Physician_Fee_Schedule_Rules / 2005pfs

Why This Topic Matters

It helps readers understand which Medicare policy areas were updated for the 2005 fee schedule year and how those updates are organized across coverage, payment, and administrative requirements.

Article Sections

1. PART 403 — Special Programs and Projects

   Updates related to religious nonmedical health care institutions and their home service program requirements, including oversight and payment framework references.

2. PART 405 — Federal Health Insurance for the Aged and Disabled

   Changes affecting Medicare payment-related coverage for certain services, including clinical trial-related services, drugs and biologicals, preventive examination coverage, screening tests, therapy services, telehealth, deductible amounts, and physician scarcity and shortage area incentives.

3. PART 411 — Exclusions From Medicare and Limitations on Medicare Payment

   Revisions to exclusions and beneficiary notice-related provisions tied to services not covered or not reasonable and necessary.

4. PART 414 — Payment for Part B Medical and Other Health Services

   Updates to payment rules under Part B, including care plan oversight, telehealth payment, incentive payments, and new subparts addressing drugs, biologicals, and dispensing or supplying fees.

5. Subpart K - Payment for Drugs and Biologicals in 2005

   A new payment methodology framework for Medicare Part B drugs and biologicals in 2005, including definitions, pricing concepts, limitations, and exceptions.

6. Subpart L - Supplying and Dispensing Fees

   New fee provisions for certain pharmacy-supplied and supplier-dispensed drugs and biologicals covered under Part B.

7. PART 418 — Hospice Care

   New hospice pre-election evaluation and counseling requirements and the related payment framework.

8. PART 424 — Conditions for Medicare Payment

   Revisions to supplier payment, claim reassignment, and enrollment-related definitions and limitations.

9. PART 484 — Home Health Services

   A terminology correction within home health regulations affecting the definition of an occupational therapy assistant.

10. PART 486 — Conditions for Coverage of Specialized Services Furnished by Suppliers

    Removal and reservation of a subpart within supplier coverage rules.

11. Addendum A — Explanation and Use of Addenda B

    Background on the physician fee schedule addenda and how the accompanying payment information is organized.

12. Addendum B — 2005 Relative Value Units and Related Information Used in Determining Medicare Payments for 2005

    General guidance describing the structure of fee schedule data, code listings, status indicators, modifiers, and relative value unit fields used for Medicare payment reference.