In CY 1999, we began the 4year transition to resourcebased PE RVUs utilizing a ``topdown'' methodology whereby we allocated aggregate specialtyspecific practice costs to individual procedures. The specialtyspecific PEs were derived from the American Medical Association's (AMA's) Socioeconomic Monitoring Survey (SMS). In addition, under section 212 of the BBRA, we established a process extending through March 2005 to supplement the SMS data with data submitted by a specialty. The aggregate PEs for a given specialty were then allocated to the services furnished by that specialty on the basis of the direct input data (that is, the staff time, equipment, and supplies) and work RVUs assigned to each CPT code.

For CY 2007, we implemented a new methodology for calculating PE RVUs. Under this new methodology, we use the same data sources for calculating PE, but instead of using the ``topdown'' approach to calculate the direct PE RVUs, under which the aggregate direct and indirect costs for each specialty are allocated to each individual service, we now utilize a ``bottomup'' approach to calculate the direct costs. Under the ``bottom up'' approach, we determine the direct PE by adding the costs of the resources (that is, the clinical staff, equipment, and supplies) typically required to provide each service. The costs of the resources are calculated using the refined direct PE inputs assigned to each CPT code in our PE database, which are based on our review of recommendations received from the AMA's Relative Value Update Committee (RUC). For a more detailed explanation of the PE methodology see the June 29, 2006 proposed notice (71 FR 37242) and the CY 2007 PFS final rule with comment period (71 FR 69629).
1. Current Methodology

a. Data Sources for Calculating Practice Expense

The AMA's SMS survey data and supplemental survey data from the specialties of cardiothoracic surgery, vascular surgery, physical and occupational therapy, independent laboratories, allergy/immunology, cardiology, dermatology, gastroenterology, radiology, independent diagnostic testing facilities (IDTFs), radiation oncology, and urology are used to develop the PE per hour (PE/HR) for each specialty. For those specialties for which we do not have PE/HR, the appropriate PE/HR is obtained from a crosswalk to a similar specialty.

The AMA developed the SMS survey in 1981 and discontinued it in 1999. Beginning in 2002, we incorporated the 1999 SMS survey data into our calculation of the PE RVUs, using a 5year average of SMS survey data. (See the CY 2002 PFS final rule with comment period (66 FR 55246).) The SMS PE survey data are adjusted to a common year, 2005. The SMS data provide the following six categories of PE costs:

In accordance with section 212 of the BBRA, we established a process to supplement the SMS data for a specialty with data collected by entities and organizations other than the AMA (that is, those entities and organizations representing the specialty itself). (See the Criteria for Submitting Supplemental Practice Expense Survey Data interim final rule with comment period (65 FR 25664).) Originally, the deadline to submit supplementary survey data was through August 1, 2001. In the CY 2002 PFS final rule (66 FR 55246), the deadline was extended through August 1, 2003. To ensure maximum opportunity for specialties to submit supplementary survey data, we extended the deadline to submit surveys until March 1, 2005 in the Revisions to Payment Policies Under the Physician Fee Schedule for CY 2004 final rule with comment period (68 FR 63196) (hereinafter referred to as CY 2004 PFS final rule with comment period).

The direct cost data for individual services were originally developed by the Clinical Practice Expert Panels (CPEP). The CPEP data include the supplies, equipment, and staff times specific to each procedure. The CPEPs consisted of panels of physicians, practice administrators, and nonphysicians (for example, RNs) who were nominated by physician specialty societies and other groups. There were 15 CPEPs consisting of 180 members from more than 61 specialties and subspecialties. Approximately 50 percent of the panelists were physicians.

The CPEPs identified specific inputs involved in each physician's service provided in an office or facility setting. The inputs identified were the quantity and type of nonphysician labor, medical supplies, and medical equipment.

In 1999, the AMA's RUC established the Practice Expense Advisory Committee (PEAC). From 1999 to March 2004, the PEAC, a multispecialty committee, reviewed the original CPEP inputs and provided us with recommendations for refining these direct PE inputs for existing CPT codes. Through its last meeting in March 2004, the PEAC provided recommendations for over 7,600 codes which we have reviewed and almost all of which we have accepted. As a result, the current PE inputs differ markedly from those originally recommended by the CPEPs. The PEAC has now been replaced by the Practice Expense Review Committee (PERC), which acts to assist the RUC in recommending PE inputs. b. Allocation of PE to Services

The aggregate level specialtyspecific PEs are derived from the AMA's SMS survey and supplementary survey data. To establish PE RVUs for specific services, it is necessary to establish the direct and indirect PE associated with each service.
(i) Direct costs. The direct costs are determined by adding the costs of the resources (that is, the clinical staff, equipment, and supplies) typically required to provide the service. The costs of these resources are calculated from the refined direct PE inputs in our PE database. These direct inputs are then scaled to the current aggregate pool of direct PE RVUs. The aggregate pool
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of direct PE RVUs can be derived using the following formula: (PE RVUs x physician CF) x (average direct percentage from SMS / (Supplemental PE/HR data)).
(ii) Indirect costs. The SMS and supplementary survey data are the source for the specialtyspecific aggregate indirect costs used in our PE calculations. Then, we allocate the indirect costs to the code level on the basis of the direct costs specifically associated with a code and the maximum of either the clinical labor costs or the physician work RVUs. For calculation of the 2009 PE RVUs, we are proposing to use the 2007 procedurespecific utilization data crosswalked to 2008 services. To arrive at the indirect PE costs

c. Facility/Nonfacility Costs

Procedures that can be furnished in a physician's office, as well as in a hospital or facility setting, have two PE RVUs: Facility and nonfacility. The nonfacility setting includes physicians' offices, patients' homes, freestanding imaging centers, and independent pathology labs. Facility settings include hospitals, ambulatory surgical centers (ASCs), and skilled nursing facilities (SNFs). The methodology for calculating PE RVUs is the same for both facility and nonfacility RVUs, but is applied independently to yield two separate PE RVUs. Because the PEs for services provided in a facility setting are generally included in the payment to the facility (rather than the payment to the physician under the PFS), the PE RVUs are generally lower for services provided in the facility setting.
d. Services With Technical Components (TCs) and Professional Components (PCs)

Diagnostic services are generally comprised of two components: A professional component (PC) and a technical component (TC), both of which may be performed independently or by different providers. When services have TCs, PCs, and global components that can be billed separately, the payment for the global component equals the sum of the payment for the TC and PC. This is a result of using a weighted average of the ratio of indirect to direct costs across all the specialties that furnish the global components, TCs, and PCs; that is, we apply the same weighted average indirect percentage factor to allocate indirect expenses to the global components, PCs, and TCs for a service. (The direct PE RVUs for the TC and PC sum to the global under the bottomup methodology.)

e. Transition Period

As discussed in the CY 2007 PFS final rule with comment period (71 FR 69674), we are implementing the change in the methodology for calculating PE RVUs over a 4year period. During this transition period, the PE RVUs will be calculated on the basis of a blend of RVUs calculated using our methodology described previously in this section (weighted by 25 percent during CY 2007, 50 percent during CY 2008, 75 percent during CY 2009, and 100 percent thereafter), and the CY 2006 PE RVUs for each existing code. PE RVUs for codes that are new during this period will be calculated using only the current PE methodology and will be paid at the fully transitioned rate.

f. PE RVU Methodology

The following is a description of the PE RVU methodology. (i) Setup File

First, we create a setup file for the PE methodology. The setup file contains the direct cost inputs, the utilization for each procedure code at the specialty and facility/nonfacility place of service level, and the specialtyspecific survey PE per physician hour data.
(ii) Calculate the Direct Cost PE RVUs

Sum the costs of each direct input.

Step 1: Sum the direct costs of the inputs for each service. The direct costs consist of the costs of the direct inputs for clinical labor, medical supplies, and medical equipment. The clinical labor cost is the sum of the cost of all the staff types associated with the service; it is the product of the time for each staff type and the wage rate for that staff type. The medical supplies cost is the sum of the supplies associated with the service; it is the product of the quantity of each supply and the cost of the supply. The medical equipment cost is the sum of the cost of the equipment associated with the service; it is the product of the number of minutes each piece of equipment is used in the service and the equipment cost per minute. The equipment cost per minute is calculated as described at the end of this section.

Apply a BN adjustment to the direct inputs.

Step 2: Calculate the current aggregate pool of direct PE costs. To do this, multiply the current aggregate pool of total direct and indirect PE costs (that is, the current aggregate PE RVUs multiplied by the CF) by the average direct PE percentage from the SMS and supplementary specialty survey data.

Step 3: Calculate the aggregate pool of direct costs. To do this, for all PFS
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services, sum the product of the direct costs for each service from Step 1 and the utilization data for that service.

Step 4: Using the results of Step 2 and Step 3 calculate a direct PE BN adjustment so that the proposed aggregate direct cost pool does not exceed the current aggregate direct cost pool and apply it to the direct costs from Step 1 for each service.

Step 5: Convert the results of Step 4 to an RVU scale for each service. To do this, divide the results of Step 4 by the Medicare PFS CF.
(iii) Create the indirect PE RVUs

Create indirect allocators.

Step 6: Based on the SMS and supplementary specialty survey data, calculate direct and indirect PE percentages for each physician specialty.

Step 7: Calculate direct and indirect PE percentages at the service level by taking a weighted average of the results of Step 6 for the specialties that furnish the service. Note that for services with TCs and PCs we are calculating the direct and indirect percentages across the global components, PCs, and TCs. That is, the direct and indirect percentages for a given service (for example, echocardiogram) do not vary by the PC, TC and global component.

Step 8: Calculate the service level allocators for the indirect PEs based on the percentages calculated in Step 7. The indirect PEs are allocated based on the three components: the direct PE RVU, the clinical PE RVU, and the work RVU.

For most services the indirect allocator is: indirect percentage * (direct PE RVU/direct percentage) + work RVU.

There are two situations where this formula is modified:

Note: For global services, the indirect allocator is based on both the work RVU and the clinical labor PE RVU. We do this to recognize that, for the professional service, indirect PEs will be allocated using the work RVUs, and for the TC service, indirect PEs will be allocated using the direct PE RVU and the clinical labor PE RVU. This also allows the global component RVUs to equal the sum of the PC and TC RVUs.
)For presentation purposes in the examples in Table 1, the formulas were divided into two parts for each service. The first part does not vary by service and is the indirect percentage * (direct PE RVU/direct percentage). The second part is either the work RVU, clinical PE RVU, or both depending on whether the service is a global service and whether the clinical PE RVU exceeds the work RVU (as described earlier in this step).

Apply a BN adjustment to the indirect allocators.

Step 9: Calculate the current aggregate pool of indirect PE RVUs by multiplying the current aggregate pool of PE RVUs by the average indirect PE percentage from the physician specialty survey data. This is similar to the Step 2 calculation for the direct PE RVUs.

Step 10: Calculate an aggregate pool of proposed indirect PE RVUs for all PFS services by adding the product of the indirect PE allocators for a service from Step 8 and the utilization data for that service. This is similar to the Step 3 calculation for the direct PE RVUs.

Step 11: Using the results of Step 9 and Step 10, calculate an indirect PE adjustment so that the aggregate indirect allocation does not exceed the available aggregate indirect PE RVUs and apply it to indirect allocators calculated in Step 8. This is similar to the Step 4 calculation for the direct PE RVUs.

Calculate the Indirect Practice Cost Index.

Step 12: Using the results of Step 11, calculate aggregate pools of specialtyspecific adjusted indirect PE allocators for all PFS services for a specialty by adding the product of the adjusted indirect PE allocator for each service and the utilization data for that service.

Step 13: Using the specialtyspecific indirect PE/HR data, calculate specialtyspecific aggregate pools of indirect PE for all PFS services for that specialty by adding the product of the indirect PE/HR for the specialty, the physician time for the service, and the specialty's utilization for the service.

Step 14: Using the results of Step 12 and Step 13, calculate the specialtyspecific indirect PE scaling factors as under the current methodology.

Step 15: Using the results of Step 14, calculate an indirect practice cost index at the specialty level by dividing each specialty specific indirect scaling factor by the average indirect scaling factor for the entire PFS.

Step 16: Calculate the indirect practice cost index at the service level to ensure the capture of all indirect costs. Calculate a weighted average of the practice cost index values for the specialties that furnish the service. (NOTE: For services with TCs and PCs, we calculate the indirect practice cost index across the global components, PCs, and TCs. Under this method, the indirect practice cost index for a given service (for example, echocardiogram) does not vary by the PC, TC and global component.)

Step 17: Apply the service level indirect practice cost index calculated in Step 16 to the service level adjusted indirect allocators calculated in Step 11 to get the indirect PE RVU.

(iv) Calculate the Final PE RVUs

Step 18: Add the direct PE RVUs from Step 6 to the indirect PE RVUs from Step 17.

Step 19: Calculate and apply the final PE BN adjustment by comparing the results of Step 18 to the current pool of PE RVUs. This final BN adjustment is required primarily because certain specialties are excluded from the PE RVU calculation for ratesetting purposes, but all specialties are included for purposes of calculating the final BN adjustment. (See ``Specialties excluded from ratesetting calculation'' below in this section.)
(v) Setup File Information

The equipment cost per minute is calculated as:
(1/(minutes per year * usage)) * price * ((interest rate/(1 (1/((1 + interest rate) * life of equipment)))) + maintenance)
Where:
minutes per year = maximum minutes per year if usage were continuous (that is, usage = 1); 150,000 minutes.
usage = equipment utilization assumption; 0.5.
price = price of the particular piece of equipment.
interest rate = 0.11.
life of equipment = useful life of the particular piece of equipment.

maintenance = factor for maintenance; 0.05.

Note: To illustrate the PE calculation, in Table 1 we have used the conversion factor (CF) of $34.0682 which was published in the CY 2008 PFS final rule with comment period.
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Table 1.Calculation of PE RVUs Under Methodology for Selected Codes 99213 Office 33533 CABG, 93000 ECG, Step Source Formula visit, est arterial, single 71020 Chest xray 71020TC Chest x 7102026 Chest x complete 93005 ECG, tracing 93010 ECG, report Nonfacility Facility Nonfacility ray Nonfacility ray Nonfacility Nonfacility Nonfacility Nonfacility (1) Labor cost (Lab)................. Step 1................. AMA.................... ....................... $13.32 $77.52 $5.74 $5.74 $ $6.12 $6.12 $ (2) Supply cost (Sup)................ Step 1................. AMA.................... ....................... $2.98 $7.34 $3.39 $3.39 $ $1.19 $1.19 $ (3) Equipment cost (Eqp)............. Step 1................. AMA.................... ....................... $0.19 $0.65 $8.17 $8.17 $ $0.12 $0.12 $ (4) Direct cost (Dir)................ Step 1................. ....................... =(1)+(2)+(3)........... $16.50 $85.51 $17.31 $17.31 $ $7.43 $7.43 $ (5) Direct adjustment (Dir Adj)...... Steps 24.............. See footnote*.......... ....................... 0.592 0.592 0.592 0.592 0.592 0.592 0.592 0.592 (6) Adjusted labor................... Steps 24.............. =Lab*Dir Adj........... =(1)*(5)............... $7.88 $45.88 $3.40 $3.40 $ $3.62 $3.62 $ (7) Adjusted supplies................ Steps 24.............. =Sup*Dir Adj........... =(2)*(5)............... $1.77 $4.34 $2.01 $2.01 $ $0.71 $0.71 $ (8) Adjusted equipment............... Steps 24.............. =Eqp*Dir Adj........... =(3)*(5)............... $0.12 $0.39 $4.84 $4.84 $ $0.07 $0.07 $ (9) Adjusted direct.................. Steps 24.............. ....................... =(6)+(7)+(8)........... $9.76 $50.61 $10.24 $10.24 $ $4.40 $4.40 $ (10) Conversion Factor (CF).......... Step 5................. MFS.................... ....................... $34.0682 $34.0682 $34.0682 $34.0682 $34.0682 $34.0682 $34.0682 $34.0682 (11) Adj. labor cost converted....... Step 5................. =(Lab*Dir Adj)/CF...... =(6)/(10).............. $0.23 $1.35 $0.10 $0.10 $ $0.11 $0.11 $ (12) Adj. supply cost converted...... Step 5................. =(Sup*Dir Adj)/CF...... =(7)/(10).............. $0.05 $0.13 $0.06 $0.06 $ $0.02 $0.02 $ (13) Adj. equip cost converted....... Step 5................. =(Eqp*Dir Adj)/CF...... =(8)/(10).............. $0.00 $0.01 $0.14 $0.14 $ $0.00 $0.00 $ (14) Adj. direct cost converted...... Step 5................. ....................... =(11)+(12)+(13)........ $0.29 $1.49 $0.30 $0.30 $ $0.13 $0.13 $ (15) Wrk RVU* Wrk Scaler............. Setup File............. MFS.................... ....................... $0.81 $29.62 $0.19 $ $0.19 $0.15 $ $0.15 (16) Dirpct........................ Steps 6, 7............. Surveys................ ....................... 33.8% 32.6% 40.7% 40.7% 40.7% 37.7% 37.7% 37.7% (17) Indpct........................ Steps 6, 7............. Surveys................ ....................... 66.2% 67.4% 59.3% 59.3% 59.3% 62.3% 62.3% 62.3% (18) Ind. Alloc. formula (1st part).. Step 8................. See Step 8............. ....................... ((14)/(16))*(17) ((14)/(16))*(17) ((14)/(16))*(17) ((14)/(16))*(17) ((14)/(16))*(17) ((14)/(16))*(17) ((14)/(16))*(17) ((14)/(16))*(17) (19) Ind. Alloc. (1st part).......... Step 8................. ....................... See (18)............... $0.56 $3.07 $0.44 $0.44 $ $0.21 $0.21 $ (20) Ind. Alloc. formulas (2nd part). Step 8................. See Step 8............. ....................... (15) (15) (15)+(11) (11) (15) (15)+(11) (11) (15) (21) Ind. Alloc. (2nd part).......... Step 8................. ....................... See (20)............... $0.81 $29.62 $0.29 $0.10 $0.19 $0.25 $0.11 $0.15 (22) Indirect Allocator (1st+2nd).... Step 8................. ....................... =(19)+(21)............. $1.37 $32.69 $0.73 $0.53 $0.19 $0.47 $0.32 $0.15 (23) Indirect Adjustment (Ind Adj)... Steps 911............. See footnote**......... ....................... 0.364 0.364 0.364 0.364 0.364 0.364 0.364 0.364 (24) Adjusted Indirect Allocator..... Steps 911............. =Ind Alloc * Ind Adj... ....................... $0.50 $11.89 $0.26 $0.19 $0.07 $0.17 $0.12 $0.05 (25) Ind.Practice Cost Index (PCI)... Steps 1216............ See Steps 1216........ ....................... $0.973 $0.934 $1.075 $1.075 $1.075 $1.281 $1.281 $1.281 (26) Adjusted Indirect............... Step 17................ = Adj. Ind Alloc*PCI... =(24)*(25)............. $0.49 $11.11 $0.28 $0.21 $0.07 $0.22 $0.15 $0.07 (27) PE RVU.......................... Steps 1819............ =(Adj Dir+Adj Ind) =((14)+(26)) *budn..... $0.77 $12.60 $0.59 $0.51 $0.07 $0.35 $0.28 $0.07 *budn. \*\ The direct adj = [current pe rvus * CF * avg dir pct] / [sum direct inputs] = [Step 2] / [Step 3]. \**\ The indirect adj = [current pe rvus * avg ind pct] / [sum of ind allocators] = [Step 9]/[Step 10. Note: Final PE RVU in Table 1, row 27, may not match Addendum B due to rounding. [[Page 38512]]
2. PE Proposals for CY 2009

a. RUC Recommendations for Direct PE Inputs

The RUC provided recommendations for PE inputs for the codes listed in the Table 2.
Table 2.Codes With RUC PE Recommendations
CPT \1\ code Description
29805........................ Shoulder arthroscopy, dx.
29830........................ Elbow arthroscopy.
29840........................ Wrist arthroscopy
29870........................ Knee arthroscopy, dx.
29900........................ Mcp joint arthroscopy, dx.
90465........................ Immune admin 1 inj, <8 yrs.
90466........................ Immune admin addl inj, <8 y. 90467........................ Immune admin o/n, addl <8 yrs. 90468........................ Immune admin o/n, addl <8 y. 90471........................ Immunization admin.
90472........................ Immunization admin, each admin 90473........................ Immune admin oral/nasal
90474........................ Immune admin oral/nasal addl. 93510........................ Left heart catheterization.
96405........................ Chemo intralesional, up to 7. 96406........................ Chemo intralesional over 7.
96440........................ Chemotherapy, intracavitary. 96445........................ Chemotherapy, intracavitary. 96450........................ Chemotherapy, into CNS.
96542........................ Chemotherapy injection.
99174........................ Ocular photoscreening.
99185........................ Regional hypothermia.
99186........................ Total body hypothermia.
\1\ CPT codes and descriptions are copyright 2008 American Medical Association.

We are in agreement with the RUC recommendations, (including the recommendation that no change be made to the direct inputs for CPT 93510, a cardiac catheterization code), except for inclusion of the clinical staff time related to quality activities for the following immunization codes: CPT codes 90465, 90466, 90467, 90468, 90471, 90472, 90473 and 90474. While we allow this time for mammography services due to the specific regulatory requirements required by the Mammography Quality Standards Act of 1992 (Pub. L. 102539) (MQSA), such MQSA time is not a regulatory requirement for immunization services.

b. Equipment TimeinUse

The formula for estimating the cost per minute for equipment is based upon a variety of factors, including the cost of the equipment, useful life, interest rate, maintenance cost, and utilization. The purpose of this formula is to identify an estimated cost per minute for the equipment that can be multiplied by the time the equipment is in use to obtain an estimated per use equipment cost to develop the resourcebased PE RVU.

In calculating the estimated cost per minute for services that are in use 24 hours per day for 7 days per week, we have assumed that the maximum amount of time that the equipment can be in use is approximately 525,000 minutes (that is, 525,000 minutes = (24 hours per day) x (7 days per week) x (52 weeks per year) x (60 minutes per hour)).

For CY 2008, we used 525,000 minutes to calculate the per minute equipment cost for the equipment used in CPT code 93012, Telephonic transmission of postsymptom electrocardiogram rhythm strip(s), 24hour attended monitoring, per 30 day period of time; tracing only and CPT code 93271, Patient demand single or multiple event recording with presymptom memory loop, 24hour attended monitoring, per 30 day period of time; monitoring, receipt of transmissions, and analysis. Based on information presented to us by a provider group suggesting that the equipment was in use continuously, we determined that this equipment is used 24 hours a day, 7 days a week. Thus, we assigned the equipment a 100 percent usage rate. However, in subsequent discussions with a provider group, we determined that, although there may be a 100 percent usage rate for a particular month, this does not correspond to a 100 percent usage rate for a year. Therefore, for CY 2009 we are proposing to apply our standard utilization rate of 50 percent to the 525,000 maximum minutes of use, consistent with our utilization rate assumption for other equipment. This results in 262,500 minutes (that is, 262,500 = 525,000 x 0.50) of average use over the course of the year.

In the CY 2008 PFS rule, we used 43,200 minutes (60 minutes per hour x 24 hours per day x 30 days per month) to estimate the per use cost of the equipment in these monthly services. We are continuing to use 43,200 minutes in determining the equipment cost per use for these codes. The PE RVUs would increase from 5.28 to 5.98 as a result of this change.
c. Change to PE Database Inputs for Certain Cardiac Stress Tests

The direct PE inputs for CPT code 93025, Microvolt Twave alternans for assessment of ventricular arrhythmias, for clinical labor are not consistent with the other cardiac stress tests, CPT codes 93015, Cardiovascular stress test using maximal or submaximal treadmill or bicycle exercise, continuous electrocardiographic monitoring, and/or pharmacological stress; with physician supervision, with interpretation and report, and 93017, Cardiovascular stress test using maximal or submaximal treadmill or bicycle exercise, continuous
electrocardiographic monitoring, and/or pharmacological stress; tracing only, without interpretation and report. These codes were refined by the PEAC in January 2002, the same year that CPT code 93025 was implemented. Because of this overlap in timing, the codes that the PEAC refined utilize registered nurses (RNs) while CPT 93025 uses a ``blend'' of RNs and physicians.

To provide consistency across the family, we are proposing to designate the RN as the labor type for CPT code 93025. In addition, we are proposing to add the specific Microvolt Twave testing equipment, priced at $40,000, to replace the two different cardiac stress testing treadmill devices that are currently assigned to this code and reflected in the PE database. We are also proposing to assign the service period time, 53 minutes, to the exam table and the Microvolt Twave testing treadmill because neither piece of equipment is available for use by others during the testing interval. The Twave stress test must be done in quiet room. Using this rationale for the other two stress testing CPT codes (that is, 93015 and 93017), we are also proposing to revise the PE database for these services and allocate the 55minute service period time to the exam table and the stress testing equipment rather than the 41 minutes currently assigned. d. Revisions to Sec. 414.22(b)(5)(i) Concerning Practice Expense

Current regulations at Sec. 414.22(b)(5)(i) provide an explanation of the two levels of PE RVUsfacility and nonfacilitythat are used in determining payment under the PFS. Section 414.22(b)(5)(i)(A) discusses facility PE RVUs and Sec. 414.22 (b)(5)(i)(B) discusses nonfacility PE RVUs. Language in each of these sections incorrectly implies that the facility PE RVU is lower than or equal to the nonfacility PE RVU

FOR FURTHER INFORMATION CONTACT

Pam West, (410) 7862302, for issues related to practice expense.

Rick Ensor, (410) 7865617, for issues related to practice expense methodology.

Stephanie Monroe, (410) 7866864, for issues related to malpractice RVUs.

Esther Markowitz, (410) 7864595, for issues related to telehealth services.

Craig Dobyski, (410) 7864584, for issues related to geographic practice cost indices.

Ken Marsalek, (410) 7864502, for issues related to the multiple procedure payment reduction for diagnostic imaging.

Catherine Jansto, (410) 7867762, or Cheryl Gilbreath, (410) 786 5919, for issues related to payment for covered outpatient drugs and biologicals.

Edmund Kasaitis, (410) 7860477, or Bonny Dahm (410) 7864006, for issues related to the Competitive Acquisition Program (CAP) for Part B drugs.

Corrine Axelrod, (410) 7865620, for issues related to Health Professional Shortage Area Bonus Payments.

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Henry Richter, (410) 7864562, for issues related to payments for endstage renal disease facilities.

August Nemec, (410) 7860612, for issues related to independent diagnostic testing facilities and enrollment issues; and the revision to the ``Appeals of CMS or CMS contractor Determinations When a Provider or Supplier Fails to Meet the Requirements for Medicare Billing Privileges'' final rule.

Lisa Ohrin, (410) 7864565, for issues related to incentive payment and shared saving programs.

Don Romano, (410) 7861401, for issues related to antimarkup provisions.

Diane Stern, (410) 7861133, for issues related to the quality reporting system for physician payment for CY 2009.

Andrew Morgan, (410) 7862543, for issues related to the e prescribing exemption for computer generated fax transmissions.

Terri Harris, (410) 7866830, for issues related to payment for comprehensive outpatient rehabilitation facilities (CORFs).

Lauren Oviatt, (410) 7864683, for issues related to CORF conditions of coverage.

Trisha Brooks, (410) 7864561, for issues related to personnel standards for portable xray suppliers.

David Walczak, (410) 7864475, for issues related to beneficiary signature for nonemergency ambulance transport services.

Jean Stiller, (410) 7860708, for issues related to the prohibition concerning providers of sleep tests

Mark Horney, (410) 7864554, for issues related to the solicitation for comments and data pertaining to physician organ retrieval services.

Diane Milstead, (410) 7863355, or Gaysha Brooks, (410) 7869649, for all other issues.