cy2016 medicare proposed rules issued for hospital

of 27 CRV-328302-AA JUL2015

See page 4 for important information about the uses and limitations of this document. CPT Copyright 2014 American Medical Association. All rights reserved. CPT is a registered trademark of the American Medical Association

CY2016 Medicare Proposed Rules Issued for Hospital Outpatient, Ambulatory Surgical Center and Physician Fee Schedule Interventional Cardiology, Peripheral Interventions, Rhythm Management Summary: On July 1, 2015, the Centers for Medicare and Medicaid Services (CMS) released the Calendar Year (CY) 2016 proposed policies and payment rates for Medicare’s Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Centers (ASC). CMS also released the CY 2016 proposed rule and payment rates for the Physician Fee Schedule (PFS) on July 8, 2015. As is customary, CMS provides the public an opportunity to comment on proposed changes prior to finalizing their decisions in the Final Rules. The final policy and payment rate are expected around November 1, 2015, and go into effect January 1, 2016. Hospital Outpatient Prospective Payment System CMS estimates that total OPPS payments would decrease by $43 million (0.1 percent), holding case-mix and volume constant. See Table 1 for interventional cardiology, peripheral interventions, and rhythm management related procedures.

Important OPPS Policy Changes Affect Cardiovascular Procedures Proposed Change to Device Edit Policy (C-Codes) - In CY 2015, CMS finalized a policy whereby any claim assigned to a comprehensive APC required the C-code for the device to be included on the claim for the claim to be processed regardless of whether the comprehensive APC was considered device intensive (i.e. 40% of the cost of the procedure were attributable to the cost of the device). For CY 2016, CMS is proposing to modify this policy so only comprehensive APCs that are found to be device intensive will require the C-code on the claim in order to be processed. Claims submitted with a procedure code requiring a device C-code assigned to an APC would be denied and returned to the provider. Cardiovascular APCs include: pacemakers, ICDs, coronary interventions, and peripheral interventional procedures.

CY 2016 APC

CY 2015 APC

CY 2015 APC Title

5221 0105 Level I Pacemaker

5222

0090 Level II Pacemaker

5223 0089 Level III Pacemaker

5224 0655 Level IV Pacemaker

5231 0107 Level I ICD

5232 0108 Level II ICD

5192 0229 Level II Endovascular

5193 0319 Level III Endovascular

Proposed Adjustment to OPPS Payments for Discontinued Device Intensive Procedures - CMS has long instructed hospitals regarding the use of modifiers (-73 discontinued outpatient hospital/ASC procedure prior to the administration of anesthesia, -74 Discontinued outpatient hospital/ASC procedure after the administration of anesthesia, and -52 Reduced services) for when hospitals have to discontinue a procedure and still need to be paid for the services rendered. In this proposed rule, CMS is clarifying how the device costs for device intensive procedures will be handled for those procedures that are discontinued prior to the administration of anesthesia (i.e. -73, potential for -52). CMS is proposing for CY 2016 to reduce the APC payment by 100% of the device cost offset amount for those device intensive procedures discontinued prior to the induction of anesthesia. However when anesthesia (including local) is used primarily for interventions, CMS will continue to reimburse at 100% (i.e. -74).

of 27 CRV-328302-AA JUL2015


Multiple Imaging Composite APCs – CMS proposes continuing to provide a single payment for multiple imaging services done within the same imaging family on the same day of service. There are three imaging families, Ultrasound, CT/CTA and MRI/MRA. There are five multiple imaging composite APCs, differentiating when CT/CTA and MRI/MRA are done with and without contrast. CMS defines a single imaging session for the “with contrast” composite APCs as at least one or more imaging procedures from the same imaging family performed with contrast on the same date of service. Hospital Outpatient Quality Reporting (OQR) Program – The Hospital OQR Program is a pay for quality data reporting program implemented for outpatient hospital services. Under the program, hospitals must meet administrative, data collection and submission, valuation, and publication requirements or they receive up to a two percentage point reduction in their annual payment update (APU). CMS previously finalized measure set for Hospital OQR Program impacting CY 2016 and subsequent years which includes: OP-3 Median time to Transfer to Another Facility for Acute Coronary Intervention (NQF #0290), among other measures. CMS proposes two new measures for the Program:

For CY 2018: OP-33 External Beam Radiotherapy (EBRT) for Bone Metastases (NQF #1822) For CY 2019: OP-34 Emergency Department Transfer Communication (EDTC) (NQF #0291)

Short Inpatient Hospital Stay (Two-Midnight Rule) - CMS adopted the Two-Midnight Rule for hospital inpatient admissions beginning on October 1, 2013, with the intent to provide greater clarity to hospital and physician stakeholders for when an inpatient admission is reasonable and eligible for payment. As a result of input, CMS is proposing the following:

Allow inpatient admission less than two-midnights on a case-by case basis based on the judgment of the admitting physician. Documentation must support the medical necessity of the admission and is subject to review.

No change for stays over two-midnight stays. The physician needs to continue to document the medical rationale for the expected length of stay and hospital admission.

CMS also proposes to change the Recovery Audit Contractor (RAC) medical review policy including reducing the look back period from 6 months to 3 months when hospitals rebill an inpatient admission denial as an outpatient claim. Transitional Pass-Through (TPT) Payment - CMS is proposing to modify the process for reviewing applications for transitional pass through payment, allowing for more transparency and public comment. Effective April 1, 2015, CMS established a new device TPT category for drug-coated balloons (DCBs), which applies to LUTONIX DCB. The TPT results in incremental payment to hospitals for outpatient services when a DCB is furnished. In addition to the Drug Coated Balloon category, one other cardiovascular TPT category was approved for wireless pulmonary artery pressure sensors (CardioMEMS). Interventional Cardiology

Complex Percutaneous Coronary Interventions (PCIs) APC 5193 (DES CTO PCI, DES AMI PCI, Stent with Atherectomy; formerly APC 319) payment proposed to decrease 0.52% to $14,768

o Complexity adjustments, including second main coronary vessel, or additional branch vessel, when in combination with DES or DES bypass graft will group to higher paying APC 0319. (See Table 1 for a list of interventional cardiology combination codes)

Percutaneous Coronary Interventions (PCIs) APC 5192 (Non-complex stents, BMS CTO, BMS, AMI, atherectomy without stents; formerly APC 229) proposed to increase 0.16% to $9,643

Peripheral Interventions CMS is proposing to assign most PI procedures to newly create APCs. See Table 1 for additional details. Venous and Arterial Mechanical Thrombectomy payments proposed to increase 21.89% to $3,926 AV Fistula Thrombectomy payments proposed to increase 2.10% to $4,634 Iliac PTA, Femoral/Popliteal PTA, and Hemodialysis Access Management (HAM) PTA payments proposed to increase by

2.10% to $4,634 Embolization payments proposed to increase 0.16% to $9,643 Tibial/Peroneal PTA, Iliac Stenting, Femoral/Popliteal Stenting, and Femoral/Popliteal Atherectomy payments proposed to

increase by 0.16%% to $9,643 Tibial/Peroneal Stenting, Tibial/Peroneal Atherectomy, and Combined PTA/Stent/Atherectomy payments proposed to

decrease by 0.52% to $14,768 Rhythm Management

Proposed payment rates for ICD system implants would decrease by 0.15% and ICD replacement procedures would decrease by 3.19%

Single and dual chamber pacemaker system implants would decrease by 1.04% and pacemaker replacements (dual and single chamber) would increase 3.47%

Proposed payment rates for ablation procedures performed in conjunction with a comprehensive EP study, which includes most ablation procedures, would increase by 8.37%

WATCHMAN™ Left Atrial Appendage Closure procedure (0281T) is restricted to the inpatient hospital site of service

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Ambulatory Surgical Center: Overall ASC payments rates proposed to increase $186 million (1.4%) over CY 2015 rates. See Table 2 for peripheral interventions, and rhythm management related procedures. Peripheral Interventions

All lower extremity bundled PTA, stent and atherectomy procedures are allowed in the ASC; however, less than 1.0% of PI procedures are performed within the ASC

Rhythm Management CRT-D/ICD/S-ICD system implants in the ASC are proposed to decrease by 1.02% Dual chamber pacemaker system implant payment rates as well as replacements are proposed to decrease by 1.32%

Physician Fee Schedule Table 3 CY 2015 final rates are calculated using the current conversion factor (CF) of $35.9335 which remains effective until December 31, 2015, moving to $36.1096 beginning January 1, 2016. Overview: Physician Fee Schedule (PFS) - Until this year, annual updates to physician fees followed the Sustainable Growth Rate (SGR) methodology. The SGR methodology threatened annual cuts of 15-30% each year in physician rates since the early 2000s, requiring Congress to pass a “doc fix” each year to avoid politically unsustainable cuts in physician reimbursement. Earlier this year Congress repealed the SGR method and replaced it with a fixed annual update with a transition to a pay for value method. In the proposed rule, CMS continues to implement these changes to the physician payment methodology. Changes include a 0.5% annual raise through 2019 for Medicare participating providers, then moving to an incentive-based payment system designed to encourage participation in alternative payment models (APM). Merit-Based Incentive Payment System (MIPS) will begin impacting physician payments in 2019. Table 3 final rates are calculated with the current conversion factor (CF) of $35.9335 which remains effective until December 31, 2015, moving to $36.1096 beginning January 1, 2016. Other Proposed Policy Changes:

Misvalued Services - CMS and other policy analysts believe that there are a number of services for which reimbursement rates may be incorrect relative to the approximate cost of delivering the services. These are commonly referred to as misvalued services. CMS has proposed 118 services as being potentially misvalued and in need of review. By reducing payments for misvalued services, CMS aims to reduce payments by 1.0% in 2016 and by 0.5% in 2017 and 2018. Cardiovascular procedure codes identified by CMS as being potentially misvalued include: arterial catheter placement, multiple device monitoring codes, and the code for 3-D mapping. CMS now invites comments on the methodology and services identified for inclusion in the calculation. Physician Value-Based Modifier - CMS continues to implement the value-based payment modifier for physicians. The program translates quality and cost performance into payment incentives for those who provide high quality, efficient care, while those who underperform may be subject to a downward adjustment. CMS proposes a +/- 4% adjustment for practices with 10 or more providers and +/- 2% for 9 or less impacting CY 2018 payments, based on CY 2016 reporting. The value-based modified adjustment will end in 2018, to be replaced by the Merit-based Incentive Payment System (MIPS). Physician Quality Reporting System (PQRS) - CMS continues implementing PQRS, proposing new measures that if finalized, would result in 300 measures in the PQRS measure set for 2016. If an individual eligible provider or group practice does not satisfactorily report these quality measures, a 2% negative payment adjustment would apply in 2018, based on 2016 reporting. The PQRS will end in 2018 and starting on January 1, 2019 the Merit-based Incentive Payment System (MIPS) will begin.

Global Surgical Package - In 2015, CMS considered addressing the valuation and coding of global surgical packages, which would have revalued 10 and 90-day global CPT codes to 0-day CPT codes. Congress stepped in and stopped the implementation of this 2015 proposal and instead CMS will now develop a process to gather information needed to potentially send surgical services for review under misvalued services. This data has to begin no later than January 1, 2017 and be from a representative sample of surgeons. The collected information must include the number and level of medical visits furnished during the global period and other items and services related to the surgery, as appropriate.

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Interventional Cardiology Coronary Stenting

PCIs payment rates are relatively stable o CTO and AMI PCIs proposed to increase by $3 to $710 o Atherectomy with stent payment rate proposed to increase $2 to $709

Stent\PTCA payment rate proposed to increase by $3 to $634 Atherectomy without stent proposed to increase by $3 to $378 Angioplasty payment rate proposed to increase by $2 to $571

Structural Heart-Valves

TAVR range of codes stable, proposed to increase an average of 0.3% with a range of $1,428-$2,024

Peripheral Interventions Physician In-Facility reimbursement is flat overall, while reimbursement to physicians for procedures done in their office is proposed to

increase 0.90% In-Facility and In-office payments for PTA, Stenting, Atherectomy, and thrombectomy remained stable with none of the

payments changing more than 1.50%

Rhythm Management Cardiac Rhythm Management device related procedures remain stable with an average increase of 0.05% Electrophysiology procedures remain stable with an average decrease of 0.48% Several device monitoring codes, including the codes for remote monitoring have been identified as potentially

misvalued. Also identified as potentially misvalued is the code for 3-D mapping

Table Index At the end of the document the following three tables list detailed changes for select Interventional Cardiology (IC), Peripheral Intervention (PI), and Rhythm Management (RM), (reflective of Cardiac Rhythm Management and Electrophysiology) related procedures:

Table 1: Hospital Outpatient CY2016 Proposed Payment Rates Table 2: ASC CY2016 Proposed Payment Rates Table 3: Physician CY2016 Proposed Fee Schedule

Comments or Questions If you have questions or would like additional information please contact:

Interventional Cardiology (IC) Peripheral Interventions (PI) Rhythm Management (RM)

Deb Lorenz Brent Hale Reimbursement Support Line

763-494-2112 763-494-1448 1-800-CARDIAC

[email protected] [email protected] [email protected]

Health economic and reimbursement information provided by Boston Scientific Corporation is gathered from third-party sources and is subject to change without notice as a result of complex and frequently changing laws, regulations, rules and policies. This information is presented for illustrative purposes on and does not constitute reimbursement or legal advice. Boston Scientific encourages providers to submit accurate and appropriate claims for services. It is always the provider’s responsibility to determine medical necessity, the proper site for delivery of any services and to submit appropriate codes, charges, and modifiers for services that are rendered. Boston Scientific recommends that you consult with your payers, reimbursement specialists and/or legal counsel regarding coding, coverage and reimbursement matters. Boston Scientific does not promote the use of its products outside their FDA-approved label.

CPT Copyright 2014 American Medical Association. All rights reserved. CPT is a registered trademark of the American Medical Association. Applicable FARS/DFARS Restrictions Apply to Government Use. Fee schedules, relative value units, conversion factors, and/or related components are not assigned by the AMA, are not part of CPT®, and the AMA is not recommending their use. The AMA does not directly or indirectly practice medicine or dispense medical services. The AMA assumes no liability for data contained or not contained herein.

APC Descriptor

CY2016

Proposed

Rate

CY2015 Final

Rate

Variance

2016 Proposed vs.

2015 Final

% YoY

Change

Interventional Cardiology

5188 Diagnostic Cardiac Catheterization (previously APC 80) $2,577 $2,576 $1 0.02%

Level I Endovascular Procedures (previously APC 83)

PTCA (92920)

Level II Endovascular Procedures (previously APC 229)

DES w/ PTCA (C9600), DES Bypass Graft (C9604), BMS w/ PTCA

(92928), BMS Bypass Graft (92937), BMS AMI PCI (92941), BMS

CTO PCI (92943), PTCA/Atherectomy (92924)

Complexity Adjustments:

PTCA + PTCA (92920 + 92920), PTCA + PTCA add branch (92920 +

92921)

Level III Endovascular Procedures (previously APC 319)

DES CTO PCI (C9607), DES AMI PCI (C9606), DES w/Atherectomy

(C9602), BMS w/Atherectomy (92933)


DES + DES (C9600 + C9600), DES + DES add branch (C9600 +

C9601), DES + Coronary Angio / Atherectomy (C9600 + 92924),

DES Bypass Graft + DES (C9604 + C9600), DES Bypass Graft + DES

add branch (C9604 + C9601), DES + DES Bypass Graft add branch

(C9600 + C9605), DES Bypass Graft + DES Bypass Graft (C9604 +

C9604), DES Bypass Graft + DES Bypass Graft add branch (C9604 +

C9605), BMS Stent + DES Stent add branch (92928 + C9601), DES

+ Vasc Stent (C9600 + 37236), DES + Iliac Stent (C9600 + 37221),

DES + Insert Pacemaker (C9600 + 33208), DES + Insert Electrode

(C9600 + 33210)

Peripheral Interventions

5183

Level 3 Vascular Procedures (previously APC 88)

Arterial Mechanical Thrombectomy (37184), Venous Mechanical

Thrombectomy (37187)

$3,926 $3,221 $705 21.89%

Level I Endovascular Procedures (previously APC 83)

Iliac PTA (37220), FemPop PTA (37224), AV Fistula Thrombectomy

(36870)

Level II Endovascular Procedures (previously APC 229)

TibPer PTA (37228), Iliac Stent (37221), FemPop Atherectomy

(37225), FemPop Stent (37226), Vasc Embolization (37241‐37244)

Complexity Adjustment:

AV Fistula Thrombectomy + AV Fistula Thrombectomy (36870 +

36870)

Table 1: CY2016 Hospital Outpatient Proposed Payment Rates for Select Procedures

5191* $4,634 $4,539 $95 2.10%

0.16%5192

‐0.52%

5191

0.16%

2.10%

5192

BSC currently has no stents FDA‐approved for CTOs

*

$14,768 $14,846 ‐$785193*

$9,643 $9,628 $15

* $4,634 $4,539 $95

* $9,643 $9,628 $15

See page 4 for important information about the uses and limitations of this document.

CPT Copyright 2014 American Medical Association. All rights reserved. CPT is a registered trademark of the American Medical Association

of 27 CRV-328302-AA JUL2015

APC Descriptor

CY2016

Proposed

Rate

CY2015 Final

Rate

Variance

2016 Proposed vs.

2015 Final

% YoY

Change


Level III Endovascular Procedures (previously APC 319)

FemPop Stent & Atherectomy (37227), TibPer Atherectomy

(37229), TibPer Stent (37230), TibPer Stent & Atherectomy

(37231)


Iliac Stent + Vasc Stent (37221 + 37236), FemPop Atherectomy +

Iliac Stent (37225 + 37221), FemPop Atherectomy + Vasc Stent

(37225 + 37236), FemPop Stent + Iliac Stent (37226 + 37221),

FemPop Stent + FemPop Atherectomy (37226 + 37225), FemPop

Stent + FemPop Stent (37226 + 37226), FemPop Stent + Vasc

Stent (37226 + 37236), FemPop Stent + DES (37226 + C9600),

Vasc embo venous + Vasc stent (37241 + 37238), Vasc embo

artery + Iliac stent (37242 + 37221), Vasc Stent + Vasc Stent

(37236 + 37238), Vasc Stent + Vasc Stent (37238 + 37238)

5352

Level 2 Percutaneous Abdominal/Biliary Procedures and Related

Procedures (previously APC 423)

Biliary Stent (47556)

$4,152 $4,096 $56 1.37%

2616 Brachytx, non‐str,Yttrium‐90 $15,853 $15,583 $271 1.74%

BSC currently has no stents FDA‐approved for use in the infrainguinal regions of the lower extremities

Rhythm Management

5188 Diagnostic Cardiac Catheterization (previously APC 80) $2,577 $2,576 $1 0.02%

Level 1 EP Procedures (previously APC 84)

Right ventricular recording (93603)

Induction of arrthymia (93618)

DFT testing not at implant (93642)


Bundle of HIS recording (93600)

Intra‐atrial recording (93602)

Intra‐atrial pacing (93610)

Intraventricular pacing (93612)

Comprehensive EP study without induction (93619)

Comprehensive EP study with induction (93620)

EP follow up study (93624)

AV Node Ablation (93650)


SVT ablation with EP study (93653)

VT ablation with EP study (93654)

A Fib ablation with EP study (93656)

*

*

*

‐4.04%‐$35$873$8385211

$14,362$15,564

2.49%$115$4,635$4,7505212

5213 8.37%$1,202

‐0.52%* 5193 $14,768 $14,846 ‐$78



of 27 CRV-328302-AA JUL2015

APC Descriptor

CY2016

Proposed

Rate

CY2015 Final

Rate

Variance

2016 Proposed vs.

2015 Final

% YoY

Change


Level 1 Pacemaker and Similar Procedures (previously APC 0105)

Repair single transvenous electrode (33218)

Repair 2 transvenous electrodes (33220)

Removal of pacemaker generator only (33233)

Removal of transvenous pacemaker electrode ‐ single (33234)

Removal of transvenous pacemaker electrode ‐ dual (33235)

Removal of ICD pulse generator only (33241)

Removal of ICD electrode(s) (33244)

Removal of S‐ICD electrode (33272)

Repositioning of S‐ICD electrode (33273)


Insertion of single chamber pacemaker generator only (33212)

Insertion of single transvenous electrode, pacemaker or ICD

(33216)

Insertion of 2 transvenous electrodes, pacemaker or ICD (33217)

Single chamber pacemaker change out (33227)

Insertion of S‐ICD electrode (33271)

Level 3 Pacemaker and Similar Procedures (Previously APC 89)

Insertion of single and dual chamber pacemaker (33206,33207,

33208)

Insertion of dual chamber pacemaker generator only (33213)

Upgrade of single to dual chamber pacemaker (33214)

LV lead insertion with attachment to previously placed device

(33224)

Dual chamber pacemaker change out (33228)

Removal of PM generator + LV pacing lead add‐on (33233 +

33225)

Implant pat‐active ht record + EP Eval (33282 + 93619)


Insertion of multiple lead pacemaker generator only (33221)

Multiple lead pacemaker change out (33229)

Insert PM ventricular + LV lead add‐on (33207 + 33225), Insert

PM atrial & Vent + LV pacing lead add‐on (33208 + 33225), Insert

PM atrial & vent + Ablate heart dys focus (33208 + 93650), Insert

pacing lead & connect + Insert 1 electrode pm‐defib (33224+

33216), Remv & replc pm gen dual lead + LV pacing lead add‐on

(33228 + 33225)

*

*

$16,985 $16,407 $578 3.52%*

3.47%$227$6,545$6,7725222

‐39.03%‐$2,554

‐1.05%‐$99$9,493$9,3945223

5221 $3,991 $6,545

5224



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APC Descriptor

CY2016

Proposed

Rate

CY2015 Final

Rate

Variance

2016 Proposed vs.

2015 Final

% YoY

Change


Level 1 ICD and Similar Procedures (ICD/S‐ICD PG only)

(previously APC 107)

Insertion of single and dual lead defibrillator pulse generator only

(33240,33230)

Single or dual lead ICD change out (33262, 33263)

Insert PM ventricular + LV lead add‐on (33207 + 33225)

Insert PM atrial & Vent + LV pacing lead add‐on (33208 + 33225)

Insert PM atrial & vent + Ablate heart dys focus (33208 + 93650)

Insert pacing lead & connect + Insert 1 electrode pm‐defib (33224

+ 33216)

Remv & replc pm gen dual lead + LV pacing lead add‐on (33228 +

33225)

Level 2 ICD and Similar Procedures (previously APC 108)

Insertion of mulitiple lead defibrillator pulse generator only

(33231)

Insertion of single or dual chamber transvenous ICD system

(33249)Multiple lead ICD change out (33264)

Insertion of subcutaneous ICD system (33270)

CRT‐D system implant (33249 + 33225)

*

5232* $30,771 $30,818

$22,186 $22,917

Symbol notes comprehensive APC

Common Procedural Terminology (CPT) copyright 2014 American Medical Association. All rights reserved.

* ‐$731 ‐3.19%

‐$47 ‐0.15%

5231



of 27 CRV-328302-AA JUL2015

CY2016

Proposed

Payment

CY2015 Final

Payment

$ $ $ %


Hemodialysis PTA

35476Transluminal balloon angioplasty, percutaneous; venous

$1,256 $1,242 $15 1.18%

35475Transluminal balloon angioplasty, percutaneous; brachiocephalic

trunk or branches, each vessel$1,328 $1,317 $11 0.84%

Thrombectomy

36870Thrombectomy, percutaneous, arteriovenous fistula, autogenous or

nonautogenous graft (includes mechanical thrombus extraction and

intra‐graft thrombolysis)

$2,289 $2,220 $69 3.12%

37184

Primary percutaneous transluminal mechanical thrombectomy,

noncoronary, arterial or arterial bypass graft, including fluoroscopic

guidance and intraprocedural pharmacological thrombolytic

injection(s); initial vessel

$2,175 $1,765 $410 23.21%

37187

Percutaneous transluminal mechanical thrombectomy, vein(s),

including intraprocedural pharmacological thrombolytic injections

and fluoroscopic guidance

$2,175 $1,765 $410 23.21%

Trach Bronch Stent

31631Bronchosopy (rigid or flexible); with tracheal dilation and placement

of tracheal stent$1,979 $1,236 $742 60.05%

Biliary Stenting

47556Biliary endoscopy, percutaneous via T‐tube or other tract; with

dilation of biliary duct stricture(s) with stent$2,300 $2,244 $55 2.47%

49421 Insert abdom drain, perm $1,465 $1,254 $211 16.84%

49423 Exchange drainage catheter $669 $706 ($37) ‐5.28%

Table 2: Ambulatory Surgical Center (ASC)

ASC CY2016 Proposed Payment Rates for Select Procedures

Variance 2016 Proposed

vs. 2015 FinalAbbreviated (Partial) DescriptionCPT®



of 27 CRV-328302-AA JUL2015

CY2016

Proposed

Payment

CY2015 Final

Payment

$ $ $ %

Table 2: Ambulatory Surgical Center (ASC)

ASC CY2016 Proposed Payment Rates for Select Procedures

Variance 2016 Proposed

vs. 2015 FinalAbbreviated (Partial) DescriptionCPT®

Rhythm Management

33208 Pacemaker ‐ dual chamber system implant $7,749 $7,853 ($104) ‐1.32%

33213 Pacemaker ‐ dual chamber pulse generator only $7,749 $7,853 ($104) ‐1.32%

33240Insertion of ICD / S‐ICD pulse generator only with existing lead

$19,763 $20,292 ($530) ‐2.61%

33249 ICD system implant $26,935 $27,212 ($277) ‐1.02%

33262Removal with replacement of ICD / S‐ICD pulse generator only with

existing electrode $19,763 $20,292 ($530) ‐2.61%

33270 S-ICD system implant $26,935 $27,212 ($277) ‐1.02%

33249 +

33225

CRT‐D System implant (33249 & 33225 when performed on the

same day)$27,204 $27,212 ($8) ‐0.03%



of 27 CRV-328302-AA JUL2015

2016

Proposed

In‐Facility

Rate

2016

Proposed

In‐Office

Rate$ $ % $ $ %

Interventional Cardiology

Diagnostic Catheterization

93451 26 $151 $0 0.25% $151 $0 0.25%

93451 NA NA NA $805 $7 0.85%

93452 26 $263 ($1) ‐0.33% $263 ($1) ‐0.33%

93452 NA NA NA $907 $5 0.57%

93453 26 $346 ($1) ‐0.34% $346 ($1) ‐0.34%

93453 NA NA NA $1,167 $6 0.49%

93454 26 $266 ($0) ‐0.05% $266 ($0) ‐0.05%

93454 NA NA NA $919 $6 0.65%

93455 26 $307 ($1) ‐0.21% $307 ($1) ‐0.21%

93455 NA NA NA $1,070 $7 0.63%

93456 26 $341 ($2) ‐0.46% $341 ($2) ‐0.46%

93456 NA NA NA $1,151 $8 0.71%

93457 26 $382 ($0) ‐0.08% $382 ($0) ‐0.08%

93457 NA NA NA $1,302 $11 0.88%

93458 26 $325 $1 0.27% $325 $1 0.27%

93458 NA NA NA $1,103 $9 0.79%

93459 26 $366 $1 0.29% $366 $1 0.29%

93459 NA NA NA $1,219 $10 0.82%

93460 26 $408 $0 0.05% $408 $0 0.05%

93460 NA NA NA $1,307 $9 0.68%

93461 26 $450 ($0) ‐0.07% $450 ($0) ‐0.07%

93461 NA NA NA $1,495 $11 0.73%

93462

Left heart catheterization by transseptal puncture through

intact septum or by transapical puncture (List separately in

addition to code for primary procedure)

$218 $2 0.82% $218 $2 0.82%

93463

Pharmacologic agent administration (eg, inhaled nitric oxide,

intravenous infusion of nitroprusside, dobutamine, milrinone,

or other agent) including assessing hemodynamic

measurements before, during, after and repeat pharmacologic

agent administration, when performed (List separately in


$101 $0 0.13% $101 $0 0.13%

93464 26 $90 $0 0.49% $90 $0 0.49%

93464 NA NA NA $281 $2 0.75%

93531 26Combined right heart catheterization and retrograde left heart

cath, for congenital cardiac anomalies$447 ($9) ‐1.89% $447 ($9) ‐1.89%

93532 26

Combined right heart catheterization and transseptal left heart

cath through intact septum with or w/o retrograde left heart

catheterization, for congenital cardiac anomalies

$556 ($8) ‐1.49% $556 ($9) ‐1.56%

93533 26

Combined right heart catheterization and transseptal left heart

cath through existing septal opening, with or w/o retrograde

left heart catheterization, for congenital cardiac anomalies

$370 ($8) ‐2.09% $370 ($8) ‐2.09%

Table 3: Physician Fee Schedule CY2016 Proposed Rule Payment Rates

Proposed 2016 PFS rates compared to Final 2015 rates effective July 1, 2015

CPT®

Modifier

Abbreviated (Partial) Description

Variance 2016

Proposed vs. 2015

Final

Variance 2016

Proposed vs.

2015 Final

Catheter placement in coronary artery(s) for coronary

angiography, including intraprocedural injection(s) for coronary

Right heart catheterization including measurement(s) of oxygen

saturation and cardiac output, when performedLeft heart catheterization including intraprocedural injection(s)

for left ventriculography; imaging supervision and Combined right heart cath and left heart catheterization

including intraprocedural injection(s) for left ventriculography, Catheter placement in coronary artery(s) for coronary

angiography, including intraprocedural injection(s) for coronary Catheter placement in coronary artery(s) for coronary






angiography, including intraprocedural injection(s) for coronary

Physiologic exercise study (eg, bicycle or arm ergometry)

including assessing hemodynamic measurements before and



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CPT®

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Variance 2016

Proposed vs. 2015

Final

Variance 2016

Proposed vs.

2015 Final

Diagnostic Cath Injection

93565

Injection procedure during cardiac catheterization including

imaging supervision and interpretation, and report; for selective

left ventricular or left arterial angiography (List separately in


$48 ($0) ‐1.01% $48 ($0) ‐1.01%

93566


imaging supervision and interpretation, and report; for selective

right ventricular or right atrial angiography (List separately in


$49 $1 1.24% $176 $2 1.11%

93567


imaging supervision and interpretation, and report; for

supravalvular aotography (List separately in addition to code

for primary procedure)

$55 $1 1.15% $146 $1 0.74%

93568


imaging supervision and interpretation, and report; for

pulmonary angiography (List separately in addition to code for

primary procedure)

$50 $1 1.22% $158 $1 0.95%

Angioplasty without Stent

92920Percutaneous transluminal coronary angioplasty; single major

coronary artery or branch$571 $2 0.36% NA NA NA

92921

Percutaneous transluminal coronary angioplasty; each

additional branch of a major coronary artery (list separately in


$0 $0 NA $0 $0 NA

Atherectomy without Stent

92924

Percutaneous transluminal coronary atherectomy, with

coronary angioplasty when performed; single major coronary

artery or branch

$678 $3 0.38% NA NA NA

92925


coronary angioplasty when performed; each additional branch

of a major coronary artery (list separately in addition to code


$0 $0 NA $0 $0 NA

Stent with Angioplasty

92928

Percutaneous transcatheter placement of intracoronary

stent(s), with coronary angioplasty when performed; single

major coronary artery or branch

$634 $3 0.43% NA NA NA

92929

Percutaneous transcatheter placement of intracoronary

stent(s), with coronary angioplasty when performed; each

additional branch of a major coronary artery (list separately in


$0 $0 NA $0 $0 NA



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Proposed vs. 2015

Final

Variance 2016

Proposed vs.

2015 Final

Stent with Atherectomy

92933


intracoronary stent, with coronary angioplasty when

performed; single major coronary artery or branch

$709 $2 0.34% NA NA NA

92934


intracoronary stent, with coronary angioplasty when

performed; each additional branch of a major coronary artery

(list separately in addition to code for primary procedure)

$0 $0 NA $0 $0 NA

Bypass Graft

92937

Percutaneous transluminal revascularization of or through

coronary artery bypass graft (internal mammary, free arterial,

venous), any combination of intracoronary stent, atherectomy

and angioplasty, including distal protection when performed;

single vessel

$634 $3 0.43% NA NA NA

92938

Percutaneous transluminal revascularization of or through

coronary artery bypass graft (internal mammary, free arterial,

venous), any combination of intracoronary stent, atherectomy

and angioplasty, including distal protection when performed;

each additional branch subtended by the bypass graft (list

separately in addition to code for primary procedure)

$0 $0 NA $0 $0 NA

Acute Myocardial Infarction

92941

Percutaneous transluminal revascularization of acute

total/subtotal occlusion during acute myocardial infarction,

coronary artery or coronary artery bypass graft, any

combination of intracoronary stent, atherectomy and

angioplasty, including aspiration thrombectomy when

performed, single vessel

$710 $3 0.39% NA NA NA

Chronic Total Occlusion

92943

Percutaneous transluminal revascularization of chronic total

occlusion, coronary artery, coronary artery branch, or coronary

artery bypass graft, any combination of intracoronary stent,

atherectomy and angioplasty; single vessel

$710 $3 0.49% NA NA NA

92944

Percutaneous transluminal revascularization of chronic total

occlusion, coronary artery, coronary artery branch, or coronary

artery bypass graft, any combination of intracoronary stent,

atherectomy and angioplasty; each additional coronary artery,

coronary artery branch, or bypass graft (list separately in


$0 $0 NA $0 $0 NA



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Proposed vs. 2015

Final

Variance 2016

Proposed vs.

2015 Final

Thrombectomy

92973 Percutaneous transluminal coronary thrombectomy mechanical $186 $1 0.49% NA NA NA

IVUS

92978 26

Intravascular ultrasound (coronary vessel or graft) during

diagnostic evaluation and/or therapeutic intervention including

imaging supervision, interpretation and report; initial vessel (List


$100 ($2) ‐1.64% $100 ($2) ‐1.64%

92979 26

Intravascular ultrasound (coronary vessel or graft) during

diagnostic evaluation and/or therapeutic intervention including

imaging supervision, interpretation and report; each additional

vessel (List separately in addition to code for primary

procedure)

$80 ($1) ‐1.29% $80 ($1) ‐1.29%

FFR

93571 26

Intravascular Doppler velocity and/or pressure derived coronary

flow reserve measurement (coronary vessel or graft) during

coronary angiography including pharmacologically induced

stress; each additional vessel (List separately in addition to code


$100 ($2) ‐1.64% $100 ($2) ‐1.64%

93572 26

Intravascular Doppler velocity and/or pressure derived coronary

flow reserve measurement (coronary vessel or graft) during

coronary angiography including pharmacologically induced

stress; initial vessel (List separately in addition to code for

primary procedure)

$80 ($1) ‐1.29% $80 ($1) ‐1.29%

Valvuloplasty

92986 Percutaneous balloon valvuloplasty; aortic valve $1,394 $6 0.41% NA NA NA

92987 Percutaneous balloon valvuloplasty; mitral valve $1,437 $6 0.41% NA NA NA

92990 Percutaneous balloon valvuloplasty; pulmonary valve $1,135 $2 0.17% NA NA NA

Transcatheter Aortic Valve Replacement

33361Transcatheter aortic valve replacement (tavr/tavi) with

prosthetic valve; percutaneous femoral artery approach$1,428 $7 0.49% NA NA NA


prosthetic valve; open femoral artery approach$1,560 $7 0.44% NA NA NA


prosthetic valve; open axillary artery approach$1,621 ($11) ‐0.66% NA NA NA


prosthetic valve; open iliac artery approach$1,699 $8 0.49% NA NA NA

33365

Transcatheter aortic valve replacement (tavr/tavi) with

prosthetic valve; transaortic approach (e.g., median

sternotomy, mediastinotomy)

$1,871 $9 0.49% NA NA NA



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Proposed vs. 2015

Final

Variance 2016

Proposed vs.

2015 Final

33366Transcatheter aortic valve replacement (TAVR/TAVI) with

prosthetic valve; transapical exposure (eg, left thoracotomy)$2,024 $9 0.44% NA NA NA

33367


prosthetic valve; cardiopulmonary bypass support with

percutaneous peripheral arterial and venous cannulation (e.g.,

femoral vessels) (list separately in addition to code for primary

procedure)

$658 $5 0.77% NA NA NA

33368


prosthetic valve; cardiopulmonary bypass support with open

peripheral arterial and venous cannulation (e.g., femoral, iliac,

axillary vessels) (list separately in addition to code for primary

procedure)

$788 $3 0.44% NA NA NA

33369


prosthetic valve; cardiopulmonary bypass support with central

arterial and venous cannulation (e.g., aorta, right atrium,

pulmonary artery) (list separately in addition to code for

primary procedure)

$1,042 $7 0.70% NA NA NA



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Final

Variance 2016

Proposed vs.

2015 Final


Non‐Coronary Angioplasty

35475Transluminal balloon angioplasty, percutaneous;

brachiocephalic trunk or branches, each vessel$351 ($0) ‐0.13% $1,606 $10 0.63%

35476 Transluminal balloon angioplasty, percutaneous; venous $284 ($0) ‐0.15% $1,473 $14 0.94%

Radiological S&I (Non‐Cor Angioplasty)

75962 26 $27 $1 4.62% $27 $1 4.62%

75962 NA NA NA $144 $4 2.82%

75964 26 $18 $0 2.54% $18 $0 2.54%

75964 NA NA NA $90 $3 3.40%

75966 26 $66 $0 0.49% $66 $0 0.49%

75966 NA NA NA $175 $2 0.91%

75968 26 $18 $0 2.50% $18 $0 2.50%

75968 NA NA NA $89 ($0) ‐0.32%

75978 26 $27 $1 4.62% $27 $1 4.62%

75978 NA NA NA $142 $3 2.32%

Iliac Artery Revascularization

37220Revascularization, endovascular, open or percutaneous, iliac

artery, unilateral, initial vessel; with transluminal angioplasty$439 ($0) 0.00% $3,262 $31 0.95%

37221

Revascularization, endovascular, open or percutaneous, iliac

artery, unilateral, initial vessel; with transluminal stent

placement(s), includes angioplasty within same vessel, when

performed

$541 $1 0.16% $4,808 $43 0.91%

37222


artery, each additional ipsilateral iliac vessel; with transluminal

angioplasty (List separately in addition to code for primary

procedure)

$199 $1 0.31% $916 $9 1.05%

37223


artery, each additional ipsilateral iliac vessel; with transluminal

stent placement(s), includes angioplasty within the same vessel,

when performed (List separately in addition to code for primary

procedure)

$227 $0 0.01% $2,674 $20 0.73%

Femoral/Popliteal Artery Revascularization

37224

Revascularization, endovascular, open or percutaneous,

femoral/popliteal artery(s), unilateral; with transluminal

angioplasty

$484 ($0) ‐0.03% $3,957 $37 0.94%

37225


femoral/popliteal artery(s), unilateral; with atherectomy,

includes angioplasty within same vessel, when performed

$657 $2 0.38% $11,377 $101 0.90%

Transluminal balloon angioplasty, peripheral artery other than

cervical carotid, renal or other visceral artery, iliac or lower Transluminal balloon angioplasty, each additional peripheral

artery other than cervical carotid, renal or other visceral artery, Transluminal balloon angioplasty, renal/visceral artery,

radiological S&ITransluminal balloon angioplasty, renal/visceral, each additional

artery, S&I (List separately in addition to code for primary Transluminal balloon angioplasty, venous (eg, subclavian

stenosis), radiological S&I



of 27 CRV-328302-AA JUL2015

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Proposed vs. 2015

Final

Variance 2016

Proposed vs.

2015 Final

37226


femoral/popliteal artery(s),unilateral;with transluminal stent

placement(s), includes angioplasty within the same vessel,

when performed

$569 $0 0.05% $9,352 $79 0.86%

37227


femoral/popliteal artery(s), unilateral; with transluminal stent

placement(s) and atherectomy, includes angioplasty within the

same vessel, when performed

$789 $2 0.26% $15,365 $138 0.91%


Tibeal / Peroneal Artery Revascularization

37228


tibeal\peroneal artery, unilateral, initial vessel; with

transluminal angioplasty

$591 $0 0.06% $5,623 $48 0.86%

37229



atherectomy, includes angioplasty within the same vessel, when

performed

$765 $1 0.16% $11,208 $84 0.75%

37230



transluminal stent placement(s), includes angioplasty within the

same vessel, when performed

$754 $0 0.06% $8,572 $66 0.78%

37231



transluminal stent placement(s) and atherectomy, includes

angioplasty within the same vessel, when performed

$819 $0 0.05% $13,793 $127 0.93%

37232


tibeal\peroneal artery, unilateral, each additional vessel; with

transluminal angioplasty (List separately in addition to code fore

primary procedure)

$215 $1 0.32% $1,253 $9 0.69%

37233



atherectomy, includes angioplasty within the same vessel, when

performed (List separately in addition to code fore primary

procedure)

$350 $1 0.28% $1,512 $7 0.44%


37234



transluminal stent placement(s), includes angioplasty within the

same vessel, when performed (List separately in addition to

code fore primary procedure)

$301 ($1) ‐0.23% $4,006 $39 0.97%



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Proposed vs. 2015

Final

Variance 2016

Proposed vs.

2015 Final

37235



transluminal stent placement(s) and atherectomy, includes

angioplasty within the same vessel, when performed (List

separately in addition to code fore primary procedure)

$428 $14 3.28% $4,216 ($45) ‐1.05%

37236

Transcatheter placement of an intravascular stent(s) (except

lower extremity, cervical carotid, extracranial vertebral or

intrathoracic carotid, intracranial, or coronary), open or

percutaneous, including radiological supervision and

interpretation and including all angioplasty within the same

vessel, when performed; initial artery

$478 ($1) ‐0.26% $4,246 $4 0.10%

37237

Transcatheter placement of an intravascular stent(s) (except

lower extremity, cervical carotid, extracranial vertebral or

intrathoracic carotid, intracranial, or coronary), open or


interpretation and including all angioplasty within the same

vessel, when performed; each additional artery (List separately

in addition to code for primary procedure)

$226 ($2) ‐0.94% $2,539 ($4) ‐0.16%

37238

Transcatheter placement of an intravascular stent(s), open or


interpretation and including angioplasty within the same vessel,

when performed; initial vein

$331 ($5) ‐1.44% $4,328 $123 2.93%

37239

Transcatheter placement of an intravascular stent(s), open or


interpretation and including angioplasty within the same vessel,

when performed; each additional vein (List separately in


$158 ($1) ‐0.64% $2,096 $21 0.99%

Catheter Access

36140 Introduction of needle or intracatheter; extremity artery $109 $1 0.83% $448 $1 0.17%

36147 Access av dial grft for eval $195 ($0) ‐0.06% $863 $9 1.08%

36148 Access av dial grft for proc $52 ($0) ‐0.21% $270 $2 0.76%

36160 Introduction of needle or intracatheter, aortic, translumbar $130 ($0) ‐0.34% $509 $2 0.42%

36200 Introduction of catheter, aorta $161 ($0) ‐0.18% $643 $4 0.60%

Catheter Placement

36215Selective catheter placement, arterial system; each first order

thoracic or brachiocephalic branch, within a vascular family$247 ($1) ‐0.24% $1,160 $9 0.74%

36216

Selective catheter placement, arterial system; initial second

order thoracic or brachiocephalic branch, within a vascular

family

$291 $4 1.24% $1,240 $42 3.50%



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Proposed vs. 2015

Final

Variance 2016

Proposed vs.

2015 Final

36217

Selective catheter placement, arterial system; initial third order

or more selective thoracic or brachiocephalic branch, within a

vascular family

$347 $6 1.65% $2,073 $136 7.02%

36218

Selective catheter placement, arterial system; additional second

order, third order, and beyond, thoracic or brachiocephalic

branch, within a vascular family (list in addition to code for

initial second or third order vessel as appropriate)

$56 $1 1.80% $199 $10 5.47%

36245

Selective catheter placement, arterial system; each first order

abdominal, pelvic, or lower extremity artery branch, within a

vascular family

$265 $0 0.08% $1,415 $15 1.08%

36246

Selective catheter placement, arterial system; initial second

order abdominal, pelvic, or lower extremity artery branch,

within a vascular family

$282 ($1) ‐0.28% $918 $5 0.53%

36247

Selective catheter placement, arterial system; initial third order

or more selective abdominal, pelvic, or lower extremity artery

branch, within a vascular family

$334 ($1) ‐0.16% $1,626 $13 0.80%

36248

Selective catheter placement, arterial system; additional second

order, third order, and beyond, abdominal, pelvic, or lower

extremity artery branch, within a vascular family (List in

addition to code for initial second or third order vessel as

appropriate

$52 $0 0.49% $158 $1 0.95%

Carotid Artery Stenting

37215Transcatheter placement of intravascular stent(s), cervical

carotid artery, percutaneous; with distal embolic protection$1,059 ($88) ‐7.64% NA NA NA

37216Transcatheter placement of intravascular stent(s), cervical

carotid artery, percutaneous; without distal embolic protection$0 $0 NA $0 $0 NA

Vena Cava Filters

37191

Insertion of inferior vena cava filter, endovascular approach

including vascular access, vessel selection and radiological

supervision and interpretation (including ultrasound) when

performed.

$251 ($0) ‐0.08% $2,718 $24 0.89%

37192

Repositioning of inferior vena cava filter, endovascular

approach including vascular access, vessel selection and

radiological supervision and interpretation (including

ultrasound) when performed.

$386 ($7) ‐1.81% $1,598 ($121) ‐7.03%

37193

Retrieval (removal) of inferior vena cava filter, endovascular

approach including vascular access, vessel selection and

radiological supervision and interpretation (including

ultrasound) when performed.

$385 ($1) ‐0.26% $1,651 $10 0.62%



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Variance 2016

Proposed vs. 2015

Final

Variance 2016

Proposed vs.

2015 Final

Thrombectomy

36870

Thrombectomy, percutaneous, arteriovenous fistula,

autogenous or nonautogenous graft (includes mechanical

thrombus extraction and intra‐graft thrombolysis)

$315 ($0) ‐0.08% $1,892 $17 0.93%

37184


noncoronary, arterial or arterial bypass graft, including

fluoroscopic guidance and intraprocedural pharmacological

thrombolytic injection(s); initial vessel

$485 ($2) ‐0.33% $2,344 $16 0.68%

37185




thrombolytic injection(s); second and all subsequent vessel(s)

within the same vascular family (List separately in addition to

code for primary mechanical thrombectomy procedure

$178 $1 0.49% $746 $10 1.32%

37186

Secondary percutaneous transluminal thrombectomy (eg,

nonprimary mechanical, snare basket, suction technique),



thrombolytic injections, provided in conjunction with another

percutaneous intervention other than primary mechanical

thrombectomy (List separately in addition to code for primary

procedure)

$263 $0 0.08% $1,423 $12 0.82%

37187


including intraprocedural pharmacological thrombolytic

injections and fluoroscopic guidance

$429 ($0) ‐0.10% $2,124 $10 0.49%

37188


including intraprocedural pharmacological thrombolytic

injections and fluoroscopic guidance, repeat treatment on

subsequent day during course of thrombolytic therapy

$309 $0 0.02% $1,835 $31 1.73%

34101Thrombectomy, with or without catheter; axillary, brachial,

innominate, subclavian artery, by arm incision$641 $2 0.26% NA NA NA

34111Thrombectomy, with or without catheter; radial or ulnar artery,

by arm incision$640 $4 0.60% NA NA NA

34201Thrombectomy, with or without catheter; femoral\popliteal,

aortoiliac artery, by leg incision$1,097 $0 0.03% NA NA NA



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Final

Variance 2016

Proposed vs.

2015 Final

34490Thrombectomy, with or without catheter; axillary and

subclavian vein, by arm incision$654 $6 0.99% NA NA NA

Thrombolysis

37211

Transcatheter therapy, arterial infusion for thrombolysis other

than coronary, any method, including radiological supervision

and interpretation, initial treatment day

$420 ($2) ‐0.37% NA NA NA

37212

Transcatheter therapy, venous infusion for thrombolysis, any

method, including radiological supervision and interpretation,

initial treatment day

$370 $0 0.10% NA NA NA

37213

Transcatheter therapy, arterial or venous infusion for

thrombolysis other than coronary, any method, including

radiological supervision and interpretation, continued

treatment on subsequent day during course of thrombolytic

therapy, including follow‐up catheter contrast injection,

position change, or exchange, when performed

$260 ($1) ‐0.20% NA NA NA

37214

Transcatheter therapy, arterial or venous infusion for

thrombolysis other than coronary, any method, including

radiological supervision and interpretation, continued

treatment on subsequent day during course of thrombolytic

therapy, including follow‐up catheter contrast injection,

position change, or exchange, when performed; cessation of

thrombolysis including removal of catheter and vessel closure

by any method

$143 ($0) ‐0.27% NA NA NA

Non‐Coronary IVUS

3725A

Intravascular ultrasound (non‐coronary vessel) during diagnostic

evaluation and/or therapeutic intervention; initial vessel (List


$94 ($19) ‐16.81% $1,440 NA NA

3725B

Intravascular ultrasound (non‐coronary vessel) during diagnostic

evaluation and/or therapeutic intervention; each additional

vessel (List separately in addition to code for primary

procedure)

$75 ($10) ‐11.77% $221 NA NA

Radiological S&I (Non‐Cor IVUS)

75945 26Intravascular ultrasound (peripheral vessel) radiological

supervision and interpretation; initial vessel$21 $0 0.49% $21 $0 0.49%

75946 26each additional non‐coronary vessel (List separately in addition

to code for primary procedure)$20 ($0) ‐1.27% $20 ($0) ‐1.27%

Angiograms

75710 26 $58 $2 4.41% $58 $2 4.41%

75710 NA NA NA $167 $4 2.71%

Angiography, extremity, unilateral, radiological supervision and

interpretation



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Final

Variance 2016

Proposed vs.

2015 Final

75716 26 $66 ($0) ‐0.06% $66 ($0) ‐0.06%

75716 NA NA NA $192 $3 1.64%

75726 26 $57 ($1) ‐1.38% $57 ($1) ‐1.38%

75726 NA NA NA $153 $1 0.49%


75731 26 $59 $1 2.36% $59 $1 2.36%

75731 NA NA NA $177 $4 2.37%

75733 26 $65 ($0) ‐0.07% $65 ($0) ‐0.07%

75733 NA NA NA $188 $3 1.66%

75736 26 $57 ($3) ‐4.96% $57 ($3) ‐4.96%

75736 NA NA NA $164 ($1) ‐0.82%

Bronchoscopy

31631Bronchosopy; with placement of tracheal stent(s) (inludes

tracheal/bronchial dilation as required)$240 ($0) ‐0.11% NA NA NA

Biliary Stenting

47556Biliary endoscopy, percutaneous via T‐Tube or other tract; with

dilation of biliary duct stricture(s) with stent$437 ($2) ‐0.41% NA NA NA

Radiological S&I (Biliary stenting)

74363 26

Percutaneous transhepatic dilation of biliary duct stricture with

or without placement of stent, radiological supervision and

interpretation

$44 ($1) ‐2.70% $44 ($1) ‐2.70%

Transhepatic Shunts (TIPS)

37182

Insertion of transvenous intrahepatic portosystemic shunt(s)

(TIPS) (includes venous access, hepatic and portal vein cath,

portography with hemodynamic evaluation, intrahepatic tract

formation/dilation, stent placement and all associated imaging

and guidance and documentation)

$873 ($5) ‐0.54% NA NA NA

37183

Revision of transvenous intrahepatic portosystemic shunt(s)

(TIPS)(includes venous access, hepatic and portal vein cath,

portography with hemodynamic evaluation, intrahepatic tract

recanulization / dilation, stent placement and all associated

imaging and guidance and documentation)

$413 ($1) ‐0.30% $6,103 $62 1.03%

Embolization

37241

Vascular embolization or occlusion, inclusive of all radiological

supervision and interpretation, intraprocedural roadmapping,

and imaging guidance necessary to complete the intervention;

venous, other than hemorrhage

$475 $9 1.88% $4,934 $238 5.06%

37242




arterial, other than hemorrhage or tumor

$519 ($1) ‐0.13% $7,914 ($2) ‐0.03%

Angiography, pelvic, selective or supraselective, radiological

supervision and interpretation

Angiography, extremity, bilateral, radiological supervision and

interpretationAngiography, visceral, selective or supraselective (with or

without flush aortogram), radiological supervision and

Angiography, adrenal, unilateral, selective, radiological

supervision and interpretationAngiography, adrenal, bilateral, selective, radiological

supervision and interpretation



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Final

Variance 2016

Proposed vs.

2015 Final

37243




for tumors, organ ischemia, or infarction

$612 ($7) ‐1.14% $10,049 $55 0.56%

37244




for arterial or venous hemorrhage or lymphatic extravasation

$717 ($5) ‐0.76% $7,000 $6 0.09%

Drainage

47510Introduction of percutaneous transhepatic catheter for biliary

drainage $489 ($1) ‐0.25% NA NA NA

47511Introduction of percutaneous transhepatic stent for internal and

external biliary drainage $598 ($2) ‐0.29% NA NA NA

47525 Change of percutaneous biliary drainage catheter $88 $0 0.08% $537 $5 0.90%

47530 Revision and/or reinsertion of transhepatic tube $364 ($3) ‐0.79% $1,414 $5 0.34%

49421Insertion of intraperitoneal cannula or catheter for drainage or

dialysis; permanent $241 $1 0.34% NA NA NA

50392Introduction of intracatheter or catheter into renal pelvis for

drainage and/or injection, percutaneous NA NA NA NA NA NA

49423Exchange of previously placed abscess or cyst drainage catheter

under radiological guidance (separate procedure)$75 ($1) ‐0.94% $566 $5 0.81%

75980 26Percutaneous transhepatic biliary drainage with contrast

monitoring, radiological supervision and interpretation$72 ($2) ‐2.91% $72 ($2) ‐2.91%

75982 26

Percutaneous placement of drainage catheter for combined

internal and external biliary drainage or of a drainage stent for

internal biliary drainage in patients with an inoperable

mechanical biliary obstruction, radiological supervision and

interpretation

$72 ($2) ‐2.45% $72 ($2) ‐2.45%

75984 26

Change of percutaneous tube or drainage catheter with

contrast monitoring (eg, genitourinary system, abscess),

radiological supervision and interpretation

$36 ($0) ‐0.51% $36 ($0) ‐0.51%



of 27 CRV-328302-AA JUL2015

2016

Proposed

In‐Facility

Rate

2016

Proposed

In‐Office

Rate$ $ % $ $ %


CPT®

Modifier


Variance 2016

Proposed vs. 2015

Final

Variance 2016

Proposed vs.

2015 Final

Rhythm Management

Device Implant Procedures

33206 Insertion of heart pacemaker and atrial electrode $482 $1 0.26% NA NA NA

33207 Insertion of heart pacemaker and ventricular electrode $514 $2 0.42% NA NA NA

33208 Insertion of heart pacemaker with transvenous electrode $557 $3 0.49% NA NA NA

33212 Insertion of pulse generator only with existing single lead $348 $2 0.49% NA NA NA

33213 Insertion of pulse generator only with existing dual lead $363 $1 0.29% NA NA NA

33221 Insertion of pulse generator only with existing mulitple leads $389 $2 0.58% NA NA NA

33214 Upgrade of pacemaker system $512 $4 0.77% NA NA NA

33215 Reposition pacing‐defib lead $324 $1 0.38% NA NA NA

33216 Insert lead pace‐defib, one $399 $2 0.40% NA NA NA

33217 Insert lead pace‐defib, dual $392 $2 0.49% NA NA NA

33218 Repair of single lead, pacer or ICD $418 $1 0.32% NA NA NA

33220 Repair of 2 leads, pacer or ICD $419 $2 0.40% NA NA NA

33222 Revise/relocate pocket, pacemaker $364 $2 0.69% NA NA NA

33223 Revise pocket, defib $438 $2 0.41% NA NA NA

33225 L ventric pacing lead (add‐on) $489 $2 0.42% NA NA NA

33227 Removal and replacement of pacemaker gen, single lead $366 $1 0.29% NA NA NA

33228 Removal and replacement of pacemaker gen, dual lead $382 $2 0.49% NA NA NA

33229 Removal and replacement of pacemaker gen, multiple lead $402 $4 0.94% NA NA NA

33230 Insert ICD pulse generator with exisitng dual leads $414 $4 1.02% NA NA NA

33231 Insert ICD pulse generator with exisitng multiple leads $431 ($1) ‐0.26% NA NA NA

33233 Removal of pacemaker system gen only $253 $1 0.49% NA NA NA

33234 Removal of pacemaker system lead, single $519 $1 0.28% NA NA NA

33235 Removal pacemaker electrode, dual lead $677 $4 0.60% NA NA NA

33240Insertion of implantable defibrillator pulse generator only; with

existing single lead $394 $2 0.49% NA NA NA

33241 Remove pulse generator only $238 $1 0.34% NA NA NA

33262 Removal and replacement of defib gen, single lead $354 ($45) ‐11.35% NA NA NA

33263 Removal and replacement of defib gen, dual lead $418 $2 0.49% NA NA NA

33264 Removal and replacement of defib gen, multiple lead $435 $2 0.49% NA NA NA

33244 Remove eltrd, transven $909 $4 0.41% NA NA NA

33249 Eltrd/insert pace‐defib $968 $4 0.42% NA NA NA

33270Insertion or replacement of permanent S‐ICD system, with

subcutaneous electrode, including DFT, when performed $618 $5 0.78% NA NA NA

33271 Insertion of S‐ICD electrode $520 $4 0.84% NA NA NA

33272 Removal of S‐ICD electrode $369 ($10) ‐2.75% NA NA NA



of 27 CRV-328302-AA JUL2015

2016

Proposed

In‐Facility

Rate

2016

Proposed

In‐Office

Rate$ $ % $ $ %


CPT®

Modifier


Variance 2016

Proposed vs. 2015

Final

Variance 2016

Proposed vs.

2015 Final

33273 Repositioning of previously implanted S‐ICD electrode $421 $3 0.75% NA NA NA

Device Evaluation

93641 26 Electrophysiology evaluation ‐ICD system $339 ($6) ‐1.81% $339 ($6) ‐1.81%

93260 NA NA NA $69 $1 1.02%

93260 TC NA NA NA $23 $0 0.49%

93260 26 $46 $1 1.29% $46 $1 1.29%

93261 NA NA NA $62 ($0) ‐0.67%

93261 TC NA NA NA $22 ($0) ‐1.11%

93261 26 $39 ($0) ‐0.42% $39 ($0) ‐0.42%

93288 NA NA NA $38 ($1) ‐1.41%

93288 TC NA NA NA $16 ($0) ‐1.74%

93288 26 $22 ($0) ‐1.16% $22 ($0) ‐1.16%

93279 NA NA NA $51 $0 0.49%

93279 TC NA NA NA $18 $0 0.49%

93279 26 $33 $0 0.49% $33 $0 0.49%

93280 NA NA NA $59 ($0) ‐0.12%

93280 TC NA NA NA $20 $0 0.49%

93280 26 $39 ($0) ‐0.43% $39 ($0) ‐0.43%

93281 NA NA NA $69 $0 0.49%

93281 TC NA NA NA $23 $0 0.49%

93281 26 $46 $0 0.49% $46 $0 0.49%

93289 NA NA NA $66 $0 0.49%

93289 TC NA NA NA $20 $0 0.49%

93289 26 $47 $0 0.49% $47 $0 0.49%

93282 NA NA NA $64 ($0) ‐0.07%

93282 TC NA NA NA $21 $0 0.49%

93282 26 $43 ($0) ‐0.34% $43 ($0) ‐0.34%

93283 NA NA NA $83 $0 0.05%

93283 TC NA NA NA $24 $0 0.49%

93283 26 $58 ($0) ‐0.13% $58 ($0) ‐0.13%

93284 NA NA NA $91 $0 0.49%

93284 TC NA NA NA $27 $0 0.49%

93284 26 $64 $0 0.49% $64 $0 0.49%

93291 NA NA NA $37 $1 1.49%

93291 TC NA NA NA $15 $0 0.49%

93291 26 $22 $0 2.16% $22 $0 2.16%

93285 NA NA NA $43 $0 0.49%

93285 TC NA NA NA $16 $0 0.49%

93285 26 $27 $0 0.49% $27 $0 0.49%

93290 NA NA NA $32 $1 1.65%

93290 TC NA NA NA $10 $0 0.49%

93290 26 $22 $0 2.16% $22 $0 2.16%

93292 NA NA NA $33 $0 0.49%

93292 TC NA NA NA $11 $0 0.49%

93292 26 $22 $0 0.49% $22 $0 0.49%

93286 NA NA NA $28 $0 0.49%

93286 TC NA NA NA $12 $0 0.49%

93286 26 $16 $0 0.49% $16 $0 0.49%

ICD Programming eval 2 lead

S‐ICD Programming device evaluation (in person)

S‐ICD Interrogation device evaluation (in person)

PM Interrogation in person all lead configurations

PM Programming eval 1 lead



ICD interrogation in person all lead configurations



ILR Innterrogation in person

ILR Programming eval

ICM Interrogation in person

Wearable defib Interrogation in person

PM Peri‐px eval and programming



of 27 CRV-328302-AA JUL2015

2016

Proposed

In‐Facility

Rate

2016

Proposed

In‐Office

Rate$ $ % $ $ %


CPT®

Modifier


Variance 2016

Proposed vs. 2015

Final

Variance 2016

Proposed vs.

2015 Final

93287 NA NA NA $37 $0 0.49%

93287 TC NA NA NA $13 $0 0.49%

93287 26 $23 $0 0.49% $23 $0 0.49%

93293 NA NA NA $55 $0 0.49%

93293 TC NA NA NA $39 $0 0.49%

93293 26 $16 $0 0.49% $16 $0 0.49%

93228 Wearable defib mobile telemetry w/phy r&I w/report $27 $0 0.49% $27 $0 0.49%

93294 PM Remote Interrogation 90 days all lead config $35 $0 0.49% $35 $0 0.49%

93295 ICD Remote interrogation 90 days all lead config $69 ($0) ‐0.04% $69 ($0) ‐0.04%

93296 PE‐ Remote data aquisition PM or ICD NA NA NA $26 $0 0.49%

93297 ICM Remote interrogation eval 30 days $27 ($0) ‐0.85% $27 ($0) ‐0.85%

93298 ILR Remote interrogation eval 30 days $27 $0 1.83% $27 $0 1.83%

93299 ICM and ILR Remote interr 30 days, tech $0 $0 NA $0 $0 NA

Electrophysiology Procedures

93462 L hrt cath trnsptl puncture $218 $2 0.82% $218 $2 0.82%

93609 26

Intraventricular and/or intra‐atrial mapping of tachycardia

site(s) with catheter manipulation to record from multiple sites

to identify origin of tachycardia (add on)

$288 ($5) ‐1.73% $288 ($5) ‐1.73%

93613 Intracardiac electrophysiologic 3‐dimensional mapping (add on) $415 $2 0.58% NA NA NA

93619 26

Comprehensive electrophysiologic evaluation with right atrial

pacing and recording, right ventricular pacing and recording, HIS

bundle recording, including insertion and repositioning of

multiple electrode catheters, without induction or attempted

induction of arrhythmia

$420 ($7) ‐1.54% $420 ($7) ‐1.54%

93620 26

Comprehensive electrophysiologic evaluation including

insertion and repositioning of multiple electrode catheters with

induction or attempted induction of arrhythmia; with right atrial

pacing and recording, right ventricular pacing and recording, His

bundle recording

$667 ($11) ‐1.64% $667 ($11) ‐1.69%

93621 26with left atrial pacing and recording from coronary sinus or left

atrium (add on)$122 ($2) ‐1.55% $122 ($2) ‐1.55%

93622 26 with left ventricular pacing and recording (add on) $178 ($2) ‐1.11% $178 ($2) ‐1.11%

93623 26Programmed stimulation and pacing after intravenous drug

infusion (add on)$165 ($3) ‐1.87% $165 ($3) ‐1.87%

93644 EP Evaluation of S‐ICD NA NA NA $285 ($20) ‐6.50%

93650

Intracardiac catheter ablation of atrioventricular node function,

atrioventricular conduction for creation of complete heart

block, with or without temporary pacemaker placement

$630 $3 0.43% NA NA NA

ICD Peri‐px eval and programming

TTM rhythm strip pacemaker eval



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2016

Proposed

In‐Facility

Rate

2016

Proposed

In‐Office

Rate$ $ % $ $ %


CPT®

Modifier


Variance 2016

Proposed vs. 2015

Final

Variance 2016

Proposed vs.

2015 Final

93653


insertion and repositioning of multiple electrode catheters with

induction or attempted induction of an arrhythmia with right

atrial pacing and recording, right ventricular pacing and

recording, HIS recording, with intracardiac catheter ablation of

arrhythmogenic focus; with treatment of supraventiricular

tachycardia by ablation of fast or slow atrioventricular

pathyway, accessory atrioventricular connection, cavo‐tricuspid

isthmus or other single atrial focus or source of atrial re‐entry.

$886 $3 0.37% NA NA NA

93654

with treatment of ventricular tachycardia or focus of ventricular

ectopy including intracardiac electrophysiologic 3D mapping,

when performed, and left ventricular pacing and recording,

when performed

$1,181 $6 0.52% NA NA NA

93655

Intracardiac catheter ablation of a descrete mechanism of

arrhythmia which is distinct from the primary ablated

mechanism, including repeat diagnostic maneuvers, to treat a

spontaneous or induced arrhythmia (add on)

$443 $2 0.49% NA NA NA

93656


transseptal catheterizations, insertion and repositioning of

multiple electrode catheters with induction or attempted

induction of an arrhythmia with atrial recording and pacing,

when possible, right ventricular pacing and recording, HIS

bundle recording with intracardiac catheter ablation of

arrhytmogenic focus, with treatment of atrial fibrillation by

ablation by pulmonary vein isolation

$1,182 $2 0.15% NA NA NA

93657

Additional linear or focal intracardiac catheter ablation of the

left or right atrium for treatment of atrial fibrillation remaining

after completion of pulmonary vein isolation (add on)

$443 $3 0.57% NA NA NA

93662 26

Intracardiac echocardiography during therapeutic/diagnostic

intervention, including imaging supervision and interpretation

(add on)

$146 ($3) ‐1.69% $146 ($3) ‐1.69%

BSC currently has no FDA‐approved ablation catheters for the treatment of atrial fibrillation

CPT Copyright 2014 American Medical Association. All rights reserved. CPT is a registered trademark of the American Medical Association. Applicable FARS/DFARS

Restrictions Apply to Government Use. Fee schedules, relative value units, conversion factors, and/or related components are not assigned by the AMA, are not

part of CPT®, and the AMA is not recommending their use. The AMA does not directly or indirectly practice medicine or dispense medical services. The AMA

assumes no liability for data contained or not contained herein.

• Please note: this coding information may include some codes for procedures for which Boston Scientific currently offers no cleared or approved products. In those

instances, such codes have been included solely in the interest of providing users with comprehensive coding information and are not intended to promote the use

of any Boston Scientific products for which they are not cleared or approved.

• National average final base payment amounts. Specific payment rates may change due to geographic wage differences.

• Payer policies will vary and should be verified prior to treatment for limitations on diagnosis, coding or site of service requirements. The coding options listed

within this guide are commonly used codes and are not intended to be an all‐inclusive list. We recommend consulting your relevant manuals for appropriate coding

options.



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