[Federal Register Volume 63, Number 20 (Friday, January 30, 1998)]
[Rules and Regulations]
[Pages 4595-4597]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 98-2328]
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DEPARTMENT OF HEALTH AND HUMAN SERVICES
Health Care Financing Administration
42 CFR Parts 400, 405, 410, 411, and 414
[HCFA-1884-CN]
RIN 0938-AH94
Medicare Program; Revisions to Payment Policies and Adjustments
to the Relative Value Units Under the Physician Fee Schedule, Other
Part B Payment Policies, and Establishment of the Clinical Psychologist
Fee Schedule for Calendar Year 1998; Correction
AGENCY: Health Care Financing Administration (HCFA), HHS.
ACTION: Correction of final rule with comment period.
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SUMMARY: This document corrects technical errors that appeared in the
final rule with comment period published in the Federal Register on
October 31, 1997 entitled ``Medicare Program; Revisions to Payment
Policies and Adjustments to the Relative Value Units Under the
Physician Fee Schedule, Other Part B Payment Policies, and
Establishment of the Clinical Psychologist Fee Schedule for Calendar
Year 1998.''
EFFECTIVE DATE: These corrections are effective October 31, 1997.
FOR FURTHER INFORMATION CONTACT:
Stanley Weintraub, (410) 786-4498.
SUPPLEMENTARY INFORMATION:
Background
In FR Doc. 97-28973 of October 31, 1997 (62 FR 59048), there were a
number of technical errors. The errors relate to an omission in the
preamble in the discussion of practice expense relative value units
(RVUs) for procedures furnished in both in-office and out-of-office
settings, to an inconsistency between the preamble discussion and
information in the addenda for HCPCS code G0101 (Cervical or Vaginal
Cancer Screening: Pelvic and Clinical Breast Examination), to
inconsistencies between the preamble discussion and the regulations
text for screening mammography and screening pelvic examinations, and
to an omission of a reference to status indicator ``I'' in the
explanation of the information in Addendum B. We also printed incorrect
information for certain procedure codes in Addendum B, beginning on
page 59103. The corrections appear in this document under the heading
``Correction of Errors.''
Correction of Errors
In FR Doc. 97-28973 of October 31, 1997 (62 FR 59048), make the
following corrections:
Page 59078
Addendum C of the proposed rule titled ``Medicare Program;
Revisions to Payment Policies Under the Physician Fee Schedule, Other
Part B Payment Policies, and Establishment of the Clinical Psychologist
Fee Schedule for Calendar Year 1998'' published in the Federal Register
on June 18, 1997 (62 FR 33158) generally provided resource-based
practice expense RVUs for both in-office and out-of-office settings. We
intended to calculate final resource-based practice expense RVUs by
code and for the two sites in the final rule. However, section 4505 of
the Balanced Budget Act of 1997 (BBA 1997) (Public Law 105-33), enacted
on August 5, 1997, postponed the implementation of this provision until
1999. For the final rule, we wanted the carriers to make the same site-
of-service calculations as they have done in previous years. However,
we neglected to change the language in the preamble to state that the
carriers will continue to calculate the differential. Therefore, on
page 59078, in the second column, in the fourth full paragraph, the
fourth sentence is incorrect and currently reads, ``To coordinate this
policy with the site-of-service distinctions in the June 1997 proposed
rule and the interaction of the provisions of section 4505 of the BBA
1997, we are listing in Addendum B the practice expense RVUs for the
two sites for the 700 procedure codes instead of allowing the carrier
to calculate the 50 percent reduction.'' Remove this sentence and
replace it with the following two sentences: ``Addendum B lists the
practice expense RVUs for both the facility and nonfacility settings.
If the code is subject to the site-of-service differential, the carrier
will reduce the facility practice expense RVU by 50 percent in
calculating the allowance for the code.''
Page 59091
On page 59091, in the first column, in the first full sentence, we
incorrectly stated that the RVUs assigned to HCPCS code G0101 (Cervical
or Vaginal Cancer Screening: Pelvic and Clinical Breast Examination)
are comparable to the RVUs assigned to a new patient office visit. This
statement is inconsistent with the RVUs assigned to this code, which
are correctly listed in Addenda B and C. We should have stated that the
RVUs for HCPCS code G0101 are comparable to the RVUs assigned to an
established patient office visit. Therefore, remove the first full
sentence in the first column on page 59091 and replace it with the
following: ``We decided that this service is comparable to a level 2
evaluation and management established patient office visit.''
Page 59100
On page 59100, there is an inaccuracy that needs to be corrected so
that the regulations text is consistent with the preamble discussion of
mammography services on pages 59078 through 59079, which states that
section 4101(a) of the BBA 1997 amends section 1834(c)(2)(A) of the
Social Security Act effective January 1, 1998 to simply provide that in
the case of any woman over 39 years of age, payment may be made for a
screening mammography if at least 11 months have passed following the
month in which the last screening mammography was performed. On page
59100, we failed to state in the amendatory language in item 4 for
Sec. 410.34 (Mammography services: Conditions for and limitations on
coverage) that we were removing paragraphs (d)(5) and (d)(6), which
specify certain age limitations on the frequency of screening
mammography before the enactment of the BBA 1997 and which are now
obsolete. In addition, because we should have removed these two
paragraphs, the line
[[Page 4596]]
of asterisks following paragraph (d)(4) in the regulations text itself
should not have been included. Therefore, on page 59100, in the first
column, correct the amendatory language in item 4 to read as follows:
``4. Section 410.34 is amended by revising the introductory text to
paragraph (d) and paragraph (d)(4), and by removing paragraphs (d)(5)
and (d)(6), to read as follows:'' Also on page 59100, in the
regulations text itself under Sec. 410.34 (Mammography services:
Conditions for and limitations on coverage), remove the asterisks that
follow paragraph (d)(4).
Page 59101
On page 59101, there is an inaccuracy that needs to be corrected so
that the regulations text is consistent with the law and the preamble
discussion of screening pelvic examinations on pages 59082 through
59083, which defines such an examination to be one performed for the
early detection of cervical or vaginal cancer without regard to whether
the results are normal or not. On page 59101, in the regulations text
under Sec. 410.56 (Screening pelvic examinations), correct paragraphs
(b)(1) and (b)(4) by removing the words ``and found to be normal'' at
the end of each sentence.
Page 59103
On page 59103, in the explanation of the information in Addendum B,
we omitted a reference to status indicator ``I.'' Therefore, on page
59103, add the following after the entry for status code ``G'':
``I=Code not valid for Medicare purposes. Medicare does not
recognize codes assigned this status. Medicare uses another code for
reporting of, and payment for, these services. This indicator is
treated in the same manner as status indicator ``G.'' Its use allows
for more efficient carrier processing of Medicare claims.
Addendum B, pages 59103 through 59247
We assigned incorrect RVUs to the following CPT codes. Entries on
the pages listed below for the codes listed are corrected as follows:
Page 59103 for CPT codes 11055, 11056, and 11057; page 59104 for CPT
code 11719; page 59158 for CPT codes 59150 and 59151; page 59183 for
CPT codes 76076 and 76076-TC; and page 59214 for CPT codes 92543,
92543-TC, and 92543-26.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Non-
Physician facility Facility Non-
CPT \1\/HCPCS MOD Status Description work RVUs practice practice Malpractice facility Facility Global
\2\ \3\ \4\ expense expense RVUs total total
RVUs \5\ RVUs \5\
--------------------------------------------------------------------------------------------------------------------------------------------------------
* * * * * * *
11055......... ............ R Trim skin lesion.. 0.27 0.26 0.26 0.01 0.54 0.54 000
11056......... ............ R Trim 2-4 skin 0.39 0.35 0.35 0.02 0.76 0.76 000
lesions.
11057......... ............ R Trim over 4 skin 0.50 0.28 0.28 0.02 0.80 0.80 000
lesions.
* * * * * * *
11719......... ............ R Trim nail(s)...... 0.11 0.24 0.12 0.01 0.36 0.24 000
* * * * * * *
59150......... ............ A Treat ectopic..... *11.20 4.53 4.53 1.05 16.78 16.78 090
59151......... ............ A Treat ectopic *11.10 8.61 8.61 0.64 20.35 20.35 090
pregnancy.
76076......... ............ A Dual energy x-ray 0.22 0.82 0.82 0.07 1.11 1.11 XXX
study.
76076......... TC.......... A Dual energy x-ray 0.00 0.72 0.72 0.05 0.77 0.77 XXX
study.
* * * * * * *
92543......... ............ A Caloric vestibular 0.10 0.21 0.21 0.02 0.33 0.33 XXX
test.
92543......... TC.......... A Caloric vestibular 0.00 0.10 0.10 0.01 0.11 0.11 XXX
test.
92543......... 26.......... A Caloric vestibular 0.10 0.11 0.11 0.01 0.22 0.22 XXX
test.
* * * * * * *
--------------------------------------------------------------------------------------------------------------------------------------------------------
\1\ CPT codes and descriptions only are copyright 1997 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply.
\2\ Copyright 1994 American Dental Association. All rights reserved.
\3\ + Indicates RVUs are not used for Medicare payment.
\4\ * Work RVUs increased in global surgical package.
\5\ # Indicates reduction of Practice Expense RVUs as a result of 110% PE reduction.
Page 59239
We erroneously assigned a status indicator of ``A'' (Active code)
in the column labeled ``Status'' for HCPCS code G0116 (NETT;
psychosocial counsel). The corrected status indicator should be ``R,''
which means restricted coverage.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Non-
Physician facility Facility Non-
CPT \1\/HCPCS MOD Status Description work practice practice Malpractice facility Facility Global
\2\ RVUS\3\ \4\ expense expense RVUs total total
RVUs\5\ RVUs\5\
--------------------------------------------------------------------------------------------------------------------------------------------------------
* * * * * * *
G0116......... ............ R NETT; psychosocial 0.11 0.35 0.35 0.05 1.51 1.51 XXX
counsel.
* * * * * * *
--------------------------------------------------------------------------------------------------------------------------------------------------------
\1\ CPT codes and descriptions only are copyright 1997 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply.
\2\ Copyright 1994 American Dental Association. All rights reserved.
\3\ Indicates RVUs are not used for Medicare payment.
\4\ Work RVUs increased in global surgical package.
\5\ Indicates reduction of Practice Expense RVUs as a result of 110% PE reduction.
Additionally, we printed incorrect short descriptors for certain
codes in Addendum B. Entries on the pages listed below for the codes
listed are corrected as follows: Page 59107 for CTP code 17200; page
59194 for CPT codes 80004, 80009, 80010, 80018, and 80019; page 59202
for CTP codes 86287, 86290, 86295, and 86311; page 59208 for CPT
[[Page 4597]]
codes 88157, and 88157-26; page 59211 for CTP codes 90825 and 90855;
and page 59226 for CPT codes 99353 and 99376.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Non-
facility Facility Non-
CPT \1\/ HCPCS MOD Status Description Physician practice practice Malpractice facility Facility Global
\2\ work RVUs 3 expense expense RVUs total total
4 RVUs \5\ RVUs \5\
--------------------------------------------------------------------------------------------------------------------------------------------------------
* * * * * * *
17200......... ............ D Electro-cautery of * 0.00 0.00 0.00 0.00 0.00 0.00 XXX
skin tags.
* * * * * * *
80004......... ............ D 4 clinical 0.00 0.00 0.00 0.00 0.00 0.00 XXX
chemistry tests.
* * * * * * *
80009......... ............ D 9 clinical 0.00 0.00 0.00 0.00 0.00 0.00 XXX
chemistry tests.
* * * * * * *
80010......... ............ D 10 clinical 0.00 0.00 0.00 0.00 0.00 0.00 XXX
chemistry tests.
* * * * * * *
80018......... ............ D 17-18 blood/urine 0.00 0.00 0.00 0.00 0.00 0.00 XXX
tests.
* * * * * * *
80019......... ............ D 19 blood/urine 0.00 0.00 0.00 0.00 0.00 0.00 XXX
tests.
* * * * * * *
86287......... ............ D Hepatitis B 0.00 0.00 0.00 0.00 0.00 0.00 XXX
(HBsAg).
* * * * * * *
86290......... ............ D Hepatitis BC 0.00 0.00 0.00 0.00 0.00 0.00 XXX
antibody test.
* * * * * * *
86295......... ............ D Hepatitis BE 0.00 0.00 0.00 0.00 0.00 0.00 XXX
antibody test.
* * * * * * *
86311......... ............ D HIV antigen test.. 0.00 0.00 0.00 0.00 0.00 0.00 XXX
* * * * * * *
88157......... ............ D TBS smear 0.00 0.00 0.00 0.00 0.00 0.00 XXX
(bethesda system).
* * * * * * *
88157......... 26.......... D TSB smear 0.00 0.00 0.00 0.00 0.00 0.00 XXX
(bethesda system).
* * * * * * *
90825......... ............ D Evaluation of 0.00 0.00 0.00 0.00 0.00 0.00 XXX
tests/records.
* * * * * * *
90855......... ............ D Individual 0.00 0.00 0.00 0.00 0.00 0.00 XXX
psychotherapy.
* * * * * * *
99353......... ............ D Home visit/estab 0.00 0.00 0.00 0.00 0.00 0.00 XXX
patient.
* * * * * * *
99376......... ............ D Care plan 0.00 0.00 0.00 0.00 0.00 0.00 XXX
oversight/over 60.
* * * * * * *
--------------------------------------------------------------------------------------------------------------------------------------------------------
\1\ CPT codes and descriptions only are copyright 1997 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply.
\2\ Copyright 1994 American Dental Association. All rights reserved.
\3\ Inidcates RVUs are not used for Medicare payment.
\4\ Work RVUs increased in global surgical package.
\5\ Indicates reduction of Practice Expense RVUs as a result of 100% reduction.
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)
Dated: January 14, 1998.
Neil J. Stillman,
Deputy Assistant, Secretary for, Information Resources Management.
[FR Doc. 98-2328 Filed 1-29-98; 8:45 am]
BILLING CODE 4120-01-M
