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Medicare Program; Medicare Program; Changes to the Hospital Outpatient Prospective Payment System and Calendar Year 2004 Payment Rates; Final Rule; Correction

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Information about this document as published in the Federal Register.

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AGENCY:

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

ACTION:

Correction of final rule with comment period.

SUMMARY:

This document corrects errors in the final rule with comment period that appeared in the Federal Register on November 7, 2003, entitled “Medicare Program; Changes to the Hospital Outpatient Prospective Payment System Start Printed Page 75443and Calendar Year 2004 Payment Rates; Final Rule.” This notice is a supplement to the November 7, 2003 final rule and is completely separate from any notice that promulgates new policy that results from enactment of the Medicare Prescription Drug, Improvement, and Modernization Act of 2003.

EFFECTIVE DATE:

January 1, 2004.

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FOR FURTHER INFORMATION CONTACT:

Dana Burley, (410) 786-0378.

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SUPPLEMENTARY INFORMATION:

I. Background

In FR Doc. 03-27791 of November 7, 2003 (68 FR 63398), there were several technical errors as well as a number of public comments that were received timely, but that we inadvertently failed to address. The errors include incorrect or potentially misleading responses, and in Addenda A and B, omissions and typographical errors. In addition, we are adding information to the addenda that was not available when we published the final rule. This additional information does not affect payment under the hospital outpatient prospective payment system (OPPS). We ordinarily provide a 30-day delay in the effective date of the provisions of a notice. Section 553(d) of the Administrative Procedure Act (5 U.S.C. 553(d)) ordinarily requires a 30-day delay in the effective date of final rules after the date of their publication in the Federal Register. This 30-day delay in effective date can be waived, however, if an agency finds good cause that the delay is impracticable, unnecessary, or contrary to the public interest, and the agency incorporates a statement of the finding and its reasons in the notice issued. In addition, section 1871(e)(1) of the Social Security Act, as amended by section 903(b)(1) of the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (DIMA), also requires that a substantive change in a regulation shall not become effective before the end of the 30-day period that begins on the date that the Secretary has issued or published the substantive change. Section 1871(e)(1) of the Social Security Act, as amended by section 903(b)(1) of DIMA, provides an exception to that requirement if the Secretary finds that the waiver of such 30-day period is necessary to comply with statutory requirements or that the application of such 30-day period is contrary to the public interest. We find good cause to waive the 30-day delay in effective date for this correction notice as set forth in section III, “Waiver of 30-Day Delay in Effective Date,” below.

II. Correction of Errors

A. Correction of Inaccurate Information

On page 63423, first column, fifth sentence, we stated: “The case of APC 0108, we used the external device cost data that was used to set the median for the 2003 OPPS because we received no outside data for the 2004 OPPS for this APC and because the proposed median of $28,685.30 set forth in the proposed rule was considerably higher than the final rule data median of $23,944.80, which resulted when additional claims were used to calculate the median cost.”

We subsequently determined that external data that met our preferred criteria for use in setting payment rates had been furnished as part of a timely, properly submitted comment for APC 0108. Therefore, we have revised the median cost and payment rate ($23,641.27) that was in the final rule for this APC using the data submitted in the comment. The new payment rate is $24,699.74. See Table 1 below for the complete revised values information.

To correct this error, we remove the fifth sentence in column 1 on page 63423 and replace it with the following: “In the case of APC 0108, we used external device cost data submitted in a comment on the proposed rule to set the median for the 2004 OPPS. The proposed median of $28,685.30 set forth in the proposed rule was considerably higher than the median calculated for the final rule, $23,944.80, which resulted when additional claims were used to calculate the median cost. The use of this external data raised the payment rate to a level we believe is more appropriate.”

B. Responses to Comments Not Included in the Final Rule

Bone Marrow Harvesting

Comment: A commenter asserted that the claims data for Physicians' Current Procedural Terminology (CPT) codes 38230 (bone marrow harvesting), 38240 (bone marrow/stem cell transplantation, allogenic), and 38241 (bone marrow/stem cell transplantation, autologous) are seriously flawed. For instance, the median cost for CPT code 38230 (using data for 35 claims) was $74.81. The commenter stated that CPT code 38230 involves a 60-90 minute operating room procedure performed under general anesthesia, with costs more closely approaching the payment rate for APC 0111 (paying $718.67) than APC 0123 (paying $288.53), its current APC placement. The commenter expressed similar concern over the claims data for CPT codes 38240 and 38241, asserting that their placement in APC 0123 results in inadequate payment to cover the costs of bone marrow and stem cell transplantation.

The commenter urged us to move CPT codes 38230, 38240, and 38241 from APC 0123 (bone marrow harvesting/stem cell transplant, paying $288.53) to APC 0111 (blood product exchange, paying $718.67).

Response: We agree with the commenter that the claims data for CPT code 38230 appear to be based on flawed claims. We believe that the costs involved in performing CPT code 38230 (bone marrow harvesting) are more similar to the costs involved in performing CPT codes 38205 and 38206 (stem cell harvesting, placed in APC 0111); therefore, we will move CPT code 38230 from APC 0123 to APC 0111. We will maintain the payment rate for APC 0111 at $718.67 as stated in the November 7, 2003 final rule, since we believe the claims for CPT code 38230 represent aberrant data and should not be used to recalculate the payment rate for APC 0111.

In contrast, we do not believe that the claims data for CPT codes 38240 and 38241 are flawed. The resource utilization of performing bone marrow and stem cell transplantations is similar to the resource utilization of performing infusion therapy services (which are paid $210 in APC 0110), since bone marrow and stem cell transplantations involve no incision and no unusual instruments or equipment. Therefore, we believe that the APC placement of CPT codes 38240 and 38241 in APC 0123 sufficiently captures the costs involved in performing these services. Although these codes will remain in APC 0123, their payment rate in APC 0123 will increase by $47.01 (from $288.53 to $335.54) above the rate stated in the November 7, 2003 final rule, as a result of moving CPT code 38230 out of APC 0123 and recalculating the median for APC 0123 based on CPT codes 38240 and 38241 that remain in APC 0123.

Cobalt 60-Based Stereotactic Radiosurgery

Comment: A commenter requested that we combine CPT codes G0242 (Cobalt 60-based stereotactic radiosurgery plan) and G0243 (Cobalt 60-based stereotactic radiosurgery delivery). The commenter explained that, before 2000, we allowed Cobalt 60-based stereotactic radiosurgery to be appropriately billed using CPT code 61793 (stereotactic radiosurgery—particle beam, gamma ray or linear accelerator—one or more sessions), the same code that non-Medicare payers continue to use for this procedure. Start Printed Page 75444However, our current guidelines for coding this procedure necessitate the billing of two codes (planning and delivery), and therefore, correct billing of this treatment using the current codes results in a multiple procedure claim. The commenter asserted that because we calculate medians using only single claims, the APC placement of Healthcare Common Procedure Coding System (HCPCS) codes G0242 and G0243 was based on aberrant single claims.

The commenter requested that these codes (G0242 and G0243) be combined into a single procedure code (that is, CPT code 61793) in order for us to accurately capture the costs of this treatment in a single claim because both parts of this treatment (planning and delivery) are always delivered on the same day in one surgical procedure. Based on resource consumption and clinical homogeneity, the commenter suggested that we place this single procedure code in one of the following APCs: 0222 (paying $12,670), 0226 (paying $7,437), or 0227 (paying $8,775).

Response: In addition to the above comment, we received several other comments stating that HCPCS code G0242 (Cobalt 60-based stereotactic radiosurgery plan) was being used inappropriately for linear accelerator-based stereotactic radiosurgery (SRS) planning in addition to Cobalt 60-based SRS planning, due to the nonexistence of a code to bill for linear accelerator-based SRS planning. Considering the current misuse of HCPCS code G0242 and the potential for causing greater confusion by combining CPT codes G0242 and G0243, we created a planning code for linear accelerator-based SRS (G0338) to distinguish this procedure from Cobalt 60-based SRS planning. Since the claims data for G0242 represent costs for linear accelerator-based SRS planning (due to misuse of the code) in addition to Cobalt 60-based SRS planning, we are uncertain of how to combine these data with G0243 (Cobalt 60-based SRS delivery) to determine an accurate payment rate for a combined code for planning and delivery of Cobalt 60-based SRS. Therefore, we will solicit input from the APC Panel at its next meeting in early 2004.

In the meantime, we will maintain two separate HCPCS codes (G0242 and G0243) for the planning and delivery of Cobalt 60-based SRS treatment, consistent with the use of two G codes for the planning (G0338) and delivery (G0173, G0251, G0339, G0340, as applicable) of each type of linear accelerator-based SRS treatment, as described below.

Correct Coding for Various Types of Stereotactic Radiosurgery (SRS):

  • Cobalt 60-based, multi-source SRS—

Planning—G0242 (APC 1516 paying $1,450)

Delivery—G0243 (APC 1528 paying $5,250)

  • Linear accelerator-based SRS—

Non-robotic linear accelerator-based SRS (complete session)

—Planning—G0338 (APC 1516 paying $1,450)

—Delivery—G0173 (APC 1528 paying $5,250)

Non-robotic linear accelerator-based SRS (fractionated sessions)

—Planning—G0338 (APC 1516 paying $1,450)

—Delivery—G0251 (APC 1513 paying $1,150, per session)

Image-guided robotic linear accelerator-based SRS (complete session or first session of fractionated treatment)—

—Planning—G0338 (APC 1516 paying $1,450)

—Delivery—G0339 (APC 1528 paying $5,250)

Image-guided robotic linear accelerator-based SRS (fractionated treatment, 2nd—5th sessions)—

—Planning—G0338 (APC 1516 paying $1,450)

—Delivery—G0340 (APC 1525 paying $3,750, per session)

Comment: A commenter urged us to recognize the cost and clinical differences between HCPCS codes G0243 and G0173 by placing them in separate APCs.

Response: We believe that the low volume of single claims for HCPCS code G0243 (172 single claims out of 1,033 total claims = 17 percent of total claims) does not substantiate movement of this code into a procedural APC at this time, and there is no clinical reason for a reassignment. Therefore, we will keep HCPCS code G0243 in new technology APC 1528 with a payment of $5,250 for CY 2004.

ProstacScint

Comment: The manufacturer of ProstaScint (indium capromab pendetide), a diagnostic agent used for the imaging of prostate cancer, indicated that this product's proposed payment rate is significantly below the cost that hospitals incur in acquiring ProstaScint. The manufacturer stated that reduced payment would restrict hospitals from providing ProstaScint studies to Medicare beneficiaries and have a significant negative effect on the treatment and outcomes of patients at risk for prostate cancer. The commenter submitted a survey of hospitals demonstrating their costs of purchasing ProstaScint.

Response: We agree with the commenter that the use of only hospital claims data to set the payment rate for ProstaScint may adversely impact beneficiary access. We believe that the external data submitted by the manufacturer meets our preferred criteria; therefore, we will use the external data to establish an adjusted median cost for this product by blending the median cost derived from our dampening methodology with the external cost data on a one-to-one ratio.

APCHCPCSShort descriptor2004 adjusted median costExternal acquisition cost2004 1:1 Blended median cost
1604A9507Indium/111 capromab pendetide$726.50$1,610.75$1,168.63

Arthroscopy

Comment: One commenter requested that we assign CPT code 29827 to APC 0042 (Level II Arthroscopy). The code was new for 2003 and was assigned to APC 0041 (Level I Arthroscopy). The commenter provided information to support the assertion that the procedure described by CPT code 29827 is very similar to that described by CPT code 29826 with regard to operating room time required, equipment requirements, and complexity. However, procedures coded as CPT code 29826 are assigned to APC 0042.

Response: Our medical staff evaluated this request and decided that they would like the advice of the APC Panel before making a determination. In their analysis of the assignments for CPT codes 29826 and 29827, they determined that it would be appropriate to solicit input from the APC Panel regarding the clinical coherence of both APCs 0041 and 0042. The APC Panel will meet in early 2004, and we plan to include these APCs on the agenda for its Start Printed Page 75445consideration. The date for the APC Panel meeting and registration information will be published in the Federal Register and on the CMS OPPS Web site at least 60 days before the meeting date.

Photoselective Vaporization of the Prostate

Comment: Several commenters urged us to increase payment for CPT codes 52647 and 52648 (photoselective vaporization of the prostate (PVP)). They expressed concern that other less effective procedures requiring less skill have a significantly higher proposed payment rate. Commenters stated that the proposed payment rate for PVP under APC 0163 does not cover the costs of providing access to this new technology.

Response: Based on our claims data, we believe that CPT codes 52647 and 52648 are appropriately placed in APC 0163 for CY 2004, but the commenters may want to consider applying for a new CPT/HCPCS code for this procedure so that it is identifiable separately from other procedures. Alternatively, PVP may be a candidate for consideration under the OPPS new technology process. We refer interested parties to our Web site www.cms.hhs.gov/​providers/​hopps/​ for further information on the new technology application and evaluation process.

Inpatient-Only List

Comment: We received a comment requesting that we remove several codes from the inpatient-only list. The codes are: 44901 (Incision and drainage of appendiceal abscess; percutaneous); 49021 (Drainage of peritoneal abscess or localized peritonitis, exclusive of appendiceal abscess; percutaneous); 49041 (Drainage of subdiaphragmatic or subphrenic abscess; percutaneous); and 49061 (Drainage of retroperitoneal abscess; percutaneous). The commenters based their request on the fact that codes they believe are similar to 44901, 49021, 49041, and 49061 are not on the inpatient-only list. Codes that they used as examples included 32201 (Pneumonostomy; with percutaneous drainage of abscess or cyst); and 50021 (Drainage of perirenal or renal abscess; percutaneous).

Response: The information provided by the commenter did not provide an adequate basis for our medical staff to make a decision. Instead, our physicians will solicit input from additional specialty groups that provide care to the patients undergoing these procedures. We will also present this issue to the APC Panel for consideration at its next meeting in early 2004.

Neutron Radiotherapy

Comment: We received a comment requesting that we create a new “G” code for neutron radiotherapy so that these procedures can be assigned to a new APC. At this time, the procedures are coded using a CPT code that includes other procedures that the commenter does not believe are related to neutron radiotherapy. The commenter believes the combination of procedures in the CPT code is inappropriate.

Response: We evaluated this request and continue to believe that the current coding is appropriate. We do not believe that creation of a new “G” code is warranted in this case because there is a CPT code that specifically describes this procedure.

Magnetic Resonance Imaging and Magnetic Resonance Angiography

Comment: We received a comment requesting that we assign magnetic resonance imaging and magnetic resonance angiography to separate APCs. These procedures are currently assigned to APCs 0336 and 0337.

Response: We evaluated this request and continue to believe that the current assignments are appropriate and result in accurate payment for the procedures.

Fetal Echocardiogram

Comment: We received one comment requesting that we reassign codes for fetal echocardiograms (CPT 76825 through 76827) to APC 0269. The codes are currently assigned to APCs 0671 and 0697.

Response: We believe that the APC assignments for these CPT codes continue to be appropriate. We used most of the submitted claims for calculating medians for these codes. We believe the resource use and clinical coherence in the current APCs are appropriate.

New Orphan Drug

Comment: We received a comment requesting that arsenic trioxide (Trisenox) be considered as a single-indication orphan drug for Medicare OPPS. The drug has orphan status from the FDA for treatment of multiple myeloma, myelodysplastic syndrome, chronic myeloid leukemia, and chronic lymphocystic anemia.

Response: After careful evaluation, we agree that arsenic trioxide does meet our criteria for special payment as a single indication orphan drug. As we stated in our final rule (68 FR 63453), we are setting payment under the 2004 OPPS for single indication orphan drugs at 88 percent of the average wholesale price listed for these drugs in the April 1, 2003 single drug pricer unless we are presented with verifiable information that shows that our payment rate does not reflect the price that is widely available to the hospital market. For 2004, the payment rate for Trisenox will be $34.32 per unit.

C. Revisions and Corrections to Addenda A and B

As a result of a HCPCS coding change, the relative weight, payment rate, and minimum unadjusted copayment for APC 0012 as published on page 63478, are incorrect. Code 11057 moved from APC 0012 to APC 0013, and we failed to update the APCs in time for the final rule. The correct values for APC 0012 are: relative weight, 0.7612; payment rate, $41.53; and minimum unadjusted copayment amount, $8.31. The correct values for APC 0013 are relative weight, 1.1302; payment rate, $61.66; and the minimum unadjusted copayment is unchanged. These values are listed in bold type in Table 1 below.

As a result of our use of external data, APC 0108 has new values in Addendum A on page 63479. The correct relative weight is 452.6995, the payment rate increases to $24,669.74, and the minimum unadjusted copayment becomes $4,939.95. These values are listed in bold type in Table 1 below.

In response to a comment, we moved HCPCS code 43752 from APC 0272 to APC 0121. This move resulted in new Addendum A values for both of these APCs. The incorrect values on page 63479 for APC 0121 are corrected as follows: relative weight, 2.1114; payment rate, $115.2; and minimum unadjusted copayment amount, $23.04.

On page 63481, the incorrect values for APC 0272 are corrected as follows: relative weight, 1.4184; payment rate, $77.39; and minimum unadjusted copayment, $15.48.

In response to a comment that we overlooked, we moved CPT code 38230 from APC 0123 to APC 0111. This resulted in new values for APC 0123 in Addendum A. The values on page 63479 are corrected as follows: relative weight, 6.1499; payment rate, $335.54; and minimum unadjusted copayment amount, $67.11. There are no changes to the values for APC 0111. These values are listed in bold type in Table 1 below.

On page 63482, the values for APC 0321 are incorrect due to a change in the status indicator for HCPCS code 90901. The status indicator was changed to “A” and, therefore, does not contribute to the calculation of the APC median. We correct the values for APC 0321 by Start Printed Page 75446replacing the values on page 63482 with the following: relative weight, 1.4817; payment rate, $80.84; and minimum unadjusted copayment amount, $16.17. These values are listed in bold type in Table 1 below.

The status indicator for HCPCS code 96105 was changed to “A” and, therefore, should not contribute to the calculation of the APC median. The values for APC 0373 on page 63482 are incorrect because the code (96105) was used under its previous status indicator “X” and was therefore included in the media calculation. We replace the values in Addendum A on page 63482 with the following correct values: relative weight, 2.3288; payment rate, $127.06; and minimum unadjusted copayment amount, $25.41. These values are listed in bold type in Table 1 below.

The relative weight, copayment and payment rates are incorrect for APC 0384 as published on page 63482. Two HCPCS codes (43268 and 43269) were moved from APC 0151 into APC 0384, and those changes were not reflected in the published Addendum A. We replace the values for APC 0384 with the following: relative weight, 36.54; payment rate, $1,993.66; national unadjusted copayment, $433.01; and minimum unadjusted copayment, $398.73. The values for APC 0151 do not change. These values are listed in bold type in Table 1 below.

APC 0413 was listed in Addendum A on page 63483 in error. No codes are assigned to this APC, so it no longer exists. We remove APC 0413.

We correct Addenda A and B by adding the relative weight for APC 0734 on page 63484 in Addendum A and for CPT/HCPCS codes C1774 and Q0137 on pages 63610 and 36350, respectively, in Addendum B. The relative weight is 0.0594 for both of these codes.

The values for APC 1604 are incorrect as published on page 63486. Additional data were available but inadvertently were not used in the median calculation for this APC. The new values reflect use of the additional data. We correct the values for APC 1604 as follows: relative weight, 20.2752; payment rate, $1,106.24; and minimum unadjusted copayment, $221.25. These values are listed in bold type in Table 1 below.

On page 63487, the payment rate for APC 9012 is corrected to reflect its new status as a single-indication orphan drug. We correct the payment rate to $34.32 and the minimum unadjusted copayment to $6.86.

On page 63488, the descriptor for APC 9116 is incorrect. We correct it to read “Inj. Ertapenem sodium, per 500 mg.”

For the following CPT/HCPCS codes on the pages identified, beginning on page 63488 and concluding on page 63644, we listed outdated descriptors. We correct the descriptor on page 63488 for code 0002T; page 63496 for code 15852; page 63548 for code 55870; page 63619 for code E0141; page 63622 for codes E0973 and E0974; page 63623 for code E0978; page 63624 for code E1226; page 63627 for codes G0210, G0213, G0214, G0215, G0230, G0246, G0247, G0248; page 63630 for code J1563; page 63631 for codes J2260 and J2324; page 63633 for code J8700; page 63636 for code K0560; page 63637 for codes K0600, K0607, K0614, K0615, K0616, and K0617; page 63643 for codes L4350, L4360, and L4386; and on page 63644 for codes L5646 and L5648. See Table 2—Corrections to Addendum B of the November 7, 2003, Final Rule for corrections to Addendum B for the codes identified above.

On page 63627, CPT/HCPCS G0244 is listed with an incorrect relative weight, payment rate, and copayment amount. We correct the current relative weight, payment rate, and copayment, by inserting 6.6961, $365.35, and $73.07, respectively. See Table 2 below for the corrected values.

On page 63634, CPT/HCPCS J9017 is listed with an incorrect relative weight, payment rate, and copayment. J9017 is an orphan drug and is reimbursed at 88 percent of AWP. We correct the addendum by replacing current values with a payment rate of $34.32 and minimum unadjusted copayment of $6.86.

On page 63590, we incorrectly assigned status indicator A to CPT/HCPCS 90918 through 90925. These codes are replaced by G0320 through G0327. Therefore, codes 90918 through 90925 are assigned status indicator E. On page 63590, for CPT/HCPCS 90918, 90919, 90920, 90921, 90922, 90924, and 90925, we remove the status indicator A and insert status indicator E. See Table 2—Corrections to Addendum B of the November 7, 2003, Final Rule for corrections to Addendum B for the codes identified above.

The following CPT/HCPCS codes were omitted from Addendum B of the November 7, 2003, final rule: 99375, status indicator E, home health care supervision, effective 1/1/03; 99378, status indicator E, hospice care supervision, effective 1/1/03; G0308, status indicator A, condition NI, ESRD related svc 4+mo<2yrs; G0309, status indicator A, condition NI, ESRD related svc 2-3mo<2rs; G0310, status indicator A, condition NI, ESRD related svc 1vst<2yr; G0311, status indicator A, condition NI, ESRD related svs 4+mo 2-11 yr; G0312, status indicator A, condition NI, ESRD related svs 2-3 mo 2-11 yr; G0313, status indicator A, condition NI, ESRD related svs 1 mon 2-11 yr; G0314, status indicator A, condition NI, ESRD related svs 4+mo 12-19; G0315, status indicator A, condition NI, ESRD related svs 2-3 mo 12-19; G0316, status indicator A, condition NI, ESRD related svs 1 vst 12-19y; G0317, status indicator A, condition NI, ESRD related svs 4+mo 20+yrs; G0318, status indicator A, condition NI, ESRD related svs 2-3 mo 20+y; G0319, status indicator A, condition NI, ESRD related svs 1 visit 20+y; G0320, status indicator A, condition NI, ESRD related svs home under 2; G0321, status indicator A, condition NI, ESRD related svs home mo<2ys; G0322, status indicator A, condition NI, ESRD related svs home mo12-19; G0328, status indicator A, condition NI, fecal blood scrn immunoassay; all effective 1/1/04; and P9603, status indicator A, One-way allow prorated miles, effective 1/1/92. See Table 2—Corrections to Addendum B of the November 7, 2003, Final Rule for corrections to Addendum B for the codes identified above.

On page 63608, we incorrectly assigned status indicator B and condition NI to CPT/HCPCS A9527, I-131 tositumomab therapeutic. New code A9534, with the same descriptor, replaces A9527, effective 1/1/04. A9527 is removed effective 1/1/04, with no grace period. On page 63608, for CPT/HCPCS A9527, we remove the status indicator of B and insert a status indicator of D. We remove the condition NI and insert a condition of DNG. See Table 2—Corrections to Addendum B of the November 7, 2003, Final Rule for corrections to Addendum B for the code identified above.

For the CPT/HCPCS codes on the pages identified, beginning on page 63490 and concluding on page 63653, we incorrectly listed status indicator E instead of status indicator B. We correct the status indicator on page 63490 for codes 0054T, 0055T, 0056T, 0057T, 0060T, and 0061T; page 63598 for codes 99002 and 99140; page 63604 for codes A4671, A4672, and A4673; page 63605 for codes A4674 and A4728; page 63624 for code E1634; page 63633 for J7330; page 63641 for L3350; and page 63653 for code V2761. See Table 2—Corrections to Addendum B of the November 7, 2003, Final Rule for corrections to Addendum B for the codes identified above.

For the following CPT/HCPCS codes on the pages identified, beginning on page 63490 and concluding on page 63619, we incorrectly listed condition Start Printed Page 75447DG (deleted with grace). These codes are not deleted for 2004, and the condition should be blank. We correct the condition on page 63490 for codes 00546, 00548, 00550, 00560, 00562, 00563, and 00566; and page 63539 for codes 47135, 47136, 47300, and 47350; and page 63619 for E0165. See Table 2—Corrections to Addendum B of the November 7, 2003, Final Rule for corrections to Addendum B for the codes identified above.

On page 63569, CPT/HCPCS 76977 was inadvertently assigned an incorrect status indicator. We remove status indicator S and insert status indicator X. The payment rates are correct as is. See Table 2—Corrections to Addendum B of the November 7, 2003, Final Rule for corrections to Addendum B for the code identified above.

On page 63590, CPT/HCPCS 92019 was assigned an incorrect status indicator. We remove status indicator S and insert status indicator T. The payment rates are correct as is. See Table 2—Corrections to Addendum B of the November 7, 2003, Final Rule for corrections to Addendum B for the code identified above.

On page 63608, CPT/HCPCS A9700 was incorrectly assigned an APC, relative weight, payment rate, and copayment. A9700 is not payable under OPPS, and no payment should be made for this service. We remove the APC, relative weight, payment rate, and minimum unadjusted copayment. See Table 2—Corrections to Addendum B of the November 7, 2003, Final Rule for corrections to Addendum B for the code identified above.

On page 63588, CPT/HCPCS codes 90296 and 90581 are incorrectly assigned a status indicator, APC, relative weight, payment rate, and copayment. Effective 1/1/04, codes 90296 and 90581 are packaged services and therefore are assigned status indicator N. For codes 90296 and 90581, we remove status indicator K, APC, payment rate, and minimum unadjusted copayment, and insert status indicator N. See Table 2—Corrections to Addendum B of the November 7, 2003, Final Rule for corrections to Addendum B for the codes identified above.

On page 63623, CPT/HCPCS code E1065 omits condition DG. This code is deleted with grace period effective January 1, 2004. We correct this by inserting DG in the condition column.

Many codes were incorrectly listed with status indicator A that should be listed with the new status indicator Y, indicating that the code is not paid under OPPS, but should be billed to the Durable Medical Equipment Regional Carrier (DMERC). They are listed in Tables 3-5. In addition, codes A4232, A4632, E0188, E0189, E0218, E0602, E0740, E0760, E0765, K0610, K0611, K0612, and K0613 were incorrectly listed with status indicator E, but should be listed with status indicator Y. Codes E0967, E0969, E0977, E0980, E0994, E0997, E0998, E0999, E1001, E1035, E1065, and E1227 were incorrectly listed with status indicator B, but should be listed with status indicator Y. For all these codes, we remove the current status indicator and insert status indicator Y. See Tables 3-5 for a list of codes for which the status indicator has changed from A, E, or B to Y.

On page 63471 of the November 7, 2002 Final Rule, we specify that HCPCS codes for drugs, biologicals, and radiopharmaceuticals that are new for 2004 yet have no predecessor will be assigned packaged status for 2004.

On pages 63608 and 63652, HCPCS codes A9526 and Q4078, respectively, were incorrectly assigned a status indicator, APC, relative weight, payment rate, and copayment. Effective 1/1/04, codes A9526 and Q4078 are packaged services and therefore are assigned status indicator N. For these codes, we remove status indicator K, APC, payment rate, and minimum unadjusted copayment, and insert status indicator N.

On page 63415 of the November 7, 2003 Final Rule, we state that we plan to delete HCPCS C1088 effective 1/1/04. Addendum B does not list this code as deleted. For HCPCS C1088, we remove status indicator T, APC, payment rate, and minimum unadjusted copayment, and insert status indicator D and condition DNG (deleted with no grace period).

III. Waiver of 30-Day Delay in Effective Date

We ordinarily provide a 30-day delay in the effective date of the provisions of a notice. Section 553(d) of the Administrative Procedure Act (5 U.S.C. 553(d)) ordinarily requires a 30-day delay in the effective date of final rules after the date of their publication in the Federal Register. This 30-day delay in effective date can be waived, however, if an agency finds good cause that the delay is impracticable, unnecessary, or contrary to the public interest. In addition, section 1871(e)(1) of the Social Security Act, as amended by section 903(b)(1) of the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (DIMA), also requires that a substantive change in a regulation shall not become effective before the end of the 30-day period that begins on the date that the Secretary has issued or published the substantive change. Section 1871(e)(1) of the Social Security Act, as amended by section 903(b)(1) of DIMA, provides an exception to that requirement if the Secretary finds that the waiver of such 30-day period is necessary to comply with statutory requirements or that the application of such 30-day period is contrary to the public interest. The agency must incorporate a statement of the good cause finding and rationale in the published rule.

In this case, we believe that it is in the public interest to make the corrections identified above effective January 1, 2004 without the 30-day delay in effective date. In most cases, these errors were the result of our inadvertent failure to address a number of public comments that were received timely, incorrect or potentially misleading responses, and omissions and typographical errors in Addenda A and B. In addition, we have added information to the addenda that was not available when we published the November 7, 2003 final rule. This information does not affect payment under the OPPS. A delay in the effective date of this notice would result, in most cases, in underpayment of hospitals beginning January 1, 2004. If we did not make these changes, hospitals would be paid improperly, and beneficiaries' access to care may be impeded. Therefore, we find good cause to waive the 30-day delay in effective date.

Table 1.—Addendum A Corrections as Corrected by This Federal Register Document

APCGroup titleStatus indicatorRelative weightPayment rateNational unadjusted copaymentMinimum unadjusted copayment
0012Level I Debridement & DestructionT0.761241.5311.188.31
0013Level II Debridement & DestructionT1.130261.6614.2012.33
Start Printed Page 75448
0108Insertion/Replacement/Repair of Cardioverter-Defibrillator LeadsT452.699524699.744939.95
0121Level I Tube changes and RepositioningT2.1114115.2043.8023.04
0123Bone Marrow Harvesting and Bone Marrow/Stem Cell TransplantS6.1499335.5467.11
0272Level I FluoroscopyX1.418477.3938.3615.48
0321Biofeedback and Other TrainingS1.481780.8421.7816.17
0339ObservationS6.6961365.3573.07
0373Neuropsychological TestingX2.3288127.0625.41
0384GI Procedures with StentsT36.54001993.66433.01398.73
APC 0413 is deleted
0734Injection, darbepoetin alfa (for non-ESRD, per 1 mcgK0.05943.240.65
9012Arsenic TrioxideK34.32.6.86
1604IN 111 capromab pendetide, per doseK20.27521106.24221.25

Table 2.—Addendum B Corrections as Corrected by This Federal Register Document

CPT/HCPCSStatus indicatorConditionDescriptionAPCRelative weightPayment rateNational unadjusted copaymentMinimum unadjusted copayment
0002TCDGendo repair abd aa aorto uni
00546CAnesth, lung, chest wall surg
00548NAnesth, trachea, bronchi surg
0054TBNIBone surgery using computer
00550NAnesth, sternal debridement
0055TBNIBone surgery using computer
00560CAnesth, open heart surgery
00562CAnesth, open heart surgery
00563NAnesth, heart proc w/pump
00566NAnesth, cabg w/o pump
0056TBNIBone surgery using computer
0057TBNIUppr gi scope w/ thrml txmnt
0060TBNIElectrical impedance scan
0061TBNIDestruction of tumor, breast
11001TDebride infected skin add-on00120.761241.5311.188.31
11055TTrim skin lesion00120.761241.5311.188.31
11056TTrim skin lesions, 2 to 400120.761241.5311.188.31
11057TTrim skin lesions, over 400131.130261.6614.2012.33
11200TRemoval of skin tags00131.130261.6614.2012.33
11300TShave skin lesion00120.761241.5311.188.31
11301TShave skin lesion00120.761241.5311.188.31
11302TShave skin lesion00120.761241.5311.188.31
11305TShave skin lesion00131.130261.6614.2012.33
11306TShave skin lesion00131.130261.6614.2012.33
11307TShave skin lesion00131.130261.6614.2012.33
11308TShave skin lesion00131.130261.6614.2012.33
11310TShave skin lesion00131.130261.6614.2012.33
11311TShave skin lesion00131.130261.6614.2012.33
11312TShave skin lesion00131.130261.6614.2012.33
11730TRemoval of nail plate00131.130261.6614.2012.33
11732TRemove nail plate, add-on00120.761241.5311.188.31
11900TInjection into skin lesions00120.761241.5311.188.31
11901TAdded skin lesions injection00120.761241.5311.188.31
15786TAbrasion, lesion, single00120.761241.5311.188.31
15787TAbrasion, lesions, add-on00131.130261.6614.2012.33
15788TChemical peel, face, epiderm00120.761241.5311.188.31
15792TChemical peel, nonfacial00120.761241.5311.188.31
15793TChemical peel, nonfacial00120.761241.5311.188.31
15852XDressing change not for burn03400.631434.456.89
16000TInitial treatment of burn(s)00120.761241.5311.188.31
16020TTreatment of burn(s)00131.130261.6614.2012.33
16025TTreatment of burn(s)00120.761241.5311.188.31
17250TChemical cautery, tissue00131.130261.6614.2012.33
17271TDestruction of skin lesions00131.130261.6614.2012.33
17340TCryotherapy of skin00120.761241.5311.188.31
17360TSkin peel therapy00120.761241.5311.188.31
Start Printed Page 75449
17380THair removal by electrolysis00120.761241.5311.188.31
31502TChange of windpipe airway01212.1114115.2043.8023.04
38230SBone marrow collection011113.1719718.67200.18143.73
38240SBone marrow/stem transplant01236.1499335.5467.11
38241SBone marrow/stem transplant01236.1499335.5467.11
43219TEsophagus endoscopy038436.54001993.66433.01398.73
43256TUppr gi endoscopy w stent038436.54001993.66433.01398.73
43268TEndo cholangiopancreatograph038436.54001993.66433.01398.73
43269TEndo cholangiopancreatograph038436.54001993.66433.01398.73
43752TNasal/orogastric w/stent01212.1114115.2043.8023.04
43760TChange gastrostomy tube01212.1114115.2043.8023.04
43761TReposition gastrostomy tube01212.1114115.2043.8023.04
44370TSmall bowel endoscopy/stent038436.54001993.66433.01398.73
44379TS bowel endoscope w/stent038436.54001993.66433.01398.73
44383TIleoscopy w/stent038436.54001993.66433.01398.73
44397TColonoscopy w/stent038436.54001993.66433.01398.73
44500TIntro, gastrointestinal tube01212.1114115.2043.8023.04
45327TProctosigmoidoscopy w/stent038436.54001993.66433.01398.73
45345TSigmoidoscopy w/stent038436.54001993.66433.01398.73
45387TColonoscopy w/stent038436.54001993.66433.01398.73
46916TCryosurgery, anal lesion(s)00131.130261.6614.2012.33
47135CTransplantation of liver
47136CTransplantation of liver
47300CSurgery for liver lesion
47350CRepair liver wound
51705TChange of bladder tube01212.1114115.2043.8023.04
54050TDestruction, penis lesion(s)00131.130261.6614.2012.33
54056TCryosurgery, penis lesion(s)00120.761241.5311.188.31
55870TElectroejaculation01974.8280263.4252.68
62194TReplace/irrigate catheter01212.1114115.2043.8023.04
69220TClean out mastoid cavity00120.761241.5311.188.31
70370XThroat x-ray & fluoroscopy02721.418477.3938.3615.48
70371XSpeech evaluation, complex02721.418477.3938.3615.48
71023XChest x-ray and fluoroscopy02721.418477.3938.3615.48
71034XChest x-ray and fluoroscopy02721.418477.3938.3615.48
71090XX-ray & pacemaker insertion02721.418477.3938.3615.48
74340XX-ray guide for GI tube02721.418477.3938.3615.48
76000XFluoroscope examination02721.418477.3938.3615.48
76120XCine/video x-rays02721.418477.3938.3615.48
76496XFluoroscopic procedure02721.418477.3938.3615.48
76977XUs bone density measure03400.631434.456.89
90296NDiphtheria antitoxin
90581NAnthrax vaccine, sc
90911SBiofeedback peri/uro/rectal03211.481780.8421.7816.17
90918EESRD related services, month
90919EESRD related services, month
90920EESRD related services, month
90921EESRD related services, month
90922EESRD related services, day
90923EESRD related services, day
90924EESRD related services, day
90925EESRD related services, day
92019TEye exam & treatment06992.2303121.6947.4624.34
96100XPsychological testing03732.3288127.0625.41
96110XDevelopmental test, lim03732.3288127.0625.41
96111XDevelopmental test, extend03732.3288127.0625.41
96115XNeurobehavior status exam03732.3288127.0625.41
96117XNeuropsych test battery03732.3288127.0625.41
96920TLaser tx, skin < 250 sq cm00120.761241.5311.188.31
96921TLaser tx, skin 250-500 sq cm00120.761241.5311.188.31
96922TLaser tx, skin > 500 sq cm00131.130261.6614.2012.33
99002BDevice handling
99140BEmergency anesthesia
99375EHome health care supervision
99378EHospice care supervision
A4671BNIDisposable cycler set
A4672BNIDrainage ext line, dialysis
A4673BNIExt line w easy lock connect
A4674BNIChem/antisept solution, 8oz
A4728BNIDialysate solution, non-dex
Start Printed Page 75450
A9507KIndium/111 capromab pendetid160420.27521106.24221.25
A9526NNIAmmonia N-13, per dose
A9527DDNGI-131 tositumomab therapeut
A9700EEchocardiography Contrast
C1088DDNGLaser Optic Tr Sys0.65
C1774KDGDarbepoetin alfa, 1 mcg07340.05943.24
E0141YRigid wheeled walker adj/fix
E0165ACommode chair stationry det
E0973BW/Ch access det adj armrest
E0974BW/Ch access anti-rollback
E0978BW/C acc,saf belt pelv strap
E1065BDGWheelchair power attachment
E1226BW/C access fully reclineback
E1634BNIPeritoneal dialysis clamp
G0210SPET img wholebody dxlung1450.00290.00
G0213SPET img wholbody dx1450.00290.00
G0214SPET img wholebod init1450.00290.00
G0215SPETimg wholebod restag1450.00290.00
G0230SPET myocard viability post1450.00290.00
G0244SObserv care by facility topt03396.6961365.3573.07
G0246VFollowup eval of foot pt lop06000.927850.6210.12
G0247TRoutine footcare pt w lops00090.665236.298.347.26
G0248SDemonstrate use home inr mon1503150.0030.00
G0272XDGNaso/oro gastric tube pl MD02721.418477.3938.3615.48
G0299TNFInser/repos single icd+leads0108452.699524699.744939.95
G0300TNFInsert reposit lead dual+gen0108452.699524699.744939.95
G0308ANIESRD related svc 4+mo<2yrs
G0309ANIESRD related svc 2-3mo<2yrs
G0310ANIESRD related svc 1vst<2yr
G0311ANIESRD related svs 4+mo 2-11 yr
G0312ANIESRD relate svs 2-3 mo 2-11 y
G0313ANIESRD related svs 1 mon 2-11 y
G0314ANIESRD related svs 4+mo 12-19
G0315ANIESRD related svs 2-3 mo 12-19
G0316ANIESRD related svs 1 vis/ 12-19y
G0317ANIESRD related svs 4+mo 20+yrs
G0318ANIESRD related svs 2-3 mo 20+y
G0319ANIESRD related svs 1 visit 20+y
G0320ANIESRD related svs home undr 2
G0321ANIESRD related svs home mo<2ys
G0322ANIESRD related svs hom mo12-19
G0328ANIFecal blood scrn immunoassay
J1563KIV immune globulin09050.805743.968.79
J2260KInj milrinone lactate/5 MG70070.212911.622.32
J2324GNesiritide9114151.6222.66
J7330BCultured chondrocytes implnt
J8700KTemozolomide10860.06903.760.75
J9017KArsenic trioxide901234.326.86
K0560NDGMCP joint 2-piece for implnt
K0600YNFFunctional neuromuscularstim
K0607YNFRepl batt for AED
K0614YDGChem/antisept solution, 8oz
K0615YDGSGD prerec mes >8min <=20min
K0616YDGSGD prerec mes>20min <=40min
K0617YDGSGD prerec mes > 40min
L3350BShoe heel wedge
L4350AAnkle control orthosi prefab
L4360APneumati walking boot prefab
L4386ANon-pneum walk boot prefab
L5646ABelow knee cushion socket
L5648AAbove knee cushion socket
P9603AOne-way allow prorated miles
Q0137KNIDarbepoetin alfa, non esrd07340.05943.240.65
Q4078NDGAmmonia N-13, per dose
V2761BNIMirror coating
Start Printed Page 75451

Table 3.— HCPCS With Status Indicators That Changed From B to Y

CPT/ HCPCSDescription
E0967Wheelchair hand rims.
E0969Wheelchair narrowing device.
E0977Wheelchair wedge cushion.
E0980Wheelchair safety vest.
E0994Wheelchair arm rest.
E0997Wheelchair caster w/ a fork.
E0998Wheelchair caster w/o a fork.
E0999Wheelchr pneumatic tire w/wh.
E1001Wheelchair wheel.
E1035Patient transfer system.
E1065Wheelchair power attachment.
E1227Wheelchair spec sz spec ht a.

Table 4.—HCPCS With Status Indicators That Changed From A to Y.

CPT/HCPCSDescription
A4221Maint drug infus cath per wk.
A4222Drug infusion pump supplies.
A4230Infus insulin pump non needle.
A4231Infusion insulin pump needle.
A4253Blood glucose/reagent strips.
A4254Battery for glucose monitor.
A4255Glucose monitor platforms.
A4256Calibrator solution/chips.
A4257Replace Lensshield Cartridge.
A4258Lancet device each.
A4259Lancets per box.
A4265Paraffin.
A4556Electrodes, pair.
A4557Lead wires, pair.
A4558Conductive paste or gel.
A4595TENS suppl 2 lead per month.
A4608Transtracheal oxygen cath.
A4609Trach suction cath clsed sys.
A4610Trach sctn cath 72h clsedsys.
A4611Heavy duty battery.
A4612Battery cables.
A4613Battery charger.
A4615Cannula nasal.
A4616Tubing (oxygen) per foot.
A4617Mouth piece.
A4618Breathing circuits.
A4619Face tent.
A4620Variable concentration mask.
A4621Tracheotomy mask or collar.
A4624Tracheal suction tube.
A4628Oropharyngeal suction cath.
A4630Repl bat t.e.n.s. own by pt.
A4631Wheelchair battery.
A4633Uvl replacement bulb.
A4635Underarm crutch pad.
A4636Handgrip for cane etc.
A4637Repl tip cane/crutch/walker.
A4639Infrared ht sys replcmnt pad.
A4640Alternating pressure pad.
A7000Disposable canister for pump.
A7001Nondisposable pump canister.
A7002Tubing used w suction pump.
A7003Nebulizer administration set.
A7004Disposable nebulizer sml vol.
A7005Nondisposable nebulizer set.
A7006Filtered nebulizer admin set.
A7007Lg vol nebulizer disposable.
A7008Disposable nebulizer prefill.
A7009Nebulizer reservoir bottle.
A7010Disposable corrugated tubing.
A7011Nondispos corrugated tubing.
A7012Nebulizer water collec devic.
A7013Disposable compressor filter.
A7014Compressor nondispos filter.
A7015Aerosol mask used w nebulize.
A7016Nebulizer dome & mouthpiece.
A7017Nebulizer not used w oxygen.
A7018Water distilled w/nebulizer.
A7019Saline solution dispenser.
A7020Sterile H2O or NSS w lgv neb.
A7025Replace chest compress vest.
A7026Replace chst cmprss sys hose.
A7030CPAP full face mask.
A7031Replacement facemask interfa.
A7032Replacement nasal cushion.
A7033Replacement nasal pillows.
A7034Nasal application device.
A7035Pos airway press headgear.
A7036Pos airway press chinstrap.
A7037Pos airway pressure tubing.
A7038Pos airway pressure filter.
A7039Filter, non disposable w pap.
A7044PAP oral interface.
E0100Cane adjust/fixed with tip.
E0105Cane adjust/fixed quad/3 pro.
E0110Crutch forearm pair.
E0111Crutch forearm each.
E0112Crutch underarm pair wood.
E0113Crutch underarm each wood.
E0114Crutch underarm pair no wood.
E0116Crutch underarm each no wood.
E0117Underarm springassist crutch.
E0130Walker rigid adjust/fixed ht.
E0135Walker folding adjust/fixed.
E0141Rigid wheeled walker adj/fix.
E0142Walker rigid wheeled with se.
E0143Walker folding wheeled w/o s.
E0144Enclosed walker w rear seat.
E0145Walker whled seat/crutch att.
E0146Folding walker wheels w seat.
E0147Walker variable wheel resist.
E0148Heavyduty walker no wheels.
E0149Heavy duty wheeled walker.
E0153Forearm crutch platform atta.
E0154Walker platform attachment.
E0155Walker wheel attachment, pair.
E0156Walker seat attachment.
E0157Walker crutch attachment.
E0158Walker leg extenders set of 4.
E0159Brake for wheeled walker.
E0160Sitz type bath or equipment.
E0161Sitz bath/equipment w/faucet.
E0162Sitz bath chair.
E0163Commode chair stationry fxd.
E0164Commode chair mobile fixed a.
E0165Commode chair stationry det.
E0166Commode chair mobile detach.
E0167Commode chair pail or pan.
E0168Heavyduty/wide commode chair.
E0169Seatlift incorp commodechair.
E0175Commode chair foot rest.
E0176Air pressre pad/cushion nonp.
E0177Water press pad/cushion nonp.
E0178Gel pressre pad/cushion nonp.
E0179Dry pressre pad/cushion nonp.
E0180Press pad alternating w pump.
E0181Press pad alternating w/pump.
E0182Pressure pad alternating pump.
E0184Dry pressure mattress.
E0185Gel pressure mattress pad.
E0186Air pressure mattress.
E0187Water pressure mattress.
E0191Protector heel or elbow.
E0192Pad wheelchr low press/posit.
E0193Powered air flotation bed.
E0194Air fluidized bed.
E0196Gel pressure mattress.
E0197Air pressure pad for mattress.
E0198Water pressure pad for mattr.
E0199Dry pressure pad for mattress.
E0200Heat lamp without stand.
E0202Phototherapy light w/photom.
E0205Heat lamp with stand.
E0210Electric heat pad standard.
E0215Electric heat pad moist.
E0217Water circ heat pad w/pump.
E0220Hot water bottle.
E0221Infrared heating pad system.
E0225Hydrocollator unit.
E0230Ice cap or collar.
E0235Paraffin bath unit portable.
E0236Pump for water circulating p.
E0238Heat pad non-electric moist.
E0239Hydrocollator unit portable.
E0249Pad water circulating heat u.
E0250Hosp bed fixed ht w/mattress.
E0251Hosp bed fixed ht w/o mattress.
E0255Hospital bed var ht w/mattress.
E0256Hospital bed var ht w/o matt.
E0260Hosp bed semi-electr w/matt.
E0261Hosp bed semi-electr w/o matt.
E0265Hosp bed total electr w/matt.
E0266Hosp bed total elec w/o matt.
E0271Mattress innerspring.
E0272Mattress foam rubber.
E0275Bed pan standard.
E0276Bed pan fracture.
E0277Powered pres-redu air mattrs.
E0280Bed cradle.
E0290Hosp bed fx ht w/o rails w/m.
E0291Hosp bed fx ht w/o rail w/o.
E0292Hosp bed var ht w/o rail w/o.
E0293Hosp bed var ht w/o rail w/.
E0294Hosp bed semi-elect w/ mattrs.
E0295Hosp bed semi-elect w/o matt.
E0296Hosp bed total elect w/matt.
E0297Hosp bed total elect w/o matt.
E0305Rails bed side half length.
E0310Rails bed side full length.
E0316Bed safety enclosure.
E0325Urinal male jug-type.
E0326Urinal female jug-type.
E0371Nonpower mattress overlay.
E0372Powered air mattress overlay.
E0373Nonpowered pressure mattress.
E0424Stationary compressed gas 02.
E0431Portable gaseous 02.
E0434Portable liquid 02.
E0439Stationary liquid 02.
E0441Oxygen contents, gaseous.
E0442Oxygen contents, liquid.
E0443Portable 02 contents, gas.
E0444Portable 02 contents, liquid.
E0450Volume vent stationary/porta.
E0454Pressure ventilator.
Start Printed Page 75452
E0455Oxygen tent excl croup/ped t.
E0457Chest shell.
E0459Chest wrap.
E0460Neg press vent portabl/statn.
E0461Vol vent noninvasive interfa.
E0462Rocking bed w/ or w/o side r.
E0480Percussor elect/pneum home m.
E0482Cough stimulating device.
E0483Chest compression gen system.
E0484Non-elec oscillatory pep dvc.
E0500Ippb all types.
E0550Humidif extens supple w ippb.
E0555Humidifier for use w/ regula.
E0560Humidifier supplemental w/ I.
E0565Compressor air power source.
E0570Nebulizer with compression.
E0571Aerosol compressor for svneb.
E0572Aerosol compressor adjust pr.
E0574Ultrasonic generator w svneb.
E0575Nebulizer ultrasonic.
E0580Nebulizer for use w/ regulat.
E0585Nebulizer w/ compressor & he.
E0590Dispensing fee dme neb drug.
E0600Suction pump portab hom modl.
E0601Cont airway pressure device.
E0605Vaporizer room type.
E0606Drainage board postural.
E0607Blood glucose monitor home.
E0610Pacemaker monitr audible/vis.
E0615Pacemaker monitr digital/vis.
E0617Automatic ext defibrillator.
E0620Cap bld skin piercing laser.
E0621Patient lift sling or seat.
E0627Seat lift incorp lift-chair.
E0628Seat lift for pt furn-electr.
E0629Seat lift for pt furn-non-el.
E0630Patient lift hydraulic.
E0635Patient lift electric.
E0636PT support & positioning sys.
E0650Pneuma compresor non-segment.
E0651Pneum compressor segmental.
E0652Pneum compres w/cal pressure.
E0655Pneumatic appliance half arm.
E0660Pneumatic appliance full leg.
E0665Pneumatic appliance full arm.
E0666Pneumatic appliance half leg.
E0667Seg pneumatic appl full leg.
E0668Seg pneumatic appl full arm.
E0669Seg pneumatic appli half leg.
E0671Pressure pneum appl full leg.
E0672Pressure pneum appl full arm.
E0673Pressure pneum appl half leg.
E0691Uvl pnl 2 sq ft or less.
E0692Uvl sys panel 4 ft.
E0693Uvl sys panel 6 ft.
E0694Uvl md cabinet sys 6 ft.
E0701Helmet w face guard prefab.
E0720Tens two lead.
E0730Tens four lead.
E0731Conductive garment for tens/.
E0744Neuromuscular stim for scoli.
E0745Neuromuscular stim for shock.
E0747Elec osteogen stim not spine.
E0748Elec osteogen stim spinal.
E0776Iv pole.
E0779Amb infusion pump mechanical.
E0780Mech amb infusion pump <8hrs.
E0781External ambulatory infus pu.
E0784Ext amb infusn pump insulin.
E0791Parenteral infusion pump sta.
E0840Tract frame attach headboard.
E0850Traction stand free standing.
E0855Cervical traction equipment.
E0860Tract equip cervical tract.
E0870Tract frame attach footboard.
E0880Trac stand free stand extrem.
E0890Traction frame attach pelvic.
E0900Trac stand free stand pelvic.
E0910Trapeze bar attached to bed.
E0920Fracture frame attached to b.
E0930Fracture frame free standing.
E0935Exercise device passive moti.
E0940Trapeze bar free standing.
E0941Gravity assisted traction de.
E0942Cervical head harness/halter.
E0943Cervical pillow.
E0944Pelvic belt/harness/boot.
E0945Belt/harness extremity.
E0946Fracture frame dual w cross.
E0947Fracture frame attachmnts pe.
E0948Fracture frame attachmnts ce.
E0962Wheelchair 1 inch cushion.
E0963Wheelchair 2 inch cushion.
E0964Wheelchair 3 inch cushion.
E0965Wheelchair 4 inch cushion.
E0968Wheelchair commode seat.
E1011Ped wc modify width adjustm.
E1012Int seat sys planar ped w/c.
E1013Int seat sys contour ped w/c.
E1014Reclining back add ped w/c.
E1015Shock absorber for man w/c.
E1016Shock absorber for power w/c.
E1017HD shck absrbr for hd man wc.
E1018HD shck absrber for hd powwc.
E1020Residual limb support system.
E1025Pedwc lat/thor sup nocontour.
E1026Pedwc contoured lat/thor sup.
E1027Ped wc lat/ant support.
E1031Rollabout chair with casters.
E1037Transport chair, ped size.
E1038Transport chair, adult size.
E1210Whlchr moto ful arm leg rest.
E1211Wheelchair motorized w/ det.
E1225Wheelchair spec sz semi-recl.
E1228Wheelchair spec sz spec ht b.
E1230Power operated vehicle.
E1231Rigid ped w/c tilt-in-space.
E1232Folding ped wc tilt-in-space.
E1233Rig ped wc tltnspc w/o seat.
E1234Fld ped wc tltnspc w/o seat.
E1235Rigid ped wc adjustable.
E1236Folding ped wc adjustable.
E1237Rgd ped wc adjstabl w/o seat.
E1238Fld ped wc adjstabl w/o seat.
E1296Wheelchair special seat heig.
E1297Wheelchair special seat dept.
E1298Wheelchair spec seat depth/w.
E1310Whirlpool non-portable.
E1340Repair for DME, per 15 min.
E1353Oxygen supplies regulator.
E1355Oxygen supplies stand/rack.
E1372Oxy suppl heater for nebuliz.
E1390Oxygen concentrator.
E1405O2/water vapor enrich w/heat.
E1406O2/water vapor enrich w/o he.
E1700Jaw motion rehab system.
E1701Repl cushions for jaw motion.
E1702Repl measr scales jaw motion.
E1800Adjust elbow ext/flex device.
E1801SPS elbow device.
E1802Adjst forearm pro/sup device.
E1805Adjust wrist ext/flex device.
E1806SPS wrist device.
E1810Adjust knee ext/flex device.
E1811SPS knee device.
E1815Adjust ankle ext/flex device.
E1816SPS ankle device.
E1818SPS forearm device.
E1820Soft interface material.
E1821Replacement interface SPSD.
E1825Adjust finger ext/flex devc.
E1830Adjust toe ext/flex device.
E1840Adj shoulder ext/flex device.
E2000Gastric suction pump hme mdl.
E2100Bld glucose monitor w voice.
E2101Bld glucose monitor w lance.
K0001Standard wheelchair.
K0002Stnd hemi (low seat) whlchr.
K0003Lightweight wheelchair.
K0004High strength ltwt whlchr.
K0005Ultralightweight wheelchair.
K0006Heavy duty wheelchair.
K0007Extra heavy duty wheelchair.
K0009Other manual wheelchair/base.
K0010Stnd wt frame power whlchr.
K0011Stnd wt pwr whlchr w control.
K0012Ltwt portbl power whlchr.
K0014Other power whlchr base.
K0015Detach non-adjus hght armrst.
K0016Detach adjust armrst cmplete.
K0017Detach adjust armrest base.
K0018Detach adjust armrst upper.
K0019Arm pad each.
K0020Fixed adjust armrest pair.
K0022Reinforced back upholstery.
K0023Planr back insrt foam w/strp.
K0024Plnr back insrt foam w/hrdwr.
K0025Hook-on headrest extension.
K0026Back upholst lgtwt whlchr.
K0027Back upholst other whlchr.
K0028Manual fully reclining back.
K0029Reinforced seat upholstery.
K0030Solid plnr seat sngl dnsfoam.
K0031Safety belt/pelvic strap.
K0032Seat uphols lgtwt whlchr.
K0033Seat upholstery other whlchr.
K0035Heel loop with ankle strap.
K0036Toe loop each.
K0037High mount flip-up footrest.
K0038Leg strap each.
K0039Leg strap h style each.
K0040Adjustable angle footplate.
K0041Large size footplate each.
K0042Standard size footplate each.
K0043Ftrst lower extension tube.
K0044Ftrst upper hanger bracket.
K0045Footrest complete assembly.
K0046Elevat legrst low extension.
K0047Elevat legrst up hangr brack.
K0048Elevate legrest complete.
K0049Calf pad each.
K0050Ratchet assembly.
K0051Cam relese assem ftrst/lgrst.
K0052Swingaway detach footrest.
K0053Elevate footrest articulate.
K0054Seat wdth 10-12/15/17/20 wc.
K0055Seat dpth 15/17/18 ltwt wc.
Start Printed Page 75453
K0056Seat ht <17 or >=21 ltwt wc.
K0057Seat wdth 19/20 hvy dty wc.
K0058Seat dpth 17/18 power wc.
K0059Plastic coated handrim each.
K0060Steel handrim each.
K0061Aluminum handrim each.
K0062Handrim 8-10 vert/obliq proj.
K0063Hndrm 12-16 vert/obliq proj.
K0064Zero pressure tube flat free.
K0065Spoke protectors.
K0066Solid tire any size each.
K0067Pneumatic tire any size each.
K0068Pneumatic tire tube each.
K0069Rear whl complete solid tire.
K0070Rear whl compl pneum tire.
K0071Front castr compl pneum tire.
K0072Frnt cstr cmpl sem-pneum tir.
K0073Caster pin lock each.
K0074Pneumatic caster tire each.
K0075Semi-pneumatic caster tire.
K0076Solid caster tire each.
K0077Front caster assem complete.
K0078Pneumatic caster tire tube.
K0079Wheel lock extension pair.
K0080Anti-rollback device pair.
K0081Wheel lock assembly complete.
K008222 nf deep cycl acid battery.
K008322 nf gel cell battery each.
K0084Grp 24 deep cycl acid battry.
K0085Group 24 gel cell battery.
K0086U-1 lead acid battery each.
K0087U-1 gel cell battery each.
K0088Battry chrgr acid/gel cell.
K0089Battery charger dual mode.
K0090Rear tire power wheelchair.
K0091Rear tire tube power whlchr.
K0092Rear assem cmplt powr whlchr.
K0093Rear zero pressure tire tube.
K0094Wheel tire for power base.
K0095Wheel tire tube each base.
K0096Wheel assem powr base complt.
K0097Wheel zero presure tire tube.
K0098Drive belt power wheelchair.
K0099Pwr wheelchair front caster.
K0100Amputee adapter pair.
K0102Crutch and cane holder.
K0103Transfer board < 25″.
K0104Cylinder tank carrier.
K0105Iv hanger.
K0106Arm trough each.
K0107Wheelchair tray.
K0108W/c component-accessory NOS.
K0114Whlchr back suprt inr frame.
K0115Back module orthotic system.
K0116Back & seat modul orthot sys.
K0195Elevating whlchair leg rests.
K0268Humidifier nonheated w PAP.
K0452Wheelchair bearings.
K0455Pump uninterrupted infusion.
K0460WC power add-on joystick.
K0461WC power add-on tiller cntrl.
K0462Temporary replacement eqpmnt.
K0531Heated humidifier used w pap.
K0532Noninvasive assist wo backup.
K0533Noninvasive assist w backup.
K0534Invasive assist w backup.
K0538Neg pressure wnd thrpy pump.
K0539Neg pres wnd thrpy dsg set.
K0540Neg pres wnd thrp canister.
K0541SGD prerecorded msg <= 8 min.
K0542SGD prerecorded msg > 8 min.
K0543SGD msg formed by spelling.
K0544SGD w multi methods msg/accs.
K0545SGD sftwre prgrm for PC/PDA.
K0546SGD accessory, mounting systm.
K0547SGD accessory NOC.
K0549Hosp bed hvy dty xtra wide.
K0550Hosp bed xtra hvy dty x wide.
L3964Seo mobile arm sup att to wc.
L3965Arm supp att to wc rancho ty.
L3966Mobile arm supports reclinin.
L3968Friction dampening arm supp.
L3969Monosuspension arm/hand supp.
L3970Elevat proximal arm support.
L3972Offset/lat rocker arm w/ ela.
L3974Mobile arm support supinator.

Table 5.—HCPCS With Status Indicators That Changed From E to Y

CPT/HCPCSDescription
A4232Syringe w/needle insulin 3cc.
A4632Infus pump rplcemnt battery.
E0188Synthetic sheepskin pad.
E0189Lambswool sheepskin pad.
E0218Water circ cold pad w pump.
E0602Manual breast pump.
E0740Incontinence treatment systm.
E0760Osteogen ultrasound stimltor.
E0765Nerve stimulator for tx n&v.
K0610Peritoneal dialysis clamp.
K0611Disposable cycler set.
K0612Drainage ext line, dialysis.
K0613Ext line w/easy lock connect.
K0614Chem/antisept solution, 8oz.

(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: December 22, 2003.

Ann C. Agnew,

Executive Secretary to the Department.

End Signature End Supplemental Information

[FR Doc. 03-32016 Filed 12-24-03; 1:03 pm]

BILLING CODE 4120-01-P