Federal Register, Volume 75, Number 226, November 24, 2010, Pages 71519-72652 Page: 71,843
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Federal Register/Vol. 75, No. 226/Wednesday, November 24, 2010/Rules and Regulations 71843
required that at least one unit of one of
the separately payable codes in column
B must be on the claim (we permitted
any number of units of these codes to
be on the claim). Where there are codes
listed in column C, we also required
that at least one unit of one and only
one of the codes that appears under
column C must be on the claim (we
permitted any number of units of the
code to be on the claim). Where there
are codes in column D, we required at
least one unit of each of the codes in
column D (we permitted any number of
units of these codes to be on the claim).
In addition, in column E, we identified
several codes that were paid separately
in CY 2009 but which we decided
should be packaged into the new
endovascular revascularization CPT
codes if they appeared on the claim
with the other codes in columns B
through D.
For example, in determining the CPT
median cost for new CPT code 37221,we used only those claims that
contained one unit of one and only one
of the CPT codes listed under column B,
specifically CPT code 37205 or 37207,
and at least one unit (while allowing
multiple units) of one and only one of
the CPT codes that appear under
column C, specifically CPT codes
36000, 36245, or 36246. We allowed any
number of units for the code in column
D, and packaged the costs for the codes
in column E (CPT codes 35454 and
35473) if they appeared on the claim.
We applied this same methodology to
select claims that we believe reflected
the services defined in each new CPT
code. In addition, we excluded claims
that met these criteria if the claim
contained a service to which a status
indicator of "S," "T," "V," or "X" was
assigned, if such code did not meet the
criteria for the new code. By doing this,
we simulated a single procedure bill for
the new code. In addition, we applied
the standard packaging, trimming, andwage standardization that we apply in
the median calculation process. We
used approximately 19,283 claims that
met the code specific criteria to
calculate CPT level medians and the
median cost for these new codes. Table
7 below displays the combinations of
CY 2009 code data that we used to
select the claims we used to create
simulated median costs for the new
codes (columns A through E), and the
frequency of claims that met the criteria
(column F) we calculated for each new
code using the CY 2009 data for the
previously existing CPT codes for these
services. We note that we did not
identify any claims that met the criteria
for new CPT codes 37222, 37223, 37234
and 37235, in part due to the
requirement that there must be no major
separately paid procedures on the claim
other than those we identified for the
new code.
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United States. Office of the Federal Register. Federal Register, Volume 75, Number 226, November 24, 2010, Pages 71519-72652, periodical, November 24, 2010; Washington D.C.. (https://digital.library.unt.edu/ark:/67531/metadc52807/m1/332/: accessed March 28, 2024), University of North Texas Libraries, UNT Digital Library, https://digital.library.unt.edu; crediting UNT Libraries Government Documents Department.