[Federal Register Volume 64, Number 91 (Wednesday, May 12, 1999)]
[Rules and Regulations]
[Pages 25456-25460]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 99-11511]
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DEPARTMENT OF HEALTH AND HUMAN SERVICES
Health Care Financing Administration
42 CFR Parts 405, 410, 413, 414, 415, 424, and 485
[HCFA-1006-CN]
RIN 0938-AI52
Medicare Program; Revisions to Payment Policies and Adjustments
to the Relative Value Units Under the Physician Fee Schedule for
Calendar Year 1999; 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
November 2, 1998, entitled ``Medicare Program; Revisions to Payment
Policies and Adjustments to the Relative Value Units Under the
Physician Fee Schedule for Calendar Year 1999.''
EFFECTIVE DATE: January 1, 1999.
FOR FURTHER INFORMATION CONTACT: Diane Milstead, (410) 786-3355
SUPPLEMENTARY INFORMATION:
Background
In FR Doc. 98-29181 of November 2, 1998, (63 FR 58814), there were
a number of technical errors. The errors relate to the omission of
background information, an incorrect reference, the qualification
requirements for nonphysician practitioners, a typographical error, a
correction to a CPT code modifier in Table 6, an inconsistency in the
preamble and addendum, the omission of status indicator references, the
omission of a facility type in the regulations text, and revisions to
Addendum B.
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, 1998, that is, January 1, 1999.
Discussion of Addendum B
1. We inadvertently omitted the professional and technical portions
for the following CPT code. Entries on the page listed below are
corrected as follows: Page 59073 for CPT codes 78020-26 and 78020-TC.
These corrections are reflected in correction number 19 to follow.
2. We assigned incorrect status codes to the following CPT codes.
Entries on pages listed below are corrected as follows: Page 59087 for
CPT code 82251; page 59114 for CPT codes 90471 and 90472; page 59181
for CPT code R0070; and page 59182 for CPT code R0075. These
corrections are reflected in correction number 20 to follow.
3. We assigned incorrect RVUs or modifiers for the following CPT
codes. Entries on pages listed below are corrected as follows: Page
59109 for CPT code 88141; page 59132 for CPT codes 94014, 94014-26, and
94014-TC; 94015, 94015-26, 94015-TC; and 94016; page 59168 for CPT code
G0124; and page 59169 for CPT code G0141. These corrections are
reflected in correction number 21 to follow.
4. We stated that we would not provide a transition for codes
representing services that are new beginning in 1999. The codes
identified below are new CPT codes, but do not represent new services.
These codes were previously reported with a different CPT code. We
failed to apply the transition to these services. The corrected RVUs
for the codes are as follows: Page 58965 for CPT codes 31623, 31624,
and 31643; page 58977 for CPT codes 35682, and 35683; page 59133 for
CPT codes 94621, 94621-26, and 94621-TC. These corrections are
reflected in correction number 22 to follow.
5. We erroneously assigned relative value units to the following
CPT codes in the facility setting. By definition the following CPT
codes cannot be performed in the facility setting. Columns associated
with facility relative value units should be set to NA in Addendum B.
Entries on pages listed below are corrected as follows: Page 59144 for
CPT codes 99321, 99322, 99323, 99331, 99332, 99333, 99341, 99342,
99343, 99344, 99345, 99347, 99348, 99349, and 99350; page 59145 for CPT
codes 99374 and 99375. These corrections are reflected in correction
number 23 to follow.
Correction of Errors
In FR Doc. 98-29181 of November 2, 1998, make the following
corrections:
1. On page 58814, column three, ``Table of Contents'', after
subsection ``I.B'', add a new subsection ``C'' to read as follows:
``C. Components of the Fee Schedule Payment Amounts''
2. On page 58816, column one, add a new subsection ``C'', to read
as follows:
``C. Components of the Fee Schedule Payment Amounts''
Under the formula set forth in section 1848(b)(1) of the Act, the
payment amount for each service paid for under the physician fee
schedule is the product of three factors: (1) A nationally uniform
relative value for the service; (2) a geographic adjustment factor
(GAF) for each physician fee schedule area; and (3) a nationally
uniform conversion factor (CF) for the service. The CF converts the
relative values into payment amounts.
For each physician fee schedule service, there are three relative
values: (1) An RVU for physician work; (2) an RVU for practice expense
(NOTE: This RVU will vary on a code by code basis depending upon if the
service is performed in a facility or non-facility setting); and (3) an
RVU for malpractice
[[Page 25457]]
expense. For each of these components of the fee schedule there is a
geographic practice cost index (GPCI) for each fee schedule area. The
GPCIs reflect the relative costs of practice expenses, malpractice
insurance, and physician work in an area compared to the national
average for each component.
The general formula for calculating the Medicare fee schedule
amount for a given service in a given fee schedule area can be
expressed as:
Payment = [(RVU work * GPCI work) + (RVU practice expense * GPCI
practice expense) + (RVU malpractice * GPCI malpractice)] * CF
The CF for calendar year 1999 appears in Section V. ``Physician Fee
Schedule Update and Conversion Factor for Calendar Year 1999.'' The
RVUs for calendar year 1999 are in Addendum B. The GPCIs for calendar
year 1999 can be found in Addendum D of the October 31, 1997, final
rule (62 FR 59255).
Section 1848(e) of the Act requires the Secretary to develop GAFs
for all physician fee schedule areas. The total GAF for a fee schedule
area is equal to a weighted average of the individual GPCIs for each of
the three components of the service. Thus, the GPCIs reflect the
relative costs of practice expenses, malpractice insurance, and
physician work in an area compared to the national average. In
accordance with the law, however, the GAF for the physician's work
reflects one-quarter of the relative cost of physician's work compared
to the national average.''
3. On page 58827, in column three, bullet two, line two, ``REUS''
is corrected to read ``RVUs.''
4. On page 58828, in column 1, the first full paragraph, lines 4
and 11, ``REUS'' is corrected to read ``RVUs.''
5. On page 58844, there is an inaccuracy in the discussion
concerning physician direction of concurrent anesthesia services. In
the discussion, we inadvertently failed to include the revisions to the
policy that were made in the September 1, 1983 final rule (48 FR 39740)
and currently appear in section 15018C of the Medicare Carrier Manual
(MCM).
Therefore, on page 58844, column three, the second full paragraph
from the top is corrected to read as follows: ``If a physician is
directing four concurrent surgical procedures and devotes extensive
time to checking or discharging other patients in the recovery room or
handling scheduling matters, this could unduly diminish physician
involvement in the surgical cases. If significantly reduced, a
physician's involvement in the surgical cases would become
``supervision'' rather than ``medical direction.'' Also, a physician
cannot personally be extensively involved in recovery room or
scheduling matters of significant duration because such personal
services would diminish the scope of control necessary for medical
direction.''
6. On page 58874, in the second column, third paragraph beginning
``Result of evaluation of comments'' we discuss the qualifications
required for a nurse practitioner to be eligible for Medicare Part B
payment. We erred in establishing the effective date for the
requirements for nurse practitioners. The date should be January 1,
2000. The provisions for nurse practitioner qualifications will not be
effective until January 1, 2000. In column 2, paragraph 3, line 3,
insert the words ``after December 31, 1999,'' after the comma.
7. On page 58878, in the third column, fourth full paragraph, the
first bullet, the name of the national accreditation organization was
published incorrectly. Therefore, remove the word ``National.'' Also,
we inadvertently omitted the word ``or'' after the semicolon. The word
``or'' was included in the proposed rule and there was no change
intended in this area. Therefore, the word ``or'' should be added after
the semicolon. The first bullet should now read as follows: ``Has
graduated from a physician assistant educational program that is
accredited by the Commission on Accreditation of Allied Health
Education Programs; or''
In the second bullet, the third line we incorrectly stated that the
national certification examination is ``certified'' by the National
Commission on Certification of Physician Assistants. This organization
``administers'' the examination. Therefore, the word ``certified'' is
removed and replaced with ``administered.'' The second bullet should
now read as follows: ``Has passed the national certification
examination that is administered by the National Commission on
Certification of Physician Assistants; and'
8. On page 58889, in Table 6, the last line, the second column, the
modifier for CPT code 94014, remove ``26'' and leave the column blank.
9. On page 58892, in the third column, the third bullet, line 6,
remove the word ``National''. In line 7, remove the second use of the
word ``on'' and add the word ``of'', and add the word ``or'' after the
semicolon. Line 11, the word ``certified'' is replaced with
``administered.'' The third bullet should now read as follows: ``
Proposed Sec. 410.74(c) is revised to state that a physician assistant
is an individual who--
Has graduated from a physician assistant educational
program that is accredited by the Commission on Accreditation of Allied
Health Education Programs; or
Has passed the national certification examination that is
administered by the National Commission on Certification of Physician
Assistants; and
Is licensed by the State to practice as a physician
assistant.''
Sec. 410.74 [Corrected]
10. On page 58908, in column one, in the regulations text, under
Sec. 410.74, paragraph (c)(1), remove the word ``National'' and add the
word ``or'' after the semicolon. In paragraph (c)(2), line two, remove
the word ``of'' and add the phrase ``that is administered by.''
Sec. 410.75 [Corrected]
11. On page 58908, in column one, in the regulations text, under
Sec. 410.75, paragraph (b), ``For'' is corrected to read, ``After
December 31, 1999, for''.
Sec. 414.32 [Corrected]
12. On page 58911, in the first column, correct the amendatory
language in item 5, and add paragraph (a)(6) to read as follows:
``5. In Sec. 414.32, the heading and paragraphs (a)(6) and (b) are
revised to read as follows:
(a) Definition. * * *
(6) Skilled nursing facilities.''
Sec. 485.705 [Corrected]
13. On page 58913, in column one, in the regulations text, under
Sec. 485.705, paragraph (c)(8) introductory text is corrected to read
as follows:
``(c) * * *
(8) After December 31, 1999, a nurse practitioner is a person who
must:''
14. On page 58913, column one, Sec. 485.705(c)(10)(i) is corrected
by removing the word ``National'' and, after the semicolon, replacing
the word ``and'' with ``or'' and paragraph (c)(10)(ii) is corrected by,
removing the word ``certified'' and adding ``administered'' in its
place. In paragraph (c)(10)(iii), the first use of the phrase ``as a
physician assistant'' is removed.
Addendum B [Corrected]
15. On page 58913, in column three, add the following after the
entry for status code ``G':
``H = Deleted modifier (code used to have a modifier of TC and PC)
I = Code not valid for Medicare purposes. Medicare does not recognize
codes assigned this status. Medicare uses another code
[[Page 25458]]
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.''
16. On page 58914, in columns two and three, in the definitions for
``11'' and ``12'', remove the words ``for 1999.''
Addendum B
17. In the table of Addendum B, the following CPT codes are added
to read as follows:
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Transi- Transi-
Non- tioned Facility tioned Transi- Transi-
CPT1 \1\ HCPCS Physi- facility non- practice facility Mal-prac- Non- tioned Facility tioned
\2\ Mod Status Description cian work practice facility expense pratice tice RVUs facility non- Total facility Global
RVUs \3\ expense expense RVUs expense total facility total
RVUs RVUs RVUs total
------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
* * * * * * *
78020.......... 26 A Thyroid met uptake.. 0.60 0.02 0.02 0.02 0.02 0.02 0.64 0.64 0.64 0.64 ZZZ
78020.......... TC A Thyroid met uptake.. 0.00 0.15 0.15 0.15 0.15 0.06 0.21 0.21 0.21 0.21 ZZZ
* * * * * * *
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\1\ CPT codes and descriptions only are copyright 1998 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.
18. In the table to Addendum B, the following CPT codes are
correctly revised to read as follows:
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Non-
Physician facility Transitioned Facility Transitioned Non- Transitioned Transitioned
CPT1 \1\/ Mod Status Description work RVUs practice non-facility practice facility Malpractice facility non-facility Facility facility Global
HCPCS \2\ \3\ expense expense RVUs expense pratice RVUs total total total total
RVUs RVUs expense RVUs
------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
* * * * * * *
82251........ X Assay Bilirubin.. 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 XXX
* * * * * * *
90471........ X Immunization 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 XXX
admin, single.
90472........ X Immunization 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 XXX
admin, 2+.
* * * * * * *
R0070........ C Transport 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 XXX
portable x-ray.
R0075........ C Transport port x- 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 XXX
ray multipl.
* * * * * * *
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\1\ CPT codes and descriptions only are copyright 1998 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.
19. In the table to Addendum B, the following CPT codes are
correctly revised to read as follows:
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Non-
Physician facility Transitioned Facility Transitioned Non- Transitioned Transitioned
CPT1 \1\/ Mod Status Description work RVUs practice non-facility practice facility Malpractice facility non-facility Facility facility Global
HCPCS \2\ \3\ expense expense RVUs expense pratice RVUs total total total total
RVUs RVUs expense RVUs
------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
* * * * * * *
88141........ A Cytpath c/vag 0.42 0.18 0.56 0.18 0.31 0.03 .63 1.01 0.63 0.76 ZZZ
interpret.
* * * * * * *
94014........ A Patient recorded 0.52 0.63 0.63 0.63 0.63 0.04 1.19 1.19 1.19 1.19 XXX
spirometry.
94014........ 26 H Patient recorded 0.52 0.20 0.20 0.20 0.20 0.02 0.74 0.74 0.74 0.74 XXX
spirometry.
94014........ TC H Patient recorded 0.00 0.43 0.43 0.43 0.43 0.02 0.45 0.45 0.45 0.45 XXX
spirometry.
94015........ A Patient recorded 0.00 0.43 0.00 0.43 0.00 0.02 0.45 0.00 0.45 0.00 XXX
spirometry.
94015........ 26 H Patient recorded 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 XXX
spirometry.
94015........ TC H Patient recorded 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 XXX
spirometry.
94016........ A Review patient 0.52 0.20 0.20 0.20 0.20 0.02 0.74 0.74 0.74 0.74 XXX
spirometry.
* * * * * * *
G0124........ A Screen c/v thin 0.42 0.18 0.30 0.18 0.30 0.03 0.63 0.75 0.63 0.75 XXX
layer by MD.
G0141........ A Scr c/v cyto, 0.42 0.18 0.15 0.18 0.15 0.03 0.63 0.60 0.63 0.60 XXX
autosys and md.
* * * * * * *
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\1\ CPT codes and descriptions only are copyright 1998 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.
20. In the table to Addendum B, the following CPT codes are
correctly revised to read as follows:
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Non-
Physician facility Transitioned Facility Transitioned Non- Transitioned Transitioned
CPT1 \1\/ Mod Status Description work RVUs practice non-facility practice facility Malpractice facility non- Facility facility Global
HCPCS \2\ \3\ expense expense RVUs expense pratice RVUs total facility total total
RVUs RVUs expense RVUs total
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* * * * * * *
31623........ A Dx Bronchoscope/ 3.07 3.33 3.34 1.25 2.82 0.27 6.67 6.68 4.59 6.16 OOO
brush.
31624........ A Dx Bronchoscope/ 3.11 3.35 3.34 1.26 2.82 0.27 6.73 6.72 4.64 6.20 OOO
lavage.
* * * * * * *
31643........ A Dx Bronchoscope/ 3.50 1.73 2.94 1.23 2.81 0.66 5.89 7.10 5.39 6.97 OOO
catheter.
[[Page 25459]]
* * * * * * *
35682........ A Composite bypass 7.20 2.81 7.92 2.74 7.90 2.75 12.76 17.87 12.69 17.85 ZZZ
graft.
35683........ A Composite bypass 8.50 3.32 8.05 3.22 8.02 2.75 14.57 19.30 14.47 19.27 ZZZ
graft.
* * * * * * *
94621........ A Plum stress/test 0.88 1.74 2.11 1.74 2.11 0.12 2.74 3.11 2.74 3.11 XXX
complex.
94621........ 26 A Plum stress/test 0.88 0.27 0.64 0.27 0.64 0.04 1.19 1.56 1.19 1.56 XXX
complex.
94621........ TC A Plum stress/test 0.00 1.47 1.47 1.47 1.47 0.08 1.55 1.55 1.55 1.55 XXX
complex.
* * * * * * *
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\1\ CPT codes and descriptions only are copyright 1998 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.
21. In the table to Addendum B, the following CPT codes are
correctly revised to read as follows:
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Non-
Physician facility Transitioned Facility Transitioned Non- Transitioned
CPT1\1\/ HCPCS\2\ Mod Status Description work practice non-facility practice facility Malpractice facility facility Facility Transitioned Global
RVUs\3\ expense expense RVUs expense practice RVUs total total total facility
RVUs RVUs expense RVUs
----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
* * * * * * *
99321............................ ............. A.............. Rest home visit, 0.71 0.38 0.40 NA NA 0.02 1.11 1.13 NA NA XXX
new patient.
99322............................ ............. A.............. Rest home visit, 1.01 0.59 0.56 NA NA 0.04 1.64 1.61 NA NA XXX
new patient.
99323............................ ............. A.............. Rest home visit, 1.28 0.74 0.78 NA NA 0.05 2.07 2.11 NA NA XXX
new patient.
99331............................ ............. A.............. Rest home visit, 0.60 0.38 0.32 NA NA 0.02 1.00 0.94 NA NA XXX
estab pat.
99332............................ ............. A.............. Rest home visit, 0.80 0.48 0.41 NA NA 0.02 1.30 1.23 NA NA XXX
estab pat.
99333............................ ............. A.............. Rest home visit, 1.00 0.58 0.51 NA NA 0.02 1.60 1.53 NA NA XXX
estab pat.
99341............................ ............. A.............. Home visit, new 1.01 0.49 0.56 NA NA 0.04 1.54 1.61 NA NA XXX
patient.
99342............................ ............. A.............. Home visit, new 1.52 0.74 0.67 NA NA 0.04 2.30 2.23 NA NA XXX
patient.
99343............................ ............. A.............. Home visit, new 2.27 1.09 0.90 NA NA 0.05 3.41 3.22 NA NA XXX
patient.
99344............................ ............. A.............. Home visit, new 3.03 1.35 1.03 NA NA 0.07 4.45 4.13 NA NA XXX
patient.
99345............................ ............. A.............. Home visit, new 3.79 1.61 1.09 NA NA 0.07 5.47 4.95 NA NA XXX
patient.
99347............................ ............. A.............. Home visit, estab 0.76 0.41 0.47 NA NA 0.03 1.20 1.26 NA NA XXX
patient.
99348............................ ............. A.............. Home visit, estab 1.26 0.63 0.59 NA NA 0.03 1.92 1.88 NA NA XXX
patient.
99349............................ ............. A.............. Home visit, estab 2.02 0.91 0.72 NA NA 0.04 2.97 2.78 NA NA XXX
patient.
99350............................ ............. A.............. Home visit estab 3.03 1.24 0.93 NA NA 0.05 4.32 4.01 NA NA XXX
patient.
* * * * * * *
99374............................ ............... B.............. Home health care +1.10 1.03 0.67 NA NA 0.03 2.16 1.80 NA NA XXX
supervision.
99375............................ ............. A.............. Home health care 1.73 1.11 0.69 NA NA 0.03 2.87 2.45 NA NA XXX
supervision.
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\1\ CPT codes and descriptions only are copyright 1998 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.
[[Page 25460]]
(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: April 30, 1999.
Neil J. Stillman,
Deputy Assistant Secretary for Information Resources Management.
[FR Doc. 99-11511 Filed 5-11-99; 8:45 am]
BILLING CODE 4120-01-P
