Physician Fee Schedule Corrections

DEPARTMENT OF HEALTH AND HUMAN SERVICES Centers for Medicare & Medicaid Services 42 CFR Parts 410, 411, 414, 415, 485, and 498 CMS-1413-CN3 RIN 0938-AP40 Medicare Program; Payment Policies Under the Physician Fee Schedule and Other Revisions to Part B for CY 2010; Corrections. AGENCY:

Centers for Medicare & Medicaid Services (CMS),

HHS. ACTION: SUMMARY:

Final rule; correction. This document corrects several technical and

typographical errors in the final rule with comment period that appeared in the November 25, 2009, Federal Register entitled “Medicare Program; Payment Policies Under the Physician Fee Schedule and Other Revisions to Part B for CY 2010”. EFFECTIVE DATE:

This correction is effective

January 1, 2010. FOR FURTHER INFORMATION CONTACT: Diane Milstead, (410)786-3355. SUPPLEMENTARY INFORMATION:

CMS-1413-CN3 I.

2

Background In FR Doc. E9-26502 of November 25, 2009 (74 FR 61738)

(hereinafter referred to as the CY 2010 PFS final rule with comment period), there were a number of technical and typographical errors that are identified and corrected in the Correction of Errors section of this notice.

The

provisions of this notice are effective as if they had been included in the CY 2010 PFS final rule with comment period. Accordingly, the corrections are effective January 1, 2010. II. Summary of Errors A.

Errors in the Preamble On page 61738, we are correcting the figure for the

CY 2010 conversion factor (CF).

This change results from a

technical error in adjusting relative value units (RVUs) to reflect the agency’s policy related to the consultation codes. On page 61746, we are correcting the note referencing the CF used in Table 1. On pages 61747 and 61748, we are replacing Table 1, Calculation of practice expense (PE) relative value units (RVUs) under Methodology for Selected Codes. On page 61941, we are correcting language concerning the Five–year Review of work and the potential for adjustment of PE RVUS.

CMS-1413-CN3 On page 61952, in Table 30, we are correcting the CMS 2010 Interim work RVU (WRVU) for CPT code 51729-26. On page 61955, we are correcting the reference to the status indicator assigned to CPT code 90470. On page 61968, we are correcting the figures for the CY 2010 physician fee schedule (PFS) CF and national anesthesia CF for the reasons indicated above. On page 61969, we are correcting the discussion concerning the CY 2010 CF for the reasons indicated above. On page 61969, in Table 44, we are correcting the lines concerning the CY 2010 CF budget neutrality adjustment and CY 2010 CF for the reasons indicated above. On page 61969, we are correcting the language preceding Table 45 for the reasons indicated above. On page 61970, in Table 45, we are correcting the lines concerning the CY 2010 anesthesia adjustment and the CY 2010 anesthesia CF contained in the table for the reasons indicated above. On pages 61985 and 61986, we are replacing Table 50 in its entirety to correct the payment amounts for CY 2010. On page 62001, in the discussion concerning removing self-administered drugs from the SGR calculation we are deleting the word “proposal” which was inadvertently included in the sentence and substituting the word

3

CMS-1413-CN3 “change”.

4

We are also correcting the CY 2010 payment

amounts associated with CPT code 99203. B.

Errors in the Addenda On pages 62044 through 62143 of Addendum B, Relative

Value Units and Related Information Used in Determining Medicare Payments for 2009, the RVUs and status indicators listed for CPT codes 90470, and 95803, 95803-TC 95803-26 are corrected.

In addition the RVUs for CPT codes 51729,

51729-26, 74261, 74261-TC, 74262, 74262-TC, 75571, 75571-TC, 75572, 75572-TC, 75573, 75573-TC, 77078, 77078-TC, 77084, 77084-TC, 94011, 94012, 94013,99221, 99222, 99223, 99304, 99305 and 99306, G0425, G0426, G0427, G0252-26 and the global period for CPT codes 75565, 75565-TC, 75565-26 are corrected. On pages 62145 and 62146, of Addendum C, Codes with Interim RVUs, the global period listed for CPT code 75565 and the RVUs for CPT codes 51729-26, 94011, 94012 and 94013 are corrected. III. Correction of Errors In FR Doc. E9-26502 of November 25, 2009 (74 FR 61738), make the following corrections:

CMS-1413-CN3 A.

Corrections to the Preamble

1.

On page 61738, in the 1st column; in the 2nd

paragraph, line 13, the figure “$28.4061” is corrected to read “$28.3895.” 2.

On page 61746, in the 3rd column; in the last

paragraph, line 3, the figure “$28.3769” is corrected to read “$36.0666.” 3.

On pages 61747 and 61748, Table 1 is replaced in

its entirety to reflect the corrected CF.

5

CMS-1413-CN3 TABLE 1:

Step

(1)

Labor cost (Lab)

(2)

Suppy cost (Sup) Equipment cost (Eqp)

(3) (4) (5)

Direct cost (Dir) Direct adjustment (Dir Adj)

(6)

Adjusted labor

(7)

Adjusted supplies

(8)

Adjusted equipment

(9)

(13)

Adjusted direct Conversion Factor (CF) Adj. labor cost converted Adj. supply cost converted Adj. equip cost converted

(14)

Adj. direct cost converted

(15)

Wrk RVU

(16)

Dir_pct

(17)

Ind_pct Ind. Alloc. formula (1st part)

(10) (11) (12)

(18) (19) (20)

Ind. Alloc. (1st part) Ind. Alloc. formulas (2nd part)

Step 1 Step 1 Step 1 Step 1 Steps 2-4 Steps 2-4 Steps 2-4 Steps 2-4 Steps 2-4 Step 5 Step 5 Step 5 Step 5 Step 5 Setup File Steps 6, 7 Steps 6, 7 Step 8 Step 8 Step 8

Source

6 Calculation of PE RVUs Under Methodology For Selected Codes

Formula

99213

33533

71020

71020TC

7102026

93000

93005

93010

Office visit, est Nonfacility

CABG, arterial, single Facility

Chest x-ray Nonfacility

Chest x-ray Nonfacility

Chest x-ray Nonfacility

ECG, complete Nonfacility

ECG, tracing Nonfacility

ECG, report Nonfacility

AMA

$13.32

$77.52

$5.74

$5.74

$0.00

$6.12

$6.12

$0.00

AMA

$2.98

$7.34

$3.39

$3.39

$0.00

$1.19

$1.19

$0.00

AMA

$0.19

$0.65

$8.17

$8.17

$0.00

$0.12

$0.12

$0.00

$16.50

$85.51

$17.31

$17.31

$0.00

$7.43

$7.43

$0.00

0.4991

0.4991

0.4991

0.4991

0.4991

0.4991

0.4991

0.4991

=(1)*(5)

$6.65

$38.69

$2.87

$2.87

$0.00

$3.06

$3.06

$0.00

=(2)*(5)

$1.49

$3.66

$1.69

$1.69

$0.00

$0.60

$0.60

$0.00

=(3)*(5)

$0.10

$0.33

$4.08

$4.08

$0.00

$0.06

$0.06

$0.00

=(6)+(7)+(8)

$8.23

$42.68

$8.64

$8.64

$0.00

$3.71

$3.71

$0.00

36.06666

36.06666

36.06666

36.06666

36.06666

36.06666

36.06666

36.06666

=(6)/(10)

0.18

1.07

0.08

0.08

-

0.08

0.08

-

=(7)/(10)

0.04

0.10

0.05

0.05

-

0.02

0.02

-

=(8)/(10)

-

0.01

0.11

0.11

-

-

-

-

0.23

1.18

0.24

0.24

-

0.10

0.10

-

0.97

33.75

0.22

-

0.22

0.17

0.00

0.17

Surveys

26.0%

18.0%

28.0%

28.0%

28.0%

29.0%

29.0%

29.0%

Surveys

74.0%

82.0%

72.0%

72.0%

72.0%

71.0%

71.0%

71.0%

0.66

5.38

0.60

0.60

0.25

0.25

-

=(1)+(2)+(3) See footnote* =Lab*Dir Adj =Sup*Dir Adj =Eqp*Dir Adj

MFS =(Lab*Dir Adj)/CF =(Sup*Dir Adj)/CF =(Eqp*Dir Adj)/CF

=(11)+(12)+(13) MFS

See Step 8 See (18) See Step 8

-

CMS-1413-CN3

7 Step

(24)

Ind. Alloc. (2nd part) Indirect Allocator (1st+2nd) Indirect Adjustment (Ind Adj) Adjusted Indirect Allocator

(25)

Ind.Practice Cost Index (PCI)

(26)

Adjusted Indirect

(27)

PE RVU

(21) (22) (23)

Step 8 Step 8 Steps 9-11 Steps 9-11 Steps 1216 Step 17 Steps 1819

Source

Formula

33533

71020

71020TC

7102026

93000

93005

93010

Office visit, est Nonfacility

CABG, arterial, single Facility

Chest x-ray Nonfacility

Chest x-ray Nonfacility

Chest x-ray Nonfacility

ECG, complete Nonfacility

ECG, tracing Nonfacility

ECG, report Nonfacility

See (20)

0.97

33.75

0.30

0.08

0.22

0.25

0.08

0.17

=(19)+(21)

1.63

39.13

0.90

0.68

0.22

0.51

0.34

0.17

0.370

0.370

0.370

0.370

0.370

0.370

0.370

0.370

0.60

14.36

0.33

0.25

0.08

0.19

0.12

0.06

1.090

0.890

0.860

0.860

0.860

0.930

0.930

0.930

=(24)*(25)

0.66

12.81

0.28

0.21

0.07

0.17

0.12

0.06

=((14)+(26)) *budn

0.88

13.91

0.52

0.45

0.07

0.28

0.22

0.06

See footnote** =Ind Alloc * Ind Adj See Steps 12-16 = Adj. Ind Alloc*PCI =(Adj Dir+Adj Ind) *budn

99213

Note: PE RVU in Table 1, row 27, may not match Addendum B due to rounding. * The direct adj = [current pe rvus * CF * avg dir pct] / [sum direct inputs] = [Step 2] / [Step 3] ** The indirect adj = [current pe rvus * avg ind pct] / [sum of ind allocators] = [Step 9] / [Step 10]

CMS-1413-CN3

8

4. On page 61941, in the 2nd column; in the 3rd paragraph, lines 12 through 14, the phrase “the PE inputs, and we could be impacted and we would them accordingly” is corrected to read “the PE inputs could be impacted and we would therefore adjust them accordingly.” 5.

On page 61952, in Table 30, line 15, is corrected

to read as follows: #

51729

6.

26

CYSTOMETROGRAM W/VP&UP

On page 61955, in the 1

st

2.51

Agree

2.11

column; in the 2nd full

paragraph, the last sentence, “We have assigned a status indicator of “N” (Non-covered) to this service and will publish the AMA RUC-recommended value in accordance with our practice for non-covered CPT codes” is corrected to read “We have assigned a status indicator of “I” (Not valid for Medicare purposes.

Medicare uses another code for the

reporting of and the payment for these services).

We will

publish the AMA RUC-recommended value in accordance with the practice for non-covered CPT codes.” 7.

On page 61968, in the 2nd column; in the 1st full

paragraph under Table 43, a.

Line 1, the figure “$28.4061” is corrected to read

“$28.3895”. b.

Line 3, the figure “$16.6191” is corrected to read

“$16.6108”.

CMS-1413-CN3

9

8.

On page 61969,

a.

In the 3rd column, in the 1st partial paragraph,

line 3, the figure “1.00103” is corrected to read “1.000445”. b.

In Table 44 the last two lines are corrected to

read as follows: TABLE 44:

Calculation of the CY 2010 PFS CF

CY 2010 CF Budget Neutrality Adjustment

0.0445 percent (1.000445)

CY 2010 Conversion Factor

c.

$28.3895

In the 3rd column, the paragraph following Table

44, the last 2 lines, the phrase “policies for PE and malpractice RVUs” is corrected to read “policies for work, PE, and malpractice RVUs”. 9.

On page 61970, Table 45, the last two lines of are

corrected to read as follows TABLE 45: Calculation of the CY 2010 Anesthesia Conversion Factor CY 2010 Anesthesia Adjustment 0.94 percent (1.0094) CY 2010 Anesthesia Conversion Factor $16.6108

10.

On pages 61985 and 61986, Table 50 is corrected

in its entirety including the title to read as follows:

CMS-1413-CN3

10

TABLE 50: Impact of Final Rule with Comment Period and Physician Update on CY 2010 Payment for Selected Procedures CPT1/ HCPCS

Facility MOD

11721 17000 27130 27244 27447 33533 35301 43239 66821 66984 67210 71010 71010 77056 77056 77057 77057 77427 78465 88305 90801 90862

26 26 26

26 26

90935 92012 92014 92980 93000 93010 93015 93307 93510 98941 99203 99213 99214 99222 99223 99231 99232 99233 99236 99239 99243

26 26

Description

Debride nail, 6 or more Destruct premalg lesion Total hip arthroplasty Treat thigh fracture Total knee arthroplasty CABG, arterial, single Rechanneling of artery Upper GI endoscopy, biopsy After cataract laser surgery Cataract surg w/iol, 1 stage Treatment of retinal lesion Chest x-ray Chest x-ray Mammogram, both breasts Mammogram, both breasts Mammogram, screening Mammogram, screening Radiation tx management, x5 Heart image (3d), multiple Tissue exam by pathologist Psy dx interview Medication management Hemodialysis, one evaluation Eye exam established pat Eye exam & treatment Insert intracoronary stent Electrocardiogram, complete Electrocardiogram report Cardiovascular stress test Echo exam of heart Left heart catheterization Chiropractic manipulation Office/outpatient visit, new Office/outpatient visit, est Office/outpatient visit, est Initial hospital care Initial hospital care Subsequent hospital care Subsequent hospital care Subsequent hospital care Observ/hosp same date Hospital discharge day Office consultation

2009

2010

Non-facility Percent Change

2009

$27.77 $48.69 $1,359.71 $1,144.39 $1,456.37 $1,892.05 $1,067.93

$20.72 $40.88 $1,082.21 $916.98 $1,157.72 $1,533.32 $868.15

-25% -16% -20% -20% -21% -19% -19%

40.39 69.97 NA NA NA NA NA

$165.55 $251.38 $638.74 $561.56 NA $9.02 NA $44.36 NA $35.71

$134.00 $216.33 $548.77 $478.65

$27.82

-19% -14% -14% -15% NA -21% NA -22% NA -22%

323.16 266.53 NA 580.67 24.16 9.02 107.48 44.36 81.15 35.71

$188.27 $78.99 $37.15 $128.04 $45.08

$153.02 $62.17 $28.96 $100.21 $35.77

-19% -21% -22% -22% -21%

188.27 78.99 37.15 152.92 55.18

$66.36 $45.80 $70.33 $847.93

$53.09 $38.33 $58.77 $644.16

-20% -16% -16% -24%

NA 70.69 103.15 NA

$7.10 $72.96 $38.33 $185.10 $24.13 $57.35 $38.04 $58.77 $100.21 $147.06 $30.09 $54.22 $77.79 $166.08 $77.79 Discontined

NA -21% -27% -23% -26% -20% -16% -15% -15% -18% -18% -19% -19% -19% -20% -19% Discontinued

20.92 9.02 100.27 49.77 248.86 33.90 91.97 61.31 92.33 NA NA NA NA NA NA NA 124.79

$20.92 $9.02 $100.27 $49.77 $248.86 $30.30 $68.17 $44.72 $69.25 $122.63 $180.33 $37.15 $66.72 $95.58 $207.38 $96.30 $97.38

NA $7.10 NA $34.64 NA

NA

2010

Percent Change

$31.23 $57.91

-23% -17% NA NA NA NA NA

$256.92 $228.54 $493.69 $18.17 $7.10 $82.90 $34.64 $61.61 $27.82

-20% -14% NA -15% -25% -21% -23% -22% -24% -22%

$153.02 $62.17 $28.96 $120.94 $44.29

-19% -21% -22% -21% -20%

$58.77 $85.74

NA -17% -17% NA

NA NA NA NA NA

NA

NA

NA $15.61 $7.10 $72.96 $38.33 $185.10 $27.25 $76.94 $51.67 $77.50 NA NA NA NA NA NA NA Discontinued

-25% -21% -27% -23% -26% -20% -16% -16% -16% NA NA NA NA NA NA NA Discontinued

CMS-1413-CN3 CPT1/ HCPCS

11 Facility

MOD

99244 99253 99254 99283 99284 99291 99292 99348 99350 G0008

Description

Office consultation Inpatient consultation Inpatient consultation Emergency dept visit Emergency dept visit Critical care, first hour Critical care, addÏl 30 min Home visit, est patient Home visit, est patient Admin influenza virus vac

Non-facility

2009

2010

Percent Change

$154.00 $114.69 $165.55 $61.31 $114.33 $212.07 $106.04 NA NA NA

Discontined Discontined Discontined $48.55 $91.13 $170.05 $84.88 NA NA NA

Discontinued Discontinued Discontinued -21% -20% -20% -20% NA NA NA

2009 184.30 NA NA NA NA 253.91 114.69 79.35 160.86 20.92

2010 Discontinued NA NA NA NA $203.27 $91.70 $63.88 $130.31 $16.75

Percent Change Discontinued NA NA NA NA -20% -20% -19% -19% -20%

11. On page 62001, a.

In the 1st column, in the 1st full paragraph, line

19, the phrase “proposal will cost” is corrected to read “change will cost”. b.

In the 3rd column, the 1st full paragraph, the

sentence “Based on this rule, the 2010 national payment amount in the non-facility setting for CPT code 99203, as shown in Table 49, is $76.98 which means that, in 2010, the beneficiary coinsurance for this service would be $15.40.” is corrected to read “Based on this rule, the 2010 national payment amount in the non-facility setting for CPT code 99203, as shown in Table 50 is $76.94 which means that, in 2010, the beneficiary coinsurance for this service would be $15.38.” B.

Corrections to the Addenda 1.

On pages 62044 through 62143, in Addendum B:

Relative Value Units and Related Information Used in

CMS-1413-CN3

12

Determining Medicare Payments for 2010, the following CPT codes are corrected to read as follows:

1

CPT / HCPCS 29870 36481 37183 47382 50200 51729 51729 55873 74261 74261 74262 74262 75565 75565 75565 75571 75571 75572 75572 75573 75573 77078 77078

Mod

26

TC TC

TC 26 TC TC TC TC

77084 77084 90470 92610 94011 94012 94013 95803 95803 95803 99221 99222

Status A A A A A A A A A A A A A A A A A A A A A A A

TC

TC 26

A I A A A A A A A A A

Description

Knee arthroscopy, dx Insertion of catheter, vein Remove hepatic shunt (tips) Percut ablate liver rf Renal biopsy perq Cystometrogram w/vp&up Cystometrogram w/vp&up Cryoablate prostate Ct colonography, w/o dye Ct colonography, w/o dye Ct colonography, w/dye Ct colonography, w/dye Card mri vel flw map add-on Card mri vel flw map add-on Card mri vel flw map add-on Ct hrt w/o dye w/ca test Ct hrt w/o dye w/ca test Ct hrt w/3d image Ct hrt w/3d image Ct hrt w/3d image, congen Ct hrt w/3d image, congen Ct bone density, axial Ct bone density, axial Magnetic image, bone marrow Magnetic image, bone marrow Immune admin H1N1 im/nasal Evaluate swallowing function Up to 2 yrs old, spirometry = 2 yrs, spiromtry w/dilator = 2 yrs, lung volumes Actigraphy testing Actigraphy testing Actigraphy testing Initial hospital care Initial hospital care

Physician Work 2 RVUs 5.19 6.98 7.99 15.22 2.63 2.51 2.51 13.60 2.28 0.00 2.50 0.00

Fully Implemented NonFacility PE 2 RVUs 9.05 45.38 127.96 102.11 12.11 6.03 0.88 147.06 8.95 8.26 10.12 9.36

Year 2010 Transitional NonFacility PE 2 RVUs 9.05 14.46 127.96 102.11 12.11 6.03 0.88 147.06 8.95 8.26 10.12 9.36

Fully Implemented Facility PE 2 RVUs 5.02 2.41 2.45 5.05 1.08 NA 0.88 6.30 NA NA NA NA

Year 2010 Transitional Facility PE 2 RVUs 4.66 2.41 3.16 6.35 1.24 NA 0.88 10.14 NA NA NA NA

MalPractice 2 RVUs 0.72 0.65 0.54 1.06 0.22 0.14 0.13 1.46 0.10 0.01 0.11 0.01

Global 090 000 000 010 000 000 000 090 XXX XXX XXX XXX

0.25 0.00 0.25 0.58 0.00 1.75 0.00 2.55 0.00 0.25 0.00

2.27 2.18 0.09 1.88 1.70 5.49 4.92 7.74 6.97 2.46 2.38

2.27 2.18 0.09 1.88 1.70 5.49 4.92 7.74 6.97 3.91 3.82

NA NA 0.09 NA NA NA NA NA NA NA NA

NA NA 0.09 NA NA NA NA NA NA NA NA

0.02 0.01 0.01 0.02 0.01 0.05 0.01 0.07 0.01 0.02 0.01

ZZZ ZZZ ZZZ XXX XXX XXX XXX XXX XXX XXX XXX

1.60

7.79

12.49

NA

NA

0.08

0.00

7.29

11.91

NA

NA

0.01

0.20 1.30 2.00 3.10 0.66 1.00 0.00 1.00 1.92 2.61

0.42 0.79 NA NA NA 2.22 1.90 0.32 NA NA

0.42 1.79 NA NA NA 2.22 1.90 0.32 NA NA

NA 0.57 0.62 0.93 0.18 NA NA 0.32 0.71 0.99

NA 0.57 0.62 0.93 0.18 NA NA 0.32 0.59 0.82

0.01 0.01 0.05 0.08 0.03 0.05 0.01 0.04 0.13 0.15

XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX

CMS-1413-CN3

1

CPT / HCPCS 99223 99304 99305 99306 G0252 G0341 G0425 G0426 G0427

Mod

Status A A A A N A A A A

26

Description

Initial hospital care Nursing facility care, init Nursing facility care, init Nursing facility care, init PET imaging initial dx Percutaneous islet celltrans Inpt telehealth consult 30m Inpt telehealth consult 50 m Inpt telehealth consult 70/>m

13

Physician Work 2 RVUs 3.86 1.64 2.35 3.06 1.50 6.98 1.92 2.61 3.86

Fully Implemented NonFacility PE 2 RVUs NA 0.77 1.05 1.30 0.55 45.38 NA NA NA

Year 2010 Transitional NonFacility PE 2 RVUs NA 0.62 0.82 1.01 0.60 14.46 NA NA NA

Fully Implemented Facility PE 2 RVUs 1.45 0.77 1.05 1.30 0.55 NA 0.71 0.99 1.45

Year 2010 Transitional Facility PE 2 RVUs 1.20 0.62 0.82 1.01 0.60 NA 0.71 0.99 1.45

MalPractice 2 RVUs 0.20 0.10 0.14 0.16 0.08 0.35 0.13 0.15 0.20

Global XXX XXX XXX XXX XXX 000 XXX XXX XXX

1

CPT codes and descriptors only are copyright 2009 American Medical Association. All Rights Reserved. Applicable FARS/DFARS apply. If values are reflected for codes not payable by Medicare, please note that these values have been established as a courtesy to the general public and are not used for Medicare payment. 3 Work RVUs reflect increases for 10 and 90 day global period codes as a result of the elimination of the consultation codes. 4 The budget neutrality reduction from the chiropractic demonstration is not reflected in the RVUs for CPT codes 98940, 98941, and 98942. The required reduction will only be reflected in the files used for Medicare payment. 2

2.

On pages 62145 and 62146, in Addendum C: Codes

with Interim RVUs, the following CPT codes are corrected to read as follows:

1

CPT / HCPCS 51729 75565 94011 94012 94013

Mod 26 26

Status A A A A A 1

Description

Cystometrogram w/vp&up Card mri vel flw map add-on Up to 2 yrs old, spirometry = 2 yrs, spiromtry w/dilator = 2 yrs, lung volumes

Physician Work 2 RVUs 2.51 0.25 2.00 3.10 0.66

Fully Implemented NonFacility PE 2 RVUs 0.88 0.09 NA NA NA

Year 2010 Transitional NonFacility PE 2 RVUs 0.88 0.09 NA NA NA

Fully Implemented Facility PE 2 RVUs 0.88 0.09 0.62 0.93 0.18

Year 2010 Transitional Facility PE 2 RVUs 0.88 0.09 0.62 0.93 0.18

MalPractice 2 RVUs 0.13 0.01 0.05 0.08 0.03

CPT codes and descriptors only are copyright 2009 American Medical Association. All Rights Reserved. Applicable FARS/DFARS apply. 2 If values are reflected for codes not payable by Medicare, please note that these values have been established as a courtesy to the general public and are not used for Medicare payment. 3 Work RVUs reflect increases for 10 and 90 day global period codes as a result of the elimination of the consultation codes. 4 The budget neutrality reduction from the chiropractic demonstration is not reflected in the RVUs for CPT codes 98940, 98941, and 98942. The required reduction will only be reflected in the files used for Medicare payment.

Global 000 ZZZ XXX XXX XXX

CMS-1413-CN3

14

IV. Waiver of Proposed Rulemaking and Delay in Effective Date We ordinarily publish a notice of proposed rulemaking in the Federal Register to provide a period for public comment before the provisions of a rule take effect in accordance with section 553(b) of the Administrative Procedure Act (APA) (5 U.S.C. 553(b)).

However, we can

waive the notice and comment procedure if the Secretary finds, for good cause, that the notice and comment process is impracticable, unnecessary, or contrary to the public interest, and incorporates a statement of the finding and the reasons for it in the rule. Section 553(d) of the APA ordinarily requires a 30-day delay in the effective date of final rules after the date of their publication.

This 30-day delay in effective date

can be waived, however, if an agency finds for good cause that the delay is impracticable, unnecessary, or contrary to the public interest, and the agency incorporates a statement of the findings and its reasons in the rule issued. This document merely corrects typographical and technical errors made in FR Doc. E9-26502, the CY 2010 PFS final rule with comment period, which appeared in the November 25, 2009 Federal Register (74 FR 61738), and is

CMS-1413-CN3

15

(with limited exceptions not relevant to these corrections, but noted in the rule), effective January 1, 2010.

The

provisions of the final rule with comment period have been subjected previously to notice and comment procedures.

The

corrections contained in this document are consistent with, and do not make substantive changes to, the payment methodologies and policies adopted in the CY 2010 PFS final rule with comment period.

As such, these corrections are

being made to ensure the CY 2010 PFS final rule with comment period accurately reflects the policies adopted in that rule.

We find, therefore, for good cause that it is

unnecessary and would be contrary to the public interest to undertake further notice and comment procedures to incorporate these corrections into the CY 2010 PFS final rule with comment period. For the same reasons, we are also waiving the 30-day delay in effective date for these corrections.

We believe

that it is in the public interest to ensure that the CY 2010 PFS final rule with comment period accurately states our policies as of the date they take effect. Therefore, we find that delaying the effective date of these corrections beyond the effective date of the final rule with comment period would be contrary to the public

CMS-1413-CN3 interest.

In so doing, we find good cause to waive the

30-day delay in the effective date.

16

CMS-1413-CN3 Authority:

(Catalog of Federal Domestic Assistance Program

No. 93.774, Medicare--Supplementary Medical Insurance Program)

Dated:

December 3, 2009.

________________________ Dawn L. Smalls Executive Secretary to the Department.

BILLING CODE 4120-01-P

[FR Doc. 2009-29256 Filed 12/07/2009 at 4:15 pm; Publication Date: 12/10/2009]