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CMS-1503-FC 1626 CPT 1 / HCPCS Mod Status Description Physi- cian Work RVUs 2 Fully Imple- mented Non- Facility PE RVUs 2 Year 2011 Transi- tional Non- Facility PE RVUs 2 Fully Imple- mented Facility PE RVUs 2 Year 2011 Transi- tional Facility PE RVUs 2 Mal- Practice RVUs 2 Global 27447 A Total knee arthroplasty 23.25 NA NA 18.45 17.56 4.56 090 27448 A Incision of thigh 11.60 NA NA 10.55 10.07 2.28 090 27450 A Incision of thigh 14.61 NA NA 12.81 12.28 2.89 090 27454 A Realignment of thigh bone 19.17 NA NA 16.08 15.00 3.78 090 27455 A Realignment of knee 13.36 NA NA 12.18 11.59 2.62 090 27457 A Realignment of knee 14.03 NA NA 12.05 11.51 2.76 090 27465 A Shortening of thigh bone 18.60 NA NA 15.39 14.25 3.68 090 27466 A Lengthening of thigh bone 17.28 NA NA 14.53 13.93 3.41 090 27468 A Shorten/lengthen thighs 19.97 NA NA 16.44 15.46 3.92 090 27470 A Repair of thigh 17.14 NA NA 14.81 14.11 3.38 090 27472 A Repair/graft of thigh 18.72 NA NA 15.52 14.85 3.69 090 27475 A Surgery to stop leg growth 8.93 NA NA 6.34 7.21 1.77 090 27477 A Surgery to stop leg growth 10.14 NA NA 9.72 9.24 1.98 090 27479 A Surgery to stop leg growth 13.16 NA NA 11.78 11.24 0.92 090 27485 A Surgery to stop leg growth 9.13 NA NA 9.04 8.63 1.81 090 27486 A Revise/replace knee joint 21.12 NA NA 17.04 16.23 4.14 090 27487 A Revise/replace knee joint 27.11 NA NA 20.59 19.64 5.32 090 27488 A Removal of knee prosthesis 17.60 NA NA 14.97 14.22 3.46 090 27495 A Rein<strong>for</strong>ce thigh 16.54 NA NA 14.02 13.39 3.25 090 27496 A Decompression of thigh/knee 6.78 NA NA 7.96 7.15 1.33 090 27497 A Decompression of thigh/knee 7.79 NA NA 7.98 7.12 1.53 090 27498 A Decompression of thigh/knee 8.66 NA NA 9.09 7.87 1.68 090 27499 A Decompression of thigh/knee 9.43 NA NA 9.55 8.52 1.86 090 27500 A Treatment of thigh fracture 6.30 7.76 7.36 6.70 6.30 1.22 090 27501 A Treatment of thigh fracture 6.45 7.21 6.87 7.09 6.70 1.26 090 27502 A Treatment of thigh fracture 11.36 NA NA 9.69 9.31 2.19 090 27503 A Treatment of thigh fracture 11.27 NA NA 10.53 9.99 2.20 090 27506 A Treatment of thigh fracture 19.65 NA NA 16.66 15.78 3.86 090
CMS-1503-FC 1627 CPT 1 / HCPCS Mod Status Description Physi- cian Work RVUs 2 Fully Imple- mented Non- Facility PE RVUs 2 Year 2011 Transi- tional Non- Facility PE RVUs 2 Fully Imple- mented Facility PE RVUs 2 Year 2011 Transi- tional Facility PE RVUs 2 Mal- Practice RVUs 2 Global 27507 A Treatment of thigh fracture 14.48 NA NA 11.90 11.39 2.85 090 27508 A Treatment of thigh fracture 6.20 8.02 7.65 7.17 6.80 1.20 090 27509 A Treatment of thigh fracture 8.14 NA NA 9.41 9.03 1.59 090 27510 A Treatment of thigh fracture 9.80 NA NA 8.84 8.54 1.87 090 27511 A Treatment of thigh fracture 15.11 NA NA 11.95 11.62 2.97 090 27513 A Treatment of thigh fracture 19.25 NA NA 14.41 14.08 3.79 090 27514 A Treatment of thigh fracture 14.60 NA NA 11.63 11.68 2.87 090 27516 A Treat thigh fx growth plate 5.59 8.22 7.71 7.35 6.87 1.10 090 27517 A Treat thigh fx growth plate 9.12 NA NA 9.47 8.98 1.79 090 27519 A Treat thigh fx growth plate 13.25 NA NA 10.91 10.81 2.61 090 27520 A Treat kneecap fracture 3.04 5.73 5.46 4.96 4.64 0.58 090 27524 A Treat kneecap fracture 10.37 NA NA 10.04 9.59 2.02 090 27530 A Treat knee fracture 4.09 6.75 6.43 6.00 5.66 0.77 090 27532 A Treat knee fracture 7.55 9.20 8.75 8.16 7.74 1.48 090 27535 A Treat knee fracture 13.41 NA NA 10.93 10.61 2.62 090 27536 A Treat knee fracture 17.39 NA NA 14.94 14.16 3.42 090 27538 A Treat knee fracture(s) 5.09 7.77 7.39 6.94 6.55 0.99 090 27540 A Treat knee fracture 11.30 NA NA 10.76 10.40 2.21 090 27550 A Treat knee dislocation 5.98 7.47 7.13 6.48 6.14 1.10 090 27552 A Treat knee dislocation 8.18 NA NA 8.83 8.37 1.60 090 27556 A Treat knee dislocation 13.00 NA NA 10.76 10.67 2.57 090 27557 A Treat knee dislocation 15.90 NA NA 12.50 12.36 3.14 090 27558 A Treat knee dislocation 18.39 NA NA 13.99 13.61 3.61 090 27560 A Treat kneecap dislocation 3.99 6.36 5.97 5.64 5.12 0.76 090 27562 A Treat kneecap dislocation 5.98 NA NA 7.13 6.55 1.18 090 27566 A Treat kneecap dislocation 12.71 NA NA 11.40 10.90 2.50 090 27570 A Fixation of knee joint 1.79 NA NA 2.31 2.19 0.34 010 27580 A Fusion of knee 21.10 NA NA 17.90 17.11 4.14 090
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DEPARTMENT OF HEALTH AND HUMAN SERV
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CMS-1503-FC 3 Centers for Medicare
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CMS-1503-FC 5 Elizabeth Truong, (41
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CMS-1503-FC 7 (1) The interim final
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CMS-1503-FC 9 Inputs (7) Equipment
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CMS-1503-FC 11 6. Medicare Economic
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CMS-1503-FC 13 6. Neuropsychologica
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CMS-1503-FC 15 (3) Equipment Time f
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CMS-1503-FC 17 2. Section 5501(b):
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CMS-1503-FC 19 Products (2) Final R
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CMS-1503-FC 21 a. Legislative and R
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CMS-1503-FC 23 17. Section 4103: Me
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CMS-1503-FC 25 ACC American College
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CMS-1503-FC 27 CBP Competitive Bidd
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CMS-1503-FC 29 E/M Evaluation and m
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CMS-1503-FC 31 HITECH Health Inform
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CMS-1503-FC 33 MIEA-TRHCA Medicare
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CMS-1503-FC 35 PACE Program of All-
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CMS-1503-FC 37 RVRBS Resource-Based
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CMS-1503-FC 39 rule with comment pe
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CMS-1503-FC 41 This resource-based
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CMS-1503-FC 43 premium data collect
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CMS-1503-FC 45 CY 2011 PFS proposed
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CMS-1503-FC 47 appropriately reflec
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CMS-1503-FC 49 appropriate payment
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CMS-1503-FC 51 highest level initia
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CMS-1503-FC 53 PFS update of -21.2
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CMS-1503-FC 55 final rule with comm
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CMS-1503-FC 57 period (74 FR 61743
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CMS-1503-FC 59 Practice Expense Inf
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CMS-1503-FC 61 the PPIS data. In th
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CMS-1503-FC 63 implemented PFS amou
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CMS-1503-FC 65 the service to deter
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CMS-1503-FC 67 f. Alternative Data
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CMS-1503-FC 69 used in the allocati
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CMS-1503-FC 71 develop further idea
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CMS-1503-FC 73 Step 8: Calculate th
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CMS-1503-FC 75 physician time for t
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CMS-1503-FC 77 specialties, from th
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CMS-1503-FC 79 minutes per year = m
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CMS-1503-FC 81 Step Source Formula
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CMS-1503-FC 83 expensive diagnostic
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CMS-1503-FC 85 assumption will be a
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CMS-1503-FC 87 3135(a) of the ACA),
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CMS-1503-FC 89 rate assumption appl
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CMS-1503-FC 91 CPT Code Short Descr
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CMS-1503-FC 93 supply item as a dir
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CMS-1503-FC 95 appear in the direct
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CMS-1503-FC 97 inputs for CPT code
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CMS-1503-FC 99 93786. After conside
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CMS-1503-FC 101 (four venoms) and 9
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CPT Code CMS-1503-FC 103 CMS Equipm
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CMS-1503-FC 105 CPT/ HCPCS Code Sho
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CMS-1503-FC 111 database. The comme
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CMS-1503-FC 113 of cardiac structur
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CMS-1503-FC 115 flawed. Response: A
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CMS-1503-FC 117 51729 were assigned
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CMS-1503-FC 119 inputs, we noted th
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CMS-1503-FC 121 requests on an ad h
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CMS-1503-FC 123 We solicited public
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CMS-1503-FC 125 high volumes in phy
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CMS-1503-FC 127 ongoing basis throu
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CMS-1503-FC 129 payment to cover th
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CMS-1503-FC 131 B. Malpractice Rela
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CMS-1503-FC 133 where they would be
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CMS-1503-FC 135 CY 2011 New/ CY 201
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CMS-1503-FC 137 CY 2011 New/ CY 201
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CMS-1503-FC 139 CY 2011 New/ CY 201
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CMS-1503-FC 141 RVUs. Services ment
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CMS-1503-FC 143 C. Potentially Misv
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CMS-1503-FC 145 equipment) for indi
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CMS-1503-FC 147 Section 1848(c)(2)(
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CMS-1503-FC 149 methodology (73 FR
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CMS-1503-FC 151 more. Over the past
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CMS-1503-FC 153 misvalued codes as
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CMS-1503-FC 155 including the use o
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CMS-1503-FC 157 overvaluation of pr
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CMS-1503-FC 159 requiring an initia
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CMS-1503-FC 161 payment for practit
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CMS-1503-FC 163 CPT Code Short Desc
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CMS-1503-FC 165 standard" to which
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CMS-1503-FC 167 than or equal to 0.
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CMS-1503-FC 169 Comment: A number o
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CMS-1503-FC 171 In the CYs 2009 and
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Pre- Service Time CMS-1503-FC 173 i
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CMS-1503-FC 175 The methodology dis
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CMS-1503-FC 177 inappropriate input
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CMS-1503-FC 179 RUC were not consis
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CMS-1503-FC 181 consumption of offi
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CMS-1503-FC 183 AMA RUC for CY 2012
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CMS-1503-FC 185 billed as an outpat
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CMS-1503-FC 187 inpatient or outpat
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CMS-1503-FC 189 MPPR policy, with t
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CMS-1503-FC 191 expanding the exist
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CMS-1503-FC 193 under the PFS) for
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CMS-1503-FC 195 MPPR policy in CY 2
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CMS-1503-FC 197 appropriately valui
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CMS-1503-FC 199 ultrasound. Another
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CMS-1503-FC 201 furnished with more
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CMS-1503-FC 203 acknowledge that th
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CMS-1503-FC 205 under the PFS. We b
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CMS-1503-FC 207 TABLE 17: CPT Code
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CMS-1503-FC 209 "always therapy" se
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CMS-1503-FC 211 Based on CY 2009 PF
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CMS-1503-FC 213 TABLE 19: Examples
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CMS-1503-FC 215 and position patien
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CMS-1503-FC 217 TABLE 20: Sample Pa
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CMS-1503-FC 219 respectively, notab
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CMS-1503-FC 221 Response: We apprec
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CMS-1503-FC 223 were systematically
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CMS-1503-FC 225 CY 2011 if there we
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CMS-1503-FC 227 However, we believe
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CMS-1503-FC 229 of therapy services
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CMS-1503-FC 231 and speech-language
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CMS-1503-FC 233 because SLP service
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CMS-1503-FC 235 Response: Through t
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CMS-1503-FC 237 commenters on the C
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CMS-1503-FC 239 service by the same
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CMS-1503-FC 241 under the PFS. Most
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CMS-1503-FC 243 prices for the 65 s
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CMS-1503-FC 245 because company pol
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CMS-1503-FC 247 CMS Supply Code Sup
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CMS-1503-FC 249 CMS Supply Code Sup
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CMS-1503-FC 251 on the GSA schedule
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CMS-1503-FC 253 that the periodicit
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CMS-1503-FC 255 is reasonable to us
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CMS-1503-FC 257 solely because larg
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CMS-1503-FC 259 more appropriately
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CMS-1503-FC 261 included the direct
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CMS-1503-FC 263 Prior to implementi
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CMS-1503-FC 265 individual high-cos
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CMS-1503-FC 267 D. Geographic Pract
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CMS-1503-FC 269 complete an analysi
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CMS-1503-FC 271 PE GPCI calculated
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CMS-1503-FC 273 ACA) requires that
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CMS-1503-FC 275 We proposed to assi
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CMS-1503-FC 277 CY 2011 PFS propose
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CMS-1503-FC 279 physicians' service
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CMS-1503-FC 281 that items such as
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CMS-1503-FC 283 GPCIs at least ever
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CMS-1503-FC 285 changes to the work
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CMS-1503-FC 287 Comment: Many comme
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CMS-1503-FC 289 files that are not
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CMS-1503-FC 293 the results on the
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CMS-1503-FC 295 In light of the com
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CMS-1503-FC 297 Medicare PFS. Comme
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CMS-1503-FC 299 than 48.3 percent (
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CMS-1503-FC 301 various studies reg
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CMS-1503-FC 303 this section. Confi
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CMS-1503-FC 305 summarizing or resp
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CMS-1503-FC 307 that the cost weigh
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CMS-1503-FC 309 both non-physician
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CMS-1503-FC 311 (7) Consumer Price
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CMS-1503-FC 313 We proposed to use
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CMS-1503-FC 315 categories, as well
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CMS-1503-FC 317 well as photocopier
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CMS-1503-FC 319 The proposed weight
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CMS-1503-FC 321 captured in the que
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CMS-1503-FC 323 judgments about rel
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CMS-1503-FC 325 TABLE 30: CMS Compo
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CMS-1503-FC 327 (11) Fixed Capital
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CMS-1503-FC 329 purchase, as well a
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CMS-1503-FC 331 was within 0.3 perc
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CMS-1503-FC 333 2006 Cost Categorie
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CMS-1503-FC 335 should move forward
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CMS-1503-FC 337 that the estimates
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CMS-1503-FC 339 • The Chemicals a
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CMS-1503-FC 341 Expense categories,
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CMS-1503-FC 343 Comment: One commen
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CMS-1503-FC 345 technology. Respons
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CMS-1503-FC 347 the MEI only increa
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CMS-1503-FC 349 by CMS. Suggested m
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CMS-1503-FC 351 price (ASP) and, si
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CMS-1503-FC 353 CY 1999 and CY 2004
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CMS-1503-FC 355 heavily weighted to
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CMS-1503-FC 357 adjustment to the w
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CMS-1503-FC 359 F. Allowed Expendit
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CMS-1503-FC 361 "physicians' servic
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CMS-1503-FC 363 ● Physician work
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CMS-1503-FC 365 TABLE 37: CY 2009 S
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CMS-1503-FC 367 We estimate that th
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CMS-1503-FC 369 This factor was cal
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CMS-1503-FC 371 (3) Factor 3--Estim
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CMS-1503-FC 373 the SGR of 1.6 perc
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CMS-1503-FC 375 + Computing the dif
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CMS-1503-FC 377 Consistent with sec
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CMS-1503-FC 379 specified that the
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CMS-1503-FC 381 period, we are resc
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CMS-1503-FC 383 acts to extend it.
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CMS-1503-FC 385 expected effects of
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CMS-1503-FC 387 the feasibility of
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CMS-1503-FC 389 (75 FR 40097 throug
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CMS-1503-FC 391 information about p
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CMS-1503-FC 393 dedicated professio
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CMS-1503-FC 395 are not medically r
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CMS-1503-FC 397 documentation in th
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CMS-1503-FC 399 similarly for effic
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CMS-1503-FC 401 feasibility of usin
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CMS-1503-FC 403 being furnished are
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CMS-1503-FC 405 commenters agreed t
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CMS-1503-FC 407 To that end, some c
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CMS-1503-FC 409 the efficiencies th
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CMS-1503-FC 411 valuation of therap
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CMS-1503-FC 413 commenters recommen
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CMS-1503-FC 415 intervention are in
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CMS-1503-FC 417 However, there are
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CMS-1503-FC 419 be important in mak
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CMS-1503-FC 421 B. Diabetes Self-Ma
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CMS-1503-FC 423 • That HCPCS G010
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CMS-1503-FC 425 HCPCS codes for KDE
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CMS-1503-FC 427 http://www.cms.gov/
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CMS-1503-FC 429 not show up for the
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CMS-1503-FC 431 requests, we refer
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CMS-1503-FC 433 process. After cons
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CMS-1503-FC 435 (End-stage renal di
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CMS-1503-FC 437 recommendations as
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CMS-1503-FC 439 code would clearly
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CMS-1503-FC 441 CY 2011 proposal to
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CMS-1503-FC 443 duration of acute e
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CMS-1503-FC 445 separate HCPCS code
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CMS-1503-FC 447 arms, legs; each ad
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CMS-1503-FC 449 sq cm or less) and
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CMS-1503-FC 451 application of skin
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CMS-1503-FC 453 fair and balanced t
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CMS-1503-FC 455 definitions would a
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CMS-1503-FC 457 application would b
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CMS-1503-FC 459 HCPCS code G0440 is
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CMS-1503-FC 461 and 15341 to HCPCS
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CMS-1503-FC 463 our crosswalk propo
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CMS-1503-FC 465 file. H. Intranasal
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CMS-1503-FC 467 Response: We would
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CMS-1503-FC 469 our CY 2011 proposa
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CMS-1503-FC 471 clarification. Spec
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CMS-1503-FC 473 the resources neede
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CMS-1503-FC 475 In the CY 2011 PFS
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CMS-1503-FC 477 Independent Diagnos
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CMS-1503-FC 479 for cardiac and oth
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CMS-1503-FC 481 data applied to all
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CMS-1503-FC 483 submission of $21,5
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CMS-1503-FC 485 as transparent and
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CMS-1503-FC 487 consultations, offi
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CMS-1503-FC 489 ● Offices of a ph
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CMS-1503-FC 491 Section 1834(m)(2)(
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CMS-1503-FC 493 Requestors should s
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CMS-1503-FC 495 diagnosis, medical
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CMS-1503-FC 497 rulemaking, we had
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CMS-1503-FC 499 furnished to the el
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CMS-1503-FC 501 individual as indiv
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CMS-1503-FC 503 services, and that
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CMS-1503-FC 505 commenters' shared
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CMS-1503-FC 507 psychiatric hospita
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CMS-1503-FC 509 telehealth consulta
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CMS-1503-FC 511 comprehensive, coor
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CMS-1503-FC 513 services. One comme
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CMS-1503-FC 515 proposed rule (74 F
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CMS-1503-FC 517 discussion of subse
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CMS-1503-FC 519 commenter agreed wi
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CMS-1503-FC 521 not believe that th
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CMS-1503-FC 523 any proposals regar
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CMS-1503-FC 525 ● Individual and
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CMS-1503-FC 527 V. Addressing Inter
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CMS-1503-FC 529 misvalued codes and
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CMS-1503-FC 531 experience which in
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CMS-1503-FC 533 2. CY 2010 Interim
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CMS-1503-FC 535 c. Myocardial Perfu
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CMS-1503-FC 537 included in the myo
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CMS-1503-FC 539 noted that when thi
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CMS-1503-FC 541 RVUs we established
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CMS-1503-FC 543 endorsed CMS' decis
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CMS-1503-FC 545 public notice and t
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CMS-1503-FC 547 Comment: Several co
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CMS-1503-FC 551 have replaced petro
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CMS-1503-FC 553 (or nerves innervat
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CMS-1503-FC 555 service since the o
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CMS-1503-FC 557 displayed in Table
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CMS-1503-FC 559 physical effort, an
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CMS-1503-FC 561 recommending the me
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CMS-1503-FC 563 recommended that th
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CMS-1503-FC 565 basis for CY 2011.
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CMS-1503-FC 567 perform this servic
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CMS-1503-FC 569 which is a value be
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CMS-1503-FC 571 and complex than CP
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CMS-1503-FC 573 with comment period
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CMS-1503-FC 575 generator and repla
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CMS-1503-FC 577 of 18 minutes. The
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CMS-1503-FC 579 for CPT code 90461
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CMS-1503-FC 581 Therefore we are as
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CMS-1503-FC 583 patient), and recom
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CPT Code 37220 37221 37222 37223 37
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CMS-1503-FC 587 The AMA RUC used a
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CMS-1503-FC 589 we are requesting t
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CMS-1503-FC 591 When the AMA RUC re
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CMS-1503-FC 593 and add new codes t
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CMS-1503-FC 595 work RVUs that are
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CMS-1503-FC 597 the CMS decision in
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CMS-1503-FC 599 52332. Therefore, w
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CMS-1503-FC 601 21.47 work RVUs to
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CMS-1503-FC 603 misvalued codes in
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CMS-1503-FC 605 maintain the curren
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CMS-1503-FC 607 code 99213, a more
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CMS-1503-FC 617 Many of the refinem
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CMS-1503-FC 619 For add-on codes, o
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CMS-1503-FC 621 equipment items in
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CMS-1503-FC 623 reflect the actual
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CMS-1503-FC 631 CPT Code 11042 1104
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CMS-1503-FC 635 CPT Code 37227 Shor
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CMS-1503-FC 645 CPT Code 93453 9345
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CMS-1503-FC 651 CPT Code 93464 9356
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CMS-1503-FC 653 CPT Code 95956 9644
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CMS-1503-FC 655 VI. Provisions of t
Page 657 and 658:
CMS-1503-FC 657 care (74 FR 61846).
Page 659 and 660:
CMS-1503-FC 659 January 1, 2012, an
Page 661 and 662:
Page 663 and 664:
CMS-1503-FC 663 methods of reportin
Page 665 and 666:
CMS-1503-FC 665 particular, noted t
Page 667 and 668:
CMS-1503-FC 667 geographic adjustme
Page 669 and 670:
CMS-1503-FC 669 risk adjusted and s
Page 671 and 672:
CMS-1503-FC 671 influence. Others e
Page 673 and 674:
CMS-1503-FC 673 In determining diff
Page 675 and 676:
CMS-1503-FC 675 discontinue our use
Page 677 and 678:
CMS-1503-FC 677 Some commenters men
Page 679 and 680:
CMS-1503-FC 679 In addition, we rec
Page 681 and 682:
CMS-1503-FC 681 Medicare Prescripti
Page 683 and 684:
CMS-1503-FC 683 Section 136 of the
Page 685 and 686:
CMS-1503-FC 685 2. Amendment to Sec
Page 687 and 688:
CMS-1503-FC 687 to continue to oper
Page 689 and 690:
CMS-1503-FC 689 Interactive Psychot
Page 691 and 692:
CMS-1503-FC 691 H. Section 3108: Pe
Page 693 and 694:
CMS-1503-FC 693 that any changes to
Page 695 and 696:
CMS-1503-FC 695 Third, in order to
Page 697 and 698:
CMS-1503-FC 697 payment is made) to
Page 699 and 700:
CMS-1503-FC 699 K. Section 3122: Ex
Page 701 and 702:
CMS-1503-FC 701 equipment to a 75 p
Page 703 and 704:
CMS-1503-FC 703 forth in section 18
Page 705 and 706:
CMS-1503-FC 705 beneficiary, not th
Page 707 and 708:
CMS-1503-FC 707 Section 3136(a)(2)
Page 709 and 710:
CMS-1503-FC 709 standard power whee
Page 711 and 712:
CMS-1503-FC 711 power wheelchairs,
Page 713 and 714:
CMS-1503-FC 713 commenter requested
Page 715 and 716:
CMS-1503-FC 715 O. Section 3139: Pa
Page 717 and 718:
CMS-1503-FC 717 In summary, we are
Page 719 and 720:
CMS-1503-FC 719 proposed to be used
Page 721 and 722:
CMS-1503-FC 721 other health care p
Page 723 and 724:
CMS-1503-FC 723 To create a forecas
Page 725 and 726:
CMS-1503-FC 725 if the update facto
Page 727 and 728:
CMS-1503-FC 727 the annual update t
Page 729 and 730:
CMS-1503-FC 729 percentage increase
Page 731 and 732:
CMS-1503-FC 731 less than zero, the
Page 733 and 734:
CMS-1503-FC 733 purposes, we have m
Page 735 and 736:
CMS-1503-FC 735 proposed rule d. DM
Page 737 and 738:
CMS-1503-FC 737 sections 3401(m), (
Page 739 and 740:
CMS-1503-FC 739 or update of a list
Page 741 and 742:
CMS-1503-FC 741 Further, the ACA al
Page 743 and 744:
CMS-1503-FC 743 direct observation
Page 745 and 746:
CMS-1503-FC 745 ++ Ability to succe
Page 747 and 748:
CMS-1503-FC 747 term "health profes
Page 749 and 750:
CMS-1503-FC 749 include language on
Page 751 and 752:
CMS-1503-FC 751 vitamins. ++ Use or
Page 753 and 754:
CMS-1503-FC 753 beneficiary shall b
Page 755 and 756:
CMS-1503-FC 755 appropriate, to hea
Page 757 and 758:
CMS-1503-FC 757 However, other comm
Page 759 and 760:
CMS-1503-FC 759 recommendation at t
Page 761 and 762:
CMS-1503-FC 761 ++ The list of risk
Page 763 and 764:
CMS-1503-FC 763 or through an HRA,
Page 765 and 766:
CMS-1503-FC 765 therefore, we are i
Page 767 and 768:
CMS-1503-FC 767 satisfaction and re
Page 769 and 770:
Page 771 and 772:
CMS-1503-FC 771 in Opening a Nation
Page 773 and 774:
CMS-1503-FC 773 In summary, as a re
Page 775 and 776:
CMS-1503-FC 775 GXXXA or GXXXB, pro
Page 777 and 778:
CMS-1503-FC 777 AMA RUCs process to
Page 779 and 780:
CMS-1503-FC 779 as discussed in sec
Page 781 and 782:
CMS-1503-FC 781 visit for an establ
Page 783 and 784:
CMS-1503-FC 783 the CPT codes. We c
Page 785 and 786:
CMS-1503-FC 785 CY 2011 proposal to
Page 787 and 788:
CMS-1503-FC 787 beneficiaries when
Page 789 and 790:
CMS-1503-FC 789 ● The specific se
Page 791 and 792:
Page 793 and 794:
CMS-1503-FC 793 is an "additional p
Page 795 and 796:
CMS-1503-FC 795 considered "additio
Page 797 and 798:
Page 799 and 800:
CMS-1503-FC 799 Wellness Visits Pro
Page 801 and 802:
CMS-1503-FC 801 for clinical labora
Page 803 and 804:
CMS-1503-FC 803 and fecal occult bl
Page 805 and 806:
CMS-1503-FC 805 In §410.152, we pr
Page 807 and 808:
CMS-1503-FC 807 Response: Glaucoma
Page 809 and 810:
CMS-1503-FC 809 Medicare Part A or
Page 811 and 812:
CMS-1503-FC 811 publication of the
Page 813 and 814:
CMS-1503-FC 813 Medicare will conti
Page 815 and 816:
CMS-1503-FC 815 report, the CMS-222
Page 817 and 818:
CMS-1503-FC 817 with the provisions
Page 819 and 820:
CMS-1503-FC 819 Preventive Service
Page 821 and 822:
Page 823 and 824:
Page 825 and 826:
Page 827 and 828:
Page 829 and 830:
CMS-1503-FC 829 3. Extension of Wai
Page 831 and 832:
CMS-1503-FC 831 circumstances under
Page 833 and 834:
CMS-1503-FC 833 E/M visits; ● 992
Page 835 and 836:
CMS-1503-FC 835 practitioner, 89-ce
Page 837 and 838:
CMS-1503-FC 837 Medicare, arguing t
Page 839 and 840:
CMS-1503-FC 839 would limit the num
Page 841 and 842:
CMS-1503-FC 841 for the PCIP, regar
Page 843 and 844:
CMS-1503-FC 843 denominator for pur
Page 845 and 846:
CMS-1503-FC 845 CPT Code Descriptio
Page 847 and 848:
CMS-1503-FC 847 was limited to prim
Page 849 and 850:
CMS-1503-FC 849 optional method. Th
Page 851 and 852:
CMS-1503-FC 851 flexibility in dete
Page 853 and 854:
CMS-1503-FC 853 determining eligibi
Page 855 and 856:
CMS-1503-FC 855 applicable (eligibi
Page 857 and 858:
CMS-1503-FC 857 monitor changes in
Page 859 and 860:
CMS-1503-FC 859 or not the service
Page 861 and 862:
CMS-1503-FC 861 We note that Medica
Page 863 and 864:
CMS-1503-FC 863 2. Section 5501(b):
Page 865 and 866:
CMS-1503-FC 865 professional servic
Page 867 and 868:
CMS-1503-FC 867 "HPSA surgical ince
Page 869 and 870:
CMS-1503-FC 869 in surgical special
Page 871 and 872:
CMS-1503-FC 871 in areas that are d
Page 873 and 874:
CMS-1503-FC 873 1834(g)(2)(B) of th
Page 875 and 876:
CMS-1503-FC 875 (DHS) payable by Me
Page 877 and 878:
CMS-1503-FC 877 patient's signature
Page 879 and 880:
CMS-1503-FC 879 purposes of the phy
Page 881 and 882:
CMS-1503-FC 881 procedure or immedi
Page 883 and 884:
Page 885 and 886:
CMS-1503-FC 885 are finalizing our
Page 887 and 888:
CMS-1503-FC 887 notice include supp
Page 889 and 890:
CMS-1503-FC 889 referral be include
Page 891 and 892:
CMS-1503-FC 891 services for which
Page 893 and 894:
CMS-1503-FC 893 patient's main medi
Page 895 and 896:
CMS-1503-FC 895 minimum time limit
Page 897 and 898:
CMS-1503-FC 897 retroactive claims
Page 899 and 900:
CMS-1503-FC 899 State Medicaid Agen
Page 901 and 902:
CMS-1503-FC 901 from the date the p
Page 903 and 904:
CMS-1503-FC 903 intention to provid
Page 905 and 906:
CMS-1503-FC 905 an extension of tim
Page 907 and 908:
CMS-1503-FC 907 entitled to Medicar
Page 909 and 910:
CMS-1503-FC 909 because we did not
Page 911 and 912:
CMS-1503-FC 911 trigger when the ex
Page 913 and 914:
CMS-1503-FC 913 delays caused by th
Page 915 and 916:
CMS-1503-FC 915 benefits exhaust cl
Page 917 and 918:
CMS-1503-FC 917 year after the date
Page 919 and 920:
CMS-1503-FC 919 therefore will not
Page 921 and 922:
CMS-1503-FC 921 correction will tri
Page 923 and 924:
CMS-1503-FC 923 2. Subdividing Larg
Page 925 and 926:
CMS-1503-FC 925 We found that count
Page 927 and 928:
CMS-1503-FC 927 these islands or wh
Page 929 and 930:
CMS-1503-FC 929 commenter provide a
Page 931 and 932:
CMS-1503-FC 931 CBA Name County TAB
Page 933 and 934:
CMS-1503-FC 933 items must currentl
Page 935 and 936:
CMS-1503-FC 935 PAOC that removing
Page 937 and 938:
CMS-1503-FC 937 DMEPOS Allowed Amou
Page 939 and 940:
CMS-1503-FC 939 21 Additional MSAs
Page 941 and 942:
CMS-1503-FC 941 additional reportin
Page 943 and 944:
CMS-1503-FC 943 nation, in order to
Page 945 and 946:
CMS-1503-FC 945 VII. Other Provisio
Page 947 and 948:
CMS-1503-FC 947 Although problems w
Page 949 and 950:
Previous Quarter Reported NDCs CMS-
Page 951 and 952:
CMS-1503-FC 951 be done to obtain a
Page 953 and 954:
CMS-1503-FC 953 Comment: A commente
Page 955 and 956:
CMS-1503-FC 955 reported, then a ma
Page 957 and 958:
CMS-1503-FC 957 monitor manufacture
Page 959 and 960:
CMS-1503-FC 959 Although this secti
Page 961 and 962:
CMS-1503-FC 961 the Act and is also
Page 963 and 964:
CMS-1503-FC 963 amount for each HCP
Page 965 and 966:
CMS-1503-FC 965 Product" indicates
Page 967 and 968:
CMS-1503-FC 967 acquisition costs b
Page 969 and 970:
CMS-1503-FC 969 prohibited. They st
Page 971 and 972:
CMS-1503-FC 971 Response: For the r
Page 973 and 974:
CMS-1503-FC 973 calculations be car
Page 975 and 976:
CMS-1503-FC 975 supplier or any oth
Page 977 and 978:
CMS-1503-FC 977 Response: We descri
Page 979 and 980:
CMS-1503-FC 979 For CY 2011, we pro
Page 981 and 982:
CMS-1503-FC 981 specify the timing
Page 983 and 984:
CMS-1503-FC 983 Association of Chai
Page 985 and 986:
CMS-1503-FC 985 After careful revie
Page 987 and 988:
CMS-1503-FC 987 B. Ambulance Fee Sc
Page 989 and 990:
CMS-1503-FC 989 Claims Processing M
Page 991 and 992:
CMS-1503-FC 991 mile or less than o
Page 993 and 994:
CMS-1503-FC 993 Second, we consider
Page 995 and 996:
CMS-1503-FC 995 system should be co
Page 997 and 998:
CMS-1503-FC 997 instructions set fo
Page 999 and 1000:
CMS-1503-FC 999 For the reasons dis
Page 1001 and 1002:
CMS-1503-FC 1001 requiring that the
Page 1003 and 1004:
CMS-1503-FC 1003 we monitored. (See
Page 1005 and 1006:
CMS-1503-FC 1005 not change the amb
Page 1007 and 1008:
CMS-1503-FC 1007 rates for ambulanc
Page 1009 and 1010:
CMS-1503-FC 1009 overburdened and u
Page 1011 and 1012:
CMS-1503-FC 1011 fractional mileage
Page 1013 and 1014:
CMS-1503-FC 1013 trip computer, or
Page 1015 and 1016:
CMS-1503-FC 1015 then implementatio
Page 1017 and 1018:
CMS-1503-FC 1017 cannot comply with
Page 1019 and 1020:
CMS-1503-FC 1019 billing policy is
Page 1021 and 1022:
CMS-1503-FC 1021 be required to rep
Page 1023 and 1024:
CMS-1503-FC 1023 requisition. While
Page 1025 and 1026:
CMS-1503-FC 1025 documenting that t
Page 1027 and 1028:
CMS-1503-FC 1027 are two different
Page 1029 and 1030:
CMS-1503-FC 1029 services. One of t
Page 1031 and 1032:
CMS-1503-FC 1031 laboratory test pa
Page 1033 and 1034:
CMS-1503-FC 1033 shipping addresses
Page 1035 and 1036:
CMS-1503-FC 1035 physician. The com
Page 1037 and 1038:
CMS-1503-FC 1037 of analyses used t
Page 1039 and 1040:
CMS-1503-FC 1039 section 651 of MMA
Page 1041 and 1042:
CMS-1503-FC 1041 continue to update
Page 1043 and 1044:
CMS-1503-FC 1043 2. Estimating Per
Page 1045 and 1046:
CMS-1503-FC 1045 Comment: One comme
Page 1047 and 1048:
CMS-1503-FC 1047 access to dialysis
Page 1049 and 1050:
CMS-1503-FC 1049 Also, in the CY 20
Page 1051 and 1052:
CMS-1503-FC 1051 Using treatment co
Page 1053 and 1054:
CMS-1503-FC 1053 F. Issues Related
Page 1055 and 1056:
CMS-1503-FC 1055 "Physician Quality
Page 1057 and 1058:
CMS-1503-FC 1057 educational videos
Page 1059 and 1060:
CMS-1503-FC 1059 Response: As we no
Page 1061 and 1062:
CMS-1503-FC 1061 practice. Commente
Page 1063 and 1064:
CMS-1503-FC 1063 reported, and is c
Page 1065 and 1066:
CMS-1503-FC 1065 Quality Reporting
Page 1067 and 1068:
CMS-1503-FC 1067 2015, where it is
Page 1069 and 1070:
CMS-1503-FC 1069 Response: We appre
Page 1071 and 1072:
CMS-1503-FC 1071 reporting with res
Page 1073 and 1074:
CMS-1503-FC 1073 numerator and deno
Page 1075 and 1076:
CMS-1503-FC 1075 will include both
Page 1077 and 1078:
CMS-1503-FC 1077 The following is a
Page 1079 and 1080:
CMS-1503-FC 1079 period (that is, J
Page 1081 and 1082:
CMS-1503-FC 1081 in-person registry
Page 1083 and 1084:
CMS-1503-FC 1083 ● Obtain and kee
Page 1085 and 1086:
CMS-1503-FC 1085 and performance ra
Page 1087 and 1088:
CMS-1503-FC 1087 calculate the meas
Page 1089 and 1090:
Page 1091 and 1092:
CMS-1503-FC 1091 2011 will need to
Page 1093 and 1094:
CMS-1503-FC 1093 ● Be able to inc
Page 1095 and 1096:
CMS-1503-FC 1095 that self-nominate
Page 1097 and 1098:
CMS-1503-FC 1097 For the 2011 Physi
Page 1099 and 1100:
CMS-1503-FC 1099 required to report
Page 1101 and 1102:
CMS-1503-FC 1101 reporting threshol
Page 1103 and 1104:
CMS-1503-FC 1103 Reporting System q
Page 1105 and 1106:
CMS-1503-FC 1105 measures group app
Page 1107 and 1108:
CMS-1503-FC 1107 Based on the comme
Page 1109 and 1110:
CMS-1503-FC 1109 g. Reporting Optio
Page 1111 and 1112:
CMS-1503-FC 1111 reporting option i
Page 1113 and 1114:
CMS-1503-FC 1113 Response: We agree
Page 1115 and 1116:
Page 1117 and 1118:
CMS-1503-FC 1117 criteria for satis
Page 1119 and 1120:
CMS-1503-FC 1119 identical to the r
Page 1121 and 1122:
CMS-1503-FC 1121 such a short time
Page 1123 and 1124:
CMS-1503-FC 1123 • Agree to atten
Page 1125 and 1126:
CMS-1503-FC 1125 those Medicare Par
Page 1127 and 1128:
CMS-1503-FC 1127 nominating before
Page 1129 and 1130:
CMS-1503-FC 1129 Program, we propos
Page 1131 and 1132:
Page 1133 and 1134:
CMS-1503-FC 1133 groups can select
Page 1135 and 1136:
CMS-1503-FC 1135 VII.F.2.(i).(5). o
Page 1137 and 1138:
CMS-1503-FC 1137 opportunity to pro
Page 1139 and 1140:
CMS-1503-FC 1139 ++ Section 1848(k)
Page 1141 and 1142:
CMS-1503-FC 1141 programs to which
Page 1143 and 1144:
Page 1145 and 1146:
CMS-1503-FC 1145 depend on the deve
Page 1147 and 1148:
Page 1149 and 1150:
CMS-1503-FC 1149 151, 154, 155, 173
Page 1151 and 1152:
CMS-1503-FC 1151 groups should be a
Page 1153 and 1154:
CMS-1503-FC 1153 well. One commente
Page 1155 and 1156:
CMS-1503-FC 1155 Response: We will
Page 1157 and 1158:
CMS-1503-FC 1157 Although they were
Page 1159 and 1160:
CMS-1503-FC 1159 Physician Quality
Page 1161 and 1162:
Page 1163 and 1164:
Page 1165 and 1166:
CMS-1503-FC 1165 Please note that d
Page 1167 and 1168:
CMS-1503-FC 1167 applicable measure
Page 1169 and 1170:
Page 1171 and 1172:
CMS-1503-FC 1171 implementation, an
Page 1173 and 1174:
CMS-1503-FC 1173 Comment: Several c
Page 1175 and 1176:
CMS-1503-FC 1175 The titles of the
Page 1177 and 1178:
CMS-1503-FC 1177 • Measure #2: Di
Page 1179 and 1180:
CMS-1503-FC 1179 Comment: Because t
Page 1181 and 1182:
Page 1183 and 1184:
CMS-1503-FC 1183 Comment: We receiv
Page 1185 and 1186:
CMS-1503-FC 1185 would not be appro
Page 1187 and 1188:
CMS-1503-FC 1187 TABLE 85: Measures
Page 1189 and 1190:
CMS-1503-FC 1189 TABLE 89: Measures
Page 1191 and 1192:
CMS-1503-FC 1191 * This measures gr
Page 1193 and 1194:
CMS-1503-FC 1193 part of the PGP an
Page 1195 and 1196:
Page 1197 and 1198:
CMS-1503-FC 1197 on the Physician C
Page 1199 and 1200:
CMS-1503-FC 1199 report 2011 Physic
Page 1201 and 1202:
CMS-1503-FC 1201 • Ensure that th
Page 1203 and 1204:
CMS-1503-FC 1203 Comment: Some comm
Page 1205 and 1206:
CMS-1503-FC 1205 requirements throu
Page 1207 and 1208:
CMS-1503-FC 1207 not satisfactorily
Page 1209 and 1210:
CMS-1503-FC 1209 practice assessmen
Page 1211 and 1212:
CMS-1503-FC 1211 ("Additional Incen
Page 1213 and 1214:
CMS-1503-FC 1213 is required to qua
Page 1215 and 1216:
CMS-1503-FC 1215 experience with ca
Page 1217 and 1218:
CMS-1503-FC 1217 the year the eligi
Page 1219 and 1220:
CMS-1503-FC 1219 Response: While we
Page 1221 and 1222:
CMS-1503-FC 1221 System]." Therefor
Page 1223 and 1224:
CMS-1503-FC 1223 quality improvemen
Page 1225 and 1226:
CMS-1503-FC 1225 participation, the
Page 1227 and 1228:
CMS-1503-FC 1227 However, with resp
Page 1229 and 1230:
CMS-1503-FC 1229 comments of ensuri
Page 1231 and 1232:
Page 1233 and 1234:
CMS-1503-FC 1233 physicians exclude
Page 1235 and 1236:
Page 1237 and 1238:
CMS-1503-FC 1237 we believe interim
Page 1239 and 1240:
CMS-1503-FC 1239 improves successfu
Page 1241 and 1242:
CMS-1503-FC 1241 before July 1, 201
Page 1243 and 1244:
CMS-1503-FC 1243 professionals repo
Page 1245 and 1246:
CMS-1503-FC 1245 • Given that thi
Page 1247 and 1248:
CMS-1503-FC 1247 review process whe
Page 1249 and 1250:
CMS-1503-FC 1249 section 1848(m)(5)
Page 1251 and 1252:
CMS-1503-FC 1251 practice) earns an
Page 1253 and 1254:
CMS-1503-FC 1253 which eligible pro
Page 1255 and 1256:
CMS-1503-FC 1255 feedback reports w
Page 1257 and 1258:
CMS-1503-FC 1257 Under section 1848
Page 1259 and 1260:
CMS-1503-FC 1259 end of the 2012 pa
Page 1261 and 1262:
CMS-1503-FC 1261 Eligible professio
Page 1263 and 1264:
CMS-1503-FC 1263 Although we are fi
Page 1265 and 1266:
CMS-1503-FC 1265 patient visit. The
Page 1267 and 1268:
CMS-1503-FC 1267 Part B covered pro
Page 1269 and 1270:
CMS-1503-FC 1269 (a) Generate a com
Page 1271 and 1272:
CMS-1503-FC 1271 Inquiry and Respon
Page 1273 and 1274:
CMS-1503-FC 1273 We intend to post
Page 1275 and 1276:
CMS-1503-FC 1275 Comment: Several c
Page 1277 and 1278:
CMS-1503-FC 1277 claims data). If t
Page 1279 and 1280:
CMS-1503-FC 1279 incentive payment
Page 1281 and 1282:
CMS-1503-FC 1281 EHR Reporting"), t
Page 1283 and 1284:
CMS-1503-FC 1283 option for large g
Page 1285 and 1286:
CMS-1503-FC 1285 required to indica
Page 1287 and 1288:
CMS-1503-FC 1287 our proposal to re
Page 1289 and 1290:
CMS-1503-FC 1289 1848(a)(5) (A)(i)
Page 1291 and 1292:
Page 1293 and 1294:
CMS-1503-FC 1293 for the year. Unde
Page 1295 and 1296:
CMS-1503-FC 1295 electronic prescri
Page 1297 and 1298:
CMS-1503-FC 1297 if the successful
Page 1299 and 1300:
CMS-1503-FC 1299 disadvantage eligi
Page 1301 and 1302:
CMS-1503-FC 1301 they have successf
Page 1303 and 1304:
CMS-1503-FC 1303 Comment: While our
Page 1305 and 1306:
CMS-1503-FC 1305 • Eligible profe
Page 1307 and 1308:
CMS-1503-FC 1307 2012 to better ref
Page 1309 and 1310:
CMS-1503-FC 1309 electronic prescri
Page 1311 and 1312:
CMS-1503-FC 1311 G. DMEPOS Provisio
Page 1313 and 1314:
CMS-1503-FC 1313 The fee schedule m
Page 1315 and 1316:
CMS-1503-FC 1315 and services" in s
Page 1317 and 1318:
CMS-1503-FC 1317 revise the nationa
Page 1319 and 1320:
CMS-1503-FC 1319 proposed to define
Page 1321 and 1322:
CMS-1503-FC 1321 solicited public c
Page 1323 and 1324:
Page 1325 and 1326:
CMS-1503-FC 1325 (2) Definition of
Page 1327 and 1328:
CMS-1503-FC 1327 not result in the
Page 1329 and 1330:
CMS-1503-FC 1329 beneficiary’s ho
Page 1331 and 1332:
CMS-1503-FC 1331 replacement diabet
Page 1333 and 1334:
CMS-1503-FC 1333 For purposes of im
Page 1335 and 1336:
CMS-1503-FC 1335 Response: We disag
Page 1337 and 1338:
CMS-1503-FC 1337 manufacturer, mode
Page 1339 and 1340:
CMS-1503-FC 1339 may continue to as
Page 1341 and 1342:
Page 1343 and 1344:
CMS-1503-FC 1343 practitioner to hi
Page 1345 and 1346:
CMS-1503-FC 1345 include OTS orthot
Page 1347 and 1348:
CMS-1503-FC 1347 data. Therefore, t
Page 1349 and 1350:
CMS-1503-FC 1349 reduce the number
Page 1351 and 1352:
CMS-1503-FC 1351 with supporting in
Page 1353 and 1354:
CMS-1503-FC 1353 supplier’s contr
Page 1355 and 1356:
CMS-1503-FC 1355 We proposed the fo
Page 1357 and 1358:
CMS-1503-FC 1357 not involved with
Page 1359 and 1360:
CMS-1503-FC 1359 Issues to be resol
Page 1361 and 1362:
CMS-1503-FC 1361 The HO would make
Page 1363 and 1364:
CMS-1503-FC 1363 within 5 days of r
Page 1365 and 1366:
CMS-1503-FC 1365 terminate contract
Page 1367 and 1368:
CMS-1503-FC 1367 §414.226(c)(1)(ii
Page 1369 and 1370:
CMS-1503-FC 1369 b. Furnishing Oxyg
Page 1371 and 1372:
CMS-1503-FC 1371 For this reason, w
Page 1373 and 1374:
CMS-1503-FC 1373 payment period in
Page 1375 and 1376:
CMS-1503-FC 1375 H. Provider and Su
Page 1377 and 1378:
CMS-1503-FC 1377 Medicare program."
Page 1379 and 1380:
CMS-1503-FC 1379 certification revo
Page 1381 and 1382:
CMS-1503-FC 1381 specified in 14 CF
Page 1383 and 1384:
CMS-1503-FC 1383 J. Physician Self-
Page 1385 and 1386:
CMS-1503-FC 1385 c. Revisions Effec
Page 1387 and 1388:
CMS-1503-FC 1387 at 411.355(g), we
Page 1389 and 1390:
CMS-1503-FC 1389 RADIATION THERAPY
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CMS-1503-FC 1391 recognized timely
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CMS-1503-FC 1393 1861(ddd)(1), as a
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CMS-1503-FC 1395 §410.32(a)(2)) wh
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CMS-1503-FC 1411 Quality Reporting
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CMS-1503-FC 1413 Section VII.F.2 of
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CMS-1503-FC 1421 XI. Regulatory Imp
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CMS-1503-FC 1431 proportion of tota
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CMS-1503-FC 1433 We note that in se
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CMS-1503-FC 1435 TABLE 102: Impact
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CMS-1503-FC 1437 CPT/ HCPCS Code MO
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CMS-1503-FC 1439 Section 1848(e)(1)
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CMS-1503-FC 1441 3. Section 3102: E
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CMS-1503-FC 1443 7. Section 3107: E
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CMS-1503-FC 1447 ESRD market basket
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CMS-1503-FC 1453 services. Effectiv
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CMS-1503-FC 1465 approximately 79 h
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CMS-1503-FC 1483 List of Subjects 4
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CMS-1503-FC 1487 6. Section 409.20
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CMS-1503-FC 1489 Eligible beneficia
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CMS-1503-FC 1491 (viii) Furnishing
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CMS-1503-FC 1493 (vi) Furnishing of
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CMS-1503-FC 1495 as follows: * * *
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CMS-1503-FC 1935 ADDENDUM D: FINAL
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CMS-1503-FC 1937 2010 Contractor Lo
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CMS-1503-FC 1945 ADDENDUM G: CPT/HC
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CMS-1503-FC 1983 77799 Radium/radio
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CMS-1503-FC 2023 Composite Rate ESR
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