Proposed fee schedule: CMS issues rule with predictable -4.3% 2006 update; agency seeks your comments before Sept. 30

Why This Topic Matters

The proposed rule can affect reimbursement, coverage, and reporting requirements across many specialties and services. Readers following Medicare policy need to understand the scope of the changes and which areas of practice may be impacted before the rule is finalized.

Article Sections

1. Overall payment update and specialty impacts

   Introduces the proposed annual physician fee schedule update and summarizes how different specialties are expected to be affected. It also frames the broader Medicare payment context for the year ahead.

2. SGR

   Discusses the sustainable growth rate framework and its role in the proposed update. The section addresses CMS’s explanation of spending growth and budget pressures.

3. Pay-for-performance

   Covers CMS’s discussion of quality measurement and payment reform. It places the proposal in the context of broader physician payment policy discussions.

4. Practice expense data

   Summarizes CMS’s proposed approach to updating practice expense values and stabilizing annual changes. It also notes the expected effects on practice-related payment patterns.

5. Supplementary PE data

   Describes the submission of practice expense information by specialty organizations and CMS’s review of those materials. The section focuses on the administrative process for incorporating outside data.

6. Nuclear medicine

   Addresses CMS’s proposal involving imaging-related policy and self-referral concerns. It highlights the broader regulatory treatment of nuclear medicine within the rule.

7. Therapy caps

   Covers annual therapy cost limitations and the planned timing for implementation. The section places therapy policy within the broader Medicare payment update.

8. Glaucoma screening

   Summarizes the proposed expansion of preventive screening eligibility. It focuses on beneficiary coverage considerations.

9. Outpatient drugs

   Reviews CMS’s proposed changes to drug pricing methodology under Medicare. It includes reporting and calculation updates affecting manufacturer submissions.

10. ESRD

    Discusses proposed payment and wage-index changes affecting end stage renal disease facilities. The section focuses on facility-level Medicare payment policy.

11. Telehealth services

    Covers services proposed for telehealth payment and restrictions on other telehealth uses. It also addresses the communication format CMS expects for coverage.

12. High-osmolar contrast material (HOCM)

    Notes a planned coding update related to radiological materials. The section is limited to the proposed treatment of this material category.

13. Splints and casts

    Summarizes a proposed payment change for durable treatment items. It reflects another small but relevant billing-policy adjustment.

14. Allergy test

    Covers a payment-related update connected to allergy testing supplies. The section focuses on a specific procedure payment refinement.

15. Physical medicine

    Discusses movement of selected services from one pricing approach to another. The section is part of the broader practice payment update.

16. Teaching anesthesiologists

    Addresses billing policy clarification for anesthesia teaching situations. It concerns how Medicare treats the presence of teaching professionals during resident care.

17. Metered-dose inhalers (MDIs)

    Summarizes how coverage for inhalation-related equipment is expected to shift under a new benefit structure. The section places the item in the broader Medicare drug coverage discussion.

18. GPCIs

    Explains proposed updates to geographic practice cost indices and locality changes. The section is relevant to regional payment adjustments.

19. Opting-out of Medicare and concierge care

    Covers proposed rule changes affecting private contracting and opt-out procedures. It focuses on compliance and physician participation rules.

20. Drug dispensing and supplying fees

    Discusses fee-related policy changes for dispensing and supplying drugs. The section addresses comment-seeking on how these fees should be structured.

21. Chiropractic demo

    Describes a planned demonstration project involving chiropractic services. The section outlines the geographic and policy scope of the demonstration.

22. Independent labs

    Summarizes the projected payment effect for independent laboratories. It also touches on supplies and RBRVS-related payment changes.

23. FQHCs

    Covers reporting expectations for federally qualified health centers working with Medicare Advantage plans. The section focuses on administrative obligations.

24. National coverage decisions

    Discusses a proposed comment period before new national coverage decisions are issued. The section addresses procedural changes to coverage policy.