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医疗保险计划;2006日历年医师费率表下支付政策的修订以及与B部分门诊药品和生物制品竞争性采购计划相关的某些规定。带有评论的最终规则。

Medicare program; revisions to payment policies under the physician fee schedule for calendar year 2006 and certain provisions related to the Competitive Acquisitions Program of outpatient drugs and biologicals under Part B. Final rule with comment.

出版信息

Fed Regist. 2005 Nov 21;70(223):70115-476.

PMID:16299947
Abstract

This rule addresses Medicare Part B payment policy, including the physician fee schedule that are applicable for calendar year (CY) 2006; and finalizes certain provisions of the interim final rule to implement the Competitive Acquisition Program (CAP) for Part B Drugs. It also revises Medicare Part B payment and related policies regarding: Physician work; practice expense (PE) and malpractice relative value units (RVUs); Medicare telehealth services; multiple diagnostic imaging procedures; covered outpatient drugs and biologicals; supplemental payments to Federally Qualified Health Centers (FQHCs); renal dialysis services; coverage for glaucoma screening services; National Coverage Decision (NCD) timeframes; and physician referrals for nuclear medicine services and supplies to health care entities with which they have financial relationships. In addition, the rule finalizes the interim RVUs for CY 2005 and issues interim RVUs for new and revised procedure codes for CY 2006. This rule also updates the codes subject to the physician self-referral prohibition and discusses payment policies relating to teaching anesthesia services, therapy caps, private contracts and opt-out, and chiropractic and oncology demonstrations. As required by the statute, it also announces that the physician fee schedule update for CY 2006 is -4.4 percent, the initial estimate for the sustainable growth rate for CY 2006 is 1.7 percent and the conversion factor for CY 2006 is $36.1770.

摘要

本规则涉及医疗保险B部分的支付政策,包括适用于2006日历年(CY)的医师费用表;并最终确定了暂行最终规则的某些条款,以实施B部分药品的竞争性采购计划(CAP)。它还修订了医疗保险B部分的支付及相关政策,涉及:医师工作;执业费用(PE)和医疗事故相对价值单位(RVU);医疗保险远程医疗服务;多项诊断成像程序;涵盖的门诊药品和生物制品;向联邦合格医疗中心(FQHC)的补充支付;肾透析服务;青光眼筛查服务的覆盖范围;国家覆盖决策(NCD)时间框架;以及医师向与其有财务关系的医疗保健实体转诊核医学服务和用品的情况。此外,该规则最终确定了2005日历年的暂行RVU,并发布了2006日历年新的和修订的程序代码的暂行RVU。本规则还更新了受医师自我转诊禁令约束的代码,并讨论了与教学麻醉服务、治疗上限、私人合同和退出、以及脊椎按摩疗法和肿瘤学示范相关的支付政策。根据法规要求,它还宣布2006日历年的医师费用表更新为-4.4%,2006日历年可持续增长率的初步估计为1.7%,2006日历年的换算系数为36.1770美元。

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