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Rule

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

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AGENCY:

Centers for Medicare & Medicaid Services (CMS), HHS.

ACTION:

Final rule.

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 § 419.32(b)(1)(iii), revised at 66 FR 59856, published on November 30, 2001 and § 419.62(d), added at 66 FR 55865, published on November 2, 2001, is April 1, 2002.

Start Further Info

FOR FURTHER INFORMATION CONTACT:

Robert Braver, (410) 786-0378.

End Further Info End Preamble Start Supplemental Information

SUPPLEMENTARY INFORMATION:

Availability of Copies and Electronic Access

Copies: To order copies of the Federal Register containing this document, send your request to: New Orders, Superintendent of Documents, P.O. Box 371954, Pittsburgh, PA 15250-7954. Specify the date of the issue requested and enclose a check or money order payable to the Superintendent of Documents, or enclose your Visa or Master Card number and expiration date. Credit card orders can also be placed by calling the order desk at (202) 512-1800 or by faxing to (202) 512-2250. The cost for each copy is $9. As an alternative, you can view and photocopy the Federal Register document at most libraries designated as Federal Depository Libraries and at many other public and academic libraries throughout the country that receive the Federal Register.

This Federal Register document is also available from the Federal Register online database through GPO Access, a service of the U.S. Government Printing Office. The Web site address is: http://www.access.gpo.gov/​nara/​index.html.

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 §§ 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. Start Printed 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

APCDescriptionDevice costs (before fold-in) reflected in APC rateAdditional device costs folded into APC rateTotal offset for device costs
12345
0032Insertion of Central Venous/Arterial Catheter$73.79$279.97$353.76
0046Open/Percutaneous Treatment Fracture or DislocationNA100.29100.29
0048Arthroplasty with ProsthesisNA514.64514.64
0057Bunion ProceduresNA162.89162.89
0070Thoracentesis/Lavage ProceduresNA26.4726.47
0080Diagnostic Cardiac Catheterization164.27134.39298.66 Start Printed Page 9558
0081Non-Coronary Angioplasty or Atherectomy307.06362.95670.01
0082Coronary Atherectomy242.951,214.061,457.01
0083Coronary Angioplasty528.64383.31911.95
0085Level II Electrophysiologic EvaluationNA1,578.031,578.03
0086Ablate Heart Dysrhythm FocusNA1,320.961,320.96
0087Cardiac Electrophysiologic Recording/MappingNA1,980.161,980.16
0088Thrombectomy162.72261.14423.86
0089Insertion/Replacement of Permanent Pacemaker and Electrodes3,175.703,286.366,462.06
0090Insertion/Replacement of Pacemaker Pulse Generator2,921.062,123.205,044.26
0094Resuscitation and CardioversionNA19.3419.34
0103Miscellaneous Vascular ProceduresNA207.18207.18
0104Transcatheter Placement of Intracoronary Stents428.161,256.311,684.47
0106Insertion/Replacement/Repair of Pacemaker and/or Electrodes657.591,049.131,706.72
0107Insertion of Cardioverter-Defibrillator6,803.8511,099.6217,903.47
0108Insertion/Replacement/Repair of Cardioverter-Defibrillator Leads6,940.2719,607.2026,547.47
0111Blood Product ExchangeNA209.72209.72
0115Cannula/Access Device ProceduresNA127.26127.26
0117Chemotherapy Administration by Infusion OnlyNA30.0330.03
0118Chemotherapy Administration by Both Infusion and Other TechniqueNA28.5028.50
0119Implantation of DevicesNA3,348.983,348.98
0120Infusion Therapy Except ChemotherapyNA35.1235.12
0121Level I Tube Changes and RepositioningNA6.106.10
0122Level II Tube Changes and Repositioning72.55214.82287.37
0124Revision of Implanted Infusion PumpNA3,308.763,308.76
0144Diagnostic AnoscopyNA128.28128.28
0151Endoscopic Retrograde Cholangio-Pancreatography (ERCP)60.920.0060.92
0152Percutaneous Biliary Endoscopic Procedures107.610.00107.61
0153Peritoneal and Abdominal ProceduresNA41.2341.23
0154Hernia/Hydrocele Procedures108.11378.73486.84
0161Level II Cystourethroscopy and other Genitourinary ProceduresNA11.2011.20
0162Level III Cystourethroscopy and other Genitourinary ProceduresNA319.68319.68
0163Level IV Cystourethroscopy and other Genitourinary ProceduresNA901.51901.51
0179Urinary Incontinence ProceduresNA3,400.903,400.90
0182Insertion of Penile Prosthesis2,238.90569.112,808.14
0202Level VIII Female Reproductive Proc505.321,233.411,738.73
0203Level V Nerve InjectionsNA420.98420.98
0207Level IV Nerve InjectionsNA63.6363.63
0222Implantation of Neurological Device4,458.579,599.9914,058.56
0223Implantation of Pain Management Device421.333,330.143,751.47
0225Implantation of Neurostimulator Electrodes1,182.0011,941.0613,123.06
0226Implantation of Drug Infusion ReservoirNA3,363.743,363.74
0227Implantation of Drug Infusion Device3,810.462,395.556,206.01
0229Transcatherter Placement of Intravascular Shunts1,074.41842.971,917.38
0246Cataract Procedures with IOL Insert146.820.00146.82
0259Level VI ENT Procedures12,407.523,836.1316,243.65
0264Level II Miscellaneous Radiology ProceduresNA61.5961.59
0312Radioelement ApplicationsNA5,897.225,897.22
0313BrachytherapyNA998.23998.23
0685Level III Needle Biopsy/Aspiration Except Bone MarrowNA210.75210.75
0686Level V Skin RepairNA465.77465.77
0687Revision/Removal of Neurostimulator ElectrodesNA1,444.651,444.65
0688Revision/Removal of Neurostimulator Pulse Generator ReceiverNA6,238.796,238.79
0692Electronic Analysis of Neurostimulator Pulse GeneratorsNA644.44644.44

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. Start Printed 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)
622700210
622720210
622730212
62310-623190212
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 § 419.32 “Calculation of prospective payment rates for hospital outpatient services,” and § 419.62 “Transitional pass-through payments: General rules.” At §§ 419.32(b)(1)(iii) and 419.62(d), we are revising our language to specify that the provisions Start Printed Page 9560under 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.

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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.

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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.

Start List of Subjects

List of Subjects 42 CFR Part 419

End List of Subjects

For the reasons set forth in the preamble, 42 CFR part 419 is corrected Start Printed Page 9568by making the following correcting amendments:

Start Part

PART 419—PROSPECTIVE PAYMENT SYSTEM FOR HOSPITAL OUTPATIENT DEPARTMENT SERVICES

1. The authority citation continues to read as follows:

Start Authority

Authority: Secs. 1102, 1833(t), and 1871 of the Social Security Act (42 U.S.C. 1302, 1395l(t), and 1395hh).

End Authority
[Corrected]

2. In § 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,”.

[Corrected]

In § 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)

Start Signature

Dated: February 27, 2002.

Thomas A. Scully,

Administrator, Centers for Medicare & Medicaid Services.

Approved: February 27, 2002.

Tommy G. Thompson,

Secretary.

End Signature

Addendum A.—List of Ambulatory Payment Classifications (APCs) With Status Indicators, Relative Weights, Payment Rates, and Copayment Amounts Calendar Year 2002

APCGroup titleStatus indicatorRelative weightPayment rateNational unadjusted copaymentMinimum unadjusted copayment
0001PhotochemotherapyS0.43$21.89$7.88$4.38
0002Fine needle Biopsy/AspirationT0.42$21.38$11.76$4.28
0003Bone Marrow Biopsy/AspirationT1.04$52.94$27.08$10.59
0004Level I Needle Biopsy/ Aspiration Except Bone MarrowT2.48$126.24$32.57$25.25
0005Level II Needle Biopsy /Aspiration Except Bone MarrowT4.05$206.16$90.71$41.23
0006Level I Incision & DrainageT2.19$111.48$33.95$22.30
0007Level II Incision & DrainageT6.79$345.64$72.03$69.13
0008Level III Incision and DrainageT10.99$559.43$113.67$111.89
0009Nail ProceduresT0.63$32.07$8.34$6.41
0010Level I Destruction of LesionT0.66$33.60$9.86$6.72
0011Level II Destruction of LesionT1.48$75.34$27.88$15.07
0012Level I Debridement & DestructionT0.66$33.60$9.18$6.72
0013Level II Debridement & DestructionT1.37$69.74$17.66$13.95
0015Level IV Debridement & DestructionT2.08$105.88$31.20$21.18
0016Level V Debridement & DestructionT3.04$154.75$65.00$30.95
0017Level VI Debridement & DestructionT9.73$495.30$227.84$99.06
0018Biopsy of Skin/Puncture of LesionT1.06$53.96$17.66$10.79
0019Level I Excision/ BiopsyT4.24$215.83$78.91$43.17
0020Level II Excision/ BiopsyT8.49$432.17$130.53$86.43
0021Level IV Excision/ BiopsyT11.89$605.25$236.51$121.05
0022Level V Excision/ BiopsyT13.99$712.15$292.94$142.43
0023Exploration Penetrating WoundT2.09$106.39$40.37$21.28
0024Level I Skin RepairT2.29$116.57$41.97$23.31
0025Level II Skin RepairT3.41$173.58$65.57$34.72
0026Level III Skin RepairT12.69$645.97$277.92$129.19
0027Level IV Skin RepairT18.12$922.38$383.10$184.48
0028Level I Breast SurgeryT14.08$716.73$303.74$143.35
0029Level II Breast SurgeryT23.90$1,216.61$632.64$243.32
0030Level III Breast SurgeryT34.40$1,751.10$763.55$350.22
0032Insertion of Central Venous/Arterial CatheterT12.71$646.99$129.40
0033Partial HospitalizationP4.17$212.27$48.17$42.45
0035Placement of Arterial or Central Venous CatheterT0.13$6.62$2.91$1.32
0041Level I ArthroscopyT23.74$1,208.46$580.06$241.69
0042Level II ArthroscopyT35.97$1,831.02$804.74$366.20
0043Closed Treatment Fracture Finger/Toe/TrunkT4.07$207.18$41.44
0044Closed Treatment Fracture/Dislocation Except Finger/Toe/TrunkT2.54$129.30$38.08$25.86
0045Bone/Joint Manipulation Under AnesthesiaT11.74$597.61$277.12$119.52
0046Open/Percutaneous Treatment Fracture or DislocationT27.86$1,418.19$535.76$283.64
0047Arthroplasty without ProsthesisT26.51$1,349.47$537.03$269.89
0048Arthroplasty with ProsthesisT43.44$2,211.27$725.94$442.25
0049Level I Musculoskeletal Procedures Except Hand and FootT15.93$810.90$356.95$162.18
0050Level II Musculoskeletal Procedures Except Hand and FootT20.75$1,056.26$507.15$211.25
0051Level III Musculoskeletal Procedures Except Hand and FootT28.73$1,462.47$675.24$292.49
0052Level IV Musculoskeletal Procedures Except Hand and FootT36.15$1,840.18$930.91$368.04
0053Level I Hand Musculoskeletal ProceduresT11.76$598.63$253.49$119.73
0054Level II Hand Musculoskeletal ProceduresT19.95$1,015.53$472.33$203.11
0055Level I Foot Musculoskeletal ProceduresT15.52$790.03$355.34$158.01
0056Level II Foot Musculoskeletal ProceduresT18.95$964.63$405.81$192.93
0057Bunion ProceduresT24.49$1,246.64$496.65$249.33
0058Level I Strapping and Cast ApplicationS1.28$65.16$19.27$13.03
0059Level II Strapping and Cast ApplicationS2.23$113.52$29.59$22.70
0060Manipulation TherapyS0.23$11.71$2.34
0068CPAP InitiationS3.04$154.75$85.11$30.95 Start Printed Page 9569
0069ThoracoscopyT23.72$1,207.44$591.64$241.49
0070Thoracentesis/Lavage ProceduresT4.61$234.67$79.60$46.93
0071Level I Endoscopy Upper AirwayT1.04$52.94$14.22$10.59
0072Level II Endoscopy Upper AirwayT1.22$62.10$34.16$12.42
0073Level III Endoscopy Upper AirwayT3.31$168.49$74.14$33.70
0074Level IV Endoscopy Upper AirwayT11.39$579.80$295.70$115.96
0075Level V Endoscopy Upper AirwayT17.52$891.84$445.92$178.37
0076Endoscopy Lower AirwayT7.61$387.38$189.82$77.48
0077Level I Pulmonary TreatmentS0.39$19.85$10.92$3.97
0078Level II Pulmonary TreatmentS0.87$44.29$19.04$8.86
0079Ventilation Initiation and ManagementS0.60$30.54$16.80$6.11
0080Diagnostic Cardiac CatheterizationT34.93$1,778.08$838.92$355.62
0081Non-Coronary Angioplasty or AtherectomyT29.42$1,497.60$710.91$299.52
0082Coronary AtherectomyT92.53$4,710.15$1,351.74$942.03
0083Coronary AngioplastyT59.84$3,046.10$794.30$609.22
0084Level I Electrophysiologic EvaluationS6.90$351.24$115.91$70.25
0085Level II Electrophysiologic EvaluationT58.28$2,966.69$654.48$593.34
0086Ablate Heart Dysrhythm FocusT73.14$3,723.12$1,265.37$744.62
0087Cardiac Electrophysiologic Recording/MappingT52.77$2,686.20$537.24
0088ThrombectomyT34.57$1,759.75$678.68$351.95
0089Insertion/Replacement of Permanent Pacemaker and ElectrodesT150.39$7,655.45$2,246.59$1,531.09
0090Insertion/Replacement of Pacemaker Pulse GeneratorT116.11$5,910.46$2,133.88$1,182.09
0091Level I Vascular LigationT21.15$1,076.62$348.23$215.32
0092Level II Vascular LigationT20.02$1,019.10$505.37$203.82
0093Vascular Repair/Fistula ConstructionT14.24$724.87$277.34$144.97
0094Resuscitation and CardioversionS6.12$311.53$105.29$62.31
0095Cardiac RehabilitationS0.62$31.56$16.73$6.31
0096Non-Invasive Vascular StudiesS1.72$87.55$48.15$17.51
0097Cardiac and Ambulatory Blood Pressure MonitoringX0.85$43.27$23.80$8.65
0098Injection of Sclerosing SolutionT1.25$63.63$20.88$12.73
0099ElectrocardiogramsS0.36$18.33$10.08$3.67
0100Stress Tests and Continuous ECGX1.48$75.34$41.44$15.07
0101Tilt Table EvaluationS3.76$191.40$105.27$38.28
0103Miscellaneous Vascular ProceduresT16.04$816.50$295.70$163.30
0104Transcatheter Placement of Intracoronary StentsT96.97$4,936.16$987.23
0105Revision/Removal of Pacemakers, AICD, or VascularT14.85$755.92$370.40$151.18
0106Insertion/Replacement/Repair of Pacemaker and/or ElectrodesT36.85$1,875.81$503.07$375.16
0107Insertion of Cardioverter-DefibrillatorT381.66$19,428.02$4,224.27$3,885.60
0108Insertion/Replacement/Repair of Cardioverter-Defibrillator LeadsT576.78$29,360.41$5,872.08
0109Removal of Implanted DevicesT6.30$320.70$131.49$64.14
0110TransfusionS5.34$271.83$114.17$54.37
0111Blood Product ExchangeS21.21$1,079.67$300.74$215.93
0112Apheresis, Photopheresis, and PlasmapheresisS36.46$1,855.96$612.47$371.19
0113Excision Lymphatic SystemT15.62$795.12$326.55$159.02
0114Thyroid/Lymphadenectomy ProceduresT29.46$1,499.63$493.78$299.93
0115Cannula/Access Device ProceduresT21.47$1,092.91$506.74$218.58
0116Chemotherapy Administration by Other Technique Except InfusionS0.91$46.32$9.26
0117Chemotherapy Administration by Infusion OnlyS4.03$205.14$52.69$41.03
0118Chemotherapy Administration by Both Infusion and Other TechniqueS4.22$214.81$72.03$42.96
0119Implantation of DevicesT80.14$4,079.45$815.89
0120Infusion Therapy Except ChemotherapyT3.10$157.80$42.67$31.56
0121Level I Tube changes and RepositioningT2.56$130.31$52.53$26.06
0122Level II Tube changes and RepositioningT9.94$505.99$114.93$101.20
0123Bone Marrow Harvesting and Bone Marrow/Stem Cell TransplantS8.62$438.79$87.76
0124Revision of Implanted Infusion PumpT89.58$4,559.98$912.00
0125Refilling of Infusion PumpT3.01$153.22$30.64
0130Level I LaparoscopyT26.06$1,326.56$659.53$265.31
0131Level II LaparoscopyT37.85$1,926.72$1,001.89$385.34
0132Level III LaparoscopyT56.38$2,869.97$1,239.22$573.99
0140Esophageal Dilation without EndoscopyT5.68$289.13$107.24$57.83
0141Upper GI ProceduresT7.25$369.05$184.67$73.81
0142Small Intestine EndoscopyT6.98$355.31$152.78$71.06
0143Lower GI EndoscopyT7.31$372.11$186.06$74.42
0144Diagnostic AnoscopyT4.46$227.03$49.32$45.41 Start Printed Page 9570
0145Therapeutic AnoscopyT10.88$553.84$179.39$110.77
0146Level I SigmoidoscopyT2.75$139.99$64.40$28.00
0147Level II SigmoidoscopyT5.74$292.19$137.33$58.44
0148Level I Anal/Rectal ProcedureT2.41$122.68$43.59$24.54
0149Level III Anal/Rectal ProcedureT13.61$692.80$293.06$138.56
0150Level IV Anal/Rectal ProcedureT18.19$925.94$437.12$185.19
0151Endoscopic Retrograde Cholangio-Pancreatography (ERCP)T15.39$783.41$245.46$156.68
0152Percutaneous Biliary Endoscopic ProceduresT16.23$826.17$207.38$165.23
0153Peritoneal and Abdominal ProceduresT23.70$1,206.42$496.31$241.28
0154Hernia/Hydrocele ProceduresT31.58$1,607.55$556.98$321.51
0155Level II Anal/Rectal ProcedureT5.30$269.79$99.82$53.96
0156Level II Urinary and Anal ProceduresT2.46$125.22$37.57$25.04
0157Colorectal Cancer Screening: Barium EnemaS1.99$101.30$22.19$20.26
0158Colorectal Cancer Screening: ColonoscopyT6.59$335.46$83.87$67.09
0159Colorectal Cancer Screening: Flexible SigmoidoscopyS2.34$119.12$29.78$23.82
0160Level I Cystourethroscopy and other Genitourinary ProceduresT5.16$262.66$105.06$52.53
0161Level II Cystourethroscopy and other Genitourinary ProceduresT13.80$702.48$249.36$140.50
0162Level III Cystourethroscopy and other Genitourinary ProceduresT25.23$1,284.31$427.49$256.86
0163Level IV Cystourethroscopy and other Genitourinary ProceduresT40.63$2,068.23$792.58$413.65
0164Level I Urinary and Anal ProceduresT1.02$51.92$15.58$10.38
0165Level III Urinary and Anal ProceduresT5.25$267.25$91.76$53.45
0166Level I Urethral ProceduresT12.27$624.59$218.73$124.92
0167Level II Urethral ProceduresT22.41$1,140.76$555.84$228.15
0168Level III Urethral ProceduresT18.53$943.25$405.60$188.65
0169LithotripsyT39.85$2,028.52$1,115.69$405.70
0170Dialysis for Other Than ESRD PatientsS0.29$14.76$3.25$2.95
0179Urinary Incontinence ProceduresT140.14$7,133.69$3,067.48$1,426.74
0180CircumcisionT15.11$769.16$304.87$153.83
0181Penile ProceduresT22.21$1,130.58$621.82$226.12
0182Insertion of Penile ProsthesisT88.04$4,481.59$1,492.28$896.32
0183Testes/Epididymis ProceduresT18.97$965.65$448.94$193.13
0184Prostate BiopsyT4.86$247.39$123.70$49.48
0187Miscellaneous Placement/RepositioningX4.24$215.83$94.96$43.17
0188Level II Female Reproductive ProcT0.81$41.23$11.95$8.25
0189Level III Female Reproductive ProcT1.26$64.14$18.60$12.83
0190Surgical HysteroscopyT17.01$865.88$424.28$173.18
0191Level I Female Reproductive ProcT0.23$11.71$3.40$2.34
0192Level IV Female Reproductive ProcT2.52$128.28$35.33$25.66
0193Level V Female Reproductive ProcT11.23$571.65$171.13$114.33
0194Level VI Female Reproductive ProcT15.95$811.92$397.84$162.38
0195Level VII Female Reproductive ProcT20.74$1,055.75$483.80$211.15
0196Dilation and CurettageT13.56$690.26$338.23$138.05
0197Infertility ProceduresT2.41$122.68$49.55$24.54
0198Pregnancy and Neonatal Care ProceduresT1.32$67.19$32.92$13.44
0199Vaginal DeliveryT5.12$260.63$72.98$52.13
0200Therapeutic AbortionT11.41$580.81$307.83$116.16
0201Spontaneous AbortionT14.42$734.04$329.65$146.81
0202Level VIII Female Reproductive ProcT63.90$3,252.77$1,593.85$650.55
0203Level V Nerve InjectionsT15.88$808.36$363.78$161.67
0204Level VI Nerve InjectionsT2.25$114.53$43.52$22.91
0206Level III Nerve InjectionsT3.62$184.27$75.55$36.85
0207Level IV Nerve InjectionsT5.40$274.88$123.69$54.98
0208Laminotomies and LaminectomiesT29.29$1,490.98$298.20
0209Extended EEG Studies and Sleep Studies, Level IIS10.60$539.58$280.58$107.92
0212Level II Nervous System InjectionsT3.79$192.93$88.78$38.59
0213Extended EEG Studies and Sleep Studies, Level IS2.66$135.40$70.41$27.08
0214ElectroencephalogramS2.11$107.41$53.71$21.48
0215Level I Nerve and Muscle TestsS0.66$33.60$17.47$6.72
0216Level III Nerve and Muscle TestsS2.63$133.88$60.25$26.78
0218Level II Nerve and Muscle TestsS1.04$52.94$23.82$10.59
0220Level I Nerve ProceduresT13.68$696.37$327.29$139.27
0221Level II Nerve ProceduresT21.55$1,096.98$463.62$219.40
0222Implantation of Neurological DeviceT304.29$15,489.58$3,097.92
0223Implantation of Pain Management DeviceT75.83$3,860.05$772.01
0224Implantation of Reservoir/Pump/ShuntT28.65$1,458.40$453.41$291.68
0225Implantation of Neurostimulator ElectrodesT269.11$13,698.78$2,739.76
0226Implantation of Drug Infusion ReservoirT76.24$3,880.92$776.18 Start Printed Page 9571
0227Implantation of Drug Infusion DeviceT140.36$7,144.89$1,428.98
0228Creation of Lumbar Subarachnoid ShuntT54.08$2,752.89$696.46$550.58
0229Transcatherter Placement of Intravascular ShuntsT76.09$3,873.29$996.86$774.66
0230Level I Eye Tests & TreatmentsS0.62$31.56$14.52$6.31
0231Level III Eye Tests & TreatmentsS2.05$104.35$46.96$20.87
0232Level I Anterior Segment Eye ProceduresT3.52$179.18$78.84$35.84
0233Level II Anterior Segment Eye ProceduresT10.90$554.85$266.33$110.97
0234Level III Anterior Segment Eye ProceduresT19.20$977.36$469.13$195.47
0235Level I Posterior Segment Eye ProceduresT5.60$285.06$78.91$57.01
0236Level II Posterior Segment Eye ProceduresT16.30$829.74$165.95
0237Level III Posterior Segment Eye ProceduresT32.16$1,637.07$818.54$327.41
0238Level I Repair and Plastic Eye ProceduresT3.02$153.73$58.96$30.75
0239Level II Repair and Plastic Eye ProceduresT5.84$297.28$115.94$59.46
0240Level III Repair and Plastic Eye ProceduresT13.91$708.07$315.31$141.61
0241Level IV Repair and Plastic Eye ProceduresT17.84$908.13$384.47$181.63
0242Level V Repair and Plastic Eye ProceduresT24.26$1,234.93$597.36$246.99
0243Strabismus/Muscle ProceduresT17.81$906.60$431.39$181.32
0244Corneal TransplantT38.69$1,969.48$851.42$393.90
0245Level I Cataract Procedures without IOL InsertT10.50$534.49$251.21$106.90
0246Cataract Procedures with IOL InsertT20.73$1,055.24$495.96$211.05
0247Laser Eye Procedures Except RetinalT4.05$206.16$94.83$41.23
0248Laser Retinal ProceduresT4.35$221.43$94.05$44.29
0249Level II Cataract Procedures without IOL InsertT21.93$1,116.32$524.67$223.26
0250Nasal Cauterization/PackingT2.11$107.41$37.59$21.48
0251Level I ENT ProceduresT2.44$124.21$27.99$24.84
0252Level II ENT ProceduresT5.99$304.91$114.24$60.98
0253Level III ENT ProceduresT12.40$631.21$284.00$126.24
0254Level IV ENT ProceduresT17.47$889.29$272.41$177.86
0256Level V ENT ProceduresT26.76$1,362.19$623.05$272.44
0258Tonsil and Adenoid ProceduresT17.53$892.35$437.25$178.47
0259Level VI ENT ProceduresT378.75$19,279.89$9,447.14$3,855.98
0260Level I Plain Film Except TeethX0.70$35.63$19.60$7.13
0261Level II Plain Film Except Teeth Including Bone Density MeasurementX1.22$62.10$34.15$12.42
0262Plain Film of TeethX0.65$33.09$10.90$6.62
0263Level I Miscellaneous Radiology ProceduresX1.62$82.46$44.53$16.49
0264Level II Miscellaneous Radiology ProceduresX3.74$190.38$104.71$38.08
0265Level I Diagnostic Ultrasound Except VascularS0.95$48.36$26.60$9.67
0266Level II Diagnostic Ultrasound Except VascularS1.55$78.90$43.40$15.78
0267Vascular UltrasoundS2.34$119.12$65.52$23.82
0269Level I Echocardiogram Except TransesophagealS3.87$197.00$102.44$39.40
0270Transesophageal EchocardiogramS5.34$271.83$146.79$54.37
0271MammographyS0.60$30.54$16.80$6.11
0272Level I FluoroscopyX1.38$70.25$38.64$14.05
0274MyelographyS5.27$268.26$128.12$53.65
0275ArthrographyS2.61$132.86$69.09$26.57
0276Level I Digestive RadiologyS1.49$75.85$41.72$15.17
0277Level II Digestive RadiologyS2.16$109.95$60.47$21.99
0278Diagnostic UrographyS2.36$120.13$66.07$24.03
0279Level I Angiography and Venography except ExtremityS7.77$395.52$174.57$79.10
0280Level II Angiography and Venography except ExtremityS13.63$693.82$353.85$138.76
0281Venography of ExtremityS4.35$221.43$115.16$44.29
0282Miscellaneous Computerized Axial TomographyS1.59$80.94$44.51$16.19
0283Computerized Axial Tomography with Contrast MaterialS4.51$229.58$126.27$45.92
0284Magnetic Resonance Imaging and Magnetic Resonance Angiography with Contrast MaterialS7.18$365.49$201.02$73.10
0285Positron Emission Tomography (PET)S18.83$958.52$415.21$191.70
0286Myocardial ScansS5.43$276.41$152.03$55.28
0287Complex VenographyS4.09$208.20$114.51$41.64
0288CT, Bone DensityS1.18$60.07$33.03$12.01
0289Needle Localization for Breast BiopsyX1.63$82.97$44.80$16.59
0290Standard Non-Imaging Nuclear MedicineS1.76$89.59$49.27$17.92
0291Level I Diagnostic Nuclear Medicine Excluding Myocardial ScansS3.52$179.18$90.20$35.84
0292Level II Diagnostic Nuclear Medicine Excluding Myocardial ScansS4.22$214.81$118.15$42.96
0294Level I Therapeutic Nuclear MedicineS5.04$256.56$141.11$51.31
0295Level II Therapeutic Nuclear MedicineS12.17$619.50$340.73$123.90
0296Level I Therapeutic Radiologic ProceduresS3.41$173.58$95.47$34.72 Start Printed Page 9572
0297Level II Therapeutic Radiologic ProceduresS7.11$361.93$172.51$72.39
0299Miscellaneous Radiation TreatmentS0.21$10.69$5.66$2.14
0300Level I Radiation TherapyS2.08$105.88$47.72$21.18
0301Level II Radiation TherapyS5.18$263.68$52.74
0302Level III Radiation TherapyS11.23$571.65$216.55$114.33
0303Treatment Device ConstructionX3.01$153.22$69.28$30.64
0304Level I Therapeutic Radiation Treatment PreparationX1.63$82.97$41.52$16.59
0305Level II Therapeutic Radiation Treatment PreparationX3.74$190.38$91.38$38.08
0310Level III Therapeutic Radiation Treatment PreparationX14.59$742.69$339.05$148.54
0312Radioelement ApplicationsS124.64$6,344.67$1,268.93
0313BrachytherapyS35.74$1,819.31$363.86
0314Hyperthermic TherapiesS3.92$199.54$101.77$39.91
0320Electroconvulsive TherapyS3.90$198.53$80.06$39.71
0321Biofeedback and Other TrainingS0.93$47.34$21.78$9.47
0322Brief Individual PsychotherapyS1.16$59.05$12.40$11.81
0323Extended Individual PsychotherapyS1.74$88.57$21.26$17.71
0324Family PsychotherapyS2.71$137.95$27.59
0325Group PsychotherapyS1.38$70.25$18.27$14.05
0330Dental ProceduresS11.04$561.98$112.40
0332Computerized Axial Tomography and Computerized Angiography without Contrast MaterialS3.26$165.95$91.27$33.19
0333Computerized Axial Tomography and Computerized Angio w/o Contrast Material followed by ContrastS5.25$267.25$146.98$53.45
0335Magnetic Resonance Imaging, MiscellaneousS5.41$275.39$151.46$55.08
0336Magnetic Resonance Imaging and Magnetic Resonance Angiography without ContrastS6.32$321.71$176.94$64.34
0337MRI and Magnetic Resonance Angiography without Contrast Material followed by Contrast MaterialS8.60$437.77$240.77$87.55
0339ObservationS6.90$351.24$70.25
0340Minor Ancillary ProceduresX0.85$43.27$10.82$8.65
0341Skin Tests and Miscellaneous Red Blood Cell TestsX0.11$5.60$3.08$1.12
0342Level I PathologyX0.21$10.69$5.88$2.14
0343Level II PathologyX0.39$19.85$10.72$3.97
0344Level III PathologyX0.56$28.51$15.68$5.70
0345Level I Transfusion Laboratory ProceduresX0.27$13.74$5.37$2.75
0346Level II Transfusion Laboratory ProceduresX0.77$39.20$12.03$7.84
0347Level III Transfusion Laboratory ProceduresX1.57$79.92$20.13$15.98
0348Fertility Laboratory ProceduresX0.77$39.20$7.84
0352Level I InjectionsX0.41$20.87$4.17
0353Level II Allergy InjectionsX0.25$12.73$2.92$2.55
0354Administration of Influenza/Pneumonia VaccineK0.11$5.60
0355Level I ImmunizationsK0.19$9.67$5.05$1.93
0356Level II ImmunizationsK1.12$57.01$11.40
0359Level II InjectionsX1.80$91.63$18.33
0360Level I Alimentary TestsX1.36$69.23$34.62$13.85
0361Level II Alimentary TestsX3.27$166.46$83.23$33.29
0362Fitting of Vision AidsX0.87$44.29$9.63$8.86
0363Otorhinolaryngologic Function TestsX1.74$88.57$32.77$17.71
0364Level I AudiometryX0.58$29.52$11.51$5.90
0365Level II AudiometryX1.32$67.19$20.16$13.44
0367Level I Pulmonary TestX0.70$35.63$17.82$7.13
0368Level II Pulmonary TestsX1.48$75.34$38.42$15.07
0369Level III Pulmonary TestsX3.51$178.67$58.50$35.73
0370Allergy TestsX0.81$41.23$11.81$8.25
0371Level I Allergy InjectionsX0.70$35.63$7.13
0372Therapeutic PhlebotomyX0.53$26.98$10.09$5.40
0373Neuropsychological TestingX1.01$51.41$14.39$10.28
0374Monitoring Psychiatric DrugsX0.89$45.30$9.97$9.06
0600Low Level Clinic VisitsV0.87$44.29$8.86
0601Mid Level Clinic VisitsV0.95$48.36$9.67
0602High Level Clinic VisitsV1.38$70.25$14.05
0610Low Level Emergency VisitsV1.24$63.12$19.57$12.62
0611Mid Level Emergency VisitsV2.16$109.95$36.47$21.99
0612High Level Emergency VisitsV3.51$178.67$54.14$35.73
0620Critical CareS8.45$430.14$150.55$86.03
0685Level III Needle Biopsy/Aspiration Except Bone MarrowT9.21$468.83$206.28$93.77
0686Level V Skin RepairT24.15$1,229.33$565.49$245.87
0687Revision/Removal of Neurostimulator ElectrodesT42.58$2,167.49$997.05$433.50 Start Printed Page 9573
0688Revision/Removal of Neurostimulator Pulse Generator ReceiverT146.12$7,438.09$3,644.66$1,487.62
0689Electronic Analysis of Cardioverter-defibrillatorsS0.43$21.89$12.03$4.38
0690Electronic Analysis of Pacemakers and other Cardiac DevicesS0.38$19.34$10.63$3.87
0691Electronic Analysis of Programmable Shunts/PumpsS3.18$161.87$89.02$32.37
0692Electronic Analysis of Neurostimulator Pulse GeneratorsS14.43$734.54$403.99$146.91
0693Level II Breast ReconstructionT32.00$1,628.93$798.17$325.79
0694Level III Excision/BiopsyT4.01$204.13$81.65$40.83
0695Level VII Debridement & DestructionT15.87$807.85$266.59$161.57
0697Level II Echocardiogram Except TransesophagealS2.09$106.39$55.32$21.28
0698Level II Eye Tests & TreatmentsS1.04$52.94$20.64$10.59
0699Level IV Eye Tests & TreatmentT6.49$330.37$148.66$66.07
0701SR 89 chloride, per mCiG$963.42$137.92
0702SM 153 lexidronam, 50 mCiG$1,020.00$146.02
0704IN 111 Satumomab pendetide per doseG$1,591.25$227.80
0705TC 99M tetrofosmin, per doseG$114.00$16.32
0706New Technology—Level I ($0-$50)S$25.00$5.00
0707New Technology—Level II ($50-$100)S$75.00$15.00
0708New Technology—Level III ($100-$200)S$150.00$30.00
0709New Technology—Level IV ($200-$300)S$250.00$50.00
0710New Technology—Level V ($300-$500)S$400.00$80.00
0711New Technology—Level VI ($500-$750)S$625.00$125.00
0712New Technology—Level VII ($750-$1000)S$875.00$175.00
0713New Technology—Level VIII ($1000-$1250)S$1,125.00$225.00
0714New Technology—Level IX ($1250-$1500)S$1,375.00$275.00
0715New Technology—Level X ($1500-$1750)S$1,625.00$325.00
0716New Technology—Level XI ($1750-$2000)S$1,875.00$375.00
0717New Technology—Level XII ($2000-$2500)S$2,250.00$450.00
0718New Technology—Level XIII ($2500-$3000)S$2,750.00$550.00
0719New Technology_Level XIV ($3000-$3500)S$3,250.00$650.00
0720New Technology—Level XV ($3500-$5000)S$4,250.00$850.00
0721New Technology—Level XVI ($5000-$6000)S$5,500.00$1,100.00
0725Leucovorin calcium inj, 50 mgG$4.15$0.38
0726Dexrazoxane hcl injection, 250 mgG$194.52$24.98
0727Etidronate disodium inj 300 mgG$63.65$9.11
0728Filgrastim 300 mcg injectionG$179.08$23.00
0730Pamidronate disodium , 30 mgG$265.87$38.06
0731Sargramostim injection 50 mcgG$29.06$4.16
0732Mesna injection 200 mgG$36.48$3.30
0733Non esrd epoetin alpha inj, 1000 uG$12.26$1.57
0734Darepoetin alfa, 1 MCGG$4.74$0.68
0750Dolasetron mesylate, 10 mgG$16.45$2.11
0754Metoclopramide hcl injection up to 10 mgG$1.17$0.11
0755Thiethylperazine maleate inj up to 10 mgG$4.60$0.66
0762Dronabinol 2.5mg oralG$3.28$0.42
0763Dolasetron mesylate oral, 100 mgG$69.64$8.94
0764Granisetron hcl injection 10 mcgG$18.54$2.65
0765Granisetron hcl 1 mg oralG$44.69$6.40
0768Ondansetron hcl injection 1 mgG$6.09$0.78
0769Ondansetron hcl 8mg oralG$26.41$3.39
0800Leuprolide acetate, 3.75 mgG$93.47$12.00
0801Cyclophosphamide oral 25 mgG$2.03$0.18
0802Etoposide oral 50 mgG$52.43$6.73
0803Melphalan oral 2 mgG$2.29$0.33
0807Aldesleukin/single use vialG$672.60$96.29
0809Bcg live intravesical vacG$166.49$21.38
0810Goserelin acetate implant 3.6 mgG$446.49$63.92
0811Carboplatin injection 50 mgG$114.46$16.39
0812Carmus bischl nitro inj 100 mgG$117.84$16.87
0813Cisplatin 10 mg injectionG$42.18$3.82
0814Asparaginase injection 10,000 uG$62.61$8.96
0815Cyclophosphamide 100 mg injG$5.82$0.75
0816Cyclophosphamide lyophilized 100 mgG$4.89$0.63
0817Cytarabine hcl 100 mg injG$6.10$0.55
0818Dactinomycin 0.5 mgG$13.87$1.99
0819Dacarbazine 100 mg injG$12.68$1.15
0820Daunorubicin 10 mgG$76.62$6.94
0821Daunorubicin citrate liposom 10 mgG$64.60$9.25
0822Diethylstilbestrol injection 250 mgG$14.41$1.30 Start Printed Page 9574
0823Docetaxel, 20 mgG$297.83$42.64
0824Etoposide 10 mg injG$10.45$0.95
0826Methotrexate Oral 2.5 mgG$3.45$0.31
0827Floxuridine injection 500 mgG$129.56$16.64
0828Gemcitabine HCL 200 mgG$106.72$15.28
0830Irinotecan injection 20 mgG$134.25$19.22
0831Ifosfomide injection 1 gmG$156.64$22.42
0832Idarubicin hcl injection 5 mgG$412.21$59.01
0833Interferon alfacon-1, 1 mcgG$4.10$0.59
0834Interferon alfa-2a inj recombinant 3 million uG$34.86$4.99
0836Interferon alfa-2b inj recombinant, 1 millionG$11.28$1.45
0838Interferon gamma 1-b inj, 3 million uG$285.65$40.89
0839Mechlorethamine hcl inj 10 mgG$12.01$1.72
0840Melphalan hydrochl 50 mgG$400.74$57.37
0841Methotrexate sodium inj 5 mgG$0.45$0.04
0842Fludarabine phosphate inj 50 mgG$271.82$38.91
0843Pegaspargase, singl dose vialG$1,225.57$179.74
0844Pentostatin injection, 10 mgG$1,654.14$236.80
0847Doxorubicin hcl 10 mg vl chemoG$37.46$4.81
0849Rituximab, 100 mgG$454.55$65.07
0850Streptozocin injection, 1 gmG$117.64$16.84
0851Thiotepa injection, 15 mgG$116.97$10.59
0852Topotecan, 4 mgG$664.19$95.08
0853Vinblastine sulfate inj, 1 mgG$4.11$0.37
0854Vincristine sulfate 1 mg injG$30.16$3.87
0855Vinorelbine tartrate, 10 mgG$88.83$12.72
0856Porfimer sodium, 75 mgG$2,603.66$372.74
0857Bleomycin sulfate injection 15 uG$289.37$37.16
0858Cladribine, 1mgG$53.39$4.83
0859Fluorouracil injection 500 mgG$2.73$0.25
0860Plicamycin (mithramycin) inj 2.5 mgG$93.80$13.43
0861Leuprolide acetate injection 1 mgG$69.79$6.32
0862Mitomycin 5 mg injG$121.65$11.01
0863Paclitaxel injection, 30 mgG$173.50$22.28
0864Mitoxantrone hcl, 5 mgG$244.21$34.96
0865Interferon alfa-n3 inj, human leukocyte derived, 2G$7.86$1.12
0884Rho d immune globulin inj, 1 dose pkgG$34.11$4.38
0886Azathioprine oral 50mgG$1.25$0.11
0887Azathioprine parenteral 100 mgG$1.06$0.10
0888Cyclosporine oral 100 mgG$5.22$0.67
0889Cyclosporin parenteral 250mgG$25.08$3.22
0890Lymphocyte immune globulin 250 mgG$269.06$38.52
0891Tacrolimus oral per 1 mgG$2.91$0.42
0900Alglucerase injection, per 10 uG$37.53$5.37
0901Alpha 1 proteinase inhibitor, 10 mgG$2.09$0.30
0902Botulinum toxin a, per unitG$4.39$0.63
0903Cytomegalovirus imm IV/vialG$638.48$91.40
0905Immune globulin 500 mgG$35.63$3.23
0906RSV-ivig, 50 mgG$15.51$1.99
0907Ganciclovir Sodium 500 mg injectionK0.42$21.38$4.28
0908Tetanus immune globulin inj up to 250 uG$102.60$13.18
0909Interferon beta-1a, 33 mcgG$225.22$32.24
0910Interferon beta-1b/0.25 mgG$68.40$9.79
0911Streptokinase per 250,000 iuK1.67$85.01$17.00
0913Ganciclovir long act implant 4.5 mgG$4,750.00$680.00
0916Injection imiglucerase/unitG$3.75$0.54
0917Pharmacologic stressorsK0.35$17.82$3.56
0925Factor viii per iuG$0.87$0.08
0926Factor VIII (porcine) per iuG$2.09$0.30
0927Factor viii recombinant per iuG$1.12$0.14
0928Factor ix complex per iuG$0.48$0.04
0929Anti-inhibitor per iuG$1.43$0.18
0930Antithrombin iii injection per iuG$1.05$0.15
0931Factor IX non-recombinant, per iuG$0.71$0.09
0932Factor IX recombinant, per iuG$1.12$0.16
0949Plasma, Pooled Multiple Donor, Solvent/Detergent TK2.80$142.53$28.51
0950Blood (Whole) For TransfusionK1.98$100.79$20.16
0952CryoprecipitateK0.66$33.60$6.72
0954RBC leukocytes reducedK2.69$136.93$27.39 Start Printed Page 9575
0955Plasma, Fresh FrozenK2.14$108.93$21.79
0956Plasma Protein FractionK1.20$61.08$12.22
0957Platelet ConcentrateK0.93$47.34$9.47
0958Platelet Rich PlasmaK1.11$56.50$11.30
0959Red Blood CellsK1.95$99.26$19.85
0960Washed Red Blood CellsK3.62$184.27$36.85
0961Infusion, Albumin (Human) 5%, 50 mlK2.08$105.88$21.18
0962Infusion, Albumin (Human) 25%, 50 mlK1.05$53.45$10.69
0963Albumin (human), 5%, 250 mlK10.35$526.86$105.37
0964Albumin (human), 25%, 20 mlK2.08$105.88$21.18
0965Albumin (human), 25%, 50mlK5.20$264.70$52.94
0966Plasmaprotein fract, 5%, 250mlK5.95$302.88$60.58
0970New Technology—Level I ($0-$50)T$25.00$5.00
0971New Technology—Level II ($50-$100)T$75.00$15.00
0972New Technology—Level III ($100-$200)T$150.00$30.00
0973New Technology—Level IV ($200-$300)T$250.00$50.00
0974New Technology—Level V ($300-$500)T$400.00$80.00
0975New Technology—Level VI ($500-$750)T$625.00$125.00
0976New Technology—Level VII ($750-$1000)T$875.00$175.00
0977New Technology—Level VIII ($1000-$1250)T$1,125.00$225.00
0978New Technology—Level IX ($1250-$1500)T$1,375.00$275.00
0979New Technology—Level X ($1500-$1750)T$1,625.00$325.00
0980New Technology—Level XI ($1750-$2000)T$1,875.00$375.00
0981New Technology—Level XII ($2000-$2500)T$2,250.00$450.00
0982New Technology—Level XIII ($2500-$3000)T$2,750.00$550.00
0983New Technology_Level XIV ($3000@ndash;$3500)T$3,250.00$650.00
0984New Technology—Level XV ($3500-$5000)T$4,250.00$850.00
0985New Technology—Level XVI ($5000-$6000)T$5,500.00$1,100.00
1002Cochlear implant systemH
1009Cryoprecip reduced plasmaK0.82$41.74$8.35
1010Blood, L/R, CMV-negK2.74$139.48$27.90
1011Platelets, HLA-m, L/R, unitK11.27$573.69$114.74
1012Platelet concentrate, L/R, irradiated, unitK1.83$93.15$18.63
1013Platelet concentrate, L/R, unitK1.12$57.01$11.40
1014Platelets, aph/pher, L/R, unitK8.50$432.68$86.54
1016Blood, L/R, froz/deglycerol/washedK6.80$346.15$69.23
1017Platelets, aph/pher, L/R, CMV-neg, unitK8.86$451.01$90.20
1018Blood, L/R, irradiatedK2.98$151.69$30.34
1019Platelets, aph/pher, L/R, irradiated, unitK9.16$466.28$93.26
1024Quinupristin/dalfopristin 500 mg (150/350)G$102.05$13.11
1045Iobenguane sulfate I-131G$495.65$70.96
1058TC 99M oxidronate, per vialG$36.74$5.26
1059Cultured chondrocytes implntG$14,250.00$2,040.00
1064I-131 cap, each add mCiG$5.86$0.75
1065I-131 sol, each add mCiG$15.81$2.03
1066IN 111 satumomab pendetideG$1,591.25$227.80
1079CO 57/58 0.5 mCiG$253.84$36.34
1084Denileukin diftitox, 300 MCGG$999.88$143.14
1086Temozolomide, oral 5 mgG$6.05$0.87
1087I-123 per 100 uciG$0.65$0.06
1089Coo 57, 0.5 MciG$81.10$10.41
1091IN 111 Oxyquinoline, per .5 mCiG$427.50$61.20
1092IN 111 Pentetate, per 0.5 mCiG$256.50$23.22
1094TC 99M Albumin aggr,1.0 cmCiG$33.09$4.25
1095Technetium TC 99M DepreotideG$38.00$5.44
1096TC 99M Exametazime, per doseG$445.31$63.75
1097TC 99M Mebrofenin, per vialG$51.44$7.36
1098TC 99M Pentetate, per vialG$22.43$2.88
1099TC 99M Pyrophosphate, per vialG$39.11$5.60
1122TC 99M arcitumomab, per vialG$1,235.00$176.80
1166Cytarabine liposomal, 10 mgG$371.45$53.18
1167Epirubicin hcl, 2 mgG$24.94$3.57
1178Busulfan IV, 6 mgG$26.48$3.79
1188I-131 cap, per 1-5 mCiG$117.25$15.06
1200TC 99M Sodium GlucoheptonateG$22.61$3.24
1201TC 99M succimer, per vialG$135.66$19.42
1202TC 99M Sulfur Colloid, per doseG$76.00$9.76
1203Verteporfin for injectionG$1,458.25$208.76
1205Technetium Tc 99m disofeninG$79.17$11.33 Start Printed Page 9576
1207Octreotide acetate depot 1mgG$138.08$19.77
1305ApligrafG$1,157.81$165.75
1348I-131 sol, per 1-6 mCiG$146.57$18.82
1400Diphenhydramine hcl 50mgG$0.23$0.02
1401Prochlorperazine maleate 5mgG$0.65$0.06
1402Promethazine hcl 12.5mg oralG$0.01
1403Chlorpromazine hcl 10mg oralG$0.27$0.02
1404Trimethobenzamide hcl 250mgG$0.38$0.03
1405Thiethylperazine maleate10mgG$0.56$0.08
1406Perphenazine 4mg oralG$0.62$0.06
1407Hydroxyzine pamoate 25mgG$0.28$0.03
1409Factor viia recombinant, per 1.2 mgG$1,596.00$228.48
1600Technetium TC 99M sestamibiG$121.70$17.42
1601Technetium TC 99M medronateG$42.18$5.42
1602Technetium TC 99M apcitideG$475.00$68.00
1603Thallous chloride TL 201, per mCiG$78.16$7.08
1604IN 111 capromab pendetide, per doseG$2,192.13$313.82
1605Abciximab injection, 10 mgG$513.02$73.44
1606Anistreplase, 30 uG$2,693.80$385.64
1607Eptifibatide injection, 5 mgG$11.31$1.45
1608Etanercept injection, 25 mgG$141.01$20.19
1609Rho(D) immune globulin h, sd, 100 iuG$20.55$2.64
1611Hylan G-F 20 injection, 16 mgG$213.87$27.47
1612Daclizumab, parenteral, 25 mgG$397.29$56.88
1613Trastuzumab, 10 mgG$52.83$7.56
1614Valrubicin, 200 mgG$423.22$60.59
1615Basiliximab, 20 mgG$1,437.78$205.83
1616Histrelin acetate, 10 mgsG$14.16$2.03
1617LepirudinG$131.96$18.89
1618Vonwillebrandfactrcmplx, per iuG$0.95$0.14
1619Ga 67, per mCiG$25.62$2.32
1620Technetium tc99m bicisateG$403.99$57.83
1621Xenin xe 133G$29.93$2.71
1622Technetium tc99m mertiatideG$137.75$19.72
1623Technetium tc99m glucepatateG$22.61$3.24
1624Sodium phosphate p32G$81.10$7.78
1625Indium 111-in pentetreotideG$935.75$133.96
1626Technetium tc99m oxidronateG$1.47$0.21
1627Technetium tc99mlabeled rbcsG$40.90$5.85
1628Chromic phosphate p32G$150.86$21.60
1713Anchor/screw bn/bn,tis/bnH
1714Cath, trans atherectomy, dirH
1715Brachytherapy needleH
1716Brachytx seed, Gold 198H
1717Brachytx seed, HDR Ir-192H
1718Brachytx seed, Iodine 125H
1719Brachytxseed, Non-HDR Ir-192H
1720Brachytx seed, Palladium 103H
1721AICD, dual chamberH
1722AICD, single chamberH
1724Cath, trans atherec,rotationH
1725Cath, translumin non-laserH
1726Cath, bal dil, non-vascularH
1727Cath, bal tis dis, non-vasH
1728Cath, brachytx seed admH
1729Cath, drainageH
1730Cath, EP, 19 or fewer electH
1731Cath, EP, 20 or more elecH
1732Cath, EP, diag/abl, 3D/vectH
1733Cath, EP, othr than cool-tipH
1750Cath, hemodialysis,long-termH
1751Cath, inf, per/cent/midlineH
1752Cath, hemodialysis,short-termH
1753Cath, intravas ultrasoundH
1754Catheter, intradiscalH
1755Catheter, intraspinalH
1756Cath, pacing, transesophH
1757Cath, thrombectomy/embolectH
1758Cath, ureteralHStart Printed Page 9577
1759Cath, intra echocardiographyH
1760Closure dev, vasc, imp/insertH
1762Conn tiss, human (inc fascia)H
1763Conn tiss, non-humanH
1764Event recorder, cardiacH
1765Adhesion barrierH
1766Intro/sheath, strble, non-peelH
1767Generator, neurostim, impH
1768Graft, vascularH
1769Guide wireH
1770Imaging coil, MR, insertableH
1771Rep dev, urinary, w/slingH
1772Infusion pump, programmableH
1773Retrieval dev, insertH
1775FDG, per dose (4-40 mCi/ml)G$475.00$68.00
1776Joint device (implantable)H
1777Lead, AICD, endo single coilH
1778Lead, neurostimulatorH
1779Lead, pmkr, transvenous VDDH
1780Lens, intraocularH
1781Mesh (implantable)H
1782MorcellatorH
1784Ocular dev, intraop, det retH
1785Pmkr, dual, rate-respH
1786Pmkr, single, rate-respH
1787Patient progr, neurostimH
1788Port, indwelling, impH
1789Prosthesis, breast, impH
1813Prosthesis, penile, inflatabH
1815Pros, urinary sph, impH
1816Receiver/transmitter, neuroH
1817Septal defect imp sysH
1874Stent, coated/cov w/del sysH
1875Stent, coated/cov w/o del syH
1876Stent, non-coa/no-cov w/delH
1877Stent, non-coat/cov w/o delH
1878Matrl for vocal cordH
1879Tissue marker, impH
1880Vena cava filterH
1881Dialysis access systemH
1882AICD, other than sing/dualH
1883Adapt/ext, pacing/neuro leadH
1885Cath, translumin angio laserH
1887Catheter, guidingH
1891Infusion pump, non-prog, permH
1892Intro/sheath, fixed, peel-awayH
1893Intro/sheath, fixed, non-peelH
1894Intro/sheath, non-laserH
1895Lead, AICD, endo dual coilH
1896Lead, AICD, non sing/dualH
1897Lead, neurostim test kitH
1898Lead, pmkr, other than transH
1899Lead, pmkr/AICD combinationH
2615Sealant, pulmonary, liquidH
2616Brachytx seed, Yttrium-90H
2617Stent, non-cor, tem w/o delH
2618Probe, cryoablationH
2619Pmkr, dual, non rate-respH
2620Pmkr, single, non rate-respH
2621Pmkr, other than sing/dualH
2622Prosthesis, penile, non-infH
2625Stent, non-cor, tem w/del sysH
2626Infusion pump, non-prog, tempH
2627Cath, suprapubic/cystoscopicH
2628Catheter, occlusionH
2629Intro/sheath, laserH
2630Cath, EP, cool-tipH
2631Rep dev, urinary, w/o slingH
7000Amifostine, 500 mgG$392.06$56.13 Start Printed Page 9578
7001Amphotericin B lipid complex, 50 mgG$109.25$15.64
7003Epoprostenol injection 0.5 mgG$12.04$1.72
7005Gonadorelin hydroch, 100 mcgG$192.37$27.54
7007Milrinone lactate, per 5 ml, injK0.44$22.40$4.48
7010Morphine sulfate (preservative free) 10 mgG$1.02$0.09
7011Oprelvekin injection, 5 mgG$245.81$35.19
7014Fentanyl citrate injectionG$1.23$0.11
7015Busulfan, oral, 2 mgG$1.91$0.27
7019Aprotinin, 10,000 kiuG$2.16$0.31
7022Elliot's B solution, per mlG$1.43$0.20
7023Bladder calculi irrig solG$24.70$3.54
7024Corticorelin ovine triflutatG$368.03$52.69
7025Digoxin immune FAB (ovine)G$551.66$78.97
7026Ethanolamine oleate, 100 mgG$39.73$5.69
7027Fomepizole, 15 mgG$10.93$1.56
7028Fosphenytoin, 50 mgG$5.73$0.82
7029Glatiramer acetate, per doseG$30.07$4.30
7030Hemin, per 1 mgG$0.99$0.14
7031Octreotide acetate injectionG$138.08$19.77
7032Sermorelin acetate, 0.5 mgG$13.60$1.95
7033Somatrem, 5mgG$209.48$29.99
7034Somatropin injectionG$39.90$5.12
7035Teniposide, 50 mgG$222.80$31.90
7036Urokinase 250,000 iu injK6.44$327.82$65.56
7037Urofollitropin, 75 iuG$73.29$10.49
7038Muromonab-CD3, 5 mgG$269.06$38.52
7039Pegademase bovine inj 25 I.UG$139.33$19.95
7040Pentastarch 10% solutionG$15.11$2.16
7041Tirofiban hydrochloride 12.5 mgG$436.41$62.48
7042Capecitabine, oral, 150 mgG$2.43$0.35
7043Infliximab injection 10 mgG$63.24$9.05
7045Trimetrexate glucoronateG$118.75$17.00
7046Doxorubicin hcl liposome inj 10 mgG$358.95$51.39
7047Droperidol/fentanyl injG$6.67$0.95
7048Alteplase recombinantK0.36$18.33$3.67
7049Filgrastim 480 mcg injectionG$285.38$36.65
7050Prednisone oralG$0.07$0.01
7051Leuprolide acetate implant, 65 mgG$5,399.80$773.02
7052Somatrem injectionG$41.90$6.00
7315Sodium hyaluronate injection, 20mgG$130.63$18.70
7316Sodium hyaluronate injection, 5mgG$26.13$3.74
9000Na chromate Cr51, per 0.25mCiG$0.52$0.07
9001Linezolid inj, 200mgG$24.13$3.45
9002Tenecteplase, 50mg/vialG$2,612.50$374.00
9003Palivizumab, per 50mgG$664.49$95.13
9004Gemtuzumab ozogamicin inj, 5mgG$1,929.69$276.25
9005Reteplase injectionG$1,306.25$187.00
9006Tacrolimus injG$113.15$16.20
9007Baclofen Intrathecal kit-1ampG$79.80$11.42
9008Baclofen refill kit_per 500 mcgG$11.69$1.67
9009Baclofen refill kit—per 2000 mcgG$49.12$7.03
9010Baclofen refill kit—per 4000 mcgG$43.08$6.17
9011Caffeine Citrate, inj,G$3.05$0.44
9012Arsenic TrioxideG$23.75$3.40
9013Co 57 Cobaltous CIG$81.10$10.41
9015Mycophenolate mofetil oral 250 mgG$2.40$0.34
9016Echocardiography contrastG$118.75$17.00
9018Botulinum tox B, per 100 uG$8.79$1.26
9019Caspofungin acetate, 5 mgG$34.20$4.90
9020Sirolimus tablet, 1 mgG$6.51$0.93
9100Iodinated I-131 albuminG$10.34$1.48
910251 na chromate, per 50mCiG$64.84$9.28
9103Na iothalamate I-125, per 10 uciG$17.18$2.46
9104Anti-thymocycte globulin rabbitG$325.09$46.54
9105Hep B imm glob, per 1 mlG$133.00$17.08
9106Sirolimus, 1 mgG$6.51$0.93
9108Thyrotropin alfa, per 1.1 mgG$531.05$76.02
9109Tirofliban hcl, per 6.25 mgG$207.81$29.75
9110Alemtuzumab, per mlG$486.88$69.70 Start Printed Page 9579
9111Inj, bivalirudin, per 250mg vialG$397.81$56.95
9112Perflutren lipid micro, per 2mlG$148.20$21.22
9113Inj pantoprazole sodium, vialG$22.80$3.26
9114Nesiritide, per 1.5 mg vialG$433.20$62.02
9115Inj, zoledronic acid, per 2 mgG$406.78$58.23
9200Orcel, per 36 cm2G$1,135.25$162.52
9201Dermagraft, per 37.5 sq cmG$577.60$82.69
9217Leuprolide acetate suspnsion, 7.5 mgG$592.60$84.84
9500Platelets, irradiatedK1.69$86.03$17.21
9501Platelets, pheresisK9.22$469.33$93.87
9502Platelet pheresis irradiatedK10.00$509.04$101.81
9503Fresh frozen plasma, ea unitK1.57$79.92$15.98
9504RBC deglycerolizedK4.14$210.74$42.15
9505RBC irradiatedK2.45$124.71$24.94
9506Granulocytes, pheresisK28.14$1,432.44$286.49

Addendum D.—Payment Status Indicators for the Hospital Outpatient Prospective Payment System

IndicatorServiceStatus
APulmonary Rehabilitation Clinical TrialNot Paid Under Outpatient PPS.
ADurable Medical Equipment, Prosthetics and OrthoticsDMEPOS Fee Schedule.
APhysical, Occupational and Speech TherapyPhysician Fee Schedule.
AAmbulanceAmbulance Fee Schedule.
AEPO for ESRD PatientsNational Rate.
AClinical Diagnostic Laboratory ServicesLaboratory Fee Schedule.
APhysician Services for ESRD PatientsPhysician Fee Schedule.
AScreening MammographyPhysician Fee Schedule.
CInpatient ProceduresAdmit Patient; Bill as Inpatient.
DDeleted CodeCodes are deleted effective with the beginning of the calendar year.
ENon-Covered Items and ServicesNot Paid Under Outpatient PPS.
FAcquisition of Corneal TissuePaid at Reasonable Cost.
GDrug/Biological Pass-ThroughAdditional Payment.
HDevice Pass-ThroughAdditional Payment.
KNon Pass-Through Drug/BiologicalPaid Under Outpatient PPS.
NIncidental Services, packaged into APC RatePackaged.
PPartial HospitalizationPaid Per Diem APC.
SSignificant Procedure, Not Discounted When MultiplePaid Under Outpatient PPS.
TSignificant Procedure, Multiple Procedure Reduction AppliesPaid Under Outpatient PPS.
VVisit to Clinic or Emergency DepartmentPaid Under Outpatient PPS.
XAncillary ServicePaid Under Outpatient PPS.
End Part End Supplemental Information

BILLING CODE 4120-01-P

BILLING CODE 4120-01-C

[FR Doc. 02-5071 Filed 2-28-02; 8:45 am]

BILLING CODE 4120-01-P