Medicare Program; Revisions to Payment Policies Under the Physician Fee Schedule for Calendar Year 2000

AGENCY:

Health Care Financing Administration (HCFA), HHS.

ACTION:

Correction of final rule with comment period.

SUMMARY:

This document corrects technical errors that appeared in the final rule with comment period published in the Federal Register on November 2, 1999, entitled “Medicare Program; Revisions to Payment Policies Under the Physician Fee Schedule for Calendar Year 2000.”

EFFECTIVE DATE:

January 1, 2000.

FOR FURTHER INFORMATION CONTACT:

Diane Milstead, (410) 786-3355.

SUPPLEMENTARY INFORMATION:

Background

In FR Doc. 99-28367 of November 2, 1999, (64 FR 59380), there were a number of technical errors. The errors relate to the omission of language discussing payment for pulse oximetry, temperature gradient studies and venous pressure determinations and the removal of the x-ray requirement before chiropractic manipulation; acceptance of the RUC recommendations for work relative value units (RVUs); RUC recommendations for CPT codes 17276 and 95165; a comment on codes in the “zero work” pool; discussion of CPT code 61862 and the correct billing procedures; and regulations text definitions concerning the coverage of prostate screening. Additionally there are various revisions to Addenda B and C.

The provisions in this correction notice are effective as if they had been included in the document published in the Federal Register on November 2, 1999, that is, January 1, 2000.

Discussion of Addenda B and C

1. On page 39626 of the July 22, 1999 proposed rule, we discussed revising the work RVUs for certain pediatric surgical services to reflect more appropriate data. We inadvertently omitted these work RVU changes from Addendum B of the November 2, 1999 final rule. Entries on the pages listed below are corrected as follows: Page 59451 for CPT code 21740; page 59476 for CPT codes 38550 and 38555; page 59477 for CPT code 39503; page 59479 for CPT codes 42810 and 42815; page 59480 for CPT codes 43305, 43310, 43312, and 43831; page 59482 for CPT codes 45120 and 45121; page 59483 for CPT codes 46715, 46716, 46730, 46735, 46740, and 46751; page 59484 for CPT codes 47700 and 47701; page 59485 for CPT codes 49215, 49495, 49580, 49600, 49605, and 49606; page 59488 for CPT code 51940; and page 59495 for CPT code 60280. These corrections are reflected in correction number 8 to follow.

2. On page 59421 of the November 2, 1999 final rule, we assigned 5.85 work RVUs to CPT code 61885. We inadvertently omitted this value from Addenda B and C. Entries on the pages listed below are corrected as follows: Page 59497 and page 59582 for CPT code 61885. These corrections are reflected in correction number 9 to follow.

3. In Addendum B, we assigned incorrect status indicators for the following CPT codes: Page 59553 for CPT codes 94760 and 94761; and page 59578 for HCFA Common Procedure Coding System (HCPCS) codes Q0183, Q0184, Q0185, Q0186, Q1001, Q1002, Q1003, Q1004, and Q1005. These corrections are reflected in correction number 10 to follow.

4. On page 39630 of the July 22, 1999 proposed rule, we discussed accepting the RUC work RVU recommendations for five CPT codes that were carrier priced for 1999. The status of these codes would also change from Carrier Priced (C) to Active (A) in the final rule. We inadvertently omitted the work RVUs, status indicator, and correct global indicator changes from Addendum B of the final rule. Entries on the pages listed below are corrected as follows: Page 59473 for CPT code 35500; page 59475 for CPT code 36823; page 59476 for CPT code 38792; page 59495 for CPT 60650 (renumbered from CPT code 56321 for which we accepted the RUC recommendation); page 59476 for CPT code 38120 (renumbered from CPT code 56345 for which we accepted the RUC recommendation); and page 59481 for CPT code 44201 (renumbered from CPT code 56347 for which we accepted the RUC recommendation). In addition, we failed to reflect the practice expense values assigned to these codes. These corrections are reflected in correction 11 to follow.

5. In Addendum B, we inadvertently published incorrect global periods for CPT codes 33968, 47560, 62263, 96570 and 96571. Entries on pages listed below are corrected as follows: Pages 59472 and 59582 for CPT code 33968; page 59484 for CPT code 47560; pages 59497 and 59582 for CPT code 62263; and pages 59556 and 59583 for CPT codes 96570 and 96571. These corrections are reflected in correction number 12 to follow.

6. On page 39629 of the July 22, 1999 proposed rule, we proposed changing ventricular assist device insertions, CPT codes 33975 and 33976, to an XXX global and reducing the work RVUs accordingly. In the November 2, 1999 final rule, in Addendum B, we changed the global periods to XXX but inadvertently failed to reduce the work RVUs as stated in the proposed rule. Entries on the page listed below are corrected as follows: Page 59472 for CPT codes 33975 and 33976. In addition, we failed to show the adjustments to the CPEP data made to accommodate the changing global periods. These corrections are reflected in correction number 13 to follow.

7. In Addendum B, we inadvertently assigned incorrect practice expense and malpractice RVUs to HCPCS codes G0102, G0104, G0105, and incorrect malpractice relative value units for CPT codes 59000 through 59899. Entries on the pages listed below are corrected as follows: Page 59571 for HCPCS codes G0102, G0104, and G0105; pages 59494 and 59495 for CPT codes 59000 through 59899. These corrections are reflected in correction number 14 to follow.

8. On pages 59448 and 59582 of Addendum B, we assigned an incorrect procedure status and global period to CPT code 20979. Entries on pages listed below are corrected as follows: Pages 59448 and 59582 for CPT code 20979. These corrections are reflected in correction number 15 to follow.

9. In Addendum B, we inadvertently assigned incorrect practice expense RVUs for HCPCS codes G0106, G0106-26, G0106-TC, G0120, G0120-26, G0120-TC, G0170, G0171 and CPT code 45378-53. Entries on pages listed below are corrected as follows: Page 59571 for HCPCS codes G0106, G0106-26, G0106-TC, G0120, G0120-26 and G0120-TC; page 59572 and page 59583 for G0170 and G0171; and page 59482 for CPT 45378-53. These corrections are reflected in correction number 16 to follow.

10. We incorrectly denoted that CPT code 40814 was not applicable in a non-facility setting. On page 59477 of Addendum B, the applicable practice expense values are included for the nonfacility setting for CPT code 40814. These corrections are reflected in correction number 17 to follow.

11. In Addendum B, we assigned incorrect practice expense and/or malpractice RVUs for HCPCS codes G0163, G0163-26, G0163-TC, G0164, G0164-26, G0164-TC, G0165, G0165-26, and G0165-TC. Entries on the pages listed below are corrected as follows: Page 59571 for HCPCS codes G0163, G0163-26, and G0163-TC and page 59572 for G0164, G0164-26, G0164-TC, G0165, G0165-26 and G0165-TC. These corrections are reflected in correction number 18 to follow.

Correction of Errors

In FR Doc. 99-28367 of November 2, 1999, make the following corrections:

1. On page 59395, second column, after the sixth full paragraph, add the following:

CPT code 17276, Destruction, malignant lesion, any method scalp, neck, hands, feet, genitalia; lesion diameter over 4.0cm

The RUC forwarded a recommendation for supplies. We accepted the recommendation but deleted what appeared to be duplicated gauze supplies.”

2. On page 59398, first column, after the last paragraph insert the following:

“CPT Code 95165, professional services for the supervision and provision of antigens for allergen immunotherapy.

The nature of the RUC's recommendation regarding this code was significantly different than its recommendations regarding other codes. The RUC did not examine the direct expense inputs for code 95165 but commented on the definition of dose used for claims involving this code. Because the direct expense inputs have not been reviewed, we believe that it is not appropriate to revise the practice expense value at this time.”

3. On page 59406, in the last line of column two, insert the words “, in Table 7,” between the words “95956” and “should”.

4. On page 59413, column three, after line 7, add the following:

“Result of Evaluation of Comments:

We are adopting our proposal to bundle payment for these services beginning January 2000 with the exception of code 94762, which we will continue to pay separately when continuous overnight monitoring is medically necessary as a separate procedure.

M. Removal of Requirement for X-ray Before Chiropractic Manipulation

We are conforming our regulations to section 4513(a) of the BBA that deleted the requirement that a spinal subluxation be demonstrated by an x-ray for a chiropractor to receive payment under Medicare Part B for manual manipulation of the spine to correct a subluxation.

Comment: We received one comment requesting we revise § 410.22 (Limitations on services of a chiropractor) to recognize chiropractors as physicians for purposes of ordering and furnishing diagnostic tests and other services and supplies related to manual manipulation for treatment of subluxation of the spine.

Response: We believe that extending the scope of services of the chiropractor to include other services, such as ordering and furnishing diagnostic tests, is inconsistent with section 1861(r) of the Act. Thus, we cannot implement this comment.

Comment: Two commenters expressed concern that the x-ray requirement has been removed without being replaced by clear”

5. On page 59418, in the third column, line 6 from the top, replace “69” with “85”, and line 9, replace “31” with “15”.

6. On page 59440, in the second column, § 410.39 is corrected by adding paragraphs (a)(4) and (a)(5) as follows:

7. On page 59440, in the second and third columns, in § 410.39, paragraphs (b) and (d), add the phrase “as defined in paragraphs (a)(4) or (a)(5) of this section,” after the word “midwife.”

Addendum B [Corrected]

8. In the table of Addendum B, the following CPT codes are corrected to read as follows:

9. In the table of Addenda's B and C, the following CPT code is corrected to read as follows:

10. In the table of Addendum B, the following HCPCS codes are corrected to read as follows:

11. In the table of Addendum B, the following CPT codes are corrected to read as follows:

12. In the table of Addenda's B and/or C, the following CPT codes are corrected to read as follows:

13. In table of Addendum B, the following CPT codes are corrected to read as follows:

14. In table of Addendum B, the following CPT codes are corrected to read as follows:

15. In table of Addenda B and C, the following CPT code is corrected to read as follows:

16. In the table of Addendum B, the following CPT codes are corrected to read as follows:

17. In the table of Addendum B, the following CPT code is corrected to read as follows:

18. In the table of Addendum B, the following HCPCS codes are corrected to read as follows:

(Section 1848 of the Social Security Act (42 U.S.C. 1395w-4)) (Catalog of Federal Domestic Assistance Program No. 93.774, Medicare—Supplementary Medical Insurance Program)