50 0.14 0.18 0.14 0.18 0.03 0.67 0.71 0.67 0.71 XXX
76821 .... .......... A Middle cerebral artery echo ................................. 0.70 1.83 1.87 NA NA 0.15 2.68 2.72 NA NA XXX
E:\FR\FM\01DER2.SGM
76821 .... TC .... A Middle cerebral artery echo ................................. 0.00 1.63 1.62 NA NA 0.12 1.75 1.74 NA NA XXX
76821 .... 26 ..... A Middle cerebral artery echo ................................. 0.70 0.20 0.25 0.20 0.25 0.03 0.93 0.98 0.93 0.98 XXX
76825 .... .......... A Echo exam of fetal heart ...................................... 1.67 4.29 3.00 NA NA 0.18 6.14 4.85 NA NA XXX
76825 .... TC .... A Echo exam of fetal heart ...................................... 0.00 3.80 2.43 NA NA 0.11 3.91 2.54 NA NA XXX
01DER2
76825 .... 26 ..... A Echo exam of fetal heart ...................................... 1.67 0.49 0.57 0.49 0.57 0.07 2.23 2.31 2.23 2.31 XXX
Year Year Year
2007 2007 Fully Im-
VerDate Aug<31>2005
RVUs cility Total
RVUs
10:50 Nov 30, 2006

76830 .... .......... A Transvaginal us, non-ob ...................................... 0.69 2.62 1.97 NA NA 0.13 3.44 2.79 NA NA XXX
76830 .... TC .... A Transvaginal us, non-ob ...................................... 0.00 2.43 1.75 NA NA 0.10 2.53 1.85 NA NA XXX
76830 .... 26 ..... A Transvaginal us, non-ob ...................................... 0.69 0.19 0.22 0.19 0.22 0.03 0.91 0.94 0.91 0.94 XXX
76831 .... .......... A Echo exam, uterus ............................................... 0.72 2.67 2.00 NA NA 0.13 3.52 2.85 NA NA XXX
Jkt 211001
76831 .... TC .... A Echo exam, uterus ............................................... 0.00 2.47 1.76 NA NA 0.10 2.57 1.86 NA NA XXX
76831 .... 26 ..... A Echo exam, uterus ............................................... 0.72 0.20 0.24 0.20 0.24 0.03 0.95 0.99 0.95 0.99 XXX
76856 .... .......... A Us exam, pelvic, complete ................................... 0.69 2.67 1.99 NA NA 0.13 3.49 2.81 NA NA XXX
76856 .... TC .... A Us exam, pelvic, complete ................................... 0.00 2.46 1.76 NA NA 0.10 2.56 1.86 NA NA XXX
PO 00000
76856 .... 26 ..... A Us exam, pelvic, complete ................................... 0.69 0.21 0.23 0.21 0.23 0.03 0.93 0.95 0.93 0.95 XXX
76857 .... .......... A Us exam, pelvic, limited ....................................... 0.38 2.46 1.99 NA NA 0.08 2.92 2.45 NA NA XXX
76857 .... TC .... A Us exam, pelvic, limited ....................................... 0.00 2.32 1.86 NA NA 0.06 2.38 1.92 NA NA XXX
76857 .... 26 ..... A Us exam, pelvic, limited ....................................... 0.38 0.14 0.13 0.14 0.13 0.02 0.54 0.53 0.54 0.53 XXX
Frm 00327
76870 .... .......... A Us exam, scrotum ................................................ 0.64 2.67 1.97 NA NA 0.13 3.44 2.74 NA NA XXX
76870 .... TC .... A Us exam, scrotum ................................................ 0.00 2.48 1.76 NA NA 0.10 2.58 1.86 NA NA XXX
76870 .... 26 ..... A Us exam, scrotum ................................................ 0.64 0.19 0.21 0.19 0.21 0.03 0.86 0.88 0.86 0.88 XXX
76872 .... .......... A Us, transrectal ...................................................... 0.69 3.37 2.52 NA NA 0.14 4.20 3.35 NA NA XXX
Fmt 4701
76872 .... TC .... A Us, transrectal ...................................................... 0.00 3.10 2.29 NA NA 0.10 3.20 2.39 NA NA XXX
76872 .... 26 ..... A Us, transrectal ...................................................... 0.69 0.27 0.23 0.27 0.23 0.04 1.00 0.96 1.00 0.96 XXX
76873 .... .......... A Echograp trans r, pros study ............................... 1.55 3.43 2.81 NA NA 0.25 5.23 4.61 NA NA XXX
76873 .... TC .... A Echograp trans r, pros study ............................... 0.00 2.87 2.29 NA NA 0.16 3.03 2.45 NA NA XXX
Sfmt 4700
76873 .... 26 ..... A Echograp trans r, pros study ............................... 1.55 0.56 0.52 0.56 0.52 0.09 2.20 2.16 2.20 2.16 XXX
76880 .... .......... A Us exam, extremity .............................................. 0.59 3.05 1.97 NA NA 0.11 3.75 2.67 NA NA XXX
76880 .... TC .... A Us exam, extremity .............................................. 0.00 2.89 1.79 NA NA 0.08 2.97 1.87 NA NA XXX
76880 .... 26 ..... A Us exam, extremity .............................................. 0.59 0.16 0.18 0.16 0.18 0.03 0.78 0.80 0.78 0.80 XXX
76885 .... .......... A Us exam infant hips, dynamic .............................. 0.74 3.03 2.08 NA NA 0.13 3.90 2.95 NA NA XXX
76885 .... TC .... A Us exam infant hips, dynamic .............................. 0.00 2.83 1.85 NA NA 0.10 2.93 1.95 NA NA XXX
76885 .... 26 ..... A Us exam infant hips, dynamic .............................. 0.74 0.20 0.23 0.20 0.23 0.03 0.97 1.00 0.97 1.00 XXX
76886 .... .......... A Us exam infant hips, static ................................... 0.62 2.20 1.76 NA NA 0.11 2.93 2.49 NA NA XXX
76886 .... TC .... A Us exam infant hips, static ................................... 0.00 2.03 1.57 NA NA 0.08 2.11 1.65 NA NA XXX
E:\FR\FM\01DER2.SGM
76886 .... 26 ..... A Us exam infant hips, static ................................... 0.62 0.17 0.19 0.17 0.19 0.03 0.82 0.84 0.82 0.84 XXX
76930 .... .......... A Echo guide, cardiocentesis .................................. 0.67 2.08 1.85 NA NA 0.12 2.87 2.64 NA NA XXX
76930 .... TC .... A Echo guide, cardiocentesis .................................. 0.00 1.74 1.58 NA NA 0.10 1.84 1.68 NA NA XXX
76930 .... 26 ..... A Echo guide, cardiocentesis .................................. 0.67 0.34 0.27 0.34 0.27 0.02 1.03 0.96 1.03 0.96 XXX
01DER2
76932 .... .......... C Echo guide for heart biopsy ................................. 0.00 NA NA NA NA 0.00 NA NA NA NA XXX
76932 .... TC .... C Echo guide for heart biopsy ................................. 0.00 NA NA NA NA 0.00 NA NA NA NA XXX
76932 .... 26 ..... A Echo guide for heart biopsy ................................. 0.67 0.35 0.28 0.35 0.28 0.02 1.04 0.97 1.04 0.97 XXX
76936 .... .......... A Echo guide for artery repair ................................. 1.99 5.81 6.67 NA NA 0.47 8.27 9.13 NA NA XXX
76936 .... TC .... A Echo guide for artery repair ................................. 0.00 5.17 6.01 NA NA 0.34 5.51 6.35 NA NA XXX
76936 .... 26 ..... A Echo guide for artery repair ................................. 1.99 0.64 0.66 0.64 0.66 0.13 2.76 2.78 2.76 2.78 XXX
69949
Year
69950
Year Year
2007 2007 Fully Im-
VerDate Aug<31>2005
RVUs cility Total
RVUs
76937 .... .......... A Us guide, vascular access ................................... 0.30 0.58 0.51 0.58 0.51 0.13 1.01 0.94 1.01 0.94 ZZZ
76937 .... TC .... A Us guide, vascular access ................................... 0.00 0.49 0.41 0.49 0.41 0.10 0.59 0.51 0.59 0.51 ZZZ
76937 .... 26 ..... A Us guide, vascular access ................................... 0.30 0.09 0.10 0.09 0.10 0.03 0.42 0.43 0.42 0.43 ZZZ
10:50 Nov 30, 2006

76940 .... .......... C Us guide, tissue ablation ...................................... 0.00 NA NA NA NA 0.00 NA NA NA NA XXX
76940 .... TC .... C Us guide, tissue ablation ...................................... 0.00 NA NA NA NA 0.00 NA NA NA NA XXX
76940 .... 26 ..... A Us guide, tissue ablation ...................................... 2.00 0.58 0.63 0.58 0.63 0.31 2.89 2.94 2.89 2.94 XXX
76941 .... .......... C Echo guide for transfusion ................................... 0.00 NA NA NA NA 0.00 NA NA NA NA XXX
76941 .... TC .... C Echo guide for transfusion ................................... 0.00 NA NA NA NA 0.00 NA NA NA NA XXX
Jkt 211001
76941 .... 26 ..... A Echo guide for transfusion ................................... 1.34 0.43 0.46 0.43 0.46 0.07 1.84 1.87 1.84 1.87 XXX
76942 .... .......... A Echo guide for biopsy .......................................... 0.67 4.64 3.43 NA NA 0.13 5.44 4.23 NA NA XXX
76942 .... TC .... A Echo guide for biopsy .......................................... 0.00 4.42 3.21 NA NA 0.10 4.52 3.31 NA NA XXX
76942 .... 26 ..... A Echo guide for biopsy .......................................... 0.67 0.22 0.22 0.22 0.22 0.03 0.92 0.92 0.92 0.92 XXX
PO 00000
76945 .... .......... C Echo guide, villus sampling ................................. 0.00 NA NA NA NA 0.00 NA NA NA NA XXX
76945 .... TC .... C Echo guide, villus sampling ................................. 0.00 NA NA NA NA 0.00 NA NA NA NA XXX
76945 .... 26 ..... A Echo guide, villus sampling ................................. 0.67 0.20 0.22 0.20 0.22 0.03 0.90 0.92 0.90 0.92 XXX
76946 .... .......... A Echo guide for amniocentesis .............................. 0.38 0.44 1.35 NA NA 0.12 0.94 1.85 NA NA XXX
Frm 00328
76946 .... TC .... A Echo guide for amniocentesis .............................. 0.00 0.33 1.22 NA NA 0.10 0.43 1.32 NA NA XXX
76946 .... 26 ..... A Echo guide for amniocentesis .............................. 0.38 0.11 0.13 0.11 0.13 0.02 0.51 0.53 0.51 0.53 XXX
76948 .... .......... A Echo guide, ova aspiration .................................. 0.38 0.43 1.34 NA NA 0.12 0.93 1.84 NA NA XXX
76948 .... TC .... A Echo guide, ova aspiration .................................. 0.00 0.33 1.22 NA NA 0.10 0.43 1.32 NA NA XXX
Fmt 4701
76948 .... 26 ..... A Echo guide, ova aspiration .................................. 0.38 0.10 0.12 0.10 0.12 0.02 0.50 0.52 0.50 0.52 XXX
76950 .... .......... A Echo guidance radiotherapy ................................ 0.58 1.22 1.43 NA NA 0.10 1.90 2.11 NA NA XXX
76950 .... TC .... A Echo guidance radiotherapy ................................ 0.00 1.02 1.24 NA NA 0.07 1.09 1.31 NA NA XXX
76950 .... 26 ..... A Echo guidance radiotherapy ................................ 0.58 0.20 0.19 0.20 0.19 0.03 0.81 0.80 0.81 0.80 XXX
Sfmt 4700
76965 .... .......... A Echo guidance radiotherapy ................................ 1.34 1.22 4.80 NA NA 0.37 2.93 6.51 NA NA XXX
76965 .... TC .... A Echo guidance radiotherapy ................................ 0.00 0.70 4.35 NA NA 0.29 0.99 4.64 NA NA XXX
76965 .... 26 ..... A Echo guidance radiotherapy ................................ 1.34 0.52 0.45 0.52 0.45 0.08 1.94 1.87 1.94 1.87 XXX
76970 .... .......... A Ultrasound exam follow-up .................................. 0.40 2.07 1.41 NA NA 0.08 2.55 1.89 NA NA XXX
76970 .... TC .... A Ultrasound exam follow-up .................................. 0.00 1.96 1.28 NA NA 0.06 2.02 1.34 NA NA XXX
76970 .... 26 ..... A Ultrasound exam follow-up .................................. 0.40 0.11 0.13 0.11 0.13 0.02 0.53 0.55 0.53 0.55 XXX
76975 .... .......... C GI endoscopic ultrasound .................................... 0.00 NA NA NA NA 0.00 NA NA NA NA XXX
76975 .... TC .... C GI endoscopic ultrasound .................................... 0.00 NA NA NA NA 0.00 NA NA NA NA XXX
76975 .... 26 ..... A GI endoscopic ultrasound .................................... 0.81 0.29 0.28 0.29 0.28 0.04 1.14 1.13 1.14 1.13 XXX
E:\FR\FM\01DER2.SGM
76977 .... .......... A Us bone density measure .................................... 0.05 0.10 0.66 NA NA 0.06 0.21 0.77 NA NA XXX
76977 .... TC .... A Us bone density measure .................................... 0.00 0.09 0.64 NA NA 0.05 0.14 0.69 NA NA XXX
76977 .... 26 ..... A Us bone density measure .................................... 0.05 0.01 0.02 0.01 0.02 0.01 0.07 0.08 0.07 0.08 XXX
76998 .... .......... C Us guide, intraop .................................................. 0.00 NA NA NA NA 0.00 NA NA NA NA XXX
01DER2
76998 .... TC .... C Us guide, intraop .................................................. 0.00 NA NA NA NA 0.00 NA NA NA NA XXX
76998 .... 26 ..... A Us guide, intraop .................................................. 1.20 0.34 0.39 0.34 0.39 0.13 1.67 1.72 1.67 1.72 XXX
76999 .... .......... C Echo examination procedure ............................... 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 XXX
76999 .... TC .... C Echo examination procedure ............................... 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 XXX
76999 .... 26 ..... C Echo examination procedure ............................... 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 XXX
77001 .... .......... A Fluoroguide for vein device .................................. 0.38 2.58 1.73 NA NA 0.11 3.07 2.22 NA NA ZZZ
Year Year Year
2007 2007 Fully Im-
VerDate Aug<31>2005
RVUs cility Total
RVUs
77001 .... TC .... A Fluoroguide for vein device .................................. 0.00 2.47 1.60 NA NA 0.10 2.57 1.70 NA NA ZZZ
77001 .... 26 ..... A Fluoroguide for vein device .................................. 0.38 0.11 0.13 0.11 0.13 0.01 0.50 0.52 0.50 0.52 ZZZ
77002 .... .......... A Needle localization by xray .................................. 0.54 1.15 1.40 NA NA 0.09 1.78 2.03 NA NA XXX
10:50 Nov 30, 2006

77002 .... TC .... A Needle localization by xray .................................. 0.00 1.01 1.24 NA NA 0.07 1.08 1.31 NA NA XXX
77002 .... 26 ..... A Needle localization by xray .................................. 0.54 0.14 0.16 0.14 0.16 0.02 0.70 0.72 0.70 0.72 XXX
77003 .... .......... A Fluoroguide for spine inject .................................. 0.60 0.74 1.28 NA NA 0.10 1.44 1.98 NA NA XXX
77003 .... TC .... A Fluoroguide for spine inject .................................. 0.00 0.60 1.13 NA NA 0.07 0.67 1.20 NA NA XXX
77003 .... 26 ..... A Fluoroguide for spine inject .................................. 0.60 0.14 0.15 0.14 0.15 0.03 0.77 0.78 0.77 0.78 XXX
Jkt 211001
77011 .... .......... A Ct scan for localization ......................................... 1.21 19.50 11.38 NA NA 0.47 21.18 13.06 NA NA XXX
77011 .... TC .... A Ct scan for localization ......................................... 0.00 19.16 10.99 NA NA 0.42 19.58 11.41 NA NA XXX
77011 .... 26 ..... A Ct scan for localization ......................................... 1.21 0.34 0.39 0.34 0.39 0.05 1.60 1.65 1.60 1.65 XXX
77012 .... .......... A Ct scan for needle biopsy .................................... 1.16 2.14 7.02 NA NA 0.47 3.77 8.65 NA NA XXX
PO 00000
77012 .... TC .... A Ct scan for needle biopsy .................................... 0.00 1.81 6.65 NA NA 0.42 2.23 7.07 NA NA XXX
77012 .... 26 ..... A Ct scan for needle biopsy .................................... 1.16 0.33 0.37 0.33 0.37 0.05 1.54 1.58 1.54 1.58 XXX
77013 .... .......... C Ct guide for tissue ablation .................................. 0.00 NA NA NA NA 0.00 NA NA NA NA XXX
77013 .... TC .... C Ct guide for tissue ablation .................................. 0.00 NA NA NA NA 0.00 NA NA NA NA XXX
Frm 00329
77013 .... 26 ..... A Ct guide for tissue ablation .................................. 3.99 1.19 1.27 1.19 1.27 0.18 5.36 5.44 5.36 5.44 XXX
77014 .... .......... A Ct scan for therapy guide .................................... 0.85 4.43 3.53 NA NA 0.20 5.48 4.58 NA NA XXX
77014 .... TC .... A Ct scan for therapy guide .................................... 0.00 4.16 3.25 NA NA 0.16 4.32 3.41 NA NA XXX
77014 .... 26 ..... A Ct scan for therapy guide .................................... 0.85 0.27 0.28 0.27 0.28 0.04 1.16 1.17 1.16 1.17 XXX
Fmt 4701
77021 .... .......... A Mr guidance for needle place .............................. 1.50 9.20 11.08 NA NA 0.64 11.34 13.22 NA NA XXX
77021 .... TC .... A Mr guidance for needle place .............................. 0.00 8.76 10.59 NA NA 0.55 9.31 11.14 NA NA XXX
77021 .... 26 ..... A Mr guidance for needle place .............................. 1.50 0.44 0.49 0.44 0.49 0.09 2.03 2.08 2.03 2.08 XXX
77022 .... .......... C Mri for tissue ablation ........................................... 0.00 NA NA NA NA 0.00 NA NA NA NA XXX
Sfmt 4700
77022 .... TC .... C Mri for tissue ablation ........................................... 0.00 NA NA NA NA 0.00 NA NA NA NA XXX
77022 .... 26 ..... A Mri for tissue ablation ........................................... 4.24 1.22 1.34 1.22 1.34 0.24 5.70 5.82 5.70 5.82 XXX
77031 .... .......... A Stereotact guide for brst bx ................................. 1.59 1.71 6.19 NA NA 0.46 3.76 8.24 NA NA XXX
77031 .... TC .... A Stereotact guide for brst bx ................................. 0.00 1.27 5.69 NA NA 0.37 1.64 6.06 NA NA XXX
77031 .... 26 ..... A Stereotact guide for brst bx ................................. 1.59 0.44 0.50 0.44 0.50 0.09 2.12 2.18 2.12 2.18 XXX
77032 .... .......... A Guidance for needle, breast ................................ 0.56 0.56 1.26 NA NA 0.09 1.21 1.91 NA NA XXX
77032 .... TC .... A Guidance for needle, breast ................................ 0.00 0.40 1.08 NA NA 0.07 0.47 1.15 NA NA XXX
77032 .... 26 ..... A Guidance for needle, breast ................................ 0.56 0.16 0.18 0.16 0.18 0.02 0.74 0.76 0.74 0.76 XXX
77051 .... .......... A Computer dx mammogram add-on ...................... 0.06 0.19 0.38 0.19 0.38 0.02 0.27 0.46 0.27 0.46 ZZZ
E:\FR\FM\01DER2.SGM
77051 .... TC .... A Computer dx mammogram add-on ...................... 0.00 0.17 0.36 0.17 0.36 0.01 0.18 0.37 0.18 0.37 ZZZ
77051 .... 26 ..... A Computer dx mammogram add-on ...................... 0.06 0.02 0.02 0.02 0.02 0.01 0.09 0.09 0.09 0.09 ZZZ
77052 .... .......... A Comp screen mammogram add-on ..................... 0.06 0.19 0.38 0.19 0.38 0.02 0.27 0.46 0.27 0.46 ZZZ
77052 .... TC .... A Comp screen mammogram add-on ..................... 0.00 0.17 0.36 0.17 0.36 0.01 0.18 0.37 0.18 0.37 ZZZ
01DER2
77052 .... 26 ..... A Comp screen mammogram add-on ..................... 0.06 0.02 0.02 0.02 0.02 0.01 0.09 0.09 0.09 0.09 ZZZ
77053 .... .......... A X-ray of mammary duct ....................................... 0.36 0.59 2.21 NA NA 0.16 1.11 2.73 NA NA XXX
77053 .... TC .... A X-ray of mammary duct ....................................... 0.00 0.49 2.09 NA NA 0.14 0.63 2.23 NA NA XXX
77053 .... 26 ..... A X-ray of mammary duct ....................................... 0.36 0.10 0.12 0.10 0.12 0.02 0.48 0.50 0.48 0.50 XXX
77054 .... .......... A X-ray of mammary ducts ...................................... 0.45 1.56 3.25 NA NA 0.21 2.22 3.91 NA NA XXX
77054 .... TC .... A X-ray of mammary ducts ...................................... 0.00 1.43 3.10 NA NA 0.19 1.62 3.29 NA NA XXX
69951
Year
69952
Year Year
2007 2007 Fully Im-
VerDate Aug<31>2005
RVUs cility Total
RVUs
77054 .... 26 ..... A X-ray of mammary ducts ...................................... 0.45 0.13 0.15 0.13 0.15 0.02 0.60 0.62 0.60 0.62 XXX
77055 .... .......... A Mammogram, one breast ..................................... 0.70 1.51 1.34 NA NA 0.09 2.30 2.13 NA NA XXX
77055 .... TC .... A Mammogram, one breast ..................................... 0.00 1.31 1.12 NA NA 0.06 1.37 1.18 NA NA XXX
10:50 Nov 30, 2006

77055 .... 26 ..... A Mammogram, one breast ..................................... 0.70 0.20 0.22 0.20 0.22 0.03 0.93 0.95 0.93 0.95 XXX
77056 .... .......... A Mammogram, both breasts .................................. 0.87 1.93 1.68 NA NA 0.11 2.91 2.66 NA NA XXX
77056 .... TC .... A Mammogram, both breasts .................................. 0.00 1.69 1.41 NA NA 0.07 1.76 1.48 NA NA XXX
77056 .... 26 ..... A Mammogram, both breasts .................................. 0.87 0.24 0.27 0.24 0.27 0.04 1.15 1.18 1.15 1.18 XXX
77057 .... .......... A Mammogram, screening ...................................... 0.70 1.33 1.43 NA NA 0.10 2.13 2.23 NA NA XXX
Jkt 211001
77057 .... TC .... A Mammogram, screening ...................................... 0.00 1.13 1.21 NA NA 0.07 1.20 1.28 NA NA XXX
77057 .... 26 ..... A Mammogram, screening ...................................... 0.70 0.20 0.22 0.20 0.22 0.03 0.93 0.95 0.93 0.95 XXX
77058 .... .......... A Mri, one breast ..................................................... 1.63 20.61 18.76 NA NA 0.99 23.23 21.38 NA NA XXX
77058 .... TC .... A Mri, one breast ..................................................... 0.00 20.15 18.25 NA NA 0.92 21.07 19.17 NA NA XXX
PO 00000
77058 .... 26 ..... A Mri, one breast ..................................................... 1.63 0.46 0.51 0.46 0.51 0.07 2.16 2.21 2.16 2.21 XXX
77059 .... .......... A Mri, both breasts .................................................. 1.63 20.51 23.46 NA NA 1.31 23.45 26.40 NA NA XXX
77059 .... TC .... A Mri, both breasts .................................................. 0.00 20.05 22.95 NA NA 1.24 21.29 24.19 NA NA XXX
77059 .... 26 ..... A Mri, both breasts .................................................. 1.63 0.46 0.51 0.46 0.51 0.07 2.16 2.21 2.16 2.21 XXX
Frm 00330
77071 .... .......... A X-ray stress view .................................................. 0.41 0.76 0.33 0.76 0.33 0.06 1.23 0.80 1.23 0.80 XXX
77072 .... .......... A X-rays for bone age ............................................. 0.19 0.39 0.39 NA NA 0.03 0.61 0.61 NA NA XXX
77072 .... TC .... A X-rays for bone age ............................................. 0.00 0.34 0.34 NA NA 0.02 0.36 0.36 NA NA XXX
77072 .... 26 ..... A X-rays for bone age ............................................. 0.19 0.05 0.05 0.05 0.05 0.01 0.25 0.25 0.25 0.25 XXX
Fmt 4701
77073 .... .......... A X-rays, bone length studies ................................. 0.27 0.64 0.81 NA NA 0.06 0.97 1.14 NA NA XXX
77073 .... TC .... A X-rays, bone length studies ................................. 0.00 0.55 0.72 NA NA 0.05 0.60 0.77 NA NA XXX
77073 .... 26 ..... A X-rays, bone length studies ................................. 0.27 0.09 0.09 0.09 0.09 0.01 0.37 0.37 0.37 0.37 XXX
77074 .... .......... A X-rays, bone survey, limited ................................ 0.45 1.34 1.20 NA NA 0.08 1.87 1.73 NA NA XXX
Sfmt 4700
77074 .... TC .... A X-rays, bone survey, limited ................................ 0.00 1.21 1.05 NA NA 0.06 1.27 1.11 NA NA XXX
77074 .... 26 ..... A X-rays, bone survey, limited ................................ 0.45 0.13 0.15 0.13 0.15 0.02 0.60 0.62 0.60 0.62 XXX
77075 .... .......... A X-rays, bone survey complete ............................. 0.54 2.14 1.76 NA NA 0.10 2.78 2.40 NA NA XXX
77075 .... TC .... A X-rays, bone survey complete ............................. 0.00 1.98 1.58 NA NA 0.08 2.06 1.66 NA NA XXX
77075 .... 26 ..... A X-rays, bone survey complete ............................. 0.54 0.16 0.18 0.16 0.18 0.02 0.72 0.74 0.72 0.74 XXX
77076 .... .......... A X-rays, bone survey, infant .................................. 0.70 1.91 1.20 NA NA 0.08 2.69 1.98 NA NA XXX
77076 .... TC .... A X-rays, bone survey, infant .................................. 0.00 1.73 0.98 NA NA 0.05 1.78 1.03 NA NA XXX
77076 .... 26 ..... A X-rays, bone survey, infant .................................. 0.70 0.18 0.22 0.18 0.22 0.03 0.91 0.95 0.91 0.95 XXX
77077 .... .......... A Joint survey, single view ...................................... 0.31 0.64 1.07 NA NA 0.08 1.03 1.46 NA NA XXX
E:\FR\FM\01DER2.SGM
77077 .... TC .... A Joint survey, single view ...................................... 0.00 0.53 0.97 NA NA 0.06 0.59 1.03 NA NA XXX
77077 .... 26 ..... A Joint survey, single view ...................................... 0.31 0.11 0.10 0.11 0.10 0.02 0.44 0.43 0.44 0.43 XXX
77078 .... .......... A Ct bone density, axial .......................................... 0.25 4.52 3.41 NA NA 0.17 4.94 3.83 NA NA XXX
77078 .... TC .... A Ct bone density, axial .......................................... 0.00 4.45 3.33 NA NA 0.16 4.61 3.49 NA NA XXX
01DER2
77078 .... 26 ..... A Ct bone density, axial .......................................... 0.25 0.07 0.08 0.07 0.08 0.01 0.33 0.34 0.33 0.34 XXX
77079 .... .......... A Ct bone density, peripheral .................................. 0.22 0.72 2.45 NA NA 0.06 1.00 2.73 NA NA XXX
77079 .... TC .... A Ct bone density, peripheral .................................. 0.00 0.66 2.38 NA NA 0.05 0.71 2.43 NA NA XXX
77079 .... 26 ..... A Ct bone density, peripheral .................................. 0.22 0.06 0.07 0.06 0.07 0.01 0.29 0.30 0.29 0.30 XXX
77080 .... .......... A Dxa bone density, axial ........................................ 0.20 0.79 2.59 NA NA 0.18 1.17 2.97 NA NA XXX
77080 .... TC .... A Dxa bone density, axial ........................................ 0.00 0.73 2.50 NA NA 0.17 0.90 2.67 NA NA XXX
Year Year Year
2007 2007 Fully Im-
VerDate Aug<31>2005
RVUs cility Total
RVUs
77080 .... 26 ..... A Dxa bone density, axial ........................................ 0.20 0.06 0.09 0.06 0.09 0.01 0.27 0.30 0.27 0.30 XXX
77081 .... .......... A Dxa bone density/peripheral ................................ 0.22 0.69 0.80 NA NA 0.06 0.97 1.08 NA NA XXX
77081 .... TC .... A Dxa bone density/peripheral ................................ 0.00 0.63 0.72 NA NA 0.05 0.68 0.77 NA NA XXX
10:50 Nov 30, 2006

77081 .... 26 ..... A Dxa bone density/peripheral ................................ 0.22 0.06 0.08 0.06 0.08 0.01 0.29 0.31 0.29 0.31 XXX
77082 .... .......... A Dxa bone density, vert fx ..................................... 0.17 0.41 0.71 NA NA 0.06 0.64 0.94 NA NA XXX
77082 .... TC .... A Dxa bone density, vert fx ..................................... 0.00 0.36 0.65 NA NA 0.05 0.41 0.70 NA NA XXX
77082 .... 26 ..... A Dxa bone density, vert fx ..................................... 0.17 0.05 0.06 0.05 0.06 0.01 0.23 0.24 0.23 0.24 XXX
77083 .... .......... A Radiographic absorptiometry ............................... 0.20 0.37 0.71 NA NA 0.06 0.63 0.97 NA NA XXX
Jkt 211001
77083 .... TC .... A Radiographic absorptiometry ............................... 0.00 0.32 0.64 NA NA 0.05 0.37 0.69 NA NA XXX
77083 .... 26 ..... A Radiographic absorptiometry ............................... 0.20 0.05 0.07 0.05 0.07 0.01 0.26 0.28 0.26 0.28 XXX
77084 .... .......... A Magnetic image, bone marrow ............................ 1.60 13.81 12.24 NA NA 0.66 16.07 14.50 NA NA XXX
77084 .... TC .... A Magnetic image, bone marrow ............................ 0.00 13.33 11.73 NA NA 0.59 13.92 12.32 NA NA XXX
PO 00000
77084 .... 26 ..... A Magnetic image, bone marrow ............................ 1.60 0.48 0.51 0.48 0.51 0.07 2.15 2.18 2.15 2.18 XXX
77261 .... .......... A Radiation therapy planning .................................. 1.39 0.49 0.51 0.49 0.51 0.07 1.95 1.97 1.95 1.97 XXX
Frm 00331
77280 .... .......... A Set radiation therapy field .................................... 0.70 4.45 3.89 NA NA 0.22 5.37 4.81 NA NA XXX
77280 .... TC .... A Set radiation therapy field .................................... 0.00 4.21 3.66 NA NA 0.18 4.39 3.84 NA NA XXX
77280 .... 26 ..... A Set radiation therapy field .................................... 0.70 0.24 0.23 0.24 0.23 0.04 0.98 0.97 0.98 0.97 XXX
Fmt 4701
Sfmt 4700
77299 .... .......... C Radiation therapy planning .................................. 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 XXX
77299 .... TC .... C Radiation therapy planning .................................. 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 XXX
77299 .... 26 ..... C Radiation therapy planning .................................. 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 XXX
77300 .... .......... A Radiation therapy dose plan ................................ 0.62 1.19 1.45 NA NA 0.10 1.91 2.17 NA NA XXX
77300 .... TC .... A Radiation therapy dose plan ................................ 0.00 0.98 1.25 NA NA 0.07 1.05 1.32 NA NA XXX
E:\FR\FM\01DER2.SGM
77300 .... 26 ..... A Radiation therapy dose plan ................................ 0.62 0.21 0.20 0.21 0.20 0.03 0.86 0.85 0.86 0.85 XXX
77301 .... .......... A Radiotherapy dose plan, imrt ............................... 7.99 57.55 37.25 NA NA 1.88 67.42 47.12 NA NA XXX
77301 .... TC .... A Radiotherapy dose plan, imrt ............................... 0.00 54.86 34.66 NA NA 1.48 56.34 36.14 NA NA XXX
77301 .... 26 ..... A Radiotherapy dose plan, imrt ............................... 7.99 2.69 2.59 2.69 2.59 0.40 11.08 10.98 11.08 10.98 XXX
01DER2
77305 .... .......... A Teletx isodose plan simple .................................. 0.70 0.91 1.79 NA NA 0.15 1.76 2.64 NA NA XXX
77305 .... TC .... A Teletx isodose plan simple .................................. 0.00 0.67 1.56 NA NA 0.11 0.78 1.67 NA NA XXX
77305 .... 26 ..... A Teletx isodose plan simple .................................. 0.70 0.24 0.23 0.24 0.23 0.04 0.98 0.97 0.98 0.97 XXX
77310 .... .......... A Teletx isodose plan intermed ............................... 1.05 1.26 2.32 NA NA 0.18 2.49 3.55 NA NA XXX
77310 .... TC .... A Teletx isodose plan intermed ............................... 0.00 0.91 1.98 NA NA 0.13 1.04 2.11 NA NA XXX
77310 .... 26 ..... A Teletx isodose plan intermed ............................... 1.05 0.35 0.34 0.35 0.34 0.05 1.45 1.44 1.45 1.44 XXX
69953
Year
69954
Year Year
2007 2007 Fully Im-
VerDate Aug<31>2005
RVUs cility Total
RVUs
77315 .... .......... A Teletx isodose plan complex ............................... 1.56 2.11 2.90 NA NA 0.22 3.89 4.68 NA NA XXX
77315 .... TC .... A Teletx isodose plan complex ............................... 0.00 1.58 2.39 NA NA 0.14 1.72 2.53 NA NA XXX
77315 .... 26 ..... A Teletx isodose plan complex ............................... 1.56 0.53 0.51 0.53 0.51 0.08 2.17 2.15 2.17 2.15 XXX
10:50 Nov 30, 2006

77321 .... .......... A Special teletx port plan ........................................ 0.95 1.52 3.64 NA NA 0.26 2.73 4.85 NA NA XXX
77321 .... TC .... A Special teletx port plan ........................................ 0.00 1.20 3.33 NA NA 0.21 1.41 3.54 NA NA XXX
77321 .... 26 ..... A Special teletx port plan ........................................ 0.95 0.32 0.31 0.32 0.31 0.05 1.32 1.31 1.32 1.31 XXX
77326 .... .......... A Brachytx isodose calc simp ................................. 0.93 3.01 2.75 NA NA 0.18 4.12 3.86 NA NA XXX
77326 .... TC .... A Brachytx isodose calc simp ................................. 0.00 2.69 2.44 NA NA 0.13 2.82 2.57 NA NA XXX
Jkt 211001
77326 .... 26 ..... A Brachytx isodose calc simp ................................. 0.93 0.32 0.31 0.32 0.31 0.05 1.30 1.29 1.30 1.29 XXX
77327 .... .......... A Brachytx isodose calc interm ............................... 1.39 4.12 3.97 NA NA 0.25 5.76 5.61 NA NA XXX
77327 .... TC .... A Brachytx isodose calc interm ............................... 0.00 3.65 3.52 NA NA 0.18 3.83 3.70 NA NA XXX
77327 .... 26 ..... A Brachytx isodose calc interm ............................... 1.39 0.47 0.45 0.47 0.45 0.07 1.93 1.91 1.93 1.91 XXX
PO 00000
77328 .... .......... A Brachytx isodose plan compl ............................... 2.09 5.28 5.54 NA NA 0.36 7.73 7.99 NA NA XXX
77328 .... TC .... A Brachytx isodose plan compl ............................... 0.00 4.57 4.86 NA NA 0.25 4.82 5.11 NA NA XXX
77328 .... 26 ..... A Brachytx isodose plan compl ............................... 2.09 0.71 0.68 0.71 0.68 0.11 2.91 2.88 2.91 2.88 XXX
77331 .... .......... A Special radiation dosimetry .................................. 0.87 0.81 0.79 NA NA 0.06 1.74 1.72 NA NA XXX
Frm 00332
77331 .... TC .... A Special radiation dosimetry .................................. 0.00 0.52 0.51 NA NA 0.02 0.54 0.53 NA NA XXX
77331 .... 26 ..... A Special radiation dosimetry .................................. 0.87 0.29 0.28 0.29 0.28 0.04 1.20 1.19 1.20 1.19 XXX
77332 .... .......... A Radiation treatment aid(s) .................................... 0.54 1.57 1.53 NA NA 0.10 2.21 2.17 NA NA XXX
77332 .... TC .... A Radiation treatment aid(s) .................................... 0.00 1.38 1.35 NA NA 0.07 1.45 1.42 NA NA XXX
Fmt 4701
77332 .... 26 ..... A Radiation treatment aid(s) .................................... 0.54 0.19 0.18 0.19 0.18 0.03 0.76 0.75 0.76 0.75 XXX
Sfmt 4700
77336 .... .......... A Radiation physics consult .................................... 0.00 1.14 2.52 NA NA 0.16 1.30 2.68 NA NA XXX
77370 .... .......... A Radiation physics consult .................................... 0.00 3.05 3.38 NA NA 0.18 3.23 3.56 NA NA XXX
77371 .... .......... A Srs, multisource ................................................... 0.00 30.25 30.25 NA NA 0.13 30.38 30.38 NA NA XXX
77372 .... .......... A Srs, linear based .................................................. 0.00 22.93 22.93 NA NA 0.13 23.06 23.06 NA NA XXX
77373 .... .......... A Sbrt delivery ......................................................... 0.00 42.87 42.87 NA NA 0.13 43.00 43.00 NA NA XXX
77399 .... .......... C External radiation dosimetry ................................ 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 XXX
E:\FR\FM\01DER2.SGM
77399 .... TC .... C External radiation dosimetry ................................ 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 XXX
77399 .... 26 ..... C External radiation dosimetry ................................ 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 XXX
77401 .... .......... A Radiation treatment delivery ................................ 0.00 0.50 1.45 NA NA 0.11 0.61 1.56 NA NA XXX
01DER2
Year Year Year
2007 2007 Fully Im-
VerDate Aug<31>2005
RVUs cility Total
RVUs
10:50 Nov 30, 2006

77417 .... .......... A Radiology port film(s) ........................................... 0.00 0.36 0.53 NA NA 0.04 0.40 0.57 NA NA XXX
77418 .... .......... A Radiation tx delivery, imrt .................................... 0.00 13.15 16.80 NA NA 0.13 13.28 16.93 NA NA XXX
77421 .... .......... A Stereoscopic x-ray guidance ................................ 0.39 2.00 3.11 NA NA 0.12 2.51 3.62 NA NA XXX
Jkt 211001
77421 .... TC .... A Stereoscopic x-ray guidance ................................ 0.00 1.87 2.98 NA NA 0.10 1.97 3.08 NA NA XXX
77421 .... 26 ..... A Stereoscopic x-ray guidance ................................ 0.39 0.13 0.13 0.13 0.13 0.02 0.54 0.54 0.54 0.54 XXX
77422 .... .......... A Neutron beam tx, simple ...................................... 0.00 13.19 4.58 NA NA 0.13 13.32 4.71 NA NA XXX
77423 .... .......... A Neutron beam tx, complex ................................... 0.00 8.59 3.84 NA NA 0.13 8.72 3.97 NA NA XXX
PO 00000
77427 .... .......... A Radiation tx management, x5 .............................. 3.70 1.43 1.15 1.43 1.15 0.17 5.30 5.02 5.30 5.02 XXX
77431 .... .......... A Radiation therapy management ........................... 1.81 0.80 0.71 0.80 0.71 0.09 2.70 2.61 2.70 2.61 XXX
77432 .... .......... A Stereotactic radiation trmt .................................... 7.92 2.71 2.85 2.71 2.85 0.41 11.04 11.18 11.04 11.18 XXX
77435 .... .......... A Sbrt management ................................................. 13.00 4.63 4.63 NA NA 0.67 18.30 18.30 NA NA XXX
Frm 00333
77470 .... .......... A Special radiation treatment .................................. 2.09 1.95 9.35 NA NA 0.70 4.74 12.14 NA NA XXX
77470 .... TC .... A Special radiation treatment .................................. 0.00 1.24 8.67 NA NA 0.59 1.83 9.26 NA NA XXX
77470 .... 26 ..... A Special radiation treatment .................................. 2.09 0.71 0.68 0.71 0.68 0.11 2.91 2.88 2.91 2.88 XXX
77499 .... .......... C Radiation therapy management ........................... 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 XXX
Fmt 4701
77499 .... TC .... C Radiation therapy management ........................... 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 XXX
77499 .... 26 ..... C Radiation therapy management ........................... 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 XXX
77520 .... .......... C Proton trmt, simple w/o comp .............................. 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 XXX
77522 .... .......... C Proton trmt, simple w/comp ................................. 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 XXX
Sfmt 4700
77523 .... .......... C Proton trmt, intermediate ..................................... 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 XXX
77525 .... .......... C Proton treatment, complex ................................... 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 XXX
77600 .... .......... R Hyperthermia treatment ....................................... 1.56 9.71 5.09 NA NA 0.24 11.51 6.89 NA NA XXX
77600 .... TC .... R Hyperthermia treatment ....................................... 0.00 9.28 4.61 NA NA 0.16 9.44 4.77 NA NA XXX
77600 .... 26 ..... R Hyperthermia treatment ....................................... 1.56 0.43 0.48 0.43 0.48 0.08 2.07 2.12 2.07 2.12 XXX
E:\FR\FM\01DER2.SGM
01DER2
77750 .... .......... A Infuse radioactive materials ................................. 4.94 4.61 3.33 4.61 3.33 0.32 9.87 8.59 9.87 8.59 090
77750 .... TC .... A Infuse radioactive materials ................................. 0.00 2.94 1.73 2.94 1.73 0.07 3.01 1.80 3.01 1.80 090
69955
Year
69956
Year Year
2007 2007 Fully Im-
VerDate Aug<31>2005
RVUs cility Total
RVUs
77750 .... 26 ..... A Infuse radioactive materials ................................. 4.94 1.67 1.60 1.67 1.60 0.25 6.86 6.79 6.86 6.79 090
77761 .... .......... A Apply intrcav radiat simple ................................... 3.82 6.32 4.27 6.32 4.27 0.33 10.47 8.42 10.47 8.42 090
77761 .... TC .... A Apply intrcav radiat simple ................................... 0.00 5.06 3.14 5.06 3.14 0.14 5.20 3.28 5.20 3.28 090
10:50 Nov 30, 2006

77761 .... 26 ..... A Apply intrcav radiat simple ................................... 3.82 1.26 1.13 1.26 1.13 0.19 5.27 5.14 5.27 5.14 090
77762 .... .......... A Apply intrcav radiat interm ................................... 5.73 7.70 6.01 7.70 6.01 0.48 13.91 12.22 13.91 12.22 090
77762 .... TC .... A Apply intrcav radiat interm ................................... 0.00 5.76 4.15 5.76 4.15 0.19 5.95 4.34 5.95 4.34 090
77762 .... 26 ..... A Apply intrcav radiat interm ................................... 5.73 1.94 1.86 1.94 1.86 0.29 7.96 7.88 7.96 7.88 090
77763 .... .......... A Apply intrcav radiat compl .................................... 8.60 10.39 8.03 10.39 8.03 0.66 19.65 17.29 19.65 17.29 090
Jkt 211001
77763 .... TC .... A Apply intrcav radiat compl .................................... 0.00 7.51 5.25 7.51 5.25 0.23 7.74 5.48 7.74 5.48 090
77763 .... 26 ..... A Apply intrcav radiat compl .................................... 8.60 2.88 2.78 2.88 2.78 0.43 11.91 11.81 11.91 11.81 090
77776 .... .......... A Apply interstit radiat simpl .................................... 4.67 7.51 4.23 7.51 4.23 0.57 12.75 9.47 12.75 9.47 090
77776 .... TC .... A Apply interstit radiat simpl .................................... 0.00 5.80 3.09 5.80 3.09 0.13 5.93 3.22 5.93 3.22 090
PO 00000
77776 .... 26 ..... A Apply interstit radiat simpl .................................... 4.67 1.71 1.14 1.71 1.14 0.44 6.82 6.25 6.82 6.25 090
77777 .... .......... A Apply interstit radiat inter ..................................... 7.49 7.90 6.92 7.90 6.92 0.61 16.00 15.02 16.00 15.02 090
77777 .... TC .... A Apply interstit radiat inter ..................................... 0.00 5.40 4.52 5.40 4.52 0.22 5.62 4.74 5.62 4.74 090
77777 .... 26 ..... A Apply interstit radiat inter ..................................... 7.49 2.50 2.40 2.50 2.40 0.39 10.38 10.28 10.38 10.28 090
Frm 00334
77778 .... .......... A Apply interstit radiat compl ................................... 11.23 11.43 9.38 11.43 9.38 0.84 23.50 21.45 23.50 21.45 090
77778 .... TC .... A Apply interstit radiat compl ................................... 0.00 7.62 5.75 7.62 5.75 0.27 7.89 6.02 7.89 6.02 090
77778 .... 26 ..... A Apply interstit radiat compl ................................... 11.23 3.81 3.63 3.81 3.63 0.57 15.61 15.43 15.61 15.43 090
77781 .... .......... A High intensity brachytherapy ................................ 1.21 4.43 16.73 NA NA 1.14 6.78 19.08 NA NA XXX
Fmt 4701
77781 .... TC .... A High intensity brachytherapy ................................ 0.00 4.02 16.23 NA NA 1.06 5.08 17.29 NA NA XXX
77781 .... 26 ..... A High intensity brachytherapy ................................ 1.21 0.41 0.50 0.41 0.50 0.08 1.70 1.79 1.70 1.79 XXX
Sfmt 4700
77789 .... .......... A Apply surface radiation ........................................ 1.14 2.07 1.14 2.07 1.14 0.08 3.29 2.36 3.29 2.36 000
77789 .... TC .... A Apply surface radiation ........................................ 0.00 1.67 0.76 1.67 0.76 0.02 1.69 0.78 1.69 0.78 000
E:\FR\FM\01DER2.SGM
77789 .... 26 ..... A Apply surface radiation ........................................ 1.14 0.40 0.38 0.40 0.38 0.06 1.60 1.58 1.60 1.58 000
77790 .... .......... A Radiation handling ............................................... 1.05 1.47 1.00 NA NA 0.07 2.59 2.12 NA NA XXX
77790 .... TC .... A Radiation handling ............................................... 0.00 1.12 0.66 NA NA 0.02 1.14 0.68 NA NA XXX
77790 .... 26 ..... A Radiation handling ............................................... 1.05 0.35 0.34 0.35 0.34 0.05 1.45 1.44 1.45 1.44 XXX
01DER2
77799 .... .......... C Radium/radioisotope therapy ............................... 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 XXX
77799 .... TC .... C Radium/radioisotope therapy ............................... 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 XXX
77799 .... 26 ..... C Radium/radioisotope therapy ............................... 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 XXX
78000 .... .......... A Thyroid, single uptake .......................................... 0.19 1.72 1.21 NA NA 0.07 1.98 1.47 NA NA XXX
78000 .... TC .... A Thyroid, single uptake .......................................... 0.00 1.67 1.15 NA NA 0.06 1.73 1.21 NA NA XXX
78000 .... 26 ..... A Thyroid, single uptake .......................................... 0.19 0.05 0.06 0.05 0.06 0.01 0.25 0.26 0.25 0.26 XXX
Year Year Year
2007 2007 Fully Im-
VerDate Aug<31>2005
RVUs cility Total
RVUs
78001 .... .......... A Thyroid, multiple uptakes ..................................... 0.26 2.12 1.59 NA NA 0.08 2.46 1.93 NA NA XXX
78001 .... TC .... A Thyroid, multiple uptakes ..................................... 0.00 2.05 1.50 NA NA 0.07 2.12 1.57 NA NA XXX
78001 .... 26 ..... A Thyroid, multiple uptakes ..................................... 0.26 0.07 0.09 0.07 0.09 0.01 0.34 0.36 0.34 0.36 XXX
10:50 Nov 30, 2006

78003 .... .......... A Thyroid suppress/stimul ....................................... 0.33 1.76 1.26 NA NA 0.07 2.16 1.66 NA NA XXX
78003 .... TC .... A Thyroid suppress/stimul ....................................... 0.00 1.67 1.15 NA NA 0.06 1.73 1.21 NA NA XXX
78003 .... 26 ..... A Thyroid suppress/stimul ....................................... 0.33 0.09 0.11 0.09 0.11 0.01 0.43 0.45 0.43 0.45 XXX
78006 .... .......... A Thyroid imaging with uptake ................................ 0.49 5.86 3.38 NA NA 0.15 6.50 4.02 NA NA XXX
78006 .... TC .... A Thyroid imaging with uptake ................................ 0.00 5.72 3.22 NA NA 0.13 5.85 3.35 NA NA XXX
Jkt 211001
78006 .... 26 ..... A Thyroid imaging with uptake ................................ 0.49 0.14 0.16 0.14 0.16 0.02 0.65 0.67 0.65 0.67 XXX
78007 .... .......... A Thyroid image, mult uptakes ................................ 0.50 2.81 2.76 NA NA 0.16 3.47 3.42 NA NA XXX
78007 .... TC .... A Thyroid image, mult uptakes ................................ 0.00 2.67 2.60 NA NA 0.14 2.81 2.74 NA NA XXX
78007 .... 26 ..... A Thyroid image, mult uptakes ................................ 0.50 0.14 0.16 0.14 0.16 0.02 0.66 0.68 0.66 0.68 XXX
PO 00000
78010 .... .......... A Thyroid imaging .................................................... 0.39 3.94 2.45 NA NA 0.13 4.46 2.97 NA NA XXX
78010 .... TC .... A Thyroid imaging .................................................... 0.00 3.83 2.32 NA NA 0.11 3.94 2.43 NA NA XXX
78010 .... 26 ..... A Thyroid imaging .................................................... 0.39 0.11 0.13 0.11 0.13 0.02 0.52 0.54 0.52 0.54 XXX
78011 .... .......... A Thyroid imaging with flow .................................... 0.45 4.27 2.99 NA NA 0.15 4.87 3.59 NA NA XXX
Frm 00335
78011 .... TC .... A Thyroid imaging with flow .................................... 0.00 4.14 2.84 NA NA 0.13 4.27 2.97 NA NA XXX
78011 .... 26 ..... A Thyroid imaging with flow .................................... 0.45 0.13 0.15 0.13 0.15 0.02 0.60 0.62 0.60 0.62 XXX
78015 .... .......... A Thyroid met imaging ............................................ 0.67 5.10 3.38 NA NA 0.17 5.94 4.22 NA NA XXX
78015 .... TC .... A Thyroid met imaging ............................................ 0.00 4.91 3.16 NA NA 0.14 5.05 3.30 NA NA XXX
Fmt 4701
78015 .... 26 ..... A Thyroid met imaging ............................................ 0.67 0.19 0.22 0.19 0.22 0.03 0.89 0.92 0.89 0.92 XXX
78016 .... .......... A Thyroid met imaging/studies ................................ 0.82 8.12 4.85 NA NA 0.21 9.15 5.88 NA NA XXX
78016 .... TC .... A Thyroid met imaging/studies ................................ 0.00 7.89 4.58 NA NA 0.18 8.07 4.76 NA NA XXX
78016 .... 26 ..... A Thyroid met imaging/studies ................................ 0.82 0.23 0.27 0.23 0.27 0.03 1.08 1.12 1.08 1.12 XXX
Sfmt 4700
78018 .... .......... A Thyroid met imaging, body .................................. 0.86 7.47 6.16 NA NA 0.33 8.66 7.35 NA NA XXX
78018 .... TC .... A Thyroid met imaging, body .................................. 0.00 7.23 5.87 NA NA 0.29 7.52 6.16 NA NA XXX
78018 .... 26 ..... A Thyroid met imaging, body .................................. 0.86 0.24 0.29 0.24 0.29 0.04 1.14 1.19 1.14 1.19 XXX
78020 .... .......... A Thyroid met uptake .............................................. 0.60 1.68 1.56 1.68 1.56 0.16 2.44 2.32 2.44 2.32 ZZZ
78020 .... TC .... A Thyroid met uptake .............................................. 0.00 1.51 1.36 1.51 1.36 0.14 1.65 1.50 1.65 1.50 ZZZ
78020 .... 26 ..... A Thyroid met uptake .............................................. 0.60 0.17 0.20 0.17 0.20 0.02 0.79 0.82 0.79 0.82 ZZZ
78070 .... .......... A Parathyroid nuclear imaging ................................ 0.82 3.19 4.21 NA NA 0.15 4.16 5.18 NA NA XXX
78070 .... TC .... A Parathyroid nuclear imaging ................................ 0.00 2.96 3.94 NA NA 0.11 3.07 4.05 NA NA XXX
78070 .... 26 ..... A Parathyroid nuclear imaging ................................ 0.82 0.23 0.27 0.23 0.27 0.04 1.09 1.13 1.09 1.13 XXX
E:\FR\FM\01DER2.SGM
78075 .... .......... A Adrenal nuclear imaging ...................................... 0.74 11.04 7.02 NA NA 0.32 12.10 8.08 NA NA XXX
78075 .... TC .... A Adrenal nuclear imaging ...................................... 0.00 10.83 6.77 NA NA 0.29 11.12 7.06 NA NA XXX
78075 .... 26 ..... A Adrenal nuclear imaging ...................................... 0.74 0.21 0.25 0.21 0.25 0.03 0.98 1.02 0.98 1.02 XXX
78099 .... .......... C Endocrine nuclear procedure ............................... 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 XXX
01DER2
78099 .... TC .... C Endocrine nuclear procedure ............................... 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 XXX
78099 .... 26 ..... C Endocrine nuclear procedure ............................... 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 XXX
78102 .... .......... A Bone marrow imaging, ltd .................................... 0.55 3.91 2.65 NA NA 0.14 4.60 3.34 NA NA XXX
78102 .... TC .... A Bone marrow imaging, ltd .................................... 0.00 3.76 2.47 NA NA 0.12 3.88 2.59 NA NA XXX
78102 .... 26 ..... A Bone marrow imaging, ltd .................................... 0.55 0.15 0.18 0.15 0.18 0.02 0.72 0.75 0.72 0.75 XXX
78103 .... .......... A Bone marrow imaging, mult ................................. 0.75 5.09 3.85 NA NA 0.20 6.04 4.80 NA NA XXX
69957
Year
69958
Year Year
2007 2007 Fully Im-
VerDate Aug<31>2005
RVUs cility Total
RVUs
78103 .... TC .... A Bone marrow imaging, mult ................................. 0.00 4.88 3.60 NA NA 0.17 5.05 3.77 NA NA XXX
78103 .... 26 ..... A Bone marrow imaging, mult ................................. 0.75 0.21 0.25 0.21 0.25 0.03 0.99 1.03 0.99 1.03 XXX
78104 .... .......... A Bone marrow imaging, body ................................ 0.80 5.96 4.75 NA NA 0.25 7.01 5.80 NA NA XXX
10:50 Nov 30, 2006

78104 .... TC .... A Bone marrow imaging, body ................................ 0.00 5.71 4.48 NA NA 0.22 5.93 4.70 NA NA XXX
78104 .... 26 ..... A Bone marrow imaging, body ................................ 0.80 0.25 0.27 0.25 0.27 0.03 1.08 1.10 1.08 1.10 XXX
78110 .... .......... A Plasma volume, single ......................................... 0.19 2.03 1.28 NA NA 0.07 2.29 1.54 NA NA XXX
78110 .... TC .... A Plasma volume, single ......................................... 0.00 1.98 1.21 NA NA 0.06 2.04 1.27 NA NA XXX
78110 .... 26 ..... A Plasma volume, single ......................................... 0.19 0.05 0.07 0.05 0.07 0.01 0.25 0.27 0.25 0.27 XXX
Jkt 211001
78111 .... .......... A Plasma volume, multiple ...................................... 0.22 2.02 2.50 NA NA 0.15 2.39 2.87 NA NA XXX
78111 .... TC .... A Plasma volume, multiple ...................................... 0.00 1.96 2.42 NA NA 0.14 2.10 2.56 NA NA XXX
78111 .... 26 ..... A Plasma volume, multiple ...................................... 0.22 0.06 0.08 0.06 0.08 0.01 0.29 0.31 0.29 0.31 XXX
78120 .... .......... A Red cell mass, single ........................................... 0.23 1.96 1.85 NA NA 0.12 2.31 2.20 NA NA XXX
PO 00000
78120 .... TC .... A Red cell mass, single ........................................... 0.00 1.89 1.77 NA NA 0.11 2.00 1.88 NA NA XXX
78120 .... 26 ..... A Red cell mass, single ........................................... 0.23 0.07 0.08 0.07 0.08 0.01 0.31 0.32 0.31 0.32 XXX
78121 .... .......... A Red cell mass, multiple ........................................ 0.32 2.06 2.79 NA NA 0.15 2.53 3.26 NA NA XXX
78121 .... TC .... A Red cell mass, multiple ........................................ 0.00 1.97 2.68 NA NA 0.14 2.11 2.82 NA NA XXX
Frm 00336
78121 .... 26 ..... A Red cell mass, multiple ........................................ 0.32 0.09 0.11 0.09 0.11 0.01 0.42 0.44 0.42 0.44 XXX
78122 .... .......... A Blood volume ....................................................... 0.45 2.09 4.09 NA NA 0.26 2.80 4.80 NA NA XXX
78122 .... TC .... A Blood volume ....................................................... 0.00 1.97 3.94 NA NA 0.24 2.21 4.18 NA NA XXX
78122 .... 26 ..... A Blood volume ....................................................... 0.45 0.12 0.15 0.12 0.15 0.02 0.59 0.62 0.59 0.62 XXX
Fmt 4701
78130 .... .......... A Red cell survival study ......................................... 0.61 3.32 3.12 NA NA 0.17 4.10 3.90 NA NA XXX
78130 .... TC .... A Red cell survival study ......................................... 0.00 3.14 2.92 NA NA 0.14 3.28 3.06 NA NA XXX
78130 .... 26 ..... A Red cell survival study ......................................... 0.61 0.18 0.20 0.18 0.20 0.03 0.82 0.84 0.82 0.84 XXX
78135 .... .......... A Red cell survival kinetics ...................................... 0.64 8.09 5.84 NA NA 0.28 9.01 6.76 NA NA XXX
Sfmt 4700
78135 .... TC .... A Red cell survival kinetics ...................................... 0.00 7.91 5.63 NA NA 0.25 8.16 5.88 NA NA XXX
78135 .... 26 ..... A Red cell survival kinetics ...................................... 0.64 0.18 0.21 0.18 0.21 0.03 0.85 0.88 0.85 0.88 XXX
78140 .... .......... A Red cell sequestration ......................................... 0.61 2.68 3.77 NA NA 0.24 3.53 4.62 NA NA XXX
78140 .... TC .... A Red cell sequestration ......................................... 0.00 2.51 3.58 NA NA 0.21 2.72 3.79 NA NA XXX
78140 .... 26 ..... A Red cell sequestration ......................................... 0.61 0.17 0.19 0.17 0.19 0.03 0.81 0.83 0.81 0.83 XXX
78185 .... .......... A Spleen imaging .................................................... 0.40 4.90 3.10 NA NA 0.15 5.45 3.65 NA NA XXX
78185 .... TC .... A Spleen imaging .................................................... 0.00 4.79 2.97 NA NA 0.13 4.92 3.10 NA NA XXX
78185 .... 26 ..... A Spleen imaging .................................................... 0.40 0.11 0.13 0.11 0.13 0.02 0.53 0.55 0.53 0.55 XXX
78190 .... .......... A Platelet survival, kinetics ...................................... 1.09 8.77 6.77 NA NA 0.38 10.24 8.24 NA NA XXX
E:\FR\FM\01DER2.SGM
78190 .... TC .... A Platelet survival, kinetics ...................................... 0.00 8.44 6.39 NA NA 0.30 8.74 6.69 NA NA XXX
78190 .... 26 ..... A Platelet survival, kinetics ...................................... 1.09 0.33 0.38 0.33 0.38 0.08 1.50 1.55 1.50 1.55 XXX
78191 .... .......... A Platelet survival .................................................... 0.61 3.21 6.46 NA NA 0.40 4.22 7.47 NA NA XXX
78191 .... TC .... A Platelet survival .................................................... 0.00 3.04 6.27 NA NA 0.37 3.41 6.64 NA NA XXX
01DER2
78191 .... 26 ..... A Platelet survival .................................................... 0.61 0.17 0.19 0.17 0.19 0.03 0.81 0.83 0.81 0.83 XXX
78195 .... .......... A Lymph system imaging ........................................ 1.20 8.15 5.40 NA NA 0.28 9.63 6.88 NA NA XXX
78195 .... TC .... A Lymph system imaging ........................................ 0.00 7.82 5.01 NA NA 0.22 8.04 5.23 NA NA XXX
78195 .... 26 ..... A Lymph system imaging ........................................ 1.20 0.33 0.39 0.33 0.39 0.06 1.59 1.65 1.59 1.65 XXX
78199 .... .......... C Blood/lymph nuclear exam ................................... 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 XXX
78199 .... TC .... C Blood/lymph nuclear exam ................................... 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 XXX
Year Year Year
2007 2007 Fully Im-
VerDate Aug<31>2005
RVUs cility Total
RVUs
78199 .... 26 ..... C Blood/lymph nuclear exam ................................... 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 XXX
78201 .... .......... A Liver imaging ........................................................ 0.44 4.48 3.00 NA NA 0.15 5.07 3.59 NA NA XXX
78201 .... TC .... A Liver imaging ........................................................ 0.00 4.36 2.86 NA NA 0.13 4.49 2.99 NA NA XXX
10:50 Nov 30, 2006

78201 .... 26 ..... A Liver imaging ........................................................ 0.44 0.12 0.14 0.12 0.14 0.02 0.58 0.60 0.58 0.60 XXX
78202 .... .......... A Liver imaging with flow ......................................... 0.51 5.06 3.55 NA NA 0.16 5.73 4.22 NA NA XXX
78202 .... TC .... A Liver imaging with flow ......................................... 0.00 4.92 3.39 NA NA 0.14 5.06 3.53 NA NA XXX
78202 .... 26 ..... A Liver imaging with flow ......................................... 0.51 0.14 0.16 0.14 0.16 0.02 0.67 0.69 0.67 0.69 XXX
78205 .... .......... A Liver imaging (3D) ................................................ 0.71 4.93 5.85 NA NA 0.34 5.98 6.90 NA NA XXX
Jkt 211001
78205 .... TC .... A Liver imaging (3D) ................................................ 0.00 4.73 5.62 NA NA 0.31 5.04 5.93 NA NA XXX
78205 .... 26 ..... A Liver imaging (3D) ................................................ 0.71 0.20 0.23 0.20 0.23 0.03 0.94 0.97 0.94 0.97 XXX
78206 .... .......... A Liver image (3d) with flow .................................... 0.96 13.75 8.12 NA NA 0.15 14.86 9.23 NA NA XXX
78206 .... TC .... A Liver image (3d) with flow .................................... 0.00 13.48 7.80 NA NA 0.11 13.59 7.91 NA NA XXX
PO 00000
78206 .... 26 ..... A Liver image (3d) with flow .................................... 0.96 0.27 0.32 0.27 0.32 0.04 1.27 1.32 1.27 1.32 XXX
78215 .... .......... A Liver and spleen imaging ..................................... 0.49 4.52 3.46 NA NA 0.16 5.17 4.11 NA NA XXX
78215 .... TC .... A Liver and spleen imaging ..................................... 0.00 4.38 3.30 NA NA 0.14 4.52 3.44 NA NA XXX
78215 .... 26 ..... A Liver and spleen imaging ..................................... 0.49 0.14 0.16 0.14 0.16 0.02 0.65 0.67 0.65 0.67 XXX
Frm 00337
78216 .... .......... A Liver & spleen image/flow .................................... 0.57 2.63 3.41 NA NA 0.20 3.40 4.18 NA NA XXX
78216 .... TC .... A Liver & spleen image/flow .................................... 0.00 2.47 3.23 NA NA 0.18 2.65 3.41 NA NA XXX
78216 .... 26 ..... A Liver & spleen image/flow .................................... 0.57 0.16 0.18 0.16 0.18 0.02 0.75 0.77 0.75 0.77 XXX
78220 .... .......... A Liver function study .............................................. 0.49 2.84 3.63 NA NA 0.21 3.54 4.33 NA NA XXX
Fmt 4701
78220 .... TC .... A Liver function study .............................................. 0.00 2.70 3.47 NA NA 0.19 2.89 3.66 NA NA XXX
78220 .... 26 ..... A Liver function study .............................................. 0.49 0.14 0.16 0.14 0.16 0.02 0.65 0.67 0.65 0.67 XXX
78223 .... .......... A Hepatobiliary imaging ........................................... 0.84 7.99 4.95 NA NA 0.23 9.06 6.02 NA NA XXX
78223 .... TC .... A Hepatobiliary imaging ........................................... 0.00 7.75 4.68 NA NA 0.19 7.94 4.87 NA NA XXX
Sfmt 4700
78223 .... 26 ..... A Hepatobiliary imaging ........................................... 0.84 0.24 0.27 0.24 0.27 0.04 1.12 1.15 1.12 1.15 XXX
78230 .... .......... A Salivary gland imaging ......................................... 0.45 3.91 2.72 NA NA 0.15 4.51 3.32 NA NA XXX
78230 .... TC .... A Salivary gland imaging ......................................... 0.00 3.79 2.58 NA NA 0.13 3.92 2.71 NA NA XXX
78230 .... 26 ..... A Salivary gland imaging ......................................... 0.45 0.12 0.14 0.12 0.14 0.02 0.59 0.61 0.59 0.61 XXX
78231 .... .......... A Serial salivary imaging ......................................... 0.52 2.63 3.17 NA NA 0.19 3.34 3.88 NA NA XXX
78231 .... TC .... A Serial salivary imaging ......................................... 0.00 2.48 3.00 NA NA 0.17 2.65 3.17 NA NA XXX
78231 .... 26 ..... A Serial salivary imaging ......................................... 0.52 0.15 0.17 0.15 0.17 0.02 0.69 0.71 0.69 0.71 XXX
78232 .... .......... A Salivary gland function exam ............................... 0.47 2.60 3.42 NA NA 0.20 3.27 4.09 NA NA XXX
78232 .... TC .... A Salivary gland function exam ............................... 0.00 2.47 3.27 NA NA 0.18 2.65 3.45 NA NA XXX
E:\FR\FM\01DER2.SGM
78232 .... 26 ..... A Salivary gland function exam ............................... 0.47 0.13 0.15 0.13 0.15 0.02 0.62 0.64 0.62 0.64 XXX
78258 .... .......... A Esophageal motility study .................................... 0.74 5.57 3.74 NA NA 0.17 6.48 4.65 NA NA XXX
78258 .... TC .... A Esophageal motility study .................................... 0.00 5.32 3.49 NA NA 0.14 5.46 3.63 NA NA XXX
78258 .... 26 ..... A Esophageal motility study .................................... 0.74 0.25 0.25 0.25 0.25 0.03 1.02 1.02 1.02 1.02 XXX
01DER2
78261 .... .......... A Gastric mucosa imaging ...................................... 0.69 5.69 4.68 NA NA 0.25 6.63 5.62 NA NA XXX
78261 .... TC .... A Gastric mucosa imaging ...................................... 0.00 5.50 4.45 NA NA 0.22 5.72 4.67 NA NA XXX
78261 .... 26 ..... A Gastric mucosa imaging ...................................... 0.69 0.19 0.23 0.19 0.23 0.03 0.91 0.95 0.91 0.95 XXX
78262 .... .......... A Gastroesophageal reflux exam ............................ 0.68 5.65 4.77 NA NA 0.25 6.58 5.70 NA NA XXX
78262 .... TC .... A Gastroesophageal reflux exam ............................ 0.00 5.46 4.55 NA NA 0.22 5.68 4.77 NA NA XXX
78262 .... 26 ..... A Gastroesophageal reflux exam ............................ 0.68 0.19 0.22 0.19 0.22 0.03 0.90 0.93 0.90 0.93 XXX
69959
Year
69960
Year Year
2007 2007 Fully Im-
VerDate Aug<31>2005
RVUs cility Total
RVUs
78264 .... .......... A Gastric emptying study ........................................ 0.78 6.73 4.98 NA NA 0.25 7.76 6.01 NA NA XXX
78264 .... TC .... A Gastric emptying study ........................................ 0.00 6.51 4.73 NA NA 0.22 6.73 4.95 NA NA XXX
78264 .... 26 ..... A Gastric emptying study ........................................ 0.78 0.22 0.25 0.22 0.25 0.03 1.03 1.06 1.03 1.06 XXX
10:50 Nov 30, 2006

78267 .... .......... X Breath tst attain/anal c-14 .................................... 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 XXX
78268 .... .......... X Breath test analysis, c-14 .................................... 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 XXX
78270 .... .......... A Vit B-12 absorption exam .................................... 0.20 1.81 1.67 NA NA 0.11 2.12 1.98 NA NA XXX
78270 .... TC .... A Vit B-12 absorption exam .................................... 0.00 1.76 1.60 NA NA 0.10 1.86 1.70 NA NA XXX
78270 .... 26 ..... A Vit B-12 absorption exam .................................... 0.20 0.05 0.07 0.05 0.07 0.01 0.26 0.28 0.26 0.28 XXX
Jkt 211001
78271 .... .......... A Vit b-12 absrp exam, int fac ................................. 0.20 1.83 1.75 NA NA 0.11 2.14 2.06 NA NA XXX
78271 .... TC .... A Vit b-12 absrp exam, int fac ................................. 0.00 1.78 1.68 NA NA 0.10 1.88 1.78 NA NA XXX
78271 .... 26 ..... A Vit b-12 absrp exam, int fac ................................. 0.20 0.05 0.07 0.05 0.07 0.01 0.26 0.28 0.26 0.28 XXX
78272 .... .......... A Vit B-12 absorp, combined .................................. 0.27 1.95 2.30 NA NA 0.14 2.36 2.71 NA NA XXX
PO 00000
78272 .... TC .... A Vit B-12 absorp, combined .................................. 0.00 1.88 2.21 NA NA 0.13 2.01 2.34 NA NA XXX
78272 .... 26 ..... A Vit B-12 absorp, combined .................................. 0.27 0.07 0.09 0.07 0.09 0.01 0.35 0.37 0.35 0.37 XXX
78278 .... .......... A Acute GI blood loss imaging ................................ 0.99 8.06 5.92 NA NA 0.29 9.34 7.20 NA NA XXX
78278 .... TC .... A Acute GI blood loss imaging ................................ 0.00 7.78 5.60 NA NA 0.25 8.03 5.85 NA NA XXX
Frm 00338
78278 .... 26 ..... A Acute GI blood loss imaging ................................ 0.99 0.28 0.32 0.28 0.32 0.04 1.31 1.35 1.31 1.35 XXX
78282 .... .......... C GI protein loss exam ............................................ 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 XXX
78282 .... TC .... C GI protein loss exam ............................................ 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 XXX
78282 .... 26 ..... A GI protein loss exam ............................................ 0.38 0.10 0.12 0.10 0.12 0.02 0.50 0.52 0.50 0.52 XXX
Fmt 4701
78290 .... .......... A Meckel"s divert exam ......................................... 0.68 7.97 4.45 NA NA 0.19 8.84 5.32 NA NA XXX
78290 .... TC .... A Meckel"s divert exam ......................................... 0.00 7.78 4.23 NA NA 0.16 7.94 4.39 NA NA XXX
78290 .... 26 ..... A Meckel"s divert exam ......................................... 0.68 0.19 0.22 0.19 0.22 0.03 0.90 0.93 0.90 0.93 XXX
78291 .... .......... A Leveen/shunt patency exam ................................ 0.88 5.82 3.98 NA NA 0.20 6.90 5.06 NA NA XXX
Sfmt 4700
78291 .... TC .... A Leveen/shunt patency exam ................................ 0.00 5.57 3.69 NA NA 0.16 5.73 3.85 NA NA XXX
78291 .... 26 ..... A Leveen/shunt patency exam ................................ 0.88 0.25 0.29 0.25 0.29 0.04 1.17 1.21 1.17 1.21 XXX
78299 .... .......... C GI nuclear procedure ........................................... 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 XXX
78299 .... TC .... C GI nuclear procedure ........................................... 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 XXX
78299 .... 26 ..... C GI nuclear procedure ........................................... 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 XXX
78300 .... .......... A Bone imaging, limited area .................................. 0.62 3.94 3.00 NA NA 0.17 4.73 3.79 NA NA XXX
78300 .... TC .... A Bone imaging, limited area .................................. 0.00 3.76 2.80 NA NA 0.14 3.90 2.94 NA NA XXX
78300 .... 26 ..... A Bone imaging, limited area .................................. 0.62 0.18 0.20 0.18 0.20 0.03 0.83 0.85 0.83 0.85 XXX
78305 .... .......... A Bone imaging, multiple areas .............................. 0.83 5.13 4.24 NA NA 0.23 6.19 5.30 NA NA XXX
E:\FR\FM\01DER2.SGM
78305 .... TC .... A Bone imaging, multiple areas .............................. 0.00 4.90 3.97 NA NA 0.19 5.09 4.16 NA NA XXX
78305 .... 26 ..... A Bone imaging, multiple areas .............................. 0.83 0.23 0.27 0.23 0.27 0.04 1.10 1.14 1.10 1.14 XXX
78306 .... .......... A Bone imaging, whole body ................................... 0.86 5.68 4.84 NA NA 0.26 6.80 5.96 NA NA XXX
78306 .... TC .... A Bone imaging, whole body ................................... 0.00 5.44 4.56 NA NA 0.22 5.66 4.78 NA NA XXX
01DER2
78306 .... 26 ..... A Bone imaging, whole body ................................... 0.86 0.24 0.28 0.24 0.28 0.04 1.14 1.18 1.14 1.18 XXX
78315 .... .......... A Bone imaging, 3 phase ........................................ 1.02 8.07 5.86 NA NA 0.29 9.38 7.17 NA NA XXX
78315 .... TC .... A Bone imaging, 3 phase ........................................ 0.00 7.78 5.53 NA NA 0.25 8.03 5.78 NA NA XXX
78315 .... 26 ..... A Bone imaging, 3 phase ........................................ 1.02 0.29 0.33 0.29 0.33 0.04 1.35 1.39 1.35 1.39 XXX
78320 .... .......... A Bone imaging (3D) ............................................... 1.04 5.00 5.95 NA NA 0.35 6.39 7.34 NA NA XXX
78320 .... TC .... A Bone imaging (3D) ............................................... 0.00 4.71 5.61 NA NA 0.31 5.02 5.92 NA NA XXX
Year Year Year
2007 2007 Fully Im-
VerDate Aug<31>2005
RVUs cility Total
RVUs
78320 .... 26 ..... A Bone imaging (3D) ............................................... 1.04 0.29 0.34 0.29 0.34 0.04 1.37 1.42 1.37 1.42 XXX
78350 .... .......... N Bone mineral, single photon ................................ 0.22 0.00 0.82 NA NA 0.06 0.28 1.10 NA NA XXX
78350 .... TC .... N Bone mineral, single photon ................................ 0.00 0.00 0.75 NA NA 0.05 0.05 0.80 NA NA XXX
10:50 Nov 30, 2006

78350 .... 26 ..... N Bone mineral, single photon ................................ 0.22 0.00 0.07 0.00 0.07 0.01 0.23 0.30 0.23 0.30 XXX
78351 .... .......... N Bone mineral, dual photon ................................... 0.30 NA NA 0.07 0.11 0.01 NA NA 0.38 0.42 XXX
78399 .... .......... C Musculoskeletal nuclear exam ............................. 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 XXX
78399 .... TC .... C Musculoskeletal nuclear exam ............................. 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 XXX
78399 .... 26 ..... C Musculoskeletal nuclear exam ............................. 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 XXX
Jkt 211001
78414 .... .......... C Non-imaging heart function .................................. 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 XXX
78414 .... TC .... C Non-imaging heart function .................................. 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 XXX
78414 .... 26 ..... A Non-imaging heart function .................................. 0.45 0.14 0.16 0.14 0.16 0.02 0.61 0.63 0.61 0.63 XXX
78428 .... .......... A Cardiac shunt imaging ......................................... 0.78 5.26 3.22 NA NA 0.16 6.20 4.16 NA NA XXX
PO 00000
78428 .... TC .... A Cardiac shunt imaging ......................................... 0.00 4.88 2.91 NA NA 0.13 5.01 3.04 NA NA XXX
78428 .... 26 ..... A Cardiac shunt imaging ......................................... 0.78 0.38 0.31 0.38 0.31 0.03 1.19 1.12 1.19 1.12 XXX
78445 .... .......... A Vascular flow imaging .......................................... 0.49 4.34 2.61 NA NA 0.13 4.96 3.23 NA NA XXX
78445 .... TC .... A Vascular flow imaging .......................................... 0.00 4.18 2.44 NA NA 0.11 4.29 2.55 NA NA XXX
Frm 00339
78445 .... 26 ..... A Vascular flow imaging .......................................... 0.49 0.16 0.17 0.16 0.17 0.02 0.67 0.68 0.67 0.68 XXX
78456 .... .......... A Acute venous thrombus image ............................ 1.00 9.86 5.71 NA NA 0.33 11.19 7.04 NA NA XXX
78456 .... TC .... A Acute venous thrombus image ............................ 0.00 9.36 5.33 NA NA 0.29 9.65 5.62 NA NA XXX
78456 .... 26 ..... A Acute venous thrombus image ............................ 1.00 0.50 0.38 0.50 0.38 0.04 1.54 1.42 1.54 1.42 XXX
Fmt 4701
78457 .... .......... A Venous thrombosis imaging ................................. 0.77 4.53 3.32 NA NA 0.17 5.47 4.26 NA NA XXX
78457 .... TC .... A Venous thrombosis imaging ................................. 0.00 4.31 3.07 NA NA 0.14 4.45 3.21 NA NA XXX
78457 .... 26 ..... A Venous thrombosis imaging ................................. 0.77 0.22 0.25 0.22 0.25 0.03 1.02 1.05 1.02 1.05 XXX
78458 .... .......... A Ven thrombosis images, bilat ............................... 0.90 4.30 4.33 NA NA 0.25 5.45 5.48 NA NA XXX
Sfmt 4700
78458 .... TC .... A Ven thrombosis images, bilat ............................... 0.00 4.05 4.03 NA NA 0.21 4.26 4.24 NA NA XXX
78458 .... 26 ..... A Ven thrombosis images, bilat ............................... 0.90 0.25 0.30 0.25 0.30 0.04 1.19 1.24 1.19 1.24 XXX
78459 .... .......... C Heart muscle imaging (PET) ................................ 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 XXX
78459 .... TC .... C Heart muscle imaging (PET) ................................ 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 XXX
78459 .... 26 ..... A Heart muscle imaging (PET) ................................ 1.50 0.54 0.56 0.54 0.56 0.05 2.09 2.11 2.09 2.11 XXX
78460 .... .......... A Heart muscle blood, single .................................. 0.86 4.44 3.10 NA NA 0.17 5.47 4.13 NA NA XXX
78460 .... TC .... A Heart muscle blood, single .................................. 0.00 4.17 2.81 NA NA 0.13 4.30 2.94 NA NA XXX
78460 .... 26 ..... A Heart muscle blood, single .................................. 0.86 0.27 0.29 0.27 0.29 0.04 1.17 1.19 1.17 1.19 XXX
78461 .... .......... A Heart muscle blood, multiple ............................... 1.23 3.79 4.81 NA NA 0.30 5.32 6.34 NA NA XXX
E:\FR\FM\01DER2.SGM
78461 .... TC .... A Heart muscle blood, multiple ............................... 0.00 3.40 4.39 NA NA 0.25 3.65 4.64 NA NA XXX
78461 .... 26 ..... A Heart muscle blood, multiple ............................... 1.23 0.39 0.42 0.39 0.42 0.05 1.67 1.70 1.67 1.70 XXX
78464 .... .......... A Heart image (3d), single ...................................... 1.09 5.75 7.03 NA NA 0.41 7.25 8.53 NA NA XXX
78464 .... TC .... A Heart image (3d), single ...................................... 0.00 5.27 6.62 NA NA 0.37 5.64 6.99 NA NA XXX
01DER2
78464 .... 26 ..... A Heart image (3d), single ...................................... 1.09 0.48 0.41 0.48 0.41 0.04 1.61 1.54 1.61 1.54 XXX
78465 .... .......... A Heart image (3d), multiple ................................... 1.46 11.36 12.08 NA NA 0.67 13.49 14.21 NA NA XXX
78465 .... TC .... A Heart image (3d), multiple ................................... 0.00 10.66 11.51 NA NA 0.62 11.28 12.13 NA NA XXX
78465 .... 26 ..... A Heart image (3d), multiple ................................... 1.46 0.70 0.57 0.70 0.57 0.05 2.21 2.08 2.21 2.08 XXX
78466 .... .......... A Heart infarct image ............................................... 0.69 4.34 3.23 NA NA 0.17 5.20 4.09 NA NA XXX
78466 .... TC .... A Heart infarct image ............................................... 0.00 4.10 2.99 NA NA 0.14 4.24 3.13 NA NA XXX
69961
Year
69962
Year Year
2007 2007 Fully Im-
VerDate Aug<31>2005
RVUs cility Total
RVUs
78466 .... 26 ..... A Heart infarct image ............................................... 0.69 0.24 0.24 0.24 0.24 0.03 0.96 0.96 0.96 0.96 XXX
78468 .... .......... A Heart infarct image (ef) ........................................ 0.80 5.98 4.45 NA NA 0.22 7.00 5.47 NA NA XXX
78468 .... TC .... A Heart infarct image (ef) ........................................ 0.00 5.56 4.14 NA NA 0.19 5.75 4.33 NA NA XXX
10:50 Nov 30, 2006

78468 .... 26 ..... A Heart infarct image (ef) ........................................ 0.80 0.42 0.31 0.42 0.31 0.03 1.25 1.14 1.25 1.14 XXX
78469 .... .......... A Heart infarct image (3D) ...................................... 0.92 6.21 5.70 NA NA 0.31 7.44 6.93 NA NA XXX
78469 .... TC .... A Heart infarct image (3D) ...................................... 0.00 5.77 5.36 NA NA 0.28 6.05 5.64 NA NA XXX
78469 .... 26 ..... A Heart infarct image (3D) ...................................... 0.92 0.44 0.34 0.44 0.34 0.03 1.39 1.29 1.39 1.29 XXX
78472 .... .......... A Gated heart, planar, single .................................. 0.98 5.95 5.87 NA NA 0.34 7.27 7.19 NA NA XXX
Jkt 211001
78472 .... TC .... A Gated heart, planar, single .................................. 0.00 5.56 5.52 NA NA 0.30 5.86 5.82 NA NA XXX
78472 .... 26 ..... A Gated heart, planar, single .................................. 0.98 0.39 0.35 0.39 0.35 0.04 1.41 1.37 1.41 1.37 XXX
78473 .... .......... A Gated heart, multiple ............................................ 1.47 7.54 8.46 NA NA 0.48 9.49 10.41 NA NA XXX
78473 .... TC .... A Gated heart, multiple ............................................ 0.00 6.94 7.93 NA NA 0.42 7.36 8.35 NA NA XXX
PO 00000
78473 .... 26 ..... A Gated heart, multiple ............................................ 1.47 0.60 0.53 0.60 0.53 0.06 2.13 2.06 2.13 2.06 XXX
78478 .... .......... A Heart wall motion add-on ..................................... 0.50 0.80 1.54 NA NA 0.12 1.42 2.16 NA NA XXX
78478 .... TC .... A Heart wall motion add-on ..................................... 0.00 0.56 1.31 NA NA 0.10 0.66 1.41 NA NA XXX
78478 .... 26 ..... A Heart wall motion add-on ..................................... 0.50 0.24 0.23 0.24 0.23 0.02 0.76 0.75 0.76 0.75 XXX
Frm 00340
78480 .... .......... A Heart function add-on .......................................... 0.30 0.70 1.51 NA NA 0.12 1.12 1.93 NA NA XXX
78480 .... TC .... A Heart function add-on .......................................... 0.00 0.55 1.31 NA NA 0.10 0.65 1.41 NA NA XXX
78480 .... 26 ..... A Heart function add-on .......................................... 0.30 0.15 0.20 0.15 0.20 0.02 0.47 0.52 0.47 0.52 XXX
78481 .... .......... A Heart first pass, single ......................................... 0.98 5.07 5.46 NA NA 0.31 6.36 6.75 NA NA XXX
Fmt 4701
78481 .... TC .... A Heart first pass, single ......................................... 0.00 4.57 5.06 NA NA 0.28 4.85 5.34 NA NA XXX
78481 .... 26 ..... A Heart first pass, single ......................................... 0.98 0.50 0.40 0.50 0.40 0.03 1.51 1.41 1.51 1.41 XXX
78483 .... .......... A Heart first pass, multiple ...................................... 1.47 6.86 8.02 NA NA 0.46 8.79 9.95 NA NA XXX
78483 .... TC .... A Heart first pass, multiple ...................................... 0.00 6.07 7.42 NA NA 0.41 6.48 7.83 NA NA XXX
Sfmt 4700
78483 .... 26 ..... A Heart first pass, multiple ...................................... 1.47 0.79 0.60 0.79 0.60 0.05 2.31 2.12 2.31 2.12 XXX
78491 .... .......... C Heart image (pet), single ..................................... 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 XXX
78491 .... TC .... C Heart image (pet), single ..................................... 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 XXX
78491 .... 26 ..... A Heart image (pet), single ..................................... 1.50 0.60 0.59 0.60 0.59 0.06 2.16 2.15 2.16 2.15 XXX
78492 .... .......... C Heart image (pet), multiple .................................. 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 XXX
78492 .... TC .... C Heart image (pet), multiple .................................. 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 XXX
78492 .... 26 ..... A Heart image (pet), multiple .................................. 1.87 0.91 0.78 0.91 0.78 0.07 2.85 2.72 2.85 2.72 XXX
78494 .... .......... A Heart image, spect ............................................... 1.19 6.19 7.17 NA NA 0.35 7.73 8.71 NA NA XXX
78494 .... TC .... A Heart image, spect ............................................... 0.00 5.65 6.72 NA NA 0.30 5.95 7.02 NA NA XXX
E:\FR\FM\01DER2.SGM
78494 .... 26 ..... A Heart image, spect ............................................... 1.19 0.54 0.45 0.54 0.45 0.05 1.78 1.69 1.78 1.69 XXX
78496 .... .......... A Heart first pass add-on ........................................ 0.50 0.92 5.67 0.92 5.67 0.32 1.74 6.49 1.74 6.49 ZZZ
78496 .... TC .... A Heart first pass add-on ........................................ 0.00 0.67 5.47 0.67 5.47 0.30 0.97 5.77 0.97 5.77 ZZZ
78496 .... 26 ..... A Heart first pass add-on ........................................ 0.50 0.25 0.20 0.25 0.20 0.02 0.77 0.72 0.77 0.72 ZZZ
01DER2
78499 .... .......... C Cardiovascular nuclear exam .............................. 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 XXX
78499 .... TC .... C Cardiovascular nuclear exam .............................. 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 XXX
78499 .... 26 ..... C Cardiovascular nuclear exam .............................. 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 XXX
78580 .... .......... A Lung perfusion imaging ........................................ 0.74 4.83 3.97 NA NA 0.21 5.78 4.92 NA NA XXX
78580 .... TC .... A Lung perfusion imaging ........................................ 0.00 4.61 3.73 NA NA 0.18 4.79 3.91 NA NA XXX
78580 .... 26 ..... A Lung perfusion imaging ........................................ 0.74 0.22 0.24 0.22 0.24 0.03 0.99 1.01 0.99 1.01 XXX
Year Year Year
2007 2007 Fully Im-
VerDate Aug<31>2005
RVUs cility Total
RVUs
78584 .... .......... A Lung V/Q image single breath ............................. 0.99 2.74 3.34 NA NA 0.21 3.94 4.54 NA NA XXX
78584 .... TC .... A Lung V/Q image single breath ............................. 0.00 2.46 3.02 NA NA 0.17 2.63 3.19 NA NA XXX
78584 .... 26 ..... A Lung V/Q image single breath ............................. 0.99 0.28 0.32 0.28 0.32 0.04 1.31 1.35 1.31 1.35 XXX
10:50 Nov 30, 2006

78585 .... .......... A Lung V/Q imaging ................................................ 1.09 8.09 6.53 NA NA 0.35 9.53 7.97 NA NA XXX
78585 .... TC .... A Lung V/Q imaging ................................................ 0.00 7.78 6.18 NA NA 0.30 8.08 6.48 NA NA XXX
78585 .... 26 ..... A Lung V/Q imaging ................................................ 1.09 0.31 0.35 0.31 0.35 0.05 1.45 1.49 1.45 1.49 XXX
78586 .... .......... A Aerosol lung image, single ................................... 0.40 3.89 3.02 NA NA 0.16 4.45 3.58 NA NA XXX
78586 .... TC .... A Aerosol lung image, single ................................... 0.00 3.78 2.89 NA NA 0.14 3.92 3.03 NA NA XXX
Jkt 211001
78586 .... 26 ..... A Aerosol lung image, single ................................... 0.40 0.11 0.13 0.11 0.13 0.02 0.53 0.55 0.53 0.55 XXX
78587 .... .......... A Aerosol lung image, multiple ................................ 0.49 5.12 3.51 NA NA 0.16 5.77 4.16 NA NA XXX
78587 .... TC .... A Aerosol lung image, multiple ................................ 0.00 4.98 3.35 NA NA 0.14 5.12 3.49 NA NA XXX
78587 .... 26 ..... A Aerosol lung image, multiple ................................ 0.49 0.14 0.16 0.14 0.16 0.02 0.65 0.67 0.65 0.67 XXX
PO 00000
78588 .... .......... A Perfusion lung image ........................................... 1.09 8.11 4.70 NA NA 0.23 9.43 6.02 NA NA XXX
78588 .... TC .... A Perfusion lung image ........................................... 0.00 7.81 4.35 NA NA 0.18 7.99 4.53 NA NA XXX
78588 .... 26 ..... A Perfusion lung image ........................................... 1.09 0.30 0.35 0.30 0.35 0.05 1.44 1.49 1.44 1.49 XXX
78591 .... .......... A Vent image, 1 breath, 1 proj ................................ 0.40 3.87 3.21 NA NA 0.16 4.43 3.77 NA NA XXX
Frm 00341
78591 .... TC .... A Vent image, 1 breath, 1 proj ................................ 0.00 3.76 3.08 NA NA 0.14 3.90 3.22 NA NA XXX
78591 .... 26 ..... A Vent image, 1 breath, 1 proj ................................ 0.40 0.11 0.13 0.11 0.13 0.02 0.53 0.55 0.53 0.55 XXX
78593 .... .......... A Vent image, 1 proj, gas ........................................ 0.49 4.51 3.84 NA NA 0.20 5.20 4.53 NA NA XXX
78593 .... TC .... A Vent image, 1 proj, gas ........................................ 0.00 4.37 3.68 NA NA 0.18 4.55 3.86 NA NA XXX
Fmt 4701
78593 .... 26 ..... A Vent image, 1 proj, gas ........................................ 0.49 0.14 0.16 0.14 0.16 0.02 0.65 0.67 0.65 0.67 XXX
78594 .... .......... A Vent image, mult proj, gas ................................... 0.53 4.99 5.12 NA NA 0.27 5.79 5.92 NA NA XXX
78594 .... TC .... A Vent image, mult proj, gas ................................... 0.00 4.84 4.95 NA NA 0.25 5.09 5.20 NA NA XXX
78594 .... 26 ..... A Vent image, mult proj, gas ................................... 0.53 0.15 0.17 0.15 0.17 0.02 0.70 0.72 0.70 0.72 XXX
Sfmt 4700
78596 .... .......... A Lung differential function ...................................... 1.27 8.33 7.70 NA NA 0.42 10.02 9.39 NA NA XXX
78596 .... TC .... A Lung differential function ...................................... 0.00 7.98 7.30 NA NA 0.37 8.35 7.67 NA NA XXX
78596 .... 26 ..... A Lung differential function ...................................... 1.27 0.35 0.40 0.35 0.40 0.05 1.67 1.72 1.67 1.72 XXX
78599 .... .......... C Respiratory nuclear exam .................................... 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 XXX
78599 .... TC .... C Respiratory nuclear exam .................................... 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 XXX
78599 .... 26 ..... C Respiratory nuclear exam .................................... 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 XXX
78600 .... .......... A Brain imaging, ltd static ........................................ 0.44 6.83 3.98 NA NA 0.16 7.43 4.58 NA NA XXX
78600 .... TC .... A Brain imaging, ltd static ........................................ 0.00 6.71 3.84 NA NA 0.14 6.85 3.98 NA NA XXX
78600 .... 26 ..... A Brain imaging, ltd static ........................................ 0.44 0.12 0.14 0.12 0.14 0.02 0.58 0.60 0.58 0.60 XXX
E:\FR\FM\01DER2.SGM
78601 .... .......... A Brain imaging, ltd w/flow ...................................... 0.51 5.02 3.93 NA NA 0.20 5.73 4.64 NA NA XXX
78601 .... TC .... A Brain imaging, ltd w/flow ...................................... 0.00 4.88 3.77 NA NA 0.18 5.06 3.95 NA NA XXX
78601 .... 26 ..... A Brain imaging, ltd w/flow ...................................... 0.51 0.14 0.16 0.14 0.16 0.02 0.67 0.69 0.67 0.69 XXX
78605 .... .......... A Brain imaging, complete ...................................... 0.53 4.46 3.80 NA NA 0.20 5.19 4.53 NA NA XXX
01DER2
78605 .... TC .... A Brain imaging, complete ...................................... 0.00 4.31 3.63 NA NA 0.18 4.49 3.81 NA NA XXX
78605 .... 26 ..... A Brain imaging, complete ...................................... 0.53 0.15 0.17 0.15 0.17 0.02 0.70 0.72 0.70 0.72 XXX
78606 .... .......... A Brain imaging, compl w/flow ................................ 0.64 8.07 5.08 NA NA 0.24 8.95 5.96 NA NA XXX
78606 .... TC .... A Brain imaging, compl w/flow ................................ 0.00 7.89 4.88 NA NA 0.21 8.10 5.09 NA NA XXX
78606 .... 26 ..... A Brain imaging, compl w/flow ................................ 0.64 0.18 0.20 0.18 0.20 0.03 0.85 0.87 0.85 0.87 XXX
78607 .... .......... A Brain imaging (3D) ............................................... 1.23 14.39 8.83 NA NA 0.40 16.02 10.46 NA NA XXX
69963
Year
69964
Year Year
2007 2007 Fully Im-
VerDate Aug<31>2005
RVUs cility Total
RVUs
78607 .... TC .... A Brain imaging (3D) ............................................... 0.00 14.04 8.42 NA NA 0.35 14.39 8.77 NA NA XXX
78607 .... 26 ..... A Brain imaging (3D) ............................................... 1.23 0.35 0.41 0.35 0.41 0.05 1.63 1.69 1.63 1.69 XXX
78608 .... .......... C Brain imaging (PET) ............................................. 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 XXX
10:50 Nov 30, 2006

78608 .... TC .... C Brain imaging (PET) ............................................. 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 XXX
78608 .... 26 ..... A Brain imaging (PET) ............................................. 1.50 0.43 0.49 0.43 0.49 0.06 1.99 2.05 1.99 2.05 XXX
78609 .... .......... C Brain imaging (PET) ............................................. 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 XXX
78609 .... TC .... C Brain imaging (PET) ............................................. 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 XXX
78609 .... 26 ..... A Brain imaging (PET) ............................................. 1.50 0.43 0.49 0.43 0.49 0.06 1.99 2.05 1.99 2.05 XXX
Jkt 211001
78610 .... .......... A Brain flow imaging only ........................................ 0.30 4.19 2.32 NA NA 0.11 4.60 2.73 NA NA XXX
78610 .... TC .... A Brain flow imaging only ........................................ 0.00 4.10 2.21 NA NA 0.10 4.20 2.31 NA NA XXX
78610 .... 26 ..... A Brain flow imaging only ........................................ 0.30 0.09 0.11 0.09 0.11 0.01 0.40 0.42 0.40 0.42 XXX
78615 .... .......... A Cerebral vascular flow image .............................. 0.42 5.06 4.26 NA NA 0.23 5.71 4.91 NA NA XXX
PO 00000
78615 .... TC .... A Cerebral vascular flow image .............................. 0.00 4.94 4.12 NA NA 0.21 5.15 4.33 NA NA XXX
78615 .... 26 ..... A Cerebral vascular flow image .............................. 0.42 0.12 0.14 0.12 0.14 0.02 0.56 0.58 0.56 0.58 XXX
78630 .... .......... A Cerebrospinal fluid scan ...................................... 0.68 8.11 5.98 NA NA 0.30 9.09 6.96 NA NA XXX
78630 .... TC .... A Cerebrospinal fluid scan ...................................... 0.00 7.92 5.76 NA NA 0.27 8.19 6.03 NA NA XXX
Frm 00342
78630 .... 26 ..... A Cerebrospinal fluid scan ...................................... 0.68 0.19 0.22 0.19 0.22 0.03 0.90 0.93 0.90 0.93 XXX
78635 .... .......... A CSF ventriculography ........................................... 0.61 8.05 4.10 NA NA 0.16 8.82 4.87 NA NA XXX
78635 .... TC .... A CSF ventriculography ........................................... 0.00 7.88 3.88 NA NA 0.14 8.02 4.02 NA NA XXX
78635 .... 26 ..... A CSF ventriculography ........................................... 0.61 0.17 0.22 0.17 0.22 0.02 0.80 0.85 0.80 0.85 XXX
Fmt 4701
78645 .... .......... A CSF shunt evaluation ........................................... 0.57 7.97 4.71 NA NA 0.20 8.74 5.48 NA NA XXX
78645 .... TC .... A CSF shunt evaluation ........................................... 0.00 7.81 4.53 NA NA 0.18 7.99 4.71 NA NA XXX
78645 .... 26 ..... A CSF shunt evaluation ........................................... 0.57 0.16 0.18 0.16 0.18 0.02 0.75 0.77 0.75 0.77 XXX
78647 .... .......... A Cerebrospinal fluid scan ...................................... 0.90 13.60 8.06 NA NA 0.35 14.85 9.31 NA NA XXX
Sfmt 4700
78647 .... TC .... A Cerebrospinal fluid scan ...................................... 0.00 13.36 7.77 NA NA 0.31 13.67 8.08 NA NA XXX
78647 .... 26 ..... A Cerebrospinal fluid scan ...................................... 0.90 0.24 0.29 0.24 0.29 0.04 1.18 1.23 1.18 1.23 XXX
78650 .... .......... A CSF leakage imaging ........................................... 0.61 8.17 5.68 NA NA 0.27 9.05 6.56 NA NA XXX
78650 .... TC .... A CSF leakage imaging ........................................... 0.00 7.99 5.48 NA NA 0.24 8.23 5.72 NA NA XXX
78650 .... 26 ..... A CSF leakage imaging ........................................... 0.61 0.18 0.20 0.18 0.20 0.03 0.82 0.84 0.82 0.84 XXX
78660 .... .......... A Nuclear exam of tear flow .................................... 0.53 4.03 2.74 NA NA 0.14 4.70 3.41 NA NA XXX
78660 .... TC .... A Nuclear exam of tear flow .................................... 0.00 3.87 2.56 NA NA 0.12 3.99 2.68 NA NA XXX
78660 .... 26 ..... A Nuclear exam of tear flow .................................... 0.53 0.16 0.18 0.16 0.18 0.02 0.71 0.73 0.71 0.73 XXX
78699 .... .......... C Nervous system nuclear exam ............................ 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 XXX
E:\FR\FM\01DER2.SGM
78699 .... TC .... C Nervous system nuclear exam ............................ 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 XXX
78699 .... 26 ..... C Nervous system nuclear exam ............................ 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 XXX
78700 .... .......... A Kidney imaging, morphol ..................................... 0.45 4.26 3.47 NA NA 0.18 4.89 4.10 NA NA XXX
78700 .... TC .... A Kidney imaging, morphol ..................................... 0.00 4.12 3.32 NA NA 0.16 4.28 3.48 NA NA XXX
01DER2
78700 .... 26 ..... A Kidney imaging, morphol ..................................... 0.45 0.14 0.15 0.14 0.15 0.02 0.61 0.62 0.61 0.62 XXX
78701 .... .......... A Kidney imaging with flow ..................................... 0.49 5.04 4.06 NA NA 0.20 5.73 4.75 NA NA XXX
78701 .... TC .... A Kidney imaging with flow ..................................... 0.00 4.90 3.90 NA NA 0.18 5.08 4.08 NA NA XXX
78701 .... 26 ..... A Kidney imaging with flow ..................................... 0.49 0.14 0.16 0.14 0.16 0.02 0.65 0.67 0.65 0.67 XXX
78707 .... .......... A K flow/funct image w/o drug ................................ 0.96 5.15 4.88 NA NA 0.27 6.38 6.11 NA NA XXX
78707 .... TC .... A K flow/funct image w/o drug ................................ 0.00 4.88 4.57 NA NA 0.23 5.11 4.80 NA NA XXX
Year Year Year
2007 2007 Fully Im-
VerDate Aug<31>2005
RVUs cility Total
RVUs
78707 .... 26 ..... A K flow/funct image w/o drug ................................ 0.96 0.27 0.31 0.27 0.31 0.04 1.27 1.31 1.27 1.31 XXX
78708 .... .......... A K flow/funct image w/drug .................................... 1.21 3.17 4.45 NA NA 0.28 4.66 5.94 NA NA XXX
78708 .... TC .... A K flow/funct image w/drug .................................... 0.00 2.83 4.06 NA NA 0.23 3.06 4.29 NA NA XXX
10:50 Nov 30, 2006

78708 .... 26 ..... A K flow/funct image w/drug .................................... 1.21 0.34 0.39 0.34 0.39 0.05 1.60 1.65 1.60 1.65 XXX
78709 .... .......... A K flow/funct image, multiple ................................. 1.41 8.35 5.79 NA NA 0.29 10.05 7.49 NA NA XXX
78709 .... TC .... A K flow/funct image, multiple ................................. 0.00 7.95 5.34 NA NA 0.23 8.18 5.57 NA NA XXX
78709 .... 26 ..... A K flow/funct image, multiple ................................. 1.41 0.40 0.45 0.40 0.45 0.06 1.87 1.92 1.87 1.92 XXX
78710 .... .......... A Kidney imaging (3D) ............................................ 0.66 5.02 5.85 NA NA 0.34 6.02 6.85 NA NA XXX
Jkt 211001
78710 .... TC .... A Kidney imaging (3D) ............................................ 0.00 4.83 5.64 NA NA 0.31 5.14 5.95 NA NA XXX
78710 .... 26 ..... A Kidney imaging (3D) ............................................ 0.66 0.19 0.21 0.19 0.21 0.03 0.88 0.90 0.88 0.90 XXX
78725 .... .......... A Kidney function study ........................................... 0.38 2.26 2.00 NA NA 0.13 2.77 2.51 NA NA XXX
78725 .... TC .... A Kidney function study ........................................... 0.00 2.15 1.87 NA NA 0.11 2.26 1.98 NA NA XXX
PO 00000
78725 .... 26 ..... A Kidney function study ........................................... 0.38 0.11 0.13 0.11 0.13 0.02 0.51 0.53 0.51 0.53 XXX
78730 .... .......... A Urinary bladder retention ..................................... 0.15 1.97 1.68 NA NA 0.10 2.22 1.93 NA NA ZZZ
78730 .... TC .... A Urinary bladder retention ..................................... 0.00 1.91 1.57 NA NA 0.08 1.99 1.65 NA NA ZZZ
78730 .... 26 ..... A Urinary bladder retention ..................................... 0.15 0.06 0.11 0.06 0.11 0.02 0.23 0.28 0.23 0.28 ZZZ
Frm 00343
78740 .... .......... A Ureteral reflux study ............................................. 0.57 5.17 3.02 NA NA 0.15 5.89 3.74 NA NA XXX
78740 .... TC .... A Ureteral reflux study ............................................. 0.00 5.01 2.84 NA NA 0.12 5.13 2.96 NA NA XXX
78740 .... 26 ..... A Ureteral reflux study ............................................. 0.57 0.16 0.18 0.16 0.18 0.03 0.76 0.78 0.76 0.78 XXX
78761 .... .......... A Testicular imaging w/flow ..................................... 0.71 4.58 3.73 NA NA 0.20 5.49 4.64 NA NA XXX
Fmt 4701
78761 .... TC .... A Testicular imaging w/flow ..................................... 0.00 4.38 3.50 NA NA 0.17 4.55 3.67 NA NA XXX
78761 .... 26 ..... A Testicular imaging w/flow ..................................... 0.71 0.20 0.23 0.20 0.23 0.03 0.94 0.97 0.94 0.97 XXX
78799 .... .......... C Genitourinary nuclear exam ................................. 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 XXX
78799 .... TC .... C Genitourinary nuclear exam ................................. 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 XXX
Sfmt 4700
78799 .... 26 ..... C Genitourinary nuclear exam ................................. 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 XXX
78800 .... .......... A Tumor imaging, limited area ................................ 0.66 4.06 3.73 NA NA 0.22 4.94 4.61 NA NA XXX
78800 .... TC .... A Tumor imaging, limited area ................................ 0.00 3.88 3.52 NA NA 0.18 4.06 3.70 NA NA XXX
78800 .... 26 ..... A Tumor imaging, limited area ................................ 0.66 0.18 0.21 0.18 0.21 0.04 0.88 0.91 0.88 0.91 XXX
78801 .... .......... A Tumor imaging, mult areas .................................. 0.79 5.75 4.81 NA NA 0.27 6.81 5.87 NA NA XXX
78801 .... TC .... A Tumor imaging, mult areas .................................. 0.00 5.53 4.55 NA NA 0.22 5.75 4.77 NA NA XXX
78801 .... 26 ..... A Tumor imaging, mult areas .................................. 0.79 0.22 0.26 0.22 0.26 0.05 1.06 1.10 1.06 1.10 XXX
78802 .... .......... A Tumor imaging, whole body ................................. 0.86 7.68 6.29 NA NA 0.34 8.88 7.49 NA NA XXX
78802 .... TC .... A Tumor imaging, whole body ................................. 0.00 7.44 6.01 NA NA 0.30 7.74 6.31 NA NA XXX
E:\FR\FM\01DER2.SGM
78802 .... 26 ..... A Tumor imaging, whole body ................................. 0.86 0.24 0.28 0.24 0.28 0.04 1.14 1.18 1.14 1.18 XXX
78803 .... .......... A Tumor imaging (3D) ............................................. 1.09 14.15 8.73 NA NA 0.40 15.64 10.22 NA NA XXX
78803 .... TC .... A Tumor imaging (3D) ............................................. 0.00 13.84 8.37 NA NA 0.35 14.19 8.72 NA NA XXX
78803 .... 26 ..... A Tumor imaging (3D) ............................................. 1.09 0.31 0.36 0.31 0.36 0.05 1.45 1.50 1.45 1.50 XXX
01DER2
78804 .... .......... A Tumor imaging, whole body ................................. 1.07 14.02 12.08 NA NA 0.34 15.43 13.49 NA NA XXX
78804 .... TC .... A Tumor imaging, whole body ................................. 0.00 13.72 11.73 NA NA 0.30 14.02 12.03 NA NA XXX
78804 .... 26 ..... A Tumor imaging, whole body ................................. 1.07 0.30 0.35 0.30 0.35 0.04 1.41 1.46 1.41 1.46 XXX
78805 .... .......... A Abscess imaging, ltd area .................................... 0.73 3.94 3.73 NA NA 0.21 4.88 4.67 NA NA XXX
78805 .... TC .... A Abscess imaging, ltd area .................................... 0.00 3.74 3.49 NA NA 0.18 3.92 3.67 NA NA XXX
78805 .... 26 ..... A Abscess imaging, ltd area .................................... 0.73 0.20 0.24 0.20 0.24 0.03 0.96 1.00 0.96 1.00 XXX
69965
Year
69966
Year Year
2007 2007 Fully Im-
VerDate Aug<31>2005
RVUs cility Total
RVUs
78806 .... .......... A Abscess imaging, whole body ............................. 0.86 7.85 7.01 NA NA 0.39 9.10 8.26 NA NA XXX
78806 .... TC .... A Abscess imaging, whole body ............................. 0.00 7.61 6.73 NA NA 0.35 7.96 7.08 NA NA XXX
78806 .... 26 ..... A Abscess imaging, whole body ............................. 0.86 0.24 0.28 0.24 0.28 0.04 1.14 1.18 1.14 1.18 XXX
10:50 Nov 30, 2006

78807 .... .......... A Nuclear localization/abscess ................................ 1.09 13.41 8.56 NA NA 0.39 14.89 10.04 NA NA XXX
78807 .... TC .... A Nuclear localization/abscess ................................ 0.00 13.11 8.19 NA NA 0.35 13.46 8.54 NA NA XXX
78807 .... 26 ..... A Nuclear localization/abscess ................................ 1.09 0.30 0.37 0.30 0.37 0.04 1.43 1.50 1.43 1.50 XXX
78811 .... .......... C Tumor imaging (pet), limited ................................ 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 XXX
78811 .... TC .... C Tumor imaging (pet), limited ................................ 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 XXX
Jkt 211001
78811 .... 26 ..... A Tumor imaging (pet), limited ................................ 1.54 0.44 0.51 0.44 0.51 0.11 2.09 2.16 2.09 2.16 XXX
78812 .... .......... C Tumor image (pet)/skul-thigh ............................... 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 XXX
78812 .... TC .... C Tumor image (pet)/skul-thigh ............................... 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 XXX
78812 .... 26 ..... A Tumor image (pet)/skul-thigh ............................... 1.93 0.56 0.64 0.56 0.64 0.11 2.60 2.68 2.60 2.68 XXX
PO 00000
78813 .... .......... C Tumor image (pet) full body ................................. 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 XXX
78813 .... TC .... C Tumor image (pet) full body ................................. 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 XXX
78813 .... 26 ..... A Tumor image (pet) full body ................................. 2.00 0.58 0.66 0.58 0.66 0.11 2.69 2.77 2.69 2.77 XXX
78814 .... .......... C Tumor image pet/ct, limited ................................. 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 XXX
Frm 00344
78814 .... TC .... C Tumor image pet/ct, limited ................................. 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 XXX
78814 .... 26 ..... A Tumor image pet/ct, limited ................................. 2.20 0.62 0.73 0.62 0.73 0.11 2.93 3.04 2.93 3.04 XXX
78815 .... .......... C Tumorimage pet/ct skul-thigh ............................... 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 XXX
78815 .... TC .... C Tumorimage pet/ct skul-thigh ............................... 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 XXX
Fmt 4701
78815 .... 26 ..... A Tumorimage pet/ct skul-thigh ............................... 2.44 0.70 0.81 0.70 0.81 0.11 3.25 3.36 3.25 3.36 XXX
78816 .... .......... C Tumor image pet/ct full body ............................... 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 XXX
78816 .... TC .... C Tumor image pet/ct full body ............................... 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 XXX
78816 .... 26 ..... A Tumor image pet/ct full body ............................... 2.50 0.72 0.83 0.72 0.83 0.11 3.33 3.44 3.33 3.44 XXX
Sfmt 4700
78890 .... .......... B Nuclear medicine data proc ................................. 0.05 0.38 1.10 NA NA 0.07 0.50 1.22 NA NA XXX
78890 .... TC .... B Nuclear medicine data proc ................................. 0.00 0.37 1.08 NA NA 0.06 0.43 1.14 NA NA XXX
78890 .... 26 ..... B Nuclear medicine data proc ................................. 0.05 0.01 0.02 0.01 0.02 0.01 0.07 0.08 0.07 0.08 XXX
78891 .... .......... B Nuclear med data proc ........................................ 0.10 0.86 2.22 NA NA 0.14 1.10 2.46 NA NA XXX
78891 .... TC .... B Nuclear med data proc ........................................ 0.00 0.84 2.18 NA NA 0.13 0.97 2.31 NA NA XXX
78891 .... 26 ..... B Nuclear med data proc ........................................ 0.10 0.02 0.04 0.02 0.04 0.01 0.13 0.15 0.13 0.15 XXX
78999 .... .......... C Nuclear diagnostic exam ...................................... 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 XXX
78999 .... TC .... C Nuclear diagnostic exam ...................................... 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 XXX
78999 .... 26 ..... C Nuclear diagnostic exam ...................................... 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 XXX
E:\FR\FM\01DER2.SGM
79005 .... .......... A Nuclear rx, oral admin .......................................... 1.80 1.70 2.85 NA NA 0.22 3.72 4.87 NA NA XXX
79005 .... TC .... A Nuclear rx, oral admin .......................................... 0.00 1.20 2.27 NA NA 0.14 1.34 2.41 NA NA XXX
79005 .... 26 ..... A Nuclear rx, oral admin .......................................... 1.80 0.50 0.58 0.50 0.58 0.08 2.38 2.46 2.38 2.46 XXX
79101 .... .......... A Nuclear rx, iv admin ............................................. 1.96 2.04 2.98 NA NA 0.22 4.22 5.16 NA NA XXX
01DER2
79101 .... TC .... A Nuclear rx, iv admin ............................................. 0.00 1.37 2.31 NA NA 0.14 1.51 2.45 NA NA XXX
79101 .... 26 ..... A Nuclear rx, iv admin ............................................. 1.96 0.67 0.67 0.67 0.67 0.08 2.71 2.71 2.71 2.71 XXX
79200 .... .......... A Nuclear rx, intracav admin ................................... 1.99 2.13 3.01 NA NA 0.23 4.35 5.23 NA NA XXX
79200 .... TC .... A Nuclear rx, intracav admin ................................... 0.00 1.55 2.35 NA NA 0.14 1.69 2.49 NA NA XXX
79200 .... 26 ..... A Nuclear rx, intracav admin ................................... 1.99 0.58 0.66 0.58 0.66 0.09 2.66 2.74 2.66 2.74 XXX
79300 .... .......... C Nuclr rx, interstit colloid ........................................ 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 XXX
Year Year Year
2007 2007 Fully Im-
VerDate Aug<31>2005
RVUs cility Total
RVUs
79300 .... TC .... C Nuclr rx, interstit colloid ........................................ 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 XXX
79300 .... 26 ..... A Nuclr rx, interstit colloid ........................................ 1.60 0.55 0.56 0.55 0.56 0.13 2.28 2.29 2.28 2.29 XXX
79403 .... .......... A Hematopoietic nuclear tx ..................................... 2.25 2.77 4.57 NA NA 0.24 5.26 7.06 NA NA XXX
10:50 Nov 30, 2006

79403 .... TC .... A Hematopoietic nuclear tx ..................................... 0.00 2.09 3.73 NA NA 0.14 2.23 3.87 NA NA XXX
79403 .... 26 ..... A Hematopoietic nuclear tx ..................................... 2.25 0.68 0.84 0.68 0.84 0.10 3.03 3.19 3.03 3.19 XXX
79440 .... .......... A Nuclear rx, intra-articular ...................................... 1.99 1.65 2.92 NA NA 0.22 3.86 5.13 NA NA XXX
79440 .... TC .... A Nuclear rx, intra-articular ...................................... 0.00 1.09 2.24 NA NA 0.14 1.23 2.38 NA NA XXX
79440 .... 26 ..... A Nuclear rx, intra-articular ...................................... 1.99 0.56 0.68 0.56 0.68 0.08 2.63 2.75 2.63 2.75 XXX
Jkt 211001
79445 .... .......... C Nuclear rx, intra-arterial ....................................... 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 XXX
79445 .... TC .... C Nuclear rx, intra-arterial ....................................... 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 XXX
79445 .... 26 ..... A Nuclear rx, intra-arterial ....................................... 2.40 0.70 0.79 0.70 0.79 0.12 3.22 3.31 3.22 3.31 XXX
79999 .... .......... C Nuclear medicine therapy .................................... 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 XXX
PO 00000
79999 .... TC .... C Nuclear medicine therapy .................................... 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 XXX
79999 .... 26 ..... C Nuclear medicine therapy .................................... 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 XXX
80500 .... .......... A Lab pathology consultation .................................. 0.37 0.19 0.21 0.11 0.15 0.01 0.57 0.59 0.49 0.53 XXX
80502 .... .......... A Lab pathology consultation .................................. 1.33 0.30 0.48 0.24 0.47 0.04 1.67 1.85 1.61 1.84 XXX
Frm 00345
83020 .... 26 ..... A Hemoglobin electrophoresis ................................. 0.37 0.12 0.14 0.12 0.14 0.01 0.50 0.52 0.50 0.52 XXX
83912 .... 26 ..... A Genetic examination ............................................ 0.37 0.11 0.12 0.11 0.12 0.01 0.49 0.50 0.49 0.50 XXX
84165 .... 26 ..... A Protein e-phoresis, serum .................................... 0.37 0.11 0.13 0.11 0.13 0.01 0.49 0.51 0.49 0.51 XXX
84166 .... 26 ..... A Protein e-phoresis/urine/csf ................................. 0.37 0.11 0.13 0.11 0.13 0.01 0.49 0.51 0.49 0.51 XXX
Fmt 4701
84181 .... 26 ..... A Western blot test .................................................. 0.37 0.12 0.14 0.12 0.14 0.01 0.50 0.52 0.50 0.52 XXX
84182 .... 26 ..... A Protein, western blot test ..................................... 0.37 0.12 0.15 0.12 0.15 0.02 0.51 0.54 0.51 0.54 XXX
85060 .... .......... A Blood smear interpretation ................................... 0.45 0.14 0.17 0.14 0.17 0.02 0.61 0.64 0.61 0.64 XXX
85097 .... .......... A Bone marrow interpretation .................................. 0.94 1.29 1.76 0.28 0.38 0.04 2.27 2.74 1.26 1.36 XXX
Sfmt 4700
85390 .... 26 ..... A Fibrinolysins screen ............................................. 0.37 0.12 0.13 0.12 0.13 0.01 0.50 0.51 0.50 0.51 XXX
85396 .... .......... A Clotting assay, whole blood ................................. 0.37 NA NA 0.05 0.13 0.04 NA NA 0.46 0.54 XXX
85576 .... 26 ..... A Blood platelet aggregation ................................... 0.37 0.12 0.15 0.12 0.15 0.01 0.50 0.53 0.50 0.53 XXX
86077 .... .......... A Physician blood bank service .............................. 0.94 0.38 0.39 0.30 0.37 0.03 1.35 1.36 1.27 1.34 XXX
86255 .... 26 ..... A Fluorescent antibody, screen ............................... 0.37 0.12 0.14 0.12 0.14 0.01 0.50 0.52 0.50 0.52 XXX
86256 .... 26 ..... A Fluorescent antibody, titer .................................... 0.37 0.12 0.14 0.12 0.14 0.01 0.50 0.52 0.50 0.52 XXX
86320 .... 26 ..... A Serum immunoelectrophoresis ............................ 0.37 0.12 0.14 0.12 0.14 0.01 0.50 0.52 0.50 0.52 XXX
E:\FR\FM\01DER2.SGM
86325 .... 26 ..... A Other immunoelectrophoresis .............................. 0.37 0.11 0.13 0.11 0.13 0.01 0.49 0.51 0.49 0.51 XXX
86327 .... 26 ..... A Immunoelectrophoresis assay ............................. 0.42 0.13 0.17 0.13 0.17 0.02 0.57 0.61 0.57 0.61 XXX
86334 .... 26 ..... A Immunofix e-phoresis, serum ............................... 0.37 0.12 0.14 0.12 0.14 0.01 0.50 0.52 0.50 0.52 XXX
86335 .... 26 ..... A Immunfix e-phorsis/urine/csf ................................ 0.37 0.12 0.14 0.12 0.14 0.01 0.50 0.52 0.50 0.52 XXX
01DER2
86485 .... .......... C Skin test, candida ................................................. 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 XXX
86490 .... .......... A Coccidioidomycosis skin test ............................... 0.00 0.12 0.25 NA NA 0.02 0.14 0.27 NA NA XXX
86510 .... .......... A Histoplasmosis skin test ....................................... 0.00 0.14 0.28 NA NA 0.02 0.16 0.30 NA NA XXX
86580 .... .......... A TB intradermal test ............................................... 0.00 0.16 0.23 NA NA 0.02 0.18 0.25 NA NA XXX
87164 .... 26 ..... A Dark field examination ......................................... 0.37 0.12 0.12 0.12 0.12 0.01 0.50 0.50 0.50 0.50 XXX
87207 .... 26 ..... A Smear, special stain ............................................. 0.37 0.11 0.15 0.11 0.15 0.01 0.49 0.53 0.49 0.53 XXX
69967
Year
69968
Year Year
2007 2007 Fully Im-
VerDate Aug<31>2005
RVUs cility Total
RVUs
88104 .... .......... A Cytopath fl nongyn, smears ................................. 0.56 1.14 0.93 NA NA 0.04 1.74 1.53 NA NA XXX
88104 .... TC .... A Cytopath fl nongyn, smears ................................. 0.00 0.99 0.71 NA NA 0.02 1.01 0.73 NA NA XXX
88104 .... 26 ..... A Cytopath fl nongyn, smears ................................. 0.56 0.15 0.22 0.15 0.22 0.02 0.73 0.80 0.73 0.80 XXX
10:50 Nov 30, 2006

88106 .... .......... A Cytopath fl nongyn, filter ...................................... 0.56 1.48 1.39 NA NA 0.04 2.08 1.99 NA NA XXX
88106 .... TC .... A Cytopath fl nongyn, filter ...................................... 0.00 1.33 1.17 NA NA 0.02 1.35 1.19 NA NA XXX
88106 .... 26 ..... A Cytopath fl nongyn, filter ...................................... 0.56 0.15 0.22 0.15 0.22 0.02 0.73 0.80 0.73 0.80 XXX
88107 .... .......... A Cytopath fl nongyn, sm/fltr ................................... 0.76 1.98 1.66 NA NA 0.05 2.79 2.47 NA NA XXX
88107 .... TC .... A Cytopath fl nongyn, sm/fltr ................................... 0.00 1.75 1.35 NA NA 0.02 1.77 1.37 NA NA XXX
Jkt 211001
88107 .... 26 ..... A Cytopath fl nongyn, sm/fltr ................................... 0.76 0.23 0.31 0.23 0.31 0.03 1.02 1.10 1.02 1.10 XXX
88108 .... .......... A Cytopath, concentrate tech .................................. 0.56 1.45 1.27 NA NA 0.04 2.05 1.87 NA NA XXX
88108 .... TC .... A Cytopath, concentrate tech .................................. 0.00 1.30 1.05 NA NA 0.02 1.32 1.07 NA NA XXX
88108 .... 26 ..... A Cytopath, concentrate tech .................................. 0.56 0.15 0.22 0.15 0.22 0.02 0.73 0.80 0.73 0.80 XXX
PO 00000
88112 .... .......... A Cytopath, cell enhance tech ................................ 1.18 1.49 1.85 NA NA 0.04 2.71 3.07 NA NA XXX
88112 .... TC .... A Cytopath, cell enhance tech ................................ 0.00 1.19 1.39 NA NA 0.02 1.21 1.41 NA NA XXX
88112 .... 26 ..... A Cytopath, cell enhance tech ................................ 1.18 0.30 0.46 0.30 0.46 0.02 1.50 1.66 1.50 1.66 XXX
88125 .... .......... A Forensic cytopathology ........................................ 0.26 0.25 0.27 NA NA 0.02 0.53 0.55 NA NA XXX
Frm 00346
88125 .... TC .... A Forensic cytopathology ........................................ 0.00 0.19 0.17 NA NA 0.01 0.20 0.18 NA NA XXX
88125 .... 26 ..... A Forensic cytopathology ........................................ 0.26 0.06 0.10 0.06 0.10 0.01 0.33 0.37 0.33 0.37 XXX
88141 .... .......... A Cytopath, c/v, interpret ......................................... 0.42 0.37 0.21 0.37 0.21 0.02 0.81 0.65 0.81 0.65 XXX
88160 .... .......... A Cytopath smear, other source ............................. 0.50 0.89 0.85 NA NA 0.04 1.43 1.39 NA NA XXX
Fmt 4701
88160 .... TC .... A Cytopath smear, other source ............................. 0.00 0.76 0.66 NA NA 0.02 0.78 0.68 NA NA XXX
88160 .... 26 ..... A Cytopath smear, other source ............................. 0.50 0.13 0.19 0.13 0.19 0.02 0.65 0.71 0.65 0.71 XXX
Sfmt 4700
88172 .... .......... A Cytopathology eval of fna .................................... 0.60 0.85 0.76 NA NA 0.04 1.49 1.40 NA NA XXX
88172 .... TC .... A Cytopathology eval of fna .................................... 0.00 0.67 0.52 NA NA 0.02 0.69 0.54 NA NA XXX
88172 .... 26 ..... A Cytopathology eval of fna .................................... 0.60 0.18 0.24 0.18 0.24 0.02 0.80 0.86 0.80 0.86 XXX
88173 .... .......... A Cytopath eval, fna, report .................................... 1.39 2.29 2.18 NA NA 0.07 3.75 3.64 NA NA XXX
88173 .... TC .... A Cytopath eval, fna, report .................................... 0.00 1.89 1.64 NA NA 0.02 1.91 1.66 NA NA XXX
E:\FR\FM\01DER2.SGM
88173 .... 26 ..... A Cytopath eval, fna, report .................................... 1.39 0.40 0.54 0.40 0.54 0.05 1.84 1.98 1.84 1.98 XXX
88182 .... .......... A Cell marker study ................................................. 0.77 1.91 1.97 NA NA 0.07 2.75 2.81 NA NA XXX
88182 .... TC .... A Cell marker study ................................................. 0.00 1.79 1.69 NA NA 0.04 1.83 1.73 NA NA XXX
88182 .... 26 ..... A Cell marker study ................................................. 0.77 0.12 0.28 0.12 0.28 0.03 0.92 1.08 0.92 1.08 XXX
01DER2
88184 .... .......... A Flowcytometry/ tc, 1 marker ................................. 0.00 2.44 1.60 NA NA 0.02 2.46 1.62 NA NA XXX
88185 .... .......... A Flowcytometry/tc, add-on ..................................... 0.00 1.48 0.85 NA NA 0.02 1.50 0.87 NA NA ZZZ
88187 .... .......... A Flowcytometry/read, 2–8 ...................................... 1.36 0.39 0.44 0.39 0.44 0.01 1.76 1.81 1.76 1.81 XXX
88188 .... .......... A Flowcytometry/read, 9–15 .................................... 1.69 0.44 0.54 0.44 0.54 0.01 2.14 2.24 2.14 2.24 XXX
88189 .... .......... A Flowcytometry/read, 16 & > ................................. 2.23 0.48 0.68 0.48 0.68 0.01 2.72 2.92 2.72 2.92 XXX
88199 .... .......... C Cytopathology procedure ..................................... 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 XXX
Year Year Year
2007 2007 Fully Im-
VerDate Aug<31>2005
RVUs cility Total
RVUs
88199 .... TC .... C Cytopathology procedure ..................................... 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 XXX
88199 .... 26 ..... C Cytopathology procedure ..................................... 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 XXX
88291 .... .......... A Cyto/molecular report ........................................... 0.52 0.27 0.20 0.27 0.20 0.02 0.81 0.74 0.81 0.74 XXX
10:50 Nov 30, 2006

88299 .... .......... C Cytogenetic study ................................................. 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 XXX
88300 .... .......... A Surgical path, gross ............................................. 0.08 0.58 0.49 NA NA 0.02 0.68 0.59 NA NA XXX
88300 .... TC .... A Surgical path, gross ............................................. 0.00 0.56 0.46 NA NA 0.01 0.57 0.47 NA NA XXX
88300 .... 26 ..... A Surgical path, gross ............................................. 0.08 0.02 0.03 0.02 0.03 0.01 0.11 0.12 0.11 0.12 XXX
88302 .... .......... A Tissue exam by pathologist ................................. 0.13 1.28 1.10 NA NA 0.03 1.44 1.26 NA NA XXX
Jkt 211001
88302 .... TC .... A Tissue exam by pathologist ................................. 0.00 1.24 1.04 NA NA 0.02 1.26 1.06 NA NA XXX
88302 .... 26 ..... A Tissue exam by pathologist ................................. 0.13 0.04 0.06 0.04 0.06 0.01 0.18 0.20 0.18 0.20 XXX
PO 00000
Frm 00347
Fmt 4701
88311 .... .......... A Decalcify tissue .................................................... 0.24 0.25 0.23 NA NA 0.02 0.51 0.49 NA NA XXX
88311 .... TC .... A Decalcify tissue .................................................... 0.00 0.18 0.14 NA NA 0.01 0.19 0.15 NA NA XXX
Sfmt 4700
88311 .... 26 ..... A Decalcify tissue .................................................... 0.24 0.07 0.09 0.07 0.09 0.01 0.32 0.34 0.32 0.34 XXX
88312 .... .......... A Special stains ....................................................... 0.54 2.46 1.76 NA NA 0.03 3.03 2.33 NA NA XXX
88312 .... TC .... A Special stains ....................................................... 0.00 2.31 1.55 NA NA 0.01 2.32 1.56 NA NA XXX
88312 .... 26 ..... A Special stains ....................................................... 0.54 0.15 0.21 0.15 0.21 0.02 0.71 0.77 0.71 0.77 XXX
88313 .... .......... A Special stains ....................................................... 0.24 1.91 1.42 NA NA 0.02 2.17 1.68 NA NA XXX
88313 .... TC .... A Special stains ....................................................... 0.00 1.85 1.33 NA NA 0.01 1.86 1.34 NA NA XXX
88313 .... 26 ..... A Special stains ....................................................... 0.24 0.06 0.09 0.06 0.09 0.01 0.31 0.34 0.31 0.34 XXX
88314 .... .......... A Histochemical stain .............................................. 0.45 1.97 2.04 NA NA 0.04 2.46 2.53 NA NA XXX
88314 .... TC .... A Histochemical stain .............................................. 0.00 1.83 1.86 NA NA 0.02 1.85 1.88 NA NA XXX
E:\FR\FM\01DER2.SGM
88314 .... 26 ..... A Histochemical stain .............................................. 0.45 0.14 0.18 0.14 0.18 0.02 0.61 0.65 0.61 0.65 XXX
88318 .... .......... A Chemical histochemistry ...................................... 0.42 2.96 1.98 NA NA 0.03 3.41 2.43 NA NA XXX
88318 .... TC .... A Chemical histochemistry ...................................... 0.00 2.83 1.81 NA NA 0.01 2.84 1.82 NA NA XXX
88318 .... 26 ..... A Chemical histochemistry ...................................... 0.42 0.13 0.17 0.13 0.17 0.02 0.57 0.61 0.57 0.61 XXX
01DER2
88319 .... .......... A Enzyme histochemistry ........................................ 0.53 3.22 3.36 NA NA 0.04 3.79 3.93 NA NA XXX
88319 .... TC .... A Enzyme histochemistry ........................................ 0.00 3.07 3.16 NA NA 0.02 3.09 3.18 NA NA XXX
88319 .... 26 ..... A Enzyme histochemistry ........................................ 0.53 0.15 0.20 0.15 0.20 0.02 0.70 0.75 0.70 0.75 XXX
88321 .... .......... A Microslide consultation ......................................... 1.63 0.74 0.78 0.49 0.54 0.05 2.42 2.46 2.17 2.22 XXX
88323 .... .......... A Microslide consultation ......................................... 1.83 2.19 1.88 NA NA 0.07 4.09 3.78 NA NA XXX
88323 .... TC .... A Microslide consultation ......................................... 0.00 1.73 1.34 NA NA 0.02 1.75 1.36 NA NA XXX
69969
Year
69970
Year Year
2007 2007 Fully Im-
VerDate Aug<31>2005
RVUs cility Total
RVUs
88323 .... 26 ..... A Microslide consultation ......................................... 1.83 0.46 0.54 0.46 0.54 0.05 2.34 2.42 2.34 2.42 XXX
88325 .... .......... A Comprehensive review of data ............................ 2.50 2.24 2.76 0.63 0.87 0.07 4.81 5.33 3.20 3.44 XXX
88329 .... .......... A Path consult introp ............................................... 0.67 0.68 0.66 0.20 0.27 0.02 1.37 1.35 0.89 0.96 XXX
10:50 Nov 30, 2006

88331 .... .......... A Path consult intraop, 1 bloc ................................. 1.19 1.24 1.14 NA NA 0.08 2.51 2.41 NA NA XXX
88331 .... TC .... A Path consult intraop, 1 bloc ................................. 0.00 0.86 0.66 NA NA 0.04 0.90 0.70 NA NA XXX
88331 .... 26 ..... A Path consult intraop, 1 bloc ................................. 1.19 0.38 0.48 0.38 0.48 0.04 1.61 1.71 1.61 1.71 XXX
88332 .... .......... A Path consult intraop, add"l ................................. 0.59 0.47 0.46 NA NA 0.04 1.10 1.09 NA NA XXX
88332 .... TC .... A Path consult intraop, add"l ................................. 0.00 0.29 0.23 NA NA 0.02 0.31 0.25 NA NA XXX
Jkt 211001
88332 .... 26 ..... A Path consult intraop, add"l ................................. 0.59 0.18 0.23 0.18 0.23 0.02 0.79 0.84 0.79 0.84 XXX
88333 .... .......... A Intraop cyto path consult, 1 ................................. 1.20 1.35 1.15 NA NA 0.08 2.63 2.43 NA NA XXX
88333 .... TC .... A Intraop cyto path consult, 1 ................................. 0.00 0.97 0.66 NA NA 0.04 1.01 0.70 NA NA XXX
88333 .... 26 ..... A Intraop cyto path consult, 1 ................................. 1.20 0.38 0.49 0.38 0.49 0.04 1.62 1.73 1.62 1.73 XXX
PO 00000
88334 .... .......... A Intraop cyto path consult, 2 ................................. 0.73 0.78 0.65 NA NA 0.04 1.55 1.42 NA NA XXX
88334 .... TC .... A Intraop cyto path consult, 2 ................................. 0.00 0.56 0.40 NA NA 0.02 0.58 0.42 NA NA XXX
88334 .... 26 ..... A Intraop cyto path consult, 2 ................................. 0.73 0.22 0.25 0.22 0.25 0.02 0.97 1.00 0.97 1.00 XXX
88342 .... .......... A Immunohistochemistry ......................................... 0.85 2.01 1.60 NA NA 0.05 2.91 2.50 NA NA XXX
Frm 00348
88342 .... TC .... A Immunohistochemistry ......................................... 0.00 1.78 1.27 NA NA 0.02 1.80 1.29 NA NA XXX
88342 .... 26 ..... A Immunohistochemistry ......................................... 0.85 0.23 0.33 0.23 0.33 0.03 1.11 1.21 1.11 1.21 XXX
88346 .... .......... A Immunofluorescent study ..................................... 0.86 1.94 1.67 NA NA 0.05 2.85 2.58 NA NA XXX
88346 .... TC .... A Immunofluorescent study ..................................... 0.00 1.71 1.34 NA NA 0.02 1.73 1.36 NA NA XXX
Fmt 4701
88346 .... 26 ..... A Immunofluorescent study ..................................... 0.86 0.23 0.33 0.23 0.33 0.03 1.12 1.22 1.12 1.22 XXX
88347 .... .......... A Immunofluorescent study ..................................... 0.86 1.33 1.28 NA NA 0.05 2.24 2.19 NA NA XXX
88347 .... TC .... A Immunofluorescent study ..................................... 0.00 1.14 0.97 NA NA 0.02 1.16 0.99 NA NA XXX
88347 .... 26 ..... A Immunofluorescent study ..................................... 0.86 0.19 0.31 0.19 0.31 0.03 1.08 1.20 1.08 1.20 XXX
Sfmt 4700
88348 .... .......... A Electron microscopy ............................................. 1.51 17.88 11.48 NA NA 0.13 19.52 13.12 NA NA XXX
88348 .... TC .... A Electron microscopy ............................................. 0.00 17.47 10.90 NA NA 0.07 17.54 10.97 NA NA XXX
88348 .... 26 ..... A Electron microscopy ............................................. 1.51 0.41 0.58 0.41 0.58 0.06 1.98 2.15 1.98 2.15 XXX
88349 .... .......... A Scanning electron microscopy ............................. 0.76 8.84 4.88 NA NA 0.09 9.69 5.73 NA NA XXX
88349 .... TC .... A Scanning electron microscopy ............................. 0.00 8.62 4.58 NA NA 0.06 8.68 4.64 NA NA XXX
88349 .... 26 ..... A Scanning electron microscopy ............................. 0.76 0.22 0.30 0.22 0.30 0.03 1.01 1.09 1.01 1.09 XXX
88355 .... .......... A Analysis, skeletal muscle ..................................... 1.85 3.31 7.41 NA NA 0.13 5.29 9.39 NA NA XXX
88355 .... TC .... A Analysis, skeletal muscle ..................................... 0.00 2.92 6.72 NA NA 0.06 2.98 6.78 NA NA XXX
88355 .... 26 ..... A Analysis, skeletal muscle ..................................... 1.85 0.39 0.69 0.39 0.69 0.07 2.31 2.61 2.31 2.61 XXX
E:\FR\FM\01DER2.SGM
88356 .... .......... A Analysis, nerve ..................................................... 3.02 6.63 4.79 NA NA 0.19 9.84 8.00 NA NA XXX
88356 .... TC .... A Analysis, nerve ..................................................... 0.00 5.84 3.65 NA NA 0.07 5.91 3.72 NA NA XXX
88356 .... 26 ..... A Analysis, nerve ..................................................... 3.02 0.79 1.14 0.79 1.14 0.12 3.93 4.28 3.93 4.28 XXX
88358 .... .......... A Analysis, tumor ..................................................... 0.95 1.10 0.91 NA NA 0.17 2.22 2.03 NA NA XXX
01DER2
88358 .... TC .... A Analysis, tumor ..................................................... 0.00 0.94 0.57 NA NA 0.07 1.01 0.64 NA NA XXX
88358 .... 26 ..... A Analysis, tumor ..................................................... 0.95 0.16 0.34 0.16 0.34 0.10 1.21 1.39 1.21 1.39 XXX
88360 .... .......... A Tumor immunohistochem/manual ........................ 1.10 2.28 1.87 NA NA 0.08 3.46 3.05 NA NA XXX
88360 .... TC .... A Tumor immunohistochem/manual ........................ 0.00 2.00 1.45 NA NA 0.02 2.02 1.47 NA NA XXX
88360 .... 26 ..... A Tumor immunohistochem/manual ........................ 1.10 0.28 0.42 0.28 0.42 0.06 1.44 1.58 1.44 1.58 XXX
88361 .... .......... A Tumor immunohistochem/comput ........................ 1.18 2.72 2.94 NA NA 0.17 4.07 4.29 NA NA XXX
Year Year Year
2007 2007 Fully Im-
VerDate Aug<31>2005
RVUs cility Total
RVUs
88361 .... TC .... A Tumor immunohistochem/comput ........................ 0.00 2.46 2.51 NA NA 0.07 2.53 2.58 NA NA XXX
88361 .... 26 ..... A Tumor immunohistochem/comput ........................ 1.18 0.26 0.43 0.26 0.43 0.10 1.54 1.71 1.54 1.71 XXX
88362 .... .......... A Nerve teasing preparations .................................. 2.17 5.24 4.83 NA NA 0.15 7.56 7.15 NA NA XXX
10:50 Nov 30, 2006

88362 .... TC .... A Nerve teasing preparations .................................. 0.00 4.63 3.99 NA NA 0.06 4.69 4.05 NA NA XXX
88362 .... 26 ..... A Nerve teasing preparations .................................. 2.17 0.61 0.84 0.61 0.84 0.09 2.87 3.10 2.87 3.10 XXX
88365 .... .......... A Insitu hybridization (fish) ...................................... 1.20 2.90 2.32 NA NA 0.05 4.15 3.57 NA NA XXX
88365 .... TC .... A Insitu hybridization (fish) ...................................... 0.00 2.66 1.88 NA NA 0.02 2.68 1.90 NA NA XXX
88365 .... 26 ..... A Insitu hybridization (fish) ...................................... 1.20 0.24 0.44 0.24 0.44 0.03 1.47 1.67 1.47 1.67 XXX
Jkt 211001
88367 .... .......... A Insitu hybridization, auto ...................................... 1.30 5.16 4.31 NA NA 0.12 6.58 5.73 NA NA XXX
88367 .... TC .... A Insitu hybridization, auto ...................................... 0.00 4.94 3.85 NA NA 0.06 5.00 3.91 NA NA XXX
88367 .... 26 ..... A Insitu hybridization, auto ...................................... 1.30 0.22 0.46 0.22 0.46 0.06 1.58 1.82 1.58 1.82 XXX
88368 .... .......... A Insitu hybridization, manual ................................. 1.40 4.69 2.96 NA NA 0.12 6.21 4.48 NA NA XXX
PO 00000
88368 .... TC .... A Insitu hybridization, manual ................................. 0.00 4.48 2.46 NA NA 0.06 4.54 2.52 NA NA XXX
88368 .... 26 ..... A Insitu hybridization, manual ................................. 1.40 0.21 0.50 0.21 0.50 0.06 1.67 1.96 1.67 1.96 XXX
88371 .... 26 ..... A Protein, western blot tissue .................................. 0.37 0.10 0.12 0.10 0.12 0.01 0.48 0.50 0.48 0.50 XXX
88372 .... 26 ..... A Protein analysis w/probe ...................................... 0.37 0.11 0.15 0.11 0.15 0.01 0.49 0.53 0.49 0.53 XXX
Frm 00349
88380 .... .......... C Microdissection ..................................................... 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 XXX
88380 .... TC .... C Microdissection ..................................................... 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 XXX
88380 .... 26 ..... C Microdissection ..................................................... 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 XXX
88384 .... .......... C Eval molecular probes, 11–50 ............................. 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 XXX
Fmt 4701
88384 .... TC .... C Eval molecular probes, 11–50 ............................. 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 XXX
88384 .... 26 ..... C Eval molecular probes, 11–50 ............................. 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 XXX
88385 .... .......... A Eval molecul probes, 51–250 .............................. 1.50 14.35 8.90 NA NA 0.12 15.97 10.52 NA NA XXX
88385 .... TC .... A Eval molecul probes, 51–250 .............................. 0.00 14.13 8.36 NA NA 0.06 14.19 8.42 NA NA XXX
Sfmt 4700
88385 .... 26 ..... A Eval molecul probes, 51–250 .............................. 1.50 0.22 0.54 0.22 0.54 0.06 1.78 2.10 1.78 2.10 XXX
88386 .... .......... A Eval molecul probes, 251–500 ............................ 1.88 14.25 8.84 NA NA 0.16 16.29 10.88 NA NA XXX
88386 .... TC .... A Eval molecul probes, 251–500 ............................ 0.00 13.97 8.15 NA NA 0.08 14.05 8.23 NA NA XXX
88386 .... 26 ..... A Eval molecul probes, 251–500 ............................ 1.88 0.28 0.69 0.28 0.69 0.08 2.24 2.65 2.24 2.65 XXX
88399 .... .......... C Surgical pathology procedure .............................. 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 XXX
88399 .... TC .... C Surgical pathology procedure .............................. 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 XXX
88399 .... 26 ..... C Surgical pathology procedure .............................. 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 XXX
89049 .... .......... A Chct for mal hyperthermia ................................... 1.40 3.69 3.59 0.22 0.26 0.06 5.15 5.05 1.68 1.72 XXX
89060 .... 26 ..... A Exam,synovial fluid crystals ................................. 0.37 0.12 0.15 0.12 0.15 0.01 0.50 0.53 0.50 0.53 XXX
E:\FR\FM\01DER2.SGM
89100 .... .......... A Sample intestinal contents ................................... 0.60 8.84 3.58 0.60 0.31 0.03 9.47 4.21 1.23 0.94 XXX
89105 .... .......... A Sample intestinal contents ................................... 0.50 7.57 3.56 0.45 0.24 0.02 8.09 4.08 0.97 0.76 XXX
89130 .... .......... A Sample stomach contents .................................... 0.45 6.86 3.02 0.39 0.20 0.02 7.33 3.49 0.86 0.67 XXX
01DER2
89220 .... .......... A Sputum specimen collection ................................ 0.00 0.36 0.41 NA NA 0.02 0.38 0.43 NA NA XXX
89230 .... .......... A Collect sweat for test ........................................... 0.00 0.08 0.10 NA NA 0.02 0.10 0.12 NA NA XXX
69971
Year
69972
Year Year
2007 2007 Fully Im-
VerDate Aug<31>2005
RVUs cility Total
RVUs
89240 .... .......... C Pathology lab procedure ...................................... 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 XXX
90281 .... .......... I Human ig, im ........................................................ 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 XXX
90283 .... .......... I Human ig, iv ......................................................... 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 XXX
10:50 Nov 30, 2006

90287 .... .......... I Botulinum antitoxin ............................................... 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 XXX
90288 .... .......... I Botulism ig, iv ....................................................... 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 XXX
90291 .... .......... I Cmv ig, iv ............................................................. 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 XXX
90296 .... .......... E Diphtheria antitoxin .............................................. 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 XXX
90371 .... .......... E Hep b ig, im .......................................................... 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 XXX
Jkt 211001
90375 .... .......... E Rabies ig, im/sc .................................................... 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 XXX
90376 .... .......... E Rabies ig, heat treated ......................................... 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 XXX
90378 .... .......... X Rsv ig, im, 50mg .................................................. 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 XXX
90379 .... .......... I Rsv ig, iv .............................................................. 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 XXX
PO 00000
90384 .... .......... I Rh ig, full-dose, im ............................................... 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 XXX
90385 .... .......... E Rh ig, minidose, im .............................................. 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 XXX
90386 .... .......... I Rh ig, iv ................................................................ 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 XXX
90389 .... .......... I Tetanus ig, im ...................................................... 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 XXX
Frm 00350
90393 .... .......... E Vaccina ig, im ....................................................... 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 XXX
90396 .... .......... E Varicella-zoster ig, im ........................................... 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 XXX
90399 .... .......... I Immune globulin ................................................... 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 XXX
90465 .... .......... A Immune admin 1 inj, < 8 yrs ................................ 0.17 0.45 0.35 NA NA 0.01 0.63 0.53 NA NA XXX
Fmt 4701
90466 .... .......... A Immune admin addl inj, < 8 y .............................. 0.15 0.12 0.13 0.04 0.11 0.01 0.28 0.29 0.20 0.27 ZZZ
90467 .... .......... R Immune admin o or n, < 8 yrs ............................. 0.17 0.17 0.17 0.07 0.09 0.01 0.35 0.35 0.25 0.27 XXX
90468 .... .......... R Immune admin o/n, addl < 8 y ............................. 0.15 0.10 0.11 0.03 0.05 0.01 0.26 0.27 0.19 0.21 ZZZ
90471 .... .......... A Immunization admin ............................................. 0.17 0.45 0.35 NA NA 0.01 0.63 0.53 NA NA XXX
Sfmt 4700
90472 .... .......... A Immunization admin, each add ............................ 0.15 0.12 0.13 0.04 0.11 0.01 0.28 0.29 0.20 0.27 ZZZ
90473 .... .......... R Immune admin oral/nasal ..................................... 0.17 0.16 0.18 0.04 0.06 0.01 0.34 0.36 0.22 0.24 XXX
90474 .... .......... R Immune admin oral/nasal addl ............................. 0.15 0.07 0.09 0.03 0.05 0.01 0.23 0.25 0.19 0.21 ZZZ
90476 .... .......... E Adenovirus vaccine, type 4 .................................. 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 XXX
90477 .... .......... E Adenovirus vaccine, type 7 .................................. 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 XXX
90581 .... .......... E Anthrax vaccine, sc .............................................. 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 XXX
90585 .... .......... E Bcg vaccine, percut .............................................. 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 XXX
90586 .... .......... E Bcg vaccine, intravesical ...................................... 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 XXX
90632 .... .......... E Hep a vaccine, adult im ....................................... 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 XXX
E:\FR\FM\01DER2.SGM
90633 .... .......... E Hep a vacc, ped/adol, 2 dose .............................. 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 XXX
90634 .... .......... E Hep a vacc, ped/adol, 3 dose .............................. 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 XXX
90636 .... .......... E Hep a/hep b vacc, adult im .................................. 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 XXX
90645 .... .......... E Hib vaccine, hboc, im ........................................... 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 XXX
01DER2
90646 .... .......... E Hib vaccine, prp-d, im .......................................... 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 XXX
90647 .... .......... E Hib vaccine, prp-omp, im ..................................... 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 XXX
90648 .... .......... E Hib vaccine, prp-t, im ........................................... 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 XXX
90649 .... .......... E H papilloma vacc 3 dose im ................................ 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 XXX
90655 .... .......... X Flu vaccine no preserv 6–35m ............................ 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 XXX
90656 .... .......... X Flu vaccine no preserv 3 & > ............................... 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 XXX
Year Year Year
2007 2007 Fully Im-
VerDate Aug<31>2005
RVUs cility Total
RVUs
90657 .... .......... X Flu vaccine, 3 yrs, im ........................................... 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 XXX
90658 .... .......... X Flu vaccine, 3 yrs & >, im .................................... 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 XXX
90660 .... .......... X Flu vaccine, nasal ................................................ 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 XXX
10:50 Nov 30, 2006

90665 .... .......... E Lyme disease vaccine, im .................................... 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 XXX
90669 .... .......... N Pneumococcal vacc, ped <5 ................................ 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 XXX
90675 .... .......... E Rabies vaccine, im ............................................... 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 XXX
90676 .... .......... E Rabies vaccine, id ................................................ 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 XXX
90680 .... .......... E Rotovirus vacc 3 dose, oral ................................. 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 XXX
Jkt 211001
90690 .... .......... E Typhoid vaccine, oral ........................................... 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 XXX
90691 .... .......... E Typhoid vaccine, im ............................................. 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 XXX
90692 .... .......... E Typhoid vaccine, h-p, sc/id .................................. 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 XXX
90693 .... .......... E Typhoid vaccine, akd, sc ..................................... 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 XXX
PO 00000
90698 .... .......... E Dtap-hib-ip vaccine, im ........................................ 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 XXX
90700 .... .......... E Dtap vaccine, < 7 yrs, im ..................................... 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 XXX
90701 .... .......... E Dtp vaccine, im .................................................... 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 XXX
90702 .... .......... E Dt vaccine < 7, im ................................................ 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 XXX
Frm 00351
90703 .... .......... E Tetanus vaccine, im ............................................. 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 XXX
90704 .... .......... E Mumps vaccine, sc .............................................. 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 XXX
90705 .... .......... E Measles vaccine, sc ............................................. 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 XXX
90706 .... .......... E Rubella vaccine, sc .............................................. 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 XXX
Fmt 4701
90707 .... .......... E Mmr vaccine, sc ................................................... 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 XXX
90708 .... .......... E Measles-rubella vaccine, sc ................................. 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 XXX
90710 .... .......... E Mmrv vaccine, sc ................................................. 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 XXX
90712 .... .......... E Oral poliovirus vaccine ......................................... 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 XXX
Sfmt 4700
90713 .... .......... E Poliovirus, ipv, sc/im ............................................ 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 XXX
90714 .... .......... E Td vaccine no prsrv >/= 7 im ............................... 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 XXX
90715 .... .......... E Tdap vaccine >7 im .............................................. 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 XXX
90716 .... .......... E Chicken pox vaccine, sc ...................................... 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 XXX
90717 .... .......... E Yellow fever vaccine, sc ...................................... 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 XXX
90718 .... .......... E Td vaccine > 7, im ............................................... 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 XXX
90719 .... .......... E Diphtheria vaccine, im .......................................... 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 XXX
90720 .... .......... E Dtp/hib vaccine, im ............................................... 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 XXX
90721 .... .......... E Dtap/hib vaccine, im ............................................. 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 XXX
E:\FR\FM\01DER2.SGM
90723 .... .......... I Dtap-hep b-ipv vaccine, im .................................. 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 XXX
90725 .... .......... E Cholera vaccine, injectable .................................. 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 XXX
90727 .... .......... E Plague vaccine, im ............................................... 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 XXX
90732 .... .......... X Pneumococcal vaccine ........................................ 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 XXX
01DER2
90733 .... .......... E Meningococcal vaccine, sc .................................. 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 XXX
90734 .... .......... E Meningococcal vaccine, im .................................. 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 XXX
90735 .... .......... E Encephalitis vaccine, sc ....................................... 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 XXX
90736 .... .......... E Zoster vacc, sc ..................................................... 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 XXX
90740 .... .......... X Hepb vacc, ill pat 3 dose im ................................ 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 XXX
90743 .... .......... X Hep b vacc, adol, 2 dose, im ............................... 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 XXX
69973
Year
69974
Year Year
2007 2007 Fully Im-
VerDate Aug<31>2005
RVUs cility Total
RVUs
90744 .... .......... X Hepb vacc ped/adol 3 dose im ............................ 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 XXX
90746 .... .......... X Hep b vaccine, adult, im ...................................... 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 XXX
90747 .... .......... X Hepb vacc, ill pat 4 dose im ................................ 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 XXX
10:50 Nov 30, 2006

90748 .... .......... I Hep b/hib vaccine, im .......................................... 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 XXX
90749 .... .......... E Vaccine toxoid ...................................................... 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 XXX
90760 .... .......... A Hydration iv infusion, init ...................................... 0.17 1.30 1.40 NA NA 0.07 1.54 1.64 NA NA XXX
90761 .... .......... A Hydrate iv infusion, add-on .................................. 0.09 0.31 0.38 NA NA 0.04 0.44 0.51 NA NA ZZZ
90765 .... .......... A Ther/proph/diag iv inf, init .................................... 0.21 1.61 1.72 NA NA 0.07 1.89 2.00 NA NA XXX
Jkt 211001
90766 .... .......... A Ther/proph/dg iv inf, add-on ................................. 0.18 0.37 0.44 NA NA 0.04 0.59 0.66 NA NA ZZZ
90767 .... .......... A Tx/proph/dg addl seq iv inf .................................. 0.19 0.68 0.84 NA NA 0.04 0.91 1.07 NA NA ZZZ
90768 .... .......... A Ther/diag concurrent inf ....................................... 0.17 0.33 0.41 NA NA 0.04 0.54 0.62 NA NA ZZZ
90772 .... .......... A Ther/proph/diag inj, sc/im ..................................... 0.17 0.45 0.35 NA NA 0.01 0.63 0.53 NA NA XXX
PO 00000
90773 .... .......... A Ther/proph/diag inj, ia .......................................... 0.17 0.30 0.31 NA NA 0.02 0.49 0.50 NA NA XXX
90774 .... .......... A Ther/proph/diag inj, iv push ................................. 0.18 1.33 1.31 NA NA 0.04 1.55 1.53 NA NA XXX
90775 .... .......... A Ther/proph/diag inj add-on ................................... 0.10 0.51 0.56 NA NA 0.04 0.65 0.70 NA NA ZZZ
90779 .... .......... C Ther/prop/diag inj/inf proc .................................... 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 XXX
Frm 00352
90801 .... .......... A Psy dx interview ................................................... 2.80 1.49 1.25 0.60 0.85 0.06 4.35 4.11 3.46 3.71 XXX
90802 .... .......... A Intac psy dx interview .......................................... 3.01 1.51 1.28 0.66 0.90 0.07 4.59 4.36 3.74 3.98 XXX
90804 .... .......... A Psytx, office, 20–30 min ....................................... 1.21 0.55 0.51 0.22 0.34 0.03 1.79 1.75 1.46 1.58 XXX
90805 .... .......... A Psytx, off, 20–30 min w/e&m ............................... 1.37 0.60 0.53 0.24 0.38 0.03 2.00 1.93 1.64 1.78 XXX
Fmt 4701
90806 .... .......... A Psytx, off, 45–50 min ........................................... 1.86 0.52 0.66 0.33 0.53 0.04 2.42 2.56 2.23 2.43 XXX
90807 .... .......... A Psytx, off, 45–50 min w/e&m ............................... 2.02 0.71 0.70 0.36 0.56 0.05 2.78 2.77 2.43 2.63 XXX
90808 .... .......... A Psytx, office, 75–80 min ....................................... 2.79 0.68 0.94 0.49 0.80 0.06 3.53 3.79 3.34 3.65 XXX
90809 .... .......... A Psytx, off, 75–80, w/e&m ..................................... 2.95 0.87 0.97 0.53 0.82 0.07 3.89 3.99 3.55 3.84 XXX
Sfmt 4700
90810 .... .......... A Intac psytx, off, 20–30 min ................................... 1.32 0.52 0.51 0.24 0.38 0.04 1.88 1.87 1.60 1.74 XXX
90811 .... .......... A Intac psytx, 20–30, w/e&m ................................... 1.48 0.72 0.61 0.26 0.41 0.04 2.24 2.13 1.78 1.93 XXX
90813 .... .......... A Intac psytx, 45–50 min w/e&m ............................. 2.13 0.84 0.79 0.38 0.60 0.05 3.02 2.97 2.56 2.78 XXX
90815 .... .......... A Intac psytx, 75–80 w/e&m .................................... 3.06 1.00 1.04 0.54 0.85 0.07 4.13 4.17 3.67 3.98 XXX
90816 .... .......... A Psytx, hosp, 20–30 min ....................................... 1.25 NA NA 0.32 0.43 0.03 NA NA 1.60 1.71 XXX
90817 .... .......... A Psytx, hosp, 20–30 min w/e&m ........................... 1.41 NA NA 0.36 0.44 0.03 NA NA 1.80 1.88 XXX
E:\FR\FM\01DER2.SGM
90823 .... .......... A Intac psytx, hosp, 20–30 min ............................... 1.36 NA NA 0.34 0.45 0.03 NA NA 1.73 1.84 XXX
01DER2
90824 .... .......... A Intac psytx, hsp 20–30 w/e&m ............................. 1.52 NA NA 0.38 0.46 0.04 NA NA 1.94 2.02 XXX
90845 .... .......... A Psychoanalysis ..................................................... 1.79 0.39 0.53 0.32 0.49 0.04 2.22 2.36 2.15 2.32 XXX
Year Year Year
2007 2007 Fully Im-
VerDate Aug<31>2005
RVUs cility Total
RVUs
90846 .... .......... R Family psytx w/o patient ...................................... 1.83 0.51 0.62 0.43 0.60 0.04 2.38 2.49 2.30 2.47 XXX
90847 .... .......... R Family psytx w/patient .......................................... 2.21 0.74 0.80 0.49 0.69 0.05 3.00 3.06 2.75 2.95 XXX
90849 .... .......... R Multiple family group psytx .................................. 0.59 0.30 0.28 0.20 0.23 0.02 0.91 0.89 0.81 0.84 XXX
10:50 Nov 30, 2006

90853 .... .......... A Group psychotherapy ........................................... 0.59 0.27 0.26 0.20 0.22 0.01 0.87 0.86 0.80 0.82 XXX
90857 .... .......... A Intac group psytx .................................................. 0.63 0.36 0.31 0.21 0.24 0.01 1.00 0.95 0.85 0.88 XXX
90862 .... .......... A Medication management ...................................... 0.95 0.62 0.46 0.27 0.31 0.02 1.59 1.43 1.24 1.28 XXX
90865 .... .......... A Narcosynthesis ..................................................... 2.84 1.19 1.32 0.65 0.85 0.12 4.15 4.28 3.61 3.81 XXX
90870 .... .......... A Electroconvulsive therapy .................................... 1.88 1.91 1.93 0.39 0.54 0.04 3.83 3.85 2.31 2.46 000
Jkt 211001
90875 .... .......... N Psychophysiological therapy ................................ 1.20 0.52 0.81 0.28 0.42 0.04 1.76 2.05 1.52 1.66 XXX
90876 .... .......... N Psychophysiological therapy ................................ 1.90 0.67 1.04 0.44 0.66 0.05 2.62 2.99 2.39 2.61 XXX
90880 .... .......... A Hypnotherapy ....................................................... 2.19 0.57 0.92 0.39 0.62 0.05 2.81 3.16 2.63 2.86 XXX
90882 .... .......... N Environmental manipulation ................................. 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 XXX
PO 00000
90885 .... .......... B Psy evaluation of records .................................... 0.97 0.22 0.33 0.22 0.33 0.02 1.21 1.32 1.21 1.32 XXX
90887 .... .......... B Consultation with family ....................................... 1.48 0.61 0.77 0.34 0.51 0.04 2.13 2.29 1.86 2.03 XXX
90889 .... .......... B Preparation of report ............................................ 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 XXX
90899 .... .......... C Psychiatric service/therapy .................................. 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 XXX
Frm 00353
90901 .... .......... A Biofeedback train, any meth ................................ 0.41 0.47 0.61 0.11 0.13 0.02 0.90 1.04 0.54 0.56 000
90911 .... .......... A Biofeedback peri/uro/rectal .................................. 0.89 1.37 1.51 0.30 0.31 0.06 2.32 2.46 1.25 1.26 000
90918 .... .......... I ESRD related services, month ............................. 11.16 4.68 5.75 3.74 5.52 0.36 16.20 17.27 15.26 17.04 XXX
Fmt 4701
90922 .... .......... I ESRD related services, day ................................. 0.37 0.16 0.20 0.12 0.19 0.01 0.54 0.58 0.50 0.57 XXX
90923 .... .......... I Esrd related services, day ................................... 0.28 0.10 0.12 0.08 0.12 0.01 0.39 0.41 0.37 0.41 XXX
Sfmt 4700
90935 .... .......... A Hemodialysis, one evaluation .............................. 1.22 NA NA 0.55 0.64 0.04 NA NA 1.81 1.90 000
90937 .... .......... A Hemodialysis, repeated eval ................................ 2.11 NA NA 0.79 0.93 0.07 NA NA 2.97 3.11 000
90940 .... .......... X Hemodialysis access study .................................. 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 XXX
90945 .... .......... A Dialysis, one evaluation ....................................... 1.28 NA NA 0.56 0.66 0.04 NA NA 1.88 1.98 000
90947 .... .......... A Dialysis, repeated eval ......................................... 2.16 NA NA 0.80 0.94 0.07 NA NA 3.03 3.17 000
90989 .... .......... X Dialysis training, complete ................................... 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 XXX
90993 .... .......... X Dialysis training, incompl ..................................... 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 XXX
E:\FR\FM\01DER2.SGM
90997 .... .......... A Hemoperfusion ..................................................... 1.84 NA NA 0.51 0.62 0.06 NA NA 2.41 2.52 000
90999 .... .......... C Dialysis procedure ................................................ 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 XXX
91000 .... .......... A Esophageal intubation .......................................... 0.73 2.19 0.80 2.19 0.80 0.04 2.96 1.57 2.96 1.57 000
91000 .... TC .... A Esophageal intubation .......................................... 0.00 1.95 0.55 1.95 0.55 0.01 1.96 0.56 1.96 0.56 000
01DER2
91000 .... 26 ..... A Esophageal intubation .......................................... 0.73 0.24 0.25 0.24 0.25 0.03 1.00 1.01 1.00 1.01 000
91010 .... .......... A Esophagus motility study ..................................... 1.25 3.65 4.22 3.65 4.22 0.12 5.02 5.59 5.02 5.59 000
91010 .... TC .... A Esophagus motility study ..................................... 0.00 3.09 3.75 3.09 3.75 0.06 3.15 3.81 3.15 3.81 000
91010 .... 26 ..... A Esophagus motility study ..................................... 1.25 0.56 0.47 0.56 0.47 0.06 1.87 1.78 1.87 1.78 000
69975
Year
69976
Year Year
2007 2007 Fully Im-
VerDate Aug<31>2005
RVUs cility Total
RVUs
10:50 Nov 30, 2006

91020 .... .......... A Gastric motility studies ......................................... 1.44 4.78 4.58 4.78 4.58 0.13 6.35 6.15 6.35 6.15 000
91020 .... TC .... A Gastric motility studies ......................................... 0.00 4.16 4.06 4.16 4.06 0.06 4.22 4.12 4.22 4.12 000
91020 .... 26 ..... A Gastric motility studies ......................................... 1.44 0.62 0.52 0.62 0.52 0.07 2.13 2.03 2.13 2.03 000
91022 .... .......... A Duodenal motility study ........................................ 1.44 3.09 4.08 3.09 4.08 0.13 4.66 5.65 4.66 5.65 000
Jkt 211001
91022 .... TC .... A Duodenal motility study ........................................ 0.00 2.47 3.54 2.47 3.54 0.06 2.53 3.60 2.53 3.60 000
91022 .... 26 ..... A Duodenal motility study ........................................ 1.44 0.62 0.54 0.62 0.54 0.07 2.13 2.05 2.13 2.05 000
91030 .... .......... A Acid perfusion of esophagus ............................... 0.91 2.90 2.55 2.90 2.55 0.06 3.87 3.52 3.87 3.52 000
91030 .... TC .... A Acid perfusion of esophagus ............................... 0.00 2.47 2.20 2.47 2.20 0.02 2.49 2.22 2.49 2.22 000
PO 00000
91030 .... 26 ..... A Acid perfusion of esophagus ............................... 0.91 0.43 0.35 0.43 0.35 0.04 1.38 1.30 1.38 1.30 000
91034 .... .......... A Gastroesophageal reflux test ............................... 0.97 4.10 4.96 4.10 4.96 0.12 5.19 6.05 5.19 6.05 000
91034 .... TC .... A Gastroesophageal reflux test ............................... 0.00 3.68 4.60 3.68 4.60 0.06 3.74 4.66 3.74 4.66 000
91034 .... 26 ..... A Gastroesophageal reflux test ............................... 0.97 0.42 0.36 0.42 0.36 0.06 1.45 1.39 1.45 1.39 000
Frm 00354
91035 .... .......... A G-esoph reflx tst w/electrod ................................. 1.59 11.29 10.92 11.29 10.92 0.12 13.00 12.63 13.00 12.63 000
91035 .... TC .... A G-esoph reflx tst w/electrod ................................. 0.00 10.57 10.32 10.57 10.32 0.06 10.63 10.38 10.63 10.38 000
91035 .... 26 ..... A G-esoph reflx tst w/electrod ................................. 1.59 0.72 0.60 0.72 0.60 0.06 2.37 2.25 2.37 2.25 000
91037 .... .......... A Esoph imped function test ................................... 0.97 3.38 3.04 3.38 3.04 0.12 4.47 4.13 4.47 4.13 000
Fmt 4701
91037 .... TC .... A Esoph imped function test ................................... 0.00 2.95 2.68 2.95 2.68 0.06 3.01 2.74 3.01 2.74 000
91037 .... 26 ..... A Esoph imped function test ................................... 0.97 0.43 0.36 0.43 0.36 0.06 1.46 1.39 1.46 1.39 000
91038 .... .......... A Esoph imped funct test > 1h ................................ 1.10 2.78 2.36 2.78 2.36 0.12 4.00 3.58 4.00 3.58 000
91038 .... TC .... A Esoph imped funct test > 1h ................................ 0.00 2.27 1.94 2.27 1.94 0.06 2.33 2.00 2.33 2.00 000
Sfmt 4700
91038 .... 26 ..... A Esoph imped funct test > 1h ................................ 1.10 0.51 0.42 0.51 0.42 0.06 1.67 1.58 1.67 1.58 000
91040 .... .......... A Esoph balloon distension tst ................................ 0.97 9.27 10.67 9.27 10.67 0.12 10.36 11.76 10.36 11.76 000
91040 .... TC .... A Esoph balloon distension tst ................................ 0.00 8.89 10.32 8.89 10.32 0.06 8.95 10.38 8.95 10.38 000
91040 .... 26 ..... A Esoph balloon distension tst ................................ 0.97 0.38 0.35 0.38 0.35 0.06 1.41 1.38 1.41 1.38 000
91052 .... .......... A Gastric analysis test ............................................. 0.79 2.98 2.59 2.98 2.59 0.05 3.82 3.43 3.82 3.43 000
91052 .... TC .... A Gastric analysis test ............................................. 0.00 2.60 2.28 2.60 2.28 0.02 2.62 2.30 2.62 2.30 000
91052 .... 26 ..... A Gastric analysis test ............................................. 0.79 0.38 0.31 0.38 0.31 0.03 1.20 1.13 1.20 1.13 000
91055 .... .......... A Gastric intubation for smear ................................. 0.94 2.41 2.81 2.41 2.81 0.07 3.42 3.82 3.42 3.82 000
91055 .... TC .... A Gastric intubation for smear ................................. 0.00 2.13 2.54 2.13 2.54 0.02 2.15 2.56 2.15 2.56 000
E:\FR\FM\01DER2.SGM
91055 .... 26 ..... A Gastric intubation for smear ................................. 0.94 0.28 0.27 0.28 0.27 0.05 1.27 1.26 1.27 1.26 000
91065 .... .......... A Breath hydrogen test ............................................ 0.20 1.29 1.42 1.29 1.42 0.03 1.52 1.65 1.52 1.65 000
91065 .... TC .... A Breath hydrogen test ............................................ 0.00 1.23 1.35 1.23 1.35 0.02 1.25 1.37 1.25 1.37 000
91065 .... 26 ..... A Breath hydrogen test ............................................ 0.20 0.06 0.07 0.06 0.07 0.01 0.27 0.28 0.27 0.28 000
01DER2
91100 .... .......... A Pass intestine bleeding tube ................................ 1.08 2.14 2.63 0.37 0.30 0.07 3.29 3.78 1.52 1.45 000
91105 .... .......... A Gastric intubation treatment ................................. 0.37 1.74 2.01 0.07 0.09 0.03 2.14 2.41 0.47 0.49 000
91110 .... .......... A Gi tract capsule endoscopy ................................. 3.64 20.51 21.77 NA NA 0.16 24.31 25.57 NA NA XXX
91110 .... TC .... A Gi tract capsule endoscopy ................................. 0.00 18.81 20.38 NA NA 0.07 18.88 20.45 NA NA XXX
91110 .... 26 ..... A Gi tract capsule endoscopy ................................. 3.64 1.70 1.39 1.70 1.39 0.09 5.43 5.12 5.43 5.12 XXX
91111 .... .......... A Esophageal capsule endoscopy .......................... 1.00 18.65 18.65 NA NA 0.05 19.70 19.70 NA NA XXX
Year Year Year
2007 2007 Fully Im-
VerDate Aug<31>2005
RVUs cility Total
RVUs
91111 .... TC .... A Esophageal capsule endoscopy .......................... 0.00 18.19 18.19 NA NA 0.02 18.21 18.21 NA NA XXX
91111 .... 26 ..... A Esophageal capsule endoscopy .......................... 1.00 0.46 0.46 0.46 0.46 0.03 1.49 1.49 1.49 1.49 XXX
91120 .... .......... A Rectal sensation test ............................................ 0.97 9.04 10.49 9.04 10.49 0.11 10.12 11.57 10.12 11.57 XXX
10:50 Nov 30, 2006

91120 .... TC .... A Rectal sensation test ............................................ 0.00 8.73 10.16 8.73 10.16 0.04 8.77 10.20 8.77 10.20 XXX
91120 .... 26 ..... A Rectal sensation test ............................................ 0.97 0.31 0.33 0.31 0.33 0.07 1.35 1.37 1.35 1.37 XXX
91122 .... .......... A Anal pressure record ............................................ 1.77 3.74 4.76 3.74 4.76 0.21 5.72 6.74 5.72 6.74 000
91122 .... TC .... A Anal pressure record ............................................ 0.00 3.21 4.18 3.21 4.18 0.08 3.29 4.26 3.29 4.26 000
91122 .... 26 ..... A Anal pressure record ............................................ 1.77 0.53 0.58 0.53 0.58 0.13 2.43 2.48 2.43 2.48 000
Jkt 211001
91123 .... .......... B Irrigate fecal impaction ......................................... 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 XXX
91132 .... .......... C Electrogastrography ............................................. 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 XXX
91132 .... TC .... C Electrogastrography ............................................. 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 XXX
91132 .... 26 ..... A Electrogastrography ............................................. 0.52 0.26 0.20 0.26 0.20 0.02 0.80 0.74 0.80 0.74 XXX
PO 00000
91133 .... .......... C Electrogastrography w/test ................................... 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 XXX
91133 .... TC .... C Electrogastrography w/test ................................... 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 XXX
91133 .... 26 ..... A Electrogastrography w/test ................................... 0.66 0.30 0.25 0.30 0.25 0.03 0.99 0.94 0.99 0.94 XXX
91299 .... .......... C Gastroenterology procedure ................................ 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 XXX
Frm 00355
91299 .... TC .... C Gastroenterology procedure ................................ 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 XXX
91299 .... 26 ..... C Gastroenterology procedure ................................ 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 XXX
92002 .... .......... A Eye exam, new patient ........................................ 0.88 0.97 0.97 0.28 0.33 0.02 1.87 1.87 1.18 1.23 XXX
92004 .... .......... A Eye exam, new patient ........................................ 1.67 1.59 1.67 0.55 0.65 0.04 3.30 3.38 2.26 2.36 XXX
Fmt 4701
92012 .... .......... A Eye exam established pat .................................... 0.67 0.93 1.01 0.24 0.28 0.02 1.62 1.70 0.93 0.97 XXX
92014 .... .......... A Eye exam & treatment ......................................... 1.10 1.31 1.39 0.39 0.45 0.03 2.44 2.52 1.52 1.58 XXX
92015 .... .......... N Refraction ............................................................. 0.38 0.10 1.14 0.09 0.14 0.01 0.49 1.53 0.48 0.53 XXX
92018 .... .......... A New eye exam & treatment ................................. 2.50 NA NA 0.93 1.04 0.07 NA NA 3.50 3.61 XXX
Sfmt 4700
92019 .... .......... A Eye exam & treatment ......................................... 1.31 NA NA 0.45 0.53 0.03 NA NA 1.79 1.87 XXX
92020 .... .......... A Special eye evaluation ......................................... 0.37 0.26 0.32 0.13 0.15 0.01 0.64 0.70 0.51 0.53 XXX
92025 .... .......... A Corneal topography .............................................. 0.35 0.44 0.44 0.44 0.44 0.02 0.81 0.81 0.81 0.81 XXX
92025 .... TC .... A Corneal topography .............................................. 0.00 0.32 0.32 0.32 0.32 0.01 0.33 0.33 0.33 0.33 XXX
92025 .... 26 ..... A Corneal topography .............................................. 0.35 0.12 0.12 0.12 0.12 0.01 0.48 0.48 0.48 0.48 XXX
92060 .... .......... A Special eye evaluation ......................................... 0.69 0.79 0.75 NA NA 0.03 1.51 1.47 NA NA XXX
92060 .... TC .... A Special eye evaluation ......................................... 0.00 0.55 0.47 NA NA 0.01 0.56 0.48 NA NA XXX
92060 .... 26 ..... A Special eye evaluation ......................................... 0.69 0.24 0.28 0.24 0.28 0.02 0.95 0.99 0.95 0.99 XXX
92065 .... .......... A Orthoptic/pleoptic training .................................... 0.37 0.88 0.62 NA NA 0.02 1.27 1.01 NA NA XXX
E:\FR\FM\01DER2.SGM
92065 .... TC .... A Orthoptic/pleoptic training .................................... 0.00 0.79 0.48 NA NA 0.01 0.80 0.49 NA NA XXX
92065 .... 26 ..... A Orthoptic/pleoptic training .................................... 0.37 0.09 0.14 0.09 0.14 0.01 0.47 0.52 0.47 0.52 XXX
92070 .... .......... A Fitting of contact lens ........................................... 0.70 0.94 1.04 0.24 0.30 0.02 1.66 1.76 0.96 1.02 XXX
92081 .... .......... A Visual field examination(s) ................................... 0.36 0.96 0.95 NA NA 0.02 1.34 1.33 NA NA XXX
01DER2
92081 .... TC .... A Visual field examination(s) ................................... 0.00 0.85 0.81 NA NA 0.01 0.86 0.82 NA NA XXX
92081 .... 26 ..... A Visual field examination(s) ................................... 0.36 0.11 0.14 0.11 0.14 0.01 0.48 0.51 0.48 0.51 XXX
69977
Year
69978
Year Year
2007 2007 Fully Im-
VerDate Aug<31>2005
RVUs cility Total
RVUs
92100 .... .......... A Serial tonometry exam(s) ..................................... 0.92 1.28 1.33 0.30 0.35 0.02 2.22 2.27 1.24 1.29 XXX
10:50 Nov 30, 2006

92120 .... .......... A Tonography & eye evaluation .............................. 0.81 1.00 1.05 0.27 0.31 0.02 1.83 1.88 1.10 1.14 XXX
92130 .... .......... A Water provocation tonography ............................. 0.81 1.21 1.26 0.29 0.35 0.02 2.04 2.09 1.12 1.18 XXX
92135 .... .......... A Opthalmic dx imaging .......................................... 0.35 0.80 0.79 NA NA 0.02 1.17 1.16 NA NA XXX
92135 .... TC .... A Opthalmic dx imaging .......................................... 0.00 0.68 0.65 NA NA 0.01 0.69 0.66 NA NA XXX
92135 .... 26 ..... A Opthalmic dx imaging .......................................... 0.35 0.12 0.14 0.12 0.14 0.01 0.48 0.50 0.48 0.50 XXX
Jkt 211001
92136 .... .......... A Ophthalmic biometry ............................................ 0.54 1.46 1.60 NA NA 0.08 2.08 2.22 NA NA XXX
92136 .... TC .... A Ophthalmic biometry ............................................ 0.00 1.25 1.37 NA NA 0.07 1.32 1.44 NA NA XXX
92136 .... 26 ..... A Ophthalmic biometry ............................................ 0.54 0.21 0.23 0.21 0.23 0.01 0.76 0.78 0.76 0.78 XXX
92140 .... .......... A Glaucoma provocative tests ................................. 0.50 0.92 0.97 0.16 0.20 0.01 1.43 1.48 0.67 0.71 XXX
PO 00000
92225 .... .......... A Special eye exam, initial ...................................... 0.38 0.25 0.23 0.13 0.15 0.01 0.64 0.62 0.52 0.54 XXX
92226 .... .......... A Special eye exam, subsequent ............................ 0.33 0.24 0.22 0.12 0.14 0.01 0.58 0.56 0.46 0.48 XXX
92230 .... .......... A Eye exam with photos .......................................... 0.60 0.73 1.33 0.21 0.20 0.02 1.35 1.95 0.83 0.82 XXX
92235 .... .......... A Eye exam with photos .......................................... 0.81 2.32 2.54 NA NA 0.08 3.21 3.43 NA NA XXX
Frm 00356
92235 .... TC .... A Eye exam with photos .......................................... 0.00 2.01 2.18 NA NA 0.06 2.07 2.24 NA NA XXX
92235 .... 26 ..... A Eye exam with photos .......................................... 0.81 0.31 0.36 0.31 0.36 0.02 1.14 1.19 1.14 1.19 XXX
92240 .... .......... A Icg angiography .................................................... 1.10 4.48 5.70 NA NA 0.09 5.67 6.89 NA NA XXX
92240 .... TC .... A Icg angiography .................................................... 0.00 4.06 5.22 NA NA 0.06 4.12 5.28 NA NA XXX
Fmt 4701
92240 .... 26 ..... A Icg angiography .................................................... 1.10 0.42 0.48 0.42 0.48 0.03 1.55 1.61 1.55 1.61 XXX
92250 .... .......... A Eye exam with photos .......................................... 0.44 1.33 1.48 NA NA 0.02 1.79 1.94 NA NA XXX
92250 .... TC .... A Eye exam with photos .......................................... 0.00 1.18 1.30 NA NA 0.01 1.19 1.31 NA NA XXX
92250 .... 26 ..... A Eye exam with photos .......................................... 0.44 0.15 0.18 0.15 0.18 0.01 0.60 0.63 0.60 0.63 XXX
Sfmt 4700
92260 .... .......... A Ophthalmoscopy/dynamometry ............................ 0.20 0.23 0.25 0.07 0.09 0.01 0.44 0.46 0.28 0.30 XXX
92265 .... .......... A Eye muscle evaluation ......................................... 0.81 1.01 1.37 NA NA 0.06 1.88 2.24 NA NA XXX
92265 .... TC .... A Eye muscle evaluation ......................................... 0.00 0.76 1.10 NA NA 0.02 0.78 1.12 NA NA XXX
92265 .... 26 ..... A Eye muscle evaluation ......................................... 0.81 0.25 0.27 0.25 0.27 0.04 1.10 1.12 1.10 1.12 XXX
92270 .... .......... A Electro-oculography ............................................. 0.81 1.38 1.50 NA NA 0.05 2.24 2.36 NA NA XXX
92270 .... TC .... A Electro-oculography ............................................. 0.00 1.14 1.19 NA NA 0.02 1.16 1.21 NA NA XXX
92270 .... 26 ..... A Electro-oculography ............................................. 0.81 0.24 0.31 0.24 0.31 0.03 1.08 1.15 1.08 1.15 XXX
92275 .... .......... A Electroretinography .............................................. 1.01 2.47 2.08 NA NA 0.05 3.53 3.14 NA NA XXX
92275 .... TC .... A Electroretinography .............................................. 0.00 2.10 1.66 NA NA 0.02 2.12 1.68 NA NA XXX
E:\FR\FM\01DER2.SGM
92275 .... 26 ..... A Electroretinography .............................................. 1.01 0.37 0.42 0.37 0.42 0.03 1.41 1.46 1.41 1.46 XXX
92283 .... .......... A Color vision examination ...................................... 0.17 1.01 0.89 NA NA 0.02 1.20 1.08 NA NA XXX
92283 .... TC .... A Color vision examination ...................................... 0.00 0.96 0.82 NA NA 0.01 0.97 0.83 NA NA XXX
92283 .... 26 ..... A Color vision examination ...................................... 0.17 0.05 0.07 0.05 0.07 0.01 0.23 0.25 0.23 0.25 XXX
01DER2
92284 .... .......... A Dark adaptation eye exam ................................... 0.24 1.24 1.72 NA NA 0.02 1.50 1.98 NA NA XXX
92284 .... TC .... A Dark adaptation eye exam ................................... 0.00 1.15 1.64 NA NA 0.01 1.16 1.65 NA NA XXX
92284 .... 26 ..... A Dark adaptation eye exam ................................... 0.24 0.09 0.08 0.09 0.08 0.01 0.34 0.33 0.34 0.33 XXX
92285 .... .......... A Eye photography .................................................. 0.20 0.82 0.95 NA NA 0.02 1.04 1.17 NA NA XXX
92285 .... TC .... A Eye photography .................................................. 0.00 0.75 0.86 NA NA 0.01 0.76 0.87 NA NA XXX
92285 .... 26 ..... A Eye photography .................................................. 0.20 0.07 0.09 0.07 0.09 0.01 0.28 0.30 0.28 0.30 XXX
Year Year Year
2007 2007 Fully Im-
VerDate Aug<31>2005
RVUs cility Total
RVUs
92286 .... .......... A Internal eye photography ..................................... 0.66 2.15 2.83 NA NA 0.04 2.85 3.53 NA NA XXX
92286 .... TC .... A Internal eye photography ..................................... 0.00 1.91 2.55 NA NA 0.02 1.93 2.57 NA NA XXX
92286 .... 26 ..... A Internal eye photography ..................................... 0.66 0.24 0.28 0.24 0.28 0.02 0.92 0.96 0.92 0.96 XXX
10:50 Nov 30, 2006

92287 .... .......... A Internal eye photography ..................................... 0.81 1.97 2.28 0.31 0.31 0.02 2.80 3.11 1.14 1.14 XXX
92310 .... .......... N Contact lens fitting ............................................... 1.17 1.05 1.10 0.27 0.41 0.04 2.26 2.31 1.48 1.62 XXX
92311 .... .......... A Contact lens fitting ............................................... 1.08 1.30 1.14 0.33 0.35 0.03 2.41 2.25 1.44 1.46 XXX
Jkt 211001
92314 .... .......... N Prescription of contact lens .................................. 0.69 1.13 0.99 0.16 0.24 0.01 1.83 1.69 0.86 0.94 XXX
92315 .... .......... A Prescription of contact lens .................................. 0.45 1.33 0.97 0.14 0.16 0.01 1.79 1.43 0.60 0.62 XXX
PO 00000
92325 .... .......... A Modification of contact lens ................................. 0.00 0.85 0.51 NA NA 0.01 0.86 0.52 NA NA XXX
92326 .... .......... A Replacement of contact lens ............................... 0.00 0.75 1.41 NA NA 0.06 0.81 1.47 NA NA XXX
92340 .... .......... N Fitting of spectacles ............................................. 0.37 0.44 0.64 0.08 0.13 0.01 0.82 1.02 0.46 0.51 XXX
Frm 00357
92352 .... .......... B Special spectacles fitting ...................................... 0.37 0.56 0.65 0.08 0.13 0.01 0.94 1.03 0.46 0.51 XXX
92353 .... .......... B Special spectacles fitting ...................................... 0.50 0.59 0.70 0.12 0.17 0.02 1.11 1.22 0.64 0.69 XXX
92354 .... .......... B Special spectacles fitting ...................................... 0.00 0.28 6.72 NA NA 0.10 0.38 6.82 NA NA XXX
Fmt 4701
92355 .... .......... B Special spectacles fitting ...................................... 0.00 0.44 3.36 NA NA 0.01 0.45 3.37 NA NA XXX
92358 .... .......... B Eye prosthesis service ......................................... 0.00 0.23 0.79 NA NA 0.05 0.28 0.84 NA NA XXX
92370 .... .......... N Repair & adjust spectacles .................................. 0.32 0.39 0.51 0.07 0.12 0.02 0.73 0.85 0.41 0.46 XXX
92371 .... .......... B Repair & adjust spectacles .................................. 0.00 0.24 0.53 NA NA 0.02 0.26 0.55 NA NA XXX
Sfmt 4700
92499 .... .......... C Eye service or procedure ..................................... 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 XXX
92499 .... TC .... C Eye service or procedure ..................................... 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 XXX
92499 .... 26 ..... C Eye service or procedure ..................................... 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 XXX
92502 .... .......... A Ear and throat examination .................................. 1.51 NA NA 0.79 1.03 0.05 NA NA 2.35 2.59 000
92504 .... .......... A Ear microscopy examination ................................ 0.18 0.55 0.51 0.05 0.08 0.01 0.74 0.70 0.24 0.27 XXX
92506 .... .......... A Speech/hearing evaluation ................................... 0.86 3.28 2.76 0.25 0.36 0.03 4.17 3.65 1.14 1.25 XXX
92507 .... .......... A Speech/hearing therapy ....................................... 0.52 1.18 1.13 0.15 0.21 0.02 1.72 1.67 0.69 0.75 XXX
92508 .... .......... A Speech/hearing therapy ....................................... 0.26 0.51 0.51 0.08 0.11 0.01 0.78 0.78 0.35 0.38 XXX
92511 .... .......... A Nasopharyngoscopy ............................................. 0.84 2.92 3.21 0.62 0.74 0.03 3.79 4.08 1.49 1.61 000
E:\FR\FM\01DER2.SGM
92512 .... .......... A Nasal function studies .......................................... 0.55 0.94 1.09 0.16 0.18 0.02 1.51 1.66 0.73 0.75 XXX
92516 .... .......... A Facial nerve function test ..................................... 0.43 1.15 1.19 0.13 0.20 0.01 1.59 1.63 0.57 0.64 XXX
92520 .... .......... A Laryngeal function studies ................................... 0.75 0.87 0.60 0.21 0.35 0.03 1.65 1.38 0.99 1.13 XXX
92526 .... .......... A Oral function therapy ............................................ 0.55 1.67 1.65 0.16 0.19 0.02 2.24 2.22 0.73 0.76 XXX
01DER2
92531 .... .......... B Spontaneous nystagmus study ............................ 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 XXX
92532 .... .......... B Positional nystagmus test .................................... 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 XXX
92533 .... .......... B Caloric vestibular test ........................................... 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 XXX
92534 .... .......... B Optokinetic nystagmus test .................................. 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 XXX
92541 .... .......... A Spontaneous nystagmus test ............................... 0.40 1.10 1.05 NA NA 0.04 1.54 1.49 NA NA XXX
92541 .... TC .... A Spontaneous nystagmus test ............................... 0.00 0.99 0.88 NA NA 0.02 1.01 0.90 NA NA XXX
69979
Year
69980
Year Year
2007 2007 Fully Im-
VerDate Aug<31>2005
RVUs cility Total
RVUs
92541 .... 26 ..... A Spontaneous nystagmus test ............................... 0.40 0.11 0.17 0.11 0.17 0.02 0.53 0.59 0.53 0.59 XXX
92542 .... .......... A Positional nystagmus test .................................... 0.33 1.24 1.16 NA NA 0.03 1.60 1.52 NA NA XXX
92542 .... TC .... A Positional nystagmus test .................................... 0.00 1.15 1.02 NA NA 0.02 1.17 1.04 NA NA XXX
10:50 Nov 30, 2006

92542 .... 26 ..... A Positional nystagmus test .................................... 0.33 0.09 0.14 0.09 0.14 0.01 0.43 0.48 0.43 0.48 XXX
92543 .... .......... A Caloric vestibular test ........................................... 0.10 0.64 0.59 NA NA 0.02 0.76 0.71 NA NA XXX
92543 .... TC .... A Caloric vestibular test ........................................... 0.00 0.61 0.54 NA NA 0.01 0.62 0.55 NA NA XXX
92543 .... 26 ..... A Caloric vestibular test ........................................... 0.10 0.03 0.05 0.03 0.05 0.01 0.14 0.16 0.14 0.16 XXX
92544 .... .......... A Optokinetic nystagmus test .................................. 0.26 1.00 0.93 NA NA 0.03 1.29 1.22 NA NA XXX
Jkt 211001
92544 .... TC .... A Optokinetic nystagmus test .................................. 0.00 0.93 0.82 NA NA 0.02 0.95 0.84 NA NA XXX
92544 .... 26 ..... A Optokinetic nystagmus test .................................. 0.26 0.07 0.11 0.07 0.11 0.01 0.34 0.38 0.34 0.38 XXX
92545 .... .......... A Oscillating tracking test ........................................ 0.23 0.98 0.85 NA NA 0.03 1.24 1.11 NA NA XXX
92545 .... TC .... A Oscillating tracking test ........................................ 0.00 0.92 0.75 NA NA 0.02 0.94 0.77 NA NA XXX
PO 00000
92545 .... 26 ..... A Oscillating tracking test ........................................ 0.23 0.06 0.10 0.06 0.10 0.01 0.30 0.34 0.30 0.34 XXX
92546 .... .......... A Sinusoidal rotational test ...................................... 0.29 1.80 1.94 NA NA 0.03 2.12 2.26 NA NA XXX
92546 .... TC .... A Sinusoidal rotational test ...................................... 0.00 1.72 1.82 NA NA 0.02 1.74 1.84 NA NA XXX
92546 .... 26 ..... A Sinusoidal rotational test ...................................... 0.29 0.08 0.12 0.08 0.12 0.01 0.38 0.42 0.38 0.42 XXX
Frm 00358
92547 .... .......... A Supplemental electrical test ................................. 0.00 0.11 0.09 0.11 0.09 0.06 0.17 0.15 0.17 0.15 ZZZ
92548 .... .......... A Posturography ...................................................... 0.50 1.64 2.10 NA NA 0.15 2.29 2.75 NA NA XXX
92548 .... TC .... A Posturography ...................................................... 0.00 1.50 1.87 NA NA 0.13 1.63 2.00 NA NA XXX
92548 .... 26 ..... A Posturography ...................................................... 0.50 0.14 0.23 0.14 0.23 0.02 0.66 0.75 0.66 0.75 XXX
Fmt 4701
92551 .... .......... N Pure tone hearing test, air ................................... 0.00 0.25 0.25 NA NA 0.01 0.26 0.26 NA NA XXX
92552 .... .......... A Pure tone audiometry, air .................................... 0.00 0.56 0.47 NA NA 0.04 0.60 0.51 NA NA XXX
92553 .... .......... A Audiometry, air & bone ........................................ 0.00 0.71 0.67 NA NA 0.06 0.77 0.73 NA NA XXX
92555 .... .......... A Speech threshold audiometry .............................. 0.00 0.38 0.38 NA NA 0.04 0.42 0.42 NA NA XXX
Sfmt 4700
92556 .... .......... A Speech audiometry, complete ............................. 0.00 0.51 0.56 NA NA 0.06 0.57 0.62 NA NA XXX
92557 .... .......... A Comprehensive hearing test ................................ 0.00 1.26 1.21 NA NA 0.12 1.38 1.33 NA NA XXX
92559 .... .......... N Group audiometric testing .................................... 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 XXX
92560 .... .......... N Bekesy audiometry, screen .................................. 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 XXX
92561 .... .......... A Bekesy audiometry, diagnosis ............................. 0.00 0.68 0.71 NA NA 0.06 0.74 0.77 NA NA XXX
92562 .... .......... A Loudness balance test ......................................... 0.00 0.67 0.48 NA NA 0.04 0.71 0.52 NA NA XXX
92563 .... .......... A Tone decay hearing test ...................................... 0.00 0.48 0.41 NA NA 0.04 0.52 0.45 NA NA XXX
92564 .... .......... A Sisi hearing test ................................................... 0.00 0.43 0.46 NA NA 0.05 0.48 0.51 NA NA XXX
92565 .... .......... A Stenger test, pure tone ........................................ 0.00 0.23 0.36 NA NA 0.04 0.27 0.40 NA NA XXX
E:\FR\FM\01DER2.SGM
92567 .... .......... A Tympanometry ..................................................... 0.00 0.49 0.51 NA NA 0.06 0.55 0.57 NA NA XXX
92568 .... .......... A Acoustic refl threshold tst ..................................... 0.00 0.15 0.32 NA NA 0.04 0.19 0.36 NA NA XXX
92569 .... .......... A Acoustic reflex decay test .................................... 0.00 0.15 0.35 NA NA 0.04 0.19 0.39 NA NA XXX
92571 .... .......... A Filtered speech hearing test ................................ 0.00 0.40 0.39 NA NA 0.04 0.44 0.43 NA NA XXX
01DER2
92572 .... .......... A Staggered spondaic word test ............................. 0.00 0.60 0.22 NA NA 0.01 0.61 0.23 NA NA XXX
92575 .... .......... A Sensorineural acuity test ...................................... 0.00 1.09 0.50 NA NA 0.02 1.11 0.52 NA NA XXX
92576 .... .......... A Synthetic sentence test ........................................ 0.00 0.54 0.47 NA NA 0.05 0.59 0.52 NA NA XXX
92577 .... .......... A Stenger test, speech ............................................ 0.00 0.24 0.60 NA NA 0.07 0.31 0.67 NA NA XXX
92579 .... .......... A Visual audiometry (vra) ........................................ 0.00 0.84 0.76 NA NA 0.06 0.90 0.82 NA NA XXX
92582 .... .......... A Conditioning play audiometry ............................... 0.00 1.07 0.82 NA NA 0.06 1.13 0.88 NA NA XXX
Year Year Year
2007 2007 Fully Im-
VerDate Aug<31>2005
RVUs cility Total
RVUs
92583 .... .......... A Select picture audiometry .................................... 0.00 0.69 0.84 NA NA 0.08 0.77 0.92 NA NA XXX
92584 .... .......... A Electrocochleography ........................................... 0.00 1.16 2.14 NA NA 0.21 1.37 2.35 NA NA XXX
92585 .... .......... A Auditor evoke potent, compre .............................. 0.50 1.91 2.02 NA NA 0.17 2.58 2.69 NA NA XXX
10:50 Nov 30, 2006

92585 .... TC .... A Auditor evoke potent, compre .............................. 0.00 1.77 1.83 NA NA 0.14 1.91 1.97 NA NA XXX
92585 .... 26 ..... A Auditor evoke potent, compre .............................. 0.50 0.14 0.19 0.14 0.19 0.03 0.67 0.72 0.67 0.72 XXX
92586 .... .......... A Auditor evoke potent, limit ................................... 0.00 1.40 1.74 NA NA 0.14 1.54 1.88 NA NA XXX
92587 .... .......... A Evoked auditory test ............................................ 0.13 0.62 1.19 NA NA 0.12 0.87 1.44 NA NA XXX
92587 .... TC .... A Evoked auditory test ............................................ 0.00 0.58 1.13 NA NA 0.11 0.69 1.24 NA NA XXX
Jkt 211001
92587 .... 26 ..... A Evoked auditory test ............................................ 0.13 0.04 0.06 0.04 0.06 0.01 0.18 0.20 0.18 0.20 XXX
92588 .... .......... A Evoked auditory test ............................................ 0.36 1.02 1.48 NA NA 0.14 1.52 1.98 NA NA XXX
92588 .... TC .... A Evoked auditory test ............................................ 0.00 0.92 1.33 NA NA 0.13 1.05 1.46 NA NA XXX
92588 .... 26 ..... A Evoked auditory test ............................................ 0.36 0.10 0.15 0.10 0.15 0.01 0.47 0.52 0.47 0.52 XXX
PO 00000
92590 .... .......... N Hearing aid exam, one ear .................................. 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 XXX
92591 .... .......... N Hearing aid exam, both ears ............................... 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 XXX
92592 .... .......... N Hearing aid check, one ear .................................. 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 XXX
92593 .... .......... N Hearing aid check, both ears ............................... 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 XXX
Frm 00359
92594 .... .......... N Electro hearng aid test, one ................................. 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 XXX
92595 .... .......... N Electro hearng aid tst, both .................................. 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 XXX
92596 .... .......... A Ear protector evaluation ....................................... 0.00 0.93 0.68 NA NA 0.06 0.99 0.74 NA NA XXX
92597 .... .......... A Oral speech device eval ...................................... 0.86 1.69 1.69 0.25 0.40 0.03 2.58 2.58 1.14 1.29 XXX
Fmt 4701
92601 .... .......... A Cochlear implt f/up exam < 7 ............................... 0.00 4.87 3.84 NA NA 0.07 4.94 3.91 NA NA XXX
92602 .... .......... A Reprogram cochlear implt < 7 ............................. 0.00 3.34 2.62 NA NA 0.07 3.41 2.69 NA NA XXX
92603 .... .......... A Cochlear implt f/up exam 7 > ............................... 0.00 3.17 2.40 NA NA 0.07 3.24 2.47 NA NA XXX
92604 .... .......... A Reprogram cochlear implt 7 > ............................. 0.00 2.09 1.54 NA NA 0.07 2.16 1.61 NA NA XXX
Sfmt 4700
92605 .... .......... B Eval for nonspeech device rx .............................. 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 XXX
92606 .... .......... B Non-speech device service .................................. 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 XXX
92607 .... .......... A Ex for speech device rx, 1hr ................................ 0.00 4.27 3.38 NA NA 0.05 4.32 3.43 NA NA XXX
92608 .... .......... A Ex for speech device rx addl ............................... 0.00 0.86 0.63 NA NA 0.05 0.91 0.68 NA NA XXX
92609 .... .......... A Use of speech device service .............................. 0.00 2.29 1.77 NA NA 0.04 2.33 1.81 NA NA XXX
92610 .... .......... A Evaluate swallowing function ............................... 0.00 1.61 2.98 NA NA 0.08 1.69 3.06 NA NA XXX
92611 .... .......... A Motion fluoroscopy/swallow ................................. 0.00 1.85 3.04 NA NA 0.08 1.93 3.12 NA NA XXX
92612 .... .......... A Endoscopy swallow tst (fees) .............................. 1.27 2.74 2.74 0.37 0.59 0.04 4.05 4.05 1.68 1.90 XXX
92613 .... .......... A Endoscopy swallow tst (fees) .............................. 0.71 0.23 0.36 0.23 0.35 0.05 0.99 1.12 0.99 1.11 XXX
E:\FR\FM\01DER2.SGM
92614 .... .......... A Laryngoscopic sensory test ................................. 1.27 2.24 2.44 0.37 0.59 0.04 3.55 3.75 1.68 1.90 XXX
92615 .... .......... A Eval laryngoscopy sense tst ................................ 0.63 0.19 0.31 0.19 0.31 0.05 0.87 0.99 0.87 0.99 XXX
92616 .... .......... A Fees w/laryngeal sense test ................................ 1.88 2.92 3.27 0.54 0.88 0.06 4.86 5.21 2.48 2.82 XXX
92617 .... .......... A Interprt fees/laryngeal test ................................... 0.79 0.23 0.39 0.23 0.39 0.05 1.07 1.23 1.07 1.23 XXX
01DER2
92620 .... .......... A Auditory function, 60 min ..................................... 0.00 1.87 1.32 NA NA 0.06 1.93 1.38 NA NA XXX
92621 .... .......... A Auditory function, + 15 min .................................. 0.00 0.40 0.29 NA NA 0.06 0.46 0.35 NA NA ZZZ
92625 .... .......... A Tinnitus assessment ............................................ 0.00 1.82 1.30 1.82 1.30 0.06 1.88 1.36 1.88 1.36 XXX
92626 .... .......... A Eval aud rehab status .......................................... 0.00 1.85 2.11 NA NA 0.06 1.91 2.17 NA NA XXX
92627 .... .......... A Eval aud status rehab add-on .............................. 0.00 0.42 0.52 0.42 0.52 0.02 0.44 0.54 0.44 0.54 ZZZ
92630 .... .......... I Aud rehab pre-ling hear loss ............................... 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 XXX
69981
Year
69982
Year Year
2007 2007 Fully Im-
VerDate Aug<31>2005
RVUs cility Total
RVUs
92633 .... .......... I Aud rehab postling hear loss ............................... 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 XXX
92640 .... .......... A Aud brainstem implt programg ............................. 0.00 1.40 1.40 1.40 1.40 0.01 1.41 1.41 1.41 1.41 XXX
92700 .... .......... C Ent procedure/service .......................................... 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 XXX
10:50 Nov 30, 2006

92950 .... .......... A Heart/lung resuscitation cpr ................................. 3.79 3.24 3.96 0.79 0.93 0.28 7.31 8.03 4.86 5.00 000
92953 .... .......... A Temporary external pacing .................................. 0.23 NA NA 0.07 0.07 0.02 NA NA 0.32 0.32 000
92960 .... .......... A Cardioversion electric, ext .................................... 2.25 4.40 5.83 1.48 1.25 0.07 6.72 8.15 3.80 3.57 000
92961 .... .......... A Cardioversion, electric, int .................................... 4.59 NA NA 2.52 2.19 0.29 NA NA 7.40 7.07 000
92970 .... .......... A Cardioassist, internal ............................................ 3.51 NA NA 1.63 1.20 0.16 NA NA 5.30 4.87 000
Jkt 211001
92971 .... .......... A Cardioassist, external ........................................... 1.77 NA NA 1.09 0.91 0.06 NA NA 2.92 2.74 000
92973 .... .......... A Percut coronary thrombectomy ............................ 3.28 NA NA 1.82 1.42 0.23 NA NA 5.33 4.93 ZZZ
92974 .... .......... A Cath place, cardio brachytx ................................. 3.00 NA NA 1.70 1.31 0.21 NA NA 4.91 4.52 ZZZ
92975 .... .......... A Dissolve clot, heart vessel ................................... 7.24 NA NA 3.94 3.09 0.50 NA NA 11.68 10.83 000
PO 00000
92977 .... .......... A Dissolve clot, heart vessel ................................... 0.00 1.70 6.46 NA NA 0.46 2.16 6.92 NA NA XXX
92978 .... .......... C Intravasc us, heart add-on ................................... 0.00 NA NA NA NA 0.00 NA NA NA NA ZZZ
92978 .... TC .... C Intravasc us, heart add-on ................................... 0.00 NA NA NA NA 0.00 NA NA NA NA ZZZ
92978 .... 26 ..... A Intravasc us, heart add-on ................................... 1.80 1.00 0.78 1.00 0.78 0.06 2.86 2.64 2.86 2.64 ZZZ
Frm 00360
92979 .... .......... C Intravasc us, heart add-on ................................... 0.00 NA NA NA NA 0.00 NA NA NA NA ZZZ
92979 .... TC .... C Intravasc us, heart add-on ................................... 0.00 NA NA NA NA 0.00 NA NA NA NA ZZZ
92979 .... 26 ..... A Intravasc us, heart add-on ................................... 1.44 0.80 0.62 0.80 0.62 0.06 2.30 2.12 2.30 2.12 ZZZ
92980 .... .......... A Insert intracoronary stent ..................................... 14.82 NA NA 8.43 6.65 1.03 NA NA 24.28 22.50 000
Fmt 4701
92981 .... .......... A Insert intracoronary stent ..................................... 4.16 NA NA 2.31 1.80 0.29 NA NA 6.76 6.25 ZZZ
92982 .... .......... A Coronary artery dilation ........................................ 10.96 NA NA 6.30 4.97 0.76 NA NA 18.02 16.69 000
92984 .... .......... A Coronary artery dilation ........................................ 2.97 NA NA 1.64 1.28 0.21 NA NA 4.82 4.46 ZZZ
92986 .... .......... A Revision of aortic valve ........................................ 22.70 NA NA 15.88 12.84 1.51 NA NA 40.09 37.05 090
Sfmt 4700
92992 .... .......... C Revision of heart chamber ................................... 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 090
92993 .... .......... C Revision of heart chamber ................................... 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 090
92995 .... .......... A Coronary atherectomy .......................................... 12.07 NA NA 6.92 5.45 0.84 NA NA 19.83 18.36 000
92996 .... .......... A Coronary atherectomy add-on ............................. 3.26 NA NA 1.81 1.41 0.10 NA NA 5.17 4.77 ZZZ
92997 .... .......... A Pul art balloon repr, percut .................................. 11.98 NA NA 5.27 4.93 0.40 NA NA 17.65 17.31 000
92998 .... .......... A Pul art balloon repr, percut .................................. 5.99 NA NA 2.79 2.35 0.28 NA NA 9.06 8.62 ZZZ
93000 .... .......... A Electrocardiogram, complete ............................... 0.17 0.34 0.47 NA NA 0.03 0.54 0.67 NA NA XXX
E:\FR\FM\01DER2.SGM
93005 .... .......... A Electrocardiogram, tracing ................................... 0.00 0.27 0.41 NA NA 0.02 0.29 0.43 NA NA XXX
93010 .... .......... A Electrocardiogram report ...................................... 0.17 0.07 0.06 0.07 0.06 0.01 0.25 0.24 0.25 0.24 XXX
93012 .... .......... A Transmission of ecg ............................................. 0.00 4.15 5.55 NA NA 0.18 4.33 5.73 NA NA XXX
93014 .... .......... A Report on transmitted ecg ................................... 0.52 0.21 0.20 0.21 0.20 0.02 0.75 0.74 0.75 0.74 XXX
01DER2
93015 .... .......... A Cardiovascular stress test .................................... 0.75 1.91 1.95 NA NA 0.14 2.80 2.84 NA NA XXX
93016 .... .......... A Cardiovascular stress test .................................... 0.45 0.23 0.19 0.23 0.19 0.02 0.70 0.66 0.70 0.66 XXX
93017 .... .......... A Cardiovascular stress test .................................... 0.00 1.53 1.64 NA NA 0.11 1.64 1.75 NA NA XXX
93018 .... .......... A Cardiovascular stress test .................................... 0.30 0.15 0.12 0.15 0.12 0.01 0.46 0.43 0.46 0.43 XXX
93024 .... .......... A Cardiac drug stress test ....................................... 1.17 2.41 1.79 NA NA 0.12 3.70 3.08 NA NA XXX
93024 .... TC .... A Cardiac drug stress test ....................................... 0.00 1.82 1.30 NA NA 0.08 1.90 1.38 NA NA XXX
Year Year Year
2007 2007 Fully Im-
VerDate Aug<31>2005
RVUs cility Total
RVUs
93024 .... 26 ..... A Cardiac drug stress test ....................................... 1.17 0.59 0.49 0.59 0.49 0.04 1.80 1.70 1.80 1.70 XXX
93025 .... .......... A Microvolt t-wave assess ....................................... 0.75 3.90 6.67 NA NA 0.14 4.79 7.56 NA NA XXX
93025 .... TC .... A Microvolt t-wave assess ....................................... 0.00 3.52 6.36 NA NA 0.11 3.63 6.47 NA NA XXX
10:50 Nov 30, 2006

93025 .... 26 ..... A Microvolt t-wave assess ....................................... 0.75 0.38 0.31 0.38 0.31 0.03 1.16 1.09 1.16 1.09 XXX
93040 .... .......... A Rhythm ECG with report ...................................... 0.16 0.19 0.20 NA NA 0.02 0.37 0.38 NA NA XXX
93041 .... .......... A Rhythm ECG, tracing ........................................... 0.00 0.14 0.15 NA NA 0.01 0.15 0.16 NA NA XXX
93042 .... .......... A Rhythm ECG, report ............................................ 0.16 0.05 0.05 0.05 0.05 0.01 0.22 0.22 0.22 0.22 XXX
93224 .... .......... A ECG monitor/report, 24 hrs .................................. 0.52 2.32 3.29 NA NA 0.24 3.08 4.05 NA NA XXX
Jkt 211001
93225 .... .......... A ECG monitor/record, 24 hrs ................................. 0.00 1.06 1.20 NA NA 0.08 1.14 1.28 NA NA XXX
93227 .... .......... A ECG monitor/review, 24 hrs ................................. 0.52 0.28 0.21 0.28 0.21 0.02 0.82 0.75 0.82 0.75 XXX
PO 00000
93231 .... .......... A Ecg monitor/record, 24 hrs .................................. 0.00 0.92 1.37 NA NA 0.11 1.03 1.48 NA NA XXX
Frm 00361
93236 .... .......... C ECG monitor/report, 24 hrs .................................. 0.00 0.00 0.00 NA NA 0.00 0.00 0.00 NA NA XXX
93268 .... .......... A ECG record/review ............................................... 0.52 5.75 7.02 NA NA 0.28 6.55 7.82 NA NA XXX
93270 .... .......... A ECG recording ..................................................... 0.00 0.29 1.00 NA NA 0.08 0.37 1.08 NA NA XXX
Fmt 4701
93271 .... .......... A Ecg/monitoring and analysis ................................ 0.00 5.24 5.82 NA NA 0.18 5.42 6.00 NA NA XXX
93272 .... .......... A Ecg/review, interpret only ..................................... 0.52 0.22 0.20 0.22 0.20 0.02 0.76 0.74 0.76 0.74 XXX
93278 .... .......... A ECG/signal-averaged ........................................... 0.25 0.61 1.09 NA NA 0.12 0.98 1.46 NA NA XXX
93278 .... TC .... A ECG/signal-averaged ........................................... 0.00 0.51 0.99 NA NA 0.11 0.62 1.10 NA NA XXX
Sfmt 4700
93278 .... 26 ..... A ECG/signal-averaged ........................................... 0.25 0.10 0.10 0.10 0.10 0.01 0.36 0.36 0.36 0.36 XXX
93303 .... .......... A Echo transthoracic ............................................... 1.30 4.60 4.41 NA NA 0.27 6.17 5.98 NA NA XXX
93303 .... TC .... A Echo transthoracic ............................................... 0.00 4.02 3.90 NA NA 0.23 4.25 4.13 NA NA XXX
93303 .... 26 ..... A Echo transthoracic ............................................... 1.30 0.58 0.51 0.58 0.51 0.04 1.92 1.85 1.92 1.85 XXX
93307 .... .......... A Echo exam of heart .............................................. 0.92 3.75 4.10 NA NA 0.26 4.93 5.28 NA NA XXX
93307 .... TC .... A Echo exam of heart .............................................. 0.00 3.28 3.72 NA NA 0.23 3.51 3.95 NA NA XXX
E:\FR\FM\01DER2.SGM
93307 .... 26 ..... A Echo exam of heart .............................................. 0.92 0.47 0.38 0.47 0.38 0.03 1.42 1.33 1.42 1.33 XXX
93308 .... .......... A Echo exam of heart .............................................. 0.53 2.63 2.26 NA NA 0.15 3.31 2.94 NA NA XXX
93308 .... TC .... A Echo exam of heart .............................................. 0.00 2.35 2.04 NA NA 0.13 2.48 2.17 NA NA XXX
93308 .... 26 ..... A Echo exam of heart .............................................. 0.53 0.28 0.22 0.28 0.22 0.02 0.83 0.77 0.83 0.77 XXX
01DER2
93312 .... .......... A Echo transesophageal ......................................... 2.20 7.51 5.31 NA NA 0.37 10.08 7.88 NA NA XXX
93312 .... TC .... A Echo transesophageal ......................................... 0.00 6.48 4.46 NA NA 0.29 6.77 4.75 NA NA XXX
93312 .... 26 ..... A Echo transesophageal ......................................... 2.20 1.03 0.85 1.03 0.85 0.08 3.31 3.13 3.31 3.13 XXX
93313 .... .......... A Echo transesophageal ......................................... 0.95 NA NA 0.14 0.19 0.06 NA NA 1.15 1.20 XXX
93314 .... .......... A Echo transesophageal ......................................... 1.25 7.21 4.99 NA NA 0.33 8.79 6.57 NA NA XXX
93314 .... TC .... A Echo transesophageal ......................................... 0.00 6.63 4.49 NA NA 0.29 6.92 4.78 NA NA XXX
69983
Year
69984
Year Year
2007 2007 Fully Im-
VerDate Aug<31>2005
RVUs cility Total
RVUs
93315 .... .......... C Echo transesophageal ......................................... 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 XXX
93315 .... TC .... C Echo transesophageal ......................................... 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 XXX
10:50 Nov 30, 2006

93316 .... .......... A Echo transesophageal ......................................... 0.95 NA NA 0.26 0.25 0.05 NA NA 1.26 1.25 XXX
93317 .... .......... C Echo transesophageal ......................................... 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 XXX
93317 .... TC .... C Echo transesophageal ......................................... 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 XXX
Jkt 211001
93318 .... .......... C Echo transesophageal intraop ............................. 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 XXX
93318 .... TC .... C Echo transesophageal intraop ............................. 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 XXX
93318 .... 26 ..... A Echo transesophageal intraop ............................. 2.20 0.91 0.59 0.91 0.59 0.14 3.25 2.93 3.25 2.93 XXX
93320 .... .......... A Doppler echo exam, heart ................................... 0.38 1.68 1.82 1.68 1.82 0.13 2.19 2.33 2.19 2.33 ZZZ
PO 00000
93320 .... TC .... A Doppler echo exam, heart ................................... 0.00 1.49 1.66 1.49 1.66 0.12 1.61 1.78 1.61 1.78 ZZZ
93320 .... 26 ..... A Doppler echo exam, heart ................................... 0.38 0.19 0.16 0.19 0.16 0.01 0.58 0.55 0.58 0.55 ZZZ
93321 .... .......... A Doppler echo exam, heart ................................... 0.15 0.62 1.04 0.62 1.04 0.09 0.86 1.28 0.86 1.28 ZZZ
93321 .... TC .... A Doppler echo exam, heart ................................... 0.00 0.54 0.97 0.54 0.97 0.08 0.62 1.05 0.62 1.05 ZZZ
Frm 00362
93321 .... 26 ..... A Doppler echo exam, heart ................................... 0.15 0.08 0.07 0.08 0.07 0.01 0.24 0.23 0.24 0.23 ZZZ
93325 .... .......... A Doppler color flow add-on .................................... 0.07 0.66 2.36 0.66 2.36 0.22 0.95 2.65 0.95 2.65 ZZZ
93325 .... TC .... A Doppler color flow add-on .................................... 0.00 0.63 2.33 0.63 2.33 0.21 0.84 2.54 0.84 2.54 ZZZ
93325 .... 26 ..... A Doppler color flow add-on .................................... 0.07 0.03 0.03 0.03 0.03 0.01 0.11 0.11 0.11 0.11 ZZZ
Fmt 4701
93501 .... .......... C Right heart catheterization ................................... 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 000
Sfmt 4700
93501 .... TC .... C Right heart catheterization ................................... 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 000
93501 .... 26 ..... A Right heart catheterization ................................... 3.02 1.64 1.27 1.64 1.27 0.21 4.87 4.50 4.87 4.50 000
93503 .... .......... C Insert/place heart catheter ................................... 0.00 NA NA 0.00 0.00 0.00 NA NA 0.00 0.00 000
93505 .... .......... C Biopsy of heart lining ........................................... 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 000
93505 .... TC .... C Biopsy of heart lining ........................................... 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 000
93505 .... 26 ..... A Biopsy of heart lining ........................................... 4.37 2.37 1.85 2.37 1.85 0.30 7.04 6.52 7.04 6.52 000
93508 .... .......... C Cath placement, angiography .............................. 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 000
93508 .... TC .... C Cath placement, angiography .............................. 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 000
93508 .... 26 ..... A Cath placement, angiography .............................. 4.09 2.27 2.13 2.27 2.13 0.28 6.64 6.50 6.64 6.50 000
E:\FR\FM\01DER2.SGM
93510 .... .......... C Left heart catheterization ..................................... 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 000
93510 .... TC .... C Left heart catheterization ..................................... 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 000
93510 .... 26 ..... A Left heart catheterization ..................................... 4.32 2.38 2.22 2.38 2.22 0.30 7.00 6.84 7.00 6.84 000
93511 .... .......... C Left heart catheterization ..................................... 0.00 NA NA 0.00 0.00 0.00 NA NA 0.00 0.00 000
01DER2
93511 .... TC .... C Left heart catheterization ..................................... 0.00 NA NA 0.00 0.00 0.00 NA NA 0.00 0.00 000
93514 .... .......... C Left heart catheterization ..................................... 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 000
93514 .... TC .... C Left heart catheterization ..................................... 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 000
93524 .... .......... C Left heart catheterization ..................................... 0.00 NA NA 0.00 0.00 0.00 NA NA 0.00 0.00 000
Year Year Year
2007 2007 Fully Im-
VerDate Aug<31>2005
RVUs cility Total
RVUs
93524 .... TC .... C Left heart catheterization ..................................... 0.00 NA NA 0.00 0.00 0.00 NA NA 0.00 0.00 000
93526 .... .......... C Rt & Lt heart catheters ......................................... 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 000
10:50 Nov 30, 2006

93526 .... TC .... C Rt & Lt heart catheters ......................................... 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 000
93526 .... 26 ..... A Rt & Lt heart catheters ......................................... 5.98 3.29 2.93 3.29 2.93 0.42 9.69 9.33 9.69 9.33 000
93527 .... .......... C Rt & Lt heart catheters ......................................... 0.00 NA NA 0.00 0.00 0.00 NA NA 0.00 0.00 000
93527 .... TC .... C Rt & Lt heart catheters ......................................... 0.00 NA NA 0.00 0.00 0.00 NA NA 0.00 0.00 000
Jkt 211001
93528 .... .......... C Rt & Lt heart catheters ......................................... 0.00 NA NA 0.00 0.00 0.00 NA NA 0.00 0.00 000
93528 .... TC .... C Rt & Lt heart catheters ......................................... 0.00 NA NA 0.00 0.00 0.00 NA NA 0.00 0.00 000
93529 .... .......... C Rt, lt heart catheterization .................................... 0.00 NA NA 0.00 0.00 0.00 NA NA 0.00 0.00 000
PO 00000
93529 .... TC .... C Rt, lt heart catheterization .................................... 0.00 NA NA 0.00 0.00 0.00 NA NA 0.00 0.00 000
93529 .... 26 ..... A Rt, lt heart catheterization .................................... 4.79 2.64 2.36 2.64 2.36 0.33 7.76 7.48 7.76 7.48 000
93530 .... .......... C Rt heart cath, congenital ...................................... 0.00 NA NA 0.00 0.00 0.00 NA NA 0.00 0.00 000
93530 .... TC .... C Rt heart cath, congenital ...................................... 0.00 NA NA 0.00 0.00 0.00 NA NA 0.00 0.00 000
Frm 00363
93530 .... 26 ..... A Rt heart cath, congenital ...................................... 4.22 1.87 1.92 1.87 1.92 0.29 6.38 6.43 6.38 6.43 000
93531 .... .......... C R & l heart cath, congenital ................................. 0.00 NA NA 0.00 0.00 0.00 NA NA 0.00 0.00 000
93531 .... TC .... C R & l heart cath, congenital ................................. 0.00 NA NA 0.00 0.00 0.00 NA NA 0.00 0.00 000
93531 .... 26 ..... A R & l heart cath, congenital ................................. 8.34 3.77 3.63 3.77 3.63 0.58 12.69 12.55 12.69 12.55 000
Fmt 4701
93532 .... .......... C R & l heart cath, congenital ................................. 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 000
93532 .... TC .... C R & l heart cath, congenital ................................. 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 000
93533 .... .......... C R & l heart cath, congenital ................................. 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 000
Sfmt 4700
93533 .... TC .... C R & l heart cath, congenital ................................. 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 000
93539 .... .......... C Injection, cardiac cath .......................................... 0.00 NA NA 0.00 0.00 0.00 NA NA 0.00 0.00 000
93540 .... .......... C Injection, cardiac cath .......................................... 0.00 NA NA 0.00 0.00 0.00 NA NA 0.00 0.00 000
93541 .... .......... C Injection for lung angiogram ................................ 0.00 NA NA 0.00 0.00 0.00 NA NA 0.00 0.00 000
93542 .... .......... C Injection for heart x-rays ...................................... 0.00 NA NA 0.00 0.00 0.00 NA NA 0.00 0.00 000
93543 .... .......... C Injection for heart x-rays ...................................... 0.00 NA NA 0.00 0.00 0.00 NA NA 0.00 0.00 000
93544 .... .......... C Injection for aortography ...................................... 0.00 NA NA 0.00 0.00 0.00 NA NA 0.00 0.00 000
93545 .... .......... C Inject for coronary x-rays ..................................... 0.00 NA NA 0.00 0.00 0.00 NA NA 0.00 0.00 000
E:\FR\FM\01DER2.SGM
93555 .... .......... C Imaging, cardiac cath ........................................... 0.00 0.00 0.00 NA NA 0.00 0.00 0.00 NA NA XXX
93555 .... TC .... C Imaging, cardiac cath ........................................... 0.00 0.00 0.00 NA NA 0.00 0.00 0.00 NA NA XXX
93555 .... 26 ..... A Imaging, cardiac cath ........................................... 0.81 0.45 0.35 0.45 0.35 0.03 1.29 1.19 1.29 1.19 XXX
93556 .... .......... C Imaging, cardiac cath ........................................... 0.00 0.00 0.00 NA NA 0.00 0.00 0.00 NA NA XXX
01DER2
93556 .... TC .... C Imaging, cardiac cath ........................................... 0.00 0.00 0.00 NA NA 0.00 0.00 0.00 NA NA XXX
93556 .... 26 ..... A Imaging, cardiac cath ........................................... 0.83 0.46 0.36 0.46 0.36 0.03 1.32 1.22 1.32 1.22 XXX
93561 .... .......... C Cardiac output measurement ............................... 0.00 NA NA NA NA 0.00 NA NA NA NA 000
93561 .... TC .... C Cardiac output measurement ............................... 0.00 NA NA NA NA 0.00 NA NA NA NA 000
93561 .... 26 ..... A Cardiac output measurement ............................... 0.50 0.14 0.16 0.14 0.16 0.02 0.66 0.68 0.66 0.68 000
93562 .... .......... C Cardiac output measurement ............................... 0.00 NA NA NA NA 0.00 NA NA NA NA 000
69985
Year
69986
Year Year
2007 2007 Fully Im-
VerDate Aug<31>2005
RVUs cility Total
RVUs
93562 .... TC .... C Cardiac output measurement ............................... 0.00 NA NA NA NA 0.00 NA NA NA NA 000
93562 .... 26 ..... A Cardiac output measurement ............................... 0.16 0.03 0.05 0.03 0.05 0.01 0.20 0.22 0.20 0.22 000
93571 .... .......... C Heart flow reserve measure ................................. 0.00 NA NA NA NA 0.00 NA NA NA NA ZZZ
10:50 Nov 30, 2006

93571 .... TC .... C Heart flow reserve measure ................................. 0.00 NA NA NA NA 0.00 NA NA NA NA ZZZ
93571 .... 26 ..... A Heart flow reserve measure ................................. 1.80 0.99 0.76 0.99 0.76 0.06 2.85 2.62 2.85 2.62 ZZZ
93572 .... .......... C Heart flow reserve measure ................................. 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 ZZZ
93572 .... TC .... C Heart flow reserve measure ................................. 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 ZZZ
93572 .... 26 ..... A Heart flow reserve measure ................................. 1.44 0.75 0.56 0.75 0.56 0.04 2.23 2.04 2.23 2.04 ZZZ
Jkt 211001
93580 .... .......... A Transcath closure of asd ..................................... 17.97 NA NA 9.73 7.97 1.25 NA NA 28.95 27.19 000
93581 .... .......... A Transcath closure of vsd ...................................... 24.39 NA NA 13.39 10.39 1.72 NA NA 39.50 36.50 000
93600 .... .......... C Bundle of His recording ....................................... 0.00 NA NA NA NA 0.00 NA NA NA NA 000
93600 .... TC .... C Bundle of His recording ....................................... 0.00 NA NA NA NA 0.00 NA NA NA NA 000
PO 00000
93600 .... 26 ..... A Bundle of His recording ....................................... 2.12 1.11 0.90 1.11 0.90 0.16 3.39 3.18 3.39 3.18 000
93602 .... .......... C Intra-atrial recording ............................................. 0.00 NA NA NA NA 0.00 NA NA NA NA 000
93602 .... TC .... C Intra-atrial recording ............................................. 0.00 NA NA NA NA 0.00 NA NA NA NA 000
93602 .... 26 ..... A Intra-atrial recording ............................................. 2.12 1.09 0.89 1.09 0.89 0.17 3.38 3.18 3.38 3.18 000
Frm 00364
93603 .... .......... C Right ventricular recording ................................... 0.00 NA NA NA NA 0.00 NA NA NA NA 000
93603 .... TC .... C Right ventricular recording ................................... 0.00 NA NA NA NA 0.00 NA NA NA NA 000
93603 .... 26 ..... A Right ventricular recording ................................... 2.12 1.08 0.88 1.08 0.88 0.18 3.38 3.18 3.38 3.18 000
93609 .... .......... C Map tachycardia, add-on ..................................... 0.00 NA NA NA NA 0.00 NA NA NA NA ZZZ
Fmt 4701
93609 .... TC .... C Map tachycardia, add-on ..................................... 0.00 NA NA NA NA 0.00 NA NA NA NA ZZZ
93609 .... 26 ..... A Map tachycardia, add-on ..................................... 4.99 2.73 2.15 2.73 2.15 0.35 8.07 7.49 8.07 7.49 ZZZ
93610 .... .......... C Intra-atrial pacing ................................................. 0.00 NA NA NA NA 0.00 NA NA NA NA 000
93610 .... TC .... C Intra-atrial pacing ................................................. 0.00 NA NA NA NA 0.00 NA NA NA NA 000
Sfmt 4700
93610 .... 26 ..... A Intra-atrial pacing ................................................. 3.02 1.53 1.25 1.53 1.25 0.24 4.79 4.51 4.79 4.51 000
93612 .... .......... C Intraventricular pacing .......................................... 0.00 NA NA NA NA 0.00 NA NA NA NA 000
93612 .... TC .... C Intraventricular pacing .......................................... 0.00 NA NA NA NA 0.00 NA NA NA NA 000
93612 .... 26 ..... A Intraventricular pacing .......................................... 3.02 1.48 1.24 1.48 1.24 0.25 4.75 4.51 4.75 4.51 000
93613 .... .......... A Electrophys map 3d, add-on ................................ 6.99 NA NA 3.83 3.03 0.49 NA NA 11.31 10.51 ZZZ
93615 .... .......... C Esophageal recording .......................................... 0.00 NA NA NA NA 0.00 NA NA NA NA 000
93615 .... TC .... C Esophageal recording .......................................... 0.00 NA NA NA NA 0.00 NA NA NA NA 000
93615 .... 26 ..... A Esophageal recording .......................................... 0.99 0.49 0.33 0.49 0.33 0.03 1.51 1.35 1.51 1.35 000
93616 .... .......... C Esophageal recording .......................................... 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 000
E:\FR\FM\01DER2.SGM
93616 .... TC .... C Esophageal recording .......................................... 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 000
93616 .... 26 ..... A Esophageal recording .......................................... 1.49 0.43 0.43 0.43 0.43 0.09 2.01 2.01 2.01 2.01 000
93618 .... .......... C Heart rhythm pacing ............................................. 0.00 NA NA NA NA 0.00 NA NA NA NA 000
93618 .... TC .... C Heart rhythm pacing ............................................. 0.00 NA NA NA NA 0.00 NA NA NA NA 000
01DER2
93618 .... 26 ..... A Heart rhythm pacing ............................................. 4.25 2.36 1.84 2.36 1.84 0.30 6.91 6.39 6.91 6.39 000
93619 .... .......... C Electrophysiology evaluation ................................ 0.00 NA NA NA NA 0.00 NA NA NA NA 000
93619 .... TC .... C Electrophysiology evaluation ................................ 0.00 NA NA NA NA 0.00 NA NA NA NA 000
93619 .... 26 ..... A Electrophysiology evaluation ................................ 7.31 3.93 3.37 3.93 3.37 0.51 11.75 11.19 11.75 11.19 000
93620 .... .......... C Electrophysiology evaluation ................................ 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 000
93620 .... TC .... C Electrophysiology evaluation ................................ 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 000
Year Year Year
2007 2007 Fully Im-
VerDate Aug<31>2005
RVUs cility Total
RVUs
93621 .... .......... C Electrophysiology evaluation ................................ 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 ZZZ
93621 .... TC .... C Electrophysiology evaluation ................................ 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 ZZZ
10:50 Nov 30, 2006

93621 .... 26 ..... A Electrophysiology evaluation ................................ 2.10 1.15 0.90 1.15 0.90 0.15 3.40 3.15 3.40 3.15 ZZZ
93622 .... .......... C Electrophysiology evaluation ................................ 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 ZZZ
93622 .... TC .... C Electrophysiology evaluation ................................ 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 ZZZ
93622 .... 26 ..... A Electrophysiology evaluation ................................ 3.10 1.68 1.33 1.68 1.33 0.22 5.00 4.65 5.00 4.65 ZZZ
93623 .... .......... C Stimulation, pacing heart ..................................... 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 ZZZ
Jkt 211001
93623 .... TC .... C Stimulation, pacing heart ..................................... 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 ZZZ
93623 .... 26 ..... A Stimulation, pacing heart ..................................... 2.85 1.56 1.22 1.56 1.22 0.20 4.61 4.27 4.61 4.27 ZZZ
93624 .... .......... A Electrophysiologic study ....................................... 4.80 NA NA 2.67 4.29 0.46 NA NA 7.93 9.55 000
93624 .... TC .... A Electrophysiologic study ....................................... 0.00 NA NA 0.00 1.98 0.13 NA NA 0.13 2.11 000
PO 00000
93624 .... 26 ..... A Electrophysiologic study ....................................... 4.80 2.67 2.31 2.67 2.31 0.33 7.80 7.44 7.80 7.44 000
93631 .... .......... C Heart pacing, mapping ......................................... 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 000
93631 .... TC .... C Heart pacing, mapping ......................................... 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 000
93631 .... 26 ..... A Heart pacing, mapping ......................................... 7.59 2.76 2.77 2.76 2.77 0.97 11.32 11.33 11.32 11.33 000
Frm 00365
93640 .... .......... C Evaluation heart device ........................................ 0.00 NA NA NA NA 0.00 NA NA NA NA 000
93640 .... TC .... C Evaluation heart device ........................................ 0.00 NA NA NA NA 0.00 NA NA NA NA 000
93640 .... 26 ..... A Evaluation heart device ........................................ 3.51 1.92 1.50 1.92 1.50 0.24 5.67 5.25 5.67 5.25 000
93641 .... .......... C Electrophysiology evaluation ................................ 0.00 NA NA NA NA 0.00 NA NA NA NA 000
Fmt 4701
93641 .... TC .... C Electrophysiology evaluation ................................ 0.00 NA NA NA NA 0.00 NA NA NA NA 000
93642 .... .......... A Electrophysiology evaluation ................................ 4.88 7.45 8.90 7.45 8.90 0.57 12.90 14.35 12.90 14.35 000
93642 .... TC .... A Electrophysiology evaluation ................................ 0.00 4.77 6.57 4.77 6.57 0.42 5.19 6.99 5.19 6.99 000
Sfmt 4700
93660 .... .......... A Tilt table evaluation .............................................. 1.89 3.05 2.58 3.05 2.58 0.08 5.02 4.55 5.02 4.55 000
93660 .... TC .... A Tilt table evaluation .............................................. 0.00 2.04 1.77 2.04 1.77 0.02 2.06 1.79 2.06 1.79 000
93660 .... 26 ..... A Tilt table evaluation .............................................. 1.89 1.01 0.81 1.01 0.81 0.06 2.96 2.76 2.96 2.76 000
93662 .... .......... C Intracardiac ecg (ice) ........................................... 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 ZZZ
93662 .... TC .... C Intracardiac ecg (ice) ........................................... 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 ZZZ
E:\FR\FM\01DER2.SGM
93662 .... 26 ..... A Intracardiac ecg (ice) ........................................... 2.80 1.53 1.22 1.53 1.22 0.09 4.42 4.11 4.42 4.11 ZZZ
93668 .... .......... N Peripheral vascular rehab .................................... 0.00 0.40 0.40 NA NA 0.01 0.41 0.41 NA NA XXX
93701 .... .......... A Bioimpedance, thoracic ........................................ 0.17 0.70 0.91 NA NA 0.02 0.89 1.10 NA NA XXX
93701 .... TC .... A Bioimpedance, thoracic ........................................ 0.00 0.64 0.84 NA NA 0.01 0.65 0.85 NA NA XXX
01DER2
93701 .... 26 ..... A Bioimpedance, thoracic ........................................ 0.17 0.06 0.07 0.06 0.07 0.01 0.24 0.25 0.24 0.25 XXX
93720 .... .......... A Total body plethysmography ................................ 0.17 1.19 0.87 NA NA 0.07 1.43 1.11 NA NA XXX
93721 .... .......... A Plethysmography tracing ...................................... 0.00 1.14 0.82 NA NA 0.06 1.20 0.88 NA NA XXX
93722 .... .......... A Plethysmography report ....................................... 0.17 0.05 0.05 0.05 0.05 0.01 0.23 0.23 0.23 0.23 XXX
93724 .... .......... A Analyze pacemaker system ................................. 4.88 3.53 5.29 3.53 5.29 0.39 8.80 10.56 8.80 10.56 000
93724 .... TC .... A Analyze pacemaker system ................................. 0.00 0.91 3.20 0.91 3.20 0.24 1.15 3.44 1.15 3.44 000
69987
Year
69988
Year Year
2007 2007 Fully Im-
VerDate Aug<31>2005
RVUs cility Total
RVUs
93724 .... 26 ..... A Analyze pacemaker system ................................. 4.88 2.62 2.09 2.62 2.09 0.15 7.65 7.12 7.65 7.12 000
93727 .... .......... A Analyze ilr system ................................................ 0.52 0.65 0.31 0.65 0.31 0.02 1.19 0.85 1.19 0.85 XXX
93731 .... .......... A Analyze pacemaker system ................................. 0.45 0.79 0.70 NA NA 0.05 1.29 1.20 NA NA XXX
10:50 Nov 30, 2006

93731 .... TC .... A Analyze pacemaker system ................................. 0.00 0.55 0.51 NA NA 0.04 0.59 0.55 NA NA XXX
93731 .... 26 ..... A Analyze pacemaker system ................................. 0.45 0.24 0.19 0.24 0.19 0.01 0.70 0.65 0.70 0.65 XXX
Jkt 211001
93733 .... .......... A Telephone analy, pacemaker ............................... 0.17 0.92 0.83 NA NA 0.07 1.16 1.07 NA NA XXX
93733 .... TC .... A Telephone analy, pacemaker ............................... 0.00 0.84 0.76 NA NA 0.06 0.90 0.82 NA NA XXX
93733 .... 26 ..... A Telephone analy, pacemaker ............................... 0.17 0.08 0.07 0.08 0.07 0.01 0.26 0.25 0.26 0.25 XXX
PO 00000
Frm 00366
93736 .... .......... A Telephonic analy, pacemaker .............................. 0.15 0.90 0.74 NA NA 0.07 1.12 0.96 NA NA XXX
93736 .... TC .... A Telephonic analy, pacemaker .............................. 0.00 0.83 0.68 NA NA 0.06 0.89 0.74 NA NA XXX
93736 .... 26 ..... A Telephonic analy, pacemaker .............................. 0.15 0.07 0.06 0.07 0.06 0.01 0.23 0.22 0.23 0.22 XXX
Fmt 4701
93740 .... .......... B Temperature gradient studies .............................. 0.16 0.04 0.15 NA NA 0.02 0.22 0.33 NA NA XXX
93740 .... TC .... B Temperature gradient studies .............................. 0.00 0.00 0.11 NA NA 0.01 0.01 0.12 NA NA XXX
93740 .... 26 ..... B Temperature gradient studies .............................. 0.16 0.04 0.04 0.04 0.04 0.01 0.21 0.21 0.21 0.21 XXX
93741 .... .......... A Analyze ht pace device sngl ................................ 0.80 1.04 0.99 NA NA 0.07 1.91 1.86 NA NA XXX
Sfmt 4700
93741 .... TC .... A Analyze ht pace device sngl ................................ 0.00 0.60 0.65 NA NA 0.04 0.64 0.69 NA NA XXX
93741 .... 26 ..... A Analyze ht pace device sngl ................................ 0.80 0.44 0.34 0.44 0.34 0.03 1.27 1.17 1.27 1.17 XXX
93742 .... .......... A Analyze ht pace device sngl ................................ 0.91 1.18 1.07 NA NA 0.07 2.16 2.05 NA NA XXX
93742 .... TC .... A Analyze ht pace device sngl ................................ 0.00 0.67 0.67 NA NA 0.04 0.71 0.71 NA NA XXX
93742 .... 26 ..... A Analyze ht pace device sngl ................................ 0.91 0.51 0.40 0.51 0.40 0.03 1.45 1.34 1.45 1.34 XXX
93743 .... .......... A Analyze ht pace device dual ................................ 1.03 1.22 1.15 NA NA 0.07 2.32 2.25 NA NA XXX
93743 .... TC .... A Analyze ht pace device dual ................................ 0.00 0.65 0.71 NA NA 0.04 0.69 0.75 NA NA XXX
93743 .... 26 ..... A Analyze ht pace device dual ................................ 1.03 0.57 0.44 0.57 0.44 0.03 1.63 1.50 1.63 1.50 XXX
93744 .... .......... A Analyze ht pace device dual ................................ 1.18 1.37 1.19 NA NA 0.08 2.63 2.45 NA NA XXX
E:\FR\FM\01DER2.SGM
93744 .... TC .... A Analyze ht pace device dual ................................ 0.00 0.72 0.68 NA NA 0.04 0.76 0.72 NA NA XXX
93744 .... 26 ..... A Analyze ht pace device dual ................................ 1.18 0.65 0.51 0.65 0.51 0.04 1.87 1.73 1.87 1.73 XXX
93745 .... .......... C Set-up cardiovert-defibrill ..................................... 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 XXX
93745 .... TC .... C Set-up cardiovert-defibrill ..................................... 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 XXX
01DER2
93745 .... 26 ..... C Set-up cardiovert-defibrill ..................................... 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 XXX
93760 .... .......... N Cephalic thermogram ........................................... 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 XXX
93762 .... .......... N Peripheral thermogram ........................................ 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 XXX
93770 .... .......... B Measure venous pressure ................................... 0.16 0.04 0.07 NA NA 0.02 0.22 0.25 NA NA XXX
93770 .... TC .... B Measure venous pressure ................................... 0.00 0.00 0.02 NA NA 0.01 0.01 0.03 NA NA XXX
93770 .... 26 ..... B Measure venous pressure ................................... 0.16 0.04 0.05 0.04 0.05 0.01 0.21 0.22 0.21 0.22 XXX
Year Year Year
2007 2007 Fully Im-
VerDate Aug<31>2005
RVUs cility Total
RVUs
93784 .... .......... A Ambulatory BP monitoring ................................... 0.38 1.54 1.54 NA NA 0.03 1.95 1.95 NA NA XXX
93786 .... .......... A Ambulatory BP recording ..................................... 0.00 0.88 0.90 NA NA 0.01 0.89 0.91 NA NA XXX
93788 .... .......... A Ambulatory BP analysis ....................................... 0.00 0.52 0.51 NA NA 0.01 0.53 0.52 NA NA XXX
10:50 Nov 30, 2006

93790 .... .......... A Review/report BP recording ................................. 0.38 0.14 0.13 0.14 0.13 0.01 0.53 0.52 0.53 0.52 XXX
93797 .... .......... A Cardiac rehab ....................................................... 0.18 0.32 0.31 0.09 0.08 0.01 0.51 0.50 0.28 0.27 000
93798 .... .......... A Cardiac rehab/monitor .......................................... 0.28 0.44 0.46 0.13 0.12 0.01 0.73 0.75 0.42 0.41 000
93799 .... .......... C Cardiovascular procedure .................................... 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 XXX
93799 .... TC .... C Cardiovascular procedure .................................... 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 XXX
Jkt 211001
93799 .... 26 ..... C Cardiovascular procedure .................................... 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 XXX
93875 .... .......... A Extracranial study ................................................. 0.22 2.50 2.38 NA NA 0.12 2.84 2.72 NA NA XXX
93875 .... TC .... A Extracranial study ................................................. 0.00 2.43 2.30 NA NA 0.11 2.54 2.41 NA NA XXX
93875 .... 26 ..... A Extracranial study ................................................. 0.22 0.07 0.08 0.07 0.08 0.01 0.30 0.31 0.30 0.31 XXX
PO 00000
Frm 00367
93886 .... .......... A Intracranial study .................................................. 0.94 6.83 6.77 NA NA 0.45 8.22 8.16 NA NA XXX
93886 .... TC .... A Intracranial study .................................................. 0.00 6.55 6.42 NA NA 0.39 6.94 6.81 NA NA XXX
Fmt 4701
93886 .... 26 ..... A Intracranial study .................................................. 0.94 0.28 0.35 0.28 0.35 0.06 1.28 1.35 1.28 1.35 XXX
93888 .... .......... A Intracranial study .................................................. 0.62 4.73 4.36 NA NA 0.32 5.67 5.30 NA NA XXX
93888 .... TC .... A Intracranial study .................................................. 0.00 4.54 4.14 NA NA 0.27 4.81 4.41 NA NA XXX
93888 .... 26 ..... A Intracranial study .................................................. 0.62 0.19 0.22 0.19 0.22 0.05 0.86 0.89 0.86 0.89 XXX
Sfmt 4700
93890 .... .......... A Tcd, vasoreactivity study ...................................... 1.00 6.08 5.20 NA NA 0.45 7.53 6.65 NA NA XXX
93890 .... TC .... A Tcd, vasoreactivity study ...................................... 0.00 5.78 4.82 NA NA 0.39 6.17 5.21 NA NA XXX
93890 .... 26 ..... A Tcd, vasoreactivity study ...................................... 1.00 0.30 0.38 0.30 0.38 0.06 1.36 1.44 1.36 1.44 XXX
93892 .... .......... A Tcd, emboli detect w/o inj .................................... 1.15 6.59 5.52 NA NA 0.45 8.19 7.12 NA NA XXX
93892 .... TC .... A Tcd, emboli detect w/o inj .................................... 0.00 6.25 5.09 NA NA 0.39 6.64 5.48 NA NA XXX
93892 .... 26 ..... A Tcd, emboli detect w/o inj .................................... 1.15 0.34 0.43 0.34 0.43 0.06 1.55 1.64 1.55 1.64 XXX
93893 .... .......... A Tcd, emboli detect w/inj ....................................... 1.15 6.28 5.34 NA NA 0.45 7.88 6.94 NA NA XXX
93893 .... TC .... A Tcd, emboli detect w/inj ....................................... 0.00 5.94 4.91 NA NA 0.39 6.33 5.30 NA NA XXX
93893 .... 26 ..... A Tcd, emboli detect w/inj ....................................... 1.15 0.34 0.43 0.34 0.43 0.06 1.55 1.64 1.55 1.64 XXX
E:\FR\FM\01DER2.SGM
93922 .... .......... A Extremity study ..................................................... 0.25 3.07 2.78 NA NA 0.15 3.47 3.18 NA NA XXX
93922 .... TC .... A Extremity study ..................................................... 0.00 2.99 2.70 NA NA 0.13 3.12 2.83 NA NA XXX
93922 .... 26 ..... A Extremity study ..................................................... 0.25 0.08 0.08 0.08 0.08 0.02 0.35 0.35 0.35 0.35 XXX
01DER2
93925 .... .......... A Lower extremity study .......................................... 0.58 7.82 7.05 NA NA 0.39 8.79 8.02 NA NA XXX
69989
Year
69990
Year Year
2007 2007 Fully Im-
VerDate Aug<31>2005
RVUs cility Total
RVUs
93925 .... TC .... A Lower extremity study .......................................... 0.00 7.64 6.85 NA NA 0.35 7.99 7.20 NA NA XXX
93925 .... 26 ..... A Lower extremity study .......................................... 0.58 0.18 0.20 0.18 0.20 0.04 0.80 0.82 0.80 0.82 XXX
93926 .... .......... A Lower extremity study .......................................... 0.39 5.05 4.31 NA NA 0.27 5.71 4.97 NA NA XXX
10:50 Nov 30, 2006

93926 .... TC .... A Lower extremity study .......................................... 0.00 4.94 4.18 NA NA 0.23 5.17 4.41 NA NA XXX
93926 .... 26 ..... A Lower extremity study .......................................... 0.39 0.11 0.13 0.11 0.13 0.04 0.54 0.56 0.54 0.56 XXX
93930 .... .......... A Upper extremity study .......................................... 0.46 6.09 5.54 NA NA 0.41 6.96 6.41 NA NA XXX
93930 .... TC .... A Upper extremity study .......................................... 0.00 5.95 5.38 NA NA 0.37 6.32 5.75 NA NA XXX
93930 .... 26 ..... A Upper extremity study .......................................... 0.46 0.14 0.16 0.14 0.16 0.04 0.64 0.66 0.64 0.66 XXX
Jkt 211001
93931 .... .......... A Upper extremity study .......................................... 0.31 4.11 3.64 NA NA 0.27 4.69 4.22 NA NA XXX
93931 .... TC .... A Upper extremity study .......................................... 0.00 4.02 3.54 NA NA 0.24 4.26 3.78 NA NA XXX
93931 .... 26 ..... A Upper extremity study .......................................... 0.31 0.09 0.10 0.09 0.10 0.03 0.43 0.44 0.43 0.44 XXX
PO 00000
Frm 00368
Fmt 4701
93975 .... .......... A Vascular study ...................................................... 1.80 8.23 7.78 NA NA 0.56 10.59 10.14 NA NA XXX
93975 .... TC .... A Vascular study ...................................................... 0.00 7.64 7.18 NA NA 0.43 8.07 7.61 NA NA XXX
93975 .... 26 ..... A Vascular study ...................................................... 1.80 0.59 0.60 0.59 0.60 0.13 2.52 2.53 2.52 2.53 XXX
Sfmt 4700
93980 .... .......... A Penile vascular study ........................................... 1.25 3.50 3.02 NA NA 0.42 5.17 4.69 NA NA XXX
E:\FR\FM\01DER2.SGM
93980 .... TC .... A Penile vascular study ........................................... 0.00 3.03 2.59 NA NA 0.34 3.37 2.93 NA NA XXX
93980 .... 26 ..... A Penile vascular study ........................................... 1.25 0.47 0.43 0.47 0.43 0.08 1.80 1.76 1.80 1.76 XXX
93981 .... .......... A Penile vascular study ........................................... 0.44 2.75 2.85 NA NA 0.33 3.52 3.62 NA NA XXX
93981 .... TC .... A Penile vascular study ........................................... 0.00 2.59 2.70 NA NA 0.31 2.90 3.01 NA NA XXX
01DER2
93981 .... 26 ..... A Penile vascular study ........................................... 0.44 0.16 0.15 0.16 0.15 0.02 0.62 0.61 0.62 0.61 XXX
93990 .... .......... A Doppler flow testing ............................................. 0.25 5.16 4.28 NA NA 0.26 5.67 4.79 NA NA XXX
93990 .... TC .... A Doppler flow testing ............................................. 0.00 5.10 4.20 NA NA 0.23 5.33 4.43 NA NA XXX
93990 .... 26 ..... A Doppler flow testing ............................................. 0.25 0.06 0.08 0.06 0.08 0.03 0.34 0.36 0.34 0.36 XXX
94002 .... .......... A Vent mgmt inpat, init day ..................................... 1.99 NA NA 0.39 0.34 0.09 NA NA 2.47 2.42 XXX
94003 .... .......... A Vent mgmt inpat, subq day .................................. 1.37 NA NA 0.33 0.33 0.06 NA NA 1.76 1.76 XXX
Year Year Year
2007 2007 Fully Im-
VerDate Aug<31>2005
RVUs cility Total
RVUs
94004 .... .......... A Vent mgmt nf per day .......................................... 1.00 NA NA 0.24 0.24 0.04 NA NA 1.28 1.28 XXX
94005 .... .......... B Home vent mgmt supervision .............................. 1.50 0.69 0.69 NA NA 0.06 2.25 2.25 NA NA XXX
94010 .... .......... A Breathing capacity test ......................................... 0.17 0.73 0.69 NA NA 0.03 0.93 0.89 NA NA XXX
10:50 Nov 30, 2006

94010 .... TC .... A Breathing capacity test ......................................... 0.00 0.69 0.64 NA NA 0.02 0.71 0.66 NA NA XXX
94010 .... 26 ..... A Breathing capacity test ......................................... 0.17 0.04 0.05 0.04 0.05 0.01 0.22 0.23 0.22 0.23 XXX
94014 .... .......... A Patient recorded spirometry ................................. 0.52 0.82 0.77 NA NA 0.03 1.37 1.32 NA NA XXX
94015 .... .......... A Patient recorded spirometry ................................. 0.00 0.68 0.61 NA NA 0.01 0.69 0.62 NA NA XXX
94016 .... .......... A Review patient spirometry .................................... 0.52 0.14 0.16 0.14 0.16 0.02 0.68 0.70 0.68 0.70 XXX
Jkt 211001
94060 .... .......... A Evaluation of wheezing ........................................ 0.31 1.31 1.13 1.31 1.13 0.07 1.69 1.51 1.69 1.51 XXX
94060 .... TC .... A Evaluation of wheezing ........................................ 0.00 1.23 1.04 1.23 1.04 0.06 1.29 1.10 1.29 1.10 XXX
94060 .... 26 ..... A Evaluation of wheezing ........................................ 0.31 0.08 0.09 0.08 0.09 0.01 0.40 0.41 0.40 0.41 XXX
94070 .... .......... A Evaluation of wheezing ........................................ 0.60 0.99 0.86 NA NA 0.13 1.72 1.59 NA NA XXX
PO 00000
94070 .... TC .... A Evaluation of wheezing ........................................ 0.00 0.84 0.69 NA NA 0.10 0.94 0.79 NA NA XXX
94070 .... 26 ..... A Evaluation of wheezing ........................................ 0.60 0.15 0.17 0.15 0.17 0.03 0.78 0.80 0.78 0.80 XXX
94150 .... .......... B Vital capacity test ................................................. 0.07 0.48 0.48 NA NA 0.02 0.57 0.57 NA NA XXX
94150 .... TC .... B Vital capacity test ................................................. 0.00 0.46 0.45 NA NA 0.01 0.47 0.46 NA NA XXX
Frm 00369
94150 .... 26 ..... B Vital capacity test ................................................. 0.07 0.02 0.03 0.02 0.03 0.01 0.10 0.11 0.10 0.11 XXX
94200 .... .......... A Lung function test (MBC/MVV) ............................ 0.11 0.48 0.45 NA NA 0.03 0.62 0.59 NA NA XXX
94200 .... TC .... A Lung function test (MBC/MVV) ............................ 0.00 0.45 0.42 NA NA 0.02 0.47 0.44 NA NA XXX
94200 .... 26 ..... A Lung function test (MBC/MVV) ............................ 0.11 0.03 0.03 0.03 0.03 0.01 0.15 0.15 0.15 0.15 XXX
Fmt 4701
94240 .... .......... A Residual lung capacity ......................................... 0.26 0.81 0.70 NA NA 0.06 1.13 1.02 NA NA XXX
94240 .... TC .... A Residual lung capacity ......................................... 0.00 0.75 0.62 NA NA 0.05 0.80 0.67 NA NA XXX
94240 .... 26 ..... A Residual lung capacity ......................................... 0.26 0.06 0.08 0.06 0.08 0.01 0.33 0.35 0.33 0.35 XXX
94250 .... .......... A Expired gas collection .......................................... 0.11 0.51 0.61 NA NA 0.02 0.64 0.74 NA NA XXX
Sfmt 4700
94250 .... TC .... A Expired gas collection .......................................... 0.00 0.48 0.58 NA NA 0.01 0.49 0.59 NA NA XXX
94250 .... 26 ..... A Expired gas collection .......................................... 0.11 0.03 0.03 0.03 0.03 0.01 0.15 0.15 0.15 0.15 XXX
94260 .... .......... A Thoracic gas volume ............................................ 0.13 0.76 0.63 NA NA 0.05 0.94 0.81 NA NA XXX
94260 .... TC .... A Thoracic gas volume ............................................ 0.00 0.73 0.59 NA NA 0.04 0.77 0.63 NA NA XXX
94260 .... 26 ..... A Thoracic gas volume ............................................ 0.13 0.03 0.04 0.03 0.04 0.01 0.17 0.18 0.17 0.18 XXX
94350 .... .......... A Lung nitrogen washout curve ............................... 0.26 0.62 0.73 NA NA 0.05 0.93 1.04 NA NA XXX
94350 .... TC .... A Lung nitrogen washout curve ............................... 0.00 0.55 0.65 NA NA 0.04 0.59 0.69 NA NA XXX
94350 .... 26 ..... A Lung nitrogen washout curve ............................... 0.26 0.07 0.08 0.07 0.08 0.01 0.34 0.35 0.34 0.35 XXX
94360 .... .......... A Measure airflow resistance .................................. 0.26 0.95 0.77 NA NA 0.07 1.28 1.10 NA NA XXX
E:\FR\FM\01DER2.SGM
94360 .... TC .... A Measure airflow resistance .................................. 0.00 0.89 0.69 NA NA 0.06 0.95 0.75 NA NA XXX
94360 .... 26 ..... A Measure airflow resistance .................................. 0.26 0.06 0.08 0.06 0.08 0.01 0.33 0.35 0.33 0.35 XXX
94370 .... .......... A Breath airway closing volume .............................. 0.26 0.59 0.69 NA NA 0.03 0.88 0.98 NA NA XXX
94370 .... TC .... A Breath airway closing volume .............................. 0.00 0.52 0.61 NA NA 0.02 0.54 0.63 NA NA XXX
01DER2
94370 .... 26 ..... A Breath airway closing volume .............................. 0.26 0.07 0.08 0.07 0.08 0.01 0.34 0.35 0.34 0.35 XXX
94375 .... .......... A Respiratory flow volume loop ............................... 0.31 0.72 0.63 NA NA 0.03 1.06 0.97 NA NA XXX
94375 .... TC .... A Respiratory flow volume loop ............................... 0.00 0.64 0.54 NA NA 0.02 0.66 0.56 NA NA XXX
94375 .... 26 ..... A Respiratory flow volume loop ............................... 0.31 0.08 0.09 0.08 0.09 0.01 0.40 0.41 0.40 0.41 XXX
94400 .... .......... A CO2 breathing response curve ............................ 0.40 1.02 0.89 NA NA 0.09 1.51 1.38 NA NA XXX
94400 .... TC .... A CO2 breathing response curve ............................ 0.00 0.92 0.77 NA NA 0.06 0.98 0.83 NA NA XXX
69991
Year
69992
Year Year
2007 2007 Fully Im-
VerDate Aug<31>2005
RVUs cility Total
RVUs
94400 .... 26 ..... A CO2 breathing response curve ............................ 0.40 0.10 0.12 0.10 0.12 0.03 0.53 0.55 0.53 0.55 XXX
94450 .... .......... A Hypoxia response curve ...................................... 0.40 1.03 0.89 NA NA 0.04 1.47 1.33 NA NA XXX
94450 .... TC .... A Hypoxia response curve ...................................... 0.00 0.94 0.78 NA NA 0.02 0.96 0.80 NA NA XXX
10:50 Nov 30, 2006

94450 .... 26 ..... A Hypoxia response curve ...................................... 0.40 0.09 0.11 0.09 0.11 0.02 0.51 0.53 0.51 0.53 XXX
94452 .... .......... A Hast w/report ........................................................ 0.31 1.13 1.05 NA NA 0.04 1.48 1.40 NA NA XXX
94452 .... TC .... A Hast w/report ........................................................ 0.00 1.05 0.96 NA NA 0.02 1.07 0.98 NA NA XXX
94452 .... 26 ..... A Hast w/report ........................................................ 0.31 0.08 0.09 0.08 0.09 0.02 0.41 0.42 0.41 0.42 XXX
94453 .... .......... A Hast w/oxygen titrate ........................................... 0.40 1.58 1.53 NA NA 0.04 2.02 1.97 NA NA XXX
Jkt 211001
94453 .... TC .... A Hast w/oxygen titrate ........................................... 0.00 1.48 1.41 NA NA 0.02 1.50 1.43 NA NA XXX
94453 .... 26 ..... A Hast w/oxygen titrate ........................................... 0.40 0.10 0.12 0.10 0.12 0.02 0.52 0.54 0.52 0.54 XXX
94610 .... .......... A Surfactant admin thru tube .................................. 1.16 0.35 0.35 0.35 0.35 0.26 1.77 1.77 1.77 1.77 XXX
94620 .... .......... A Pulmonary stress test/simple ............................... 0.64 0.79 2.06 NA NA 0.13 1.56 2.83 NA NA XXX
PO 00000
94620 .... TC .... A Pulmonary stress test/simple ............................... 0.00 0.62 1.87 NA NA 0.10 0.72 1.97 NA NA XXX
94620 .... 26 ..... A Pulmonary stress test/simple ............................... 0.64 0.17 0.19 0.17 0.19 0.03 0.84 0.86 0.84 0.86 XXX
94621 .... .......... A Pulm stress test/complex ..................................... 1.42 3.17 2.45 NA NA 0.16 4.75 4.03 NA NA XXX
94621 .... TC .... A Pulm stress test/complex ..................................... 0.00 2.71 2.00 NA NA 0.10 2.81 2.10 NA NA XXX
Frm 00370
94621 .... 26 ..... A Pulm stress test/complex ..................................... 1.42 0.46 0.45 0.46 0.45 0.06 1.94 1.93 1.94 1.93 XXX
94640 .... .......... A Airway inhalation treatment .................................. 0.00 0.36 0.32 NA NA 0.02 0.38 0.34 NA NA XXX
94642 .... .......... C Aerosol inhalation treatment ................................ 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 XXX
94644 .... .......... A Cbt, 1st hour ........................................................ 0.00 0.92 0.92 NA NA 0.02 0.94 0.94 NA NA XXX
Fmt 4701
94645 .... .......... A Cbt, each addl hour ............................................. 0.00 0.34 0.34 NA NA 0.02 0.36 0.36 NA NA XXX
94660 .... .......... A Pos airway pressure, CPAP ................................ 0.76 0.82 0.69 0.20 0.22 0.04 1.62 1.49 1.00 1.02 XXX
94662 .... .......... A Neg press ventilation, cnp ................................... 0.76 NA NA 0.19 0.22 0.03 NA NA 0.98 1.01 XXX
94664 .... .......... A Evaluate pt use of inhaler .................................... 0.00 0.40 0.33 NA NA 0.04 0.44 0.37 NA NA XXX
Sfmt 4700
94667 .... .......... A Chest wall manipulation ....................................... 0.00 0.54 0.53 NA NA 0.05 0.59 0.58 NA NA XXX
94668 .... .......... A Chest wall manipulation ....................................... 0.00 0.50 0.46 NA NA 0.02 0.52 0.48 NA NA XXX
94680 .... .......... A Exhaled air analysis, o2 ....................................... 0.26 1.10 1.67 1.10 1.67 0.07 1.43 2.00 1.43 2.00 XXX
94680 .... TC .... A Exhaled air analysis, o2 ....................................... 0.00 1.03 1.59 1.03 1.59 0.06 1.09 1.65 1.09 1.65 XXX
94680 .... 26 ..... A Exhaled air analysis, o2 ....................................... 0.26 0.07 0.08 0.07 0.08 0.01 0.34 0.35 0.34 0.35 XXX
94681 .... .......... A Exhaled air analysis, o2/co2 ................................ 0.20 1.06 2.16 NA NA 0.13 1.39 2.49 NA NA XXX
94681 .... TC .... A Exhaled air analysis, o2/co2 ................................ 0.00 1.01 2.10 NA NA 0.12 1.13 2.22 NA NA XXX
94681 .... 26 ..... A Exhaled air analysis, o2/co2 ................................ 0.20 0.05 0.06 0.05 0.06 0.01 0.26 0.27 0.26 0.27 XXX
94690 .... .......... A Exhaled air analysis ............................................. 0.07 1.04 1.75 NA NA 0.05 1.16 1.87 NA NA XXX
E:\FR\FM\01DER2.SGM
94690 .... TC .... A Exhaled air analysis ............................................. 0.00 1.02 1.73 NA NA 0.04 1.06 1.77 NA NA XXX
94690 .... 26 ..... A Exhaled air analysis ............................................. 0.07 0.02 0.02 0.02 0.02 0.01 0.10 0.10 0.10 0.10 XXX
94720 .... .......... A Monoxide diffusing capacity ................................. 0.26 1.15 1.04 NA NA 0.07 1.48 1.37 NA NA XXX
94720 .... TC .... A Monoxide diffusing capacity ................................. 0.00 1.09 0.96 NA NA 0.06 1.15 1.02 NA NA XXX
01DER2
94720 .... 26 ..... A Monoxide diffusing capacity ................................. 0.26 0.06 0.08 0.06 0.08 0.01 0.33 0.35 0.33 0.35 XXX
94725 .... .......... A Membrane diffusion capacity ............................... 0.26 0.96 2.43 NA NA 0.13 1.35 2.82 NA NA XXX
94725 .... TC .... A Membrane diffusion capacity ............................... 0.00 0.89 2.35 NA NA 0.12 1.01 2.47 NA NA XXX
94725 .... 26 ..... A Membrane diffusion capacity ............................... 0.26 0.07 0.08 0.07 0.08 0.01 0.34 0.35 0.34 0.35 XXX
94750 .... .......... A Pulmonary compliance study ............................... 0.23 1.69 1.43 NA NA 0.05 1.97 1.71 NA NA XXX
94750 .... TC .... A Pulmonary compliance study ............................... 0.00 1.63 1.36 NA NA 0.04 1.67 1.40 NA NA XXX
Year Year Year
2007 2007 Fully Im-
VerDate Aug<31>2005
RVUs cility Total
RVUs
94750 .... 26 ..... A Pulmonary compliance study ............................... 0.23 0.06 0.07 0.06 0.07 0.01 0.30 0.31 0.30 0.31 XXX
94760 .... .......... T Measure blood oxygen level ................................ 0.00 0.06 0.05 NA NA 0.02 0.08 0.07 NA NA XXX
94761 .... .......... T Measure blood oxygen level ................................ 0.00 0.11 0.08 NA NA 0.06 0.17 0.14 NA NA XXX
10:50 Nov 30, 2006

94762 .... .......... A Measure blood oxygen level ................................ 0.00 0.84 0.56 NA NA 0.10 0.94 0.66 NA NA XXX
94770 .... .......... A Exhaled carbon dioxide test ................................. 0.15 0.77 0.76 NA NA 0.08 1.00 0.99 NA NA XXX
94770 .... TC .... A Exhaled carbon dioxide test ................................. 0.00 0.74 0.72 NA NA 0.07 0.81 0.79 NA NA XXX
94770 .... 26 ..... A Exhaled carbon dioxide test ................................. 0.15 0.03 0.04 0.03 0.04 0.01 0.19 0.20 0.19 0.20 XXX
94772 .... .......... C Breath recording, infant ........................................ 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 XXX
Jkt 211001
94772 .... TC .... C Breath recording, infant ........................................ 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 XXX
94772 .... 26 ..... C Breath recording, infant ........................................ 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 XXX
94774 .... .......... C Ped home apnea rec, compl ................................ 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 YYY
94775 .... .......... C Ped home apnea rec, hk-up ................................ 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 YYY
PO 00000
94776 .... .......... C Ped home apnea rec, downld .............................. 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 YYY
94777 .... .......... C Ped home apnea rec, report ................................ 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 YYY
94799 .... .......... C Pulmonary service/procedure .............................. 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 XXX
94799 .... TC .... C Pulmonary service/procedure .............................. 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 XXX
Frm 00371
94799 .... 26 ..... C Pulmonary service/procedure .............................. 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 XXX
95004 .... .......... A Percut allergy skin tests ....................................... 0.00 0.16 0.12 NA NA 0.01 0.17 0.13 NA NA XXX
95010 .... .......... A Percut allergy titrate test ...................................... 0.15 0.29 0.31 0.04 0.06 0.01 0.45 0.47 0.20 0.22 XXX
95012 .... .......... A Exhaled nitric oxide meas .................................... 0.00 0.48 0.48 NA NA 0.01 0.49 0.49 NA NA XXX
Fmt 4701
95015 .... .......... A Id allergy titrate-drug/bug ..................................... 0.15 0.20 0.16 0.04 0.06 0.01 0.36 0.32 0.20 0.22 XXX
95024 .... .......... A Id allergy test, drug/bug ....................................... 0.00 0.21 0.17 NA NA 0.01 0.22 0.18 NA NA XXX
95027 .... .......... A Id allergy titrate-airborne ...................................... 0.00 0.24 0.17 NA NA 0.01 0.25 0.18 NA NA XXX
95028 .... .......... A Id allergy test-delayed type .................................. 0.00 0.29 0.25 NA NA 0.01 0.30 0.26 NA NA XXX
Sfmt 4700
95044 .... .......... A Allergy patch tests ................................................ 0.00 0.15 0.19 NA NA 0.01 0.16 0.20 NA NA XXX
95052 .... .......... A Photo patch test ................................................... 0.00 0.15 0.23 NA NA 0.01 0.16 0.24 NA NA XXX
95056 .... .......... A Photosensitivity tests ............................................ 0.00 1.21 0.43 NA NA 0.01 1.22 0.44 NA NA XXX
95060 .... .......... A Eye allergy tests ................................................... 0.00 NA NA 0.00 0.35 0.02 NA NA 0.02 0.37 XXX
95065 .... .......... A Nose allergy test .................................................. 0.00 NA NA 0.00 0.20 0.01 NA NA 0.01 0.21 XXX
95070 .... .......... A Bronchial allergy tests .......................................... 0.00 0.79 1.91 NA NA 0.02 0.81 1.93 NA NA XXX
95071 .... .......... A Bronchial allergy tests .......................................... 0.00 0.88 2.41 NA NA 0.02 0.90 2.43 NA NA XXX
95075 .... .......... A Ingestion challenge test ....................................... 0.95 0.67 0.78 0.26 0.35 0.03 1.65 1.76 1.24 1.33 XXX
95115 .... .......... A Immunotherapy, one injection .............................. 0.00 0.22 0.35 0.00 0.29 0.02 0.24 0.37 0.02 0.31 XXX
E:\FR\FM\01DER2.SGM
95117 .... .......... A Immunotherapy injections .................................... 0.00 0.27 0.44 0.00 0.38 0.02 0.29 0.46 0.02 0.40 XXX
95120 .... .......... I Immunotherapy, one injection .............................. 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 XXX
95125 .... .......... I Immunotherapy, many antigens ........................... 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 XXX
95130 .... .......... I Immunotherapy, insect venom ............................. 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 XXX
01DER2
95131 .... .......... I Immunotherapy, insect venoms ........................... 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 XXX
95144 .... .......... A Antigen therapy services ...................................... 0.06 0.26 0.21 0.02 0.02 0.01 0.33 0.28 0.09 0.09 XXX
69993
Year
69994
Year Year
2007 2007 Fully Im-
VerDate Aug<31>2005
RVUs cility Total
RVUs
10:50 Nov 30, 2006

95180 .... .......... A Rapid desensitization ........................................... 2.01 1.59 1.92 0.73 0.88 0.04 3.64 3.97 2.78 2.93 XXX
95199 .... .......... C Allergy immunology services ............................... 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 XXX
Jkt 211001
95250 .... .......... A Glucose monitoring, cont ..................................... 0.00 3.49 3.95 NA NA 0.01 3.50 3.96 NA NA XXX
95251 .... .......... A Gluc monitor, cont, phys i&r ................................ 0.85 0.27 0.21 0.27 0.21 0.02 1.14 1.08 1.14 1.08 XXX
95805 .... .......... A Multiple sleep latency test .................................... 1.88 6.99 14.70 NA NA 0.43 9.30 17.01 NA NA XXX
95805 .... TC .... A Multiple sleep latency test .................................... 0.00 6.50 14.08 NA NA 0.34 6.84 14.42 NA NA XXX
PO 00000
95805 .... 26 ..... A Multiple sleep latency test .................................... 1.88 0.49 0.62 0.49 0.62 0.09 2.46 2.59 2.46 2.59 XXX
95806 .... .......... A Sleep study, unattended ...................................... 1.66 3.84 3.46 NA NA 0.39 5.89 5.51 NA NA XXX
95806 .... TC .... A Sleep study, unattended ...................................... 0.00 3.36 2.93 NA NA 0.31 3.67 3.24 NA NA XXX
95806 .... 26 ..... A Sleep study, unattended ...................................... 1.66 0.48 0.53 0.48 0.53 0.08 2.22 2.27 2.22 2.27 XXX
Frm 00372
95807 .... .......... A Sleep study, attended .......................................... 1.66 11.72 11.82 NA NA 0.50 13.88 13.98 NA NA XXX
95807 .... TC .... A Sleep study, attended .......................................... 0.00 11.29 11.31 NA NA 0.42 11.71 11.73 NA NA XXX
95807 .... 26 ..... A Sleep study, attended .......................................... 1.66 0.43 0.51 0.43 0.51 0.08 2.17 2.25 2.17 2.25 XXX
95808 .... .......... A Polysomnography, 1–3 ........................................ 2.65 15.55 13.79 NA NA 0.55 18.75 16.99 NA NA XXX
Fmt 4701
95808 .... TC .... A Polysomnography, 1–3 ........................................ 0.00 14.85 12.92 NA NA 0.42 15.27 13.34 NA NA XXX
95808 .... 26 ..... A Polysomnography, 1–3 ........................................ 2.65 0.70 0.87 0.70 0.87 0.13 3.48 3.65 3.48 3.65 XXX
95810 .... .......... A Polysomnography, 4 or more ............................... 3.52 17.67 17.54 NA NA 0.59 21.78 21.65 NA NA XXX
95810 .... TC .... A Polysomnography, 4 or more ............................... 0.00 16.75 16.42 NA NA 0.42 17.17 16.84 NA NA XXX
Sfmt 4700
95810 .... 26 ..... A Polysomnography, 4 or more ............................... 3.52 0.92 1.12 0.92 1.12 0.17 4.61 4.81 4.61 4.81 XXX
95811 .... .......... A Polysomnography w/cpap .................................... 3.79 19.70 19.32 NA NA 0.61 24.10 23.72 NA NA XXX
95811 .... TC .... A Polysomnography w/cpap .................................... 0.00 18.72 18.12 NA NA 0.43 19.15 18.55 NA NA XXX
95811 .... 26 ..... A Polysomnography w/cpap .................................... 3.79 0.98 1.20 0.98 1.20 0.18 4.95 5.17 4.95 5.17 XXX
95812 .... .......... A Eeg, 41–60 minutes ............................................. 1.08 5.85 4.49 NA NA 0.17 7.10 5.74 NA NA XXX
95812 .... TC .... A Eeg, 41–60 minutes ............................................. 0.00 5.54 4.07 NA NA 0.11 5.65 4.18 NA NA XXX
95812 .... 26 ..... A Eeg, 41–60 minutes ............................................. 1.08 0.31 0.42 0.31 0.42 0.06 1.45 1.56 1.45 1.56 XXX
95813 .... .......... A Eeg, over 1 hour .................................................. 1.73 6.53 5.40 NA NA 0.20 8.46 7.33 NA NA XXX
95813 .... TC .... A Eeg, over 1 hour .................................................. 0.00 6.03 4.75 NA NA 0.11 6.14 4.86 NA NA XXX
E:\FR\FM\01DER2.SGM
95813 .... 26 ..... A Eeg, over 1 hour .................................................. 1.73 0.50 0.65 0.50 0.65 0.09 2.32 2.47 2.32 2.47 XXX
95816 .... .......... A Eeg, awake and drowsy ....................................... 1.08 5.26 4.10 NA NA 0.16 6.50 5.34 NA NA XXX
95816 .... TC .... A Eeg, awake and drowsy ....................................... 0.00 4.95 3.68 NA NA 0.10 5.05 3.78 NA NA XXX
95816 .... 26 ..... A Eeg, awake and drowsy ....................................... 1.08 0.31 0.42 0.31 0.42 0.06 1.45 1.56 1.45 1.56 XXX
01DER2
95819 .... .......... A Eeg, awake and asleep ....................................... 1.08 6.10 3.76 NA NA 0.16 7.34 5.00 NA NA XXX
95819 .... TC .... A Eeg, awake and asleep ....................................... 0.00 5.79 3.34 NA NA 0.10 5.89 3.44 NA NA XXX
95819 .... 26 ..... A Eeg, awake and asleep ....................................... 1.08 0.31 0.42 0.31 0.42 0.06 1.45 1.56 1.45 1.56 XXX
95822 .... .......... A Eeg, coma or sleep only ...................................... 1.08 5.49 4.82 NA NA 0.19 6.76 6.09 NA NA XXX
95822 .... TC .... A Eeg, coma or sleep only ...................................... 0.00 5.18 4.40 NA NA 0.13 5.31 4.53 NA NA XXX
95822 .... 26 ..... A Eeg, coma or sleep only ...................................... 1.08 0.31 0.42 0.31 0.42 0.06 1.45 1.56 1.45 1.56 XXX
Year Year Year
2007 2007 Fully Im-
VerDate Aug<31>2005
RVUs cility Total
RVUs
95824 .... .......... C Eeg, cerebral death only ...................................... 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 XXX
95824 .... TC .... C Eeg, cerebral death only ...................................... 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 XXX
95824 .... 26 ..... A Eeg, cerebral death only ...................................... 0.74 0.22 0.29 0.22 0.29 0.04 1.00 1.07 1.00 1.07 XXX
10:50 Nov 30, 2006

95827 .... .......... A Eeg, all night recording ........................................ 1.08 11.46 4.89 NA NA 0.19 12.73 6.16 NA NA XXX
95827 .... TC .... A Eeg, all night recording ........................................ 0.00 11.17 4.51 NA NA 0.14 11.31 4.65 NA NA XXX
95827 .... 26 ..... A Eeg, all night recording ........................................ 1.08 0.29 0.38 0.29 0.38 0.05 1.42 1.51 1.42 1.51 XXX
95829 .... .......... A Surgery electrocorticogram .................................. 6.20 25.25 29.56 NA NA 0.50 31.95 36.26 NA NA XXX
95829 .... TC .... A Surgery electrocorticogram .................................. 0.00 23.42 27.37 NA NA 0.02 23.44 27.39 NA NA XXX
Jkt 211001
95829 .... 26 ..... A Surgery electrocorticogram .................................. 6.20 1.83 2.19 1.83 2.19 0.48 8.51 8.87 8.51 8.87 XXX
95830 .... .......... A Insert electrodes for EEG .................................... 1.70 2.98 3.21 0.43 0.66 0.11 4.79 5.02 2.24 2.47 XXX
95831 .... .......... A Limb muscle testing, manual ............................... 0.28 0.38 0.44 0.09 0.12 0.01 0.67 0.73 0.38 0.41 XXX
95832 .... .......... A Hand muscle testing, manual .............................. 0.29 0.36 0.34 0.10 0.12 0.02 0.67 0.65 0.41 0.43 XXX
PO 00000
95833 .... .......... A Body muscle testing, manual ............................... 0.47 0.47 0.55 0.13 0.21 0.02 0.96 1.04 0.62 0.70 XXX
95834 .... .......... A Body muscle testing, manual ............................... 0.60 0.54 0.61 0.18 0.26 0.03 1.17 1.24 0.81 0.89 XXX
95851 .... .......... A Range of motion measurements .......................... 0.16 0.26 0.34 0.04 0.07 0.01 0.43 0.51 0.21 0.24 XXX
95852 .... .......... A Range of motion measurements .......................... 0.11 0.21 0.25 0.03 0.05 0.01 0.33 0.37 0.15 0.17 XXX
Frm 00373
95857 .... .......... A Tensilon test ......................................................... 0.53 0.59 0.60 0.17 0.22 0.02 1.14 1.15 0.72 0.77 XXX
95860 .... .......... A Muscle test, one limb ........................................... 0.96 1.15 1.36 NA NA 0.07 2.18 2.39 NA NA XXX
95860 .... TC .... A Muscle test, one limb ........................................... 0.00 0.83 0.96 NA NA 0.02 0.85 0.98 NA NA XXX
95860 .... 26 ..... A Muscle test, one limb ........................................... 0.96 0.32 0.40 0.32 0.40 0.05 1.33 1.41 1.33 1.41 XXX
Fmt 4701
95861 .... .......... A Muscle test, 2 limbs ............................................. 1.54 1.67 1.48 NA NA 0.13 3.34 3.15 NA NA XXX
95861 .... TC .... A Muscle test, 2 limbs ............................................. 0.00 1.15 0.84 NA NA 0.06 1.21 0.90 NA NA XXX
95861 .... 26 ..... A Muscle test, 2 limbs ............................................. 1.54 0.52 0.64 0.52 0.64 0.07 2.13 2.25 2.13 2.25 XXX
Sfmt 4700
95865 .... .......... A Muscle test, larynx ............................................... 1.57 1.35 1.43 NA NA 0.11 3.03 3.11 NA NA XXX
95865 .... TC .... A Muscle test, larynx ............................................... 0.00 0.88 0.73 NA NA 0.03 0.91 0.76 NA NA XXX
95865 .... 26 ..... A Muscle test, larynx ............................................... 1.57 0.47 0.70 0.47 0.70 0.08 2.12 2.35 2.12 2.35 XXX
95866 .... .......... A Muscle test, hemidiaphragm ................................ 1.25 1.33 0.90 NA NA 0.10 2.68 2.25 NA NA XXX
E:\FR\FM\01DER2.SGM
95866 .... TC .... A Muscle test, hemidiaphragm ................................ 0.00 0.93 0.38 NA NA 0.03 0.96 0.41 NA NA XXX
95866 .... 26 ..... A Muscle test, hemidiaphragm ................................ 1.25 0.40 0.52 0.40 0.52 0.07 1.72 1.84 1.72 1.84 XXX
95867 .... .......... A Muscle test cran nerv unilat ................................. 0.79 1.12 0.98 NA NA 0.07 1.98 1.84 NA NA XXX
95867 .... TC .... A Muscle test cran nerv unilat ................................. 0.00 0.88 0.66 NA NA 0.04 0.92 0.70 NA NA XXX
01DER2
95867 .... 26 ..... A Muscle test cran nerv unilat ................................. 0.79 0.24 0.32 0.24 0.32 0.03 1.06 1.14 1.06 1.14 XXX
95868 .... .......... A Muscle test cran nerve bilat ................................. 1.18 1.43 1.26 NA NA 0.10 2.71 2.54 NA NA XXX
95868 .... TC .... A Muscle test cran nerve bilat ................................. 0.00 1.07 0.79 NA NA 0.05 1.12 0.84 NA NA XXX
95868 .... 26 ..... A Muscle test cran nerve bilat ................................. 1.18 0.36 0.47 0.36 0.47 0.05 1.59 1.70 1.59 1.70 XXX
95869 .... .......... A Muscle test, thor paraspinal ................................. 0.37 1.02 0.53 NA NA 0.04 1.43 0.94 NA NA XXX
95869 .... TC .... A Muscle test, thor paraspinal ................................. 0.00 0.90 0.38 NA NA 0.02 0.92 0.40 NA NA XXX
69995
Year
69996
Year Year
2007 2007 Fully Im-
VerDate Aug<31>2005
RVUs cility Total
RVUs
95869 .... 26 ..... A Muscle test, thor paraspinal ................................. 0.37 0.12 0.15 0.12 0.15 0.02 0.51 0.54 0.51 0.54 XXX
95870 .... .......... A Muscle test, nonparaspinal .................................. 0.37 0.99 0.53 NA NA 0.04 1.40 0.94 NA NA XXX
95870 .... TC .... A Muscle test, nonparaspinal .................................. 0.00 0.87 0.38 NA NA 0.02 0.89 0.40 NA NA XXX
10:50 Nov 30, 2006

95870 .... 26 ..... A Muscle test, nonparaspinal .................................. 0.37 0.12 0.15 0.12 0.15 0.02 0.51 0.54 0.51 0.54 XXX
95872 .... .......... A Muscle test, one fiber ........................................... 2.88 1.72 1.35 NA NA 0.13 4.73 4.36 NA NA XXX
95872 .... TC .... A Muscle test, one fiber ........................................... 0.00 0.77 0.64 NA NA 0.05 0.82 0.69 NA NA XXX
95872 .... 26 ..... A Muscle test, one fiber ........................................... 2.88 0.95 0.71 0.95 0.71 0.08 3.91 3.67 3.91 3.67 XXX
95873 .... .......... A Guide nerv destr, elec stim .................................. 0.37 0.94 0.51 0.94 0.51 0.04 1.35 0.92 1.35 0.92 ZZZ
Jkt 211001
95873 .... TC .... A Guide nerv destr, elec stim .................................. 0.00 0.82 0.36 0.82 0.36 0.02 0.84 0.38 0.84 0.38 ZZZ
95873 .... 26 ..... A Guide nerv destr, elec stim .................................. 0.37 0.12 0.15 0.12 0.15 0.02 0.51 0.54 0.51 0.54 ZZZ
95874 .... .......... A Guide nerv destr, needle emg ............................. 0.37 0.95 0.52 0.95 0.52 0.04 1.36 0.93 1.36 0.93 ZZZ
95874 .... TC .... A Guide nerv destr, needle emg ............................. 0.00 0.83 0.36 0.83 0.36 0.02 0.85 0.38 0.85 0.38 ZZZ
PO 00000
95874 .... 26 ..... A Guide nerv destr, needle emg ............................. 0.37 0.12 0.16 0.12 0.16 0.02 0.51 0.55 0.51 0.55 ZZZ
95875 .... .......... A Limb exercise test ................................................ 1.10 1.31 1.41 NA NA 0.11 2.52 2.62 NA NA XXX
95875 .... TC .... A Limb exercise test ................................................ 0.00 0.99 0.98 NA NA 0.06 1.05 1.04 NA NA XXX
95875 .... 26 ..... A Limb exercise test ................................................ 1.10 0.32 0.43 0.32 0.43 0.05 1.47 1.58 1.47 1.58 XXX
Frm 00374
95900 .... .......... A Motor nerve conduction test ................................ 0.42 0.93 1.18 NA NA 0.04 1.39 1.64 NA NA XXX
95900 .... TC .... A Motor nerve conduction test ................................ 0.00 0.79 1.01 NA NA 0.02 0.81 1.03 NA NA XXX
95900 .... 26 ..... A Motor nerve conduction test ................................ 0.42 0.14 0.17 0.14 0.17 0.02 0.58 0.61 0.58 0.61 XXX
95903 .... .......... A Motor nerve conduction test ................................ 0.60 1.02 1.15 NA NA 0.05 1.67 1.80 NA NA XXX
Fmt 4701
95903 .... TC .... A Motor nerve conduction test ................................ 0.00 0.84 0.91 NA NA 0.02 0.86 0.93 NA NA XXX
95903 .... 26 ..... A Motor nerve conduction test ................................ 0.60 0.18 0.24 0.18 0.24 0.03 0.81 0.87 0.81 0.87 XXX
95904 .... .......... A Sense nerve conduction test ............................... 0.34 0.86 1.03 NA NA 0.04 1.24 1.41 NA NA XXX
95904 .... TC .... A Sense nerve conduction test ............................... 0.00 0.75 0.89 NA NA 0.02 0.77 0.91 NA NA XXX
Sfmt 4700
95904 .... 26 ..... A Sense nerve conduction test ............................... 0.34

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Friday,

42 CFR Parts 405, 410, et al.

1. ASP Issues Services

A. General CY 2007 BBA Balanced Budget Act of 1997 (Pub. L.

BILLING CODE 4120–01–C

care Claims ....... 75.2% 24.8% 24.8%

Direct PE per hour:

BILLING CODE 4120–01–C

TABLE 5.—PRACTICE EXPENSE SUPPLY ITEM ADDITIONS FOR CY 2007

TABLE 6.—PRACTICE EXPENSE EQUIPMENT ITEM ADDITIONS FOR CY 2007

Fort Worth, TX ......................................................................................................................................... 0.998 0.996 ¥0.17

Oklahoma ................................................................................................................................................. 0.913 0.893 ¥2.14

Montana ................................................................................................................................................... 0.928 0.902 ¥2.83

7XXX1 .............................................................................................................. $341.89 $256.42 $316.55 $256.42

OPPS cap. a revenue center. Given this outpatient imaging. Commenters

In the CY 2007 PFS proposed rule, we addressed are as follows: (http://questions.cms.hhs.gov/cgi-bin/

eliminated. reported ASP data, if applicable, to a civil money penalty as specified in

enrollment growth of 3 percent (1.03) CY 2005. and future years.

TABLE 10.—WAGE INDEX TRANSITION BLEND

2007 .................................................. 0.80* ................................................. None ................................................. 50 50

TABLE 11.—WAGE INDEX VALUES FOR URBAN LOCALES IN PUERTO RICO

10380 ................ Aguadilla-Isabela-San Sebastian ......................................................................................................................... 0.3922

TABLE 11.—WAGE INDEX VALUES FOR URBAN LOCALES IN PUERTO RICO—Continued

41900 ................ San German-Cabo Rojo ....................................................................................................................................... 0.4893

TABLE 13.—PROCTOSCOPY-ANOSCOPY FAMILY OF CODES

applying BN for this 5-Year Review of

BILLING CODE 4120–01–C

TABLE 17.—CARRIER PRICED CODES

CPT code * Mod Short descriptor Status indicator

TABLE 17.—CARRIER PRICED CODES—Continued

70555 ....... .................. FMRI BRAIN BY PHYS/PSYCH ...................................................................................................... Carrier Priced.

TABLE 17.—CARRIER PRICED CODES—Continued

76998 ....... .................. US GUIDE, INTRAOP ..................................................................................................................... Carrier Priced.

93618 ....... .................. HEART RHYTHM PACING ............................................................................................................. Carrier Priced.

TABLE 17.—CARRIER PRICED CODES—Continued

93641 ....... .................. ELECTROPHYSIOLOGY EVALUATION ......................................................................................... Carrier Priced.

TABLE 20.—INCREASE IN THE MEDICARE ECONOMIC INDEX UPDATE FOR CY 2007 1

Medicare Economic Index Total, productivity adjusted 3 ................................................................................................. N/A 2.1

4/1/96–3/31/97 .................................. $48.9 $48.9 $48.9 $48.9 N/A

1/1/01–12/31/01 ................................ 62.0 66.3 315.4 312.8 CY 2001=4.5%

1/1/07–12/31/07 ................................ 83.2 NA 776.5 NA CY 2007=1.8%

Target 06 − Actual06 Target 4/96 −12/06 − Actual4/96 −12/06

$81.7 − $94.9 $693.3 − $735.9

Fees .................................................................... 2.6 percent (1.026) .......................................... 2.2 percent (1.022).

Total ............................................................ 0.7 percent (1.007) .......................................... 1.80 percent (1.018).

TABLE 23.—2006 SGR CALCULATION

Fees .................................................................... 2.7 percent (1.027) .......................................... 2.2 percent (1.022).

Total ............................................................ 1.7 percent (1.017) .......................................... 2.1 percent (1.021).

Overall ............................................................... 40.136 million ................................................... 40.735 million

Overall .................................................................................................................................................. 39.601 million .......... 40.136 million.

$20.00 ..................................................................................................................................................... N/A 10/01/2001–12/31/2002.

21.86 ....................................................................................................................................................... 3.1 01/01/2005–12/31/2005.

BILLING CODE 4120–01–C

All Providers ..................................................................................................... 4,539 34.4 0.0 0.5

Hospital Based ......................................................................................... 581 3.7 0.4 1.0

BILLING CODE 4120–01–C R. Impact on Beneficiaries benefit (referred to as the Welcome to

alternatives that were considered. detection of AAAs as part of the IPPE

TABLE 40.—ACCOUNTING STATEMENT: CLASSIFICATION OF ESTIMATED CY 2007 EXPENDITURES ASSOCIATED WITH CY

Annualized Monetized Transfers .............................................................. Estimated decrease in expenditures of $3.7 billion.