CPT Review of Drug Administration Services

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CPT Review of Drug Administration Services

• AMA Presentation

2
Drug Administration WorkgroupFormation

• In responding to the Medicare Prescription Drug,
  Improvement, and Modernization Act of 2003, the
  CPT Editorial Panel created the CPT Drug
  Administration Workgroup
• The Workgroup was created in February 2004 to
  determine appropriate reporting of services
  associated with the administration of covered
  outpatient drugs and biologicals

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Drug Administration WorkgroupComposition

• Glenn Littenberg, MD, CPT Editorial Panel (Chair)
• American College of Physicians
• American College of Rheumatology
• American Gastroenterological Association
• American Society of Clinical Oncology
• American Society of Hematology
• American Urological Association, Inc.
• Centers for Medicare and Medicaid Services
• Infectious Diseases Society of North America
• X12 Pharmacy Advisory Panel

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Drug Administration WorkgroupObjectives

1. Define the terminology within the drug
   administration codes
2. Establish codes with sufficient granularity to
   define the physician work, practice expense and
   drug agents
3. Create short descriptions of the typical patient
   provided by the physician for each code (ie,
   vignettes) in order to help define resource use

5
Drug Administration WorkgroupProcess

• Telephone conference calls with workgroup and
  with stakeholders outside normal CPT process
• Proposal placed on AMA website in early June
• Public meeting convened June 21 in D.C. and
  additional public conference call on June 23
• Drug Administration Workgroup reached overall
  consensus on June 22

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Drug Administration WorkgroupRecommendations

• The Workgroup will propose that the CPT Editorial
  Panel consider 4 issues
• Drug Infusion/Administration Codes increase
  granularity
• Severe Reaction Management
• Clinical Treatment Planning
• Anti-neoplastic pharmaceutical preparation

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CPT Editorial Panel Consideration

• The Workgroup proposal is under consideration by
  the CPT Advisory Committee members for comment
• CPT Editorial Panel to consider August 13-14
• Panel may approve, refine, or table one or more
  elements of the proposal

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CPT Editorial Panel Meeting

• Open to all CPT/HCPAC Advisors and staff
• Open to invited guests Congressional staff have
  been invited
• Closed to public to maintain confidential
  decision making
• Individual Panel member votes are confidential

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RUC Review of Drug Administration Services

• Sherry L. Smith, MS, CPA
• Secretary
• AMA/Specialty Society RVS Update Committee

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Expedited RUC Review

• Typically, August Panel actions are considered by
  the RUC at the following February meeting
• AMA RUC staff working with interested specialties
  to coordinate review in September
• The RUC has solicited all medical specialty
  societies to determine the level of interest

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RUC Survey Process

• All interested specialties are meeting on July
  31st to review aspects of RUC survey process and
  to coordinate the following
• - Reference Service List (comparable services)
• - Descriptions of typical patients and services
• - Determining descriptions of physician
  activities

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Development of Physician Work Recommendations

• The CPT Editorial Panel actions will be finalized
  by August 20
• Surveys will be in the field by late August.
  Will measure physician time and complexity and
  compare to other established physician services
  to determine appropriate work relative values
• In September, specialties will review survey
  results and develop recommendations to RUC due
  September 22nd

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Practice Expense

• Interested specialty societies will develop
  recommendations on practice expense direct
  inputs, including
• Clinical staff time
• Medical supplies
• Medical equipment
• The RUC recommends the type and quantity of the
  inputs. CMS determines the pricing of each input
• The RUC will review in September and compare to
  previously developed standards for all services

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RUC MeetingSeptember 29-October 2

• RUC will review physician work relative value and
  direct practice expense input recommendations for
  all new and revised codes
• RUC will develop recommendations and submit to
  CMS immediately following the meeting for
  consideration in the development of the Final
  Rule for the 2005 Medicare Fee Schedule

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CMS will make final determination

• CMS medical officers and staff will review and
  consider the RUCs recommendations on physician
  work and any other comments that they receive on
  the Proposed Rule
• CMS will consider the direct practice expense
  inputs as one data element in the overall
  methodology to develop practice expense relative
  values

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RUC Process is Open

• The RUC has worked diligently to ensure that the
  process is open and all interested specialty
  societies are included in the review
• Other individuals may attend the RUC meeting at
  the invitation of the Chairman
• We have invited Congressional staff to attend the
  September 29-October 2 RUC meeting