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Regulations & Resources


Up-to-date information on Medicare rules and regulations that affect the provision of oncology drugs and services and links to relevant resources for practicing oncologists.

ESAs
ASCO Summary of ESA Changes to FDA Label
Hematocrit/Hemoglobin Reporting on ESA Claims
ASCO Letter to CMS Requesting Clarification of ESA NCD
CMS Letter on ESA Transmittal
ESA Response from Aetna
ESA Response from BCBSA
ESA Response from UnitedHealthcare
ESA Response from Blue Shield of CA
ASCO's National Audioconference on CMS' NCD on ESAs
ASCO's Recommended Revisions to CMS' ESA NCD
ASCO FAQs on CMS' National Coverage Decision on ESAs
ASCO Letter to CMS on ESA National Coverage Decision

Physician Quality Reporting Initiative (PQRI)
General Information
ASCO National Audioconference on PQRI
2007 PQRI Measures for Consideration by Oncology Providers (Updated with links to PQRI worksheets)
CMS Website on PQRI

National Oncologic PET Registry
McCarthy Joint Comment Letter on CAG-00181R2
Comments on Proposed PET NCD
ASCO Letter to CMS on National Coverage Analysis for PET
Medlearn Matters Article: "Payment for Positron Emission Tomography Scans"
Pre-PET Case Form
Post-PET Case Report Forms
Referring Physician Information Sheet
ASCO's FAQs for Referring Physicians
CMS Transmittal 956
National Oncologic PET Registry Website

Medicare Part B Drugs and Average Sales Price
ASCO Letter to CMS on DrugPoints Compendium and Off-Label Coverage
ASCO Comments to HHS on IVIG
Q1 2006 Payment Allowance Limits for Medicare Part B Drugs
Q2 2005 Payment Allowance Limits for Medicare Part B Drugs
Revised Q1 2005 Payment Allowance Limits for Medicare Part B Drugs
Revisions to Q1 2005 Average Sales Price Medicare Part B Drug Pricing

Drug Payment Comparison for Q1 2007
Drug Payment Comparison for Q4 2006
Drug Payment Comparison for Q3 2006
Drug Payment Comparison for Q2 2006
Drug Payment Comparison for Q1 2006
Drug Payment Comparison for Q4 2005
Drug Payment Comparisons for Q3 2005
Drug Payment Comparisons for Q2 2005
Drug Payment Comparisons for Q1 2005

Competitive Acquisition Program for Part B Drugs and Biologicals
Comments on DME CAP Proposed Rule
CAP List of Drugs
CAP Physician Election Agreement
CMS Transmittal on CAP Physician Election Process
Medlearn Article on Additional Requirements for CAP 
Comments on CAP Interim Final Rule 09/01/05
CAP Vendor Bidding Process Update 08/04/05
Summary of CAP Final Rule
Comments on CAP Proposed Rule
Summary of  CAP Proposed Rule
CAP Proposed Rule
CMS CAP Fact Sheet 2/25/05
CMS CAP Press Release 2/25/05

Oncology Demonstration Project
CMS FAQs on 2006 Demonstration Project
2006 Oncology Demonstration Project Website
Medlearn Article on Oncology Demonstration Documentation and Reporting
Medlearn Article on Oncology Demonstration Billing and Coding
CMS Transmittal 36 on 2006 Demo Project
G-codes for 2006 Oncology Demonstration Project
2006 Demonstration Project FAQs
Documentation Template - Head and Neck Cancer
Documentation Template - Esophageal Cancer
Documentation Template - Gastric Cancer
Documentation Template - Colon Cancer
Documentation Template - Rectal Cancer
Documentation Template - Pancreatic Cancer
Documentation Template - Lung Cancer
Documentation Template - Breast Cancer
Documentation Template - Ovarian Cancer
Documentation Template - Prostate Cancer
Documentation Template - Non-Hodgkin's Lymphoma
Documentation Template - Multiple Myeloma
Documentation Template - Chronic Myelogenous Leukemia
HCPCS Update 2005
2006 Demonstration Project Impact on Your Practice Spreadsheet
2006 Chemotherapy Demonstration Project Fact Sheet
Patient Demonstration Form
CMS Demonstration Project Fact Sheet
CMS Demonstration Project Medicare Facts 11/01/04
CMS Demonstration Project Press Release 11/01/04

Physician Fee Schedule and Drug Administration
2010:
ASCO Comments on Proposed 2010 Physician Fee Schedule
Summary of 2010 Proposed Physician Fee Schedule

2009:
Table 39: CY 2010 Total Allowed Charge (CMS)
2009 Physician Payment Regulations
Summary of 2009 Physician Fee Schedule Final Rule
Cross reference of new 2009 CPT drug administration codes
Joint Anti-Markup Letter
Comments on 2009 Proposed Physician Fee Schedule
Summary of 2009 Physician Fee Schedule Proposed Rule

2008:
Summary for 2008 Medicare Physician Fee Schedule
Comments on 2008 Proposed Fee Schedule
Summary of 2008 Physician Fee Schedule Proposed Rule

2007:
Comments on 2007 Proposed Fee Schedule
Summary of 2007 Physician Fee Schedule Proposed Rule
Comments on Practice Expense and Relative Work Value Proposed Rule
Summary of Practice Expense and Relative Work Value Proposed Rule

2006:
FAQs for 2006 Drug Administration
Summary of 2006 Physician Fee Schedule Final Rule
2006 Physician Fee Schedule Final Rule
Comments on 2006 Physician Fee Schedule Proposed Rule
Summary of 2006 Physician Fee Schedule Proposed Rule
2006 Physician Fee Schedule Proposed Rule 08/05

2005:
2005 Physician Fee Schedule Final Rule
Comments on 2005 Physician Fee Schedule Proposed Rule
2005 CMS Physician Fee Schedule Proposed Rule 
­ASCO's FAQs on CMS Drug Administration Project
Synopsis of CPT Editorial Panel Actions to Revise Drug Administration Codes and Guidelines, February 10-13, 2005
CMS FAQs on Drug Administration 04/15/05
CPT Codes for Drug Administration
Coding and Payment Changes for Medicare Drug Administration Codes
­Table 26: Impact of Drug and Physician Fee Schedule Payment Changes on Total Medicare Allowed Charges for Selected Specialties
­Table 28: Drug Pricing Table Used for Payment Impacts
Hospital Outpatient Prospective Payment System
2010 Hospital Outpatient Prospective Payment System
2009 Hospital Outpatient Prospective Payment System
Summary of HOPPS 2009 Final Rule
ASCO Comments on HOPPS 2009 Final Rule
ASCO Comments on HOPPS 2008 Final Rule
Summary of 2008 Medicare HOPPS (Interim Final Regulations)
HOPPS and CY 2008 Payment Rates
CMS Proposed Changes for 2008 Hospital Outpatient Department Payments
Comments on 2007 HOPPS Proposed Rule
Summary of 2007 Medicare HOPPS Proposed Rule
Summary of 2006 Medicare HOPPS Proposed Rule
Summary of 2005 Medicare HOPPS

Medicare Part D Prescription Drug Benefit
ASCO's Comments to USP on 2008 Model Guidelines
ASCO's Medicare Part D Factsheet
ASCO Summary on 2007 Part D Formulary Guidelines
2007 Part D Formulary Guidelines
CMS Recommended Language for Writing Scripts
Medicare Part D Fact Sheet
CMS Part D Frequently Asked Questions
Medicare Prescription Drug Program Provider Tool Kit
CMS Medicare Prescription Drug Outreach Effort Presentation 
CMS Provider Partnership Page

Educational Tools & Resources
Rebasing Sign-On Letter to Chairman Pratt
Final RAC Sign-On Letter to CMS
AMA Letter to FTC Regarding Red Flags Rule
January 22, 2009 Adapting to Changes in Medicare for 2009 - Audioconference Call
FAQs on ASCO/AMA Survey
Cancer Policy Alert: Leucovorin Shortage, January 2009
Consultation Sign-on Letter October 2008
ICD-10 Sign-On Letter Final
2009 ICD-9-CM Code Updates
Physician Comments on DEA NPMR on E-Prescribing Rule
Off-Label Compendia Letter to Medicare CMDs
ICD-10-CM Proposed Rule Summary
Request to CMS for Recognition of DrugPoints Compendium
Request to CMS for Recognition of NCCN Drug Compendium
January 9, 2008 Adapting to Changes in Medicare for 2008 - Audioconference Call
January 18, 2007 Adapting to Changes in Medicare for 2007 Audioconference Call
Clinical Trials Comments to MCAC 
Clinical Trials Questions from MCAC
AMA Sign-On Consultation Letter toCMS
ASCO Comments on USP 797
May 24, 2006 Adapting to Changes in Medicare Audioconference Call
March 7, 2006 Adapting to Changes in Medicare Audioconference Call
2006 Adapting to Changes in Medicare Audioconference Call
2006 Coding Cross Reference Sheet
Medicare Coverage Policies by State
Coding and Reimbursement Hotline 
Practical Tips for the Practicing Oncologist 3rd Edition
Practice Management Curriculum
2005 Medicare Coding Audioconference Call  
Patient Letter
PhRMA Member Patient Assistance Program Brochure
The Medicare Replacement Drug Demonstration Patient Brochure

Reports, Studies and Letters
ASCO Letter to CMS Regarding AMA PPI Survey
Letter on ABNs and MUEs
ASCO Letter to National Government Services Regarding Draft Policy for Vitamin D Testing
ASCO Letter to CMS Regarding Oral vs. Intravenous Coverage
OIG Report: Adequacy of Part B Drug Reimbursement to Physician Pratices for Treatment of Cancer Patients
GAO Report: Medicare Chemotherapy Payments
ASCO comments on list of evidentiary priorities

Go to ASCO's Medicare Modernization Act web page

 



 
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