[Federal Register: March 1, 2002 (Volume 67, Number 41)]
[Rules and Regulations]
[Page 9555-9579]
From the Federal Register Online via GPO Access [wais.access.gpo.gov]
[DOCID:fr01mr02-17]
[[Page 9555]]
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Part V
Department of Health and Human Services
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Centers for Medicare & Medicaid Services
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42 CFR Parts 413, 419, and 489
Medicare Program; Correction of Certain Calendar Year 2002 Payment
Rates Under the Hospital Outpatient Prospective Payment System and the
Pro Rata Reduction on Transitional Pass-Through Payments; Correction of
Technical and Typographical Errors; Final Rule
[[Page 9556]]
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DEPARTMENT OF HEALTH AND HUMAN SERVICES
Centers for Medicare & Medicaid Services
42 CFR Parts 413, 419, and 489
[CMS-1159-F4]
RIN 0938-AK54
Medicare Program; Correction of Certain Calendar Year 2002
Payment Rates Under the Hospital Outpatient Prospective Payment System
and the Pro Rata Reduction on Transitional Pass-Through Payments;
Correction of Technical and Typographical Errors
AGENCY: Centers for Medicare & Medicaid Services (CMS), HHS.
ACTION: Final rule.
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SUMMARY: This final rule corrects inadvertent technical errors that
affect the amounts and factors used to determine the payment rates for
services paid under the Medicare hospital outpatient prospective
payment system as published in the November 30, 2001 final rule
entitled ``Changes to the Hospital Outpatient Prospective Payment
System for Calendar Year 2002.'' In addition, this final rule corrects
the amount of the uniform reduction to be applied to transitional pass-
through payments for CY 2002. This final rule also corrects other
technical and typographical errors that appeared in the November 30,
2001 final rule.
EFFECTIVE DATE: This final rule is effective on April 1, 2002. The
effective date for Sec. 419.32(b)(1)(iii), revised at 66 FR 59856,
published on November 30, 2001 and Sec. 419.62(d), added at 66 FR
55865, published on November 2, 2001, is April 1, 2002.
FOR FURTHER INFORMATION CONTACT: Robert Braver, (410) 786-0378.
SUPPLEMENTARY INFORMATION:
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I. Background
On November 30, 2001, we published a final rule announcing the
final ambulatory payment classification (APC) groups, relative weights,
and payment rates under the hospital outpatient prospective payment
system (OPPS) for calendar year (CY) 2002 (66 FR 59856). As discussed
in detail in that final rule, in setting the APC relative weights, we
incorporated 75 percent of the estimated transitional pass-through
costs for devices eligible for transitional pass-through payments in CY
2002 into the costs of the APC groups associated with the use of the
devices (66 FR 59906).
After publication of the November 30, 2001 final rule, we
discovered that the final rule reflected several inadvertent technical
errors in which we incorrectly associated specific devices approved for
transitional pass-through payments with particular procedures. The
magnitude of these errors was significant enough to affect not only the
estimate of total transitional pass-through payments and the uniform
reduction percentage to be applied to transitional pass-through
payments in 2002, but also the payment rates for all procedure-related
APCs. (Procedure-related APCs are those other than the APCs for pass-
through drugs and devices, new technology, and partial
hospitalization.) Using rates that reflected these errors would have
inappropriately affected payments to hospitals. Thus, we determined
that it would be inappropriate to allow the payment rates published on
November 30, 2001 to become effective without further changes. In order
to ensure that there were no other errors that might also have
significant implications for OPPS payments, we decided to undertake an
intensive review of the relevant data files. Because of the time needed
for this review, we were unable to complete it and recalculate the
rates before the previously published effective date of January 1, 2002
announced in the November 30, 2001 final rule. We therefore decided to
continue to pay for services covered under the OPPS after January 1,
2002 and until no later than April 1, 2002 under the rates in effect on
December 31, 2001. In addition, we decided to make transitional pass-
through payments during that period without applying the uniform
reduction announced on November 30, 2001.
Therefore, on December 31, 2001, we published a final rule,
entitled ``Prospective Payment System for Hospital Outpatient Services;
Delay in Effective Date of Calendar Year 2002 Payment Rates and the Pro
Rata Reduction on Transitional Pass-Through Payments' (66 FR 67494),
that announced we would indefinitely delay the effective date for
Secs. 419.32(b)(1)(iii) and 419.62(d) of the regulations. We also
announced that we were delaying until no later than April 1, 2002, the
effective date of the updated OPPS payment rates and the uniform
reduction of transitional pass-through payments that we published in
the preamble and addenda of the November 30, 2001 final rule.
We did not delay the following provisions of the November 30, 2001
final rule:
Medicare, Medicaid, and SCHIP Benefits Improvement and
Protection Act of 2000 coinsurance limit.
Limitation of copayment amount to inpatient hospital
deductible amount.
Changes in services covered within the scope of OPPS.
Categories of hospitals subject to, and excluded from, the
OPPS.
Criteria for new technology APCs.
Provider-based issues.
Change to the definition of ``single-use devices'' for
transitional pass-through payments.
We have also discovered typographical and other technical errors in
the preamble and addenda to the November 30, 2001 final rule. These
errors involve the incorrect assignment of status indicators (SIs) to
certain Physicians' Current Procedural Terminology (CPT) codes,
inconsistencies between the preamble and addenda in the assignment of
codes to APC groups, and similar matters. Correction of these
typographical and technical errors does not involve any changes in the
policies announced in the November 30, 2001 final rule. Corrections to
the preamble text are listed below. The appropriate corrections are
incorporated into the new addenda A, B, C, and D. The corrected addenda
A and D are printed at the end of this rule. Addenda B and C are
available on our Web site: http://www.cms.hhs.gov. Tables 2 and 3 below
summarize the corrections to the errors in addenda A and B.
[[Page 9557]]
II. Correction of Errors
In the FR Doc. 01-29621 published November 30, 2001 (66 FR 59856),
we are making the corrections described below.
A. Corrections of Device Cost Assignments to APCs
Since publication of the December 31, 2001 final rule, we have
conducted an intensive internal review of device costs associated with
specific CPT codes. We have also considered information concerning the
use of devices brought to our attention from hospitals, manufacturers,
and other such sources. As a result of this review, we determined that
we had inadvertently associated device(s) with certain procedures for
which no devices are used, incorrectly identified device(s) used with
certain other procedures, or failed to associate one or more devices
with procedures requiring the use of those devices. The following APCs
were affected:
APC 0084 Level I Electrophysiologic Evaluation
APC 0085 Level II Electrophysiologic Evaluation
APC 0090 Insertion/Replacement of Pacemaker/Pulse
Generator
APC 0091 Level I Vascular Ligation
APC 0104 Transcatheter Placement of Intracoronary Stents
APC 0229 Transcatheter Placement of Intravascular Shunts
APC 0237 Level III Posterior Segment Eye Procedures
APC 0241 Level IV Repair and Plastic Eye Procedures
APC 0242 Level V Repair and Plastic Eye Procedures
APC 0246 Cataract Procedures with IOL Insert
APC 0248 Laser Retinal Procedures
APC 0312 Radioelement Applications
APC 0313 Brachytherapy
The changes in the assignment of device costs associated with these 13
APCs resulted in a net reduction in the estimate of total transitional
pass-through payments for CY 2002.
In addition, the changes in the assignment of device costs
associated with these 13 APCs have caused changes to the median costs
for these APCs. (Median costs are used to set the relative weights of
each APC. The relative weight of each APC is the ratio of its median
cost to the median cost of APC 601, Mid-level clinic visit, adjusted by
the ``scalar'' that is discussed below.) We found that the changes in
the assignment of device costs and the resulting changes in the median
costs of the 13 associated APC groups affected the relative payment
weights for all procedure-related APCs as well as the estimate of
aggregate CY 2002 payments.
The changes in relative payment weights resulting from revisions in
the assignment of device costs associated with the 13 APCs identified
above required that we recalculate the ``scalar,'' which is the factor
that we use to ensure compliance with section 1833(t)(9)(B) of the
Social Security Act (the Act). That section of the Act provides that
APC reclassification and recalibration changes (and wage index changes)
must be made in a manner so that the estimated aggregate payments under
the OPPS for a particular year are neither greater nor less than the
estimated aggregate payments would have been without these changes. The
corrections, as well as appropriate adjustments made under the
authority of section 1833(t)(2)(E) of the Act, have the overall effect
of revising the scalar from 0.945, which we announced in the November
30, 2001 final rule (66 FR 59886), to 0.951. This revised scalar has
the effect of slightly increasing the relative weights of the
procedure-related APCs (except for those for which we revised the
device-associated costs).
We are also revising the target that we set for outlier payments in
the November 30, 2001 final rule from 2.0 percent to 1.5 percent, and
thus we are revising the threshold for outlier payments from 3 times
the applicable APC payment for a service to 3.5 times the applicable
payment amount for a service. These adjustments ensure that the payment
rate for every procedure-related APC is at least equal to and in no
case lower than the rate published in the November 30, 2001 final rule
(except for those APCs for which we revised the device-associated
costs). The conversion factor is reduced by 1.5 percent (rather than
2.0 percent) to reflect the revised outlier target and 0.5 percent for
the adjustments described above that are due to changes in relative
payment weights resulting from revisions in the assignment of device
costs. The overall effect of these adjustments does not change the
conversion factor announced in the November 2, 2001 final rule. The
conversion factor remains $50.904.
Recalculation of the scalar changes the offset amounts that we
published in Table 5 in the November 30, 2001 final rule. Certain APC
rates increased as a result of the incorporation of 75 percent of the
pass-through costs of devices eligible for pass-through payments. Those
amounts were deducted from the pass-through payments for those devices,
so that the increases to the APC rates were offset by the simultaneous
reduction of the associated pass-through costs, as described in the
November 30, 2001 final rule (66 FR 59904-59906). The recalculated
offset amounts are listed in Table 1 below, which parallels Table 5 of
the November 30, 2001 final rule (66 FR 59907). Column 3 shows the
device costs already included in the rates for 25 APCs before we
incorporated 75 percent of the pass-through device costs into the
rates. The label ``NA'' in column 3 means that there were no device
costs associated with the APC before incorporating 75 percent of pass-
through device costs into the rates. In Table 1, the amounts in column
3 have not changed since the November 30, 2001 final rule. In Table 1,
the amounts in column 5, which are the sum of columns 3 and 4, have
changed to account for the corrections in column 4.
Table 1.--Offsets To Be Applied for Each APC That Contains Device Costs
------------------------------------------------------------------------
Device
costs Additional Total
(before device offset for
APC Description fold-in) costs device
reflected folded into costs
in APC rate APC rate
1 2...................... 3 4 5
------------------------------------------------------------------------
0032 Insertion of Central $73.79 $279.97 $353.76
Venous/Arterial
Catheter..............
0046 Open/Percutaneous NA 100.29 100.29
Treatment Fracture or
Dislocation...........
0048 Arthroplasty with NA 514.64 514.64
Prosthesis............
0057 Bunion Procedures...... NA 162.89 162.89
0070 Thoracentesis/Lavage NA 26.47 26.47
Procedures............
0080 Diagnostic Cardiac 164.27 134.39 298.66
Catheterization.......
[[Page 9558]]
0081 Non-Coronary 307.06 362.95 670.01
Angioplasty or
Atherectomy...........
0082 Coronary Atherectomy... 242.95 1,214.06 1,457.01
0083 Coronary Angioplasty... 528.64 383.31 911.95
0085 Level II NA 1,578.03 1,578.03
Electrophysiologic
Evaluation............
0086 Ablate Heart Dysrhythm NA 1,320.96 1,320.96
Focus.................
0087 Cardiac NA 1,980.16 1,980.16
Electrophysiologic
Recording/Mapping.....
0088 Thrombectomy........... 162.72 261.14 423.86
0089 Insertion/Replacement 3,175.70 3,286.36 6,462.06
of Permanent Pacemaker
and Electrodes........
0090 Insertion/Replacement 2,921.06 2,123.20 5,044.26
of Pacemaker Pulse
Generator.............
0094 Resuscitation and NA 19.34 19.34
Cardioversion.........
0103 Miscellaneous Vascular NA 207.18 207.18
Procedures............
0104 Transcatheter Placement 428.16 1,256.31 1,684.47
of Intracoronary
Stents................
0106 Insertion/Replacement/ 657.59 1,049.13 1,706.72
Repair of Pacemaker
and/or Electrodes.....
0107 Insertion of 6,803.85 11,099.62 17,903.47
Cardioverter-
Defibrillator.........
0108 Insertion/Replacement/ 6,940.27 19,607.20 26,547.47
Repair of Cardioverter-
Defibrillator Leads...
0111 Blood Product Exchange. NA 209.72 209.72
0115 Cannula/Access Device NA 127.26 127.26
Procedures............
0117 Chemotherapy NA 30.03 30.03
Administration by
Infusion Only.........
0118 Chemotherapy NA 28.50 28.50
Administration by Both
Infusion and Other
Technique.............
0119 Implantation of Devices NA 3,348.98 3,348.98
0120 Infusion Therapy Except NA 35.12 35.12
Chemotherapy..........
0121 Level I Tube Changes NA 6.10 6.10
and Repositioning.....
0122 Level II Tube Changes 72.55 214.82 287.37
and Repositioning.....
0124 Revision of Implanted NA 3,308.76 3,308.76
Infusion Pump.........
0144 Diagnostic Anoscopy.... NA 128.28 128.28
0151 Endoscopic Retrograde 60.92 0.00 60.92
Cholangio-
Pancreatography (ERCP)
0152 Percutaneous Biliary 107.61 0.00 107.61
Endoscopic Procedures.
0153 Peritoneal and NA 41.23 41.23
Abdominal Procedures..
0154 Hernia/Hydrocele 108.11 378.73 486.84
Procedures............
0161 Level II NA 11.20 11.20
Cystourethroscopy and
other Genitourinary
Procedures............
0162 Level III NA 319.68 319.68
Cystourethroscopy and
other Genitourinary
Procedures............
0163 Level IV NA 901.51 901.51
Cystourethroscopy and
other Genitourinary
Procedures............
0179 Urinary Incontinence NA 3,400.90 3,400.90
Procedures............
0182 Insertion of Penile 2,238.90 569.11 2,808.14
Prosthesis............
0202 Level VIII Female 505.32 1,233.41 1,738.73
Reproductive Proc.....
0203 Level V Nerve NA 420.98 420.98
Injections............
0207 Level IV Nerve NA 63.63 63.63
Injections............
0222 Implantation of 4,458.57 9,599.99 14,058.56
Neurological Device...
0223 Implantation of Pain 421.33 3,330.14 3,751.47
Management Device.....
0225 Implantation of 1,182.00 11,941.06 13,123.06
Neurostimulator
Electrodes............
0226 Implantation of Drug NA 3,363.74 3,363.74
Infusion Reservoir....
0227 Implantation of Drug 3,810.46 2,395.55 6,206.01
Infusion Device.......
0229 Transcatherter 1,074.41 842.97 1,917.38
Placement of
Intravascular Shunts..
0246 Cataract Procedures 146.82 0.00 146.82
with IOL Insert.......
0259 Level VI ENT Procedures 12,407.52 3,836.13 16,243.65
0264 Level II Miscellaneous NA 61.59 61.59
Radiology Procedures..
0312 Radioelement NA 5,897.22 5,897.22
Applications..........
0313 Brachytherapy.......... NA 998.23 998.23
0685 Level III Needle Biopsy/ NA 210.75 210.75
Aspiration Except Bone
Marrow................
0686 Level V Skin Repair.... NA 465.77 465.77
0687 Revision/Removal of NA 1,444.65 1,444.65
Neurostimulator
Electrodes............
0688 Revision/Removal of NA 6,238.79 6,238.79
Neurostimulator Pulse
Generator Receiver....
0692 Electronic Analysis of NA 644.44 644.44
Neurostimulator Pulse
Generators............
------------------------------------------------------------------------
As noted above, the estimates of transitional pass-through payments
for devices, and of total pass-through payments for all eligible items,
have decreased because of the corrections of device costs associated
with specific procedures. After we incorporated 75 percent of the
estimated pass-through device costs into the APCs, the remaining
estimate of total pass-through payments for CY 2002 is 1.20 billion,
which results in a uniform reduction in pass-through payments for 2002
of 63.6 percent.
During the first quarter of CY 2002, payments to hospitals for
outpatient services are based on the rates and Healthcare Common
Procedure Coding System (HCPCS) codes that were in effect for CY 2001,
and a uniform reduction of transitional pass-through payments does not
apply. Hospitals have thus received the advantage of much higher pass-
through payments during the first quarter of CY 2002 than they would
have, had we proceeded with implementation of the revised CY 2002 rates
and the requisite uniform reduction for services furnished on or after
January 1, 2002.
[[Page 9559]]
We are making four revised addenda available. Revised Addendum A
and Addendum D are printed at the end of this preamble. Addendum A
shows the corrected relative weights and payment rates, as well as the
national unadjusted copayment and minimum unadjusted copayment amounts
that are effective April 1, 2002. Addendum D incorporates several
corrections to the payment status indicator addendum that was published
on November 30, 2001.
Revised Addendum B and Addendum C are available on our Web site at
http://www.cms.hhs.gov. Addendum B shows payment rates, weights, APC
assignment, and payment status by HCPCS code. Addendum C lists the
HCPCS codes in each APC group.
On December 31, 2001, we published a final rule that delayed the
effective date of the payment rates and the uniform reduction to the
transitional pass-through payments under the OPPS announced in the
November 30, 2001 final rule until no later than April 1, 2002. We also
announced that payment under the OPPS would continue to be made under
the payment rates in effect on December 31, 2001, and that we would not
apply a uniform reduction to payments for transitional pass-through
items. This final rule implements the revised payment rates in Addendum
A effective for services furnished on or after April 1, 2002. Also,
effective for services furnished on or after April 1, 2002, a uniform
reduction of 63.6 percent applies to transitional pass-through payments
made under the OPPS. In addition, effective for services furnished on
or after April 1, 2002, the threshold for determining outlier payments
is when service costs are 3.5 times greater than the applicable APC
payment amount. Also, effective for services furnished on or after
April 1, 2002, payment will be made for new 2002 HCPCS codes and
modifiers that are payable under the OPPS.
B. Correction of Technical and Typographical Errors in the Preamble and
the Regulations Text of the November 30, 2001 Final Rule
We are correcting the following typographical and technical errors
in the preamble and regulations text of the November 30, 2001 final
rule. As we have stated previously, these corrections do not involve
any changes in the policies announced in that rule.
1. On page 59863, in column two, the heading ``Level I Nerve
Injections (to include Trigger Point, Joint, Other Injections, and
Lower Complexity Nerve Blocks)'' is corrected to read ``Level VI Nerve
Injections (APC 204) (to include Trigger Point, Joint, Other
Injections, and Lower Complexity Nerve Blocks).''
2. On page 59863, in column two, the chart that will be under the
revised heading (see item 1 above) ``Level VI Nerve Injections (APC
204) (to include Trigger Point, Joint, Other Injections, and Lower
Complexity Nerve Blocks)'' is revised to read:
------------------------------------------------------------------------
Reassigned
CPT Code
from APC
------------------------------------------------------------------------
27096...................................................... (\1\)
62270...................................................... 0210
62272...................................................... 0210
62273...................................................... 0212
62310-62319................................................ 0212
------------------------------------------------------------------------
\1\ Currently packaged.
3. On page 59863, in column two, the heading ``Level II Nerve
Injections (to include Moderate Complexity Nerve Blocks and
Epidurals):'' is corrected to read ``Level III Nerve Injections (APC
206) (to include Moderate Complexity Nerve Blocks and Epidurals):''.
4. On page 59863, in column two and continuing to the top of column
three, the heading ``Level III Nerve Injections (to include Moderately
High Complexity Epidurals, Facet Blocks, and Disk Injections):'' is
corrected to read ``Level IV Nerve Injections (APC 207) (to include
Moderately High Complexity Epidurals, Facet Blocks, and Disk
Injections):''.
5. On page 59863, in column three, the heading ``Level IV Nerve
Injections (to include High Complexity Lysis of Adhesions, Neurolytic
Procedures, Removal of Implantable Pumps and Stimulators):'' is
corrected to read ``Level V Nerve Injections (APC 203) (to include High
Complexity Lysis of Adhesions, Neurolytic Procedures, Removal of
Implantable Pumps and Stimulators):''.
6. On page 59868, in column two, the first and second complete
sentences beginning at line five from the top of the page are corrected
to read ``We would note that payment for IMRT planning includes payment
for the following CPT codes: 77300, 77336, 77370, 77280-77295, 77305-
77321. The only CPT codes that may be billed in addition to 77301 (IMRT
planning) are the CPT codes 77332-77334.''
7. On page 59870, in column one, the last sentence is corrected to
read ``According to our methodology for pricing new technology
services, these services will be reassigned to APC 0714, New
Technology--Level IX ($1250-$1500), which results in a payment rate of
$1,375 with a status indicator of `S,' indicating that the multiple
procedure discount is not applied.''
8. On page 59883, in column two, on line 17 from the top of the
page, ``G0224,'' is corrected to read ``G0244.''
9. On page 59883, in column two, beginning at the bottom of the
page and continuing to the top of column three, the list of acceptable
diagnosis codes for chest pain is corrected to read as follows:
For Chest Pain:
411.1 Intermediate coronary syndrome
411.81 Coronary occlusion without myocardial infarction
411.0 Postmyocardial infarction syndrome
411.89 Other acute ischemic heart disease
413.0 Angina decubitus
413.1 Prinzmetal angina
413.9 Other and unspecified angina pectoris
786.05 Shortness of breath
786.50 Chest pain, unspecified
786.51 Precordial pain
786.52 Painful respiration
786.59 Other chest pain
10. On page 59883, in column three, the list of acceptable
diagnosis codes for congestive heart failure is corrected to read as
follows:
For Congestive Heart Failure:
391.8 Other acute rheumatic heart disease
398.91 Rheumatic heart failure (congestive)
402.01 Malignant hypertensive heart disease with congestive heart
failure
402.11 Benign hypertensive heart disease with congestive heart
failure
402.91 Unspecified hypertensive heart disease with congestive heart
failure
404.01 Malignant hypertensive heart and renal disease with
congestive heart failure
404.03 Malignant hypertensive heart and renal disease with
congestive heart and renal failure
404.11 Benign hypertensive heart and renal disease with congestive
heart failure
404.13 Benign hypertensive heart and renal disease with congestive
heart and renal failure
404.91 Unspecified hypertensive heart and renal disease with
congestive heart failure
404.93 Unspecified hypertensive heart and renal disease with
congestive heart and renal failure
428.0 Congestive heart failure
428.1 Left heart failure
428.9 Heart failure, unspecified
11. On page 59883, in column three, the second-to-last sentence is
corrected to read ``For asthma, a peak expiratory flow rate (PEFR) (CPT
code 94010), or pulse oximetry (CPT codes 94760 or 94761).''
12. We are also making revisions to our regulations under 42 CFR
Part 419, specifically Sec. 419.32 ``Calculation of prospective payment
rates for hospital outpatient services,'' and Sec. 419.62
``Transitional pass-through payments: General rules.'' At
Secs. 419.32(b)(1)(iii) and 419.62(d), we are revising our language to
specify that the provisions
[[Page 9560]]
under these sections are applicable to a portion of CY 2002 and not
necessarily the entire year for 2002.
C. Correction of Technical and Typographical Errors in Addenda A, B, C,
and D
Addenda A, B, and D as published in the November 30, 2001 final
rule contain a number of typographical and technical errors that do not
involve any changes in the policies announced in that rule. Addenda A
and D at the end of this document reflect the corrections of these
errors. Corrected addenda B and C are available on our Web site at
http://www.cms.hhs.gov.
1. Corrections to Addendum A
Table 2, Corrections to Addendum A of the November 30, 2001 final
rule, shows the APC listings for which corrections are required. It
provides the data as published in that final rule and the additions and
corrections to these data.
BILLING CODE 4120-01-P
[[Page 9561]]
[GRAPHIC] [TIFF OMITTED] TR01MR02.000
[[Page 9562]]
[GRAPHIC] [TIFF OMITTED] TR01MR02.001
[[Page 9563]]
2. Corrections to Addendum B of the November 30, 2001 Final Rule
Table 3, Corrections to Addendum B of the November 30, 2001 final
rule shows the APC assignments for which corrections are required. It
provides the data as published in that final rule and the additions and
corrections to these data.
[[Page 9564]]
[GRAPHIC] [TIFF OMITTED] TR01MR02.002
[[Page 9565]]
[GRAPHIC] [TIFF OMITTED] TR01MR02.003
[[Page 9566]]
[GRAPHIC] [TIFF OMITTED] TR01MR02.004
BILLING CODE 4120-01-C
[[Page 9567]]
3. Corrections to Addendum D of the November 30, 2001 Final Rule
On page 60091, there are two corrections to Addendum D as published
in the November 30, 2001 final rule.
a. Under the status column for Screening Mammography, ``Lower of
Charges or National Rate'' is revised to read ``Physician Fee
Schedule.''
b. We are adding a status indicator that was inadvertently omitted.
In the indicator column we are adding, where it should appear
alphabetically, status indicator ``D'', ``Deleted Code'' under the
service column, and ``Codes Are Deleted Effective with the Beginning of
the Calendar Year'' under the status column.
III. Waiver of Notice of Proposed Rulemaking
We ordinarily publish a notice of proposed rulemaking in the
Federal Register and invite public comment on the proposed rule. The
notice of proposed rulemaking includes a reference to the legal
authority under which the rule is proposed, and the terms and
substances of the proposed rule or a description of the subjects and
issues involved. This procedure can be waived, however, if an agency
finds good cause that a notice-and-comment procedure is impracticable,
unnecessary, or contrary to the public interest and incorporates a
statement of the finding and its reasons in the rule issued. The rates
in this final rule incorporate the correction of errors that were
identified in connection with the rates published in the November 30,
2001 final rule.
We find that it is in the general public interest to proceed with
implementing the corrected rates without proposed rulemaking and public
comment. The delay in implementing the 2002 rates was necessary to
correct identified inadvertent technical errors and to allow us to
review our data files to ensure that other errors could also be
identified and corrected. As a matter of good public policy, we do not
believe that the necessary delay in implementing the CY 2002 OPPS rates
should result in continued uncertainty among hospitals, beneficiaries,
and others regarding CY 2002 payment rates for OPPS services. The
public is expecting the corrected OPPS update for CY 2002 to be made
effective no later than April 1, 2002. Thus, there is an urgent need,
effective for services furnished on or after April 1, 2002, to
implement the corrected rate update and new 2002 HCPCS codes for
Medicare payments under the OPPS. There is not sufficient time to
provide notice of proposed rulemaking without further delaying the
effective date of the rates. Therefore, we find that it is contrary to
the public interest to continue to delay the effective date of the
rates.
IV. Collection of Information Requirements
This document does not impose information collection and record-
keeping requirements. Consequently, the Office of Management and Budget
need not review it under the authority of the Paperwork Reduction Act
of 1995.
V. Regulatory Impact Statement
We have examined the impacts of this rule as required by Executive
Order 12866 (September 1993, Regulatory Planning and Review) and the
Regulatory Flexibility Act (RFA) (September 19, 1980 Pub. L. 96-354).
Executive Order 12866 directs agencies to assess all costs and benefits
of available regulatory alternatives and, if regulation is necessary,
to select regulatory approaches that maximize net benefits (including
potential economic, environmental, public health and safety effects,
distributive impacts, and equity). A regulatory impact analysis (RIA)
must be prepared for major rules with economically significant effects
($100 million or more annually).
As discussed above in this preamble, this final rule corrects
inadvertent technical errors in the November 30, 2001 final rule that
implemented the CY 2002 payments for the hospital OPPS. We note that
the November 30, 2001 final rule was not a major rule. As we also
discussed above in the preamble, this final rule corrects the estimate
of the transitional pass-through payments for CY 2002 and the resulting
uniform reduction that is required for that year, the median costs for
several APCs, the scalar used to adjust the relative payment weights
for the effects of recalibration, and device cost assignment to device-
related APCs. We also note that on November 2, 2001, we published a
final rule that announced the updated conversion factor for payments
under the OPPS (66 FR 55857).
The RFA requires agencies to analyze options for regulatory relief
of small businesses. For purposes of the RFA, small entities include
small businesses, nonprofit organizations, and government agencies.
Most hospitals and most other providers and suppliers are small
entities, either by nonprofit status or by having revenues between $5
million and $25 million (for details see the Small Business
Administration's final rule that set forth size standards for health
care industries at 65 FR 69432). Individuals and States are not
included in the definition of a small entity.
In addition, section 1102(b) of the Act requires us to prepare a
regulatory impact analysis for any final rule that may have a
significant impact on the operations of a substantial number of small
rural hospitals. Such an analysis must conform to the provisions of
section 604 of the RFA. With the exception of hospitals located in
certain New England counties, for purposes of section 1102(b) of the
Act, we define a small rural hospital as a hospital with not more than
100 beds that is located outside of a Metropolitan Statistical Area
(MSA) or New England County Metropolitan Area (NECMA). Section 601(g)
of the Social Security Amendments of 1983 (Pub. L. 98-21) designated
hospitals in certain New England counties as belonging to the adjacent
NECMA. Thus, for purposes of the PPS, we classify these hospitals as
urban hospitals. See the November 30, 2001 final rule for the
regulatory impact analysis related to the updated CY 2002 hospital OPPS
payments.
Section 202 of the Unfunded Mandates Reform Act of 1995 also
requires that agencies assess anticipated costs and benefits before
issuing any rule that may result in an expenditure in any 1 year by
State, local, or tribal governments, in the aggregate, or by the
private sector, of $110 million. This final rule will not have a
significant economic effect on these governments or the private sector.
Executive Order 13132 establishes certain requirements that an
agency must meet when it promulgates a final rule that imposes
substantial direct compliance costs on State and local governments,
preempts State law, or otherwise has Federalism implications. This
final rule will not have a substantial effect on States or local
governments.
Because the November 30, 2001 final rule includes the relevant
impact analysis for the changes to the hospital OPPS, we are not
preparing analyses for either the RFA or section 1102(b) of the Act.
In accordance with the provisions of Executive Order 12866, this
regulation was reviewed by the Office of Management and Budget.
List of Subjects 42 CFR Part 419
Hospitals, Medicare, Reporting and recordkeeping requirements.
For the reasons set forth in the preamble, 42 CFR part 419 is
corrected
[[Page 9568]]
by making the following correcting amendments:
PART 419--PROSPECTIVE PAYMENT SYSTEM FOR HOSPITAL OUTPATIENT
DEPARTMENT SERVICES
1. The authority citation continues to read as follows:
Authority: Secs. 1102, 1833(t), and 1871 of the Social Security
Act (42 U.S.C. 1302, 1395l(t), and 1395hh).
Sec. 419.32 [Corrected]
2. In Sec. 419.32, paragraph (b)(1)(iii) is corrected by removing
the phrase ``For calendar year 2002,'' and adding in its place the
phrase ``For the portion of calendar year 2002 that is affected by
these rules,''.
Sec. 419.62 [Corrected]
In Sec. 419.62, paragraph (d) is corrected by removing the phrase
``For CY 2002'' and adding in its place ``For the portion of CY 2002
affected by these rules,''.
(Catalog of Federal Domestic Assistance Program No. 93.773,
Medicare--Hospital Insurance; and Program No. 93.774, Medicare--
Supplementary Medical Insurance Program)
Dated: February 27, 2002.
Thomas A. Scully,
Administrator, Centers for Medicare & Medicaid Services.
Approved: February 27, 2002.
Tommy G. Thompson,
Secretary.
Addendum A.--List of Ambulatory Payment Classifications (APCs) With Status Indicators, Relative Weights, Payment
Rates, and Copayment Amounts Calendar Year 2002
----------------------------------------------------------------------------------------------------------------
National Minimum
APC Group title Status indicator Relative Payment unadjusted unadjusted
weight rate copayment copayment
----------------------------------------------------------------------------------------------------------------
0001 Photochemotherapy......... S 0.43 $21.89 $7.88 $4.38
0002 Fine needle Biopsy/ T 0.42 $21.38 $11.76 $4.28
Aspiration.
0003 Bone Marrow Biopsy/ T 1.04 $52.94 $27.08 $10.59
Aspiration.
0004 Level I Needle Biopsy/ T 2.48 $126.24 $32.57 $25.25
Aspiration Except Bone
Marrow.
0005 Level II Needle Biopsy / T 4.05 $206.16 $90.71 $41.23
Aspiration Except Bone
Marrow.
0006 Level I Incision & T 2.19 $111.48 $33.95 $22.30
Drainage.
0007 Level II Incision & T 6.79 $345.64 $72.03 $69.13
Drainage.
0008 Level III Incision and T 10.99 $559.43 $113.67 $111.89
Drainage.
0009 Nail Procedures........... T 0.63 $32.07 $8.34 $6.41
0010 Level I Destruction of T 0.66 $33.60 $9.86 $6.72
Lesion.
0011 Level II Destruction of T 1.48 $75.34 $27.88 $15.07
Lesion.
0012 Level I Debridement & T 0.66 $33.60 $9.18 $6.72
Destruction.
0013 Level II Debridement & T 1.37 $69.74 $17.66 $13.95
Destruction.
0015 Level IV Debridement & T 2.08 $105.88 $31.20 $21.18
Destruction.
0016 Level V Debridement & T 3.04 $154.75 $65.00 $30.95
Destruction.
0017 Level VI Debridement & T 9.73 $495.30 $227.84 $99.06
Destruction.
0018 Biopsy of Skin/Puncture of T 1.06 $53.96 $17.66 $10.79
Lesion.
0019 Level I Excision/ Biopsy.. T 4.24 $215.83 $78.91 $43.17
0020 Level II Excision/ Biopsy. T 8.49 $432.17 $130.53 $86.43
0021 Level IV Excision/ Biopsy. T 11.89 $605.25 $236.51 $121.05
0022 Level V Excision/ Biopsy.. T 13.99 $712.15 $292.94 $142.43
0023 Exploration Penetrating T 2.09 $106.39 $40.37 $21.28
Wound.
0024 Level I Skin Repair....... T 2.29 $116.57 $41.97 $23.31
0025 Level II Skin Repair...... T 3.41 $173.58 $65.57 $34.72
0026 Level III Skin Repair..... T 12.69 $645.97 $277.92 $129.19
0027 Level IV Skin Repair...... T 18.12 $922.38 $383.10 $184.48
0028 Level I Breast Surgery.... T 14.08 $716.73 $303.74 $143.35
0029 Level II Breast Surgery... T 23.90 $1,216.61 $632.64 $243.32
0030 Level III Breast Surgery.. T 34.40 $1,751.10 $763.55 $350.22
0032 Insertion of Central T 12.71 $646.99 ........... $129.40
Venous/Arterial Catheter.
0033 Partial Hospitalization... P 4.17 $212.27 $48.17 $42.45
0035 Placement of Arterial or T 0.13 $6.62 $2.91 $1.32
Central Venous Catheter.
0041 Level I Arthroscopy....... T 23.74 $1,208.46 $580.06 $241.69
0042 Level II Arthroscopy...... T 35.97 $1,831.02 $804.74 $366.20
0043 Closed Treatment Fracture T 4.07 $207.18 ........... $41.44
Finger/Toe/Trunk.
0044 Closed Treatment Fracture/ T 2.54 $129.30 $38.08 $25.86
Dislocation Except Finger/
Toe/Trunk.
0045 Bone/Joint Manipulation T 11.74 $597.61 $277.12 $119.52
Under Anesthesia.
0046 Open/Percutaneous T 27.86 $1,418.19 $535.76 $283.64
Treatment Fracture or
Dislocation.
0047 Arthroplasty without T 26.51 $1,349.47 $537.03 $269.89
Prosthesis.
0048 Arthroplasty with T 43.44 $2,211.27 $725.94 $442.25
Prosthesis.
0049 Level I Musculoskeletal T 15.93 $810.90 $356.95 $162.18
Procedures Except Hand
and Foot.
0050 Level II Musculoskeletal T 20.75 $1,056.26 $507.15 $211.25
Procedures Except Hand
and Foot.
0051 Level III Musculoskeletal T 28.73 $1,462.47 $675.24 $292.49
Procedures Except Hand
and Foot.
0052 Level IV Musculoskeletal T 36.15 $1,840.18 $930.91 $368.04
Procedures Except Hand
and Foot.
0053 Level I Hand T 11.76 $598.63 $253.49 $119.73
Musculoskeletal
Procedures.
0054 Level II Hand T 19.95 $1,015.53 $472.33 $203.11
Musculoskeletal
Procedures.
0055 Level I Foot T 15.52 $790.03 $355.34 $158.01
Musculoskeletal
Procedures.
0056 Level II Foot T 18.95 $964.63 $405.81 $192.93
Musculoskeletal
Procedures.
0057 Bunion Procedures......... T 24.49 $1,246.64 $496.65 $249.33
0058 Level I Strapping and Cast S 1.28 $65.16 $19.27 $13.03
Application.
0059 Level II Strapping and S 2.23 $113.52 $29.59 $22.70
Cast Application.
0060 Manipulation Therapy...... S 0.23 $11.71 ........... $2.34
0068 CPAP Initiation........... S 3.04 $154.75 $85.11 $30.95
[[Page 9569]]
0069 Thoracoscopy.............. T 23.72 $1,207.44 $591.64 $241.49
0070 Thoracentesis/Lavage T 4.61 $234.67 $79.60 $46.93
Procedures.
0071 Level I Endoscopy Upper T 1.04 $52.94 $14.22 $10.59
Airway.
0072 Level II Endoscopy Upper T 1.22 $62.10 $34.16 $12.42
Airway.
0073 Level III Endoscopy Upper T 3.31 $168.49 $74.14 $33.70
Airway.
0074 Level IV Endoscopy Upper T 11.39 $579.80 $295.70 $115.96
Airway.
0075 Level V Endoscopy Upper T 17.52 $891.84 $445.92 $178.37
Airway.
0076 Endoscopy Lower Airway.... T 7.61 $387.38 $189.82 $77.48
0077 Level I Pulmonary S 0.39 $19.85 $10.92 $3.97
Treatment.
0078 Level II Pulmonary S 0.87 $44.29 $19.04 $8.86
Treatment.
0079 Ventilation Initiation and S 0.60 $30.54 $16.80 $6.11
Management.
0080 Diagnostic Cardiac T 34.93 $1,778.08 $838.92 $355.62
Catheterization.
0081 Non-Coronary Angioplasty T 29.42 $1,497.60 $710.91 $299.52
or Atherectomy.
0082 Coronary Atherectomy...... T 92.53 $4,710.15 $1,351.74 $942.03
0083 Coronary Angioplasty...... T 59.84 $3,046.10 $794.30 $609.22
0084 Level I Electrophysiologic S 6.90 $351.24 $115.91 $70.25
Evaluation.
0085 Level II T 58.28 $2,966.69 $654.48 $593.34
Electrophysiologic
Evaluation.
0086 Ablate Heart Dysrhythm T 73.14 $3,723.12 $1,265.37 $744.62
Focus.
0087 Cardiac Electrophysiologic T 52.77 $2,686.20 ........... $537.24
Recording/Mapping.
0088 Thrombectomy.............. T 34.57 $1,759.75 $678.68 $351.95
0089 Insertion/Replacement of T 150.39 $7,655.45 $2,246.59 $1,531.09
Permanent Pacemaker and
Electrodes.
0090 Insertion/Replacement of T 116.11 $5,910.46 $2,133.88 $1,182.09
Pacemaker Pulse Generator.
0091 Level I Vascular Ligation. T 21.15 $1,076.62 $348.23 $215.32
0092 Level II Vascular Ligation T 20.02 $1,019.10 $505.37 $203.82
0093 Vascular Repair/Fistula T 14.24 $724.87 $277.34 $144.97
Construction.
0094 Resuscitation and S 6.12 $311.53 $105.29 $62.31
Cardioversion.
0095 Cardiac Rehabilitation.... S 0.62 $31.56 $16.73 $6.31
0096 Non-Invasive Vascular S 1.72 $87.55 $48.15 $17.51
Studies.
0097 Cardiac and Ambulatory X 0.85 $43.27 $23.80 $8.65
Blood Pressure Monitoring.
0098 Injection of Sclerosing T 1.25 $63.63 $20.88 $12.73
Solution.
0099 Electrocardiograms........ S 0.36 $18.33 $10.08 $3.67
0100 Stress Tests and X 1.48 $75.34 $41.44 $15.07
Continuous ECG.
0101 Tilt Table Evaluation..... S 3.76 $191.40 $105.27 $38.28
0103 Miscellaneous Vascular T 16.04 $816.50 $295.70 $163.30
Procedures.
0104 Transcatheter Placement of T 96.97 $4,936.16 ........... $987.23
Intracoronary Stents.
0105 Revision/Removal of T 14.85 $755.92 $370.40 $151.18
Pacemakers, AICD, or
Vascular.
0106 Insertion/Replacement/ T 36.85 $1,875.81 $503.07 $375.16
Repair of Pacemaker and/
or Electrodes.
0107 Insertion of Cardioverter- T 381.66 $19,428.02 $4,224.27 $3,885.60
Defibrillator.
0108 Insertion/Replacement/ T 576.78 $29,360.41 ........... $5,872.08
Repair of Cardioverter-
Defibrillator Leads.
0109 Removal of Implanted T 6.30 $320.70 $131.49 $64.14
Devices.
0110 Transfusion............... S 5.34 $271.83 $114.17 $54.37
0111 Blood Product Exchange.... S 21.21 $1,079.67 $300.74 $215.93
0112 Apheresis, Photopheresis, S 36.46 $1,855.96 $612.47 $371.19
and Plasmapheresis.
0113 Excision Lymphatic System. T 15.62 $795.12 $326.55 $159.02
0114 Thyroid/Lymphadenectomy T 29.46 $1,499.63 $493.78 $299.93
Procedures.
0115 Cannula/Access Device T 21.47 $1,092.91 $506.74 $218.58
Procedures.
0116 Chemotherapy S 0.91 $46.32 ........... $9.26
Administration by Other
Technique Except Infusion.
0117 Chemotherapy S 4.03 $205.14 $52.69 $41.03
Administration by
Infusion Only.
0118 Chemotherapy S 4.22 $214.81 $72.03 $42.96
Administration by Both
Infusion and Other
Technique.
0119 Implantation of Devices... T 80.14 $4,079.45 ........... $815.89
0120 Infusion Therapy Except T 3.10 $157.80 $42.67 $31.56
Chemotherapy.
0121 Level I Tube changes and T 2.56 $130.31 $52.53 $26.06
Repositioning.
0122 Level II Tube changes and T 9.94 $505.99 $114.93 $101.20
Repositioning.
0123 Bone Marrow Harvesting and S 8.62 $438.79 ........... $87.76
Bone Marrow/Stem Cell
Transplant.
0124 Revision of Implanted T 89.58 $4,559.98 ........... $912.00
Infusion Pump.
0125 Refilling of Infusion Pump T 3.01 $153.22 ........... $30.64
0130 Level I Laparoscopy....... T 26.06 $1,326.56 $659.53 $265.31
0131 Level II Laparoscopy...... T 37.85 $1,926.72 $1,001.89 $385.34
0132 Level III Laparoscopy..... T 56.38 $2,869.97 $1,239.22 $573.99
0140 Esophageal Dilation T 5.68 $289.13 $107.24 $57.83
without Endoscopy.
0141 Upper GI Procedures....... T 7.25 $369.05 $184.67 $73.81
0142 Small Intestine Endoscopy. T 6.98 $355.31 $152.78 $71.06
0143 Lower GI Endoscopy........ T 7.31 $372.11 $186.06 $74.42
0144 Diagnostic Anoscopy....... T 4.46 $227.03 $49.32 $45.41
[[Page 9570]]
0145 Therapeutic Anoscopy...... T 10.88 $553.84 $179.39 $110.77
0146 Level I Sigmoidoscopy..... T 2.75 $139.99 $64.40 $28.00
0147 Level II Sigmoidoscopy.... T 5.74 $292.19 $137.33 $58.44
0148 Level I Anal/Rectal T 2.41 $122.68 $43.59 $24.54
Procedure.
0149 Level III Anal/Rectal T 13.61 $692.80 $293.06 $138.56
Procedure.
0150 Level IV Anal/Rectal T 18.19 $925.94 $437.12 $185.19
Procedure.
0151 Endoscopic Retrograde T 15.39 $783.41 $245.46 $156.68
Cholangio-Pancreatography
(ERCP).
0152 Percutaneous Biliary T 16.23 $826.17 $207.38 $165.23
Endoscopic Procedures.
0153 Peritoneal and Abdominal T 23.70 $1,206.42 $496.31 $241.28
Procedures.
0154 Hernia/Hydrocele T 31.58 $1,607.55 $556.98 $321.51
Procedures.
0155 Level II Anal/Rectal T 5.30 $269.79 $99.82 $53.96
Procedure.
0156 Level II Urinary and Anal T 2.46 $125.22 $37.57 $25.04
Procedures.
0157 Colorectal Cancer S 1.99 $101.30 $22.19 $20.26
Screening: Barium Enema.
0158 Colorectal Cancer T 6.59 $335.46 $83.87 $67.09
Screening: Colonoscopy.
0159 Colorectal Cancer S 2.34 $119.12 $29.78 $23.82
Screening: Flexible
Sigmoidoscopy.
0160 Level I Cystourethroscopy T 5.16 $262.66 $105.06 $52.53
and other Genitourinary
Procedures.
0161 Level II Cystourethroscopy T 13.80 $702.48 $249.36 $140.50
and other Genitourinary
Procedures.
0162 Level III T 25.23 $1,284.31 $427.49 $256.86
Cystourethroscopy and
other Genitourinary
Procedures.
0163 Level IV Cystourethroscopy T 40.63 $2,068.23 $792.58 $413.65
and other Genitourinary
Procedures.
0164 Level I Urinary and Anal T 1.02 $51.92 $15.58 $10.38
Procedures.
0165 Level III Urinary and Anal T 5.25 $267.25 $91.76 $53.45
Procedures.
0166 Level I Urethral T 12.27 $624.59 $218.73 $124.92
Procedures.
0167 Level II Urethral T 22.41 $1,140.76 $555.84 $228.15
Procedures.
0168 Level III Urethral T 18.53 $943.25 $405.60 $188.65
Procedures.
0169 Lithotripsy............... T 39.85 $2,028.52 $1,115.69 $405.70
0170 Dialysis for Other Than S 0.29 $14.76 $3.25 $2.95
ESRD Patients.
0179 Urinary Incontinence T 140.14 $7,133.69 $3,067.48 $1,426.74
Procedures.
0180 Circumcision.............. T 15.11 $769.16 $304.87 $153.83
0181 Penile Procedures......... T 22.21 $1,130.58 $621.82 $226.12
0182 Insertion of Penile T 88.04 $4,481.59 $1,492.28 $896.32
Prosthesis.
0183 Testes/Epididymis T 18.97 $965.65 $448.94 $193.13
Procedures.
0184 Prostate Biopsy........... T 4.86 $247.39 $123.70 $49.48
0187 Miscellaneous Placement/ X 4.24 $215.83 $94.96 $43.17
Repositioning.
0188 Level II Female T 0.81 $41.23 $11.95 $8.25
Reproductive Proc.
0189 Level III Female T 1.26 $64.14 $18.60 $12.83
Reproductive Proc.
0190 Surgical Hysteroscopy..... T 17.01 $865.88 $424.28 $173.18
0191 Level I Female T 0.23 $11.71 $3.40 $2.34
Reproductive Proc.
0192 Level IV Female T 2.52 $128.28 $35.33 $25.66
Reproductive Proc.
0193 Level V Female T 11.23 $571.65 $171.13 $114.33
Reproductive Proc.
0194 Level VI Female T 15.95 $811.92 $397.84 $162.38
Reproductive Proc.
0195 Level VII Female T 20.74 $1,055.75 $483.80 $211.15
Reproductive Proc.
0196 Dilation and Curettage.... T 13.56 $690.26 $338.23 $138.05
0197 Infertility Procedures.... T 2.41 $122.68 $49.55 $24.54
0198 Pregnancy and Neonatal T 1.32 $67.19 $32.92 $13.44
Care Procedures.
0199 Vaginal Delivery.......... T 5.12 $260.63 $72.98 $52.13
0200 Therapeutic Abortion...... T 11.41 $580.81 $307.83 $116.16
0201 Spontaneous Abortion...... T 14.42 $734.04 $329.65 $146.81
0202 Level VIII Female T 63.90 $3,252.77 $1,593.85 $650.55
Reproductive Proc.
0203 Level V Nerve Injections.. T 15.88 $808.36 $363.78 $161.67
0204 Level VI Nerve Injections. T 2.25 $114.53 $43.52 $22.91
0206 Level III Nerve Injections T 3.62 $184.27 $75.55 $36.85
0207 Level IV Nerve Injections. T 5.40 $274.88 $123.69 $54.98
0208 Laminotomies and T 29.29 $1,490.98 ........... $298.20
Laminectomies.
0209 Extended EEG Studies and S 10.60 $539.58 $280.58 $107.92
Sleep Studies, Level II.
0212 Level II Nervous System T 3.79 $192.93 $88.78 $38.59
Injections.
0213 Extended EEG Studies and S 2.66 $135.40 $70.41 $27.08
Sleep Studies, Level I.
0214 Electroencephalogram...... S 2.11 $107.41 $53.71 $21.48
0215 Level I Nerve and Muscle S 0.66 $33.60 $17.47 $6.72
Tests.
0216 Level III Nerve and Muscle S 2.63 $133.88 $60.25 $26.78
Tests.
0218 Level II Nerve and Muscle S 1.04 $52.94 $23.82 $10.59
Tests.
0220 Level I Nerve Procedures.. T 13.68 $696.37 $327.29 $139.27
0221 Level II Nerve Procedures. T 21.55 $1,096.98 $463.62 $219.40
0222 Implantation of T 304.29 $15,489.58 ........... $3,097.92
Neurological Device.
0223 Implantation of Pain T 75.83 $3,860.05 ........... $772.01
Management Device.
0224 Implantation of Reservoir/ T 28.65 $1,458.40 $453.41 $291.68
Pump/Shunt.
0225 Implantation of T 269.11 $13,698.78 ........... $2,739.76
Neurostimulator
Electrodes.
0226 Implantation of Drug T 76.24 $3,880.92 ........... $776.18
Infusion Reservoir.
[[Page 9571]]
0227 Implantation of Drug T 140.36 $7,144.89 ........... $1,428.98
Infusion Device.
0228 Creation of Lumbar T 54.08 $2,752.89 $696.46 $550.58
Subarachnoid Shunt.
0229 Transcatherter Placement T 76.09 $3,873.29 $996.86 $774.66
of Intravascular Shunts.
0230 Level I Eye Tests & S 0.62 $31.56 $14.52 $6.31
Treatments.
0231 Level III Eye Tests & S 2.05 $104.35 $46.96 $20.87
Treatments.
0232 Level I Anterior Segment T 3.52 $179.18 $78.84 $35.84
Eye Procedures.
0233 Level II Anterior Segment T 10.90 $554.85 $266.33 $110.97
Eye Procedures.
0234 Level III Anterior Segment T 19.20 $977.36 $469.13 $195.47
Eye Procedures.
0235 Level I Posterior Segment T 5.60 $285.06 $78.91 $57.01
Eye Procedures.
0236 Level II Posterior Segment T 16.30 $829.74 ........... $165.95
Eye Procedures.
0237 Level III Posterior T 32.16 $1,637.07 $818.54 $327.41
Segment Eye Procedures.
0238 Level I Repair and Plastic T 3.02 $153.73 $58.96 $30.75
Eye Procedures.
0239 Level II Repair and T 5.84 $297.28 $115.94 $59.46
Plastic Eye Procedures.
0240 Level III Repair and T 13.91 $708.07 $315.31 $141.61
Plastic Eye Procedures.
0241 Level IV Repair and T 17.84 $908.13 $384.47 $181.63
Plastic Eye Procedures.
0242 Level V Repair and Plastic T 24.26 $1,234.93 $597.36 $246.99
Eye Procedures.
0243 Strabismus/Muscle T 17.81 $906.60 $431.39 $181.32
Procedures.
0244 Corneal Transplant........ T 38.69 $1,969.48 $851.42 $393.90
0245 Level I Cataract T 10.50 $534.49 $251.21 $106.90
Procedures without IOL
Insert.
0246 Cataract Procedures with T 20.73 $1,055.24 $495.96 $211.05
IOL Insert.
0247 Laser Eye Procedures T 4.05 $206.16 $94.83 $41.23
Except Retinal.
0248 Laser Retinal Procedures.. T 4.35 $221.43 $94.05 $44.29
0249 Level II Cataract T 21.93 $1,116.32 $524.67 $223.26
Procedures without IOL
Insert.
0250 Nasal Cauterization/ T 2.11 $107.41 $37.59 $21.48
Packing.
0251 Level I ENT Procedures.... T 2.44 $124.21 $27.99 $24.84
0252 Level II ENT Procedures... T 5.99 $304.91 $114.24 $60.98
0253 Level III ENT Procedures.. T 12.40 $631.21 $284.00 $126.24
0254 Level IV ENT Procedures... T 17.47 $889.29 $272.41 $177.86
0256 Level V ENT Procedures.... T 26.76 $1,362.19 $623.05 $272.44
0258 Tonsil and Adenoid T 17.53 $892.35 $437.25 $178.47
Procedures.
0259 Level VI ENT Procedures... T 378.75 $19,279.89 $9,447.14 $3,855.98
0260 Level I Plain Film Except X 0.70 $35.63 $19.60 $7.13
Teeth.
0261 Level II Plain Film Except X 1.22 $62.10 $34.15 $12.42
Teeth Including Bone
Density Measurement.
0262 Plain Film of Teeth....... X 0.65 $33.09 $10.90 $6.62
0263 Level I Miscellaneous X 1.62 $82.46 $44.53 $16.49
Radiology Procedures.
0264 Level II Miscellaneous X 3.74 $190.38 $104.71 $38.08
Radiology Procedures.
0265 Level I Diagnostic S 0.95 $48.36 $26.60 $9.67
Ultrasound Except
Vascular.
0266 Level II Diagnostic S 1.55 $78.90 $43.40 $15.78
Ultrasound Except
Vascular.
0267 Vascular Ultrasound....... S 2.34 $119.12 $65.52 $23.82
0269 Level I Echocardiogram S 3.87 $197.00 $102.44 $39.40
Except Transesophageal.
0270 Transesophageal S 5.34 $271.83 $146.79 $54.37
Echocardiogram.
0271 Mammography............... S 0.60 $30.54 $16.80 $6.11
0272 Level I Fluoroscopy....... X 1.38 $70.25 $38.64 $14.05
0274 Myelography............... S 5.27 $268.26 $128.12 $53.65
0275 Arthrography.............. S 2.61 $132.86 $69.09 $26.57
0276 Level I Digestive S 1.49 $75.85 $41.72 $15.17
Radiology.
0277 Level II Digestive S 2.16 $109.95 $60.47 $21.99
Radiology.
0278 Diagnostic Urography...... S 2.36 $120.13 $66.07 $24.03
0279 Level I Angiography and S 7.77 $395.52 $174.57 $79.10
Venography except
Extremity.
0280 Level II Angiography and S 13.63 $693.82 $353.85 $138.76
Venography except
Extremity.
0281 Venography of Extremity... S 4.35 $221.43 $115.16 $44.29
0282 Miscellaneous Computerized S 1.59 $80.94 $44.51 $16.19
Axial Tomography.
0283 Computerized Axial S 4.51 $229.58 $126.27 $45.92
Tomography with Contrast
Material.
0284 Magnetic Resonance Imaging S 7.18 $365.49 $201.02 $73.10
and Magnetic Resonance
Angiography with Contrast
Material.
0285 Positron Emission S 18.83 $958.52 $415.21 $191.70
Tomography (PET).
0286 Myocardial Scans.......... S 5.43 $276.41 $152.03 $55.28
0287 Complex Venography........ S 4.09 $208.20 $114.51 $41.64
0288 CT, Bone Density.......... S 1.18 $60.07 $33.03 $12.01
0289 Needle Localization for X 1.63 $82.97 $44.80 $16.59
Breast Biopsy.
0290 Standard Non-Imaging S 1.76 $89.59 $49.27 $17.92
Nuclear Medicine.
0291 Level I Diagnostic Nuclear S 3.52 $179.18 $90.20 $35.84
Medicine Excluding
Myocardial Scans.
0292 Level II Diagnostic S 4.22 $214.81 $118.15 $42.96
Nuclear Medicine
Excluding Myocardial
Scans.
0294 Level I Therapeutic S 5.04 $256.56 $141.11 $51.31
Nuclear Medicine.
0295 Level II Therapeutic S 12.17 $619.50 $340.73 $123.90
Nuclear Medicine.
0296 Level I Therapeutic S 3.41 $173.58 $95.47 $34.72
Radiologic Procedures.
[[Page 9572]]
0297 Level II Therapeutic S 7.11 $361.93 $172.51 $72.39
Radiologic Procedures.
0299 Miscellaneous Radiation S 0.21 $10.69 $5.66 $2.14
Treatment.
0300 Level I Radiation Therapy. S 2.08 $105.88 $47.72 $21.18
0301 Level II Radiation Therapy S 5.18 $263.68 ........... $52.74
0302 Level III Radiation S 11.23 $571.65 $216.55 $114.33
Therapy.
0303 Treatment Device X 3.01 $153.22 $69.28 $30.64
Construction.
0304 Level I Therapeutic X 1.63 $82.97 $41.52 $16.59
Radiation Treatment
Preparation.
0305 Level II Therapeutic X 3.74 $190.38 $91.38 $38.08
Radiation Treatment
Preparation.
0310 Level III Therapeutic X 14.59 $742.69 $339.05 $148.54
Radiation Treatment
Preparation.
0312 Radioelement Applications. S 124.64 $6,344.67 ........... $1,268.93
0313 Brachytherapy............. S 35.74 $1,819.31 ........... $363.86
0314 Hyperthermic Therapies.... S 3.92 $199.54 $101.77 $39.91
0320 Electroconvulsive Therapy. S 3.90 $198.53 $80.06 $39.71
0321 Biofeedback and Other S 0.93 $47.34 $21.78 $9.47
Training.
0322 Brief Individual S 1.16 $59.05 $12.40 $11.81
Psychotherapy.
0323 Extended Individual S 1.74 $88.57 $21.26 $17.71
Psychotherapy.
0324 Family Psychotherapy...... S 2.71 $137.95 ........... $27.59
0325 Group Psychotherapy....... S 1.38 $70.25 $18.27 $14.05
0330 Dental Procedures......... S 11.04 $561.98 ........... $112.40
0332 Computerized Axial S 3.26 $165.95 $91.27 $33.19
Tomography and
Computerized Angiography
without Contrast Material.
0333 Computerized Axial S 5.25 $267.25 $146.98 $53.45
Tomography and
Computerized Angio w/o
Contrast Material
followed by Contrast.
0335 Magnetic Resonance S 5.41 $275.39 $151.46 $55.08
Imaging, Miscellaneous.
0336 Magnetic Resonance Imaging S 6.32 $321.71 $176.94 $64.34
and Magnetic Resonance
Angiography without
Contrast.
0337 MRI and Magnetic Resonance S 8.60 $437.77 $240.77 $87.55
Angiography without
Contrast Material
followed by Contrast
Material.
0339 Observation............... S 6.90 $351.24 ........... $70.25
0340 Minor Ancillary Procedures X 0.85 $43.27 $10.82 $8.65
0341 Skin Tests and X 0.11 $5.60 $3.08 $1.12
Miscellaneous Red Blood
Cell Tests.
0342 Level I Pathology......... X 0.21 $10.69 $5.88 $2.14
0343 Level II Pathology........ X 0.39 $19.85 $10.72 $3.97
0344 Level III Pathology....... X 0.56 $28.51 $15.68 $5.70
0345 Level I Transfusion X 0.27 $13.74 $5.37 $2.75
Laboratory Procedures.
0346 Level II Transfusion X 0.77 $39.20 $12.03 $7.84
Laboratory Procedures.
0347 Level III Transfusion X 1.57 $79.92 $20.13 $15.98
Laboratory Procedures.
0348 Fertility Laboratory X 0.77 $39.20 ........... $7.84
Procedures.
0352 Level I Injections........ X 0.41 $20.87 ........... $4.17
0353 Level II Allergy X 0.25 $12.73 $2.92 $2.55
Injections.
0354 Administration of K 0.11 $5.60 ........... ...........
Influenza/Pneumonia
Vaccine.
0355 Level I Immunizations..... K 0.19 $9.67 $5.05 $1.93
0356 Level II Immunizations.... K 1.12 $57.01 ........... $11.40
0359 Level II Injections....... X 1.80 $91.63 ........... $18.33
0360 Level I Alimentary Tests.. X 1.36 $69.23 $34.62 $13.85
0361 Level II Alimentary Tests. X 3.27 $166.46 $83.23 $33.29
0362 Fitting of Vision Aids.... X 0.87 $44.29 $9.63 $8.86
0363 Otorhinolaryngologic X 1.74 $88.57 $32.77 $17.71
Function Tests.
0364 Level I Audiometry........ X 0.58 $29.52 $11.51 $5.90
0365 Level II Audiometry....... X 1.32 $67.19 $20.16 $13.44
0367 Level I Pulmonary Test.... X 0.70 $35.63 $17.82 $7.13
0368 Level II Pulmonary Tests.. X 1.48 $75.34 $38.42 $15.07
0369 Level III Pulmonary Tests. X 3.51 $178.67 $58.50 $35.73
0370 Allergy Tests............. X 0.81 $41.23 $11.81 $8.25
0371 Level I Allergy Injections X 0.70 $35.63 ........... $7.13
0372 Therapeutic Phlebotomy.... X 0.53 $26.98 $10.09 $5.40
0373 Neuropsychological Testing X 1.01 $51.41 $14.39 $10.28
0374 Monitoring Psychiatric X 0.89 $45.30 $9.97 $9.06
Drugs.
0600 Low Level Clinic Visits... V 0.87 $44.29 ........... $8.86
0601 Mid Level Clinic Visits... V 0.95 $48.36 ........... $9.67
0602 High Level Clinic Visits.. V 1.38 $70.25 ........... $14.05
0610 Low Level Emergency Visits V 1.24 $63.12 $19.57 $12.62
0611 Mid Level Emergency Visits V 2.16 $109.95 $36.47 $21.99
0612 High Level Emergency V 3.51 $178.67 $54.14 $35.73
Visits.
0620 Critical Care............. S 8.45 $430.14 $150.55 $86.03
0685 Level III Needle Biopsy/ T 9.21 $468.83 $206.28 $93.77
Aspiration Except Bone
Marrow.
0686 Level V Skin Repair....... T 24.15 $1,229.33 $565.49 $245.87
0687 Revision/Removal of T 42.58 $2,167.49 $997.05 $433.50
Neurostimulator
Electrodes.
[[Page 9573]]
0688 Revision/Removal of T 146.12 $7,438.09 $3,644.66 $1,487.62
Neurostimulator Pulse
Generator Receiver.
0689 Electronic Analysis of S 0.43 $21.89 $12.03 $4.38
Cardioverter-
defibrillators.
0690 Electronic Analysis of S 0.38 $19.34 $10.63 $3.87
Pacemakers and other
Cardiac Devices.
0691 Electronic Analysis of S 3.18 $161.87 $89.02 $32.37
Programmable Shunts/Pumps.
0692 Electronic Analysis of S 14.43 $734.54 $403.99 $146.91
Neurostimulator Pulse
Generators.
0693 Level II Breast T 32.00 $1,628.93 $798.17 $325.79
Reconstruction.
0694 Level III Excision/Biopsy. T 4.01 $204.13 $81.65 $40.83
0695 Level VII Debridement & T 15.87 $807.85 $266.59 $161.57
Destruction.
0697 Level II Echocardiogram S 2.09 $106.39 $55.32 $21.28
Except Transesophageal.
0698 Level II Eye Tests & S 1.04 $52.94 $20.64 $10.59
Treatments.
0699 Level IV Eye Tests & T 6.49 $330.37 $148.66 $66.07
Treatment.
0701 SR 89 chloride, per mCi... G ........... $963.42 ........... $137.92
0702 SM 153 lexidronam, 50 mCi. G ........... $1,020.00 ........... $146.02
0704 IN 111 Satumomab pendetide G ........... $1,591.25 ........... $227.80
per dose.
0705 TC 99M tetrofosmin, per G ........... $114.00 ........... $16.32
dose.
0706 New Technology--Level I S ........... $25.00 ........... $5.00
($0-$50).
0707 New Technology--Level II S ........... $75.00 ........... $15.00
($50-$100).
0708 New Technology--Level III S ........... $150.00 ........... $30.00
($100-$200).
0709 New Technology--Level IV S ........... $250.00 ........... $50.00
($200-$300).
0710 New Technology--Level V S ........... $400.00 ........... $80.00
($300-$500).
0711 New Technology--Level VI S ........... $625.00 ........... $125.00
($500-$750).
0712 New Technology--Level VII S ........... $875.00 ........... $175.00
($750-$1000).
0713 New Technology--Level VIII S ........... $1,125.00 ........... $225.00
($1000-$1250).
0714 New Technology--Level IX S ........... $1,375.00 ........... $275.00
($1250-$1500).
0715 New Technology--Level X S ........... $1,625.00 ........... $325.00
($1500-$1750).
0716 New Technology--Level XI S ........... $1,875.00 ........... $375.00
($1750-$2000).
0717 New Technology--Level XII S ........... $2,250.00 ........... $450.00
($2000-$2500).
0718 New Technology--Level XIII S ........... $2,750.00 ........... $550.00
($2500-$3000).
0719 New Technology--Level XIV S ........... $3,250.00 ........... $650.00
($3000-$3500).
0720 New Technology--Level XV S ........... $4,250.00 ........... $850.00
($3500-$5000).
0721 New Technology--Level XVI S ........... $5,500.00 ........... $1,100.00
($5000-$6000).
0725 Leucovorin calcium inj, 50 G ........... $4.15 ........... $0.38
mg.
0726 Dexrazoxane hcl injection, G ........... $194.52 ........... $24.98
250 mg.
0727 Etidronate disodium inj G ........... $63.65 ........... $9.11
300 mg.
0728 Filgrastim 300 mcg G ........... $179.08 ........... $23.00
injection.
0730 Pamidronate disodium , 30 G ........... $265.87 ........... $38.06
mg.
0731 Sargramostim injection 50 G ........... $29.06 ........... $4.16
mcg.
0732 Mesna injection 200 mg.... G ........... $36.48 ........... $3.30
0733 Non esrd epoetin alpha G ........... $12.26 ........... $1.57
inj, 1000 u.
0734 Darepoetin alfa, 1 MCG.... G ........... $4.74 ........... $0.68
0750 Dolasetron mesylate, 10 mg G ........... $16.45 ........... $2.11
0754 Metoclopramide hcl G ........... $1.17 ........... $0.11
injection up to 10 mg.
0755 Thiethylperazine maleate G ........... $4.60 ........... $0.66
inj up to 10 mg.
0762 Dronabinol 2.5mg oral..... G ........... $3.28 ........... $0.42
0763 Dolasetron mesylate oral, G ........... $69.64 ........... $8.94
100 mg.
0764 Granisetron hcl injection G ........... $18.54 ........... $2.65
10 mcg.
0765 Granisetron hcl 1 mg oral. G ........... $44.69 ........... $6.40
0768 Ondansetron hcl injection G ........... $6.09 ........... $0.78
1 mg.
0769 Ondansetron hcl 8mg oral.. G ........... $26.41 ........... $3.39
0800 Leuprolide acetate, 3.75 G ........... $93.47 ........... $12.00
mg.
0801 Cyclophosphamide oral 25 G ........... $2.03 ........... $0.18
mg.
0802 Etoposide oral 50 mg...... G ........... $52.43 ........... $6.73
0803 Melphalan oral 2 mg....... G ........... $2.29 ........... $0.33
0807 Aldesleukin/single use G ........... $672.60 ........... $96.29
vial.
0809 Bcg live intravesical vac. G ........... $166.49 ........... $21.38
0810 Goserelin acetate implant G ........... $446.49 ........... $63.92
3.6 mg.
0811 Carboplatin injection 50 G ........... $114.46 ........... $16.39
mg.
0812 Carmus bischl nitro inj G ........... $117.84 ........... $16.87
100 mg.
0813 Cisplatin 10 mg injection. G ........... $42.18 ........... $3.82
0814 Asparaginase injection G ........... $62.61 ........... $8.96
10,000 u.
0815 Cyclophosphamide 100 mg G ........... $5.82 ........... $0.75
inj.
0816 Cyclophosphamide G ........... $4.89 ........... $0.63
lyophilized 100 mg.
0817 Cytarabine hcl 100 mg inj. G ........... $6.10 ........... $0.55
0818 Dactinomycin 0.5 mg....... G ........... $13.87 ........... $1.99
0819 Dacarbazine 100 mg inj.... G ........... $12.68 ........... $1.15
0820 Daunorubicin 10 mg........ G ........... $76.62 ........... $6.94
0821 Daunorubicin citrate G ........... $64.60 ........... $9.25
liposom 10 mg.
0822 Diethylstilbestrol G ........... $14.41 ........... $1.30
injection 250 mg.
[[Page 9574]]
0823 Docetaxel, 20 mg.......... G ........... $297.83 ........... $42.64
0824 Etoposide 10 mg inj....... G ........... $10.45 ........... $0.95
0826 Methotrexate Oral 2.5 mg.. G ........... $3.45 ........... $0.31
0827 Floxuridine injection 500 G ........... $129.56 ........... $16.64
mg.
0828 Gemcitabine HCL 200 mg.... G ........... $106.72 ........... $15.28
0830 Irinotecan injection 20 mg G ........... $134.25 ........... $19.22
0831 Ifosfomide injection 1 gm. G ........... $156.64 ........... $22.42
0832 Idarubicin hcl injection 5 G ........... $412.21 ........... $59.01
mg.
0833 Interferon alfacon-1, 1 G ........... $4.10 ........... $0.59
mcg.
0834 Interferon alfa-2a inj G ........... $34.86 ........... $4.99
recombinant 3 million u.
0836 Interferon alfa-2b inj G ........... $11.28 ........... $1.45
recombinant, 1 million.
0838 Interferon gamma 1-b inj, G ........... $285.65 ........... $40.89
3 million u.
0839 Mechlorethamine hcl inj 10 G ........... $12.01 ........... $1.72
mg.
0840 Melphalan hydrochl 50 mg.. G ........... $400.74 ........... $57.37
0841 Methotrexate sodium inj 5 G ........... $0.45 ........... $0.04
mg.
0842 Fludarabine phosphate inj G ........... $271.82 ........... $38.91
50 mg.
0843 Pegaspargase, singl dose G ........... $1,225.57 ........... $179.74
vial.
0844 Pentostatin injection, 10 G ........... $1,654.14 ........... $236.80
mg.
0847 Doxorubicin hcl 10 mg vl G ........... $37.46 ........... $4.81
chemo.
0849 Rituximab, 100 mg......... G ........... $454.55 ........... $65.07
0850 Streptozocin injection, 1 G ........... $117.64 ........... $16.84
gm.
0851 Thiotepa injection, 15 mg. G ........... $116.97 ........... $10.59
0852 Topotecan, 4 mg........... G ........... $664.19 ........... $95.08
0853 Vinblastine sulfate inj, 1 G ........... $4.11 ........... $0.37
mg.
0854 Vincristine sulfate 1 mg G ........... $30.16 ........... $3.87
inj.
0855 Vinorelbine tartrate, 10 G ........... $88.83 ........... $12.72
mg.
0856 Porfimer sodium, 75 mg.... G ........... $2,603.66 ........... $372.74
0857 Bleomycin sulfate G ........... $289.37 ........... $37.16
injection 15 u.
0858 Cladribine, 1mg........... G ........... $53.39 ........... $4.83
0859 Fluorouracil injection 500 G ........... $2.73 ........... $0.25
mg.
0860 Plicamycin (mithramycin) G ........... $93.80 ........... $13.43
inj 2.5 mg.
0861 Leuprolide acetate G ........... $69.79 ........... $6.32
injection 1 mg.
0862 Mitomycin 5 mg inj........ G ........... $121.65 ........... $11.01
0863 Paclitaxel injection, 30 G ........... $173.50 ........... $22.28
mg.
0864 Mitoxantrone hcl, 5 mg.... G ........... $244.21 ........... $34.96
0865 Interferon alfa-n3 inj, G ........... $7.86 ........... $1.12
human leukocyte derived,
2.
0884 Rho d immune globulin inj, G ........... $34.11 ........... $4.38
1 dose pkg.
0886 Azathioprine oral 50mg.... G ........... $1.25 ........... $0.11
0887 Azathioprine parenteral G ........... $1.06 ........... $0.10
100 mg.
0888 Cyclosporine oral 100 mg.. G ........... $5.22 ........... $0.67
0889 Cyclosporin parenteral G ........... $25.08 ........... $3.22
250mg.
0890 Lymphocyte immune globulin G ........... $269.06 ........... $38.52
250 mg.
0891 Tacrolimus oral per 1 mg.. G ........... $2.91 ........... $0.42
0900 Alglucerase injection, per G ........... $37.53 ........... $5.37
10 u.
0901 Alpha 1 proteinase G ........... $2.09 ........... $0.30
inhibitor, 10 mg.
0902 Botulinum toxin a, per G ........... $4.39 ........... $0.63
unit.
0903 Cytomegalovirus imm IV/ G ........... $638.48 ........... $91.40
vial.
0905 Immune globulin 500 mg.... G ........... $35.63 ........... $3.23
0906 RSV-ivig, 50 mg........... G ........... $15.51 ........... $1.99
0907 Ganciclovir Sodium 500 mg K 0.42 $21.38 ........... $4.28
injection.
0908 Tetanus immune globulin G ........... $102.60 ........... $13.18
inj up to 250 u.
0909 Interferon beta-1a, 33 mcg G ........... $225.22 ........... $32.24
0910 Interferon beta-1b/0.25 mg G ........... $68.40 ........... $9.79
0911 Streptokinase per 250,000 K 1.67 $85.01 ........... $17.00
iu.
0913 Ganciclovir long act G ........... $4,750.00 ........... $680.00
implant 4.5 mg.
0916 Injection imiglucerase/ G ........... $3.75 ........... $0.54
unit.
0917 Pharmacologic stressors... K 0.35 $17.82 ........... $3.56
0925 Factor viii per iu........ G ........... $0.87 ........... $0.08
0926 Factor VIII (porcine) per G ........... $2.09 ........... $0.30
iu.
0927 Factor viii recombinant G ........... $1.12 ........... $0.14
per iu.
0928 Factor ix complex per iu.. G ........... $0.48 ........... $0.04
0929 Anti-inhibitor per iu..... G ........... $1.43 ........... $0.18
0930 Antithrombin iii injection G ........... $1.05 ........... $0.15
per iu.
0931 Factor IX non-recombinant, G ........... $0.71 ........... $0.09
per iu.
0932 Factor IX recombinant, per G ........... $1.12 ........... $0.16
iu.
0949 Plasma, Pooled Multiple K 2.80 $142.53 ........... $28.51
Donor, Solvent/Detergent
T.
0950 Blood (Whole) For K 1.98 $100.79 ........... $20.16
Transfusion.
0952 Cryoprecipitate........... K 0.66 $33.60 ........... $6.72
0954 RBC leukocytes reduced.... K 2.69 $136.93 ........... $27.39
[[Page 9575]]
0955 Plasma, Fresh Frozen...... K 2.14 $108.93 ........... $21.79
0956 Plasma Protein Fraction... K 1.20 $61.08 ........... $12.22
0957 Platelet Concentrate...... K 0.93 $47.34 ........... $9.47
0958 Platelet Rich Plasma...... K 1.11 $56.50 ........... $11.30
0959 Red Blood Cells........... K 1.95 $99.26 ........... $19.85
0960 Washed Red Blood Cells.... K 3.62 $184.27 ........... $36.85
0961 Infusion, Albumin (Human) K 2.08 $105.88 ........... $21.18
5%, 50 ml.
0962 Infusion, Albumin (Human) K 1.05 $53.45 ........... $10.69
25%, 50 ml.
0963 Albumin (human), 5%, 250 K 10.35 $526.86 ........... $105.37
ml.
0964 Albumin (human), 25%, 20 K 2.08 $105.88 ........... $21.18
ml.
0965 Albumin (human), 25%, 50ml K 5.20 $264.70 ........... $52.94
0966 Plasmaprotein fract, 5%, K 5.95 $302.88 ........... $60.58
250ml.
0970 New Technology--Level I T ........... $25.00 ........... $5.00
($0-$50).
0971 New Technology--Level II T ........... $75.00 ........... $15.00
($50-$100).
0972 New Technology--Level III T ........... $150.00 ........... $30.00
($100-$200).
0973 New Technology--Level IV T ........... $250.00 ........... $50.00
($200-$300).
0974 New Technology--Level V T ........... $400.00 ........... $80.00
($300-$500).
0975 New Technology--Level VI T ........... $625.00 ........... $125.00
($500-$750).
0976 New Technology--Level VII T ........... $875.00 ........... $175.00
($750-$1000).
0977 New Technology--Level VIII T ........... $1,125.00 ........... $225.00
($1000-$1250).
0978 New Technology--Level IX T ........... $1,375.00 ........... $275.00
($1250-$1500).
0979 New Technology--Level X T ........... $1,625.00 ........... $325.00
($1500-$1750).
0980 New Technology--Level XI T ........... $1,875.00 ........... $375.00
($1750-$2000).
0981 New Technology--Level XII T ........... $2,250.00 ........... $450.00
($2000-$2500).
0982 New Technology--Level XIII T ........... $2,750.00 ........... $550.00
($2500-$3000).
0983 New Technology--Level XIV T ........... $3,250.00 ........... $650.00
($3000@ndash;$3500).
0984 New Technology--Level XV T ........... $4,250.00 ........... $850.00
($3500-$5000).
0985 New Technology--Level XVI T ........... $5,500.00 ........... $1,100.00
($5000-$6000).
1002 Cochlear implant system... H ........... ........... ........... ...........
1009 Cryoprecip reduced plasma. K 0.82 $41.74 ........... $8.35
1010 Blood, L/R, CMV-neg....... K 2.74 $139.48 ........... $27.90
1011 Platelets, HLA-m, L/R, K 11.27 $573.69 ........... $114.74
unit.
1012 Platelet concentrate, L/R, K 1.83 $93.15 ........... $18.63
irradiated, unit.
1013 Platelet concentrate, L/R, K 1.12 $57.01 ........... $11.40
unit.
1014 Platelets, aph/pher, L/R, K 8.50 $432.68 ........... $86.54
unit.
1016 Blood, L/R, froz/ K 6.80 $346.15 ........... $69.23
deglycerol/washed.
1017 Platelets, aph/pher, L/R, K 8.86 $451.01 ........... $90.20
CMV-neg, unit.
1018 Blood, L/R, irradiated.... K 2.98 $151.69 ........... $30.34
1019 Platelets, aph/pher, L/R, K 9.16 $466.28 ........... $93.26
irradiated, unit.
1024 Quinupristin/dalfopristin G ........... $102.05 ........... $13.11
500 mg (150/350).
1045 Iobenguane sulfate I-131.. G ........... $495.65 ........... $70.96
1058 TC 99M oxidronate, per G ........... $36.74 ........... $5.26
vial.
1059 Cultured chondrocytes G ........... $14,250.00 ........... $2,040.00
implnt.
1064 I-131 cap, each add mCi... G ........... $5.86 ........... $0.75
1065 I-131 sol, each add mCi... G ........... $15.81 ........... $2.03
1066 IN 111 satumomab pendetide G ........... $1,591.25 ........... $227.80
1079 CO 57/58 0.5 mCi.......... G ........... $253.84 ........... $36.34
1084 Denileukin diftitox, 300 G ........... $999.88 ........... $143.14
MCG.
1086 Temozolomide, oral 5 mg... G ........... $6.05 ........... $0.87
1087 I-123 per 100 uci......... G ........... $0.65 ........... $0.06
1089 Coo 57, 0.5 Mci........... G ........... $81.10 ........... $10.41
1091 IN 111 Oxyquinoline, per G ........... $427.50 ........... $61.20
.5 mCi.
1092 IN 111 Pentetate, per 0.5 G ........... $256.50 ........... $23.22
mCi.
1094 TC 99M Albumin aggr,1.0 G ........... $33.09 ........... $4.25
cmCi.
1095 Technetium TC 99M G ........... $38.00 ........... $5.44
Depreotide.
1096 TC 99M Exametazime, per G ........... $445.31 ........... $63.75
dose.
1097 TC 99M Mebrofenin, per G ........... $51.44 ........... $7.36
vial.
1098 TC 99M Pentetate, per vial G ........... $22.43 ........... $2.88
1099 TC 99M Pyrophosphate, per G ........... $39.11 ........... $5.60
vial.
1122 TC 99M arcitumomab, per G ........... $1,235.00 ........... $176.80
vial.
1166 Cytarabine liposomal, 10 G ........... $371.45 ........... $53.18
mg.
1167 Epirubicin hcl, 2 mg...... G ........... $24.94 ........... $3.57
1178 Busulfan IV, 6 mg......... G ........... $26.48 ........... $3.79
1188 I-131 cap, per 1-5 mCi.... G ........... $117.25 ........... $15.06
1200 TC 99M Sodium G ........... $22.61 ........... $3.24
Glucoheptonate.
1201 TC 99M succimer, per vial. G ........... $135.66 ........... $19.42
1202 TC 99M Sulfur Colloid, per G ........... $76.00 ........... $9.76
dose.
1203 Verteporfin for injection. G ........... $1,458.25 ........... $208.76
1205 Technetium Tc 99m G ........... $79.17 ........... $11.33
disofenin.
[[Page 9576]]
1207 Octreotide acetate depot G ........... $138.08 ........... $19.77
1mg.
1305 Apligraf.................. G ........... $1,157.81 ........... $165.75
1348 I-131 sol, per 1-6 mCi.... G ........... $146.57 ........... $18.82
1400 Diphenhydramine hcl 50mg.. G ........... $0.23 ........... $0.02
1401 Prochlorperazine maleate G ........... $0.65 ........... $0.06
5mg.
1402 Promethazine hcl 12.5mg G ........... $0.01 ........... ...........
oral.
1403 Chlorpromazine hcl 10mg G ........... $0.27 ........... $0.02
oral.
1404 Trimethobenzamide hcl G ........... $0.38 ........... $0.03
250mg.
1405 Thiethylperazine G ........... $0.56 ........... $0.08
maleate10mg.
1406 Perphenazine 4mg oral..... G ........... $0.62 ........... $0.06
1407 Hydroxyzine pamoate 25mg.. G ........... $0.28 ........... $0.03
1409 Factor viia recombinant, G ........... $1,596.00 ........... $228.48
per 1.2 mg.
1600 Technetium TC 99M G ........... $121.70 ........... $17.42
sestamibi.
1601 Technetium TC 99M G ........... $42.18 ........... $5.42
medronate.
1602 Technetium TC 99M apcitide G ........... $475.00 ........... $68.00
1603 Thallous chloride TL 201, G ........... $78.16 ........... $7.08
per mCi.
1604 IN 111 capromab pendetide, G ........... $2,192.13 ........... $313.82
per dose.
1605 Abciximab injection, 10 mg G ........... $513.02 ........... $73.44
1606 Anistreplase, 30 u........ G ........... $2,693.80 ........... $385.64
1607 Eptifibatide injection, 5 G ........... $11.31 ........... $1.45
mg.
1608 Etanercept injection, 25 G ........... $141.01 ........... $20.19
mg.
1609 Rho(D) immune globulin h, G ........... $20.55 ........... $2.64
sd, 100 iu.
1611 Hylan G-F 20 injection, 16 G ........... $213.87 ........... $27.47
mg.
1612 Daclizumab, parenteral, 25 G ........... $397.29 ........... $56.88
mg.
1613 Trastuzumab, 10 mg........ G ........... $52.83 ........... $7.56
1614 Valrubicin, 200 mg........ G ........... $423.22 ........... $60.59
1615 Basiliximab, 20 mg........ G ........... $1,437.78 ........... $205.83
1616 Histrelin acetate, 10 mgs. G ........... $14.16 ........... $2.03
1617 Lepirudin................. G ........... $131.96 ........... $18.89
1618 Vonwillebrandfactrcmplx, G ........... $0.95 ........... $0.14
per iu.
1619 Ga 67, per mCi............ G ........... $25.62 ........... $2.32
1620 Technetium tc99m bicisate. G ........... $403.99 ........... $57.83
1621 Xenin xe 133.............. G ........... $29.93 ........... $2.71
1622 Technetium tc99m G ........... $137.75 ........... $19.72
mertiatide.
1623 Technetium tc99m G ........... $22.61 ........... $3.24
glucepatate.
1624 Sodium phosphate p32...... G ........... $81.10 ........... $7.78
1625 Indium 111-in G ........... $935.75 ........... $133.96
pentetreotide.
1626 Technetium tc99m G ........... $1.47 ........... $0.21
oxidronate.
1627 Technetium tc99mlabeled G ........... $40.90 ........... $5.85
rbcs.
1628 Chromic phosphate p32..... G ........... $150.86 ........... $21.60
1713 Anchor/screw bn/bn,tis/bn. H ........... ........... ........... ...........
1714 Cath, trans atherectomy, H ........... ........... ........... ...........
dir.
1715 Brachytherapy needle...... H ........... ........... ........... ...........
1716 Brachytx seed, Gold 198... H ........... ........... ........... ...........
1717 Brachytx seed, HDR Ir-192. H ........... ........... ........... ...........
1718 Brachytx seed, Iodine 125. H ........... ........... ........... ...........
1719 Brachytxseed, Non-HDR Ir- H ........... ........... ........... ...........
192.
1720 Brachytx seed, Palladium H ........... ........... ........... ...........
103.
1721 AICD, dual chamber........ H ........... ........... ........... ...........
1722 AICD, single chamber...... H ........... ........... ........... ...........
1724 Cath, trans H ........... ........... ........... ...........
atherec,rotation.
1725 Cath, translumin non-laser H ........... ........... ........... ...........
1726 Cath, bal dil, non- H ........... ........... ........... ...........
vascular.
1727 Cath, bal tis dis, non-vas H ........... ........... ........... ...........
1728 Cath, brachytx seed adm... H ........... ........... ........... ...........
1729 Cath, drainage............ H ........... ........... ........... ...........
1730 Cath, EP, 19 or fewer H ........... ........... ........... ...........
elect.
1731 Cath, EP, 20 or more elec. H ........... ........... ........... ...........
1732 Cath, EP, diag/abl, 3D/ H ........... ........... ........... ...........
vect.
1733 Cath, EP, othr than cool- H ........... ........... ........... ...........
tip.
1750 Cath, hemodialysis,long- H ........... ........... ........... ...........
term.
1751 Cath, inf, per/cent/ H ........... ........... ........... ...........
midline.
1752 Cath, hemodialysis,short- H ........... ........... ........... ...........
term.
1753 Cath, intravas ultrasound. H ........... ........... ........... ...........
1754 Catheter, intradiscal..... H ........... ........... ........... ...........
1755 Catheter, intraspinal..... H ........... ........... ........... ...........
1756 Cath, pacing, transesoph.. H ........... ........... ........... ...........
1757 Cath, thrombectomy/ H ........... ........... ........... ...........
embolect.
1758 Cath, ureteral............ H ........... ........... ........... ...........
[[Page 9577]]
1759 Cath, intra H ........... ........... ........... ...........
echocardiography.
1760 Closure dev, vasc, imp/ H ........... ........... ........... ...........
insert.
1762 Conn tiss, human (inc H ........... ........... ........... ...........
fascia).
1763 Conn tiss, non-human...... H ........... ........... ........... ...........
1764 Event recorder, cardiac... H ........... ........... ........... ...........
1765 Adhesion barrier.......... H ........... ........... ........... ...........
1766 Intro/sheath, strble, non- H ........... ........... ........... ...........
peel.
1767 Generator, neurostim, imp. H ........... ........... ........... ...........
1768 Graft, vascular........... H ........... ........... ........... ...........
1769 Guide wire................ H ........... ........... ........... ...........
1770 Imaging coil, MR, H ........... ........... ........... ...........
insertable.
1771 Rep dev, urinary, w/sling. H ........... ........... ........... ...........
1772 Infusion pump, H ........... ........... ........... ...........
programmable.
1773 Retrieval dev, insert..... H ........... ........... ........... ...........
1775 FDG, per dose (4-40 mCi/ G ........... $475.00 ........... $68.00
ml).
1776 Joint device (implantable) H ........... ........... ........... ...........
1777 Lead, AICD, endo single H ........... ........... ........... ...........
coil.
1778 Lead, neurostimulator..... H ........... ........... ........... ...........
1779 Lead, pmkr, transvenous H ........... ........... ........... ...........
VDD.
1780 Lens, intraocular......... H ........... ........... ........... ...........
1781 Mesh (implantable)........ H ........... ........... ........... ...........
1782 Morcellator............... H ........... ........... ........... ...........
1784 Ocular dev, intraop, det H ........... ........... ........... ...........
ret.
1785 Pmkr, dual, rate-resp..... H ........... ........... ........... ...........
1786 Pmkr, single, rate-resp... H ........... ........... ........... ...........
1787 Patient progr, neurostim.. H ........... ........... ........... ...........
1788 Port, indwelling, imp..... H ........... ........... ........... ...........
1789 Prosthesis, breast, imp... H ........... ........... ........... ...........
1813 Prosthesis, penile, H ........... ........... ........... ...........
inflatab.
1815 Pros, urinary sph, imp.... H ........... ........... ........... ...........
1816 Receiver/transmitter, H ........... ........... ........... ...........
neuro.
1817 Septal defect imp sys..... H ........... ........... ........... ...........
1874 Stent, coated/cov w/del H ........... ........... ........... ...........
sys.
1875 Stent, coated/cov w/o del H ........... ........... ........... ...........
sy.
1876 Stent, non-coa/no-cov w/ H ........... ........... ........... ...........
del.
1877 Stent, non-coat/cov w/o H ........... ........... ........... ...........
del.
1878 Matrl for vocal cord...... H ........... ........... ........... ...........
1879 Tissue marker, imp........ H ........... ........... ........... ...........
1880 Vena cava filter.......... H ........... ........... ........... ...........
1881 Dialysis access system.... H ........... ........... ........... ...........
1882 AICD, other than sing/dual H ........... ........... ........... ...........
1883 Adapt/ext, pacing/neuro H ........... ........... ........... ...........
lead.
1885 Cath, translumin angio H ........... ........... ........... ...........
laser.
1887 Catheter, guiding......... H ........... ........... ........... ...........
1891 Infusion pump, non-prog, H ........... ........... ........... ...........
perm.
1892 Intro/sheath, fixed, peel- H ........... ........... ........... ...........
away.
1893 Intro/sheath, fixed, non- H ........... ........... ........... ...........
peel.
1894 Intro/sheath, non-laser... H ........... ........... ........... ...........
1895 Lead, AICD, endo dual coil H ........... ........... ........... ...........
1896 Lead, AICD, non sing/dual. H ........... ........... ........... ...........
1897 Lead, neurostim test kit.. H ........... ........... ........... ...........
1898 Lead, pmkr, other than H ........... ........... ........... ...........
trans.
1899 Lead, pmkr/AICD H ........... ........... ........... ...........
combination.
2615 Sealant, pulmonary, liquid H ........... ........... ........... ...........
2616 Brachytx seed, Yttrium-90. H ........... ........... ........... ...........
2617 Stent, non-cor, tem w/o H ........... ........... ........... ...........
del.
2618 Probe, cryoablation....... H ........... ........... ........... ...........
2619 Pmkr, dual, non rate-resp. H ........... ........... ........... ...........
2620 Pmkr, single, non rate- H ........... ........... ........... ...........
resp.
2621 Pmkr, other than sing/dual H ........... ........... ........... ...........
2622 Prosthesis, penile, non- H ........... ........... ........... ...........
inf.
2625 Stent, non-cor, tem w/del H ........... ........... ........... ...........
sys.
2626 Infusion pump, non-prog, H ........... ........... ........... ...........
temp.
2627 Cath, suprapubic/ H ........... ........... ........... ...........
cystoscopic.
2628 Catheter, occlusion....... H ........... ........... ........... ...........
2629 Intro/sheath, laser....... H ........... ........... ........... ...........
2630 Cath, EP, cool-tip........ H .......... 
