DEPARTMENT OF HEALTH AND HUMAN SERVICES Centers for ...

CMS-1503-FC 241
under the PFS.
Most of the current prices for high-cost supplies included in the direct PE
database are from 2004 or earlier. There are currently 62 unique supplies with prices of
$150 or more in the proposed CY 2011 PE database, which is available on the CMS Web
site under the supporting data files for the CY 2011 PFS proposed rule at
http://www.cms.gov/PhysicianFeeSched/. Finally, we note that we do not actually pay
the supply prices included in the PE database but, instead, use them to develop the PE
RVUs according to our standard PE methodology as described in section II.A.2. of this
final rule with comment period. Payment for a procedure that uses a supply is based
upon the PE RVUs that result from the PE methodology, and supplies are among the
direct PE inputs for procedures. Therefore, it is the relativity of high-cost supply prices
to prices for other PE items (equipment, low-cost supplies, and clinical labor) that is
important.
Accordingly, in the CY 2009 PFS proposed rule (73 FR 38582), we proposed a
process to update the prices for high-cost supplies priced at $150 or more that are
included in the PE inputs for procedures paid under the PFS PE methodology. The
CY 2009 proposed rule described a publicly transparent process in which CMS would
publish a list of the high-cost supplies in the PFS proposed rule (65 supplies were
included in the CY 2009 PFS proposed rule), and specialty societies or other relevant
organizations would provide acceptable documentation supporting the pricing for the
supplies during the 60-day public comment period. Furthermore, in that same proposed
rule (73 FR 38582), we provided guidance on what constitutes valid, reliable
documentation that reflects the typical price of the high-cost item in the marketplace. We