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DEPARTMENT OF HEALTH AND HUMAN SERVICES Centers for ...

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CMS-1503-FC 104<br />

(8) Establishing Overall Direct PE Supply Price Inputs Based on Unit Prices and<br />

Quantities<br />

In the CY 2011 PFS proposed rule (75 FR 40057), we stated that we had<br />

identified minor errors in total price inputs <strong>for</strong> a number of supply items due to<br />

mathematical mistakes in multiplying the item unit price and the quantity used in<br />

particular CPT codes <strong>for</strong> the associated services. We proposed to modify the direct PE<br />

database to appropriately include the overall supply price input <strong>for</strong> a supply item as the<br />

product of the unit price and the quantity of the supply item used in the CPT code. Most<br />

of the overall supply price input changes were small, and we adjusted the proposed<br />

CY 2011 direct PE database accordingly. The CPT and Level II HCPCS codes and<br />

associated supplies <strong>for</strong> nonfacility and facility settings that were subject to these<br />

corrections are displayed in Tables 6 and 7, respectively.<br />

Table 6: Overall Supply Price Calculation Corrections <strong>for</strong> Nonfacility Settings<br />

CPT/<br />

HCPCS<br />

Code<br />

Short Descriptor<br />

CMS Supply<br />

Code with<br />

Overall Price<br />

Description of Supply<br />

11952 Therapy <strong>for</strong> contour defects<br />

Corrections<br />

SC029 needle, 18-27g<br />

11954 Therapy <strong>for</strong> contour defects SC029 needle, 18-27g<br />

15820 Revision of lower eyelid SA082 pack, ophthalmology visit (w-dilation)<br />

15821 Revision of lower eyelid SA082 pack, ophthalmology visit (w-dilation)<br />

15822 Revision of upper eyelid SA082 pack, ophthalmology visit (w-dilation)<br />

17311 Mohs, 1 stage, h/n/hf/g SG078 tape, surgical occlusive 1in (Blenderm)<br />

17312 Mohs addl stage SG078 tape, surgical occlusive 1in (Blenderm)<br />

17313 Mohs, 1 stage, t/a/l SG078 tape, surgical occlusive 1in (Blenderm)<br />

17314 Mohs, addl stage, t/a/l SG078 tape, surgical occlusive 1in (Blenderm)<br />

21011 Exc face les sc < 2 cm SH046 lidocaine 1% w-epi inj (Xylocaine w-epi)<br />

21013 Exc face tum deep < 2 cm SH046 lidocaine 1% w-epi inj (Xylocaine w-epi)<br />

21073 Mnpj of tmj w/anesth SG079 tape, surgical paper 1in (Micropore)<br />

21076 Prepare face/oral prosthesis SL047 dental stone powder<br />

21081 Prepare face/oral prosthesis SK024 film, dental<br />

21310 Treatment of nose fracture SB034 mask, surgical, with face shield<br />

23075 Exc shoulder les sc < 3 cm<br />

SG056<br />

SH021<br />

gauze, sterile 4in x 4in (10 pack uou)<br />

bupivacaine 0.25% inj (Marcaine)<br />

24075 Exc arm/elbow les sc < 3 cm<br />

SG056<br />

SH021<br />

gauze, sterile 4in x 4in (10 pack uou)<br />

bupivacaine 0.25% inj (Marcaine)<br />

25075 Exc <strong>for</strong>earm les sc < 3 cm SG056 gauze, sterile 4in x 4in (10 pack uou)

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