ࡱ> 65 @\p Ray Woods Ba==[.8X@"1* Comic Sans MS1* Comic Sans MS1* Comic Sans MS1* Comic Sans MS1Arial1Arial1Arial1Arial1@Arial1 Arial1* MS Sans Serif1@Arial1Arial1 Arial1 Arial1*  Comic Sans MS1*$ Comic Sans MS1( Arial Narrow1Arial1 Arial1* Comic Sans MS1 Arial1 Arial1( Arial Narrow"$"#,##0_);\("$"#,##0\)!"$"#,##0_);[Red]\("$"#,##0\)""$"#,##0.00_);\("$"#,##0.00\)'""$"#,##0.00_);[Red]\("$"#,##0.00\)7*2_("$"* #,##0_);_("$"* \(#,##0\);_("$"* "-"_);_(@_).))_(* #,##0_);_(* \(#,##0\);_(* "-"_);_(@_)?,:_("$"* #,##0.00_);_("$"* \(#,##0.00\);_("$"* "-"??_);_(@_)6+1_(* #,##0.00_);_(* \(#,##0.00\);_(* "-"??_);_(@_) "$"#,##0.00"Yes";"Yes";"No""True";"True";"False""On";"On";"Off"!"$"#,##0.00;[Red]"$"#,##0.00                + ) , *     (   (8  8   8  8 8  8 8    8@@ 8@ @ 8 8@ 8@  x 8@ @ 8@ @ <@ @ <@ @  8  8 8  8 8 8@ 8 @  x`@  8 8 8 x@  *xb@@   )xb@   *xb@  *xb@  *x b @  8  *xb@@   )xb@   *xb@  *xb@  *x b @  a< a<  x`@  <@ <@@ )8 x@  <  q <  8 )8  8@ @  x`@  8@ 8@ @ 8!@ @ 8!@ @ 8!@ @ <!@@  x!b@ @  Page28RT=.Special medical radiation physics consultation Description1Therapeutic radiology treatment planning; complex=Therapeutic radiology simulation-aided field setting; complexBrachytherapy isodose calculation; intermediate (multiplane dosage calculations, application involving 5 to 10 sources/ribbons, remote afterloading brachytherapy, 9 to 12 sourcessSpecial treatment procedure (e.g. total body irradiation, hemibody irradiation, per oral, vaginal cone irradiation)WRemote afterloading high intensity brachytherapy; 9 to 12 source positions or cathetersBasic radiation dosimetry calculation, central axis depth dose, TDF, NSD, gap calculation, off axis factor, tissue inhomogeneity factors, as required during course of treatment, only when prescribed by the treating physicianfSpecial dosimetry (e.g. TLD, microdosimetry) (specify), only when prescribed by the treating physicianDRGSENAX0305031303040981 CPT/ HCPCS$Principal and Secondary Procedure(s)WRemote afterloading high intensity brachytherapy; over 12 source positions or cathetersBrachytherapy isodose calculation; intermediate (multiplane dosage calculations, application involving over 12 sources/ribbons, remote afterloading brachytherapy, 9 to 12 sources22001/2002 Ambulatory Payment Classification (APC) 0311 / 0305SPercutaneous Cardiovascular Procedure without Coronary Artery Stent and without AMIMPercutaneous cardiovascular procedure with coronary artery stent without AMI.36.0x 36.0x and 92.27#Hospital Inpatient DRGs for FY 2002wRelevant Payment Amounts for Intravascular (Intracoronary) Brachytherapy with the Novoste"! Beta-Cath"! System 1Percutaneous cardiovascular procedure with AMI. N/A410.0x with 36.0x, or 92.27fNote : Payments shown in these tables are National Average amounts and will vary with every hospital.%Adjusted Payment Amount for FY 2002**)Description - Radiation Oncology ServicesT Each additional vesselEPercutaneous transluminal coronary balloon angioplasty; single vessel,Unlisted cardiovascular service or procedure0Description - Interventional Cardiology ServicesTranscatheter placement of radiation delivery device for subsequent coronoary intravascular brachytherapy (List separately in addition to code for primary procedure)Y CPT/HCPCS codes and payment amounts associated with use of the Novoste"! Beta-Cath"! System  n* FY 2002 payments and weights are derived from the August 1, 2001, Federal Register (66 Fed. Reg. No. 148). `* Current Procedural Technology (CPT) 2000 American Medical Association. All Rights Reserved.Suggested CPT* Codes and Payment Amounts for Intravascular (Intracoronary) Brachytherapy with the Novoste"! Beta-Cath"! System (Technical Charges): Outpatient Hospital SettingStatus Indicator**h*** 2001 payments and weights come from the November 13, 2000, Federal Register (65 Fed. Reg. No. 219) 0302/0299** Status indicators explain how various services are treated under the hospital outpatient prospective payment system. Status indicator E means the service is non-covered, and no APC payment will be made. Status indicator X means the service is ancillary, and will receive an APC payment. Status indicator S indicates a significant procedure, and will receive a full APC payment.I** Status indicators explain how various services are treated under the hospital outpatient prospective payment system. Status indicator S indicates a significant procedure, and will receive an APC payment. Status indicator T means that a multiple procedure reduction of 50% applies on all but the highest paying T procedure.Z CPT*/HCPCS codes and payment amounts associated with use of the Novoste"! Beta-Cath"! System  2001 Payment Amount***2002 Payment Amount**** 0082 / 00830096&Unadjusted Payment Amount for FY 2002*** Adjusted payment amounts represent estimated national average payment amounts for large, urban hospitals. Copyright Covance Health Economics and Outcomes Services , March 2002**** 2002 payments and weights come from the March 1, 2002 Federal Register (67 Fed. Reg. No. 41). The Addenda containing these rates cannot be found in the paper version of this final rule; they are only available on the internet. **** 2002 payments and weights come from the March 1, 2002 Federal Register (67 Fed. Reg. No. 41). The Addenda containing these rates cannot be found in the paper version of this final rule; they are only available on the internet. Suggested CPT* Codes and Payment Amounts for Intravascular (Intracoronary) Brachytherapy with the Novoste"! Beta-Cath"! System (Technical Charges): Interventional CardiologyBG b'I[ [ {#@ @  y-0  dMbP?_*+%&R &8D00645C 04/02&'(?)?M\\novprt1\HPLJ4000-06?dXXLetter.HP LaserJet 4000 Series PCL 62xUN1 gd;ΫgOP fI ZglǓG#.. ^[kpwSv5W9Ft9ZhAc)7f!޺HMT{ ;6@v[1YXm%!T͙I4$:v }C0@oРMQL1RpLrqe)q ϧSQa vPa`l?q;ϼLEK$F޲L'uHظ+ת*FЩ%OVF,NxWm+,勹oO+&4!L[k`*/_Či3UM F"D>1A'ww[˝}Ž؆DHhCxCAﷂv7 |r.@s"dX??U} U} 8'} } } 8}  6@I/ ! X#X#X# ]]]  "  "  " ccccc `aaab R 6 6 H8 Y"~ S @ ( ' IW2g@~ Z@~ T(@ $ %J[@~ [8@~ U0@ V WXù-@~ \$@ && ^!^^^^ ^+^^^^ _9____ 00000 00000 00000 FJJX >@<F   *7 @ 7=  dMbP?_*+%&R &8D00645C 04/02&?'?(?)?M\\novprt1\HPLJ4000-06?dXXLetter.HP LaserJet 4000 Series PCL 62xUN1 gd;ΫgOP fI ZglǓG#.. ^[kpwSv5W9Ft9ZhAc)7f!޺HMT{ ;6@v[1YXm%!T͙I4$:v }C0@oРMQL1RpLrqe)q ϧSQa vPa`l?q;ϼLEK$F޲L'uHظ+ת*FЩ%OVF,NxWm+,勹oO+&4!L[k`*/_Či3UM F"D>1A'ww[˝}Ž؆DHhCxCAﷂv7 |r.@s"UXX??U}  } A}  } U}  }  } } G v.    @ @ @  @+@h@:@ f-ggggh i*jjjjk A B# C. D D4 E5~ 4@ 7    @~ 4@ 7   @F@~ 4@ 8   @F@~ 4@ 8   @F@~ 4@ 7  0 #@F@~ 4p@ 7   [@FY5A~ 4@ 7    [@FY5A~ 4@@ 8    >@F4@~ 40@ 7    >@F4@~ 5@ 9 1 2 3@G@ l, llllm e1eeeee d/dddddMN e:eeeeeKK  *h""TTNNNNNNNNN""&&> @<F$$$2 7 @ C H  dMbP?_*+%&R &8D00645C 0402&'(?)?M\\novprt1\HPLJ4000-06?dXXLetter.HP LaserJet 4000 Series PCL 62xUN1 gd;ΫgOP fI ZglǓG#.. ^[kpwSv5W9Ft9ZhAc)7f!޺HMT{ ;6@v[1YXm%!T͙I4$:v }C0@oРMQL1RpLrqe)q ϧSQa vPa`l?q;ϼLEK$F޲L'uHظ+ת*FЩ%OVF,NxWm+,勹oO+&4!L[k`*/_Či3UM F"D>1A'ww[˝}Ž؆DHhCxCAﷂv7 |r.@s"dX??U} } 1} q } }  }  } @ v  )w  w X @  @ h@:@ n<ooooo p3qqqqr ; <( =. > >4 ?5~ :@ L) +$ Q-t A-@~ +`@ *& +$ +6,HA-A~ +@ *% +$ +6,HA-A~ +p@ *' + Q7,6@-@ s,sssss t2ttttt d/ ddddd e; eeeee PP OO MN KK"""TNNNN"""">@<F2  7 Oh+'0HPdx  Tina Ommaya EmployeeyaMicrosoft Excel@;d@w#&@@՜.+,0 PXh px CHEOSge Page 1APage 1BPage2  Worksheets  !"#$&'()*+,./01234Root Entry FbCWorkbookHSummaryInformation(%DocumentSummaryInformation8-