health economics policy & payment reimbursement … · 2019-12-05 · 10891775doc rev 1a fy19...
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10891775DOC Rev 1AFY19 HEPP C APV Reimbursement Update Short Standard
HEALTH ECONOMICS POLICY & PAYMENTREIMBURSEMENT UPDATE
JANUARY, 2019
Aortic, Peripheral, Venous and Coronary – Renal Denervation
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REIMBURSEMENT 101
WHAT’S NEW
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INTRODUCTION
10891775DOC Rev 1AFY19 HEPP C APV Reimbursement Update Short Standard
NOVEMBER ‘18
The purpose of this interactive dashboard is to providereimbursement updates and information related to Medtronic’sAortic, Peripheral, Venous and Coronary-Renal Denervationproducts.
Please note that this document doesn’t include an exhaustive listof all related codes.
For further information please see the links to the Inpatient,Outpatient and ASC rules as well as the Physician Fee Schedulein the bibliography section: here.
Alternatively, please contact the Health Economics Policy andPayment Team at:
www.medtronic.com/cvreimbursement
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REIMBURSEMENT UPDATEINTRODUCTIONINTRODUCTION
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Reimbursement information is gathered from the CMS web site and ispresented for illustrative purposes only. This information cannotguarantee coverage or reimbursement, and does not constitutereimbursement or legal advice. We strongly recommend that you workwith a qualified consultant or attorney to determine the billing practicesfor your office.
Every effort has been made to ensure that the information provided inthis document is accurate. Reimbursement information changesperiodically. Service providers should make sure that they are reviewingthe most recent update to this document and the most recentreimbursement guidance from their payers. As a result, Medtronic canmake no representation or warranty regarding this information or itscompleteness, accuracy, timeliness, or applicability with respect to anyparticular patient or third party payer. Medtronic may not carry productsused in all procedures listed.
Service providers are responsible for their decisions relating to coding andreimbursement submissions. This document reflects payment estimatesonly and is not a guarantee of payment.
AMA CPT ® Copyright Statement: CPT ® codes and descriptions arecopyright 2018 American Medical Association or such other date ofpublication of CPT ®. All Rights Reserved.
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THERAPIES SERVICES TOOLS CASE REVIEWS
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CORONARY-RDN AORTIC PERIPHERAL VENOUS
Drug Eluting Stents
Bare Metal Stents
Balloons
Renal Denervation (RDN)
Abdominal Aortic
Thoracic Aortic
Ancillary
Drug-Coated Balloon
Atherectomy
Stent
Balloons
Embolic Protection
RF Ablation
Non-Thermal
Embolization
ECONOMIC VALUE & VALUE BASED HEALTHCARE INITIATIVES
U.S. REIMBURSEMENT TRAINING & EDUCATION
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REIMBURSEMENTUPDATES
In-Person & Webinars Medicare coding, coverage and compensation information Coding and payment scenarios Specific coding guidelines for procedures Relevant updates for upcoming payment and policy changes
CASE ANALYSES
Case reviews for Medtronic product-related procedures Documentation and coding Payment reconciliation & appeals reviews
ANALYTICS
Hospital & Physician Benchmarking tools to compare your facility with national data. Facility comparison tools
REIMBURSEMENTCONTACT INFO
Coronary, Aortic, and Peripheral: (877) 347-9662
Venous:(866) 260-3987
Email: [email protected]
Website: www.medtronic.com/cvreimbursement
CODING RESOURCES
Coding guides Charge sheets Therapy worksheets Coverage Policy Matrix
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All tools can be found at our website at: http://www.medtronic.com/us-en/healthcare-professionals/products/cardiovascular/coding-coverage-reimbursement.html
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CODING SHEETS
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PURPOSE:
• Reconcile physician documentation with hospital charges, coding and payment
• Improve documentation, charge capture and coding
• Reduce rework and physician documentation queries
*Total of 10 de-identified cases 2-3 months prior to review date related to Coronary, Aortic, Peripheral, or Venous
PHYSICIAN OP NOTES
Indications Procedure Summary Procedure Details
Findings/Results Impressions
HOSPITAL CASE REPORT & CHARGE SHEET
Payer type Procedure Charges Supplies used & device coding Detailed case log
Moderate sedation time Angiograms Interventions
HOSPITAL/PHYSICIAN STANDARDIZED BILL
Setting of care Diagnosis codes Procedure codes Supply coding & charges
REMITTANCE NOTICE
Payer type Payment amount Payment adjustment reasons
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TOOLS
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PHYSICIAN Documentation:Who? MDs involved
Why? Indications
What? Procedures performed & findings
How? Procedure details
CATH LAB TECH/ RN Document procedure details Capture all equipment/supply charges and procedure charges
CATH LAB CODER/ ANALYST
Update Charge Sheets Link Procedure Code to Charges Review charges with MD documentation to confirm correct charges and coding
HEALTH INFORMATION MANAGEMENT/ CODERS
Confirm MD documentation with hospital coding Identify and clarify coding edits Applies appropriate procedure modifiers and submits bills
REVENUE INTEGRITY Review remittance and reconcile charges with payments Appeal inappropriate adjustments and denials
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KEY STAKEHOLDERS
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COMPONENTSCODESSETTINGSCOVERAGETIMELINEFUTURE
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COMPONENTS CODES SETTINGS COVERAGE TIMELINE FUTURE
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CODING COVERAGE PAYMENT
ICD-10
HCPCS-CPT®
POS
NCDs (National Coverage Determinations)
LCDs (Local Coverage Determinations)
MS-DRGs (Medicare Severity-Diagnosis Related Group)
APCs(Ambulatory Payment Classifications)
ASCs(Ambulatory Surgical Center)
MPFS(Medicare Physician Fee Schedule)
Why was it done?
What was done?
Where was it done?
Will it be paid for? Who pays?
How much?
DOCUMENTATION IS KEY!
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Provider Setting Diagnosis Procedure
Physicians Facility/Office ICD-10-CM CPT®
Hospitals Outpatient ICD-10-CM CPT®
ASCs Outpatient ICD-10-CM CPT®
Hospitals Inpatient ICD-10-CM ICD-10-PCS
Physicians, hospitals and all other providers must use ICD-10 diagnosis codes.
Hospitals must also use ICD-10-PCS procedure codes for inpatient cases.
Implementation of ICD-10 does not affect use of CPT® codes.
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FACILITY / TECHNICAL FEES PROFESSIONAL FEES
HOSPITAL INPATIENTMS-DRGs HIPPSEffective Oct 1st
HOSPITAL OUTPATIENTAPCs HOPPS
Effective Jan 1st
AMBULATORY SURGERY CENTER (ASC)ASC Fee Schedule
Effective Jan 1st
PHYSICIAN PROFESSIONAL FEESMedicare Physician Fee Schedule
Facility Fee ScheduleResource Based Relative Value System (RBRVS)
Effective Jan 1st
OFFICE BASED LAB (OBL)Medicare Physician Fee Schedule
Non-Facility Fee Schedule – RBRVS Effective Jan 1st
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CODES
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Source: https://www.cms.gov/Medicare/Medicare-Contracting/Medicare-Administrative-Contractors/Who-are-the-MACs.html#MapsandLists
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CY 2019 OPPS, ASC & MPFS updates in effect Q1 HCPCS updates
January 2019 Q2 HCPCS updates FY 2020 Proposed IPPS
April 2019 Q3 HCPCS updates Proposed FY 2020
OPPS/ASC & MPFS
July 2019
Submit final comments for OPPS, ASC & MPFS
September 2019 Final FY 2020 IPPS
August 2019
MDT 2020 Medicare RBT Update Webinars
December 2019 CY 2020 OPPS, ASC &
MPFS updates in effect Q1 HCPCS updates
January 2020
Q4 HCPCS updates FY 2020 IPPS in effect
October 2019
CY 2020 Final OPPS, ASC & MPFS
November 2019
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CODES SETTINGS COVERAGE
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CMSCenters for Medicare & Medicaid Services
MACRAMedicare Access and CHIP Reauthorization Act of 2015
APMAlternative Payment Models
QPPQuality Payment Program
MIPSMerit-based Incentive Payment System
• Medicare Part A
• Inpatient
• Medicare Part B
• Outpatient
• Professional services
• Eliminates SGR
• Amends Quality Reporting Programs
• Creates 2 new quality-based payment systems
• EHR used by at least 50% of clinicians
• Payments based on quality measure and include at least one outcome measure
• Accepts financial risk of 8% of Medicare revenues; or 3% of expected expenditure
• Submit up to 6 quality measures for minimum of 90 days
• Submit quality measures for (>90 days)
• Submit 15 quality measures for full CY 2017
• 2017 – 271 total quality measures
• 2018 – 275 total quality measures
• 3 Vascular Surgery specialty quality measures related to aortic aneurysms
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CODES SETTINGS COVERAGE
ACRONYMS
TIMELINE
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Note: Medtronic doesn’t offer products with approved indications for all procedures listed.
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CORONARY PERIPHERAL AORTIC VENOUS
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WHAT’S NEW
Diagnostic Caths
11 Diagnostic Cardiac Cath codes (93451-
93461) will be reimbursed in the ASC setting of
care January 2019.
PCIs
Medicare only pays for PCIs in the hospital Inpatient
and Outpatient setting of care
Hospital outpatient payment reductions due to
hospital reported costs and volumes based on 2017
claims
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Lower Extremity
No change to DCB payment assignments and
the four-level structure for Endovascular
Procedures. SFA DCB alone procedures (37224
+ C2623) will remain assigned to C-APC 5192
and the CY2019 National Medicare outpatient
payment will be $4,679
CMS acknowledged the stakeholder comments
and states the following:
“…we do share similar concerns with the
commenters regarding the significant
differential payments between the
procedures assigned within the current four-
level structure of the Endovascular
Procedures APCs and intend to revisit this
particular issue in future rulemaking.”
AVF Maintenance
Reassignment of diagnostic angiography of the
dialysis circuit procedure (36901) to a higher valued
Level 2 Vascular procedure
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CORONARY AORTIC VENOUSPERIPHERAL
Abdominal & Thoracic
All the abdominal and thoracic aortic procedures remain
on the inpatient only list (Addendum E) and will be only
paid as inpatient procedures for CY2019.
Endoanchor Code
+34712 - Transcatheter delivery of enhanced fixation
device(s) to the endograft (e.g, anchor, screw, tack) and
all associated radiological supervision and interpretation
Percutaneous access Code
+34713 - Percutaneous access and closure of femoral
artery for delivery of endograft through a large sheath
(12 French or larger), including ultrasound guidance,
when performed, unilateral
Bundled EVAR CPT® Codes
Reminder of the 2018 bundling for EVAR
procedures:
34701 Aorto-aortic tube endograft
34702 Aorto-aortic tube endograft rupture
34703 Aorto-uniiliac endograft
34704 Aorto-uniiliac endograft rupture
34705 Aorto-biiliac endograft
34706 Aorto-biiliac endograft rupture
34707 Ilio-iliac tube endograft
34708 Ilio-iliac tube endograft rupture
34709 Placement of extension prosthesis
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CORONARY VENOUSPERIPHERAL AORTIC
Superficial
In the Outpatient setting, Level 3 (RF Ablation) &
4 (Cyanoacrylate) Vascular Procedure payments
remain stable with a slight increase.
Embolization
Hospital outpatient payment reductions due to
hospital reported costs and volumes based on 2017
claims
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Note: Medtronic doesn’t offer products with approved indications for all procedures listed.
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AAA REPAIR (EVAR) - FY 2019 FINAL PAYMENTS Continued on the next page
MS -DRG
Description FY 2018 Weight
FY 2018Medicare National Payment
FY 2019 Weight
FY 2019Medicare National Payment
Payment Impact (% change from FY18)
268 Aortic & Heart Assist Procedures (except Pulsation Balloon) w/ MCC
6.5268 $39,334 6.7037 $40,929 4.1%
269 Aortic & Heart Assist Procedures (except Pulsation Balloon) w/o MCC
4.1556 $25,044 4.1509 $25,343 1.2%
Average Payment $27,635 $28,183 2.0%
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MS -DRG
Description FY 2018 Weight
FY 2018Medicare National Payment
FY 2019 Weight
FY 2019Medicare National Payment
Payment Impact (% change from FY18)
219 Cardiac Valve & Oth Major Cardiothoracic Proc w/o Cardiac Cath w/ MCC
7.6075 $45,846 7.6916 $46,961 2.4%
220 Cardiac Valve & Oth Major Cardiothoracic Proc w/o Cardiac Cath w/ CC
5.1403 $30,978 5.2053 $31,781 2.6%
221 Cardiac Valve & Oth Major Cardiothoracic Proc w/o Cardiac Cath w/o CC/MCC
4.5838 $27,624 4.6074 $28,130 1.8%
Average Payment $36,938 $38,162 3.3%
TAA REPAIR (TEVAR) - FY 2019 FINAL PAYMENTS
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Medtronic’s aortic products are only covered in an inpatient setting so there will be no outpatient or ASC
payments listed.
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Medtronic’s aortic products are only covered in an inpatient setting so there will be no outpatient or ASC
payments listed.
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OUTPATIENT
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2019 NATIONAL PAYMENT RATES Continued on the next page
CPT® CPT® Description CY 2019 Non-Facility CY 2019 Facility
Total RVUs
Payment % Payment Change
Total RVUs
Payment % Payment Change
33880 Endovasc taa repr incl subcl N/A N/A N/A 52.01 $1,874 -0.2%
33881 Endovasc taa repr w/o subcl N/A N/A N/A 44.64 $1,609 -0.3%
33883 Insert endovasc prosth taa N/A N/A N/A 32.32 $1,165 -0.5%
33884 Endovasc prosth taa add-on N/A N/A N/A 11.41 $411 -5.4%
33886 Endovasc prosth delayed N/A N/A N/A 27.70 $998 -1.7%
33889 Artery transpose/endovas taa N/A N/A N/A 22.85 $823 -0.8%
33891 Car-car bp grft/endovas taa N/A N/A N/A 27.71 $999 -1.1%
34701 Evasc rpr a-ao ndgft N/A N/A N/A 35.85 $1,292 0.5%
34702 Evasc rpr a-ao ndgft rpt N/A N/A N/A 53.54 $1,930 0.4%
34703 Evasc rpr a-unilac ndgft N/A N/A N/A 40.36 $1,455 0.4%
34704 Evasc rpr a-unilac ndgft rpt N/A N/A N/A 67.26 $2,424 0.6%
34705 Evac rpr a-biiliac ndgft N/A N/A N/A 44.39 $1,600 0.2%
34706 Evasc rpr a-biiliac rpt N/A N/A N/A 66.88 $2,410 0.3%
34707 Evasc rpr ilio-iliac ndgft N/A N/A N/A 33.44 $1,205 0.5%
34708 Evasc rpr ilio-iliac rpt N/A N/A N/A 53.68 $1,935 0.2%
34709 Plmt xtn prosth evasc rpr N/A N/A N/A 9.38 $338 0.1%
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2019 NATIONAL RVUs Continued on the next page
AORTIC
CPT® CPT® Description CY 2019 Non-Facility CY 2019 Facility
Work RVUs
PE RVUs MP RVUs Work RVUs
PE RVUs MP RVUs
33880 Endovasc taa repr incl subcl N/A N/A N/A 34.58 9.65 7.78
33881 Endovasc taa repr w/o subcl N/A N/A N/A 29.58 8.39 6.67
33883 Insert endovasc prosth taa N/A N/A N/A 21.09 6.57 4.66
33884 Endovasc prosth taa add-on N/A N/A N/A 8.20 1.34 1.87
33886 Endovasc prosth delayed N/A N/A N/A 18.09 5.62 3.99
33889 Artery transpose/endovas taa N/A N/A N/A 15.92 3.31 3.62
33891 Car-car bp grft/endovas taa N/A N/A N/A 20.00 3.28 4.43
34701 Evasc rpr a-ao ndgft N/A N/A N/A 23.71 6.88 5.26
34702 Evasc rpr a-ao ndgft rpt N/A N/A N/A 36.00 9.80 7.74
34703 Evasc rpr a-unilac ndgft N/A N/A N/A 26.52 7.54 6.30
34704 Evasc rpr a-unilac ndgft rpt N/A N/A N/A 45.00 11.84 10.42
34705 Evac rpr a-biiliac ndgft N/A N/A N/A 29.58 8.21 6.60
34706 Evasc rpr a-biiliac rpt N/A N/A N/A 45.00 11.83 10.05
34707 Evasc rpr ilio-iliac ndgft N/A N/A N/A 22.28 6.35 4.81
34708 Evasc rpr ilio-iliac rpt N/A N/A N/A 36.50 9.59 7.59
34709 Plmt xtn prosth evasc rpr N/A N/A N/A 6.50 1.43 1.45
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2019 NATIONAL PAYMENT RATES Continued on the next page
CPT® CPT® Description CY 2019 Non-Facility CY 2019 Facility
Total RVUs
Payment % Payment Change
Total RVUs
Payment % Payment Change
34710 Dlyd plmt xtn prosth 1st vsl N/A N/A N/A 23.24 $838 0.1%
34711 Dlyd plmt xtn prosth ea addl N/A N/A N/A 8.66 $312 0.1%
34712 Tcat dlvr enhncd fixj dev N/A N/A N/A 19.85 $715 0.0%
34713 Perq access & clsr fem art N/A N/A N/A 3.73 $134 -0.2%
34714 Opn fem art expos cndt crtj N/A N/A N/A 7.84 $283 0.0%
34808 Endovas iliac a device addon N/A N/A N/A 6.11 $220 0.9%
34812 Opn fem art expos N/A N/A N/A 6.00 $216 -0.2%
34813 Femoral endovas graft add-on N/A N/A N/A 6.85 $247 -0.3%
34820 Opn iliac art expos N/A N/A N/A 10.09 $364 -1.6%
34830 Open aortic tube prosth repr N/A N/A N/A 50.80 $1,831 -0.6%
34831 Open aortoiliac prosth repr N/A N/A N/A 55.99 $2,018 -0.1%
34832 Open aortofemor prosth repr N/A N/A N/A 53.96 $1,945 -1.8%
34833 Opn ilac art expos cndt crtj N/A N/A N/A 11.72 $422 -0.4%
34834 Opn brach art expos N/A N/A N/A 3.75 $135 -0.9%
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2019 NATIONAL RVUs Continued on the next page
CPT® CPT® Description CY 2019 Non-Facility CY 2019 Facility
Work RVUs
PE RVUs MP RVUs Work RVUs
PE RVUs MP RVUs
34710 Dlyd plmt xtn prosth 1st vsl N/A N/A N/A 15.00 4.98 3.26
34711 Dlyd plmt xtn prosth ea addl N/A N/A N/A 6.00 1.32 1.34
34712 Tcat dlvr enhncd fixj dev N/A N/A N/A 12.00 5.42 2.43
34713 Perq access & clsr fem art N/A N/A N/A 2.50 0.72 0.51
34714 Opn fem art expos cndt crtj N/A N/A N/A 5.25 1.54 1.05
34808 Endovas iliac a device addon N/A N/A N/A 4.12 0.97 1.02
34812 Opn fem art expos N/A N/A N/A 4.13 0.92 0.95
34813 Femoral endovas graft add-on N/A N/A N/A 4.79 0.96 1.10
34820 Opn iliac art expos N/A N/A N/A 7.00 1.51 1.58
34830 Open aortic tube prosth repr N/A N/A N/A 35.23 7.53 8.04
34831 Open aortoiliac prosth repr N/A N/A N/A 37.98 9.44 8.57
34832 Open aortofemor prosth repr N/A N/A N/A 37.98 7.97 8.01
34833 Opn ilac art expos cndt crtj N/A N/A N/A 8.16 1.70 1.86
34834 Opn brach art expos N/A N/A N/A 2.65 0.50 0.60
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2019 NATIONAL PAYMENT RATES Continued on the next page
CPT® CPT® Description CY 2019 Non-Facility CY 2019 Facility
Total RVUs
Payment % Payment Change
Total RVUs
Payment % Payment Change
35226 Repair blood vessel lesion N/A N/A N/A 24.15 $870 -0.3%
35371 Rechanneling of artery N/A N/A N/A 23.70 $854 -0.4%
36200 Place catheter in aorta 16.23 $585 2.2% 4.05 $146 -0.1%
36215 Place catheter in artery 29.40 $1,060 2.8% 6.16 $222 -0.2%
36216 Place catheter in artery 31.68 $1,142 2.1% 7.93 $286 -0.1%
36217 Place catheter in artery 53.12 $1,914 0.8% 9.51 $343 0.3%
36245 Ins cath abd/l-ext art 1st 37.43 $1,349 0.9% 6.89 $248 -0.5%
37235 Tib/per revasc stnt & ather 119.07 $4,291 2.3% 11.68 $421 0.1%
37236 Open/perq place stent 1st 101.62 $3,662 -6.7% 12.94 $466 -0.4%
37242 Vasc embolize/occlude artery
211.50 $7,622 2.0% 13.86 $500 -0.5%
37252 Intrvasc us noncoronary 1st 35.78 $1,289 -7.8% 2.65 $96 -0.3%
75956-26 Xray endovasc thor ao repr 9.82 $354 -0.4% 9.82 $354 -0.4%
75957-26 Xray endovasc thor ao repr 8.43 $304 -0.2% 8.43 $304 -0.2%
75958-26 Xray place prox ext thor ao 5.60 $202 -0.4% 5.60 $202 -0.4%
75959-26 Xray place dist ext thor ao 4.88 $176 -1.1% 4.88 $176 -1.1%
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2019 NATIONAL RVUs
CPT® CPT® Description CY 2019 Non-Facility CY 2019 Facility
Work RVUs
PE RVUs MP RVUs Work RVUs
PE RVUs MP RVUs
35226 Repair blood vessel lesion N/A N/A N/A 15.30 5.35 3.50
35371 Rechanneling of artery N/A N/A N/A 15.31 4.87 3.52
36200 Place catheter in aorta 2.77 12.87 0.59 2.77 0.69 0.59
36215 Place catheter in artery 4.17 24.64 0.59 4.17 1.40 0.59
36216 Place catheter in artery 5.27 25.43 0.98 5.27 1.68 0.98
36217 Place catheter in artery 6.29 45.62 1.21 6.29 2.01 1.21
36245 Ins cath abd/l-ext art 1st 4.65 32.01 0.77 4.65 1.47 0.77
37235 Tib/per revasc stnt & ather 7.80 109.64 1.63 7.80 2.25 1.63
37236 Open/perq place stent 1st 8.75 91.10 1.77 8.75 2.42 1.77
37242 Vasc embolize/occlude artery
9.80 200.36 1.34 9.80 2.72 1.34
37252 Intrvasc us noncoronary 1st 1.80 33.60 0.38 1.80 0.47 0.38
75956-26 Xray endovasc thor ao repr 7.00 1.56 1.26 7.00 1.56 1.26
75957-26 Xray endovasc thor ao repr 6.00 1.33 1.10 6.00 1.33 1.10
75958-26 Xray place prox ext thor ao 4.00 0.89 0.71 4.00 0.89 0.71
75959-26 Xray place dist ext thor ao 3.50 0.77 0.61 3.50 0.77 0.61
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Medtronic’s aortic products are only covered in an inpatient setting and therefore no comparisons have
been shown.
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HCPCS (C-Code) HCPCS Code Description
C1887 Catheter, guiding (may include infusion/perfusion capability)
AORTIC
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Note: Medtronic doesn’t offer products with approved indications for all procedures listed.
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PERIPHERAL - FY 2019 FINAL PAYMENTS Continued on the next page
MS -DRG
Description FY 2018 Weight
FY 2018Medicare National Payment
FY 2019 Weight
FY 2019Medicare National Payment
Payment Impact (% change from FY18)
252 Other Vascular Procedures w/ MCC
3.2334 $19,486 3.2598 $19,903 2.1%
253 Other Vascular Procedures w/ CC
2.5350 $15,277 2.5943 $15,839 3.7%
254 Other Vascular Procedures w/o CC/MCC
1.8127 $10,924 1.8100 $11,051 1.2%
Average Payment $16,429 $16,889 2.8%
NOTE: Average payment is a weighted average based upon historical volumes
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CAROTID ARTERY STENTING - FY 2019 FINAL PAYMENTS
MS -DRG
Description FY 2018 Weight
FY 2018Medicare National Payment
FY 2019 Weight
FY 2019Medicare National Payment
Payment Impact (% change from FY18)
034 Carotid Artery Stent w/ MCC 3.9918 $24,057 3.5998 $21,979 -8.6%
035 Carotid Artery Stent w/ CC 2.2278 $13,426 2.2203 $13,556 1.0%
036 Carotid Artery Stent w/o CC/MCC
1.7636 $10,628 1.7260 $10,538 -0.8%
Average Payment $13,154 $12,984 -1.3%
NOTE: Average payment is a weighted average based upon historical volumes
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C-APCs CY 2019 National Payments % Change
5192 Level II Endovascular procedures (Cor & Per PTAs)
$4,679 -8.0%
5193 Level III Endovascular procedures (Cor & Per interventions)
$9,669 -8.0%
5194 Level IV Endovascular procedures (Complex Cor & Per interventions)
$15,355 -4.1%
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CLICK HERE FOR HCPCS CODES PAYABLE UNDER THE 2019 OPPS APCS 5192-5194
2019 PERIPHERAL OUTPATIENT PAYMENTS Continued on the next page
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APC 5192 - Level 2 Endovascular Procedures
HCPCS Short Descriptor HCPCS Short Descriptor0338T Trnscth renal symp denrv u 37220 Iliac revasc0339T Trnscth renal symp denrv b 37224 Fem/popl revas w/tla36902 Intro cath dialysis circui 37246 Trluml balo angiop 1st art36904 Thrmbc/nfs dialysis circui 37248 Trluml balo angiop 1st vei37183 Remove hepatic shunt (tips 92920 Prq cardiac angioplast 1 a37184 Prim art m-thrmbc 1st vsl 92986 Revision of aortic valve37187 Venous mech thrombectomy
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Source: Addendum C - CY2019 NFRM Addendum C.1101201 LINK
APC 5193 - Level 3 Endovascular Procedures
HCPCS Short Descriptor HCPCS Short Descriptor0234T Trluml perip athrc renal a 37244 Vasc embolize/occlude blee0236T Trluml perip athrc abd aor 61623 Endovasc tempory vessel oc0237T Trluml perip athrc brchioc 61626 Transcath occlusion non-cn0505T Ev fempop artl revsc 92924 Prq card angio/athrect 1 a36903 Intro cath dialysis circui 92928 Prq card stent w/angio 1 v36905 Thrmbc/nfs dialysis circui 92937 Prq revasc byp graft 1 vsl37221 Iliac revasc w/stent 92943 Prq card revasc chronic 1v37225 Fem/popl revas w/ather 92987 Revision of mitral valve37226 Fem/popl revasc w/stent 92990 Revision of pulmonary valv37228 Tib/per revasc w/tla 92997 Pul art balloon repr percu37236 Open/perq place stent 1st C9600 Perc drug-el cor stent sing37238 Open/perq place stent same C9604 Perc d-e cor revasc t cabg37241 Vasc embolize/occlude veno C9754 Perc av fistula, direct37242 Vasc embolize/occlude arte C9755 Rf magnetic-guide av fistul37243 Vasc embolize/occlude orga
PROCEDURES THAT MAP TO EACH OF THE APCS Continued on the next page
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PROCEDURES THAT MAP TO EACH OF THE APCS
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Source: Addendum C - CY2019 NFRM Addendum C.1101201 LINK
APC 5194 - Level 4 Endovascular Procedures
HCPCS Short Descriptor HCPCS Short Descriptor0238T Trluml perip athrc iliac a 93580 Transcath closure of asd33274 Tcat insj/rpl perm ldls pm 93581 Transcath closure of vsd36906 Thrmbc/nfs dialysis circui 93582 Perq transcath closure pda37227 Fem/popl revasc stnt & ath 93590 Perq transcath cls mitral37229 Tib/per revasc w/ather 93591 Perq transcath cls aortic37230 Tib/per revasc w/stent C9602 Perc d-e cor stent ather s37231 Tib/per revasc stent & ath C9607 Perc d-e cor revasc chro si92933 Prq card stent/ath/angio
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CPT® Code CPT® Description CY 2019Payments
% Change
37220 Iliac revasc $2,002 -20.7%
37221 Iliac revasc w/stent $5,834 -8.9%
37224 Fem/popl revas w/tla $2,887 14.3%
37225 Fem/popl revas w/ather $6,411 -8.7%
37226 Fem/popl revasc w/stent $6,223 -7.8%
37227 Fem/popl revasc stnt & ather $10,354 -4.7%
37228 Tib/per revasc w/tla $5,484 22.4%
37229 Tib/per revasc w/ather $9,787 -4.3%
37230 Tib/per revasc w/stent $9,604 -5.9%
37231 Tib/per revasc stent & ather $9,851 -4.1%
37232 Tib/per revasc PTA add-on N/A N/A
37233 Tib/per revasc ather add-on N/A N/A
37234 Tib/per revasc stent N/A N/A
37235 Tib/per revasc stent + ather N/A N/A
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CPT® Code CPT® Description CY 2019Payments
% Change
37236 Open/perq place stent 1st $5,741 28.1%
37238 Open/perq place stent same $5,873 -9.9%
37241 Vasc embolize/occlude venous $4,056 -9.1%
37242 Vasc embolize/occlude artery $5,787 29.2%
37243 Vasc embolize/occlude organ $4,056 -9.5%
37246 Trluml balo angiop 1st art $2,002 -20.7%
37248 Trluml balo angiop 1st vein $2,002 -20.7%
37252 Intravasc ultrasound noncor 1st vessel N/A N/A
37253 Intravasc ultrasound noncor addtl vessel N/A N/A
93668 Peripheral vascular rehab N/A N/A
0238T Trluml perip athrc iliac art $6,582 -36.2%
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2019 PERIPHERAL NATIONAL PAYMENTS - AV FISTULA MAINTENANCE
CPT® Code CPT® Description CY 2019Payments
% Change
36901 Intro cath dialysis circuit $523 63.7%
36902 Intro cath dialysis circuit $2,002 -20.7%
36903 Intro cath dialysis circuit $6,002 33.9%
36904 Thrmbc/nfs dialysis circuit $2,663 5.5%
36905 Thrmbc/nfs dialysis circuit $4,056 -9.5%
36906 Thrmbc/nfs dialysis circuit $9,724 40.4%
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2019 NATIONAL PAYMENT RATES Continued on the next page
CPT® CPT® Description CY 2019 Non-Facility CY 2019 Facility
Total RVUs
Payment % Payment Change
Total RVUs
Payment % Payment Change
37220 Iliac revasc PTA 83.76 $3,019 -3.3% 11.68 $421 -0.2%
37221 Iliac revasc w/stent 118.87 $4,284 -7.5% 14.43 $520 -0.1%
37224 Fem/pop revasc PTA 100.68 $3,628 -4.3% 12.94 $466 -0.1%
37225 Fem/pop revasc w/ather 345.28 $12,444 11.8% 17.61 $635 -0.3%
37226 Fem/pop revasc w/stent 299.48 $10,793 18.6% 15.18 $547 -0.3%
37227 Fem/po revasc w/ stent + ather
444.89 $16,033 6.5% 21.17 $763 -0.3%
37228 Tib/per revasc PTA 145.94 $5,260 -3.0% 15.81 $570 -0.3%
37229 Tib/per revasc w/ ather 345.48 $12,451 13.4% 20.56 $741 -0.2%
37230 Tib/per revasc w/ stent 294.13 $10,600 26.4% 20.39 $735 0.0%
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CPT® CPT® Description CY 2019 Non-Facility CY 2019 Facility
Work RVUs
PE RVUs MP RVUs Work RVUs
PE RVUs MP RVUs
37220 Iliac revasc PTA 7.90 74.16 1.70 7.90 2.08 1.70
37221 Iliac revasc w/stent 9.75 107.03 2.09 9.75 2.59 2.09
37224 Fem/pop revasc PTA 8.75 90.10 1.83 8.75 2.36 1.83
37225 Fem/pop revasc w/ather 11.75 331.00 2.53 11.75 3.33 2.53
37226 Fem/pop revasc w/stent 10.24 287.04 2.20 10.24 2.74 2.20
37227 Fem/po revasc w/ stent + ather
14.25 427.60 3.04 14.25 3.88 3.04
37228 Tib/per revasc PTA 10.75 132.93 2.26 10.75 2.80 2.26
37229 Tib/per revasc w/ ather 13.80 328.78 2.90 13.80 3.86 2.90
37230 Tib/per revasc w/ stent 13.55 277.65 2.93 13.55 3.91 2.93
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Total RVUs
Payment % Payment Change
Total RVUs
Payment % Payment Change
37231 Tib/per revasc stent + ather
422.60 $15,230 11.9% 22.16 $799 0.1%
37232 Tib/per revasc PTA add-on
31.13 $1,122 -7.3% 5.85 $211 -0.6%
37233 Tib/per revasc ather add-on
37.93 $1,367 -6.7% 9.53 $343 -0.6%
37234 Tib/per revasc stent 109.75 $3,955 -0.3% 8.32 $300 0.0%
37235 Tib/per revasc stent + ather
119.07 $4,291 2.3% 11.68 $421 0.1%
37252 Intravasc ultrasound noncor 1st vessel
35.78 $1,289 -7.8% 2.65 $96 -0.3%
37253 Intravasc ultrasound noncor addtl vessel
5.60 $202 -4.3% 2.13 $77 -0.4%
93668 Peripheral vascular rehab 0.50 $18 -9.0% N/A N/A N/ACORONARY
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CPT® CPT® Description CY 2019 Non-Facility CY 2019 Facility
Work RVUs
PE RVUs MP RVUs Work RVUs
PE RVUs MP RVUs
37231 Tib/per revasc stent + ather
14.75 404.75 3.10 14.75 4.31 3.10
37232 Tib/per revasc PTA add-on
4.00 26.33 0.80 4.00 1.05 0.80
37233 Tib/per revasc ather add-on
6.50 30.10 1.33 6.50 1.70 1.33
37234 Tib/per revasc stent 5.50 103.06 1.19 5.50 1.63 1.19
37235 Tib/per revasc stent + ather
7.80 109.64 1.63 7.80 2.25 1.63
37252 Intravasc ultrasound noncor 1st vessel
1.80 33.60 0.38 1.80 0.47 0.38
37253 Intravasc ultrasound noncor addtl vessel
1.44 3.85 0.31 1.44 0.38 0.31
93668 Peripheral vascular rehab 0.00 0.47 0.03 N/A N/A N/A
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CPT® CPT® Description CY 2019 Non-Facility CY 2019 Facility
Total RVUs
Payment % Payment Change
Total RVUs
Payment % Payment Change
36901 Intro Cath Dialysis Circuit(Diagnostics)
18.33 $661 8.1% 4.88 $176 -0.3%
36902 Intro Cath Dialysis Circuit(PTA)
36.09 $1,301 2.2% 6.98 $252 0.1%
36903 Intro Cath Dialysis Circuit(Stent)
152.20 $5,485 -4.2% 9.23 $333 0.0%
36904 Thrmbc/NFS Dialysis Circuit
53.11 $1,914 3.5% 10.77 $388 0.0%
36905 Thrmbc/NFS Dialysis Circuit
66.80 $2,407 2.7% 12.91 $465 -0.1%
36906 Thrmbc/NFS Dialysis Circuit
186.56 $6,723 -3.2% 14.90 $537 -0.2%
36907 Balo Angiop Ctr Dialysis Seg
20.43 $736 -4.4% 4.26 $154 -0.4%
36908 Stent Plmt Ctr Dialysis Seg
68.02 $2,451 -11.3% 6.03 $217 -1.0%
36909 Dialysis Circuit Embolj 54.98 $1,981 -1.3% 5.84 $210 -3.2%
PERIPHERAL
2019 NATIONAL PAYMENT RATES – AV FISTULA MAINTENANCE Continued on the next page
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CPT® CPT® Description CY 2019 Non-Facility CY 2019 Facility
Work RVUs
PE RVUs MP RVUs Work RVUs
PE RVUs MP RVUs
36901 Intro Cath Dialysis Circuit(Diagnostics)
3.36 14.50 0.47 3.36 1.05 0.47
36902 Intro Cath Dialysis Circuit(PTA)
4.83 30.59 0.67 4.83 1.48 0.67
36903 Intro Cath Dialysis Circuit(Stent)
6.39 144.86 0.95 6.39 1.89 0.95
36904 Thrmbc/NFS Dialysis Circuit
7.50 44.57 1.04 7.50 2.23 1.04
36905 Thrmbc/NFS Dialysis Circuit
9.00 56.58 1.22 9.00 2.69 1.22
36906 Thrmbc/NFS Dialysis Circuit
10.42 174.72 1.42 10.42 3.06 1.42
36907 Balo Angiop Ctr Dialysis Seg
3.00 17.01 0.42 3.00 0.84 0.42
36908 Stent Plmt Ctr Dialysis Seg
4.25 63.14 0.63 4.25 1.15 0.63
36909 Dialysis Circuit Embolj 4.12 50.25 0.61 4.12 1.11 0.61
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CPT® Physician Office Based Lab (Non-Facility MPFS- POS - 11) (Tech. only)
AmbulatorySurgery Ctr (ASCs - POS - 24)
Hospital Outpt(C-APCs – POS - 22)
Hospital Inpt(MS-DRGs –POS - 21)
37220 – Iliac PTA $2,598 (-3.8%) $2,002 (-20.7%) $4,679 (-8.0%)
$19,903 +2.1%(252)
$15,839 +3.7%(253)
$11,051 +1.2% (254)
37221 – Iliac Stent $3,764 (-8.4%) $5,834 (-8.9%) $9,669 (-8.0%)
37222-Iliac PTA add-on $621 (-8.9%) $0 $0
37223-Iliac Stent add-on $2,033 (-14.2%) $0 $0
37224 – Fem/pop PTA $3,162 (-4.9%) $2,887 (14.3%) $4,679 (-8.0%)
37225-Fem/pop Atherectomy
$11,809 (12.5%) $6,411 (-8.7%) $9,669 (-8.0%)
37226-Fem/pop Stent $10,246 (19.8%) $6,223 (-7.8%) $9,669 (-8.0%)
37227-Fem/pop Stent & Atherectomy
$15,270 (6.8%) $10,354 (-4.7%) $15,355 (-4.1%)
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CPT® Physician Office Based Lab (Non-Facility MPFS- POS - 11) (Tech. only)
AmbulatorySurgery Ctr (ASCs - POS - 24)
Hospital Outpt(C-APCs – POS - 22)
Hospital Inpt(MS-DRGs –POS - 21)
37228-Tib/per PTA $4,690 (-3.4%) $5,484 (22.4%) $9,669 (-8.0%)
$19,903 +2.1%(252)
$15,839 +3.7%(253)
$11,051 +1.2% (254)
37229-Tib/per Ather $11,710 (14.4%) $9,787 (-4.3%) $15,355 (-4.1%)
37232-Tib/per PTA add-on
$911 (-8.7%) N/A N/A
37233-Tib/per Atheradd-on
$1,024 (-8.5%) N/A N/A
37234-Tib/per Stent add-on
$3,655 (-0.4%) N/A N/A
37235-Tib/per Stent & Atherectomy add-on
$3,870 (2.6%) N/A N/A
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HCPCS (C-Code) HCPCS Code Description
C1714 Catheter transluminal atherectomy, directional
C1725 Catheter, transluminal angioplasty, non-laser (may include infusion/perfusion capability)
C1751 Catheter, infusion, inserted peripherally, centrally or midline (other than hemodialysis)
C1769 Guide wire
C1773 Retrieval device, insertable
C1876 Stent, non-coated/non-covered, w/ delivery system
C1884 Embolizaton protective system
C1887 Catheter, guiding (may include infusion/perfusion capability)
C1894 Introducer
C2623 Catheter, transluminal angioplasty, drug-coated, non-laser
PERIPHERAL
COMPARISON
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Note: Medtronic doesn’t offer products with approved indications for all procedures listed.
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Medtronic’s Venous products are rarely performed in an inpatient setting (unless due to certain co-
morbidities) and therefore do not have a MS-DRG list display
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NOTE: For a full list of what CPT® codes map to each APC see Addendum C. - HCPCS Codes Payable Under the 2019 OPPS by APC (LINK)
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2019 VENOUS NATIONAL OUTPATIENT PAYMENTS
C-APCs CY 2019 National Payments
% Change
5183 Level III Vascular procedures $2,642 6.0%
5184 Level IV Vascular procedures $4,377 2.6%
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CPT® Code CPT® Description CY 2019 Payments % Change
36465 Njx noncmpnd sclrsnt 1 vein $798 -2.4%
36466 Njx noncmpnd sclrsnt mlt vn $798 -2.4%
36470 Njx sclrsnt 1 incmptnt vein $77 1.1%
36471 Njx sclrsnt mlt incmptnt vn $134 2.3%
36473 Endovenous mchnchem 1st vein $1,305 0.5%
36474 Endovenous mchnchem add-on $0 -
36475 Endovenous rf 1st vein $1,305 0.5%
36476 Endovenous rf vein add-on $0 -
36478 Endovenous laser 1st vein $1,305 0.5%
36479 Endovenous laser, subsequent vein; add-on $0 -
36482 Endoven ther chem adhes 1st $2,247 1.1%
36483 Endoven ther chem adhes sbsq $0 -
37765 Stab phleb veins xtr 10-20 $333 -1.0%
37766 Phleb veins - extrem 20+ $375 -1.1%
2019 VENOUS NATIONAL PAYMENTS
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ASC
CPT® CPT® Description CY 2019 Non-Facility CY 2019 Facility
Total RVUs
Payment % Payment Change
Total RVUs
Payment % Payment Change
36465 Njx concmpnd sclrsnt 1 vein 43.64 $1,573 -3.2% 3.45 $124 -0.2%
36466 Njx noncmpnd sclrsnt mult vein 45.87 $1,653 -2.6% 4.39 $158 -0.1%
36470 Njx sclrsnt 1 incmptnt vein 3.02 $109 0.8% 1.11 $40 0.1%
36471 Njx sclrsnt mlt incmptnt vn 5.47 $197 1.6% 2.21 $80 0.1%
36473 Endovenous mechanochemical, 1st vein
41.4 $1,492 -3.2% 5.15 $186 0.5%
36474 Endovenous mechanochemical, mechanochemical 2nd/ subsequent veins; add-on
7.87 $284 0.1% 2.57 $93 0.1%
36475 Endovenous ablation incomplete vein, 1st vein
40.6 $1,463 -5.6% 8.11 $292 -0.3%
36476 Endovenous ablation incomplete vein RF 2nd/subsequent veins; add on
8.55 $308 2.4% 3.93 $142 -0.4%
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CPT® CPT® Description CY 2019 Non-Facility CY 2019 Facility
Work RVUs
PE RVUs MP RVUs Work RVUs
PE RVUs MP RVUs
36465 Njx concmpnd sclrsnt 1 vein 2.35 40.82 0.47 2.35 0.63 0.47
36466 Njx noncmpnd sclrsnt mult vein 3.00 42.27 0.60 3.00 0.79 0.60
36470 Njx sclrsnt 1 incmptnt vein 0.75 2.13 0.14 0.75 0.22 0.14
36471 Njx sclrsnt mlt incmptnt vn 1.50 3.71 0.26 1.50 0.45 0.26
36473 Endovenous mechanochemical, 1st vein
3.50 37.21 0.69 3.50 0.96 0.69
36474 Endovenous mechanochemical, mechanochemical 2nd/ subsequent veins; add-on
1.75 5.76 0.36 1.75 0.46 0.36
36475 Endovenous ablation incomplete vein, 1st vein
5.30 34.22 1.08 5.30 1.73 1.08
36476 Endovenous ablation incomplete vein RF 2nd/subsequent veins; add on
2.65 5.35 0.55 2.65 0.73 0.55
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ASC
CPT® CPT® Description CY 2019 Non-Facility CY 2019 Facility
Total RVUs
Payment % Payment Change
Total RVUs
Payment % Payment Change
36478 Endovenous laser, 1st vein 32.10 $1,157 -6.4% 8.06 $290 -0.1%
36479 Endovenous laser, subsequent vein; add-on
9.03 $325 2.4% 3.95 $142 -0.1%
36482 Endovenous ther chem adhes 1st vein
57.99 $2,090 -3.3% 5.12 $185 -0.1%
36483 Endovenous ther chem adhessbsq vein
4.26 $154 4.5% 2.57 $93 0.5%
37765 Stab phleb veins xtr 10-20 18.52 $667 -0.4% 12.96 $467 -0.2%
37766 Phleb veins - extrem 20+ 22.01 $793 -0.5% 15.82 $570 -0.4%
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CPT® CPT® Description CY 2019 Non-Facility CY 2019 Facility
Work RVUs
PE RVUs MP RVUs Work RVUs
PE RVUs MP RVUs
36478 Endovenous laser, 1st vein 5.30 25.8 1.00 5.30 1.76 1.00
36479 Endovenous laser, subsequent vein; add-on
2.65 5.87 0.51 2.65 0.79 0.51
36482 Endovenous ther chem adhes 1st vein
3.50 53.79 0.70 3.50 0.92 0.70
36483 Endovenous ther chem adhessbsq vein
1.75 2.16 0.35 1.75 0.47 0.35
37765 Stab phleb veins xtr 10-20 7.71 9.24 1.57 7.71 3.68 1.57
37766 Phleb veins - extrem 20+ 9.66 10.4 1.95 9.66 4.21 1.95
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ASC
CPT® CPT® Description CY 2019 Non-Facility CY 2019 Facility
Total RVUs
Payment % Payment Change
Total RVUs
Payment % Payment Change
37241 Vasc embolize/occlude venous
137.34 $4,950 2.5% 12.86 $463 -0.3%
37242 Vasc embolize/occlude artery 211.50 $7,622 2.0% 13.86 $500 -0.5%
37243 Vasc embolize/occlude organ 273.62 $9,861 -0.4% 16.33 $589 -0.2%
37244 Vasc embolize/occlude bleed 195.67 $7,052 2.2% 19.31 $696 -0.2%
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CPT® CPT® Description CY 2019 Non-Facility CY 2019 Facility
Work RVUs
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PE RVUs MP RVUs
37241 Vasc embolize/occlude venous
8.75 127.12 1.47 8.75 2.64 1.47
37242 Vasc embolize/occlude artery 9.80 200.36 1.34 9.80 2.72 1.34
37243 Vasc embolize/occlude organ 11.74 260.86 1.02 11.74 3.57 1.02
37244 Vasc embolize/occlude bleed 13.75 180.66 1.26 13.75 4.30 1.26
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CPT® Physician Office Based Lab (Non-Facility MPFS-POS - 11) (Tech. only)
AmbulatorySurgery Ctr (ASCs - POS - 24)
Hospital Outpt(C-APCs – POS -22)
36465 - Njx concmpnd sclrsnt 1 vein $1,448 -3% $798 -2.4% $1,549 -1.2%
36466 - Njx noncmpnd sclrsnt mult vein $1,495 -3% $798 -2.4% $1,549 -1.2%
36470 - Njx sclrsnt 1 incmptnt vein $69 1% $77 1.1% $314 1.1%
36471 - Njx sclrsnt mlt incmptnt vn $117 3% $134 2.3% $314 1.1%
36473 - Endovenous mechanochemical, 1st vein $1,306 -4% $1,305 0.5% $2,642 6.0%
36474 - Endovenous mechanochemical, mechanochemical 2nd/ subsequent veins; add-on
$191 0% $0 - $0 -
36475 - Endovenous ablation incomplete vein, 1st vein
$1,171 -7% $1,305 0.5% $2,642 6.0%
36476 - Endovenous ablation incomplete vein RF 2nd/subsequent veins; add on
$167 5% $0 - $0 -
36478 - Endovenous laser, 1st vein $866 -8% $1,305 0.5% $2,642 6.0%
36479 - Endovenous laser, subsequent vein; add-on $183 4% $0 - $0 -
36482 - Endovenous therapy chem adhes 1st vein $1,905 -4% $2,247 1.1% $4,377 2.6%
36483 - Endovenous therapy chem adhes sbsq vein $61 11% $0 - $0 -
37765 - Stab phleb veins xtr 10-20 $200 -1% $333 -1.0% $2,642 6.0%
37766 - Phleb veins - extrem 20+ $223 -1% $375 -1.1% $2,642 6.0%
*POS = Place of Service code
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HCPCS (C-Code) HCPCS Code Description
C1888 Endovascular non-cardiac ablative catheter
C1894 Introducer/sheath, non-laser
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DRUG ELUTING STENTS – FY 2019 FINAL PAYMENTS Continued on the next page
MS -DRG
Description FY 2018 Weight
FY 2018Medicare National Payment
FY 2019 Weight
FY 2019Medicare National Payment
Payment Impact (% change from FY18)
246 Perc Cardiovascular Proc with DES w/MCC or 4+ vessels/stents
3.2103 $19,347 3.2388 $19,774 2.2%
247 Perc Cardiovascular Proc with DES w/o MCC
2.1156 $12,750 2.0771 $12,682 -0.5%
Average Payment $14,757 $15,119 2.5%
NOTE: Average payment is a weighted average based upon historical volumes
NOTE: Coronary AMI (CPT® 92941), that previously tracked to 5194, is an inpatient only procedure
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BARE METAL STENTS – FY 2019 FINAL PAYMENTS Continued on the next page
MS -DRG
Description FY 2018 Weight
FY 2018Medicare National Payment
FY 2019 Weight
FY 2019Medicare National Payment
Payment Impact (% change from FY18)
248 Perc Cardiovascular Proc w/non-DES w/MCC or 4+ vessels/stents
3.0476 $18,366 3.1726 $19,370 5.5%
249 Perc Cardiovascular Proc w/non-DES w/o MCC
1.9567 $11,792 1.9901 $12,151 3.0%
Average Payment $14,308 $15,124 5.7%
NOTE: Average payment is a weighted average based upon historical volumes
NOTE: Coronary AMI (CPT® 92941), that previously tracked to 5194, is an inpatient only procedure
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MS -DRG
Description FY 2018 Weight
FY 2018Medicare National Payment
FY 2019 Weight
FY 2019Medicare National Payment
Payment Impact (% change from FY18)
250 Perc Cardiovascular Proc w/o Coronary Artery Stent w/MCC
2.5059 $15,102 2.5868 $15,794 4.6%
251 Perc Cardiovascular Proc w/o Coronary Artery Stent w/o MCC
1.6627 $10,020 1.6778 $10,244 2.2%
Average Payment $11,946 $12,461 4.3%
PERCUTANEOUS TRANSLUMINAL CORONARY ANGIOPLASTY – FY 2019 FINAL PAYMENTS
NOTE: Average payment is a weighted average based upon historical volumes
NOTE: Coronary AMI (CPT® 92941), that previously tracked to 5194, is an inpatient only procedure
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C-APCs CY 2019 National Payments
% Change
5191 Level I Endovascular procedures (Dx cardiac caths)
$2,810 -0.1%
5192 Level II Endovascular procedures (Cor & Per PTAs)
$4,679 -8.0%
5193 Level III Endovascular procedures (Cor & Per interventions)
$9,669 -8.0%
5194 Level IV Endovascular procedures (Complex Cor & Per interventions)
$15,355 -4.2%
CLICK HERE FOR HCPCS CODES PAYABLE UNDER THE 2019 OPPS APCS 5191-5194
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CHANGES FROM PAY FOR VOLUME TO PAY FOR VALUE Continued on the next page
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APC 5192 - Level 2 Endovascular Procedures
HCPCS Short Descriptor HCPCS Short Descriptor0338T Trnscth renal symp denrv u 37220 Iliac revasc0339T Trnscth renal symp denrv b 37224 Fem/popl revas w/tla36902 Intro cath dialysis circui 37246 Trluml balo angiop 1st art36904 Thrmbc/nfs dialysis circui 37248 Trluml balo angiop 1st vei37183 Remove hepatic shunt (tips 92920 Prq cardiac angioplast 1 a37184 Prim art m-thrmbc 1st vsl 92986 Revision of aortic valve37187 Venous mech thrombectomy
APC 5191 – Level 1 Endovascular Procedures
HCPCS Short Descriptor HCPCS Short Descriptor93451 Right heart cath 93459 L hrt art/grft angio93452 Left hrt cath w/ventrclgrp 93460 R&l hrt art/ventricle angi93453 R&l hrt cath w/ventriclgrp 93461 R&l hrt art/ventricle angi93454 Coronary artery angio s&i 93530 Rt heart cath congenital93455 Coronary art/grft angio s& 93531 R & l heart cath congenita93456 R hrt coronary artery angi 93532 R & l heart cath congenita93457 R hrt art/grft angio 93533 R & l heart cath congenita93458 L hrt artery/ventricle ang
Source: Addendum C - CY2019 NFRM Addendum C.1101201 LINK
PROCEDURES THAT MAP TO EACH OF THE APCS Continued on the next page
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APC 5194 - Level 4 Endovascular ProceduresHCPCS Short Descriptor HCPCS Short Descriptor0238T Trluml perip athrc iliac a 93580 Transcath closure of asd33274 Tcat insj/rpl perm ldls pm 93581 Transcath closure of vsd36906 Thrmbc/nfs dialysis circui 93582 Perq transcath closure pda37227 Fem/popl revasc stnt & ath 93590 Perq transcath cls mitral37229 Tib/per revasc w/ather 93591 Perq transcath cls aortic37230 Tib/per revasc w/stent C9602 Perc d-e cor stent ather s37231 Tib/per revasc stent & ath C9607 Perc d-e cor revasc chro si92933 Prq card stent/ath/angio
APC 5193 - Level 3 Endovascular ProceduresHCPCS Short Descriptor HCPCS Short Descriptor0234T Trluml perip athrc renal a 37244 Vasc embolize/occlude blee0236T Trluml perip athrc abd aor 61623 Endovasc tempory vessel oc0237T Trluml perip athrc brchioc 61626 Transcath occlusion non-cn0505T Ev fempop artl revsc 92924 Prq card angio/athrect 1 a36903 Intro cath dialysis circui 92928 Prq card stent w/angio 1 v36905 Thrmbc/nfs dialysis circui 92937 Prq revasc byp graft 1 vsl37221 Iliac revasc w/stent 92943 Prq card revasc chronic 1v37225 Fem/popl revas w/ather 92987 Revision of mitral valve37226 Fem/popl revasc w/stent 92990 Revision of pulmonary valv37228 Tib/per revasc w/tla 92997 Pul art balloon repr percu37236 Open/perq place stent 1st C9600 Perc drug-el cor stent sing37238 Open/perq place stent same C9604 Perc d-e cor revasc t cabg37241 Vasc embolize/occlude veno C9754 Perc av fistula, direct37242 Vasc embolize/occlude arte C9755 Rf magnetic-guide av fistul37243 Vasc embolize/occlude orga
Source: Addendum C - CY2019 NFRM Addendum C.1101201 LINK
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In the 2019 ASC payment model, the following Coronary codes will now be paid:
CPT® Code CPT® Description CY 2019Payments
% Change
93451 Right heart cath $1,359 N/A
93452 Left hrt cath w/ventrclgrphy $1,359 N/A
93453 R&l hrt cath w/ventriclgrphy $1,359 N/A
93454 Coronary artery angio s&i $1,359 N/A
93455 Coronary art/grft angio s&i $1,359 N/A
93456 R hrt coronary artery angio $1,359 N/A
93457 R hrt art/grft angio $1,359 N/A
93458 L hrt artery/ventricle angio $1,359 N/A
93459 L hrt art/grft angio $1,359 N/A
93460 R&l hrt art/ventricle angio $1,359 N/A
93461 R&l hrt art/ventricle angio $1,359 N/A
CORONARY
CORONARY ASC 2019 NATIONAL PAYMENTS
CORONARY
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CPT® CPT® Description CY 2019 Non-Facility CY 2019 Facility
Total RVUs
Payment % Payment Change
Total RVUs
Payment % Payment Change
92920 Prq cardiac angioplast 1 art N/A N/A N/A 15.49 $558 0.2%
92921 Prq cardiac angio addl art 0.00 $0 N/A 0.00 $0 N/A
92924 Prq card angio/ athrect 1 art N/A N/A N/A 18.48 $666 0.3%
92925 Prq card angio/ athrect addl 0.00 $0 N/A 0.00 $0 N/A
92928 Prq card stent w/ angio 1 art N/A N/A N/A 17.24 $621 0.3%
92929 Prq card stent w/ angio addl 0.00 $0 N/A 0.00 $0 N/A
92933 Prq card stent/ ath/ angio N/A N/A N/A 19.34 $697 0.4%
92934 Prq card stent/ ath/ angio 0.00 $0 N/A 0.00 $0 N/A
92937 Prq revasc byp graft 1 vsl N/A N/A N/A 17.23 $621 0.3%
92938 Prq revasc byp graft 1 addl 0.00 $0 N/A 0.00 $0 N/A
92941 Prq card revasc mi 1 vsl N/A N/A N/A 19.39 $699 0.4%
92943 Prq card chronic 1vsl N/A N/A N/A 19.38 $698 0.4%
92944 Prq card chronic addl 0.00 $0 N/A 0.00 $0 N/A
2019 NATIONAL PAYMENT RATES Continued on the next page
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CPT® CPT® Description CY 2018 Non-Facility CY 2018 Facility
Work RVUs
PE RVUs MP RVUs Work RVUs
PE RVUs MP RVUs
92920 Prq cardiac angioplast 1 art N/A N/A N/A 9.85 3.39 2.25
92921 Prq cardiac angio addl art 0.00 0.00 0.00 0.00 0.00 0.00
92924 Prq card angio/ athrect 1 art N/A N/A N/A 11.74 4.02 2.72
92925 Prq card angio/ athrect addl 0.00 0.00 0.00 0.00 0.00 0.00
92928 Prq card stent w/ angio 1 art N/A N/A N/A 10.96 3.76 2.52
92929 Prq card stent w/ angio addl 0.00 0.00 0.00 0.00 0.00 0.00
92933 Prq card stent/ ath/ angio N/A N/A N/A 12.29 4.21 2.84
92934 Prq card stent/ ath/ angio 0.00 0.00 0.00 0.00 0.00 0.00
92937 Prq revasc byp graft 1 vsl N/A N/A N/A 10.95 3.75 2.53
92938 Prq revasc byp graft 1 addl 0.00 0.00 0.00 0.00 0.00 0.00
92941 Prq card revasc mi 1 vsl N/A N/A N/A 12.31 4.23 2.85
92943 Prq card chronic 1vsl N/A N/A N/A 12.31 4.23 2.84
92944 Prq card chronic addl 0.00 0.00 0.00 0.00 0.00 0.00CORONARY
2019 NATIONAL RVUs Continued on the next page
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CPT® CPT® Description CY 2019 Non-Facility CY 2019 Facility
Total RVUs
Payment % Payment Change
Total RVUs
Payment % Payment Change
92978 Endoluminal imaging of coronary vessel or graft using intravascular ultrasound (IVUS) or optical coherence tomography (OCT)
0.00 $0 - N/A N/A N/A
92978-TC 0.00 $0 - N/A N/A N/A
92978-26 2.79 $101 0.8% 2.79 $101 0.8%
92979 Endoluminal IVUS oct c each addtl vessel
0.00 $0 - N/A N/A N/A
92979-TC 0.00 $0 - N/A N/A N/A
92979-26 2.22 $80 -0.3% 2.22 $80 -0.3%
93454 Coronary artery angio s&i 24.85 $896 4.2% N/A N/A N/A
93454-TC 17.84 $643 5.8% N/A N/A N/A
93454-26 7.01 $253 0.4% 7.01 $253 0.4%
93458 L hrt artery/ ventricle angio 29.50 $1,063 2.6% N/A N/A N/A
93458-TC 20.85 $751 3.6% N/A N/A N/A
93458-26 8.65 $312 0.2% 8.65 $312 0.2%
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CPT® CPT® Description CY 2019 Non-Facility CY 2019 Facility
Work RVUs
PE RVUs MP RVUs Work RVUs
PE RVUs MP RVUs
92978 Endoluminal imaging of coronary vessel or graft using intravascular ultrasound (IVUS) or optical coherence tomography (OCT)
0.00 0.00 0.00 N/A N/A N/A
92978-TC 0.00 0.00 0.00 N/A N/A N/A
92978-26 1.80 0.63 0.36 1.80 0.63 0.36
92979 Endoluminal IVUS oct c each addtl vessel
0.00 0.00 0.00 N/A N/A N/A
92979-TC 0.00 0.00 0.00 N/A N/A N/A
92979-26 1.44 0.50 0.28 1.44 0.50 0.28
93454 Coronary artery angio s&i 4.54 19.38 0.93 N/A N/A N/A
93454-TC 0.00 17.81 0.03 N/A N/A N/A
93454-26 4.54 1.57 0.90 4.54 1.57 0.90
93458 L hrt artery/ ventricle angio 5.60 22.74 1.16 N/A N/A N/A
93458-TC 0.00 17.81 0.04 N/A N/A N/A
93458-26 5.60 1.93 1.12 5.60 1.93 1.12
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CPT® CPT® Description CY 2019 Non-Facility CY 2019 Facility
Total RVUs
Payment % Payment Change
Total RVUs
Payment % Payment Change
93459 L hrt art/ grft angio 32.40 $1,168 1.7% N/A N/A N/A
93459-TC 22.61 $815 2.4% N/A N/A N/A
93459-26 9.79 $353 0.0% 9.79 $353 0.0%
93460 R&l hrt art/ ventricle angio 35.39 $1,275 3.1% N/A N/A N/A
93460-TC 24.44 $881 4.6% N/A N/A N/A
93460-26 10.95 $395 -0.1% 10.95 $395 -0.1%
93571 Heart flow reserve measure (FFR)
N/A N/A N/A N/A N/A N/A
93571-TC N/A N/A N/A N/A N/A N/A
93571-26 2.24 $81 -19.0% 2.24 $81 -19.0%
93572 Heart flow reserve measure (FFR)
N/A N/A N/A N/A N/A N/A
93572-TC N/A N/A N/A N/A N/A N/A
93572-26 1.81 $65 -18.7% 1.81 $65 -18.7%
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CPT® CPT® Description CY 2019 Non-Facility CY 2019 Facility
Work RVUs
PE RVUs MP RVUs Work RVUs
PE RVUs MP RVUs
93459 L hrt art/ grft angio 6.35 24.74 1.31 N/A N/A N/A
93459-TC 0.00 22.57 0.04 N/A N/A N/A
93459-26 6.35 2.17 1.27 6.35 2.17 1.27
93460 R&l hrt art/ ventricle angio 7.10 26.84 1.45 N/A N/A N/A
93460-TC 0.00 24.40 0.04 N/A N/A N/A
93460-26 7.10 2.44 1.41 7.10 2.44 1.41
93571 Heart flow reserve measure (FFR)
N/A N/A N/A N/A N/A N/A
93571-TC N/A N/A N/A N/A N/A N/A
93571-26 1.38 0.59 0.27 1.38 0.59 0.27
93572 Heart flow reserve measure (FFR)
N/A N/A N/A N/A N/A N/A
93572-TC N/A N/A N/A N/A N/A N/A
93572-26 1.00 0.61 0.20 1.00 0.61 0.20
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CPT® Physician Office Based Lab (Non-Facility MPFS- POS -11)
AmbulatorySurgery Ctr (ASCs - POS -24)
Hospital Outpt(C-APCs –POS - 22)
Hospital Inpt(MS-DRGs –POS - 21)
93454 – Coronary Angiography $ 896 4.2% $ 1,359 N/A
$2,810(-0.1%)
N/A93458 – Left Heart Cath w/ Cors $1,063 2.6% $ 1,359 N/A
93459 – Left heart cath w/ bypass $ 1,168 1.7% $ 1,359 N/A
93460 – Left & Right heart cath $ 1,275 3.1% $ 1,359 N/A
92928 – Coronary BMS
N/A N/A
$9,669(-8.0%)
MS-DRG 248/249$19,370/ $12,151
MS-DRG 246/247$19,776/ $12,682
C9600 – Coronary DES
92937 – Coronary Bypass any PCI MS-DRG 248/249$19,370/ $12,151
C9604 – Coronary DES w/ bypass MS-DRG 246/247$19,776/ $12,682
92941 – Coronary AMI any PCI MS-DRG 248/249$19,370/ $12,151
92943 – Coronary CTO any PCI
C9602 – Coronary DES w/ Ather $15,355(-4.1%)
MS-DRG 246/247$19,776/ $12,682
C9606 – Coronary DES w/ AMI N/A
C9607 – Coronary DES w/ CTO $15,355(-4.1%)
*POS = Place of Service code
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HCPCS (C-Code) HCPCS Code Description
C1725 Catheter, transluminal angioplasty, non-laser (may include infusion/perfusion capability)
C1757 Catheter, thrombectomy/embolectomy
C1874 Stent, coated/covered, w/ delivery system
C1876 Stent, non-coated/non-covered, w/ delivery system
C1887 Catheter, guiding (may include infusion/perfusion capability)
CORONARY
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The Physician Fee Schedules can be found at: https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/PhysicianFeeSched/
The Outpatient rules can be found at: https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/HospitalOutpatientPPS/Hospital-Outpatient-Regulations-and-Notices-Items/CMS-1678-FC.html?DLPage=1&DLEntries=10&DLSort=2&DLSortDir=descending
The Inpatient rules can be found at: https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/AcuteInpatientPPS/FY2018-IPPS-Final-Rule-Home-Page.html
The ASC rules can be found at: https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/ASCPayment/ASC-Regulations-and-Notices-Items/CMS-1678-P.html
CPT® copyright 2018 American Medical Association. All rights reserved. CPT® is a registered trademark of the American MedicalAssociation. Applicable FARS/DFARS Restrictions Apply to Government Use. Fee schedules, relative value units, conversion factorsand/or related components are not assigned by the AMA, are not part of CPT, and the AMA is not recommending their use. The AMAdoes not directly or indirectly practice medicine or dispense medical services. The AMA assumes no liability for data contained or notcontained herein.
Medtronic does not represent or guarantee that this information is complete, accurate, or applicable to any particular patient or thirdparty payer. Medtronic disclaims all liability for any consequence resulting from reliance on this document. The final decision of billing forany service must be made by the health care provider considering the medical necessity of the service furnished as well as therequirements of third-party payers and any local, state, or federal laws and regulations that apply. Medtronic is providing this informationin an educational capacity with the understanding that Medtronic is not engaged in rendering accounting, or other professional services.Medtronic encourages all health care providers to consult with their own advisors regarding coding and payment.
Medtronic doesn’t offer products with approved indications for all procedures listed.
10891775DOC Rev 1A FY19 HEPP C APV Reimbursement Update Short Standard © 2018 Medtronic. All rights reserved. Medtronic,Medtronic logo and Further, Together are trademarks of Medtronic. All other brands are trademarks of a Medtronic company.
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