CPT Review of Drug Administration Services AMA Presentation

Drug Administration Workgroup Formation 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

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

Drug Administration Workgroup Objectives 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

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

Drug Administration Workgroup Recommendations The Workgroup will propose that the CPT Editorial Panel consider 4 issues: 1. Drug Infusion/Administration Codes – increase granularity 2. Severe Reaction Management 3. Clinical Treatment Planning 4. Anti-neoplastic pharmaceutical preparation

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

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

RUC Review of Drug Administration Services Sherry L. Smith, MS, CPA Secretary AMA/Specialty Society RVS Update Committee

Expedited RUC Review Typically, August Panel actions are considered by the RUC at the following February meeting 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 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 The RUC has solicited all medical specialty societies to determine the level of interest

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

Development of Physician Work Recommendations The CPT Editorial Panel actions will be finalized by August 20 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 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 22 nd In September, specialties will review survey results and develop recommendations to RUC – due September 22 nd

Practice Expense Interested specialty societies will develop recommendations on practice expense direct inputs, including: 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 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 The RUC will review in September and compare to previously developed standards for all services

RUC Meeting September 29-October 2 RUC will review physician work relative value and direct practice expense input recommendations for all new and revised codes 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 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

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

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 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 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 We have invited Congressional staff to attend the September 29-October 2 RUC meeting