Message from the CPC Chair
CMS released the 2006 Medicare fee schedule earlier this month, which outlines the new oncology demonstration project for 2006. While the extension of the demonstration project into 2006 is a positive step given that it was set to expire, the fee schedule does include a 4.4% cut to all physicians due to the Medicare physician payment formula (sustainable growth rate, or SGR).

For decades, ASCO has advocated that oncology practices need to be appropriately reimbursed for all of the services they provide in order to continue to provide high levels of care to patients. Ensuring that oncology practices can continue to provide quality care to all of our patients continues to be our priority as we head into 2006.


2006 Demonstration Project:
The 2006 oncology demonstration project will assess the extent to which practices adhere to quality evidence-based practice guidelines for patient care.ASCO has developed a spreadsheet to help you determine the impact of the demonstration on your practice.

ASCO’s clinical practice guidelines and technology assessments can be accessed at www.asco.org/guidelines, and NCCN’s guidelines can be accessed at www.nccn.org. To help ease the transition to this new demonstration, in the coming weeks, we will be developing detailed tools and resources for you to use in understanding and adapting the demonstration project to your practice.

Scheduled Cuts to Physician Payments (SGR):
As mentioned above, all physician payments are scheduled to be cut by 4.4% on January 1, 2006, unless Congress acts to fix the flawed Medicare payment formula.ASCO has been actively supporting the American Medical Association’s (AMA) efforts to avoid these cuts by joining the AMA and other specialty societies in communicating with leaders of the House and the Senate. ASCO has been asking for immediate Congressional action to prevent the scheduled 2006 cut and to provide two years of positive payment updates, beginning in 2006.

Now is the time to reach out to your representatives in Congress on this critical issue, while they are back in their home states for Thanksgiving recess. Please call your Senators and Representative today and ask them to ensure that this year’s budget reconciliation legislation includes positive updates for two years for physician payments. You can find your Member’s contact information by visiting ASCO’s Grassroots Action Center at www.capwiz.com/asco. Be sure to thank them for their attention to this important matter.


News and Notes:
2006 CPT Codes Published
The 2006 CPT codes for drug administration have been published.ASCO has developed a cross-reference sheet between the 2006 CPT codes, Medicare's 2005 G-codes, and the 2005 CPT codes for drug administration.

Update on V58 code changes
Effective October 1, ICD-9-CM encounter code V58.1 was expanded. Code V58.1 was revised and is now defined as an encounter for antineoplastic chemotherapy and immunotherapy. V58.11 should be used for an encounter for antineoplastic chemotherapy, and V58.12 should be used to report an encounter for antineoplastic immunotherapy. There is no longer a grace period to use the old codes so practices should ensure that the new codes are being reported.

A more detailed explanation of how the V codes should be used is forthcoming. In the meantime, you may want to check with your local carrier to verify if the V-code is necessary and whether V58.11 or V8.12 should be reported. Some Medicare carriers have identified which V-code should be used in conjunction with the administration of specific drugs and should be able to provide details on their billing requirements.

Medicare Participation Options Fact Sheet
The American Medicare Association (AMA) has drafted a "Medicare Participation Options for Physicians" fact sheet that contains guidance for physicians on Medicare participation/non-participation options.

ASCO Receives AMA CPT Educational Excellence Award
ASCO is pleased to report that it has received the 2005 Educational Excellence Award from the AMA CPT Editorial Panel. By presenting this award, the AMA recognized ASCO’s efforts to provide comprehensive and timely information to its members regarding new and revised CPT codes for drug administration that were established last year.W. Charles Penley, MD, ASCO’s CPT Advisor, accepted the award on behalf of the society.

Participation in Support Services Survey Critical
ASCO, in conjunction with the Administrators in Oncology/Hematology Assembly (AOHA) of the Medical Group Management Association (MGMA), is seeking help with an important survey on the costs associated with providing supportive care services to patients with cancer.The survey was sent last month to a random sample of oncology practices throughout the country.As no study currently documents the prevalence and resource expenditures for support services furnished by oncology practices, participation by practices that received the survey is crucial.Please contact ASCO at (703) 299-1050 with any questions.

Fluorouracil (5FU) Supply Shortage
Practices may be experiencing supply problems with fluorouracil (injection), in part due to a recall on 10 ml vials by American Pharmaceutical Partners.American Pharmaceutical Partners has posted information about the recall on its website. APP plans to release 20 ml vials in early December but has not issued any release information for other vial sizes. Sicor Pharmaceuticals has released its fluorouracil product Adrucil in 100 ml, 50 ml, and 10 ml vials this month to fill some backorders but continues to operate on backorder. Valeant Pharmaceuticals has the drug on backorder with no release date.

Medicare Part D Prescription Drug Program
Enrollment in the new Medicare Part D prescription drug program opened to beneficiaries November 15, 2005; this initial enrollment period will last through May 15, 2006. ASCO has written a fact sheet with basic information about the program and will be providing additional resources in the coming weeks.

National Oncologic PET Registry Expected to Launch
Earlier this year, CMS announced its intent to expand coverage for PET studies to include all cancers and currently non-covered indications (with the exceptions of breast cancer diagnosis and regional lymph node staging) if patients are enrolled in either a) a high quality clinical trial or b) a "clinical study that is designed to collect additional information at the time of the scan to assist in patient management," such as a registry.The National Oncology PET Registry, which is being managed through the American College of Radiology Imaging Network, has been established to meet the Medicare requirements for PET coverage expansion. In order for PET facilities to bill Medicare under this program, referring physicians will be required to complete data collection forms describing patient management and transmit this information to the PET facility.

More information about CMS' expansion of PET coverage can be accessed at http://www.cms.hhs.gov/medlearn/matters/mmarticles/2005/MM3741.pdf.Final approval for the NOPR from CMS is pending so patients may not yet be entered in the registry.NOPR plans to launch its website www.cancerpetregistry.org on December 5, 2005.ASCO will provide additional details about the NOPR, including any instructions from CMS and specific guidance for referring physicians, in the coming weeks.