[Federal Register: November 2, 1998 (Volume 63, Number 211)] [Rules and Regulations] [Page 58913-58962] From the Federal Register Online via GPO Access [wais.access.gpo.gov] [DOCID:fr02no98-18] [[pp. 58913-58962]] Medicare Program; Revisions to Payment Policies and Adjustments to the Relative Value Units Under the Physician Fee Schedule for Calendar Year 1999 [[Continued from page 58912]] [[Page 58913]] (5) A physical therapist assistant must meet the requirements in part 484 of this chapter. (6) A social worker must meet the requirements in part 484 of this chapter. (7) A vocational specialist is a person who has a baccalaureate degree and-- (i) Two years experience in vocational counseling in a rehabilitation setting such as a sheltered workshop, State employment service agency, etc.; or (ii) At least 18 semester hours in vocational rehabilitation, educational or vocational guidance, psychology, social work, special education or personnel administration, and 1 year of experience in vocational counseling in a rehabilitation setting; or (iii) A master's degree in vocational counseling. (8) A nurse practitioner is a person who must: (i) Possess a master's degree in nursing; (ii) Be a registered professional nurse who is authorized by the State in which the services are furnished, to practice as a nurse practitioner in accordance with State law; and, (iii) Be certified as a nurse practitioner by the American Nurses Credentialing Center. (9) A clinical nurse specialist is a person who must: (i) Be a registered nurse who is currently licensed to practice in the State where he or she practices and be authorized to perform the services of a clinical nurse specialist in accordance with State law; (ii) Have a master's degree in a defined clinical area of nursing from an accredited educational institution; and, (iii) Be certified as a clinical nurse specialist by the American Nurses Credentialing Center. (10) A physician assistant is a person who: (i) Has graduated from a physician assistant educational program that is accredited by the National Commission on Accreditation of Allied Health Education Programs; and (ii) Has passed the national certification examination that is certified by the National Commission on Certification of Physician Assistants; and (iii) Is licensed by the State as a physician assistant to practice as a physician assistant. 3. In Sec. 485.711, paragraph (b)(3) is revised to read as follows: Sec. 485.711 Conditions of participation: Plan of care and physician involvement. * * * * * (b) * * * (3) The plan of care and results of treatment are reviewed by the physician or by the individual who established the plan at least as often as the patient's condition requires, and the indicated action is taken. (For Medicare patients, the plan must be reviewed by a physician, nurse practitioner, clinical nurse specialist, or physician assistant at least every 30 days, in accordance with Sec. 410.61(e) of this chapter.) * * * * * (Catalog of Federal Domestic Assistance Program No. 93.774, Medicare--Supplementary Medical Insurance Program) Dated: October 20, 1998. Nancy-Ann Min DeParle, Administrator, Health Care Financing Administration. Dated: October 26, 1998. Donna E. Shalala, Secretary. Note: These addenda will not appear in the Code of Federal Regulations. Addendum A--Explanation and Use of Addenda B Through C The addenda on the following pages provide various data pertaining to the Medicare fee schedule for physicians' services furnished in 1999. Addendum B contains the RVUs for work, non-facility practice expense, facility practice expense, and malpractice expense, and other information for all services included in the physician fee schedule. Addendum C provides interim RVUs and related information for codes that are subject to comment. Each code listed in Addendum C is also included in Addendum B. Further explanations of the information in these addenda are provided at the beginning of each addendum. Addendum B--1999 Relative Value Units and Related Information Used in Determining Medicare Payments for 1999 This addendum contains the following information for each CPT code and alphanumeric HCPCS code, except for alphanumeric codes beginning with B (enteral and parenteral therapy), E (durable medical equipment), K (temporary codes for nonphysicians' services or items), or L (orthotics), and codes for anesthesiology. 1. CPT/HCPCS code. This is the CPT or alphanumeric HCPCS number for the service. Alphanumeric HCPCS codes are included at the end of this addendum. 2. Modifier. A modifier is shown if there is a technical component (modifier TC) and a professional component (PC) (modifier -26) for the service. If there is a PC and a TC for the service, Addendum B contains three entries for the code: One for the global values (both professional and technical); one for modifier -26 (PC); and one for modifier TC. The global service is not designated by a modifier, and physicians must bill using the code without a modifier if the physician furnishes both the PC and the TC of the service. Modifier -53 is shown for a discontinued procedure. There will be RVUs for the code (CPT code 45378) with this modifier. 3. Status indicator. This indicator shows whether the CPT/HCPCS code is in the physician fee schedule and whether it is separately payable if the service is covered. A=Active code. These codes are separately payable under the fee schedule if covered. There will be RVUs for codes with this status. The presence of an ``A'' indicator does not mean that Medicare has made a national decision regarding the coverage of the service. Carriers remain responsible for coverage decisions in the absence of a national Medicare policy. B=Bundled code. Payment for covered services is always bundled into payment for other services not specified. If RVUs are shown, they are not used for Medicare payment. If these services are covered, payment for them is subsumed by the payment for the services to which they are incident. (An example is a telephone call from a hospital nurse regarding care of a patient.) C=Carrier-priced code. Carriers will establish RVUs and payment amounts for these services, generally on a case-by-case basis following review of documentation, such as an operative report. D=Deleted code. These codes are deleted effective with the beginning of the calendar year. E=Excluded from physician fee schedule by regulation. These codes are for items or services that we chose to exclude from the physician fee schedule payment by regulation. No RVUs are shown, and no payment may be made under the physician fee schedule for these codes. Payment for them, if they are covered, continues under reasonable charge or other payment procedures. G=Code not valid for Medicare purposes. Medicare does not recognize codes assigned this status. Medicare uses another code for reporting of, and payment for, these services. N=Noncovered service. These codes are noncovered services. Medicare payment may not be made for these codes. If RVUs are shown, they are not used for Medicare payment. P=Bundled or excluded code. There are no RVUs for these services. No separate payment should be made for them under the physician fee schedule. [[Page 58914]] --If the item or service is covered as incident to a physician's service and is furnished on the same day as a physician's service, payment for it is bundled into the payment for the physician's service to which it is incident (an example is an elastic bandage furnished by a physician incident to a physician's service). --If the item or service is covered as other than incident to a physician's service, it is excluded from the physician fee schedule (for example, colostomy supplies) and is paid under the other payment provisions of the Act. R=Restricted coverage. Special coverage instructions apply. If the service is covered and no RVUs are shown, it is carrier-priced. T=Injections. There are RVUs for these services, but they are only paid if there are no other services payable under the physician fee schedule billed on the same date by the same provider. If any other services payable under the physician fee schedule are billed on the same date by the same provider, these services are bundled into the service(s) for which payment is made. X=Exclusion by law. These codes represent an item or service that is not within the definition of ``physicians'' services'' for physician fee schedule payment purposes. No RVUs are shown for these codes, and no payment may be made under the physician fee schedule. (Examples are ambulance services and clinical diagnostic laboratory services.) 4. Description of code. This is an abbreviated version of the narrative description of the code. 5. Physician work RVUs. These are the RVUs for the physician work for this service in 1999. Codes that are not used for Medicare payment are identified with a ``+.'' 6. Non-facility practice expense RVUs. These are the fully implemented resource-based practice expense RVUs for non-facility settings. 7. Transition non-facility practice expense RVUs. Blended 1999 non- facility practice expense RVUs. 8. Facility practice expense RVUs. These are the fully implemented resource-based practice expense RVUs for facility settings. 9. Transition facility practice expense RVUs. Blended 1999 facility practice expense RVUs. 10. Malpractice expense RVUs. These are the RVUs for the malpractice expense for the service for 1999. 11. Non-facility total. This is the sum of the work, fully implemented non-facility practice expense, and malpractice expense RVUs for 1999. 12. Transition non-facility total. This is the sum of the work, transition non-facility practice expense, and malpractice expense RVUs for 1999. 13. Facility total. This is the sum of the work, fully implemented facility practice expense, and malpractice expense RVUs for 1999. 14. Transition facility total. This is the sum of the work, transition facility practice expense, and malpractice expense RVUs for 1999. 15. Global period. This indicator shows the number of days in the global period for the code (0, 10, or 90 days). An explanation of the alpha codes follows: MMM = The code describes a service furnished in uncomplicated maternity cases including antepartum care, delivery, and postpartum care. The usual global surgical concept does not apply. See the 1998 Physicians' Current Procedural Terminology for specific definitions. XXX = The global concept does not apply. YYY = The global period is to be set by the carrier (for example, unlisted surgery codes). ZZZ = The code is part of another service and falls within the global period for the other service. BILLING CODE 4120-01-P [[Page 58915]] [GRAPHIC] [TIFF OMITTED] TR02NO98.000 [[Page 58916]] [GRAPHIC] [TIFF OMITTED] TR02NO98.001 [[Page 58917]] [GRAPHIC] [TIFF OMITTED] TR02NO98.002 [[Page 58918]] [GRAPHIC] [TIFF OMITTED] TR02NO98.003 [[Page 58919]] [GRAPHIC] [TIFF OMITTED] TR02NO98.004 [[Page 58920]] [GRAPHIC] [TIFF OMITTED] TR02NO98.005 [[Page 58921]] [GRAPHIC] [TIFF OMITTED] TR02NO98.006 [[Page 58922]] [GRAPHIC] [TIFF OMITTED] TR02NO98.007 [[Page 58923]] [GRAPHIC] [TIFF OMITTED] TR02NO98.008 [[Page 58924]] [GRAPHIC] [TIFF OMITTED] TR02NO98.009 [[Page 58925]] [GRAPHIC] [TIFF OMITTED] TR02NO98.010 [[Page 58926]] [GRAPHIC] [TIFF OMITTED] TR02NO98.011 [[Page 58927]] [GRAPHIC] [TIFF OMITTED] TR02NO98.012 [[Page 58928]] [GRAPHIC] [TIFF OMITTED] TR02NO98.013 [[Page 58929]] [GRAPHIC] [TIFF OMITTED] TR02NO98.014 [[Page 58930]] [GRAPHIC] [TIFF OMITTED] TR02NO98.015 [[Page 58931]] [GRAPHIC] [TIFF OMITTED] TR02NO98.016 [[Page 58932]] [GRAPHIC] [TIFF OMITTED] TR02NO98.017 [[Page 58933]] [GRAPHIC] [TIFF OMITTED] TR02NO98.018 [[Page 58934]] [GRAPHIC] [TIFF OMITTED] TR02NO98.019 [[Page 58935]] [GRAPHIC] [TIFF OMITTED] TR02NO98.020 [[Page 58936]] [GRAPHIC] [TIFF OMITTED] TR02NO98.021 [[Page 58937]] [GRAPHIC] [TIFF OMITTED] TR02NO98.022 [[Page 58938]] [GRAPHIC] [TIFF OMITTED] TR02NO98.023 [[Page 58939]] [GRAPHIC] [TIFF OMITTED] TR02NO98.024 [[Page 58940]] [GRAPHIC] [TIFF OMITTED] TR02NO98.025 [[Page 58941]] [GRAPHIC] [TIFF OMITTED] TR02NO98.026 [[Page 58942]] [GRAPHIC] [TIFF OMITTED] TR02NO98.027 [[Page 58943]] [GRAPHIC] [TIFF OMITTED] TR02NO98.028 [[Page 58944]] [GRAPHIC] [TIFF OMITTED] TR02NO98.029 [[Page 58945]] [GRAPHIC] [TIFF OMITTED] TR02NO98.030 [[Page 58946]] [GRAPHIC] [TIFF OMITTED] TR02NO98.031 [[Page 58947]] [GRAPHIC] [TIFF OMITTED] TR02NO98.032 [[Page 58948]] [GRAPHIC] [TIFF OMITTED] TR02NO98.033 [[Page 58949]] [GRAPHIC] [TIFF OMITTED] TR02NO98.034 [[Page 58950]] [GRAPHIC] [TIFF OMITTED] TR02NO98.035 [[Page 58951]] [GRAPHIC] [TIFF OMITTED] TR02NO98.036 [[Page 58952]] [GRAPHIC] [TIFF OMITTED] TR02NO98.037 [[Page 58953]] [GRAPHIC] [TIFF OMITTED] TR02NO98.038 [[Page 58954]] [GRAPHIC] [TIFF OMITTED] TR02NO98.039 [[Page 58955]] [GRAPHIC] [TIFF OMITTED] TR02NO98.040 [[Page 58956]] [GRAPHIC] [TIFF OMITTED] TR02NO98.041 [[Page 58957]] [GRAPHIC] [TIFF OMITTED] TR02NO98.042 [[Page 58958]] [GRAPHIC] [TIFF OMITTED] TR02NO98.043 [[Page 58959]] [GRAPHIC] [TIFF OMITTED] TR02NO98.044 [[Page 58960]] [GRAPHIC] [TIFF OMITTED] TR02NO98.045 [[Page 58961]] [GRAPHIC] [TIFF OMITTED] TR02NO98.046 [[Page 58962]] [GRAPHIC] [TIFF OMITTED] TR02NO98.047 [[Continued on page 58963]]